No abstract

Robison, in 1923 (22), suggested that phosphatase plays an important r6le in the formation of bone in the human body. He found a very active phosphatase in preparatory areas of ossification, and held that this enzyme hydrolyzed the phosphoric esters in the blood to bring about a local increase in the concentration of the phosphate ions. It was his theory that the solubility product of tertiary calcium phosphate was thereby exceeded, and that deposition of this salt therefore occurred in the ossifying zone. Evidence has since accumulated, chiefly through the work of Robison and Kay and their associates, to strengthen this hypothesis and to make 1 Presented in abstract form before tlie meeting of the Society for Clinical Investigatioll at Atlantic City, N.

No abstract

In previous publications of this series (1,2), it has been demonstrated that exophthalmic goiter is associated with a calcium and phosphorus excretion elevated in excess of the increased general metabolism. Several conditions have a high urinary calcium excretion. As far as is now known, such a high calcium output when elevated in both urine and feces is found only in hyperthyroidism and vitamine D deficiencies (3). A patient with osteomalacia, carefully studied by Gargill, Gilligan, and Blumgart (4), showed an analogous high urinary and fecal calcium excretion, which returned to normal after large doses of vitamine D. It was, therefore, of interest to determine whether hyperthyroid cases, because of the elevated metabolic demand, could be suffering from vitamine D deficiencies due to an increased need for vitamines. The idea gains some support in the work of Plimmer (5) of Cowgill and Klotz (6) and of Himwich, Goldfarb and Cowgill (7), which indicates that the amount of vitamine B required by the organism is determined chiefly by its caloric requirement. In hyperthyroidism the publications of McCarrison (8) have directed attention to the relation of diet and hyperthyroidism, and Rabinowitch (9) and Fraser and Cameron (10) have published observations which suggested that the addition of vitamines A and D to iodine gave a somewhat greater improvement in Grave's disease, than did iodine alone. In the following observations, this problem was studied by giving irradiated ergosterol to hyperthyroid patients who were maintained on an otherwise constant regime. METHODSThe same careful metabolic routine fully described in previous publications (11), was followed. Further descriptions of this technic need not be added here. The diet was essentially neutral in its acid-base contents as calculated from Sherman's tables (12). The constituents were similar to those of Table VII in paper XI of this series (13), though the total amounts were increased to conform with the caloric needs of 1273