The method of aspiration, which should always be followed by syringing, is chiefly distinguished from injection in that it aims at removing the fluid which is mixed with pathological elements. It is a method which is very commonly used in treating excessive serous, bloody, or sero-purulent effusions in the joint, which threaten to overstretch the capsule and ligaments.

Aspiration with syringing can be used with advantage in so-called metastatic diseases of joints in which the exudation is sero-purulent. [In wholly purulent cases it is better to open by incision and to drain the joint.] For the puncture a fine or medium trocar is used, and for syringing a fairly large syringe, or an aspirator, with a solution of borax, salicylate or thymol (1:100), carbolic acid (2:100), or sublimate (1 : 5,000), after which a moderately tight antiseptic bandage is applied. Massage may be given later on as soon as the wound is healed, even if some exudation (non-purulent) is still present in the joint. By using this method one can often prevent the consequences of too prolonged distension of the joint, prevent permanent stretching, check serous effusion, and promote absorption; in certain cases this method may promote the healing of intra-articular fractures (see Patella Fracture). It is obvious that aspiration, like every other operation on a joint, must be carried out under strictly antiseptic conditions.

The latest method of treating joints is by fibrolysin and injections of fibrolysin. One makes injections of fibrolysin [= thiosinamin] between the gluteal muscles (rather than in the veins), generally making use of Merck-Mendel's ampulla-, giving a daily dose of 2.3 c.c, and about thirty injections in all. The effects of the preparation, which is essentially a urinary product, are thought to be due to its "lymphogenic, hyperaemic, and chaemotactic" properties. It cannot be denied that its effects in promoting absorption are most striking. This method has been used in gouty, chronic rheumatic, deforming, and bacterial diseases of joints, especially also in Hoffa's chronic progressive polyarthritis. It has also come into use in other chronic inflammatory processes - for example, Dupuytren's contraction and urethral stricture.

My own experience of this method is at present limited, but what I have seen has been promising: especially in one case of synovitis crepitans, in a strong-willed lady of seventy, when I had succeeded by massage in restoring almost normal mobility after it had been much reduced for a long time; walking, which was still rather troublesome, was greatly improved by further treatment, consisting merely of injections of fibrolysin.