Treatment.—­The treatment of the disease consists in regulating the diet, improving the surroundings, and preventing deformity.  Phosphorus in doses of 100th grain may be given dissolved in cod-liver oil, and preparations of iron and lime may be added with advantage.  To avoid those postures which predispose to deformities, the child should lie as much as possible.  In the well-to-do classes this is readily accomplished by the aid of a nurse and the use of a perambulator.  In hospital out-patients the child is kept off its feet by the use of a light wooden splint applied to the lateral aspect of each lower extremity, and extending from the pelvis to 6 inches beyond the sole.

When deformities are already present, the treatment depends upon whether or not there is any prospect of the bone straightening naturally.  Under five years of age this may, as a rule, be confidently expected; the child should be kept off its feet, and the limbs bathed and massaged.  In children of five or six and upwards, the prospect of natural straightening is a diminishing one, and it is more satisfactory to correct the deformity by operation.  In rickety curvature of the spine, the child should lie on a firm mattress, or, to allow of its being taken into the open air, upon a double Thomas’ splint extending from the occiput to the heels; the muscles acting on the trunk should be braced up by massage and appropriate exercises.

#Late Rickets# or #Rachitis Adolescentium# is met with at any age from nine to seventeen, and is generally believed to be due to a recrudescence of rickets which had been present in childhood.  The disease is not attended with any disturbance of the general health; the pathological changes are the same as in infantile rickets, but are for the most part confined to the ossifying junctions, especially those which are most active during adolescence, for example at the knee-joint.  The patient is easily tired, complains of pain in the bones, and, unless care is taken, deformity is liable to ensue.  There can be no doubt that adolescent rickets plays an important part in the production of the deformities which occur at or near puberty, especially knock-knee and bow-knee.

#Scurvy-Rickets# or #Infantile Scurvy#.—­This disease, described by Barlow and Cheadle, is met with in infants under two years who have been brought up upon sterilised or condensed milk and other proprietary foods, and is most common in the well-to-do classes.  The haemorrhages, which are so characteristic of the disease, are usually preceded for some weeks by a cachectic condition, with listlessness and debility and disinclination for movement.  Very commonly the child ceases to move one of his lower limbs—­pseudo-paralysis—­and screams if it is touched; a swelling is found over one of the bones, usually the femur, accompanied by exquisite tenderness; the skin is tense and shiny, and there may be some oedema.  These symptoms are due to a sub-periosteal haemorrhage, and associated with this there may be crepitus from separation of an epiphysis, rarely from fracture of the shaft of the bone.  X-ray photographs show enlargement of the bone, the periosteum being raised from the shaft and new bone formed in relation to it.  Haemorrhages also occur into the skin, presenting the appearance of bruises, into the orbit and conjunctiva, and from the mucous membranes.