A CASE OF CONGENITAL DEFORMITY. 
By A. L. Stavely, M. D., 
Assistant Resident Gynecologist in the Johns Hoploins Hospital. 
[From The Johns Hopkins Hospital Bulletin, No. 18, December, 1891.] [From The Johns Hopkins Hospital Bulletin, No. 18, December, 1891.] 
A CASE OF CONGENITAL DEFORMITY. 
By A. L. Stavely, M. D., 
Assistant Resident Gynecologist. 
In the gynecological dispensary service of the Johns Hopkins 
Hospital the following case of a congenital deformity, attributed to 
maternal impression, appeared: 
Rosa H., aet. 21, married two years, sterile, presented herself on 
June, 23,1891, for treatment. 
She presents a congenital deformity of both arms. On the 
right side the shoulder is remarkably well developed and the same 
is true of the arm for one-half the normal length. It then 
abruptly terminates, and joined to it is an insignificant forearm. 
The right scapula is rather smaller than normal. The elbow 
joint possesses rotary motion and can be moved antero-posterior- 
ally or laterally with almost equal ease. 
The skin over the posterior margin of the acromial process has 
a very marked indentation. The arm can be raised from the 
body only to an angle of 60°. 
There is good antero-posterior movement at the articulation 
corresponding to the wrist. The measurements are as follows : 
Length of humerus, six inches ; circumference of arm at axilla, 
twelve inches; circumference of arm just above elbow, ten and 
one-fourth inches ; length of radius, three and one-fourth inches ; 
length of ulna, three inches; circumference of upper portion of 
forearm, five inches ; circumference of lower portion of forearm, 
four and five-eights inches. The internal condyle of the humerus 
is very prominent: the external is absent. 
The radius articulates with a bone corresponding to a metacar- 
pal, two inches in length, and the ulna with a similar bone two 
and one-half inches in length, the latter having a marked out- 
ward bowing. 
The internal metacarpal is surmounted by a rudimentary 
phalangeal bone which terminates in a claw. The external metacarpal articulates with a phalangeal bone 
three-fourths of an inch in length and possessing a well-developed 
nail. 
The distal ends of the phalanges are connected by a bridge of 
bone. Adherent to the outside of the hand is a pendulous ball 
of tissue about the size of a cherry. The entire length of the 
arm is twelve inches. On the left side there is perfect motion in 
the shoulder joint, absolutely none at the elbow, and good move- 
ment in the wrist and three finger joints. 
Distance from acromial process to a point corresponding to the 
elbow, ten inches ; circumference of arm at axilla, twelve inches ; 
circumference of arm at elbow, eight inches. Forearm is five inches in length ; circumference of upper por- 
tion of forearm, eight inches ; circumference of lower portion, 
five and one-half inches. Corresponding to the carpus is a bone 
one and one-half inches long and one and one-half inches wide at 
the base. 
Internal metacarpal is two inches long; middle metacarpal, 
two and one-half inches ; external metacarpal, two inches. 
She has three fingers. The first is crooked, has two phalanges, 
and is two inches long ; the second has three phalanges and is 
three and one-half inches long ; the third has three phalanges and 
is three inches long. 
Circumference at the base of the fingers, six inches ; the entire 
length of the extremity, twenty-two inches. Corresponding to 
the internal condyle of the humerus is a small, though well- 
defined, projection of bone. 
There is no joint at the elbow and the humerus is continuous 
with a flat bone, which corresponds to the radius and ulna, and 
which is probably the result of a coalescence of the two bones. 
There is an outward bowing of the whole extremity. 
Having seen this deformity, the wonder is that she can accom- 
plish so much ; yet with her two wretched substitutes for upper 
extremities she can write, scrub, iron clothes, make her own 
dresses and perform other things equally surprising. At present 
she is engaged in the delicate task of making a bridal trousseau 
for one of her friends. 
The father and mother are perfectly healthy and neither pos- 
sess any deformity, except the father who has become stoop- 
shouldered from bending while at work. 
She has five sisters and six brothers, all of whom were without 
any visible deformity. 
The mother attributes her child’s condition to this: 
About twenty-two years ago she, the mother, owned a number 
of cows and was in the habit of purchasing “ slop ” for the ani- 
mals from a man, who, at one time, had sustained an injury to the 
right arm, which injury necessitated an amputation about mid- 
way between the shoulder and elbow. 
During the third month of her pregnancy this man went to her 
to collect some money due him, and in order to receive it he 
extended the stump, which she had never noticed before. The 
sight of the maimed limb frightened her, and at the time she 
involuntarily placed her hands upon his shoulders. She thought about it frequently after that and “ felt very sorry for the poor 
fellow.” 
Although most of the present authorities are opposed to the 
theory that the mother can by any mental impression affect her 
ehild in utero, they have not been able to offer any satisfactory 
explanation of these peculiar deformities. 
Some abnormalities can be properly attributed to physical 
causes, as blows or falls upon the abdomen, directly affecting the 
growth of the embryo. Unconscious muscular action has been 
advanced as a possible cause. 
Rudimentary developments of arms or legs are often due to the 
presence of amniotic bands, which constrict the parts, retard their 
growth, and occasionally result in their complete amputation. 
In corroboration of this amputated members have been found 
loose in the uterine cavity. 
Loops in the umbilical cord by a gradual strangulation of a 
part are said to be productive of the same result. 
That the present deformity was not due to any constricting 
force is quite evident from the fact that there is complete absence 
of a number of bones on both sides. 
If it had been due to constriction there would have been rudi- 
mentary development of, but not a deficiency in, the number of 
bones as in this case. 
Inherited disease, as syphilis, is an occasional factor in the 
formation of abnormalities. A diseased condition of the uterus 
or its contained membranes, the presence of growths in the cavity 
or walls of the uterus, or on the other hand a deficiency of liquor 
amnii or impaired development of the uterus itself are all con- 
sidered as possible and likely causes of congenital deformity.