RACHITIS.

The Rickets.

Rachitis, Sauv. gen. 294. Lin. 212. Vog. 312. Sag. gen. 120. Boerh. 1480. Hoffm. III. 487. Zeviani della Rachitide. Glisson de Rachitide.

Description. This is one of the diseases peculiar to infancy. It seldom attacks children till they are nine months, nor after they are two years old; but it frequently happens in the intermediate space between these two periods. The disease shows itself by a flaccid tumor of the head and face, a loose flabby skin, a swelling of the abdomen, and falling away of the other parts, especially of the muscles. There are protuberances of the epiphyses of the joints; the jugular veins swell, while the rest decrease; and the legs grow crooked. If the child has begun to walk before he is seized with this disease, there is a flowless, debility, and tottering in his motion, which soon brings on a constant desire of sitting, and afterwards of lying down; insomuch that nothing at last is moveable but the neck and head. As they grow older, the head is greatly enlarged, with ample sutures; the thorax is compressed on the sides, and the sternum rises up sharp, while the extremities of the ribs are knotty. The abdomen is protuberant, and the teeth black and carious. In such patients as have died of this disease, all the solids appear soft and flaccid, and the fluids disflolved and mucous.

Cause. The rickets may proceed from scrophulous or venereal taints in the parents, and may be increased by those of the nurse. It is likewise promoted by feeding the child with aqueous and mucous substances, crude summer fruits, fish, unleavened farinaceous aliment, and too great a quantity of sweet things.—Sometimes it follows intermittent fevers and chronic disorders; and in short, is caused by anything which tends to debilitate the body, and induce a vifcid and unhealthy state of the juices.

Prognosis. The rickets do not usually prove fatal by themselves, but if not cured in time, they make the person throughout life deformed in various ways; and often produce very pernicious disorders, such as carious bones in different parts of the body.

Cure. This is to be effected by mild cathartics, alteratives, and tonics, such as are used in other diseases attended with a debility of the system and a vitiated state of the blood and juices. In the Western islands of Scotland, the medicine used for the cure of the rickets is an oil extracted from the liver of the skate-fish. The method of application is as follows: First, the wrists and ankles are rubbed with the oil in the evening: this immediately raises a fever of several hours duration. When the fever from the first rubbing subsides, the same parts are rubbed again the night following; and repeated as long as the rubbing of these parts continues to excite the fever.—When no fever can be excited by rubbing the wrists and ankles alone, they are rubbed again along with the knees and elbows. This increased unction brings on the fever again; and is practised as before, till it no longer has that effect. Then the vertebrae and sides are rubbed, along with the former parts; and this unction, which again brings on the fever, is repeated as the former. When no fever can be any longer excited by this unction, a flannel shirt dipped in the oil is put upon the body of the patient: this brings on a more violent and sensible fever than any of the former unctions; and is continued till the cure is completed, which it commonly is in a short time.

A German physician, Dr Strack, has lately published a paper, in which he recommends the filings of iron as a certain remedy in the rickets. This disease, he observes, in general begins with children when they are about 16 months old. It is seldom observed with children before they be one year old, and seldom attacks them after they pass two; and it is very generally worse where it begins early than where it begins late. For effecting a cure, it is, he affirms, a matter of the utmost consequence to be able to distinguish, very early, whether a child will be afflicted with rickets or not. And this, he affirms us, may be determined by the following symptoms: Paleness and swelling of the countenance; and in that part of the cheeks which should naturally be red, a yellow colour approaching to that of sulphur. When that is the case, he directs that a medicine should be immediately had recourse to which will retard the further progress of the disease, and remove what has already taken place. For this purpose, he advises that five grains of the filings of iron, and as much rhubarb, should be rubbed up with ten grains of sugar, and given for a dose every morning fasting, and every evening an hour before supper. But if considerable looseness should be produced, it will be necessary, at first, to persist in the use of one dose only every day.

After a month's continuance in this course, according to Dr Strack, there in general ensues a keen appetite for food, quick digestion, and a copious flow of urine; by means of which the fulness of the face and yellowness of the complexion are by degrees removed, while the natural colour of the countenance and firmness of the body in general are gradually restored. This practice, he affirms us, has never failed of success in any one instance; not even in those children born of parents greatly afflicted with the rickets.

In addition to the use of chalybeates, great benefit is often also obtained in this disease from the use of the cold bath; which under prudent administration, is perhaps one of the most effectual remedies for this complaint with which we are yet acquainted.

Mr Bonhorne of Paris, in a late treatise on the subject of rachitis, has endeavoured to prove, that the disease arises from a peculiar acid, and in the cure he particularly recommends phosphate of soda, phosphate and muriate of lime; but above all other articles alkaline lotions. The efficacy of these remedies, however, is not yet confirmed by experience. And we may conclude with observing, that both in the prevention and cure nothing has been found so successful as cold bathing.

When the bones of rickety children begin to bend, they may sometimes be restored to their natural shape by compresses, bolsters, and proper supports. See the article Surgery.

ORDER III. IMPETIGINES.

Impetigines, Sauv. Clas X. Ord. V. Sag. Clas III. Ord. V.