II. IIUINKWAÏKII. -- Sirnv 01' A liliACIIVDACTVLOUS FAMILV. 5.')3 



/)"' There is slill anolher l'aclor, and one lo wliich a large share of Ihe shorte- 

 iiing is atli'ibutable. I hâve alreaily drawn allenLion lo Lhe pièce ofcarlllage or 

 i^n-islie liotween lhe shafl and epiphysis. So long as Ihis cartilage remains, lhe 



bone can and does increase in lenglh 

 pari pafisu wilh lhe ^^ 



growlh of lhe indivi- jal 



ihial, bnt aller il has LZj 



1 o 



become ossified, no i — \ 



furllier growlh of llio j i- j 



boue in lenglh can 

 occnr al Ihis poinl. 



Now, Ihis layer of 

 carlilage does nol be- 

 come ossified in lhe 

 normal individual unlil 

 aboul lhe 20"' year, so 

 Ihal unlil Ihat âge lhe 

 |ihalanx can and does 

 increase in lenglh. 

 If liowever. ossifica- 

 lion occurs premalii- 

 rcly, lhe growlh of lhe 

 bone will be arresled, 

 and a permanenl shor- 

 i;(l,i(i\- loiiing will be lhe 

 '""'■ resull. 

 Tins is exaclly «liai lias happeneil in Ihis l'amily espe( 

 and mile fingei's. 



In figure ô lhe secon<l phalanx is seen lo be veiy shoi 

 This is lhe liand of a woman (N" 0). 



Figure 10 shows lhe hand of lier son aged 1 4. Ilere Ihere is no sign of an 

 epiphysis lo lhe second phalanx excepl in lhe middle finger: whei-e il has 

 already uniled lo lhe shafl. Ihrough premalure ossification of lhe carlilaginous 

 plaie. In lh<» ollier lingers il would appear never lo bave been présent. The 

 abnorinalily in Ihis hny's hand w ill Iherefore l)e an almosl exact repelilion of 

 lhe molhers. 



Thèse Ihree cases represenl lhe exlriMue type of deformily in Ihis l'amily. 

 Figure II shows a modification of Ihis type in lhe adull. Il shows llu; 

 hand of lhe woman N" 12 in lhe chai-l. The second phalanx is seen lo be niucli 

 more shurli'neil in lhe index and lilllc linucr llian in lhe middle and rint,-- fin- 



c 



■<\ I 



H. s. — Oulliiio 

 ol'bones(nntfiilly 

 ossified) or bra- 

 chydaclylous (in- 

 g(?rs of a chilri. 

 — I. Ist plKilaiix 



AvillM.|,i|,hysisiH 

 lia.r — '.' 'Jll.l 



phalanx «illmul 

 ,.pi|,liysis. 

 Tcniiiiia! 

 laiix will 



|,lia- 

 ''l'i- 



n Ih 



(■// fini>e 



irsl 



lldw inay Ihis be accoiinled loi.' 



I lliink lhe explanalion is supplied by lhe Radiograph (Fig- 12) of lier 

 daughler aged 8 years iN" I!)). In Ihis girl's hand there is an a|)j)arenl 

 absence of lhe epiphysis from lhe -4"' linger(2nd phalanx) and in lhe index finger 

 ankylosis has already laken place; but in lhe middle and ring fingers Uie epiphy- 

 sis is slill separaled by carlilage which has nol yel undergone ossification. 

 When growlh is complète this giiTs hand will be like lhe mother's wilh lhe 

 2n(l phalanx much shorler in llie Isl and llh lingers than is lhe 2nd and ."rd. 



