THE RELATION OF DIET TO DISEASE 431 
evidence of a drain of inorganic salts during the produc- 
tion of milk unless the calcium and phosphorus of the 
diet were liberally supplied. In osteomalacia it would 
seem that inefficient diet, if not the cause, was at least a 
very potent factor in pathogenesis. The disturbance 
of the calcium-phosphorus-metabolism may be due to 
the deprivation of the alkaline salts as in the famine 
osteomalacia, to a drain from the alkaline storage of the 
body associated with an inefficient diet as in the osteo- 
malacia of pregnancy and lactation or to the combined 
action of a diet faulty in more than its salt content, which 
by the production of acid in its oxidation and by favoring 
the development of acid-forming bacteria, causes a drain 
of the body alkali for neutralization of the acid ; or it may 
possibly be due to a combination of all these factors act- 
ing through their influence on the ductless glands. 
Paget 's disease or Osteitis Deformans is a chronic 
constitutional process which usually involves all the 
bones of the adult skeleton. DaCosta (7) believed it to be 
a disorder of bone metabolism probably dependent upon 
absence or perversion of some internal secretion. We 
have had the unique opportunity of observing three cases 
of this disease in Cebida?, the family of monkeys wliich has 
presented the highest incidence of osteomalacia. The 
experience is all the more interesting because of the 
typical picture presented by the specimens, and of the 
absence of references in the literature on the subject, to 
the occurrence of the malady in wild animals. The inter- 
esting point about these cases lies in the fact that the 
disease appeared in all three only after lime water was 
added to the diet to supply the deficiency of calcium. 
Search for literary record of the disease brought to 
light a case in a horse that Barthelemy (8) described, but 
this involved the epiphyses of the bone while osteitis 
(7) Publication of the Jefferson Medical College and Hospital, Vol. 
6, p. 1, 1915. 
(8) These de Lyon, 1901. 
