Anomalies And Curiosities Of Medicine Part 20

Falla of Jedburgh speaks of an infant who was born without forearms or hands; at the elbow there was a single finger attached by a thin string of tissue. This was the sixth child, and it presented no other deformity. Falla also says that instances of intrauterine digital amputation are occasionally seen.

According to Annandale, supernumerary digits may be cla.s.sified as follows:--

(1) A deficient organ, loosely attached by a narrow pedicle to the hand or foot (or to another digit).

(2) A more or less developed organ, free at its extremity, and articulating with the head or sides of a metacarpal, metatarsal, or phalangeal bone.

(3) A fully developed separate digit.

(4) A digit intimately united along its whole length with another digit, and having either an additional metacarpal or metatarsal bone of its own, or articulating with the head of one which is common to it and another digit.

Superst.i.tions relative to supernumerary fingers have long been prevalent. In the days of the ancient Chaldeans it was for those of royal birth especially that divinations relative to extra digits were cast. Among the ancients we also occasionally see ill.u.s.trations emblematic of wisdom in an individual with many fingers, or rather double hands, on each arm.

Hutchinson, in his comments on a short-limbed, polydactylous dwarf which was dissected by Ruysch, the celebrated Amsterdam anatomist, writes as follows.--

"This quaint figure is copied from Theodore Kerckring's 'Spicilegium Anatomic.u.m,' published in Amsterdam in 1670. The description states that the body was that of an infant found drowned in the river on October 16, 1668. It was dissected by the renowned Ruysch. A detailed description of the skeleton is given. My reason for now reproducing the plate is that it offers an important item of evidence in reference to the development of short-limbed dwarfs. Although we must not place too much reliance on the accuracy of the draughtsman, since he has figured some superfluous lumbar vertebrae, yet there can be no doubt that the limbs are much too short for the trunk and head. This remark especially applies to the lower limbs and pelvis. These are exactly like those of the Norwich dwarf and of the skeleton in the Heidelberg Museum which I described in a recent number of the 'Archives.' The point of extreme interest in the present case is that this dwarfing of the limbs is a.s.sociated with polydactylism. Both the hands have seven digits. The right foot has eight and the left nine. The conditions are not exactly symmetrical, since in some instances a metacarpal or metatarsal bone is wanting; or, to put it otherwise, two are welded together. It will be seen that the upper extremities are so short that the tips of the digits will only just touch the iliac crests.

"This occurrence of short limbs with polydactylism seems to prove conclusively that the condition may be due to a modification of development of a totally different nature from rickets. It is probable that the infant was not at full term. Among the points which the author has noticed in his description are that the fontanelle was double its usual size; that the orbits were somewhat deformed; that the two halves of the lower jaw were already united; and that the ribs were short and badly formed. He also, of course, draws attention to the shortness of the limbs, the stoutness of the long bones, and the supernumerary digits. I find no statement that the skeleton was deposited in any museum, but it is very possible that it is still in existence in Amsterdam, and if so it is very desirable that it should be more exactly described."

In Figure 126, A represents division of thumb after Guyot-Daubes, shows a typical case of supernumerary fingers, and C pictures Morand's case of duplication of several toes.

Forster gives a sketch of a hand with nine fingers and a foot with nine toes. Voight records an instance of 13 fingers on each hand and 12 toes on each foot. Saviard saw an infant at the Hotel-Dieu in Paris in 1687 which had 40 digits, ten on each member. Annandale relates the history of a woman who had six fingers and two thumbs on each hand, and another who had eight toes on one foot.

Meckel tells of a case in which a man had 12 fingers and 12 toes, all well formed, and whose children and grandchildren inherited the deformity. Mason has seen nine toes on the left foot. There is recorded the account of a child who had 12 toes and six fingers on each hand, one fractured. Braid describes talipes varus in a child of a few months who had ten toes. There is also on record a collection of cases of from seven to ten fingers on each hand and from seven to ten toes on each foot. Scherer gives an ill.u.s.tration of a female infant, otherwise normally formed, with seven fingers on each hand, all united and bearing claw-like nails. On each foot there was a double halux and five other digits, some of which were webbed.

