_Chronic Disease of a Joint_ may be the tailing off of an acute affection, and under the influence of alternate douchings of hot and cold water, of counter-irritation by blistering or "firing," and of massage, it may eventually clear up, especially if the general health of the individual is looked after. But if chronic disease lingers in the joint of a child or young person, the probability of its being under the influence of tuberculous infection must be considered. In such a case prolonged and absolute rest is the one thing necessary. If the disease be in the hip, knee, ankle or foot, the patient may be fitted with an appropriate Thomas's splint and allowed to walk about, for it is highly important to have these patients out in the fresh air. If the disease be in the shoulder, elbow, wrist or hand, a leather or poro-plastic splint should be moulded on, and the arm worn in a sling. There must be no hurry; convalescence will needs be slow. And if the child can be sent to a bracing sea-side place it will be much in his favour.
As the disease clears up, the surface heat, the pains and the tenderness having disappeared, and the joint having so diminished in size as to be scarcely larger than its fellow--though the wasting of the muscles of the limb may cause it still to appear considerably enlarged--the splint may be gradually left off. This remission may be for an hour or two every other day; then every other night; then every other day, and so on, the freedom being gained little by little, and the surgeon watching the case carefully. On the slightest indication of return of trouble, the former restrictive measures must be again resorted to. Massage and gentle exercises may be given day by day, but there must be no thought of "breaking down the stiffness." Many a joint has in such circumstances been wrecked by the manipulations of a "bone-setter."
_Permanent Stiffness._--During the treatment of a case of chronic disease of a joint, the question naturally arises as to whether the joint will be left permanently stiff. People have the idea that if an inflamed joint is kept long on a splint, it may eventually be found permanently stiff. And this is quite correct. But it should be clearly understood that it is not the _rest_ of the inflamed joint which causes the stiffness. The matter should be put thus: in tuberculous and other forms of chronic disease stiffness may ensue in spite of long-continued rest. It is the destructive disease, not the enforced rest which causes it; for inflammation of a joint rest is absolutely necessary.