_Treatment of Affections of the Joints._—After the infliction of
a wound, accidental or not, in order to prevent inflammation of a
joint from becoming violent, it is of the utmost importance to bring
the edges of the wound into close apposition. Sometimes neither
local action, nor disturbance of the constitution, supervene on an
opening, even of considerable size, being made into a joint, while the
slightest puncture often gives rise to the most dreadful symptoms,
both local and general. An incised wound, of no great extent, will be
sufficiently closed by the careful application of adhesive plaster,
and attention to the position of the limb; but if it is extensive
stitches become indispensable. The parts must be kept in a state of
complete relaxation and rest; cold cloths or iced water, allowed to
drop or run over the surface by capillary attraction, should be
assiduously applied. The patient’s bowels must be freely opened, and
he is to be kept on low diet. If inflammatory action occur, bleeding,
locally and generally, must be had recourse to energetically,
accompanied with warm fomentations to the parts; and, at the same
time, preparations of antimony, and other saline medicines, are to be
administered internally. If there be reason, from the symptoms, to
suspect the formation of matter, the parts ought to be attentively
examined, in order to detect its presence; and, when discovered to
exist, it must be evacuated without delay. In chronic cases, even local
bleeding to any great extent is inadmissible. In some a few leeches
may be applied, followed by counter-irritation, with advantage. The
employment of counter-irritation is, perhaps, chiefly to be trusted
to in the treatment of those more chronic affections of the joints in
which, from the painful feelings, there is reason to dread disease
of cartilage or bone. Of these, blisters are most in use; though,
from my own experience, I cannot much recommend them. Their constant
repetition is exceedingly annoying, and the slow progress which is
made towards a cure under their use is far from encouraging. Tartrate
of antimony, applied in the form either of ointment or of plaster,
is generally productive of much advantage, in the first instance, by
causing a great degree of superficial irritation, and relieving the
internal parts. After the pustules have been fully developed, its
use is to be discontinued till the surface be nearly whole, when it
is again to be resumed, if the recurrence of painful feelings should
demand it. Caustic issues have been much praised, and are occasionally
beneficial. An eschar is made by the caustic potass applied to the
skin, or by rubbing the bichloride of mercury, or any other caustic,
into scarifications made by the lancet: the slough separates, and pus
is discharged. Instead of promoting a continuation of the discharge, by
applying savine ointment, and inserting foreign bodies, or employing
other irritating dressings, it is better, when the sore begins to heal,
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