578 LEWELLYS F. BAEKEE 



in the muscles of the neck and trunk, in the eye muscles, in the diaphragm 

 and, rarely, in the autonomically innervated smooth muscle of the viscera 

 (bronchi, heart, digestive apparatus, urogenital apparatus). These 

 attacks of tonic spasm are not, as a rule, accompanied by loss of con- 

 sciousness. Their duration is variable ; they may last from a few seconds 

 or a minute to a few hours or even a few days. 



The hyper excitability of the sensory nerves is manifested by: (1) 

 pains in the muscles during the spasms, (2) paresthesias, especially in the 

 distal parts of the extremities, and (3) increased response to electrical 

 and mechanical stimuli applied to the sensory nerves (Hoffmann's phe- 

 nomenon). 



Flaccid or spastic paresis of the lower extremities may follow the 

 tetanic seizures or may appear as equivalents of them. Disturbed mental 

 states and epilepsy are sometimes associated with tetany. 



When the attacks of tetany occur spontaneously, the tetany is said to 

 be manifest; otherwise it is said to be latent. 



Tetany may occur in epidemic form. It is endemic in certain places 

 (notably in Vienna and in Heidelberg). Sporadic cases of tetany may 

 occur anywhere. 



The syndrome of tetany may be acute or chronic. In chronic tetany, 

 vasomotor phenomena, secretory phenomena, and trophic changes are com- 

 mon. Among these may be mentioned dermatographism, hyperidrosis, 

 polyuria, intermittent swelling of the joints, local edemas of the hands 

 and feet, loss of the hair and of the nails, defects in the enamel of the 

 teeth, and early cataract in the eyes. 



Tetany may occur at any age. Thus it affects both adults (tetania 

 adultorum) and children, either sucklings (tetania infantum) or older 

 children (tetania puerorum). 



The syndrome is very common in children that have rickets, and in 

 these children laryngospasm is one of the commonest symptoms. The 

 identity of tetany and the spasmophile diathesis of children is maintained 

 by many podiatrists. 



In adults, several ''forms' of tetany have been described according to 

 the several different conditions with which it may be associated. Thus, 

 tetany may accompany certain diseases of the digestive apparatus 

 (tetania gastrica, tetania colonica) ; or it may occur in combination with 

 the processes of maternity, either during pregnancy or during the lactating 

 period (tetania cjravidamm, tetania lactantium) ; or it may develop in 

 the course of certain infer (ions or intoxications; or it may appear after 

 operation for goiter (tetania strumipriva). Sometimes it develops in per- 

 sons otherwise apparently healthy (tetania idiopathica, epidemic-endemic 

 tetany, tetany of workmen}. 



Tetany occurs in loth se.\:es, though certain forms of tetany occur 

 predominantly in males, other forms predominantly in females. 



