[NICHOLLS] CHONDRODYSTROPHIA FŒTALIS 31 
We have, therefore, in this case a very typical example of chon- 
drodystrophia fœtalis, of the subvariety called by Kaufmann Chon- 
drodystrophia hyperplastica. It is worthy of note that lordosis is 
absent, and the disturbance of development is confined to the limbs 
and head. Consequently, we are not dealing with primary or “‘essen- 
tial’’ dwarfism, but with a symptomatic form, for the former involves 
the body as a whole. 
If symptomatic, of what is it symptomatic? Is it rickets? 
While there may, in some cases, be a superficial resemblance be- 
tween the two conditions, careful study will show some important 
and characteristic differences. The dwarfism in chondrodystrophia 
is micromelic: not so in rickets. Periosteal bone formation is not 
interfered with in chondrodystrophia while it is in rickets. Basilar 
synostosis does not occur in rickets, nor do you get the “‘trident’’ de- 
formity of the hands. Moreover, developmental anomalies, such 
as cleft palate, polydactyly, and syndactyly, do not occur in rickets. 
In healed rickets, the bones affected are abnormally dense, while in 
many cases of chondrodystrophia they are normal in consistence, 
though possibly somewhat vascular, while in some they are soft. 
This last point would seem to negative the conclusion that chondro- 
dystrophia is rickets that has run its course during intrauterine 
existence. 
Is it cretinism? This is more difficult to decide. There is a 
certain amount of evidence to show that Kaufmann’s ‘“‘cretinoid”’ 
type of chondrodystrophia may be regarded as cretinism of intrau- 
terine incidence. This evidence may be stated as follows: 
Virchow! found in the Canton of Glarus, Switzerland, where 
goitrous cretinism is endemic, not a few cases of chondrodystrophic 
dwarfism, without the gross manifestations of cretinism. Micro- 
scopical investigation of the growing ends of the bones show that in 
cretinism and chondrodystrophia there is a striking similarity. In 
both we have small stature, a peculiar facial configuration, feeble 
mental powers, with sundry minor points of resemblance. Hofmeister? 
found that the lesions in the bones, produced by thyroidectomizing 
rabbits, were identical with those described by Kaufmann, H. Miiller, 
Kirchberg, and Marchand as occurring in chondrodystrophia. Le- 
blanc? and Nasan“ state that chondrodystrophia is often associated 
with myxcedema. In twelve cases of the cretinoid type, culled from 


1 Virchow’s Archiv. XCIV, 1883. 
? Beiträge zur klin. Chirurgie, 1894. 
3 Comptes rendus de Soc. de Biologie, book 88-89, 1902. 
4 Révue de Neurologie, 1901, p. 549. 
