184 THE DISEASES OF THE PARATHYROID GLANDS 



systoles. In almost all cases there was an acute exacerbation of the tetanic 

 conditions, together with paresthesias or spasms. In the declining stage 

 of the disease, all these manifestations were very much less pronounced. 



An abnormally strong vascular action of the adrenalin could also be 

 demonstrated on the parathyroidectomized dog. 



Later, in the consideration of the metabolism, I will take up the question 

 of the glycosuric action of adrenalin in tetany. 



Again, the sensitiveness to pilocarpine is essentially increased in the 

 acute stage of tetany. There occurs abnormally strong outbreak of sweat 

 or salivation, together with flow of tears, initial contraction of the erectores 

 pilorum muscles (gooseflesh), later marked reddening of the skin of the body 

 with sensation of heat and rushes to the head, abnormal increase of the 

 secretion of gastric juice and relaxations of stomach tonus; further, symptoms 

 that we do hardly see on the administration of this pilocarpine; symptoms 

 such as nausea, diarrhea, urinary and rectal pressure. Also pilocarpine 

 induces frequent tetanic spasms in the various muscular territories. The 

 manifestations of an increased tonus in the vegetative nerves in the first stage 

 of tetany are of very manifold nature. Here I follow almost verbatim the 

 expositions on the subject in the work of Kahn and myself. 



Spasmodic conditions of the smooth ciliary muscle seem to occur very 

 rarely. Kunn and Fr. Muller saw mydriasis in the attack (spasm of the 

 dilatator papillae?). Peer and also Escherich observed transitory differences 

 in the size of the pupils, that Peer regarded as spasmodic conditions. A . 

 Fuchs saw during the attack appreciable diminution in the time of pupillary 

 reaction. Finkelstein saw pupillary rigidity. Ibrahim saw pupillary 

 differences in one case (unilateral spasm of the dilator pupillae). In this 

 case the neck, pharyngeal and eye muscles were especially involved in the 

 spasm, thus simulating the picture of a meningitis. The cerebrospinal fluid 

 was clear, however. 



Little is known as to lachrymation in tetany; evidence as to the proba- 

 bility of its occurrence is furnished in one case only, that of Kahn and myself. 

 Here there existed slight redness of the conjunctiva and there was often an 

 increase in the lachrymation simultaneously with the exacerbation of the 

 tetany, as well as an increased flow of saliva. 



Marked sweats are frequently found in the acute stage of tetany. 



In tetany it is difficult to refer changes in the type of breathing to al- 

 terations in the tonus of the smooth musculature of the bronchi, as we must 

 not overlook what part spasms of the diaphragm and of the intercostal 

 muscles eventually play in its production. Ibrahim, Finkelstein and Popper 

 report cases of tachypnea. We saw dyspnea occur very frequently. 



Disturbances of the action of the heart seem to be very frequent. Kahn 

 and / could observe in almost all cases in the acute stage strengthening of 

 the cardiac action, loud sounds at the apex, and even accentuated second 



