Anomalies And Curiosities Of Medicine Part 19

Instances of duplication of the epiglottis attended with a species of double voice possess great interest. French described a man of thirty, by occupation a singer and contortionist, who became possessed of an extra voice when he was sixteen. In high and falsetto tones he could run the scale from A to F in an upper and lower range. The compa.s.s of the low voice was so small that he could not reach the high notes of any song with it, and in singing he only used it to break in on the falsetto and produce a sensation. He was supposed to possess a double epiglottis.

Roe describes a young lady who could whistle at will with the lower part of her throat and without the aid of her lips. Laryngeal examination showed that the fundamental tones were produced by vibrations of the edges of the vocal cords, and the modifications were effected by a minute adjustment of the ventricular bands, which regulated the laryngeal opening above the cord, and pressing firmly down closed the ventricle and acted as a damper preventing the vibrations of the cords except in their middle third. Morgan in the same journal mentions the case of a boy of nineteen, who seemed to be affected with laryngeal catarrh, and who exhibited distinct diphthongia. He was seen to have two glottic orifices with a.s.sociate bands. The treatment was directed to the catarrh and consequent paresis of the posterior bands, and he soon lost his evidences of double voice.

{footnote} The following is a description of the laryngeal formation of a singer who has recently acquired considerable notice by her ability to sing notes of the highest tones and to display the greatest compa.s.s of voice. It is extracted from a Cleveland, Ohio, newspaper: "She has unusual development of the larynx, which enables her to throw into vibration and with different degrees of rapidity the entire length of the vocal cords or only a part thereof. But of greatest interest is her remarkable control over the muscles which regulate the division and modification of the resonant cavities, the laryngeal, pharyngeal, oral, and nasal, and upon this depends the quality of her voice. The uvula is bifurcated, and the two divisions sometimes act independently. The epiglottis during the production of the highest notes rises upward and backward against the posterior pharyngeal wall in such a way as almost entirely to separate the pharyngeal cavities, at the same time that it gives an unusual conformation to those resonant chambers."

Complete absence of the eyes is a very rare anomaly. Wordsworth describes a baby of seven weeks, otherwise well formed and healthy, which had congenital absence of both eyes. The parents of this child were in every respect healthy. There are some cases of monstrosities with closed, adherent eyelids and absence of eyes. Holmes reports a case of congenital absence of both eyes, the child otherwise being strong and perfect. The child died of cholera infantum. He also reports a case very similar in a female child of American parents. In a girl of eight, of German parents, he reports deficiency of the external walls of each orbit, in addition to great deformity of the side of the head.

He also gives an instance of congenital paralysis of the levator palpebrae muscles in a child whose vision was perfect and who was otherwise perfect. Holmes also reports a case of enormous congenital exophthalmos, in which the right eye protruded from the orbit and was no longer covered by the cornea. Kinney has an account of a child born without eyeb.a.l.l.s. The delivery was normal, and there was no history of any maternal impression; the child was otherwise healthy and well formed.

Landes reports the case of an infant in which both eyes were absent.

There were six fingers on each hand and six toes on each foot. The child lived a few weeks. In some instances of supposed absence of the eyeball the eye is present but diminutive and in the posterior portion of the orbit. There are instances of a single orbit with no eyes and also a single orbit containing two eyes. Again we may have two orbits with an absence of eyes but the presence of the lacrimal glands, or the eyes may be present or very imperfectly developed. Mackenzie mentions cases in which the orbit was more or less completely wanting and a ma.s.s of cellular tissue in each eye.

Cases of living cyclopia, or individuals with one eye in the center of the forehead after the manner of the mythical Cyclops, are quite rare.

Vallentini in 1884 reports a case of a male cyclopic infant which lived for seventy-three hours. There were median fissures of the upper lip, preauricular appendages, oral deformity, and absence of the olfactory proboscis The fetus was therefore a cyclops arrhynchus, or cyclocephalus. Blok describes a new-born infant which lived for six or seven hours, having but one eye and an extremely small mouth.

The "Four-eyed Man of Cricklade" was a celebrated English monstrosity of whom little reliable information is obtainable. He was visited by W.

