622 LEWELLYS F. BARKEK 



rather than with a simple hypoparathyrosis, as in tetany. The pos- 

 sibility that, some gland of internal secretion, in addition to the para- 

 thyroids, may be involved has also to be considered. He thinks it very 

 probable, too, that many cases of acquired myotonia have something, as 

 far as pathogenesis is concerned, in common with tetania myotonica. 



The possibility that a disturbance of internal secretions may exist in 

 many cases of pure acquired myotonia, and the facts of the familial ap- 

 pearance and of abnormal constitutional makeup in many cases of tetania 

 myotonica, speak in favor of a similar endocrine pathogenesis for true 

 Thomson's disease (myotonia congenita), especially since single symp- 

 toms of tetany are not rare in the latter disease. The usual absence of 

 symptoms of tetany in Thomsen's disease may be explained, von Orzech- 

 owski believes, by the tendency to reciprocal suppression, the symptoms 

 of tetany in this instance being wholly suppressed by the myotonia. In 

 the present state of our knowledge, it is fair to assume that the tetany 

 symptoms in tetania myotonica are due to hypoparathyrosis, but we must 

 admit, I think, that we are as yet completely in the dark as far as any 

 explanation of the myotonic phenomena themselves is concerned. 



10. The Reflexes in Tetany 



On account of the now well known hyperexcitability of the motor 

 and sensory nerves in tetany, one might expect to find the deep or tendon 

 reflexes always exaggerated in this syndrome. As a matter of fact, this 

 is not the case. It is true that they are increased in some patients, but 

 they are normal in others ; and, in perhaps the majority of instances, 

 they are decreased, especially at the time of spontaneous paroxysms and 

 in the periods immediately following them. 



Anomalies of the superficial reflexes (abdominal, plantar) do not 

 seem to have been observed in tetany. 



11. Sensory Tetany 



Paresthesias, especially acroparesthesias,, are very common in tetany; 

 they constitute a part of the classical syndrome. These paresthesias 

 often appear as prodromata to the outbreak of spontaneous attacks of 

 tetany spasm. Grant and Goldman, in the tetany of forced respiration 

 describe the constant occurrence of paresthesias before the onset of the 

 tetany spasms. 



In some instances paresthesias may appear as "equivalents" of the 

 motor tetany attack. 



F. Parkes Weber (1911) has suggested that the numbness and tingling 



