Local Treatment.—­This is mechanical, supplemented by baths, rubbing, friction, electricity and preceded, if necessary, by attending to the bones.  If the rickets is still active, and the bones are soft and yielding, standing and walking should be forbidden, the limb should be straightened by manipulation and the correct position secured and maintained by an outside splint and bandage.  Sometimes operative measures are needed.

Bow legs. (Genu Varum).—­This is the opposite of knock knees, and the deformity usually affects both limbs, the knees being widely separated.  The disease begins in early childhood; the cause is rickets, and the deformity is the direct result of the weight of the body and muscular action.

[Deformities 371]

Treatment.—­Spontaneous recovery occurs; but if the case is at all severe, and the child is young enough that the bones have not become firmly set in the abnormal curves, mechanical treatment should be employed to bring the limbs to a better position.  This may be done by plaster of paris or braces.  This must be used intelligently and continuously.  Children should not be allowed to walk so early, especially those of slow development.

Club foot (Talipes).—­Varieties: 

1.  The heel may be drawn up and the foot extended (Talipes Equinus).

2.  The foot may be flexed, bent up, (Talipes Calcaneus).

3.  The foot may be drawn inward, adducted, (Talipes Varus).

4.  The foot may be drawn outward, abducted, (Talipes Valgus); or, two may be combined, extended, and drawn inward (Equino Varus).

In the congenital (born with it) variety the displacement is almost always one of adduction, that is, drawn inward, with commonly some elevation of the heel.  It generally affects both feet, but it may be confined to one and if only one is affected, the right is oftener affected than the left.  The deformity varies.  At the time of birth and for some months afterwards the deformity can usually be corrected by proper manipulation, but later, if left to itself, it becomes in greater or less measure fixed, because of the muscular contraction, and developed changes in the shape of the bones.

Cause—­It is not known.

Treatment is successful if it is begun early.  Each case should be treated as it needs.  The treatment should be varied to suit each case.  Bandaging or adhesive straps properly applied has been used with success.  Sometimes the leg must be kept motionless by plaster of Paris or gutta-percha bandages.  They must be frequently removed and reapplied.  In older cases the tendons must be cut and braces applied.  Parents are careless who neglect such a case for even one month.

INTOXICANTS AND SUN STROKES