The influence of heredity on this anomaly is well demonstrated.

Reaumur was one of the first to prove this, as shown by the Kelleia family of Malta, and there have been many corroboratory instances reported; it is shown to last for three, four, and even five generations; intermarriage with normal persons finally eradicates it.

It is particularly in places where consanguineous marriages are prevalent that supernumerary digits persist in a family. The family of Foldi in the tribe of Hyabites living in Arabia are very numerous and confine their marriages to their tribe. They all have 24 digits, and infants born with the normal number are sacrificed as being the offspring of adultery. The inhabitants of the village of Eycaux in France, at the end of the last century, had nearly all supernumerary digits either on the hands or feet. Being isolated in an inaccessible and mountainous region, they had for many years intermarried and thus perpetuated the anomaly. Communication being opened, they emigrated or married strangers and the s.e.xdigitism vanished. Maupertuis recalls the history of a family living in Berlin whose members had 24 digits for many generations. One of them being presented with a normal infant refused to acknowledge it. There is an instance in the Western United States in which supernumerary digits have lasted through five generations. Cameron speaks of two children in the same family who were polydactylic, though not having the same number of supernumerary fingers.

Smith and Norwell report the case of a boy of fifteen both of whose hands showed webbing of the middle and ring fingers and accessory nodules of bone between the metacarpals, and six toes on each foot. The boy's father showed similar malformations, and in five generations 21 out of 28 individuals were thus malformed, ten females and 11 males.

The deformity was especially transmitted in the female line.

Instances of supernumerary thumbs are cited by Panaroli, Ephemerides, Munconys, as well as in numerous journals since. This anomaly is not confined to man alone; apes, dogs, and other lower animals possess it.

Bucephalus, the celebrated horse of Alexander, and the horse of Caesar were said to have been cloven-hoofed.

Hypertrophy of the digits is the result of many different processes, and true hypertrophy or gigantism must be differentiated from acromegaly, elephantiasis, leontiasis, and arthritis deformans, for which distinction the reader is referred to an article by Park. Park also calls attention to the difference between acquired gigantism, particularly of the finger and toes, and another condition of congenital gigantism, in which either after or before birth there is a relatively disproportionate, sometimes enormous, overgrowth of perhaps one finger or two, perhaps of a limited portion of a hand or foot, or possibly of a part of one of the limbs. The best collection of this kind of specimens is in the College of Surgeons in London.

Curling quotes a most peculiar instance of hypertrophy of the fingers in a sickly girl. The middle and ring fingers of the right hand were of unusual size, the middle finger measuring 5 1/2 inches in length four inches in circ.u.mference. On the left hand the thumb and middle fingers were hypertrophied and the index finger was as long as the middle one of the right hand. The middle finger had a lateral curvature outward, due to a displacement of the extensor tendon. This affection resembled acromegaly. Curling cites similar cases, one in a Spanish gentleman, Governor of Luzon, in the Philippine Islands, in 1850, who had an extraordinary middle finger, which he concealed by carrying it in the breast of his coat.

Hutchinson exhibited a photograph showing the absence of the radius and thumb, with shortening of the forearm. Conditions more or less approaching this had occurred in several members of the same family. In some they were a.s.sociated with defects of development in the lower extremities also.

The varieties of club-foot--talipes varus, valgus, equinus, equino-varus, etc.--are so well known that they will be pa.s.sed with mention only of a few persons who have been noted for their activity despite their deformity. Tyrtee, Parini, Byron, and Scott are among the poets who were club-footed; some writers say that Shakespeare suffered in a slight degree from this deformity. Agesilas, Genserie, Robert II, Duke of Normandy, Henry II, Emperor of the West, Otto II, Duke of Brunswick, Charles II, King of Naples, and Tamerlane were victims of deformed feet. Mlle. Valliere, the mistress of Louis XIV, was supposed to have both club-foot and hip-disease. Genu valgum and genu varum are ordinary deformities and quite common in all cla.s.ses.

