TETANY 185 



pulmonic sound, in one case an accentuated aortic second. To this is added 

 lability of the heart action, in other words, slight tachycardia on psychical 

 excitement and abnormally high pulse rate on working. Complaints as to 

 cardiac palpitations are frequent. In two cases we observed, toward the 

 end of the stay at the hospital, occurrences of mitral systolic murmurs 

 that surely were not there previously. 



Very noteworthy are the statements of Ibrahim. This author saw sudden 

 death without spasm of the glottis in three cases of tetany of sucklings, 

 without signs of suffocation showing at autopsy. Signs of status thymico- 

 lymphaticus were in these cases absent or only slightly developed. In two 

 of these cases the heart was relaxed in dilatation. In the third case the right 

 ventricle was relaxed, the left unusually hard and forcibly contracted. 

 Ibrahim thought of tetany of the heart, probably called forth by vagal or 

 sympathetic excitement. We do not as yet know how far abnormal condi- 

 tions of excitability of the autonomous heart ganglia or heart regulating 

 nerves are responsible for the manifestations mentioned. 



In tetany of adults manifestations on the part of the vascular apparatus 

 are very pronounced. In the acute stage all tetanics have pronounced vaso- 

 motor disturbances. They all look pale, in spite of the fact that, as we 

 shall see later, blood counts show high figures for red cells and a hemoglobin 

 value not lowered. Emotions often call forth abnormally intensive varia- 

 tions of tonus in the vessels; and the edematous swellings that are observed 

 not infrequently are to be regarded as angiospastic manifestations. Ibrahim 

 saw, in a suckling suffering with tetany, edema of the legs, with kidneys in- 

 tact, and Kahn and / several times saw marked edema of the skin over the 

 metacarpo-phalangeal joints after severe attacks. Curschmann described 

 pronounced angiospastic manifestations, vascular spasms of the fingers 

 and toes. Heat relieved the attacks. Here too would belong the char- 

 acteristic puffiness of the face which was first described by v. Frankl-Hoch- 

 wart and which we have also frequently observed. The face is pale but does 

 not possess the livid coloration that tends to appear in myxedema. 



I now take up the question of the blood picture in tetany, as it stands in 

 intimate relationship with the manifestations on the part of the vascular 

 apparatus. Until the appearance of our work, the statements as to blood 

 changes in tetany were concerned only with cases of so-called stomach tetany. 

 In isolated cases there has been observed appreciable increase in the number 

 of red cells, or increase in the specific gravity (F. M tiller, Fleiner, Kuckein, 

 also ourselves), and attempts had been made to refer these to the organism's 

 poverty in water, that might have been brought about by deficiency in 

 absorption on account of pyloric stenosis, or the vomiting of large amounts 

 of gastric juice. Our investigations showed decisively that this polyglobulia 

 is directly a tetany symptom. Above all, it could be shown that in the case 

 of "stomach tetany" this polyglobulia existed only in the acute stages, and 



