In her, the first indication of the trouble was at the age of eighteen months, and began with pain in the fingers of the right hand, followed by swelling and redness. The condition resembled an acute dactylitis. This all disappeared after six months, and has left no deformity. During the six months, the child was continuously under iodide of potash. The first distinct nodule appeared at the age of two years, in the upper end of the left humerus, and has also nearly disappeared. The second nodule appeared on the left tibia below the knee, in exactly the same position where the mother, grandmother, and greatgrandmother have osseous growths. This nodule is now the size of a hickory-nut. It does not appear to be growing, and does not cause pain. She also has one about the size of a bean on the right tibia near the ankle. The child has been a very healthy child, is of good size, with splendid color and high spirits. She was given iodide of potash continuously since she was eighteen months old, with the exception of intervals when it had to be discontinued, because of a peculiar urticarial eruption. The iodide has apparently had a decided effect in arresting the disease. I now pass to the description of the photographs. There are seven plates: Figure 1 shows most beautifully the particular type of osseous growth. The picture resembles Ochsner's case in the Annals of Surgery for October, 1907. Note the T. P. WARING AND E. R. CORSON. 291 enlargements of the whole upper half of the bone, and especially of the head; also, the obliteration of the bicipital groove, which is very evident in all good X-ray pictures. Note also the areas of dense and spongy bone. There is no definition to the tuberosities. The upper end of the humerus is the most common site for bone tumors and bone cysts. It is also interesting to note in the picture the large spacing in the acromio-clavicular joint. Left humerus showing two large osteomata on upper third of the shaft-note the large spacing at the acromio-clavicular joint. Figure 2, also a beautiful photograph, shows a most remarkable deformity. The changes in the bones are so great as to give one the idea that they were taken from a dwarf; and truly the changes in the bones are those of dwarfism. You will note that the shaft of both ulna and radius are enlarged and shortened. There was evidently some change at or below the epiphysis of the lower end of the ulna, so that there was loss of nutrition resulting in atrophy. The only character of the normal ulna is FIG. II. Right forearm and elbow showing the peculiar malformation of radius and ulna. in the upper end, and this shows a shortened olecranon process, and a strange tubercle below the coronoid process. The trochlear surface is immense, and no head of radius can be made out. Note that in spite of the great deformity the carpus presents its normal relation to the lower end of the radius, thus giving the woman a good and useful hand. Figure 3, the right hip showing large osteomatous mass growing from the neck of femur. Note the large mass between the trochanters, the enlargement of the lesser trochanter, and the absence of any neck to the head of the bone. The pelvis appears normal. Figure 4, right ankle joint showing great enlargement of external malleolus. Lower end of tibia, though normal in conformation, is spread out and much enlarged in proportion to normal size of bone. Figure 5, left ankle showing malformation of the external and internal malleoli and a bony spur projecting from the tibia eight centimeters above the joint, also a probable malformation of the astragalus. It was from this tibia that a large growth was removed in childhood. Note also that the epiphysis is intact, showing nonunion, and thus exemplifying inhibition of growth of normal bone. Compare with photograph of normal child aged fifteen. Figure 6, profile view of skull showing size of sella turcica and of the pituitary body. They seem normal. This fact brings out clearly that the disease process has a different origin from that of acromegaly. The condition resembles more nearly that of dwarfism. Morphologically, dwarfism and gigantism have not been sufficiently studied, but from the fact that growth or lack of growth takes place in those bones formed from the mesoblast, it is evident that the changes are due to an |