JOINT DISEASE.
The term is a wide one, and embraces a number of affections whose treatment will he found under the head of the primary affection as Rheumatism, Rheumatoid Arthritis, Gout, Actinomycosis, Locomotor Ataxia, Pymia, &c.
When the inflammatory process is confined to the synovial membrane the term " Svnovitis " is employed, and under its own heading the treat ment of this form of joint affection will he detailed.
Arthritis is the name usually employed as a synonym for Joint Disease, and implies the condition in which periostitis with osteomyelitis affecting the ends of the bones entering into the formation of the joint coexists usually with synovitis. It may he acute or chronic.
Acute arthritis the result of a septic infection, either caused by penetrat ing wounds or by Staphylococcus or Streptococcus pyogenes carried by the blood-stream, must be promptly treated by absolute rest for the joint and the entire limb. As disintegration of the articulation is liable to ensue the limb should be immobilised in the position in which a permanent ankylosis will insure the least inconvenience. Cold water, ice, Leiter's Tubes, or evaporating lotions should be applied as in the treatment of ordinary synovitis. Occasionally pain yields more promptly to the application of Spirit Lotion covered in by oiled silk—a method which places a superficial joint like the knee in the position of an internal part, encouraging the natural resistant powers of the tissues to have fullest scope in their struggle for resolution by permitting a free flushing of the parts with arterial blood. The method of causing an artificial passive hyperaemia acts in the same manner. An elastic bandage is applied above the joint to cause such a degree of pressure as will retard the venous circulation without diminishing the arterial supply. The hyperaemia may be kept up for long periods, hut the most modern method is to apply it for only an hour or two at a time, after which the bandage is removed and the limb elevated to dissipate anasarca. Klapp's suction-bell acts in the same manner, hut is only applicable to joints like those of the fingers.
Leeching may be employed when pain is severe, and any local anodyne application like Belladonna may he used. Blistering is seldom of much use.
The weight and pulley may be employed where the tendency towards flexion is present.
Should fluid accumulate in the joint, the hypodermic needle may be employed for diagnostic purposes, and if its purulent nature is evident, aspiration should not be performed, but the joint must be freely incised without delay to completely empty the purulent collection, after which the cavity is to be flushed by a stream of warm Saline solution mopped out by a strong antiseptic and thorough drainage provided. Some surgeons inject a stream of Hydrogen Peroxide, others leave the joint filled by Iodoform emulsion as in the treatment of tuberculous arthritis. When extensive general destruction of the synovial membrane is found involving the capsule of the joint the entire cavity and any pockets connected with it may be gently parked with Iodoform gauze. In most instances much good may be accomplished by vaccine treatment after the specific microbe has been detected in the joint secretion or pus.
The treatment of early joint infections reached a high degree of perfec tion in France. Here the joint was thoroughly explored for any foreign body in the form of metal or cloth, or loose fragment of detached bone.
Such were removed. Thorough disinfection of the joint cavity was carried out by normal saline solution and ether. The synovial cavity was then closed completely and drainage was provided for down to hut not inside the cavity of the joint.
Where the operation of incision is resorted to early, a good useful joint may be fairly hoped for. Secondary abscesses in the neighbourhood of the joint must be promptly incised, and these should be flushed out and injected with the hydrogen peroxide or other antiseptic. In severe cases ordinary drainage will often fail, and the method of continuous drainage must be carried out, by means of which the circulation of Eusol or Dakin's solution through the joint is kept up.