EFFUSIONS OF LIQUID FATTY MATTERS. 153 
The subcutaneous detachment becomes filled with liquid, sometimes 
slowly, then again rapidly, but, in general, without noticeable inflam- 
matory phenomena ; a soft swelling, uniformly fluctuating, is formed. 
It seems that, in the collection of serosity, the exudation comes both 
from the lymphatics (lymphorragy) and from the stretched blood-vessels, 
allowing only the passage of the serous portion of the blood. In fatty 
collections, the pocket is filled with fatty drops, issuing from the sub- 
dermic connective tissue. 
The seat of the swelling, the absence of phlegmasic phenomena or 
their slight intensity, the total and uniform fluctuation, clearly indicate 
the nature of the disease. The diagnosis presents no difficulties. 
The effusion of serosity has no tendency to disappear spontaneously ; 
when it occurs one must have recourse to active therapeutics. Among 
the means recommended are: puncture, and injection of iodine 
(Leblanc, Nocard), incision of the walls of the cavity (Leblanc, Adam, 
Violet), drainage of the pocket by a seton passed through it vertically 
or with several runs towards the most dependent point of the swelling 
(Neumann), and, finally, blistering applications. 
Puncture with the trocar is always insufficient; it allows, ordinarily, 
the entire evacuation of the liquid; but in a few days, often the next, 
the swelling has returned. On the extremities we have also tried many 
times, without success, puncture, and compression with a wadded dress- 
ing. Irritant injections (pure or a diluted tincture of iodine, strong 
antiseptic solutions) made in the pocket after the evacuation of the 
liquid, not uncommonly are followed by recovery; the two opposite 
walls of the cavity become inflamed and rapidly adhere to each other ; 
in the great majority of cases, however, several injections, a week 
apart, have to be made. When the operation is not done aseptically, 
the cavity suppurates and, like abscesses, must be treated by incision 
and detersive injections. 
With vesicating frictions, the absorption of the effusive fluid is 
rarely obtained ; it demands a long time, and often one is obliged to 
end the treatment by having recourse to other means. 
Cauterization with spaced deep points is principally useful for old 
serous collections on the extremities. 
Puncture, or iodine injections associated with blisters, give relief, 
either by giving rise, in the pouch, to modifications, which, as after the 
simple iodine injection, dry up the exudation ; or again by starting in 
it a suppurative inflammation. 
It is by producing suppuration that setons, inserted through the 
cavity, act. A fenestrated drain, secured at both ends, exposes the 
skin less than setons to tearings and lacerations, it better insures the 
flow of the pus, and gives the same results. 
Extensive incision, made at the start, has the inconvenience of exfos- 
