The symptoms of rachitis become apparent at the pelvis and at the wide open, soft parts of the skull, the unossified fontanelles.  The cartilage in the wrists and ankles becomes thick.  Slow development of the teeth, swollen glands in the neck, inflammations in different parts of the body, cramps and convulsions,—­among others, of the vocal cords,—­are further indications.  In the progressive development of the disease, the softened cartilage grows and protrudes everywhere, especially in the thorax, such as “rachitis rosary.”  Crooked bones and hunchbacks not infrequently develop.

Therapy.

Diet:  Older children should receive chopped meat, eggs, zwieback or whole grain bread.  Bouillon will stimulate their digestion.  Uffelmann recommends a mixture of one part veal bouillon and two to three parts of milk, which children like.

It is unnecessary to give calcium directly, when a rachitic diet is observed.  Sufficient is contained in the Dech-Manna-Diet, given principally in milk and as a rule also in the drinking water.

Quantities of amylaceous (starchy) food, candy, cakes and other sweets, coarse vegetables and potatoes must be avoided, since with children they are the cause of stomach trouble, resulting in decomposition and the formation of acids in the intestines.

Breakfast:  Milk and whole grain bread, or oatmeal porridge and fruit.—­Whole grain bread signifies any variety of bread made from flour containing the entire contents of the grain, the gluten as well as the bran; among these are Graham-bread, rye-bread, pilot-bread, and Rhenish black bread.

Mid-morning Lunch:  Raw scraped carrots; for small children and for those having poor teeth, oat flakes.

Dinner:  Every other day—­legumes, prepared in various ways, and fruit, vegetables or fresh greens; for example: 

(a) White beans boiled to the consistency of a thick soup, with apples.

(b) Fresh pea soup containing rice, barley, sweet corn or oatmeal; a thick pea-porridge with parsley, served with carrots, cabbage, white turnips, red cabbage, Savoy cabbage, or various fresh greens; or simply browned.

(c) Dried pea soup with similar contents; barley porridge, fresh greens, baked potatoes; or browned and eaten with any vegetables.

(d) Lentils boiled in soup with the same contents as before; or as porridge, particularly with potatoes and fresh greens.

Care must be taken never to eat leguminous products in large quantities, because their nutritious properties are so high.  Potatoes should be used whole when added to other vegetables, and steamed not strained, because they easily lose thereby their valuable sulphuric contents.

Afternoon Lunch:  Fruit and whole grain bread, or a glass of milk and bread.

Supper:  In summer, cold or warm porridge with fruit and fresh greens, and besides these millet, buckwheat, oats, barley and Graham-bread, as especially efficient bone material.  Sweet or sour milk proves a relishing addition.  In winter, soup made of the above grains, or of potatoes not deprived of their mineral contents by peeling and straining.