820 DISTENSIONS OF SYNOVIAL CAVITIES IN FORE LIMB. 



some if accompanied by inflammation of tendon and by lameness, 

 complications which are also more frequent in hind than in fore 

 limbs. As a rule, the swelling appears distinctly above the 

 sesamoid bones. 



Treatment must follow general principles, and it is here only 

 necessary to remark that recent painful conditions are best treated 

 by cold douches, or by immersing the parts in cold water. This 

 should, when possible, be supplemented by bandaging and com- 

 pression. As soon as inflammation subsides, moist warm applica- 

 tions may replace the cold ones, compression being continued and, 

 if the parts are not painful, massage may be tried. Light work 

 also promotes absorption. Though moderate recent swellings may 

 sometimes be dispersed in this way, the effect is seldom permanent, 

 for distension generally recurs with work, and the practitioner is 

 forced to resort to irritants like cantharides ointment, ungt. 

 hydrarg. biniodid. 1 : 8, sublimate, &c, or, better still, to blistering- 

 plaster, cantharides collodion, or the firing-iron. The effect of these 

 applications is to be ascribed to the regular and lasting pressure 

 produced by the swelling acting on tendon sheaths or capsules of 

 joints, and assisting absorption. On account of the pressure it 

 exercises, blistering-plaster acts more energetically than blistering 

 ointment. The firing-iron produces its effect by cicatricial 

 contraction. When freely used it is most effective, though, as it 

 leaves scars, and only substitutes one blemish for another, it should 

 not be lightly resorted to ; nevertheless it is one of the most valuable 

 remedies in such cases. 



The effect of artificial drainage has been much overstated. In 

 France, however, drainage and the subsequent injection of iodine 

 solution, has long been a favourite method of treating chronically 

 distended synovial cavities. Simple evacuation by trocar is in nowise 

 dangerous if performed with aseptic precautions, but its effect is 

 not lasting, and the tendon sheath or joint refills in a few hours, 

 though, after repeated abstraction of fluid further distension may 

 be stopped. Cure is always uncertain, and even the after-injection 

 of iodine does not ensure it. Sometimes the tendon sheath undergoes 

 gradual thickening and its contents become absorbed, success or 

 failure appearing particularly to depend on the degree of inflammation 

 produced by the injection. It is best to use a freshly-prepared 

 solution of iodine, to see that it is removed after injection, and to 

 follow this with a blister or with firing ; when blistering is contra- 

 indicated, a tight bandage may be substituted. To test the relative 

 danger of iodine injections, Leblanc and Thierry made a series of 



