gone out of fashion, but the cautery may still be employed
with benefit for the relief of pain in cases in which ulceration of
cartilage is a prominent feature.

The application of the X-rays has proved beneficial in synovial lesions
in superficial joints such as the wrist or elbow; prolonged exposures
are made at fortnightly intervals, and on account of the cicatricial
contraction which attends upon recovery, the joint must be kept in good
position.

Conservative treatment is only abandoned if improvement does not show
itself after a thorough trial, or if the disease relapses after apparent
cure.

_Operative Treatment._--Other things being equal, operation is more
often indicated in adults than in children, because after the age of
twenty there is less prospect of recovery under conservative treatment,
there is more tendency for the disease to relapse and to invade the
internal organs, and there is no fear of interfering with the growth of
the bones. The state of the general health may necessitate operation as
the most rapid method of removing the disease. The social status of the
patient must also be taken into account; the bread-winner, under
existing social conditions, may be unable to give up his work for a
sufficient time to give conservative measures a fair trial.

The _local conditions_ which decide for or against operation are
differently regarded by different surgeons, but it may be said in
general terms that operative interference is indicated in cases in which
the disease continues to progress in spite of a fair trial of
conservative measures; in cases unsuited for conservative
treatment--that is to say, where there are severe bone lesions.
Operative interference is indicated also when the functional result will
be better than that likely to be obtained by conservative measures, as
is often the case in the knee and elbow. Cold abscesses should, if
possible, be dealt with before operating on the joint.

In many cases the extent of the operation can only be decided after
exploration. The aim is to remove all the disease with the least
impairment of function and the minimum sacrifice of healthy tissue. The
more open the method of operating the better, so that all parts of the
joint may be available for inspection. The methods of Kocher, which
permit of dislocating the joint, are specially to be recommended, as
this procedure affords the freest possible access. Diseased synovial
membrane is removed with th