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, they 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 "cooling" efifect 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 salts 

 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 warm water to a bleeding surface helps to 

 check haemorrhage, and consequently may be useful in the very early stage 

 of a sprain, when the ruptured blood-vessels are still bleeding. Its tempera- 

 ture should be from 120° to 125° F. A few minutes will suffice to produce 

 the desired effect. The application of warm water is useful only when the 

 injured part is near the surface ; for it could have little or no effect it the 

 site of hurt were deep-seated. If long continued, it would act injuriously ; 

 for by softening the tissues, it would increase the amount of the exudation. 

 Its beneficial effect is generally more apparent 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 df the tissues, and by the pressure thereby obtained, checks the 

 flow 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 effect much benefit in acute inflammation. Although the 

 application 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 compared 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 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, 

 gets subsequently as big or bigger than before, the exercise will do little 

 or no good, and may be hurtful, the best means of avoiding which contin- 

 gency are massage (p. 675) and properly distributed pressure (as with cotton 

 wadding, see page 44). 



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

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

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

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

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

 quent weakness. I take sprains below the knee and hook as an illustration, 

 because their progress can be followed out with comparative ease, owing 

 to the superficial position of the affected structures. In every case of un- 

 complicated sprain, I would certainly refrain from applying a counter- 

 irritant until all heat and pain have disappeared from the part. With 

 respect to the treatmeiit of sprain when complicated by inflammation of 

 bone, see page 52 et seq. 



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

 proof that benefit has been effected by the application — 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 neuro- 

 tomy), we shall find that the skin has become greatly thickened, and that 

 it must necessarily form a permanent bandage, in accomplishing which 



