TRUE DWARFISM 483 



and at the age of thirty-six, 128 cm. tall, the epiphysial junctures were open, 

 the" bone nuclei had developed further. In an individual thirty-three years 

 old the inhibition had begun at the age of ten years, at twenty years he was 

 109 cm. tall, at thirty- three years 134 cm. tall; in a woman thirty years old 

 the inhibition had begun at the age of eight years, at nineteen years she 

 was 103 cm. tall, now 132 cm. tall. To the Paltaufs type belongs probably 

 the celebrated dwarf Helen Giibler called the "Puppenfee" [doll fairy]. At 

 birth she was normal. She ceased growing at the age of six years, and at 

 twenty years was 106 cm. tall. 



If we survey the cases quoted, we find that the Paltaufs type may be 

 characterized thus: At birth the individuals are of normal size, and at first 

 show a normal development. Only later, but at all events mostly in early youth, 

 they suddenly cease growing. The epiphysial junctures remain open, and 

 in all cases there occurs a quite slow further growth, the inhibition being 

 broken through in exceptional cases only. The development of the bone 

 nuclei is in nearly all cases delayed only a little, the development of the 

 intelligence is normal. On the contrary the genitalia and the secondary 

 sexual characters remain behind almost always. The cause of this growth 

 disturbance is as yet not known. 



The typical Paltaufs dwarf differs essentially from an individual with true 

 infantilism. In the latter condition not all the epiphysial junctures remain 

 open, but the ossification is highly retarded, so that we find ununited only 

 those junctures that tend to close the latest otherwise. Then too the 

 psyche of Paltaufs dwarf is ordinarily not childish. I have therefore dis- 

 carded v. Hansemann's expression "infantile dwarf" and have chosen the 

 expression " Paltaufs type." 



The distinction between the primordial dwarf and Paltaufs dwarf, on 

 the one hand, and high-grade infantilism on the other hand serves only for 

 the typical cases. It will readily be seen that transitional forms between the 

 two varieties of dwarf and true infantilism occur. To quote some examples: 

 .Joachimsthal describes among his cases two thirty-six-year-old individ- 

 uals of 1 14. cm. and 116 cm. heights respectively. With these, growth 

 has remained at a standstill at about the tenth year. We can therefore not 

 classify them with the primordial dwarfs. The epiphysial junctures were, 

 however, closed, and both menstruated regularly since their twentieth year. 

 In a female dwarf with retained epiphysial cartilages the sexual organs were 

 developed quite normally. She conceived, and at Cesarean section was 

 delivered of a child above the normal in weight and size. 



The circumstance that there are transitions between the primordial and 

 the Paltaufs type does not mean that they both rest on the same etiological 

 basis. It would be very easy to assume that in the primordial dwarf the 

 noxus took its effect in fetal life, in Paltaufs dwarf, in postfetal life. This 

 does not, however, explain the great difference in the relation of the genitalia. 



