t, render the appearance
on the palmar aspect characteristic.

The attitude is one of slight flexion with drooping of the hand and
fingers. The fingers become stiff as a result of adhesions in the
tendon sheaths, and the power of opposing the thumb and fingers may be
lost. Pain is usually absent until the articular surfaces become
carious. Softening of the ligaments may permit of lateral mobility,
and sometimes partial dislocation occurs. Abscess may be followed by
sinuses and infection of the tendon sheaths, especially those in the
palm.

The localisation of disease in individual bones or joints can be
determined by the use of the X-rays.

_Treatment._--Conservative measures may be persevered with over a
longer period than in most other joints. The forearm, wrist, and
metacarpus are immobilised in the attitude of dorsal flexion, while
the fingers and thumb are left free to allow of passive movements. It
may be necessary to give an anaesthetic to obtain the necessary degree
of dorsiflexion. To inject iodoform, the needle is inserted
immediately below the radial or the ulnar styloid process. Sometimes
the carpal bones are so soft that the needle can be made to penetrate
them in different directions. Operative treatment is indicated in
cases which resist conservative measures, or when the general health
calls for speedy removal of the disease.

_Other diseases of the wrist_ are comparatively rare. They include
pyogenic affections, such as those resulting from infective conditions
in the palm of the hand, different types of gonorrhoeal, rheumatic,
and gouty affections, and arthritis deformans. An interesting feature,
sometimes met with in arthritis deformans, consists in eburnation of
the articular surfaces of the carpal bones, although the range of
movement is almost nil.

THE HIP-JOINT

Owing to the depth of this joint from the surface, it is not possible
to detect the presence of effusion or of synovial thickening as
readily as in other joints, hence in the recognition of hip disease we
have to rely largely upon indirect evidence, such as a limp in
walking, an alteration in the attitude of the limb, or restriction of
its movements.

The whole of the anterior and fully one-half of the posterior aspect
of the neck of the femur is covered by synovial membrane, so that
lesions not only of the epiphysis and epiphysial junction, but also of
the neck of the bone, are capable of spreading directly to the
synovial m