484 VEGETATIVE DISTURBANCES 



As will be seen by the example quoted, the familial hereditary occurrence is 

 common to both types. In both types, too, the children of the person affected 

 may develop normally. 



There therefore does not seem to me to lie at hand any basis for con- 

 sidering true dwarfism as an affection of the ductless glandular system. I 

 need hardly point out that there is no involvement of the thyroid gland. 

 Aschner would indeed make the hypophysis answerable for dwarfism cer- 

 tainly incorrectly for all the symptoms characteristic of hypophysial 

 dystrophy are absent. 



in. THE RACHITIC DWARF 



Dwarfism may be the result of a high-grade rachitis developing in 

 children. According to Breus and Kolisko, in addition to the inhibition of 

 growth in height, there are found regularly also curvatures under circum- 

 stances the bones are weak and flexible. "The disturbance of the periosteal 

 ossification, in contradistinction of endochondral ossification, comes into the 

 foreground." Breus and Kolisko also state that in such cases the epiphysial 

 junctures can often remain ununited; Gulecke, however, reports three cases 

 of dwarfism who had suffered severe rachitis in early life and yet f showed on 

 X-ray examination premature synostosis of the epiphysial junctures. Gulecke 

 assumes that the epiphysial cartilages were severely damaged by the rachitis, 

 and that then reparatory processes set in which led to premature ossification. 

 In fresh cases the X-rays show washing out of the boundaries between the 

 bone nuclei and cartilage, and at the site of the epiphyses broad light zones 

 apparently representing excessively proliferated cartilage (Joachimsthat). 

 The behavior of the epiphysial junctures and the bone nuclei thus vary 

 according to the intensity of the process, according to the liveliness of the 

 proliferation of the abnormal cartilage, and the reparatory processes. 

 Rachitic dwarfism is characterized by the never-absent signs of a previous 

 rachitis and by the normal development of the intelligence and of genital sphere. 



TV. CHONDRODYSTROPHY 



(A chondroplasia) 



Historical. Chondrodystrophic dwarfs were known already in antiquity. 

 Cestan and Meige, who have concerned themselves with the historical study 

 of this disease, refer to the pictures of the Egyptian god Ptah and the goddess 

 Bes, in which typical cases of chondrodystrophy are exhibited. Also the 

 statue of Karakalla and several pictures by Velasquez show typical chondro- 

 dystrophics. Formerly chondrodystrophy was regarded as congenital or fetal 

 rickets (Sommering, H. Muller, Langer, and others). Virchoiv described a 

 chondrodystrophic dwarf that he regarded as a case of endemic cretinism. 

 In France, Porak denied the assumption of achondroplasia as fetal rachitis and 



