MINUTE ORGANISMS TO INFLAMMATION 409 
are found in multitudes in the internal organs. Mr. Cheyne’s idea, therefore, 
is that when an inflammatory attack is sufficiently severe to produce serious 
febrile disturbance, these micrococci get in, and, finding in the pus of an abscess 
a congenial soil, develop in it in abundance. 
It remains for me to say a word as to those most chronic and languid forms 
of inflammation which we term strumous. And first I have this to say, that 
chronic abscesses connected with strumous caries of the vertebrae heal com- 
pletely, as we know by experience, if we do but keep the spine sufficiently long 
at rest, and patiently persevere with thorough antiseptic care. The situation 
of the diseased part prevents the possibility of attempting its extirpation by 
operation ; but happily such treatment is not called for. The languid strumous 
abscess recovers of itself, like the acute, though much more slowly, when simi- 
larly treated, while the degenerated osseous tissue acquires again the characters 
of healthy bone. 
And, lastly, as regards strumous disease of joints, I hope to show at King’s 
College Hospital to-day the hand of a young woman who is under my treatment 
there, and illustrates the point to which I am anxious to direct your attention. 
She is a highly strumous person, who has had Pott’s disease of the spine when 
a child, and whose wrist I excised about two years ago on account of caries 
of the carpus with sinuses. She came to us this time with great swelling of the 
other wrist and drooping of the hand from its normal position with regard to 
the bones of the forearm, implying that the disease had caused considerable 
softening of the ligaments. She also suffered great pain. It was a matter of 
the utmost importance for her that I should avoid, if possible, the excision 
of this wrist also; and as the skin was unbroken I determined to try the effect 
of free antiseptic incision. On doing this I found, to my great satisfaction, 
that suppuration had not yet occurred in the degenerated tissues ; but on intro- 
ducing a sharp spoon I observed that it passed readily into the articulation 
between the carpus and the forearm and brought out granulation tissue. Already 
were the tissues of the joint in a highly disorganized state, but the languid 
inflammation had not yet induced suppuration. That night the patient slept, 
having lost the uneasiness which previously deprived her of her night’s rest, 
and we have now got the wound almost absolutely healed, while by the careful 
use of splints the position of the hand has been rectified. The swelling, too, 
has disappeared, and she bids fair to be soon added to the list of those in whom 
the hand has been rescued from excision by an early and free antiseptic incision, 
acting apparently on the same highly important principle of relief of tension. 
Here, too, you will observe, no attempt was made to extirpate all the degene- 
rated tissues. 
