PNEUMONIA WITH PERSISTENT HYPER- 
PYREXIA, FOLLOWED BY TETANY; 
ANOTHER CASE OF TETANY. 
BY 
HENRY PAGE, A.M., M.D., 
RESIDENT PHYSICIAN IN THe'chILDREn's HOSPITAL OF PHILADELPHIA. 
[Service of Drs. Griffith and Gillespie.] 
FROM 
THE MEDICAL NEWS, 
April 6, 1895. [Reprinted from The Medical News, April 6, 1895,] 
PNEUMONIA WITH PERSISTENT HYPERPYREXIA, 
FOLLOWED BY T ET A N Y- A N OT H E R CASE 
OF TETANY. 
By HENRY PAGE, A.M , M.D., 
RESIDENT PHYSICIAN IN THE CHILDREN'S HOSPITAL OF PHILADELPHIA. 
[Service of Drs. Griffith and Gillespie.] 
V. D., an Italian, aged two years, was admitted to the 
hospital September 8, 1894, with a temperature of 105°. 
No history of her illness was obtainable. Physical ex- 
amination showed a slight rachitic rosary and a very 
little chicken-breastedness. The fontanels were tightly 
closed, the skin was copper-colored, she was ill-nour- 
ished, and the whole body was covered with a thick 
downy hair. The heart was rapid, with an accentuated 
second sound, and was quite forcible. The abdominal 
examination was negative, except for some rachitic 
enlargement. A tympanitic percussion-note over the 
apex of the left lung and harsh bronchial breathing 
heard all over the chest, together with the short, jerky 
respiration and painful, short cough, strongly suggested 
a central pneumonia. 
An ice sponge-bath, lasting fifteen minutes, reduced 
the temperature to 102°. On September 9th the left 
lung at its apex showed dulness on percussion, exagger- 
ated vocal resonance, increased tactile fremitus, and 
harsh tubular breathing. Respiration was short and 
painful, indicative of extreme consolidation. At 6 a.m. 
the temperature was 106.80. An ice-bath, lasting fifteen 
minutes, brought about a drop of 6°. Alcoholic stimu- 2 
lants and strychnin were freely administered, and no 
shock resulted. In two hours the temperature was 
104.8°. Fifteen minutes in an ice-bath reduced it to 
101.80. Two hours later the temperature had again 
risen to 106.6°. The child was then packed in ice and 
her temperature taken by the rectum every five min- 
utes. In thirty minutes a fall of only i.6° was recorded, 
but she was removed from the pack in anticipation of a 
sudden drop, which did occur in half an hour, when her 
temperature was only 99°. In about forty-five minutes 
her temperature was again 105.6°. The ice pack was 
now discontinued, and the safer method of sponging was 
substituted, with less efficiency however, for in spite of 
frequent spongings the temperature in two hours was 
106.4. A tepid (8o° F.) plunge-bath was then tried for 
ten minutes, which reduced the temperature to 105.2°. 
Repeated spongings all night followed, and on the morn- 
ing of the 10th the temperature was only 101°. 
On September 10th the temperature was low until 
5 p.m. The child was during this period less restless 
and the breathing was much better. Physical examina- 
tion showed consolidation of the apex and body of the 
left lung, while over the apex of the right lung and in 
the right axilla beginning consolidation was heralded by 
dulness on percussion, bronchial breathing, and increased 
vocal resonance. At 5 p.m. the temperature was 105°. 
Repeated spongings proved useless, and at 7 p.m. the 
temperature reached its maximum of 107°. The child 
was now very delirious, uttering shrill cries like a wild 
animal, tossing from one end of her bed to the other, 
and at times she would be seized with a tetanic rigidity, 
having convulsive twitchings and a peculiar drawn, 
wrinkled facial expression. Sponging was again use- 
less, but a cold bath, accompanied with vigorous mas- 
sage, reduced the temperature to 99°. With the fall of 
temperature all nervous phenomena disappeared, and 
the child slept quietly. 3 
Her treatment all this while, in addition to efforts at 
reducing the temperature, consisted chiefly in adminis- 
tering nourishment in small amounts at short intervals. 
Stimulants were continually given in large amounts. 
Digestion and assimilation of food remained excellent 
throughout the whole course of the attack. 
On September nth both apices and most of the body 
of both lurrgs were consolidated. The temperature re- 
mained high, and was treated as before. At 8 p.m. the 
temperature was io6°. On September 12th over the 
body of the left lung a few moist rales, indicative of 
beginning resolution, were heard. The right chest re- 
mained as before. On September 13th it was noticed 
for the first time that almost the whole back was covered 
with a lesion resembling a bad burn. Several areas on 
the extremities of a similar kind developed in a few 
hours. These sores, while evidently trophic in charac- 
ter, were primarily due to her constant jactitation. The 
sores were treated as burns, and in a few days disappeared. 
The lungs now showed signs of active resolution. 
Bubbling rales were heard all over the chest. The 
cough was loose and the breathing was easy and natural. 
