218 INJURIES. 



closely adhering and encompassing the joint, of the exact shape of the 

 joint, which never varies its position, is as hard as a tanned hide, and yet 

 flexible. 



" If by the sixth or seventh day, owing to the large size of the aperture 

 in the capsule, the compression has not had the effect of closing the joint, 

 and there should be found a considerable lodgement of fluid (a mixture 

 of pus and synovia) in a depending part of the compress, another incision 

 must be made in the compress to give exit to this fluid, beginning in the 

 front at the inferior part, and continuing it upwards, but no higher than 

 necessary. • 



" It is in this stage of a bad case that great nicety of treatment is re- 

 quired, and we are not to be at all disheartened if the joint be not closed; 

 for there will be found a coagulum filling up the mouth of the wound, and 

 extending to the orifice of the capsular ligament, though scarcely sufficient 

 to close it. The nicety I allude to consists in taking care not to remove or 

 disturb this clot or plug ; for it is this coagulum, when sufficiently orga- 

 nized, that becomes as it were the cork to the bottle. This is the material 

 point on which the success of the case depends, and which differs from 

 the ordinary mode of treatment, it being customary to remove the bandage 

 every day, or every second day, in order to give the inflamed parts the 

 benefit of warm fomentations, and cleansing the wound, as it is called, 

 which, in reality, is the greatest act of violence that an opened joint can 

 receive in the shape of curative treatment ; and just as often as it is 

 repeated, are the efforts of nature opposed by the removal of this jelly- 

 like substance. 



" The next thing to be done is to spread another dressing of the adhesive 

 paste over the outside of the compress, and to apply another six-yard calico 

 roller with gentle pressure upon it. In this stage of the case, regular pres- 

 sure will be found rather to diminish than increase irritation, but there is 

 some skill required even in the simple act of applying a roller to an in- 

 flamed part. This last bandage should remain undisturbed as long as 

 possible, with the expectation that, by the next time the fluid is evacuated 

 from the compress, the capsular ligament may be found closed, and the 

 discharge of synovia ceased ; but whether so or not, the same treatment 

 should be continued. 



" There is one curious circumstance that not unfrequently attends the 

 process of cure by this treatment, and which I hail as a good omen, but 

 which many writers have remarked upon as indicative of the total destruc- 

 tion of the joint. I allude to an eruption and discharge from another part 

 of the joint, perhaps the back of the knee, and which they describe as the 

 bursting of an abscess within the joint. I merely mention this fact to show 

 that these eruptions do not always communicate with the joint, and that I 

 do not make a practice of indulging my curiosity by introducing a probe 



