RICKETS 315 



tigated the French soldiers, and noted that those who had suffered 

 from rickets in childhood showed, aside from anatomical changes, 

 mental deficiency and little resistance to bodily exertion. 



SYMPTOMATOLOGY AND DIAGNOSIS 



Rickets is primarily a disease of the bones, although it must be 

 regarded as a general disturbance of metabolism. As we gain 

 knowledge of this condition, the latter assertion may perhaps become 

 more justified. The children show a weak muscle tonus and perspire 

 profusely, particularly on the scalp. They commence to walk 

 rather late; the fontanelles remain open longer than usual and the 

 course of the disease may be controlled to a certain extent by measure- 

 ment of the opening. Swellings of the cartilage ends of the ribs 

 (rosary) are easily palpated, and sometimes are apparent even without 

 this. According to Juaristi (1056) the eyes in rickets are more round 

 and show more of the sclera, associated with bone changes in the 

 fundus of the eye; the penis is long and hangs flaccid. Evidently 

 the delayed development of the teeth is also characteristic of 

 rickets; the enamel is often lacking, and occasionally is covered with 

 a greenish deposit which has been emphasized by a number of authors 

 (1056a). According to Lichtenstein (1056b), rachitic children exhibit 

 an abnormal sense of taste. Various other symptoms associated 

 with slight muscle tonus are described. Characteristic skull forma- 

 tion of rachitic origin is also observed, and as soon as the children 

 commence to walk, the legs bend in the known way, because of the 

 weight of the body. 



The diagnosis presents no particular difficulty; the differentiation 

 from scurvy having already been discussed. The differential diag- 

 nosis between rickets and some pseudo-rachitic appearances, such 

 as "osteoporosis," is not so easily made. In this respect, the X-ray 

 may be of some help, in addition to the results of vitamine therapy, 

 as compared with calcium therapy. 



PATHOLOGICAL ANATOMY AND CHEMICAL PATHOLOGY OF RICKETS 



We find, in the work of v. Recklinghausen (1057) a careful and 

 splendid treatise of this subject. The chief sign of rickets is the 

 persistence of the cartilage in the uncalcified condition. The 



