IO2 Anatomy Applied to Medicine and Surgery. 



teum and the bone, be involved, since the tendons termi- 

 nate at the bases, of the phalanges, and, are therefore not 

 involved. Should, however, the felon begin in the second or 

 third phalanges, it may, as in the case of the first phalanx, 

 be either superficial or deep. In the former instance, i.e., 

 when superficial, the whitlow may be local, or may, spread- 

 ing through the lattice-work arrangement of the vaginal 

 sheaths, affect the synovial membrane of the tendons be- 

 neath, and then spread up the fingers, or it may, by press- 

 ure on the vincula vasculosa, which convey the vascular 

 supply to the tendons, cause destruction of these tendons. 

 In the latter case, i.e., in deep whitlow, the inflammatory 

 process may primarily affect the periosteum, bone or the 

 deeper tissues, and then, quickly involving the synovial 

 sheaths, may spread upwards, resulting in extensive de- 

 struction of the tissues. 



When the synovial membranes or thecae are affected, 

 the inflammation will spread up the fingers, and, in the 

 case of the thumb and little finger, will likely involve the 

 synovial sacs beneath the annular ligament and appear 

 above the wrist, but, in the case of the index, middle and 

 ring fingers, it will spread up as far as the necks of the 

 metacarpal bones only, since the sheaths for these fingers 

 end here. 



Tuberculosis of the Wrist Joint. It would 

 seem probable that, in tuberculosis of the wrist joint, the 

 tubercle bacilli first lodge in the os magnum and then, 

 after infecting the synovial membrane around this bone, 

 spread to the other bones. The reasons for this belief on 

 the part of the author were stated in a contribution to the 

 "Annals of Surgery," August, 1900, and briefly were (1) 

 that the os magnum is the central bone of the hand -and 

 articulates with a greater number of bones than any other 

 of the carpus, and (2) that, for this reason, traumatisms 



