Malformation of arm / by Allen Sturge.

  • Sturge, William Allen, 1850-1919.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Malformation of arm / by Allen Sturge. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the rest of the body, including the upper part of the limb itself, is healthy, the diagnosis of the mode of causation is more difficult; but a comparison of a large number of cases of congenital deficiency will show that every variety may be met with, from cases in which all the limbs are deficient or deformed in some other way, to cases in which the extremity of one finger only is deficient. As, there- fore, no line of demarcation can be drawn, dividing the cases into two well-defined groups, so it will, I believe, be impossible to attri- bute those cases lying at one end of the scale to a cause essentially different from that to which the cases at the other end of the scale have been attributed. There are two factors which may possibly be found to help us in coming to a correct conclusion with regard to certain of the doubtful cases, and to which, therefore, L think, more attention should be paid. These are—(1) the presence of rudimentary fingers on the end of the stump ; (2) the presence of umbilications over the ends of the bones. I think it is worthy of inquiry whether rudimentary fingers have been present in any of those cases in which the amputated limb has been found. It is very easy to account for them on the hypothesis of mal-development, for in that case they represent the amount of vitality left in the embryonic cells, from which the extremity of the limb should have been developed. On this hypothesis we should expect to find, as, in fact, have been found, many degrees of develop- ment, ranging from minute nodules representing fingers at one end o the scale, up to extremities of limbs, which differ but little from ie laud, at its other end. This last condition was present in one of the cases recorded by Mr. Annandale. If it be found that no ludimentary fingers occur in undoubted cases of amputation, then their presence would afford presumptive evidence in favour of the Hypothesis of mal-development. As regards the question of umbilication of the skin over the ends stl: r WUch d0S8ed P—» of sears on the stump the quest.cn ar.ses, “Do umbilication and scarring necessarily ■udma e amputation? This question can only bo anfwereTby a caicfhil examination of cases in which multiple deformity is present so as to exclude the hypothesis of amputation. There is certainh’ no a priori reason why the formation of a rounded stumn nf( i ' S ruction of the embryonic cells from which tl e’Sy of ! limb be S‘ve rise to the 2*