422 ON EXCISION OF THE WRIST FOR CARIES 



siderably stronger, and he used it occasionally to work the bellows of a forge. 

 He still derived benefit from a palmar support with which he had been furnished, 

 but he had gone without it for a week at a time, and promised soon to be entirely 

 independent of it. 



Case 4. — Helen M , aged fourteen, a schoolgirl, admitted on the 19th 



of Februar}^ 1864, attributed the disease, which had appeared seven months 

 before in her left wrist, to a violent squeeze experienced at that time. Three 

 months after the accident it suppurated, and was opened on the dorsal aspect 

 by a medical man ; but its condition became rapidly aggravated, and at length 

 her parents sent her to the infirmary to have the hand amputated. That this 

 was the only feasible treatment was certainly a most natural conclusion from 

 the appearance presented by the affected part. The hand was enormously 

 swollen both on the palmar and dorsal aspects, and drooped helplessly from 

 ligamentous relaxation ; while the fingers were almost fixed in a semiflexed 

 position. There were several sinuses on the back of the hand, and in front of 

 the wrist a deep ragged grey sore as large as a half-crown, and another smaller 

 ulcer on the palm. Her general health at the same time was much reduced. 



But most unpromising as the case appeared, I determined to give the hand 

 a chance, and at the same time test fully the capabilities of the new method. 

 On the 5th of March I removed the carious mass, when the metacarpal bone 

 of the middle finger proved to be so extensively affected that it was necessary 

 to drill it with the gouge into a mere tube, which must have reached to near 

 the knuckle, as a portion of the cartilage in connexion with the epiphysis was 

 removed by the instrument. 



The result turned out satisfactory, and she left the hospital on the 30th of 

 July, with the sores and sinuses almost healed, and able to move all the fingers 

 freety, and also, at an earlier stage than in anyprevious case, to raise the knuckles 

 above the level of the forearm by muscular effort. In October she could support 

 a kettle of water on the radial border of the hand, and her general health was 

 completely re-estabhshed. In the middle of December she could take up a quart 

 bottle full of water, holding it by the neck between the forefinger and thumb. 

 She was herself disposed to dispense with the palmar support, but was recom- 

 mended to continue it, so as to favour as much as possible the rapid increase 

 of strength and usefulness. There had been no discharge for the last month, 

 except a httle moisture on the removal of a scab ; and the part once so greatly 

 deformed was nearly natural in appearance. When I last saw her (March 

 1865), she told me she was learning to work at a sewing-machine, and found 

 her hand thoroughly useful for the purpose. 



