A nutritional disease of children, rickets, or rachitis, usually begins in the period between the sixth and the thirtieth months. The term rachitis, from the Greek word meaning spine (as the spine is an important part affected) was suggested by Francis Glisson (1591-1677) in his classical description of the disease (Tractatus de Rachitide. 1650), which was one of the earliest medical monographs published in England. An important factor in its production is the absence, or even shortage, of the supply to the tissues of a substance described as vitamin D. This vitamin, as well as the other necessary dietetic constituents of this nature, is present in sufficient quantities in the mother’s milk when this is good.
If, however, the mother’s milk is thin, as is usual, for example, after nursing for over nine months, or if a child is fed on starchy foods, even with the addition of fat in the form of margarine, there will be starvation as regards this essential vitamin. This may apparently occur, also, if a child suffers from constant indigestion, especially if diarrhea is present, a common result of giving starchy food, such as sopped bread, potatoes and com flour to a young infant.
A deficiency of the anti-rachitic vitamin is made good if the body is sufficiently exposed to ultra-violet rays, either in natural sunlight or artificially produced. Fats deficient in the vitamin acquire it by being submitted to these rays, and, in exposure of the body to them, it would appear that ergosterol in the skin acquires the properties of the vitamin. The passage of the rays is arrested by clothing, however, and by ordinary window glass. The lack of active exercise in the open air seems to have some influence in causing the disease, but is a subordinate factor as compared with those mentioned.
Rickets begins insidiously, but sooner or later the child becomes restless and peevish, with a certain amount of fever and free sweating, from the head especially, when it sleeps. There is great tenderness over the body, the slightest touch being resented. The appetite and digestion are impaired, and commonly there is constipation alternating with diarrhea. The child tends to become pot-bellied. Teething is delayed, and the fontanels, or spaces between the bones of the skull, are slow in filling up.
The ends of the long bones become swollen, so that the wrists and other joints are unduly large, and there are rows of enlargements down each end of the chest in front, at the junctions of the ribs and cartilages, forming the so-called rickety rosary. The child is slow in beginning to walk; or, if it has done so, may lose the art; the muscular weakness may be so great as to suggest paralysis.
As time goes on, the frontal eminences on the skull become enlarged, producing a broad, square forehead and sometimes portions of the skull towards the back of the head become thin, and papery. The bones of the legs bend, causing “bow“leg; or knock knee, and there is commonly fiat foot. If the child rests much weight on the arms, these also may bend. The spine develops a hump and the walls of the chest are flattened; the breast bone may be pushed forward, a condition described as pigeon breast. Sometimes, however, particularly if there is nasal obstruction, as from adenoids, the breast bone is depressed, forming the funnel-shaped chest. The pelvis is deformed, and in females this may be of much consequence should they subsequently become pregnant, as it may greatly increase the difficulties of childbirth.
Children suffering from rickets are prone to certain nervous troubles, such as convulsions, tetany, and a spasmodic type of choking, known as laryngismus stridulus.
It is most important to prevent rickets. This can be done by giving a child the diet, the sunshine, the fresh air and the exercise which it requires.
When the disease actually exists, the same hygienic requirements must be satisfied but, as the child will be kept in bed for a time, the room in which it is confined should be thoroughly ventilated day and night. Should the weather permit, the child may be allowed to lie out of doors during the day. If natural sunlight is not available, a course of treatment by artificial ultra-violet light should be procured, if possible. Cod-liver oil is a very valuable addition to the diet, but should be given in an emulsion, or with malt, in view of the difficulty of digesting the plain oil.
The child should not be allowed to get on its feet until the bones are sufficiently strong, and to prevent its doing so it may be necessary to attach long splints to either side of the body and the corresponding limb. When tenderness has disappeared, gentle massage of the muscles should be employed, however. The deformity of the limbs generally disappears, but if it persists in a troublesome degree surgical treatment may be desirable.
Application and treatment:
A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. It is associated with swelling of the belly area.
Symptoms are: swollen belly, lean and wasted appearance, may have a large mass of tissue around naval area, abdominal wall veins prominent, falling hair, fever, no perspiration, crying without tears, nasal discharge, mental disorders, irregular bowel movements with liquid stool or constipation with undigested food particles evident, cloudy urine, tongue coating irregular, pulse wiry and taut like a violin string.
Lack of sunlight and proper food causes abnormally soft bones with deformity, bending and twisting occurring. Ordinary window glass removes the ultraviolet rays to cause rickets and special kinds of glass are made that do not remove the rays. Mercury vapor lamps are effective. Foods help like cod liver oil, egg yolk and vitamin D, and positive magnetized foods. Also needed is calcium, (raw milk and acidophilus, whey, rice polishings in electrolyte drink – 1/2 tsp each in 1 glass of milk) add also vitamin D in drink. This gives phosphorus also. Vitamins A and C are also helpful. Women who have suffered from rickets should not marry unless they are – reasonably free from deformity and disease.