CAPPED KNEE. 329 



exceedingly obstinate, tardy and tedious of reduction, and to be the 

 more tiresome in resisting remedy, the more remote its date of 

 origin and chronic its nature. 



So long as any heat continued perceptible in the tumour, one 

 would naturally feel disposed to commence with antiphlogistic re- 

 medies — a brisk dose of cathartic medicine, combined with the 

 use either of fomentations and poultices, or of evaporating lotions, 

 according to the stage the inflammation was in — notwithstanding 

 the experienced in these matters know but too well that but little 

 benefit is to be expected from such remedies in any case save the 

 one which is recent, or such a one as has not lost the natural pro- 

 pensity of parts, give them time, to recover of themselves their 

 normal condition. And even in other cases — cases in which this 

 restorative power seems to have expended itself or to have grown 

 dormant, and wherein fresh action seems cogently called for before 

 absorption of the collected fluid can be expected to be brought 

 about, I have always found that blood-letting, either from the 

 shoulder or the toe, with the simultaneous application of a blister 

 upon the swelling, and the combined operation of purgative me- 

 dicine, has proved more effective than any of the ointments said to 

 promote absorption, such as those of antimony, iodine, mercury, &c. 



Now and then, however, it will turn out that, instead of the 

 fresh action excited by the blister producing absorption of the 

 effused fluid, it will give rise not merely to a temporary augmenta- 

 tion — which, indeed, is very commonly the effect of a blister, but — 

 to fresh and permanent enlargement of the tumour, rendering the 

 fluctuation more perceptible than it ever has been, and shewing a 

 disposition, the same as any purulent abscess would, to point. At 

 this stage operation becomes inevitable. The tumour may be 

 punctured with a lancet, better held to cut longitudinally than 

 transversely ; the serous fluid, often stained with blood, let out ; 

 and the case treated the same as any other serous abscess, save 

 that setoning is not advisable here, and that, the sooner the parts 

 can be got to granulate by injections, mild at first and increased in 

 strength afterwards, the better. Sometimes it happens that the 

 sheath of the extensor tendon in front of the knee becomes opened 



VOL. IV. u u 



