580 LEWELLYS F. BARKEE 



Changes of diet, of occupation, and of surroundings, the control of intoxi- 

 cations and of infections, the administration of calcium salts, the exhibi- 

 tion of parathyroid substance and of parathyroid nucleoprotein, and the 

 transplantation of parathyroid glands are the means of cure and of ame- 

 lioration thus far devised that have proved most serviceable. 



II. Historical Notes on Tetany 



To understand the present status of any subject in clinical medicine, 

 an acquaintance with at least the broad general outlines of the historical 

 development of that subject would seem to be necessary. I shall, there- 

 fore, endeavor to explain, as briefly as is compatible with some de- 

 gree of order and perspicuity, the way in which our present knowledge 

 of tetany has gradually evolved. 



If we leave out of account certain vague references in the writings of 

 the ancients to muscle spasms that may have been tetany, we must admit 

 that British observers were the first to recognize the syndrome of manifest 

 tetany. It was on children rather than on adults that these first definite 

 observations of the occurrence of the tonic spasms of tetany were made. 

 Clarke, in his "Commentaries on Some of the Most Important Diseases of 

 Children" (1815), discussed spasm of the glottis and called attention to 

 the rigidity of the extremities that complicates this affection. It is 

 especially interesting that, in this first report of spasms now recognizable 

 as having been due to the tetany of childhood, one of the most charac- 

 teristic features of infantile tetany, namely laryngospasm, was described. 

 In the year following Clarke's publication, Kellie, of Leeds, contributed 

 a paper to the Edinburgh Medical and Surgical Journal entitled, "]STote 

 upon the Swelling of the Back of the Hand and of the Foot and upon a 

 Spasmodic Affection of the Thumbs and Toes which Frequently Accom- 

 panies It," in which he described what we now know must have been 

 tetany. In his paper, Kellie also makes reference to spasm of the glottis 

 as a part of the syndrome. 



The medical writers of Continental Europe remained for a long time 

 unacquainted with these early British observations. Thus, German 

 authors have usually given the credit for the first recognition of the 

 syndrome now known as tetany to Steinheim, a general practitioner 

 in Altona, who, in 1S30, described the condition as a "rare form of acute 

 articular rheumatism." French authors, on the other hand, have at- 

 tributed the first observation of tetany to Dance, who, in 1831, described 

 the condition as "intermittent tetanus." But one Frenchman, B. Oddo, 

 of Marseilles, who in 1SJKJ wrote a careful review of the history of 

 tetany, recognized the priority of the British observers and gave Clarke 

 and Kellie the credit for its discovery. 



