440 



BONE, PATHOLOGICAL CONDITIONS OF. 



Rickets. The consideration of this subject 

 has been too frequently mixed up with that of 

 the disease entitled mollities ossium (osteo- 

 malaxie), or with that of the interstitial absorp- 

 tion of bone which occurs in aged persons. 

 Kachitis seems not to be so much a softening 

 of bone that had previously been solid and 

 perfect, as an interruption in the first instance 

 of the process of ossification. It is a disease 

 of early life, generally commencing, or at 

 least first observed about the period when the 

 infant should make its earliest attempts to walk, 

 and rarely appearing after the age of two years. 

 It would appear that the disease should be 

 considered as connected with inadequate nu- 

 trition throughout the body generally, rather 

 than as being confined to the osseous system ; 

 its effects are only most obviously marked on 

 that system ; and it is quite certain that all 

 the bones of the skeleton are more or less af- 

 fected, although particular local causes com- 

 monly produce much greater deformity in one 

 than in another. 



The early symptoms of rickets are invariably 

 those of imperfect or deranged nutrition, pale- 

 ness of skin, flaccidity of fibre, &c. Along 

 with these symptoms or shortly succeeding to 

 them the deformities appear which cause the 

 disease to be ranked amongst the affections of 

 the osseous system. In mild cases these ex- 

 tend no farther than to an increase in the cur- 

 vature of some of the long bones and an aug- 

 mented expansion of their extremities. Whether 

 from its supporting the whole weight of the body 

 or from the action of the strong muscles behind 

 it, the tibia generally suffers in a remarkable 

 degree : the legs are not only bent forwards, 

 the curve being sharp and sudden about the 

 lower third of the bone, but they are twisted in 

 such a manner as to bring the internal ankle 

 below its proper level, deformities which, not- 

 withstanding a perfect recovery, are never com- 

 pletely removed afterwards. Rickets, consi- 

 dered alone, is not very dangerous to life : in 

 most instances it proceeds no farther than has 

 been already described the visceral derange- 

 ments are either subdued or subside sponta- 

 neously, the healthy functions are re-estab- 

 lished, and amongst them that of ossification, 

 and the patient soon becomes enabled to per- 

 form the ordinary motions, while the deformity 

 in some slight degree disappears. But if the 

 disease is severe or protracted, or complicated 

 with a scrofulous taint, it generally leaves 

 tokens behind it which embitter the patient's 

 future existence, or hurry him to a premature 

 grave. Sometimes the head becomes flattened, 

 or pushed so as to project backwards, or is 

 otherwise strangely deformed. More frequently 

 still the chest suffers in shape, either in the 

 ribs, the spine, or in both, and the compressed 

 and contracted thorax, or laterally curved spine, 

 with all their accompaniments and consequences 

 of deranged respiration, will be the result. But 

 of all the parts which suffer from this disease, 

 perhaps the pelvis is that which is most fre- 

 quently engaged. Placed between the spine 

 and the thighs, it is the fulcrum and centre on 

 which numerous motions are performed; it is 



surrounded by powerful muscles and subjected 

 to irregular and unequal pressure ; and it also 

 sustains the weight of the principal part of the 

 body. Hence arise the strangest and some- 

 times the most complicated distortions, and 

 woe to the female who at the age of woman- 

 hood becomes pregnant under such circum- 

 stances. The remote consequences of rickets 

 may, therefore, be far more formidable than 

 the immediate. 



The actual condition of a bone with reference 

 to its structure is the next point to which we 

 must direct our attention. Is there an absolute 

 deficiency in the quantity of ossific matter 

 secreted, the place of which is supplied (espe- 

 cially about the epiphyses of the bones) by a 

 soft substance which increases their bulk ? or is 

 the earthy material removed by absorption 

 previous to the deposition of this softer sub- 

 stance ? The question is not easily answered, 

 for patients seldom die of rickets alone; and 

 when they perish, it is generally in consequence 

 of some complication of scrofula producing 

 hydrocephalus, tabes mesenterica, glandular 

 abscesses, or, it may be, caries ; and it is evi- 

 dent that the examination of a case so mixed 

 cannot afford a satisfactory demonstration of 

 the disease itself. It cannot, therefore, be a 

 matter of surprise if some difference of opinion 

 has existed. The following is the description 

 of a ricketty bone as given by Boyer.* It is 

 lighter, of a red or brown colour, pierced by a 

 great number of dilated bloodvessels, porous 

 and spongy, soft and compressible, moistened 

 with a sort of sanies that may be pressed out 

 as from a sponge, or rather from leather that 

 has been soaked to maceration. The walls of 

 the medullary cylinder of the long bones of 

 the extremities are greatly thinned, whilst the 

 bones of the skull are increased in thickness 

 and become spongy, and, as it were, reticulated. 

 Both the one and the other, but especially the 

 long bones, hare acquired a remarkable sup- 

 pleness, but when bent beyond a certain point 

 they break : and the fracture takes place more 

 easily if the inflexion is made rapidly. The 

 medullary cavity of the long bones contains, 

 instead of marrow, a reddish serosity, totally 

 devoid of that fat and oily character which 

 appertains to marrow in its natural state. The 

 result of Mr. Stanley'sf experience is that the 

 consistence of a ricketty bone is but slightly 

 different from that of common cartilage, an 

 opinion more consonant with our notions of 

 the disease than Boyer's exaggerated descrip- 

 tion is calculated to convey. We ourselves 

 have never met with that extreme degree of 

 softness which has been occasionally described, 

 or which would permit of the bone being di- 

 vided by a knife. MeckelJ states that the bones 

 of ricketty patients are soft, spongy, flexible, 

 and curved, both in situations where they are 

 subjected to muscular actions, and where they 

 have some weight to support. In the meantime 



* Boyev, Traite ties Maladies Chirurgicalcs, torn, 

 iii. p. 625. 



t Medico-Chirurgical Transactions, vol. vii. 

 \ Meckel, Manuel d'Anatomie, torn. i. p. 344. 



