THE SPASNIOPHILE DIATHESIS AS A CLINICAL ENTITY The three above-described clinical pictures, tetany, laryngospasm, and eclarnpsia, are quite different in their manifestations, and the only thing that they have in common is the soil on which they grow—the spasmoplaile diathesis. Another reason, however, for including them in the same group, is that they frequently occur either in combination or in alternation in the same individual, and possess a number of com mon clinical charaeteristics in respect to the etiology, the age at which they occur, the peculiar type of children subject to the diseases, etc.
Before taking up these factors in detail, it should be emphasized that in many children the spasmophile diathesis can be demonstrated by repeated careful examination, even though they have never pre sented symptoms of any of the above-mentioned diseases. The theory first adopted by Thiemich that the presence of galvanic overexcita bility is sufficient to characterize a child as pathologic has not yet found general acceptance. On the other hand, the observations which we have mach' at the Breslau Kinderklinik during a number of years, have tended to strengthen our opinion more and more, and in recent times Finkelstein and H. Neumann have adopted the same view. The explanation which follows accordingly applies to the spasmophile diathesis in general, whether it manifests itself in one form or another, or remains permanently latent.
Galvanic overexeitability, and along with it the remaining symp toms of latency, is so variable and so much affected by the nutrition that a high degree of excitability may be present. one day and vanish the next, to be replaced by normal conditions. On the other hand, unless it is influenced by treatment, the spasmophile diathesis may persist for many months with only moderate changes in its intensity. These two facts have a very great theoretical interest, inasmueh as they demonstrate that we are dealing with a functional condition which is not dependent upon the relative degree of development of the peripheral and central nervous system, and is therefore not to be regarded as a phase of development in the sense in which that terin is used by Solt mann (see page 297).
In accordance with the above, the pathologic findings that have been described by various authors in tetany and eelampsia cannot be regarded as the material counterpart of the functional disturbance, but merely as secondary and accidental changes.
The observation which, both from the practical, and as we shall see later, from the functional standpoint, is most important. for the explanation of the pathogenesis of the spasmophile diathesis, is the fact that it is influenced by the food. The rarity of eclanipsia or laryngo spasm in breast-fed children, and the fact that both conditions can be curecl by feeding the children on breast milk-have long been known to good observers. The exact proof, however, that not only the clinical manifestations but the primary (galvanie) overexcitability is closely dependent on the food, we owe to two series of investigations by Gregor, who discovered two fundamental factors: first, that the withdrawal of food, provicling sufficient water is administered (tea diet), causes the disappearance of the most extreme clegree of overexeitability in from twenty-four to forty-eight hours: and second, that if. the child is after wards fecl on breast-milk, the normal eondition eontinties permanently, whereas artificial feeding is followed by a renewed increase in the gal vanie irritability. With this observation as a basis a number of authors proceeded to study the influence of the individual ingredients of arti ficial food.
Investigations along this line, which are by no means completed, while they have resulted in the postulation of certain definite laws, have also demonstrated the extremely complex nature of the problem. It appears that the influence of diet is by no means a simple, direct in fluence, hut is exerted in some as yet unexplained way through metab olism or the functions of individual organs. This is proved by the fact that the same change of food in children does not always produce the satne result, and produees but little effeet, or fails altogether, in some cases.