616 LEWELLYS F. BAKKEE 



tetany, or, rather, to the disturbance of parathyroid function and of the 

 calcium metabolism underlying it. 



A good illustration of the enamel defects in the teeth of an adult male 

 who had had tetany in childhood will be found in Fig. 9, taken from 

 Phleps's article on tetany in Lewandowsky's Handbuch. I had myself 

 observed such enamel defects in adult human beings in more than one 

 instance; before I learned of the work of Erdheim and of Fleischmann 

 I had no idea of their cause. The J. P. Munroe case of chronic tetany 

 reported at Charlotte, N. C., showed this enamel dystrophy in high degree. 



It is well to be always on the lookout for these enamel defects when 

 examining patients, for, if found, they prove that the patient has had 

 tetany in early life and not infrequently they give the clew, too, to the 

 presence of a chronic tetany still existent. When parallel rows of enamel 

 defects are visible in an adult, as in the figure, the terrace-like or stair- 

 case-like appearance of the teeth permits one to assume the existence of a 

 recurring tetany during the developmental period. Patients presenting 

 such enamel defects should be questioned regarding the occurrence of 

 laryngospasm and other muscle spasms in earlier life. Especially, if the 

 parents of such a patient be still living, it will sometimes be possible to 

 secure from them a history that points to tetany in the early childhood 

 of their offspring. 



Crystalline Lens. The crystalline lens is made up, as is well known, 

 of epithelial cells, so arranged that some are centrally placed (nucleus of 

 the lens), others peripherally placed (cortex of the lens). 



Clinicians have long known that persons suffering from attacks of 

 tetany are especially prone to the development of cataract. Thus, Lands- 

 berg (1888), von Eiselsberg, Hoffmann (1897), Westphal (1901), and 

 Wangenmann (1902) reported cataract developing in human beings after 

 tetania strumipriva. And after attacks of idiopathic tetany, the develop- 

 ment of cataract was observed by Bernhardt (1891), Wettendorfer 

 (1897), Peters (1898), Freiind (1899), Uhthoff (1901), Saska (1904), 

 and others. After tetania gravidarum, too, cataract has been observed by 

 a number of clinicians. 



Even in the tetany of children cataract may appear, Peters (1901) 

 having observed distinct turbidity of the deeper cortical layers of the 

 lens in both eyes in a child three years old that had suffered from several 

 severe attacks of tetany. He has reported, too, a similar opacity in the 

 lens of a seven-year-old girl, and, still more interesting, he has^ described 

 tetany and beginning cataract in the children of a mother who had re- 

 covered from tetania -ravidaruin. One of these children was eight years 

 old, the other torn-. An older sister of these two children had a central 

 cataract, though, as far as was known, she had never suffered from tetany. 

 Peters has emphasized, therefore, the importance of careful examination 

 of the eyes in children that have had tetanv. 



