Common disorders and diseases of childhood / [George Frederic Still].

  • Still, G. Frederic (George Frederic), Sir, 1868-1941.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Common disorders and diseases of childhood / [George Frederic Still]. Source: Wellcome Collection.

    714/792 (page 698)
    found in syphilitic infants. I do not know that it is ever found in pure rickets. In either case the bossing is usually, but not always, symmetrical, affecting the parietal and frontal bones near the anterior fontanelle, and so producing the natiform or hot-cross-bun skull. Craniotabes has seemed to me to be very rarely due to syphilis (see p. 93); indeed, in examining the heads of syphilitic infants for craniotabes I have been struck with the firmness of the bones, which have often seemed to become firm and hard rather earlier than in infants who showed no evidence of syphilis ; in my own experience craniotabes has been associated most often with laryngismus stridulus and tetany, which are both recognized as rachitic manifestations, and in most of these cases there has been no suspicion of syphilis. There is no doubt that congenital syphilis may cause extensive absorption of the bones of the skull as in the following case : Edward H., aged ten months, was brought for a rash on the face, buttocks, and head. He was slightly hoarse, and had condylomata about the anus ; the fundus oculi showed choroidoretinitis ; but the remarkable feature of the case was the presence just in front of the frontal eminences of two symmetrical gaps, one in each frontal bone, triangular in shape—the base of the triangle being above—and measuring about one inch in the transverse line of the fore- head, whilst the distance from base to apex (which reached nearly halfway down the forejiead) was also about one inch. The bone appeared to be entirely absent in these areas, and I concluded—wrongly, as events proved—that it was an unusual example of congenital defect of ossification. The child was treated with mercury and iodide for the other syphilitic manifestations, and in the course of a few weeks it was found that the holes in the frontal bones had com- pletely disappeared, being filled up with hard thick bone with a somewhat uneven surface. No swelling of any sort had been noticed over these areas before the absorption of the bone ; so that it was unlikely that it had been preceded by any gummatous dejmsit. Nephritis. Less common than any of the affections already mentioned is nephritis as a result of congenital syphilis. Several such cases have recently been recorded by Dr. Carpenter, Dr. Sutherland, Dr. Walker, and others. I have had four syphilitic children with nephritis under my observation. One developed general oedema at the age of six weeks and died six weeks later; the kidney showed acute nephritis. Another showed symptoms of nephritis at the age of three years and three months, became dropsical with ascites and died : intercellular cirrhosis of the liver was found and an acute nephritis chiefly of interstitial character. A third came under treatment at the age of three months with ‘ pseudo-paralysis ’ of one arm, enlarged spleen, anaemia,