HX64082601 
 
 QM117.P95 Some observations on 
 
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 Columbia SSnttJem'tp 
 
 tntI)e€itpoflfttilork 
 
 College of ^tjpgicianss anb ^urgeong 
 Eibrarp 
 
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 Bulletin of the 
 
 University of Kentucky 
 
 Lexington 
 
 From the Laboratory of 
 
 Anatomy and Physiology 
 
 PUBLISHED BY THE UNIVERSITY 
 
 Vol. VIII NOVEMBER, 1916 No. 11 
 
 Entarad m» Second Class Matter at the Post Office, Lexington, Kentucky, nnder the 
 Act of July 16. 1894. 
 
 ':?o"ltnn:'^ 
 
Some Observations on the Ossification 
 of the Bones of the 
 
 TUT 
 
 iO 
 
 /A 
 
 MD) 
 
 By J. W. PRYOR, M.D., 
 
 Professor of Anatomy and Physiology, 
 University of Kentucky. 
 
 University Press, Lexington. 
 
1. M. B.— Female, 1 year, 2 months, 20 days. 
 
o 
 
 in 
 
 C") 
 
 CM 
 
 SOME OBSERVATIONS ON THE OSSIFICATION OF THE 
 BONES OF THE HAND.* 
 
 Previous to the advent of the X-Ray all timlings as to the time 
 of appearance of points of ossification in bones and other features 
 pertaining to the process of ossification were dependent upon speci- 
 mens obtained from the dead house. Obviously all conclusions were 
 based upon the examination of comparatively few subjects. Many 
 errors that have been perpetuated in standard works of anatomy are 
 due to these facts. 
 
 In a Bulletin of State University of Kentucky, published April, 
 1908, I gave the results of the examination of the hands of five hun- 
 dred and fifty-four ( 554) children from three months to fourteen 
 years of age. Over two hundred (200) of these were under seven 
 years of age. 
 
 The name, age, number of child, order of ossification and size 
 of nucleus in M. M. was given. 
 
 A careful study of these negatives resulted in the following 
 
 observations : 
 
 First. — The process of ossification is inaugurated much sooner 
 
 than hitherto supposed. 
 
 Second. — The bones of the female ossify in advance of the male. 
 This is measured at first by days, then months, then years. 
 
 Third. — The chronological order in which the bones of the car- 
 pus are ossified is difi'erent from that formerly supposed. 
 
 Pourth. — The bones of the first child, as a rule, ossify sooner than 
 those of subsecjuent children. 
 
 Pifth. — Regardless of the variations (normal) the ossification is 
 bilaterally "^vmmetrical. 
 
 Si.vth. — The union of the epiphyses with the shaft takes place 
 much sooner than formerW supposed. 
 
 Sevcuth.—Y arintion in the ossification of bones is a heritable 
 trait. 
 
 *A summary of this article was read before the Kentucky State Medical Association, 
 Louisville, September 21-23, 1915. 
 
2. E. C— Female, 6 months. 
 
 3. E. C— Female, 2 years, 5 months, 13 days. 
 
It is my purpose to call attention to each of these observations, 
 giving some of the proof, in the way of illustrations and otherwise, 
 that I believe to be conclusive. At any rate, I have based my con- 
 clusion on the proof I submit, and I sincerely hope others will investi- 
 gate this subject and confirm or deny my conclusions. I see no reason 
 why there should be a decided difference between the hands of chil- 
 dren in the State of Kentucky and those of other States. 
 
 First. — The process of ossification is inaugurated much sooner 
 than hitherto supposed. 
 
 The OS magnum is the first bone in the human carpus to begin the 
 process of ossification. In the hand of the female, the first point will 
 make its appearance before the child is six months of age. In excep- 
 tional instances ossification may begin before birth. 
 
 In all of the hands of those under three years of age, the size of 
 the nucleus would indicate the average appearance of the magnum 
 between the third and sixth month, and that of the unciform a few 
 months later. The cuneiform will make its appearance between the 
 second and third years. The fourth bone of the carpus to begin ossifi- 
 cation is the semilunar, the nucleus of which will appear between the 
 third and fourth year ; while that of the scaphoid -will appear when the 
 child is about four years of age, or early in the fifth year. It is only in 
 rare or exceptional instances that you find the semilunar or scaphoid 
 appearing after the child is five years of age. 
 
 The trapezoid and trapezium will make their appearance betw^een 
 the fotn-th and fifth year, in the order named. The last bone, or pisi- 
 form will begin ossification between the ninth and tenth year. An ex- 
 amination of the table will show that in only six instances can we record 
 the absence of any of the bones that should be present when the child 
 was six years of age or older. 
 
 The male hand is slower to develop. The difference is measured 
 at first by days, then months, then years. An examination of this 
 part of the table will show that in only six instances can we find the 
 absence of any of the seven bones of the carpus that should be present 
 when the child was seven years of age or older. 
 
 The first eighteen illustrations given are fairly representative of 
 the average hands of both the male and female. 
 
 While Figure 1 is somewhat in advance of the average in some 
 
4. C. G. B. — Female, i year, 9 momhs, 24 days; right. 
 
 5. C. G. B.— Female, 1 year, 9 months, 24 days, left. 
 
respects, in others it is no farther advanced than many that I have 
 observed. Figure 2 is the hand of E. C, female, age 6 months, and 
 Figure 3 is the same hand taken at the age of 2 years, 5 months and 13 
 days. 
 
 Figure 4 and 5 are the right and left hand of a little girl 1 year, 9 
 months and 26 days of age. The magnum and unciform show at least 
 one year's growth and a large number of epiphyses of the metacorpal 
 bones and phalanges are well under way in ossification. 
 
 In the male hand, I would call your attention to Figure 12, P. M., 
 male, age 8 months and 25 days, and Figure 13 is the same hand taken 
 at the age of 1 year, 6 months and 6 days. 
 
 My investigation along this line brought me to the following con- 
 clusions in regard to' the time of appearance of points of ossification in 
 the bones of the carpus : 
 
 between the third and sixth month. 
 
 between the fourth and tenth month. 
 
 between the fifth and tenth month. 
 
 between the sixth and twelfth month. 
 
 between the second and third year. 
 
 when about three 5fears of age. 
 
 between the third and fourth year. 
 
 when about four years of age. 
 
 at four years of age, or early in fifth year.. 
 
 when about five years of age. 
 
 laetween fourth and fifth year (preceding. 
 
 trapezium), 
 between fifth and sixth year (preceding' 
 
 trapezium ). 
 
 lietween fourth and fifth year ( preceded 
 
 by trapezoid), 
 between fifth and sixth year (preceded by 
 
 trapezoid) . 
 
 between the ninth and tenth year, 
 between the twelfth and thirteenth year. 
 
 P 
 
 Ph <! 
 
 < 
 
 1 Fcniaic: 
 I Male: 
 \ Female: 
 \Male: 
 1 Female: 
 I Male: 
 i Female: 
 I Male: 
 \ Female: 
 } Male: 
 f Female: 
 
 6. Tr.\pEzoid \ ji/„/^,. 
 
 1. Os 3.IAGNUM. 
 
 2. Unciform . . 
 
 3. Cuneiform . 
 
 4. Semilunar . 
 
 5. Scaphoid . . . 
 
 7. Trapezium 
 
 f Femal 
 ] Male: 
 
 \ Female. 
 is. Pisiform I Male: 
 
 The early appearance of points of ossification in the hand is also 
 seen in those of the epiphyses, especially those of the phalanges and 
 
 metacarpal bones. . , • i ^, 
 
 The Epiphyses of the hand are all cartilagmous at birth, ihe 
 
 diaphyses are Avell advanced in ossification, having commenced this 
 
 process "about the eighth week of intra-uterine life." 
 
