In Reply. —
The subject of bone dysplasias is still not very well understood and consequently open to controversy; the untreated cretin usually presents with epiphyseal dysgenesis and metaphyseal and disaphyseal dysplastic changes secondary to delayed and abnormal skeletal maturation. The results are stunted height, coxa plana, bowed legs, increased lumbar kyphosis, and shortening at the base of the skull,1,2 features that may resemble those of achondroplasia and some forms of mucopolysaccharidosis. El Nino de Vallecas, besides his dwarfed body, has the stunted look of an idiot, a feature absent in the normally intelligent achondroplastic.Velázquez has several paintings of dwarfs at the Prado Museum in Madrid, Spain. The female dwarf displayed in his painting Las Meninas was Maria Barbola, a German lady-in-waiting for the princess and most probably an achondroplastic.
Dominguez R. Velázquez' Dwarfs: A Profusion of Diagnoses-Reply. JAMA. 1989;262(3):350. doi:10.1001/jama.1989.03430030037017
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