Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/452/
BONE, PATHOLOGICAL CONDITIONS OF. 
Rickets.—The consideration of this subject 
has been too frequently mixed up with that of 
the disease entitled mollities ossium (osteo- 
nialaxie), or with that of the interstitial absorp¬ 
tion of bone which occurs in aged persons. 
Rachitis seems not to be so much a softening 
of bone that had previously been solid and 
perfect, as an interruption in the first instance 
of the process of ossification. It is a disease 
of early life, generally commencing, or at 
least first observed about the period when the 
infant should make its earliest attempts to walk, 
and rarely appearing after the age of two years. 
It would appear that the disease should be 
considered as connected with inadequate nu¬ 
trition throughout the body generally, rather 
than as being confined to the osseous system ; 
its effects are only most obviously marked on 
that system ; and it is quite certain that all 
the bones of the skeleton are more or less af¬ 
fected, although particular local causes com¬ 
monly produce much greater deformity in one 
than in another. 
The early symptoms of rickets are invariably 
those of imperfect or deranged nutrition, pale¬ 
ness of skin, flaccidity of fibre, &c. Along 
with these symptoms or shortly succeeding to 
them the deformities appear which cause the 
disease to be ranked amongst the affections of 
the osseous system. In mild cases these ex¬ 
tend no farther than to an increase in the cur¬ 
vature of some of the long bones and an aug¬ 
mented expansion of their extremities. Whether 
from its supporting the whole weight of the body 
or from the action of the strong muscles behind 
it, the tibia generally suffers in a remarkable 
degree : the legs are not only bent forwards, 
the curve being sharp and sudden about the 
lower third of the bone, but they are twisted in 
such a manner as to bring the internal ankle 
below its proper level, deformities which, not¬ 
withstanding a perfect recovery, are never com¬ 
pletely removed afterwards. Rickets, consi¬ 
dered alone, is not very dangerous to life : in 
most instances it proceeds no farther than has 
been already described—the visceral derange¬ 
ments are either subdued or subside sponta¬ 
neously, the healthy functions are re-estab¬ 
lished, and amongst them that of ossification, 
and the patient soon becomes enabled to per¬ 
form the ordinary motions, while the deformity 
in some slight degree disappears. But if the 
disease is severe or protracted, or complicated 
with a scrofulous taint, it generally leaves 
tokens behind it which embitter the patient’s 
future existence, or hurry him to a premature 
grave. Sometimes the head becomes flattened, 
or pushed so as to project backwards, or is 
otherwise strangely deformed. More frequently 
still the chest suffers in shape, either in the 
ribs, the spine, or in both, and the compressed 
and contracted thorax, or laterally curved spine, 
with all their accompaniments and consequences 
of deranged respiration, will be the result. But 
of all the parts which suffer from this disease, 
perhaps the pelvis is that which is most fre¬ 
quently engaged. Placed between the spine 
and the thighs, it is the fulcrum and centre on 
which numerous motions are performed; it is 
surrounded by powerful muscles and subjected | 
to irregular and unequal pressure ; and it also I 
sustains the weight of the principal part of the 
body. Hence arise the strangest and some¬ 
times the most complicated distortions, and 
woe to the female who at the age of woman¬ 
hood becomes pregnant under such circum¬ 
stances. The remote consequences of rickets 
may, therefore, be far more formidable than ” : 
the immediate. 
The actual condition of a bone with reference ; 
to its structure is the next point to which we 
must direct our attention. Is there an absolute 
deficiency in the quantity of ossifie matter \ 
secreted, the place of which is supplied (espe- - 
daily about the epiphyses of the bones) by a 
soft substance which increases their bulk ? or is 
the earthy material removed by absorption * 
previous to the deposition of this softer sub- • 
stance ? The question is not easily answered, 
for patients seldom die of rickets alone; and 
when they perish, it is generally in consequence ' * 
of some complication of scrofula producing 5 
hydrocephalus, tabes mesenterica, glandular 
abscesses, or, it may be, caries ; and it is evi¬ 
dent that the examination of a case so mixed 
cannot afford a satisfactory demonstration of 
the disease itself. It cannot, therefore, be a 3 
matter of surprise if some difference of opinion : 
has existed. The following is the description r 
of a ricketty bone as given by Boyer.* It is 
lighter, of a red or brown colour, pierced by a 
great number of dilated bloodvessels, porous i 
and spongy, soft and compressible, moistened 
with a sort of sanies that may be pressed out 
as from a sponge, or rather from leather that 
has been soaked to maceration. The walls of 
the medullary cylinder of the long bones of 1 
the extremities are greatly thinned, whilst the 
bones of the skull are increased in thickness 1 < 
and become spongy, and, as it were, reticulated. * 
Both the one and the other, but especially the 
long bones, have acquired a remarkable sup¬ 
pleness, but when bent beyond a certain point 
they break : and the fracture takes place more 
easily if the inflexion is made rapidly. The ‘l 
medullary cavity of the long bones contains, 
instead of marrow, a reddish serosity, totally 
devoid of that fat and oily character which 
appertains to marrow in its natural state. The I 
result of Mr. Stanley’sf experience is that the 
consistence of a ricketty bone is out slightly j 
different from that of common cartilage, an |. 
opinion more consonant with our notions of 1 
the disease than Boyer’s exaggerated descrip- || 
tion is calculated to convey. We ourselves 1L 
have never met with that extreme degree of I. 
softness which has been occasionally described, 
or which would permit of the bone being di- 11 
vided by a knife. MeckelJ states that the bones f | » 
of ricketty patients are soft, spongy, flexible, il, 
and curved, both in situations where they are 11 
subjected to muscular actions, and where they 11 
have some weight to support. In the meantime || 
* Boyer, Traité des Maladies Chirurgicales, tom. *• I 
iii. p. 625. 
f Medico-Chirurgical Transactions, vol. vii. 
j Meckel, Manuel d'Anatomie, tom. i. p. 344.
        

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