 The first point of ossification to appear, of the epiphyses, is that 
 
 of the lower extremity of the radius. While the lower extremity of the 
 
6. M. B. — Female, 2 years, 3 months, 10 days. 
 
 -3JP 
 
 7. R. A. — Female, 3 years, 10 months, 20 days. 
 
9 
 
 radius and the ulna are not a part of the hand, I think the develop- 
 ment of these epiphyses should be considered in connection with the 
 development of the hand. 
 
 In the hand of the female a point of ossification may appear, in 
 the epiphysis, of the lower extremity of the radius, as early as two or 
 three months after birth. 
 
 This we see in the hand of M. B. female, age one year, two months 
 and twenty days (Fig. 1). I will here call attention to all of the illus- 
 trations given, the youngest of which indicates an early ossification 
 of this epiphysis. In every hand of the female I have seen, the size 
 of the nucleus would indicate its appearance before the close of the first 
 year, and in the majority about the eighth month. This epiphysis will 
 unite with the shaft between the seventeenth and twentieth years. In 
 the majority of instances it will unite about the seventeenth or eight- 
 eenth year. It appears earlier than that of the ulna, but is later in 
 uniting with the shaft. 
 
 In the hand of the male the epiphysis of the lower extremity of the 
 radius is a few months later in developing. The hand of P. M. male, 
 age ten months and seven days, does not show any evidence of ossifica- 
 tion of this epiphysis. A negative of the same hand taken a few 
 months later, /'. e., at the age of one year, six months, and six days, 
 (Fig 13.), shows an oblong nucleus, five m. m. in width and two m. m. 
 in thickness, indicating its appearance soon after the close of the first 
 year. 
 
 This is the fifth child of his parents and would be somewhat slower 
 in developing. In every hand of the male, that I have examined, a 
 point of ossification had appeared in the epiphysis of the lower 
 extremity of the radius before the child was two years of age. 
 
 I think in a majority of the cases this epiphysis will begin to ossify 
 in the hand of the male early in the second year, that is about the 
 fifteenth month. This epiphysis will unite with the shaft between the 
 eighteenth and twenty-first year." Like the hand of the female, it 
 appears before that of the ulna, but is later in uniting with the shaft. 
 
 A point of ossification of the epiphysis of the lower extremity of 
 the ulna, of the hand of the female, may appear before the end of the 
 fifth year. The youngest hand I have seen in which this epiphysis had 
 appeared was at the age of four years and six months. I have observed 
 
10 
 
 8. D. P. — Female, 4 years, 4 months, 24 days. 
 
 9. C. D. — Female, 4 years, 8 months, 18 days. 
 
11 
 
 a few when between five and six years of age. At least ninety per 
 cent, will not appear until the child' is sir years of age, and between that 
 and seven. Although this epiphysis appears four or five years after that 
 of the radius, it unites with the shaft before it. It unites with the shaft 
 about the si.vtccnth or seventeenth year, sometimes several years sooner. 
 In the hand of the male, the earliest appearance of the epiphysis 
 of the lower extremity of the ulna, was at the age of five years and four 
 months. Very few appeared before the child was seven years of age, 
 and the majority between seven and eight years old. In the hand of the 
 male, this epiphysis will unite with the shaft from the seventeenth to 
 ihe.twentieth year. 
 
 In regard to the ossification of the epiphysis of the hand, Cun- 
 ningham^ says : "The secondary centers from which the heads of the 
 second, third, fourth, and fifth metacarpals and the base of the first 
 are developed appear about the third year and usually completely fuse 
 with the shaft about the age of twenty. There may be an independent 
 center for the Styloid process of the third metacarpal. The phalanges 
 are ossified from primary and secondary centers. From the former, 
 which appear as early as the ninth week of foetal life, the shaft and 
 distal extremities are developed ; whilst the latter, which begin to appear 
 about the third year, form the proximal epiphysis, which unite with 
 the shaft from eighteen to twenty." 
 
 I quote from Morris- as follows : "Each of the metacarpal bones 
 and phalanges are ossified from a primary center for the greater part 
 of the bone and from one epiphyseal center. The primary nucleus 
 appears from the eighth to the tenth week of intra-uterine life. In 
 the inner four metacarpal bones the epiphysis is distal, whilst in the 
 first metacarpal bone, and in all the phalanges it is proximal. The 
 epiphyseal nuclei appear from the third to the fifth year and are united 
 to their respective shafts about the twentieth year. The third meta- 
 carpal occasionally has an additional nucleus for the prominent Styloid 
 process, which may remain distinct and form a Styloid bone, and traces 
 of a proximal epiphysis have been observed in the second metacarpal 
 bone." 
 
 1 Text Book of Anatomy, Cunningham, pages 212, 213. 
 - Human Anatomy, page 152. 
 
12 
 
 10. L. F. — Female, 5 years, 9 months, 28 days. 
 
 11. W. S.— Male, 1 year, 9 months, 10 days. 
 
13 
 
 HoLDEN^ gives the following: "Each metacarpal bone has a center 
 of ossification for the shaft and proximal end, which appears near the 
 distal end about the eighth week of foetal life. Each also has an epi- 
 physis at its distal end, of which the nucleus appears from about 
 the third to the fifth year. The metacarpal bone of the thumb, how- 
 ever, has its epiphysis at the proximal end, like the phalanges of the 
 fingers. All unite to the shaft about the nineteenth year. Each 
 phalanx has two centers of ossification : one for the shaft and distal 
 end, appearing about the eighth week ; the other for the proximal end, 
 appearing from the third to tlie fifth year, and remaining an epiphysis 
 till about the twentieth year." 
 
 Gray* says : "The metacarpal bones are each developed by two 
 centers, one for the shaft and one for the distal extremity, for the 
 four inner metacarpal bones, one for the shaft and one for the base, for 
 the metacarpal bone of the thumb, which in this respect resembles the 
 phalanges. About the third year the digital extremities of the four 
 inner metacarpal bones and the base of the first metacarpal begins to 
 ossify and they unite about the twentieth year. 
 
 "The phalanges are each developed by two centers ; one for the 
 shaft and one for the base. Ossification of the base commences in the 
 first row between the third and fourth years, and a year later in those 
 of the second and third row. The two centers become united in each 
 row, between the eighteenth and twentieth years." 
 
 Poland-'' dififers but little from the others quoted, he says : "The 
 epiphysis of the metacarpal bone of the thumb is developed like one of 
 the phalanges, the epiphysis being situated at its proxiiral end. In the 
 four inner or true metacarpals the epiphysis is placed at the lower 
 extremity. Both morphologically and developmentally this bone should 
 be regarded as a phalanx. The epiphyses hitherto cartilaginous in all 
 the metacarpal bones begin to ossify about the third and unite with 
 the shaft about the nineteenth year. Ossification takes place succes- 
 sively from the first phalanges to the second, and lastly in the third, 
 in the first row from the third to the fourth year and on the second 
 and third row from the fourth to the fifth year. The epiphysis of the 
 
 3 Human Osteology, Holden, pages 355-338. 
 
 4 Gray's Anatomy, pages 205, 206. 
 
 5 Skiagraphic Atlas, Poland, pages, 5, 6. 
 
14 
 
 
 
 ;r- 
 
 ■f' 
 
 *... 
 
 
 ^ 
 
 
 
 
 
 1 
 
 12. P. M.— Male, 8 months, 21 days. 
 
 13. P. M. -Male, 1 year, 6 months, 6 days. 
 
15 
 
 terminal phalanx of the little finger is frequently absent, the epiphyses 
 unite to their respective shafts alx)ut the nineteenth year." 
 
 My observations differ very materially from the above, quoted 
 from the latest editions of these standard works. 
 
 There is no distinction made b_y any of these authors between the 
 hand of the male and that of the female, and yet there can be no ques- 
 tion that the hand of the female develops much sooner than that of the 
 male. As I have said before, this is first measured by days, then 
 months, then years. The fully developed hand of the female being at 
 least two years in advance of that of the male. Whilst the individual 
 skiagrams show this difference in the development of the hand of the 
 female in advance of that of the male, the contrast is more distinctly 
 and picturesquely shown in twins of the same sex and those of diff'erent 
 sexes. 
 
