. The diseases of children : medical and surgical. ex-aggerated and involves the lumbar, so that the spine bows out backwards,a result largely due to the weakening of the ligaments (see fig. 38). It must not be supposed that all the changes in the shape of the bonestake place in any one case, and the degree of deformity differs according tothe severity of the case. As before remarked, the shape of the head may bequite normal, and only the epiphysial swelling and deformity be noted inthe ribs and fore-arms. Sometimes muscular weakness is the symptomwhich most strikes the friends : the child is
. The diseases of children : medical and surgical. ex-aggerated and involves the lumbar, so that the spine bows out backwards,a result largely due to the weakening of the ligaments (see fig. 38). It must not be supposed that all the changes in the shape of the bonestake place in any one case, and the degree of deformity differs according tothe severity of the case. As before remarked, the shape of the head may bequite normal, and only the epiphysial swelling and deformity be noted inthe ribs and fore-arms. Sometimes muscular weakness is the symptomwhich most strikes the friends : the child is dyspeptic, has a rounded bellyand pale face, the teeth are late in appearing ; the child, who is perhapseighteen months or two years old, cannot stand or walk, and medical adviceis sought because the parents think the legs are paralysed ; or the child isbrought to a doctor, as it is supposed he has spinal disease, on account ofthe bowing backwards of the spine ; or the pigeon-breast is the most markedand striking symptom which alarms the Rickets 203 The phenomena noted in connection with the nervous system in ricketsare among the most important. The whole nervous system appears to beaffected, the nerve centres are in an unstable condition and readily dischargeon the slightest provocation. General convulsions are common, moreespecially during the early stages of the disease ; they vary much in theirseverity, sometimes being slight and passing away quickly, but, on the otherhand, it is no uncommon thing for a rickety child of a year, eighteenmonths, or two years to die in a few moments in a fit. Laryngismus iscommon, and indeed is almost confined to those who are rickety. Tetanyis also common in rickety children. A hypertrophic condition of the brain,with a large head, is not uncommon. Rickety children are exceedingly liableto bronchial catarrh and broncho-pneumonia, and in them all chest troublesare apt to be serious. They are liable also to suffer from dyspeptic troub
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