OBLITERATION OF SUTURES IN SKULL 511 



proportion in which this happened was not larger than in the 

 jaormal skulls. This fact is further strengthened by the cir- 

 cumstance that in most cases of premature obUteration no other 

 symptoms of rhachitis were visible, they possessed a normal 

 structure of the bone tissue and of the tooth-enamel. 



Another argument pleading against the rhachitical character 

 of the premature obliteration is the great regularity with which 

 the process commences and proceeds. In all the skulls de- 

 scribed in the foregoing paragraph, it was clear that the synos- 

 tosis of the sagittal suture regularly commenced at the very 

 point where in normal cases the obliteration begins, i.e., in the 

 obelion. Should the process be of a pathological nature the 

 starting-point of the synostosis should be very inconstant. 



Finally, if the obliteration is really the effect of some general 

 constitutional disease, how can we understand that the process 

 confines itself to the whole length of one suture only? In the 

 sagittal suture the synostosis is often complete, extending from 

 the bregma to the lambda point. Why, one may ask, does 

 not the process continue along the coronal and lambda sutures? 

 Is such an anatomically strictly confined extension of the proc- 

 ess in accordance with a supposed pathological origin? I 

 must admit that these arguments prove nowhere decisively 

 that the premature synostosis cannot be caused by some con- 

 stitutional disease. But on the whole I think that they form a 

 strong evidence against it. On the other hand, I will by no 

 means absolutely deny all genetical correlation between anom- 

 alies in the system of sutures of the infantile skulls and con- 

 stitutional diseases. I willingly admit the possibility of such a 

 relation, but I wish to reserve it for those cases in which an en- 

 tire or partial closure of several sutures is seen in an often very 

 irregular manner. 



Now the question arises as to the real significance of the pre- 

 mature closure. If it is not, as I just made clear, the result 

 of some pathological cause, from which point of view is the phe- 

 nomenon to be explained? I believe I am able to give such an 

 explanation, and I wish to give in the following pages a brief 

 account of my opinion upon this subject. 



