TETANY IN GASTROINTESTINAL DISEASES 217 



in the hands and feet, the diagnosis of tetany appears to be very likely; often 

 there occur in the further course of the disease fibrillary contractions, or 

 Trousseau's phenomenon, or only transitorially a slight degree of heightened 

 galvanic hyperexcitability thus making entirely certain the diagnosis. 

 Not rarely, during the tetany season, Reichmann's disease may be attended 

 with quite rudimentary forms of tetany. 



v. Frankl-Hochwart and Fleiner have regarded certain cases of gastric 

 tetany described in the literature as spurious, as they showed only sensa- 

 tion of tension in the hands, with the absence of Erb's phenomenon. During 

 the last few years I have observed six cases of gastric tetany (see also Falta 

 and Kahn) ; in almost all I was dealing with a typical Reichmann's disease 

 with marked dilatation of the stomach and increased peristalsis, indeed even 

 antiperistalsis, phenomena that retrogress in many such cases on appro- 

 priate treatment. In some galvanic hyperexcitability, mostly of a slight 

 grade, was present quite transitorily. However, the paresthesias and the 

 sensation of tension outlasted Erb's phenomenon for a long time. Therefore, 

 in the formes frustes we may miss Erb's phenomenon, even on repeated 

 examinations. We fully recognize its prominent importance for the diag- 

 nosis; there do occur, however, isolated cases in which it is absent and 

 in which the diagnosis tetany can be established in spite of this fact. 



Concerning diseases that may be confused with tetany I mention only 

 the following: Tetanus is readily distinguished from it by the increase in 

 reflexes, by the noninvolvement of the hands, and by the absence of the 

 typical symptoms of tetany. Also the delimitation from meningitis, from 

 acroparesthesia in chronic poisonings and from occupational spasms is 

 always easy, as in these diseases the typical distinguishing symptoms of 

 tetany are absent. Hysteria may occur combined with tetany, and in such a 

 way that tetany spasms and hysterical spasms are present simultaneously, or 

 the hysterical spasms may come to the fore on the retrogression of the tetany, 

 or hysteria alone may exist simulating tetany (pseudotetany) (E. Freund, 

 H. Curschmann, F. Chvostek). In this form, naturally Erb's phenomenon 

 is absent, but hysterical stigmata are present. The pseudotetany attacks 

 may simulate the true tetany attacks in an illusory manner. The uni- 

 lateral occurrence of the spasms would rather point to the thought of hys- 

 teria. Yet it should not be forgotten that a few true cases of hemitetany 

 have been known (H. Freund, v. Frankl-Hochwart, v. Jaksch, E. Freund, et 

 a/.). Too, Trousseau's phenomena is often simulated illusorily. Especially 

 to be considered is the absence of the paresthesias usually attending tetany 

 attacks, and of Erb's phenomenon, and the presence of fibrillary contrac- 

 tions. If these cases of pronounced hysterical symptoms are added to 

 a true tetany, Erb's phenomenon is decisive. 



In the differential diagnosis between epilepsy and tetany it is especially 

 important to determine whether epileptiform convulsions belong to tetany 



