436 THE DISEASES OF THE SEXUAL GLANDS 



collected forty-seven cases of osteomalacia that were treated with 

 adrenalin. Of these, eleven were gravid and thirty-five nongravid 

 women. Of the gravid women 45 per cent, were cured, and about 18 

 per cent, improved. Of the nongravid women about 17 per cent, were 

 cured, and 40 per cent, improved. 



6. In some cases of osteomalacia improvement follows the injection of 

 pituitrinum infundibulare (Bondi, Pal). Lately Pal has reported 

 concerning excellent influencing of the osteomalacia, in two cases, 

 through injections of pituitrinum glandulare. 



Three forms of osteomalacia are to be distinguished. The puerperal form 

 which is by far the most frequent. The rheumatic form, which is rare, 

 which mostly does not follow a severe course and which occurs also in women 

 independent of a preceding labor; it is also observed in man. Finally 

 the senile form. 



The views as to the bone processes in osteomalacia are many. One 

 group of authors imparts the most important value to the decalcification of 

 the completed bones, another group to the apposition of especially calcium- 

 poor bones. Likewise is there division of the authors as to whether rachitis 

 and osteomalacia are two different disease conditions or constitute one and 

 the same disease process, that leads when it develops in youth, to rickets, and 

 when it develops in the fully developed organism to osteomalacia. Cristo- 

 foletti sets forth the facts that speak against the unitary theory, as well as 

 gross anatomical difference: the endemic occurrence of osteomalacia that 

 is independent of the extension of the rachitis, the occurrence in grown 

 people, and finally the cardinal symptom of osteomalacia, the pain, which is 

 absent in rachitis. The fact also seems to me noteworthy that rachitis 

 mostly affects persons who were not rachitic in youth. 



As might be expected, investigations as to calcium metabolism in osteo- 

 malacia show great disturbances. Almost regularly is found negative calcium 

 equilibrium. Especially is the elimination of calcium through the intestine 

 increased. That therewith the phosphorus is also eliminated in increased 

 amount in the feces is not characteristic for osteomalacia, as the calcium 

 carries with it the phosphorus. The calcium contents of the blood in os- 

 teomalacia is somewhat raised (Capellani). We can see a certain relation 

 between pregnancy and osteomalacia in that fact that osteophytes that 

 normally form during pregnancy are very poor in lime. 



Of the hypotheses that are at hand as to the pathogenesis of osteo- 

 malacia, I mention those only which concern the ductless glands. The 

 assumption of a specific thyrogenic disturbance cannot be accepted as 

 correct, nor can the view that goiter formation and the osteomalacia have 

 a causal connection. Among thirty-four cases of osteomalacia, Bossi saw not 

 one with a goiter; and I can also very well reject the supposition of a pri- 

 mary functional disturbance of the chromaffin tissue. The sexual glandular 



