Excerpt from Anemia in Infancy and Early Childhood

The two instances hitherto spoken of illustrate the close connection of two conditions noticed in very early life depending upon the anatomical structure of the affected organ. In brief, I shall allude to two others which become manifest at a little later period of infant life. Thus, in rha chitis, while the heart is of average size, the arteries are ab normally large, the liver is of extraordinary volume, and the lungs are small. Great width of arteries lowers the pressure of the blood. One of the results of this physio logical fact is the murmur audible in the brain of rhachi ticial babies, which, by no means, as Jurasz explained it, results from the anomalies of the carotic canal. Another result of the low blood pressure is the retardation of the circulation in the muscles, and more yet about the epiphy ses, which swell and soften. It is not the growth of the epiphyses alone which, by itself, results in general rhachi tis, for the epiphyses are still in their cartilaginous condi tion up to adolescence, and some do not ossify until the twentieth year of life; but no rhachitis is met with at this advanced stage. Thus it is by no means the anatomical condition of the cartilaginous tissue which is one of the causes of rhachitis, but the condition of the arteries supply ing the epiphyses. Besides, the large size and active condi tion of the liver give rise to a copious formation of choles tearin, the importance of which, in the establishment of a hyperplastic condition of cartilage cells and tissue elements in general, has long been recognized. Thus, ossification becomes irregular and defective, and the rhachiticial bone contains an abnormally large quantity of fat, in contrast with the deficient percentage of lime, which either is not introduced or not assimilated in consequence of the faulty nature of the preliminary stages of osseous development.

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