Among the characteristics of rickets, the one which assumes first importance is inferiority of stature in comparison with the normal man. In this connection I quote the following figures from Bonnifay:[33]
| Age | Stature in centimetres | |
|---|---|---|
| Rachitic children | Normal children | |
| 11 months | 66.5 | 69.4 |
| 2 years | 70.7 | 74.8 |
| 2-3 years | 75.8 | 83.0 |
| 3-4 years | 76.8 | 91.9 |
| 5-6 years | 91-93 | 101.25 |
| 6-7 years | 105.0 | 106.8 |
| 7-8 years | 110.6 | 115.3 |
| 8-9 years | 118.4 | 119.0 |
| 9-10 years | 121.6 | 124.4 |
But together with diminution of stature there exist in rickets various deformities of the skeleton, especially in the bones of the cranium, in the vertebral column and in the frame of the thorax; although even the pelvis and the limbs have been known to show the characteristic deformities.
An objective knowledge of the first symptoms of rickets ought to be regarded as indispensable on the part of mistresses in children's asylums, and in any case to form an important chapter in pedagogic anthropology. For it is well known that in the early stages of rickets the child may be so guided in its growth as to save it from deformities of the skeleton, even though a definite limitation of the stature may not be prevented.
That is to say, that through the intervention of hygiene and pedagogy the rachitic child may be saved from becoming a cripple or a hunchback, and will simply remain an individual of low stature; with certain signs and proportions of the skeleton indicative of the attack through which he has passed. Even in very severe cases it is at least possible to minimize the deformity of the thorax and the curvature of the vertebral column.
The precursory signs of rickets in a child are: a characteristic muscular weakness, frequently accompanied by excessive development of adipose tissue, giving an illusory impression of abundant nutrition; delay in the development of the teeth and in locomotion, which from the very beginning may be accompanied by curvature of the long bones of the legs. The bregmatic fontanelle of the cranium closes later than at the normal period, and is larger than in normal cases, just as the entire cerebral cranium is abnormally developed in volume, while the facial portion remains small, especially in regard to the jaw bones.
One of the most salient characteristics, however, is the peculiar enlargement of the articular heads of the long bones, easily recognizable in the size of the wrists; the enlargement is also found in the extremities of the ribs, which at their points of union on each side of the sternum form a succession of little lumps, like the beads of a rosary. In conjunction with these characteristics, it is to be noted, at all ages, as appears from the figures given by Bonnifay, that there is a notable diminution of stature.
The treatment of rickets is medical and pedagogical combined. Children of this type should be removed from the public school, where the school routine might have a fatally aggravating effect upon the pathological condition of such children. In fact, gymnastics based upon marching and exercising in an erect position, together with a prolonged sitting posture, are likely to produce weaknesses of the skeleton and deformities, even where there are no symptoms of rickets!
The establishment of infant asylums for rachitic children is one of the most enlightened movements of the modern school. We Italians are certainly not the last to found such institutions, and Padua possesses one of the oldest and most perfect asylums of this sort of which Europe can boast. Asylums for rachitic children ought to have a special school equipment, so far as concerns the benches and the apparatus for medical and orthopedic gymnastics; furthermore they should be provided with a pharmaceutical stock of remedies suited to building up the osseous system and the organism in general; and a school refectory should be provided, adapted to the condition of the children. The methods of instruction should rigorously avoid any form of fatigue, and instead provide the child with psychic stimuli designed to overcome a sluggishness due to the mental prostration to which he is for the most part subject. As regards their situation, these asylums for rachitic children may be advantageously located upon the sea-coast.