CONTUSIONS. ISt 
Targement ; contusions of the third degree, with destruction of the tissues 
and more or less extensive mortification. Zhe primitive effusions of 
serosity and of liquid greasy matters will be considered in the next 
chapter. 
The contusions of the first degree, with or without excoriation of the 
epidermis, heal by natural processes. Rest, only, is required for the 
diseased ‘part. One may, however, use with advantage, especially if 
there is swelling, either antiphlogistics—cold epithems, compresses wet 
with cold water or an astringent solution (alum water, white lotion, 
‘solution of metallic sulphates)—or slight resolutive topical remedies 
If pain is severe, narcotics will allay it (poultices or opiate ointments), 
or analgesics (cocained vaseline), and also fomentations or continued 
immersion in warm water. Scarifications, recommended by some 
French and other authors, must not be used. 
For contusions of the second degree, more active interference is de- 
manded. If they are recent, cold water, or salt water, applications 
and simple white lotions (that of alum) are useful; they hasten 
hemostasis and arrest the growth of the bloody tumor. Later, one 
should use resolutive lotions (various tinctures, camphorated alcohol), 
and the tincture of iodine painted over the parts ; beside these, massage 
which spreads the extravasated liquid over a wider surface and stimu- 
lates its absorption; or also methodic pressure, made with an India 
rubber band, or one of linen or of flannel, if the bloody swelling is 
upon an extremity. 
These means fail when the tumor is old and surrounded by fibrinous 
‘strata and an organized membrane,—in a word, when it is encysted. It is 
for such cases that sudden and rather strong compression has been 
recommended to rupture the wall of the pseudo-cyst, or puncture or 
‘incision of this wall, and irritant injections into the pouch after evacu- 
ation of its contents. For bloody tumors with clots, one should 
puncture with the larger trocar of Dieulafoy or that of Potain. The 
liquid should be expelled by methodical pressures made upon the 
swelling, followed by a washing of the pouch with a strong solution of 
‘carbolic acid, cresyl, or tincture of iodine; a compressive bandage 
should be applied, if the region permits it. When the walls of the 
bloody collection are thickened, already doubled up by a neo ‘membrane, 
the effusion returns; a new puncture and another antiseptic injection is 
required. Some hematomas contain large clots, whose exit from the 
cavity through a simple puncture is impossible. They must be opened 
with an incision sufficiently extended to permit the removal of these 
clots ; afterwards, they are to be treated as other bloody collections, It 
js rarely necessary to have recourse to curetting of the walls. If 
suppuration occurs, the pouch must be freely opened, irrigated, and 
drained. 
