226 DISEASES OF THE JOINTS. 



at the lower part of the tub, which is to be well supplied with 

 water. A very small stream of water will be sufficient. 



If this plan of treatment does not seem to succeed, a blister 

 must be used. 



Practitioners of surgery recommend ice in gutta-percha bags 

 instead of water : these are scarcely applicable to our patients. 



Such, then, is the treatment when the lips of the wound admit 

 of being brought into apposition, and when the practitioner has 

 been called in before the advent of suppuration. If it be a lace- 

 rated wound, its lips must be brought together as well as possible, 

 and retained in that position by the application of the styptic 

 colloid. 



If these means are ineffective, if the injury has been inflicted for 

 a longer period than a few hours, when inflammation is already 

 established, and pus has commenced to be formed, to plug 

 up the wound at this stage would only cause the fluid accumu- 

 lated within the capsule of the joint to burst out at some other 

 spot. The application of the actual cautery, of hot lime, and 

 of the various caustics and astringents, with the view of coagu- 

 lating the synovia, as recommended by many teachers, writers, 

 and practitioners, cannot be too highly condemned ; and it must 

 always be remembered by the practitioner that every wound 

 which has commenced to suppurate must heal by granulations ; 

 and that the more perfect formation of these goes on in the 

 deeper-seated parts of the wound — that is to say, that the heal- 

 ing must be from within outwards : the plugging of the outer 

 orifice, while pus is being formed, causes it to accumulate in the 

 joint and surrounding structures, adds to the suffering of the 

 animal, and, in too many cases, causes its death. 



An extended experience warrants me in recommending the 

 application of a blister to the whole surface of the joint, as 

 the most successful treatment that can be adopted if the wound 

 has failed to heal by the primary or adhesive process. The 

 blister acts by removing pain, limiting motion, exciting the 

 formation of healthy granulations, and (as a result of the swell- 

 ing it produces) causing the approximation of the surfaces of the 

 wound. 



The coagulum of synovia which accumulates upon the wound 

 should never be removed, as it prevents the admission of air and 

 of organic germs into the joint, and thus limits the formation of pus. 



