TETAXV 183 



(Schultze, Hoffmann, Bettmann, Kasparek, v. Voss, Schiejfferdecker and 

 Schultze, v. Orzechowski, et al.). 



In such cases we also observe mechanical hyperexcitability of the muscles 

 and formation of pits on percussion, indeed even typical myotonic reaction 

 on testing with the galvanic and faradic currents. We shall consider this 

 more fully in the discussion of the pathogenesis. 



I have already mentioned disturbances of the sensorium. In a series of 

 cases psychoses have also been observed (v. Frankl-Hochwart, Kraepelin, 

 Hirschl, and others). In acute cases, v. Frankl-Hochwart several times saw 

 typical hallucinatory confusion or deep depression; he found abnormal 

 psychical excitement and even depressive mental attitudes, fourteen times 

 among thirty-seven cases. Erdheim saw characteristic conditions of excite- 

 ment also in parathyroidectomized rats. 



Finally it remains to be mentioned that in certain cases a slight grade 

 of choked disc or neuroretinitis has been observed (v. Jaksch, Hanke). 



I now come to the description of the behavior of the vegetative nerves in 

 this condition. In the literature there have appeared up to the present 

 only a few scattered references as to this question; nevertheless I can find 

 ground for my statements in the work 1 did in collaboration with Eppinger 

 and Rudinger and especially with Fr. Kahn; in addition, there is a detailed 

 work on the subject of Ibrahim. The vegetative nerves show in tetany 

 manifestations of increased excitability on one hand and long-continued 

 heightening of tone on the other. 



Kahn and 7 in one case observed hyperexcitability of the sympathetic 

 nerves accompanying the vessels. After application of the bandage for the 

 elicitation of Trousseau's phenomenon there occurred in addition to this 

 phenomenon, pronounced anemia of the phalanges of the third, fourth, and 

 fifth finger. Since that time I have seen this symptom once, in the case of 

 E. C. to be described later (Observation XVIII). In this case there occurred 

 regularly on application of the bandage to the upper arm or thigh, simul- 

 taneously with Trousseau's phenomenon, a pronounced anemia of the ex- 

 tremity. Here also belongs the pronounced dermographism that we find so 

 extraordinarily frequent in the acute stage of the disease. 



The electrical hyperexcitability of the vegetative nerves in man is hard 

 to demonstrate. On the other hand, we may readily show the chemical 

 hyperexcitability as seen in the behavior of the patient on the action of 

 adrenalin or pilocarpine. After subcutaneous injection of adrenalin in the 

 acute stage of tetany there occurs almost regularly an abnormally strong 

 action on the blood-pressure, on the heart action, on the contraction of the 

 vessels of the skin, and also on the tetanic spasm. The increase in the 

 blood-pressure and the pulse rate was especially rapid. To it were often 

 added extreme paleness of the face and the skin of the entire body, strength- 

 ening of the heart action, subjective cardiac palpitations, and even extra- 



