366 WilUdin Mackenzie : 



the skin were removed, or un endeavour might rather be 

 made to attach them to the Tibia. On the other hand, cases 

 of congenital absence of the Fibula in man, since, as before 

 stated, it may be associated with absence of outer toes, but 

 occaisionally Avith loss or deformity of the inner toes, are 

 associated with impairment of gait and operative interference 

 is necessary. The loss of inner toes seems to have caused difl&- 

 culty to surgeons in explaining, but the reason is easily under- 

 stood on comparative lines. On examining the foot of the 

 Kangaroo we see two degenerate inner toes, a powerful middle 

 toe, which is practically the continuation of the foot, and a 

 small, though intermediate, outer toe. No doubt the position 

 and length of the middle toe have been the determining factors 

 in its natural selection ; but in spite of this change in the foot 

 the Fibula is not congenitally absent, as a reference to the 

 description will show. Thus from a consideration of the mode 

 of disappearance of the Fibula in animals master exponents of 

 the same mode of progression as Homo Sapiens exhibits, it is 

 obvious that in causing a congenital absence of the Fibula to 

 occur in man. Nature has carried the progress of one of T'he 

 consequences of the erect position, and associated gait beyond 

 that of the other consequences with which it should be co- 

 ordinate, although she may thereby give us a hint of to what 

 this evolution is tending. In other words, if the consequences 

 of the assunaption of the erect attitude with its associated gait 

 are manifold, and must in the type which will be naturally 

 selected and eventually persist be co-ordinate ; and if Nature 

 has in these congenital Fibulae cases allowed one member of the 

 associated group of consequential processes to progress disco- 

 ordinately in advance of the rest, it suggests itself that the 

 indicated method of correction of the natural error lies along 

 either one of two directions. Firstly, bringing back the ad- 

 vanced member, e.g., plastically replacing the undeveloped mid- 

 fibula; or, secondly, recognising and permitting the condition 

 of this disco-ordinate member, and artificially re-establishing 

 co-ordination through the other members of the associated 

 group of consequences of the assumption of the erect attitude 

 and gait. 



