OSTEOMALACIA 435 



point mentioned, it would be well to investigate whether ovulation or the 

 giving-off of hormones is not inhibited by the great amount of iron ingestion. 

 At all events it seems to me that such a specific influence of iron on the ovaries 

 is not at all necessary. The difference of chlorosis from anemia consists 

 in the fact that the bone marrow in the former is not diseased, but simply 

 gives out because of increased demands, in the course of which exhaustion 

 the formation of the red cells is less affected than that of the hemoglobin. 

 It is thus readily understood why in chlorosis abundant administration of iron 

 works better than in the anemias. With the increase of the hemoglobin 

 may be exercised a favorable influence on the entire organism and indirectly 

 on the sexual glands. 



Appendix. Osteomalacia 



In way of an appendix, some remarks as to the relations between osteo- 

 malacia and the ductless glands might find place here. There are no doubt 

 a number of, in part, important facts that point to the involvement of the 

 ductless glandular system in the development of the osteomalacic process; 

 the most important of these observations are the following: 



1. Osteomalacia occurs almost exclusively in women, and indeed, in the 

 overwhelming majority of cases, during pregnancy. 



2. Castration leads very often to a rapid cure or at least a considerable 

 improvement of the osteomalacic process (Fehling). Also after labor 

 or after artificially induced abortion, Osteomalacia tends to cure or 

 at least to improve, just to relapse at the next pregnancy. 



3. The curative or ameliorative action of castration can in such cases 

 enter in without the interruption of the pregnancy (cases of Cramer, 

 W alcher, Cristofoletto) . 



4. Frequently symptoms are found in Osteomalacia that point to an in- 

 volvement of the other ductless glands. Thus for instance osteo- 

 malacia is not rarely complicated with Basedow's disease (Latzko), 

 or with Basedow's and tetany (Koppen, v. Recklinghausen) . Mobius 

 reports a case of Basedow's that later went over into myxedema, and 

 then later acquired puerperal Osteomalacia. Moreover, there is found 

 in Osteomalacia frequently, perhaps regularly, a hyperplasia of the 

 parathyroids (Erdheim, Strada, et al.J. This hyperplasia of the para- 

 thyroids does not tend to occur in senile osteoporosis. 



5. In Osteomalacia the glycosuric action of adrenalin and apparently 

 also its action on the heart and vessels is strikingly slight (Cristo- 

 foletti, see also Reinhardt, Merletti, v. Neusser, Englander, et al.}. This 

 is also true for Osteomalacia during pregnancy, because otherwise 

 in pregnancy the action of adrenalin is especially powerful. Further- 

 more, long-continued injections of adrenalin in many cases of osteo- 

 malacia have exerted favorable influence (Rossi). Cristofoletti has 



