The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
In the extremities we see _bow-legs_, _knock-knees_, _clubbing of the
ends of the long bones_, bending of the neck of the femur, _flat-foot_,
_club-foot_, etc.; while the clubbing of the bone ends also may be well
marked in the bones of the upper extremity, where, however, marked
deformity is less common, because the upper extremity does not bear
the weight of the growing body. In the skull the bones remain soft
and yielding to pressure, with a tendency to return to their original
membranous condition, and this is the condition comprised under the
term _craniotabes rachitica_. The _fontanelles always remain open_ for
an undue time; the sutures are broad and membranous. The _bones of the
face grow less rapidly_, giving to the face a disproportionately small
size; _dentition is delayed_ and the _teeth decay easily_. The upper
incisors often project far over the lower.
In the thorax there are enlargements of the sternal ends of the ribs,
causing a row of nodules referred to as the _rachitic rosary_. The ribs
tend to sink in, the sternum to be protruded forward, and the deformity
known as _pigeon-breast_ becomes often pronounced. Curvatures of the
spinal column, especially _kyphosis_, are common, and distinct degrees
of _lateral curvature_ are frequently begun as rachitic deformities, to
be magnified by perverted muscle action as the child grows older. In
the pelvis the innominate bones approach each other, causing the pelvic
cavity to become contracted, or the sacral promontory projects too
far, or in various other ways the normal pelvic diameters are so far
compromised that _rachitic deformities of the pelvis_ constitute the
most common and serious obstacles to normal labor in adult women, and
are frequently the cause of major obstetric operations.
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