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are not extraordinary or exaggerated compared with figures published in other
places* where an attempt has been made to assess the incidence of the disease,
which show also that the risks are not confined to England, although on the
Continent rickets is known, somewhat unpleasantly, as " the English disease."
But if they are in any way correct, whatever the actual powers of the exrachitic
patient in the adult period of life, it would seem it might be advantageous
and a public economy to run the problem further to earth and really get at the
base of rickets (or of rickety appearances) and their more certain cure. One
must not forget that with the precautions taken according to our present state
of knowledge, no child in this Borough attending a Welfare Centre regularly has
any right to develop true rickets.
Dental caries we have discussed before in the same connection since there
is at least some evidence that it may be led up to by poor quality teeth, such as
are encountered frequently in rickets. This year the figure for dental caries
again shows 20 per cent. of the total children affected, and 57 per cent, of those
showing caries at the age of 2 years already having four or more teeth affected
(exactly as last year) and 36 per cent. ditto at the age of 3 years. Since at
the age of 2, many children have not even cut their full first set of 20, it is obvious
that physiological growth can hardly keep pace with pathology here, and that
dental treatment is never going to solve the problem. Like rickets, it remains
something we do not know about yet, at bottom—that resists our methods of
prevention ; that awaits real, practical exploration still in the human patient,
and that apparently needs earlier and different methods of prophylaxis if improvement
is to be attained.
These are some of the problems that in spite of the excellent showing of
our records in certain respects, and the steady gratifying progress of the children
towards greater apparent general well-being, remain with us to whet our appetites
and our interest for further endeavours to get a child population that by
comparison with others, at home or outside England, is beyond reproach. In
Woolwich we are not without the means to do this, given the necessary reinforcements
in knowledge and in our medical understanding.
References.
(1) Germany. Schmol of Dresden found unmistakable evidence of past rickets in 89 per
cent. of children submitted to post-mortem examination between the years of 1901 and 1908.
(2) Ferguson and Findlay (Medical Research Special Report No. 70, 1917) found
well over 50 per cent. Glasgow children with definite signs of having had rickets."
W United, States. Eliot (Newhaven) in 1925 found X-ray evidence suggesting an incidence
of 90-96 per cent. rickets in a series of children of native American and mixed European stocks
that were examined.
(4) England. McGonigle in 1923 found 83 per cent. of 2,676 County Durhan school children
with definite rachitic signs plus 11 per cent. " query rickets."
(5) England. Of 1,638 London five year old school children examined under auspices of London
ounty Council at the request of the Board of Education Committee, 87.5 per cent. found to
how rickety stigmata.