I KNOW of no disease in the whole list of human ailments more interesting than that which forms the subject of this essay, whether it be considered from a pathological, and historical, or a clinical point of view. Here we have a disease common to all nations, climes, and kindred, with symptoms, phases, and features that are plainly recognized the world over; a disease which, while rarely fatal, produces serious and irreparable ravages in the framework of the organism, which in its advanced stages affects every organ and every tissue in the body; stunting the growth of the young, a blemish upon the beauty of the mature, a serious menace to maternity from distortion of the pelvis; a disease whose effects we are powerless to overcome, and yet one which is conceded by all authorities to be easily preventable.
Such is a brief and partial description of the affection to which I invite your attention. I shall waste no time in describing the features of well-marked cases. Its pigeon breasted, narrow- chested, how-legged victims are common sights in every land, and their clinical history is familiar to every physician. I shall not spend you time either in a discussion of controverted points, such as heredity, syphilitic complications, etc.
I desire rather to point out, as clearly as I may, the early symptoms by which the rachitic cachexia may be recognized before any serious damage is done to the organism, and which, to my mind, have been ignored or treated carelessly by those who have written upon the subject; and then to give you what of averting all harm by promptly arresting the progress of those symptoms, as well as aborting the disease itself.
However we may regard rachitis from a controversial standpoint; however so many factors may be considered as entering into the aetiology of a given case, all authorities are agreed upon one point, viz., that the one factor that enters prominently into every case is the factor of defective food. It matters not whether the rachitic child has been nursed at the breast or bottle-fed, the one indictment that cannot be quashed, the one fact that cannot be denied, is the insufficiency or inefficiency of the food supply.
In the beginning of every case of rickets there is somewhere a fault that amounts to a failure in the matter of alimentation. The nourishment does not nourish. Some essential element necessary to the economy is either absent or is presented in a form which is ineffective. With a ravenous appetite there is lack of normal growth. With abundance of ailment there is perverted nutrition. Abundance does not satisfy; there is starvation in the midst of plenty. When breast-fed children develop the rachitic habit it is usually due to prolonged lactation, and it is of nurslings that I desire first to speak. In doing so, the necessity of brevity must excuse my apparent dogmatism.
Now there are certain facts regarding lactation that have a bearing on this subject, and these facts are so frequently observed as to be incontrovertible.
First. The health of the mother and the abundance of her milk is not always a reliable criterion by which to judge of its nutritive qualities. In other words, there are many women in perfect health and with an ample supply of milk who cannot successfully nurse their offspring.
Second. It is a law of nature, to which there are few if any exception, that every nursing woman’s milk begins to deteriorate in quality after she has nursed for a period of form seven to ten or twelve months, and this deterioration progresses steadily, whatever may be her general health, until she ceases to perform the function.
Now it is a significant fact that while rachitis is far more common among bottle-fed than breast-fed children, it still does occur among children who are nursed at the breast, and is very much more common among those who are nursed into the second year. Indeed, statistics show indubitably that there is a direct and proportionate relationship between prolonged lactation and rachitis. I know of no accurate means of ascertaining the time when the milk begins to deteriorate in a given case by any chemical, microscopical, or mechanical test.
The time unquestionably varies with different women and with the same woman at different times, but I am satisfied from personal observation that with American women, especially with those living in the large cities, the time of beginning deterioration is, on the average, less than twelve months. In some cases it may occur as early as the fifth or sixth month. As soon as the milk begins to deteriorate the child feels it. The evidences of mad-nutrition are soon manifested, and to the experienced physician the sings are unmistakable. Its body may still be plump and its color normal,. its bowels may be regular and its appetite unimpaired. It may not as yet show any marked changes in temper or reluctance to being fondled.
Long before there are any sings of articular enlargements any where; long before there is any development of a “rachitic rosary;” long before there is any flattening of the cranial bones or incipient craniotabes, there are symptoms of unmistakable import if only they are given their true significance. The first of these signs to appear usually is habitual sweating of the head while sleeping. Cranial perspiration during sleep, and especially during the day-nape, is always ominous. It may not always point to rickets, but it is always a dyscrasia.
But the most significant and certain of the early sings of impending rickets is found in the delayed evolution of the teeth. I do not refer altogether to the eruption of the teeth, although this has its significance, but to the whole phenomena of teething.
A perfectly this process by the fifth or sixth month. If this age be reached, and there be no increase of the salivary secretion; no tumefaction of the gums; no irritation of the nervous system, accompanied with suggestive actions pointing to the mouth as its seat; if, word, there is no change in the inner contour of the jaw indicative of activity there; and if this condition goes on to the seventh or eighth mouth, the watchful physician should be on his guard. If, in addition, cranial perspiration is present whenever the child slumbers; and further, if the mental condition, the settled characteristic melancholy, is apparent, we need not wait for further development to diagnose the disease.
Another symptom connected with teething is often present in children in whom the disease has stated, after one or more teeth have erupted. It is the prolonged interval that elapses between the cutting of single teeth or pairs of them. These intervals are, as a rule, reasonable regular in healthy children, and any unusual delay in the continuance of the process of tooth evolution should not be allowed to pass unnoticed.
When these conditions are recognized, it is neither an act of prudence or wisdom to delay a radical change of diet. The child should be taken from the breast at once and placed on artificial food. At the same time it should be given systematically and persistently the indicated Homoeopathic remedy. Our pharmacopoeia is rich in remedies of untold value in these cases. Mercurius Solubilis, Colchicum, Asafoetida, Silicea and Sulphur have all been given successfully in appropriate cases, besides many more which I need not name. But the remedy of all remedies-the one which is in the truest sense Homoeopathic to the typical case of rachitis in all its stage and phases; the one remedy to be first thought of in the incipiency of the disease; the remedy which, in itself, is a standing monument to the grains of him who gave to the world the immortal aphorism, “similia similibus curantur” -is Phosphorus.
Whoever reads a proving of Phosphorus, reads a description of the essential features of rachitis. Even in the cases of poisoning from this drug, there is much that is suggestive of its disease similimum. Phosphorus has produced osteo-malacia in the adult, a diseased condition which, in its course and nature, is almost identical with the rachitis of infancy. But clinical experience shows that we do not get the best value of Phosphorous when we give it in its simple and direct form. It combines too readily with oxygen to form Phosphoric acid for it to serve our use. By adding it to lime, however, and forming our Calcarea phosphorica, we have a remedy for rachitis par excellence.
Calcarea phosphorica covers more completely than any other single remedy the full picture of a typical case of this disease. It has both fontanelles open, tardy dentition, sweating of the head, the pot-bellied abdomen, indisposition to being handled, the settle melancholy, the soft, spongy condition of the bones; and, indeed, the whole catalogue of symptoms with which you ar so familiar.
Many of these symptoms are also covered by Calcarea carbonica, but not to the same extent and fulness. Comparing the two drugs, I should say that Calcarea carbonica meets more quickly the objective symptoms, while Calcarea phosphorica more its subjective ones. In other words, the first acts on the blood and the soft tissues, while the other affects the osseous and the harder tissues. The one acts superficially, the other more profoundly.
