TETANY OF MATERNITY 213 



parathyroid parenchyma as on the inhibition in growth of these organs con- 

 ditioned by it. Erdheim and his collaborators, on the basis of their investi- 

 gations, adhere to the view that the tetania infantum depends on a hypo- 

 parathyroidism, and that the artificial nourishment constitutes only the 

 occasioning factor. Erdheim is corroborated by Peters, Schmorl, v. Verebely 

 and Strada. Auerbach, Grosser and Betke, Bliss, Raymond, Jorgensen and 

 others have pronounced against the assumptions on the ground of patho- 

 logico-anatomical investigations. Thus Escherich's views in their universal 

 form are to-day not generally shared. 



Heubner has grouped together the diseases mentioned under the less 

 prejudicial name of spasmophilic diathesis. 



The etiology of the tetany of later childhood (puerile tetany according 

 to Escherich] is as yet unknown; perhaps it is identical with that of the idio- 

 pathic form. 



6. The Tetany of Maternity 



Under this heading we understand the tetany observed in pregnant, 

 child-bearing, or puerperal women, v. Frankl-Hochwart has collected fifty- 

 three certain cases from the literature, and adds to them twenty-three of his 

 own. Of these twenty-eight affected women who were pregnant, nineteen 

 occurred after the delivery, and twenty-nine during the puerperium. The 

 beginning of tetany in pregnant women occurs in the sixth to the eighth 

 month [of pregnancy]. 



To-day maternity tetany can scarcely make a bid for the distinction of 

 a form sui generis. A portion of the cases belong in the group of tetany 

 after strumectomy, the rest in great part to the group of idiopathic tetany; 

 these come from places affected with tetany and occur especially in the 

 tetany months, and it seems to me noteworthy that there do occur epidemics 

 chiefly in the form of maternity tetany. While for example, according to 

 the summary of Adler and Thaler, maternity tetany is relatively rare in Vienna 

 (at the first gynecological clinic at Vienna only nine cases of the tetany of 

 maternity were observed among about 30,000 cases) ; a great number of the 

 cases described by Krajewska and also by McCarrison belong to this group. 

 In all the forms the pregnancy or lactation plays the role of the determining 

 factor only. This has been established by numerous experiments on animals. 

 At first Horsley, later Vassale, Pineles, Erdheim, and especially Adler and 

 Thaler, showed that in partially ectomized animals that show no signs of 

 tetany, the tetany comes to expression with the progress of the pregnancy. 

 In cases of slight parathyroid insufficiency, this may occur only in the course 

 of the second pregnancy, or, as has repeatedly been observed, there may even 

 occur a normal pregnancy interpolated between pregnancies complicated 

 with tetany. A very interesting case of this sort is reported by Meinert. 

 In this case there had been two births that were normal, then in the third there 



