WHITE. SWELLING. 



flammation is fubdued, left it aggravate the difeafe. Iffues 

 and fetons, which are ufeful in ulceration of the cartilages, 

 Mr. Brodie deems ufelefs in the prefent difeafe. Platters 

 of gum ammoniac, and others of a fimilar nature, are of 

 little efiicacy while inflammation exifts, but afterwards they 

 are of ufe in guarding the joint from the influence of exter- 

 nal cold, and preventing a relapfe. For the removal of a 

 moderate degree of fwelling and iliffnefs, left by the pail 

 inflammation, Mr. Brodie entertains a favourable opinion of 

 exercife of the limb, and friftion with camphorated mercu- 

 rial ointment, or by the hand with finely powdered ftarch. 

 When the fridion, however, produces inflammation again, it is 

 to be difcontinued, and leeches applied. When the fwelling 

 and iliffnefs areconfiderable, Mr. Brodie has never feen friftion 

 do much good, and, as it is in fuch cafes particularly apt to 

 bring on inflammation again, it is to be employed with much 

 caution. According to the fame author, friftion is more 

 efficacious, where the ftiffnefs of a joint depends on a con- 

 trafted ftate of the mufcles, or tendons of the limb, or on 

 thefe being glued to each other, or the furrounding parts, 

 than where it is the confequence of difeafe of the joint itfelf. 

 In fome cafes, the pumping of warm water on the part, 

 from a height of feveral feet, as praftifed at fome of the 

 watering places, is beneficial ; but in this plan, the fame 

 cautions are neceffary, as in the employment of friftion. 



With regard to the cafes which Mr. Brodie defcribes as 

 depending upon a total lofs of the natural ftrufture of the 

 fynovial membrane, which is converted into a pulpy fub- 

 itance, one-quarter, or one-half, of an inch in thicknefs, are, 

 according to this gentleman, quite incurable, and they at 

 length terminate in ulceration of the cartilages, abfcefles, 

 &c. Hence, when the health begins to fuffer, he confiders 

 amputation proper. See Medico-Chir. Tranf. vol. v. 



When white-fwcUings are accompanied with ulceration of 

 the cartilages, all motion of the joint is extremely hurtful. 

 Indeed, as Mr. Brodie well obferves, keeping the limb in a 

 flate of perfeft quietude is a very important, if not the moft 

 important circunillance to be attended to in the treatment. 

 According to the lame writer, it is in thefe cafes, in which 

 ulceration of the cartilage occurs as a primary difeafe, that 

 cauftic indues are ufually produftive of fingular benefit ; 

 but he deems them of little ufe in any other difeafes of the 

 joints. He thinks fetons, and blifters kept open with the 

 favine cerate, may alfo be ufed with advantage in the fame 

 defcription of cafes. Bleeding can only be proper, when, 

 from the bad effefts of exercife, the articular furfaces are 

 inflamed, and pain and fever prevail. Mr. Brodie afl^ures 

 U8, that the warm-bath relieves the fymptoms in the early 

 ftage, if it does not ilop the progrefs of the difeafe ; but 

 he condemns plafters of gum ammoniac, embrocations, 

 liniments, and friftions, as either ufelefs or hurtful. Op. 

 Cit. vol. vi. 



