Osteomalacia.

This very peculiar condition is not so common in this country, as among the poorer classes in the old country. It is known sometimes as malecosteon or mollitis ostium. It is characterized by a deficiency in the earthy principle of the bones. Not so much that this principle is not supplied, as that from inflammatory conditions, which are apparent in the medullary tissue of the bone, the bone becomes soft and flexible. The earthy principle is eliminated principally by the kidneys in the form of oxalate of lime. The outlines of the bones are not altered but are retained in form as cartilage. This in turn becomes disintegrated and softened and in some cases actually liquefies.

This condition was at one time confounded with rachitis, but recent writers point out their great dissimilarity. The condition is not always a general one. It may be confined to a few bones, but when general it produces sometimes most startling distortions and exceedingly strange appearances. A case is reported by Morand of a woman who died in 1752 greatly deformed. The trunk of the body was only twentythree inches in length and the soles of the feet could easily be placed against the sides of the head. In these cases the pelvis becomes narrower, its anterior-posterior diameter being greatly increased.

The condition is much more common in females than males. Out of 511 cases, 61 were males, not quite 12 percent.

Almost nothing is known of the causes of this strange disease. Locality is one of the first causes, as indeed there are but few localities in which it may be found. In fact, by far the greater number of cases are found along the shores of the river Rhine. It is presumed from analyses there have been made, that lactic acid is the cause of the disorganization of the organic structure of the bones, as this substance has been often found in the marrow of bone so affected.

There are diagnostic points which will enable a physician to distinguish between this and the rickets. The first is that this disorder is a disease of adult life only, two cases having been known under twenty and very few under twenty-five, while rickets is a disease peculiar to childhood. This is attended with severe pain, while rickets is usually painless. This condition is steadily progressive, while in rickets the progress is often arrested and recovery ensues. This condition affects females principally, while with rickets as many males as females are affected.

The disease is difficult of recognition in its early stages because the pain and soreness resemble rheumatism, and cannot ordinarily be otherwise distinguished until the bones begin to yield. There are symptoms similar to chronic myelitis; pain in the limbs, extreme sensitiveness to pressure over the spinous processes, with contraction of the adductor muscles of the thighs.

There is difficulty in breathing, great difficulty in walking or standing. In some cases the disease advances with considerable rapidity, in others, progress is slow. In all the prognosis is unfavorable, recovery having taken place in only a few cases. In the treatment of this serious disease the functional activity of the vital organs should be greatly encouraged. Tonics of the most active character are indicated, among which phosphorus has the first place. This agent may be given in the form of the phosphates, but the tincture will usually produce the best results. A complete change in all the habits of life, as well as in locality, is very desirable, and the constant administration of alkaline waters, would seem to be indicated by the pathology of the disease. One patient strangely recovered after the administration of chloroform.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.