CHAPTER III 



RICKETS 



This universally important disease occurs invariably in the first 

 or second year as a result of a deficient diet. In fact, during the 

 last war, the disease occurred almost in all ages, so that the boundary 

 lines between the real rickets, rachitis tarda and osteomalacia have 

 almost disappeared. As we shall see, the inadequate diet of itself, 

 even under the best hygienic conditions, suffices to develop the 

 disease; the role of other factors such as lack of air and light, is not 

 ruled out. By and large, the number of cases of rickets increases 

 with the rejection of the natural modes of nutrition and the adoption 

 of artificial feeding of infants. The further child nutrition strays 

 from the normal (breast milk), the less it corresponds to the age of 

 the child, and the more severe are the symptoms of rickets. This 

 disease is chronic and is not dangerous to life of itself, but it does 

 predispose towards infections, especially of the respiratory apparatus. 



Rickets occurs everywhere, especially in the temperate zone, less 

 in the north (Iceland, Greenland, Norway), rarer in the tropics and 

 also southern Italy and Spain. Rickets is seldom noted in countries 

 where breast feeding is prevalent, as a rule, but increases in the in- 

 dustrial centers, following artificial infant feeding and lack of sunlight. 

 A racial influence is not noticeable; for example, rickets frequently 

 develops among negroes and southern Italians in America, whereas 

 in their native countries they are unaffected (Cautley, 1029; Strong- 

 man and Bowditch, 1029a). The frequently observed racial predis- 

 position may be attributed as well to the dietary customs. Con- 

 densed milk together with proprietary foods, as well as a one-sided 

 carbohydrate diet, leads almost invariably to the development of 

 rickets. According to Dennett (1030), there is no danger of rickets 

 from cooked milk, as such. However, even breast-milk may be an 

 insufficient food, especially when the mother's diet is inadequate. 

 We have noted an analogy to this in other avitaminoses, particularly 

 in beriberi. 



It is evident that rickets arises when the diet either is lacking 

 in a certain vitamine indispensable for normal metabolism, or contains 

 it in insufficient amounts. We shall speak of other complicating 



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