Lectures on the American eclectic system of surgery . 194 HIP-JOINT DISEASE. serviceable. When the trocar is inserted the surgeon shouldconsider the position of the large vessels and nerves that theymay escape a lesion. The usual place to make the puncture isa little above and posterior to the great trochanter. Instead ofa trochar, a slender bistoury, or tenotome may be employed tomake an opening into the joint. Using either instrument thecapsular ligament must be punctured, when it has not alreadybeen perforated by the morbid processes. After the puncturehas been made, the limb may be rotated
Lectures on the American eclectic system of surgery . 194 HIP-JOINT DISEASE. serviceable. When the trocar is inserted the surgeon shouldconsider the position of the large vessels and nerves that theymay escape a lesion. The usual place to make the puncture isa little above and posterior to the great trochanter. Instead ofa trochar, a slender bistoury, or tenotome may be employed tomake an opening into the joint. Using either instrument thecapsular ligament must be punctured, when it has not alreadybeen perforated by the morbid processes. After the puncturehas been made, the limb may be rotated, especially inward, toforce out the fluid. This having been well done, and the woundcovered with the belladonna or aconite plaster to prevent theair from freely passing into the articulation, and keep in checkany inflammation that might be excited by the paracentesis, ananaesthetic should be used to obviate the pain. The operation Fig. Application of the Wire Splint. having been performed, the patient is to be replaced in the wireapparatus and retained there constantly until another tappingof the joint is required, or recovery is so far advanced as torender it safe to exercise the limb a little. Under the influenceof such local treatment, and the internal exhibition of stimu-lants, anodynes, arterial sedatives, or tonics, as the symptomsof the case require, the patient will steadily improve. Theslight shortening of the limb which is likely to result in manycases, even with a favorable termination, may be remedied bythe use of a shoe, which has a correspondingly high heel. Thestiffness of the limb, which is caused in part by the organiza-tion of plastic lymph among the tissues in the vicinity of thejoint, and sometimes within the capsular ligament, is in manycases to be let alone, at least until it be ascertained whether HIP-JOINT DISEASE. 195 the motion of walking diminishes the difficulty. If it do notimprove by us
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