562 DISEASES OF THE ORGANS OF LOCOMOTION. 



fractures of rachitic bones are chiefly due to the weight of the body 

 resting on them, and to the action of the muscles. We have given a 

 different explanation for the occurrence of pectus carinatum ; and the 

 fact, that children who have become rachitic during their first year, and 

 still have straight legs, usually have chicken-breast, perfectly agrees 

 with this explanation. Children attacked by rachitis during the first 

 year are the ones who are affected with craniotabes, from lying so 

 long on their backs, probably from the pressure of the brain on the 

 inner surface of the skull, while the bed presses on the outer surface. 

 It is of little importance whether the rolling the head, thinness of the 

 hair over the occiput, disturbed sleep, attacks of spasmus glottidis, 

 eclampsia, and other symptoms of anomalous cerebral functions, which 

 are often seen in such children, are to be regarded as the results of 

 craniotabes, or as concomitant symptoms. Careful pressure on the 

 soft parts of the head is well borne by many children, while in others 

 it induces convulsions. We must further mention that chronic bron* 

 chial catarrh is the most frequent complication of rachitis early in life ; 

 its absence is exceptional. In this disease, the teeth are generally cut 

 very late, and often irregularly ; it frequently happens that the child 

 is a year old before he has a tooth in his mouth. Finally, there is no 

 question that rachitic children, who have acquired their disease during 

 the first months of life, usually differ from other children of equal age, 

 by their bright answers, and their attentive, sensible manners ; but, in 

 spite of the large head, we cannot agree to refer this precocious men- 

 tal development of rachitic children to hypertrophy of the brain, be- 

 cause we also see it in other children who are confined to the bed by 

 any disease, and so kept away from other children, and constantly sur- 

 rounded by sedate, grown persons ; and because in so-called hyper- 

 trophy of the brain there is not an increase of the nerve-elements, but 

 of the neuroglia. Moreover, the contrast between the physical help- 

 lessness and the mental development causes the latter to appear 

 greater than it really is ; and children three years of age, who cannot 

 yet walk, are usually considered younger than they really are. If the 

 disease end in recovery, the first sign of improvement is generally a 

 decrease of the emaciation. The loose skin is again filled by the 

 limbs, the wrinkled and old face grows smooth, while the protuberant 

 belly becomes smaller. After a while the children begin to sit up in 

 bed, and play. At this time there is great danger of curvature of the 

 upper and lower ends of the vertebrae, and permanent distortions of 

 the spinal column. At the commencement of convalescence, curva- 

 tures and partial fractures of the extremities also are most likely to 

 occur when the children attempt to get out of bed, and walk around, 

 holding i to the chairs. The symptoms of rachitis differ in some 



