The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland.
- Luther Emmett Holt
- Date:
- 1911
Licence: Public Domain Mark
Credit: The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![ally .noticed when the infant is a few weeks old that one or sometimes both arms are not moved, and'»that the parts are tender when handled. The arm is very frequently held in marked inward rotation with the palm looking outward, resembling the position in Erb's palsy; but careful ex- amination makes it evident that the loss of power is only apparent, and that it is due either to the j)ain which motion produces or to epiphyseal separation. A history will usually be obtained that loss of power did not exist at birth, but developed subsequently. The electrical reactions in these cases are normal, and the rapid improvement under mercurial treatment is diagnostic. The only visceral symptoms of importance are, enlargement of the spleen, which is almost invariably present in the active stage of hereditary syphilis, and jaundice with or without enlargement of the liver. Late Hereditary Syphilis.—The symptoms may come on at any period during childhood or a])out the time of jJi-d^erty, l)ut very rarely at a later time than this. They arc seen both in those who have had the usual symptoms of hereditary syphilis in early infancy, and in others where the most careful examination into the history fails to disclose any symptoms whatever of early syphilis. It is fair to assume in such cases either that early symptoms were absent or that they were of trivial im- portance. Late hereditaiy syphilis shows itself by symptoms which in acquired disease would be classed as tertiary. The most characteristic are the affections of the teeth, the bones, gummatous deposits in the solid vis- cera, the skin, or mucous membranes, the breaking down of which may lead to ulceration. Teeth.—There are no peculiarities in the first teeth of syphilitic chil- dren except their proneness to early decay. They are rather more likely to appear early than late. The characteristic teeth of syphilis are those of the second set. In estimating the diagnostic value of these changes, only the upper central incisors are to be relied upon; these are the test teeth. Although changes are frequently seen in other teeth, they are not always diagiiostic. Typi- cal syphilitic teeth, according to Hutchinson, have each a single notch in the centre of the edge (Fig. 214). The notch is usually shal- low and more or less crescentic in shape. The enamel is generally deficient in the centre of Fig. 214.—Typical Hutch- inson's Teeth. (After ^^^^ notch, and the tooth here is apt to be dis- Fournier.) Coloured. The teeth in other cases are vari- ously dwarfed and deformed. (See Fig. 215.) They often taper regularly from the base to the edge, giving rise to the term screw-driver teeth. The teeth are not so flat as the normal](https://iiif.wellcomecollection.org/image/b21218407_1124.jp2/full/800%2C/0/default.jpg)
