410 THE RELATIONS OF MINUTE ORGANISMS TO INFLAMMATION 
Two days ago we sent home a little boy who came to us with an exceedingly 
severe condition of ‘ white swelling’: gelatinous degeneration of the synovial 
membrane of the knee-joint. Sympathetically the bones also had become 
affected, and the ends of both the tibia and the femur were greatly enlarged. 
Suppuration, however, had not yet occurred. I cut down antiseptically into 
the joint on each side with great freedom, and also gouged extensively into 
the substance of the femur and tibia on the same principle as we trephine or 
gouge a chronic ostitis in the shaft of the tibia: and I have the satisfaction 
of sending that boy home with two minute superficial sores alone remaining 
unhealed, exposed in the windows of a water-glass case, with instructions to 
come once a week to be dressed till healing shall be complete. The swelling 
meanwhile is almost gone, and we may now look upon that case as one of a knee 
rescued from excision, and in a far better condition as to promise of future 
usefulness than excision could have afforded. Such a result I should not have 
thought of aiming at had I been possessed with the idea that complete extirpa- 
tion of the tissues which had suffered degeneration was essential to the cure 
of strumous disease. 
I feel, gentlemen, that pressed as we are for time, I have dealt very inade- 
quately with one branch only of the subject of our discussion. I can only hope 
that the facts which I have adduced may serve to remind some who have been 
led to entertain doubts upon the question, that, whether as regards the etiology 
or the treatment of inflammation, it would be a great mistake to disregard the 
influence of the nervous system. 
