This condition must be differentiated from certain similar con ditions which occur in infants suffering from chronic nutritional dis turbances without gastroenteric phenomena in the intermediary- metabo lism. In such infants similar permanent spasms ()Can' 110t infrequently in association with galvanic overexcitability; they disappear gradually when the infant is placed on breast-milk and return whenever an attempt is made to return to artificial feeding. This observation, which we owe Gregors, is of fundamental importance and will be referred to again.
There is another disease which resembles symptomatic hypertonia and permanent spasm and whieh has been described by Escherich under the term P.seudotetanus This condition, which has since been observed by other writers, occurs in children between four and sixteen years. of age, boys, and is described by Esclacrich as follows:— The subject, usually a boy, who has previously been in perfect health and is in no wise tainted by heredity begins to plain of a feeling of ness in the legs whieh interferes with walking so that Ile has to stay in bed. The rigidity- in spite of the rest in bed continues to spread rapidly to the upper portion.s of the body, the back and the laead, and the patient lies in complete tension, immovable and as rigid as a piece of wood. All the muscles of the trunk, the neck and legs are in a state of maximum eontraction, they stand out prominently and are as hard as marble. The cles of the face also are in a state of tonic Fi011 producing a peculiar expression of countenance which Soltmann deseribes as resembling the sion of a person who is blinded by a very bright light. The teeth are tightly clenched and can be separated only a short distance even with the use of considerable force. During rest and when the child is asleep, the rigidity relaxes but never subsides altogether. On the other hand, cooling of the body, noises, touching the patient or psychic exitation produce paroxysms which inay lead to still greater muscular contrac tions, associated sometimes with pain, to opisthotonos, spasm of the diaphragm, dyspnrea, etc. At the height of the disease, paroxysms of this kind may occur spontaneously without any recognizable cause several times a day. The arms and hands and the eyes are not affected
and retain full freedom of motion, presenting a marked contrast to the rest of the body which looks as if it were carved out of wood. All the other organs and functions are normal.
This condition begins a few days after the onset of the disease and persists without change for from 3 to weeks when the contractures gradually relax and the patient, after considerable persuasion is at last induced to use his legs again. Complete recovery takes place in front 2 to 4 weeks. Relapses have not been observed.
The nature of this disease has never been fully explained. Escherich called his eases tetany, in spite of the absence of the characteristic overexeitability, but Pfaundler, who recently made an exhaustive study of a new case, rejects Escherich's view for this very reason.
In two of the eases reported in the literature (Kiihn, Gomez) the presence of latent symptoms of tetany is expressly mentioned.
Organic diseases of the brain, while they may produce similar pictures, and hysteria can be readily exeluded by the general habit of the patient and the fairly typical course, terminating in permanent recovery; but the distinction from genuine traumatic or "rheumatic tetanus" is exceedingly difficult at least during, the beginning of the disease. Hence any wound in a child must be carefully searched for the Nieolaier bacillus. A negative finding is of course ambiguous. The absence of fever, which is present as a rule, in pseudotetanus does not exclude infectious tetanus. In his ease Pfaundler was unable to find the Nicolaier bacillus, nor could he demonstrate tetanus toxin nor tetanus antitoxin. Nevertheless he eonsiders psemlotetanus an infectious disease closely related in its etiology to traumatic tetanus.
The treatment consists in controlling the convulsions and the pain with chloral and bromides or if necessary. injeetions of morphine. The child must be well nourished, which, owing to the trismus is quite difficult. If necessary, the stomaeh tube must be employed.