produce such irritation as to cause a return of inflammatory action,
their use must be discontinued till such action has been subdued by
the usual means. If the thickening of the external parts has occurred
to such an extent as to cause immobility of the joint, or if partial
anchylosis has ensued, the limb may be brought to the most convenient
position, the knee nearly, but not quite, straight, the elbow half
bent, and so on, by the cautious use of a jointed splint, fitted with
an extending screw. The practitioner is not to be deterred from having
recourse to the above practice, even when matter has collected and
burst externally, for sometimes under its employment the cavities of
abscesses contract rapidly. After the swelling and other symptoms of
disease have subsided, the joint is to be slightly moved, but with
great care; and, by a gradual increase of the movement, the natural
motion of the part may be ultimately restored. The great object in
treating chronic affections of joints must be to give them support, and
prevent motion as much as possible. This is effected pretty well in the
articulations, removed from the trunk, by the process above described,
modified according to circumstances. The filth and smell arising from
the plasters often becomes annoying, and, above all, the eruptions and
excoriations produced by them prove so troublesome that the application
requires to be discontinued. The principal and most essential
indication, that of securing repose to the affected parts, is fully
as well obtained by the application of well-adjusted splints. These
may be formed of lint soaked in a mucilage of gum acacia, as described
in the _Practical Surgery_, p. 150, or coarse linen may be smeared
over thickly with a coating of mucilage mixed with common whiting,
and another layer of linen spread over that. This is laid out smooth
and allowed to dry; portions of this sheet are cut to the form of the
affected joint, and, after being moistened, are applied and retained
by a roller. A firm case is thus formed, which may be afterwards lined
with lint or cotton wadding, and so reapplied. The most suitable
splints of all are made of leather, prepared without oil, softened
in warm water, and put on as above described. They are, when they
have become dry, pared and well fitted, then lined with wash-leather,
and padded as may be required. The employment of these splints gives
great relief in cases where further excited action has been lighted
up in the joint in consequence of the surface of the articulating
cartilage having become ulcerated from its free or attached surfaces,
or in consequence of matter finding its way into the synovial cavity
from the cancelli in the head of the bone. In cases, also, where the
painful sensations have existed from the first, and even before any
great alteration in the external form of the joint has taken place,
indicating primary ulceration of cartilage, this practice affords
immediate relief.
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