In a more advanced stage of such disease, serous, and sometimes purulent matter, is formed in the cellular tissues between the muscles of the flesh; and when such is the case, nothing can be more poisonous than such abominable carrion.

A theory of the effects of this medicine, with many successful cases, may be seen in a pamphlet, called, "Experiments on Mucilaginous and Purulent Matter," published by Dr. Darwin in 1780.

"Suddenly the skeleton shriveled up into an indescribably hideous and dwarf-like form, just as when you bring a large spider into the focus of a burning glass, and watch the purulent blood hiss and bubble in the heat."

The discharge from the eyes is simply mucus and pus, but if not constantly dried away will gum the inflamed lids together, that from the nostrils is not only purulent, but often mixed with dark blood.

Added to this is always the extreme probability of the wound becoming purulent, and later the dread of general septic infection of the blood-stream ensuing, and death resulting from that.

(See Suppurative or Purulent Arthritis, Chapter XII.) (g) Ostitis and Caries of the Os Pedis.

Should this be found at all necrotic, it may be taken that purulent inflammation of the navicular bursa and of the navicular bone itself exists.

Instead of the glistening and clear appearance it ordinarily presents, its glenoid cartilage is found to be showing hæmorrhagic or even purulent spots of necrosis.

If, in spite of our precautions, the discharge becomes purulent, then the track made by the penetrating object should be syringed twice daily with a 1 in 1,000 solution of perchloride of mercury.

(See also Treatment of Purulent Arthritis in Chapter XII.)

The treatment necessary in such a case will be found described in Chapter X. When the Complication of Purulent Arthritis has arisen, the surgeon has to admit to himself, reluctantly no doubt, that the case is often beyond hope of aid from him.

(See Treatment of Purulent Arthritis, Chapter XII.)

Diffuse Purulent Inflammation of the Sub-coronary Tissue.

(b) Purulent Arthritis.

a, Cavity in the horn of the wall; b, enlargement of the coronet and the horn of the wall following subcoronary suppuration; c, cavity in the wall following purulent inflammation of the sensitive laminæ; d, hollow in the horn of the sole consequent upon suppuration of the sensitive sole.] (c) Necrosis of the Extensor Pedis.

This may arise either as a result of spreading purulent infection of the coronary cushion, or as a result of direct injury immediately over it.

The discharge continually oozing from these keeps the heel constantly wet with a thick purulent discharge, which is nearly always blood-stained, and very often foetid.

Unless it is followed by a severe purulent arthritis, it is not so grave a complication as at first sight it would appear.

When the fracture is complicated by the formation of pus, as in the case of prick, then the case, with the attendant purulent synovitis and arthritis, is even more hopeless still.

In other words, there oozes through, without actual rupture of the membrane, a thin, blood-stained, and purulent-looking discharge.

This, of course, constitutes a condition of acute purulent arthritis.

(c) PURULENT OR SUPPURATIVE ARTHRITIS.

Finally it breaks at one or more spots, and there exudes from the opening or openings a purulent and oftentimes sanious discharge, which coagulates about each fistula after the manner of ordinary synovia.

In less favourable cases the purulent discharge continues, and (always a bad sign) becomes more or less chocolate-like in colour, distinctly thin, and stinking.

Fever, or hospital gangrene, or pyaemia, or purulent discharge of some kind may else supervene.