DISEASES FROM SEPTIC INFECTION OF WOUNDS. 317 



open by means of vaseline. When the location of the fistulous 

 sinus admits of it we split open the fistulous passage and convert 

 it into an open wound. When the fistulous caual is not very deep 

 we may also try to produce healthy granulations by means of actual 

 cautery, or the injection of caustic fluids and introduction of cray- 

 ons of caustic (nitrate of silver or caustic potash). Always try to 

 slit open the canal, if possible, as it produces the best effects. Ni- 

 trate of silver or any of the mineral acids, and in obstinate cases a 

 small piece of corrosive sublimate, is pushed down into the bottom 

 of the wound; these caustics produce more or less irritation and 

 consequent sloughing of the wall of the canal and allow the growth 

 of healthy granulations. 



Contusions. In subcutaneous wounds of the soft tissues 

 (bruises and contusions) we find a different condition of the tissues. 

 These injuries are generally caused by some blunt object — for in- 

 stance, a blow, kick, shock, or fall. The soft parts are bruised 

 and injured according to the intensity of traumatism; very slight 

 resistance is offered by the loose connective tissue; small blood- 

 vessels are ruptured from crushing or bruising of the soft parts, 

 and the hemorrhage that follows percolates all through the torn 

 tissues. The greatest amount of resistance is found in the skin, 

 face, sinews, and large bloodvessels. 



Clinical Symptoms of Contusions. One of the first symp- 

 toms of a subcutaneous bruise is a swelling in the region of the 

 injury. This appears, as a rule, immediately after the injury, and 

 is due to the blood running out of the torn vessels. The fluids 

 in the enlargement always contain lymphatic substances on account 

 of the laceration of certain lymphatic glands. In rare cases we 

 see a lymphatic secretion only, which is distinguished from the 

 blood secretion by being very slowly absorbed. The fluid which 

 appears lies either in the loose connective tissue under the skin or 

 between the muscles, and, as a rule, is irregularly divided, or we 

 may find the condition presented in a number of ways, so that we 

 may have a " doughy " swelling in one case, or it is accumulated 

 in centres in another, and we see a fluctuating swelling or a '' blood- 

 boil" (hsematin), or it may run into a cavity, and we have a bloody 

 secretion of the joint (hsemarthrosis), or we find a bloody secretion 

 in the cavity of the chest (hsematothorax). The swellings, as a rule, 

 occur shortly after a contusion, and in the early stages rarely show 



