298 STUDIES ON PATHOLOGIC OVA. 



when these changes may have occurred in a sterile medium. The difficulty of 

 distinguishing between ante-mortem and post-mortem changes, which impressed 

 Phisalix and also others, is very great, if not insurmountable in some cases. This 

 is true especially if it be assumed that an irregular or uncorrelated growth can occur 

 under post-mortem, ante-partum conditions, for such growth could easily produce 

 anomalous forms. But it must be admitted that the existence of a genuine post- 

 mortem growth is merety an inference at present. 



In considering some of the strange forms to which attention has been called 

 one can not disregard such instances in the newborn as that reported by Cowie 

 (1914). The posture of this infant reminds one very strikingly of some of the 

 fetuses in the accompanying illustrations. This seems very disconcerting at first 

 thought, but there is, of course, no reason why a condition responsible for the 

 occurrence of multiple intrauterine fractures, such as are present in this infant, 

 should not result in very abnormal postures. Moreover, if fetal bone disease may 

 begin very early, it is also probable that some of these strange, relatively .early 

 fetal forms well may be genuine fetal anomalies and pathologic in addition. 



The cases reported by de Lima (1915), especially cases 2 and 3, also belong 

 among those which simulate some early fetal forms. Nevertheless, in these, and 

 also in the other 2 cases reported by him, de Lima found bony defects. The same 

 thing was true of the outwardly similar cases in infants and children reported by 

 McKenzie (1897). 



However, in view of the occurrence of these outward resemblances, it is not 

 always possible to distinguish normal specimens which have suffered post-mortem 

 deformations or changes in posture of the extremities from true developmental 

 anomalies by outward inspection alone. This difficulty is particularly great in 

 connection with changes in form and position of the hands, the feet, and the head 

 and neck, and greatest of all, in connection with the knees. Even a cursory ex- 

 amination of some of the accompanying figures must also show that we at present 

 are unable to decide whether any of these young specimens with pronounced 

 deflections of the head and neck are cases of genuine torticollis and others are 

 genuine cases of club-hand or club-foot, or genu varus, or valgum, for example. 

 Indeed, this difficulty could be avoided only if these conditions arose only late 

 in pregnancy, or if the cyemata showing them never were aborted before term. 

 Waiving the exact definition of club-hand and club-foot, it must strike the attention 

 of anyone that caput obstipum and apparent club-hands and club-feet so often are 

 associated in these relatively early specimens, most of which are decidedly macer- 

 ated. In 10 out of 21 cases of club-hand and club-foot listed as such among 3,000 

 accessions, excluding 2 cases with an embryonic length of 2.5 and 16 mm., respec- 

 tively, clubbing was present in all the extremities. This is a wholly different 

 relationship from that which obtains between these anomalies at the time of birth, 

 when they seem to be associated but very rarely. However, in practically all of 

 these cases of universal clubbing of macerated specimens the anomaly is associated 

 with other developmental defects, as is not infrequently the case in the congenital 

 condition. 



