A system of surgery . g air and the sea-side may be recom-mended. The first point in the treatment of thevarious deformities is the prevention oftheir increase. Thus, infants with a weakspine must be kept as much as possible in the supine position, thosewith bent fore-arms must be prevented from crawling, and those withbent legs from walking or standing, except in moderate amount. Ifthe curvatures are severe, splints should be applied to bow-legs on theinner, to knock-knees on the outer, side of the limb. In severe casesbelow six years of age osteoclasis may be indicated if all signs ofactive
A system of surgery . g air and the sea-side may be recom-mended. The first point in the treatment of thevarious deformities is the prevention oftheir increase. Thus, infants with a weakspine must be kept as much as possible in the supine position, thosewith bent fore-arms must be prevented from crawling, and those withbent legs from walking or standing, except in moderate amount. Ifthe curvatures are severe, splints should be applied to bow-legs on theinner, to knock-knees on the outer, side of the limb. In severe casesbelow six years of age osteoclasis may be indicated if all signs ofactive disease have disappeared; when this is necessary, it shouldbe effected by consecutive attempts with moderate force, made onthe same occasion, rather than by one severe effort. After six yearsof age osteotomy may be called for. Late rickets.—The condition known under this name differs inno essential particular from the infantile disease. In Drewitts caseexamination of the bones showed the subperiosteal and epiphysial. Fig. 77.—Late Eickets. Fe-male. Aged 12. (Gluttonscase.) 374 RIOKETS. changes to be identical. The causation is not so distinctly to betraced, but there is much reason to believe that the disease is merelya recrudescence of an earlier attack which has passed unnoticed. Ashas been pointed out by Clutton, the cases differ from those in whichbending of the bones occurs between the ages of six and nine, sincein the latter the history of rickets is a continuous one. The bendingof the bones also differs from that observed at puberty or later,as in the so-called adolescent knock-knee and bow-leg, since itis accompanied by the enlargement of the epiphyses observed ininfantile rickets (Fig. 77). Late rickets usually comes under observation in children fromnine to thirteen years of age. The curvatures and epiphysialenlargements are more striking in the lower extremity, but thewhole skeleton may be involved. As in the infantile disease, the treatment depends entirely onat
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