. The diseases of infancy and childhood. he middle of the first year is often seenin cases of arrested cerebral development. This indicates a serious con-dition, usually microcephalus. Closure of the fontanel in the earlymonths of the second year may be due to the slow growth of thebrain in a child suffering from general malnutrition but otherwisenormal. By far the most frequent cause of delayed closure of the fontanel isrickets, in which condition it may be open up to the end of the thirdyear. A large fontanel is one of the striking features of cretinism, and THE HEAD 23 in untreated cases is
. The diseases of infancy and childhood. he middle of the first year is often seenin cases of arrested cerebral development. This indicates a serious con-dition, usually microcephalus. Closure of the fontanel in the earlymonths of the second year may be due to the slow growth of thebrain in a child suffering from general malnutrition but otherwisenormal. By far the most frequent cause of delayed closure of the fontanel isrickets, in which condition it may be open up to the end of the thirdyear. A large fontanel is one of the striking features of cretinism, and THE HEAD 23 in untreated cases is often seen as late as the eighth year or later. Ininfancy an open fontanel with a rapid growth of the head should atonce suggest hydrocephalus. There is an hereditary condition in whichthe fontanel remains open even to adult life. Two such cases in fatherand son were shown us by Marie in Paris. In both there was also lack ofunion between the two portions of the clavicle. Shape of the Head.—The deformity which results from compression. Fro. 3.—Premature Ossification of the Sagittal Suture. Death at six weeks. during labor usually disappears by the end of the first month. Duringthe first year the head often becomes flattened at the occiput in conse-quence of the childs lying too much upon the back. This is easilyremedied by changing his position. A slight obliquity of the head mayresult from a habitual position during nursing or sleep. A marked de-gree of obliquity is sometimes congenital, but usually disappears bythe third or fourth year. The other abnormalities in the shape of the head are chiefly due torickets and hydrocephalus, more rarely to congenital malformations ofthe brain. They will be considered in the chapter devoted to these topics. 24 GROWTH AND DEVELOPMENT Premature ossification of the sutures of the cranium occasionallygives rise to striking deformities of the head. Depending upon thesutures involved the head may be long and narrow or it may be short andhigh
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