345 



position to become chronic, will require stimulating treatment in order 

 to counteract that tendency by the quickened activity of the process of 

 absorption, and we must again draw upon the resources of experience 

 in the form of the blisters, the fomentations, the iodine and the mercu- 

 rial helps as heretofore mentioned. Good results may always be insured 

 from their judicious and timely administration while combatting the 

 aberrations of nature, but little, from them or from any of the allies of 

 the curative art, by their unintelligent and misdirected employment. 

 In applying the powerful mineral inunctions much patience and wisdom 

 are demanded. It should be done by carefully and perseveringly rub- 

 bing in small quantities daily ; it should be done softly and gently, not 

 with force of arms, nor with the expectation of producing an astonish- 

 ing effect by heavy dosing and main strength in a few hours; it should 

 be after the manner of a siege rather than that of a charge. The ob- 

 ject must be to induce the drugs to permeate the afi'ected part until the 

 entire mass is penetrated. Of course cases will be encountered which 

 resist every form of treatment but the last of all (in dealing with ex- 

 ternal and excessive growths). The tumor remains as a fixed fact ; 

 it continues to grow; it is large and pendulous at the elbow; its weight 

 is estimated in pounds; it is not an eyesore merely, but an uncomfort- 

 able, burdensome mass, excoriating all the surrounding parts and being 

 itself excoriated in turn ; mild treatment has failed and is no longer to 

 be relied on. There is no longer an alternative between the abandon- 

 ment of the patient and the amputation of the tumor. But there is a 

 choice of modes and instrumentalities, a question of preference between 

 the ligature, the electric cautery, and the bistoury. Each has its advo- 

 cates among practitioners. In a case like the present, one of the prac- 

 tical embarrassments arises in connection with the application and re- 

 tention of bandages and other dressings after the amputation has been 

 performed. It is a somewhat difficult problem, owing to the conforma- 

 tion and proportions of the body of the patient, and involves the exer- 

 cise of a considerable amount of practical ingenuity to adjust and retain 

 the appliances necessary to insure a good final result in obtaining a 

 proper cicatrix. 



In our long description of the treatment of the varieties of capped 

 elbow we have thus far omitted any mention of one method which has 

 to some extent received the sanction of experience, and which is prac- 

 ticed and commended by not a few. We refer to the use of setons, in- 

 troduced through and through the tumor. We mention it to say that 

 our experience is adverse to this mode. We are led to this opinion not 

 only by our observation of many failures, but from the fact that in many 

 cases the use of the seton has been followed by the formation of large 

 fibrous tumors, which in our opinion have resulted from it. 



Capped Jcncc. — The passage of the tendons of the extensor muscle of 

 the cannon, as it glides in front of the knee joint, is assisted by one 

 of the little bursas we have before mentioned, and when this becomes 



