676 LEWELLYS F. BAKKEK 



1. Conditions (Other than Tetany) in which Hyper- 

 kinetic Phenomena Resembling Those of 

 Tetany May Occur 



a. Tonic Spasms Involving the Musculature as a Whole 



Tetanus. When, in tetanus, the cramps involve the muscles of the face, 

 neck, jaws, and trunk, as well a.s those of the extremities, a syndrome simi- 

 lar to tetany may result, But the absence of the typical tetany signs 

 (Chvostek's phenomenon, Erb's phenomenon) and a decrease of reflex 

 excitability rather than an increase, usually permit one quickly to distin- 

 guish tetanus from tetany. The anamnesis also helps to differentiate. 



Hydrophobia. In hydrophobia the tonic spasm affects especially the 

 muscles of deglutition (so-called "cephalic tetanus"). These muscles may, 

 though rarely, be affected in tetany, but then the other tetany signs are 

 present and there is no history of dogbite. 



Strychnin Poisoning. The paroxysms of muscle spasm in strychnin 

 poisoning begin with clonic contractions that quickly become tonic, and 

 between the single paroxysms there is complete muscular relaxation. Trous- 

 seau's phenomenon is absent. The anamnesis is of help in differentiation. 



Tetanus neonatorum... This disease may occur during the first few 

 days of life, the source of infection being the umbilical wound. Trismus 

 is a prominent feature, though the limbs may also be involved or the spasms 

 may become generalized, usually, however, only after the muscles of the 

 neck and pharynx have become affected. This progress is the opposite to 

 what occurs in tetany. Moreover, tetany is exceedingly rare before the 

 third month of life. 



Meningitis. In epidemic cerebrospinal meningitis, there may be rigid- 

 ity of the neck, opisthotonos, hyperesthesia of the skin and of the muscles, 

 and fever ; and tetany may, very rarely, yield a picture resembling this. 

 But in cerebrospinal meningitis due to meningococcus infection, the pain 

 is not dependent upon the muscle spasms for its production, nor is it lim- 

 ited to the muscles actually in spasms. Moreover, there are no remissions 

 of the muscular spasms such as are seen in tetany. The typical tetany 

 signs (Erb's phenomenon, Trousseau's phenomenon) are absent in menin- 

 gitis. Lumbar puncture reveals, in epidemic meningitis, the presence of 

 polymorphynuclear leucocytes and of meningococci. 



Tuberculous meningitis in children occurs most often between the third 

 and the fifth years, whereas tetany in children occurs chiefly between the 

 first and the third year. In tuberculous meningitis there is a long pre- 

 monitory stage, which is absent in tetany. Spasms resembling tetany 

 spasms are rare in tuberculous meningitis; and the headache, the vomiting, 

 and the paralysis of the cerebral nerves, especially of those innervating the 



