2l8 THE DISEASES OF THE PARATHYROID GLANDS 



or whether there exists a true epilepsy in addition to the tetany. Especial 

 attention must be directed to the aura, to the incontinence of urine and feces 

 during the attack and to the postepileptic stupor. Loss of consciousness in 

 tetany is very rare, in epilepsy it is the principal symptom. In similar 

 fashion a case of tetany with symptoms of myotonia must be investigated 

 with regard to the cardinal symptoms of true myotonia (myotonic reaction) . 



The galvanic hyperexcitability is important, according to Escherich, 

 for differentiation from eclamptic convulsions of the years of childhood. 



The prognosis for the different clinical forms of tetany is not the same, 

 and in strumiprivic tetany the prognosis quoad vitam may be very un- 

 favorable. To-day such cases scarcely come into consideration. The 

 prognosis of idiopathic tetany quoad sanitationem was formerly regarded as 

 favorable. Since v. Frankl-Hochwart has reviewed his cases the views as to 

 this point have changed considerably. Of fifty-five cases only nine were 

 entirely healthy, seven showed chronic tetany, general nervousness and 

 chronic invalidism, nineteen showed slight tetany symptoms and trophic 

 disturbances, six showed chronic invalidism without symptoms of tetany, 

 eleven had died four to eleven years after the outset of the tetany. Saiz 

 furnishes similar unfavorable statistics. He states that of nine cases only 

 one remained free of distress, and that also this individual had sustained a re- 

 currence. Cases of death from tetany of maternity have been reported 

 (Trousseau, Schundlechner, Blazicek, et al.). Also transition into chronic 

 tetany has been observed, v. Frankl-Hochwart, Adler, and Thaler and 

 Novak, in contradistinction of Fellner, hold therefore the prognosis as doubt- 

 ful. Especially unfavorable is the prognosis in tetania gastrica; here it 

 happens that the stomach affection itself frequently influences the prognosis 

 unfavorably. Also in the tetany of childhood the revisions of the more 

 recent period have furnished rather unfavorable results as to the length 

 of life and especially as to the further development (Escherich, Thiemich, 

 Birk, and Potpetschnigg) . 



According to Escherich, 25 per cent, of the nurslings at the hospitals who 

 are sick with tetany die, and Thiemich and Birk in Breslau and Potpetschnigg 

 in Graz have concerned themselves with the later fate of children who have 

 been sick with tetany. Both statistics come to the result that a not in- 

 considerable number of such children soon die. Those investigated were 

 only rarely quite normal. In the majority of cases they showed disturbances 

 of the psychical and intellectual development and especially remaining be- 

 hind in the development of speech. 



The treatment of tetany should be concerned first of all with efforts to 

 replace the lacking parathyroid function or to improve the insufficient para- 

 thyroid function. It is a pity that up to the present all attempts have been 

 futile. The substitution therapy that was so valuable in thyroid insufficiency 

 has in this case up to the present led to no certain result. It is intelligible 



