PATHOLOGY OF METABOLISM IN INFANCY 809 



cess of sodium ions present was responsible for the appearance of tetany 

 rather than any specific action of alkali. Lust (6) described two cases and 

 Raabe one in which the symptoms of tetany developed in infants coin- 

 cident with the occurrence of edema, and disappeared as the edema de- 

 creased. It was suggested by them that the sodium chlorid retained in the 

 edema fluids was responsible for the development of the symptoms of 

 tetany. Brown and Fletcher take a similar viewpoint. 



Aside from alterations in mineral metabolism, the only metabolic 

 change of any importance which has been observed in infantile tetany 

 is the excretion of considerable amounts of guanidin and methyl-guanidin 

 (Paton and Findlay). These substances were found in the urines of several 

 older children with tetany. The same substances were found in excess 

 in the blood and urine of parathyroidectomized dogs. A possible con- 

 nection between the observed changes in metabolism of guanidin and of 

 calcium is brought out by the work of Watanabe(<i), who has shown that in- 

 jection of methyl-guanidin into animals leads to an increase in the blood 

 phosphate content and a decrease in the blood calcium content coinci- 

 dent with the development of tetany. 



The known alterations in the metabolism in infantile tetany furnish a 

 basis for rational therapy. The administration of calcium salts in suffi- 

 cient amounts very regularly results in the disappearance of all mani- 

 festations of the condition. Berend, reasoning from the similarity in 

 the physiological actions of magnesium and of calcium on the nervous 

 system, suggested the use of magnesium therapeutically in tetany. It has 

 been found that subcutaneous injection of magnesium sulphate regularly 

 leads to a disappearance of the symptoms of tetany. Inasmuch as calcium 

 retention is usually better in infants fed on breast milk than in those arti- 

 ficially fed, it is customary to feed infants suffering from tetany on 

 breast milk when this can be obtained. Cod liver oil when fed by mouth 

 has been shown to lead to increased calcium retention, especially in in- 

 fants whose calcium retention has been poor. For this reason cod liver oil 

 has been widely used in the treatment of infantile tetany. 



Metabolism in "Exudative Diathesis" (Eczema) 



Under the name of "exudative diathesis" Czerny has described a 

 clinical picture in infants and young children which he considers^ be 

 due to an alteration in the chemical processes of the body. He attributes 

 the alterations in metabolism to a functional incapacity of the body to 

 utilize food, especially fat. A congenital and constitutional factor is be- 

 lieved by Czerny to be the basis for the condition. 



The manifestations of the exudative diathesis as described by Czerny 

 are varied in character. One of the manifestations is a failure of the 



