The Southern herald., 1886-03-13
MANUAL SURGERY.



eessory tendons of the extensor commu-
mis- digitorum muscle is attracting in
creasing attention. The weakness of
the third or ring finger is due to two
accessory tendons connecting its mo-
tive muscle with those of the second
and little fingers.
In consequence of this connection,
the ring finger is incapable of free and
independent motion. Every one has
probably noticed his own inability tC
raise his ring finger any distance above
the plane of the hand when the neigh
boring digits are not similarly elevated,
and, if musician, has found it a great
Inconvenience. Occasionally these
tendons are found to be present only
in one hand, which is usually the right,
and in rare cases they are entirely
absent. The restriction which they i'm
pose upon the motion of the ring finger
can be somewhat lessened by incessant
practice, but can never be entirely
overcome. 1t is continual disadvan-
tage, both in music and in other arts
To free the ring finger by dividing
the binding tendons is not new sug-
gestion, but it has only been during the
past year that the operation has come
into any prominence. DR.. William S.
Forbes. Of Philadelphia, has given the
subject particular attention. The opera
tion, as practiced by him, is very sim
pie, but should only be undertaken by
one well acquainted with the anatomy
of the hand. A narrow, pointed bis
toury is inserted into an incision less
than one-sixteenth of an inch in length
made through the skin and fascia, just
below the carpal articulation of the
metacarpal bone of the third finger,
and above the radial accessory tendon
of the hand, parallel with the extenSor
muscle. The blade of the bistoury is
kept horizontal, and the handle is
somewhat depressed. In this position
the blade is moved beneath the ac-
cessory tendon, and so far down the
hand as to be a little above and be,
tween the knuckles of the third and
middle fingers. The instrument is now
turned with the edge toward the skin.
The middle finger being strongly
dexed, and the accessory tendon made
taut by extending the ring finger, a
gentle saving motion of the blade
sewers the tendon at once. The bis
toury is turned flat again, and with
drawn through the incision. The ten
don on the opposite side of the extern
sor muscle, that is, between the third
and little fingers, is divided in
similar manner. Not quarter of o
drachm of blood is spent by the opera
ton. Each incision is covered by a
piece of adhesive plaster, and g figure
of-eight bandage carried around the
wrist and hand. Two days after the
operation, the patient is required to ex-
ercise on the piano in order to prevent
the tendons from reuniting. A slight
swelling remains for perhaps a week,
at the end of which time the liberation
is complete, and the ring finger can be
elevated an inch further above the
plane of the hand. DR.. Forbes writes
us that up TO December 10, 1885, he
had performed the operation upon
tifty-two patients, and that in all cases
the result was perfectly satisfactory.
The operation has raised a great deal
of opposition among more conservative
musicians, who maintain that partial
freedom bought by years of constant
exercise is preferable to perfect liberia
ton gained by few minutes surgery.
Others, again, contend that the method
3 unnatural, and tends to interfere
with the designs of creation. But this
is an objection which we need scarcely
argue. Such a question should give
rise to no partisanship. II the method
be good it should be accepted. If it
does not prove efficient, the suggestion
has done no injury. The favorable ex-
perience of so large number of pa.
tients is certainly a strong argument in
its favor, All of these people testify
that the freedom resulting from the
operation is most gratifying, and that
they have experienced no loss of power
in any other direction.
The discussion has also been taken
up with much interest on the other side
of the water. One of the most cele-
brated English surgeons, DR.. Noble
Smith, has repeated the operation with
perfectly satisfactory results. He rec
ommends, however, that it be per-
formed by an experienced operator,
and in cases where the accessory ten
dons are well defined. He regards the
risks of the operation as infnitesimal,
but very properly adds that the patient
should, nevertheless, be warned that
no wound can be made without some
danger. Scientific Americ0n.