TETANY IN AMERICA. 
With a Report of Five Cases. 
BY 
J. P. CROZER GRIFFITH, M.D., 
CLINICAL PROFESSOR OF THE DISEASES OF CHILDREN IN THE UNIVERSITY OF 
PENNSYLVANIA ; PROFESSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA 
POLYCLINIC ; PHYSICIAN TO THE CHILDREN'S HOSPITAL, ETC. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
February, 1895. Extracted from The American Journal of the Medical Sciences, February, 1895. 
TETANY IN AMERICA.1 
With a Report of Five Cases. 
By J. P. Crozer Griffith, M.D., 
CLINICAL PROFESSOR OF THE DISEASES OF CHILDREN IN THE UNIVERSITY OF PENNSYLVANIA ; 
PROFESSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA POLYCLINIC ; 
PHYSICIAN TO THE CHILDREN'S HOSPITAL, ETC. 
Although frequent enough in many parts of Europe, tetany is of 
sufficiently rare occurrence in this country to warrant the report of the 
following instances, and to render interesting a review of the cases 
published in America. 
Considerable confusion exists regarding the exact application of the 
term " tetany." Certain writers would confine it to those cases in which 
there is a very marked intermission in the spasm, reserving the word 
" arthrogryposis " for those in which the contraction is more continuous. 
The condition described as " carpo-pedal spasms " is by some writers 
considered quite distinct from tetany, and by others, as, for instance, 
Fagge, viewed as a minor form of it. Striimpell denies the existence of 
tetany in early childhood, and Henoch draws the line sharply between 
the disease as seen in children and in adults. Others, as Schlesinger, 
speak of a tetany and a psuedo-tetany, making the distinction largely on 
etiological grounds. Some would exclude all cases which do not exhibit 
marked increase of the mechanical and electrical excitability of the 
nerves and muscles, while others, admitting the great frequency of these 
conditions, do not consider them as essential to diagnosis. 
Finally, several distinct varieties of tetany have been described-as, 
for instance, rheumatic tetany, chronic tetany, tetany following thyroid- 
ectomy, and tetany due to dilatation of the stomach. 
The more one studies the subject the more impossible does it seem to 
establish any line of demarcation between the different forms of the 
disease. There are numberless gradations between the conditions of well- 
marked, widespread, intermittent contractions, and of the continuous or 
intermittent carpo-pedal spasms. Then, too, some cases exhibit inter- 
mittent contractions at one time and continuous at another, or intermit- 
tent in one part of the body and continuous in another part. Not every 
case shows all the cardinal symptoms, including those described by 
Trousseau, Chvostek, and Erb. While, therefore, it is very possible 
that two or more diverse conditions may be included in the term, in the 
1 Read before the Association of American Physicians. Washington, May, 1894. GRIFFITH: TETANY IN AMERICA. 
2 
present state of our knowledge it seems best to define tetany as a disease 
consisting of tonic spasms either continuous or paroxysmal; usually 
symmetrical; affecting especially the extremities, but often widespread 
or sometimes confined to one limb ; not accompanied by unconsciousness 
and not depending upon any irritative lesion of the brain, cord, or 
nerves, or upon hysteria. 
Tetany has been so thoroughly described in other countries during 
recent years that any account of its symptoms would be out of place 
before this body, and I may now simply present the clinical histories of 
the cases which I have seen. I regret that the details are in some par- 
ticulars far from complete. 
Case I.-Willie McG., aged nineteen months; fairly well nourished ; 
had several eclampsic convulsions when about two weeks of age; pneu- 
monia at about one year. No note made of the existence of rickets or 
other form of ill health. About March 17, 1886, he began to vomit and 
continued this until the 21st. On the 20th he commenced to scream and 
his eyes turned up and often crossed. The thumbs became flexed into 
the palms ; the fingers firmly bent at the metacarpo-phalangeal articula- 
tions, but straight elsewhere and adducted; the wrists flexed ; the feet 
and toes extended. The hands and feet had a somewhat blue and swollen 
appearance. By the next day all spasm was gone, but by the afternoon 
of the 23d (two days later) all the symptoms had returned. The abdo- 
men was swollen and tender. During the night following there was 
some stridulous breathing after cough, and on the 24th the spasm of the 
extremities was still present, although the eyes were now unaffected. 
Effort made forcibly to overcome the contraction caused screaming. 
The bowels were constipated ; the tonsils enlarged, and they and the 
pharynx somewhat red; some mucous rales were audible in the chest. 
The record made on April 1st, one week later, states that the contrac- 
tions were still present to some extent. The child let the hands hang 
most of the time with the wrists flexed, and he could not seize a pencil 
at all easily. He would crawl on his hands and knees instead of on his 
hands and feet, as was his custom when well. On April 14th it was 
recorded that full power had returned. About April 21st he developed 
rubella, which was preceded and accompanied by severe diarrhoea. 
April 22d, he awoke screaming, the contractions having suddenly returned 
in full force. The screaming lasted only a short time, but efforts forcibly 
to straighten the limbs brought it on again. In about three hours the 
spasm passed away. There was no further trouble until June 14th, when 
vomiting and diarrhoea with cough set in and continued, and on the 
morning of the 18th crying with flexion of the thumbs and wrists and 
extreme extension of the toes developed. The child kept putting his 
hands to his feet as though the latter were the seat of pain. He was 
better in the afternoon, worse at night, and on the next day much as 
when first seen, except that the fingers were straight and separated from 
each other. There was no pain except on passive motion. Nothing 
further was heard of the patient for some years, when I learned that 
there had been attacks of tetany on several occasions. About three 
years ago he died of some obscure meningeal affection in the Children's 
Hospital of Philadelphia. No autopsy could be obtained. GRIFFITH: TETANY IN AMERICA. 
3 
This case illustrates well the close etiological association of tetany 
with gastro-intestinal disturbance. Pain, it will be noticed, occurred 
only when the attacks began or when the parts were handled. The 
stridulous respiration heard on one occasion indicated a tendency to 
laryngismus, the close connection of which with tetany is so well under- 
stood. The separation of the fingers seen in the attack in June is worthy 
of remark, as it differed from the accoucheur's position more commonly 
witnessed. For the most part the contractions in this case lasted several 
days or a week or more, and should therefore be called continuous. On 
other occasions they were of short duration, lasting but a few hours or 
a day, and cannot be placed in this category. 
Case II.-Charles S., light mulatto, aged two years, was brought to 
the out-patient department of the Children's Hospital, May 1, 1889. 
The mother stated that for five months he had had difficulty in swallow- 
ing, solid food being taken more easily than liquid. The latter made 
him choke so that he grew " black in the face " and had to be beaten on 
the back to make him breathe again. He had also at times difficulty in 
breathing, the inspiration having a distinctly crowing character. The 
mother further stated that he sometimes had " spasms " in which the 
fingers were drawn inward and the wrists flexed, and that this condition 
would last for " some time." Examination of the child showed him to 
be a well-marked case of rickets. While in the clinic room his respira- 
tion was distinctly noisy, but the clinical notes indicate that it was 
rather the expiration than the inspiration. This may have been an 
error. He was ordered cod-liver oil and rock-salt baths, but he did not 
return. Several futile attempts were later made to see him in order to 
study his symptoms more fully. About a year later I learned that he 
had continued to have the attacks of tetany at intervals. 
The brief and incomplete notes of this case serve at least to illustrate 
the close connection between rickets, laryngismus stridulus, and tetany. 
The nature of the difficulty in swallowing is not clear. Very probably 
there was a spasm of the muscles of deglutition accompanied by a 
spasm of the larynx. 
