760 



FRANCIS H. McCRUDDEN 



of several rapidly succeeding pregnancies and periods of prolonged lac- 

 tation, the loss of calcium has been very great. Even then the tendency 

 is to recover, and unless a new pregnancy supervenes before recovery 

 takes place, such recovery may be permanent. But if each new preg- 

 nancy, with its consequent need for calcium, comes on before the bones 

 have made up previous losses of calcium, osteomalacia may become perma- 

 nent. And finally, the decrease in the calcium phosphate content of the 

 bone becomes so great that it is beyond the power of the body to increase 

 anabolic processes to such an extent that they will not only balance 

 the increased catabolism, but make up also for earlier losses. An exam- 



Chart 1. 



pie of the disease showing the typical course and final cure by castration 

 is seen in the case of Neumann, referred to a few paragraphs back. 



We may represent a case of the disease showing the typical course 

 in chart form. 



The abscissae represent time, the ordinates represent amount of cal- 

 cium in the bony system. P x P 2 , etc., represent the beginning of preg- 

 nancy ; W x W 2 , etc., represent the end of pregnancy and lactation (wean- 

 ing), i l i 2 represent the beginnings of improvement. The line n-n' repre- 

 sents normal calcium content in the bones; the line m-m' the amount of 

 calcium in the bones, below which symptoms of osteomalacia appear. The 

 crosshatched areas represent periods of osteomalacia. In this imaginary 

 case, there is a short, mild attack during the fourth pregnancy from 

 which the patient completely recovers, next, a somewhat more severe at- 

 tack during the fifth pregnancy from which the patient likewise recovers, 

 but not to a completely normal condition. Osteomalacia again returns 

 early in the sixth pregnancy and remains permanent. The lengthening 



