training of these tendons--for example,
washerwomen or riveters. It also occurs as a result of excessive
piano-playing, fencing, or rowing.

At the ankle it affects the peronei, the extensor digitorum longus, or
the tibialis anterior. It is most often met with in relation to the
tendo-calcaneus--_Achillo-dynia_--and results from the pressure of
ill-fitting boots or from the excessive use and strain of the tendon in
cycling, walking, or dancing. There is pain in raising the heel from the
ground, and creaking can be felt on palpation.

The _treatment_ consists in putting the affected tendon at rest, and
with this object a splint may be helpful; the usual remedies for
inflammation are indicated: Bier's hyperaemia, lead and opium
fomentations, and ichthyol and glycerine. The affection readily subsides
under treatment, but is liable to relapse on a repetition of the
exciting cause.

_Gouty Teno-synovitis._--A deposit of urate of soda beneath the
endothelial covering of tendons or of that lining their sheaths is
commonly met with in gouty subjects. The accumulation of urates may
result in the formation of visible nodular swellings, varying in size
from a pea to a cherry, attached to the tendon and moving with it. They
may be merely unsightly, or they may interfere with the use of the
tendon. Recurrent attacks of inflammation are prone to occur. We have
removed such gouty masses with satisfactory results.

_Suppurative Teno-synovitis._--This form usually follows upon infected
wounds of the fingers--especially of the thumb or little finger--and is
a frequent sequel to whitlow; it may also follow amputation of a finger.
Once the infection has gained access to the sheath, it tends to spread,
and may reach the palm or even the forearm, being then associated with
cellulitis. In moderately acute cases the tendon and its sheath become
covered with granulations, which subsequently lead to the formation of
adhesions; while in more acute cases the tendon sloughs. The pus may
burst into the cellular tissue outside the sheath, and the suppuration
is liable to spread to neighbouring sheaths or to adjacent bones or
joints--for example, those of the wrist.

The _treatment_ consists in inducing hyperaemia and making small
incisions for the escape of pus. The site of incision is determined by
the point of greatest tenderness on pressure. After the inflammation has
subsided, active and passive movements are employed to prevent the
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