. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. in rickety children. Irregularityin the formation of the medullary spaces also plays acertain part. In the flat bones growth in thicknessis hindered. In the skull the disease affects chiefly the frontaland parietal bones. The bony substance may be sopoorly developed that the bones are soft and flattened,yielding to pressure (cranio-tabes). In other places,especially the frontal and parietal eminences, thebones are thickened and prominent from the over-formation of bony tissue. The cra
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. in rickety children. Irregularityin the formation of the medullary spaces also plays acertain part. In the flat bones growth in thicknessis hindered. In the skull the disease affects chiefly the frontaland parietal bones. The bony substance may be sopoorly developed that the bones are soft and flattened,yielding to pressure (cranio-tabes). In other places,especially the frontal and parietal eminences, thebones are thickened and prominent from the over-formation of bony tissue. The cranial sutures andfontanelles remain open for a long time, and hydro-cephalus is often present. The upper and lowermaxillae are flattened and irregularly developed, andthe implantation of the teeth is irregular and abnor-mal. The weight of the body causes bending of thesoftened bones; the spine becomes kyphotic orscoliotic; the thorax is constricted laterally, and thejunctions of the cartilage and bone of the ribs becomethickened (beaded ribs or rickety rosary). The pel- 128 Bockenlieinier, Atlas. Tib. I.,. Fig. 05. Rliacliilib. Inlraclioiieb cruris iitriubL|iie. P(. rft«. XI \__1. vie bones remain small, so that the rickety pelvis isa cause of obstructed labor. Lastly, in severe cases,the lower extremities become extremely bent and thebones are liable to greenstick fracture. In the second year there is usually thickening ofthe epiphyses of the bones of the limbs, especiallythe lower ends of the ulna, radius and tibia; whilethe diaphyses, especially of the femur, tibia andfibula are curved. The femurs are bent outwards,the bones of the leg outwards and forwards (). Genu valgum occurs in the knees. The archof the foot sinks in, causing flat foot. In severecases of rickets the children remain so backward ingrowth that they become dwarfs. The so-calledfetal rickets, according to recent investigations, hasnothing to do with rickets. True rickets occursexclusively in chil
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