220 THE DISEASES OF THE PARATHYROID GLANDS 



behaves against increased administration of sugar. We should expect, on 

 the contrary, in conditions of increased dissipation of calcium, a result from 

 the calcium administration. Perhaps we may explain in this manner the 

 favorable results of calcium treatment in Basedow's disease. 



There therefore remains for the treatment of tetany only symptomatic 

 therapy, a therapy that likewise is almost ineffective. Weak sedatives such 

 as the bromides and valerian are especially ineffective. In severer cases we 

 can occasionally ameliorate the condition by the use of chloral. Levi 

 claims to have had good results through blood-letting, and Narbut through 

 lumbar puncture. The means that have proved best are rest in bed, diet 

 poor in meats, protracted warm baths, and roborants. The phosphorus 

 liver oil had been especially recommended in cases complicated with osteo- 

 malacia. In the tetany of sucklings, Escherich recommends the interpolation 

 of days with just adequate diet; it is especially important to substitute 

 natural feeding for cow's milk whenever possible. Worthy of notice is the 

 statement of McCarrison that some cases of tetany disappeared when the 

 patient moved to another place. In women conception should be pre- 

 vented or even pregnancy interrupted. Certain drugs, such as ergo tin, 

 are to be avoided in the tetany of pregnancy (Novak) . 



Gastric tetany deserves an especial consideration. Here the question of 

 operation (gastroenterostomy) has met with lively discussion. While Albu 

 recommends operation as soon as possible, Fleiner would first await the results 

 of internal therapy. Also Chvostek favors internal treatment. The results 

 of the surgical treatment now seem very much to encourage this method of 

 treatment. According to the latest statistics by Wirth, of twenty-one oper- 

 ated cases, seventeen remained permanently cured, while according to 

 older statistics of Albu the mortality of cases treated internally reached 77 per 

 cent. The question is, however, rather more complicated than one would 

 gather from these statistics. In case of assured pyloric stenosis, operation is 

 indeed not to be rejected, the question is only whether operation should be 

 undertaken immediately or whether it should be postponed until we find 

 that we can accomplish no good by attempts to improve through internal 

 treatment. Much will depend upon whether gastric lavage can be borne. 

 The chief difficulty is met with in the diagnosis of the pyloric stenosis. 

 Cases of Reichmann's disease may present all the symptoms of pyloric 

 stenosis increased peristalsis in front of a fluoroscope, indeed even anti- 

 peristalsis. Even in cases of true gastric tetany we saw not only a 

 disappearance of the tetanic symptoms but also a lessening of the size of the 

 stomach and a cessation of the spasm of the pylorus this as the result of 

 gastric lavage every evening, and the administration of a dry diet rich in 

 fats and of enemas to satisfy thirst. In such cases perhaps operation 

 would be without curative results. 



