RICKETS. 33 



it has a great difficulty in coughing. If, therefore, bronchitis should set in, and 

 secretion is poured into the lung tubes, the child is not able to cough it out as a 

 healthy child does, but dies suffocated. These weak, rickety children are peculiarly 

 liable to be attacked with bronchitis during measles and whooping cough, and when 

 so attacked they very generally die ; and, although the death is generally ascribed 

 to bronchitis, it ought really to be ascribed to the rickety condition. Laryngismus 

 str'ululiis* or false croup (see False Croup), is another disease which is very common 

 in rickety subjects, and so, too, are general convulsions. 



The subjects of rickets are very thin, and they are often spoken of as suffering 

 from atrophy. The liver is occasionally enlarged, as is also the spleen, and this, 

 together with weakness of the abdominal muscles, causes a prominence of the belly. 



The bones of rickety children have been found to contain scarcely one -third the 

 proper amount of earthy matter. 



Rickets is probably one of those diseases which is absolutely preventible, and 

 hence a knowledge of the causes which are said to produce it is of the utmost 

 importance. First, then, it is not hereditary. Parents of healthy constitutions may 

 have rickety children, and parents who have been rickety do not seem liable to 

 transmit the disease from which they have suffered. The health of the mother at 

 the time she is pregnant with and nursing her child seems to have considerable 

 influence on the development of rickets. The first children in a family are seldom 

 rickety. The disease usually shows itself after the birth of one or two children, 

 and after rickets has once shown itself the subsequent children seem also to be liable 

 to the disease. The explanation offered of this fact is as follows : A poor man 

 marries, and his wages are, perhaps, adequate for his position in life. In a year, 

 probably, their firstborn arrives, but if they have been prudent people, and have 

 been properly thrifty, something has been saved to meet the slight extra expense 

 entailed, and their one child is a scarcely appreciable burden on their exchequer. 

 The mother, being well-fed, is able to nurse her offspring without difficulty, and the 

 child passes satisfactorily through its infancy. The family continues to increase, 

 but not so the wages of the father, and when the second child arrives, and still more 

 when the third makes its appearance, the parents begin to find that what was enough 

 for two is not enough for five. The mother, probably, has to live upon, a scantier 

 diet than heretofore ; and, in addition to the call upon her system entailed by 

 suckling a baby, she finds that the performance of her household duties is no slight 

 tax upon her strength. Dreading the periodic increase of her family, she suckles 

 her baby much longer than she ought, and instead of nursing it for nine months, she 

 probably keeps it at the breast for twice that period, hoping thereby to escape 

 becoming pregnant. As a consequence, she becomes terribly anaemic ; she looks pale, 

 bloodless, thin, and weak. Her strength is not sufficient for her household work, 

 her head aches, her heart palpitates, and the slightest extra exertion makes her pant 

 for breath. In this weakened state of health she becomes pregnant again, and this 

 fourth child, born of parents in straitened circumstances, and nursed by a mother 

 whose blood has been impoverished by want of proper food and over-nursing, is 

 almost certain to become rickety. One rickety child having been born, and the 

 circumstances which have produced it not being removed, subsequent children are 

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