Case HI.-Peter W., aged forty-eight years, a well-developed and 
muscular negro, was brought by the police patrol to St. Agnes Hospital, 
July 15, 1890, the attack having come on him suddenly while at work. 
His family history was good, with the exception of the death of his 
mother from phthisis. He had had " typhoid pneumonia " nine years 
previously, and had had the ordinary diseases of childhood. He stated 
that ever since birth he had suffered from " cramps " about once a year, 
but that for the last few years they had occurred more frequently. He 
had an attack in the autumn of 1889, another in May, 1890, and a third 
two weeks before coming to the hospital. They consisted of muscular 
cramps which were sometimes very painful and which usually began in 
the hands or feet and extended throughout the body. 
The feet would be drawn into dorsal flexion, the knees and hips ex- 
tended and stiff, the thumbs bent into the palms and the fingers closed 
tightly over them, the wrists flexed, the elbows flexed and drawn to the 4 
GRIFFITH: TETANY IN AMERICA. 
sides, and the head held stiff. The jaws would be tightly closed, or 
sometimes could be opened and not shut again. The breathing would 
be painful and difficult, and the man feel as though each moment would 
be his last. The attack would come on slowly and increase in severity. 
At its height the spasms would be somewhat remittent, lasting some 
minutes, and then partially relaxing, while the greatest intensity of the 
pain shifted from one part of the body to another. The whole duration 
of an attack would be four or five hours. 
When admitted he was in great pain and bathed in profuse perspira- 
tion. He had a temperature of 97° F., and a full and strong pulse. 
He was unable to pass water. The spasm and pain made walking im- 
possible. The muscles of the neck, back, and extremities were involved, 
but particularly those of the latter. The neck was stiff and there was 
occasionally slight arching of the back, the weight resting mainly on the 
shoulders and the nates. The muscles of the calves were as hard as 
iron and the pectorals stood out like eggs under the skin. The indi- 
vidual paroxysms lasted one or two minutes and were followed by com- 
plete relaxation, lasting five or ten minutes. An exceedingly anxious 
expression of face accompanied the onset of the convulsions, which the 
man dreaded greatly. The spasm never seemed to be present with equal 
severity everywhere at once, but showed its greatest intensity now in one 
portion of the body and now in another. The upper extremities, how- 
ever, were much more frequently attacked. A curious feature of the 
case was the fact that if the forearm or leg happened to be in the posi- 
tion of extension at the time of the onset of a spasm, the member stif- 
fened in that position; and the converse was true if it was in flexion. 
There was no affection of speech. The patient appeared able to open 
the mouth and move the tongue readily. Percussion of the pectoral 
muscles during the intermissions produced a momentary vigorous con- 
traction. There was marked anaesthesia of the lower portion of the 
body as far upward as the umbilicus, the man being unable to feel the 
prick of a pin. 
The spasms diminished in intensity in the course of a couple of hours, 
after hypodermatic injections of morphine and atropine had been admin- 
istered ; but they returned later in the day, and appeared even through 
the next day, the 16th, although with less severity and frequency. 
On the 17th he felt sore all over and the muscles were tender, but there 
was no more spasm. Nothing abnormal was found on physical exami- 
nation of the chest and abdomen. The thyroid gland was unaltered. On 
the 19th it was observed that compression of the upper arm produced a 
cramp-like pain in the forearm and a flexion of the wrist. This was 
relieved when the pressure was removed and friction of the muscles 
employed. The abdominal, cremasteric, and plantar reflexes were nor- 
mal. The knee-jerk was absent, even with reinforcement. Efforts to 
induce ankle-clonus produced slight cramp in the calf muscles. Pressure 
over the exit of the facial nerve was followed by slight twitching of the 
muscles of the face. 
The man had no more trouble while under observation. On the 23d, 
eight days after admission, it was noticed that there was no longer any 
anaesthesia of the lower extremities. The knee-jerk was still absent. 
The course of the attack had been afebrile. About a week after his 
entrance into the hospital. Dr. G. Betton Massey kindly tested his elec- 
trical reactions for me. There was found distinct quantitative increase GRIFFITH: TETANY IN AMERICA. 
5 
of the general electrical excitability of the muscles. This was not more 
marked in any one muscle than in others. No qualitative changes were 
discovered and the normal formula was invariably present. There was 
" a decided increase in the electro-muscular sensation, a gentle contrac- 
tion causing a pain that resembled that of the tetanic attacks." 
This instance of tetany is the only one of my cases occurring in an 
adult, and even here the disease began very early in life. The case is 
of interest on account of the severity and the wide extent of the spasms. 
The contraction caused by tapping the pectorals is an instance of the 
mechanical irritability common in this disease, as is the well-known 
facialis symptom of Chvostek, also present in this case. Trousseau's 
symptom-the production of spasm by pressure upon the artery or 
nerve, especially of the arm-and the increased electrical excitability- 
Erb's symptom-were also witnessed. Inability to urinate, from which 
the man at first suffered, and anaesthesia have been recorded by others 
also as occurring in this disease. The closing of the fingers over the 
thumb is not so common as the extension at the metacarpo-phalangeal 
joints. 
Case IV.-Emily W., aged three and one-half years. She was stated 
to have had good health until the occurrence of severe diphtheria four 
months before. As she was convalescing palsy set in, involving princi- 
pally the muscles of the pharynx and lower extremities. Nearly fatal 
heart-failure is said to have occurred on several occasions. There was 
no history of the existence of any pain. She recovered very slowly from 
this condition, and by the end of twelve or fourteen weeks from the onset 
of the diphtheria she could walk only a few steps. Soon after this she 
was taken while in church with a severe attack of fainting and had to 
be carried home. In the afternoon of the same day fever developed and 
continued during three days. Then, for three days she suffered con- 
stantly with great pain, especially when handled. She seemed unable 
to get into any comfortable position. The pain then suddenly and 
entirely ceased and simultaneously the hands passed into the bent posi- 
tion, which was, it is said, as marked at the beginning as when I first 
saw her. Pain did not recur except on passive motion. This condition 
persisted without intermission for three weeks, during which she was 
kept in bed; and she was then placed in the wards of the Children's 
Hospital, October 11, 1892. 
On examination, she was found to be a well-developed though decid- 
edly irritable and somewhat delicate-looking child. There was no evi- 
dence of rickets. She sat in apparent comfort in bed. The hands were 
flexed at the wrist to quite a right angle, as shown in the illustration, 
and the skin over the joint was tense, red, and somewhat oedematous. 
The fingers were flexed at the metacarpo-phalangeal articulations, but 
extended elsewhere. They were also decidedly adducted toward each 
other, the middle and ring fingers overlapping the others to some ex- 
tent. The thumb was flexed into the palm, but its terminal phalanx 
was in extension and protruded between the middle and ring fingers. 
The feet were extended; the effort to flex them seemed to give pain, 
but the irritability of the child rendered it difficult to determine how 6 
GRIFFITH : TETANY IN AMERICA. 
much actual suffering was produced. It was clear, however, that the 
manipulation of the hands was very painful. The knee-jerks were 
absent. Rest in bed and bromide of potash were ordered for about a 
week, but without benefit, and iodide of potash was equally useless. 
Fig. 1 
No change could be observed in the condition for some weeks. Even 
during sleep the contraction continued, and attempts made to overcome 
it roused the child with the pain. The patient's irritability and the 
constant contraction at the wrist prevented at this time any successful 
attempt to bring on a spasm by compression of the upper arm. Tapping 
or stroking the face in front of the ear was not followed by muscular 
contraction. On several occasions the endeavor was made to determine 
the electrical reactions, but without success, owing to the fear and crying 
which resulted. 