Drury, who is accredited with reporting the following--

"'So wondrous a thing, such a lusus naturae, such a scorn and spite of nature I have never seen. It was a dreadful and shocking sight.' This unfortunate had four eyes placed in pairs, 'one eye above the other and all four of a dull brown, encircled with red, the pupils enormously large.' The vision in each organ appeared to be perfect. 'He could shut any particular eye, the other three remaining open, or, indeed, as many as he chose, each several eye seeming to be controlled by his will and acting independently of the remainder. He could also revolve each eye separately in its...o...b..t, looking backward with one and forward with another, upward with one and downward with another simultaneously.' He was of a savage, malignant disposition, delighting in ugly tricks, teasing children, torturing helpless animals, uttering profane and blasphemous words, and acting altogether like the monster, mental and physical, that he was. 'He could play the fiddle, though in a silly sort, having his notes on the left side, while closing the right pair of eyes. He also sang, but in a rough, screeching voice not to be listened to without disgust.'"

There is a recent report of a child born in Paris with its eyes in the top of its head. The infant seemed to be doing well and crowds of people have flocked to see it. Recent reports speak of a child born in Portland, Oregon, which had a median rudimentary eye between two normal eyes. Fournier describes an infant born with perfectly formed eyes, but with adherent eyelids and closed ocular aperture. Forlenze has seen the pupils adherent to the conjunctiva, and by dissection has given sight to the subject.

Dubois cites an instance of supernumerary eyelid. At the external angle of the eyelid was a fold of conjunctiva which extended 0.5 cm. in front of the conjunctiva, to which it did not adhere, therefore const.i.tuting a fourth eyelid. Fano presents a similar case in a child of four months, in whom no other anomaly, either of organs or of vision, was observed. On the right side, in front of the external half of the sclerotic, was observed a semilunar fold with the concavity inward, and which projected much more when the lower lid was depressed. When the eyelid rolled inward the fold rolled with the globe, but never reached so far as the circ.u.mference of the cornea and did not interfere with vision.

Total absence of both irides has been seen in a man of eighteen. Dixon reports a case of total aniridia with excellent sight in a woman of thirty-seven. In Guy's Hospital there was seen a case of complete congenital absence of the iris. Hentzschel speaks of a man with congenital absence of the iris who had five children, three of whom exhibited the same anomaly while the others were normal. Benson, Burnett, Demaux, Lawson, Morison, Reuling, Samelson, and others also report congenital deficiency of the irides in both eyes.

Jeaffreson describes a female of thirty, living in India, who was affected with complete ossification of the iris. It was immovable and quite beautiful when seen through the transparent cornea; the sight was only slightly impaired. No cause was traceable.

Multiple Pupils.--More than one pupil in the eye has often been noticed, and as many as six have been seen. They may be congenital or due to some pathologic disturbance after birth. Marcellus Donatus speaks of two pupils in one eye. Beer, Fritsche, and Heuermann are among the older writers who have noticed supernumerary pupils. Higgens in 1885 described a boy whose right iris was perforated by four pupils,--one above, one to the inner side, one below, and a fourth to the outer side. The first three were slit-shaped; the fourth was the largest and had the appearance as of the separation of the iris from its insertion. There were two pupils in the left eye, both to the outer side of the iris, one being slit-like and the other resembling the fourth pupil in the right eye. All six pupils commenced at the periphery, extended inward, and were of different sizes. The fundus could be clearly seen through all of the pupils, and there was no posterior staphyloma nor any choroidal changes. There was a rather high degree of myopia. This peculiarity was evidently congenital, and no traces of a central pupil nor marks of a past iritis could be found.

Clinical Sketches a contains quite an extensive article on and several ill.u.s.trations of congenital anomalies of the iris.

Double crystalline lenses are sometimes seen. Fritsch and Valisneri have seen this anomaly and there are modern references to it.

Wordsworth presented to the Medical Society of London six members of one family, all of whom had congenital displacement of the crystalline lens outward and upward. The family consisted of a woman of fifty, two sons, thirty-five and thirty-seven, and three grandchildren--a girl of ten and boys of five and seven. The irides were tremulous.

Clark reports a case of congenital dislocation of both crystalline lenses. The lenses moved freely through the pupil into the anterior chambers. The condition remained unchanged for four years, when glaucoma supervened.

Differences in Color of the Two Eyes.--It is not uncommon to see people with different colored eyes. Anastasius I had one black eye and the other blue, from whence he derived his name "Dicore," by which this Emperor of the Orient was generally known. Two distinct colors have been seen in an iris. Berry gives a colored ill.u.s.tration of such a case.

