.650 LEWELLYS F. BAEKEE 



of a large series of infections, it is in typhoid, measles, influenza, tubercu- 

 losis, pneumonia, and acute articular rheumatism that the complicating 

 tetany has most frequently been seen. In many of these instances, how- 

 ever, the patients had suffered from attacks of tetany earlier in their 

 lives. Moreover, tetany in association with infections occurs most often 

 during the tetany months and among people who reside in tetany towns. 

 It would seem very clear, therefore, that the infection with which the 

 tetany is associated is merely the exciting cause of an outbreak of tetany in 

 a patient who already suffers from the disease in a chronic or in a latent 

 form. 



In favor of this view several facts may be adduced. Thus, the observa- 

 tions of Chvostek junior (1907) showed that, among patients who had had 

 tetany and were in the period of remission, an attack could be precipitated 

 by the administration of old tuberculin. Eppinger has suggested that 

 possibly the poison of tuberculosis contains a component that has a 

 specific injurious effect upon the parathyroid glands, just as many assume 

 that the poison of tuberculosis also specifically affects the adrenal glands. 

 The frequent occurrence of Chvostek's sign in severe tuberculosis has been 

 repeatedly emphasized. The occurrence of tetany in the course of miliary 

 tuberculosis, however, may be due to the presence of miliary tubercles in 

 the parathyroid glands themselves, as has been demonstrated by Milton 

 Winternitz. 



4. Tetany in Association with Intoxications 



What has been said concerning tetany in association with infections 

 holds also for tetany in association with intoxications. The intoxication 

 must be looked upon as a releasing cause in persons who are predisposed to 

 tetany by an already existent parathyroid insufficiency or some other pre- 

 disposing condition. Among the intoxications that have been especially 

 noted in connection with tetany may be mentioned those due to alcohol, 

 to morphin, to phosphorus, to chloroform, to lead, and to ergot. Tetany 

 in connection with nephritis and uremia has also been described as an 

 intoxication tetany. 



5. Tetany Associated with Menstruation, Pregnancy 

 and Lactation (Maternity Tetany) 



Von Frankl-IIochwart was able to collect seventy-six instances in 

 which tetany was associated with pregnancy or with the period subsequent 

 to it. In twenty-eight of these cases, the tetany appeared between the sixth 

 and the eighth month of pregnancy. In nineteen of the cases it occurred 