On November 2d, six weeks after the onset of the attack, the child 
permitted the extension of her hands to a considerable degree and with- 
out complaint, if her attention were diverted. She kept them, however, 
when at rest, in the same position as at first, and was as little able to use 
them. Persistent careful efforts were now daily made to straighten the 
hands by manipulation and by placing large balls of raw cotton in the 
palms. By November 8th there was decided lessening of the spasm, 
perhaps the result of great improvement in the general health. By 
November 14th, eight weeks after the onset, the hands were almost 
entirely relaxed, and, although the thumbs were still in the palms, the 
child could handle a doll awkwardly. On this date firm compression 
of the upper arm caused complaint of pain and a slight increase in the 
flexion of the hand. The feet were no longer extended. 
She now improved rapidly, and by December 1st was practically well. 
When she first recommenced walking, on November 20th, she com- 
plained of pain in the feet and cried when they were handled. Later, 
she developed at different times measles, pertussis, and severe ulcerous 
stomatitis, but without the return of the tetany, and on May 15th she 
was in excellent condition, hearty, and well-nourished. 
This case is in some respects an interesting one. The position of the 
wrists in constant flexion, combined with the history of former paralyses, 
suggested the possibility of a wrist-drop resulting from the diphtheria. 
A brief study of the patient, however, showed that there was positive GRIFFITH: TETANY IN AMERICA. 
7 
contracture. Other interesting features were the sudden cessation of a 
three days' severe pain simultaneously with the development of extreme 
contraction ; the persistent absence of the facialis symptom and of any 
discoverable cause for the tetany other than the diphtheria weeks before. 
The presence of oedema of the articulations is a common feature where 
the flexion is persistent. 
Case V.-Emma S., six weeks old, was brought to the Children's 
Clinic of the Hospital of the University of Pennsylvania on December 
6, 1892. She had been fed at the breast and was fairly well nourished. 
She had had no illnesses, except occasional colic and eructation of gas, 
and she had not been fretful. Two weeks previously the mother had 
noticed that the child cried whenever picked up or when its legs were 
moved, and that its knees were constantly held flexed. She stated that 
this condition had persisted without intermission, and that the effort to 
straighten the joints caused crying. 
The examination made on December 6th showed that the knees were 
partially but not rigidly flexed, and that efforts to extend them were 
painful and caused the hamstring tendons to stand out as hard cords, 
and the tissues over the knee-caps to appear baggy and wrinkled- 
apparently the result of stretching by the constant flexion. The knee- 
jerks were normal. Further physical examination revealed nothing 
out of the way. The child was ordered bromide of potash and anti- 
pyrine, with inunctions of warm oil over the tense tendons. By December 
13th, one week later, the legs could be extended more easily and with 
less pain. Former treatment was replaced by a cough mixture, which 
a slight bronchitis demanded. By December 19th the legs were decid- 
edly better and the child could herself extend them to a considerable 
degree. By December 28th, three weeks from the first visit, the legs 
were still improving, but the baby was losing weight. It had been 
suffering for a week from diarrhoea, vomiting, and colic, and the mother's 
milk was rapidly growing so thin and insufficient that artificial feeding 
was deemed necessary. After this date the legs continued to improve ; 
the gastro-enteric symptoms became temporarily better, but soon returned 
with increased force. On or before January 11th-i. e., about a month 
after the first visit-the legs were completely relaxed; but on this date 
the arms became rigidly flexed at the elbows, the wrists slightly bent, 
and the thumbs drawn into the palms. When seen two days later the 
condition was a little better: the flexion of the left elbow had ceased, 
the fingers were freely movable, but the thumb was still incurved. On 
the right side the elbow was still bent, the wrist not so much ; the fingers 
overlapped each other and were strongly flexed over the thumb. Efforts 
to straighten the right arm caused pain. Compression of the left arm was 
not followed by contraction, and neither pressure over the exit of the 
facial nerve nor stroking with the finger in front of the ear had any 
effect. The knees wTere still free from spasm. There was severe bron- 
chitis in addition to the vomiting. Electrical examination made about 
this date by Dr. Evans, of the Clinic for Nervous Diseases of the Uni- 
versity of Pennsylvania, showed a quantitative diminution of both faradic 
and galvanic contractility, but no alteration of the formula. 
For two months from this time, i.e., until the middle of March, the 
child lost ground steadily in health and became greatly emaciated, GRIFFITH: TETANY IN AMERICA. 
8 
although vomiting occurred only occasionally and there was no diar- 
rhoea. A flat, papular, widely-diffused syphiloderm had made its appear- 
ance. The tetany had returned in the left arm, and the elbows of both 
sides remained always more or less flexed, the thumbs always bent in and 
the fingers generally clasped over them, and only movable with con- 
siderable force. The wrists were not flexed and the knees were only 
occasionally bent. The feet had assumed the position of marked dorsal 
flexion, and retained this much of the time. Efforts to straighten the 
arms always caused pain. After the middle of March the child's gen- 
eral health began to improve rapidly and the tetany grew much less 
evident. By March 27th, three and a half months after the first visit, 
it had gained much in nutrition and weight, although still a miserable 
specimen. The eruption had spread. The elbows were still slightly 
flexed; the thumbs were constantly in the palms, and the child cried 
when they were forcibly withdrawn. There was no spasm elsewhere. 
Trousseau's and the facialis symptoms could not be obtained. 
Up to May 1st the baby had continued to improve, and the contrac- 
tures by this date were entirely gone except in the thumbs, which were 
still always flexed into the palms, although not so firmly as before. The 
eruption was disappearing under the influence of mercurial inunctions. 
Soon after this a change in the food brought on a return of vomiting, 
together with a reappearance of the contractures in both elbows. The 
weather was now hot, and the patient became exhausted, although vomit- 
ing had ceased. It died on May 24th, six months after the onset of the 
tetany. There was no autopsy. 
This case is peculiar in several respects. The contracture starting at 
the knee-joint and persisting there for weeks without involving other 
parts is certainly an unusual mode of onset. The suspicion was at first 
aroused that the condition was one of congenital contraction of the ten- 
dons ; but the later development of contractures at the wrists and elbows, 
apparently consecutive to gastro-enteric disturbance, made the diagnosis 
of tetany reasonably sure. Possibly the quantitative diminution of the 
electrical excitability may have been due to the great muscular wasting. 
The case is, for the most part, an instance of continuous spasm. The 
flexion of the wrists lasted scarcely two days and may be called inter- 
mittent. The contraction at the elbows was continuous, although with 
decided remissions and exacerbations. The contraction at the knees 
was continuous until they gradually assumed the normal position, after 
which it became distinctly intermittent. The flexion of the thumbs was 
obstinately continuous for at least four months. 
One is surprised at the paucity of records of tetany to be found in the 
medical literature of America. I have made a somewhat extended 
search for cases, both under the heading of tetany and under those of 
trismus, laryngismus, spasm, and so on, lest some instances of the first- 
mentioned disorder should be concealed under the names of the others. 
Undoubtedly numerous cases have occurred which have not been recog- 
nized by physicians, and still more, although recognized, have never been GRIFFITH: TETANY IN AMERICA. 
9 
published. Undoubtedly, too, I have overlooked the reports of many. 
Still, the results of the search prove that tetany is undoubtedly com- 
paratively rare in this hemisphere. 
For reasons already indicated I have included cases of so-called carpo- 
pedal spasm, except such as were clearly the immediate prodromal evi- 
dences of eclampsia and certainly attended by unconsciousness; for the 
study even of the few American cases shows that it is impossible to regard 
carpo-pedal spasm as other than a mild exhibition of tetany. 
