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disease are disconcerting to the pathologist and discouraging to the nosologist, tempting one to compare them with what has been said about the hydatidiform mole, that it is due to "einen unbekannten Etwas der Mutter" (An unknown something of the mother).

The following case has been under my observation for a number of years, though the diagnosis was not made until the early part of last year (1906).

A male child, age eight years, born of healthy parents, is the second child in the family. His sister is a well grown and developed girl, 14 years old. The mother is tall and apparently healthy. The father and the male members in his family in particular are rather short in stature, though above five feet. The father has short, stubby fingers. The grandfather of the child, on the paternal side, is described as a man of short stature with large trunk and short limbs but with no other characteristics of this disease. During the pregnancy, the mother felt exceptionally well and labor was normal. No history of miscarriages, lues or alcoholism. Shortly after birth it was noticed that the child's legs rotated outward. Before one year had passed a stunting of growth and inability to sit up was noticed. At the age of 10 months he was supposed to have had cerebrospinal meningitis, such symptoms as opisthotonus, high fever and vomiting being noted, upon recovery the supposed "weakness" continued until the child was four years of age. At that time he was a "peculiar mass of bone and flesh," flexibility of the spinal column and extreme movements of the hip-joints were noticed. He could sit and creep but neither stand nor walk. His mental condition was bright. A brace to support the body was a failure. Massage and electricity in a very mild way improved matters very materially, the child began to walk, his intelligence made rapid strides and all looked hopeful. But his mother noticed that in spite of his good health-barring slight digestive disturbanceshis limbs were not growing in proper relation to the trunk-he would outgrow his coats and waists long before his trousers, and his stockings were much too long for his legs though they fitted the feet. Examination of the child shows a large vault of the cranium, square turned-up nose, large forehead, prognathus, short neck, large trunk in proportion to the size of the body, protruding abdomen, marked lordosis, short arms and legs with bowing of the humeri and tibial bones. The fingers are short, thick and spatulate. Knee-caps are present now, in his early life they could not be felt. Skin is of good color and soft, and hair abundantly grown.

Roentgenograms and the following description of the bones were made by Dr H. O. Feiss. "Radiographs show that the shaft of the humerus is considerably thickened as though the bone was growing in thickness rather than length. There is considerable bowing of the radius and ulna The lower epiphysis of the femur is quite rough both at its junction with the diaphysis and at the joint. Radiograph of the pelvis shows thickening of the necks of the bones and close union between the epiphyses and the neck. Another radiograph of the upper extremity shows a flattening externally of the epiphyses of the upper end of the humerus." The diagnosis of achondroplasia was confirmed by consultation with Dr H. O. Feiss of this city and Dr E. H. Bradford, of Boston, Mass. The following measurements were taken on July 19, 1906: Anterior superior spine to internal malleolus, right 15 Anterior superior spine to internal cordyle.

inches.

right 83% inches.

Internal condyle to internal malleolus, right 7 inches.

Left about the same.

Right arm: end of clavicle to external condyle, 51⁄2 inches.

external condyle to styloid of ulna, 534 inches.

From the supraclavicular notch to anterior superior spine, 121⁄2 inches. Height 40% inches, weight 391⁄2 pounds (clothed).

On October 3, 1907, one year and three months later, these measurements were noted:

Anterior superior spine to internal malleolus, right 1634 in., increase 134 in. Anterior superior spine to internal condyle, right 94 in., increase in. Right arm, end of clavicle to external condyle, 63⁄4 inches, increase 14 in. External condyle to styloid of ulna 6 inches, increase 4 inch.

From the supraclavicular notch to anterior superior spine, 13 inches, increase 1⁄2 inch.

Weight, 45 pounds (clothed), increase, 51⁄2 pounds.

Height, 4134 inches, increase 14 inches.

The average weight and height for a child of eight years according to Boas is 544 pounds and 48.2 inches respectively; thus this case is 91⁄2 pounds under weight and 6.45 inches undersized.

Prognosis and treatment: As stated before, most cases are still-born or die soon after birth, but those who survive early childhood possess ordinary health. Dr Bradford stated that such cases are not more liable to fractures. They attain an average height of 4 feet 5 inches. No medication will alter the condition. In my case the treatment first was for infantile paralysis and rickets. Phosphorus, cod-liver oil and malt extracts in various cominbations were given for a long time but with no results from this therapy.

Thyroid extract, beginning with one-half grain doses three times daily, and gradually increasing to 12 grains per day, was used for about two months with no change in the condition. Massage and a mild Faradic current, when the child could neither stand or walk, were the only forms of treatment from which results were obtained. Recently physical exercises were tried but caused too much fatigue for their continuance.

Summary: Achondroplasia is a distinct disease, differing from rickets. It has characteristics of its own-as already described. The medical and physical treatment is of no avail.

1.

REFERENCES.

Ueber sogenannte fötale Rachitis. Müller. Würzburg, Med. Zeitschrift, 1860, I, pp. 221-276.

2. Ueber Rachitis congen. Urtel. Diss. Halle, 1873.

Untersuchungen über die sogenannte fötale Rachitis, Berlin, 1872.

Lancet, June 9, 1906, pp. 1599.

3.

4.

5.

De l'Achondroplasie. Clermont, 1890.

Veronal Dermatitis-Report of a Case

By H. B. ORMSBY, M. D.

Visiting Assistant in the Diseases of Chillren and in Medicine, Cleveland College of Physicians and Surgeons.

A perusal of the literature of drug eruptions has satisfied me that veronal dermatitis is of such rare occurrence as to warrant the report of a case before this Section. Drug eruptions are frequently seen by every physician, especially those due to quinin, bromids, copaiba, iodids, antipyrin, iodo form and arsenic. But I have never seen any eruption so acute, so extensive and which caused so much suffering as in this case of veronal dermatitis which occurred recently in my practice.

Veronal, a fine, white crystalline substance, having a slightly bitter taste, soluble in 12 parts of boiling water and in 145 parts of cold water, was first introduced in 1903 by Fisher and von Merring. It is commonly prescribed in five to 10 grain doses, every three to five hours until sleep is produced. A single dose of 10 grains near bedtime is frequently sufficient to produce a quiet, restful sleep for from six to eight hours, followed very rarely by any depressing after-effect such as nausea, vomiting or lowering of arterial tension. It is generally considered one of the best hypnotics of the day, especially in acute or subacute melancholia, in acute alcoholism in 20 grain doses, in low nervous states following acute inflammatory diseases, etc. Yet, there have been a few cases, including my own, of unfavorable results following its use, probably due to idiosyncrasy and not to its being a dangerous drug, as it is a valuable addition to our armamentarium.

A. C. Jordon (British Medical Journal, March 5, 1907) reports two cases of slight antipyrin-like rash, lasting two days, following the use of veronal. H. David, of Berlin (Berliner Klin. Wochensch., Nov. 30, 1904), reports a slight erythema lasting three days. P. T. Held (Therapeut. Monatshefte, Nov., 1904) observed a pemphigus-like rash from the ingestion of 9.0 grams at one dose, taken with suicidal intent but followed by recovery. Kuhn (Deut. Med. Wochensch., March 16, 1906) reports an itching rash upon the face and upper part of the body, with the formation of vesicles on the buccal and pharyngeal mucous membranes. Clark (Lancet, 1905) reports a dermatitis after a total amount of 7.5 grams of veronal taken within a few days. House

Read before the Clinical and Pathological Section of the Cleveland Academy of Medicine, December 6, 1907