The varieties of strabismus are so common that they will be pa.s.sed without mention. Kuhn presents an exhaustive a.n.a.lysis of 73 cases of congenital defects of the movements of the eyes, considered clinically and didactically. Some or all of the muscles may be absent or two or more may be amalgamated, with anomalies of insertion, false, double, or degenerated, etc.

The influence of heredity in the causation of congenital defects of the eye is strikingly ill.u.s.trated by De Beck. In three generations twelve members of one family had either coloboma iridis or irideremia. He performed two operations for the cure of cataract in two brothers. The operations were attended with difficulty in all four eyes and followed by cyc.l.i.tis. The result was good in one eye of each patient, the eye most recently blind. Posey had a case of coloboma in the macular region in a patient who had a supernumerary tooth. He believes the defects were inherited, as the patient's mother also had a supernumerary tooth.

Nunnely reports cases of congenital malformation in three children of one family. The globes of two of them (a boy and a girl) were smaller than natural, and in the boy in addition were flattened by the action of the recti muscles and were soft; the sclera were very vascular and the cornea, conical, the irides dull, thin, and tremulous; the pupils were not in the axis of vision, but were to the nasal side. The elder sister had the same congenital condition, but to a lesser degree. The other boy in the family had a total absence of irides, but he could see fairly well with the left eye.

Anomalies of the Ears.--Bilateral absence of the external ears is quite rare, although there is a species of sheep, native of China, called the "Yungti," in which this anomaly is constant. Bartholinus, Lycosthenes, Pare, Schenck, and Oberteuffer have remarked on deficient external ears. Guys, the celebrated Ma.r.s.eilles litterateur of the eighteenth century, was born with only one ear. Chantreuil mentions obliteration of the external auditory ca.n.a.l in the new-born. Bannofont reports a case of congenital imperforation of the left auditory ca.n.a.l existing near the tympanic membrane with total deafness in that ear. Lloyd described a fetus showing absence of the external auditory meatus on both sides. Munro reports a case of congenital absence of the external auditory meatus of the right ear; and Richardson speaks of congenital malformation of the external auditory apparatus of the right side.

There is an instance of absence of the auditory ca.n.a.l with but partial loss of hearing. Mussey reports several cases of congenitally deficient or absent aural appendages. One case was that in which there was congenital absence of the external auditory meatus of both ears without much impairment of hearing. In neither ear of N. W. G.o.ddard, aged twenty-seven, of Vermont, reported in 1834, was there a vestige of an opening or pa.s.sage in the external ear, and not even an indentation.

The Eustachian tube was closed. The integuments of the face and scalp were capable of receiving acoustic impressions and of transmitting them to the organs of hearing. The authors know of a student of a prominent New York University who is congenitally deficient in external ears, yet his hearing is acute. He hides his deformity by wearing his hair long and combed over his ears.

The knowledge of anomalous auricles is lost in antiquity. Figure 103 represents the head of an aegipan in the British Museum showing a supernumerary auricle. As a rule, supernumerary auricles are preauricular appendages. Warner, in a report of the examination of 50,000 children, quoted by Ballantyne, describes 33 with supernumerary auricles, represented by sessile or pedunculated outgrowths in front of the tragus. They are more commonly unilateral, always congenital, and can be easily removed, giving rise to no unpleasant symptoms. They have a soft and elastic consistency, and are usually composed of a hyaline or reticular cartilaginous axis covered with connective or adipose tissue and skin bearing fine hairs; sometimes both cartilage and fat are absent. They are often a.s.sociated with some form of defective audition--harelip, ocular disturbance, club-feet, congenital hernia, etc. These supernumerary members vary from one to five in number and are sometimes hereditary. Reverdin describes a man having a supernumerary nipple on the right side of his chest, of whose five children three had preauricular appendages. Figure 104 represents a girl with a supernumerary auricle in the neck, described in the Lancet, 1888. A little girl under Birkett's care in Guy's Hospital more than answered to Macbeth's requisition, "Had I three ears I'd hear thee!"

since she possessed two superfluous ones at the sides of the neck, somewhat lower than the angle of the jaw, which were well developed as to their external contour and made up of fibrocartilage. There is mentioned the case of a boy of six months on the left side of whose neck, over the middle anterior border of the sternocleidomastoid muscle, was a nipple-like projection 1/2 inch in length; a rod of cartilage was prolonged into it from a thin plate, which was freely movable in the subcutaneous tissue, forming a striking a.n.a.logue to an auricle. Moxhay cites the instance of a mother who was frightened by the sight of a boy with hideous contractions in the neck, and who gave birth to a child with two perfect ears and three rudimentary auricles on the right side, and on the left side two rudimentary auricles.

