404 AN ADDRESS ON THE RELATIONS OF 
Let me give one more example, and that is the effect of the actual cautery in 
certain forms of articular disease. When I went first to Edinburgh, the thing 
that struck me most was the effect of the cautery as applied by Mr. Syme in 
certain cases of joint disease. The first instance of this which I saw was a young 
woman with an exceedingly painful affection of the shoulder-joint. It was not 
hysteria, for there was atrophy of the deltoid muscle from instinctive disuse, 
and the disease was marked by intense pain, extending to the finger-tips, instead 
of being limited to the joint, as it would be in hysteria. The pain was, at the 
same time, worse at night, depriving her almost entirely of sleep, and it was 
accompanied by other abnormal sensations. Mr. Syme applied the actual 
cautery of red-hot iron before and behind the joint, and when the patient woke 
up from the chloroform sleep the pain was gone, and never returned ; and the 
disease, which had been going on and gradually progressing for months, was 
cut short from that time, and before long she left the hospital with a well- 
developed deltoid muscle. Several cases of a similar nature happened to occur 
about that time. One was that of a young man with ‘ ulceration of cartilage’ 
in the articulations between the occiput and the atlas, and between the atlas 
and the axis. The disease caused exquisite agony, shooting down to the 
shoulders and up into the head. The patient could not raise his head from the 
pillow without supporting it with his hand ; he could not look up to the ceiling 
or turn his head at all to one side without moving his whole body Here, again, 
the pain was worse at night, and that the disease had already produced great 
effects was evident from the fact that on examining the throat with the finger 
we felt an irregular prominence of the bodies of the vertebrae in the posterior 
wall of the pharynx. Mr. Syme applied the cautery to the skin of the back of 
the neck over the upper cervical vertebrae, and though in this instance the 
abolition of pain was not immediate, but took place more gradually, this most 
formidable inflammatory disorder, which had long resisted other forms of treat- 
ment, went on steadily to complete cure; and that the cure was permanent was 
proved by his coming to the hospital some time after to introduce his bride to us.? 
Now if it be true that counter-irritation is a powerful means of treating 
inflammation, and if the explanation which I have given of the mode of the 
action of counter-irritation, as illustrated by the physiological cases, is correct, 
then I say the effect of counter-irritation in the treatment of inflammation 
throws great light upon the nature of inflammation itself, and upon the relation 
of the nervous system to it. If counter-irritation cures an inflammation by 
withdrawing nervous action from the affected part, it follows that the inflamma- 
tion so cured was maintained by an abnormal action of the nerves of the part. 
+ See also vol a; ps 373: 
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