Studies in neurological diagnosis / by James J. Putnam and George A. Waterman.

  • Putnam, James Jackson, 1846-1918.
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: Studies in neurological diagnosis / by James J. Putnam and George A. Waterman. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    CLXVIII. Peculiar Abnormality of Development. Improvement under Treatment. The patient is a girl five years old. On account of pe- culiar circumstances nothing of her family history or pre- vious symptoms could be obtained. It was learned, how- ever, that during the past two or three years there had been no noticeable physical nor mental development. She is un- able to walk or talk, but is always good-natured and smiling. She takes notice of bright objects held before her, but does not play with toys. She has never learned to make known her desire to micturate or defecate. Examination shows a child with marked pallor of the mu- cous membranes. The skin is dry and waxy; the hair is thin and dry and falls easily. The head is large, and the face is full. The features suggest that the child is a boy rather than a girl. The mouth is held open, and the broad and thick tongue protrudes from it most of the time, though it is often withdrawn. The nose is broad and flat. The head is thrown back, and the breathing is noisy, as if in conse- quence of a severe cold in the head. There are large masses of fat about the eyes, neck, and shoulders, and marked pads of fat are seen above the clavicles. The thy- roid gland is not palpable. The child is able to stand if she supports herself by a chair; and in this position the legs are abducted and the feet turned outward, so that the knees point in almost opposite directions. The legs seem short in comparison with the body, which gives the latter an impression of un- due length. The thighs are covered with thick masses and folds of fat. The heart examination shows a loud systolic murmur over the whole precordia, loudest over the pulmonic area, and transmitted far into the axilla. The pulmonic second is