The following are brief abstracts of the 72 cases which I have been 
able to collect, arranged, as far as possible, in chronological order-at 
least as far as the year of publication is concerned. It has been found 
impossible in these abstracts to make a sharp distinction between " con- 
tinuous " and " intermittent " contractions. For the sake of conveni- 
ence I have rather arbitrarily denominated those spasms as continuous 
which appear to have lasted uninterruptedly for more than two days, 
and those as intermittent which did not last longer than two days with- 
out permanent or temporary disappearance. 
The Roman numerals are employed to designate the cases reported 
with more or less detail. The capital letters, in parentheses, indicate the 
brief references without description which have been made to cases other 
than these. 
I. 1833. Eberle (Diseases and Physical Education of Children, 1833, 
527).-Healthy child of nine months. Repeated attacks of laryn- 
gismus. " Spasmodic affection of the respiratory muscles" and opisthot- 
onos lasting ten to twelve minutes. Feet and hands in typical continuous 
contraction. 
II. 1844. A. F. Axson (New Orleans Med. Journ., 1844, i. 45).- 
Girl, four months. Dentition thought to be cause. Attacks of laryn- 
gismus, sometimes with retraction of head ; flexion of thumbs into palms ; 
flexion of toes. Spasms last one-half to two minutes; occur often in 
day. Treated by cold to head. 
Ill to VI. 1844. J. P. Epperson (West. Journ. of Med. and Surg., 
1844, 2d S., ii. 25).-Four children in one family; colored; all under 
one year. Frequent attacks of laryngismus, lasting few seconds or 
minutes; later with strabismus, continuous characteristic spasm of feet 
and hands, and occasionally slight spasm of arms and legs. Treated 
successfully with stramonium. 
(A.) Three other children in this family had earlier died from same 
condition. 
VII. 1848. J. F. Meigs (Diseases of Children, 1st ed., 1848, 424). 
-Boy, seven months. Chronic intestinal derangement. Continuous 
spasm of hands and feet, with swelling, lasting four months. Occasional 
spasmodic movements of face, arms, and body. Laryngismus frequent. 
VIII. 1848. J. F. Meigs (76id.,429).-Child, two years. Attack 
of tonic flexion of toes lasting a few hours; relieved by purgative. 
IX. 1850. C. D. Meigs (Diseases of Children, 1850, p. 167).-Boy, 
six months. Frequent attacks of laryngismus simultaneously with in- 
termittent contractions of hands and feet, opisthotonos, turning of head 10 
GRIFFITH: TETANY IN AMERICA. 
to right, general rigidity, and finally with development of general con- 
vulsions. Death in couple of weeks or less. 
X. 1853. J. F. Meigs (Diseases of Children, 1853, 2d ed , 463).- 
Child, nine months; delicate; persistent digestive disturbance; open 
wound. General convulsions followed in few days by painful tonic 
characteristic spasms of hands and feet, nearly continuous for two months, 
with occasional remissions. Occasional tonic, chiefly intermittent, spasm 
of arms and thighs, and retraction of head and trunk. Later a relapse 
with laryngismus. 
(B.) In a later edition Meigs and Pepper (Diseases of Children, 1870, 
4th ed., 529) refer to " two other cases " in which the contraction was 
decided, but lasted a short time only. One of these is possibly Case 
VIII., detailed above. 
XI. 1858. W. J. Kincaid (Transac. Ohio State Med. Soc., 1858, 
xiii. 69).-Boy, four and a half months. For weeks had had laryngismus 
badly; then also began to have hands and feet spasmodically flexed in 
some severer attacks. Cured by cannabis and chloroform internally. 
XII. 1859. R. R. McMeens (Cincin. Lancet and Observ., 1859, ii. 
457).-Boy, twelve months. Well developed. Dentition and digestive 
disturbances considered the cause. Subject to laryngismus. Developed 
in addition characteristic [continuous ?] spasm of hands and feet, with 
persistent flexion and partial paralysis of upper and lower extremities. 
Recovered. 
XIII. 1862. V. J. Fourgeaud (Pacific Med. and Surg. Journ., 1862, 
v. 303).-Girl of nineteen months. No cause discoverable except general 
weakness and emaciation. Nearly persistent, tonic spasm of lower half 
of body ; momentary partial relaxations. No evidence of pain. Spasm 
present during sleep. Spasm gradually became intermittent. Whole 
duration about six weeks. Disease at first simulated a spinal spastic 
palsy, as legs were crossed. 
XIV. 1866. L. H. Carpio (Gac. Med. de Mexico, 1866, ii. 222).- 
Blacksmith, fifty years old. Superficial wound of abdomen, and few 
hours later abundant sweating ; slight trismus of left side with powerful 
painful contractions of left side of neck. Paroxysms intermittent; in- 
duced by moving head or coughing. Entire relaxation and no pain 
between paroxysms. Attacks ceased in five days. 
XV. 1871. Arnold (Balt. Med. Journ. and Bull., 1871, ii. 347).- 
Nursing woman of thirty-two years. [Appears to have been intermittent] 
tetany of left side of face, right arm, and slightly of right leg. Sometimes 
pain in nape of neck. Trousseau's sign present. [Report very incom- 
plete.] 
XVI. 1871. Zuniga (Gac. Med. de Mexico, 1871, vi. 377).-Black- 
smith, twenty years ; old suppurating wound. Exhibited trismus, tetanic 
physiognomy, copious sweating, spasm of muscles of abdomen, neck, 
trunk, and lower limbs. Difficult respiration [spasm of intercostal mus- 
cles ?]. Trismus chiefly persistent. Other contractions more inter- 
mittent. Condition had lasted twenty-four days when reported, although 
improving under chloral. 
(C.) Zuniga (Ibid.') says that another case of tetany had been in the 
hospital a few days before. 
XVII. 1872. W. R. Nichols (Canada Med. Journ., 1872, viii. 161). 
-Boy, sixteen years. Gradual onset; no cause given. Trismus, con- 
tortion of face, spasm of muscles of neck and back [opisthotonos], ab- GRIFFITH : TETANY IN AMERICA. 
11 
domen, and limbs. [No notes regarding hands and feet.] Pupils dilated 
and oscillating; strabismus ; difficulty in swallowing. Spasm continu- 
ous, with remissions only. Excitement made worse ; no cramp-like pain. 
Trousseau's symptom present. Recovered after three weeks' treatment 
with iodide of potash followed by bromide of potash. 
XVIII. 1875. M. Alfaro (An. Asoc. Larry, Mexico, 1875, i. 97).- 
Healthy man, thirty years. Slight faintness and tingling in lower limbs 
ushered in general tetanic rigidity with trismus, distorted features, con- 
tracted pupils, adduction of thumbs, extension of feet, legs, thighs, and 
arms. Respiration interfered with. Four attacks in a few hours, each 
lasting ten to fifteen minutes. Similar attacks since age of fifteen ; first 
shortly after death of mother; others usually after psychic disturb- 
ance. 
XIX. 1876. J. S. Green (Transac. N. Y. Obstet. Soc., 1876-78, i. 
160).-Delicate girl, four years old. After an attack of diarrhoea there 
developed intermittent spasms of feet, legs, hands, and forearms, lasting 
two to five minutes, with some degree of persistence between them. In 
one paroxysm there was opisthotonos. Position of hands characteristic. 
Paroxysms so painful that ansesthesia with chloroform required for six 
hours. Disease lasted in all about forty-eight hours. 
