TREATMENT OF SYNOVIAL DISTENSIONS. 821 



thirty-two ; — •fifteen into joints, seven into mucous bursae and ten 

 into tendon sheaths, without in any case having bad results. Need- 

 less to say, they observed full aseptic precautions. In general, this 

 treatment is uncertain, and when the distension is indurated, 

 impracticable. Masses of fibrin can only be removed by incision, 

 and although in theory such operation should not be dangerous 

 if performed aseptically, yet there is no certainty that dressings 

 will remain in position ; and even when the preliminary dressing, 

 applied for the purpose of sterilising the parts, has not been interfered 

 with, dressings applied after operation are often violently rubbed 

 off. The same is true in regard to animals other than the horse. 

 The opening of distended joints or flexor tendon sheaths is in general 

 dangerous, though there seems no particular risk in opening extensor 

 sheaths, even when the parts cannot be kept aseptic. The risk need 

 not prevent operation being tried, but attention should certainly 

 be previously directed to the danger, and asepsis should be observed. 

 With this object, twenty-four hours beforehand, the hair is shaved 

 from the point of operation, the skin washed, and a dressing moistened 

 with 1 per 1,000 of sublimate applied. After casting the horse for 

 operation and removing the dressing an incision is made, at the most 

 prominent point of the swelling ; the finger is then introduced, the 

 condition of the sheath examined, and any masses of fibrin, &c, 

 removed. The cavity is washed out with a solution of iodine and 

 iodide of potassium in water (1 : 3 : 16), followed by sublimate 

 or carbolic solution. The loose distended skin can then be partly 

 cut away in an elliptical form, the wound closed with silk, and a 

 protective dressing applied to exercise light pressure. This dressing 

 should not be changed for about eight days. The wound probably 

 closes in three to four days, though the cicatrix is not then sufficiently 

 firm to prevent re-opening if the animal be moved. Operating in 

 this way Ries cured a large wind gall (enlarged sesamoid sheath) 

 and an enlargement of the precarpal sheath of the extensor pedis 

 tendon which had resisted all ordinary methods of treatment. In 

 distension of the extensor sheaths gauze drains may be used, but 

 Moller prefers operation. 



Bosco has recommended opening enlarged tendon sheaths with 

 the red-hot iron, and favourable results have since been announced 

 by other operators. The glowing point of a fine firing -iron is thrust 

 into the enlargement, allowing its contents to be discharged. More 

 or less severe inflammation results, and recovery may possibly 

 follow. As the point of operation itself is sterilised and an aseptic 

 wound produced which soon closes by inflammatory swelling, 



