This is a fundamental nutritional disturbance, occurring most frequently between the sixth and eighth months, and is due to a combination mainly of improper food, poor hygienic surroundings, race, and climate. The Italian and the negro are peculiarly susceptible in the north temperate climate. Practically all colored babies in the North become rachitic, even on a good breast, while in the South the condition is rare. The rachitic baby is pale, flabby, pot-bellied, large-headed, though commonly fat. The other striking symptoms are in the bones. These fail to harden properly, or even become softer, are thickened at the four corners of the head, and at the epiphyses of the long bones, especially at the wrists, ankles, and sternal ends of the ribs. Various deformities of the chest and limbs occur as a result of these changes. Teeth appear late, from the tenth to the fifteenth month, or later. The muscles are weak, and walking occurs late.

Rickets rarely occurs to any degree in white children on good breast feeding. It is rarely absent in severe degree in babies fed for a long time exclusively on any proprietary food that is used without fresh milk. The small amount of fat and fresh animal proteid, and the large amount of carbohydrates, are doubtless important factors. Fat overfeeding will quite as definitely produce it. Slight evidence of rickets occurs in nearly all babies that are fed artificially, and in many on good breast feeding. Striking symptoms occur only in serious errors in diet and hygiene, except apparently in certain conditions of race and climate. Its essential nature is not clear. Marantic babies are commonly not rachitic.

Treatment

Fresh milk, appropriately modified and in proper amount, together with such other food as is indicated for that age and weight, is the important point. Fresh air, day and night, sunshine and outdoor life are only next in importance. Cod-liver oil, especially with the addition of phosphorus, is a very valuable addition to the treatment.