490 VEGETATIVE DISTURBANCES 



is waddling, that the intelligence develops normally, and that finally the sexual 

 glands and the genitalia develop and functionate normally. Indeed in many 

 cases the genitalia are developed remarkably well. 



Here are set forth two cases observed at the first medical clinic. The 

 notes concerning the first case, four years old (Observation LXII) , have un- 

 fortunately been mislaid. I can only show the characteristic illustration, 

 that shows the characteristics of chondrodystrophic dwarf in pronounced 

 manner. The root of the nose is markedly retracted; the extremities are 

 enormously shortened, the skin has become too wide for its extremities, 

 lying in thick folds. 



Observation LXIII. U. W., seventeen years old. Father of the patient normally 

 developed. The same is true of the father's parents and three brothers and sisters (except 

 that one sister has a syndactylism of three fingers). The mother of the patient seems to 

 have had rickets in early life, but is of normal development. Of brothers and sisters of 

 the patient only the youngest, a girl one year old, is living; she is entirely normal. The 

 eldest child died at the age of fourteen years of tuberculosis, was normally developed. 

 The second child died at three-fourth year, the third at one-fourth year, the fourth is the 

 patient. The fifth and sixth died at one-fourth and one-half years, the seventh im- 

 mediately after birth. 



The patient, like the rest of the children, was, acpording to statement, normal at birth. 

 At six months of age he seems to have had pain in passing urine, and soon after the father 

 observed that the child remained behind in growth, and only the head was much too large. 

 The increase in the size of the head lasted until about the seventh year. He learned to 

 speak at two years, the intelligence developed entirely normally. At about one-half 

 year he has had paresthesia and fatigue in the legs. He began to walk with knees pressed 

 together and for some weeks sitting down has been difficult too. 



Height 125 cm., span width 126 cm., acromion to points of finger 47 cm.; upper border 

 of trochanter major to the heel 53 cm. Length of hands, 15 cm., breadth 10 cm.; length 

 of feet 21 cm. 



The cranial skull is much larger than the facial skull, is somewhat quadrangular; root 

 of nose deeply retracted. On looking to the left 'or upward, horizontal or vertical nystag- 

 mus respectively. ChwsteWs phenomenon present on both sides. Slight dextroscoliosis of 

 the thoracic spine. The hands are short and broad, the fingers alike in length, typical 

 mains a trident. X-ray shows that the epiphysial junctures of the fingers are not as yet 

 united. The sella turcica is pressed together in the vertical diameter, broadened in the 

 horizontal. 



The musculature is normally developed, the genitalia hyperplastic. There is no axil- 

 lary hair, nor hair on the linea alba. There exists a moderately large struma of rather soft 

 consistency. 



There are spasms of the lower extremities. Legs adducted when at rest, with slight 

 equinus position. Patellar and foot-clonus present, Babinski positive. Hypalgesia and 

 hyperesthesia from about the height of the arch of the ribs downward, becoming less from 

 the fossae of the ilia down; very slight on the feet. 



Summary: Typical Chondrodystrophy. At first we thought of a hydro- 

 cephalus, descending degeneration of the pyramidal tracts and spastic paresis 

 of the extremities. Yet there were no other points for our adhering to the 

 diagnosis hydrocephalus. It is possible that the spastic paresis was produced 



