. Médecine interne ; un travail pour le médecin sur le diagnostic et le traitement, avec un index complet 24. est faible et instable sur ses pieds et peu enclins à marcher. Il isdiffuse la tendresse des tissus et son refus d'être manipulé ou touché.Free la transpiration, surtout sur la tête et le cou, est commun. Les faibles-ness des muscles, et en particulier dans les jambes, est évocatrice d'une partialparalysis-pseudoparalysis de rachitisme. Les modifications apparaissent squelettique earlyin l'évolution de la maladie et sont caractéristiques. Ils se composent de : 1.- Le rosaire/ composcd RHACHiTic nodulaire de l'élargissement

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. Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index. is feeble and unsteady on his feet and disinclined to walk. There isdiffuse tenderness of the tissues and unwillingness to be handled or touched.Free sweating, especially about the head and neck, is common. The weak-ness of the muscles, and especially in the legs, is suggestive of partialparalysis—pseudoparalysis of rickets. The skeletal changes appear earlyin the course of the disease and are characteristic. They consist of: 1.- The RHACHiTic rosary/ composcd of nodular enlargements of the ribs attheir juncture with the cartilages on both sides. These enlargementsmay be readily felt upon palpation and in thin children may be recognizedupon inspection. They appear early and gradually increase in size untilsome time in the second year, after which they gradually disappear. 2.Changes in the Thorax.—Shallow furrows, corresponding to the junc-tion of the cartilages with the ribs, pass obliquely downward and outward.A similar transverse depression extends from the level of the ensiform. Fig. 314.—Rickets. Showing the epiphyseal enlargements, the rosary, the distended belly, and thedeformities as a whole.—Pennsylvania Hospital. cartilage toward the infra-axillaiy space—Harrison V groove. The sternumprojects, particularly in its lower half, giving rise to the prominent deform-ity known as chicken- or pigeon-hreast. These changes in the contour ofthe chest are not peculiar to rickets and may occur in any condition habitu-ally interfering with inspiration in early life. 3. Changes in the Head.—As a rule the head appears large, the frontal and parietal eminences areexaggerated, and the fontanelles remain open for a long time. The fore-head is prominent, the top of the skull flattened, and, in some cases, thehead viewed from above appears square—caput quadratum. Craniotabes.—There are circumscribed areas, mostly in the occipital, parietal, and squa-m

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• bookcentury1900
• bookdecade1920
• booksubjectmedicine
• bookyear192