METABOLISM IN DISEASES OF BONES AND JOINTS T47 



TABLE 23 



INTAKE AND OUTGO IN OSTEOMALACIA DURING A PERIOD OF IMPROVEMENT (AFTER 



OVARIOTOMY) 



TABLE 24 



INTAKE AND OUTGO IN OSTEOMALACIA AFTER RELAPSE 



The study shown in Table 22, with a loss of calcium and a retention 

 of sulphur and magnesium, was carried out during the active stage of 

 the disease (Goldthwait, Painter, Osgood and McCrudden). 



The study shown in Table 23 was carried out after removal of the 

 ovaries, and at a time when the patient showed such marked clinical im- 

 provement that union of an ununited bone, the result of an osteotomy, 

 took place. The clinical improvement was accompanied by a retention 

 of calcium. Sulphur was still retained, but not in such excess as during 

 the active period of the disease. Thus Table 22 (active period) shows 

 the ratio of sulphur retention to that of nitrogen as 73 :100 ; as clinical 

 improvement began, the ratio fell to 25:100 (Table 23). 



The study shown in Table 24 was carried out more than a year later. 

 Just before this study was made, the condition began to grow worse ; two 

 spontaneous fractures had occurred a few weeks previously. Correspond- 

 ing with the clinical relapse there was a marked negative calcium balance. 

 The intake and outgo of sulphur nearly balanced at this time. 



The studies shown in Tables 23 and 24 were made soon after the 

 change in direction of the calcium metabolism had begun, if we may 

 judge this by the onset of change in the clinical condition for better or 

 worse. It will be noticed that in both cases there is a delay in the corre- 

 sponding inverse change in direction of sulphur and magnesium balance. 

 The significance of this lag will be discussed later. 



There are a few other metabolism observations in the literature, made 

 during recovery from osteomalacia. 



Neumann(a) cites the case of a woman with osteomalacia who 

 gave birth to a child on January ninth, began to show improvement about 

 March first, and was, apparently, clinically well by April first. A com- 



