Reprinted from. The Medical Record, February 7, 1885, 
MARTIN’S METHOD OF TREATMENT OF SY- 
NOVITIS, ESPECIALLY OF THE KNEE-JOINT. 
Sir : The announcement of the surgical uses, other than 
haemostatic, of the pure rubber bandage, was made to 
the American Medical Association by my father, Dr. 
Henry A. Martin, at Chicago, in 1877. Since that time 
the almost constant reports of new applications of its 
use, in very varied requirements of surgery, and its uni- 
versal adoption in all parts of the world, have given it a 
most prominent position among the appliances of modern 
surgery. Although in the minds of many physicians the 
use of the bandage is associated chiefly with the treat- 
ment of varicose veins, eczema, and chronic ulcer of the 
leg—yet the greatest benefit is to be obtained from it in 
many other affections, and this is true in the highest 
degree of inflammations of, and effusions into, the joints : 
—notably the varied degrees of synovitis of the knee. 
At the International Medical Congress at London, in 
1881, my father presented a concise paper giving his 
special investigations in regard to this subject. This 
paper is published in the Transactions of the Congress. 
Since his return, he has devoted himself very earnestly to 
following out the method of treatment which he advo- 
cated there, and it was his intention to lay the whole 
matter before the American Medical Association at the 
coming meeting, next summer. Owing to his sudden 
death, this will be impossible, but as I have kept the 
records of his cases, and have operated on and had 
charge of many of them, I may be permitted to set down 
briefly some of the results that have been arrived at. 
During the past thirty-one years over four hundred 
cases of synovitis of the knee and its sequelae, of every 
form and degree of severity, in every variety of diathesis 
and complication, however chronic or acute, have been 
To the Editor of The Medical Record. 2 
treated by the use of the pure rubber or “ Martin” band- 
age—applied to the limb from the foot to above the knee. 
The joint is previously strapped from three inches above 
to a corresponding point below the patella, with non- 
irritating rubber plaster. This strapping is not applied 
for the ordinary reasons, but to obviate, or at least miti- 
gate, a troublesome chafing of the skin in the popliteal 
space, from walking exercise while the bandage is on the 
limb. One such strapping will remain in situ for four or 
five weeks, and in a very large proportion of cases has 
not to be repeated. The plaster, however, must be per- 
fectly non-irritating. The bandage should be applied as 
tightly as the patient can wear it with comfort. There 
is no danger to the circulation by following this rule, as 
no dangerous constriction of the limb could be endured 
without pain and discomfort. The bandage thus applied 
should be worn in general for from four to six weeks, 
according to the severity of the case, day and night; 
and, after that, during the day only, or while in the up- 
right position, for from four to eight weeks longer. Many 
patients prefer to wear them a good deal longer, to 
prevent any possible return of trouble, but this is in 
general not at all necessary. 
When the bandages are thus applied, great comfort and 
support are at once experienced, and with these much 
increased capacity to use the joint. Very soon it becomes 
evident that absorption of effused fluid, and of the inter- 
stitial deposits in the tissues of the synovial sac, and of 
the other tissues about the joint, is going on ; and, in 
a space of time? too short to be credible to those who 
have not accurately pursued the practice, and carefully 
and repeatedly observed the fact, the enlarged and weak- 
ened articulation is restored to the normal size, and, if 
not immediately to its original strength, to a far greater 
capacity for use, and eventually to a perfect restoration 
in all respects. 
In cases where the amount of fluid effusion within the 
sac is small, or where the thickening of the sac is the 
principal element of the case, these results may be always 
looked for with certainty and rapidity. Sometimes, how- 3 
ever, when the amount of fluid effusion is very large, the 
use of the bandage alone (although of the greatest value 
as a palliative, by strengthening the joint, and permitting 
painless use of the limb) will produce complete absorption 
of the fluid very slowly, if at all. The existence of these 
exceptionally obstinate cases induced my father, some 
twelve years ago, to add to the use of the bandage a pre- 
ceding thorough aspiration of the sac, all the other points 
of treatment being exactly as before described. This 
was done at first only in exceptionally obstinate cases, in 
which the effusion within the synovial sac was large, but 
the operation was gradually found to be entirely free 
from danger, and latterly aspiration has been practised in 
all cases in which, being chronic, the synovial effusion is 
of any considerable amount, and even in the most acute 
cases in which rapid effusion produces great distention 
and consequent pain. The results of my father’s experi- 
ence are summed up in the following statements : 
1. In the last twelve years over two hundred cases of 
synovitis of the knee, and its sequelae, have been treated 
by aspiration with a single strapping of the joint, and 
subsequent use of the bandage. 
2. In these cases the knee-joint has been punctured 
over four hundred times. 
3. In all these cases, with the exception of a very few, 
and these only in the early stages of treatment, the patient 
was not only permitted, but obliged to take a daily and 
considerable amount of walking exercise. 
4. In not a single instance has there been failure of 
absolute and entire cure, requiring, in one case, seven- 
teen weeks, but in no other more than eleven weeks. 
5. Although no antiseptic measure, beyond perfect 
cleanliness of the aspirating needle, was employed, in not 
one instance has any ill symptom followed the operation. 
When the needle is withdrawn, the puncture is at once 
covered securely with adhesive plaster. 
Sir Benjamin Brodie long ago declared most emphati- 
cally, that when the synovial sac is distended with fluid, 
it can be punctured, and the effusion drawn off with per- 
fect safety. „ He does not by any means regard this as a 4 
help in treatment, however, as he says the fluid will ac- 
cumulate again, and in a few hours the joint will be as 
much distended as before. The originality and value of 
my father’s method of treatment lies in successfully dem- 
onstrating the fact that thorough aspiration of the knee- 
joint, followed by proper use of the rubber bandage, gives 
us a complete and satisfactory method of cure in even 
the worst cases of synovitis. By the firm and equable press- 
ure of the rubber bandage, the re-accumulation of fluid 
is checked. If there is any return of the fluid at all, it 
is in very much diminished quantity, and a second, or 
perhaps in severe cases a third, aspiration of the joint is 
all that is ever required. One great advantage of it is to 
explode the idea that perfect rest of the joint is the only 
way to hope for a cure. The patient is emphatically not 
to be confined to bed, or, worse still, to a fixed splint. 
When the joint is strengthened by a properly applied 
rubber bandage, exercise is a very great and important 
adjunct in the treatment. This very day I have visited 
a lady who passed last summer in Switzerland. While 
there, she was attacked with acute synovitis of the left 
knee, with large amount of effusion into the sac. She 
was kept in bed, with the limb placed on a fixed splint 
and continually poulticed. After sweltering through the 
hot weather with the limb swathed in many thicknesses 
of cotton wadding, at the expiration of two months the 
splint was removed, and—she has come home with a 
joint almost immovable ! I am sure that had this case 
been treated by prompt aspiration of the sac, and the 
proper use of the rubber bandage, a perfect and rapid 
cure would have resulted without a week’s confinement 
of the patient to her bed. 
I trust that other surgeons will have employed this 
method of treatment in a sufficient number of cases, to. 
make a thorough discussion of it possible at the next 
meeting of the American Medical Association. 
Francis C. Martin, M.D. 
Roxbuky, Mass., December 22, 1884.