THE SYMPATHETIC SYSTEM 107 



COURSE DURATION ENDING. 



In the mild cases the contractures stay localized to the 

 ends of the upper extremities. They occur in attacks 

 lasting anywhere from a few minutes to a few hours; 

 rarely they may persist several days. A series of repeated 

 attacks constitutes an attack of tetany; these attacks last 

 on an average of about two weeks and end in recovery. 

 Recurrences are, however, frequent. 



In the moderately severe cases, the contractures are 

 more pronounced. They are often accompanied by a 

 slight fever, general malaise and vaso motor disturbances, 

 erythema and edema. They can become generalized 

 and involve the muscles of the trunk and the face, simu- 

 lating tetanus. 



In the severe cases, particularly in children, the con- 

 tractures are accompanied by or alternate with tonic or 

 clonic convulsions, followed by a coma and comparable 

 to an epileptic attack. 



In all those types of cases, death may occur by asphyxia, 

 due to spasm of the glottis and contracture of the respira- 

 tory muscles (this is a real danger in infants), or by 

 eclampsia during one of the epileptiform attacks. For 

 this reason, the prognosis of tetany should always be 

 guarded even in the mild cases. 



CLINICAL MANIFESTATIONS OF TETANY. 

 I. SURGICAL TETANY OR POSTOPERATIVE TETANY. 



This was first observed by Nathan Weiss in 1880 

 following the removal of a goitre. It was described by 

 J. L. and A. Reverdin and by Kocher. 



The disease manifests itself a few hours or a few days 

 after intervention by a prickling sensation or stabbing 

 pains in the limbs. Attacks of painful contractures 