The pumping of warm water upon difeafed joints is a 

 method which is at prefent very frequently adopted, as 

 fome conceive, with decidedly beneficial effefts. The plan 

 is not altogether modern. Le Dran, and feveral other old 

 praftitioners, recommend throwing warm water upon dif- 

 eafed joints, and they prove the advantages of this treatment 

 by a relation of many fnccefsful cafes. In order to derive 

 the greatefl; poffible good from the plan, the water ftiould 

 be as warm as the patient can bear it, and it ought to fall 

 upon the part from a height of feven or eight feet. The 

 fize of the ftream mull alfo vary according to the degree of 

 fenfibility in the tumour. When the pain is acute, the end 

 of the pipe muff be clofed with apiece of tin, perforated by 

 many holes, like the fpout of a watering-pot. But when 

 9 



the pain is inconfiderable, the pipe may terminate in a fingle 

 opening, the diameter of which fhould vary from half an 

 inch to an inch, according to circumftances. The applica- 

 tion is fometimes to be continued nearly an hour, and when 

 it is finiflied, the patient ought to go to bed, and the joint 

 be covered with bladders filled with water as hot as the 

 patient can bear. Boyer recommends the application of 

 the bladders to be perfevered in for the fpace of two hours, 

 after which they are to be removed, and perfpiration from 

 the part promoted by covering it with warm cloths, or 

 flannels. In the evening, the bladders are to be repeated for 

 fome hours. The dafliing of warm water againll the dif- 

 eafed joint is to be praftifed every day, or every other day, 

 according as the patient can bear the plan, without too 

 much fatigue or inconvenience. This treatment, fays 

 baron Boyer, is proper in all kinds of white-fwellings, and 

 in every ftage of the difeafe ; but it is much the moft ufe- 

 ful in thofe'cafes in which the foft parts alone are affefted, 

 and at an early period, before the complaint has made great 

 progrefs. Favourable effefts may be expefted from this 

 method, when, after each application of the water, the part 

 affefted perfpires copioufly, when it grows gradually 

 fofter, and when, after a certain number of trials, the 

 fwelling begins to diminifli. Under thefe circumftances, 

 the plan is to be continued and repeated very often, as a 

 long perfeverance in it has frequently produced extraor- 

 dinary cures. When none of the above-defcribed changes 

 happen, little benefit can be hoped for from the method ; 

 but ftill the patient fhould not abandon it, before its ineffi- 

 cacy has been proved by adequate trials. 



When there is no fuitable apparatus for applying the 

 warm water, it may be injefted againft the part with a large 

 fyringe, which has a pipe about half an inch in diameter, 

 made with four or five holes, for the difcharge of the fluid. 

 The injeftions may be rendered more or lefs aftive, by pro- 

 pelling the water with more or lels force. 



Thefe affufions operate only by the heat and ftrength of 

 the current of water. Boyer ilates, that their aftivity may 

 be augmented by adding to the fluid a quantity of the 

 muriate of foda or muriate of ammonia, or fome potaffa or 

 foda ; and he thinks it Hill better to employ a fulphuretted 

 mineral water, either natural or faftitious. The aftivity 

 of the affufions may alfo be increafed by heating the water 

 to a high temperature, letting it fall from a confiderable 

 height, and making the ftream large. It is a plan, faya 

 baron Boyer, adapted to thofe white-fwellings which are 

 fituated in the foft parts on the outfide of the joints ; and 

 which are indolent, and unattended with mucli pain. When 

 thefe aftive affufions are applied to white-fwellings 

 which are painful, and which affeft the bones, they 

 often increafe the patient's fufferings, and accelerate the 

 progrefs of the difeafe. See Traite des Mai. Chir. tom. iv, 

 p. 512, &c. 



Of late years, furgeons have frequently made trial of dry- 

 rubbing, as it is termed, or friftion of the joint, performed 

 with the hand, for feveral hours a day, with the mere apph- 

 cation of a little powdered ftarch, or hair-powder, in order 

 to prevent the part from being chafed. It is a method 

 which was firit praftifed to a confiderable extent at Oxford, 

 and with great fuccefs. Many poor women there earned 

 a livehhood by rubbing difeafed joints at the rate of fixpence 

 per hour. Indeed, there can be no doubt, that, in indolent 

 rheumatic wliite-fwellings, fimple friftion often removes the 

 fwelhng in an expeditious manner, as well as the ftiffnefs of 

 the affefted joint. The plan, however, will not effeft a cure 

 in fcrofulous cafes ; nor can it be adopted without manifeft 



barm 



