A NOTE ON THE LITTLE FINGER OF THE MONGOLIAN IDIOT AND OF NORMAL CHILDREN.*

BY J. PARK WEST, M.D., Bellaire, 0 .

Five years ago Dr. T. Telford Smith called attention;t to a peculiarity in the shape of the hand which existed to a greater or less degree in nearly every case of Mongolian idiocy he had exam­ ined, and consisted of a marked outward bowing or curving of the little finger. The skiagraph accompanying his paper shows "that the second phalanx of the little finger is considerably shorter than normal, and there is much lateral displacement of the terminal phalanx." Two years ago a girl, two and a half years old, who pre­ sented many of the physical but none of the mental character­ istics of the Mongol type of idiocy, came under my care. Her little fingers were somewhat curved, but not so much as those of her cousin, a normal male one month her junior. Of four Mongolian imbeciles seen previously but one had as much curve in the little fingers as this normal boy. This suggested the examination of the little fingers of other normal children, and after seeing a small number straight little fingers appeared to be the exception and a varying degree of curvature was quite common. To form an estimate of the various degrees of curvature and the percentage of the different forms, I have within the past two years examined the little fingers of 605 children under twelve years of age, 296 being males and 309 females. These were children (with the exception of about 30 seen at a school) I had occasion or could m ake occasion to see in any way, and a number were seen several times. They were the ordinary children of an industrial community made up chiefly of American­ born, with a few Bohemians, Russians, Germans, Italians and French. None were excluded except a few feeble-minded, a * Read before the American Pediatric Society, Niagara Fall s, N. Y., May 27, 28, 29, 190 1. 1' Pediatrics, October, 1896. W EsT: rhe Little Finger of Mongohan Idiot. 919 few with rheumatism, marked rachitis or deformities, and, after 50 for each year had been obtained, no more for that period were examined. Before the examinations had proceeded far it became evident that four varieties of little fingers existed in normal children, and for convenience they were recorded as follows, viz.: (I) Straight; (2) slight curve; (3) distinct curve j (4) marked curve. Of the 605 children, 112, or 18.5 per cent., had straight little fingers; 175, or 28. 9 per cent., a slight curve;

Fig. I.-STRA I GHT LITTLE FINGER.

199, or J2·9 per cent., a distinct curve; and 119, or 19. 6 per cent., a marked curve. . The curving or bowing in this last class (Fig. IV.), cor­ responds in degree to' that shown in the photographs of the idiots of the Mongol type published by Dr. Smith, and this skiagraph (Fig. V.), shows even more distinctly the same ana­ tomical condition causes the curving in this feeble-minded type and in the normal child with the marked bowing of the little 920 WEsT: The Little Finger of Mongolian Idiot.

Fig. 1! .-SLI GHT CURVE I N LITTLE FINGEK. Same in Ring Finger .

Fig. 111. -DIHINCT CURV E IN LITTLE FINGER. WEsT : 7he Little Finger of Mongolian Idiot. 921 fingers. A few children showing the marked curve to the naked eye do not show this anatomical condition distinctly to the fluoroscope; but some in the third class, those with a distinct but not so marked curve, (Fig. III.), also show the short middle and more or less displaced distal phalanx. It was not unusual to find the children of a family showing quite different degrees of curving in the little fingers, and 51 of the 605, or about 8 per cent., showed a different amount of

Fig. IV.-MARKED CURVE IN LITTLE FIN GER . bending in these two fingers without previous disease or injury to account for it. In a small number, probably 2 per cent., there was a distinct curve in the ring finger as shown in the second photograph (Fig. II.} Five sets of twins were seen and only one pair had fingers alike. Close examination for stigmata of degeneration was seldom made, but my impression is they were not present oftener in the third and fourth classes than in the other two. From my 922 WEST: 'The Little Finger oj Mongolian Idiot. knowledge of quite a number and trom inquiries about others l believe the mental capacity of the four classes is about the same. Four children under two years of age with the markedly curved little fingers have been watched from birth. The mental and physical development of all has been fully up to the average, and in three of them there has been an increase of the curving. I have seen but nine Mongolian imbeciles within the past four years. I assisted at the birth of two of these, and the ages

fig. V .-SKIAGRAPH OF HA ND OF FIG. IV. of the others varied from nine months to twelve years. Only one had such a bowing in the little fin gers as this fourth photo­ graph shows. Two others had a less marked curving that was apparently due to the anatomical peculiarity mentioned. Three had very slight curving and two had straight little fingers. One, nine months old, seen for the first time ten days ago, had the right little finger straight and the left somewhat curved, and it WEsT: 'Th e Little Finger of Mongolian Idiot. 923

is likely this will increase as the child grows older. Of the two seen at birth one had straight little fin gers, the other a very slight bend at the distal phalangeal joint that had almost disappeared before his death, seven months later. A conclusion cannot be based on these few cases, but there is a striking similarity in them and in the normal children. I am indebted to my colleague, Dr. ]. S. McClellan, for the skiagraph and for the privilege of examining the hands of several children with the fluoroscope.

