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INANITION AND MALNUTRITION 



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I.; 



historical survey of the questions concerning the etiology of rickets has recently 



been made by Park ('23) and by Vaughan ('23). 



Human Rickets. — For the present, we are concerned merely with the more 



general effects of rickets upon the growth of the body as a whole, leaving a 



consideration of the effects upon the skeleton and other organs for later chapters. 



The occurrence of fetal rickets has often 

 been claimed, but according to Wieland 

 ('10) it is very doubtful. Huenekens 

 ('17) found premature infants especially 

 susceptible to rickets, and J. H. Hess 

 ('23) gives the characteristics in this class 

 of cases. Rickets in the human species 

 does not ordinarily appear before the 

 latter half of the first year, and is most 

 frequent during the rapid growth period 

 of the first two years. It may occur at 

 any later age, however, and in the adult 

 I it is usually designated as osteomalacia. 

 According to Ruffer ('21), rickets 

 has existed in Egypt since 2,000 B.C., 

 § and probably much earlier. Deformity 

 of the spine and legs (probably rachitic 

 in origin) was described by Soranus as 

 prevalent among Roman children of the 

 first' century, A.D. In most civilized 

 countries today rickets is still a very 

 potent factor in stunting growth, produc- 

 ing deformity and lowering resistance to 

 infection (Findlay and Ferguson '18). 

 Kissel ('97) noted a variable degree of 

 rickets in 80 per cent of 2,530 children 

 examined at Moscow ; and Schmorl ('09a) 

 found evidence of either active or healed 

 rickets in 345 (89.4 per cent) of 385 

 children under 5 years of age autopsied at 

 Dresden. Increased frequency of rickets 



Fig. 43. — Ventral view of a child, 8 years , . , . ., , , , • , 



old; died from rickets. Note the enlarged during and since the world war has been 



head, deformed limbs, distended abdomen reported by numerous observers. 



and deformed thorax (marked groove in the m-, , , ., , , 



costochrondrai region, with enlarged costo- The external appearance ot the body 



chondral joints, forming a "rickety rosary"), in rickets is shown in Fig. 43. The 



well-known characteristic features were 

 recognized by Whistler (1645) an d Glisson (1650), and described by many 

 later observers. They include an enlarged cranium, deformed thorax (with 

 enlarged costochondral joints often forming a "rickety rosary"), distended 

 abdomen ("pot belly"), enlarged wrist, knee and ankle joints, with variable 

 curvature of the lower limbs. Most of the deformities are the mechanical result 



