108 ENDOCRINE GLANDS 



occur, symmetrically localized to the ringers of the hand. 

 This takes on the typical "obstetrical hand" appearance. 

 These contractures may involve the feet or become gener- 

 alized. The electric reaction shows a hyperexcitability 

 and tetany. The mechanical hyperexcitability of the 

 nerves is easily brought out by the Trousseau and Chvostek 

 signs. The attacks, sometimes short, sometimes long, 

 re-occur after a certain interval. They are often accom- 

 panied by fever, acceleration of the pulse, intense dyspnea, 

 salivation and vomiting. All of which are toxic symptoms 

 similar to those seen in experimental tetany. 



Post operative tetany does not always manifest itself 

 under this typical form. There are also convulsive forms 

 (Fr. Hochwart) characterized by clonic or tonic con- 

 vulsions and periods of quiescence. 



This condition sometimes gets well spontaneously and 

 completely. It can also become chronic, the attacks 

 occurring at long intervals, but persisting for years. 

 Kocher has observed it associated with myxedema. 

 Some cases die, either as a result of spasm of the glottis 

 or after a convulsion. 



II. MEDICAL OR SPONTANEOUS TETANY. 



This condition is seen: 



1. During the course of some cerebro spinal affection, 

 especially in tuberculous meningitis, cerebro spinal menin- 

 gitis, hemorrhages of the meninges, hydrocephalus, etc. 

 In these cases tetany is only a nervous syndrome added to 

 the primary infection. 



2. Following gastro intestinal disorders. In children 

 various gastro intestinal affections are often complicated 

 by attacks of tetany. In adults, the most commtfn cause 

 is a gastric affection. Tetany is observed in the course of 

 pyloric stenosis of ulcerative or neoplastic origin, following 



