. tened andthickened phalanges with overdevelopment particularly of their bases. The most important points in this radiographic study arethe shortening and deformity of the diaphyses, with Irregularformation of the bony substance and the greater thickening of thecortex at the middle with thinning out toward the epiphyses;the greatly and abruptly enlarged ends of the shafts andthe enlarged and distorted epiphyses, and in some in- DYSTROPHIC CONDITIONS OF INFANCY 13 stances the complete absence of the normal articular sur-face; the deficient ossification of the anterior portion ofth
. tened andthickened phalanges with overdevelopment particularly of their bases. The most important points in this radiographic study arethe shortening and deformity of the diaphyses, with Irregularformation of the bony substance and the greater thickening of thecortex at the middle with thinning out toward the epiphyses;the greatly and abruptly enlarged ends of the shafts andthe enlarged and distorted epiphyses, and in some in- DYSTROPHIC CONDITIONS OF INFANCY 13 stances the complete absence of the normal articular sur-face; the deficient ossification of the anterior portion ofthe ribs, the deficient ossification of the posterior portionof the left rib, and the presence of symmetrical ex-ostoses on the bones of the upper extremity. These find-ings are in close agreement with those recently reported byFussell and Pancoast of Philadelphia. Similar findings have al-so been reported by Bullard and George of Boston, who also notethat near the epiphyseal ends the diaphyses become Fig. 8. M. E. Achondroplasia. Radiograph of right leg below the great distance to which the lower end of the fibula extendsbelow the lower tibial margin, also the irregularity in size and shapeof the astragalus. Apart from the changes in the bony, cartilaginous, and liga-mentous skeleton, this patient presents no deviation from thenormal. The thoracic and abdominal viscera, the skin, the ner-vous system, the blood and the excreta show nothing is no absence of the thyroid. During the short time thathe has been under observation neither thyroid extract nor pituitaryhas had any effect upon his growth or general condition. 14 ALEXANDER SPINGARN Every pediatric clinic reports its cases of sporadic cretin-ism, and of its miraculous results in their treatment. In the ele-gant diction of Osler,s not the magic wand of Prospero, or thebrave kiss of the daughter of Hippocrates ever effected such achange as that which we are now enabled to make in these un-f
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