358 



Or, again, instead of altogether x^assing off, the oedema may diminish 

 in extent, becoming more defined in form and remain as a tnmor more 

 or less developed on the front part of the knee. Resulting from the 

 crushing of small blood vessels, this is essentially a bloody tumor. It 

 is somewhat soft, not painful, surrounded by a little swelling, round, 

 more or less fluctuating, and after a few days becomes cripitant under 

 the pressure of the hand. 



But instead of possessing all the characteristics of a bloody tumor 

 it may also assume those of a serous growtli, as often occurs when the 

 violence (the bruise), though perhaps slight, has been frequently 

 repeated. In that case the tumor becomes better defined, generally 

 painless, without any surrounding swelling, is niucli softer, is fluctu- 

 ating, and more or less pendulous. 



In other cases, however, this serous tumor becomes the seat of an 

 acute inflammation, perhaps from repetition of the original violence; 

 or it may set in as the immediate result of the bruise, and a phleg- 

 monous inflammation may thus be established. The' tumor is now 

 surrounded with oedema, more or less diffused, and becomes hot and 

 painful. The flexion of the knee can no longer take place; walking 

 is much interfered with — a large acute abscess has been formed, and 

 it is this that constitutes the capped Ixiiee. 



Whatever may be the nature of the tumors, whether shown Avhen 

 opened to be bloody, cystic, or i^urulent, or when tliey ulcerate as they 

 sometimes do, though the cavity of the abscess may fill up in a short 

 time, the x)robability is that there will always remain in front of the 

 knee a i^lastic deposit, develoi^ed in varying degrees, which will resist 

 all treatment and continue unabsorbed for life. 



Though simple bruises of the knee without extensive lesions are 

 usually of trifling account, a different i)rognosis must be pronounced 

 when the lesion assumes more important dimensions; and though 

 a capped knee may be comparatively an affair of little importance 

 we have seen cases where not only extensive blemishes were left to 

 disfigure the patient, but where the animals had become worthlesss in 

 consequence of the extension of the diseased process to the various 

 elements of structure composing the joint, and giving rise to the most 

 complicated cases of carpitis. 



We have seen that usually the first symptom which is observed is the 

 oedematous swelling on the fore part of the knee, the first lesion, in 

 fact, and therefore requiring immediate attention. The prevention of 

 the inflamuiation, and consequently of the abscess, is the prime object 

 in view, and it maj^ be realized by the use of warm water fomentations 

 or compresses applied over the swelling, which may be used either in 

 a simple form or combined with astringents, such as Goulard's extract, 

 alum, or sulphate of zinc. The application of warm poultices of oil 

 meal or ground flaxseed, enveloping the whole joint and kept in place 

 hy bandages, is often followed by absorption of the swelling, or, if the 



