RICKETS, or RACHI'TIS (from the Gr. rhachis, the spine, because a peculiar form of spinal curvature, results from the affection), is regarded by some writers as a special disease of the bones, and by others as merely one of the various forms of scrofula. Whichever view be correct, there can be no doubt that the general symptoms in rickets are closely allied to those in scrofula, and that the same general plan of treatment is equally useful in both affections. The characteristic symptom in rickets is the imperfect development, atrophy, softness, and consequent distortion of some or many of the bones. The bones thus affected consist of a sort of gelatinous tissue, which will bend without breaking; and they are so soft that they may be cut with the knife. On microscopico chemical examination, the structural arrangement of the bone is found to be unaffected, while there is a great deficiency of the earthy salts to which the normal bones owe their firmness. While 100 parts of healthy bone contain about 32 per cent of organic matter, and 68 per cent of inorganic matter, or earthy salts, the proportions are altogether reversed in rickets. Thus, in this disease, Marchand found 79.4 per cent of organic matter, and 20.6 per cent of earthy salts in a femur; while Ragsky found 81.12 per cent of organic matter, and only 18.88 of earthy salts in a humerus: thus showing that these bones contained less than one-third of the normal quantity of earthy salts. The weight of the body acting on bones thus constructed causes them to bend, and the thighs or shins are abnormally arched. or the spine is curved, or, in slighter cases, only the normal form of the ankle is modified. In aggravated cases, the chest is so affected as to give rise to the condition known as pigeon-breasted; the lower jaw is imperfectly developed, and the teeth project; and the pelvis becomes so altered in form as to render future childbearing in the highest degree perilous. Rickets is exclusively a disease of child
hood. and generally attacks the children of the poor.
The treatment must be mainly directed to tee improvement of the general health. Free exposure to pure bracing air, sponging with sea-water, or sea-bathing, if the little patient can bear it. an abundance of animal food, cod-liver oil, iron, and quiuia, include all that need be said about general treatment. Dr. Druitt recommends a jelly contain ing phosphate of lime (with the view of restoring to the bones the salt in which they are specially deficient). It is well worthy of further trial, and may be prepared as follows:L Boil about four ounces of ivory-dust m water for ten minutes; then strain off the water and throw it away with the impurities which it has taken up. Add more water, in wide]] the dust should be stewed till the jelly is extracted, and the dust itself is soft enough to crush between the teeth. Lemon-juice, wine, sugar, or other flavoring ingredi ents may be added; and the softened ivory-dust should be eaten with the jelly.
When a child with crooked legs is brought to a surgeon, he must carefully ascertain whether the crookedness depends on mere relaxation of the joints, or whether it lies in the bones themselves. In the former case the child will probably grow up straight when Ills general health improves; whereas in the latter ease (if the femur or tibia is absolutely bent), the surgeon must give a very guarded opinion.