The diseases of infants and children . s. 195, 196and 197), the thickening in the latter position being always much moreevident on the pleural surface. Moderate thickening of the shaft of thelong bones also takes place and all the distinctions of outline marked byangles, ridges and the like, are less marked than in normal bones. Thereis also thickening of the flat bones in certain regions, with the production,especially upon the skull, of large bosses; while in other portions of the 1 Jahrb. f. Ivinderh., 1899, L, 268. • Zeitschr. f. Biol., 1890, XXVII, 517. 3 Monatsschr. f. Ivinderh., Orig.,
The diseases of infants and children . s. 195, 196and 197), the thickening in the latter position being always much moreevident on the pleural surface. Moderate thickening of the shaft of thelong bones also takes place and all the distinctions of outline marked byangles, ridges and the like, are less marked than in normal bones. Thereis also thickening of the flat bones in certain regions, with the production,especially upon the skull, of large bosses; while in other portions of the 1 Jahrb. f. Ivinderh., 1899, L, 268. • Zeitschr. f. Biol., 1890, XXVII, 517. 3 Monatsschr. f. Ivinderh., Orig., 1911, X, 435. Arch. f. Kinderh., 1910, LIII, 380; LIV, 83. RACHITIS 587 cranium spots of very thin, parchment-like bone may be found (Cranio-tabes). (See Vol. II, p. 428.) These alterations produce deformities ofmany sorts, and fractures are common (Fig. 198). The degree of deformityvaries greatly, depending upon the severity of the case. Arrested growthin the length of the bones may occur as a result of the changes in Fig. 195.—Radioguaph of the Wkist in the enlarKcrnent at the wrist-joint. From a colored child, aged 2 years aud 9months, in the Childrens Hospital of Philadelphia. LongitU(Hnal section shows the junction of the shaft and the epiphysesmuch wider, thicker and softer than normal (Fig. 199) with a broadeningof the bluish, cartilaginous layer. The centres of ossification are liyper-emic, spongy and enlarged. It is to this and to the general widening ofthe cartilaginous layer, that the enlargement of the epiphysis is medulla of the shaft is redder and more jelly-like than normal and themedullary cavity broadened and its bony divisions rarefied. The perios-teum of both the flat and long bones is hyperemic, and beneath it are 588 THE DISEASES OF CHILDREN several layers of friable, spongy, vascular tissue, with large inter-trabecular spaces. Microscopically there are very characteristic changes seen. Theproliferating layer of the
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