222 



ON RECENT IMPROVEMENTS IN THE 



chronic thickening of the textures has markedly subsided. The same thing 

 will be probably still more apparent when the dressing is again changed after 

 forty-eight hours more, when also the serous stain on the gauze resulting from 

 two days' discharge will be only a small fraction of that seen after the first 

 twenty-four hours The tube being further shortened to the requisite degree, 

 the dressing now applied might be left untouched for a week so far as regards 



the purpose of ensuring absence of putrefaction ; but 

 it will be well to expose the part again in two or three 

 days in order to ascertain whether or not the drainage- 

 tube may be dispensed with ; the rule being that it 

 should be continued so long as the serous stain on the 

 gauze is more than the puncture, as distinguished 

 from the interior of the sac, would account for. This 

 is probably the case within a week of the opening of 

 the bursa ; and then, the drainage-tube being dis- 

 continued, and a small piece of protective being 

 interposed between the puncture and the gauze so as 

 to permit cicatrization, the little sore will be found 

 completely healed in the course of another day or 

 two. At the same time the sac will be free from any 

 fluid accumulation, and the surrounding thickening 

 either quite gone or quickly disappearing. 



While we have thus a sure, speedy, and (except 

 the infliction of the puncture) a painless ^ method of 

 remedying a troublesome complaint, the results are 

 of considerable theoretical interest. It is plain that 

 the antiseptic employed does not penetrate into the 

 bursa, so as to exert any direct action on the part 

 affected. All that the treatment does is, while 

 guarding against the access of putrefactive fermenta- 

 tion, to provide that the plasma poured out from the 

 synovial surface shall flow freely away as fast as it is effused and never accumu- 

 late in the cavity. Yet when these conditions are complied with, the obstinate 

 chronic inflammation, which has perhaps already resisted rest and counter- 

 irritation, immediately proceeds to subside, the morbid tendency of the synovial 

 membrane is soon entirely lost, and the surrounding inflammatory thickening is 



^ If it be desired, the puncture may be performed painlessly after congelation of the integument 

 by Richardson's method with ether spray, the skin being washed with the carbohc lotion before freezing, 

 and the antiseptic spray substituted for the anaesthetic before the tenotome is introduced. 



