Johnston, Thomas Fair.

2019-02-15T14:31:22Z

2019-02-15T14:31:22Z

1904

In choosing a subject for my thesis I have experienced considerable difficulty, firstly in getting an appropriate subject and secondly in doing that subject sufficient justice. When a man has access to a laboratory he has ample opportunity of doing some original research work. To a man daily engaged in busy practice such opportunity is very limited and what original work he may do can only be in a clinical form, that is anything original, either symptomatic or Therapeutic, in connexion with the numerous forms of disease with which he daily comes in contact. It is under these circumstances that I have chosen Rickets as a subject for my thesis. How often has one not heard the Phrase, "Only a case of Rickets" as if to imply that such a case were trivial, of no consequence and beneath the notice of the average practitioner, but when one comes to realise the important and far- reaching changes that are apt to occur in the development and the growth of a rickety child, and how such a child, especially the female, is handicapped in life, we see that it is a very important disease indeed and quite worthy of the greatest care and attention of every practitioner whose lot it is to treat such cases. To those who are constantly called to treat cases of rickets I need offer little excuse for my choice of this subject, but I feel assured that it will appeal to the Physician, the Surgeon and the Gyncologist. How often is the physician handicapped in his treatment of pulmonary cases by rickety changes in the chest! how often is the surgeon called upon to operate upon rickety deformities, amongst the most common of-which I may mention Knock Knee, and how often is the obstetrician confronted with Rickety Pelvis! The hospital physician, however willing he may be to enter into the study of Rickets, is seriously handicapped, inasmuch as he does not see much of the onset of the disease, which is its most interesting stage, but it is usually in its later stage that it comes under his observation. In fact he sees the cases that have been a failure in home treatment and have been sent to hospital as a last resource. While cases in the later stage pour in upon him he is unable to fill his beds with cases of chronic Rickets as he has to admit more urgent cases. Therefore his opportunities for careful clinical study are limited. In large towns where the great majority of cases occur amongst the poorer classes, the acute stage is frequently not observed, or, if it is, it is most likely treated by the mother, or by the chemist who may recommend a few simple powders. Even if the case is recognised, and advised for hospital treatment, the mother is usually and naturally unwilling to leave her last -born in hospital, vet I am convinced that this is the time when active treatment may be undertaken with the greatest hope of success. In a large working class and colliery practice such as mine the state of things is different. The doctor knows all the families under his care and he keeps an eye on each member of the community from the time he brings him or her into the world. As the practice is a contract one and his visits are not charged, he is more frequently called in to treat the slighter ailments of childhood, than ;would be the case if his visits were paid for, and, as part of his con- tract is to supply medicine, the chemist has fewer opportunities of prescribing. During his daily visits to the houses of his patients, he has constantly before him the agencies affecting the health of the children and therefore has not to rely so much on the mother for a history of the surroundings and a description of the dietary of her children. Now, ,whilst the colliery doctor has these advantages in the clinical study of Rickets, it must be noted that in his busy life, some distance from the large towns, he is quite unable to follow up his observations by research work in a laboratory. It is nevertheless his duty to contribute what little he can, trusting that it may be of use in the solution of one of our most difficult medical problems. What I am about to write has been learned in the course of my attendance, during the last six years, on some seven hundred families, in the North of England, where Rickets is fairly common. In my district 27% of the children born suffer from Rickets but this appears to be a much lower proportion than what occurs in many other places.

( "Schwarz has observed rickety changes in 80% of cases at the second Vienna obstetric clinic. ")

In writing I base my facts on 200 consecutive cases. I shall deal very lightly with the history and the geographical distribution of the disease as I am unable to add to what is already known in these respects and, for a reason previously given, I shall omit that part of the study which falls to be done in the laboratory or the Post Mortem room.

http://hdl.handle.net/1842/34799

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Already catalogued

A contribution on rickets

Thesis or Dissertation

Doctoral

MD Doctor of Medicine