WRIST-JOINT (ABNORMAL ANATOMY). 



1525 



with the fistulous orifices of canals, which con- 

 duct purulent matter from the centres of some 

 of the carious hones, and from the interstices 

 between them. At this period of the disease we 

 can, hy holding the lower part of the forearm 

 with one hand, and grasping the metacarpus 

 with the other, move these parts laterally in 

 opposite directions, clearly ascertaining that 

 all the hones are loose and carious, and in an 

 irrecoverable state of disorganisation. The 

 constitution of the patient invariably sympa- 

 thises deeply with this state of things ; and 

 the wasting effects of hectic fever are found 

 usually coinciding with the disease of the 

 wrist and carpus ; and, if amputation be not 

 performed, the life of the patient may be sa- 

 crificed. This operation, however, almost in- 

 variably succeeds in arresting altogether the 

 hectical symptoms, and the patient is restored 

 to health. 



The scrofulous disease of the cancellons 

 structure of the bones of the carpus, and of 

 the carpal extremity of the radius, does not 

 always proceed thus unfavourably. Occasion- 

 ally, instead of suppuration, a resolution of tire 

 inflammatory action may ensue, or anchylo- 

 sis, with partial displacement backwards of 

 the bones of the forearm at the wrist-joint, 

 may be established. This last, however, may 

 be looked upon rather as an arrest of the 

 morbid action than as a cure, because the 

 patient is not only deprived of the use of the 

 wrist, and sometimes of the medio-carpal 

 joints, but also of the use of the fingers; in- 

 flammatory action in these cases having been 

 communicated to the flexor tendons and their 

 sheaths, rigidity of the ligaments, or even 

 anchylosis of the joints of the fingers, too 

 generally follows as a natural consequence. 



It may here be asked, whether, in the pro- 

 gress of this disease, the wrist-joint is liable 

 to those spontaneous displacements of the 

 bones which other articulations affected with 

 white swelling seem to be. To which we 

 reply, If we except the partial displacement 

 backwards of the ulna, previously mentioned, 

 these displacements must be considered as rare. 

 Bonnet of Lyons, who has had much expe- 

 rience, says he has not himself met with any 

 case of spontaneous luxation of the hand, 

 whether backwards or forwards, the result of 

 disease; nor has he read of any such recorded. 

 Nelaton relates, however, that Richet showed 

 him a preparation found in the dead-room, in 

 which it was observed that the bones of the 

 carpus had lost their usual relation to the 

 radius, the inferior extremity of which was 

 carried into the palm of the hand, while the 

 bones of the carpus were carried back- 

 wards on the dorsal suriace of the forearm. 

 Numerous fistulous orifices were seen, which 

 evidently had, up to the period of the pa- 

 tient's death, furnished a purulent discharge, 

 so that the disease had not been completely 

 cured, although it was manifest that the liga- 

 ments had resumed their firmness and solidity, 

 and that the luxation had taken place a long 

 time previous to death. 



Here, then, is a reply in the affirmative to 



the quaere, whether spontaneous dislocation 

 of the wrist-joint occur ; and an unquestion- 

 able example of dislocation of the bones of 

 the forearm forwards adduced, on the respect- 

 able authorities of Nelaton and Richet. To 

 this observation we may add the following, 

 showing that complete dislocation backwards 

 of both the bones of the forearm may occur 

 at the wrist (see fig. 936.) ; and here the testi- 

 mony as to this fact rests also on the produc- 

 tion of a specimen found in the dissecting 

 room*; its history is unknown. By examin- 



Fig. 936. 



ing this preparation, in which the dislocation 

 backwards of both the bones of the forearm 

 had evidently taken place, we can observe 

 much overlapping of these bones on the dor- 

 sum of the carpus, so that the styloid process 

 of the dislocated radius quite overhangs the 

 trapezium, even so far as the root of the 

 meta-carpal bone of the thumb, and the ulna 

 lies in contact with the back of the cuneiform 

 bone, so that the articular extremity of the 

 radius has passed down for more than an inch 

 below its ordinary situation ; the anterior sur- 

 face of the bones of the forearm, when they 

 lie on the dorsum of the carpal bones, are 

 solidly united to them. (See jig.9'36.) 

 Anatomical Characters of Chronic Strumous 



* This specimen formerly belonged to the Mu- 

 seum in Park Street, Dublin, where I saw it. ] 

 now is to be found, I presume, in the Museum o: the 

 Queen's College, Belfast. 



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