File:Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index (1920) (14782526524).jpg

Identifier: internalmedicine02wils (find matches)
Title: Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index
Year: 1920 (1920s)
Authors: Wilson, J. C. (James Cornelius), 1847-1934 Potter, Nathaniel Bowditch, 1869-1919
Subjects: Medicine Diagnosis
Publisher: Philadelphia, London, J. B. Lippincott Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ordinaiy lesions and deformities of well-marked rickets. In cases attended by painsin the bones the rhachitic hand may sug-gest syphilis, but the association of the lesionsof infantile syphilis render the differentialdiagnosis easy. In the lower extremities thelower end of the tibia, of the fibula, and ofthe femur show progressive enlargementsproportionate to the severity of the case. Ifthe child walks, the femurs are curved forward and the bones of the legsfor^vard and outward. Exceptionally the curves may cause the deformityknown as knock-knee. These abnormal curvatures are due to the musculartraction and the weight of the body upon the decalcified and softened bone. The liver is enlarged: the spleen enlarged and palpable. There isusually more or less fiatulent distention. These conditions combine torender the belly large and protuberant, a condition made more conspicu-ous by the relatively small size of the thorax. The urine shows no eon.stant changes. There is slight ana?mia; the
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Fig. 315.—The skeleton of the bodyshown in Fig. 314. 336 MEDICAL DIAGNOSIS. haemoglobin is decreased; leueocvtosis may or may not be present. Thenervons symptoms increase with the severity of the other sjonptoms.Convulsions are common. Tetany and laryngismus stridulus are occa-sional intercurrent affections. The growth of the child is greatly retardedand many dwarfs are rhachitic. Diagnosis.—Direct.—Many cases are so slight as to escape recogni-tion. Weakness, fretfulness, pallor, diffuse soreness, profuse sweating ofthe head during sleep, an open fontanelle, and irregular evening feverjustify a provisional diagnosis, especially when defects of hygiene anddiet exist. When to these symptoms are added the skeletal changes abovedescribed, especially those which first appear, namely, the rosary andcraniotabes, it becomes positive. Prognosis. — The slighter forms are amenable to treatment and recoverytakes place without deformity. The graver cases recover more slowly andwith lastin

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