458 DR HARRY RAINY AND DR J. W. BALLANTYNE. 



graph (fig. 16) are the acute curvature of the lower lumbar region associated 

 with the spina bifida, the well-developed state of the lower and upper jaws and 

 of the basis cranii, and the deformed condition of the feet and knees (genu 

 recurvatum). The latter abnormalities are often considered to be of amniotic origin. 



The condition of genu recurvatum may occur by itself, and is shown in fig. 17, 

 Plate VIII, where it was present in an otherwise healthy infant. 



Fig. 18, Plate VIII, shows a foetus from the practice of Dr Arthur Wilson, 

 Edinburgh, in 1893, with anencephalus and exencephalus. The details are given in 

 the Transactions of the Edinburgh Obstetrical Society, vol. xix, p. 49, 1894. The 

 K-ray photograph gives additional information regarding the basis cranii, where the 

 pituitary fossa is clearly outlined and the basi-occiput is well-developed. 



Fig. 19, Plate VIII, is from an anencephalic fcetus, full details of which were 

 published in the Journal of Obstetrics and Gynecology of the British Empire for 

 1902 (vol. ii, p. 521). There was practically no doubt that the fcetus was post- 

 mature, for the labour, which was due on April 25th or 26th, did not occur till 

 June 13th, and the anatomy of the monster showed advanced development of all 

 its parts except its head (anencephalic). The circumference of the shoulders was 

 42 cm. ; the weight was nine pounds, which was high when it is borne in mind 

 that there were no cranial vault bones ; the length was 55 cm. The X-ray features 

 bear out the diagnosis of post-maturity. 



Fig. 20, Plate IX, represents a foetus aprosopus (faceless fcetus), w r hich was 

 born to a woman, forty-three years of age, as her first child. She afterwards had 

 a normal infant. The mother is described as healthy and active, but very neurotic. 

 The pregnancy, which terminated at about the eighth month, was accompanied by 

 some hydramnios. The external appearances are shown in fig. 67 (p. 434) of the 

 Manual of Antenatal Pathology, vol. ii.* The malformation affects the head and the 

 left hand. The former is reduced to little more than a rounded knob, and shows no 

 external trace of nose, eyes, or mouth ; there are two large external ears situated 

 laterally. The left hand exhibited marked irregularity of the digits, the ring finger 

 being shorter than the little finger. 



The X-ray appearances are as follows : — there is an irregular mass of bone at the 

 apex of the vertebral column, in which the lower jaw can be easily recognised and is 

 seen to articulate at the level of the ears. 



Fig. 21, Plate IX, is a second case of foetus aprosopus, which was sent to 

 Dr Ballantyne in the end of 1905 by Dr Macdonald. Several of the vertebral 

 bodies in the lower dorsal region show malformation (half vertebrae, etc.) ; the 

 right clavicle is irregularly bent in its central portion ; and the ossific nuclei in 

 the lower ends of the femora are absent. The cranial bones form an irregular 

 mass, in which it is impossible to separate the constituent elements. 



* Manual of Antenatal Pathology and Hygiene, by J. W. Ballantyne, M.D. Edinburgh : William Green & Sons, 

 1902-1905. 



