376 REPORT OF SOME CASES OF ARTICULAR DISEASE 



swelling both diminished greatly during the first four weeks after the cauteri- 

 zation ; some aggravation of the symptoms then occurred for a time, but as 

 the sore was still open, Mr. Syme thought it unnecessary to interfere further, 

 and a gradual improvement afterwards took place, till at the time of her leaving 

 the infirmary (the 14th of February, 1854) there was scarcely any swelling and 

 very little pain. 



I saw her again on the loth of June ; there was then no swelling whatever 

 about the wrist, and no uneasiness except a painful feeling of weakness when 

 she exerted it much. 



Case IV. — Disease between the Atlas and Axis; Actual Cautery applied with 



great benefit. 



Thomas Smith, aet. 27, admitted the 20th of June, 1854. Generally enjoyed 

 good health till eighteen months ago, when a stiffness of the neck came on without 

 any assignable cause, with pain when he turned round his head on the pillow ; 

 the pain increased greatly, and deprived him altogether of sleep for seven weeks, 

 during which time he lost three stone in weight. There was severe pain in the 

 head as well as in the neck, aggravated to an extreme degree by either nodding 

 or turning of the head, particularly the latter, which, indeed, he at last never 

 did without turning the rest of the body also. He applied to numerous medical 

 men in Birmingham, where he lives ; and blisters and caustic issues were 

 repeatedly applied to the back of the neck, but never gave more than very slight 

 and very transient relief, and he says that from the commencement of his 

 complaint he never had one minute's freedom from pain, except during sleep, 

 till he came here. 



At this time he was, according to his own account, about as bad as he had 

 been at all. His countenance wore a peculiar expression of mingled suffering 

 and apprehension, as Mr. Syme expressed it. He complained of severe pain in 

 the neck and head, aggravated by any sudden movement, so that there was 

 a great constraint about all his actions. He always kept his head bolt upright 

 except when in bed, and could neither lie down nor get up without supporting 

 his head with his hands ; he never turned his head without the rest of the body, 

 but gentle nodding was not very painful. There was great swelling of the 

 upper part of the neck, and he could only open his mouth a little way ; 

 deglutition was extremely difficult, and a remarkable prominence of the bodies 

 of the upper cervical vertebrae was to be felt in the pharynx. 



On the day after his admission, Mr. Syme applied the actual cautery over 

 the spinous processes of the upper cervical vertebrae ; the man was not under 

 chloroform, and said he hardly knew whether the pain was greater even at the 



Mi 



