Mechanical supports or splints of some' kind are of the greatest service. Plaster of Paris and silicate of soda are of great utility. Also splints made of pasteboard or wood or leather. When quick setting is required or frequent changing then plaster of Paris is best. When the pa tient can remain in bed for twenty-four hours and where quick setting is not re quired and the apparatus is to be worn for a considerable time then silicate of soda is preferable. For the upper ex tremity splints of wood, or pasteboard or leather are applicable; but these various dressings can be used in any part of the body and the choice will depend on the pecnliarities of the individual case and the mechanical abilities of the surgeon. These dressings should all be so made as to be removed every day or two, so that the parts can be inspected and bathed and excoriations prevented. In spinal disease when the patient is not fastened down in bed, then it is desirable that the apparatus be worn during the night as well as by day; it insures better rest to the diseased part. Local applications do not play a very important part in treat ment. In acute cases evaporating lotions like lead-water may be applied or an ice cap laid on the inflamed joint. When the disease becomes more chronic, then ointments like belladonna and mercury and 10-per-cent. ichthyol may be used and the joint firmly bandaged with either a flannel or rubber bandage or it may be strapped with adhesive plaster. Some times small blisters around the affected spot tend to relieve pain.
Large effusions into a joint may be tapped under the strictest antiseptic pre cautions. If pus forms, the joint may be washed out with a 1 to 5000 solution of bichloride of mercury. The injection of iocloform and glycerin emulsion 10 per-cent. into and around the joint is spoken of favorably by Senn and others.
Treatment of tubercular osteoar thritis confined entirely to intra-articular injections of iodoform. Because of the pain attendant upon ethereal solutions of this product, a mucilaginous emulsion containing 33 per cent. of iodoform, has been used; 5 cubic centimetres of this_ mixture were employed at a dose.
Injections were repeated twice a week; when improvement 11 as slow every sec ond day. In seven cases the results were very satisfactory. In the eighth case, complicated by suppurating sinuses, re section was necessary; the ninth required amputation. Results were especially good in white swelling ot the knee-joint. Five patients treated for this affection were cured in from four to six months, and the cure was permanent. Duplay and Cazin (Revue de Chin, No. 11, '97).
Excellent results obtained from a mixt ure of formalin and glycerin, 1 to 5 per cent., in the treatment of surgical tuber culosis. As an injection into abscesses
connected with diseased joints, this mixt ure is superior to an eimilson of iodo form. Hahn (Centralb. f. Chin, No. 21, '99).
*1-• tile (I iSeaSed PrOCOSS iS SO ftt ll Sit Oath ill the hone, laenamara I.a, ad otated trephining. I have often tiriiitti the affected bone with numerous liol.ts about three-sixteenths inch in thanit ter. and it has been of great serv i.e. Rarely pus may be found, but usu. a lv not. The drilling:, however, tends t ) stop the progress of the disease, and IS N% 01111V of more extended use than is now prat ticed.
The question of operative treatment in itibt rculous cases is the cause of much difference of opinion. One fact is well st ttled. and that is that conseryatisin is more desirable in orthopTdic cases than in those of general surg,ery. Abscesses may be opened if they pursue an acute conrse Avith considerable pain and dis turbance of the patient. If they are cold, chronic, and not too large, they are best let alone, as many of them AA-ill entirely disappear. Infection is very liable to at tack a discharging- collection of pus, and the g.eneral health may become affected. Abscesses play be emptied with a trocar, washed out with salt solution or weak antiseptic, and then injected with 10 per-cent. iodoform emulsion, an ounce or more being. used. This will probably have to be repeated, perhaps two or three times. Sometimes the abscess keeps on discharging without any tendency to heal until death from exhaustion or general tuberculosis supervenes. Resection of joints is to be resorted to when the sup puration is so profuse as to endanp-er life and the patient is of a suitable age. Re sections in young children interfere so much with growth as not to be advisable. In these, partial resections or erosions are to be preferred, the joint being opened and the affected tissue cut and gouged away. Operative measures are more advisable as the patient increases in age. Amputation Is only to be re sorted to as a life-saving measure, usu ally for profuse suppuration with entire disorganization of the joint. As a rule, patients are to bc kept in bed until all evidence of acute trouble has gone and remained away for two or three months. Then the patient may be allowed to go about with some appliance to keep the joint from moving, or with a high shoe and crutches. These protecting appli ances are to be worn for months after all evidence of active disease has passed away. For walking cases very nice ap pliances may be made of silicate of soda, which can be used for many months. When the patient can afford the expense, an apparatus made by the instrument maker is much preferable for all of the tuberculous cases. Its style will vary Avith the character of the case.