MEMBERS OF THE BRITISH MEDICAL ASSOCIATION 263 



inst. I introduced a large-sized drainage-tube into the joint by incision above 

 the patella, at the outer side of the limb. With the serous fluid that escaped 

 were mixed considerable portions of lymph, opaque, and in some parts of 

 yellowish-white colour ; and these portions proved on microscopic examination 

 to be masses of pus corpuscles ; so that it was clear that the case was just 

 passing into one of that justly dreaded disease under ordinary treatment, sup- 

 purative synovitis. The result, as in the former case, was immediate and 

 permanent relief from pain. His temperature next day was normal, and has 

 remained so. The discharge, purely serous in quality, is quickly diminishing 

 in quantity, and the patient eats and sleeps as in perfect health.] 



The next patient I wish to bring before you is one who came under my care 

 six weeks ago with an affection of the inner side of the ankle, which he attributed 

 to a sprain two months previously, after which he had constant pain in the 

 part, and increasing thickening of the textures. The outer side of the foot 

 and ankle looked perfectly sound. We put up the limb in a side splint of poro- 

 plastic material, and used repeated blistering, but without any advantage ; 

 pain continued to increase, and it was evident that, if left to run its course, 

 it would end in caries of the tarsus. I therefore, fifteen days ago, made an 

 antiseptic incision, expecting to open a joint, but hoping that I should not 

 find pus. To make an opening into an articulation without the presence of 

 pus would have been, without antiseptic means, an unjustifiable proceeding ; 

 but here, as I have said, I hoped not to find suppuration, because I knew that, 

 if the procedure were antiseptically conducted, the opening into the joint would 

 do no harm whatever, while I should be able in all probability to get great 

 benefit through relief of tension by free incision ; and if I should find that no 

 pus had been formed, this would make the case much more hopeful, because it 

 would show that the disease was not so far advanced as if suppuration had 

 already occurred. I was gratified, therefore, to find, on cutting into the soft 

 substance, which gave very much the same sense of fluctuation, before the 

 incision was made, as if fluid had been present, that there was no pus — nothing 

 but inflammatory degeneration of the soft parts, the lateral ligament between 

 the astragalus and the navicular bone being entirch' disorganized, so that when 

 the finger-nail was applied the softened textures gave way ^^■ith the utmost 

 readiness, and the joint lay freely open before us, the cartilages happily appearing 

 to be sound. I will now change the dressing, so that you may see the appear- 

 ance of the part. While the bandage is being cut or remoxed, the patient, 

 or an assistant, keeps his hand over the site of the wound, to prevent the dressing 

 from rising eji masse, and pumping in septic air. As 1 raise the folded gauze 

 (exactly similar to that which I applied in the last case). I take caro that t1ie 



