1. Systemic Treatment. — Improvement of the general health and medical treatment.
The treatment with tuberculin seems to promise success. We begin with one-tenth of one milligram of tuberculin (Koch), slowly increas ing the doses so as to favor the formation of-antibodies. In one case of caries of the sternum which had been refractory to surgical treat ment for years, we succeeded with this treatment in healing the process in four weeks, without any other surgical measures except the appli cation of cups to the ulcer. At present, however, this cannot be considered as conclusive.
2. Local Treatment.—The affected part should be filled with more blood. This is accomplished by the application of a constricting bandage for from fifteen minutes to one hour but not longer (Bier); under this treatment we may at times observe a more profuse discharge of pus from the fistula-, but this more rapid elimination of dead matter is not regarded as unfavorable. Ulcers are treated with cups the same as tubercular glands (Klapp).
Tubercular abscesses are never opened, least of all gravitation abscesses which are far removed from the focus in the bone. The ascend ing ones may be opened at their upper pole with a small opening to avoid the formation of fistula, the pus is let out and this is repeated until the discharge becomes serous, then we instill a few drops of a 5 per cent. iodoform emulsion into the abscess cavity and apply a firm compress fixed on the skin to avoid the leaking of lymph into this empty space.
Only in those cases in which the radiograph clearly shows a segues trum are we justified in removing it to shorten suppuration. All scraping must be avoided and the cavity is filled with 5 per cent. iodo form glycerine; the rest of the treatment is carried through by the con servative method.
Wide-open granulating wounds (fistula) are treated in the same manner. Balsam of Peru acts well in these eases, as it is cleansing and may be used in ointments.
In favorable eases we may try v. Mosetig-Moorhof's filling. For this purpose the site is made accessible by lifting up a skin-flap in such a manner that the incision in the skin is not near the focus in the bone. The diseased bone is removed, taking care to reach healthy tissue; the bone cavity is next smoothed, cleansed with carbolic acid, followed by alcohol, dried with either concentrated alcohol or hot air, then filled with the iodoform emulsion and finally the wound closed entirely. Thus we are frequently able to cure the process. New hone may form in place of the filling, which is slowly absorbed (Silbermark), but usually a fibrous callus remains (Fig. 119).
Absolute rest is of the greatest importance when the affection is near a joint. This will relieve the affected tissues. The joint should be fixed in such a position that it will be the most useful in case it should remain stiff.
If the focus should threaten to break through into the joint we should make an extracapsular opening.