TETANY 187 



May 15. Severe attack this morning, at 10 o'clock, during which blood was with- 

 drawn from the ear. The blood is dark red. 



Erythrocytes, 6,500,000. 



Leucocytes, 4200, of which: 



Polymorphonuclear neutrophiles, 63 per cent. 



Large mononuclear cells, 36 per cent. 



Eosinophiles, i per cent. 



May 1 6. Blood findings during the attack-free interval. 



Erythrocytes, 5,600,000. 



Trousseau positive; after the decline, the patient complained of severe bone pains in 

 the extremity affected. 



May 20. No attack since the i6th. Face still slightly swollen, facial expression still 

 somewhat as if the patient were going to weep. 



May 22. Erythrocytes, 5,200,000. 



May 24. Trousseau can no longer be elicited. 



May 25-31. : Patient feels well, no paresthesias; he has gained as much as 5 kg., 

 appetite excellent, no gastric disturbances. 



In a case reported by Falta and Kahn the following values were found : 

 At the beginning of the observation about 4,000,000 erythrocytes and 9 

 gm. hemoglobin. Three weeks later during a long-continued severe attack 

 7,808,000 erythrocytes and 14.86 gm. 1 hemoglobin. The next day, during 

 a period of almost free attacks there was 5,106,000 erythrocytes. Later 

 after amelioration of the spasms 4,160,000. This was a case of tetany 

 in the course of a Reichmann's disease. In another case (Observation XXIII) 

 that I report below, we likewise see a distinct agreement between the varia- 

 tion of the erythrocyte count and the tetanic condition. I would suppose 

 that the behavior of the erythrocytes furnishes a good criterion for the 

 course of the disease, just as the leucocyte formula does in Basedow's disease. 



In dogs, also, we have seen, after parathyroidectomy, the count of erythro- 

 cytes in the acute stage rise to 7,000,000. Such polyglobulias occurring dur- 

 ing the acute stage can be explained in no other way than that they are 

 due to vascular spasm, analogous to those polyglobulias which are observed 

 after injection of adrenalin (Bertelli, Falta, and Schweeger). But one is not 

 justified in assuming, on this account, that during the tetanic attack there is 

 an increased production of adrenalin ; we should rather suppose that in analogy 

 with all other conditions of excitement in tetany the seat of the hyperexcita- 

 bility is to be found in the ganglia. We have noticed no increase of blood- 

 pressure during the attack, which however does not speak against, our 

 supposition for vascular spasm need not occur in all portions of the body 

 simultaneously and thus an equalization of blood pressure may occur very 

 readily. The polyglobulia of the so-called stomach tetany is to be explained 

 in the same way. 



The leucocyte count in tetany is mostly normal. Leastwise in individual 



1 In German edition "per cent." This has been corrected to "gm." on reference to the 

 original article. Editor. 



