642 LEWELLYS F. BARKER 



they admitted, however, that much work remained to be done before a 

 clear conception of the process could be reached. 



In contrast with these findings of MacCallum and Voegtlin are those of 

 Neurath. Determining the calcium compounds that can be precipitated 

 by oxalate rather than the total calcium, this observer found an increase of 

 the calcium of the blood both in infantile tetany and in animals after 

 parathyroidectomy. 



Marine (1914), who studied parathyroidectomized dogs, found that 

 the administration of calcium salts exerted a striking palliative effect upon 

 the resultant tetany ; though this treatment might tide over .an otherwise 

 fatal case, it was in no sense curative, and the way in which the calcium 

 acted was not clear to him. 



Berghcim, Stewart, and Hawk (1914) studied carefully the calcium 

 metabolism in a negro, from whom the entire thyroid gland together with 

 the parathyroid glands were of necessity removed on account of a malig- 

 nant growth that required also laryngectomy. Tetany did not occur. 

 Though the patient was given a diet rich in calcium, they thought that this 

 alone could scarcely account for the non-appearance of tetany for a whole 

 month ; it seemed more likely that the man's organism had adapted itself 

 gradually to parathyroid insufficiency during slow reduction of the para- 

 thyroid function by the neoplasm before the operation. They found a low 

 calcium excretion in the urine (average excretion of 0.0134 gram per day 

 on a daily ingestion averaging 1.6736 grams of calcium oxide) and a 

 slight increase of the calcium content of the blood. They suggested that 

 the calcium rich diet and a compensatory action of the hypophysis cerebri 

 may have been contributing factors to the inhibition of tetany in this 

 patient. 



Certain recent studies of infantile tetany confirm, in opposition to 

 Stolzner, the view that the calcium content of the serum is reduced. 

 Rowland and Marriott (1918) assert that in their cases of tetania in- 

 fantum the amount present was only about 5.6 milligrams per 100 cubic 

 centimeters, whereas in the normal child the amount is 10 or 11 milli- 

 grams. These observers could promptly relieve the symptoms of tetany by 

 the administration of calcium. 



In human tetany in adults due to overveiitilation, Grant and Goldman 

 found, on the other hand, constantly no diminution in the calcium content 

 of the serum, but rather a slight increase. They do not deny, however, the 

 possibility that calcium may play a role in the production of the tetany of 

 forced respiration. It is known that a decrease of CO 2 in the blood results 

 in the precipitation of calcium ( Barille, Marriott). Though the centri- 

 fuge revealed no precipitated calcium, Grant and Goldman suggest that 

 very minute particles may have been held in solution by colloids and that 

 there was a loss of active calcium. 



When we survey the studies of calcium metabolism in tetany as a 



