744 



FRANCIS H. McCRUDDEN 



greater than can be accounted for by simple halisteresis ; we must assume 

 that it is due to material newly laid down to replace the calcium phosphate. 

 Metabolism Experiments in Osteomalacia. If, as the bone analyses 

 seem to indicate, the apposition of calcium is decreased, and the apposition 

 of magnesium and sulphur-rich osseoid tissue increased, we might expect 

 examination of the results of metabolism experiments in the active period 

 of the disease to show a disturbance of the equilibrium in the case of these 

 elements. Moers and Muck, Schmuzinger, Fehling(&), Denecke, and 

 Schuchardt made quantitative determinations of the calcium in the 

 urine in osteomalacia, but, since calcium is excreted chiefly in the 

 feces, and these investigators examined neither food nor feces, 

 their results are of little value. Table 17 gives a summary of all 

 the metabolism observations, with certain exceptions, reported in the 

 literature. The exceptions were those carried out on a patient who was 

 recovering, the case of one patient who was far advanced in pregnancy, 

 and the case of one patient who had suffered many years, and was so 

 severely afflicted that treatment did not afford even temporary relief. 

 These exceptions will be discussed later when the importance of the effect 

 of stage of the disease on the metabolism, an important and generally 

 overlooked point, is taken up. 



TABLE 17 



CALCIUM METABOLISM IN OSTEOMALACIA 



It will be seen from Table 17 that there is always a loss of calcium 

 by the body, a result in accord with the low calcium content of the osteo- 

 malacia bones. The significance of this loss of calcium is made more 

 striking in the studies carried out by McCrudden, at any rate, by the 

 fact that there was a positive balance of sulphur, nitrogen, magnesium, 

 and phosphorus at the same time. 



Studies of the phosphorus metabolism have given variable results. 

 Later, after we have considered the calcium metabolism in different stages 

 of the disease, the reason for the variable results will be clear. 



