182 THE DISEASES OF THE PARATHYROID GLANDS 



spasm. In latent tetany a febrile affection (angina, tuberculin injection, 

 gastrointestinal indisposition, introduction of the stomach sound, pregnancy, 

 an intoxication, etc.) may render the tetany manifest. 



Ckvostek, Jr., observed the occurrence of spasms after injection of tuber- 

 culin. Rudinger and 7 regularly saw spasms in the acute stages occur after 

 injection of adrenalin. Kahn and / saw in the acute stage, also regularly, the 

 occurrence of increase in intensity of the tetanic symptoms during the hours 

 following the injection (as will be considered later). 



Fibrillary contraction of the muscles, which are constant in the tetany 

 of parathyroidectomized animals, occur in human tetany rarely. The same 

 is also true as regards the pareses, which occur very frequently in totally 

 parathyroidectomized animals, especially in the hind extremities. 



Weakness of the extremities, especially after the spasms, may also occur 

 in human beings. Also paralysis is observed in man (v. Frankl-Hochwari). 

 Chvostek, Jr., observed for instance a temporary paralysis in the ulnar terri- 

 tory after a spasm that was long in duration, which he attributed to the long 

 drawn-out extreme position of flexion. Also slight ataxias occur in human 

 beings as well as in animals. Spastic contractures are rare. 



In adults, the sensorium is mostly uninvolved, in children it is very fre- 

 quently clouded, although also in adults, in the severe cases, especially in 

 the parathyroprivic tetany and in stomach tetany, there may occur clouding 

 or indeed complete loss of consciousness. 



The coincidence of epileptic attacks with tetany is not rare (v. Frankl- 

 Hochwart, Freund, Hirschl, Fries, Falta and Kahn, Redlich, et al.). Redlich 

 has collected seventy-two cases from the literature. Typical epilepsy may 

 have existed for years, to which tetany is then superadded, or epileptic attacks 

 may occur in the course of tetany, or may set in simultaneously with it. Espe- 

 cially in parathyroprivic individuals have been observed severe unilateral or 

 bilateral epileptiform convulsions with loss of consciousness and slowness 

 or absence of pupillary reaction. Such cases may rapidly come to a lethal 

 end; or the tetany may altogether subside, and death follow later in status 

 epilepticus, or tetany and epilepsy may pass over into a chronic stage (cases 

 of Westphal and of Redlich) . In children severe eclamptic attacks may enter 

 into the course of tetany, or may occupy a position in the foreground. In the 

 discussion of the pathogenesis I shall take up the question of the relation of 

 the two conditions. 



Finally it should be mentioned that in the severest forms of tetany, espe- 

 cially in the parathyroprivic forms and in stomach tetany, myotonic symp- 

 toms are observed not infrequently, v. Frankl-Hochwart designates them 

 as intention spasms [Intentionskrampf e] ; they express themselves in such 

 a manner that on such an attempted intentional movement as closure of the 

 hand for instance, the hand cannot be opened again for several seconds 



