H. S. Stannus 
23 
(28) Vei'y few statistics are available for comparison, but I should like to refer 
to some by writers in Egypt. Prof. Madden cites in a letter to the Lancet a case 
of cleft-palate which he operated on as the first in 11 3 ears during surgical work 
at the Kasr-el-ainy Hospital, and assigns as the cause of the lack of such cases 
the "truly awful struggle for existence" which would eliminate infants so handi- 
capped. The Lancet remarked {Lancet, July 3, 1909), in an annotation upon this 
letter, that Prof. Elliot Smith considers it to be impossible to endeavour to explain 
this rarity of congenital defects in Egypt, unless the time-honoured scapegoat of 
our too modern civilisation be invoked to account for their frequency in other 
countries. Statistics of the Kasr-el-ainy Hospital compiled by Dr Day are quoted 
in 1907 ; among 2630 total surgical admissions the only congenital deformities 
were 5 hare-lips, 2 talipes, 2 imperforate anus, 1 extroversion of bladder; in 1908, 
2702 admissions, 3 hare-lips, 2 imperforate anus, 1 hypospadias, 1 undescended 
testicle, 1 meningo-encephalocoele. Capt. G. W. G. Hughes, R.A.M.C., in a paper 
to the Lancet, July 16, 1910, referring to this annotation, remarks " Readers will 
be interested to hear that our too modern civilisation is innocent of this slur," 
and goes on to shew that many congenital defects are by no means uncommon. 
Dealing with males between the ages of 14 and 21 years he gives the following 
figures : 
Hare-lip in 0-041 %. 
Cleft-palate 0-016%. 
Polydactylism 0-058 % and 0-04 %, in two series. 
Shortened metatarsal 0-37% and 0-23%. 
Other deformities of fingers and toes 0-22 %. 
Talipes 0-16%. 
Among the thousands of ancient Egyptian bodies which Prof G. Elliot Smith 
has unearthed and examined, a single case of cleft-palate was met with, a female 
of 20 years of age with a skull of negroid type, of between the 4th and 6th 
century B.C. ; only one case of talipes (T. equinovarus) was recorded. 
It is obvious that in Egypt surgical treatment is not sought in cases of 
cleft-palate and rarely for other congenital defects but many of them are common 
enough. 
May the rarity of defects among the ancient peoples of Egypt be due to the 
same cause that acts in Nyasaland to-day ? Were the children affected with 
deformities killed at birth and "thrown onto the dust-heap" where their remains 
were soon lost trace of? Of chief interest to me are the figures published by 
Captain Hughes. He shews that a shortening of the 4th metatarsal bone occurs 
in percentages rising to 0-37 of males examined. This defect is peculiarly common 
in this country. Again, polydactylism occurs in 0-05 % and other deformities of 
fingers and toes in 0-22 7o of Egyptians, both deformities very frequently met 
with by myself in Nyasaland. 
