344 
RICHARD MIDDLETON. 
ing which at first does not manifest the general characters of 
an inflammatory production, and which gradually and continu¬ 
ally enlarges (extending over a few days or even weeks). 
The contents of the cavity remain, under all conditions, in 
a fluid state, with not the smallest formation of coagulum, so 
long as the atmosphere does not reach the interior. The 
tumor yields upon palpation and succussion—unequivocal 
proof that the bulk is fluid. The skin over the swelling is not 
painful. Blood constituents are either not at all present, or 
only so in inconsiderable quantities, and the chemical compo¬ 
sition is similar to that of blood serum and lymph. After the 
evacuation, the serosity continues to flow from the fact that 
the torn lymph vessels are not occluded as the blood ves¬ 
sels are after the opening of an hasmatoma; as a consequence, 
the course of the former is more tedious and dangerous than 
the latter. 
When not incised, the contents seek a spontaneous open¬ 
ing, and frequently in earlier days caused death to those per¬ 
sons so afflicted by the extensive suppuration. 
The therapy consists of first stopping the lymphorrhagia, 
and second, causing the resorption of the liquid. It is pro¬ 
posed to use compresses, bathing in warm water, or poultice 
with a mixture of alumen and plumbum acetatum, puncture, 
iodine injections, antiseptic operation ; without incising one 
cannot expect a favorable result. 
In the Deutschen Zeitschrift fur , Chirurgie, 1888, p. 344, the 
disease is considered under the name “ decollement traumati- 
que; ” the author states that the condition up to the present 
time has been little considered. He distinguishes (a) superfi¬ 
cial (£) deep varieties. In the former the skin is separated 
from the underlying fascia, and the pocket so made is partly 
filled with extravasate, but never completely so. The deeper 
sort has its seat either between the fascia and muscles, be¬ 
tween the muscles, between the latter and periosteum, or be¬ 
tween the periosteum and bone; it can appear without being 
in conjunction with the superficial variety. The size of the 
cavity varies as well as the appearance of its interior, which 
may be smooth, or show threads which bind it to the connec- 
