ON EXCISION OF THE WRIST FOR CARIES 



[Lancet, 1865, vol. i, pp. 308, 335, 362.] 



To save a human hand from amputation, and restore its usefulness, is 

 an object well worthy of any labour involved in it. When caries affects the 

 shoulder or the elbow, the limb is preserved by excision of the diseased joint, 

 and the brilliant success of these operations naturally suggested a similar pro- 

 cedure for the wrist. The first attempt of this kind appears to have been made 

 as early as the close of the last century by the younger Moreau, who, however, 

 gives but few details of his case. In 1839, a German surgeon, named Dietz, 

 is said to have removed all the carpal bones, together with the ends of the radius 

 and ulna, on account of caries.^ But as such an operation must necessarily 

 have been very painful and protracted, we cannot wonder that it was not 

 repeated till after the introduction of chloroform, when, in 1849, Heyf elder, 

 of Erlangen, excised the wrist-joint for disease, and he has been followed by 

 many surgeons, both British and foreign, who have adopted various methods 

 of effecting their object. 



The results of this practice, however, have not proved encouraging. For 

 although several instances of success have been put on record, it is generally 

 admitted that these are quite exceptional,^ and amputation is now again con- 

 sidered by most surgeons the appropriate treatment for caries of the carpus. 



About two years ago a more hopeful view of the subject was suggested 

 to me by a case of injury under my care in the infirmar3^ The patient was 

 a young man, seventeen years of age, who had fallen about fifty feet down the 

 shaft of a coal-mine, and, besides fracture of the left thigh, had sustained a 

 compound dislocation of the wrist of the same side, the articular ends of the 

 radius and ulna protruding anteriorly for about an inch and a half through 

 a large irregular wound. I sawed off the exposed portions of the bones, and 

 placed the limb on a splint ; and, commencing passive movement of the fingers 

 early, and maintaining it perse veringly, I had the satisfaction of seeing him, 

 at the end of five months, with a hand nearly as supple and strong as the other, 

 the chief difference between them being that the wrist of the injured side was 

 rather more slender than the sound one. 



This case appeared to me to throw light upon excision of the wrist for 

 disease. In the first place, it was clear that no operation, intentionally performed, 



' See O. Heyfcldcr, Operationslehre und Statistik der Rcsectioueii. p. :i62. 



* See Erichscn's Science and Art of Surgery, 4th edit., 1864, p. 70S. Holmes's System of Surgery, 

 vol. iii, 1862, p. Si 2. 



