424 ON EXCISION OF THE WRIST FOR CARIES 



carpus had been removed at all, more especially as a growth of new bone from the 

 radius presented considerable resemblance to the prominence of the os magnum. 

 On the 13th of February he entirely discarded the leather support, which for 

 some time he had only worn at night as a safeguard, and now (March) his hand 

 has a powerful grasp, and is in all respects nearly, if not quite, as useful as ever.^ 



Case 6. — Mary Ann L , aged nineteen, a millworker, was admitted on 



the 22nd of October, 1864. Her case differed from any of the preceding, in 

 being extremely acute. Ten days before her admission, pain came on at night 

 in the right wrist without any assignable cause, and increased from day to day 

 till it became agonizing. When I first saw her the whole hand and the neigh- 

 bouring part of the forearm were greatly s\vollen and fiery red, and contained 

 a considerable amount of pus, which I evacuated by very free incisions. This 

 relieved her only temporarily ; and, when she had been in the hospital twelve 

 days, it was obvious that some very decided treatment was called for. During 

 the whole of that time she had taken nothing but water, and had slept very 

 little, so that her flesh and strength were rapidly diminishing ; and, on 

 manipulation of the wrist, it felt like a bag of loose grating bones. 



Though I feared that the tendons might have sloughed from vicinity to 

 such intense inflammation, and that the case was likely to do little credit to the 

 operation, I felt it my duty to remove the carpus with the neighbouring articular 

 surfaces, which I did on the 2nd of November. The carpal bones were found 

 almost entirely detached from one another, and all of them, as well as those 

 of the forearm and the metacarpal bones of the fingers, were eroded by ulceration. 

 The tissues beneath the extensor tendons were so disorganized as to break 

 down readily under the finger ; but, happily, the tendons themselves had not 

 suffered seriously, as was proved by the event. 



The second night after the operation she slept without an opiate, and on 

 the following day took some beef-tea ; and from this time forward she regained 

 her strength and flesh as quickly as she had previously been losing them. The 

 cavity produced by excision of the bones consolidated with great rapidity. 

 After three weeks she could pick up a roll of bandage with the finger and thumb 

 of the unsupported hand ; and on the 28th of December (eight weeks from the 

 operation) cicatrization was complete. The wrist was then already firmer than 

 in any previous case at that period, so that the base of the hand could not be 

 moved from side to side at all, though she could herself perform flexion and exten- 

 sion, pronation and supination, with increasing freedom. She could also use 

 every joint of the fingers and thumb, which were growing more and more supple 

 as they gradually lost the thickening of tissue which the acute inflammation 



^ For a further notice of this case see p. 1 99. 



