T. Lewis and D. Embleton 
27 
The first collected description of cases which we have found is that by Kiimniel. 
This author discusses the nature of "Spalt-Hand und Spalt-Fuss" at some length, 
but his account loses much of its value in that all types are indiscriminately mixed, 
and the question of heredity receives no attention. In a later monograph Perthes 
has brought a number of cases together on the same basis. 
From the many varieties of split-hand and split-foot, one stands out prominently, 
and of this our " G " family presents notable examples. This type is characterised 
by its marked tendency to transmission, and by other features. 
Including our family we have collected in all over 180 individual cases of the 
deformity, and have studied the details or detailed records of a large number of 
these*. We are therefore in a position to give a general sketch of the condition 
and its relation to general problems of heredity. 
In searching the records for previously reported examples we have been 
fortunate in finding two earlier accounts of this remarkable family f, which contains 
more deformed members than any yet recorded. In 1886, before the introduction 
of "X rays," Anderson gave a description of it. A further brief summary was 
written by Tubby thirteen years ago. The addition of new members to the 
genealogical tree entitles the family to further consideration. 
We must express our gratitude to Dr Higham Cooper of University College 
Hospital and to Dr Edward Shenton of Guy's for the invaluable aid they have 
given us in the screening and skiagraphy of the individual subjects of this 
investigation. 
Detailed Account of the Deformities of the " G " Family. 
Observations have been for the most part confined to the bones of the hands 
and feet. Other deformities have been inquired into, and no such defects are 
known to exist. A complete examination of the family fi'om this point of view has 
not been undertaken. 
A thorough investigation of the soft parts of the hands and feet has also been 
neglected on account of the number of the deformed. From the observations made 
the following brief statements of the chief features may be made. The skin follows 
the lines of the underlying bones and tissues (Figs. 4, 5), and in no case has 
evidence of scarring been found, such as might suggest intrauterine injuries. The 
nails correspond in number almost without exception to the number of the terminal 
phalanges. When two fingers are closely syndactylised the nails are also united. 
* Since this paper has been in the press, several other famiHes showing the same deformity 
and living in London have been heard of, and other similar families in different parts of the country. 
An example which is typical is figured in Cruveilhier's well known "Atlas dAnatomie pathologique, 
etc." The deformity appears to be a by no means uncommon one. 
+ Space does not permit of our giving the proofs that the three families are identical, but we 
are depositing private evidence with additional notes and radiograms, which future observers will find 
of value, in the library of the College of Surgeons. 
4—2 
