POST-MOKTEM INTRAUTERINE CHANGES. 299 



Three of these 21 cases of clubbing were classed among the normal and 18 

 among the pathologic. With the exception of 3 fetuses which had a length of 100, 

 130, and 220 mm., respectively, all were less than 100 mm., the average length being 

 48.9mm. While it may be possible to recognize genuine clubbing, due to the absence 

 of the bones or to defects in them so early in fetal life, by microscopic examination 

 or by other special methods, this certainly can not be done by inspection alone. 

 Hence it is clear that the term dub-foot, as used in the classification of this col- 

 lection, is without special implication, except that it tells something about the 

 shape of the periphery of the extremities. 



It would also seem that if all these cases of deformed extremities in fetuses 

 were true developmental anomalies, they should be encountered in well-preserved 

 specimens, and more frequently in the older ones. That other anomalies should 

 be found associated more frequently also seems to follow from our knowledge of 

 congenital club-hand and club-foot. Among these genuine cases defective develop- 

 ment of the bones seems to be more frequently noted, for congenital club-hand 

 nearly always is accompanied by absence of either radius or ulna, while in the 

 cases under consideration here such an absence has not been established. Nor is 

 it without significance that the most pronounced forms of club-hand and club- 

 foot found in these fetuses always occurred in those longest retained and most 

 macerated. Many of them also show quite general evidences of the presence of 

 pressure defects, and unless it can be shown that a tendency to progressive elimina- 

 tion of specimens with double club-foot and hand exists, with survival of those 

 suffering from club-foot alone, one can not harmonize the frequent association of 

 these defects in fetuses with the conditions as known to exist at the time of birth. 

 However, since certain forms of congenital club-foot are probably also the result 

 of intrauterine pressure, the types found in fetuses if the latter survived would be 

 quite similar or even identical, in a morphologic sense, with the condition in the 

 newborn; yet in one case growth would have ceased before the pressure became 

 effective, while in the other it continued. The fact that congenital clubfoot is 

 relatively seldom due to bony defects would also seem to point to external factors 

 as causes, but I have no final opinion on this matter and am calling attention 

 to it merely to emphasize the fact that post-mortem intrauterine changes resulting 

 from maceration and pressure, or from both, may easily cause confusion in young 

 cyemata. 



