Dr. Sammet looked at him silently and attentively, as if waiting till the Grand Duke had completely regained his princely composure. Then he said: "Yes; we have here to do with a case which is not of very common occurrence, but which is well known and familiar to us. Yes. It is actually a case of atrophy ..." "Excuse me ... atrophy ...?" "Forgive me, Royal Highness. I mean stunted growth. Yes." "I see, stunted growth. Stunting. That's it. The left hand is stunted. But it's unheard of! I cannot understand it! Such a thing has never happened in my family! People talk nowadays about heredity." Again the doctor looked silently and attentively at the lonely and domineering man, to whom the news had only just penetrated that people were talking lately about heredity. He answered simply: "Pardon me, Royal Highness, but in this case there can be no question of heredity." "Really! You're quite sure!" said the Grand Duke rather mockingly. "That is one satisfaction. But will you be so kind as to tell me what there can be a question of, then." "With pleasure, Royal Highness. The cause of the malformation is entirely a mechanical one. It has been caused through a mechanical constriction during the development of the embryo. We call such malformations constriction-formations, yes." The Grand Duke listened with anxious disgust; he obviously feared the effect of each succeeding word on his sensitiveness. He kept his brows knit and his mouth open: the two furrows running down to his beard seemed deeper than ever. He said: "Constriction-formations, ... but how in the world ... I am quite sure every precaution must have been taken ..." "Constriction-formations," answered Dr. Sammet, "can occur in various ways. But we can say with comparative certainty that in our case ... in this case it is the amnion which is to blame." "I beg your pardon.... The amnion?" "That is one of the foetal membranes, Royal Highness. Yes. And in certain circumstances the removal of this membrane from the embryo may be retarded and proceed so slowly that threads and cords are left stretching from one to the other ... amniotic threads as we call them, yes. These threads may be dangerous, for they can bind and knot themselves round the whole of a child's limb; they can entirely intercept, for instance, the life-ducts of a hand and even amputate it. Yes." "Great heavens ... amputate it. So we must be thankful that it has not come to an amputation of the hand?" "That might have happened. Yes. But all that has happened is an unfastening, resulting in an atrophy." "And that could not be discovered, foreseen, prevented?" "No, Royal Highness. Absolutely not. It is quite certain that no blame whatever attaches to anybody. Such constrictions do their work in secret. We are powerless against them. Yes." "And the malformation is incurable? The hand will remain stunted?" Dr. Sammet hesitated; he looked kindly at the Grand Duke.