PART IV 

 SURGERY 



REPORT OF SOME CASES OF ARTICULAR DISEASE OCCURRIXCx IN 

 MR. SYME'S PRACTICE, EXEMPLIFYING THE ADVANTAGES 



OF THE ACTUAL CAUTERY 



[Monthly Journal of Medical Science, August 1854.] 



Case I. — Omalgia ; Application of the Actual Cautery ; Cure. 



Margaret Ashton, aet. 25, admitted the 25th of October, 1853 ; a servant ; 

 has generally enjoyed good health, and has a very robust appearance. Four 

 months ago, after exposure to wet and cold in washing, she had a severe fit of 

 shivering, and was seized a few days after with pain in the right shoulder, just 

 below the acromion, so severe that she could scarcely lift the arm ; this lasted 

 about twelve hours, and was followed in the course of the next day by intense 

 pain in the left shoulder, below the back part of the acromion. From that day 

 till her admission, she was unable to raise the arm ; the pain was for the first 

 two months extreme, keeping her as if ' in the fire all night', and banishing sleep 

 almost entirely. During the last two months she has rested from work, and 

 has suffered less. On admission she complained of constant gnawing pain in 

 the left shoulder, and extending down the limb as far as the elbow, and some- 

 times to the fingers ; when in the sitting posture she held the affected limb 

 with the other hand, to ease the pain ; the arm was also affected with a feeling 

 of numbness and weakness ; and although the shoulder was not very tender on 

 pressure, and very gentle passive motion of the arm could be performed, through 

 a considerable angle, without pain, yet any attempts on her own part to move 

 it produced great aggravation of her sufferings. As a result, no doubt, of 

 habitual disuse, the muscles about the shoulder were much atrophied, and this 

 caused a remarkable apparent prominence of the bony points, \'\z. the spine 

 of the scapula, the acromion, the anterior border of the outer part of the clavicle, 

 and tlic head of the humerus. The shoulder had an appearance tliat suggested 

 at first sight the idea of dislocation. 



On the 3rd of November, the patient being under the influence of chloroform, 



