ON EXCISION OF THE WRIST FOR CARIES 423 



Case 5. — Thomas M , aged twenty-one, a miner, was admitted on 



the 8th of July, 1864. About six months before, when suffering from small- 

 pox, he was seized with inflammation in the right tibia and the left carpus, 

 resulting in necrosis of the former and caries of the latter. When he came 

 into the hospital the back of the wrist was swollen, and presented two sinuses 

 through which a probe could be passed down to the diseased bone. The hand 

 was extremely feeble, and drooped when the arm was extended horizontally. 

 It was very painful, interfering seriously with his night's rest, and his general 

 health was otherwise much deranged, his pulse being 135, and his appetite 

 impaired, while he was constantly bathed in perspiration. 



On the i6th of July I extracted some exfoliations from the affected tibia, 

 and also removed from the wrist the parts represented in Fig. 2. A carious 



Fig. 2. 



cavity occupied the place of the semilunar bone, and the adjacent part of the 

 cuneiform was excavated. The other carpal bones, except the trapezium, 

 were anchylosed into one mass. Two days after these operations his pulse 

 had fallen eleven beats, and after two days more he was recovering his appetite, 

 and had lost his perspirations, while his former anxious expression was exchanged 

 for that of cheerfulness. The improvement in his general health continued, 

 and the hand made most satisfactory progress. Six weeks and six da\s after 

 the excision it was soundly healed, and the swelling had entirely disappeared. 

 He could move all the joints of all the fingers and both those of the thumb, and 

 performed to some extent all the natural actions of the wrist. A fortnight later 

 he stood the test of lifting a weight of six pounds and a half with the unsup- 

 ported hand in the horizontal position of the forearm. In November, four 

 months after the operation, the movements had so greatly increased in freedom 

 and firmness, and the hand had so thoroughly natural an appearance, that it 

 was with diOiculty some of m\- medical friends could be persuaded that the 



