he
child while sitting or being carried--for example, the arm bones become
bent in children who paddle about the floor with the aid of their arms;
and in a child who lies on its back with the lower limbs everted, the
weight of the limb may lead to curvature of the neck of the femur--coxa
vara. The clavicle or humerus may sustain greenstick fracture from the
child being lifted by the arms; the femur, by a fall. From the extreme
laxity of the ligaments, the joints can be moved beyond the normal
limits, and the child is often observed to twist its limbs into abnormal
attitudes.

_In Children who have walked._--In these children the most important
deformities occur in the spine, pelvis, and lower extremities, and
result for the most part from yielding of the softened bones under the
weight of the body. Scoliosis is the usual type of spinal curvature, and
in extreme cases it may lead to a pronounced form of hump-back. The
pelvis may remain small (_justo-minor pelvis_), or it may be contracted
in the sagittal plane (_flat pelvis_); when the bones are unusually
soft, the acetabular portions are pushed inwards by the femora bearing
the weight of the body, and the pelvis assumes the shape of a trefoil,
as in the malacia of women. The shaft of the femur is curved forwards
and laterally; the bones of the leg laterally as in bow-leg, or
forwards, or forwards and laterally just above the ankle. The
deformities at the knee (genu valgum, genu varum, and genu recurvatum),
and at the hip (coxa vara), will be described in the volume dealing with
the Extremities.

The majority of cases seen in surgical practice suffer from the
deformities resulting from rickets rather than from the active disease.
The examination of a large series of children at different ages shows
that the deformities become less and less frequent with each year. Those
who recover may ultimately show no trace of rickets, and this is
especially true of children who grow at the average rate; in those,
however, in whom growth is retarded, especially from the fifth to the
seventh year, the deformities are apt to be permanent. It may be noted
that the scoliosis due to rickets has little tendency towards recovery.

_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 adva