Causes

Rachitis, a disease of childhood, is a fault of nutrition that is most frequently caused by improper or insufficient food, and rarely by inherited weakness of digestion or other inherited disease. Parrot insists that rachitis is often a manifestation of inherited syphilis. Some children are undoubtedly born with it. It is acquired both by sucklings and by bottle-fed babies.

A variety of conditions may influence the quality of mother's milk and make it unsuitable for the proper nourishment of an infant. The nurslings of mothers who have been weakened by frequent pregnancies are apt to develop rachitis. Other conditions that weaken mothers, such as acute or chronic illnesses, will produce the same result. The loss of sleep, emotional or neurotic disorders, or errors of diet will similarly affect a mother's milk.

Rickets has been produced artificially in young animals by depriving them of animal fats and earthy salts, especially of lime-salts, such as the phosphates. When too little lime is furnished in food, the balance required is absorbed from the bones; as these have already ossified, they become weakened and softened by the withdrawal. The presence of lactic acid or phosphorus in the food hastens these results.

There is some experimental evidence that the parathyroids and possibly the thymus glands are related to calcium metabolism. These facts also suggest a possible relationship between rachitis and osteomalacia and the functional activity of these glands. McCallum and Voegtlin have shown that when the parathyroids are removed calcium is excreted in excessive quantities and the percentage in the blood and tissues is reduced. Moreover, they and other observers have shown that the teeth and bones no longer calcify normally or cease to grow. On the other hand if this condition is experimentally produced by the removal of the parathyroids from animals the transplantation of these organs into them corrects the disturbed calcium metabolism. And if tetany has been provoked it can be stopped by injections of lime-salts.

Bedt and Klose have observed changes analogous to rachitis in young dogs from whom the thymus had been removed.

These experiments doubtless throw some light upon the pathology of these diseases but do not explain its treatment.

Starches and sugars are unsuited to form the principal part of an infant's food, because they are wanting in lime and liable to be converted into lactic acid in the stomach. Many 'infants" foods upon the market are not only unsuited for those who have rickets, but will even cause the malady, because they contain too much starch and sugar and too little earthy salts.

This ailment is especially apt to develop in infants during their second year, or during the last part of their first year, when they are nursed and at the same time fed a variety of foods that they are not yet old enough to digest.

Rachitis is best prevented by having children nursed only by healthy mothers or wet-nurses sufficiently intelligent and conscientious to take proper care of themselves. When it is necessary to feed babies from a bottle, only good milk should be used, and during the earliest months of infancy modified milk is to be preferred. The milk mixture should contain 4 per cent, of fat and from 5 to 7 per cent, of milk-sugar, and during the first few weeks of life from 1/2 to 1 per cent, of protein. Lime-water should be added to this mixture to insure a faint alkalinity, and to secure to the child enough lime for its good nutrition. It has been estimated that an infant four months old should get at least fifteen grains of calcium daily. It is well, as the nurslings grow, to supplement the milk by administering daily a little calcium phosphate or lactophosphate in some other manner.

Milk should be modified month by month to meet the changing requirements of the child. By so doing the little one can be well nourished. The milk should be pure and free from dirt. If the herd of cattle from which it is obtained is not known, and the method of milking and of handling the milk is such as may not insure unusual cleanliness and purity, it should be Pasteurized when first received. During the first three or four months of childhood starches should not be mixed with the milk. Barley and oatmeal water, which contain comparatively small amounts of starch, are sometimes employed as diluents when the facilities are not at hand to modify milk properly, because they partly prevent the formation of large curds during the progress of digestion.

To prevent rickets it is absolutely necessary to break the habit so common with those who are ignorant and heedless of giving to infants and very small children a little of everything eaten and drunk by vigorous adults. Nothing is more certain to engender the disease than this. It is also important that the home of the child should be clean and filled with fresh, pure air.

Treatment

When children have developed rickets, it must be remembered that they need fats, not starches. The latter should be withheld until the child is beyond the age when they are usually given. Cream is a form of fat that is especially appropriate. Cod-liver oil is also a remedy of established reputation in these cases. Children a year or more old may also be given butter, and bacon cooked to a crisp. Inunctions of oil are also beneficial. Olive oil and cotton-seed oil are most used. Cod-liver oil is preferable, but its disagreeable odor often makes it unavailable.

Although it is best to withhold starches from such infants for a longer time than is usual, mutton broth, chicken broth, and beef-juice may be given after the sixth month. Orange-juice is also grateful and beneficial. After the twelfth month stale bread and crackers may be tried cautiously. Scraped beef and a soft-cooked egg may also be added to the diet, and gradually other fruit-juices or jellies.

Rickety children usually being anemic and peculiarly susceptible to cold, it is of great importance that they should be so clothed as to be well protected; but care must be taken not to burden them with clothing in warm weather. While enfeebled they are nervous and excitable. They should then be guarded against undue excitement. As quiet a life as possible should be prescribed for them.

As in all ailments, cleanliness and fresh air are essential. A residence of several months at the seashore during the summer is especially beneficial. Next to the suitable adjustment of food to the child's needs, a climatic change is the most important aid to the successful treatment of the disease. The child should have a daily salt bath. If old enough, it should be allowed to play upon the beach in the sunshine, dressed in a flannel bathing suit, and encouraged to run in and out of the water, to sit down in it, roll over in it, and play vigorously in it and by it. It is probable that the sun and air baths are as important elements of this treatment as the sea-water.

Hypophosphite, lactophosphate, and glycerophosphate are the most eligible preparations of calcium for administration in these cases. When anemia is a prominent symptom, various preparations of iron may be used advantageously.

Louis Starr recommends the following menu for a child of eighteen months:

Meal at 7 .30 a. m. - Eight ounces of milk with a tablespoonful of cream added and on alternate days the yolk of a soft boiled egg with a little butter, salt and broken bread and two to four tablespoons of well-cooked and strained cracked wheat porridge with cream and salt.

Meal at 11 a. m. - Eight ounces of milk with a tablespoonful of cream and a slice of whole wheat bread.

Meal at 2 p. m. - A good tablespoon of well minced chicken or mutton with gravy and a little crumbled stale bread; a tablespoonful of puree of spinach, stewed celery or cauliflower tops; bread and butter.

Meal at 6 p. m. - Milk and cream as at 7 and 11 a. m.; thin bread and butter.

Pure water to drink. And avoid excess of farinaceous food.

If diarrhea with liquid, offensive stools complicate the condition he would give a minimum of casein by substituting equal parts of veal or chicken broth and barley water for some of the milk feedings and for others give a mixture of cream, one tablespoon and freshly prepared whey six ounces.