STATISTICS OF OBSERVATIONS. 69 



Posterior fontanelle closed. Sutures closed. No craniotabes. Parietal bones 

 not prominent. Eyes : No discharge; pupils equal and react to light; external 

 ocular movements normal. Ears : No discharge ; tympanic membranes normal. 

 Nose: No discharge; alae nasi do not move with respiration. Mouth: Mucus 

 membrane, good color; no teeth; in center of hard palate is an oval ulcer 

 about 1 cm. long in diameter, which is shallow and apparently filled with 

 granulations; tonsils not prominent or reddened; pharynx normal. Glands: 

 Axillary normal; epitrochlears normal; submaxillary, cervical, posterior auri- 

 cular, occipital, inguinal, and femoral glands all enlarged and vary in size from 

 a pea to a large bean; are hard and non-tender. Chest: Symmetrical; expan- 

 sion equal; very slight rosary; no Harrison's groove. Heart: Apex impulse 

 felt in fourth space, 4 cm. from midsternum; dulness corresponds; right border 

 1 cm. from midsternum; upper border at third rib; sounds regular and of 

 good quality; no murmurs; pulmonic second louder than aortic second. Lungs : 

 Normal resonance, fremitus, and breath sounds; no rales. Abdomen above 

 level of thorax, soft, very tympanitic. Moderate diastasis of recti. No 

 masses or tenderness. Liver dulness extends from fifth space to 1 cm. below 

 costal margin, where smooth edge is felt. Smooth edge of spleen is felt 3 cm. 

 below costal margin. Genitalia normal. Extremities normal. No paralysis, 

 contractures, or edema. Epiphyses of long bones not enlarged. Reflexes: 

 knee-jerks present and equal. No Kernig sign. No stiffness of neck or neck 

 sign. 



April 22. Blood: Haemoglobin, 70 per cent (Talquist); white count, 

 10,000. Smear normal. Polynuclears, 32 per cent; small lymphocytes, 20 

 per cent; large lymphocytes, 47 per cent; endothelial cells, 1 per cent. Wasser- 

 mann reaction suspicious. 



April 23. Urine: Pale; clear; acid; albumin, slightest possible trace. No 

 sugar. Urobilinogen absent. Sediment, a few round cells. Stool : Greenish 

 brown; pasty; normal odor; acid to litmus paper; few soft curds, no tough 

 curds; little finely divided mucus. 



April 24. X-ray examination immediately after bismuth feeding, and every 

 hour thereafter for several hours. 



April 25. Von Pirquet skin tuberculin, negative 48 hours. Stool : Greenish 

 yellow and black; crumbly; acid; no curds. Bismuth in large amount. 

 Total fat in moderate excess. 



April 26. X-ray examination as before. 



April 27. Stool : Yellowish-white and black mixed (bismuth) ; acid; normal 

 odor; few soft curds; total fat in moderate excess. 



April 28. Stool: Soft yellow; acid; many small soft curds, few tough 

 curds; no mucus; total fat in moderate excess. X-ray examination as before. 

 Takes bottle well; gaining weight in spite of starvation. 



May 2. Summary: Underfed; under-weight ; bright, happy infant; very 

 active; always hungry for bottle; takes it quickly; not quite satisfied. Dis- 

 charged, relieved, Out-Patient Department. Diagnosis : Feeding; syphilis (?) . 