XX. 1877. N. B. Emerson (Iransac. Amer. Neurolog. Assoc., 1877, 
ii. 179).-Girl, twelve years. After suppression of first menstruation 
there was pain in right arm and leg followed by continuous contraction 
lasting a few days. Hands and feet in characteristic position. Then 
similar attack of left side, preceded by numbness and tingling. Salicylic 
acid followed by recovery. [As a result ?] 
XXL 1877. N. B. Emerson (Ibid.').-Male, eighteen years ; deli- 
cate. Disease began at age of four years, possibly then associated with 
some affection of brain or cord. Painful spasm, sometimes one arm, 
sometimes whole body; oftenest arm and leg of one side. Contraction 
continuous night and day and characteristic; lasted usually two to three 
days up to ten days. Respiration sometimes difficult. Attack generally 
preceded by numbness and evidences of indigestion. Trousseau's symp- 
tom not obtained; perhaps result of chloral given. Recovery under 
use of conium. 
XXII. 1879. S. Weir Mitchell (New York Med. Record, 1879, xv. 
604).-This and the following case seem very probably anomalous in- 
stances of tetany. The writer gives them no name, but describes them 
as due to obscure functional conditions. 
Boy, seventeenyears; fair health. Forty-eight hours after exposure 
to intense heat had dull pain in the legs followed next day by great, 
continuous rigidity of legs. Passive motion caused pain. Recovery in 
three weeks. 
XXIII. 1879. S. Weir Mitchell (Ibid.).-Man, forty-three years, well 
developed. Pain in back and legs, with increasing stiffness, followed in 
a few hours by fully-developed attack. Legs extended, moderately stiff; 
but least handling caused severe, intensely painful spasms of legs, feet, 
and abdominal muscles. Recovery in sixteen hours under narcotics. 
Two previous similar attacks. 
XXIV. 1879. C. K. Mills (New York Med. Rec., 1879, xvi. 218). 
-Girl, thirteen years. Rheumatism, and later diarrhoea. Painful con- 
tinuous spasm of extremities; elbows flexed ; wrists flexed and abducted ; 
thighs and feet extended. Handling left parts painful; knee-jerks in- 12 
GRIFFITH: TETANY IN AMERICA. 
creased. Recovered in two weeks with cure of diarrhoea by silver and 
opium. 
XXV. 1879. H. P. V. Petershausen (Detroit Lancet, 1879-80, iii. 
248).-Man, twenty-eight years; healthy; history of blow on head, 
possibly connected with the tetany. Disease had lasted six years. At one 
time there had been a very persistent hemiplegic condition, which finally 
disappeared. When seen were intermittent paroxysms of left arm and 
hand, neck, and facial muscles, every three or four minutes, lasting thirty 
to one hundred seconds. [Not clear whether legs involved.] Some oedema 
of hands and face. Attacks preceded by stiffness and pain. Some par- 
alysis of left arm and difficulty of speech during paroxysms and inter- 
missions. Recovery in four weeks under chloral. 
XXVI. 1880. A. H. Sowers (Proc. Nebraska Med. Soc., 1877-80, 
186).-Adult male; subject to severe dyspepsia ; had a fall and suffered 
some shock, and a few days later tetany developed. Intermittent spasm 
of whole right side, with slow' respiration. Pain in head and staring 
expression ; disposition to sleep. Disease had lasted three months. 
XXVII. 1882. J. O. Hirschfelder (Pacific Med. and Surg. Journ., 
1881-82, xiv. 385).-Adult male; fall in elevator five days before first 
attack. Symptoms not detailed, but Hirschfelder showed to his class 
that pressure on axillary nerve produced general rigidity, retraction of 
head, and well-marked tetanic convulsions; relieved when pressure was 
removed. 
XXVIII. 1884. I. W. Smith (Amer. Journ. Obstet., 1884, xvii. 
438j.-[Case reported under title " Trismus Nascentium;" possibly an 
instance of tetany.] Child three days old. Continuous flexion of lower 
limbs; inversion of feet; distortion of features; fingers variously dis- 
torted ; spasm increased by efforts at passive motion. [No trismus 
mentioned, and] child could suckle and swallow from a spoon. Humeri 
dislocated forward. 
XXIX. 1885. J. Stewart (Med. News, 1885, xlvii. 50; later, more 
completely, in Transac. Assoc. Amer. Phys., 1889, iv. 33).-Male, thirty- 
nine years ; long suffered from chronic diarrhoea. No trace of thyroid 
gland. Attacks exhibited double vision; intermittent characteristic 
spasm of hands, adduction of arms, flexion of forearms; contraction of 
facial muscles, and occasionally spasm of lower extremities. Numbness, 
pain, swelling, and sometimes herpes of hands. Attacks recurred for 
about ten days. Disease had lasted eight years. Increase of galvanic 
and of mechanical excitability. No reaction of degeneration. Knee- 
jerk increased during an attack ; later, absent or weak. 
[D.) W. A. Hammond states in a clinical lecture (N. E. Med. 
Monthly, 1885-86, v. 479) that he has seen a few cases; also, that he is 
not aware of any cases reported in America. 
(E.) G. Ross (Med. News, 1885, xlvii. 51) states that he has seen 
but few cases. 
(F.) Godfrey (Ibid., 51) says that he has seen several cases. 
XXX. 1886. H. M. Lyman (Transac. Assoc. Amer. Phys., 1886, i. 
99).-Delicate man, twenty-eight years. Attacks apt to follow over- 
eating. Spasm of arms and legs ; opisthotonos. Respiration sometimes 
difficult; occasionally severe headache. Attacks lasted from one to four 
minutes, and recurred every five to thirty minutes for one or two days; 
six to eight in a year. Each attack began w ith forcible beating of 
right arm against chest. GRIFFITH: TETANY IN AMERICA. 
13 
XXXI. 1886. H. M. Lyman {Ibid.).-Nervous man, twenty-two 
years. Attacks of cramp in left hand, forearm, and sometimes shoulder 
and side of neck. Intermittent. 
XXXII. 1886. H. M. Lyman {Ibid.').-Hysterical girl, nineteen 
years. Exhibited Trousseau's symptom in hand and wrist. [No other 
note of case.] 
XXXIII. 1886. H. M. Lyman {Ibid.).-Boy, nine years. Inter- 
mittent, painful contractions of flexor muscles of hand and forearm. 
Fingers flexed over thumb. 
XXXIV. 1886. H. M. Lyman {Ibid.).-Girl, seven years. Spasm 
of muscles of neck, arms, hands, feet, and legs, and sometimes of thorax, 
abdomen, and face. Sometimes laryngismus. Attacks began in hand ; 
three to fifteen paroxysms a day. 
(G.) H. M. Lyman {Ibid.) states that he has seen the " milder variety 
of tetany " in young children usually suffering from diarrhoea; character- 
ized by flexion of thumbs into palms, often with fingers flexed over them. 
XXXV. 1886. A. Jacobi {Transac. Assoc. Amer. Phys., 1886, i. 
106).-Young man in whom act of masturbation always brought on 
attack. Disease did not appear until age of puberty. 
XXXVI. 1886. J. T. Carpenter {Transac. Assoc. Amer. Phys., 1886, 
i. 105 ; later, more exactly, in Ibid., 1889, iv. 44).-Boy, thirteen months ; 
abscess. Turning of eyes to one side; typical contraction of arm and 
hand, first on one side, then on the other; trismus persistent. All spasm 
relaxed about third day, then returned; death in a week. [This case 
is very powerfully suggestive of tetanus.] 
