32 DISEASES OF CHILDREN. 



particularly offensive, and often have a rotten odour, from the decomposition of undi- 

 gested food in the intestines. The child is pale, sallow, and muddy-looking : it is 

 restless at night, kicks the bed-clothes oft' persistently, and when it sleeps it perspires 

 freely, so that its night-dress becomes quite wet, and the perspiration stands in beads 

 upon its forehead, and soaks the hair and the pillow. When these symptoms appear 

 before the completion of the second year, the rickety constitution may be suspected, 

 and it is important to detect it before any deformity has occurred. 



The growing ends and margins of the bones are bigger and thicker in rickets than 

 they should be, and to these points we accordingly look for confirmatory evidence. 

 The joints are big and clumsy, as an inspection of the wrists and ankles shows. The 

 ends of the ribs, where the bone joins the breast-plate of gristle which closes the 

 front of the chest, are enlarged, and by passing the hand over this line of junctions 

 we may feel them to be big and nobby. The anterior fontanel (the opening between 

 the bones on the crown, of the head) remains unduly open, and keeps so until after the 

 twenty -fourth month, at which date it is closed in healthy children, and the edges 

 of the bones forming the side and top of the skull may (by a practised hand) be felt 

 to be enlarged. The general lassitude of the child is a very marked feature; and, 

 indeed, the muscular weakness is as strongly characteristic as is the softness of the 

 bones. The child no longer delights in being played with, and neglects the games 

 which lately were its greatest source of joy. It does not, as most healthy children 

 do, draw its feet up towards its mouth; and when it is lifted from its cot or dandled by 

 its nurse it cries with pain instead of crowing with delight. In some rare cases, the 

 muscular weakness is so great, and the general helplessness of the child is so marked, 

 that it has been compared to a lay-figure made of wet brown paper. Soon the 

 deformities make their appearance. They are due to the softness of the bones. The 

 pigeon-breast is perhaps the most common and characteristic of these. The sides 

 of the chest fall in, and the breast-bone projects forward not unlike the breast of a 

 bird. The back gets bowed outwards, and it is characteristic of the crooked back 

 caused by rickets that it sometimes will straighten out if the child be held up by the 

 arm-pits. The arms and forearms are bent outwards. The thigh-bones bend forwards, 

 and the bones of the legs bend out, so as to produce the extremest degree of bandy- 

 legs. The head gets big, and the forehead is high arid square, and this, coupled with 

 the dislike for the sports of infancy which the child acquires, generally causes it to 

 be looked upon by its fiiends as a prodigy of cleverness. This is far from being 

 the fact, however, and the intellectual power is not unfrequently as much below 

 par as the physical ; but since these children often sit with their elders instead of 

 playing with their fellows, they are apt to pick up a few quaint and old-fashioned 

 expressions, which give the false notion that they are clever beyond their years. 

 The teeth are late in. being cut, and, indeed, rickets is the commonest of all causes 

 of delayed dentition. 



Rickets is not in itself a very common cause of death, but the rickety condition 

 very largely increases the danger of other diseases, and notably of all diseases that 

 affect the lungs. Whooping cough is a very fatal disease to rickety children, and 

 so is bronchitis. The reason of this is that, owing to the softness of the walls of the 

 chest, the child is unable to distend its lungs with air properly, and consequently 



