The Bone Changes Occurring in Renal and Coeliac Infantilism, and Their Relationship to Rickets

The occurrence of bone deformities associated with the presence of albumin in the urine was first observed by R. C. Lucas (1) who in the year 1883 published a paper entitled " A Form of Late Rickets associated with Albuminuria." A perusal of this paper, however, shows that the cases described were not examples of renal infantilism. The interest of British paediatricians in renal infantilism was first aroused by Morley Fletcher (2) who in the year 1911 showed before the Children's Section of the Royal Society of Medicine, a typical example of this condition occurring in a child who had developed genu valgum when five years of age. In a paper written by Miller and myself (3) in 1912 the occurrence of genu valgum in several of the cases was commented on. Naish (4) -writing upon this subject in the same year said: " The presence of rickets usually of late origin in as many as five out of the eight cases is a striking phenomenon," but the credit for emphasising the importance and striking character of the bone changes is clearly due to Barber (5) who has published a series of papers on renal dwarfism, and to whose description of the bone changes there is, from a purely clinical standpoint, little to add. Barber regards the bone changes as typical of late rickets, but has not attempted any explanation of the reason why this should occur. Paterson (6) writing in 1920 discusses whether the bone changes should be regarded as those of rickets or not, and infers that in his view the condition is not rickets, but " would suggest that these bony changes are nutritional in origin." Shipley, Park, McCollum and 8immonds (7 recording their observations on one case, suggest that the condition mnay be a true renal rickets, whereas Lathrop (8) from the same medical school,, in a paper recently published, states that although the clinical appearances are difficult to differentiate from rickets, the radiogram shows nothing suggestive of that disease, and the blood calcium and phosphorus are distinctly outside the rachitic zone.