The evidences point to the conclusion that tetany is a disorder of the nerves, somewhat generally distributed, and of toxic origin. It arises, almost always, in those who have suffered from exhausting conditions, depressing circumstances, or acute diseases, or all three.
Prognosis.—The prognosis of tetany, on the whole, is favorable. Most cases recover. Sievers (Berl. klin. Woch., Nos. 31, 3?, 'OS) notes two fatal cases which occurred in connection with dilatation of the stomach. In both there were stenosis of the pylorus from healed ulcers and enormous dilation.
In all the reports of fatal cases of tetany twenty-seven in number, there was usually found dilation due to stenosis from scars of pyloric or duodenal ulcers, or ulcer and scar without stenosis. Those cases which follow upon extirpation of the thyroid gland are usually fatal.
Treatment.—If rickets be accepted as the essential cause, it is plain we must determine what has produced that dis ease; and the findings of the foremost clinicians yet are limited here, also, to much the same factors as give origin to tetany. The disorder is one chiefly of excess of motion; and prodigality of mo I have constantly maintained, in dealing with disorders of motion, such as chorea—is always followed by exhaus tion (fatigue neuroses); hence the funda mental need for all such states is abso lute rest for both body and mind. The next indication is to remove all sources of peripheral irritation. The mass of evidence is in favor of gastrointestinal irritation being the chief factor; hence the digestive organs will need fullest at tention. As toxins are admitted to be the chief source of disturbance in tetany, eliminants are also in order. A few well directed doses of calomel will meet many indications. Beyond this, and a regula tion of diet, it is seldom needful to go. If the spasmodic phenomena are excess ive or painful, it is well to proceed in the same lines as in dealing with convulsions. The inhalation of chloroform, or a mixt ure of chloroform, nitrite of amyl, and ether (parts 3, 1, and 5), will hold the spasm in check. Sedatives, such as the bromides, chloral, and hyoscine hydro bromate may then be used, or, possibly, morphine hypodermically. Finally nu tritive tonics will be required in most cases, and to be maintained for a long time. (See CoxvuLstoxs.)
The thyroid treatment has been ap plied to tetany with some success. The thyroid gland was given raw or slightly cooked, and the dose, small to begin with, was carefully increased to 30 grains a day. In idiopathic tetany it diminished the intensity and the fre quency of the attacks and shortened the duration of the disease. This treatment is not antagonistic to the symptomatic treatment, as it does not present any in compatibility with the methods ordi narily employed. Maestro (Lancet, p. 334, Jan. 30, '97).
Automatic Movements in Children. Automatic movements may occur in the following diseases:— I. Anomalous epilepsy.
II. Hysteria of childhood. General. quasipurposeful. Hysterical, salaam, and hysterical eclampsia rotans.
III. Athetosis (athetoid movements in asthenic conditions): IV. Automatic rhythmical movements.
These are better displayed in a table:— Movements Head-nodding of assent.
and shaking Negative v Automatic e o rhythmical - menu. Gvrospasin.
movements liead-banging.
Eelampsia untaus. or salaam convulsions.
I Eelampsia rotans.
V. Tic convulsif.
VI. Induced automatic movements.
It may be advantageous to examine each division carefully and endeavor to define diagnostic features and differences, and in a few instances it is possible to assign a cause.
Anomalous Epilepsies,—In these forms there is exhibited a most marked display • of automatic imperative movements. By I relating a typical case a good concept can be formed: A boy, aged 17; weakly, nervous, and irritable. The attack begins usually with a sharp cry and without further development. The patient com mences to run aimlessly through the street, usually at a good speed. If ' stopped by anyone, he may struggle vio lently, or even pass into epileptic con vulsions, from which he awakens ex hausted, asks for water and promptly goes to sleep. His apparent oblivion to the external world, the inability to make any impression by speaking to him, his avoidance of collision with objects and people, and particularly his absence of remembrance when he awakes of events taking place during the attack, lead one to regard it a pure ease of secondary con sciousness of automatic and, usually, cen tric origin.