PAKATHYROID GLANDS 07 1 



the hospital, the symptoms often pass off very quickly, say within a few 

 days. Patients who stay at home and even some of those who are treated in 

 a hospital, may have attacks for several weeks. The attacks, however, 

 gradually grow milder and, later, they disappear entirely, though it may be 

 several weeks or even several months before the patients are quite well r 

 that is to say, before latent signs of tetany (Trousseau phenomenon, Erb 

 phenomenon, etc.) disappear. It should not be forgotten, however, that 

 those who are apparently cured are very liable to relapses in succeeding 

 years during the tetany months. In Vienna it is not uncommon to have 

 patients return year after year, in March or April, with an attack of tetany. 

 It is said that, after a time, the patients grow so accustomed to these sea- 

 sonal attacks that they no longer report to the hospitals for treatment. 

 Among the patients who suffer from recurrent attacks, trophic disturbances 

 frequently develop. 



4. Prognosis in Tetany Associated with Gastrointestinal 



Diseases 



Under medical treatment alone, gastric tetany has been found to be a 

 very serious disease. Thus Bouveret and Devic, 1892, reported the mor- 

 tality as 40 per cent and the statistics of other investigators indicate that 

 the disease when treated medically is even more grave than this. Loeb in 

 1890 reported a mortality of 71.4 per cent, Heim in 1893 a death-rate of 

 76 per cent, and Albu asserts as high a mortality even as 77.5 per cent in 

 tetania gastrica, treated medically. In other words, approximately 70 per 

 cent of the patients die, and only 30 per cent recover under non-surgical 

 measures. 



On the other hand, if cases of tetania gastrica be treated surgically, the 

 figures are reversed. According to Wirth, of 21 cases operated upon, 17 

 were permanently cured, one was improved, and only three died ; in other 

 words, under surgical therapy, 85 per cent were cured and only 15 per cent 

 died. Doubtless, as knowledge of the favorable effects of surgery in this 

 special group of cases becomes more widespread, the patients will be oper- 

 ated upon earlier and still better statistics can later on be reported. 



5. Prognosis in Maternity Tetany 



The tetany of pregnancy or of the puerperium is sometimes fatal. 

 Trousseau, as early as 1848, described a fatal case. The woman had had 

 syphilis and had been delivered of a dead child, but before delivery she 

 had become much emaciated and had suffered from severe diarrhea. At 

 first she improved a little, but about two weeks after delivery her feet 

 began to swell and she complained of weakness in the legs. During one 