 The second epiphysis to appear in the hand of the female is that 
 of the proximal extremity, of the first phalanx of the middle finger, 
 followed by the ring, index, and little fingers, then the thumb. The first 
 named mav appear as early as the sixth month, as seen in the hand 
 of M. B. female, age one year, two months, and twenty days (Fig. 1.). 
 The size of this nucleus would indicate eight to ten months' growth. 
 Another exposure of this hand was made at the age of two years, three 
 months, and ten days (Fig. 6.), which shows two new centers, that of 
 the first phalanx of the thumb and that of the second phalanx of the 
 little finger. These I have noticed in a number of instances develop 
 synchronously. This may be a coincidence. I shall endeavor to deter- 
 mine, sometime in the future, if they bear an anatomical relationship. 
 Another exposure of this hand was made at the age of three years, two 
 months, and nine days, in which we have all the epiphyses. The last to 
 appear is that of the ungual phalanx of the little finger. All have 
 appeared before the child was three years of age. 
 
 This is not an exceptional hand, as will be seen when compared 
 with Figs. 4 and 5, C. G. B., female, age one year, nine months, and 
 twenty-four days. In this hand all the epiphyses have appeared. The 
 size of the epiphyses of the first row of phalanges and those of the 
 metacarpal bones, and the form they are assuming, would indicate 
 something of the time of their appearance. The first named, appearing 
 as early as the sixth or eighth month, and all, with the exception of 
 
16 
 
 14. T. K.— Male, 3 years, 9 months, 17 days. 
 
 % 
 
 >v n,. 
 
 U^ 
 
 15. C. G. — Maie, 4 years, 4 months, 3 days. 
 
17 
 
 those of the metacarpal bone of the thumb, have made their appearance 
 before the close of the fifteenth month. That of the second metacarpal 
 bone appeared synchronous with or soon after that of the first phalanx 
 of the middle finger, i. e., between the sixth and eighth month, followed 
 by the third, fourth, fifth, and lastly the first or metacarpal bone of 
 the thumb, in which we see a minute point of ossification, appearing 
 in the twenty-second month or late in the second year. The epiphyses 
 of the second row of phalanges, beginning with the middle finger, began 
 to ossify late in the first year. This was followed by the ring, the 
 index, and little finger. All must have appeared before the close of the 
 fifteenth month. The ungual epiphyses are all present. That of the 
 thumb appearing first, having commenced to ossify as soon as the tenth 
 month. The thumb is followed by the middle finger, then the ring 
 finger, the index finger and lastly by the little finger, in which we see 
 a small point of ossification, making its appearance in the twenty-second 
 month. In this hand we have an instance in which all of the epiphyses 
 have appeared before the childi was tzvo years of age. In some respects 
 this hand is far in advance of the one just described, and in some 
 respects it presents a slower development. Note the cuneiform in the 
 former and its absence in the latter. 
 
 We will next consider the hand of D. D., female, age two years, 
 two months, and twenty-three days, fourth child of parents. This 
 child is but a few months over two years of age and all of the epiphyses 
 have appeared. That of the ungual phalanx of the little finger is a 
 minute point, but is distinct in both hands. All of the other epiphyses 
 are well advanced in ossification. In some respects this hand is in 
 advance of either of the two previously described. Note the size 
 of the nuclei of the metacarpal epiphyses and those of the magnum, 
 unciform and cuneiform bones. The sister of this child (Fig. 9.), 
 C. D., age four years, eight months, and eighteen days, is given for the 
 sake of comparison. The advanced state of ossification of all of the 
 epiphyses in this hand shows that this process had commenced fully 
 as soon as that of the sister two years and six months younger. All 
 of these epiphyses had commenced to ossify before the child was two 
 and one-half years of age. I will also call attention to the chronological 
 development of the bones of the carpus, in which we find the trapezoid 
 preceding the scaphoid. The younger sister has not reached the age 
 
18 
 
 16. J. S. Male, 5 years, 2 months, 8 days. 
 
 17. J. B. — Male, 6 years, 4 months. 
 
19 
 
 when these should appear. However, I expect to find' her liand develop- 
 ing in the same order. 
 
 The next illustration is that of E. C, age two years, five months, 
 and thirteen days, second child of parents (Fig. 3.). All of the epi- 
 physes of this hand have commenced ossification except that of the 
 first phalanx of the thumb, the second phalanx of the little finger (vou 
 will see the similarity concerning these two), and the ungual phalanges 
 of the index and little fingers. The ossificatoin of the epiphyses of this 
 hand is similar to those described. All of the nuclei will have appeared 
 before the child is three years of age. 
 
 After a careful investigation of these and a number of other hands 
 of females three years of age and younger, I have thought the average 
 hand of the female would develop in the following order : The epi- 
 physis of the first phalanx of the middle finger will show the first point 
 of ossification before the close of the first year. This will be followed 
 by the ring and index, then the little finger. All will have appeared by 
 the close of the fifteenth month. Synchronous with, or immediately 
 after this, the epiphyses of the distal extremities of the metcarpal bones 
 will appear in the following order: The first to appear is that of the 
 index finger, then the middle, then the ring, then the little finger, and 
 lastly the thumb. That of the index finger will make its appearance 
 before the close of the first year. All will have appeared by the 
 fifteenth month, except that of the thumb, which usually does not com- 
 mence to ossify until the child is over tzvo years of age. The epiphyses 
 of the second row of phalanges appear in the same order as those of the 
 first row, i. e., middle, ring, index, little fingers successively. The first 
 named appears about the close of the first year. All are usually present 
 before the child is tivo years of age. The epiphysis of the first phalanx 
 of the thumb appears synchronous with that of the second phalanx of 
 the little finger before the close of the second year. 
 
 The last row of phalanges or ungual phalanges appear in the 
 following order: The first point to appear is in the thumb, followed by 
 the middle, ring, index and little fingers. The first named will appear 
 early in the second year or between the fifteenth and tzventieth month. 
 That of the middle finger will appear soon after the thumb. All will 
 have made their appearance before the close of the third year or by the 
 time the child is three years of age. 
 
20 
 
 18. E. W.— Female, 3 years, 6 months, 21 days. 
 
 19. H. W.— Male, 5 years, 2 months, 21 days. 
 
21 
 
 In illustrating the ossification of the epiphyses in the hand of the 
 male, the youngest hand I have showing points of ossification in these 
 epiphyses is that of P. M., age one year, six months, and six days 
 (Fig. 13). This is a fifth child of parents and is somewhat slower 
 in development than the first or second children. As in the hand of the 
 female, the first epiphysis to appear is that of the lower extremity of 
 the radius. The nucleus is 5x2 m. m. This evidently appeared soon 
 after the close of the first year. In this hand the second epiphyses to 
 begin the process of ossification is a proximal epiphysis to the second 
 metacarpal bone. I would judge this made its appearance at the close 
 of the first 3-ear. 
 
 I have observed this extra epiphysis in the hands of but six families 
 out of over two hundred families. It is therefore, not of common 
 occurrence, but is comparaitvely rare. It unites very soon with the 
 shaft, sometimes before the fourth year, usually by the sixth or 
 seventh year, although the union may be delayed until the fourteenth 
 year. As it sometimes unites with the shaft so early, it is possible I 
 may have a number of hands in which the epiphyseal line is completely 
 obliterated, and it may occur with more frequency than my observa- 
 tions would indicate. 
 
 In this hand the next epiphysis to appear was that of the middle 
 finger of the first row of phalanges, followed by the ring and index 
 fingers. That of the little finger has not appeared. I would judge, 
 these made their appearance about the fifteenth month. There is a 
 minute point of ossification in the ungual phalanx of the thumb appear- 
 ing in the eighteenth month. 
 
