494 PBor. B. c. A. wmDLE on teeatological evidence 



upon a loss o£ nervous influence, it appears to me tbat many of 

 the clefts can best be accounted for in this way. For example, it 

 is a little difficult to see liow a branchial fistula can depend upon 

 a lack of material, since the aperture at the time of failure to 

 close must be excessively small. On the other band, it is not 

 difficult to see bow a failure of power to close, due to a want of 

 nerve influence, may cause the persistence of the cleft. A similar 

 explanation may be off'ered for some of the forms of cleft-palate 

 where there is no apparent lack of material. The co-existence of 

 several malformations in the same region seems to point to some 

 common cause, which is most probably to be sought for in the 

 nervous system. Such grouped malformations occur most often 

 in the face in connection with ears, eyes, and palate. It is sug- 

 gestive to observe that these are in the region of supply of the 

 trigeminus nerve, and tbat, as Anstie * observes, " the nervous 

 centre in which the trigeminus is implanted is, of all nervous 

 centres, the one which in the human subject is most liable to con- 

 genital imperfection of the kind which necessitates a break-down 

 in its governing functions at special crises in the development of 

 the organism." 



Here at present I must leave the subject of the connection of 

 nerve influence and congenital lesions ; at a later part of this pajjer 

 I shall recur to it in relation to the origin and development of a 

 malformation. 



Part 2. — Affections due to Excessive and Irregular 

 Nerve-impulse and Muscular Contractions. 



It is, of course, a well-known fact that the child after a certain 

 period of intra-uterine existence is capable of making a consider- 

 able amount of use of its muscles, and, moreover, that the amount 

 of movement varies in difEerent children. Many have held that 

 an excess of this movement, exercised with irregularity, is the 

 cause of various malformations. Talipes is that which has been 

 most commonly attributed to its influoHce ; thus Lowne f groups 

 the various forms of that defect under the heading of " Distor- 

 tion from irregular muscular contraction." These malformations, 

 he says, " are probably due to some form of cerebro-spinal irrita- 

 tion or detect." Again, speaking especially of the various forms 



* Lancet, 1866, i. p. 654. 



t Teratological Catalogue of Eoy. Coll. of Surgeons of England. 



