Congenital deformities of the upper extremities / by Arne Birch-Jensen.

  • Birch-Jensen, Arne (Arne Sofus Wind), 1910-
Date:
1949
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Congenital deformities of the upper extremities / by Arne Birch-Jensen. Source: Wellcome Collection.

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    stage owing to a poor supply of nourishment to the part distal to the point of constriction. This concept of the rudimentary fingers as exogenous formations persisted for several years (Ho vor k a 1906, Bo ich mann 1917, and others). The latter writer, however, altered his view to some extent, when, after X-ray of some congenital amputations with rudimentary fingers, he discovered that it was a question of a »defective germ cell«. As late as in 1935 Lange alleged that amputations with immovable rudimentary fingers are exogenous formations, while movable rudimentary fingers are endogenous formations. However, the fact has been established within recent years that rudimentary fingers, whether movable or immovable, are indicative of endogenous amputations only (Günther 1939). These amputations being by far the most frequent ones, the possibility of exogenous amputations is not great. Vellguth, 1937, even doubted the existence of spontaneous amputations, and tried to prove that their occurrence is a technical impossibility. The grat majority of investigators, however, still regard the exogenous aetiology as possible, but rare in proportion to the endogenous aetiology (Gruber 1937). Grooves of constriction are often taken as a proof of the action of mechani cal factors, a view to which, on the other hand, various objections have also been raised. Heidler, 1922, explained the occurrence of the grooves as due to a »primary defective development«. Streeter, 1930, and Hiickel, 1936, regarded them as local annular zones of defectively developed tissue, and B öh m ig, 1938, suggested a developmental disturbance in the vascular system as the cause of groove of constriction. Gre i g took the grooves to be of endo genous origin and independent of the amnion. According to Schwarz weller, 1939, grooves of constriction arise primarily by defective development, while secondarily epithelial defects change the amnion. This should be the reason why amniotic bands are often found at the site of the groove. Finally, Schade, 1940, stated that we cannot leave out of account the possibility that the grooves of constriction may be due to hypoplasia. At any rate they must not be regarded as amniotic, unless corresponding changes have been found in the remaining egg-cell membranes. As stated above, the congenital amputations may have both an endogenous and an exogenous aetiology; but various other congenital deformities have long since been established as having only an endogenous aetiology. This applies in the first instance to split-hand, which according to Pearson, 1908, is a dominant defect in the Mendelian sense. The defects of the rays must be supposed to be of endogenous origin, in spite of the fact that they have shown no definite mode of hereditary transmission (Wierzejewski 1910, Schwarzbach 1912, Restemeier 1920, and many others). Great uncertainty prevailed, however, as to this question at the beginning of the present century. Lotsch, 1906, was in no doubt that radial defect must be caused by radial intra-uterine injury to the