A cast of congenital rickets.

Abstract

The highest incidence of rickets is in the latter months of the first year. It is uncommon before two months of age and it becomes less frequent after the first year of life. It is quite infrequent during puberty. Only rarely is it congenital. Maxwell and his collaborators made a study of congenital rickets in infants of osteomalacic mothers in China. In the first of 2 cases reported in 1930 (6), only the roentgenograms taken during the first five days showed marked evidence of the disease. In the second case, films obtained on the first day of life exhibited mild rachitic changes. In a second paper, in 1932, Maxwell (7) reported clinical, roentgenologic, and histologic evidence of fetal rickets in children examined during the first five days of life. By 1934 (8) he was able to report 16 cases of fetal rickets. Radiologic evidence was present in all, and 5 manifested characteristic histologic changes. In a case published in 1938 (9) roentgen evidence of severe rickets was obtained on the day of delivery, and the infant suffered several fractures of the limbs during the first three weeks of life in spite of careful handling. All of these infants were born of osteomalacic mothers. Wolfe (15), in 1935, reported 3 cases proved clinically, roentgenologically, and histologically to be congenital rickets. The mothers, living in China, had suffered from osteomalacia during pregnancy. Two of the infants were stillborn. Histologic studies of the deciduous teeth in these 2 cases and of an extracted tooth of the living child revealed the hypoplasia that took place during intra-uterine life. The predentinal zone was widened and the dentine unevenly stained, with irregular margins. The probable stage of fetal life at which rickets occurred could be determined from the location of the dentine and enamel defects, which were correlated with the period at which these parts are known to develop. Wolfe concluded that changes in the bones may entirely disappear, but those in the deciduous teeth remain as permanent stigmata of rickets. Rector (12), in 1935, reported the case of an infant born in Massachusetts of a mother who had been vomiting severely for weeks. Radiologic and histologic studies of the child, which died on the second day after birth, revealed rickets. It was concluded that the rachitic process was apparently due to severe malnutrition in the mother. In Ranstrom and von Sydow's series (11) of 181 infants dying soon after birth, 103 (56.9 per cent) presented definite histologic features of rickets. Of the 69 infants dying during the first day of life, 20 (29 per cent) had rachitic changes which must be considered as congenital. The incidence of rickets was about the same in the premature and full-term infants but increased rapidly with increasing age during the first weeks of life.