Tiibercular Ostitis of Wrist. 483 



7. 149. Tubercular and Septic Disease of the Wrist, 

 involving" the Lower End of the Radius.— Lower end 



of a left radius — macerated, showing extensive changes at and 

 near the articular surface. 



For about two inches above the articular surface the bone 

 is greatly enlarged by numerous irregular periosteal outgrowths, 

 the articular surface being rarefied and superficially eroded. 



This has all the appearance of a bone, upon which septic 

 irritation has acted for some time, although probably initiated 

 by tubercular disease. The difi"erences between this and 

 the last specimen may be due to a preponderance of septic 

 influences upon this one. B. C. ii. M. 28. 



7. 150.— Senile Tuberculosis of the Bones of the Wrist. 



— Section of the bones of the left wrist of a man, aged 81 — 

 injected and in spirit, illustrating the above. This specimen 

 is from the same arm as Xo. 7. 137, which see for full history. 



The preparation consists of a longitudinal section through 

 the radius, ulna, and first row of carpal bones, and a transverse 

 section through the second row of carpal bones. 



He had noticed his M'rist enlarged for some months, but never had 

 any pain in it. He could move it freely, and complained only of the 

 disfiguration from the swelling. 



Non-vascular areas like that in the radius are seen in 

 various stages of progress in the carpal bones. There are also 

 caseous masses within the joints, especially between the radius 

 scaphoid, and in the lower radio-ulnar joint, which is distended 

 with them. 



In many places the articular cartilage is entirely removed. 

 The well-authenticated absence of pain on movement is there- 

 fore remarkable, but it may possibly be explained by the 

 non-vascular caseous condition of the bone below the eroded 

 cartilage. 



G. C. 2811. 



