Rickets. Flat Bone of Skull (Craniotabes). (Karg and Schmorl.)
For the local condition in the mouth an antiseptic mouth-wash containing a fair proportion of hydrogen dioxide is advisable. Alcoholic stimulants are called for, at least up to a certain point. Strychnine and cinchona preparations will give force to the heart’s action, and the horizontal position, for a time at least, will prevent sudden heart failure. Compound syrup of the hypophosphites, with meat preparations, will supply lacking material, while the hemorrhagic manifestations are best controlled by the fluid extract of ergot and aromatic sulphuric acid, separately or combined. Particular attention should be given to cleanliness and fresh air.
Infantile Scorbutus.
—Infantile scorbutus sometimes furnishes the surgeon with very young patients who are brought to him especially for disability of the limbs, with pain and fretfulness, leading to immobility, followed by enlargement of the lower ends of the femurs (due to subperiosteal hemorrhages) with fixation by muscle spasm; this may be followed by “spontaneous” fractures. The gums will show the same changes as are seen in adults, while subcutaneous hemorrhages and infiltrated muscles, with foul breath, ashen pallor, listlessness and apathy, and perhaps several swollen joints, will complete an unmistakable picture.
Fresh milk with orange-juice in small amounts between feedings, combined with more strictly surgical measures if needed, will secure good results in these little patients.
RICKETS.
Rickets, or rachitis, is another of the diathetic conditions, in this instance not yet considered of parasitic origin, most commonly occurring in infancy and early childhood, although its resulting lesions may persist throughout life. It is characterized by nutritional disturbances and organic irregularities.
Pathology.
—Rickets is generally referred to as “fetal” or “congenital,” according to whether the infant presents characteristic markings at birth or whether they develop later. The most marked constitutional defect seems to be in the supply of calcium salts, which leads apparently to formation of bone which has not sufficient compact tissue to make it strong. Especially along the line of junction between bone and cartilage do we see the most marked expressions of rachitic lesions. Here the cartilage is evidently actively growing, while the bone formation proceeds with difficulty, and the proportion of vascular tissue is excessive. The result is prolongations of soft vascular into the cartilaginous tissue, by which the latter becomes more or less absorbed, and this essentially interferes with ossification. In severe cases it may be lacking. At epiphyseal lines one may see a layer of osteoid tissue which is not cartilage and will not become bone. Because of its yielding nature it warps under the mechanical strain to which the bones of the extremities in young children are constantly subjected.