 Another exposure, of this hand, was made at the age of one 3'ear, 
 eleven months, and six days, that is, five months following the last. 
 All the epiphyses present at the previous sitting have increased in size. 
 You will see the nucleus of the proximal epiphysis of the second meta- 
 carpal has increased in size and is rapidly uniting with the shaft. The 
 new points of ossification to be seen are, the distal epiphyses of the 
 second and third metacarpals, and those of the second rozv of phalanges, 
 beginning with the middle finger, then the ring finger, all appearing 
 before the close of the second year. 
 
 In this hand (Fig. 13.) we find the first appearance of a scale- 
 
22 
 
 20. Erna K.— Female, 5 years, 1 month, 12 days. 
 
 -*^t'* 
 
 21. Ermie K.— Male, 5 years, 1 month, 12 days. 
 
23 
 
 I 
 
 like epiphysis, sometimes present at the distal extremity of the first 
 
 metacarpal. 
 
 Cunningham® says of this epiphysis : "There is usually a scale- 
 like epiphysis on the head of the first metacarpal, which makes its 
 appearance about eight or ten, and rapidly unites with the head." 
 
 Morris" says : "In many cases the first metacarpal has two epi- 
 physes, one for the base in the third and an additional one for the 
 head in the seventh year, but the latter is never so large as in the other 
 metacarpal bones." 
 
 Poland® says : "Traces of a distal epiphysis in the metacarpal 
 bone of the thumb are usually to be seen, and in some instances a dis- 
 tinct epiphysis (as in the Seal and some other animals) is visible at the 
 age of seven or eight years." 
 
 HoLDEN^ says : "Very often there is a distal epiphysis appearing 
 in the metacarpal of the thumb about the eighth year and an epiphysis 
 at the proximal end of the second metacarpal about the same time." 
 
 My observations are quite different from those quoted. I have 
 found this epiphysis present in about six per cent, of the cases. It is 
 possible it occurs with greater frequency, as it unites with the head of 
 the bone very rapdily and could be overlooked, and the epiphyseal line 
 is soon obliterated. I have been fortunate in having the opportunity 
 to present the first appearance of this epiphysis in one hand at least 
 (Fig. 13.). You will see a small elevation on the distal extremity of 
 the metacarpal bone of the thumb ; this I am sure is a separate point 
 of ossification. In the exposure of this hand, made six months later, 
 this epiphysis has flattened and increased in size. The epiphyseal line 
 is not distinct. 
 
 The shape of this epiphysis is quite different from others in the 
 hand. The head of the metacarpal bone is slightly hollowed. The 
 epiphysis becomes, as it is increased in size, convex on the upper 
 surface and concave beneath, thicker in the center and very thin at the 
 periphery. It thus fills the cavity in the upper extremity of the shaft 
 and forms the rounded head of the bone. 
 
 6 Text Book of Anatomy, Cunningham, page 212. 
 '■ Human Anatomy, Morris, page 152. 
 s Skiagraphic Atlas, Poland, page 58. 
 9 Human Osteology, Holden, page 335. 
 
24 
 
 22. U. W.— Female, 6 years, 2 months, 15 days. 
 
 23. H. C. T.— Male, 6 years, 4 months, 25 days. 
 
25 
 
 This cannot be seen in the print : we can ahvays see a great deal 
 of detail in the negative that is lost in the print, and there is still greater 
 loss in the half-tone. However, in the older hands we have an oppor- 
 tunity of a distinct view of this epiphysis. The older brother, G. M., 
 age six years and one month (Fig. 65.), gives a splendid example of this 
 epiphysis. The epiphyseal line is distinct, whilst in the hand of the 
 sister, age eight years and one month, the line is almost obliterated, 
 and in the hand of the still older sister, age ten years, the line is com- 
 pletely obliterated and it would be impossible to tell there had ever 
 been an epiphysis at this point. 
 
 The oldest hand in which I can positively trace this epiphysis is 
 about eight years of age, that is in which the epiphyseal line is not 
 obliterated. The size of the nuclei in all of my negatives would 
 indicate its appearance before the child was four years of age, and 
 sometimes much sooner, as in the instance I have given in which it 
 made its appearance about the seventeenth month. 
 
 In place of making its appearance at the eighth year, my observa- 
 tions indicate its disappearance at that age. 
 
 I have examined over two hundred negatives of hands four years 
 old arid older without the slightest evidence of an epiphysis appearing 
 at this point after the child has become four years of age. T am 
 sure it never appears as late as the eighth year. 
 
 The hand of W. S., male, age one year, nine months, and ten days 
 (Fig. 11.), is developing in the same order as the one described, but 
 shows more points of ossification than the other would have shown at 
 the same age. This is the first child of parents. In this hand the 
 riucleus of the epiphysis of the lower extremity of the radius is 6x3 
 m. m. This began to ossify before the close of the first year. The 
 second point to appear is that of the middle finger, first row of 
 the phalanges, followed by the ring and index fingers, and there is a 
 minute point starting in the little finger. The epiphysis of the second 
 metacarpal commenced ossification simultaneous with or a short time 
 before that of the. first phalanx of the middle finger. This is followed 
 by the third and fourth metacarpals, and there is a good sized point 
 in the ungual phalanx of the thumb. The first of these must have com- 
 menced the process of ossification by the fifteenth month. There is 
 
26 
 
 I 
 
 
 i 
 
 25. 1. B.— Female, 6 years. 
 
27 
 
 every reason to believe that the other epiphyses will appear rapidly 
 in this hand. You will note a good sized nucleus of the cuneiform 
 which has appeared after the close of the first year. 
 
 After a careful examination of a large number of other hands, 
 both male and female, four years of age and younger, I am enabled 
 to at least approximate the chronological development of the epiphyses 
 as given in the following table : 
 
28 
 
 26. E. C — Female, 5 years, 9 months, 14 days. 
 
 27. I. M. F.— Female, 5 years, 1 month, 12 days. 
 
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30 
 
 28. V. C. — Female, 5 years, 10 months, 14 days. 
 
 29. A. P.— Female, 5 years, 6 months, 1 day. 
 
Q1 
 
 The second observation. The bones of the female ossify in 
 advance of the male. This is measured at first by days, then months, 
 then years. 
 
 A\'hile this fact may be said to have been obvious, the progressive 
 differences have never been so graphically shown. This may be illus- 
 trated with the hands of twins of the same sex, in which there is a 
 development of the same degree, while in twins of different sex, the 
 hand of the female is much in advance of that of the male, as shown 
 by Fig. 20 and 21. I have a number of negatives of brothers and 
 sister's hands showing the marked difference in development. Fully 
 as much as that seen in Figs. 18 and 19. 
 
 I here append an extract from an article on "The Development of 
 the Bones in Early Life," by Thomas Morgan Rotch, M. D., Professor 
 of Pediatrics, Harvard University. 
 
 "Through the courtesy of Professor Pryor, I am making use of his 
 table of the Anatomic Index which shows the marked difference in 
 time of the anatomic development of girls and of boys. 
 
 Table \'I. — Comparison of the Development of the Wrist Index According 
 
 to Sex (Pryor). 
 
 Sex. 
 
 Female 
 Male 
 
 Female 
 Male 
 
 Female 
 Male 
 
 Female 
 Male 
 
 Female 
 Male 
 
 Age. 
 Years. 
 
 1/3 
 9 
 
 ]\Tagnnm. nnciform. 
 
 A. 
 
 B. 
 
 2V2 
 
 3/3 
 414 
 
 414 
 5^ 
 
 ^ 
 
 }ilagnnm, unciform, radius (lower epiphysis). 
 
 C. 
 Magnum, unciform, radius, cuneiform. 
 
 D. 
 
 Magnum, unciform, radium, cuneiform, semilunar. 
 
 E. 
 Magnum, unciform, radius, cuneiform, semilunar, and one of 
 
 ( the following: Scaphoid, trapezoid, trapezium. 
 
 Female 434 ] Magnum, unciform, radius, cuneiform, semilunar, and izvo of 
 Male 534 I the following: Scaphoid, trapezoid . trapezium. 
 
