METABOLISM IN DISEASES OF BONES AND JOINTS 769 



acid, I have seen three more cases of osteomalacia, all of which showed a 

 great abundance of calcium oxalate crystals in the urine. In a recent 

 report of a case, of osteomalacia by Freund and Lockwood, mention 

 is made of the great abundance of calcium oxalate crystals in the urine. 

 Furthermore, as already pointed out, renal calculi are a very frequent 

 accompaniment of osteomalacia (Henning, Berger-(&), Daires-Colley), so 

 frequent indeed that the combined condition has been referred to as cal- 

 careous metastasis (Boulby) ; and renal calculi almost always consist of 

 calcium oxalate. 



Numerous papers dealing with the relation of vitamins to bone 

 metabolism, especially in rickets, are appearing in the current medical 

 journals, but it is too early as yet to appraise the results. 



The numerous references to osteomalacia in the German, Austrian, 

 Dutch, and Danish medical journals of 1918 and 1919, testify to the 

 increase in the number of cases of this condition as the result of the 

 food shortage. The increased incidence affected not only man, but also 

 the domestic animals. It is so closely associated with lack of food that 

 it is sometimes referred to as "Hungermalazie," or "Hungerosteomalazie" 

 (Schlesinger(a) (6) ). 



Certain types of dwarfism and infantilism are undoubtedly the result 

 of imperfect bone metabolism, or, as any rate, closely associated with 

 imperfect bone metabolism (McCrudden(/)). These conditions are con- 

 sidered elsewhere in this work (see Infantilism). 



Overproduction and Bone Disease. It must be apparent from 

 what has already been said that osteomalacia, rickets, and similar 

 pathological conditions of the bone are to be regarded not as specific 

 diseases, but rather as syndromes resulting from a considerable ex- 

 aggeration of a normal condition. The calcium of the bones acts as a 

 reservoir of this element to be drawn on in times of need, and 

 consequently the total calcium content of the bones, as well as the percent- 

 age of calcium in the bones is normally subject to certain variations. A 

 considerable fall in the calcium content of the bone makes the bone soft 

 and fragile. Such a fall in the calcium content of the bone may be 

 brought about by a variety of causes. When the cause ceases to operate, 

 rapid restoration of the bone to the normal is the rule. But, as in other 

 physiological processes, there is often or always a kind of "overproduc- 

 tion," a continuance of the process for a time after the original stimulus 

 has been withdrawn, a lag in the return to normal. And this "functional 

 inertia" plays a certain part in the production of some cases of osteo- 

 malacia. 



Consider tables 27, 28, and 29, giving summaries of the metabolism 

 of one of McCrudden's cases, in three different phases of the disease in 

 one patient (McCrudden(fe), also Goldthwait, Painter, Osgood and 

 McCrudden). 



