1 88 THE DISEASES OF THE PARATHYROID GLANDS 



cases, we saw, during severe attacks, transitory hyperleucocytosis up to 

 19,000. Differential counts of the leucocytes showed, in the great majority 

 of cases, a rather distinct lymphocytosis or a relative and absolute diminu- 

 tion of the neutrophilic cells. In these cases there also were found, for the 

 most part, swellings of the lymph glands at the portions of the body accessible 

 to palpation, enlargement of the tonsils and papillae of the base of the tongue, 

 hence a slight status lymphaticus. 



With more exact investigation, there could also be demonstrated in the 

 great number of cases of tetany slight or severe disturbances in the function 

 of the gastrointestinal tract. In this connection we could distinguish two cate- 

 gories of cases. In one the tetany develops in individuals who have been 

 sick for a long time with gastric and intestinal complaints, especially with 

 those which lead to a high-grade stagnation of the gastric or intestinal con- 

 tents. To this group I shall refer more in detail in the consideration of 

 the individual forms of tetany. In the second category the gastroin- 

 testinal disturbances occur at or after the outbreak of the tetany. Many 

 such cases have been observed by Kahn and myself. Of such disturbances 

 I would mention: First, a certain hyperexcitability which, as already 

 mentioned, manifests itself in the experiment with pilocarpine in an ab- 

 normally marked laxity of the stomach and in a very pronounced stratifica- 

 tion of the gastric contents, eventually in tenesmus and diarrheas. Second, 

 manifestations of increased secretion of the gastric or intestinal glands; in 

 certain cases there is found for example a slight grade of hyper chlorhydria, 

 such as has been described by Jonas and Rudinger. On increased secretional 

 processes in the intestinal tract may depend the diarrheas we observed so 

 frequently. In many cases the tetany is ushered in with diarrheas or 

 vomiting. 



As example I cite the following: 



Observation XIX. A. W. (Case VII oiFalta and Kahn), twenty-seven-year-old woman 

 from Vienna. Entered the first medical clinic March 16, 1909. Marked chlorosis at 

 the age of sixteen. Menstruation from the age of eighteen on, regular. Three normal 

 confinements. Three days ago suffered with severe pains in the abdomen, that were 

 associated with fever, eructations, and constipation. On the next morning typical tet- 

 anic spasms in the upper extremities, hands in the obstetrician's position, flexion at the 

 elbows, upper arms drawn to the body. At least six such attacks each of about five min- 

 utes' duration. The spasms were painful. The galvanic excitability was increased. 

 Rapid recovery. 



Still more instructive is the following case, in which the gastric dis- 

 turbance set in at the same time as the tetanic spasms: 



Observation XX. L. E. (Case VIII oiFalta and Kahn), twenty-year-old woman from 

 Vienna. Entered the first medical clinic on March 23, 1911. One normal confinement. 

 Present illness began six days ago with severe pains in the back and hypogastrium, 

 with the vomiting of green-colored masses of bitter taste, and a painful spasmodic attack 

 affecting the hands and legs. The hands were in typical obstetrician's position. Two 

 days later again severe pains in the abdomen, with vomiting, associated with typical attack 



