File:The diseases of infancy and childhood (1920) (14768430942).jpg

Identifier: 39002011128551.med.yale.edu
Title: The diseases of infancy and childhood
Year: 1920 (1920s)
Authors: Holt, L. Emmett(Luther Emmett),1855-1924
Subjects:
Publisher: New York, D. Appleton
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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e may remain as permanent deformities, or they may breakdown and suppurate, with necrosis of one or both tables of the skull.This may be followed by inflammation of the dura, the pia, and even ofthe brain itself. When the long bones are affected, the symptoms are pain, tenderness,and deformity. These come on very gradually, and often the deformityis noticed before either pain or tenderness is sufficiently marked to attractattention. The pain is regularly worse at night, and often felt only atthat time; it may be mild and occasional, or so severe as virtually toprevent sleep. There is tenderness on pressure over the bones affected, 1120 THE SPECIFIC INFECTIOUS DISEASES the acuteness of which will depend upon the activity of the process.When suppuration occurs, it comes very slowly, and never with symptomsof acute inflammation. Sinuses usually continue to discharge until asequestrum is exfoliated. The course of the disease is very tedious, andthe whole duration is usually several years.
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Fig. 194.—Syphilitic Osteoperiostitis of the Left Tibia. Similar lesion to thatshown in Fig. 193; patient 8 years old. The right tibia is normal. When the cranium is affected, there are seen irregular nodes, espe-cially upon the frontal and parietal bones. They are from one to twoinches in diameter, and project from one-eighth to one-fourth of an inchabove the general outline of the skull. There may be pain, tenderness,softening, suppuration, and necrosis, as in the long bones. It is rare that disease of the bones of the cranium is due in childhoodto any other cause than syphilis, and this disease may usually be assumedto exist if traumatism can be excluded. The bosses upon the cranium HEREDITARY SYPHILIS 1121 in rickets are always large, smooth, and regular in position, and belongto infancy. Syphilitic disease of the long bones is recognized by the nociurnalpain, the tenderness and peculiar deformity, and by the association ofother late manifestations of syphilis—i. e., the pecul

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