SPASMS AND CONVULSIONS IN CHILDREN.
Tetany.—Tetany is a motor neurosis called by some authorities a disease, but is more generally described as a mere dis order based upon several pathological factors which are more or less constant. It is probably of toxic origin and bears close etiological relationship to rickets; being based upon similar causative fac tors and sharing some of the symptom phases of that disease. It is far from common, yet cannot be considered rare; and is much more frequently recognized of late years since its entity is better known and clearly described. Tetanv is manifested by characteristic attitudes of the hands and certain intermittent tonic cramps of the muscles of the arms and legs, by an excessive electrical irritabil ity, and by periods of latency, during which the cramps can be induced.
Symptoms.—The symptoms of tetany are to be divided into those of the attack and those of the period of latency. The onset of the paroxysms may be preceded by sensory phenomena, but is often sud den and without warning. The sensa tions are usually vague tingling pains in the forearms and legs, followed soon by a tonic spasm or a stiffness in the mus cles. This spasm is most marked in the upper extremities, giving rise to such a pronounced rigidity that it is almost im possible to overcome the resistance by active effort on the part of another. Oc casionally, the adductors of the thighs and arms are involved, causing the arms and legs to be drawn together; more rarely the muscles of the neck are in volved, and also those of the face and trunk. Morse (Edinburgh Med. Jour., July, '99) says the only true pathogno manic symptom is spontaneous inter mittent paroxysmal muscular contrac tions. The most common seat of these contractures is in the muscles of the fore arm, the fingers being flexed at the meta carpo-phalangeal joints, while the pha langes are extended, the thumbs being strongly adducted, the wrists acutely flexed, and the h tnds turned to the ulnar side. The position of the hand is called the "accoucher's hand" or the "writing hand." Other attitudes are, however, occasionally seen, such as a firm clutching or even complete extension of the fin gers. The forearm may be flexed upon the arm, the arm adducted to the shoul der.
If the lower extremities are involved, the thighs may be adducted, the legs extended or flexed; the toes are apt to assume the position of talipes equinus.
The spasms may affect the muscles of the abdomen, the back, the diaphragm, and the thoracic muscles; hence inspi ration is endangered and cyanosis may result, even consciousness being lost (Weiss). Trismus is rare, yet opisthotonos is not exceptional. Other muscles may be affected, as of the eyes, the oesophagus, the pharynx, the larynx, or even the blad der. Laryngeal spasm is a common ac companiment of the disorder. Naturally, this degree of overtonicity may cause muscular pains. The degree of spasm varies, and also its length. It may last from two minutes to two hours or more. As has been said, the involvement of the muscles is symmetrical. Cases have been reported of one side only, or unilateral for a time. In the contracted muscles fibillary twit chings have occurred; clonic movements almost never. Tremor is common. The spasm begins in the periphery, not from within outward, as in tetanus; nor are the masseters early affected, as in that more serious malady; nor is reflex excitability high; nor is the spasm continuous as in tetanus. During the intervals the patient is comparatively comfortable. The muscles are often ten der and sore, and they are weakened. The intervals are variable: usually a few hours, or it may be several days or weeks. Other symptoms are those of Trousseau, already mentioned. This is the fact that, if, during the passive interval, the limb be grasped in such a way that the great nerves or arteries which lie along the under surface of the limbs are pressed upon forcibly, the characteristic cramp can be made to return. It may require some continuance of this pressure to elicit the phenomenon, but when it is present it is regarded as pathognomonic of tetany. This is not always to be ob tained: in perhaps only one-fourth of all cases. Its value is great in demon strating the existence of "latent tetany": a form in which there is at no time a clearly-marked contracture. Chvostek's sign is rare in children. It consists in an extraordinary susceptibility of the nerves in tetany to mechanical impres sions. A blow with a percussion-ham mer over the facial nerve produces a twitching of the angle of the mouth or of all the muscles of the facial distribu tion.