=Symptoms.= The common symptoms of rickets which appear early are irritability; restlessness particularly at night; a tendency toward convulsions from very slight cause; digestive disturbances and profuse perspiration about the head. The baby may be fat, but is likely to be flabby and to have a characteristically white, “pasty” color. The fontanelles are large and late in closing; the abdomen is large and the chest narrow; dentition is usually delayed and the teeth may be soft and decay early. But the most conspicuous effect of rickets is upon the entire bony skeleton, due to the inadequacy of the lime deposit. The bones are soft, easily bent and broken and often misshapen. Their growth is likely to be retarded and the ends of the long bones may be enlarged, giving the familiar swollen wrists and ankles, while the nodules which form at the junction of the ribs and sternum, produce the beaded appearance so commonly called a “rickety rosary.” The bones in the arms and legs may become curved as the baby lies or sits in its crib, making him either bow-legged or knock-kneed. The deformity is increased by walking because the soft bones are easily bent by the weight of the body. The spinal column may be curved or too weak to permit the baby to sit straight or stand alone. The entire chest wall is often deformed (Figs. 142, 143) producing the familiar “chicken breast,” as well as a serious decrease in the size of the thoracic cavity, and through loss of rigidity of the bony wall, the respiratory movements may be seriously impaired. The forehead is prominent and the whole head looks square and larger than normal, while the pelvic deformities in girl babies often give rise to very serious obstetrical complications later in life, as has been previously explained. [Illustration: FIG. 143.—Interior of specimens in Fig. 142 showing nodules, due to rickets, protruding into thoracic cavity and encroaching upon space occupied by heart and lungs. This is a factor in the respiratory diseases which frequently complicate rickets. ] Although lack of fresh air and sunshine seem to be factors in producing rickets, it has been observed that the disease does not develop in poor surroundings if the diet is suitable or if cod-liver oil is given to babies fed artificially, or on unsatisfactory breast milk; but that it may occur in the presence of satisfactory hygienic conditions if the diet is faulty in certain respects. For children under a year old, the desirable food is good breast milk, or, lacking that, fresh, certified cows’ milk, with fruit juices, scraped beef, eggs and strained vegetable purées, started as early and increased as rapidly as the baby can digest them.