. The diseases of infancy and childhood. born infants,especially the more vigorous ones, are readily palpable. Care should betaken not to confound these with the rachitic rosary which appears onlyafter several months. In infants under six months there may be foundsoft spots in the cranium, usually over the occipital or posterior portionsof the parietal bones. These are from one-fourth to one inch in diam-eter, and there are usually several of them present. By pressure with thefinger they give a sort of parchment-crackling sensation. This conditionis known as craniotabes. Craniotabes is a rachi
. The diseases of infancy and childhood. born infants,especially the more vigorous ones, are readily palpable. Care should betaken not to confound these with the rachitic rosary which appears onlyafter several months. In infants under six months there may be foundsoft spots in the cranium, usually over the occipital or posterior portionsof the parietal bones. These are from one-fourth to one inch in diam-eter, and there are usually several of them present. By pressure with thefinger they give a sort of parchment-crackling sensation. This conditionis known as craniotabes. Craniotabes is a rachitic manifestation anddepends in no wise upon syphilis. A rachitic cachexia is not usuallypresent until the symptoms have existed for several months, and in manycases it is not seen at all. Deformities.—The deformities of rickets are almost invariably sym-metrical in character, and usually numerous. In extreme cases almostevery bone in the body is affected. Head.—This usually appears to be too large, and although it may not PLATE III. Typical Rickets Showing the large head, narrow chest, prominent abdomen, marked enlargementof the epiphyses at the wrists and ankles. There are also curvatures of the forearms andlegs which are not so well shown. The patient a child two and a half years old. RICKETS 240 be greater in circumference than that of a healthy child of the same age,it is out of proportion to the rest of the body. In marked cases theincrease in circumference may be one or two inches. The enlargement ischiefly clue to thickening of the cranial bones. In one case with markeddeformity, we found the skull over the parietal bones half an inch inthickness (Fig. 21). This thickening diminishes with recovery, but inmost cases the head remains throughout life larger than it should be.
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