276 
ON OPENED JOINTS* 
pressure, by the length of these notches or incisions, must be as 
limited as the urgency of the symptoms will allow ; but in every 
case I make it a rule to afford this relief in some degree. From 
this period the constitutional disturbance comparatively ceases, 
the appetite returns, and respiration is tranquillized, although 
the pulse may remain quick. But now we are possessed of a 
substitute for the injured capsular ligament,—a compress, closely 
adhering and encompassing the joint, of the exact shape of the 
joint, which never varies its position, is as hard as a tanned hide, 
and yet flexible. 
If by the sixth or seventh day, owing to the large size of the 
aperture in the capsule, the compression has not had the effect of 
closing the joint, and there should be found a considerable lodge¬ 
ment of fluid (a mixture of pus and synovia) in a depending 
part of the compress, another incision must be made in the com¬ 
press to give exit to this fluid, beginning in the front at the 
inferior part, and continuing it upwards, but no higher than 
necessary. 
It is in this stage of a bad case that great nicety of treatment 
is required, and we are not to be at all disheartened if the joint 
be not closed; for there will be found a coagulum filling up the 
mouth of the wound, and extending to the orifice of the cap¬ 
sular ligament, though scarcely sufficient to close it. The 
nicety I allude to consists in taking care not to remove or dis¬ 
turb this clot or plug; for it is this coagulum, when sufficiently 
organized, that becomes as it were the cork to the bottle. 
This is the material point on which the success of the case 
depends, and which differs from the ordinary mode of treat¬ 
ment, it being customary to remove the bandage every day, 
or every second day, in order to give the inflamed parts the be¬ 
nefit of warm fomentations, and cleansing the wound, as it is 
called, which in reality is the greatest act of violence that an 
opened joint can receive in the shape of curative treatment • and 
just as often as it is repeated, are the efforts of nature opposed by 
the removal of this jelly-like substance. 
The next thing to be done is to spread another dressing of the 
adhesive paste over the outside of the compress, and to apply 
another six-yard calico roller with gentle pressure upon it. In 
this stage of the case, regular pressure will be found rather to di¬ 
minish than increase irritation, but there is some skill required 
even in the simple act of applying a roller to an inflamed part. 
This last bandage should remain undisturbed as long as possible, 
with the expectation that, by the next time the fluid is evacuated 
from the compress, the capsular ligament may be found closed, 
k V 
9 
