On Cases Described as “Acute Rickets” Which are Probably a Combination of Scurvy and Rickets, the Scurvy Being an Essential, and the Rickets a Variable, Element

One of the earliest descriptions of infantile scurvy. Summary in Lancet 1882;(June 3):924, DOI: OSTEAL OR PERIOSTEAL CACHEXIA.In the last volume of the St. Bartholomew’s Hospital Reports there is an interesting though short account byDr. Gee of five cases of children in whom there was more or less swelling of one of the long bones, with deep cachexia,without any clear indication of inherited syphilis, unless in one case, even where it was not distinctly excluded. Someof the cases had rickety features, but the cachexia was too profound to be explained by rachitis, without enlargementof spleen, which did not exist. Of the five cases three died, one was lost sight of, and the fifth recovered. The outline oftwo cases may be given. H-, a baby fourteen months old, seen with Dr. Grosvenor, of Notting-hill. For two monthsthe lower half of the right femur and of the right tibia had been enlarging and painful; the enlargement was considerable, without signs of subperiosteal suppuration; the pallor was extreme; no fever; no signs of any internal disease, exceptof slight pulmonary catarrh. The child died next day. The fifth case was a boy aged nine months, seen with Dr. Glover.He had been brought up by hand; had never been healthy; had bad eczema at times, leaving a few scars. There wereno reasons for suspecting syphilis. There was a swelling of the left leg, at first like dropsy, but at the time of Dr. Gee’svisit more defined-the lower half of the left tibia was much enlarged, probably very painful, especially at night. Sowas the lower end of the right radius; the ribs were much beaded; the two lower incisors were through; nothing amisswas to be felt in the abdomen. A curious feature of this case was haematuria, or rather haematinuria. In one of the Ifatal cases Dr. Gee describes haemorrhage into the left eyelid, and into the gums where the teeth are being cut, and abruise over the sternum. Case 5 got well. Iodide of potassium did no good, but the little patient began toimprove with Parrish’s food. The swelling has all gone, and the patient has become strong. The rachitic element inat least three cases cannot be doubted, but the profound cachexia, apart from visceral or lymphatic disease, and theenlargement of the bones, seem to Dr. Gee to indicate a form of disease hitherto unrecognised.