PRINCIPLES OF TREATMENT. 25 



Diuretics (nitre, for instance), purify the blood by stimulating the kidneys, 

 the office of which is to remove waste material from the blood along with the 

 urine ; but as their continued use has a bad effect on the kidneys and general 

 health, tliey should be employed only for a day or two, in the event of the 

 patient being in gross condition. 



Laxative food (green fodder, carrots, &c.) has a " coolmg " effect by acting 

 on the bowels ; by being poor in substances, such as albumin, which is apt to 

 " heat" the system; and by reason of its containing certain &alts which, on 

 becoming absorbed into the blood, assist in maintaining its fluidity, and in 

 removing waste material. 



Starvation within healthy limits, as we may see from the foregoing remarks, 

 may be enforced with advantage in the acute stage of sprain. 



Belladonna, as an external application, relieves congestion by stimulating 

 the superficial blood vessels. 



Heat applied in the form of w^arm water to a bleeding surface helps to check 

 hai'morrhage, and consequently may be useful in the very early stage of a 

 sprain, when the ruptured blood-vessels are still bleeding. Its temperature 

 should be from 120° to 125'^ F. A few minutes will sufiice to produce the 

 desired efi'ect. The application of warm water is useful only when the injured 

 part is near the surface ; for it could have little or no effect if the site of hurt 

 were deep-seated. If long continued, it would act injuriously ; for by soften- 

 ing the tissues, it would increase the amount of the exudation. Its beneficial 

 efi'ect is generally more apparant than real, on account of its acting as a 

 sedative in relieving pain. 



Cold (by means of water, ice, or refrigerant lotions, for instance) causes 

 contraction of the tissues, and hy the pressure thereby obtained, checks the 

 How of an exudation from the capillaries (p. 10). As its employment tends 

 to arrest all vital action (that of repair among the number) ; it can hardly be 

 expected to efi'ect much benefit in acute inflammation. Although the appli- 

 cation of hot or cold water, when used sufficiently early, to sprains, possesses 

 certain merits ; the advantages to be obtained from it are so small, as com- 

 pared to those of evenly distributed pressure and massage, that, as a general 

 rule, we may discard its use in the treatment of sprains. 



Active exercise of a very moderate description, and judiciously regulated, 

 should, as I have already said, be given comparatively early. It should of 

 course be of a nature that would in no way be liable to cause a recurrence of 

 the acute symptoms. If a swollen limb which, after exercise, keeps " fine " 

 for a few hours, only to get subsequently as big or bigger than before, the 

 exercise will do little or no good, and may be hurtful, the best means of avoid- 

 ing which contingency are massage (p. 664) and properly distributed pres- 

 sure (as with cotton wadding, see page 45). 



Counter-irritants. — ^The application of any form of irritation — 

 whether by embrocation, blister or firing — on the surface of a sprained part, 

 by diminishing the tenseness of the tissues (p. 14), must increase the infiam- 

 mation. I have invariably found that the premature blistering of a sprained 

 part below knee or hock, is followed by permanent thickening and consequent 

 weakness. I take sprains below the knee and hock as an illustration, because 

 their progress can be followed out wdth comparative ease, owing to the 

 superficial position of the afl'ected structures. In every case of uncomplicated 

 sprain, I would certainly refrain from applying a counter irritant until all 

 heat and pain have disappeared from the part. With respect to the treatment 

 of sprain when complicated by inflammation of bone, see page 52 et seq. 



Many people think that the peeling ofl' of the scab after a blister is a 

 proof that benefit has been effected by the apj)lication — as if the swollen part 

 were composed of layers like those of an onion ! If we examine the condition 

 of skin which has been severely blistered on one or more occasions (as we may 

 observe on cutting through the skin before performing neurotomy), we shall 



