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For my own part I believe syphilis may of itself produce conditions which simulate those of rickets, but the two diseases are entirely separate and distinct.

Alteration of the bone and enlargement of the joints.—One of the chief phenomena that challenges our attention in cases of rickets is that of enlargement of the joints, which have, at the same time, associated with them characteristic deformities of the whole skeleton. Many of these are familiar to you; for instance, the bones of the lower extremity are much more bent than the other, and naturally such should be the case, they having to sustain the greater weight of the body. In looking for special alterations and enlargement of the bones, I found invariably the epiphysis of the wrist became altered first,—an explanation for which has lately been given to the effect that children are during first months of life four-legged animals, crawling on hands and knees.

The next point of interest was that of beading of the ribs, which, in each case, was found only along the fifth, sixth and seventh, they being the first to become bowed.

In none of these cases was the child's head found enlarged to anything like the extent spoken of by writers on the subject, but there was a prominence of the forehead and tenderness all over the occipital region with only a partial closure of the fontinelle.

Craniotables. This unique symptom (a study of which we are indebted to Dr. Jacobi*) was well shown in each case, but in order to detect the soft spots I had to examine the head with much care, and pursued that plan suggested by Dr. Parry, namely, after placing yourself immediately before the child, to put the heel of the hand upon either temple, carefully examining the upper portion of the occipital and the posterior portions of parietal bones with the fingers perpendicular to their surfaces.

Vogel always goes over the head twice, making but little pressure the first time on account of a fear of irritating the brain.

Associated with these craniotabic spots, and just in proportion as they were brought about from pressure of the brain and counter-pressure of the pillow upon the diseased occipital bone, did another, and I may say equally important symptom of rickets come on; I allude to that much-talked-of nervous disorder, laryngismus stridulus, and in order to satisfy myself fully that it was caused in the above way, I watched with much interest the effects of the usual nervine remedies given during these attacks to see to what extent they modified them, but found no positive relief could be obtained until the child's general condition was improved by a systematic line of treatment.

* American Journal of Obstetrics, November, 1870.

Here, before closing, permit me to say a word in connection with the treatment of rickets, which is that he only will meet with success who ignores its local symptoms, and instead seeks to apply his remedies to the conditions upon which they depend.







SECTION Seven on Dental and Oral Surgery convened in the Council Chamber June 6th, at 3.30 P. M., and was called to order by the President, Dr. D. H. GOODWILLIE, of New York; Dr. T. W. BROPHY, of Illinois, Secretary.

Dr. W. W. ALLPORT, of Illinois, moved that a committee of three be appointed, to whom all papers be referred, etc. Adopted.

The chair appointed Drs. AllPort, Brophy, and WILLIAMS.

Dr. MARSHALL moved that volunteer papers, if any were present, be now read.

The Secretary stated that there was a paper from Dr. Barrett, of Buffalo, which was accompanied by models to illustrate it, but since the models were at the hotel the reading of the paper would have to be postponed until next day.

A paper entitled Oral Hygiene was read by Dr. WILLIAM D. KEMPTON, of Ohio.

Dr. WILLIAMS advocated rest and exercise alternately.

Dr. Brushing, the circular motion so as to be more thorough in cleansing, the cross motion, etc.

Dr. Talbot spoke of the value of our Section in educating physicians, so as to enable them to teach their patients how to care for their teeth ; spoke of his little daughter, whose teeth were prone to decay, but by care it has been arrested, and in some instances prevented. Spoke of civilization not being the cause of decay, etc.

Dr. ALLPORT: Several things of importance agree with some, disagree with some. Do not believe that living in luxury leads to decay. Indians have teeth as poor as the highly civilized. The teeth posterior to second molar are not usually cleansed,

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