ENCEPHALOCELES AND OTHER ABNORMALITIES. 



99 



long and 2 mm. in diameter. This rod is joined at its other end to the everted 

 arches of the vertebra 1 underlying it. On the left scapula the subscapular angle 

 is 117, the supraspinous angle is 109.5 and the infraspinous angle is 133.5. The 

 left scapula shows a rather interesting condition, presenting three out of four features 

 often associated with Sprengel's deformity (congenital elevation of the shoulders). 

 These are, according to Horwitz: (1) changed relations of the diameters to each 

 other; (2) bending forward of the supraspinous process; (3) prolongation or round- 

 ing of superior median angle; (4) presence of exostoses and articulations with the 

 vertebral column. 



In this case the exception to the above conditions is the superior median angle, 

 which can hardly be called prolonged. Scapular measurements of the new-born 

 could not be found in the literature, but two supposedly normal sets were obtained 

 from mounted skeletons belonging to the Obstetrical Department of the Johns 

 Hopkins Hospital, and the measurements of several other scapulae were available 

 through the courtesy of Dr. A. H. Schultz. 



TABLE 3. 



omparison in millimeters of Ihu scapular HIKIXKK mi nls <>/ specimen with those 

 of several normal new-born. 



Table 3 shows that the ratio of the diameters of the right scapula of 862 a is 

 near those of the supposedly normal bones. The left scapula, on the other hand, 

 has the relations of its diameters reversed. The transverse diameter exceeds the 

 vertical. Thus its morphological index is 106.8, while none of the normal indices 

 exceeds 80. The subscapular angle on the left side is somewhat smaller than on 

 the right. The bony articulation joining the left scapula to the vertebral column 

 is attached in the upper third of the vertebral scapular margin as in most of the 

 Sprengel deformity cases. Some interest is attached to this abnormal bony spicule 

 and various suggestions have been made concerning it. The opinion seems to be 

 generally accepted that it arises from its scapular end. Cases are recorded in 

 which other anomalous bones are joined only to the scapula, and their occurrence 

 substantiates this view. Case xvi in von Recklinhausen's paper is a monster very 

 like No. 862a. In it there is " ein 1 cm. langer knocherner, rippenartiger, am oberen 

 Winkel des knorpeligen Schulterblatts articulierender Korper. " Gruber gives a 

 case found in an adult male cadaver of a "fortsatzartigen, cylindrischen Hocker an 

 der Vorderflache des Angulus superior der Scapula." No satisfactory hypothesis 

 has been advanced to further explain the origin of these bones. The length of 

 the right clavicle is 39 mm. while the left clavicle measures 34 mm. and is slightly 