 G. 
 Female 5^4 ) Magnum, unciform, radius, cuneiform, semilunar, scaphoid, 
 Male 634 i trapezoid, trapezium. 
 
 H. 
 Female 6^4 I Magnum, unciform, radius, cuneiform, semilunar, scaphoid, 
 INIale 7^4 j trai^ezo.d, traieziun:, rlra (lower epiphysis). 
 
32 
 
 30. M. R.— Female, 5 years, 1 month, 9 days. 
 
 31. J. P. — Male, 6 years, 3 months. 
 
33 
 
 TA.BLE VI— Continued. 
 I. 
 
 eina e /2 ( Same as H, but more advanced. 
 Male 9 ) 
 
 J. 
 
 ema e /2 ( S^me as I, but more advanced. 
 Alale 10 ) 
 
 K. 
 
 Female 10^ | Magnum, unciform, radius, cuneiform, semilunar, scaphoid, 
 rvlale 12^ f trapezoid, trapezium, ulna, pisiform. 
 
 The following illustrations given to me by Dr. Pryor lead me to 
 believe that somewhat different rules should be adopted for the grad- 
 ing of girls than for that of boys. In fact, there is such a manifest 
 dift'erence in the chronologic, physiologic, and anatomic ages of young 
 human beings in the formative stages of life according to sex, that we 
 should endeavor to practically make use of this knowledge in our 
 efforts to safeguard their lives." 
 
 Third. — The chronological order in which the bones of the carpus 
 are ossified is diff'erent from that formerly supposed. 
 
 In the following chronological table I have given by numbers the 
 order in which the bones of the carpus have ossified as indicated by the 
 size of the nucleus. 
 
 In this table I have included only those in which the chronology 
 was distinct. There is, of course, opportunity for error in this. There 
 may possibly be a much larger proportion of cases in which the unci- 
 form has preceded the magnum than is indicated by their relative 
 size. There could not be great error in this, at least not enough 
 to materially change the result or influence the conclusions. I have 
 not tried to obtain a large number of subjects under one year of age 
 for the reason that the results w^ere uniform in such a large majority 
 that it seemed unnecessary. The magnum is a larger bone than the 
 unciform and the nucleus of the former will soon exceed m size the 
 latter. This would indicate that the rate of deposit of lime salts in 
 the larger bone would exceed that of the smaller bone. However, the 
 larger size of the nucleus does not always indicate priority of 
 appearance. 
 
 The deposit of lime salts in anticipation of the shape of the com- 
 pleted bone is fairly uniform in all instances, and is peculiar to each 
 bone. 
 
34 
 
 32. C. B — Female, 5 years, 9 month?, 17 days, right. 
 
 33. C. B. — Female, 5 years, 9 months. 17 days lefi.. 
 
35 
 
 In all of the bones of the carpus the first appearance is that of a 
 pin point. This will become round and then elongate, and as it enlarges 
 the shadow will be characteristic of each bone. Thus that of the 
 magnum will be longer in the vertical diameter and is usually con- 
 stricted in the middle. The unciform always assumes a trianglar shape, 
 with the apex toward the centre and directed obliquely downward and 
 inward. The cuneiform becomes oval with the long diameter obliquely 
 downward and inward. 
 
 The semilunar remains round on the surface, but often becomes 
 pyramidal. The scaphoid rapidly grows in the long diameter of the 
 bone and soon distinctly anticipates the boat shape. The trapezoid and 
 trapezium remain round until they are quite large. Although the 
 palmar surface of the bone is in contact with the plate, the shadow 
 cast is largely determined by the dorsal surface w^hich is interposed 
 between the tube and the plate, thus obstructing the rays. When 
 the negative is compared with the bone, the resemblance to the dorsal 
 surface is distinct. 
 
36 
 
 34. S. G. — Female, 5 years; right. 
 
 35. S. G. — Female, 5 years, left. 
 
37 
 
 
 
 
 
 
 
 
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 Td. 5.2-Tra. 1 
 
38 
 
 36. L. F. — Male, 5 years, 4 months, 9 days; right. 
 
 37. L. F.— Male, 5 years, 4 months, 9 days; left. 
 

 
 
 
 
 
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 3 
 
 4 
 
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 6 
 
 7 
 
 
 
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40 
 
 38. S. J.— Female, 7 years, 6 months, 4 days; right. 
 
 39. S. J.— Female, 7 years, 6 months, 4 days; left. 
 

 
 
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42 
 
 40. J. S.— Female, 14 years, 3 months, 21 days. 
 
 41. B. E.— Female, 14 years, 6 months. 
 
Xame 
 
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 122. M. 
 
 123. M. 
 
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 33. E. ^r ^r. 5- 2-12 10th 
 
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 9-8-6 4th 8 P. 2 
 
 9-11-15 2nd 1 2 3 4 5 6 7 
 
 9-11-16 5th 
 
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 10-5-27 2nd 8 ■ ' 
 
 10-5-27 8 P. 5 
 
 10-6-27 ■ 8 P. 4 
 
 10-7-26 1st 
 
 11-2-15 8 P. 7 
 
 11-6- 4 3rd 8 P. 7 
 
 11-8- 6 1st 8 P. 8 
 
 12-1- 9 3rd -8 P. 6 
 
 12-7- 9 3rd 8 P. 10 
 
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 7-12 4th 1 000000 U. .3 
 
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 3- 0- 5 1st 1 2 C. 3 
 
 3- 9-17 1st 1 2 3 C. 5 
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44 
 
 42. J. B.— Male, 17 years, 2 months. 
 
 43. J. B. E. —Male, 17 years, 7 months, 14 days. 
 

 
 
 
 
 
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 35. H. \V. ...^f. 5- 2-21 1st 
 
 36. T. S M. 5- 3- -r,l 
 
 37. D. S yi. 5- 3-3 ipt 
 
 38. T. N M. 5- 3- 5 h-A 
 
 39 E. W M. 5- 3-10 1st 
 
 40. E. L M. 5- 3-11 
 
 41. R. M. ...M. 5- 3-23 2-d 
 
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 42. G. B. D..M. 5- 4- 6 3rcl 
 
 43. L. F M. 5- 4- 9 1 st 
 
 44. AV. L. ...M. S- 4-15 1st 
 
 45. R. T M. 5- 4-26 .4th 
 
 46. T. S ..M. 5- 5- 5 1st 
 
 47. T. B M. 5- 5-12 1st 
 
 48. T. R M. 5- 5-22 3rd 
 
 49. N. K M. 5- 6- 3 1st 
 
 50. H. C. T..M. 5- 6-18 3rd 
 
 51. R. E M. 5- 6-22 1st 
 
 52. A. V. CM. 5- 8-0 1st 
 
 53. T. W M. 5- 8-17 ist 
 
 54. G. S M. 5- 8-20 4th 
 
 55. A. L M. 5- 8-25 9nd 
 
 56. G. B M. 5- 8-29 5th 
 
 57. J. T. S...M. 5- 9- 6 4th 
 
 58. W. D....M. 5- 9-26 9nd 
 
 59. W. W....M. 5-10- 2 9nd 
 
 60. W. M....M. 5-10- 3 1st 
 
 61. E. T. R..M. 5-10- 3 9„d 
 
 62. H. C. T..M. 5-10-20 1st 
 
 63. B. D M. 5-11-19 ?nd 
 
 64. L. S M. 6- 0- 2 9nd 
 
 65. E. M M. 6- 0- 4 1st 
 
 66. T. D M. 6- 0- 9 2nd 
 
 67. R. G. S..M. 6- 0-25 1st 
 
 68. G. B.D...M. 6- 1- 3rd 
 
 69. G. M M. 6- 1- 4th 
 
 70. T. W M. 6- 1- 2 7th 
 
 71. R. P M. 6- 1-11 8th 
 
 72. C. B AI. 6- 1-14 9nd 
 
 73. S. H M. 6- 1-20 4th 
 
 74. S. P.....M. 6- 1-28 3rd 
 
 75. T. T M. 6- 2-11 1st 
 
 76. O. S M. 6- 2- 1 1st 
 
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46 
 
 44. C. S.— Male, 6 years, 8 months, 19 days 
 
 45. J. S. — Male, 7 years, 3 months. 
 
Name. 
 
