TETANY.
Little is to be expected from purely symptomatic treatment till the underlying cause has been discovered and removed.
Thus, when tetany is the result of thyroid removal or disease, feeding by tabloids of dried gland gives satisfactory results. Where the symptoms supervene during pregnancy, they often cease after delivery, and when they first appear during lactation there is a fair hope that they may be removed by weaning the infant. In some of these cases thyroid feeding has also proved beneficial. When tetany shows itself during rickets, the dietetic measures indicated in this disease may be fairly expected to prove satisfactory, especially when combined with free Phosphorus and Cod Liver Oil.
Gastric Tetany.—The most formidable cases are those associated with dilatation of the stomach, especially when this is caused by the cicatrisa tion of a pyloric or duodenal ulcer. Here the spasms are not rarely fatal, and though the attack is often excited by the passage of the stomach-tube, lavage must he resorted to. The theory that some poison is generated in the fermenting bag which has to do duty for a stomach is probably correct, hence washing out by a weak antiseptic solution or the free administration of emetics is valuable.
In many cases the introduction of the stomach-tube may be dispensed with and its dangers avoided by making the patient drink copious draughts of lukewarm water till emesis occurs. This plan should always be employed before resorting to ordinary lavage. Though by either of these means a fatal issue may be prevented for the time, the symptoms are certain to recur and end fatally. Gastro-enterostomy should there fore be invariably resorted to as soon as the condition of the patient warrants an abdominal operation, and many lives have of late years been saved by the surgeon. This is the only rational treatment of gastric tetany. (See Gastric Dilatation.) Where the intestinal canal lower down is at fault, the colon should be flushed with warm Saline solution used freely and followed by the administration of intestinal antiseptics like Salol, Calomel or Naphthol.
The presence of tape- and round-worms must be met by anthelmintics. Search should he made for any toxic agent upon whose presence the symptoms may be supposed to depend, and where this cannot be found or remedied the rational indication is for such stimulation of the excretory organs—skin, urine and bowels--as will hasten elimination.
In one typical case in a lady of 25 years of age, where the mouth and gums were covered with small intractable ulcers, the writer had a Vaccine prepared by Dr. T. Houston from the secretion of the sores, and complete recovery followed injections administered for several weeks; the spasms had been present for six months.
Symptomatic Treatment.--For the relief of the spasms a warm bath (go° F.) is often valuable, and the cautious administration of Chloroform or the use of a hypodermic injection of Pilocarpine (+ gr.). In rachitic tetany a dash of cold water on the face whilst the child lies in the warm bath often stops the spasm. A hot sponge may be applied over the larynx, and a whiff of Nitrite of Amyl may he tried alone or in conjunction with ice to the spine or cold affusion. Hauber employed Massage success fully whilst the patient was fully under the In the chronic form often met with, in which no obvious cause can be detected, the best routine is the administration of Bromides in large doses as in epilepsy, combined with Chloral and Valerianates. Thyroid feeding should have a short trial in all such cases.
Belladonna, Eserine, Asafcetida, Hyoscine, Cannabis Indica, and nearly every known general antispasmodic have been tried, and Gowers advo cated Digitalis in the nocturnal form. Protection from cold and all depressing causes, as overwork, etc., must be insisted upon, whilst the patient lives an open-air life.