142 INANITION AND MALNUTRITION 



Albrecht ('13) found that in pregnant cows on calcium-poor diet the skeleton 

 of the fetus develops normally, the necessary calcium being withdrawn from 

 the maternal skeleton. Evvard, Cox and Guernsey ('14) noted Imperfect 

 development of the skeleton in pigs from sows fed maize diet during pregnancy, 

 but ascribed this to deficiency of protein rather than of calcium. 



Phosphorus Deficiency. — Not many experiments have been made with diets 

 deficient in phosphates, aside from those to be mentioned later in connection 

 with rickets. Weiske ('71) and Weiske and Wildt ('73) fed phosphorus-poor 

 diets to adult goats and young lambs, but found no apparent effect on the skele- 

 ton. Later investigators (Roloff, E. Voit) explained these negative results as 

 due chiefly to the failure of the animals to eat the diet, with resultant general 

 starvation. Hart, McCollum and Fuller ('09 /09a) found that low-phosphorus 

 diet causes osteoporosis in pigs, but made no histological examination. 

 Heubner ('10), Lipschutz ('10, '11a) and Schmorl ('13) fed puppies diets poor in 

 phosphorus, and found the skeletal changes more like those of scurvy than of 

 rickets. It is probable that these diets involved also deficiency in vitamin C 

 (to be considered later). 



Rachitis. — Some of the gross deformities resulting from human rickets as 

 described by Whistler (1645) an d Glisson (1650) were mentioned in Chapter V. 

 Vincent ('04) states that the enlargement of the costochondral joints ("rickety 

 rosary") is one of the earliest and most striking changes, found by Holt in 

 142 out of 144 cases. Vincent claims this is absent in all other diseases, but it 

 occurs also in scurvy. "Pigeon breast" is frequent, with lateral compression of 

 the thorax, and a deep longitudinal groove on each side of the protuberant 

 sternum and costal cartilages. A deep transverse furrow ("Harrison's sulcus") 

 may occur at the lower end of the sternum, or there may be a funnel-shaped 

 depression in the ensiform region. Spinal deformity is common — usually 

 kyphosis, more rarely scoliosis or lordosis. Deformities of the clavicle, pelvis 

 and limbs (especially the lower) may also occur, and the epiphyses, especially 

 of the wrists and ankles, are enlarged. The skull is also especially affected, with 

 arrested growth of the facial region but enlargement of the cranium (Figs. 43 

 and 52). Regnault ('99) claimed that the enlargement of the rachitic cranium 

 is apparent, rather than real. The forehead is square and projects forward, with 

 frontal and parietal eminences thickened, vertex and occipital region flattened. 

 Thin spots ("craniotabes" of Elsasser) may occur, perhaps due partly to pres- 

 sure atrophy. The cranial sutures are usually open and the closure of the 

 fontanelles delayed. The changes in the individual bones were described fully 

 by Seibold (1827), Beylard ('52), Comby ('01), Jenner C95), and more recently 

 with excellent illustrations (including X-ray) and review of the literature by 

 Wohlauer ('n). Kauffman ('22) and Kauffman, Creekmur and Schultz ('23) 

 claim that the changes in the temporal bones in otosclerosis may represent a 

 form of late or adult rickets. 



These gross changes, which are chiefly the mechanical result of the softened 

 skeleton, have recently been described for human rickets with further details 

 by Cheadle and Poynton ('o7),Lesage ('n), Peckham ('20), Engel ('20), Maass 

 C21), Schmidt ('21), Brusa ('21), Park and Howland ('21), Marfan ('22) and 



