34 
Split-Hand and Split-Foot Deformities 
(V, 38.) J. A. (1906—1906). Screening of extremities. The child was born by the vertex, 
forceps were used and labour was prolonged. The after-birth was normal and there were no 
signs of adhesions or amputated digits. The post-mortem s(jrao mouths later was not obtainable. 
Riglit hand. The five metacarpals were present though the 1st was small and bore no 
l^halanges. The 2nd, 4th and 5th fingers had complete bones. The 3rd metacarpal had a 
l)halanx double at its distal end and this in turn bore two complete sets of phalanges. The 2nd, 
3rd and 4th fingers, namely four sets of phalanges, were united by skin (cp. Left hand of H. G. 
(V, 7)). 
Left liand. This was normal. 
The feet. The deformity was typical, the feet having each two toes, separated by wide clefts. 
The increased thickness of the 1st and 5th metatarsals and the general conformity of the foot to 
the type in other members of the family is of interest in that it indicates that little of the 
permanent adult deformity is due to use. 
(V, 39.) E. W. Gt. (1886, living). Right handed. All extremities screened. 
Right hand. Precisely similar to the left hand of R. E. G. which is figured (Fig. 7), except 
that its ep)iphyses are joined and that the 3rd metacarpal has no head. 
Left hand. This is the same as the right but it has the head of the 3rd metacarpal. 
The feet. The 1st and 5th toes are present with the full number of bones. The clefting is 
deep and the tarsus disturbed. There is welding of the remains of the 2nd and 4th metatarsals 
to the adjacent bones. 
(V, .40.) E. M. G. (1888, living, single). Ambidextrous. Skiagraphy of all extremities. 
Right hand, Fig. 13. There is no ti-ace of the bones of the thumb. The remaining meta- 
carpals are present. The 3rd bears a half phalanx. From the distal end of the 4th a 
large complex cross-bone extends to the head of the 5th, articulating with it and the conjoined 
bases of the two phalanges, presumably those of the 4tli and 5th fingers. The united phalanges 
are separate at their' distal ends, and bear, the inner one, the outer two phalanges, the latter 
united. We are inclined to the view that the 1st phalanx of the 5th finger is represented in the 
inner end of the cross-bone. 
Left hand, Fig. 12. The base only of the 1st metacarpal is present. The 2nd meta- 
carpal is thin and like the 1st bears no phalanges. The remaining metacarpals are present 
and of them the 4th and 5th have the full complement of phalanges, the two sets syndactylised 
by skin. From the head of the 3rd metacarpal a curved cross-bone proceeds to the metacarpo- 
phalangeal joint of the 4th finger. 
Righ t foot, Fig. 15. On the inner side of the cleft is the 1st metatarsal bearing two phalanges. 
On the outer side are the 4th and 5th metatarsals, carrying between them two sets of united 
phalanges. The clefting is deep and causes some displacement and modification of the tarsus. 
Left foot. This is practically identical ; the middle cuneiform appears to be welded to 
the base of the 4th metatarsal. 
(V, 41.) R. E. G. (1890, living). Right handed. Skiagraphy of all extremities. 
Right hand, Figs. 4 and 7. The thumb is entirely' absent. The 2nd metacarpal misses its 
distal end, the remainder are complete. The 5th finger is complete, the base of the 1st 
phalanx has a double articulation, the one facet for the metacarpal the other for the cross- 
bone which extends from this joint to the head of the 4th metacarpal. 
Left hand, Figs. 4 and 6. This is similar, except that the 2nd metacarpal is represented 
by its base only. 
Right foot, Figs. 6 and 9. There are the usual two toes and deep clefting. The outer toe 
has two phalanges, the inner two irregular ones. The base of the 4th metatarsal is represented. 
