# Parrot's sign

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**Parrot's sign** (19th century), refers to at least two [medical signs](/source/Signs_and_symptoms); one relating to a large [skull](/source/Skull) and another to a [pupil](/source/Pupil) reaction.[1]

One Parrot's sign describes the [bony growth](/source/Periostitis) noted at [autopsy](/source/Autopsy) by [Joseph-Marie-Jules Parrot](/source/Joseph-Marie-Jules_Parrot) and [Jonathan Hutchinson](/source/Jonathan_Hutchinson) on the skulls of children with [congenital syphilis](/source/Congenital_syphilis) (CS) in the 19th century. Later publications also refer to it as the [frontal bossing](/source/Skull_bossing) that presents in the late type CS. Initially thought to be [indicative](/source/Pathognomonic) of congenital syphilis, it was noted to be present in other conditions, particularly [rickets](/source/Rickets).

Some 19th century textbooks also described the sign as the dilatation of a [pupil](/source/Pupil) when the back of the neck is pinched in some cases of [meningitis](/source/Meningitis).

## Background

Marie Jules Parrot was a French physician in Paris, whose early work concentrated on the [brain](/source/Brain), followed by [tuberculosis](/source/Tuberculosis) and later [syphilis](/source/Syphilis).[2]

## Skull

Parrot's sign,[3] also known as 'Parrot's nodes'[4] and 'Parrot's bosses',[5][6] refers to the [bony growth](/source/Periostitis) noted at [autopsy](/source/Autopsy) by Marie Jules Parrot and [Jonathan Hutchinson](/source/Jonathan_Hutchinson) on the skulls of children with [congenital syphilis](/source/Congenital_syphilis) (CS) in the 19th century.[2][7] Later publications also describe it as the [frontal bossing](/source/Skull_bossing) that presents in the late type CS.[3][8] Initially thought to be [indicative](/source/Pathognomonic) of congenital syphilis, it was noted to be present in other conditions, particularly [rickets](/source/Rickets).[7]

A description of bone findings in CS by Parrot was published in *The Lancet* in 1879 following his presentation at a meeting hosted by [Jonathan Hutchinson](/source/Jonathan_Hutchinson) and [Thomas Barlow](/source/Sir_Thomas_Barlow,_1st_Baronet) in London.[2] In 1883 Barlow referred to the overgrowth of skull bone seen in CS as 'Parrot's swellings' and 'Parrot's bosses'.[5] The nodes were said to be indicative of CS.[9] In [Timothy Holmes](/source/Timothy_Holmes)' and Thomas Pickering 's *[A Treatise on Surgery: Its Principles and Practice](/source/A_Treatise_on_Surgery:_Its_Principles_and_Practice)* (1889) it was noted that Parrot's nodes could co-exist with [thinning bone](/source/Craniotabes) in the same skull.[10] The nodes were described in *[Gray's Anatomy](/source/Gray's_Anatomy)* (1893) as appearing like [buttocks](/source/Buttocks) or [hot cross bun](/source/Hot_cross_bun) depending on which skull bones were affected.[11] According to [D'Arcy Power](/source/D'Arcy_Power) in 1895, they were first reported by Parrot and Hutchinson, and also found in [rickets](/source/Rickets), and therefore could not strictly make them indicative of congenital syphilis.[7] In [Hamilton](/source/Henry_Hamilton_Bailey) and [Love's](/source/McNeill_Love) *[A Short Practice of Surgery](/source/Bailey_%26_Love's_A_Short_Practice_of_Surgery)* (1959), Parrot's nodes were said to consist of patches of [periostitis](/source/Periostitis) in CS.[12]

## Pupil

Parrot's sign was described in some [ophthalmology](/source/Ophthalmology) textbooks of the 19th century as the dilatation of a [pupil](/source/Pupil) when the back of the neck is pinched in some cases of [meningitis](/source/Meningitis).[13][14]

## See also

- [Ciliospinal reflex](/source/Ciliospinal_reflex)

## References

1. Pryse-Phillips, William (2009). [*Companion to Clinical Neurology*](https://books.google.com/books?id=rlZnDAAAQBAJ&pg=PA785). Oxford University Press. p. 785. ISBN 978-0-19-536772-0.

