FUSION OF HANDS. 477 



ulnar side. The point is not mentioned in cases 5, 6, and 9, which are of little value. 

 Case 3 is unsatisfactory. It is certainly allowable to question whether the phalanx grow- 

 ing in one case from the seventh finger is rightly called the thumb. If it be not a thumb 

 this case may be considered the result of the fusion of the ulnir portions of two hands. 

 Case 4 is also wanting in clearness. This leaves cases 7, 8, 10, 11, 12, 1.3, and 14 showing 

 fusion of the ulnar parts of the hands with suppression of more or less of the radial parts. 

 For reasons which will appear later it is probable that in several of these, the duplication 

 of one .side and the suppression of the other are not limited to the hand. 



The next case is placed last, out of the chronological order, because, though the poly- 

 dactylism is also due to the fusion of a part of an extra hand, it differs extremely from 

 the othei's. 



15. Carre. Seance picblique cle la Soclete Roy ale de Medeclne, Chiriirrjie, et Phar- 

 macle de Toulouse. 1838, j^p. 28-30. A goldsmith had on his right arm, beside the normal 

 hand, an extra thumb and index finger. The latter thumb was next to the normal one 

 and the index further from it showing that of course they belonged to a left hand. In- 

 deed the two thumbs were united and had, according to Carre a common metacarpal joint. 

 They were of equal size. They were flexed and extended together and had the power of 

 spreading apart. The next finger arising from the outer side of the thumb was shaped 

 like an index and had free motion in flexion, extension, and abduction. Besides the radius 

 and ulna of the normal arm there was an extra radius on the outer side of the former, 

 joined to it at the wrist, but separated from it above by an interval that could be felt. It had 

 a joint of its own at the elbow. The motion of each bone could be felt, though pronation 

 was impaired. The wrist was broad, implying the presence of additional bones. Nothing 

 is said of a metacarpal bone for the new index. 



The present specimen is the left arm of a German machinist thirty-seven years old who 

 died of chronic diarrhoea at the Massachusetts General Hospital in Boston in March, 1852. 

 The arm was dissected by the late Dr. Ainsworth and made into an old-fashioned dried 

 and varnished preparation showing most of the muscles of the upper extremity and the 

 chief arteries and nerves of the forearm and hand. The parts, of course, are much 

 shrunken and distorted, but the specimen has kept unchanged. There is no account of 

 any deformity excepting of the left arm. From a hint in the Hospital Records and from 

 an anecdote told by a physician who remembered him. it may be inferred that the patient 

 was of loose morals and of a peculiar temperament, which is recorded from the similarity to 

 Dr. Jolly's case. Figures 1 and 2 of plate 43 represent a cast taken after death which also is 

 in the Museum of the Harvard Medical School. It shows a left forearm and a very broad 

 hand having four normal fingers and, in place of the thumb, the three inner fingers of a right 

 hand which were smaller than the others. The hand is flexed and somewhat pronated. 



