RICKETS. 



may appear at any interval between thefe two periods. Its 

 progrefs is at firft ufually wry flow. The early ap- 

 pearances of its approach arc a flaccidity of the mufcular 

 flefli, and a certain degree of emaciation of the body, not- 

 withtlanding that the appetite for food is rather increafed 

 than impaired ; togetiier with a palenefs and lofs of colour 

 in the complexion, and a flight degree of fulnefs, or tume- 

 faction in the face. The head at the fame time appears 

 large witli rcfpedt to the body, and the fontanelle, and 

 even the futures of the fkull, are more open than is ufual 

 in children of the fame age. The head continuing to in- 

 creafe in fize, the forehead efpecially, becomes unulually 

 prominent, and the neck appears very (lender in proportion 

 to the head. The progrefs of dentition is alfo flow, or 

 much later than ufual ; and thofe teeth which protrude 

 themfelves fooii become black, decay, and often fall out. 

 Their ribs lofe their convexity, and become flattened at 

 their fides, while the rternum, or breaft-bone, is puflied 

 forward, fo as to form a fort of ridge. At the fame time, 

 or fometimes fooner, the epiphytes at the feveral joints 

 of the limbs become fwelled, while the limbs between the 

 joints appear, or perhaps actually become, more (lender. 

 The bones now are obvioufly every where, to a certain 

 degree, flexible, becoming varioufly bent and diftorted, and 

 efpecially the legs and the fpine of the back are incurvated 

 in various directions. If the child had already acquired 

 the power of walking before the commencement of the 

 dileafe, it becomes daily more feeble in its motions, and 

 more averfe to exertion, and at length lofes the power of 

 walking altogether. 



While theie fymptoms go on increafing, the abdomen 

 always appears preternaturally full and tumid, and the 

 ltools are generally frequent and loofe ; yet the appetite 

 often remains good. The faculties of the mind often ex- 

 hibit a premature advancement, and the power of fpeech is 

 early acquired ; but in fome cafes the underftanding is 

 impaired, and (tupidity or actual fatuity enfues. There 

 is ufually no febrile affection accompanying the difeafe at 

 its commencement ; but it feldom continues long before the 

 pulfc becomes frequent, and other lymptoms of fever enfue. 

 With thefe fymptoms the difeafe proceeds, and con- 

 tinues in fome initances for feveral years ; but, in many 

 cafes, in various ilages of that progrefs, it ccafes to ad- 

 vance, and the child gradually recovers its health and 

 (trength, except that the diftortion of the limbs, produced 

 by the difeaie, continues during tiie remainder of life. In 

 other cales, however, the malady proceeds, continually in- 

 creafing, until it has affected almoft every function of the 

 animal economy, by the derangement of the vifcera and 

 the impediment to their operation:., which the diftortion of 

 the bones occafions. The mod material danger and dillrels 

 thus produced arife from the diftortion of the (pine, ribs, 

 and fternum, by which the cavity of the cheft is greatly 

 diminiflicd, and the action ot the lung6 and of the heart 

 much impeded, or altogether arretted. The functions of 

 the liver, ftomach, &c. and thofe of tin- uterus and bladder, 

 under dittortions of the pelvis, are thus alfo often rendered 

 morbid and diftrefsful for the reft of lire. When the head, 

 too, is greatly enlarged, the exiftence ot water is to be 

 apprehended. It is unnecelTary to enter into any detail of 

 all the variety of fymptoms, which ire the fecondary effeft 

 of thefe impediments to the action of particular org. 

 (luce relief is not to be obtained effectually while the 

 mechanical impediment exifts incurably, and the origin of 

 eaeli particular fymptom will be calily explained from the 

 circumftances of each cafe. The organs themfelves, how- 

 ever, become ferioufly deranged under this ftate of pref- 



fure and obftrudtions ; and morbid conditions have been 

 difcovered in various parts internally in the bodies of thofe 

 who have died. Thus, mod of the vifcera of the abdomen, 

 the liver, fpleen, and mefenteric glands, have been found 

 to be preternaturally enlarged ; the lungs have been found 

 in a morbid ftate, apparently from fome inflammation that 

 had come on towards the termination of the difeafe. The 

 brain has been commonly found in a flaccid ftate, with 

 effutions of a ferous fluid into its cavities. The bones 

 very univerfally have been commonly found in a flaccid 

 ftate, with effufions of a ferous fluid into their cavities. The 

 bones very univerfally have been found to be foft, fo much 

 fo indeed, as to be readily cut by a knife ; and the mufcular 

 parts alfo foft and tender, the whole of the dead body being 

 without that degree of rigidity which is fo common in 

 almoft: all others. Cullen, Firft Lines, par. 1724. 



The great peculiarity, then, of this difeafe, appears to 

 confitt in a deficiency of that matter which forms the folid 

 parts of the b<rly, efpecially of the bones, or in a faulty 

 ftate of the procefs of oflification, by which that matter 

 is depofited in the membranes and fubftances deftined to 

 become bony, to give them their due firmnefs, hardnefs, 

 and (trength. There is obvioufly a defect in the quantity 

 of this matter, the place of which is fupphed, efpecially 

 about the epiphyfes of the bones, by a foft fubftance 

 which increafes their bulk. What this deficiency of oifific 

 matter depends upon, it is difficult to afcertain : it may 

 originate either in the faulty adtion of the organs of diges- 

 tion and aflimilation, by which the nutritive fluids are pre- 

 vented from being properly prepared ; or from a fault 

 in the organs of fecretion and nutrition, which prevents the 

 proper elaboration of the circulating fluids. Of the nature 

 of this latter procefs, however, we are totally ignorant ; and 

 practitioners have more generally referred to the former, and 

 afcribed the difeafe to the actual deficiency of bony matter 

 in the circulating fluids, as furnifhed by the digeftive organs : 

 yet they have been generally alfo compelled to refer this 

 deficiency to fome general laxity or debility of the fyftem. 

 But admitting the exiftence of fuch a debility, it is alto- 

 gether impoflible to account for its operation in diminifliing 

 the offific matter, being limited to the early portion of 

 childhood ; for though a mollilia ojjium, or foftnefs and 

 flexibility of the bones, has occurred in adult life, it is a 

 circumttance of extreme rarity. In a word, the etlential 

 nature of the difeafe is beyond our investigation; 



Caufes of Rickets. — Neither are the caufes of the difeafe 

 very clearly demouftrated. Great ttrefs was laid by the 

 earlier writers upon the hereditary predifpolition which 

 defcended from parents to their children ; but the very 

 rapid increafe of the dileafe among children, foon after the 

 difordcr was firft noticed, and therefore the neceflary pri- 

 mary origin of it in many whofe parents mult have been 

 free from the taint, renders the opinion untenable. Indeed 

 the rife, prevalence, and difappearance of the difeafe, during 

 a certain period of time, including about a century and a half, 

 would feem to connect its exiftence with fome more general 

 caufe ; but no one has been able to point out any pecu- 

 liar phyfical condition of the people of England, during 

 that period, to which fuch a malady can be attributed. 

 Some have imputed it to the multiplication of manufac- 

 tures and other unwholefome ins; but the manu- 

 factures continue while the dili if- lias nearly v.'nilhed. It 

 is certain, however, that in later times the difeafe has been 

 principally knowi the children of the poor, liviug 

 in clofe and uncleanly fituations, ami in dirty Ill-ventilated 

 apartments; and efpecially among thofe children who . 

 ill-nurfed, that is, in whom conftant warning and proper 



exer. 



