,644 LEWELLYS F. BARKER 



Phosphoric Acid. As was pointed out above, the behavior of anions 

 in tetany has, been but little studied. An exception may be made in the 

 case of the anion of phosphoric acid, the excretion of which has been 

 studied by Greenwald and by Schabad. 



According to Greenwald, a diminution in the phosphate excretion is 

 the most striking metabolic abnormality after parathyroidectomy, though 

 just how the phosphorus is retained in the body he was unable to determine. 



The studies of Schabad have thrown some light upon the phosphorus 

 metabolism in tetany and in rickets. This observer has asseverated that 

 the metabolism in rickets and that in rickets complicated by tetany are 

 identical as far as calcium and phosphorus are concerned. In both condi- 

 tions he found for calcium a diminution of retention with abundant ex- 

 cretion through the feces, and for phosphorus a marked preponderance of 

 the excretion through the feces in contrast with that through the urine. 

 Administration of phosphorus and cod liver oil caused, Schabad states, an 

 amelioration of symptoms in both rickets and tetany. 



Benger (1917) showed that tetany could be produced in dogs by intra- 

 venous injection of sodium phosphate in a certain quantity and of definite 

 acidity, though if the H-ion concentration were greater than pH 6 tetany 

 did not occur. The tetany was probably not due to the anion, however. 



Water. The so-called "water babies" are especially prone to exhibit 

 the phenomena of spasmophilia, including tetany. According to the meta- 

 bolic studies of Almon Fletcher and the clinical studies of Brown and 

 Fletcher, improvement in infantile tetany sets in with diuresis and the 

 overcoming of constipation. The relation of the water retention in such 

 water babies to chloride retention should be carefully studied. 



Vitamins in Tetany 



Nowhere in the literature have I found any reference to the possible 

 relation of vitamins to tetany. Certain points that may have a bearing 

 upon the subject, however, seem to me worthy of mention. I refer espe- 

 cially to the prevalence of tetany in children that are fed largely upon 

 proprietary foods, upon cow's milk alone, or upon any dietary that con- 

 tains a high percentage of carbohydrates and especially of superheated 

 carbohydrates. 



The newer studies of vitamins (McCollum) indicate their presence 

 in milk products, in leafy green vegetables, and in fruit juices. These 

 vitamins are of different sorts; all of them appear to be necessary for the 

 growth and general welfare of the body. It is conceivable, therefore, that 

 injudicious diet, especially in children, may, through vitamin deficiency, 

 be a factor in releasing tetany in patients predisposed toward it from 

 insufficiency of the parathyroid glands. But no positive statement on this 

 point dare be made until the proof has been sought and brought. 



