PREVENTION, SYMPTOMS AND TREATMENT 249 



of tincture of iodine or 1Tl,xx to ntxxx of 95 per cent, carbolic acid 

 are injected into the sac by a hypodermic syringe connected with 

 the needle. The sheath is then manipulated to bring the injection 

 in contact with its walls. 



The application of bandages, constantly wet with 2 per cent, 

 creolin solution, and absolute rest until all inflammation has sub- 

 sided, are essential. The puncture of the aspirating needle should 

 be immediately sealed with collodion. Instead of the injections 

 mentioned, a 1 per cent, solution of potassium iodide or the tincture 

 of iodine, diluted with two parts of water, are sometimes used to 

 inject the joint with and then removed. This method has been 

 employed success fully in the treatment of carpal and tarsal teno- 

 synovitis, in sesamoid teno-synovitis or windgalls, and in that in 

 front of the fetlock affecting the tendon of the extensor pedis. 



The other method of operating, which is more certain and 

 precise and preferable in human surgery, is incision. The prepara- 

 tion of the patient is the same. The sheath of the tendon is in- 

 cised and the thickened walls curetted away or excised with scissors. 

 The sac is washed with hydrogen dioxide and 2 per cent, lysol 

 solution and swabbed with tincture of iodine. The wound is 

 sutured, leaving a small drain at the lowest point. An aseptic 

 gauze dressing and bandage are then applied and left in place for 

 a week or more, if the case progresses favorably. It would be 

 better to omit the drain if the asepsis is good and can be kept so. 

 This method can not be applied safely in positions where a bandage 

 can not be retained in place. 



In the treatment of the inflamed tendon sheath or bursa at the 

 point of the shoulder (flexor brachii and infraspinatus), and at 

 the trochanter (gluteus maximus), long rest with high-heeled shoes 

 on the affected limbs are imperative. Constant irrigation with cold 

 water during acute exacerbations is indicated. In chronic inflam- 

 mation in these regions firing and blistering are of service. A 

 long rest of six to eight weeks and the avoidance of heavy work 



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