212 THE DISEASES OF THE PARATHYROID GLANDS 



is, as I fully know, not satisfactory in certain directions. It does not explain 

 why tetany is so frequent in the springtime nor why certain occupations are 

 preferred in such a striking manner. I believe moreover that it would be 

 worth while to pursue the problem further. 



5. The Tetany of Children 



The tetany of children is characterized by its great multiformity of mani- 

 festations. The assumption of the collectivity of these manifestations is of 

 recent date. In 1887 Cheadle had already stated that laryngospasm, tetany, 

 and convulsions were only the varying expression of the same "consti- 

 tutional morbid state." Since the year 1890 Escherich and v. Wagner, 

 Ganghofner, and later especially the school of Escherich maintained the teach- 

 ing of the belonging together of laryngospasm and the eclampsia of child- 

 hood, and, in spite of much opposition, have held to these doctrines, by the 

 demonstration of the increased electrical excitability and the delimination 

 from similar manifestations of another kind. The pathologico-anatomical 

 investigations of Erdheim and Yanasse seem adapted for establishing this 

 view on a safe basis. Tetany of early childhood occurs chiefly in the third 

 to the twentieth month of life. This is the form that deviates from the clinical 

 picture of tetany of adults through the multiplicity of its manifestations. 

 The tetany that sets in from the third year of life on is essentially similar 

 to the tetany of adults. The tetany of sucklings which often manifests it- 

 self only through increased galvanic, and especially anodic, hyperexcitability 

 is extraordinarily frequent in rachitic children and especially also in children 

 that have been fed artificially. This occurs almost always in the cold time 

 of the year. It shows a preference, as does rachitis, for northern countries 

 especially, but is distinguished from the tetany of adults by its uniform 

 extension. 



The investigations of Erdheim and Yanasse, already mentioned, have 

 furnished an interesting elucidation for the etiology of this form of tetany. 

 Already in 1903 Erdheim had mentioned the finding of hemorrhage in the 

 parathyroids of new-born children, and in 1906 he reported like findings in two 

 of the sucklings that had died of tetany. Yanasse then examined system- 

 atically the parathyroids of thirty-five children who had died at the age 

 of fifteen months. He found that in cases in which the electrical excitability 

 had been normal during life, the parathyroids were normal. In those chil- 

 dren, however, in whom there had existed electrical hyperexcitability, he 

 found almost constantly hemorrhages or the remains of hemorrhages (in 71 

 of the 104 cases investigated). The hemorrhages are demonstrable at about 

 the twelfth month, and are very probably to be referred to trauma during 

 birth. According to the later investigations of Haberfeld, the damaging in- 

 fluence of the hemorrhages does not act so much on the destruction of the 



