IDIOPATHIC TETANY 211 



Idiopathic tetany shows a great inclination for relapses. After the first 

 attack it passes over in the latent stage, and tends to recur the next year at 

 the time for tetany (acute relapsing form of tetany, v. Jakscti). There is in 

 addition a chronic form in which the disease never entirely disappears. 

 The first form may pass over in the latter (see prognosis). 



Concerning the etiology of idiopathic tetany we know nothing that is 

 certain. The endemic-epidemic occurrence, as is intelligible, has a priori 

 given occasion to the thought of an infection. This is supported by the 

 increase in temperature that occurs in the acute stages; I mentioned before 

 that this is rather due to disturbances in the regulation of heat, which may 

 serve as a partial manifestation of the irritable condition of the vegetative 

 nervous system; it may be said it occurs to a much greater degree after 

 parathyroidectomy. Recently A . Fucks has pointed out the resemblance of 

 the clinical pictures of tetany and ergotism (typical form of spasms, pares- 

 thesias, trophic disturbances, cataract formation, epilepsy, psychoses, etc.), 

 and is inclined to refer occupation tetany to poisoning with bad corn. Biedl 

 comments on this hypothesis, stating that there is formed in the putrefaction 

 of histidin an amino-base (imidoazolyethylamin) that is identical with the 

 active agent in ergotin'. I shall assume an expectant attitude with regard to 

 Fuck's hypothesis, as insufficient facts are at our command. 



Very important for the etiology of idiopathic tetany appears to me a 

 contribution by McCarrison. In certain valleys among the Himalaya 

 mountains exists much epidemic tetany, and indeed just in those places where 

 there is epidemic goiter. The disease affects most solely women, and the only 

 man in whom McCarrison observed it was not affected with goiter. The epi- 

 demic of tetany takes on in numbers in spring, as with us, and is increased dur- 

 ing pregnancy and lactation. The goiter that predominates in this locality is 

 of a marked degenerative character. Numerous cases of tetany observed show 

 also signs of an incomplete myxedema; very noteworthy is also the statement 

 that persons that suffer from tetany become free of this affection when they 

 go into tetany-free districts, and finally reacquire the tetany when they return 

 to the original spot. In the light of this observation seems to me important 

 the fact that our localities for tetany, Vienna and Heidelberg, show an 

 especial form of goiter in the clinical sense, further the fact already men- 

 tioned that v. Frankl-Hochwart has observed that a great number of cases 

 of tetany later show distinct symptoms of myxedema, and finally the fact that 

 Kahn and 7 have described the observation that manifestations of a slight 

 hyperthyrosis and thyroid swelling can develop in the acute stage, or im- 

 mediately at the close of the acute stage. As tetany is not frequent through- 

 out in any goiter districts in Steiermark and Tyrol it practically is absent, 

 and in Switzerland very rare we may suppose that not every goiter noxus 

 may bring about idiopathic tetany, but an especial goiter noxus or^a 

 noxus that is similar to the goiter noxus. But even such an assumption 



