FUSION OF HANDS. iSS 



wrist it "•ives off a ver}- small posterior branch, which is not well preser^■erl but which 

 seems to have had less than the usual distribution. 



The median nerve is normal as far as the elbow, running to the inner side of the extra 

 internal condyle. It is then lost in the dried libers of the Jiexor suhlimis, from which it 

 emero-es in two main divisions near the middle of the forearm. The inner of these soon 

 divides into two, of which one supplies the adjacent sides of the ring and middle fingers 

 and the other those of the middle and index fingers of the normal hand. The outer division 

 of the median supplies the outer side of the index and both sides of the extra middle 

 fino-er and one side of the extra ring finger. One of the branches to the index gives off 

 a dorsal branch, and there is a doubtful one for the extra middle finger. The musculo- 

 spiral nerve passes behind the humerus as usual. A nerve which is undoubtedly continuous 

 with it emerges from the hardened muscles over the fused outer condyles. It seems to 

 be the radial branch changed into an ulnar. It runs with the extra ulnar artery to the 

 hand, and sending a deep branch into the palm, goes to the little finger. Its continuation 

 is plain along the side of the little finger nearest to the ring finger. Tliere is a detached 

 branch on the other side of the little finger which in all probability came from it. The 

 deep In-anch sends a twig along the metacarpal bone of the ring finger. It probal)ly sup- 

 plied the side of the ring finger left unprovided for, but this is uncertain. Assuming this 

 to have lieen the case, each idnar nerve supplies the palmar surface of one finger and a half, 

 the median supplying the remaining fingers of both hands. Unfortunately no dorsal branches 

 except those mentioned have been preserved. 



Precisely of what nature and how extensive the movements in this extremity may 

 ha\e been is not easy to determine. Imt certain main facts are pretty evident. It is very 

 probable horn the structure of the spine of the scapula and the want of a deltoid ridge on 

 the humerus that this muscle was a weak one. It is certain that the joint at the elljow 

 allowed but a very limited amount of flexion. There can have l^een no true pronation and 

 supination whatever, though some irregular movement of the two ulnae on the humerus 

 may have been possible. The cast with the strong cords at the front of the wrist, made 

 probably by the ulnar flexors of the wrist and i\vi pahnarls lonyus, seems to show conclusively 

 that the hand was habitually flexed on the wrist and that no great extension can have 

 been possible. The movements of the carpus are entirely a subject for speculation. It 

 seems probable, however, that they were very free in various directions. Pronation 

 and supination were doubtless performed at the shoulder and wrist, with the help of 

 some change in the amount of extension at the elbow aided by vague lateral move- 

 ments. 



A very curious featiu'e of this extremity is the evident attempt of the extra ulna to 



