278 DISEASES OF THE BONES AND ARTICULATIONS. 



fluid directly into the joint, so as to make it aseptic. For that purpose we 

 use a slightly warm solution of 1 to 1000 solution of corrosive sublimate or a 

 2 per cent, solution of carbolic acid and a Lugol solution of iodine (1 per 

 cent, tincture of iodine, 2 per cent, of iodide of potassium, and 50 per 

 cent, of water). Either of these solutions may be injected through the 

 needle into the joint; then, by manipulation, try to work this solution 

 inside of the capsule by means of careful pressure, allowing it to flow out 

 through the needle in one or two minutes. The needle is then withdrawn 

 and the perforated opening is closed at once by means of an iodoform- 

 tampon, and over that an antiseptic dressing is placed. This should be 

 allowed to remain on the wound for a few days. 



(For further particulars, see the chapter on Treatment of 

 Wounds.) 



In chronic inflammations or great secretions we may also use simple 

 injections of disinfecting solutions, such as iodide of potassium, as a means 

 of reducing the inflammation or destroying its products. We perforate 

 directly into the cavity of the joint by means of a hypodermatic needle and 

 with a syringe inject a quantity of fluid in proportion to the size of the 

 joint. This operation has to be repeated every three or four days, fol- 

 lowing the same procedure before and after the operation as has been 

 already described. 



The joint may be opened by means of a puncture with a lancet. This is 

 advisable where there is extensive suppuration going on in the joint and 

 where the diseased part shows every indication of a septic condition. 

 The joint to be opened should be punctured by means of a lancet or bis- 

 toury, making a wound just sufficient to empty it freely. It must then be 

 cleansed with an antiseptic solution and any clots or detached portions of 

 tissue washed out ; then close the wound by means of sutures. In some 

 cases it is well to leave one corner open for drainage, that, of course, being 

 the lower one. We then place an antiseptic dressing over the whole part. 



Injuries of the Joints. 



These may be divided into several groups— true wounds of the 

 joints, contusions, distortions, and luxations. 



Wounds of the Joints. Wounds of the joints— that is to say, 

 injuries which expose the joint proper to the atmosphere — are 

 divided into perforating or cutting wounds, being produced by 

 laceration, contusion, and shot. 



^ Clinical Symptoms and Course. The first symptom of 

 injury to the joint, as a rule, is a discharge of synovia from the 

 wound. This, however, may be absent in cases where the wound 

 is very fine, or where the puncture runs in an oblique direction; 



