334 SEROUS CYSTS. 



be able to touch his elbow. The OfEord and other elbow pads 

 are eflfective appliances for accomplishing this object. In Russia, 

 an arrangement similar to the Offord pad is used with those 

 match trotters which are liable to hit their elbows. It is 

 well to employ gentle massage (p. 675) and continued fomentations 

 of warm water for a few days, and after that rub in for a con- 

 siderable time every day, during a fortnight or so, the following 

 liniment : — 



Soap liniment ... ... ... ... ^ pint 



Strong liquid ammonia ... ... ... ^drachm 



The pressure caused by the rubbing and the stimulating effect of 

 the liniment will generally make the tumour disappear. If the 

 enlargement does not yield to these simple means, pass a seton 

 through its centre in a vertical direction. A rubber tube, about 

 the thickness of a quill, may advantageously be passed round the 

 base of the tumour without cutting the skin, drawn tightly and the 

 ends tied together with string. If the base of the tumour be not 

 well defined, use a preliminary ligature of thin whip cord until the 

 tumour in front of it has swollen sufficiently for the rubber tube to 

 retain its hold ; or transfix the tumour with a suitable skewer. 

 The ligature should be tightened from time to time as may be 

 necessary. The circle of constriction should be kept free from in- 

 fection by the use of a suitable antiseptip (p. 67). The tumour will 

 fall off in about a week. Its removal, owing to the presence in it 

 of large blood-vessels, should not be hastened by the knife ; 

 although gentle torsion may be employed. The subsequent wound 

 may be treated by, for instance, the plentiful use of iodoform or 

 tannoform, or by a solution of chloride of zinc, 20 grains to the 

 ounce of water. If the tumour is already hard and fibrous, it can 

 be safely removed with the knife, or ecraseur (Fig. 113, p. 287). 

 To do this, make a long vertical incision, preferably with the hot 

 iron, through the skin, and then carefully dissect the tumour out 

 with the knife, or pass the chain of the ecraseur over it, and screw 

 up the instrument until the base of the tumour is cut through. It 

 is advisable to apply a strong caustic (such as 40 grains of chloride 

 of zinc to the ounce of water) or a red-hot firing iron to the 

 wounded surface left by removal of the tumour, so that the serous 

 membrane may not continue to secrete serous fluid and thus leave 

 a running sore. Afterwards, tannoform, iodoform, or a saturated 

 solution of iodoform in turpentine or in eucalyptus oil may be 

 freely applied to the part. 



