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 Papers by the Staff 
 
 OF THE 
 
 MEDICAL FACULTY, 
 
 McGILL UNIVERSITY, 
 
 i 
 
 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. 
 
 I 
 
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 
 
 8 
 
 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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