TREATMENT OF INFLAMMATION OF THE FLEXOR TENDONS. 843 



Great pain and resistance to treatment point to an infectious origin, 

 though such swellings occasionally disaj>pear after twelve to 

 twenty-four hours, when the sheath of the tendon is only slightly 

 involved. Moller saw a horse in which the affection changed its 

 seat several times in a few days : leaving the hind, it attacked the 

 front limbs, and vice versa (rheumatic teno-vaginitis). 



Treatment. The most important point is to stop work ; where 

 possible, absolute rest should be given, and the shoe removed. 

 Fresh cases, due to mechanical injury, are treated during the first 

 twenty-four to forty-eight hours by cold applications, the best form 

 being immersion or irrigation, but after this time little good results 

 from the employment of cold. Moist warmth, supplemented by 

 proper bandaging, is then preferable, and is applied as follows : — 

 After carefully cleansing the foot, two longish rolls of tow rather 

 thicker than a man's thumb are moistened and laid lengthwise on 

 either side of the diseased tendon, close to the metacarpus, and fixed 

 there by a linen or cotton bandage, wetted and applied tightly. 

 Over this a dry woollen bandage is placed, so as to exercise regular 

 pressure on the material below and on the diseased spot ; when 

 available, a piece of rubber tissue or waxed linen may be placed 

 between the two bandages. Some practitioners envelop the limb 

 thickly in cotton-wool, over which a calico bandage is tightly applied. 

 This dressing is changed every four hours ; the moist warmth and 

 regular pressure favour reparative changes ; excessive extravasation 

 and cellular proliferation are checked and resorption assisted. The 

 rolls of tow or cotton-wool should exercise even pressure on the 

 diseased tendon. 



When pain disappears massage may be resorted to during the 

 interval of changing the dressing, the injured tendon being rubbed 

 from below upwards with the thumb and fore-finger, using moderate 

 pressure, for about five minutes at a time, the parts being mean- 

 while covered with a piece of linen. The operation must not be 

 persevered with if pain or swelling follow. When early and care- 

 fully used, massage cures and removes the swelling in cases where, 

 with the antiphlogistic methods formerly employed, thickening 

 almost always remained. The slight vascularity of tendons in no 

 way supports the theory of the action of cold ; on the other hand 

 moist warmth and methodical compression assist absorption, and 

 are certainly not so likely to impede repair as cold. Experience 

 shows this treatment to be by far the best. 



Infriction with ointments or fluids acts like massage, though the 

 specific resolvent effect ascribed to preparations of mercury and 



