486 VEGETATIVE DISTURBANCES 



is entirely normal. The vertebral canal is narrowed, usually in the frontal 

 diameter on account of premature coalescence of the nuclei of the arches and 

 the bodies, but sometimes generally. 



There exists lordosis of the lumbar spine and kyphosis of the thoracic 

 spine. The thorax is narrowed in the sagittal diameter. In five skeletons 

 of grown chondrodystrophic dwarfs, Breus and Kolisko found frontal stenosis 1 

 of the vertebral canal in every case. According to Diederle the narrowing 

 may also be conditioned by hyperplasia of the cartilage. This was true in 

 pronounced manner in both of Lampe's cases. In one of these the spinal 

 medulla was markedly compressed on this account. 



In chondrodystrophy the ribs are broad and coarse, and at the junctions 

 of the ribs the cartilages are often swollen-up (pseudo-rosary), in such a 

 manner that the bony part embraces the cartilaginous. Siegeri describes a 

 marked swelling-out at the part of the rib bordering on the capitulum costis, 

 with sharp-angled bowing and fungus-h'ke swelling out of the epiphysis; the 

 sternum is broad and thick, body and xiphoid process are synostosed; the 

 clavicles are short, and bent in the form of an S; the scapulae very small, 

 their borders coarse, the pelvis generally narrowed, its inlet kidney-shaped. 

 The promontory [of the sacrum] projects markedly, the ilia are thickened, 

 shovel-shaped with thickened borders. Most characteristic of the micro- 

 melic growth disturbance is the inhibition in growth of length of the extremi- 

 ties, which is the proper cause of the dwarfism of the individual. Under 

 normal conditions the lower length begins to exceed the upper length already 

 toward the end of the first year of life, and the difference becomes more 

 marked as the years pass. In the disease under consideration however the 

 growth in length of the extremities remain so far behind that the relation of the 

 upper length and lower length may reach 2:1. As the periosteal bone-forma- 

 tion is not inhibited, the cortex of the diaphyses is very thick and very 

 marked places for the insertions of the muscles develop; the muscles themselves 

 are entirely normal, so that the chondrodystrophic dwarfs are very strong with 

 regards to muscular force and are clever acrobats. According to Breus 

 and Kolisko the fibula is less shortened than the tibia, so that it projects 

 markedly below the lower end of the tibia, thus producing a varus position 

 of the foot; the feet are shortened, also the upper extremities are essentially 

 shortened, likewise the hand, the breadth of which is however normal; the 

 shortened fingers stand apart from one another (main a trident, Radspeichen- 

 form). The ossification of the epiphyses proceeds very irregularly. The 

 epiphyses themselves may, as Siegeri mentions, sometimes be more hyper- 

 plastic, sometimes more hypoplastic, in the latter case embracing the di- 

 aphyses. The closure of the epiphysial junctures may occur prematurely, 

 especially those of the metacarpal bones of the hands and feet; at other places, 



1 In German edition "sclerosis," according to the original article of Breus and Kolisok 

 "stenosis." Editor. 



