It may be said to be definitely proved that in many cases of spas inophilla there has been more or less severe overfeeding with cow's milk, and the correction of this mistake alone suffices to bring on a gradual restoration to normal conditions. In others the same result is aeeomplished only by the complete withdrawal of cow's milk. In such eases the child may, if no breast-milk is available, be fed exclusively with oatmeal porriclge or a sweetened decoction of flour, and on sueh a diet the exaggerated galvanie irritability gradually returns to the normal. But the effeet is only temporary, and if the farinaceous diet is kept up longer than from one to two weeks at most, the overexcita bility- may return or the child may even exhibit very extensive nutri tional disturbances which are difficult to correct (effects of artificial feeding). The fats are comparatively less harmful; while in regard to the various kinds of sugar the question still remains undecided.
Another peculiarity that is frequently encountered in children with the spasinophile diathesis is rarhitis. If we adopt the theory which Kassowitz's school quite properly hold with regard t,o this disease, wc shall find rachitie symptoms in the great majority of spasmophile chil dren even though the .symptoms may be quite ineonspieuous. Ka.sso witz accordingly regarded the clinical manifestations of spasmophilia as nothing more than the "nervous disturbances of rachitie children," and his example has been followed by others, for example, Eseherieh, who speaks of "tetany of rachitie children.- With regard to the pathogenesis, Kassowitz assumes that the raehitie hypera.mia of the flat cranial bones produces a collateral hyperamna or circulatory dis turbance in the cerebral cortex, which in turn is the basis of the clinical phenomena. Aside from the weakness of his position, it must be said that the theory is directly contradicted by the facts; for, on the one hand, we often see children who are quite free from rachitis and yet suffer from severe manifestations of the spasmophile diathesis; and on the other hand, these phenomena are often permanently absent in many children with severe raehitis, especially of the skull. In fact, such a parallelisni between cranial rachitis and the spasmophile pheno mena, which logically follows from Kassowitz's theory, certainly does not exist. The frequent coincidence of the two disturbances, which cannot be denied, is probably explicable on the ground that the two are coordinate conditions which develop on the soil of the same chronic metabolic anomalies, and which have many points in common.
The question as to the action of phosphorus will be discussed later.
Kassowitz's theory appeared to receive strong confirmation from the peculiar relationship existing between the frequency of tetany and the different seasons of the year. Just as von Jacksch, Frankl-Hoch wart and others, found in the case of manifest tetany of adults, so also Loos, liseherich, Ganghofner and others, found that manifest tetany and larynogspasm in children increase during the beginning of winter and gradually reach their highest point in February or March; after which the eases diminish in frequency, until during midsummer the incidence becomes zero. To illustrate, we (mote liseherich's statistical table of 240 cases: Kassowitz pointed out the similar relation to the time of year existing between the incidence of tetany and that of the rachitic affec tions, and concluded that there must be an intimate connection be tween the two diseases. When, however, Loos, Ganghofner, Cassel, Fisch} and others later investigated this relation, it was found that, although both diseases increase in frequency during the last months of winter and the early spring months, there is no accurate correspondence in that respect. In general the eases of tetany are most frequent in February or March, while the rachitic affections. do not attain their maximum until April or May. But this comparatively slight devia tion is by no means such a serious objection to kassowitz's reasoning as the fact that all these statistics in regard to the frequency of rachitis have been declared worthless. I myself agree with the latter view, although I shall not stop to give my l'ea6011S, and have therefore omitted a detailed reference to the literature. No one will think of comparing the tetany of adults to rachitis, although statistics may prove that in both conditions the incidence is greatest during the spring.
The fact under consideration itself we believe, on the strength of years of observation, to be so well established that we clo not feel even tempted to offer statistics of our own.
In examining the response to galvanic irritation in several hundred children we found that not only the clinical manifestation (tetany, laryngospasm, eclampsia), but a completely latent spasinophile diathesis also was demonstrable much more frequently during the late winter and spring months than in the summer and fall. The same observation tvas made recently by Finkelstein in a number of hospital eases which he examined very thoroughly. The reason for this relation between the incidence of these diseases and the time of year is not clear.