Licence: Public Domain Mark
Credit: Surgery. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![3S IX1''I,AMMA'I1()X in chronic inflammation of joints where the cartilages are eroded and the articular surfaces of bone ex{)osed, and there is in consecjuence great pain, with nocturnal startings, but the plan is not to be recommended. Another plan of treating chronic inflammation is to endeavour to get rid of the passive congestion which exists, either by the application of cold or by massage. The cold is best a])plied by douching or by placing the affected part under a running tap of cold water for a short time two or three times a day. In this way it acts very much more advantageously than by apply- ing the cold continuously. For during its application there is a contrac- tion of the vessels, and this is followed by a dilatation with increased flow through the inflamed part. Massage is of especial benefit in the treatment of chronic inflammation, not only in mechanically emptying the congested vessels of blood, but also in getting rid of the products of inflammation. It requires, however, to be api)lied with care and skill and in a different manner, according as to which of the two objects the surgeon has in view. While the inflammation is still going on and the object of the surgeon is to empty the congested vessels, the massage must be done by very gentle rubbing, always in the direction of the course of the venous circulation, the hand being pressed very lightly on the part. When, however, the object is to break up the exudation and force it into the lymphatic channels in the later stages of the disease, the massage must be done by a rapid circular movement, in which considerable pressure may be made, in order to break up the material, and this is to be followed by pressing upwards with the thumbs so as to force the broken-up material along the lymphatic vessels. Another exceedingly useful plan of getting rid of the effused material in chronic inflammation is by pressure. This can be applied in many different ways, by ordinary bandages, by elastic bandages or by strapping. Perhaps the most efficient way and at the same time the safest, is to swathe the part in a sheet of cotton wool and then apply an elastic webbing : by this means the pressure is uniformly distributed through the whole part. Martin's elastic bandage is a useful means of api)lying uniform pressure, but requires skilled care in its application, lest it be applied too tightly, and is apt to produce irritation of the skin if kept on too long. Strapping is an effective mode of api)lying pressure in some forms of chronic inflammation, such as in joints, in bursal enlargements and in orchitis, but it is often irritating to the skin, is very painful in its removal, if the part to which it has been aj)plied is hairy and has not been shaved, and is sometimes followed by disastrous results if applied too tightly: as in a case recorded by Sir James Paget,' in which fatal cellulitis followed the apphcation of a circular piece of strapping. In some cases, especially in chronically inflamed joints, pressure may be advan- tageously combined with counter-irritation. Perhaps the best known and the most commonly employed means of doing this is by ' Scott's dressing.' This is applied in the following way. Compound mercury ointment (Scott's) is spread on strips of lint and applied all over the affected part; over this is applied a bandage and then several layers of strai)ping in a uniform manner, so as to produce ecjuable ])ressure, and over all is placed a starch bandage. By this means three objects are attained : the rube- facient and absorbent effect of the ointment, the pressure, and the physio- logical rest to the joint. ' Cliniial Lectures, p. 60.](https://iiif.wellcomecollection.org/image/b21210846_0064.jp2/full/800%2C/0/default.jpg)
