TETANY 199 



parathyroidectomized dogs and cats. In the case previously mentioned (Ob- 

 servation XXIII) it happened that the conjunctivitis regularly became 

 exacerbated with the aggravation of the tetany. 



Yet a few words with regard to growth disturbances in tetany. Schuller 

 investigated five cases of rachitis tarda and found, besides pronounced 

 Chvosiek's symptoms, remaining behind in growth, delayed ossification and 

 dentition, and marked atrophy of the bones; the last was also found in an 

 exactly investigated case of the chronic recurring form of tetany, and also in 

 three juvenile cases of occupation tetany. On the contrary, a case of tetany 

 after strumectomy, and some cases of tetany of maternity showed normal 

 relations. Schuller points out that tetany may also occur in combination 

 with osteomalacia, and believes that tetany may induce rachitic alterations 

 before the cessation of bone growth, and osteomalacia after it. A similar 

 view is held by Erdheim on the basis of histological examination of the 

 skeleton, and especially of callus formation in rats after parathyroidectomy. 

 Kassowitz had before this supposed a casual connection between rachitis 

 and tetany. 



This view I would not subscribe to. It is to be expected that high-grade, 

 and especially, long-continued, absence of parathyroid function in youthful 

 life would lead to disturbances in growth of bones. We also saw certain cases 

 of chronic recurring tetany, in which the individuals were remarkably small 

 and showed retarded epiphysial closure. The disturbance has certainly 

 nothing to do with true rachitis. Sometimes, indeed, it is difficult to separate 

 the two conditions, as combinations of rachitis and tetany are extremely 

 frequent, and according to Escherich, not less than 80-90 per cent, of all 

 tetany in children is associated with rachitis. There are certainly, however, 

 cases of tetany without rachitis, and cases of rachitis with tetany constitute 

 only an extremely small percentage of the whole number of cases. Also 

 the rarefaction of the bone trabeculae described by Schuller is not charac- 

 teristic for a withstood tetany, for we have found them in individuals who 

 have not had tetany. Experimental experiences speak, too, against a direct 

 connection between rachitis and tetany. Iselin observed remaining behind 

 in growth in parathyroidectomized rats; and similar observations have been 

 made by Jeandelize, Moussu, and Vassale and Generali on other species of 

 animals. Iselin's animals remained well proportioned, however, and showed 

 no bone perversions. 



I decline to subscribe to the doctrine of a connection between tetany 

 and osteomalacia. The number of cases in which the diseases coexisted is 

 not large. BlaZiceck, Weber, E. Freund, Schultze, Becker, have reported such 

 cases. An exception in this respect is only the markworthy observation of 

 Krajewska from Bosnia; she found tetany present among one hundred fifty 

 cases of osteomalacia no fewer than forty-eight times. All forty-eight cases 

 affected puerperal women. 



