206 THE DISEASES OF THE PARATHYROID GLANDS 



are also observed in experimental tetany, ensures relationship to tetany. 

 The intention spasms may be explained by the fact that the will impulse 

 furnishes the determining factor for a tetany spasm. In addition there 

 often occurs, however, pitting on percussion and the myotonic electrical reac- 

 tion. On the other hand there occur true cases of myotonia congenita to 

 which are superadded the clinical picture of tetany. 



In these cases, as v. Orzechowski points out, the symptoms of tetany are 

 only of a slight grade; with the decline of the tetany, the myotonia remains. 

 This coincidence of tetany and myotonia has been sufficient for Lundburg 

 and others to ascribe the cause of myotonia to an insufficiency of the para- 

 thyroids. The assumption seems to me to be fully unsubstantiated, as in 

 true myotonia all symptoms, that according to experimental experiences we 

 have come to regard as the cardinal symptoms of parathyroid insufficiency, 

 are absent. Myotonia is an affection of the muscles (Erb, Schultze and 

 Schiejjendecker and others). The occurrence of symptoms similar to those 

 of myotonia in tetany perhaps finds its explanation in a definite alteration of 

 the metabolism. It is remarkable that just those animals in whom the thy- 

 roids and parathyroids have been removed show these manifestations. 

 Furthermore, there is a case of Hoffmann's in whom the myotonic symp- 

 toms disappeared on the administration of thyroid gland, and in whom they 

 reappeared after withdrawal of the treatment, while the tetanic symptoms 

 were not essentially affected. Perhaps there is a certain relation between 

 myotonia and the high-grade mechanical hyperexcitability of the muscles 

 such as is not rarely seen in cachectic conditions. 



As for epilepsy, we have already mentioned in the consideration of the 

 symptomatology that tetany may develop on an epilepsy that has lasted for 

 a long time, and that tetany and epilepsy may develop simultaneously in 

 individuals not previously epileptic, and indeed may improve simultaneously. 

 In many cases the epileptic convulsions occurring in severe tetanic at- 

 tacks may remain the sole manifestation of epilepsy. It should fur- 

 ther be mentioned that Chvostek's phenomenon is not rarely elicitable 

 in epileptics, and that Fleischmann and Poetzl as reported by Redlich found 

 twenty-eight times defects of the enamel among sixty epileptics, a fact 

 that perhaps indicates that individuals who in early years have passed 

 through tetany, later often become epileptics. Most important for the 

 relationship between tetany and epilepsy are the cases of parathyroprivic 

 tetany with epilepsy. Redlich has collected twenty such cases from the 

 literature and adds a case of his own. The frequent coincidence of tetany 

 and epilepsy shows that this combination is "no accidental happening" 

 (v. Frankl-Hochwart, Schultze, Redlich}. As to the intimate connection 

 we really know nothing certain. Westphal supposed that tetany and 

 epilepsy depended on the same toxic cause, which, as Chvostek later elabo- 

 rated, led both to alterations in the central nervous system and to func- 



