l8o THE DISEASES OF THE PARATHYROID GLANDS 



to do with alterations in the circulation, but depends on the excitability 

 of the nerve itself (v. Frankl-Hochii'art). However, it cannot be so simply 

 explained by the increased motor irritability of the nerve alone, for v. Frankl- 

 Hochwart saw bilateral spasms occur after pressure on the nerve plexus of 

 one extremity, and Schlesinger shows that this phenomenon cannot be in- 

 duced on the purely motor facial nerve, but only on the mixed nerves. Hence 

 to the hyperexcitability of the motor nerves must be superadded that of 

 the sensory nerves or of their spinal centers and their connecting links 

 [Schaltstiicke]. 



In similar manner would be explained the leg- phenomenon lately de- 

 scribed by Schlesinger. On flexion at the hip-joint of the leg that is ex- 

 tended at the knee there can be induced under circumstances during the time 

 of the freedom from attacks, a painful tonic spasm in the extremity, after 

 from a few seconds to three minutes. Finally should be mentioned here 

 the thermic hyperexcitability described by Kashida. This expresses itself 

 in the occurrence of paresthesias and spasms on the application of cold or 

 hot irritants. 



In tetany the tendon reflexes are mostly normal, in the attack not rarely 

 diminished. 



Finally it should be mentioned that the patient frequently complains 

 of pains in the bones or joints (Falta and Kahn), especially after severe tetanic 

 attacks. I shall later report such a case. 



We now come to a symptom that in the full development of tetany makes 

 it one of the most dreadful diseases, and that has furnished its name, i.e., the 

 tetanic spasm. Here we meet with the greatest differences in the phenomena, 

 and here the individual forms of tetany show the greatest variations in the 

 localization of the spasm. In tetany of adults usually the upper extremities 

 are involved symmetrically in the spasm, and indeed in the known obstetri- 

 cian's position, yet there sometimes occur fist-positions with extended 

 thumbs, and spasms may occur unilaterally (v. Frankl-Hoclrwart, v. Jaksck, 

 Curschmann, et al.}. When the lower extremities are affected, they are 

 extended, the foot is in a slight equinovarus position, the toes are bent plan- 

 tarly, sometimes, however, dorsally. The spasms are exquisitely painful. 



As example I cite the following case (Case VI of Falta and Kahn} . 



Observation XVII. Augustine Sch., four and one-half years old, from Vienna. 

 Entered the clinic Nov. 24, 1911. For three weeks emaciation, and very poor appetite. 

 One of the two children of the same parents died in 1909, in the first year of life, of spasm 

 of the glottis. The patient herself had had spasms at two and one-half years, that lasted 

 two days and were associated with fever. No rickets. Aug., 1910 to Jan., 1911 pertussis, 

 then pneumonia with measles. Since that time frequent severe diarrheas for eight days; 

 on Feb. 22 vomiting daily, since which six to seven bowel movements daily. Since this 

 morning tonic spasms in the feet. 



The illustration shows the typical obstetrician's position of the hands. Also there 

 is distinct spasm of the left leg, as is to be seen by the tension of the tendon of the tibialis 



