1 86 . THE DISEASES OF THE PARATHYROID GLANDS 



with the decline of the tetany it again made way for normal relations; the in- 

 vestigations also showed that the polyglobulia may be for a time appreci- 

 ably increased during an acute attack, in one case rising from 5,106,000 to 

 7,808,000 red cells; finally, the investigations showed that in the cases of 

 occupation tetany the red-cell count is higher during the acute stages, and 

 that it is temporarily raised even higher during an acute attack. As ex- 

 ample, I cite the following case: 



Observation XVIII. C. E. Entered the clinic May 14, 1912. Carpenter, forty 

 years old. For about four years the patient felt a striking sensation of fatigue in the 

 arms and legs, especially after heavy work and after long walks. He also had par- 

 esthesias in the arms and legs (formication, "going to sleep" of the left leg). For two 

 years slight gastric disturbances, consisting in brief spasmodic pains, and in acid eructa- 

 tions, sometimes associated with vomiting. For the last year, the patient has felt quite 

 well. 



Two days ago he suddenly experienced nausea, acid eructations, vomiting, and a colicky 

 pain in the region of the stomach. Some hours later he experienced spasmodic drawing 

 together of the hands (according to the description, the typical obstetrician's position), 

 and formications in the tips of the fingers and twitchings of the muscles of the face. 

 Later there were also spasms of the lower extremities, which became quite rigid. The 

 spasms seem to have lasted three to four hours. The patient was conscious throughout 

 the spasm. Since then the spasms have been repeated several times. 



Rather strong potator. Inclination to bronchitides. 



Rather vigorous, large patient, pale color of the face, facial expression as if he were 

 going to cry, skin moist, apical dullness on the left, vesicular murmurs sharpened, at 

 places rhonchial and whistling murmurs. Cardiac findings normal. Liver two finger- 

 breadths below the margin of the ribs. Very well pronounced dermographism. 



Chvostek I and // strongly positive; also the frontal muscles twitch on application of 

 the test; Trousseau markedly positive, Hoffman markedly positive, Schlesinger markedly 

 positive. 



Electrical examination Ulnar Facial 



C.C.C. i.o 0.6 



An C.C. 2.5 1.8 



An O.C. 3.4 i.o 



C.C.Te. 8.0 1.2 



An C.Te. not attainable not attainable 



Mechanical hyperexcitability of the muscles very pronounced. Idiomuscular ridges 

 make their appearance. 



Patellar reflexes markedly exaggerated, suggestion of a patellar clonus. 



Coarse tremor of the fingers. 



Blood-pressure (Gartner), 125. 



In urine traces of albumin, reactions for urobilin and urobilinogen markedly positive. 



Tubercle bacilli in the sputum. 



Increase of temperature up to 37.3. 



May 14. During the day and also during the preceding night many severe tetanic 

 spasms in the upper and lower extremities, that always lasted for several hours. 



On elicitation of Trousseau's phenomenon by means of the bandage fibrillary con- 

 tractions occur in the musculature of the arms or feet respectively. Together with the 

 spasm there regularly appears, on application of the bandage, a pronounced anemia of the 

 extremity in question. 



