MALFORMATION OF THE JOINTS 



343 



of the capsule, and where there are great lameness and indications of 

 suppuration, we proceed in the following manner: 



(a) The part to be punctured must be rendered strictly aseptic; (b) 

 the part must have a particularly tight dressing over it for a few days 

 after the o])eration. 



If this latter method is not practicable on account of the position of 

 the joint or some other circumstance, puncturing the joint will not give 

 favorable results and maj^ even lead to very serious conditions (suppura- 

 tion, etc.). The method of operation is very simple. 



After having removed the hair from the region of the joint and wash- 

 ing with sublimated soap, disinfecting it with a 5-pcr cent, solution of 

 carbolic acid and 2 per cent, of creolin or 1 per cent, 

 of corrosive sublimate, we then puncture the part with 

 a good-sized hypodermatic needle and slowly evacuate 

 the sac by drawing it into the syringe. If the syringe 

 becomes filled and the joint is not entirely emptied, the 

 syringe must be detached from the needle and the 

 opening closed at once by means of the finger, as any 

 air that may find its way into the joint will produce bad 

 results. Empty the syringe and proceed as before. 



This method, as a rule, is absolutely harmless, 

 evacuating the sac in cases of serous secretions. If, 

 however, we find in the fluid withdrawn from the joint 

 many cellular elements — that is to say, if it possesses a 

 marked purulent character — we must use at the same 

 time an injection of antiseptic fluid directly into the 

 joint, so as to make it aseptic. For that purpose we 

 use a slightly warm solution of corrosive sublimate 1 

 to 1000 or a 2-per cent, solution of carbolic acid and a 

 Lugol solution of iodine (1 per cent, tincture of iodine, , ^°: ^^^■~' ^^^^ 



~ ^ i ' hypodermatic syringe 



2 per cent, of iodide of potassium, and 5U per cent of for puncturing en- 

 water). Either of these solutions ma}' be injected ^'^^^ jomts. 

 through the needle into the joint; then, by manipulation, try to work 

 this solution inside of the capsule by means of careful pressure, 

 allowing it to flow out through the needle in one or two minutes. The 

 needle is then withdrawn and the perforated opening is closed at once 

 by means of an iodoform tampon, and over that an antiseptic dressing- 

 is placed. This should be allowed to remain on the wound for a few 

 days. 



(For further particulars, see the chapter on Treatment of Wounds.) 



In chronic inflammations or great secretions we may also use simple 



injections of disinfecting solutions, such as iodide of potassium, as a means 



of reducing the inflammation or destroying its products. "We perforate 



