The diseases of children / by James Frederic Goodhart.

  • Sir James Goodhart, 1st Baronet
Date:
1913
Catalogue details

Licence: In copyright

Credit: The diseases of children / by James Frederic Goodhart. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    cry of laryngitis. Much may be learned by a glance at the shape of the head. The hydrocephalic head is one which bulges in all directions. The forehead projects ; the temporal fossae become convex ; the fontanelle and vertex more vaulted ; even the occiput becomes more rounded, and in this general tendency towards the assumption of a globular form in place of an ovoid the inter-ocular space is widened outwards and the eyes are rendered too divergent. The rickety head is mostly flattened on the vertex and some- what square ; it is also very often above the average size, but although the forehead may be overhanging, it wants the width and general rounding seen in hydrocephalus. There is also au elongated type of rickety head which has the appearance of being laterally compressed. The head of the syphilitic child is sometimes of irregular shape, almost lobulated in appearance, and betrays its component bones by the position of the enlarge- ments. The shape is due to osteophytic growth which forms upon the bones round the anterior fontanelle and spreads thence over their surfaces. The fontanelle may thus appear to lie in a hollow between four hillocks, one on each parietal and on each frontal bone. But sometimes the inter-frontal suture is con- verted into a vertical ridge, from the exuberant bone-formation along it. The skull thus affected has been called the natiform skull, from the appearances produced by the bony elevations, and, as the bones are often soft, “ craniotabes ” may be pre- sent likewise. We have called this form of skull syphilitic, but it is not yet certain whether the changes described are caused by syphilis or rickets, or possibly in some cases by both combined. The scaphoid skull is a narrow skull, in which the frontal region is boat-like and slopes away from the median line, be- tokening the small brain of an imbecile or idiot. The fontanelle by bulging may indicate excess of blood or cerebro-spinal fluid within the cranium ; by its size it may indicate defective ossi- fication, and so rickets ; but of more importance, because of almost invariable significance, is the depressed fontanelle of starvation and exhaustion ; it indicates the immediate necessity of food or stimulants. As regards the face, it may be mentioned that shades of pallor are most suggestive—a dirty white (cafe au lait) stands for congenital syphilis ; a sallow white for splenic
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