REPORT OF SOME CASES OF ARTICULAR DISEASE 375 



her awake at night. She was unable to raise the arm from the side, and had 

 a sense of weakness in the hmb, and some stiffness of the hand. There was 

 considerable swelling about the shoulder-joint, which was tender on pressure, 

 particularly at the anterior and posterior aspects. On the day of admission 

 Mr. Syme applied the actual cautery freely over the anterior and posterior parts 

 of the joint, the patient being under chloroform. From this time she lost the 

 old pain entirely, or at least was uncertain whether that which she still felt 

 was not altogether that of the burn ; and though the pain of the burn was con- 

 siderable till the sloughs separated, yet it was much less distressing than the old 

 pain, for which it was substituted, so that she slept much better than before 

 the application of the cautery. The sloughs came away on the ist of April, 

 on which day she had a slight return of the old pain near the wrist, but it has 

 not occurred again, and she is now (the 4th of April) quite easy. The swelling 

 about the shoulder has almost entirely disappeared, and there is little, if any, 

 tenderness ; the sores are granulating healthily. 



April 14. — Continues quite easy. 



She was discharged on the 27th of April ; I saw her about a month after, 

 and she still continued free from pain. 



' Case III. — Disease of Wrist-joint ; Actual Cautery ; Cure. 



Janet Archibald, aet. 32, admitted the 2nd of November, 1853. Rather 

 a weakly subject. In October last she ' took a shivering ', without any particular 

 exposure to cold, and a pricking pain came on in the left wrist, which increased 

 for a time, and was accompanied with swelling. She applied poultices medicated 

 with acetate of lead, and under their use a great improvement had taken place 

 at the end of five weeks, when she got fresh cold in it, as she says, and it became 

 excessively painful ; the pain continued ever after till her admission, and although 

 its extreme severity was then somewhat mitigated, yet it kept her awake a good 

 deal at night ; it was partly dull and heavy, and partly of a shooting character, 

 and extended down through the hand and fingers. There was also an occasional 

 tingling sensation in the lingers, and a sense of unnatural weight in the limb. 

 A great degree of swelling existed about the wrist-joint, particularly on the 

 dorsal aspect, and this part when manipulated gave a feeling very like that of 

 fluctuation, so that her medical attendant had been desirous to open what he 

 had supposed a collection of matter there. 



Mr. Syme regarded the condition of the wrist as almost hopeless, but as he 

 thought suppuration had not 3^et occurred, he determined to give the limb a 

 chance with the actual cautery, which he accordingly a]")plied on the dorsal 

 aspect in two lines, crossing one another o\er the articulation. The pain and 



