History

It is probable that tetany due to mineral (and perhaps vitamin D) deficiencies has always plagued humankind to some limited extent. In children the convulsions of tetany in the past were often attributed to "teething." But it was not until the beginning of the nineteenth century, with increased bottle feeding, that a syndrome resembling tetany was first described in England (Clarke 1815). François Rémy Lucien Corvisart gave the syndrome its name in 1852, and in 1854 Armand Trousseau described tetany in lactating women. In 1881 H. Weiss observed that tetany appeared on occasion in patients whose goiter had been removed, and in the 1880s the disease appeared in near-epidemic proportions in Vienna. Yet August Hirsch (1883-6) had nothing to say about tetany in his massive Handbook.

In 1913 E. Kehrer penned a description of neonatal tetany and suggested the administration of cal cium salts in its treatment, but according to Paul D. Sa ville and Norman Kretschmer (1960), the first satisfactory chemical study was the work of J. Howland and W. M. Marriott (1918). It was this work that distinguished rickets from tetany and reported a substantial reduction of serum calcium in infantile tetany patients. It also reported that the administration of calcium salts would relieve the symptoms.

Alfred Hess (1929) pointed out that in the United States the peak incidence of tetany was in the early spring, that cases seldom developed in the summer, and that the black young were "markedly susceptible." This suggests a role for vitamin D, given its shortage during the winter months in temperate climates and the difficulties blacks have had historically with vitamin D while wintering in those climates.

During the late 1950s and early 1960s, much attention was focused on the disease, and Arthur Bloomfield (1959) and Saville and Kretchmer (1960) surveyed the literature on what had been an important killer of the young. Subsequently, however, as more has been learned about mineral metabolism and as the disease has gone into decline, so has the name "tetany." Although it is still in the literature, the tendency since the 1960s has been to write of hypocalcemic and hypomagnesemic, rather than tetanic, convulsions.

Kenneth F. Kiple

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