754 FKANCIS H. McCKUDDEN 



acid, sulphuric acid, phosphoric acid and other continuously forming acid 

 end products of metabolism are immediately neutralized. Furthermore, 

 we know now that we cannot accept the interpretation formerly placed 

 on the results obtained by titration of the blood. 



Beck has made determinations of the nitrogen distribution in osteo- 

 malacia urine, and his low figures for ammonia show no evidence of 

 acidosis in osteomalacia. Furthermore, osteomalacia does not arise in 

 conditions accompanied by acidosis, severe diabetic coma, for example. 



From beginning to end, the evidence that the bone softening of osteo- 

 malacia is due to acid action is uniformly negative. 



The Relation of the Ovaries to Osteomalacia. At Porro's suggestion, 

 Fochier of Lyon and Levy of Copenhagen, among others, had carried 

 out supravaginal amputation of the pregnant uterus and ovaries, as a 

 complement to Cesarean section in certain cases of osteomalacia, and 

 noted that the operation had a good therapeutic effect on the disease. 

 As a result, Fochier proposed that this operation be tried in other 

 cases of osteomalacia. Believing that the good effect in these cases might 

 have been due to removal of the ovaries, Fehling(a)(6) (c) (d) car- 

 ried out ovariotomy on a number of patients with osteomalacia. The 

 operation was followed by such good results that Fehling came to the 

 conclusion that osteomalacia is due to pathologically increased activity 

 of the ovaries, leading to stimulation of the vasodilators or paralysis of 

 the vasoconstrictors, followed by congestion and hyperemia of the bones 

 and solution of the bone salts. But even if we admit such bone hyperemia, 

 and a consequent stimulation of bone metabolism, there is no reason to 

 believe it would lead to increased catabolism of calcium, rather than in- 

 creased anabolism. We need not, however, concern ourselves with these 

 details of the alleged mechanism through which the ovaries control bone 

 metabolism, but only with the larger question of the facts regarding 

 the relation of the ovaries to osteomalacia and bone growth. 



The sexual glands have long been supposed to have some control 

 over the metabolism, especially over growth, and over growth of the bones 

 in particular. This supposition is based on common experience in the 

 breeding of cattle and fowl, and on our less complete knowledge of the 

 effect of castration in man, rather than upon controlled laboratory ex- 

 periments. And some of these commonly accepted facts and conclusions 

 relating to this subject are not justified. The farmer finds, for example, 

 that his castrated male chickens grow larger and fatter than his cockerels. 

 There is no -need to assume any direct effect of castration on bone metabo- 

 lism; the difference can be explained by the more sluggish life of the 

 capon, compared with that of the active aggressive cock. Surgeons very 

 commonly state that women increase in weight after ovariotomy. As 

 a matter of fact, examination of carefully carried out studies on several 



