. A treatise on the nervous diseases of children, for physicians and students. tal condition entire absence ofspeech, or of defectivespeech in many cases, willpoint the same way. Cau-tion should, however, beexercised in not mistakingdeaf-mutism for idiocy,and if a child cannotspeak, careful examina-tion should be made inother ways to determineits intelligence ; not rare-ly, however, deaf-mutismand idiocy are combined,and at times the formerhas been the direct or in-direct cause of the latter. Among idiots the de-fects of skull formationare of especial microcephalic skul


. A treatise on the nervous diseases of children, for physicians and students. tal condition entire absence ofspeech, or of defectivespeech in many cases, willpoint the same way. Cau-tion should, however, beexercised in not mistakingdeaf-mutism for idiocy,and if a child cannotspeak, careful examina-tion should be made inother ways to determineits intelligence ; not rare-ly, however, deaf-mutismand idiocy are combined,and at times the formerhas been the direct or in-direct cause of the latter. Among idiots the de-fects of skull formationare of especial microcephalic skullis particularly frequent,and is either small in allits dimensions or amplein some and very defi-cient in others. (See ) The transverse and occipital diameters may be entirely normal, indeed thehorizontal circumference may be up to the average, andyet if some such heads are examined it will be found thatthe frontal portion is unusually small, possibly receding,while the middle and occipital portions may be entirelynormal. Such discrepancies and such asymmetry should. Fig. 136.—Congenital Idiot; MicrocephalicSkull; Extreme Contractures of AdductorMuscles of Thighs. (From a photographkindly furnished by Dr. Peterson.) 550 THE NERVOUS DISEASES OF CHILDREN. be carefully noted, for it is more important than slightdeficiencies in the total measurements. Smallness of theanterior half of the skull with receding forehead proveseither that there is very little room for the brain, or thatthe brain being small requires very little space. Asymmetryof the skull is particularly frequent, as has been shown byFisher and Peterson, in those cases in which idiocy is asso-ciated with early infantile hemiplegia. Another point to beremembered is that irregularities in the structure of theskull are not uncommon in healthy individuals, and that aslong as the cubic contents of the cavity of the skull arenear the average, defects of one kind or the other appear toplay a very small part. In vari


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