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In a previous paper (1) it was concluded that vitamin D has two fundamental and separate actions: (a) to increase the absorption of calcium from the gastro-intestinal tract, and (b) to increase the phosphate excretion in the urine. In a later paper (2) evidence was brought forth which suggested that A.T. 10 (dihydrotachysterol) has both these properties but that the ratio of the calcium absorption factor to the phosphate excretion factor is less with A.T. 10 than with vitamin D. It was pointed out (2), furthermore, that the effect of either A.T. 10 or vitamin D on phosphate excretion may be masked in patients with their parathyroids intact by a tendency in the opposite direction resulting from decreased parathyroid activity occasioned by the increased calcium absorption. It was thought that the reason A.T. 10 was not antirachitic was because of this increased effect on phosphate excretion, a property obviously not antirachitic. Finally, it was pointed out (2) that the parathyroid hormone differed in action from both vitamin D and A.T. 10 in having only the effect on phosphate excretion in the urine without any effect on calcium absorption. It was decided to test the above conclusions by studies on a patient with chronic infantile rickets. The subject of the investigation was a boy of 17 with vitamin D resistant rickets. He was the same boy who was previously reported (3) on whom it was shown that the disordered metabolism was essentially the same as in the usual form of rickets but to whom it was necessary to give massive doses of vitamin D before therapeutic results were obtained. In the present investigation the metabolic effects of A.T. 10 and parathyroid extract were studied. These data can be compared with those from similar studies already reported with vitamin D on the same patients (3). Whereas these latter studies were conducted approximately 5 years before, the underlying metabolic disorder was essentially the same during both studies. To be sure, the bones were much less rachitic during the present investigation. On the other hand the blood valuesserum calcium, phosphorus, and phosphatasewere almost identical at the beginning of both investigations.

A COMPARISON OF THE EFFECTS OF VITAMIN D, DIHYDRO-TACHYSTEROL (A.T. 10), AND PARATHYROID EXTRACT ON THE DISORDERED METABOLISM OF RICKETS