No abstract

No abstract

No abstract

oguizcs "incomplete," "latent," and so-called " tetanoid " forms, where spontaneous spasm is absent, but where Trousseau's, Erb's and Chvostek's signs are present, and ho also recognizes cases with typical muscular spasm where the accessory phenomena are absent. It appears, although it is not specifically so stated by the author, that all these incomplete and tetanoid forms occur in cases associated with gastric derangement. Frankl-Hoch wart, W. Fleinert and Ury declare that such cases are not to be considered as true tetany, and they limit tetany strictly to such cases as show typical contractures, with Trousseau's, Erb's and Chvostek's phenomena all present. Frankl-Hochwart makes the following subdivisions of tetany : (a) Tetany of adults.-(1) Tetany in sound individuals, acute or subacute, mostly mild forms, which in certain localities, as Vienna and Heidelberg, at certain seasons, especially March and April, is very prevalent, and attacks with preferonce young men of certain callings, namely, tailors and cobblers. This is called idiopathic laborer's tetany, and is often associated With light fever. (2) Tetany of gastric and intestinal affections: diarrhea, dyspepsia, gastric dilatation, helminthiasis. (3) Tetany after poisoning with chloroform, morphin, ergotin, lead. Single cases of each reported. (4) Tetany of acute infectious disease : typhoid, cholera, influenza, measles, scarlet fever. (5) Tetany of puerperal state. (0) Tetany of thyroid extirpation and strumipriva. (7) Tctany in connection with other nerve diseases, exophthalmic goitre, brain tumor, syringoinyelia. (¿) Tetany of children with relation to gastrointestinal disease, acute infectious disease and rhachitis.-Apart from the reports of individual cases there have been but two studies of the occurrence of tetany in America, namely, those of Griffith and of Morse.

For some years (since 1916) various obstetricians have watched the effect of diet on the weight of pregnant women. This attention to weight and diet has been prompted by various reasons; the desire to lessen the incidence of eclampsia12 3 ; the hope of finding earlier symptoms of toxemia than are afforded by the appearance of albumen in the urine and a rise in the blood pressure; to study the nutrition (especially calcium) of the new-born.As a result of these investigations, the weight of the patient has been added to pre-natal observations because it has become evident that any sudden gain or loss of weight during pregnancy is important; as suggesting, in ease of loss, the death of the fetus or the existence of some pathological condition in the mother, and in case of sudden gain, the retention of fluid in the body a considerable period before blood pressure, superficial oedema or urinary examination suggest it. Several writers have repeatedly urged the importance of restricting the intake of the pregnant woman. Gessner1 in analyzing the marked statistical decrease of eclampsia in Bonn during the war, concluded that it was to be explained by the high cbst of food and its resultant deprivation in the lower classes, and a similar result in the wealthier classes due to the greater effort necessary to procure and prepare it in the absence of servants. Fitzgibbon4, Master of the Rotunda Hospital, Dublin, inveighs against overfeeding of the pregnant woman, considering it a secondary cause of eclampsia. In a paper5 read before the New England Health Institute, May, 1924, the writer said, "Perhaps the most important of all the newer methods of pre-natal care consists in watching the weight of the patient to prevent overeating.The old adage that the pregnant woman should eat for two has done incalculable harm. If the pregnant woman eats excessively of carbohydrate food, she is apt to develop diabetes, as it is well known that her tolerance for sugar is low; if she overeats protein food, she is in danger of toxemia. In any case, overeating develops a great deal of fat, which makes proper exercise difficult, decreases the space through which the baby must pass and produces a larger baby and consequently a more difficult labor."The clinical experiments, of which this is a preliminary report, were initiated however for a different and, as the writer believes, a more important reason with much broader implications. The persistent high maternal mortality in childbirth has been the stimulus for detailed statistical study by the Ministry of Public Health for England and Wales6 and by the Massachusetts Department of Public Health7. These figures show a mortality of 3.81 in 1922 in England and Wales and 5.9 in 1924 in Massachusetts per 1000 living births.* Further study of these figures show that in England 36% of the deaths and in Massachusetts 22%+ of the deaths were due to puerperal infection. The English statistics do not separate operative deliveries, but the Massachusetts figures show that 61% of the maternal deaths in 1922...