680 LEWELLYS F. BAKKEK 



times a large number of "small attacks" may occur in a single day. If, in 

 such patient^ any of the tetany signs be present, the question of the exact 

 origin of the fits might come up. The study of the patient as a whole and 

 especially of his mental state, together with a search for the characteristic 

 marks known as "tetany signs," will usually resolve the difficulty. The 

 condition is rare anyway, and not likely often to be confusing. 



Epilepsy. Tetany can cause attacks that cannot be distinguished from 

 the convulsions of epilepsy, and patients with true epilepsy may occa- 

 sionally show one or more of the tetany signs when there is good reason 

 to believe that tetany is not responsible for the convulsions. The relations 

 of tetany to epilepsy have been fully described above under symptomatology 



(q.v.). 



Puerperal Eclampsia. Convulsions during and after childbirth may 

 be due to tetany or, in cases of nephropathy, to uremia. The differential 

 diagnosis is usually easy. In the nephropathic cases the presence of albu- 

 min and casts in the urine, the occurrence of edema, the content of the blood 

 in rest nitrogen, and the phenolsulphonephthalein output, give the clews. 

 In tetania gTavidarum with eclampsia Chvostek's phenomenon, Erb's phe- 

 nomenon and, often, Trousseau's phenomenon are demonstrable. 



Eclampsia infantum. Convulsions in children may be a part of the 

 spasmophile diathesis (to which tetany belongs) ; or they may be due to 

 organic brain diseases (congenital malformation of the brain, porencepha- 

 ly, cerebral hemorrhage, cerebral sclerosis, cerebral syphilis, brain tumor, 

 hydrocephalus) ; or they may be symptomatic of meningitis, or of the be- 

 ginning of some acute infection (scarlet fever). Psychasthenic fits also 

 occur in children. 



The term Spasmophilia, or Spasmopliile Diathesis, was introduced by 

 Ilcubner to designate "a condition of excitability of the nervous system in 

 early childhood accompanied by galvanic and mechanical hyperexcitability 

 of the peripheral nerves and the tendency to tonic and clonic convulsive 

 attacks." Spasrnophilia is very common, indeed, in early childhood. At 

 certain times of the year as many as thirty per cent of the sucklings will 

 show signs of a spasmophile diathesis, Under spasmophilia are included 

 not only (1) the majority of convulsive seizures in childhood and (2) at- 

 tacks of laryngospasm but also (3) a condition, existing in a number of 

 apparently healthy children, that can be recognized only by examining for 

 mechanical and galvanic hyperexcitability of the motor nerves. Some re- 

 gard the spasmophile diathesis as identical with the tetanoid state, or with 

 latent tetany, and make the diagnosis of its existence in every child in 

 which a kathodal opening contraction can be obtained with galvanic cur- 

 rents below five milliamperes in strength. 



The three principal clinical symptoms of spasmophilia are (1) laryn- 

 gospasm, (2) eclampsia infantum, and (3) tetany contractures (carpopedal 

 spasms, arthrogryposis.) Some prefer to limit the term tetany to the third 



