566 DISEASES OF THE ORGANS OF LOCOMOTION. 



periosteum and medulla, with a few delicate, bony trabeculse. In 

 recent cases the medulla is dark, brownish-red ; later, it is yellow, and 

 very fatty. There are cases of osteomalacia, where the disease is con- 

 fined to certain bones, especially the pelvis and spine ; in other cases 

 it affects almost the whole skeleton ; but, even then, the bones of the 

 skull almost always escape. Distortions of the body and limbs result 

 from the softness and flexibility of the bones ; these are often very 

 great, and actually frightful. The weight of the head occasionally 

 induces angular curvature of the cervical portion of the spinal column ; 

 the distortion of the dorsal vertebrae, and the ribs, may not only cause 

 deformity of the thorax, but may also greatly encroach on its capacity. 

 The pelvis is almost always compressed laterally by the thigh-bones, 

 often to such a degree that the horizontal branches of the pubis come 

 in contact, and project like a beak. The sacrum is also generally 

 curved into the pelvis. Sometimes the curvatures of the extremities 

 attain such a grade, that the feet are at last directed outwardly. In 

 some cases the shortening of the body is so decided, that women of 

 stately size become quite dwarf-like during the disease. 



SYMPTOMS AND COTJKSE. The first symptoms of osteomalacia are 

 boring, tearing pain, which the patients often locate in the bones. 

 This pain is usually relieved by perfect quiet, while it is increased by 

 motion. In some, but not in all cases, the pain, which at first is usu- 

 ally considered rheumatic, is accompanied by a remittent or intermit- 

 tent fever. According to many observers, copious sediments of phos- 

 phate of lime form in the urine of the patient ; where they do not 

 occur, renal calculi, consisting of phosphate of lime, are found after 

 death. It is also said that lime-salts are excreted through the sali- 

 vary glands and skin. Gradually, the gait becomes uncertain and 

 tottering, and, after a time, any motion becomes so painful, that most 

 patients fear leaving their bed. The pain is followed by distortion 

 and deformity of the body and limbs, which vary from accidental cir- 

 cumstances. Occasionally, the well-nourished state of the patient con- 

 trasts for a long time with the pain and deformity ; while in other 

 cases the general health is affected early, and the patients appear mis- 

 erable, and badly nourished. Osteomalacia has not ended in recoverj- 

 in any of the cases so far reported ; but in most of them it was not till 

 after several years of severe suffering that death occurred, from ex- 

 haustion, or from disturbances of the circulation and respiration. 



TREATMENT. The remedies theoretically recommended for osteo- 

 malacia, such as calomel and opium, phosphoric acid, lime-water, cod- 

 liver oil, and iron, have not answered in practice, and we are, unfortu 

 uately, obliged to confine ourselves to the prevention of distortions. 



