SUBSTITUTE PHYSICIAN. A recent graduate of Boston University School of Medicine, with hospital, dispensary, and maternity experience, would like to take a physician's practice for the summer. Address "H. W. A.," care of Otis Clapp & Son, 10 Park Square, Boston.

WANTED. A position as substitute by a graduate of Boston University School of Medicine. Address "H. F.," care of Otis Clapp & Son, 10 Park Square, Boston.

REMOVAL. - Dr. Jennie S. Dunn Cary, class of 1887, Boston University School of Medicine, has removed from Dorchester to No. 14 Weld Avenue, Roxbury.

PRACTICE FOR SALE. A physician retiring from general practice desires to dispose of his business in a suburban town within a short distance from New York. The practice is large, among a refined class of people, and collections are a very large percentage of charges. The place demands a man of experience and some capital, and to such a one affords an exceptional opportunity. Address "W.,” care of NEW ENGLAND MEDICAL GAZETTE (Otis Clapp & Son), 10 Park Square, Boston, Mass.

[Read before the Massachusetts Surgical and Gynecological Society.],

In the glamour and glory associated with capital surgery, we are prone to forget, or at least attach but little importance to, operations for the relief of mutilations and malformations. of lesser parts. It is very rare that life is lost because of hand mutilation, and when such a dire catastrophy does occur it is the result of virulent microbic infection rather than from loss of the member or of its function.

Victims of hand wounds are careless or indifferent, because of this immunity from fatality. The priceless value of a perfect hand is unappreciated until it is lost. Scarcely a more appalling disability can confront one than the loss of the hands, either in form or function.

In the finger tips resides the sense of touch. Through these highly specialized nerve terminals the blind read and the dumb talk. Without sight, without hearing, without speech, if but the hands are perfect, the light of education may reach the soul. With all other senses in their full vigor, absence of hands renders one a hopeless, helpless dependent. To a limited degree the feet may be educated to take the place of the hands, but their conformation and limited range of movement forbids more than the most commonplace functions. An armless dime museum freak was once exhibited. in this city, and his accomplishments were widely heralded in the public print. He could write a fairly legible — shall I say hand or foot; he could pick up small objects and move

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them from place to place. I distinctly remember seeing him sort out a desired key from a key-ring bunch and unlock a chest. In the school for crippled children there is an armless boy who has learned to work a typewriter with his toes, and write with crayon on a blackboard, and to do sundry other acts, surprising as foot accomplishments, but miserable failures when compared with the wonderful craft of the human hand.

The hand is an obtrusive member, always putting itself in dangerous places. If violence threatens the face, the hands are raised involuntarily to ward off the danger. If the equilibrium be lost, and a fall forward, backward, or sidewise be imminent, the hand goes out and takes the impact of the blow. In mechanical employments the hand is carried perilously near the rapidly revolving saw, the ravenous spines of the moulding machine, the hungry rollers of the hot laundry mangle, and alas, sometimes too near, and in a twinkling of an eye is off or a shapeless mass.

In a surgical practice of twenty years, many extremely interesting cases of hand surgery have come under my observation, many of which have already been reported, and all of which I propose to shortly embody in a monograph upon the "Surgery of the Hand."

To-day I purpose to lay before you only a few recent cases. of more than passing interest, to show what modern surgery may do to improve maimed and almost useless hands, and how much may be accomplished by the patient in training a mutilated hand to usefulness. Incidentally I would also like to suggest, as a subject of discussion, maternal impressions and their bearing upon congenital malformations, illustrated by a case of defective hand which I hope to show you.

I. A Case of Tendon Suture.

During my last term of service in the Massachusetts Homœopathic Hospital, a case was sent in by Dr. H. J. Little, of Norwell, in which the metacarpal bone of the left index finger had been severed by a blow from an axe. Both flexor and extensor tendons were severed, and the cut extended

through from dorsum to palm. Dr. Little had carefully sutured the skin wounds as a temporary measure to keep the parts supported, pending arrival at the hospital. The wound was reopened, and the ends of the severed tendons sought. The proximal ends were retracted far within their sheaths, but were finally found and brought into the field. The segments were then united with fine silk sutures adjusted at intervals about their circumference.

The wound was freely irrigated with one fourth per cent formaline solution and the integument sutured with continuous catgut. Prompt healing occurred without suppuration. Dr. Little reports the present condition, six months after the accident, as follows:

"The patient, Mr. J. H. P—, cut his hand with an axe while chopping fire wood. The handle of the axe caught on the chopping-block, causing the axe to bound upward, and as it descended again it came across the back of his hand. The cut extended from the head of the third metacarpal across the shaft of the second metacarpal just above the joint, severing the bone and both flexor and extensor tendons nearly to the first metacarpal. The axe penetrated to the palm of the hand, leaving a wound about an inch in length beneath the second metacarpal. The muscular substance between the first and second metacarpal was divided to a certain extent.

"The wound healed nicely on the dorsal surface, having a fine linear scar. On the palmar surface there has been some cicatricial contraction, but not enough to impair motion of the thumb.

"The second finger is stiff, with some motion at the metacarpo-phalangeal articulation. The motion is impaired more than half, I should say. Below that point there is no motion, as the tendons do not work and the finger is slightly flexed. Whether this result is owing to non-union or adhesions at the point of union where it was severed I cannot say positively, but am inclined to think the latter is the trouble. There is a freer movement of the thumb than is normal on account of the muscular division, but he says it is as good as ever. There is a certain amount of stiffness of the third and fourth fingers on flexion.

"He is perfectly satisfied with the result, and his finger is useful to him in all the work he has to perform. From a surgical point of view, however, I should say that the operation was a failure as far as the restoration of the tendons and their functions are concerned."

The present condition as described by Dr. Little is interesting. Voluntary flexion and extension, even though it be restricted and limited to the metacarpo-phalangeal joint only, shows that the tendons are united, for there are no other sources of motion of the index finger. The limitation of motion is easily accounted for by entanglement of the tendons in the cicatricial tissue and adhesions incident to repair in the deeper parts of the wound.

2. A Case of Powder Burn of the Hand.

Mr. H—————, while conducting Fourth of July celebrations in a suburban town, suffered a very severe burn and mutilation of the right hand from a premature explosion while priming a cannon.

Long after healing had occurred he came under my care, presenting an extensive scar on the ulnar side of the palm and contraction of the ring and little fingers quite into the palm of the hand. The scar tissue was cut away, the fingers straightened, and skin grafting by the Thiersch method resorted to. The interesting feature of the case was a splinter of wood about one and one half inches long which was found imbedded in the densest part of the cicatrix. It had remained there six months without provoking suppuration. A good result followed the operation, although some curvature of the finger persists.

3. A Case of Tubercular Ostitis of the Ring Metacarpal.

Miss M, a young woman of eighteen years, consulted me for a fusiform swelling along the right ring metacarpal. It had already reached such proportions that the neighboring metacarpal bones were pushed apart and the dorsum of the hand was markedly rounded. An incision had been made some months previously by her physician in New Brunswick,