Rachitis

“ These include rickets, scurvy-rickets, osteomalacia, ostitis deformans, osteomyelitis fibrosa, fragilitas ossium, and diseases of the nervous system.
RICKETS
Rickets or rachitis is a constitutional disease associated with disturbance of nutrition, and attended with changes in the skeleton. The disease is most common and most severe among the children of the poorer classes in large cities, who are improperly fed and are brought up in unhealthy surroundings. ”

“ The genuineness of these cases has been questioned by Cadiot and Leclainche, by Virchow and by others, but in the present uncertainty as to the dividing lines between rarefaction, rachitis and other diseases, they deserve notice in this connection.
In dogs the lesions are mostly in the young and are largely rachitic, yet the enormous swelling of the facial bones, and especially of the superior maxillary in the comparatively mature animal suggests osteo-malacia. As in rachitis there are usually impaired digestion, unthriftiness, slow, stiff movements and lack of life and vigor. ”

“ A larger number appear to result from insufficient oxygenation resulting from lung diseases, with a long chronic ailment following the acute stage. Even acute pneumonia, with its direct influence on general nutrition, stands often for the proximate cause of rachitis. Bad air alone, even swamp air, does not appear to be a sufficient cause. When it seems so, it is complicated with the main cause of rachitis; that is, bad, insufficient, improper food, with its immediate result—viz. intestinal catarrh. ”

“ PROGNOSIS.—The course and the prognosis of rachitis are, as a rule, favorable, but they change according to the degree and locality of the affection and the age of the patient. Generally there is neither fever nor rapid exhaustion. But the process lasts for months and even years. In favorable cases, when recovery takes place the teeth will grow faster, the bones become firmer, the epiphyses will diminish in relative size, the bowels become regular. ”

“ Very young babies—that is, infants of a month or two—develop rachitis in such a manner that many cases are overlooked until it is too late to relieve them in time. This occurrence takes place when there are no prominent causes, such as diarrhoea or other nutritive disorders, nor any premonitory symptoms. Such infants appear to be perfectly well; they have the average weight, and even more; they have plenty of adipose tissue, and look well. The only anomaly appears to be an undue degree of paleness. Without pain or flatulency they are constipated. ”

“ Rachitis usually attacks children somewhere between nine months and two [268] years of age, and produces a variety of well marked symptoms; such as large head and belly, protrusion of the breast-bone, flattening of the ribs, emaciation of the limbs, and various deformities of the bones. The patient may recover from the disease, but the deformity of the bones often remains, and therefore no female should become pregnant, who has had rickets, till the shape and dimensions of her pelvis are known, or it may cost her life. ”

“ The conditions of life, on the contrary, have an unquestionable influence, and if rachitis is so frequent in young animals living near towns, for example, it is undoubtedly due to that want of air, light and liberty, which first affects the mother’s health and later that of her offspring. ”

“ In those infants who become rachitical gradually while proving their malnutrition by the accumulation of large quantities of fat, it exhibits a certain degree of consistency. When rachitis develops in the second half of the first year or later, with the general emaciation the skin appears very thin, flabby, unelastic. The veins are generally large. Complications with eczema and impetigo are very frequent ”

“ Dyscrasic parents may have healthy children, and healthy parents sickly or dyscrasic ones. But the probability is greater that diseased children should come from dyscrasic parents than from healthy ones. Tuberculosis in the parents has frequently been accused of being the cause of rachitis in the infant—not directly, but in consequence of general impairment of the tissues. Gout has also been accused of being the cause of rachitis, but it is a peculiar fact that the poor have but little gout and a great deal of rachitis. ”

“ Osteomalacia is a disease of the bones in adult life, occurring most frequently in puerperal women, but also seen in women not in the puerperal state, and in men. It is characterized by a progressive softening of the bone-substance, from a gradual absorption of the lime salts, and gives rise to considerable deformity, and occasionally to spontaneous fracture.
Rachitis or rickets is not a disease of adult life, but of infancy and childhood, and never occurs after the age of puberty. It seldom begins before six months or after three years. ”

“ Rachitis again is often complicated with softening of the bones, disease of the limbs, arrested development, etc., but it must not be forgotten that although the irregularities in ossification and development of the skeleton are the symptoms most striking to the eye, they do not stand alone, and that from the point of view of development all the tissues, including the muscles, are more or less affected and that most of the physiological functions such as digestion and the secretion of urine are deranged. ”

“ As in rachitis hygienic measures give the most uniformly good results. The change of stable is especially demanded from a cellar or basement stable, one with joists laid on the ground or one with an earth floor saturated with urinary and feculent products. ”

“ In young animals even rachitis, which is accompanied by various digestive disorders, may serve as the point of origin for infectious rheumatism and all its complications.
In older animals—i.e., in animals from five to six months, or even twelve to fifteen months—infectious rheumatism may occur without a clearly defined cause. It then develops with the symptoms and lesions of that condition known as “osteomyelitis of adolescence” in human pathology. These forms of osteomyelitis are due to infection with streptococci and staphylococci. ”

“ The bare necks and chests, the exposed knees, the low stockings and thin shoes of the children of the rich, old and young, are just as many inlets of laryngeal catarrh, inflammatory disease, and phthisis. Persons suffering from nasal catarrh or pharyngeal catarrh are liable to have laryngitis. Thus, not only rachitis, with its influence on lymphatic glands and the neighboring mucous membranes, but also acute infectious diseases, such as whooping cough, measles, influenza, erysipelas, hay fever, tuberculosis, syphilis, typhoid fever, and variola, are as many causes of laryngitis. ”

“ The physical disorder is akin to Rachitis, or rickets, while the mental is substantially idiocy. The osseous structure, deficient in the phosphate of lime, is unable to sustain the weight of the body, and the cretin is thus incapacitated for active motion; the muscles are soft and wasted ”

