FUSION OF HANDS. 



485 



these two, but I believe it belongs with them. In two respects the case agrees with the 

 present one : flexion at the elbow is very limited, and when working on the floor the 

 woman supported herself on the back of the flexed carpus. This suggests a flexed position 

 of the hand. The metacai-pus was also, as in this case, strongly archeil. Mr. Murray 

 says that after many examinations he feels sure that the duplicity begins at the carpus. 

 This means that there is no third or fourth bone in the forearm. It implies no reflection 

 on hhn, to say that the idea of there being tw(j ulnae and no radius may never have occurred 

 to him. He finds a bony impediment to flexion at the elbow which he thinks is an 

 unusually large coronoiil. But such a malformation is, so far as I know, unheard of. 

 Is it not more plausible in the light of these observations to believe that the obstacle was 

 the supernumerary internal condyle or perhaps the inverted olecranon? Pronation and 

 supination, he says, were fi'eely performed. This is certainly a very sei-ious difliculty. 

 One might ([uestion, however, in the first place whether " freely " is equivalent to " per- 

 fectly" ; and it must be remembered that to one not very much on his guard these move- 

 ments are very deceptive. The part played Ijy the shoulder is greater than is often 

 believed. It is moreover not impossible that the articular surfaces at the elbow may have 

 been such as to allow a certain amount of irregular motion, which with the aid of the 

 shoulder and wrist joints, may have permitted a fair amount of twisting of the hand. With 

 all respect to Mr. Murray I can but think it most likely that the forearm consisted of 

 two ulnae. 



In the cases of Du Courai and of Fumagalli (Noe. 4 and 10) the hands could not 

 be extended. As has been already pointed out, seven of these cases showed fu.sion of the 

 ulnar sides of the hands with more or less suppression of the radial sides. The de- 

 scriptions of most of the cases are very inade(i[uate. Many of them are in children, in 

 whom perhapsa want of the proper motions of the elbow would be more easily overlooked. 

 It is probably more likely that such an oversight occurred, than that cases in which the hands 

 were evidently fused, as in this specimen, should have had forearms oi the normal struc- 

 ture. The chief importance of this observation is that in connection with Dr. Jolly's case 

 .it goes far to establish a type (jf a certain kind of polydactylism resulting from the fusion 

 of tlie ulnar portions of two hands. As has been pointed out, in all the cases recorded in 

 this paper, in which there is any statement of the fact, the fusion was of the ulnar portions 

 of the hands, excepting in cases 1 and 2 and in 15, the remarkable observation by Carre, in 

 which there was an additional tluunb and forefinger and an extra radius. It is to be 

 noticed in all these cases, which are at all adequately described, that the hands are fused 

 by corresponding sides. There is no instance of the ulnar side of one hand being joined 

 to the radial side of the other. 



The question as to the cause and the process of production of this deformity is very 

 interesting but very oljscure. The theory that amniotic folds may have caused a muti- 



