638 LEWELLYS F. BAKKEE 



calcium in the body, might easily arise, and that the necessary outcome 

 would be muscular twitching. He pointed out that, in such instances, the 

 administration of calcium salts might be expected to relieve the symptoms 

 and, perhaps, cure the disease. He further stated that to suppress neuro- 

 genic twitchings, more calcium might be required than the amounts found 

 necessary to suppress myogenic twitchings. 



J. B. MacCallum, in a series of important papers published between 

 1903 and 1906, showed that hyperexcitability in the domain of the visceral 

 nervous system can be aroused by the injection of certain salts that have 

 an action antagonistic to that of calcium, and that the symptoms result- 

 ing can be suppressed by the addition of a soluble calcium salt to the solu- 

 tion injected. 



These several observations, made by workers in general physiology, 

 were destined to influence in a directive manner the subsequent researches 

 of clinicians who studied the hyperexcitability of the motor nervous sys- 

 tem in tetany. 



As is often the case, the observations of the experimental physiologists 

 found a certain corroboration in the studies of clinicians, whose researches 

 were made entirely independently. Thus, Thiemich (&) (1903) stated that 

 spasmophilia is most common in artificially fed children and suggested 

 that cow's milk is especially likely to bring on the condition, a view that 

 was supported by the observations of Japha and of Finkelstein. Stoltzner 

 believed that this effect of cow's milk is due to excessive retention of cal- 

 cium in the tissues, and attributed tetany and spasmophilia to a sort of 

 calcium poisoning. But subsequent clinical investigators could not confirm 

 Stoltzner's view ; they demonstrated that, on the contrary, there is a cal- 

 cium deficiency in the body in tetany. Thus Quest in 1905 found that 

 the calcium content of the brain is remarkably lowered in spasmophilia, 

 and both he and Silvestri, who confirmed his findings in 1906, suggested 

 that tetany is due to hypocalcification of the nerve centers. In still later 

 papers Quest was able to show that calcium-poor food, fed to young dogs ; 

 increased the electrical excitability of their motor nerves, and further that, 

 if calcium excess were experimentally produced in the tissue juices of 

 animals, no increase, but rather a diminution, in the electrical excitability 

 of the nervous system resulted. Silvestri, in 1906, called attention to the 

 calcium deficiency that is met with in certain accidents of the puerperium 

 (tetany, eclampsia). And Netter (a) (1907) observed a favorable effect 

 from the administration of calcium salts by mouth in three cases of mani- 

 fest tetany in children. This author emphasized the impoverishment of the 

 blood and tissues in salts of calcium in diarrhea, in intoxications, and in 

 lactation in adults, and in the period of growth in children. He stated, too, 

 that the classical association of tetany and rickets brings to mind the prob- 

 ability of lime insufficiency. 



A number of other papers published at about this period dealt also with 