“ The history of rachitis, of melanosis, and of osteoporosis, as related to an abnormal frangibility of the bones, is a part of our common medical knowledge. There are few persons who have not known of cases among their friends of frequent and almost spontaneous fractures, or at least of such as seem to be produced by the slightest and most inadequate violence, and there is no tangible reason for doubting an analogous condition in dividuals of the equine race. Among local predisposing causes mention must not be omitted of such bony diseases as caries, tuberculosis, and others of the same class. ”

“ RICINO′LEIC ACID. A variety of oleic acid discovered in saponified castor oil.
RICK′ETS. Syn. Rachitis, L. A disease, generally confined to childhood, characterised by a large head, prominent forehead, protruded breast bone, flattened ribs, tumid belly, emaciated1437 limbs, and great general debility. The bones, more particularly those of the spine and legs, become distorted, and exhibit a deficiency of earthy matter; the stools are frequent and loose, a slow fever succeeds, with cough, painful and difficult respiration, and, unless the child rallies, atrophy is confirmed, and death ensues. ”

“ Rachitis should be fought at the time the child develops in the womb, by properly feeding the mother and preparing her to give it, after birth, healthy milk, with all the elements necessary for bone structure. ”

“ Even free feeding is insufficient if the fodder does not contain the material necessary for sustaining and building up the developing frame, a point which readily explains the occurrence of rachitis when young animals receive a diet deficient in certain chemical constituents. ”

“ Others call it an inflammation of the bone. Some refer it to hereditary syphilis, and a few to the influence of malaria. That the disease is epiphysitis and periostitis there is no doubt. I do not hesitate to claim it as rachitis, for epiphysitis and periostitis of early age not of rachitical basis are not apt to run such a favorable course as this form frequently does. The cases complicated with subperiosteal hemorrhages are claimed as scurvy by Th. ”

“ As the disease is one that occurs during the period of rapid growth, and is a developmental disease, everything that interferes with normal growth and development is apt to change physiological functions into pathological conditions and to produce rachitis. ”

“ It may return a number of times every day, or sometimes not for several days, during a period of many weeks or several months. The attacks which set in after inspiration are apt to be more dangerous. In such an one, but also in the other kind which sets in after the expiratory movement, death may occur suddenly, or the attack may be followed by a convulsion which may terminate fatally like any other eclamptic seizure. In this manner it is that the majority of cases of rachitis perish which terminate fatally during the active progress of the morbid process. ”

“ It is only employed when the mother is out on an errand; and, though the child's legs, of course, are somewhat constrained by the shawl, the actual time during which that is the case amounts to very little in the twenty-four hours, and is not long enough to produce the deformity. Moreover, not many miles away, at Saltcoats, on the Ayrshire coast, all the women carry their babies in precisely the same manner as in Glasgow, and yet not a single case of rachitis or osteomalacia is to be seen there. ”

“ Fat has been generally found somewhat increased in the rachitical bones, and water largely so; chondrin is diminished according to Marchand and Lehmann, but was found unaltered in the later analyses of A. Baginsky. The latter found, after having deprived the bone of fat, the organic and inorganic material to be in a proportion of 100 to 563 in the normal, and of 100 to 160 in the rachitical osseous tissue; and in 100 parts of dry bone, Gorup-Besanez found in the
Defective calcification of the forming bone is one of the principal characteristics of rachitis. ”

“ There is evidence that the most important factors in the causation of rickets are ill-health of the mother during pregnancy, and the administration to the child after its birth of food which is defective in animal fat, proteids, and salts of lime, or which contains these in such a form that they are not readily assimilated. The occurrence of the disease is favoured, and its features are aggravated, by imperfect oxygenation of the blood as the result of a deficiency of fresh air and sunlight, want of exercise, and by other conditions which prevail in the slums of large towns. ”

“ Rickets is a disease peculiar to childhood, though it may not be developed until a more advanced period of life. It rarely proves fatal, unless the lungs, heart, or other vital organs, become involved. In some instances the softening and other symptoms continue to increase until every function is affected, and death ensues.
Post-mortem examinations of those who have died of rickets have disclosed morbid changes in the brain, liver, and lymphatic glands. ”

“ But when the first alarm has quieted down, the attacks are likely to be only occasional, as when the article, drawn up with the expired air, comes in contact with the under aspect of the vocal cords. It may be that in a violent fmt of coughing it will be expelled, but, if not, the surgeon must be at hand ready to perform tracheotomy when the urgency of the symptoms demands it. Tracheotomy is the making of an opening into the trachea, the air-tube below the larynx. It is unsafe to leave a child with a foreign body loose in its windpipe, on account of the risk of sudden and fatal asphyxia. ”

“ When inflammation is confined to the trachea there is no alteration of the voice, and, except in children, in whom the calibre of the windpipe is proportionately small, usually no or only very slight dyspnoea. In mild cases there are no constitutional disturbances. Severe cases are accompanied by [p. 134] the febrile symptoms of a bad cold. The disease runs its course in from a few days to a week or two.
Uncured or too frequently repeated attacks of acute catarrh of the windpipe lead to chronic tracheitis, occasionally with considerable hypertrophy of the mucous membrane. ”

“ Many people pass through a long life with a mucous defluxion upon the trachea, and enjoy in other respects tolerable health. In such persons the disease is of a local nature. It is only when it is accompanied with debility of the whole system, that it ends in a consumption. Mr. John Harrison, of the Northern Liberties, died of this disease under my care, in the year 1801, in consequence of the discharge of pus from an ulcer which followed a hæmorrhage from the trachea being suddenly suppressed. ”