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The administration of opiates may be necessary for the relief of pain. The accumulation of an excessive amount of inflammatory exudate may endanger the vitality of the tissues by pressing on the blood vessels to such an extent as to cause stasis, and by concentrating the local action of the toxins.
While they may result from the coagulation of fibrin-forming elements in the exudate, their occurrence in tuberculous hydrops would appear to be the result of coagulation necrosis, or of fibrinous degeneration of the surface layer of the diseased synovial membrane. However formed, their shape is the result of mechanical influences, and especially of the movement of the joint.
Small blisters, properly applied, have many times seemed to be the determining factor in stopping the increase in the fluid, or to have been the starting cause of the resorption of the exudate. Saline purging should be governed by the character of the circulation. If the heart is strong, the pulse not weak, and the blood pressure good, nothing is more valuable in this condition.
Heart tonics and stimulants such as digitalis, strychnine and alcohol should be administered when the pulse beats weaken. To promote absorption of the exudate, iodide of sodium may be given. Mustard paste, or a cantharides blister applied over the region of the heart is useful in easing the pain and overcoming the inflammation.
These processes are accompanied by changes in the endothelium of the vessel walls, which result in an increased formation of lymph, which transudes into the meshes of the connective tissue giving rise to an inflammatory œdema, or, if the inflammation is on a free surface, forming an inflammatory exudate.
This will determine the fluidity and character of the exudate. If pus is found, a more radical surgical procedure than simple paracentesis must be done immediately. The point of puncture for aspiration most frequently chosen is in the fourth or fifth intercostal space, about an inch to the left of the sternal margin. Paracentesis is also often done in the region of the normal apex beat.
There are other methods of withdrawing blood and exudate from an inflamed area, for example by leeches or wet-cupping, but they are seldom employed now. Before applying leeches the part must be thoroughly cleansed, and if the leech is slow to bite, may be smeared with cream. The leech is retained in position under an inverted wine-glass or wide test-tube till it takes hold.
Meanwhile the throat becomes sore and swollen, ranging, according to the severity of the case, from a slight reddening and swelling to a furious ulcerative inflammation, with the formation of a thick membrane-like exudate, which sometimes is so severe as to raise a suspicion of possible diphtheria.
Concerning the application of the shoe Cochran says: "The most important primary procedure is the preparation of the foot to receive the shoe. All excess of growth must be removed from the anterior face of the hoof. The pressure of the wall at the toe upon the exudate between wall and coffin bone, tends to force the coffin bone and sole out of their normal position. Leave the sole alone.
Under such conditions the tension should be relieved and the exudate with its contained toxins removed by making an incision into the inflamed tissues, and applying a suction bell. When the exudate has collected in a synovial cavity, such as a joint or bursa, it may be withdrawn by means of a trocar and cannula.
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