The induction of hyperaemia is often helpful, the rubber bandage or the hot-air chamber being employed for an hour or so morning and evening.

Injection of Iodoform.—­This is carried out on the same lines as have been described for tuberculous abscess.  After the fluid contents of the joint are withdrawn, the iodoform is injected; and this may require to be repeated in a month or six weeks.

After the injection of iodoform there is usually considerable reaction, attended with fever (101 F.), headache, and malaise, and considerable pain and swelling of the joint.  In some cases there is sickness, and there may be blood pigment in the urine.  The severity of these phenomena diminishes with each subsequent injection.

The use of Scott’s dressing and of blisters and of the actual cautery has largely gone out of fashion, but the cautery may still be employed with benefit for the relief of pain in cases in which ulceration of cartilage is a prominent feature.

The application of the X-rays has proved beneficial in synovial lesions in superficial joints such as the wrist or elbow; prolonged exposures are made at fortnightly intervals, and on account of the cicatricial contraction which attends upon recovery, the joint must be kept in good position.

Conservative treatment is only abandoned if improvement does not show itself after a thorough trial, or if the disease relapses after apparent cure.

Operative Treatment.—­Other things being equal, operation is more often indicated in adults than in children, because after the age of twenty there is less prospect of recovery under conservative treatment, there is more tendency for the disease to relapse and to invade the internal organs, and there is no fear of interfering with the growth of the bones.  The state of the general health may necessitate operation as the most rapid method of removing the disease.  The social status of the patient must also be taken into account; the bread-winner, under existing social conditions, may be unable to give up his work for a sufficient time to give conservative measures a fair trial.

The local conditions which decide for or against operation are differently regarded by different surgeons, but it may be said in general terms that operative interference is indicated in cases in which the disease continues to progress in spite of a fair trial of conservative measures; in cases unsuited for conservative treatment—­that is to say, where there are severe bone lesions.  Operative interference is indicated also when the functional result will be better than that likely to be obtained by conservative measures, as is often the case in the knee and elbow.  Cold abscesses should, if possible, be dealt with before operating on the joint.