XXXVII. 1887. F. C. Shattuck {Boston Med. and Surg. Journ., 
1887, cxvi. 497).-Healthy boy, nineteen years ; had stiffness of jaw for 
year. This suddenly grew worse, and there appeared numbness, [inter- 
mittent (?) ] spasm of hands and arms and slightly of legs. Hands in 
characteristic position. Masseters hard. Pain only on passive move- 
ment. Considerable mental excitement. Speech difficult. Trousseau's 
symptom and increased electrical excitability could not be obtained. 
Condition relieved in three days under chloral and potassium bromide. 
XXXVIII. 1888. H. Hun {Med. News, 1888, liii. 415).-Woman, 
twenty-six years. Suppressed menstruation cause of first attack. De- 
ficient mental power. Disease had lasted two years. At first intermit- 
tent spasm, usually in arms.and legs; position of hands and feet char- 
acteristic. Later continuous, tonic spasm of all the muscles, excepting 
those of face, persisted even during sleep. Were also paroxysmal pain- 
ful augmentations of the spasm. Trousseau's symptom present. Faci- 
alis symptom absent. The persistent contraction interfered with the 
study of the reflexes and electrical reactions. No improvement when 
case published, after nine months of observation. 
XXXIX. 1889. J. T. Carpenter {Transac. Assoc. Amer. Phys.,1889, 
iv. 45).-Girl, eleven months ; suppuration of shoulder. Laryngismus 
and " muscular contractions of tetany." [The paroxysms were evidently 
intermittent.] Recovered, but liable for several years to attacks after 
diarrhoea or taking cold. 
(H.) F. P. Kinnicutt (Transac. Assoc. Amer. Phys., 1889, iv. 47) 
remarked in a discussion upon the subject that he had seen two cases of 
intermittent tetany in connection with great dilatation of the stomach. 
(I.) S. Weir Mitchell {Ibid., 50) said that he had seen but two cases. 
These may have been Cases XXII and XXIIL, already detailed. 14 
GRIFFITH: TETANY IN AMERICA. 
(J.) W. Pepper (Ibid., 51) stated that he had seen only one case, 
that being in a child. 
(K.) A. Jacobi (Ibid, 48) stated that he had met with five cases, 
and possibly a few more. It mav be that one of these was that referred 
to by him in 1886 (Case XXXV.). 
XL. 1889. F. T. Miles (Transac. Assoc. Amer. Phys., 1889, iv. 48). 
-Woman, twenty-two years. Dilatation of stomach; extreme emacia- 
tion. Had had numbness of fingers and toes on several occasions. De- 
veloped an attack of tetany with classical position of hands and feet; 
contraction about face and mouth ; rigidity of eyes. Died in twenty- 
four hours. 
XLI. 1889. C. W. Earle (Transac. Amer. Pcediat. Soc., 1889, i. 
153).-Girl, two and a half years ; indigestion. Characteristic contrac- 
tions with pain and swelling of hands and feet; muscles of posterior part 
of legs involved. Spasm continuous. Well in five days. Fomentations 
and nerve-sedatives. / 
XLII. 1889. C. W. Earle (Ibid.).-Girl, six months. Painful 
continuous spasm and swelling of hands and feet, lasting ten days. 
XLIIL 1889. F. C. Shattuck (Boston Med. and Surg. Journ., 1889, 
cxxi. 231).-Girl, twenty-one years. Diphtheria when sixteen, followed 
by tetany. At first attacks in one hand and arm, occurred rarely, lasted 
one to two minutes; gradually all extremities, more frequent, sometimes 
lasted an hour. Trousseau's symptom present. No inversion of elec- 
trical formula. 
XLIV. 1889. S. L. Abbott (Boston Med. and Surg. Journ., 1889, 
cxxi. 230).-Robust longshoreman, forty-three years. Spasm of all 
flexors of extremities, and to some extent of muscles about shoulders 
and abdomen. Occurred often every half-hour; lasted about a half- 
minute. Excited by muscular effort. Only slight pain. Improved 
rapidly under urethan. 
XLV. 1889. J. L. Smith (Arch, of Pcediat., 1889, vi. 374).-Boy, 
eleven months; improperly fed ; constipated ; one tooth. Had had dis- 
ease for four months. Spasm [apparently continuous] of muscles in all 
extremities. Characteristic position of hands. At times spasm of legs 
and thighs. Attacks of laryngismus. Spasm continued during sleep. 
Recovered under potassium bromide and relief of constipation. 
XLVI. 1889. J. L. Smith (Ibid., 376).-Well-nourished child, 
twenty months. Dentition thought to have been the cause. Five teeth 
prominent at once under swollen gums. Flexion of left leg and thigh ; 
[apparently continuous] for three weeks. Spasm present during sleep. 
XLVII. 1889. J. L. Smith (Ibid., 469).-Woman, thirty-nine 
years. Exposure to cold, wet, and fatigue. Intermittent pain from 
ankles to knees; in four months, constant; shortly after had continuous 
flexion of fingers, extension of feet, and flexion of toes. Spasm present 
during sleep. Sensation in toes nearly lost. Sphincter ani paralyzed 
for a time. Perspiration of extremities. Spasm of hands well in six 
months; that of feet still continuing after a year. 
XLVIII. 1889. J. L. Smith (Ibid., 472).-Girl, ten and a half 
months. Severe acute diarrhoea, followed by characteristic spasm of 
hands and feet with oedema. Several paroxysms during six days, each 
lasting a day or two, and present during sleep. Had attack of eclampsia 
on fourth day of disease. Treated with bromides and chloral and atten- 
tion to bowels. GRIFFITH: TETANY IN AMERICA. 
15 
XLIX. 1889. J. L. Smith (Ibid., 473).-Boy, fifteen months. 
Rickets; tendency to diarrhoea; earlier, an inclination to hold breath. 
Had had nearly continuous characteristic spasm of hands and feet for 
three months. Spasm present during sleep. Recovery under attention 
to diet and administration of zinc and atropine. 
L. 1890. A. Abrams (Ocdd. Med. Times, 1890, iv. 14).-Man, 
twenty-four years; excessive smoker; dilatation of stomach. Painless 
spasms in left arm and sometimes also in left leg; rarely right arm alone. 
Sometimes occurred every day at hourly intervals. Violent movements 
provoked them. Impairment of all forms of sensation in left arm and 
leg. At times formication and coldness constituted prodromes. Left 
knee-jerk slightly increased. Trousseau's and Chvostek's symptoms and 
increase of electrical excitability present. Great exhaustion after attacks. 
LI. 1890. J. Schneck (Journ. Amer. Med. Assoc., 1890, xv. 387).- 
Girl, ten years. Disease had lasted two years. At first vertigo, with 
spasm of lower limbs; later only spasm of upper extremities, neck, jaws, 
and occasionally opisthotonos. Swallowing and speech interfered with ; 
some pain attended. Hands and arms in classical position. Paroxysms 
averaged ten daily, each lasting a couple of minutes. Tinnitus, formi- 
cation and numbness followed them. Trousseau's and Chvostek's symp- 
toms and knee-jerk absent. Argyll-Robertson's pupil present. Disease 
disappeared in five or six weeks under conium and nitroglycerin. 
LIL 1891. E. H. Small (St. Louis Med. and Surg. Journ., 1891, 
lx. 271; also in several other journals).-Boy, eleven months. Rickets ; 
digestive disturbance. Characteristic continuous spasm, at first painful, 
of hands and feet, with oedema and cyanosis. In week recovery under 
fomentations, potassium bromide, and attention to bowels. 
LIIL 1892. N. E. Remmen (Chicago Med. Recorder, 1892, iii. 240). 
