766 FRANCIS H. McCRUDDEN 



connection too the soft bone is newly formed bone, poor in lime salts 

 (Eiken). 



How widely different the nature of the factors responsible for ab- 

 normal bone metabolism can be, may be judged from the fact that ap- 

 parently reliable evidence involves not only pregnancy, but also bacterial 

 infection, glands of internal secretion, arteriosclerosis, certain foodstuffs, 

 absence of vitamines, and starvation, or undernutrition. 



Montpurgo, de Sant Agnese, and Arcangeli, in Italy and Moussu and 

 Charrin, in France, have demonstrated the presence of a transmittable 

 infectious agent in osteomalacia and rickets. These investigators were 

 able to transmit the disease from one animal to another, and the essential 

 identity of rickets and osteomalacia is indicated by the fact that the 

 same organism produced either rickets or osteomalacia according to the 

 age of the infected animal. 



As to the glands with an internal secretion, practically every one of 

 them has, at one time or another, been alleged as having something to 

 do with calcium metabolism or with osteomalacia. 



The case for the ovaries has already been discussed. 



More recently, much has been written to show that osteomalacia is a 

 disease of the adrenals. But the evidence has all been based on the sup- 

 posed curative effect of adrenalin in osteomalacia. The first to suggest 

 this etiology was Bossi, an Italian physician who, beginning December 

 16, 1906, administered epinephrin for four successive days to a patient 

 with osteomalacia. At the end of that time the patient had much less 

 pain and was, therefore, discharged as cured. Within four weeks of 

 the first treatment, the published results appeared. (Bossi: "Neben- 

 niere und Osteomalakie." Centralbl. f. Gynak., Jan. 19, 1907, p. 69.) 

 A number of other just such "cures" have been reported in the litera- 

 ture. In all cases, the "cure," reported soon after treatment, meant simply 

 relief from pain. It is a well known fact that even without any treat- 

 ment, tenderness and pain rapidly disappear at times in osteomalacia; 

 such temporary relief does not indicate cure. The case reported by 

 Kaessman may indicate what happens in such cases. Kaessman 

 administered epinephrin daily, from September sixth to September 

 eleventh, 1907. On September fourteenth the patient was sent away 

 better, with instructions to keep up the treatment, only to return nine 

 days later, worse than ever. 



The evidence connecting osteomalacia and the thyroid gland is even 

 less convincing, if possible, than that connecting osteomalacia and the adre- 

 nals. Hoennicke(a) (6), who first suggested that osteomalacia is a 

 disease of the thyroid, refers to the similarity in geographic distribution 

 of osteomalacia and recognized diseases of the thyroid, such as myx- 

 edema and Graves' disease, and to the similarity in incidence, with ref- 

 erence to age, sex, and gravidity. Hoennicke further asserts that he 



