At the period when this case, the subject of so much difference of opinion between two such eminent pathologists, attracted the atten tion of the profession in Dublin, the writer had under his care, in the House of Industry, a patient who was born with deformity of both her wrist-joints and forearms, but whose right wrist-joint presented appearances closely resembling those described as characterising the deformity of the wrist and forearm in Cruveilhier's case. As the history of this woman's case was known from her birth, it was calculated to throw light on the subject in dispute. It seemed on this and other ac counts so interesting, that on the 13th of De cember, 1838, I laid it before the Pathological Society in Dublin. It was as follows : — — Deborah O'Neil, aged thirty, has been an inmate of the House of Industry, for the last seventeen years. She is liable to occasional attacks of epilepsy. She cannot be said to be insane, but she is wayward and refractory, and will not submit to any rational control. Yet she is very industrious. Her upper arms and hands bear in size and length a just proportion to the rest of her stature, which is about the middle size, but her fore arms appear scarcely more than half their normal length.
Her left forearm is dislocated forward at the radio-carpal joint, while the right forearmis dislocated, as in the preceding figure, back ward on the dorsum of the carpus.
The lower extremities of the bones of the right forearm could be seen and felt on the dorsum of the carpus, where they formed a very remarkable projection. The lowest ex tremity of the ulna could be seen to descend below the level of the lowest extremity of the dislocated radius, and when the hand of the patient was flexed could be made very proud nently to distend the skin posteriorly. When the surgeon introduced his fingers in front of the wrist-joint, and made a slight extension of the hand, the superior extremity of the carpus could be felt to be placed superiorly and ante riorly to the lowest extremities of the bones of the forearm. The hand inclined to the radial side, it could be extended on the fore arm freely, but flexion was incomplete.
The left wrist-joint presented an unique example of dislocation of the bones of the forearm exactly in the opposite direction to those already described. The forearm was thrown forwards, and the carpus with the hand on the back of the radius and ulna (flg. 926.).
This woman presented a very grotesque ap pearance in consequence of the remarkable shortness of both her forearms (figs. 926. and 927.) ; still she had a very good use of her hands, and showed admirable dexterity and skill in cutting out minute patterns on paper with her scissors.
As to this case of Deborah O'Neil, no am biguity existed. At the time the writer thus laid her case before the meeting, accompanied by casts of her forearms, she was, and had been for many years previously, an inmate in the House of Industry, under the constant observation of the whole medical staff of the institution. The history of her life was known.
It was stated that she never met with any accident, and that the peculiar deformity observable in each forearm and wrist-joint had existed from her birth.
The writer, in continuation, observed, that while congenital malformation was known very frequently to affect simultaneously both sides of the body, yet it would, on the other hand, be very difficult for any one to suggest what pro bable accidental causes could be imagined capable of dislocating the bones of both wrist joints, in opposite directions, as in the case of O'Neil : besides, the mere displacement of the bones of both forearms at the wrist-joint, con stituted only a part of the abnormal state of things noticed, because both of the forearms were so short as to measure only half the length of the arm, and did not exceed in length the measurement of the long axis of the hand. The history of her case, then, from her birth— the negative evidence as to the existence of any previous accidental cause adequate to ac count for the appearances, and the actual abnormal condition of both the upper extre mities of O'Neil — all taken together, suffi ciently proved her case to offer a curious spe cimen of congenital malformation of both wrist-joints and forearms." When the writer presented this case to the meeting of the Pathological Society, he laid before the members two casts of the mal formed extremities of the patient, and when the drawing of Cruveilhier's case (pl. 2. liv. ix.), was placed along side of the cast of the right forearm of O'Neil, every one pre sent agreed in the opinion that the cast pre sented an exact counter-part of Cruveilhier's drawing (fig. 924.).
Deborah O'Neil, five years subsequently to this date, died suddenly of apoplexy, in the Government Asylum, Island Bridge. Dr. R. W. Smith, the surgeon of the institution, made a post nzortenz examination of the affected arti culations. The result fully proved, as had been anticipated, that her right wrist-joint in every respect resembled the remarkable case brought forward by Cruveilhier.
Post Mortem Examination.—Upon the 15th of December, 1843, Mr. Smith exhibited fore a meeting of the Dublin Pathological Society, the skeleton of the limb in this case.