Although babies rarely die of rickets alone, it is one of the most serious of all health problems and obstacles to normal development and stability, since it predisposes to such diseases as bronchitis, pneumonia, tuberculosis, measles, and whooping cough and in general greatly enfeebles the powers of resistance and recuperation.
It is common among babies who are fed solely or continuously on heated milk, either boiled or canned, and on proprietary foods and sweetened condensed milk. There has been some speculation about the possible relation between rickets and fat-soluble A, but no definite conclusions have yet been reached. It is known, however, that rickets may develop among nursing babies whose mothers are on faulty diets, and that the disease may be prevented and cured by the administration of cod-liver oil, which is rich in fat-soluble A. Sunshine, also, seems to have a pronounced effect in preventing and in curing the disease.
Fig. 142.—Exterior of thorax of normal rat and rachitic rat of same age. The latter shows dwarfism and deformities resembling pigeon breast so frequently seen in human beings suffering from rickets. (From The Newer Knowledge of Nutrition, by E. V. McCollum.)
Symptoms. The common symptoms of rickets which appear early are irritability; restlessness particularly at night; a tendency toward convulsions from very slight cause; digestive disturbances and profuse perspiration about the head. The baby may be fat, but is likely to be flabby and to have a characteristically white, “pasty” color. The fontanelles are large and late in closing; the abdomen is large and the chest narrow; dentition is usually delayed and the teeth may be soft and decay early. But the most conspicuous effect of rickets is upon the entire bony skeleton, due to the inadequacy of the lime deposit. The bones are soft, easily bent and broken and often misshapen. Their growth is likely to be retarded and the ends of the long bones may be enlarged, giving the familiar swollen wrists and ankles, while the nodules which form at the junction of the ribs and sternum, produce the beaded appearance so commonly called a “rickety rosary.” The bones in the arms and legs may become curved as the baby lies or sits in its crib, making him either bow-legged or knock-kneed. The deformity is increased by walking because the soft bones are easily bent by the weight of the body. The spinal column may be curved or too weak to permit the baby to sit straight or stand alone. The entire chest wall is often deformed (Figs. [142], [143]) producing the familiar “chicken breast,” as well as a serious decrease in the size of the thoracic cavity, and through loss of rigidity of the bony wall, the respiratory movements may be seriously impaired. The forehead is prominent and the whole head looks square and larger than normal, while the pelvic deformities in girl babies often give rise to very serious obstetrical complications later in life, as has been previously explained.
Fig. 143.—Interior of specimens in Fig. [142] showing nodules, due to rickets, protruding into thoracic cavity and encroaching upon space occupied by heart and lungs. This is a factor in the respiratory diseases which frequently complicate rickets.
Although lack of fresh air and sunshine seem to be factors in producing rickets, it has been observed that the disease does not develop in poor surroundings if the diet is suitable or if cod-liver oil is given to babies fed artificially, or on unsatisfactory breast milk; but that it may occur in the presence of satisfactory hygienic conditions if the diet is faulty in certain respects. For children under a year old, the desirable food is good breast milk, or, lacking that, fresh, certified cows’ milk, with fruit juices, scraped beef, eggs and strained vegetable purées, started as early and increased as rapidly as the baby can digest them.
Treatment. Cod-liver oil and sunshine, together with proper food, are the essentials in treating rickets. When cod-liver oil is given to a baby whose diet is faulty, it exerts a marked tendency toward enabling the bones to develop satisfactorily even when the mineral content of the food is unfavorable. The use of sunshine, either by moving the baby from a dark to a light house, or by exposing his body to the direct rays of the sun is found to be of pronounced therapeutic value. These factors, in addition to general good care constitute the treatment, but it is a long slow process, taking from three to fifteen months, and it is doubtful if the damage which the disease works can ever be entirely repaired.
Rickets is more common during the cold months of the year, winter and spring, than during the milder summer and autumn seasons. A possible explanation for this lies in the higher value of the cows’ food during the warm months when green things form the diets of animals. Since it is now recognized that milk is not a constant product, but that its properties vary with the food of the animals that produce it, cows’ milk would be favorably influenced by their being put to pasture.