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RICKETS (RACHITIS).—A disease of early childhood, characterised by softening of the bones and consequent deformity. Although its manifestations are mainly evident on the skeleton, the bones becoming soft from insufficient deposits of lime-salts, the disease must be regarded as a constitutional one. It usually begins between the third and the sixth month of life, and may last until the sixth year ; and it usually prevails in children whose parents also had the disease. The affection is caused primarily by lack of fresh air, and by unsanitary dwellings, uncleanliness, and improper nourish ment. Among the predisposing factors may be reckoned pulmonary, bronchial, and intestinal catarrhs. In a large number of cases no cause is apparent, with the possible exception of a lack of fresh air. The disease occurs in rich and poor alike, and more often in boys than in girls.

The early signs of rickets are malaise, restlessness at night, perspiration (particularly about the head), diarrhoea, and sometimes cough or convul sions. It is a common error to attribute all these symptoms to teething. After a short time other characteristic evidences of the disease appear. Children who have already been able to sit up, or even to stand, refuse to remain in an upright attitude, and show an inclination to lie down. They cry when they are lifted up, especially if seized around the chest. Profuse perspiration causes the hair to fall out ; especially on the back of the head, where a bald spot soon develops. Along the front of the chest there may appear a double row of little knobs on the ribs (the " rachitic rosary ") ; and the wrists may appear swollen owing to thickenings of the ends of the bones of the forearms. The disease is characterised also by curvatures of the long bones of the body, such as the ribs, clavicles, thigh-bones, the bones of the upper and lower arm, the lower jaw, and even the bones of the pelvis. Such deformities are apt to persist until later in life ; and, under certain circum stances, they exert a deleterious influence on the functional capacity of these parts and of the neighbouring organs. The fontanels, or intervals between the bones of the skull, remain wide and soft, and the head gradually loses its round form and assumes a square shape. The vertebral column is bent, and the chest is flattened and pressed in at the sides, resulting in the so-called " chicken-breast " (see Fig.

343)- This deformity of the thorax interferes with the activity of the lungs, and children thus afflicted are vey prone to contract pulmonary diseases, which are not infrequently fatal.

Dentition is impeded, the teeth breaking through the gums late and at irregular intervals. Rickets is also often accom panied by spasm of the vocal cords (spasmodic croup) and by general convulsions, which constitute a serious menace to the life of the little patient.

Intestinal catarrh, which may be marked by habitual constipation, is present in varying degree, still further reducing the child's resistance. One of the noteworthy features of the condition is the markedly distended abdomen.

Suggestions for the prevention of the disease are discussed in the article on NURSLING, NOURISHING OF. It is of the greatest importance not to give the baby milk which has been sterilised for more than ten minutes; and, when the second year has been reached, to administer meat-broth containing eggs, rice, or farina. Gruels made with milk may be given once or twice a day ; and the child may occasionally be fed with scraped, cooked meat, soft-boiled eggs, finely-minced spinach, and apple-sauce. All so-called medicinal wines should be avoided, unless the attending physician especially recommends the use of a certain brand. Among the most important of all measures is the observance of extreme cleanliness. The child should be washed frequently, and should be given a daily bath in lukewarm water. Plenty of fresh air and bright, sunny, and \ vel - ve n t i la t ed dwellings are likewise of the greatest importance.

If it be suspected that a child suffers from rickets, the symptoms should not be ascribed to teething, nor should any time be lost in useless rubbing with various household remedies. A physician should be consulted im mediately, and his directions implicitly followed. Neglect of the condition will sooner or later result in deformed limbs, hunchback, chicken-breast. contractions of the pelvis (which in females may interfere greatly with childbirth), spasmodic croup, general convulsions, or pulmonary inflamma tions. Either of the last three affections may terminate fatally. Children who do not sit up voluntarily, should not be urged to do so ; nor should they be placed on their feet until they do so of their own volition.