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Papers by the Staff

OF THE

MEDICAL FACULTY,

McGILL UNIVERSITY,

A?" '7

[Ueprintel from Thk riiii.AiiKi pmia Mkdicai. .Ioubnai, Outobtr 14, 1899.1

A CASE OF CONGENITAL DEFICIENCY OF BOTH
CLAVICLES.

By W, F. HAMILTON, AI.D.,

of Montreal, Can.

Lecturer in Clinical Medicine, MoGill Unlversily, Assistant Physician to tbe
Royai Victoria HoHpital.

The subject of this anomaly was admitted to the
Royal Victoria Hospital complaining of pains in the
back and legs, of weakness and of inability to sleep.

She was a fairly well developed woman, 38 years of
dge and unmarried. Her shoulders were sloping and
her gait was marked by slight swaying from aide to
side with lordosis. She had worn a plaster jacket for
the last three years, as she felt her back needed more
support than her muscles afforded.

It was found on inquiry that she had " always been
troubled with a weak back." As a babe she was not
strong. Her first teeth came at 2 years of age and
thereafter. They were not lost until after her fifteenth
year, and the second teeth were very poorly developed,
few of them appearing above the gums. She began
to walk at 3 years of age.

She is one of a family of 8 children, all of whom are
living and well with the exception of one brother who
died of pulmonary tuberculosis. She has had measles,
scarlet-fever and whooping-cough. Her height is 5 feet,
and she weighed on admission about 120 pounds. The
frontal eminences are prominent and separated by a
wide and shallow furrow, running back over the crown.
The upper teeth are artificial, the palate is high and
arched. The joints generally are lax. Tliere is double

talipes planus, but no bone deformity nor deficiency is
noticed anywhere except that presented by the clavi-
cles. The scapulas are soniev..iat winged when the

patient is erect.

On examination of the clavicles one finds only the
sternal end of each bone with about one-third the shaft.
Each ends abruptly about 2\ inches from the sterno-
clavicular articulation and the remainder of the dis-

Ki(i. I.

tance to the acromion i)rocess is spanned by a fibrous
cord, more reaiiily felt on the left than on the right
side. There does not appear to be any abnormality in
the muscles about the clavicle, although on ; cannot be
certain on this point without dissection. A ■: all events,
all the ordinary movements of arms and gnoulders are
well performed, and the patient has experienced no
disability on account of this abiwrmality.

l^T

deficiency is
by the clivvi-
id when the

inds only the
lird the shaft.
1 the sterno-
r of the dis-

id by a fibrous
n on the right
abnormality in
I on J cannot be
A ■: all events,
1 gnoulders are
ixperienced no

Such a condition is very rare indeed, an<l a careful
search over niedicril literature is not rewarded with
finding many examples of the kind.

(Justave Schorstein reports a case similar in the greater
number of characteristic points, (ieorge Carpenter

Fifi. 2.

gives a report of another patient undergoing treatment
for impetigo contagiosa in whom deficiency of the
clavicles was discovered. The patient whose case is
described by Dr. Carpenter was one of six l)elonging to
the same familv in whom clavicular deformities, among

CXA

(ithcr anomalies, nro doHcribed. The fathor's clavicles
were (lividi'd near the center; one brother, aged 14
years, had a divided right clavicle; a sister, aged 12,
and a brother, aged 7, presented a similar condition.
In another brother, aged 19, a peculiar kink was ob-
served in the position where, in the other cases, the
fragments were divided.

In reviewing the literature as suggested by these two
recent writers in the Lancet, we lind that 20 cases show-
ing clavicular deficiency in some part have been re-
ported. This case now reported makes 21 . The sternal
end of the bone seems to be generally prtsent while
the acromion or outer portion of the shaft is represented
by a fibrous band.

Todd, of St. Louis, as cjuoted by Carpenter, discovered
in the dissecting-room " a subject without clavicles.
Rudiments of the clavicles were attached to the acro-
mion process and to the sternum— the intermediate por-
tions being wanting."

An attempt was made to take a skiagraph of our
case, but it showed so poorly in this way that no effort
has been made to reproduce it for this report.

I am indebted to Dr. H. B. Cushing, house physician,
for references to the literature on this case, and to Dr.
Patrick for the photographs.

S87 Mountain Street,

Montreal, Canada.

1 _

[2v\

licr's olavicles
>ther, aned 14
ister, aged 12,
ilar condition,
iiiiik was ob-
Lher ciwes, the

1 by these two
'20 casos show-
have been re-
1. Thesti'rnal
■ prtsent while
t, is represented

iter, discovered
lout clavicles,
ed to the acro-
ermediate por-

agraph of our

f that no effort

;port.

ouse physician,

ase, and to Dr.

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