476 THOMAS DWIGIIT ON THE 



The man \va-< a workingman, and it is stated could do only coarse work (grobe Arbeiten). 

 Nothing is said of the motions of the elbow. 



12. Gerrhixi. GarMta Med. Ital.-Lomhardo. No. 51. 1874. A boy five years old 

 had six fingers on each hand divided into two groups. It is a clear case of the fusion of 

 the ulnar sides of two hands. 



1-3. Laxgalli. La scienzaelapratica. Pavia, 1S75. An account of a wax model of 

 a girl's right hand found in a museum. Four fingers of tliree phalange-? represent the nor- 

 mal hand. The other four represent theab?ent thumb. Again there seems no doubt that 

 this is a case of fusion. 



14. F. Jolly. Festschrift, Rudolf Virchow gewldmet. Band I. Berlin, 1891. This 

 case is the most important one. The individual presenting the peculiarity was a living 

 man, twenty-five years old, without hereditary predisposition, but of peculiar and deficient 

 mental organization. The deformity was on the left arm, which from the shoulder down 

 was smaller and shorter than the right. The fingers were in two groups of three, each 

 consisting of a middle, ring, and little finger. The fingers of the group on the outer, or 

 radial side, were those of a right hand. One proximal phalanx of the extra set was broad at 

 its base so as to articulate with two metacarpal bones, of which there were seven in all. 

 The internal condyle of the humerus and the normal ulna were easy to feel. There was 

 no distinct external condyle and no head of the radius could be made out. Along the front 

 of the humerus in the region where the biceps should be " there is felt instead of that 

 muscle a strong bony ridge which runs to the bend of the elbow and ends in a blunt prom- 

 inence." As well as could be judged on the living, it would seem as if on about the 

 lower two thirds of the humerus there was an outgrowth, or another bone fused with it on 

 the front and outer side. The outer bone of the forearm feels at the wrist more like an 

 ulna than a radius. The man can raise his arm at the shoulder but little above a horizon- 

 tal line. It can, however, be l)rought passively to a vertical position. The photograjih 

 shoAvs a flattening in the deltoid region. The elbow can be flexed actively only to an 

 angle of about 150°. Passive flexion does not exceed 120°, the above mentioned bony 

 process locking the joint. There is next to no pronation and supination. The hand can be 

 both actively and passively flexed and extended. So can, also, the fingers either individ- 

 ually or in groups. The photograph shows a tendency to flexion and pronation of the 

 hand which the author does not mention. Dr. Jolly thinks one would be inclined to be- 

 lieve that the ulnar parts of two hands and two forearms had been fused together while the 

 radial constituents had in part been lost. He says that whether his interpretation, made 

 on the living, is the correct one will be shown certainly when there is a chance to examine 

 an analagous case. 



It should be noticed that of the preceding cases in 1, 2, 5, 6, and 9 there are two practi- 

 cally complete hands. In cases 1 and 2 (if there be no mistake) these are joined on the 



