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admittedly mild in almost every ease, but deformity none the
less. A similar state of affairs exists in other areas where we
have clinics and I have been compelled to comment on it in
other reports.
If we knew as much about the causation and prevention
of other diseases as we do about rickets, the golden age of public
health would be within sight. Even a casual reading of such
an article as that written by E. A. Park and M. M. Elliott in
"Parsons' and Barling's Diseases of Infancy and Childhood"
(Oxford Med. Publ., 1933, Vol. I, p. 216) conveys a clear
impression of the astonishing success that has crowned the
efforts of research workers and clinicians who have made a
study of this disease. Why, then, in an accessible urban area
should this disease persist? There are several factors, though
it is hard to arrange them in order of importance.
First the personal factor—the mentality of the mother.
The trouble is that no one is frightened of the disease. It may
pre-dispose to more serious illness, but as seen nowadays it is
rarely fatal of itself—and the mothers know it. It is also known
that rickets often gets better if nothing specific is done, and the
mother of ten will sometimes say with pride that all her children
had had bow-legs, "but they all grew out of it, doctor"—a sure
indication of the good family constitution. The minor permanent
deformities (one quite incurable form of flat foot is due to
rickets) are there, all the same, though they may escape the
unobservant. The effect on the general health, though more
difficult to assess, cannot be disregarded.
Second, the myth that breast-feeding protects against
rickets. It is true that the breast-fed infant is not likely to get
rickets, but many cases have been recorded of mild disease in
breast-fed infants. We can never be sure that the milk of
mothers who live in our relatively sunless climate, and more
particularly under the conditions that prevail in most urban
areas, contains a sufficiency of Vitamin D. 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
except perhaps during sunny months when they are able to
sleep out of doors for many hours at a time.
Third, the danger of cod-liver oil and malt. In bottle-fed
infants and in infants after weaning, it has long been customary