Transpositions of the character of the vertebrae are sometimes seen. In man the lumbar vertebrae have sometimes a.s.sumed the character of the sacral vertebrae, the sacral vertebrae presenting the aspect of lumbar vertebrae, etc. It is quite common to see the first lumbar vertebra presenting certain characteristics of the dorsal.

Numerical anomalies of the vertebrae are quite common, generally in the lumbar and dorsal regions, being quite rare in the cervical, although there have been instances of six or eight cervical vertebrae. In the lower animals the vertebrae are prolonged into a tail, which, however, is sometimes absent, particularly when hereditary influence exists. It has been noticed in the cla.s.s of dogs whose tails are habitually amputated to improve their appearance that the tail gradually decreases in length. Some breeders deny this fact.

Human Tails.--The prolongation of the coccyx sometimes takes the shape of a caudal extremity in man. Broca and others claim that the sacrum and the coccyx represent the normal tail of man, but examples are not infrequent in which there has been a fleshy or bony tail appended to the coccygeal region. Traditions of tailed men are old and widespread, and tailed races were supposed to reside in almost every country. There was at one time an ancient belief that all Cornishmen had tails, and certain men of Kent were said to have been afflicted with tails in retribution for their insults to Thomas a Becket. Struys, a Dutch traveler in Formosa in the seventeenth century, describes a wild man caught and tied for execution who had a tail more than a foot long, which was covered with red hair like that of a cow.

The Niam Niams of Central Africa are reported to have tails smooth and hairy and from two to ten inches long. Hubsch of Constantinople remarks that both men and women of this tribe have tails. Carpus, or Berengarius Carpensis, as he is called, in one of his Commentaries said that there were some people in Hibernia with long tails, but whether they were fleshy or cartilaginous could not be known, as the people could not be approached. Certain supposed tailed races which have been described by sea-captains and voyagers are really only examples of people who wear artificial appendages about the waists, such as palm-leaves and hair. A certain Wesleyan missionary, George Brown, in 1876 spoke of a formal breeding of a tailed race in Kali, off the coast of New Britain. Tailless children were slain at once, as they would be exposed to public ridicule. The tailed men of Borneo are people afflicted with hereditary malformation a.n.a.logous to s.e.xdigitism. A tailed race of princes have ruled Rajoopootana, and are fond of their ancestral mark. There are fabulous stories told of canoes in the East Indies which have holes in their benches made for the tails of the rowers. At one time in the East the presence of tails was taken as a sign of brute force.

There was reported from Caracas the discovery of a tribe of Indians in Paraguay who were provided with tails. The narrative reads somewhat after this manner: One day a number of workmen belonging to Tacura Tuyn while engaged in cutting gra.s.s had their mules attacked by some Guayacuyan Indians. The workmen pursued the Indians but only succeeded in capturing a boy of eight. He was taken to the house of Senor Francisco Galeochoa at Posedas, and was there discovered to have a tail ten inches long. On interrogation the boy stated that he had a brother who had a tail as long as his own, and that all the tribe had tails.

Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus, Strauss, and Wolff give descriptions of tails. Blanchard says he saw a tail fully a span in length: and there is a description in 1690 of a man by the name of Emanuel Konig, a son of a doctor of laws who had a tail half a span long, which grew directly downward from the coccyx and was coiled on the perineum, causing much discomfort. Jacob describes a pouch of skin resembling a tail which hung from the tip of the coccyx to the length of six inches. It was removed and was found to be thicker than the thumb, consisted of distinctly jointed portions with synovial capsules. Gosselin saw at his clinic a caudal appendix in an infant which measured about ten cm. Lissner says that in 1872 he a.s.sisted in the delivery of a young girl who had a tail consisting of a coccyx prolonged and covered with skin, and in 1884 he saw the same girl, at this time the tail measuring nearly 13 cm.

Virchow received for examination a tail three inches long amputated from a boy of eight weeks. Ornstein, chief physician of the Greek army, describes a Greek of twenty-six who had a hairless, conical tail, free only at the tip, two inches long and containing three vertebrae. He also remarks that other instances have been observed in recruits. Thirk of Broussa in 1820 described the tail of a Kurd of twenty-two which contained four vertebrae. Belinovski gives an account of a hip-joint amputation and extirpation of a fatty caudal extremity, the only one he had ever observed.

