OPEN JOINTS 175 



To carry out this treatment properly it is essential 

 to east the patient either on the ground or on the 

 table. The following procedure is then adopted: 



Thoroughly cleanse the region of the joint involved, 

 shave and scrub. Irrigate the joint cavity for at least 

 ten minutes with a solution of hydrargyrum chloridum 

 corrosium (1 to 3,000) at body temperature. This must 

 be done with the utmost antiseptic precaution and great 

 delicacy. If the opening in the joint is in such a posi- 

 tion that good drainage cannot be obtained, another 

 opening is to be made surgically at the desired point. 



Having thoroughly flushed the joint cavity with the 

 solution, for which purpose a fountain syringe is best, 

 it is now again flushed for a considerable time with 

 sterile physiological saline solution at body tempera- 

 ture. These washings are to be discontinued only when 

 the fluid comes out clear and free from pus, flakes, or 

 detritus. It may take a half hour of continuous irri- 

 gation to accomplish this. When this has been accom- 

 plished the interior of the joint may be considered sur- 

 gically clean and it is now injected with the following 

 suspension : 



Hydrar. lod. Rub 3iv 



01. Olivae Pura 5iv 



M. Sig. Shake before using. 



This is to be injected into the cavity slowly after 

 plugging up all openings except the one through which 

 it is to be introduced. The entire quantity is injected 

 so as to be sure every portion of the interior comes in 

 contact with the suspension. As soon as this is done 

 the entire joint is swathed in clean cotton held in place 

 by such bandages or retaining appliances as the surgeon 's 

 ingenuity may devise. This dressing is to remain in 

 place for two weeks. 



