There is little doubt
that defective nutrition and bad hygienic surroundings are
prominent factors in its production. The principal pathologic
change is seen in the epiphyseal lines of long bones and beneath
the periosteum. Figure 213 shows the appearance during life of a
patient with the highest grade of rachitis, and it can be easily
understood what a barrier to natural child-birth it would
produce. In rachitis epiphyseal swellings are seen at the wrists
and ankle-joints, and in superior cases at the ends of the
phalanges of the fingers and toes. When the shaft of a long bone
is affected, not only deformity, but even fracture may occur.
Under these circumstances the humerus and femur appear to be the
bones most likely to break; there is an associate deformity of
the head, known as "craniotabes," together with pigeon-breast and
various spinal curvature. The accompanying illustration is from a
drawing of a skeleton in the Warren Museum in Boston. The subject
was an Indian, twenty-one years of age, one of the Six Nations.
His mode of locomotion was by a large wooden bowl, in which he
sat and moved forward by advancing first one side of the bowl and
then the other, by means of his hands.
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