SyiiiptdUis. 



943 



swollen, but the true nature of tlio ,swellin,i>' is easilj- ascertained 

 on palpation (Fig. 161). Similar enlargements are to be seen 

 on the sterno-costal articulations where the button-shaped 

 cartilages form two concave lines running parallel with the 

 sternum (rachitic rosary). These l)onY swellings are, especiallj- 

 at the beginning, often somewhat sensitive to pressure. Cir- 

 cumscribed exostotic enlargements are also frequent, especially 

 in the ribs and the extremities (Frohner oljserved a ringbone 

 develop in rachitis). 



The weight of the body and the traction of the muscles 

 causes the bones to l)end and become crooked. These distor- 

 tions are most frequent and striking on the extremities which 



Fig. 161. Rachitis. Sut+er. The skeleton of tliis ilo^' is shown in Fig. 158, 



assume various abnormal shapes, such as ''dachshund" legs, 

 knock-knee, bandy-leg, legs Ijent backward, legs like bear's paws 

 (Figs. 161 and 163). The thinner bones, especially those of 

 the metacarpus and the metatarsus are sometimes bent double 

 and may break transversely (Schiitz). Lienaux points out that 

 the Achilles tendon is sometimes torn from its attachment, and 

 this may be the first or even the only sjunptom of the disease. 

 The muscles of the extremities either lose their tension or 

 some of them become contracted and thus cause much pain. 



The pressure of shoulders and elbows, and also the air 

 pressure cause the middle portions of tlie ribs to be bent in- 

 ward, giving rise on both sides of the thorax to a longitudinal 