 79. 
 
 80. 
 
 81. 
 
 82. 
 
 83. 
 
 84. 
 
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 Sc. 6-Td. 4 
 
 
 
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43 
 
 46. M. W.— Female, 6 years, 6 days. 
 
 47. J. W.— Male, 7 years, 10 months, 14 days. 
 
49 
 
 S £ 5 S i -S .5 E ^.Size 
 
 Aame. . ^^'^'-^^SSo r^ucleus 
 
 S^ ^ :5 .=3 = 5 i S S 2 .;£ 
 
 !X1 < O <5 >^ U CO CAi I-^ f-i a^ 
 
 129. L. F M. 9- 8- 7 3rd 1 2 3 4 5 6 7 
 
 130. L. B. AI..M. 9- 9-14 7th 1 2 3 4 7 6 5 
 
 131. P. C M. 9-10- 8 2nd 
 
 132. C. R AI. 9-11- 4 4th 
 
 133. T. M M. 9-11-26 1st 12 3 4 5 6 7 
 
 134. E. E M.IO- 4-13 1st 
 
 135. W. S M.IO- 5-13 4th 1 2 3 4 5 6 7 
 
 136. H. F M.IO- 5-16 3rd .. 
 
 137. W. E M.IO- 7-10 4th 
 
 138. S. F M. 10-8-0 3rd 
 
 139. W. T....M. 10- 9- 1st .. .. 3 4 5 6 7 
 
 140. B. B . . . . M. 11- 0- 4 f th 
 
 141. W. T....M.11- 3- 3 ... 1 2 3 4 6 5 7 
 
 142. F. R M. 11-3-23 6th 
 
 143. B. T M. 11- 4-22 3rd 
 
 144. H. F....M. 11- 8- 1st 8 P. 2 
 
 145. C. W....M. 12- 6- 4th 
 
 146. W. C....M. 12- 6-24 1st 
 
 147. R. F M. 12- 9- 4 2nd 8 P. 10 
 
 148. D. V. . . . M. 12-10- 8 P. 5 
 
 149. E. M....M. 12-10-21 1st 
 
 150. R. W. . . . M. 13- 0- 6 4th 
 
 151. E. P M. 13-7-25 6th 8 P. 8 
 
 152. E. S M.13-9-5 1st 8 P. 6 
 
 153. J. F M. 14- 0-16 4th 
 
 The chronological order in which the bones of the human carpus 
 are ossified is as follows: 1, Os Magnum. 2, L^nciform. 3, Cunei- 
 form. 4, vSemilunar. 5, vScaphoid. 6, Trapezoid. 7, Trapezium. 
 8. Pisiform. 
 
 In a summary of the table we find that in two hundred and forty- 
 one (241) hands there is good evidence that the magnum appeared 
 first two hundred and thirty-six (236) times and the unciform five 
 (5) times. In two hundred and forty-one (241) hands the unciform 
 appeared first in five (5) instances and the magnum two hundred and 
 thirty-six (236) times. 
 
 In those hands in which the cuneiform had made its appearance 
 it came in the third place two hundred and nineteen (219) times, and in 
 the fourth place ten (10) times. You will observe that the cuneiform 
 is not displaced by any of the other bones except the semilunar, which 
 appeared in the third place twelve (12) times, and in its own position, 
 
50 
 
 48- G. G. — Female, 4 years, 6 months, 7 days. 
 
 49. S. G.— Female, 5 years. 
 
51 
 
 the fourth, one hundred and seventy-six (176) times. Eight (<S) 
 times in the fifth position, twice (2) in the sixth, and six (6) times 
 in the seventh place, in a total of two hundred and four (204) 
 instances. 
 
 In one hundred and twenty-nine ( 129) hands we find the scaphoid 
 has appeared. Of this number it appeared three (3) times in the 
 fourth position, eighty (80) times in the lifth, twenty-seven (27) 
 times in the sixth and ninteen (19) times in the seventh place. 
 
 The table shows one hundred and twenty-four ( 124) hands in 
 which the trapezoid presents a point of ossification or a very large 
 nucleus. In eight (8) instances it appeared in the fourth place, thirty- 
 six (36) times in the fifth, fifty-nine (59) times in the sixth, and 
 twenty-one (21) times in -the seventh position. 
 
 The trapezium made its appearance seven (7) times in the fourth 
 position, thirty (30) times in the fifth, thirty-one (31) times in the 
 sixth, and fifty-one (51) times in its own position, that of the seventh. 
 
 There are ninteen ( 19) showing a nucleus of ossification in the 
 pisiform, all appearing in the eighth position. This may be more 
 distinctly seen in the form of a summary. 
 
 SUMMARY. 
 
 First 
 
 . 236 
 
 5 
 
 
 
 
 
 
 
 Second 
 
 5 
 
 236 
 
 
 
 
 
 
 
 Third 
 
 
 
 2i9 
 
 12 
 
 
 
 
 
 Fourth 
 
 
 
 10 
 
 176 
 
 3 
 
 8 
 
 7 
 
 
 Fifth 
 
 
 
 
 8 
 
 80 
 
 36 
 
 30 
 
 
 Sixth 
 
 
 
 
 2 
 
 27 
 
 59 
 
 31 
 
 
 Seventh .. . . 
 
 
 
 
 6 
 
 19 
 
 21 
 
 51 
 
 
 Eighth 
 
 
 
 
 
 
 
 
 \9 
 
 Total.... 
 
 . 241 
 
 241 
 
 229 
 
 204 
 
 129 
 
 124 
 
 119 
 
 19 
 
 If my conclusions are correct in placing them in the order in 
 which they are found in the table, and, as I have said, I have used 
 only those in which the order was distinct ; there can hardly be a 
 question that the chronological order of ossification is in accordance 
 
52 
 
 50. P. L.— Female, 3 years, 10 months. 
 
 51. A. L.— Male, 5 years, 8 months, 25 days. 
 
53 
 
 with this table. It ^^•ill. however, be seen there are all kinds of vari- 
 ations, or what might be called combinations ; thus, the magnum or 
 unciform may be found in either the first or second positions, but 
 they are never displaced by any of the other bones. 
 
 The cuneiform is rarely displaced from the third position, and 
 then only by the semilunar.' The latter bone has a strong hold on the 
 fourth place, but it may be found in the third, fifth, sixth or seventh 
 positions ; that is, in exceptional instances. 
 
 The scaphoid, trapezoid, and the trapezium frequentlv exchange 
 positions. 
 
 Fig. 22 represents the order in which the average will occur, viz. : 
 \, OS magnum. 2, unciform. Z, cuneiform. 4, semilunar. 5, scaphoid. 
 6, trapezoid. 7, trapezium. 8, pisiform. 
 
 In Fig. 12, we have an instance in which the unciform is found 
 in the first position, preceding the magnum. Fig. -13 is the same hand 
 taken eleven months later. The magnum evidently appeared soon after 
 that of the unciform, but has not had sufficient time for its nucleus to 
 grow larger than the last named bone. In Fig. 23, the semilunar has 
 appeared in the third position in advance of the cuneiform. Fig. 24 
 shows the scaphoid has preceded the semilunar and is found in the 
 fourth position ; and in Fig. 25 the trapezoid is in the fourth position 
 with the semilunar fifth. 
 
