2 . The Philippine Journal of Science 1922 
skiagrams. Permission to dissect was refused in Case I, and 
in Case II, which is still living, it was of course out of the ques- 
tion. The study of skiagrams alone is not sufficient, nor is it 
entirely satisfactory unless supplemented by actual dissection, 
for the reason that the shadows are often so indefinite that 
one cannot always accurately determine union or separation of 
bones. Moreover, the soft parts blur the image according to the 
position of the member at the time of the exposure. This ig 
true of the skiagrams of the tarsus in both cases where no 
definite idea could be gained from the most careful study of the 
shadows. Hays reports the finding of partial bony union, 
after actual dissection, which was definitely indicated as separate 
in the X-ray picture. In judging the size of bones from X-ray 
pictures alone, we again court error which may cause consider- 
able discrepancy. There was no alternative in our cases, so we 
had to do the best we could, under the circumstances, by using 
articulated adult extremities for comparison and control. 
CASE I 
A Filipino woman, aged 35 years, brought to the morgue, hav- 
ing died from accidental burns. She appeared well nourished 
and showed no deformities ‘other than those of the extremities, 
the description of which follows: 
Right hand.—The right hand shows only three digits: the 
thumb, the ring finger, and the small finger. The thumb is 
distorted. It seems to show muscular atrophy, with wrinkling 
of the skin, and tapers to a point, devoid of nail beyond the bone. 
The ring and small fingers are syndactylized by the soft tissues 
at their contiguous margins throughout their entire length. 
Each is provided with a distinct, apparently normal] nail. (Plate 
1, -ag1) 
The carpal bones are distinct and complete in number. The 
greater and lesser multangulars appear displaced distally and 
laterally, but otherwise the entire carpus seems normal. . 
The metacarpals are also complete and distinct. The first 
seems to have been partially disarticulated from the greater 
multangular, as apparently indicated by a wide gap between the 
two and by the direction of the axis of the first metacarpal, 
_ being pushed decidedly inward, parallel to the bones of the 
forearm, instead of diverging outward as it would do normally. 
The second and third are considerably displaced laterad; the 
second is somewhat smaller than normal. The fourth and 
fifth are likewise pushed to the medial side, leaving a triangular 
