ON EXCISION OF THE WRIST FOR CARIES 419 



my professional brethren ; and tirst I will give shortly some illustrative cases, 

 reserving meanwhile the details of the treatment. 



Case i. — Elizabeth M'K , a millworker, aged forty, in good general 



health, was admitted on the 27th of October, 1862, on account of suppuration 

 of the right carpus, resulting from the hand having been violently pinched in 

 a door. Pus was discharged from openings at the back of the wrist, and the 

 carpal bones were felt to grate upon one another on manipulation. 



The disease being of traumatic origin, I hoped it might subside if the limb 

 were kept at rest upon a splint, and free exit were provided for the discharge. 

 This treatment was persevered with for upwards of five months, but proved 

 unavailing ; and she also continued to suffer considerable pain. Accordingly, 

 on the i6th of April, 1863, I removed the carpus, and at the same time took 

 off so much of the bones of the forearm and of the five metacarpal bones that 

 the interval between them where they were divided measured two inches and 

 a half. The bones of the carpus and the metacarpal bones of all the fingers 

 proved to be extensively eroded by caries. 



Seven weeks after the operation the limb was almost healed and promised 

 a most satisfactory result, when, being an ignorant woman, and mistaking our 

 efforts to maintain the flexibility of the fingers for attempts to break them 

 she ran away from the hospital, and did not show herself again for nearly five 

 months, during which time she had kept the fingers extended and motionless 

 upon the splint she took out with her. Consequently they were almost abso- 

 lutely rigid, and the movements of the thumb were also extremeh' limited, 

 so that the hand was nearly useless, while, from the position in which it had 

 been habitually held, it had acquired some tendency to droop towards the ulnar 

 side. It was, however, soundly healed ; and, through repeated forcible move- 

 ment under chloroform to break down the adhesions of the tendons, and the 

 use of a leather splint to support the palm and ulnar border of the hand without 

 interfering with the thumb or fingers, it improved remarkably, and when she 

 left the hospital in April 1864 she could use it for wringing a cloth or knitting 

 a stocking. The improvement has since been progressive. In August it was 

 found that without the sphnt she could readily hft a kettle of water weighing 

 six pounds, implying a most satisfactory command of the muscles over the newly 

 formed articulation. At first I had aimed at anchylosis of the wrist, but was 

 now much better pleased to see that it retained the ]')0wer of flexion and extension, 

 eversion and inversion, pronation and supination. l^\on now (March 1865) 

 the limb is still increasing in strength, in proof of which she lately raised with 

 outstretched hand a ]~)ail of coals weighing 16A pounds. She has for the last 



