. Physical diagnosis . es.) 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 fonta
. Physical diagnosis . es.) 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. (This is associated with profuse. Fig. 3.—Syphilis of the Frontal Bone. (Curschmann.) sweating of the head.) Patchy baldness occurs in the skin diseasealopecia areata, and occasionally over the painful area in trigem-inal neuralgia. (b) General loss of hair occurs normally after many acute feversand with advancing age. Early baldness (under thirty-five) is oftenhereditary. Syphilis may produce a rapid loss of hair, local or PHYSICAL DIAGNOSIS. general, and the same is true of myxcedema; but in both these dis-eases the hair usually grows again in convalescence. (c) Parasites (pediculi) are worth looking for in the dirtierclasses and those associated with them (teachers). Their eggs ad-
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