The treatment depends on the acuteness of the attack. In the simple case, first mentioned, rest, the knee being supported on a soft pillow, and hot fomentations, will likely be sufficient. To promote the absorption of the fluid, painting with tincture of iodine or the placing of small blisters round the joint is all that is necessary. In severe cases, to ensure absolute rest, the limb must be put up in splints. A long one, carefully padded, should stretch beyond the joint both ways, and be fixed by straps at some distance from the joint. Then put on six to twelve leeches round the joint, and hot fomenta tions a short time afterwards. It is often better, especially if the inflammation is the result of a wound and has lately occurred, to put at once a large ice-bag over the joint. in such a case pound the ice, put it in an india-rubber bag, and place it over the joint, having a moderately thick piece of flannel between the bag and the skin. The ice-bag may be kept applied for hours in this way. Then give purgative medi cine, Epsom or seidlitz salts being preferable. At night twenty-tive drops of laudanum may be given to relieve the pain if the person be an adult. When the acute stage has passed away the swelling is to be got rid of, as before, by blisters, iodine paint, and the pressure of a tightly and well applied bandage. Splints must not be left too long on, lest the joint become permanently stiff or its range of move ment interfered with by the formation, within the joint, of bands of new tissue crossing it and preventing movement in certain directions. The stiffness or partial union of a joint by such bands is termed false anchylosis. To prevent it, as soon as the splint can be taken off, which time can only be judged of according to the patient, the joint should be manipulated by some one and moved gently backwards and for wards for a few moments several times a day.
Where disorganization of the joint (white swelling) has taken place the limb must be kept straight by the splint, and the patient's strength supported by food, cod-liver oil, &c., in the hope that the joint will become permanently fixed, which is the best cure to be looked for in the case. A surgical operation, and even ex cision of the joint may be necessary.
Permanent rigidity of a joint is called true anchylosis. When it is sought for as the best cure care ought to he taken to place the limb in the most favourable position for use after union has taken place. This position, for the hip and knee, is straight, for the elbow it is at a right angle.
Where an abscess has formed in the joint an opening should, of he made to permit the matter to escape.
When the inflammation is due to rheumatism, gout, &c., the treatment for these diseases should be adopted. (See RHEUMATISM, “OUT, &c.) Chronic Rheumatic Inflammation of Joints (Chronic Rheumatic Jrthritis — Rheu matic (lout) occurs frequently in elderly per sons, generally women, though it may follow an acute rheumatic attack in the young. In it, it
is, ill the main, the soft tissues round the joint, the ligaments and tendons, that are involved. Recurring inflammatory changes produce thick ening, and contraction and hardness of these soft tissues. In consequence the joints become stiff, and movement becomes restricted, and accompanied by pain if an effort is made to overcome the stiffness. With long continuance of the condition the bones become fixed in a deformed position. Frequently also the joint is deformed by painful soft swellings, somewhat sausage-shaped, which, when au attack recurs, become larger and more swollen. These are due to burste (see p. 119) over the joint, or the sheaths of tendons passing over or to the joint, which are inflamed and dropsical.
Symptoms.--Pain is the chief sy mptom, worse in damp and cold weather—pain that is rack ing, wearying, gnawing. The joint is stiff, and its movements often accompanied by a peculiar creaking sound. There are frequent recurrences of swelling and heat with increase of pain.
Treatment.—The best local remedy is heat applied by fomentations, or, best of all, hot baths—vapour or Turkish, or the dry heat or electric - light bath. M. Gueneau de Mussy strongly recommends arsenical baths made in the following manner:—Ifi grains of arseniate of soda, with lb. of carbonate of soda, are added to 30 gallons of water at a temperature of 98° Fehr.; and twelve such baths are taken --for the first four every second day, and after wards daily, the patient remaining in the bath for from seven to ten minutes. These baths sometimes produce marked improvement, the suppleness of the joints increasing after every bath; sometimes slight diarrluva, temporary excitement, and sleeplessness result. Sulphuret of potass may be used in the strength of 4 oz. to the 30 gallons of hot water, and the same number of baths taken as above recommended. Sulphur ointment is sonietimes used as an ap plication to the affected joints, nore especially where a single joint is suffering; or a lotion of equal parts of glycerine and of the tinctures of iodine, opium, and aconite may be used, the joints being wrapped in flannel after the oint ment or lotion has been applied.
In young subjects the disease should seldom be permitted to end in fixed or deformed joints. For this can nearly always be prevented by forcible movement of the joint, to stretch the contracted tendons and break down any ad hesions that have formed. As a rule it will be necessary to do this under chloroform, and afterwards to maintain the mobility by mas sage aud Swedish exercises.
Damp houses should specially be avoided. The patients should keep themselves warm, and constantly wear woollen clothing.
In reference to general treatment the diet must be carefully attended to, no heavy pastry or puddings made with suet being allowed, plain food being most suitable, at regular intervals, so that the stomach is allowed sufficient rest.