TETANY. 
GUY HINSDALE. 
Synonym.-Tetanille, Fr. 
Definition.-A disease manifested by continuous or paroxysmal tonic 
spasms, affecting chiefly the extremities but often more generalized, sometimes 
confined to one limb; not accompanied by unconsciousness; associated com- 
monly with some form of sepsis, either of peripheral or intestinal origin, and 
in all probability due to the presence of some toxic product. 
Treatment.-The keynote of treatment in any case of tetany will be to 
remove, as far as possible, any source of sepsis. The history of the case will 
guide the examiner to either the mouth, the pharynx, the larynx, the stomach, 
or the intestinal tract. If dyspepsia or intestinal putrefaction exist, this must 
be decisively met. The saline purgatives in adult cases and castor-oil in the 
case of children will be indicated. 
A non-fermentable diet should be instituted and, as far as possible, physical 
rest in bed in a separate room, from which the noise of conversation and the 
presence of unnecessary persons can be excluded. When diarrhea is present, 
as a sequel of typhoid fever or in connection with a dilated stomach, purga- 
tives should be used, if at all, with caution. Under such circumstances it is 
best to use creosote in doses of from to TTL•ij (0.015-0.18) every three or four 
hours, or from gr. ss to gr. v (0.032-0.32) of resorcin. In persons over ten 
years of age, sodium salicylate will be of benefit. Tetany may occur in cases 
of gastric dilatation due to a chronic ulcer in the neighborhood of the pylorus 
-under such circumstances being ushered in by severe vomiting and proving 
fatal in about three-fourths of the cases. Fenwick advises washing out the 
stomach either with plain water or some innocuous antiseptic solution. On 
general principles one would suppose that lavage would be of value when 
atony of the stomach with fermentation proves a troublesome symptom. It 
would appear, however, that this process has in several cases led to a fatal 
termination. In this respect our position coincides with that held in reference 
to strychnin-poisoning-that the patient is made worse by attempts to intro- 
duce a tube into the stomach. 
The first indication is to relieve the nervous phenomena. Further, much 
can be done with the aid of chloroform-inhalations, the internal use of bromids 
and chloral, and in adults the hypodermic use of morphin for the relief of 
pain and for its general influence. Pain may require the external application 
of laudanum, camphorated oil, or morphin oleate, or chloroform-liniment. 
1108 TETANY. 
1109 
Hyoscin is useful and may be employed when niorphin is objectionable. 
Chloral should be administered in doses of about 30 grains (2.) daily for 
adults, with full doses of sodium brom id . From 5 to 60 grains (0.32-4.) of 
one of the bromids daily, according to age, will probably be sufficient. The 
newer hypnotics, sulfonal and trional, will find a place in the later part of 
the day. 
Gowers advocates for nocturnal tetany " a dose of digitalis given at bed- 
time." But just how the drug acts when given in this manner we cannot say. 
It was discovered by Trousseau that an attack of tetany could be occasioned 
by pressure on the larger arteries so as to impede the circulation. Digitalis 
on the other hand gives an impetus to the circulation, and in addition, when 
used in comparatively large doses, it lowers reflex activity. It has been shown 
that, independently of its action on the circulation, digitalis has the power of 
directly exciting the inhibitory reflex center of Setschenow, thus diminishing 
reflex activity. It is quite likely that the beneficial influence noted by Gowers 
is brought about in this way. 
Tetany has been observed occasionally in an epidemic form. Under such 
circumstances the disease appears to be of a rheumatic or malarial origin. In 
some cases quinin has been administered, with rapid recovery. 
If tetany occur in women shortly after confinement a thorough search 
should be made for uterine or vaginal infection, and appropriate local anti- 
sepsis, with prompt use of the curet or similar measures, will probably be 
demanded. 
Among the medicinal agents, besides those already mentioned, that have 
been used in the treatment of cases of tetany terminating favorably are stra- 
monium, cannabis indica, conium, and nitroglycerin. Massage, electricity, and 
external applications may also be employed. Warm baths in conjunction with 
cold sponging are recommended, and seem to relieve the spasm in young chil- 
dren as promptly as in cases of laryngismus stridulus. The child should be 
placed in a warm bath and the back and chest thoroughly sponged for a minute 
or two with cold water; and this process may be repeated several times daily. 
In all cases of tetany, particularly following fevers or other wasting diseases 
and especially when suppuration has been present, it is of prime-importance 
not to neglect the general strength and nutrition. Cod-liver oil, iron, quinin, 
and strychnin, and extracts of meat, will prove of great value in conjunction 
with the special lines of treatment pointed out. 
The most recent treatment of tetany is the use of thyroid extract. Osler 
advocates this method, and cites cases of both operative and idiopathic tetany 
successfully treated in this way.