-Girl, fourteen years. Adenoid growths in naso-pharynx, with poor 
mental development. Painful spasms of extremities and rigidity of whole 
body, lasting five minutes and occurring every two months. Disease had 
lasted two years. Trousseau's and Chvostek's symptoms well marked. 
LIV. 1892. S. S. Adams (Arch, of Pcediat., 1892, ix. 881).-Boy, 
four months; digestive disturbances, phimosis, possibly rhachitis. Laryn- 
gismus and, several times, eclampsia. Later " snapping of lids," rolling 
eyes, flexion of thumbs into palms, and general rigidity attending laryn- 
gismus. These attacks several times daily. Death shortly after from 
laryngismus. 
LV. 1892. W. S. Bowen (Med. News, 1892, lx. 434).-Girl, six 
days old, when she developed attacks of laryngismus with spasm of nearly 
all muscles of body ; opisthotonos and characteristic position of extremi- 
ties. Lasted about one minute ; repeated frequently. [Clearly no tris- 
mus. No cause, unless wound left by dropping of cord on fifth day.] 
LVI. 1893. B. E. Vaughn (New York Med. Journ., 1893, Iviii. 
757).-This and the following six cases are instances of epidemic tetany ; 
five of them were in one family; all were Italians living under most 
unfavorable conditions of dampness and bad air. 
Woman, thirty-five years. Nursing; damp, close dwelling. Formi- 
cation in feet extending to head, neck, and finally hands, with constipa- 
tion and abdominal pain. Then characteristic spasms in upper extremi- 
ties, and later in feet, three to four a day, each about one hour. Increased 
electrical excitability. Disease had lasted three months when first seen. 
Quinine cured in eighteen hours. 16 
GRIFFITH: TETANY IN AMERICA. 
LVII. 1893. B. E. Vaughn (Z6td.).-Girl, fourteen years; just 
beginning to menstruate. Daughter of Case LVI. and developed dis- 
ease two weeks later. Same exposure to dampness. Formication pre- 
ceded onset of spasms, which were nearly continuous, relaxing only once 
or twice a week for a couple of hours. Position of hands and arms 
characteristic. Rapid recovery under quinine. 
LVIII. 1893. B. E. Vaughn (Ibid.).-Girl, three years; rickets; 
same exposure to dampness as with mother (Case LVI.), and disease 
began about same time. Spasm in upper extremities twice a week only. 
Recovery under quinine. 
LIX. 1893. B. E. Vaughn (Ibid.).-Girl, twelve years; menstru- 
ation recently established ; lives in damp house with mother (Case LVI.). 
Formications, abdominal pain, and constipation as in that case; then 
continuous characteristic spasm of upper extremities. Trousseau's 
symptom present. Disease had lasted about two months. Recovered in 
less than twenty-four hours under quinine. 
LX. 1893. B. E. Vaughn (Ibid.).-Woman, thirty-three years. 
Nursing; damp dwelling. Formications, as in Case LVL, for three 
weeks. Contractions [apparently continuous] began two days before 
seen. Were increased by pressure on brachial plexus. Disappeared 
after sixteen grains of quinine in two doses. 
LXL 1893. B. E. Vaughn (Ibid.).-Woman, twenty-five years. 
Damp dwelling; nursing; anaemic, looked sick, had fever and enlarged 
spleen. Formication as in Case LVI. Contractions [apparently continu- 
ous] in fingers and hands began four days before seen. Trousseau's 
symptom present. Recovered in less than twenty-four hours under 
quinine. 
LXII. 1893. B. E. Vaughn (Ibid.).-Man, working in damp place ; 
had typical spasm in both hands and feet. 
(L.) B. E. Vaughn (Ibid.) states that quite a number of other cases 
came to the morning Italian class of the New York Dispensary; those 
reported above having been seen in the afternoon hour. 
LXIII. 1893. A. S. Fraser (Canadian Practitioner, 1893, xviii. 
500).-Man, thirty years. Severe dyspepsia due to cirrhosis of stomach 
as shown by autopsy. After acute indigestion developed intermittent 
spasm of muscles of face and extremities, with characteristic position of 
hands. Spasm lasted one to two minutes; had four in an hour; fifth 
stopped by puncture with hypodermatic needle. Then occasional slight 
spasms of extremities for some months, with declining health. Then 
death, preceded by severe spasms of extremities during three days. 
LXIV. 1893. J. W. McConnell (Journ. Nerv. and Ment. Dis., 1893, 
xx. 418).-Woman, thirty-three years. Took general cold. Numbness, 
pricking, and vague pain, followed by spasm of extremities, neck, abdo- 
men, and zygomatics; tongue stiff, speech and respiration difficult. 
Muscles alternately relaxed and contracted during about one hour. 
Voluntary motion increased the spasm. Trousseau's symptom present. 
A second attack within twenty-four hours. 
LXV. 1893. A. Jacobi (Arch, of Pcediat., 1893, x. 1042).-Boy, 
three years; poorly developed ; convulsions at seven months. Fingers 
bent and thumbs flexed into palms. [Not stated how long this lasted.] 
Considers chronic meningitis the cause. 
LXVI. 1893. A. Jacobi (Ibid., 1055).-Colored child [baby ?] ; dis- 
turbed digestion or exposure apt to be followed by muscular spasms GRIFFITH: TETANY IN AMERICA. 
17 
especially in the hands, with a " peculiar forced position of the limb 
lasting a day or two." Spasm returning perhaps in a week. 
LXVII. 1893. D. J. Evans (Montreal Med. Journ., 1893, xxii. 183). 
-Girl, seventeen months, colored; rickets. Characteristic spasm of 
hands and feet, with oedema, continuing ten days, then gradually relax- 
ing. Facial reflex present; knee-jerk exaggerated; no pain. Tonic 
and dietetic treatment. 
LXVIII. 1893. D. J. Evans (Ibid.}.-Girl, ten months. Chronic 
diarrhoea, debility, probably syphilis. Five other children had died of 
convulsions. Continuous spasm of hands and feet, with exacerbations, 
lasting five days. No facial reflex. Dietetic treatment and potassium 
bromide. 
LXIX. 1893. S. Brown (North Amer. Practitioner, 1893, v. 66).- 
Man, twenty-four years. Exposure to wet and fatigue. Painful spasm 
in calves and feet, lasting about half an hour, and occurring frequently 
for three days; worse at night. Increased galvanic excitability. In- 
version of formula. Trousseau's symptom absent. 
LXX. 1893. S. Brown (Ibid.).-Young man. Tingling of whole 
right side and spasm of right arm with flexed elbow and closed hand. 
Spasms lasted one to two minutes, and usually occurred four to five times 
before breakfast, and occasionally one or more times during the day. 
Increased galvanic excitability, inversion of formula and Trousseau's 
symptom present. Disease had lasted six weeks. Recovery in six days 
under potassium bromide and galvanism. 
LXXI. 1893. S. Brown (Ibid.).-Man, twenty-seven years. Ex- 
posure to bad weather. Spasm on both "sides" [probably legs meant], 
lasting several months. [Not stated whether intermittent or continuous.] 
Says symptoms were well marked, and electrical examination confirmed 
the diagnosis. 
LXX1I. 1894. M. H. Fussell (Univ. Med. Magazine, 1894, vi. 229). 
-Girl, five years. Indigestion apt to induce laryngismus and painful 
characteristic contraction of hands and feet with flexion of elbows, re- 
traction of head, and strabismus. Spasm continuous during a few days, 
then disappearing a few days. Exertion made worse; diversion of mind 
caused nearly to disappear. Trousseau's symptom and knee-jerk absent. 
Chvostek's symptom present. Disease occurred during several years, 
especially in spring and fall. Typical epilepsy later in course of case. 