SLIGH T DISTINCT M ARKED A GE S Ex STRAIGHT N u M BER CuRVE CuRVE CURVE

Un der 1 year Male 9 8 I 2 ; } 20 . 3 I 8 5 t t Female II - :;- f . II - J 19 . ;-j 8. 30- l 55 · Between 1 and 2 years M . 10 9 t 16. I 4 t 1 1. 5 t F. 7- f b- J !6. 7-l 2- j 7·

2 and 3 " M. 10 2 8 I o t . 7 i 12. 7 t 10 3 t F. 4- f I-. 6- j l b . 5- r ;- f . 18- f 50.

1 and 4 " M . 12 I 26 ' 1. 10 . 5 I I 0 t F. 5-l 7- f -· 6- f 18. t-} 10. 24- f )0.

4 and 5 " M. 2 t I I t 2 2 . 27 t ·o F. 2 - l 4· II- J 23- l ' .

5 and 6 " M. 3 I 4 1. 6 14 I o4 25 ·o. F. 6- f 9 . 2-j . 10-r-· _o•,- r )

6 and 7 " M. 2 I 5 I 14. 5 I 22 1 F. ;- f 5· 9- f : ~-} 22 . 4- f 9' 28- r ,o.

7 and 8 '' M. 2 I 6 I 6 t oo [' F. 5-) 7· 10 - f 16 . 7- j 13' 3o- f 50.

8 and 9 " M. I I F. 5- J 6.

9 and 1 o " M. 5 I 7 t I 1. F 2 - f 7· 4- f

10 11 " and M . 7 t 5 t 8 _.,0. } ~o F. L} 5 12- ) 19 . ~ ~- ~ 18. 3- l . 25- ' .

1 I an d 12 '' M. 7 t 14· 3 I IJ F. 7- f 10- f .

M. I 12. 175· 199· 1 19. T OTALS { F. (11'1.) %) (2 8.9 %) (32 .9 f{) 924 WEST : 'The Little Finge1' of Mongolian Idiot.

DISCUSSION. DR. RoTCH. -It seems to me this corresponds somewhat with the investigations of the criminal ear. DR. KoPLIK.-In demonstrating this Mongolian finger I have long been impressed by the fact that many people can show a small bend in their fingers. The Mongolian idiot shows the bend merely a little more marked than normal children, and I am very much pleased that Dr. West should have worked out this subject.

R.heumatic Nodes in Children.-Among 75 cases of rheu­ matic nodes published in recent years fully four-fifths relate to patients over twenty years of age. Rarely are nodes found after a first attack of rheumatism, as in a case reported by A. josias (LaMed. Moderne, September 25, 1901). The subject in this instance was eleven years old and was suffering from a polyarticular rheumatic attack. The nodes were situated be­ neath the skin, which was freely movable over them and nor­ mal in color; they seemed to be adherent to the deep tendons and in some instances to the fibrous tissue covering the bones. In size they varied from that of a hempseed to that of a lentil. They were found on the hands, about the wrists, elbows, shoul­ ders, feet, ankles, knees and head. The patient was kept under observation during a period of two months, during which time most of the nodes disappeared while those which remained diminished in size. One of the nodes was removed for examination and was found to consist of a flabby tissue which histologically revealed a vascular network with thick walls. In cases. previously reported nodes were formed of fibrous tissue and sometimes of cartilage; others are said to have had necrotic areas. Nepoen is said to have found bacilli and micrococci in the lesions; bacteriological examination by josias was negative. The latter compares the rheumatic node to the endocardial vegetations of rheumatism ; in both cases there is a cellular proliferation superinduced by the same infec­ tious cause. Endocardial growths may occur without accom­ paniment of subcutaneous nodes, but the latter are always accompanied by endocardial lesions and usually by chronic symptoms as well.-Medical News.