DISEASE PRODUCING MALFORMATION OF JOINTS. 277 



Fia 61 



thickening and a large quantity of secretion of the capsule, as in 

 cases of acute inflammation of the joint, or in purulent arthritis, 

 massage with cocoanut oil is particularly adapted. In cases of 

 rheumatic inflammation of the joint, which have been recognized 

 as such, we must use internal remedies, such as recommended in 

 muscular rheumatism. 



In many traumatic and purulent inflammations of the joint we 

 can only get good results by an operation which varies according 

 to the condition. The general procedure is as follows: 



Puncturing. This method of treatment is indicated in all 

 chronic serous secretions of the joint. As soon as we find that the 

 measures which encourage reabsorption, such as tight dressing and 

 massage, do not produce good results, and where the secretion 

 causes great distention of the capsule, and where there are great 

 lameness and indications of suppuration, we 

 proceed in the following manner: 



a. The part to be punctured must be rendered 

 strictly aseptic ; b, the part must have a particu- 

 larly tight dressing over it for a few days after the 

 operation. 



If this latter method is not practicable on account 

 of the position of the joint or some other circum- 

 stance, puncturing the joint will not give favorable 

 results and may even lead to very serious conditions 

 (suppuration, etc.). The method of operation is very 

 simple. 



After having removed the hair from the region of 

 the joint and washing with sublimated soap, disin- 

 fecting it with a ^ per cent, solution of carbolic acid 

 and 2 per cent, of creolin or 1 per cent, of corrosive 

 sublimate, we then puncture the part with a good- 

 si^ed hypodermatic needle and slowly evacuate the sac 

 by drawing it into the syringe. If the syringe be- 

 comes filled and the joint is not entirely emptied, 

 the syringe must be detached from the needle and 

 the opening closed at once by means of the finger, as 

 any air that may find its way into the joint will 

 produce bad results. Empty the syringe and pro- 

 ceed as before. 



This method, as a rule, is absolutely harmless, evacuating the sac in cases 

 of serous secretions. If, however, we find in the fluid withdrawn from the 

 joint many cellular elements — that is to say, if it possesses a marked puru- 

 lent character — we must use at the same time an injection of antiseptic 



A large hypodermatic 

 syringe for puncturing 

 enlarged joints. 



