PUERPERAL INFECTION 347 



but may take a subacute course accompanied with consider- 

 able changes in the joints, the animal dwindling down to a 

 skeleton. In purulent arthritis, with periarticular abscesses 

 or diffuse phlegmon in the neighborhood of the joint, prog- 

 nosis is unfavorable. 



Pathological Anatomy. — The vessels of the synovial mem- 

 brane are injected, in more chronic cases thickened, and its 

 surface rough. The synovia is of orange color, occasionally 

 purulent. The tissues on the outside of the synovial mem- 

 brane show a gelatinous infiltration, showing little purulent 

 foci, which do not communicate with the joint. 



The cartilage of the bony extremities is destroyed in 

 the more chronic cases. In cases of osteomyelitis suppura- 

 tiva, parts of the epiphysis are thrown off; the liquefied mass 

 may perforate the bone at any place, giving rise to fistulous 

 tracts (Vogel). On post mortem, multiple pus foci in the lungs 

 and endocarditis are now and then observed. 



Therapeutics. — When the secundinse are not yet expelled, 

 they must be removed and the uterus irrigated with a 1 per cent, 

 lysol or creolin solution. Even when the afterbirth has been 

 discharged and the os uteri still sufficiently dilated to pass the 

 hand into the uterus, this irrigation must be practiced. The 

 solution is best employed cold, to produce uterine contrac- 

 tions, thus decreasing its resorbing surface. 



The diseased joints are shaved, the skin soap-washed and 

 scrubbed. Now Priessnitz fomentations of a 5 per cent, car- 

 bolic acid solution are made. This treatment, proposed by 

 Yogel, has given excellent results in many cases. The joint is 

 first covered with jute saturated in 5 per cent, carbolic acid 

 water ; over it is placed wet parchment paper, and "over the 

 whole an ordinary bandage. This dressing is renewed once 

 daily. After five or six days vesicants or massage may be used. 



Strebel orders the joint rubbed and massaged lightly three 

 times daily with a weak volatile liniment. Munch saw good 

 results from a 10 per cent, ichthyol-camphor salve. In the 

 suppurative form "Vogel recommends puncture with Paquelin's 

 thermocautery, passing the red hot point directly into the bone. 



