ON EXCISION OF THE WRIST FOR CARIES 421 



engage her. In August 1864 I saw her again. She was then emplo^'ed at 

 the sewing-machine, earning ten shilhngs a week, with the expectation of eleven 

 shilhngs before long, as she was considered one of the best hands at the work. 

 She still wore a leather support for the palm, but without it could lift a heavy 

 weight with the arm horizontal. She stated that there had been no discharge 

 from the hand for the last two months ; and that the only way in which she could 

 convince her friends of the nature of the operation she had undergone was by 

 showing to them her two arms extended side by side, the affected limb measuring 

 two inches less than the other from the elbow to the finger-tips. Lastlv, in 

 December 1864, I learned that the hand was still constantly increasing in 

 strength, and that she was on her full wages. 



Case 3. — William C , aged eighteen, a clerk, was admitted on the 14th 



of January, 1864. Two years previously I amputated the great toe of his 

 right foot on account of strumous disease. The wound was slow in healing, and 

 in walking with a stick he thinks he over-exerted the right wrist, which became 

 swollen and disabled, though for a long time free from pain. The treatment 

 employed failed to arrest the disease, and at length suppuration occurred ; and 

 a probe introduced through one of the openings by which the matter escaped 

 passed down to carious disease in the carpus. The hand had now been useless 

 for a twelvemonth, and I recommended him to submit to incision, for which 

 purpose he came into the infirmary. 



On the 1 6th of January I removed the carpus, together with the articular 

 ends of the adjacent bones. His progress afterwards was satisfactor\-. \Mthin 

 seven weeks of the operation he could bend the fingers, and raise the metacarpus 

 by muscular action at the same time ; and five weeks later he left the hospital, 

 able to pick up light objects with the unsupported hand, and to execute to some 

 extent all the natural movements of the wrist-joint. In August, after four 

 months more had elapsed, the actions of the wrist were much more free, and 

 the new joint was so secure that w^ithout any splint he could support a kettle 

 of water weighing six pounds and a half upon the radial border of the hand 

 with the arm extended horizontally, and easily lifted a chair with the arm 

 vertical. He bent the fingers imperfectly at the knuckles, but mo\'ed their 

 other joints and both those of the thumb very freel}', and he could hold a pen 

 so as to write with considerable steadiness. In September all discharge tinally 

 ceased. The hand has since remained perfecth' sound ; and when I saw him in 

 December 1864 there was nothing in its appearance to attract attention. He 

 was engaged in a situation where little writing was required, but the hand was 

 becoming more and more serviceable for that purpose. Its grasp also was con- 



