622 PRACTICE OF PHYSIC. 



stances of the acid being produced and occasioning various dis- 

 orders, without, however, its ever producing rickets. 



Another of the remote causes commonly assigned, is the 

 child's being fed with unfermented farinaceous food. But over 

 the whole world children are fed with such farinacea, while the 

 disease of rickets is a rare occurrence ; and I have known many 

 instances where children have been fed with a greater than usual 

 proportion of fermented farinacea, and also a greater proportion 

 of animal focd, without these preventing the disease. In my 

 apprehension, the like observations might be made with respect 

 to most of the circumstances that have been mentioned as the 

 remote causes of rickets. 



MDCCXXIV. Having thus offered my opinion concern- 

 ing the supposed antecedents of this disease, I proceed now 

 to mention the phenomena occurring after it has actually come 

 on. 



The disease seldom appears before the ninth month, and sel- 

 dom begins after the second year, of a child's age. In the in- 

 terval between these periods, the appearance of the disease is 

 sometimes sooner, sometimes later ; and commonly at first the 

 disease comes on slowly. The first appearances are, a flaccidity 

 of the flesh, the body at the same time becoming leaner, though 

 food be taken in pretty largely. The head appears large with 

 respect to the body ; with the fontanelle, and perhaps the su- 

 tures, more open than usual in children of the same age. The 

 head continues to grow larger, in particular, the forehead be- 

 coming unusually prominent ; and at the same time, the neck 

 continues slender, or seems to be more so, in proportion to the 

 head. The dentition is slow, or much later than usual ; and 

 those teeth which come out, readily become black, and frequent- 

 ly again fall out. The ribs lose their convexity, and become 

 flattened on the sides ; while the sternum is pushed outward, 

 and forms a sort of ridge. At the same time, or perhaps soon- 

 er, the epiphyses at the several joints of the limbs become 

 swelled ; while the limbs between the joints appear, or perhaps 

 actually become more slender. The bones seem to be every- 

 where flexible, becoming variously distorted; and particularly 

 the spine of the back becoming incurvated in different parts of 



