Rickets, including osteomalacia and tetany / by Alfred F. Hess.

  • Hess, Alfred F., 1875-1933.
Date:
1930
Catalogue details

Licence: In copyright

Credit: Rickets, including osteomalacia and tetany / by Alfred F. Hess. Source: Wellcome Collection.

    43/496 (page 39)
    It is self-evident that an investigation of the incidence of ;i disease presupposes the correctness of the diagnoses, and that a considerable number of eases are not being overlooked. Herein lies tin1 fundamental weakness of almost all the investigations and statistics relating to rickets Until very recently physicians have shown a lamentable ignorance of its primary clinical manifestations. Some have included in the category all cases associated with retarda¬ tion in teething or in walking; others have relied solely on the devel¬ opment of deformities of the legs; whereas many have confused atrophic conditions of infancy with rickets. This criticism applies to the children’s specialist as well as to the general practitioner throughout Europe and the United States. It is only lately, since the newer knowledge has heightened interest in rickets, that phy¬ sicians have bestirred themselves to master its clinical signs. The result of such non-conformity has been, as will be brought out in discussing the incidence of rickets throughout the world, that we are confronted with the most remarkable hodgepodge of statistics that is to be found in relation to any disorder. It is not uncommon in relation to one and the same locality, at practically the same period — to meet with absolutely contradictory data furnished by clinicians of high standing. But another factor has served to introduce confusion into the statistics culled from various sources. During the past few years, in addition to the uncertainties resulting from oversight or ignor¬ ance, a lack of conformity has resulted from the fact that the clinical conception of rickets has undergone a radical change, that new methods of diagnosis have been introduced which reveal to us cases which until recently escaped recognition. I have reference more particularly to the use, for early diagnosis, of the Roentgen rays and the estimation of the inorganic phosphorus of the blood. Gauged by these more delicate tests, the geographical distribution of rickets is universal. From the standpoint of diagnosis it may be stated that there are two periods in the history of rickets—the one beginning about the middle of the seventeenth century and extending without great change until about the year 1920, and the second comprising the short interval since 1920. During the first span of some two hundred and seventy years, Glisson’s teaching formed the bulwark of clinical interpretation, and irregularities in diagnosis resulted from lack of knowledge or lack of care, rather than from essential differences in viewpoint. During the second period, however, objective methods of diagnosis were introduced, which rendered it possible to compare rickets in various lands and even to gauge its relative severity. These newer methods are now being employed extensively in this country, in Europe and even in parts of the Far East, so that the time is not far distant when an accurate geo-