436 



ON EXCISION OF THE WRIST FOR CARIES 



Some idea of the appearance of the wrist may be gathered from the accom- 

 panying illustration (Fig. 6), taken from a photograph, and also from the fact 

 that the wrist measured nine inches and three-quarters in circumference, whereas 

 the sound one was slender both from natural conformation and from emaciation. 

 The surface of the swollen part was studded wth eight sinuses, through which 

 the probe could be passed down to diseased bone in the forearm, the carpus, 

 and the metacarpus. The hand drooped when the arm was extended, and the 

 fingers were entirely useless. On the 8th of June, 1864, 1 performed the operation, 



which proved very laborious on account of the condensation of 

 the soft parts and the extraordinary enlargement of the radius 

 from inflammatory hypertrpphy, which made it impossible to 

 protrude it as usual at the ulnar incision for the application 

 of the saw, while its texture was so hard as to require con- 

 siderable force with the most powerful cutting-pliers to divide it. 

 For seven weeks all went on perfectly well, so that at the 

 end of that time the circumference of the wrist was diminished 

 by an inch, and she could readily pick up a light object with 

 the finger and thumb of the unsupported hand, which drooped 

 but slightly below the horizontal level. She was also quite free 

 from uneasiness, and her general health was greatly improved. 

 Unfortunately, however, the sores, which were previously healing 

 kindly, were now attacked by hospital gangrene ; and though 

 this was checked in about five days by the application of nitric 

 acid and other measures, the previously satisfactory progress 

 was no longer observed ; and, when a month had elapsed with- 

 out improvement, I resolved to investigate the cause. Having 

 put her under the influence of chloroform, I opened up the line of 

 the ulnar incision, and, finding the end of the ulna again carious, 

 removed it with pliers ; but was pleased to find, on introducing 

 my finger into the cavity that still existed, that the large cut surface of the 

 radius was smoothly covered with granulations, as also were the ends of the 

 metacarpal bones. I therefore brought the edges of the incision together by 

 stitches, except a part sufficient for the escape of discharges, and placed the limb 

 again upon the splint. From that time forth she has advanced satisfactorily ; 

 and when she last came from her native town to see me (December 1864), the 

 discharge had almost entirely ceased, the swelling was greatly reduced, and 

 although the end of the radius was still very large, and the wrist measured eight 

 inches and a quarter in circumference, the border of the bone was to be felt 

 immediately beneath integument of normal thickness and consistence, and 



Fig. 6. 



