HAND INJURIES IN CHILDREN.

To be asked to address this Society is in itself a very great privilege, but uvhen the occasion is the first Founder’s Lecture of this Society and when the Founder was a man of such immense stature in surgery as Sterling Bunnell, I cannot help but tremble a little at the task that confronts me. There has rarely been a man uvhose work and whose writings have carried such a uveight of authority in his field. The immemise fund of knowledge that uvas documented in his early uvritings amid later collected into a book that is one of the masterpieces of surgical literature has fornied the background of the training of everyone of us in this hail. It is fitting to honor such a man. I have chosen to speak on the subject of hand injuries in children because this has been omie of the main facets of my work as plastic surgeon to the Royal Children’s Hospital in vIelbourne over the last fifteen years. During that period the great majority of hand injuries, other than of a trivial nature, which have been referred to the hospital have come under the management of myself and members of my departmrment. The patients range in age from birth to fourteen years. The most obvious feature of hand injuries in this age group is that the patterns of accidents are so different from those in adult life. What we refer to as the “umitidy” injuries, mainly the product of industrial accidents, explosive injuries, and the like, are seen occasionally in children who meddle in science laboratories or who play with detonators and the like; however, the great number of cases seen are cutting injuries in which tissue destruction and questions of viability are not the problem. They are received in and around the home by falling uvith a glass or bottle in the hand or falling on bits of broken glass or tin around yards and vacant allotments. By far the commonest offender in Melbourne in this regard is the milk bottle. Several years ago I examined the causes of a series of cut tendons and nerves in children amid found that 70 per cent were due to the child falling with a milk bottle in his hamid as he was running down a concrete path to put it out for the niilknian to collect. This figure has fallen considerably of recent years since uve have niade the public auvare of this risk in public health publicity campaigns, but it is still a very common caumse of injury. On the whole, the injuries were seen at the hospital uvithin an hour or tuvo of the accident and in most cases the children were admitted directly to our department. We have, therefore, had the opportunity of determining their treatment at the outset and this has had a profound effect on our approach to the management of hand injuries in children of all ages. Some cases, of course, were referred for secondary treatment either because of failed surgery elsewhere or because distance and other factors made primary referral impracticable. An analysis of cases referred for secondary treatment, however, revealed that a high proportion of the hands had residual lesions of temidons, nerves, or other structures whose existence was not recognized at the time when the surface wound was treated, uvith or without the aid of a doctor. rrhi brings me to the first real difference that exists in the management of children’s imijuries as compared with adults. Young children cannot give lucid mcdi-