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RICKETS

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Originally appearing in Volume V23, Page 315 of the 1911 Encyclopedia Britannica.
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RICKETS , a constitutional disease of childhood characterized chiefly by a softened See also:

condition of the bones and by other evidences of perverted See also:nutrition. It was first described in 1649 by See also:Arnold de See also:Boot, a Frisian physician practising in Ire-See also:land. Its nature and See also:causation are discussed under METABOLIC DISEASES. The name " rickets " is from the Old See also:English wrickken, to twist; the more technical medical See also:term, rachitis, which comes from See also:Greek See also:Axis, the spine, was suggested by See also:Francis Glisson in 165o, both from similarity of See also:sound and from the See also:part of the See also:body which is one of the first to be affected. Rickets can seldom be recognized until several months after See also:birth, and it most commonly attracts See also:attention at about the end of the first See also:year. The symptoms which precede the out-See also:ward manifestation of the disease are marked disorders of the See also:digestive and alimentary functions. The See also:child's appetite is diminished, and there is frequent vomiting, together with See also:diarrhoea or irregularity of the bowels, the evacuations being See also:clay-coloured and unhealthy. Along with this there is a falling away in flesh. Importance is to be attached to certain other symptoms See also:present in the See also:early stages, namely, profuse sweating of the See also:head and upper parts of the body, particularly during See also:sleep, with at the same See also:time dry See also:heat of the See also:lower parts and a tendency in the child to kick off all coverings and expose the limbs. At the same time there is See also:great tenderness of the bones, as shown by the See also:pain produced on moving or handling the child. Gradually the changes in the shape of the bones become visible, at first chiefly noticed at the ends, of the See also:long bones, as in those of the See also:arm, causing enlargements at the wrists, or in the ribs, producing a knobbed See also:appearance at the junction of their ends with the costal cartilages. The bones also from their softened condition tend to become distorted and misshapen, both by the See also:action of the muscles and by the superincumbent See also:weight of the body.

Those of the limbs are See also:

bent outwards and forwards, and the child becomes " See also:bow-legged " or " in-kneed " often to an extreme degree. The See also:trunk of the body likewise shows various alterations and deformities owing to curvatures of the spine, the flattening of the lateral curves of the ribs, and the See also:projection forwards of the sternum. The cavity of the See also:chest may thus be contracted and the development of the thoracic See also:organs interfered with as well as their functions more or less embarrassed. The See also:pelvis undergoes distortion, which may reduce its capacity to a degree that in the See also:female may afterwards See also:lead to serious difficulties in parturition. The head of the rickety child is large-looking in its upper part, the individual bones of the cranium sometimes remaining long ununited, while the See also:face is small and See also:ill-See also:developed, and the See also:teeth appear See also:late and fall out or decay early. The constitutional conditions of ill-See also:health continue, and the nutrition and development of the child are greatly retarded. The disease may terminate in recovery, with more or less of deformity and dwarfing, the bones although altered in shape becoming firmly ossified, and this is the See also:common result in the See also:majority of instances. On the other See also:hand, during the progress of the disease, various intercurrent ailments are See also:apt to arise which may cause See also:death, such as the infectious fevers, See also:bronchitis and other pulmonary affections, chronic hydrocephalus, See also:convulsions, laryngismus stridulus, &c. An acute See also:form of rickets of rare occurrence (really a form of See also:scurvy, q.v.) has been described by writers on diseases of See also:children, in which all the symptoms are of more rapid development and progress, the result in many instances being fatal. The treatment of rickets is necessarily more hygienic than medicinal, and includes such preventive See also:measures as may be exercised by strict attention to See also:personal health and nutrition on the part of mothers, especially where there appears to be any tendency to a rickety development in any members of the See also:family. Very important also is the avoidance of too prolonged See also:nursing, which by its weakening effects upon the See also:mother's health is calculated to engender the disease in any succeeding children. At the same time it must be admitted that, when the mother is healthy, her See also:milk abundant, and nursing discontinued before the See also:lapse of the first year, there is no better means of preventing the occurrence of rickets than this method of feeding an See also:infant, the disease, as is well known, being far more frequently met with in children brought up by hand.

The management of the child exhibiting any tendency to rickets is of great importance, but can only be alluded to in See also:

general terms. The digestive disorders characteristic of the setting in of the disease render necessary the greatest care and See also:watch-fulness as to See also:diet. Thus, if the child be not nursed but fed artificially, fresh milk should be almost the only See also:article of diet for at least the first year, and the See also:chief See also:element for the next. When not digested well, as may at times be shown by its appearance as a curd in the evacuations, it may be diluted with See also:water or See also:lime water, or else discontinued for a See also:short time, carefully-made gruel or See also:barley water being substituted. Many of the so-called " infants' foods " which are now so extensively used appear to be well adapted for their purpose, but when employed too abundantly and to the exclusion of the due amount of milk are often productive of digestive and intestinal disorders, probably from their containing a greater amount of starchy See also:matter than can be utilized. From the end of the first year See also:light See also:animal soups may occasionally be given with See also:advantage. The medicinal remedies most to be relied on are those which improve the digestive functions and See also:minister to nutrition, and include such agents as the preparations of See also:iron, See also:quinine, and especially See also:cod-See also:liver oil and See also:phosphorus, and the cautious use of See also:extract of See also:thyroid gland has been advocated by Henoch. Of no less importance, however, are abundance of fresh See also:air, cleanliness, warm clothing, and attention to the general See also:hygiene of the child and to regularity in all its functions. When the disease is showing See also:evidence of advancing, it is desirable to restrain the child from walking, as far as possible. But this precaution may be to some extent rendered unnecessary by the use of splints and other apparatus as supports for the limbs and body, enabling the child to move about without the See also:risk of bending and deformity of the bones which otherwise would probably be the result. The condition formerly known as foetal rickets (achondroplasia or chondrodystrophia foetalis) is now classed as a See also:separate disease. Its chief characteristics are dwarfism with shortening of the limbs and enormous enlargment of the articulations.

End of Article: RICKETS

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