The medical diseases of children . wasting may be present, but in many thechild is fat, often too fat, pale and flabby. The temperature is notraised unless some complication be present, although there is apparentlysome sensation of heat, if we judge by the frequency with which the 64 CONSTITUTIONAL DISEASES bed-clothes are kicked aside at night by the patient. Sweating oi thehead, often very profuse, may occur during sleep. Bony Changes.—These, as a rule, are first seen in the beading of theribs. Rounded eminences develop at the costochondral junctions,those of the sixth ribs being usually the
The medical diseases of children . wasting may be present, but in many thechild is fat, often too fat, pale and flabby. The temperature is notraised unless some complication be present, although there is apparentlysome sensation of heat, if we judge by the frequency with which the 64 CONSTITUTIONAL DISEASES bed-clothes are kicked aside at night by the patient. Sweating oi thehead, often very profuse, may occur during sleep. Bony Changes.—These, as a rule, are first seen in the beading of theribs. Rounded eminences develop at the costochondral junctions,those of the sixth ribs being usually the first affected. A row of thesebeads forms the rickety rosary. Similar changes may occurinternally at these junctions. The chest wall, which is unduly softand yielding, easily undergoes changes in shape. There is a tendencyfor the lower ribs to become everted, and for a transverse groove toappear, stretching from the ensiform cartilage to the posterior axillaryline (Harrisons sulcus). In more severe cases, the lateral aspects of. Fig. ii.—Rickets; Posterior Aspect of Deformed Chest. the chest may become sunken by the development of longitudinalgrooves, the costal cartilages being protruded forwards and the ribs,and possibly the clavicles also, being fractured. These changes, whichare seen in Figs. 10 and n, are associated with more or less collapse ofthe lungs. While rickets will predispose towards any type of deformityof the chest, it will be seen that the purely rachitic thorax, with itslateral depressions, differs from the true pigeon-chest. In thelatter, the sides are straightened and meet at an angle at the sternum,so that in transverse section the outline of the thorax is triangular{Figs, i and 2). In both, the capacity of the thorax is head shows many important signs. The anterior fontanelle,which should measure an inch or less at the twelfth month, and be RICKETS 65 closed by the eighteenth month, remains unduly large, and closes lateowing to defectiv
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
