Sttrrtat 3j. ter in die Bost cibunt.
The organic phosphorus contained in the Glycerophosphates, in Lecithin and in the proprietary preparations known as Sanatogen and Phytin acts as free phosphorus, and may be employed as a substitute for the nauseous phosphorated oil. As pointed out elsewhere by the writer, the undue prolongation of phosphorus treatment may cause the bones to become finally hardened in their abnormally curved position, an event seldom seen in patients who have recovered from rickets unless where neglect has permitted great deformity from pressure, etc.
Upon the theory that rickets is due to a faulty action in the ductless glands Thyroid, Suprarenal, Pituitary and Thymus, Gland extracts have been employed, and also a number of blood tonics as Arsenic, Iron, Quinine, etc., and also X rays, but the dietetic treatment of the disease is so certainly efficacious that the physician will be wise to direct his entire attention to this and leave drugs .severely alone, unless for the treatment of the dyspepsia or the gastro-enteritis which is sometimes present; complications as convulsions, laryngismus, pain and restlessness will require the administration of Bromides, but very rarely of opiates in any form. Local applications to the bones and joints are not indicated, though skilful massage in the convalescent stages always proves useful.
Bathing, except in the very acute phase of the ailment, is always advantageous, and the employment of a warm sea-water bath in which seaweed or wrack has been boiled may be used. Whilst the child is partially immersed in the bath and supported by the nurse's hands placed under the armpits, the trunk may be sponged with water gradually cooled to the temperature of the surrounding atmosphere. Later on the cold water may be allowed to flow from a height over the child's body, whilst the feet are immersed in the warm bath.
Sponging is continually indicated for the removal of profuse perspira tion, the skin being mopped with a sponge wrung out of tepid water, after which cold may be applied in the same manner.
Deformities.--Next in importance to diet comes the means of preventing permanent deformities. The child should be compelled to lie in the horizontal position -in order to take the weight of the trunk off the yielding bones, and obviously this is a vital matter in female children to prevent pelvic distortion. Though in the majority of mild cases the bent bones tend naturally to unfold their abnormal curs es as the child advances in years, this result should not be too confidently counted upon.
The children of the better-off classes where an efficient nurse can be provided should spend most of their days lying flat in a perambulator as they are wheeled about in the open air and sunshine. The children of the poorer classes should be prevented from walking or crawling by the applica tion of a straight splint applied to the outer aspect of each lower ex tremity, and extending from the pelvic bones to 4 or 6 inches beyond the foot. Spinal deformities as kyphosis and scoliosis are liable to be pro duced by permitting the child to sit up in bed or to be carried about on the nurse's arm. Should these deformities be present when the case first comes under observation they are a clear and imperative indication for the maintenance of the horizontal position in all children under 3 or 6 years of age. A hard mattress and a double Thomas's splint extending from the occiput to the feet should be used to enable the child to spend a good portion of each day in the open air; at night and in the morning the spinal muscles should be well massaged.
Bending of the leg bones, if the child be under 5 years, will probably yield to horizontal rest and assiduous massage, douching and electric stimulation of the muscles.
Deformities in older subjects where the rest treatment of rickets has been neglected will often require the operations necessary for the correction of coxa vara, coxa valga, genu yalgum and varum, flat-foot. etc.
Late Rickets.—The treatment suitable to the infantile type of the disease should be followed, whether the pathology of this condition be accepted as a relapse from a primary rickets or of the nature of a com mencing osteomalacia. Prolonged rest in these cases, which usually appear after the age of 7 or 5 and before the advent of 17, is necessary, as the deformities liable to follow arc more serious than in the case of the infantile type.
Sciervy-/?ickets.—This cannot be regarded as a variety of rickets, but must be accepted as infantile scurvy which occurs in a rickety child, and is usually the result of exclusive feeding on patent foods or on milk which has been submitted to prolonged boiling with the view of sterilising it; the disease occurs nearly always amongst the children of the better class. The treatment is that indicated for rickets with the addition of a small amount of fresh vegetable or fruit juice, mashed potato and raw meat juice. (See under Scurvy.)