OPEN JOINT. 357 



in general safe to attempt to heal it at once by the application of melted 

 shellac and finest tow. 



In cases of simple puncture the wound may sometimes be closed at 

 once and induced to heal before any irritation or inflammation sets in by 

 applying over it a bandage or packing of tow or by the insertion of a 

 suture. A light blister round the part will also be useful. 



If a case of open joint takes an unfavorable turn, if the inflammation 

 extends to the interior of the joint, if pus begins to be discharged from 

 the wound, and signs of great constitutional disturbance are apparent, 

 treatment will probably be of but little avail. It is useless to attempt 

 to block up under such circumstances the flow of synovia and pus. If 

 we do so, the result will inevitably be increased pain and irritation and 

 the formation of abscesses. The only possible treatment in such case is 

 to endeavour to reduce the inflammation by constant cold applications. 

 A favorable result can, however, hardly be expected, and the more 

 merciful course is to destroy the patient. 



Another very favorite method of treatment is by means of the carbolic 

 spray. One part of carbolic acid is diluted with forty parts of water, 

 and by means of an ingenious little instrument the spray is applied. 

 This should be used several times daily, and in the intervals the part 

 should be covered with lint soaked in the carbolic acid lotion. 



Cases of open joint, if promptly, judiciously, and carefully treated, as 

 a rule terminate favorably ; but if they are neglected or wrongly treated, 

 there is reason to fear that the inflammation and constitutional disturb- 

 ance may be so great and extensive as to produce an exostosis in the part, 

 and anchylosis or stiff joint may be the result, or the patient may sink 

 under the pain and irritation. 



Some very bad cases occasionally arise from wounds, which though 

 they do not at first penetrate the joint, yet afterwards from the effect of 

 sloughing extend into it. Such after-development, we may broadly say, 

 always arises from improper treatment. If a proper opening is not main- 

 tained for the escape of the pus, it may (though in most cases it will make 

 an exit for itself in some external part) burrow inwards and eventually 

 cause sloughing of the capsular ligament of the joint. The system of 

 tight bandages frequently adopted has a tendency to produce this result, 

 or it may arise from a scab being allowed too early to form over the 

 wound. This latter effect is generally caused by the use of strong astrin- 

 gents. It cannot be too often impressed on the reader, that all lacerated 

 wounds, whether at the knee or elsewhere, can only heal permanently and 

 safely from the bottom. In other cases the tendency on the part of the 

 wound to slough may arise from general debility of the system of the 

 patient, or from the use of unduly depleting remedies, or more often 

 from both causes combined. 



The tirst point to be attended to in such after-development is to give a 

 free exit to the pus. Fomentations will be needed for some time to 

 reduce the violent irritation and inflammation, which is certain to have 

 resulted from this increase of the mischief. As soon as the inflammation 

 is reduced, the further treatment will be the same as recommended above. 



