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Figuration. One Might Be Inclined to Explain This DR. E. HUGHES: CRANIOTABES OF THE FŒTUS AND INFANT. 1045 .experiments of Neuschlosz,40 who found that an emulsion of lecithin in water possesses a surface CRANIOTABES OF THE FŒTUS AND tension dependent on the amount of Ca present. INFANT. Too much or too little Ca had the same effect. In the therapeutic application of lime salts one also BY EDMUND HUGHES, M.R.C.S., L.R.C.P. LOND often notices opposite effects according to the amount used. IN a previous paper 1 I recorded some results of a To return for a moment t,o what Prof. Bayliss has clinical inquiry into this subject. The account then .called the " Clowes’s effect," it would seem that the given was composed under the combined disadvantages is view of the American author strongly supported of military service and paper shortage ; and this was by our experiments on the stereo-isomeric sugars. unfortunate, because the contentious nature of We have seen that pores are left between the oil- certain of the findings called for their rather full that ,drops, and it is obvious these pores, because presentment. I shall therefore make no apology they are subjected to the surface tension at the for re-stating these findings in somewhat more boundary, assume varying shapes. Now pores of a adequate form. could allow a con- definite shape sugars of definite Broadly, the position then reached was that the figuration-e.g., lævulose-to pass through, while recognised " craniotabes " arising during the first holding back sugars-e.g., glucose--of another con- few months of infancy is in many, and probably in be inclined figuration. One might to explain this most, cases only a fresh manifestation of a state of phenomenon by the aid of differences in viscosity or craniatrophy already existing in later fcetal life, But we surface tension. have found with Miss S. C. This foetal craniatrophy, having no physical differ- Hamburger that these physical constants are the ences from the later form, and occurring predominantly same for lævulose and for glucose. How can one in the same individuals, was therefore held to deserve explain this separation of glucose from lævulose, the same title. Verification of this finding would therefore, other than by supposing that the shape of entail a re-scrutiny of the common belief that cranio- the ultra-microscopic pores in the sieve plays a tabes is a sign of rickets. A simpler solution of the decisive part ? Our experiments thus lend support difficulty would be to infer the causality of syphilis. to Clowes’s theory, and vice versa the mechanism of But the only definite contribution to the problem - specific permeability has become clearer. of causality I was able to make consisted of some fresh Finally, it may be said that the conditions shown evidence tending to rule out syphilis as an acting or in our sketch by the portion below the line do not, proximate cause. The evidence given was, I think, as a rule, occur in physiological circumstances. In sufficient for that purpose ; and it must be remem- fact we know that, as a rute, all the cells of the body bered that observation alone, though powerless to are permeable to water. But there are exceptions. decide what is causal, can often determine what is not. When blood is diluted with a great deal of water I will now go over the previous findings, incor- most of the red corpuscles in absorbing water loose porating such fresh material as has since been obtained. their colouring matter and the mixture has become The total case-material is 154. But after I often saw transparent. centrifugalising of the Skull. a deposit which examined by the microscope proved Immaturity to consist of red corpuscles. These cells must have In connexion with yielding areas in the skull at been impermeable to water. Red corpuscles treated birth, the problem was early raised in course of this as to characters kind in with cobra venom are also impermeable to water. inquiry what of this the can imma- and the same is true of the eggs of sea-urchins.41 newborn skull be legitimately ascribed to When put in distilled water the latter does not enter turity. To determine this point, a parallel study was made on some hundreds of neo-natal the eggs, as Ralph Lillie has pointed out, but on living crania at various of and of adding some Ca-ions their impermeability to water stages development, is lost. stillborn and non-viable crania, in situ and detached.