672 LEWELLYS F. BARKER 



night she had a violent headache, and the next day an extraordinarily 

 severe attatk of tetany, which involved the respiratory muscles, set in. The 

 face of the patient became cyanotic, the breathing stertorous, the pulse 

 accelerated and, after a short time, she died. 



Tetany not infrequently develops during lactation, and this form, too, 

 may be fatal. 



During childbirth the tetany spasms may come on coincidently with 

 the uterine contractions (Neumann), and it has been suggested that the 

 stimulation, here starting in the uterus, is analogous to pressure on the 

 nerve in the Trousseau phenomenon. 



If maternity tetany has once occurred and the patient has survived, it 

 is doubtful whether or not she should again be permitted to become preg- 

 nant. Should pregnancy inadvertently occur, it would be wise and legiti- 

 mate to interrupt it, as tetany is likely to become more severe with each 

 succeeding pregnancy. 



In lactating women predisposed to tetany, it seems probable that the 

 suckling of the child may act as a stimulus that will call forth a tetany 

 attack (Volker). It has therefore been suggested that women subject to 

 tetany who give birth to children should not try to suckle them themselves, 

 but should employ a wet-nurse, especially as statistics show that tetany is 

 very rare during lactation in women who do not suckle their children. 



VII. General Diagnosis of Tetany 



Typical tetany presents no diagnostic difficulty. The intermittent' 

 attacks of tonic contractions with characteristic distribution of the spasms 

 in definite muscular domains, giving the well known attitudes (obstetrical 

 hand, extended knee with supinated foot, carpopedal spasms), and their 

 association with marked increase of the mechanical and of the electrical 

 excitability of the motor nerves (with low values for the cathodal closure 

 contraction) are marks that scarcely admit of confusion with any other 

 clinical syndrome. 



But every clinician of experience has been confronted with less typical 

 cases of tetany in which the diagnosis was not easy. When the spasms are, 

 atypical, or when the tetany is latent and no spontaneous attacks occur, or 

 when tetany is combined with other diseases, or when other diseases are 

 present that simulate tetany though tetany is absent, mistakes may easily 

 1)0 made. In such cases, the examiner needs to be equipped not only with 

 a thorough familiarity with the relative value for diagnosis of the several 

 tetany phenomena, but also with a wide knowledge of general medicine, 

 neurology and endocrinology, for the differential diagnosis, in obscure 

 cases, depends often upon the summation of a whole series of minute 

 details. 