In some people there is an excessive development of the auricular muscles, enabling them to move their ears in a manner similar to that of the lower animals. Of the celebrated instances the Abbe de Marolles, says Vigneul-Marville, bears witness in his "Memoires" that the Regent Cra.s.sot could easily move his ears. Saint Augustine mentions this anomaly.

Double tympanitic membrane is spoken of by Loeseke. There is sometimes natural perforation of the tympanum in an otherwise perfect ear, which explains how some people can blow tobacco-smoke from the ear. Fournier has seen several Spaniards and Germans who could perform this feat, and knew one man who could smoke a whole cigar without losing any smoke, since he made it leave either by his mouth, his ears, or in both ways.

Fournier in the same article mentions that he has seen a woman with ears over four inches long.

Strange to say, there have been reports of cases in which the ossicles were deficient without causing any imperfection of hearing. Caldani mentions a case with the incus and malleus deficient, and Scarpa and Torreau quote instances of deficient ossicles. Thomka in 1895 reported a case of supernumerary tympanic ossicle, the nature of which was unknown, although it was neither an inflammatory product nor a remnant of Meckel's cartilage.

Absence of the Limbs.--Those persons born without limbs are either the subjects of intrauterine amputation or of embryonic malformation.

Probably the most celebrated of this cla.s.s was Marc Cazotte, otherwise known as "Pepin," who died in Paris in the last century at the age of sixty-two of a chronic intestinal disorder. He had no arms, legs, or s.c.r.o.t.u.m, but from very jutting shoulders on each side were well-formed hands. His abdomen ended in a flattened b.u.t.tock with badly-formed feet attached. He was exhibited before the public and was celebrated for his dexterity. He performed nearly all the necessary actions, exhibited skilfulness in all his movements, and was credited with the ability of coitus. He was quite intellectual, being able to write in several languages. His skeleton is preserved in the Musee Dupuytren. Flachsland speaks of a woman who three times had borne children without arms and legs. Hastings describes a living child born without any traces of arms or legs. Garlick has seen a child with neither upper nor lower extremities. In place of them were short stumps three or four inches long, closely resembling the ordinary stumps after amputation. The head, chest, body, and male genitals were well formed, and the child survived. Hutchinson reports the history of a child born without extremities, probably the result of intrauterine amputation. The flaps were healed at the deltoid insertion and just below the groin. Pare says he saw in Paris a man without arms, who by means of his head and neck could crack a whip or hold an axe. He ate by means of his feet, dealt and played cards, and threw dice with the same members, exhibiting such dexterity that finally his companions refused to play with him. He was proved to be a thief and a murderer and was finally hanged at Gueldres. Pare also relates having seen a woman in Paris who sewed, embroidered, and did other things with her feet. Jansen speaks of a man in Spain, born without arms, who could use his feet as well as most people use their arms. Schenck and Lotichius give descriptions of armless people.