 The next illustration, viz. : Fig. 26, shows a different order of 
 ossification, in which the trapezoid is fifth, trapezium sixth, and 
 scaphoid seventh. Fig. 27 shows the trapezium in the fifth position, 
 and trapezoid sixth, and Fig. 28 has the trapezoid fifth, trapezium 
 sixth and scaphoid seventh. In Fig. 29 the trapezium is fifth, trape- 
 zoid sixth and scaphoid seventh. Fig. 30 shows a very unusual order 
 of ossification. The trapezoid is in the fourth position, trapezium 
 fifth, scaphoid sixth, and semilunar seventh. These may be more 
 graphically shown when grouped, or in tabluar form, as follows : 
 
54 
 
 52. W. L. — Male, 5 years, 4 months, 15 days. 
 
 53. W. L. — Male, 6 years, 10 months, 16 days. 
 
Name. 
 
 . 22— N. 
 . 12— P. 
 . 13— P. 
 . 23— H. 
 . 24— E. 
 , 25— J. 
 , 26— E. 
 
 27—1. 
 , 28— V. 
 , 29— A. 
 . 30— M. 
 
 31-J. 
 
 W 
 
 M, 
 
 M 
 
 C. 
 
 T. 
 B., 
 
 C, 
 M. 
 
 C, 
 
 P., 
 R., 
 P., 
 
 T., 
 R, 
 
 6-2-15 1 
 
 
 2 
 
 M . . 
 
 .. 8-25 
 
 M.. 
 
 ..1-6-6 
 
 M . . 
 
 ..6- 4-25 
 
 M.. 
 
 ..5-10- 3 
 
 F... 
 
 ..6-0-0 
 
 F... 
 
 ...5- 9-14 
 
 F... 
 
 ...5- 1-12 
 
 F... 
 
 ..5-10-14 
 
 F... 
 
 ..5-6-1 
 
 F... 
 
 ..5-1-9 
 
 M.. 
 
 ..6- 3-0 
 
 In arriving at these conclusions, a number of factors are to Idc. 
 taken into consideration. The rate of growth varies in different 
 famihes. In some famihes the bones ossify with much greater rapidity 
 than others. Condition of health, accidents, disease, anything that 
 would interfere with the blood supply or modify metabolism, would 
 be likely to delay or modify the process of ossification. 
 
 The shadow of the nucleus is somewhat larger than the object, 
 and the conditions under which the exposures are made should be 
 uniform, such as the distance of the tube from the plate, the time of 
 exposure and the development of the plate, should all be considered. 
 Making all possible allowance for errors on account of these factors, 
 and using such cases in which I have obtained negatives showing min- 
 ute points of ossification; then making subsequent exposures of these 
 hands at frequent intervals, one, two or more months apart, I have been 
 able to approximate the rate of growth. Then taking the size of the 
 nucleus in m. m., we can estimate the times of appearances with as 
 much freedom from error as could be determined by other methods. 
 
 Fourth. — The bones of the first child, as a rule, ossify sooner than 
 those of subsequent children. While we have some evidence of this, 
 it is not uniform by any means, and I am disposed to qualify this 
 statement until I have thoroughly investigated this side of the ques- 
 tion. 
 
 Fifth. — Regardless of the variation (normal) the ossification is 
 bilaterally symetrical. 
 
 I have but to call your attention to Figs. 32 to 39 in substantiation 
 
56 
 
 54. L. B. M.— Male, 9 years, 9 months, 14 days. 
 
 55. R. M.-Male, 8 years, 2 months, 25 days. 
 
of this statement. It is true that an occasional ditlerence in the develop- 
 ment in the two hands may he seen, hut where one difference may he 
 seen very many points of similarity exist. 
 
 Sixth. — The union of the epiphyses with the shaft takes place 
 much sooner than formerlv supposed. 
 
 I oft"er but few illustrations of this, but the examples given are 
 
 sufficient to make the statement conclusive in connection with the 
 
 examination of a large number of hands, between the ages of twelve 
 
 and twenty-two. 
 
 UXIOX OF EPIPHYSES. 
 
 Phalanges j female : 15 to 16 years. 
 
 ( Male: 1/ to 18 years. 
 
 Metacarpal j female 15 to 16 years. 
 
 ^ ( Alale 1/ to 18 years. 
 
 Lower Epiphysis of Radius ■....-. { Ff'^^le 17 to IS years. 
 
 / -Male 18 to 21 years. 
 
 Lower Epiphysis of Ulna { ^>7^1^ J^ to 17 years. 
 
 ( -^lale 1/ to 20 years 
 
 EXAMPLES. 
 Phalanges and Aletacarpal. 
 Female. ^ilale. 
 
 14..3 all united, faint line of proximal 16.4 ungual, united, 
 epiphysis of thumb. 17.2 all united. 
 
 14.4 all united. 16 g " " 
 
 14.5 " •' ^y\ . 
 
 14.6 " ' • , 
 
 14.7 " " 17.1 
 14.6 " " 17.5 " 
 14.10" " 17.6 " 
 
 14.10-; ;; i7.6 <^ « 
 
 15.6 " " '-^■^ 
 
 15.6 " " 17.9 '• " 
 
 15.8- " " 17.11 •• 
 
 .Ml united at sixteen. All united before 18. 
 
 LOWER EPIPHYSES OF RADIUS AXD ULXA. 
 
 Female. ?»Iale. 
 
 Ulna. Radius. Ulna. Radius. 
 
 14.10 — united. Distinct line. 17 — united. *Faint line. 
 
 16.2 — " Faint line. 17.2 — " 
 
 16.3 — " " " 17.6 — " 
 
 16.4 — " " "■ 18. — '•■ 
 16.9 — " " " 18. — " 
 
 16.9 — " United. 18.5 — " United. 
 
 All after 17. A few with faint 18.6 — " 
 
 line after 18. 18.9 — " 
 
 18.10— " 
 
 19.1 — •' 
 
 1^.3 — " 
 
 19.3 — •• 
 
58 
 
 ^ 
 
 
 56. W. M.— Male, 7 years, 3 months, 27 days. 
 
 57. E. M. — Male, 7 years, 5 months, 5 days. 
 
59 
 
 Scziiiih. — \'ariations in tie ossification of bones is a heritable 
 trait. 
 
 My belief that normal ossification of bones present evidence of 
 heredity is based upon the fact that we n^ay find similar conditions in 
 the chronological order of ossification of the bones of the carpus, and 
 when extra epiphyses are found to be present, they are found in the 
 hands of the brothers and sisters. 
 
 I have only met with a few instances in which there was an 
 extra epiphysis present. Such as that occasionally found at the prox- 
 nnal extremity of the metacarpal bone of the index finger. Unfortun- 
 ately when I did find this extra epiphysis present, they were in most 
 instances the only children of the parents, and I have not been able to 
 follow the families. 
 
 I have had abundant opportunity to observe the similarity of 
 the order of ossification of the bones of the carpus in the hands of 
 brothers and sisters. I have followed these cases through a number 
 of years. In some instances I have made examinations several times 
 during the year, and when necessary, during a period of several years 
 in succession, in order to obtain results. 
 
 It will be seen from the following table there may be a number of 
 variations from the usual order, and it is this variation I find to be a 
 heritable trait. 
 
 When I submitted the result of the examinations of my first 
 ten families, I thought there were no exceptions, but a later examin- 
 ation of several of these same cases gave dift'erent results. 
 
60 
 
 58. L. H.— Female, 5 years, 5 months, 25 days. 
 
 59. N. H.— Male, 6 years,3 months, 10 days. 
 
61 
 
 
 
 
 
 ^■ 
 
 C 
 
 
 •6 
 
 r-' 
 
 
 
 
 
 ^ 
 
 
 
 -73 
 
 
 ^- 
 
 rH 
 
 
 
 
 u, 
 
 
 <— 
 
 
 
 .^ 
 
 C 
 
 Name. 
 
 
 
 D 
 
 
 s 
 
 O 
 
 0^ 
 
 
 o 
 
 
 m 
 
 y Mo 
 
 
 CO 
 
 re 
 o 
 CO 
 
 t^ 
 
 i^ 
 
 'p^ 
 
 44(C. S 
 
 ....M. 
 
