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children are immune. While it is true that a breast-fed infant is less likely than any other to develop
rickets yet well authenticated cases of rickets (generally mild) have been recorded in breast-fed children.
Any breast-fed child born between June and September may develop rickets if it is not allowed out
of doors in as much light as possible throughout the winter months. It is my opinion that, as a complete
safeguard, a drachm of pure cod-liver oil or its equivalent should be given daily after the first
month to all breast-fed children during the sunless and inclement winter months.
Acute septic infection of joints complicating specific fevers, generally scarlet fever, is a rare
but exceedingly crippling condition. Only one such case has come to us recently from the Willesden
area but this unfortunate child will require constant orthopaedic treatment for about another six years,
and she will never walk normally. The trouble is that the early signs of acute arthritis in an already
sick child are not very striking. In our experience at Stanmore of a number of such cases, drawn
from a very wide area, we have found that the joint lesion has not attracted attention until an abscess
has appeared, or until stiffness and deformity are found after the child has recovered from the acute
fever. By that time the damage has been done.
Early surgical treatment may prove disappointing if the initial joint infection is unusually
severe, but sometimes excellent results follow early drainage. Early diagnosis is therefore of importance
and I should like to enter a plea for early investigation of any case of scarlet fever developing
pain in the region of a joint. To judge from our experience at the Clinic, Willesden has been blessed
with unusual freedom from these cases, but one never knows when they may arise. Septic arthritis
is admittedly rare, but it is a most crippling condition; the treatment is lengthy and therefore
expensive.