ments. The limb was now taken out of the box and thoroughly cleaned, and the plaster-of-Paris bandage applied, with a fenestra opposite the wound, so as to allow the escape of any discharge that might occur. The plaster bandage was kept on for about three weeks, and the man allowed to go about on crutches, meanwhile bearing a little weight upon the limb. At the expiration of this time the plaster bandage was removed and a simple roller bandage applied. At the end of three months, the man could bear his entire weight upon the limb, and with the aid of a simple cane, could walk about quite well. The process of cicatrization was slow, but was completed on the 24th of May, as will be seen in Fig. 3, drawn from a photograph taken

at that date, the young man walking about at that time as well as usual, with the exception that there was a slight limp in his gait.

The above case has been shown to Profs. Post, Sayre, and

Crosby, and other eminent surgeons, all of whom pronounced it a valuable example of conservative surgery, and worthy of the attention of the profession. It appears probable to me that an operation analogous to that above described may occasionally be useful in compound and comminuted fractures of the forearm as well as of the leg, in equalizing the length of the two parallel bones, when they have been unequally shortened in consequence of the injury to which they have been subjected.

VOL. XXX.-35

CICATRICIAL CONTRACTION FROM BURNS: DEFORMITY OF FACE AND OF BOTH HANDS: REPARATIVE OPERATIONS.

BY ALFRED C. POST, M.D., LL.D.,

NEW YORK.

J. W., born at Cutchogue, L. I., Dec. 25, 1876. On the 27th October, 1877, he fell over with a high chair to which he was tied. His face fell on the upper rim of a hot stove: the backs of both hands were brought into contact with the side of the stove, the commissure which joins the thumb and index finger of the right hand embracing a projecting bar of iron: the back of the left hand was burned much more severely than that of the right. Cicatrization was complete in about three months. Before the healing of the sores a number of pieces of bone were discharged from the left hand.

Nov. 6, 1878. The present condition of the child is as follows: General health good: mental and bodily development beyond the average: the right angle of the mouth is rounded, thickened, and indurated: a cicatricial ridge extends from the right commissure of the lips to the front of the chin, and obliquely upward and outward to the lobe of the ear, varying in breadth in different parts from half an inch to an inch.

Right Hand.-The thumb at its distal joint is acutely flexed and immovably bound down to the palm of the hand by very dense cicatricial tissue. There is complete luxation at this articulation. The distal phalanx of the index finger is subluxated outward at an angle of about 45°, and is quite immovable. The index and middle fingers are webbed together on their dorsal surfaces from the commissure to the articulation between the first and second phalanges. The web does not involve the palmar surface. There is free motion of all the articulations of the fingers, with the exception of the distal articulation of the index finger.

Left Hand.-The thumb and ring finger are substantially free from deformity, and enjoy perfect motion. The ring finger is slightly drawn back by a cicatricial band, which, however, does not interfere with its movements. The little finger is drawn obliquely backward and outward to an extreme degree by a dense mass of cicatricial tissue. The distal phalanx is slightly flexed, and there is a little perceptible motion. The index and middle fingers are much distorted, drawn backward, and immovably fixed. The index is dwarfed and thrown behind the medius. The distal end of the medius is bent backward. A very thick, hard cicatricial mass, in which the index, middle, and little fingers are imbedded, occupies half of the dorsal surface of the hand, which is drawn back on the forearm.

I began the treatment to-day (Nov. 6th), with an attempt to improve the condition of the right hand. I made a longitudinal incision on the dorsal surface of the index finger about threefifths of an inch in length, extending over the distal extremity of the second phalanx and the proximal extremity of the third phalanx, dividing the skin, the extensor tendon, and the periosteum. I then carefully separated the periosteum from the boue, and with Liston's bone-forceps divided the bone of the second phalanx a quarter of an inch from its extremity, and removed the end of the bone. I also excised the cicatricial band by the contraction of which the end of the finger had been distorted. After this I was able to draw the end of the finger into its normal position; but it required some effort to hold it there. I then dissected up a triangular flap from the palm of the hand, the base of the triangle towards the articulation of the first phalanx of the thumb with the corresponding metacarpal bone, the apex towards the little finger, dividing the cicatricial mass. on each side, but the thumb remained fixed, or was liberated to a very slight degree. I then excised the distal end of the first phalanx of the thumb in the same way in which I had operated on the index finger, and about to the same extent, after which I was able to bring the terminal phalanx of the thumb into a nearly straight position. I divided the web connecting the index and middle fingers, up to the commissure.

After waiting for the oozing of blood to cease, I brought together with sutures the wounds on the back of the index and of the thumb, and a part of the wound in the palm of the hand. I then applied a felt splint adapted to the dorsal surface