206 
E. STURGE. 
cartilage is impaired and ulceration of it ensues. When once 
there is ulceration of this structure, it can never regain its nor¬ 
mal condition—nature never repairing this tissue when it is 
seriously diseased. Gradually the cartilage is absorbed, leav¬ 
ing the exposed surfaces of the bone in contact, thus enabling 
their vessels to communicate with each other, and true anchy¬ 
losis can then take place. Periostitis is also taking place and 
the bone cells of the inner layer of the periosteum, which have 
been lying dormant, once more going to producing bone. A 
band of lymph is thrown out which is gradually converted into 
bone, constituting the exostosis so often seen in these diseases.. 
This band of bone, endeavoring to cement the parts together, 
is a very important factor in producing anchylosis. 
Very often, and especially when the conformation of the 
joint is bad, the diseased process starts from a strain which has 
torn a ligamentous insertion, lacerating some of its fibres and 
possibly injuring the periosteum. From this point the inflam¬ 
matory process proceeds, involving the same structures as be¬ 
fore. The same pathological phenomena are taking place in all 
bone diseases of this class with slight modifications. But this 
process is slow; the inflammation is of a sub-acute, or a chronic 
form, and our treatment must be to hasten things along. It is 
by converting a sub-acute form of inflammation into an acute, 
by setting up a reparative inflammation within the diseased 
structures and by aiding nature in every possible way that our 
success lies. 
This is not the theory of counter-irritation or metastasis, for 
when destruction of the cartilage has taken place, we certainly 
do not want to attract the inflammatory process elsewhere. Our 
object should be to stimulate the reparative powers of nature to 
their utmost, and it is good practice to get as near the seat of 
trouble as practicable, and to spare the integument all we can. 
It is not the mere application of a hot iron, drawing fantastic 
designs, but it is the methodical and scientific introduction of 
heat into the diseased structure to bring about a certain result. 
The inflammation produced by this form of cauterization, 
