ADVANCES IN SURGERY DURING THE WAR 323 



patient himself gradually increase the range of motion of the 

 joint, entire restoration of function is obtained in a majority 

 of cases ; the muscles do not atrophy and shrink and lose their 

 power, as they do when they are long immobilized and not 

 allowed exercise, and convalescence is thereby much shortened, 

 not only redounding in benefit to the patient himself, but to 

 the economic gain of the country at large. 



A radical change in the treatment of infected joint wounds 

 has been introduced and advocated especially by Willems, a 

 Belgian surgeon. He uses no drainage tubes in suppurating 

 joints, but at stated intervals the patient is required to move 

 his joint, which movement expresses the contained pus through 

 the incisions made into the joint for the escape of the pus. 

 Remarkably good results have been obtained by Willems and 

 others who have employed this method of treatment. They 

 claim that better drainage is obtained than by the use of drain- 

 age tubes, the infection is more quickly controlled, the joint 

 cleans up more rapidly, and it is a rare occurrence to have a 

 stiff joint result when the treatment by movement is persistently 

 and consistently employed. In this method of treatment move- 

 ment of the joint is begun in twelve to twenty-four hours after 

 the joint is opened by operation. Willems states that, contrary 

 to what one would expect, after the first few times movement 

 of the joint causes no great pain, since the pain on movement is 

 due to inflammation and the acute inflammation quickly sub- 

 sides, drainage by this means is so efficient. 



What has been said of joints, as to early movement and 

 exercise of the muscles of the wounded member, can also be 

 said of fractures. The importance of frequent roentgenograms 

 during convalescence has been mentioned ; progress of union 

 and the assurance that fragments remain in proper position 

 are ascertained by them. No longer are fractures immobilized 

 by rigidly immobilizing the entire injured limb with nearby 

 joints rendered incapable of movement. By the suspension 

 treatment of fractures, constant extension is obtained by a sys- 

 tem of pulleys and weights, so that even though the joints are 



