198 THE DISEASES OF THE PARATHYROID GLANDS 



those teeth that had been present during the course of the illness. Nearly 

 all of the children had also had rachitis. Flcischmann points out, however, 

 that rachitis lasts much longer than tetany, and also attains its acme much 

 later. Fleischmann also finds support for his view in the statement of 

 Fuchs that children with lamellar cataract almost always show hypoplasia 

 of the enamel. In individuals with hypoplasia of the enamel, in whom 

 nothing is known of their having had tetany, there may have existed a 

 latent tetanic condition in early childhood. Very convincing is an obser- 

 vation of Spiegler in a case of recurring tetany, who had an attack every 

 spring during eight years. In this case it was known that the tetany had 

 first made its appearance at the end of the second year of life. All teeth 

 whose crowns must have been formed at this time were normal, while the 

 teeth whose crowns developed later showed defects of the enamel. An 



FIG. 29. Enamel defect in tetany. 



entirely similar case was observed by Kahn and myself (Observation XXIII) . 

 Here were found on the canine and incisor teeth punctiform defects of 

 enamel often arranged in parallel rows; the upper parts of the molars were 

 partly broken off. The patient's mother stated definitely that already in 

 the first year of life, but more especially in the second and third years, he 

 had spasms of the glottis and spasms of the hands, while a severe rachitis 

 was added to the picture only in the third year. 



The above illustration (Fig. 29) shows the defects of enamel observed by 

 us in another case. 



The connection between tetany and defects of the enamel is by all this 

 evidence put on a sound basis; and I shall not discuss the possibility of 

 these defects being brought about by other causes. 



Perhaps the conjunctivitis accompanying tetany may also be regarded as 

 a trophic disturbance. De Quervain observed that parathyroidectomized 

 dogs often suffer from severe conjunctivitis. I saw this almost regularly in 



