. Physical diagnosis . Fig. 1.—Hydrocephalus. 6 PHYSICAL DIAGNOSIS. (c) Rachitic head, which is flatter at the vertex and more pro-tuberant at the frontal eminences, giving it a squarish outline, con-trasted with the globular shape and rounded vertex of the hydrocephalic. In rickets there are no changes in the eyes. (d) In adult life an enlargement of the skull, due to bony thick-. et b Fig. 2.—Pagets Disease. (Edes.) a, Before onset of hyperostosis cranii. b, After onset of hy-perostosis cranii. ening, forms part of the rare disease, osteitis deformans (Pagetsdisease), associated with thicken
. Physical diagnosis . Fig. 1.—Hydrocephalus. 6 PHYSICAL DIAGNOSIS. (c) Rachitic head, which is flatter at the vertex and more pro-tuberant at the frontal eminences, giving it a squarish outline, con-trasted with the globular shape and rounded vertex of the hydrocephalic. In rickets there are no changes in the eyes. (d) In adult life an enlargement of the skull, due to bony thick-. et b Fig. 2.—Pagets Disease. (Edes.) a, Before onset of hyperostosis cranii. b, After onset of hy-perostosis cranii. ening, forms part of the rare disease, osteitis deformans (Pagetsdisease), associated with thickening and bowing of the long bones(see Fig. 2). 2. The Fontanels. The anterior and larger fontanel remains about the same size forthe first year of life, then diminishes, and closes about the twenti-eth month. The posterior closes in about six weeks. In rickets,hydrocephalus, hereditary syphilis, and cretinism, the fontanelsand sutures remain open after the normal time limit. (a) Bulging fontanels mean increased intracranial tension (hy-drocephalus, hemorrhage, meningitis, or any acute febrile diseasewithout dyspnoea), (b) Depressed fontanels are seen in severe diar- THE HEAD AND FACE. 7 rhoea, wasting diseases, collapsed states, and acute dyspnoeic condi-tions. 3. The Hair. («.) A rachitic child often rubs the hair off the back of its headby constant rolling on the pillow
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