TETANY IN INFECTIOUS DISEASES AND INTOXICATIONS 209 



2. Tetany in Diseases of the Thyroid Gland 



Cases of tetany in myxedema are rare. They are strikingly frequent, 

 combined with epilepsy (cases of Stewart, Schonborn, and myself). 



Cases of thyroiditis with tetany were observed by v. Eiselsberg, and 

 Kocher. Although there are no pathologico-anatomical investigations, 

 yet it may readily be supposed that acute inflammatory or sclerosing proc- 

 esses that attack the thyroid also involve the parathyroid in sympathy. In 

 strumous degeneration of the thyroid gland the parathyroids associated 

 with the capsule may become involved and thus are brought to atrophy. 

 Such cases have been reported by Steinlechner, Fraisseix, Hirschl, Marinesco, 

 Jacobi, and others. I shall speak in the consideration of idiopathic tetany 

 of the triad described by v. Frankl-Hochwart tachycardia, tremor, and 

 Chvostek's symptoms (II and .III), with struma and vasomotor excitability. 

 This condition was called "tetanoid" by v. Frankl-Hochwart (see above 

 for the consideration of the hyperthyrosis or hypothyrosis in tetany). 



3. Tetany in Infectious Diseases and Intoxications 



Tetany has been observed in the most diverse infectious diseases. 

 Most quoted is the frequent association of tetany in epidemics of typhoid 

 fever (Aran and Rabaud). Tetany has also been observed in angina, in- 

 fluenza, acute articular rheumatism, croupous pneumonia, and many other 

 infectious diseases. For the most part these cases occur in places where 

 tetany is common and during the time of the occurrence of tetany. There- 

 fore it is very probable that in the majority of these cases the infectious 

 disease constitutes only the determining factor, that no form sui generis 

 is present, but that these cases belong to the idiopathic tetany to be de- 

 scribed later. At all events it is not improbable that a generalized infectious 

 process would affect also the parathyroids, and lead to infiltration or at least 

 to parenchymatous degeneration of these organs, thus temporarily deranging 

 their function. 



In this category belong the cases of tuberculosis of the parathyroids. 

 There have been already published numerous statements as to the occurrence 

 of this condition (Benjamin, Carnot and Delion, Pepere, Kb'nigstein, Stumme, 

 Schmorl and Eggers) . Carnot and Delion, and Pepere, observed typical tetanic 

 symptoms in phthisis, in the days immediately preceding death. Stumme 

 observed Ckvostek's phenomenon. These findings are certainly interesting 

 in consideration of the frequent occurrence of CkuosteVs phenomenon in 

 tuberculosis, as mentioned previously. 



We can regard the cases that occur in poisonings as a less independent 

 group. The most diverse poisons, such as ergotin, phosphorus, carbonic 

 oxide, spermin (Oppenheim), lead, morphine, chloroform, etc., may lead to 

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