Etiology and Pathology. — The pre dominating features are that the epiph yseal ends of the bones are thickened, and that the bony tissue which forms is deficient in lime-salts. Hyperiemia of the osteogenetic tissues first causes growth of the cartilage at the epiphyseal line, which becomes enlarged and irregu lar in histological structure. The bones are so soft that they can easily be cut, and the ligaments are elongated. When curvature of the spine ensues, we have scoliosis (see SPINE, DISEASES OF) Or lordosis; the pelvis may also become kyphotic. The skull may become thinned: a condition recognized as craniotabes, and its enlargement forms the physical basis of hydrocephalus (q. v.). Many of the deformities considered under ORTHOPRDIC SURGERY are due pri marily to radials.
Poverty, unhygienic surroundings, deficient food, artificial infant-foods, dampness, insufficient ventilation, etc., represent the etiological factors which environment procures. Hence the greater prevalence of rickets in crowded cities, especially those of the poorer countries of Europe, and among our negro population. It usually appears as soon as the child tries to walk, and may be congenital.
Treatment.—In the treatment of ra chitis the first essential is to make a positive change in the diet of the pa tient. Fresh and nutritious foods should replace the ordinary diet, and all pre pared foods for children should be strictly avoided (see NURSENTG AND ARTIFICIAL. FEEDING). Codliver-oil is the best medicament. It should be given internally and rubbed into the skin externally. The compound syrup of the hypophosphites and lactophos phate of lime are sometimes of service, but codlivcr-oil is almost a specific. Hy gienic measures, such as out-door life (the patient being wheeled out in a car riage, if need be), saltwater bathing, and residence on the sea-shore are of great value, but unfortunately the latter is seldom within the means of the patient. To prevent the occurrence of deformi ties. and to correct them the child should be kept off its feet and splints or appa ratus applied. If the disease is marked, deformities will occur even though the child does not stand on its feet.
Osteomalacia (Mollities Ossium).
This is a softening of the bones in adults which occurs most frequently in nursing-women.
Symptoms.—The early symptoms of this disease are often obscure, the pain and muscular weakness complained of often leading to a diagnosis of rheuma tism or suggesting some disease of the spinal cord. The progressive softening
of the bones, however, soon leads to de formities, which gradually increase in degree and extent. The bones of the spinal column and the pelvis suffer most, the latter giving rise to great decrease in the pelvic diameters and the former leading to decrease in height. The pa tient assumes a waddling gait through the pelvic changes. Fracture of the long hones from muscular action is often ob served. Death is usually due to exhaus tion or pulmonary disease. In rare cases the disease sometimes becomes arrested.
Diagnosis.—While rheumatism may be suggested early in the history of a given case, a diagnostic point of importance soon supervenes to indicate the true na ture of the trouble, namely: the numer ous painful areas. The sex of the patient, the possible presence of pregnancy. the presence of lime-salts in the urine, and the peculiar deformities witnessed, all serve to identify the affection.
Etiology.—The disease is almost al ways observed in women. Fehling has wrongly asserted that it never occurs in men. Though most authorities state that it does not attack childhood, it has been observed as early as the fifteenth year (Siegert, finch. med. Wadi., Nov. 1, '98). It is usually ascribed to defect ive osseous nutrition, through disorder of the trophic nerves, to deficiency of lactic acid, and to disease of the genital apparatus; but none of these may be said to have been positively demon strated.
Study of 32 cases at the Wurtzburg Maternity, from 1SS9 to 1S9S. Preg nancy is a chief factor in cases develop ing slowly, but amenable, more or less, to medical treatment. Another form is of accidental origin, thus giving an impulse to the disease which thereafter progresses without interruption. This form may oc cur in virgins.
Of the 32 cases, 1 recovered spontane ously; 4 underwent Cmsarean section; 16 were treated with phosphorized codliver oil and salt-water baths; 11 were cas trated.
The ovaries of 14 were examined after death, and all exhibited degeneration of the parenchyma and thinning of the Graafian follicles; moreover these condi tions were the more marked in direct proportion to the clinical aspect of the disease, the ovarian lesions being far more pronounced in the progressive than in the slower puerperal form of the dis ease. M. F. Schnell (Zeit. f. Geb. u. Gyn., B. 39, H. 3, '99).