1. Cole, Garrard; Waldron, Tony; Shelmerdine, Susan; Hutchinson, Ciaran; McHugh, Kieran; Calder, Alistair; Arthurs, Owen (October 2020). "The skeletal effects of congenital syphilis: the case of Parrot's bones". *Medical History*. **64** (4): 467–477. [doi:10.1017/mdh.2020.41](https://doi.org/10.1017/mdh.2020.41). [PMC 7689442](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689442). [PMID 3789442](https://pubmed.ncbi.nlm.nih.gov/3789442)

1. Harper, Kristin N.; Zuckerman, Molly K.; Harper, Megan L.; Kingston, John D.; Armelagos, George J. (2011). "The origin and antiquity of syphilis revisited: An Appraisal of Old World pre-Columbian evidence for treponemal infection". *American Journal of Physical Anthropology*. **146** (S53): 99–133. [doi:10.1002/ajpa.21613](https://doi.org/10.1002/ajpa.21613). [PMID 22101689](https://pubmed.ncbi.nlm.nih.gov/22101689)

1. Stedman, Thomas Lathrop (2005). [*Stedman's Medical Eponyms*](https://books.google.com/books?id=isqcnR6ryz0C&pg=PA544). Baltimore: Lippincott Williams & Wilkins. p. 544. ISBN 0-7817-5443-7.

1. Barlow, Thomas (January 1883). "On Cases Described as "Acute Rickets" Which are Probably a Combination of Scurvy and Rickets, the Scurvy Being an Essential, and the Rickets a Variable, Element". *Journal of the Royal Society of Medicine*. **MCT-66** (1): 159–219. [doi:10.1177/095952878306600112](https://doi.org/10.1177/095952878306600112). [PMC 2121454](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2121454). [PMID 20896608](https://pubmed.ncbi.nlm.nih.gov/20896608)

1. Thomson, Alexis & Miles, Alexander. [*Manual of Surgery Volume One*](https://books.google.com/books?id=c1YoF3w-7M0C&pg=PA207). Libronomia Company. pp. 207, 536. ISBN 978-1-4499-9483-9.

1. Power, Sir D'Arcy (1895). ["VII. Tumours of syphilitic disease of bone"](https://books.google.com/books?id=QKQtgj-HmQwC&pg=RA2-PA155). *The Surgical Diseases of Children: And Their Treatment by Modern Methods*. Philadelphia: P. Blakiston. p. 155.

1. Bhat M, Sriram (2019). ["33. Miscellaneous"](https://books.google.com/books?id=P3KSDwAAQBAJ&pg=PA1174). *SRB's Manual of Surgery*. 6th ed. Jaypee Brothers Medical Publishers. p. 1174. ISBN 978-93-5270-907-6.

1. Pepper, Augustus Joseph (1883). ["34. Osseous lesions in congenital syphilis"](https://books.google.com/books?id=anQFAAAAQAAJ&pg=PA229). *Elements of Surgical Pathology*. London: Cassell & Company. pp. 229–230.

1. Holmes, Timothy (1889). ["20. venereal diseases"](https://books.google.com/books?id=Fgs1AQAAMAAJ&pg=PA438). *A Treatise on Surgery: Its Principles and Practice*. 5th ed. Pick, Thomas Pickering (ed.). Philadelphia: Lea Brothers & Co. pp. 437–438.

1. Gray, Henry (1893). [*Anatomy, Descriptive and Surgical*](https://books.google.com/books?id=g9bZAAAAIAAJ&pg=PA227). 13th ed. Philadelphia: Lea Brothers & Co. p. 227.

1. Bailey, Hamilton & Love, McNeill (1959). [*A Short Practice Of Surgery Eleventh Edition*](https://archive.org/details/in.ernet.dli.2015.143672/page/n1111/mode/2up?q=parrot). 11th ed. London. p. 1221.

1. Oliver, Charles Augustus (1895). [*Ophthalmic Methods Employed for the Recognition of Peripheral and Central Nerve Disease*](https://books.google.com/books?id=JYAPAAAAYAAJ&pg=PA27). University of Pennsylvania Press. p. 27.

1. Norton, Arthur Brigham (1898). [*Ophthalmic diseases and therapeutics*](https://ia800307.us.archive.org/14/items/ophthalmicdiseas00nort/ophthalmicdiseas00nort.pdf). 2nd ed. Philadelphia: Boericke & Tafel. p. 98.

## Further reading

- Parrot, M.J. (May 1879). ["The osseous lesions of hereditary syphilis"](https://ia600708.us.archive.org/view_archive.php?archive=/22/items/crossref-pre-1909-scholarly-works/10.1016%252Fs0140-6736%252802%252935061-x.zip&file=10.1016%252Fs0140-6736%252802%252935509-0.pdf). *The Lancet*. **113** (2907): 696–698. [doi:10.1016/S0140-6736(02)35509-0](https://doi.org/10.1016/S0140-6736(02)35509-0)

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