ON EXCISION OF THE WRIST FOR CARIES 437 



the hand had a thoroughly natural appearance. She could extend it unsup- 

 ported without an}^ droop, and even raise it above the level of the forearm by 

 muscular effort. She had discarded the sling, and, by help of a light splint, 

 found the hand of much use to her, the movements of the thumb and fingers 

 being very satisfactory. 



In this case return of the disease appeared to be produced bv an attack of 

 hospital gangrene, and I am inclined to attribute to the same cause a similar 

 occurrence in the following instance. 



Case 9. — Alexander C , aged eighteen, a calenderer, was affected with 



spontaneous caries of the ulnar side of the right carpus, for which I performed 

 excision of the wrist on the 22nd of July, 1864. Four days afterwards the 

 ulnar incision was affected with hospital gangrene, which was subdued in the 

 course of a few days by local treatment. The hand then progressed very 

 favourably up to a certain point, and in a few weeks he could freely iiex and extend 

 all the joints of his fingers, which before the operation he could scarcely move, 

 and had perfect use of his thumb and a strong wrist. The ulnar incision, 

 however, refused to heal completely, and the soft parts in the vicinity- continued 

 thickened, and towards the close of the year the swelling there appeared to be 

 on the increase. Suspecting some return of the disease, I opened up the ulnar 

 incision on the 2nd of December, but could not find anything amiss. The 

 wound, however, continued remarkably languid, making in three months scarcely 

 any progress in healing ; and at length, on passing the probe down to the pisi- 

 form bone, I felt it bare and rough. Accordingly, on the 28th of February, 

 1865, I put the patient under chloroform, and, after extending the incision 

 sufficiently to gain access to the pisiform, I dissected out the whole of that bone, 

 which was the only diseased part that I could discover. During the month 

 that has since elapsed, the healing, so long delayed, has made good progress, 

 and as there is now no discharge from the deeper parts, I hope to see the hand 

 before long soundty cicatrized. , 



There is yet a third case with which hospital gangrene appears to have had 

 the same relations. 



Case 10. — Jane S , aged twenty-three, a milhvorker. witli idiopathic 



caries of the right carpus, had the wrist excised on the 23rd of March. i8h4. 

 For two months and a half the appearance and power of the hand jiromisod 

 an excellent result, when it was seized with hospital gangrene, and from that 

 time it gradually deteriorated, till at length, on the 2bth of August, I oxj^lored 

 it under chloroform, and found very extensive disease in Ixuh liones of the 

 forearm and in the metacarpus. I removed with cutting-pliers the affected 



