TEXAN Y 179 



the muscles that close the eyelids, in those of the alae nasi, and in those of 

 the corner of the mouth. They may even be brought about by slight 

 stroking of the front of the ear with the handle of the percussion hammer 

 (Sckultzc}. In Chvostek II there are contractions of the alae nasi and 

 muscles of the corner of the mouth on percussion under the zygomatic 

 arch. In Chvostek III percussion here causes contractions of the corner of 

 the mouth only. As to the pathognomonic significance of the different 

 degrees of Chvostek 1 s phenomena for tetany opinions are at variance. 



The phenomenon is certainly very frequent in tetany, yet it may be 

 wanting in pronounced cases and often shows great variations. On the 

 other hand slight degrees of it may occur in numerous cases of neurasthenia, 

 hysteria, and epilepsy, v. Frankl-Hochwart and Schlesinger found Chvostek 

 II and /// in nearly one-half of patients with phthisis: However, other 

 authors, for example Schonborn (Heidelberg), do not find this phenomenon 

 so frequent. It is found commonly also in rachitis. Kahn and 7 found 

 it several times in rachitis tarda. Mager found it very frequently in 

 enteroptosis, v. Frankl-Hochwart in strumous individuals. It is especially 

 frequent in all possible sorts of cachexia, especially when this is associated 

 with much loss of water from the body. Curschmann especially has pointed 

 this out. Kahn and / observed it also in severe diabetes, and also in almost 

 all cases of Reichmann's disease. It is probable that in a great number of 

 such cases this phenomenon depends not so much on the mechanical ex- 

 citability of the nerves as on that of the levator anguli oris muscle, as we 

 tap too on the insertion of this muscle in the procedure. For this view 

 speaks the fact that in the conditions named idiomuscular prominences were 

 produced regularly on the various muscles. 



Chvostek II and /// are also seen not rarely in entirely normal individuals. 

 Hence they are not pathognomonic for tetany, although it should be noted 

 that these phenomena are very frequent in the localities in which tetany is 

 endemic at the season of the tetany, and that in cases of tuberculosis in 

 which they were present they were not infrequently found associated with 

 caseation of certain of the parathyroids. Chvostek 7, when pronounced, 

 speaks very loudly for tetany; although absence of the symptom does not 

 speak against tetany, as it may be wanting in the acute stages, and like all 

 symptoms of tetany, shows great variations. The mechanical hyperex- 

 citability of the sensory nerves expresses itself in the occurrence of a burn- 

 ing sensation on percussion of the nerve trunk or on pressure over the same. 

 I shall speak later about the mechanical excitability of the sympathetic 

 nerves of the blood-vessels. 



Trousseau' 's phenomenon consists in the circumstance that pressure 

 on a nerve trunk will bring about a typical tetanic spasm in the area of dis- 

 tribution of the same, or that the constriction of an extremity with a rubber 

 bandage will also induce such a spasm. This phenomenon has nothing 



