In recent sprains and synovitis this method is rational. The good effects of the massage are continued by means of a bandage well applied. Rubber bandages are not advised except for temporary use, as when a patient with weak joints wants to go sea-bathing. A Domet (or cotton flannel) bandage may be used instead. Douglas Graham (Boston Med. and Surg. Jour., June 24, '97).
The Gibney treatment of sprained ankle is as follows: Ordinary adhesive plaster is cut into strips inch wide and in two lengths, about 12 and 18 inches long. As soon as the patient is seen, one of the longer strips is placed around the ankle, parallel to the sole of the foot, beginning in front of the big toe, carrying the strip around the ankle just above the contour of the sole, and bring ing the end back across the top of the foot to about the point where the strip began. It is well to place, overlapping this initial strip, a parallel piece. These strips should be drawn as tightly as pos sible. NeXt another strip should be placed at right angles to them, which makes it run parallel to the back of the leg. One of the shorter strips should be selected for this purpose. Beginning well behind and above the ankle, this strip should be carried down around the sole of the foot and brought up on the other side of the leg, making, as it were, a stirrup for the foot. This strip is closely applied. Now the strips should be ap plied alternately, first one around the ankle parallel to the sole, then one paral lel to the back of the leg, each one over lapping the one previously applied, run ning in the same direction, to some ex tent, until the entire foot is inclosed in a boot of adhesive plaster, having the ap pearance of a shoe in which part of the heel has been cut away. Over this dress ing is now placed an ordinary roller band age. The patient should be careful for a day or two, when he can begin to move around rather freely. This dressing should be kept on until the pain and swelling have subsided. If the dressing becomes loose, it can be reinforced by additional strips placed over the loose ones. J. H. Adams (Railway-surg., Jan. 10, '99).
Attention is called to the use of static electricity in the treatment of sprains. Personal technique is as follows: A thick woolen shawl, folded many times, is carefully placed over the ankle and foot, and the static massage roller is used as strongly as the patient can bear it for fifteen minutes on the foot, ankle, and leg. The patient is seated on a stool on the floor, not on the insulated platform. The roller is attached by the chain to the positive pole of the static machine. These patients will recover, when elec trical massage is thoroughly used, in half the time required by other forms of treatment. C. O. Files (N. Y. Med. Jour.; Pacific Med. Jour., Aug., '99).
A study of muscular and joint sprains has suggested the following conclusions: Ligaments are rarely, if ever, torn in so-called sprains, and arc never stretched. The pathology in the ma jority of sprains is a rupture of the areolar and connective tissue around the joint, and a contusion of the lining of the joints. Immobilization of muscles
is not rest. On the contrary, in all sprains the muscles should have passive exercise the first few hours and days, and active exercise after that. In the majority of cases, active exercise should be instituted from the beginning. The plaster casts should not be used at all, even in cases where there is a fracture, unless it be impossible to maintain a proper position of the joint. Hydro therapy in the shape of ice applied over a wet cloth the first few hours; water in the shape of hot fomentations or in the shape of the Scottish douche, where stimulation is desired, is of very great value. The counter-irritation of static electricity in conjunction with massage is the best treatment for a sprain. The ambulatory treatment of sprains in con junction with massage is to-day the best treatment. Ilaldor Sneve (Joni'. Amer. Med. As-or., June 1, 1901).
Pain is the obstacle of the mobiliza tion of the joint in case of sprain.
Faradization for live to ten minutes a day completely banished the pain in a number of cases of both recent and chronic sprain-. As soon as the pain cyan arrested the patient colild mobilize the joint without trouble. and thus vent or Clive the functional impotence t he injured limb. Planet and Char (Bull. de la soe. 1901).
The pathological conditions which re spond most readily to the strapping seem to possess one factor in common: rela xa lion of t reiaxathdi may follow acute or subacute inflamma tory disturbances of a rhenunatie, gonorrhwal. tuberetdons, or trau ma tie character. The good results ob tained in strapping when such relaxa tion is present are doe to the support thus trorded. It can be applied in eases of sprain so as to act as a perfect substitute for the injured ligaments, re lieving them from all superincumbent weight, wide!' adequately aceonnts for the ease with which patients walk about. A diagnosis must be made with groat care and the exact nature of the lesions ascertained. Cook (Medical Pee ord, Jan. 10, 190:3).
Success met with in ten instances in re ducing inxation at the shoulder by the following method: The at kilt being laid on his back on the ground. the surgeon, placing himself on the injured side, grasps the luxated limb at the hand begins to extend it slowly and gently. As I he energy of the extension is slightly increased the limb is gradu ally abdlict ed until it is almost verti cal,—that is to say, parallel to the axis of the body. The arm is then slowly lowered while pressure is exerted by an assistant on the head of the humerus, which, with the arm fully raised, should be over the plenoid cavity. It is neces sary, the author states, while extending and the limb, to avoid excess ive extension, and thus to avoid setting up muscular spasm. The time taken in reducing luxation of the shoulder by this method varied in the author's cases from seven to thirteen minutes. _Most of the patients on whom he has successfully applied this method were very strong workingmen. boloff ?Ccutralb. f. Chin, No. ld, 1902).