Death from atelectasis resulting from laryngismus. 
Some little analysis of these cases may be of value. Those which 
offer themselves as at all suitable for this purpose are the ones designated 
by the Roman numerals. They equal 72 cases in all. I have not in- 
cluded my own cases in this analysis, since they do not come in the 
category of those already published. 
Conclusions drawn from the cases can only have a relative value, 
particularly where figures are concerned. This is true both because 
some doubtful instances of the disease are included in the list, and be- 
cause many of the reports are incomplete or the meaning of the writers 
obscure. 
In considering the etiology of the published cases we find that 34 of 
the patients were of or above the age of puberty when the disease first 18 
GRIFFITH: TETANY IN AMERICA. 
developed, including 3 girls in whom menstruation had just been es- 
tablished ; 13 were children from two years of age to puberty; 25 were 
under two years of age, and 20 of these less than one year old. 
33 of the patients were male, 29 female, and in 10 the sex is not 
stated. 
Among the possible causes mentioned or implied, I find lactation (4 
cases) ; open wounds (6) ; psychic disturbance, including 2 instances 
of shock from falls (3) ; menstruation, developing or suppressed (4) ; 
possible affection of the brain (3) ; digestive disturbances, including 2 
cases of dilatation of the stomach (23); rheumatism or exposure to cold 
and wet (13); exposure to heat (1); diphtheria (1); dentition (3); 
syphilis (1) ; masturbation (1) ; absence of the thyroid (1) ; rickets (5) ; 
adenoid growths of the naso-pharynx (1); phimosis (1). Sometimes 
two or more of these causes were operative in the same case. 
Under the heading of symptomatology we find it stated that pain in 
the affected part, apparently due to the spasm, was present in 21 cases, 
and that it was absent or trivial in 6 cases. In the others no reference 
is made to the subject. Further, we find among the principal symptoms 
or complications, faintness (3 cases); vertigo (1) ; herpes (1) ; tingling, 
numbness, formication, etc. (15); temporary paralysis (3); anaesthesia 
(2) ; disposition to sleep (1) ; tinnitus (1) ; epilepsy (1); laryngismus 
(17) ; eclampsia (4). European observers find laryngismus and tetany 
very frequently associated ; and Loos, indeed, has maintained that the 
former is simply a laryngeal manifestation of the latter disease. Cheadle 
views laryngismus, tetany, and eclampsia as but different expressions of 
the same morbid condition. Possibly the association of tetany with one 
or the other or both of these allied affections has occurred in America 
oftener than the reports would indicate. It is interesting to notice that 
15 of the 17 cases of laryngismus were witnessed in children under one 
year of age. Also, that in 11 of the cases the contractions were chiefly 
continuous and in 6 paroxysmal. 
No numerical analysis can be made of the position of the spasm in 
the body, since it varied from an almost universal diffusion to a limita- 
tion to one limb. Trismus was present in probably 6 cases; possibly in 
a few more in which the reports do not make it quite clear. So, too, it 
is difficult to draw any conclusions with regard to the nature of the 
spasm, since we find all gradations occurring, and the writers, too, have 
not always expressed themselves clearly on this point. As nearly as I 
can determine the spasm was intermittent, in the sense already defined, 
in 38 cases and continuous in 25 cases. In 1 case (XIII.) it was at 
first continuous and later intermittent; in 1 (XXXVIII.) it was first 
intermittent and then continuous; and in 4 cases (I., VII., X., and 
XXXVI.) it was continuous in one portion of the body and intermittent GRIFFITH: TETANY IN AMERICA. 
19 
in another. In 3 cases (LXII., LXV., LXXI.) the authors do not 
give even a clue to the nature of the spasm. 
In only comparatively few cases is there any reference to the presence 
or absence of Trousseau's symptom and of increased electrical or mechan- 
ical excitability as described by Chvostek and Erb respectively. 
The treatment, so far as it has been reported, has consisted chiefly in 
remedies employed as sedatives to the nervous system, or directed against 
the exciting cause of the disease. But very few cases have been fatal, 
and these only as the result of complications. 
Finally, we can but conclude that the cases reported in America en- 
tirely uphold the view enunciated earlier in the paper, viz., that there is 
no essential difference between the tetany of adults and that of children, 
or between the continuous and the paroxysmal forms of the disease. The 
cases quoted in considering the nature of the spasm are all in evidence 
here. Moreover, continued spasm may exist in persons past the age of 
childhood (Case XVII.), contrary to the statements of some writers; 
and intermittent spasms, exactly similar to the commoner tetany of 
adults, are frequently seen in children. But were there no other in- 
stances in proof of the point advanced, the remarkable series of cases 
published by Vaughn would of themselves be sufficient. Here we find 
in one family, and at one time, one case (LVI.) of a truly intermittent 
type, another (LVII.) of a somewhat more continuous form, and a third 
(L1X.) showing very continuous contraction, yet with Trousseau's 
symptom present as proof of its true nature. AIPericaP Journal 
of the MEDICAL SCIENCES. 
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developed to perfection the features of usefulness in its department of literature, and 
presents them in unrivalled attractiveness. It is the medium chosen by the leading minds 
of the profession on both sides of the Atlantic for the presentation of elaborate Original Articles; 
its Reviews are noted for discernment and absolute candor, and its Classified Summaries of 
Progress each month present an epitome of medical advances gleaned by specialists in the 
various departments. According to unquestionable authority, " It contains many original papers 
of the highest value; nearly all the real criticisms and reviews which we possess, and such 
carefully prepared summaries of the progress of medical science and notices of foreign works that 
from this file alone, were all other publications of the press for the last fifty years destroyed, it 
would be possible to reproduce the great majority of the real contributions of the world to medical 
science during that period." 
Me<iicaI Xcw's. 
WEEKLY, $4.00 PER ANNUM. 
BY KEEPING closely in touch with the needs of the active practitioner, The News has 
achieved a reputation for utility so extensive as to render practicable its reduction in 
price from five to Four Dollars per annum. It is now by far the cheapest as well as 
the best large weekly medical journal published in America. Employing all the recognized 
resources of modern journalism, such as the cable, telegraph, resident correspondents, special 
reporters, etc., The News furnishes in the 28 quarto pages of each issue the latest and best infor- 
mation on subjects of importance and value to practitioners in all branches of medicine. Its 
numerous departments are designed to subdivide and present its material in the most attractive 
and convenient manner. 
In a word The Medical News is a crisp, fresh, weekly newspaper, and as such occupies a 
well-marked sphere of usefulness, distinct and complementary to the ideal monthly magazine, 
The American Journal of the Medical Sciences. 
The Year-Book of Treatment for 1895 
Gives a classified summary and review of the real advances in treatment made during 1894 in all 
departments of the science of medicine. Price, $1.50; or in combination with either or both the 
above journals, 75 cents. Ready early in 1895. 
The Medical News Visiting List for 1895 
Published in four styles : Weekly, dated, for 30 patients; Monthly, undated, for 120 patients per 
month; Perpetual, undated, for 30 patients weekly per year; Perpetual, for 60 patients weekly 
per year. The first three styles contain 32 pages of important data and 160 pages of assorted 
blanks; the 6o-patient perpetual consists of 256 pages of blanks. Price, each, $1.25. In com- 
bination with either or both above periodicals, 75 cents. Or, Journal, News, Visiting List 
and Year-Book, $8.50. Thumb-letter index for Visiting List, 25 cents extra. 
LEA BROTHERS & CO., PUBLISHERS, PHILADELPHIA, 706, 708 & 710 SANSOM STREET.