i go 



THE DISEASES OF THE PARATHYROID GLANDS 



directly brings it about. A short time ago, I saw also a case of typical 

 occupation tetany that showed the same thing. The report of it follows: 



Observation XXI. B., seventeen years old, shoemaker. Entered the clinic Jan. 14, 1913. 

 First attack of tetany in winter of 1911. The convulsions then lasted with interruptions 

 throughout the winter, disappearing only in April. Throughout the summer, the patient 

 felt quite well; two days ago spasms reappeared, especially in the upper extremities, and to 

 it were added formications. The symptoms, varying in intensity, have lasted until to-day. 



The patient shows the typical crying facial expression of the tetanic. There exists 

 great vasomotor excitability. All the typical symptoms of tetany are present. The 

 galvanic excitability is much increased. The examination of the blood shows 6,250,000 

 erythrocytes. There exist painful spasms, especially in the upper extremities, that are 

 often repeated throughout the day. Temperature as high as 37.5. 



Jan. 1 8. For three days no spasmodic attacks, the electrical excitability is less in- 

 creased; in blood, 4,870,000 erythrocytes. Chvostek's and Trousseau's phenomena no 

 more elicitable. 



FIG. 27. Spasm of the stomach in tetany (Falta and Kahn, Ztsch. f. klin. Med., Bd. LXXIV)- 



Jan. 23. Fresh spasms, the symptoms of tetany present once more, 5,820,000 ery- 

 throcytes. 



Jan. 24. X-ray examination two hours after breakfast shows a dilated stomach filled to 

 a marked degree with fluid; it reaches to three finger-breadths Mow the umbilicus; there 

 exists lengthened lime for emptying of the stomach, in short, signs of a hypersecretion with 

 pyloric stenosis. 



Jan. 31. Chwstek still positive, more spasms, 6,400,000 erythrocytes. 



Feb. 6. No spasms any more, but there still exists paresthesias. Chwstek and 

 Trousseau negative. 



From now on the tetanic symptoms decline, the count of erythrocytes becomes normal 

 (4,500,000-4,800,000), the X-ray examination of the stomach, that has been taken three 

 times in the course of the last two weeks, now always shows normal relations; after a 

 breakfast the X-rays show that the stomach reaches to two finger-breadths below the 

 umbilicus. Peristalsis and time of emptying are now normal. 



In this case, therefore, is to be found an ''attack" of pylorospasm and 

 hypersecretion and consecutive dilatation of the stomach occurring in the 



