NUTRITIONAL DISTURBANCES IN CHILDREN 333 



cases of Rohmer and Vonderweidt (1161a) and Scherer (1161b), 

 this therapy was for the most part supplemented by cod liver oil 

 and phosphorus. Thiemich (1162) found the calcium therapy alone 

 without effect, while Petrone and Vitale (1163) found the parathyroid 

 therapy ineffective in their cases, though Pincherle and Maggesi 

 (1163a) reported that their tetany cases showed pathological 

 changes in the endocrine glands. The third possibility, the calcium 

 impoverishment as result of rachitic metabolic disease, is strengthened 

 by the frequent association of this disease with rickets and osteo- 

 malacia. Thus, Januszewska (I.e. 1140) found 338 cases of tetany 

 among 3500 cases of osteomalacia. Sauer (I.e. 1143), too, described 

 this relationship and was strengthened in his view by a favorable 

 cod liver oil therapy. Takasu (1164) associated spasmophilia with 

 beriberi. In his cases, there was a possibility of infantile beri- 

 beri. Since the rachitic disturbance may occur at any age, the 

 related tetany may appear similarly. Klose (1165) believed that 

 this disease can not occur under the age of 2 months. Bliihdorn 

 (1166) on the contrary, found it in children of all ages. Apart from 

 this, it is not totally excluded that certain forms of tetany of preg- 

 nancy and lactation are to be attributed to the above causes, although, 

 this was denied by Faas (1167). Tetany seems to be favorably 

 affected by a one-sided flour diet, and occurs rarely in breast-fed 

 infants, according to Guthrie (1168). Lust (1169) stated that tetany 

 occurs only in 2 per cent of breast-fed and in 55.7 per cent of artifi- 

 cially-fed children. According to Bossert and Gralka (1169a) true 

 spasmophilia may be recognized by the fact that it can be influenced 

 by a change in the diet. v. Meysenbug (1170) did not believe that 

 spasmophilia had anything to do with the three known vitamines, 

 still we cannot sae that his results justify such far-reaching conclusions. 

 Jeppson and af Klercker (1170a) believe that tetany is not due to 

 the lack of calcium in the diet but to an excess of phosphorus. 



Symptoms 



The Erb sign (increase of galvanic irritability of the muscles and 

 the motor nerves) and the Chvostek sign [increase of the irritability 

 of the nerves especially the facial nerve or the popliteus (Ibrahim, 

 1170b) to mechanical stimulus] are of value in the diagnosis of 

 tetany. According to Stheehman and Arntzenius (I.e. 1159), the 

 Chvostek sign is more sensitive. Bossert (1171) occasionally ob- 



