382 DISEASES OF THE HOUSE. 



from closing prematurely. It may be taken off the next day, and a 

 daily cleansing will then be all that is necessary. In another case 

 the tumor becomes very soft in its whole extent, with evident fluctua- 

 tion and a well-defined form. The discharge of the fluid is then indi- 

 cated, and a free incision will be followed by the escape of a quantity 

 of thin yellowish liquid from a single sac. The wound should be 

 kept clean and dressed frequently, in order to insure prompt healing. 

 But if the cavity is found to be subdivided in its interior by numerous 

 bands and the cyst proves to be multilocular the partitions should be 

 torn out with the fingers and the cavity then treated in the same 

 manner as the unilocular sac. In still another case the swelling may 

 be warm and painful with indistinct fluctuation, or fluctuation only 

 at a certain point. This indicates an abscess, and necessitates an 

 incision to drain the pus, followed by the careful cleansing and 

 dressing of the wound. 



But cases occur in which all the treatment that has been described 

 fails to effect a full recovery, and instead a fibrous tumor begins to 

 develop. A change of treatment is, of course, then in order. The 

 inflammation being chronic will necessitate stimulating treatment of 

 the part in order to increase the process of absorption. We must 

 again draw upon the resources of experience in the form of blisters, 

 the fomentations, the iodin, and the mercurial ointments, as hereto- 

 fore mentioned. Good results may always be insured from their 

 judicious and timely administration. In applying the powerful min- 

 eral inunctions much patience and wisdom are required. It should 

 be done by carefully and perseveringly rubbing in small quantities 

 daily; it should be done softly and gently, not with force, nor with 

 the expectation of producing an astonishing 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 object is to induce the 

 drugs to permeate the affected part until the entire mass is pene- 

 trated. Of course cases will be encountered which resist all forms 

 of medical treatment. The tumor remains as a fixed fact; it con- 

 tinues 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. 



Resort must now be made to surgical methods, and here again we 

 must choose between the ligature, the cautery, and the knife. Each 

 has its advocates among practitioners. In a case like the present, one 

 of the difficulties arises in connection with the application and reten- 

 tion of bandages and other dressings after the amputation has been 

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

 formation and proportions of the body of the patient, and involves 



