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Updated: May 8, 2025
A variable degree of lameness is manifested in different cases. Treatment. Two general plans of handling this disease are in vogue. One, the more popular method, consists in the injection of caustic solutions of various kinds into the fistulous openings with the object of causing sloughing of necrotic tissue and the stimulation of healthy granulation of such wounds.
As a result of explosions, particles of carbon, in the form of coal-dust or gunpowder, or portions of shale, may lodge in a wound. The embedded foreign body at first acts as an irritant, and induces a reaction in the tissues in which it lodges, in the form of hyperæmia, local leucocytosis, proliferation of fibroblasts, and the formation of granulation tissue.
The disease spreads throughout the capsule and synovial membrane, which becomes diffusely thickened and infiltrated with granulation tissue which eats into and replaces the articular cartilage.
Until granulation is well advanced, the abscess cavity should be irrigated daily with a one per cent water solution of liquor cresolis compositus, or a one to two thousand water solution of corrosive sublimate. The surface of the skin in the region of the abscess should be kept clean.
The process of healing in an ulcer has already been studied, and we have learned that it takes place by the formation of granulation tissue, which becomes converted into connective tissue, and is covered over by epithelium growing in from the edges. Those ulcers which are stationary that is, neither healing nor spreading may be in one of several conditions. The Weak Condition.
Grinding of courage of three powerful races A ridge that will be famous Germans on the defensive Efforts to maintain their morale Gas shells Summer heat, dust and fatigue Prussian hatred of the British Dead bodies strapped to guns Guillemont a granulation of bricks and mortar and earth "We've only to keep at them, sir" Stalking machine guns Machine guns in craters British cheerfulness The war will be over when it is won Soldiers talk shop An incident of brutal militarism Simple rules for surviving shell fire A "happy home" with a shell arriving every minute Business-like monotony of the battle Insignificance of one man among millions A victory of position, of will, of morale!
If the case is left to nature, the discharge of pus continues, and the track opening on the skin remains as a sinus. The persistence of suppuration is due to the presence in the wall of the abscess and of the sinus, of tuberculous granulation tissue, which, so long as it remains, continues to furnish discharge, and so prevents healing.
The internal clot plays the most important part in the process; it becomes invaded by leucocytes and proliferating endothelial and connective-tissue cells, and new blood vessels permeate the mass, which is thus converted into granulation tissue. This is ultimately replaced by fibrous tissue, which permanently occludes the end of the vessel.
On examining the wound at intervals of a few days, it is found that the granulation tissue gradually increases in amount till the gap is completely filled up, and that coincidently the epithelium spreads in and covers over its surface.
The size of the abscess affords no indication of the extent of the bone lesion from which it originates. As the abscess reaches the surface, the skin becomes of a dusky red or livid colour, is gradually thinned out, and finally sloughs, forming a sinus. A probe passed into the sinus strikes carious bone. Small sequestra may be found embedded in the granulation tissue.
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