RICKETS 331 



Metabolism 



Scott (1156) studied the calcium metabolism in the puerperal 

 type of osteomalacia. The amount of calcium in the urine was 

 increased, while during pregnancy and lactation, the output was 

 decreased. The figures were as follows: normal CaCl 2 per liter of 

 urine 1.146 grams; in osteomalacia 1.36 grams; in pregnancy 

 and lactation 0.988 gram. The calcium content of the blood is 

 increased in osteomalacia; in pregnancy, no variation from the 

 normal figure was noted; normal 0.45 gram CaO per liter; osteo- 

 malacia 0.58 gram. Leo Zunz (1157) conducted metabolism 

 experiments in puerperal osteomalacia. He found a negative calcium 

 balance, with a definite improvement on castration. Elfer and 

 Kappel (1157a) conducted metabolism experiments with and with- 

 out the addition of extracts of endocrine glands. The calcium 

 and magnesium balances were sometimes negative, while the phos- 

 phorus balance remained positive. 



Therapy 



The cod liver oil therapy has not been used very much, though 

 where it has been used, the reports were favorable. Looser, Cursch- 

 mann, Kopchen, Hamel and many others, have reported on this 

 subject. In most cases, a change in diet was instituted, together 

 with the therapy. 



Etiology 



Hutchinson and Patel (1157b) observed numerous cases among 

 Mohammedan women in Bombay, and attributed the cause of the 

 disease not to the diet, early marriage or prolonged lactation, but 

 to the inertia and lack of air in accord with the domestication 

 theory of rickets. The description of cases among men, in middle 

 and old age, shows that the disease, as such, has nothing to do with 

 the puerperium. The cases in old age, as well as in middle age, show 

 that this rachitic-like condition has nothing in common with growth, 

 contrary to the findings of Mellanby on rickets in young dogs. 

 Recently, the prevalence of this disease in central Europe was 

 coincident with a lack of milk, eggs, cheese and butter. The popu- 

 lation lived on cabbage, turnips, some potatoes and meat. There 

 was, therefore, a lack of vitamine A, as in rickets. 



