Variability In Little People

To the Editor:—  Your editorial, "Big Variability in 'Little' People" (209: 411, 1969), raises some interesting points concerning the nosology of disease. As your discussion implies, increasing scientific information concerning dwarfism, chromosomal aberrations, and inborn errors of metabolism has resulted in what appears to be greater heterogeneity in the classification of the disease mechanisms in these patients. Our perception of disease is improved by new data derived from technological advances, and thus the state in question seems to exhibit greater "variability." This "variability" is a prelude to more precise (but more complex) classification.For some years in teaching I have used the condition of cretinism to exemplify this nosologic phenomenon. As the Figure shows, there has been a progressive heterogeneity in the classification of cretinism since the 18th century. With increasing scientific knowledge, the concept of cretinism has developed from the rather primitive notion of 1800 that the patients were