TETANY 



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in very intense spasms we even observed on several occasions values signify- 

 ing hyperpyrexia. Such disturbances of heat regulation also occur in human 

 tetany. In the attack-free interval, the body temperature, as v. Jaksch and v. 

 Frankl-Hochwart have emphasized, is often abnormally low. In thirty-five 

 observations on acute cases v. Jaksch saw more or less fever at the beginning of 

 the disease nine times. Kahn and my observations agree with these. We 

 frequently saw with the acute stage temperature as high as 37.8, in one 

 case up to 38.5, without exact investigation affording any ground that 

 there was any cause for the increase of temperature other than the tetany. 

 Later, after decline of the tetany, the temperature sank to normal or slightly 

 subnormal values. In certain cases we found in the acute stage transitory 

 rises of temperature after the injection of substances that otherwise do not 

 tend to induce fever (antithyroidin (Mobius}, pituitrium glandulare of Parke, 

 Davis 6* Co.}. This points to an especial lability of the regulation of heat. 

 One could be tempted to regard the increase of temperature in the sense of 

 those authors who consider idiopathic tetany as an infectious disease. The 

 fact that it is found to still higher degrees in experimental thyroprivic tet- 

 any has led Kahn and myself to the assumption that it is probably the ex- 

 pression of a condition of excitability of the vegetative nerves. 



Summarizing again all observations that can be advanced for the vegeta- 

 tive organs, we find that in the acute stage of tetany the hyperexcitability or 

 the abnormal conditions of irritability are not limited throughout to the central 

 nervous system and to the peripheral nerves, but that they involve also the vegeta- 

 tive nervous system. With the decline of the acute tetanic condition there 

 also occurs a decline of the condition of irritability of the vegetative nerves. 



Also the metabolism in tetany shows alterations. 



Disturbances in the carbohydrate metabolism are almost constant in the 

 tetanic dogs. First a few remarks as to the glycosuric action of adrenalin 

 in tetany. In the thyroidless dog it is known that the glycosuric action of 

 adrenalin is reduced. In dogs that have had only their parathyroids re- 

 moved it is mostly increased, so far as a tetanic spasm is not induced by the 

 injection (Eppinger, Falta, and Rudinger}. In the idiopathic human tetany 

 Rudinger and / never found in the acute stage glycosuria following injec- 

 tion of adrenalin; but on the contrary, as already mentioned, almost always 

 a strong reaction of the cardiovascular apparatus. This dissociation of 

 the action of adrenalin has its foundation chiefly in the increase of sugar 

 consumption through the enormous vasoconstriction and eventually in 

 the attack induced by means of injection. In the declining stage of tetany 

 we find, contrariwise, frequently a distinct glycosuric action due to adrenalin. 



In parathyroidectomized dogs the assimilation limits for dextrose are 



regularly reduced. Falkenburg and R. Hirsch, and also Frank P. Undcrhill 



and Tadasu Saiki, found this after thyroparathyroidectomy and referred it 



to the absence of the thyroid gland. This, however, leads to a heightening 



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