ON EXCISION OF THE WRIST FOR CARIES 439 



girl, whose right wrist was excised on the 27th of November, 1864, for caries 

 Hmited to the lower and outer ])art of the carpus and the base of the second 

 metacarpal bone, which appeared to be affected with tubercular deposit. The 

 hand had been useless for a year, but is now already useful as well as sound and of 

 perfect shape, with better movements than in any former case at the same stage. 



Next is James B , aged tweh'c, with disease of the left wrist, limited 



to the lower and ulnar side of the carpus and the fifth metacarpal bone, which 

 was enormously thickened and diseased in its interior throughout almost its 

 entire length. Rest and constitutional treatment having been tried in vain 

 for five months, I proceeded to operate on the 14th of August, 1864, and, instead 

 of adopting what would, I believe, be the usual course (amputation of the little 

 finger and its metacarpal bone, with the probabilit}' of the disease continuing 

 in the carpus), I excised the wrist, leaving the little finger, though it was necessary 

 to drill its metacarpal bone into a tube with the gouge. He has now a beautiful 

 and most useful hand, which is constantly increasing in strength, though there 

 still remains a sinus over the base of the fifth metacarpal bone, from which 

 a small exfoliation recently escaped. 



Third in order must be placed Andrew C , aged nine, with disease of 



the left wrist of eight months' standing, and in so severe a form as to call for 

 immediate treatment. The caries extended from the forearm to the meta- 

 carpus, and had produced great destruction in the carpus. The operation was 

 performed on the 26th of November, 1864, and the result has been very satis- 

 factory^ as regards the improvement in the general health, the strength of the 

 wrist, and the mobility of the thumb and fingers. But there have remained 

 hitherto (four months) two small sores unhealed, and these within the last few 

 days have been affected with hospital gangrene. This has, however, been 

 checked by the application of carbolic acid, and I hope has not penetrated 

 to the bones. 



Lastly, I have to record tw^o deaths. Neither of these, however, was 



directly connected with the operation. One of the patients, Alex. S , 



a stone-mason, aged forty-six, the first I operated on, was in truth not a fit subject 

 for excision, except as a means of relieving him of the agonizing pain which 

 he endured from disease of the right wrist ; for he was affected with advanced 

 phthisis as well as other complaints, and died of these sc\'en weeks after the 

 operation, which, however, had made him free during the interval from his 

 previous suffering. 



The other fatal event occurred also in one of my early cases. The patient,. 



Neil C , aged twenty-one, had the right wrist excised on tlie 4tli of July. 



1863, for extensive strumous caries. But in consequence, as I suppose, of 



