670 LEWELLYS F. BAEKER 



Obviously, therefore, childhood tetany has a high mortality at the time 

 of its occurrence (over 20 per cent), and the children that recover from the 

 first attack run the risk of dying later on from a recurrence of the tetany, 

 or of becoming permanently handicapped by chronic illnesses of various 

 sorts, including epilepsy and cataract. 



2. Prognosis in Tetany after Strumectomy 



If the postoperative tetany be violent and especially if it set in at once 

 after the operation, death almost always occurs within a few days, though 

 occasionally a patient will live for a few weeks and then succumb. 



In only a few cases in which outspoken tetany develops immediately - 

 after the operation do the patients recover completely. 



In still another group, the patients do not die from the tetany, which, 

 may indeed entirely disappear, but they develop myxedema, and have to 

 take thyroid extract continuously. 



Since the operation for goiter has been greatly improved, so that the 

 parathyroids are left in and are only rarely injured at the operation, tetany 

 has become rare after strumectomy ; it is only exceptionally, as in extensive 

 carcinomatous growth, that the parathyroids must be sacrificed by the sur- 

 geon. In certain other very difficult goiter operations, too, the parathyroid 

 glands may undergo injury. A temporary parathyroid insufficiency still oc- 

 casionally occurs after simple goiter operations, doubtless owing to slight in- 

 advertent injury to the parathyroid glands either directly, or through inter- 

 ference with their blood supply. In these cases it is, as a rule, easy to tide 

 the patient over by suitable treatment to a time when the parathyroids 

 have regained their full function (see Therapy). Even though recovery 

 occur from postoperative tetany, it must be borne in mind that there may 

 result a permanent hypoparathyroidism, in which event a pregnancy, 

 an infection, an intoxication, or a gastro-intestinal disturbance, later on in 

 life, may call forth again the symptoms of tetany. Some patients go 

 through the first pregnancy after operation without difficulty, but develop 

 tetany during the second pregnancy, during a puerperal period, or during 

 prolonged lactation. Successful transplantation of one or more parathy- 

 roid glands in tetania strumipriva makes the prognosis good. 



3. Prognosis in Idiopathic (EpidemioEndemic) Tetany 

 and in Tetany in Infections and Intoxications 



These are the cases in which the prognosis is by far the most favorable. 

 Xo death, so far as I know, lias been recorded due directly to the so-called 

 idiopathic tetany of workmen. If the patients leave their homes and enter 



