322 THE NEW WORLD OF SCIENCE 



Mention should be made of the great value of the X-Ray 

 as a diagnostic agent in empyema cases, especially if stereo- 

 scopic use of plates is employed; the extent of the empyema 

 or delimitation of the cavity to be dealt with is plainly brought 

 out. 



A decided advance has been made in the management of 

 wounds of joints. As a result of experience in joint wounds 

 during the world war it has been proved indubitably that the 

 lining membranes of the joints (synovial sacs) are quite re- 

 sistant to infection, taking rank almost with the lining mem- 

 brane of the abdomen and its contained organs in this respect. 

 Early immobilization of joints which have been wounded, in 

 case they are already infected, will usually prevent the spread of 

 infection; and the resisting power of the synovial membrane 

 lining the joint will confine the infection to a limited area, so 

 that the whole joint will not become involved, and it is neces- 

 sary then to drain only the infected portion. Since it has been 

 ascertained in these cases that the joint membrane has the power 

 to control and overcome mild infections, joints are now fear- 

 lessly closed primarily, after excision of the torn and possibly 

 infected wounded area and the cleansing of the joint of extra- 

 vasated blood and perhaps bits of foreign bodies and detached 

 bone fragments, where former teaching would have led to 

 prolonged drainage with a resultant stiff joint or one with 

 limited motion. It has also been discovered, contra to former 

 teaching, that drainage tubes introduced into or through a joint 

 prolong the suppurative process and retard recovery instead of 

 hastening it,, so that now when drainage has to be instituted, 

 the tubes are carried only down to the joint but never project 

 into it. These facts, together with immediate immobilization 

 of joint wounds, followed early in convalescence, usually cer- 

 tainly not later than ten days to two weeks, by passive and 

 active or voluntary movement of the joint, so as to avoid stiff- 

 ness, or a rigid (ankylosed) joint, have resulted in retaining 

 function which, under former methods of treatment, would 

 have been lost entirely or severely limited. By having the 



