ABNORMAL CONDITIONS OF THE HAND. 



515 



were also involved in the disease, and the three 

 metacarpal bones supporting the three fingers 

 already mentioned were also much enlarged; in 

 a word, all the bones of the metacarpus and 

 fingers, with the exception of those of the 

 thumb and little finger viewed externally, 

 seemed to enter into the formation of one mor- 

 bid mass, the size and form of which may be best 

 conceived by a reference to the annexed figure. 

 The chief bulk 



Fig. 227. of this large bony 



tumour existed 

 posteriorly, where 

 it extended as 

 high up as the line 

 of the wrist-joint, 

 and completely 

 concealed the 

 bones of the car- 

 pus. The tumour 

 did not extend it- 

 self directly for- 

 ward towards the 

 palm of the hand, 

 but passed down- 

 wards; at its re- 

 mote extremity 

 the last phalanx 

 of the middle fin- 

 ger was to be seen 

 projecting ; this phalanx was itself, however, 

 perfectly free from morbid change, and the 

 integuments covering it possessed their natural 

 sensibility. The circumference of the tumour 

 measured accurately twenty-four inches; nume- 

 rous very large protuberances shewed themselves 

 every where on its surface, which yielded but 

 little to pressure. Three of these tumours had 

 ulcerated at their most prominent points, and 

 by circular depressed openings (nearly an inch 

 in diameter) gave exit to a thin fetid ichorous 

 matter, which continued to flow from the in- 

 terior of the morbid mass. These orifices, which 

 presented some loose granulations, readily ad- 

 mitted the introduction of a probe, which could 

 be then freely moved in the interior of these 

 cavities, each of which was large enough to 

 contain an ordinary hen's egg. The integu- 

 ments every where over the whole of this mor- 

 bid growth had a perfectly healthy aspect, and 

 were freely moveable on this immense tumour, 

 except at the borders of the circular apertures 

 already mentioned. The disease existed for 

 many years, having begun, as the patient stated, 

 when he was a boy. 



The disease was unaccompanied by pain, and 

 the man's health continued good until the pe- 

 riod when the tumour had ulcerated; after which 

 he became somewhat debilitated by the exhaust- 

 ing effect of the sanious discharge on his con- 

 stitution, and his mind was depressed with the 

 idea of his being afflicted with a disease so 

 formidable in appearance, and which hitherto 

 had resisted, nay increased under, all treatment, 

 and deprived him altogether of the means of 

 earning a livelihood. Although there was some 

 difference of opinion as to the name by which 

 this disease of the bone should be designated, 

 it was agreed that there was nothing really ma- 



lignant in its nature; most of those consulted 

 on the case recommended amputation, but 

 Doctor O'Beime conceived the happy idea, 

 and speedily put it into execution, of cutting 

 out the morbid mass. Although it was rightly 

 conceived that the index finger was but little 

 diseased, and that the ring-finger was merely 

 enveloped in the tumour, still the thought of 

 preserving either of these fingers could not be 

 for a moment entertained, as the metacarpal 

 bones supporting them were known to be dis- 

 eased. It was plain that the thumb and little 

 finger only could be saved, and the lines of 

 incision which were followed may be easily 

 imagined. The operation was performed thus : 

 one incision was commenced at the root of the 

 little finger at its radial side, which was ex- 

 tended deeply through the soft parts upwards 

 and backwards as high nearly as the wrist-joint ; 

 the termination of this incision here was met 

 by another, which was commenced at the first 

 interosseous space between the index finger and 

 the thumb ; the lines of these incisions were 

 followed deeply, and, with the assistance of the 

 knife and metacarpal saw, the whole of the 

 morbid mass was removed; the haemorrhage 

 was soon arrested, and dressings applied with a 

 bandage to approximate gradually the thumb 

 and little finger. The wound was at first refrac- 

 tory, and cartilaginous granulations sprang up ; 

 to repress these, Dr. O'Beirne found nothing 

 so effectual as the actual cautery, and under its 

 influence the wound healed kindly. 



It is now nine years since the operation was 

 performed, and the man has, during that period, 

 enjoyed vigorous health ; the thumb and little 

 finger have approached each other, and in- 

 creased much in size, power, and usefulness, 

 and he is fully competent to follow his oc- 

 cupation, which is that of a land-surveyor. 



We have, in our collection at the Richmond 

 school, a cast of this remarkable hand ; and the 

 morbid mass which was removed is preserved 

 in the Museum of the Royal College of Sur- 

 geons, Dublin. A longitudinal section has been 

 made of the tumour : one half has been sub- 

 jected to long maceration, and dried ; and this 

 half exhibits well the thin osseous shell which 

 encloses the cellular and reticulated bony struc- 

 ture of the whole mass ; this portion of the 

 section shews, in short, the true structure of the 

 bony basis or skeleton (if we can so say) of the 

 disease (fig. 228). The 

 other half of the section 

 has been preserved in 

 spirits, and in the line of 

 division shews a smooth 

 cartilaginous surface, and 

 several excavations lined 

 by a smooth membrane, 

 which had enclosed an 

 albuminous fluid. Some 

 of these cavities were 

 complete isolated cysts, 

 buried deep in the in- 

 terior of the cartilaginous 

 mass; but the contents 

 of three of these cysts 

 had made their way ex- 

 2 M 2 



Fig. 228. 



