M. R., white girl, aged 12 years, was referred to me in December, 1914, with the following history: Five months before, the ends of both thumbs had become swollen and painful. A pustule appeared on the ball of each thumb. These pustules were incised by the patient's physician, evacuated and dressed at intervals for this period. Amputation of the terminal phalanges was suggested, but was refused by the family, who at about this time moved to Newark and brought the child to me.
Examination revealed a sinus on the ball of each thumb, and loose bone could be detected on probing. A roentgenogram taken by Dr. C. F. Baker, Dec. 28, 1914, revealed complete destruction of the terminal phalanges of each thumb, extending to the epiphyseal line. There were loose sequestra, in each case, as shown in Figure 1. Under local anesthesia, the sinuses were enlarged and the sequestra removed.