The temperature remained high until about midnight, 
when it suddenly fell by crisis, and after this never again 
reached ioo°. 
Convalescence was rapid, but the attack had left the 
child much emaciated and more bronzed and wrinkled 
than ever. In ten days she was sent to the country 
branch of the hospital, and remained there two weeks. 
When she returned a certain stiffness of the extremities 
was noted. This gradually grew more pronounced until 
the middle of October, when Dr. Griffith, then in charge, 
diagnosticated the condition as tetany. The contrac- 
tions involved chiefly the extremities. The forearms 
were flexed upon the arms and the wrists upon the fore- 
arms. The little fingers were usually strongly extended, 
the middle and ring-fingers strongly flexed, while the 4 
index fingers and thumbs were only partly flexed, but, 
like the other fingers, were always stiff. The legs were 
slightly flexed on the thighs, and the feet were turned 
inward in a state of talipes equino-varus. The jaws 
were slightly stiffened, showing their unnatural move- 
ments during mastication or crying. 
The position as described was constant from the 
beginning of the attack in October until the middle of 
January, there having been not a single moment of re- 
laxation. The child was always irritable and cross, 
crying whenever touched. Forcible movement of the 
limbs or arms seemed to cause pain. Excitement made 
the contractions stronger and made the extremities, 
which were usually quiet, twitch nervously. Sensation 
was always good, but the reflexes were all exaggerated. 
The blood showed 74 per cent, of hemoglobin and 
5,000,000 of red corpuscles to the cubic millimeter, which 
put to rest any suspicions of anemia suggested by the 
withered appearance. 
The treatment consisted of a salt-bath daily, followed 
by friction with the open palm. In addition to this, 
massage, rubbing in as much pure codliver-oil as pos- 
sible, was practised for fifteen minutes daily. Codliver- 
oil and iron by the mouth were given in as large doses as 
the child could assimilate. About January 1st the first 
improvement in her condition was noticed. She had 
then a small degree of voluntary movement of the arms, 
and her limbs were not drawn up. She was now placed 
upon the strongest house-diet for a child of two years, and 
the improvement was startling. She has gained a great 
deal of flesh and has now begun to talk and take notice 
of all that goes on around her. Her limbs have become 
straight and she has quite good voluntary motion of all 
parts of her body, although not even yet can she feed 
herself. Her treatment shall be conducted on the same 
general lines as stated, and a complete recovery from 
her tetany is anticipated. 5 
Another Case of Tetany. 
The only case of tetany found recorded in the hospital- 
records is given herewith. It is interesting in connection 
with the case described in that it also followed an acute 
febrile disease and ran a course very similar to that of 
our case. A photograph of this child in the hospital 
album shows the contractions of the hand to accord 
more perfectly in their position with that described by 
Trousseau than those in our case. Trousseau speaks 
of the characteristic contraction as resembling the ac- 
coucheur's hand. Our case, as detailed, had not this 
type of contraction. 
It is to be regretted that no mention is made of rickets 
in the case to be described, because the relation of 
rickets to tetany is dwelt upon so carefully by systematic 
writers as to lead us to suspect its presence whenever 
tetany is found. Our patient was certainly rachitic. 
No attack of laryngismus occurred in our case, and in 
the case to be recorded, as it is not mentioned, we can 
infer that it was never present. 
The carpo-pedal spasms of laryngismus are often 
confused with tetany, but in these two cases the lack of 
any paroxysmal character of the spasms, which are, in 
addition, unassociated with any of the characteristic 
laryngeal symptoms that give laryngismus stridulus its 
name, certainly entitles them to be called true tetany. 
Both laryngismus and tetany are neuroses, and both are 
intimately associated with the same disease-rickets. 
The report herewith is copied verbatim from the 
records : 
October u, 1892. E. W., three-and-a-half years of 
age, had diphtheria four months ago, which was followed 
by paralysis of the pharynx and legs. Her heart was 
weak, and she was subject to fainting-attacks. She 
gradually improved for from twelve to fourteen weeks, 6 
but even then she could walk but a few feet at a time. 
Last Sunday, in church, she had an alarming fainting- 
spell. She was carried home, and for three days had 
high fever. During the next three days she began to 
have pain, especially when handled. Then the hands 
went into their present position and the pain ceased. 
(The photograph accompanying the account shows the 
fingers to be huddled together in a point, with the thumb 
resting against the middle phalanx of the middle finger, 
i. e., the accoucheur's hand. The hand was tightly 
flexed upon the wrist.) 
To straighten the fingers causes the child to cry, and 
apparently gives pain. The hands are warm, but there 
is some edema of the dorsum. No relaxation occurs 
during sleep. Tetany was diagnosticated and bromids 
and tonics were ordered. These were stopped in ten 
days, having produced no effect. 
November 2. Traction upon the hands seemed to 
cause no pain. 
3th. The nurse can now almost straighten the fingers. 
20th. The child uses the hands freely. She was al- 
lowed to get up. She complains of her feet, and cries 
when they are handled. 
The feet give less pain. She is improving much 
in general health. The Medical News. 
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