 6- 8-19 1 
 
 2 
 
 3 
 
 4 
 
 
 
 5 
 
 6 
 
 
 
 45 1 J. S 
 
 . . . . M. 
 
 7-3-0 1 
 
 2 
 
 3 
 
 4 
 
 
 
 5 
 
 6 
 
 
 
 46 ni. W 
 
 F. 
 
 6-0-6 1 
 
 2 
 
 3 
 
 4 
 
 6 
 
 5 
 
 7 
 
 
 
 47 U. W 
 
 .... M. 
 
 7-10-14 1 
 
 9 
 
 3 
 
 4 
 
 6 
 
 5 
 
 7 
 
 u 
 
 48fG. G 
 
 ....F. 
 
 4-6-7 1 
 
 2 
 
 3 
 
 6 
 
 5 
 
 7 
 
 4 
 
 
 
 491 S. G 
 
 . . . . F. 
 
 5-0-1 1 
 
 2 
 
 3 
 
 6 
 
 5 
 
 7 
 
 4 
 
 
 
 50' r P. I 
 
 5M A. L 
 
 F. 
 
 3-10- ] 
 
 9 
 
 4 
 
 3 
 
 
 
 i 
 
 
 
 u 
 
 ....M. 
 
 5- 8-25 1 
 
 7 
 
 4 
 
 3 
 
 6 
 
 5 
 
 
 
 
 
 52 
 
 W. L 
 
 ....M. 
 
 5- 4-15 1 
 
 2 
 
 4 
 
 3 
 
 
 
 5 
 
 
 
 
 
 53 
 
 W. L 
 
 ....M. 
 
 6-10-16 1 
 
 2 
 
 4 
 
 3 
 
 6 
 
 5 
 
 7 
 
 
 
 54 
 
 ' L. B. M 
 
 ....M. 
 
 9- 9-14 1 
 
 2 
 
 3 
 
 
 7 
 
 6 
 
 5 
 
 
 
 55 -j 
 
 R. ^I 
 
 .... M. 
 
 8- 2-25 1 
 
 2 
 
 3 
 
 4 
 
 
 
 6 
 
 5 
 
 u 
 
 56 
 
 W. M 
 
 .... M. 
 
 7- 3-25 1 
 
 2 
 
 3 
 
 4 
 
 6 
 
 
 
 
 
 
 
 57 
 
 E. M 
 
 ....M. 
 
 7- 5- 5 1 
 
 2 
 
 3 
 
 4 
 
 6 
 
 
 
 S 
 
 
 
 58 IL. H 
 
 ....F. 
 
 5- 5-25 .1 
 
 2 
 
 3 
 
 / 
 
 4 
 
 6 
 
 5 
 
 
 
 59 1 N. H 
 
 ....M. 
 
 6- 3-10 1 
 
 2 
 
 3 
 
 5 
 
 4 
 
 
 
 
 
 
 
 60 ( E. W 
 
 ....F. 
 
 3- 6-21 1 
 
 2 
 
 3 
 
 4 
 
 6 
 
 
 
 
 
 
 
 6nH. W 
 
 62 [ S. F 
 
 ....M. 
 
 S- 2-21 : 
 
 9 
 
 3 
 
 4 
 
 
 
 
 
 b 
 
 
 
 F. 
 
 6- 0-16 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 
 
 6 
 
 
 
 63 1 A. F 
 
 . . . . M. 
 
 6-11-22 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 
 
 6 
 
 
 
 64 f P. M 
 
 . . . . M. 
 
 3-10-16 1 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 65 ^ G. M 
 
 ...M. 
 
 6-1-0 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 
 
 
 
 
 
 66 I R. M •. ... 
 
 F. 
 
 8- 1-16 1 
 
 2 
 
 3 
 
 4 
 
 b 
 
 6 
 
 7 
 
 u 
 
 68(H. F 
 
 ....M. 
 
 6-6-4 ] 
 
 2 
 
 
 
 3 
 
 
 
 
 
 
 
 
 
 69 1 W. F 
 
 M. 
 
 5- 2-29 ] 
 
 2 
 
 
 
 
 
 
 
 
 
 u 
 
 
 
 The above table includes ten families in which I had the oppor- 
 tunity of observing the hands of two or more children, all of which 
 are illustrated in this article. I have the records of thirteen other 
 families of two or more children which show hereditary characteristics 
 just as pronounced as those herewith presented. 
 
 Figs. 44 and 45 are the hands of brothers following the same 
 line of ossification of the bones of the carpus, in which we see the 
 trapezoid in the fifth position, followed by the trapezium, and both 
 have preceded the scaphoid. 
 
 In the next pair. Figs. 46 and 47. a brother and sister, the trape- 
 zoid is in tlie fifth position followed by the scaphoid in the sixth, and the 
 trapezium seventh. 
 
 Figs. 48 and 49 are sisters, in which the trapezium is in the fourth 
 position, scaphoid fifth, semilunar sixth, and the trapezoid in the 
 seventh place, while Figs. 50 to 53 are hands of a sister and two 
 
62 
 
 \a 
 
 60. E. W. — Female, 3 years, 6 months, 21 days. 
 
 f'i-} 
 
 61. H. W. — Male, 5 years, 2 months, 21 days. 
 
63 
 
 brothers, in which ihe stmilur.ar preceded the cuneiform, appearing 
 in the third position, thus placing the cuneiform fourth, the trapezoid 
 fifth, and scaphoid sixth. Several views were taken of each of these 
 hands at different times, and covering a period of several years. 
 
 The next set are four brothers, Figs. 54 to 57. The first two 
 show the same line of development with the trapezium fifth, the 
 trapezoid sixth and; scaphoid seventh. The next two brothers in the 
 family show a somewhat d'ifl:"erent line of development. While the 
 trapezium is still in the fifth place, the scaphoid has taken the sixth, 
 and the trapezoid has not appeared, but will be found later on in the 
 seventh position. 
 
 This is the only opportunity I have had to observe four children 
 of the same family. The first two were the seventh and eighth children, 
 and the second two were the ninth and tenth children. 
 
 It would appear from a study of this set that these characteristics 
 were of a Mendelian nature. 
 
 You will see similarities in each of the other groups represented by 
 Figs. 58 to 63. 
 
 Figs. 64, 65 and 66 are the hands of two brothers and a sister 
 in which we see a proximal epiphysis to the metacarpal bone of the 
 index finger in each hand. A number of exposures w^ere made of each 
 of these hands, covering a period of about five years. Figs. 12 and 13 
 are the same hand as 64. We see the early appearance of ossification 
 in the epiphysis in Fig. 13, while in Fig. 64 is uniting with the shaft. 
 Each of these hands show a scale-like epiphysis at the distal extremity 
 of the metacarpal bone of the thumb. 
 
 The last two illustrations. Figs. 68 and 69, are the hands of 
 brother, five years and two months of age, and six years and six 
 months of age respectively. 
 
 Each of these show a very slow development. I would judge this 
 to be a family characteristic. 
 
64 
 
 62. S. F. — Female, 6 years, 16 days. 
 
 63. A. F.— Male, 6 years, 11 months, 22 days. 
 
65 
 
 64. P. M.— Male, 3 years, 10 months, 16 days. 
 
 65. G. M.— Male, 6 years, 1 month. 
 
66 
 
 *S, I ^ 
 
 ,.-«<>"■• 
 
 ,^. iW|. 
 
 >^- 
 
 66. Jl. M. — Female, 8 years, 1 month, 6 days. 
 
 67. L. D. — Female, 15 years, 6 months, 2 days. 
 
67 
 
 ■i,Ai' 
 
 iy 
 
 68. H. F.^Male, 6 years, 6 months, 4 days. 
 
 • -^^V.-, 
 
 
 69. W. F.— Male, 5 years, 2 months, 29 days. 
 
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 QM117 P95 
 
 
 Pryor 
 
 
 Some observations on the oRsifi- 
 
 / 
 
 cation 
 
 of the bones of the hand.