Before the Berlin Anthropological Society there were presented two adult male Papuans, in good health and spirits, who had been brought from New Guinea; their coccygeal bones projected 1 1/2 inches. Oliver Wendell Holmes in the Atlantic Monthly, June, 1890, says that he saw in London a photograph of a boy with a considerable tail. The "Moi Boy"

was a lad of twelve, who was found in Cochin China, with a tail a foot long which was simply a ma.s.s of flesh. Miller tells of a West Point student who had an elongation of the coccyx, forming a protuberance which bulged very visibly under the skin. Exercise at the riding school always gave him great distress, and the protuberance would often chafe until the skin was broken, the blood trickling into his boots.

Bartels presents a very complete article in which he describes 21 persons born with tails, most of the tails being merely fleshy protuberances. Darwin speaks of a person with a fleshy tail and refers to a French article on human tails.

Science contains a description of a negro child born near Louisville, eight weeks old, with a pedunculated tail 2 1/2 inches long, with a base 1 1/4 inches in circ.u.mference. The tail resembled in shape a pig's tail and had grown 1/4 inch since birth. It showed no signs of cartilage or bone, and had its origin from a point slightly to the left of the median line and about an inch above the end of the spinal column.

d.i.c.kinson recently reported the birth of a child with a tail. It was a well-developed female between 5 1/2 and six pounds in weight. The coccyx was covered with the skin on both the anterior and posterior surfaces. It thus formed a tail of the size of the nail of the little finger, with a length of nearly 3/16 inch on the inner surface and 3/8 inch on the rear surface. This little tip could be raised from the body and it slowly sank back.

In addition to the familiar caudal projection of the human fetus, d.i.c.kinson mentions a group of other vestigial remains of a former state of things. Briefly these are:--

(1) The plica semilunaris as a vestige of the nict.i.tating membrane of certain birds.

(2) The pointed ear, or the turned-down tip of the ears of many men.

(3) The atrophied muscles, such as those that move the ear, that are well developed in certain people, or that s.h.i.+ft the scalp, resembling the action of a horse in ridding itself of flies.

(4) The supracondyloid foremen of the humerus.

(5) The vermiform appendix.

(6) The location and direction of the hair on the trunk and limbs.

(7) The dwindling wisdom-teeth.

(8) The feet of the fetus strongly deflected inward, as in the apes, and persisting in the early months of life, together with great mobility and a distinct projection of the great toe at an angle from the side of the foot.

(9) The remarkable grasping power of the hand at birth and for a few weeks thereafter, that permits young babies to suspend their whole weight on a cane for a period varying from half a minute to two minutes.

Horrocks ascribes to these a.n.a.l tags a pathologic importance. He claims that they may be productive of fistula in ano, superficial ulcerations, fecal concretions, fissure in ano, and that they may hypertrophy and set up tenesmus and other troubles. The presence of human tails has given rise to discussion between friends and opponents of the Darwinian theory. By some it is considered a reversion to the lower species, while others deny this and claim it to be simply a pathologic appendix.

Anomalies of the Spinal Ca.n.a.l and Contents.--When there is a default in the spinal column, the vice of conformation is called spina bifida.

This is of two cla.s.ses: first, a simple opening in the vertebral ca.n.a.l, and, second, a large cleft sufficient to allow the egress of spinal membranes and substance. Figure 130 represents a large congenital sacral tumor.

Achard speaks of partial duplication of the central ca.n.a.l of the spinal cord. De Cecco reports a singular case of duplication of the lumbar segment of the spinal cord. Wagner speaks of duplication of a portion of the spinal cord.

Foot records a case of amyelia, or absence of the spinal cord, in a fetus with hernia cerebri and complete fissure of the spinal column.

Nicoll and Arnold describe an anencephalous fetus with absence of spinal marrow; and Smith also records the birth of an amyelitic fetus.

In some persons there are exaggerated curvatures of the spine. The first of these curvatures is called kyphosis, in which the curvature is posterior; second, lordosis, in which the curvature is anterior; third, scoliosis, in which it is lateral, to the right or left.