178 



MERISTIC VARIATION. 



[part I. 



are much rarer, but in several instances they have attained a considerable 



development. 



is one of the most remarkable 



Of this class of variation the following well-known case 



*145. A. healthy female infant was brought to Guy's Hospital in 1851 on account of 

 two projecting growths about the middle of the lateral cervical regions. The 

 growths were not removed until February 1858, when they were found to have 

 increased slightly. They were situated over about the centre of the sterno-cleido- 

 mastoid muscles. To the touch they resembled the tissue of the lobe of the auricle, 

 and they contained within them a firm resisting nucleus like the cartilage of the 

 same organ. They were also covered with peculiarly delicate, soft, downy hairs, 

 like the lobe of the ear. They were excised without difficulty. Each was supplied 

 with a small artery. They appeared to be intimately associated with the fibres of 

 the platysma myoides, not dipping deeper than this structure, and to be entirely 

 cutaneous appendages. (Fig. 28.) 



Fig. 28. Child having a well- developed supernumerary auricle on each side of 

 the neck (from Birkett). 



A vertical section was made in the long axis of each growth ; and the tissues of 

 the lobe and of the fibro-cartilage of the auricle were clearly distinguished. The 

 shape of the fibro-cartilage resembled more or less closely in parts, the outline of 

 the proper auricle, and its tissues were the same. Birkett, J., Trans. Path. Soc. 

 Lond., ix., 1858, p. 448, fig. 1 . 



sufficient to suppose that aural fistula? arise by the imperfect union of these tubercles. 

 The fact, however, that these various defects in development of the branchial 

 apparatus and its derivatives are frequently associated together is well established. 

 As indicating the frequency of association with disease of the ear, Urbantschitsch 

 mentions that in 2000 aural cases, 12 instances of aural fistulas were seen. The 

 same author gives a remarkable case of the occurrence of aural fistula on the right 

 side only in many members of the same family with other important particulars (/. c). 

 1 In Lancet, 1858, n. p. 399 (quoting Harvey), and in a paper by Viuchow 

 (quoting Wilde), Arch. path. Anat. Pity*., 1864, xxx. p. 225, reference is made to a 

 case of Cassebohm, Tract, se.rtus, de aure monstri hum., Norimb., 1684, pp. 36 

 et seqq., describing a child with "four ears." On referring to the original however 

 it appears that this was merely a double monster, having two incomplete heads, 

 and thus bears no analogy with the present examples. 



