684 LEWELLYS F. BAKKEK 



actually have tetany, we are not sure that the removal of these persons to 

 another residence would be of any help. It might, perhaps, be advisable 

 for persons* known to have tetany, or a disposition to tetany, to go for a 

 holiday, or for work, during the tetany months to some place in which 

 tetany is neither endemic nor epidemic. 



By controlling the other factors that are known to favor parathyroid 

 insufficiency (certain occupations, infections, intoxications, faulty diet, 

 maternity, gastro-intestinal disturbances), something may, perhaps, be 

 done in the way of prevention. Shoemakers, tailors, carpenters, and seam- 

 stresses, who already have shown a disposition to tetany, might be advised 

 to change their occupation and be warned against too sedentary a form of 

 life, and especially against bending over of the head while at work and 

 overuse of the hands. 



Women known to be predisposed to tetany should avoid pregnancies. 

 If pregnancy should inadvertently occur, the question of its interruption, if 

 possible waiting for a time when the child is viable, might be considered. 

 The tetany mother should be forbidden to suckle her own child; a wet- 

 nurse should be obtained, or, where this is not possible, artificial feeding 

 may be resorted to. 



Experiments upon animals indicate that an excess of meat in the diet 

 seems to favor the appearance of tetany. Persons predisposed to tetany 

 should, therefore, limit their meat intake, living largely upon milk, eggs, 

 cereals, vegetables and fruits. 



All that we can do otherwise in the prevention of tetany in predis- 

 posed persons is to counsel them to live in the most rational way possible 

 under the most favorable sanitary conditions, and to recommend that they 

 avoid, especially, notoriously unfavorable factors (bodily overexertion, 

 vicious body attitudes, exposure to cold, etc.). 



Persons who have already had one attack of tetany will do well to pay 

 strict attention to the above considerations. 



X. Treatment of Tetany 



The physician who treats tetany should keep in mind that he has to 

 deal with a chronic disease, in the course of which acute exacerbations can 

 often be called forth by a variety of releasing factors. As Chvostek (d) has 

 emphasized, a therapy that is directed toward the acute attack of tetany 

 only would not fulfill its mission. A rational therapy must strive to do 

 away with the chronic disorder that underlies the outbreaks of tetany. This 

 pathological disturbance consists, as we have seen, in a vice of metabolism, 

 duo in many cases at least to an insufficiency of function of the parathyroid 

 glands. A rational therapy will, then, attempt either to restore the func- 

 tion of the parathyroid glands, or, if this be impracticable, to resort to a 



