RICKETS 449 



given to growing animals they will partially replace the calcium in 

 the bones,'*'' while it is said by Etienne''*^ that excessive feeding of calcium 

 itself leads in time to decalcification of the bones. Zuntz**^ found the 

 respiratory metabolism in osteomalacia within normal limits, but 

 tending to be low; protein metabolism shows nothing striking, but 

 there is a high excretion of phosphoric acid through the feces. 



Castration of women with osteomalacia has been frequently, but 

 not always, followed by improvement or recovery,^** and Neumann, 

 and also Goldthwait, have found that in these cases the calcium loss is 

 replaced by a marked calcium retention after the operation. What 

 the relation of the ovaries to calcium metabolism or to osteomalacia 

 may be has not yet been ascertained. Scharfe^'-* and Bucura^" both 

 state that there are no characteristic or constant structural altera- 

 tions in the ovaries in osteomalacia McCrudden^' found that the 

 improvement in calcium metabolism observed after castration may 

 be but temporary, and therefore believes that the primary cause of 

 the disease does not lie in the ovaries. He is of the opinion that re- 

 peated drains on the calcium of the bones, incited most often by preg- 

 nancy, occasionally by tumors, sometimes by unknown causes, result 

 in an excessive reaction to the stimuli, so that eventually the losses 

 become too great to be made up; that is, osteomalacia is an exaggera- 

 tion of a normal process resulting either from excessive stimulation 

 of that process, or a failure to recover when the stimulus ceases. The 

 beneficial effects of castration are probably ascribable chiefly or solely 

 to the prevention of pregnancy. Osteitis deformans seems to be a 

 localized osteomalacia. The relation of the adrenals to osteomalacia 

 advocated by Bossi,^^ is of questionable significance, and there is no 

 definite evidence as to any relation of exophthalmic goiter^^ or the para- 

 thyroids,^* although hyperplasia of the parathyroids has been des- 

 cribed.^^ 



RlCKETS^s 



As wdth osteomalacia, chemical studies of the bones in rickets have 

 thrown httle light upon the etiology or pathogenesis of this condition. 



*5 See Lehnerdt, Zeit. exp. Med., 1913 (1), 175. 



•»« Jour. Physiol, et, Path., 1912 (14), 108. 



" Arch. f. Gyn., 1913 (99), 145. 



^» Bibliography by Schnell, Zeit. Geb. u. Gyn., 1913 (75), 178. 



*3 Cent. f. Gyn., 1900 (24), 1216. 



=" Zeit. f. Heilk., 1907 (28), 209. 



" Amer. Jour, of Physiol., 1906 (17), 211. 



" Zent. f. Gyn., 1907 (31), 69 and 172. 



" Tolot and Sarvonat, Rev. d. Med., 1906 (26), 445. 



" Erdheim, Cent. med. Wiss., 1908 (46), 163. 



^5 Bauer, Frankfurter Zeit. Pathol., 1911 (7), 231. 



" Complete literature and full discussion by Pfaundler, Jahr. f. Kinderheilk., 

 1904 (60), 123; also see Albu and Neuberg, " Mineralstoffwechsel," Berlin, 1906. 

 pp. 119-124; symposium in the Verhandl. Deut. Path. Gesellsch., 1909 (13), 1. 

 Metabolism studies by Meyer, Jahrb. Kinderheilk., 1913 (77), 28. 



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