SURGERY.
Iodine Injection of the Joints. By M. Velpeau.—Amongst the af-
fections of the joints, effusion into them is a very common affection, but
is only serious as a symptom of the disease which accompanies it. When
it occurs as a serous interarticular effusion, without any marked material
lesion, recent hydrops articuli is easily cured by rest, bleeding, and topi-
cal applications, such as solutions containing muriate of ammonia or
chloride of sodium. When the effusion resists these means, M. Velpeau
applies a large flying blister, repeated every fifteen days, and then uses
frictions with mercurial or iodide of lead ointment (the latter being pre-
ferable to the iodide of potash,) aided by compression, the administra-
tion of calomel in small doses, and especially rest. There is another
remedy now used—namely, the injection of tincture of iodine. M. Vel-
peau has only tried it twice this year; but from these two cases, it is
plain that the injection thus used is neither very painful nor dangerous,
and that when thus cured, the joint is not anchylosed. In one very
bad case particularly, the injection was not more painful than when used
for the cure of hydrocele, and succeeded where the other means referred
to had failed. It is necessary that the treatment by iodine injection
should be made more generally known, as it is not usually practised.
The two points which deter surgeons from using it are, the fear of throw-
ing an irritating fluid into a large joint, and of anchylosis taking place
in case of success.
Now, both these dangers are imaginary. There is no previous incision,
but a simple puncture made. Since 1839, M. Velpeau has used this
plan twenty-five times, M. Bonnet perhaps as often, so that with cases
of the same kind, related by Berard, and since by M. Jobert, Malgaigne,
and other surgeons, there are more than one hundred cases of these
joints having been punctured and treated by the iodine injection, and
none of the patients have had any unfavorable symptom. The swelling,
with slight redness, which appears after the operation, only shows that
a natural process is going on, such as takes place in a hydrocele, and is
resolved without the application of leeches, &c.
As to the danger of anchylosis, it is equally imaginary. M. Velpeau
has seen these patients long after the operation, and in all the move-
ments of the joints were preserved. It is, in fact, in these cases, as in
hydrocele, the cure can be effected without the obliteration of the serous
sac; or if adhesions do take place, they yield after a time, and the func-
tion of the joint is restored, so that this is no serious objection; and, as
on the other hand, there is complete cure in one-half the cases, and very
marked amelioration in the other, it is to be concluded that the iodine
injection, under such circumstances, when as yet there is no induration,
is suitable, and the more so, as its use does not prevent that of other
accessory means of cure.—Dublin Med. Press, from Presse Medicale
de Beige.