40 
Split-Hand and Split-Foot Deformities 
of a deformed individual. Yet in one case a member of a deformed family is said 
to have had syndactyly only (Mayer), and in another (Anders) the grandfather was 
reported as having syndactyly of the hands. But from the accounts it would seem 
that one at least of these cases was not examined, and that consequently foot 
affection cannot be excluded, and in the other similarly there is no mention of 
feet*. Thus while a possibility remains it can nevertheless be stated as im- 
probable in the highest degree ; the records contain cases in the Mongolian 
races^-'^'''^^ ; also the absolute identity of the defect in different cases is absent. 
There is no example of intermarriage of two undeformed members of deformed 
families, an instance of which might throw light on the matter. 
Lastly atavism might be brought forward in explanation of the fact that 
a variety of split-foot deformity may skip one generation to reappear in the next. 
It remains to be shown however that the deformity in grandfather and child is 
identical as well as similar. 
( /) Origin as a result of Intrauterine conditions. The question of the 
origin of split- hand or split-foot by reason of intrauterine lesions is of frequent 
occurrence in the liteiature, and the German authors have devoted special 
attention to it. This explanation has been accepted by Kiimmel for all such 
nialforuiations, and for some of them by others^''" --. It has been supposed that 
the deformities may be produced in the following wa3^s, 
1. By an injury to the abdomen from without. 
2. By an amputation of digits through strangulation. 
3. By the pulling away of the central digit during the contraction of adhesions 
or the growth of the child. 
4. By the splitting of hands or feet through the pressure of bands or folds of 
amnion, or by the umbilical cord. 
The majority of writers have been dealing with single cases, and so far as single 
split-hand and atypical single split-foot are concerned it cannot be denied that 
this explanation will in many cases suffice. Kiimmel has been criticised by 
Perthes for extending his hypothesis to hereditary cases, but the arguments of the 
last author lose their strength if there is any possibility of the transmission of 
characters acquired in utero. We are unaware of a case of single split-foot vfhich 
can be brought within the category of the cases we are discussing, and great 
difficulties in accepting the hypothesis are met when the symmetrical nnd 
hereditary cases are dealt with. 
Intrauterine conditions might be involved in the production of deformities in 
(1) the original deformed individuals, whose deformities are transmitted; 
(2) the original individuals whose deformities are not transmitted; 
and (3) in those individuals to whom the deformity has been transmitted. 
* The only reference to the grandfather in Anders' paper is as follows : — " Der Grossvater des Kindes 
litt an Syndactylie einer Hand." 