Hulke describes a child of four whose upper limbs were absent, a small dimple only being in their place. He had free movement of the shoulders in every direction and could grasp objects between his cheeks and his acromian process; the prehensile power of the toes was well developed, as he could pick up a coin thrown to him. A monster of the same conformation was the celebrated painter, Ducornet, who was born at Lille on the 10th of January, 1806. He was completely deprived of arms, but the rest of the body was well formed with the exception of the feet, of which the second toe was faulty. The deformity of the feet, however, had the happiest result, as the s.p.a.ce between the great toe and its neighbor was much larger than ordinary and the toes much more mobile. He became so skilful in his adopted profession that he finally painted a picture eleven feet in height (representing Mary Magdalene at the feet of Christ after the resurrection), which was purchased by the Government and given to the city of Lille. Broca describes James Leedgwood, who was deprived of his arms and had only one leg. He exhibited great dexterity with his single foot, wrote, discharged a pistol, etc.; he was said to have been able to pick up a sewing-needle on a slippery surface with his eyes blindfolded. Capitan described to the Societe d'anthropologie de Paris a young man without arms, who was said to play a violin and cornet with his feet. He was able to take a kerchief from his pocket and to blow his nose; he could make a cigarette, light it, and put it in his mouth, play cards, drink from a gla.s.s, and eat with a fork by the aid of his dexterous toes. There was a creature exhibited some time since in the princ.i.p.al cities of France, who was called the "l'homme tronc." He was totally deprived of all his members. Curran describes a Hindoo, a prost.i.tute of forty, with congenital absence of both upper extremities. A slight fleshy protuberance depended from the cicatrix of the humerus and shoulder-joint of the left side, and until the age of ten there was one on the right side. She performed many tricks with her toes. Caldani speaks of a monster without arms, Davis mentions one, and Smith describes a boy of four with his upper limbs entirely absent. Breschet has seen a child of nine with only portions of the upper arms and deformity of lower extremities and pelvis. Pare says that he saw in Paris in 1573, at the gate of St. Andrew des Arts, a boy of nine, a native of a small village near Guise, who had no legs and whose left foot was represented by a fleshy body hanging from the trunk; he had but two fingers hanging on his right hand, and had between his legs what resembled a virile p.e.n.i.s. Pare attributes this anomaly to a default in the quant.i.ty of s.e.m.e.n.

The figure and skeleton of Harvey Leach, called "Hervio Nono," is in the museum of the University College in London. The pelvis was comparatively weak, the femurs hardly to be recognized, and the right tibia and foot defective; the left foot was better developed, although far from being in due proportion to the trunk above. He was one of the most remarkable gymnasts of his day, and notwithstanding the distortion of his lower limbs had marvelous power and agility in them. As an arena-horseman, either standing or sitting, he was scarcely excelled.

He walked and even ran quite well, and his power of leaping, partly with his feet and partly with his hands, was unusual. His lower limbs were so short that, erect, he touched the floor with his fingers, but he earned his livelihood as much with his lower as with his upper limbs. In his skeleton his left lower limb, between the hip and heel, measured 16 inches, while the right, between the same points, measured nine inches. Hare mentions a boy of five and a half whose head and trunk were the same as in any other child of like age. He was 22 1/2 inches high, had no spinal curvature, but was absolutely devoid of lower extremities. The right arm was two inches long and the left 2 1/4. Each contained the head and a small adjoining portion of the humerus. The legs were represented by ma.s.ses of cellular tissue and fat covered by skin which projected about an inch. He was intelligent, had a good memory, and exhibited considerable activity. He seemed to have had more than usual mobility and power of flexion of the lower lumbar region. When on his back he was unable to rise up, but resting on the lower part of the pelvis he was able to maintain himself erect. He usually picked up objects with his teeth, and could hold a coin in the axilla as he rolled from place to place. His rolling was accomplished by a peculiar twisting of the thorax and bending of the pelvis. There was no history of maternal impression during pregnancy, no injury, and no hereditary disposition to anomalous members. Figure 112 represents a boy with congenital deficiency of the lower extremities who was exhibited a few years ago in Philadelphia. In Figure 113, which represents a similar case in a girl whose photograph is deposited in the Mutter Museum of the College of Physicians, Philadelphia, we see how cleverly the congenital defect may be remedied by mechanical contrivance. With her crutches and artificial legs this girl was said to have moved about easily.

Parvin describes a "turtle-man" as an ectromelian, almost entering the cla.s.s of phocomelians or seal-like monsters; the former term signifies abortive or imperfect formation of the members. The hands and feet were normally developed, but the arms, forearms, and legs are much shortened.

The "turtle-woman" of Demerara was so called because her mother when pregnant was frightened by a turtle, and also from the child's fancied resemblance to a turtle. The femur was six inches long, the woman had a foot of six bones, four being toes, viz., the first and second phalanges of the first and second toes. She had an acetabulum, capsule, and ligamentum teres, but no tibia or fibula; she also had a defective right forearm. She was never the victim of rachitis or like disease, but died of syphilis in the Colonial Hospital. In her twenty-second year she was delivered of a full-grown child free of deformity.

There was a woman living in Bavaria, under the observation of Buhl, who had congenital absence of both femurs and both fibulas. Almost all the muscles of the thigh existed, and the main attachment to the pelvis was by a large capsular articulation. Charpentier gives the portrait of a woman in whom there was a uniform diminution in the size of the limbs.

