ing the acidosis produced by the withdrawal of carbohydrates. When the 

 acidosis supplants the alkaptonuria, the amount of acetone bodies elimi- 

 nated is larger than can be explained by the transformation of the aromatic 

 protein complexes. 



There is a distinct relationship between alkaptonuria and ochronosis. 

 That there are cases of ochronosis without alkaptonuria has also been 

 definitely shown. Out of 25 cases of ochronosis collected from the litera- 

 ture by Poulsen(&) (1910), 12 were alkaptonuric, 2 showed phenol in the 

 urine, 2 had melanin in the urine, 6 patients had normal urine and in 3 

 the urine findings were not recorded. 



It was in 1866 that Virchow(e) first described ochronosis. While per- 

 forming the autopsy on a man who had died of an aneurysm, he noticed 

 that all the cartilages were black, "black as ink," or "as if they had been 

 immersed in ink." All the cartilages showed signs of progressive hyper- 

 trophy, and the pigmentation was ascribed by Virchow to a hematin 

 pigment. 



It was Albrecht and Zdarek who in 1902 pointed out that ochronosis 

 may be due to alkaptonuria, and Osier two years later described the de- 

 velopment of this pigmentation in two cases of alkaptonuria. Further 

 testimony was advanced by Clemens, Wagner, Gross and Allard, Landois, 

 Poulsen, Soderbergh, Janney and others. 



It is not, however, only the cartilages that may be stained by the homo- 

 gentisic acid. In alkaptonuria, the cerumen may be stained dark brown 

 (Bandel). Stier also found the aural wax brown. While the alkapton has 

 not been found in sweat, the sebaceous glands secreted colored, greenish 

 substances which contained alkapton. Abderhalden and his -co-workers 

 found homogentisic acid in the blood of an alkaptonuric. 



While it is the general opinion that alkaptonuria is a harmless per- 

 version of metabolism, Umber seems to think that it may lead to arthritic 

 disease, to osteo-arthritis deformans, to ochronosis, to dysuria, etc. All 

 these conditions are due to the infiltration of the tissues with the alkapton. 

 Soderbergh found a positive Wassermann reaction in his alkaptonuric 

 patients, which he ascribed to the homogentisic acid present in the blood. 



Neuberg states that "no treatment for alkaptonuria is known, and, 

 indeed, considering that the metabolic disturbance is harmless, and in- 

 volves no danger to the patient, treatment is hardly necessary." Umber 

 recommends dietetic therapy. He suggests a protein-poor diet, and espe- 

 cially the feeding of proteins poor in the homogentisic forming amino- 

 aromatic compounds. A large fluid intake should be advised. For the 

 joints, he suggests the usual therapeutic procedures of heat, heliotherapy, 

 gymnastics, massage, and electrical treatment of the muscles adjoining 

 the affected joints. 



