RICKETS 329 



would suffer from this disease. If we accept the idea, however, 

 that cod liver oil contains the specific substance, then we admit that 

 the diet, which brings about rickets, must be lacking in this sub- 

 stance. But since butter and cod liver oil play the same part in 

 rat feeding, we have to recognize that rickets is caused by a lack 

 of vitamine A. We must accept this logical relationship, if we wish 

 to proceed to the experimental tests of the above conception. In the 

 meantime, it seems to us that the study of rickets is more likely 

 to lead to the desired end if dogs are used in preference to rats, for 

 in the latter only osteoporosis frequently develops. The develop- 

 ment of this disease in young dogs shows an appreciable similarity 

 to rickets in small children. With the elucidation of the influence 

 of light, phosphorus and particularly vitamine A, we may hope for a 

 solution of the problem of rickets. 



OSTEOMALACIA 



Late rickets, which we have already mentioned, forms the natural 

 stepping-stone between rickets in small children and osteomalacia. 

 The latter seems to be due to an identical metabolic disturbance. 

 Some demonstration for the genetic relationship is provided by Ogata 

 (1 137) . In the province of Toyama in Japan, osteomalacia developed 

 in adults, under conditions apparently similar to those giving rise 

 to rickets in children. Before the war, the disease developed almost 

 exclusively in young pregnant women, in which condition it often 

 assumed a serious aspect. This form of the disease was described by 

 Liesegang (1138) and also by Scipiades (1139), and was mostly 

 associated etiologically with the endocrine glands. A relationship 

 to the pregnancy was often suspected although this condition 

 undoubtedly was only a secondary factor. It is, however, not 

 impossible that an interruption of the pregnancy might be accom- 

 panied by an improvement Koltonski (l!39a). Januszewska (1140) 

 reported on 3500 cases in Bosnia on an inadequate diet, accompanied 

 by rheumatic manifestations. The cases appeared between Decem- 

 ber and April and showed a periodicity similar to that already noted 

 in rickets, and which was associated with improvement in the diet. 

 The disease was favorably influenced by cod liver oil. 



During the war, central Europe afforded thousands of such cases. 

 This has been observed in Vienna, especially during the summer of 



