chap, xiil] IRREGULAR POLYDACTYLISM : MAX. 353 



Case of double hallux in combination ivith extra digits on external 

 side. 



518. Man in Middlesex Hospital, 1834, having on the right foot two 

 toes articulating with the first metatarsal, and ou the left foot two toes 

 articulating with the first metatarsal, and also two toes articulating 

 with the fifth metatarsal. From the ulnar side of one of his hands 

 two fingers had been removed. In each hand the middle and ring 

 fingers were adherent throughout their length, as also were all the toes, 

 except the minimi. Five brothers and three out of four sisters of this 

 man had six toes on each foot and six fingers on each hand. The other 

 sister had seven toes on one foot and six on the other, and had two extra 

 fingers on each hand. London Med. Gaz., 1834, April, p. 65, figs. 



(4) Irregular examples. 



Thus far we have considered cases of polydactylisra that can be in 

 some degree brought into order and included in general descriptions. 

 There remain a small number of irregular cases each presenting special 

 features which make general treatment inapplicable. These cases are 

 instances of extremities, mostly feet, having seven, eight or nine digit-. 

 The descriptions of these cases are for the most part fragmentary, and 

 as the bones have been examined in only one of them (Moraxd) so far 

 as I am aware, the relations of the digits to each other and to the limb 

 are obscure. Speaking generally in these irregular examples there is 

 an appearance of division, possibly of duplication, of several digit-. It 

 should be noticed also that in some of them (e.g. Blasius, No. 520) the 

 digits did not lie evenly in one plane but were in a manner bunched up 

 so as to overlie each other. In such a case it would be interesting 

 to know whether the digits originally grew in one plane and were 

 afterwards shifted during growth, or whether the original Repetition 

 was thus irregular. 



As all these cases differ from each other an adequate account of 

 them could only be given at great length, and by reproducing the 

 original descriptions in full, together with such figures as are attainable. 

 For these reasons it would not be profitable to introduce them here, 

 though in a study of the nature of Meristic Repetition it is important 

 to remember that these irregular cases exist. As illustrative of several 

 cases I have appended an account of two complex cases in the foot and 

 of one in the hand, giving references to such others as I am acquainted 

 with. 



19*. Girl, set. 6, having abnormal toes on the left foot as follows (Fig. 103). The total 

 number of toes on the left foot was nine. From the position and form it appeared 

 that the digits (6—9) representing II, III, IV and V were normal, bat upon th< 

 radial side of these instead of a single hallux there were five toes. ( >f these 1 and 2 

 were imperfectly separated, articulating with the first metatarsal bj their first 

 phalanges, which were united to form a common proximal head. Bach had a 

 distinct second phalanx and in general form resembled a great toe having a separate 

 nail. The second metacarpal bore firstly a pair of toes, 3 and 4, which were still 

 less separate from each other than 1 and 2, the biridity being oonfined to the soft 

 parts. These two toes had one proximal and one distal phalanx in oommon. The 

 second metatarsal also bore an external digit, 5, which in form ratlin reaembli d a 

 normal third digit, being considerably shorter than »'• [and presumably oontaining 

 three phalanges]. The toes 1, 2, 3 and 4 were found alter amputation to be devoid 

 of muscles and presented onlv the terminations of the tlexor and extensor tendons 



b. 23 



