334 THE VITAMINES 



served edema and carpopedal spasms. The determination of the 

 calcium content of the blood is of help in the diagnosis. Rowland 

 and Marriott (1172) found, in normal cases, 10 to 11 mgm. calcium 

 in the blood; in rickets, somewhat less; in tetany an average of 

 5.6 mgm. and sometimes only 3.5 mgm. They found that the calcium 

 therapy, even though gradual, is effective. Eliasand Spiegel (1172a) 

 found the phosphorus content of the blood very high, while Tisdall, 

 Kramer and Howland (1172b) found that the ratio of sodium and 

 potassium to calcium and magnesium is very greatly increased. 

 Stheehman and Arntzenius (1173) found, on the other hand, that 

 the calcium content of the blood is no definite indication of tetany. 

 The calcium in the blood may be high and yet the Erb sign is posi- 

 tive, which may be associated with a lack of calcium in the tissues, 

 v. Meysenbug (1173a) states that the Thiemich sign is not associated 

 with the low calcium content of the blood and that larger doses of 

 calcium in older children do not affect the anodic reaction. The 

 determination of salt metabolism in tetany was made by Fletcher 

 (1174). Liefmann (1175) found the urinary acetone elimination 

 very high in the acute stage, while Sharpe (1176) found an increased 

 guanidine elimination in the feces. Hoobler (1177) stated that the 

 Ca- Mg- and P balances were all negative. Bolten (1177a) found 

 a decreased blood calcium content with an increase in the electrical 

 sensitivity in Fragilitas ossium (Osteopsathyrosis). 



Therapy 



Calcium therapy was described by Howland and Marriott (I.e. 

 1101). Thiemich (I.e. 1162) recommended breast feeding and 

 phospho-cod liver oil. Brown and Fletcher (1178) also recom- 

 mended phospho-cod liver oil. Stheehman (1179) and Brown, 

 MacLachlan and Simpson (1180) have corroborated the cod liver 

 oil therapy. The last named workers found the intravenous injec- 

 tion of calcium lactate without effect if not accompanied by a simul- 

 taneous phospho-cod liver oil therapy. The clinical manifestations 

 of tetany disappear in 10 to 17 days while, without the addition of 

 calcium, the action is very much delayed. Unfortunately, we have 

 found no data on cod liver oil therapy alone. Recently, Huldschin- 

 sky (1180a) has used in tetany the sun-ray therapy with which he 

 was successful in the treatment of rickets. It appears that the sub- 

 ject requires still further experimental study. 