Debout portrays a young man with almost complete absence of the thigh and leg, from whose right hip there depended a foot. Accrell describes a peasant of twenty-six, born without a hip, thigh, or leg on the right side. The external genital organs were in their usual place, but there was only one t.e.s.t.i.c.l.e in the s.c.r.o.t.u.m. The man was virile. The r.e.c.t.u.m instead of opening outward and underneath was deflected to the right.

Supernumerary Limbs.--Haller reports several cases of supernumerary extremities. Plancus speaks of an infant with a complete third leg, and Dumeril cites a similar instance. Geoffroy-Saint-Hilaire presented to the Academie des Sciences in 1830 a child with four legs and feet who was in good health. Amman saw a girl with a large thigh attached to her nates. Below the thigh was a single leg made by the fusion of two legs. No patella was found and the knee was anchylosed. One of the feet of the supernumerary limb had six toes, while the other, which was merely an outgrowth, had two toes on it.

According to Jules Guerin, the child named Gustav Evrard was born with a thigh ending in two legs and two imperfect feet depending from the left nates.

Tucker describes a baby born in the Sloane Maternity in New York, October 1, 1894, who had a third leg hanging from a bony and fleshy union attached to the dorsal spine. The supernumerary leg was well formed and had a left foot attached to it. Larkin and Jones mention the removal of a meningocele and a supernumerary limb from an infant of four months. This limb contained three fingers only, one of which did not have a bony skeleton.

Pare says that on the day the Venetians and the Genevois made peace a monster was born in Italy which had four legs of equal proportions, and besides had two supernumerary arms from the elbows of the normal limbs.

This creature lived and was baptized.

Anomalies of the Feet.--Hatte has seen a woman who bore a child that had three feet. Bull gives a description of a female infant with the left foot double or cloven. There was only one heel, but the anterior portion consisted of an anterior and a posterior part. The anterior foot presented a great toe and four smaller ones, but deformed like an example of talipes equinovarus. Continuous with the outer edge of the anterior part and curving beneath it was a posterior part, looking not unlike a second foot, containing six well-formed toes situated directly beneath the other five. The eleven toes were all perfect and none of them were webbed.

There is a cla.s.s of monsters called "Sirens" on account of their resemblance to the fabulous creatures of mythology of that name. Under the influence of compression exercised in the uterus during the early period of gestation fusion of the inferior extremities is effected. The accompanying ill.u.s.tration shows the appearance of these monsters, which are thought to resemble the enchantresses celebrated by Homer.

Anomalies of the Hand.--Blumenbach speaks of an officer who, having lost his right hand, was subsequently presented by his wife with infants of both s.e.xes showing the same deformity. Murray cites the instance of a woman of thirty-eight, well developed, healthy, and the mother of normal children, who had a double hand. The left arm was abnormal, the flexion of the elbow imperfect, and the forearm terminated in a double hand with only rudimentary thumbs. In working as a charwoman she leaned on the back of the flexed carpus. The double hand could grasp firmly, though the maximum power was not so great as that of the right hand. Sensation was equally acute in all three of the hands. The middle and ring fingers of the supernumerary hand were webbed as far as the proximal joints, and the movements of this hand were stiff and imperfect. No single finger of the two hands could be extended while the other seven were flexed. Giraldes saw an infant in 1864 with somewhat the same deformity, but in which the disposition of the muscles and tendons permitted the ordinary movements.

Absence of Digits.--Maygrier describes a woman of twenty-four who instead of having a hand on each arm had only one finger, and each foot had but two toes. She was delivered of two female children in 1827 and one in 1829, each having exactly the same deformities. Her mother was perfectly formed, but the father had but one toe on his foot and one finger on his left hand.

Kohler gives photographs of quite a remarkable case of suppression and deformity of the digits of both the fingers and toes.

Figure 123 shows a man who was recently exhibited in Philadelphia. He had but two fingers on each hand and two toes on each foot, and resembles Kohler's case in the anomalous digital conformation.

Figure 124 represents an exhibitionist with congenital suppression of four digits on each hand.

Tubby has seen a boy of three in whom the first, second, and third toes of each foot were suppressed, the great toe and the little toe being so overgrown that they could be opposed. In this family for four generations 15 individuals out of 22 presented this defect of the lower extremity. The patient's brothers and a sister had exactly the same deformity, which has been called "lobster-claw foot."