DISEASES FROM SEPTIC INFECTION OF WOUNDS. 307 



the tissues surrouading the wouads, especially the bloodvessels 

 and the lymphatics. 



Phlegmone. By this we meau the inflammatioa of the soft 

 tissues which has a teudency to formatioa of pus, especially in the 

 loose subcutaneous connective tissue between the muscles and under 

 the fasciae. There are two forms of this condition — a circum- 

 scribed and a diffused phlegmons. 



Circumscribed phlegmone. The symptoms are very, prominent, 

 especially when it is near the skin. We find in a certain circum- 

 scribed region a hot, painful, very red swelling, firm and tense in 

 the early stages, but soon becoming soft, doughy, and finally fluc- 

 tuating, due to the tissue breaking up and forming a purulent 

 liquid. From the pressure of the pus the skin becomes gradually 

 thinner and thinner, until it finally makes its exit through the 

 skin and escapes. If, for some reason, the skin is too tough, or 

 if the pus has not been allowed to escape by means of an incision,, 

 it may cause a purulent infiltration of the surrounding tissues, 

 which is very serious and ends with necrosis of the parts, espe- 

 cially of the fasciae, tendons, muscles, bones, and it may be taken 

 up in the blood, and portions of the diseased tissues are carried 

 in the circulation to different parts of the body. 



Diffused phlegmone is generally a very serious condition. The 

 local symptoms are the same as the circumscribed, but the fever 

 is much higher, and the purulent pus rapidly extends in all direc- 

 tions in the loose connective tissue, undermining and frequently 

 causing extensive necrosis of the skin, fasciae, muscles, tendons,, 

 etc. Death occurs, as a rule, from septicaemia or pyaemia. 



The treatment of diffused phlegmone consists of scarification 

 and incisions. Numerous slight incisions are made to reduce the 

 inflammatory tension of the tissues and to encourage the pus to 

 escape, also to prevent it from burrowing in different directions, 

 and to make an opening into the parts so that they can be disin- 

 fected by means of injections or irrigations of 1 to 1000 solution 

 of corrosive sublimate, 3 to 5 per cent, of carbolic acid, or 2 per 

 cent, of creolin. In circumscribed phlegmone it is better, as a 

 rule, to wait until the abscess is in that condition known as 

 "ripe," or " points." This can be distinguished from the fact 

 that the swelling fluctuates or is soft in the centre. In a light 

 skin it may be even yellow. As soon as the incision is made it 



