are promptly cared for.

Symptomatology.--A difference in the character of symptoms is
evidenced when dissimilar causes exist. Small penetrant wounds which
infect the synovial membranes cause infectious arthritis in some cases,
whereas a wound of sufficient size to produce evacuation of all synovia
will, in many instances, cause no serious distress to the subject, even
when not treated for several days. If it is not evident that an open
joint exists and the articular cavity is not exposed to view a positive
diagnosis may be early established by carefully probing the wound. In
some cases where a small wound has perforated the joint capsule,
swelling and slight change of relation of the overlying tissues may
preclude all successful exploratory probing. In such instances it is
necessary to await development of symptoms. Twenty-four hours after
injury has been inflicted, there is noticeable discharge of synovia
which coagulates about the margin of the orifice, where synovial
discharge is possible. Particularly evident is this accumulation of
coagulated synovia where wounds have been bandaged--there is no
mistaking the characteristic straw-colored coagulum which, in such
cases, is somewhat tenacious.

No difference exists between other symptoms in infectious arthritis
caused by punctures, and non-infectious arthritis, excepting the
intensity of the pain occasioned, the rise in temperature, circulatory
disturbances, etc.; all of which have been previously mentioned.

Treatment.--Just as has been stated in discussions on the subject of
open joint, probing or other instrumentation is to be avoided until the
exterior of the wound and a liberal area surrounding has been thoroughly
cleansed--too much importance can not be placed on this preliminary
measure. In cases of open joint where ragged wound margins exist and the
interior of the joint capsule is contaminated, much time is required to
thoroughly cleanse all soiled parts. In some instances an hour's time is
required for this cleansing process after the subject has been
restrained and prepared. In order to thoroughly cleanse these delicate
structures without doing them serious injury, one ought to be skillful
and careful in all manipulations of the exposed parts of the joint
capsule.

The general plan of treatment, after preliminary cleansing has been
accomplished, has been outlined on page 66 in the consideration of
scapulohumeral joint affections. The injection of undilu