conclusion and the mere acceptance of a doubtful entity like Milkman's syndrome serves to confirm this. Unfortunately impracticable in this case, a wider range of tests is recommended, such as renal function tests and the investigation of the absorption and excretion of calcium and phosphorous.
TREATMENT
Whatever the cause, treatment was unlikely to of much avail now. In the renal osteodystrophy, Liu and Chu (1943) recommended the following : a low-phosphorus, low-protein, high-calcium diet and the administration of alkalis, dihydrotachysterol, and iron. Such treatment improved the intestinal absorption and retention of calcium and phosphorus, bue recalcification of the bones was not observed by them.
Although Milkman (I930 ; 1934) had no success in his own case, Edeiken and Schneeberg (1943) noted in nineteen previous cases that there were several reported cures with calcium, vitamins A and D, and arsenicals. My own case had apparently been treated in the past with such preparations, but obviously without success.
Had the patient been willing to submit to surgical measures, osteotomies would have been necessary to correct the bowing of the femora, tibiae, and fibulae. Probably four separate operations would have been required and the risks were considered too formidable to justify.
SUMMARY
A severe osseous dystrophy is described, an extreme degree of bone softening causing widespread deformities, particularly in the lower limbs, pelvis, and spine. An outstanding feature was the presence of multiple pseudo-fractures. The exact cause of the dystrophy was not certain. I wish to thank Dr. R. McWhirter for the radiological examinations and his advice on their interpretation; Dr. C. P. Stewart for the biochemical investigations and similar help ; and Mr. D. Smith for the clinical photographs. REFERENCES BRAILSFORD, J. F. (I943), Brit. 3. Radiol., 16, 129.
-- (1944), Radiology of Bones andyoints, 3rd ed., 330.