420 



ON EXCISION OF THE WRIST FOR CARIES 



six weeks entirely discarded the support, having found the hand exactly as 

 strong without it. The new wrist is now as firmly knit as the sound one, but 

 more slender in consequence of the radius and ulna having been so freely resected. 



Case 2. — Margaret W , aged fourteen, a sewing-machine worker, was ad- 

 mitted on the 2oth of March, 1863, when she stated that a swelling had appeared 

 five months previously on the back of her right hand, which, however, remained 

 free from pain till within about three weeks, when suppuration occurred. An 

 incision was made by her medical attendant, but this failed to relieve her ; and 

 when she came into the infirmary she was still suffering severely, while there 

 was also considerable swelling of the hand. 



Fig. I. 



The limb was placed on a splint and poulticed, but additional abscesses formed 

 and opened, and at length the probe distinctly indicated caries of the carpus. 



On the 23rd of May I excised the parts represented in Fig. i. The carpus 

 was chiefly affected by the disease, but the metacarpal bones of all the fingers 

 were implicated, and the radius was anchylosed to the scaphoid and semilunar. 

 Constant attention being subsequently paid to supporting the wrist and bending 

 the fingers, she progressed steadily, though slowly. Thus seven weeks after 

 the operation, the hand no longer drooped when the arm was extended hori- 

 zontally ; three months and a half later she could take up a roll of bandage 

 between the finger and thumb ; and when three months more had elapsed 

 she knitted part of a stocking without using any splint. About this time, as 

 she had never learned to write, the nurse of the ward taught her the art, which, 

 being a clever girl, she soon learned ; and half a year afterwards I received 

 from her a letter, well written with the affected hand, requesting a certificate 

 of soundness for the satisfaction of her old employer, who was about to re- 



