exercises: we have already stated that when under a proper direction gymnastics may be of the highest possible benefit, but the general state of the constitution must be previously modified. Many surgeons who have not sufficiently studied the subject they have to treat, and are therefore unable to give a useful and enlightened opinion, frequently recommend the use of the triangle for young ladies predisposed to scrofula: the deviations for which the triangle was advised are mostly increased by this exercise; and we strongly recommend parents to guard against this danger.

Excess of intellectual occupation, strong mental emotions, may disturb the economy, and admit the development of the predisposition to scrofula.

It is not our desire to treat this question for the faculty alone; our observations are intended principally for parents, and we confine ourselves to recommending the judicious use of all physical agents. But if the disease be once seated in any organ, parental care will not then suffice; medical assistance cannot be dispensed with: the efforts of nature will not cure those glandular swellings on the neck, which if not properly treated, break, and leave indelible scars, which are incompatible with beauty.

CHAP. IV.

Rachitic Constitutions.

Most authors have considered this diathesis as a variety of the preceding disease. At the commencement of the seventeenth century this affection was commonly known in England under the denomination of Pott's malady, and on the continent it was termed the English disease. It first appeared as an epidemic in Dorsetshire and Somersetshire, was speedily propagated through England and the north of Europe, and no measures were taken to arrest its progress. Towns were still surrounded by high walls, and deep ditches filled with stagnant water, the people crowded in narrow streets and damp habitations, wanting air and light. With such a combination of circumstances the evil could but extend and increase, and the heart sickens at the description of these ancient towns when visited by this scourge.

Examples are related of children born with rachitis, but this disease is seldom manifest till after dentition; it is when children begin to walk that parents perceive the bones of the legs are weak, and may be said to bend beneath the weight of the body. Rachitism is a disease of the bones; the whole system may be influenced by it; and

the development of children thus affected is mostly tardy. As age advances, the growth of the bones does not keep pace with the growth of the tissues of the economy, and deformations ensue. Rachitism is mostly manifested after any disorder in the functions of the economy, whether of the cerebral or digestive apparatus; thus the progress of growth is sometimes arrested by convulsions, sometimes by the state of the digestive functions.

Rachitism being a disease of the blood, in which the fluids are wanting in plastic, perhaps also in phosphate qualities requisite for the consolidation of the bones, it is therefore mostly to the alteration of the blood that we must seek the cause of this disease, and thus admit the same causes for rachitism as we have done for scrofula-heredity, unwholesome nourishment, impure air, damp habitations; and although it must be allowed that the children of the opulent, who want for nothing, are often affected with rachitism, owing to the weakness of the fluids, which affect the blood; nevertheless, the great influence of physical agents, so strongly manifested on the whole animal race, must be acknowledged. For instance, is not incurvation of the bones often seen in flocks of young ducks and goslings, when continually exposed to damp and rain; and also in young hounds, kept in damp kennels? The influence of physical agents and of nourishment will be found in all diseases, whether of man or

brutes, though the manifestations are not always the same.

A child threatened with rachitism, becomes pale and thin; its limbs are small and the joints large, quite out of proportion with the other parts of the body. A child thus affected, who has not yet learnt to walk, cannot support the weight of its body; the legs hang down, as the child is incapable of communicating to them the necessary movement and strength. If the child has already walked it can no longer do so; dentition also is late when there is predisposition to rachitism. Not only are the limbs weakened, but both sides of the chest are flattened, the sternum projects, and we have what is termed a pigeon chest, which is always an unhealthy conformation. It is not merely the long bones and the ribs that are modified, but the vertebræ also; and the child, unable to maintain its equilibrium, falls either to the right or left, and becomes deformed. The width of the chest is diminished, the functions of the lungs and heart are confined, and life is curtailed. A time comes when not only the bones are softened, but their substance is so deeply altered, that caries of the vertebræ is the fatal result; for the powers of art seldom suffice to arrest the progress of this fearful disease. When children do not perish before the age of puberty, a favorable change may sometimes take place; the

CC

efforts of natur eare increased, and the imperfect organization is improved.

Rachitism has been frequently remarked as common in some localities. The recommendations that can be made for children predisposed to rachitism are confined to general observations; for instance, a good nurse, country air, attention to prevent all serious diseases, and not to make infants walk too soon. Our observations on scrofula are equally applicable to rachitism; but in the latter case no gymnastic exercises should be allowed. Dupuytren recommended champooing and pressure on the deformed chest, to bring it to its natural shape. We do not advise gymnastic exercises in cases of rachitism, because they cannot be employed with advantage when the bones are unable to render sufficient support. To fortify the constitution and improve the state of the blood, are the only rational means of preventing, and even of curing, rachitism. This disease is rather in the province of medicine than in that of maternal physical education.