BONES AND JOINTS.
In the amputation of the metacarpal bone of the thumb, which is easily performed at its articulation with the trapezium, the edge of the knife should be kept close to the ulnar edge of the bone, in order, if possible, to avoid wound ing the radial artery as it traverses the inter osseous space. The metacarpal bone of the little finger may also easily be removed by an operation similar to that practised for the thumb; the articulating surfaces are nearly plane and inclined obliquely upwards and inwards. Disarticulations may also be per formed of the other metacarpo-carpal joints; but the operations are very difficult and em barrassing, owing to the irregularity of the articular surfaces and their close connexions with each other, and in removing them singly a much neater and easier plan is, if their upper extremities are sufficiently sound, to saw through them in an oblique direction.
In amputating at the phalangeo-metacarpal articulations the flap is, if possible, made on the palmar surface. At the first joint of the fingers two flaps arc preserved by making two semilunar incisions, which extend from the head of the metacarpal bones to the termination of the commissure of the fingers, meeting be hind and before at the joint, which is an inch above. They may all be amputated together when a single flap is made on the palmar surface terminating at the line in the skin that bounds the commissure. In amputating at the other joints of the fingers it is necessary to recollect the marks, before alluded to when speaking of the skin, and to divide the lateral ligaments before entering the joints.
( F. T. 111'.Dougall.)