480 VEGETATIVE DISTURBANCES 



suits in the mixed forms. True infantilism usually shows a lower tolerance 

 for thyroid preparations. 



II. TRUE DWARFISM 



True dwarfism as a proportioned nanism may be rather well delimited 

 from the other vegetative disturbances that I have thus far described or 

 will hereafter describe in this chapter; as all of these with the exception of 

 true infantilism are disproportioned nanisms, while in true infantilism the 

 childish dimensions are retained. In spite of the fact that we are consider- 

 ing true dwarfism in this connection, it constitutes no uniform affection. In- 

 deed attempts have been made to distinguish two different types of true 

 dwarfism that differ from each other in important points and perhaps are 

 also to be separated etiologically. There exists, however, as we shall see, 

 all possible transitions between these types. As long as we do not know 

 anything certain concerning the etiology of true dwarfism a satisfactory 

 terminology for all the cases that belong in this group is not possible. 



Historical. In this short exposition I would not enter into the de- 

 scriptions that exist in the old literature. It is to be supposed that among the 

 numerous dwarfs that in former times were retained at the courts of no- 

 bility on account of curiosity or that were exhibited in the show booths 

 [as freaks] there were some that were true dwarfs. The descriptions of 

 these are, however, very inexact. Therefore I shall limit myself to the 

 fewer and more careful communications in the later literature. The first 

 exact description of the skeleton of a true dwarf originates with A. Paltauf 

 in the year 1891, while v. Hansemann was the first to separate the two 

 types of true dwarfism. v. Hansemann distinguished a nanosomia pri- 

 mordalis and a nanosomia infantalis. In the latter at the time of birth the 

 individual is 'of normal size. Growth ceases only later, the epiphysial junc- 

 tures remaining open; often the individual remains infantile. This form is 

 identical with that described by Paltauf. The primordial dwarf is small 

 from the beginning, although his development, apart from the smallness, 

 proceeds in the normal manner. He is, therefore, a veritable diminutive 

 human being; Sainton and Launois distinguish this true dwarfism from the 

 other vegetative disturbances, without, however, considering the other type. 

 Also E. Levi who has published a thorough study of this form of dwarfism, 

 has considered Paltauf 's form insufficiently. 



A. The Primordial Nanosomia. An excellent example of this form is 

 the case described by Virchow and later by v. Hansemann. It was that of 

 an individual twenty-two years old (who at the age of eleven years was 

 investigated by Virchow) who was 114 cm. tall. He was entirely well pro- 

 portioned, the intelligence was well developed, the genitalia were well de- 

 veloped, except that cryptorchidism was present. The epiphysial junctures 

 had ossified. At birth he had weighed only 500 gm. This was doubted 



