Classic cases of rickets are now rarely seen in the pediatric practice of Boston physicians. But 90 years ago, 8 out of 10 infants under 2 years of age, seen at the Boston Infants' Hospital, were found to have had rickets, as noted below.
Four hundred consecutive infants under two years of age, medical out-patients at the Infants' Hospital, were examined for evidences of rickets. Eighty percent showed more or less marked signs. A rosary was present in every case. Only those enlargements were considered as a rosary which could be felt both parallel and vertical to the long axis of the rib. It was the only symptom in 40 percent. It was accompanied by but one other symptom in 20 percent. The single associated symptom was most often delayed dentition, next, enlargement of the cranial eminences. Delayed dentition occurred in more than 50 percent. Large fontanelle, large eminences, retraction at the diaphragm, and the enlargement of the epiphyses of the extremities were each present in about 15 per cent but were symptoms of later development. Marked rhachitic deformities were rare. About 40 percent of the cases were Russian and Polish Jews. Only 12 per cent came from the southern races. Breast milk was a part of the diet in 43 per cent and formed the whole in 18 per cent. The only influence acting on all alike was improper hygienic surroundings. These therefore must be considered as the most potent cause of rickets in Boston and vicinity.