564: DISEASES OF THE ORGANS OF LOCOMOTION. 



disturbance of nutrition as its cause, we cannot fulfil the causal indi- 

 cations. 



The indications from the disease are not answered by giving car- 

 bonate and phosphate of lime, for the absence of the bony earths from 

 the bones is not the chief anomaly in rachitis. As soon as the disturb- 

 ance of nutrition in the epiphyseal cartilages and in the periosteum has 

 ceased, the ossification of the proliferation begins, and, indeed, often 

 becomes excessive, even if no material for aiding ossification be sup- 

 plied, except the calcareous salts taken in the ordinary articles of food. 

 Bitter and tonic remedies also, as well as rubia tinctorium, have not 

 fulfilled the hopes entertained of them on theoretical grounds, and 

 have been almost superseded by cod-liver oil, which is very efficacious 

 in most cases where it can be taken, as it generally can be. We do 

 not know to what peculiarity cod-liver oil owes its apparently specific 

 effect in rachitis. Brine baths are also of unmistakable benefit, and 

 should be used, particularly where the children are in a fair condition 

 as regards nutrition, or are even moderately fat. The diet suitable 

 for scrofulous patients, consisting of a small supply of vegetables, with 

 plenty of animal food, is also very important for the successful treat- 

 ment of rachitis. We would particularly recommend the administra- 

 tion of a moderate amount of finely-shaved raw beef twice a day, fol- 

 lowed by a small spoonful of Tokay or Malaga wine. Finally, we 

 should take care that rachitic children be not kept in damp, dark 

 rooms, but sent out of doors as much as possible. 



The symptomatic indications are, to guard against curvatures of the 

 bones, and to rectify any existing curvatures. The former indication 

 is more readily fulfilled than the latter; the means for fulfilling it con- 

 sist, as may be inferred from what we have already said, of the mode 

 of origin of the curvatures and partial fractures, in carefully protecting 

 the soft, pliable bones from the weight of the body, the action of the 

 muscles, and external force. Rachitic children should sleep on mat- 

 tresses, not on feather beds. It does not make so much difference about 

 the material in the mattress as about the care with which it is made, 

 for on this depend its regular fulness and the evenness of its surface. 

 High pillows should be forbidden. The nurse should carry small chil- 

 dren out in a basket ; larger ones should be drawn about in the open 

 air, in a carriage provided with a mattress. Until the bones are con- 

 solidated, sitting up in bed for a length of time should be prohibited, 

 and still more should we forbid the children running about on their 

 flexible, fragile legs. But if the curvature has already occurred, we 

 should send the child to a reliable orthopaedic institute, that is, to one 

 where the actual results after the treatment correspond to some extent 

 with the promises made before its commencement, and the accounts 