* References. Seeing that in all my cases of foetal craniotabes the bones were and that all were born 1. Hamburger : Zeitschr. f. Biol., 1889, p. 414. parietal attacked, 2. Hamburger : Koninkl. Akad. v. Wetensch. te Amsterdam, at or near term, interest here centres on the condition meeting of Dec. 29th, 1883. of the parietal at and near the end of the foetal 3. Hugo de Vries : Koninkl. Akad. v. Wetensch. te Amster- The result of makes it clear that the dam, meeting of Oct. 27th, 1882. period. study 4. Van’t Hoff: Wie die Theorie der Lösungen Entstand, condition I call foetal craniotabes and the condition Berichte d. Deutsch. Chem., Gesellsch., xxvi., 6, 1894. of the parietal due to immaturity are entirely distinct. 5. Arrhenius : Zeitschr. f. Physik., Chemie, i., 63, 1887. In the first there is of the 6. Hamburger: Zentralbl. f. Physiol., June 17th, 1893, discontinuity bone-forming Jan. 27th, and Feb. 24th, 1894. spicules-a true atrophy in some part of their course- 7. Hedin: Skandinav. Arch. f. Physiol., 1892, pp. 134 and 360. 8. Overton: Studien über die Narkose, Jena, 1901. * For the great majority (about 130) of these latter my thanks 9. Hamburger: Zeitschr. f. Biol., xxviii., 1892, 405. are due to Prof. J. M. Beattie, who kindly placed at my disposal 10. Zuntz : Dissert. Bonn, 1868 ; Loewy und Zuntz : the stillborn material brought to the Liverpool City Laboratory. Pflüger’s Arch., lviii., 1894, p. 511. This material has also furnished several morbid specimens. 11. V. Korányi: Zeitschr. f. Klin. Med., xxxiii., 1897, p. 1; xxxiv., 1898, p. 1. 12. Yandell Henderson : Jour. of Biol. Chem., xxxiii., 333, 1918. 13. Arch. f. Anat. u. 1891, Hamburger: Physiol., p. 31. Brit. Med. Jour., March 1919 ; Proc., vol. xxii., No. 4. 14. Hamburger : Osmot. Druck u. Ionenlehre, Bd. iii., p. 53. 8th, pp. 351 and 360, 1919 : and Alons: Biochem, 15. Demoor : Bull. de l’Acad. Roy. d. Belgique, N. 12, p. 857, Hamburger 1906. Zeitschr., xciv., p. 129, 1919 ; Brinkman : Quarterly Jour. of Physiol., p. 2, 1919. 16. Hamburger : Wiener Klin. Wochenschr., N. 14 u. 15, Exp. xii., 1916 ; de Boer : Jour. of li., 1917. 28. Bahlmann : Dissert, Utrecht, 1920. Physiol., 211, 29. Rona u. Takahashi : Biochem. 1913. 17. Hamburger and Bubanovic : Arch. Internat. d. Physiol., Zeitsehr., xlix., 370, x., 1910. 30. Sörensen: See Neuberg, Der Harn II., p. 1396, 1911. 31. Brinkman: Biochem. Zeitschr., xcv., p. 101, 1919. 18. Kœppe : Pflüger’s Arch., lxvii., 189, 1897. 32. Brinkman and V. Creveld : Yet to 19. : Zeitschr. f. 405. appear. Hamburger Biol., 1891, p. 33. Brinkman and V. Dam : Koninkl. Acad. v. Wetensch. te 20. Girard: C. r. de l’Acad. d. Sciences, cxlviii., p. 1047, Amsterdam, meeting of Dec. 18th, 1920. 1909; clxx., p. 821, 1920. Not 21. Lazarus Barlow : Jour. of 1895. 34. yet published. Physiol., xix., 140, 35. V. Creveld and Brinkman : Koninkl. Acad. v. Wetensch. 22. Gryns: Koninkl. Akad. v. Wetensch. te Amsterdam, meeting of Feb. 1894 ; 1896. te Amsterdam, meeting of Dec. 18th, 1920. 24th, Pflüger’s Arch., lxiii., 86, 36. Brinkman and V. Dam : Arch. Internat. de Physiol., xv., 23. Nagel’s Handbuch II., p. 744, 1907. 24. Hamburger : Physik.-chem. Untersuchungen über Phago- p. 105, 1919. zyten, Wiesbaden, 1912. 37. Brinkman : Quarterly Jour. of Exp. Physiol., xii., p. 2, 25. Snapper : Biochem. Zeitschr., li., p. 62, 1913. 1919. 38. Clowes : Jour. of Physic. Chem., xx., p. 407. 26. Hamburger : Arch. (f. Anat. u.) Physiol. i., p. 317, 1898. 27. and Brinkman : of the Kononkl. 39. Bancroft: Jour. of Physic. Chem., xvii., p. 501. Hamburger Proceedings 40. Neuschlosz : 17, 1920. Akad. v. Wetensch. te Amsterdam, vol. xix., No. 8, pp. 989, Pflüger’s Arch., clxxxi., 41. Lillie : Amer. Jour. of x., p. 997, 1917 ; Proc., vol. xx., No. 5, p. 668, 1918 ; Biochem. Physiol., 419, 1904 ; xvii., vol. No. 89, 1906 ; xxi., 200, 1908 ; xxiv., 459, 1909 ; xxvii., 289, 1911. Zeitschr., lxxxviii., p. 97, 1918 ; Proc., xxi., 4, p. 548, Full about until 1901 in 1918; Biochem. Zeitschr., xciv., p. 131, 1919 ; Hamburger: particulars permeability Hamburger : Osmotischer Druck u. Ionenlehre, 1901-04 (Bergmann, Wiesbaden). 1046 DR. E. HUGHES: CRANIOTABES OF THE FŒTUS AND INFANT. together, sometimes, with attempts at repair; in fcetal with the infantile form, and this will now b& the second, merely an evenly progressive ossifying considered seriatim. process in an Moreover-and this incomplete stage. Characters. was my main object-mistakes can seldom arise Physical in palpating these bones. The normal parietal at The atrophy occurs as depressions found on the the period in question is rigid, and the only spot inner aspect of the bone. The atrophic areas show where localised yielding due to immaturity is liable both lacunar and diffuse formations, both being to occur is a small area about the parietal in the same bone. The lacunar symmetrical " frequently present foramina. These foramina, or the " sagittal foramen areas occur as membranous spots isolated in the bone, replacing them, lie about 1 to 1¼ inches from the or it may be abutting on its margins here and there.
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