. 594 LEWELLYS F. BARKER 



often present before other signs of the disease are recognizable that it 

 should always be looked for by the podiatrist, and, if found, the galvanic 

 excitability of the motor nerves should at once be measured. 



The eye muscles are sometimes the site of spasm in manifest tetany. 

 A whole series of different involvements of the eye muscles, influencing the 

 movements of the upper lids and of the eyeballs, has been described by 

 Oddo (1896) and by Kunn (1897). Even the intrinsic muscles of the eye 

 ; are occasionally concerned (accommodation spasm; pupillary changes). 

 Strabismus, nystagmus, and conjugate deviation have all been noticed in 

 different instances in tetany. 



Spasm of the muscles of the tongue and of the pharynx may interfere 

 with swallowing and with speech in adults, or with suckling in children. 

 Apparently involvement of the muscles of the face and trunk is more 

 common in the child than in the adult. 



Spasm of the laryngeal muscles (laryngospasm) is a common symptom 

 in infantile tetany, and one by no means devoid of danger to the life of 

 the child. 



Limitation of the spasm to single muscles, or to single muscle groups 

 in various parts of the body, has been described by several authors. 



The smooth muscle innervated by the autonomic nervous system 

 (sympathetic and craniosacral) is probably more often involved in the 

 spasms of tetany than is usually believed. Thus, besides the spasm of 

 the sphincter and the dilator of the iris and of 1he ciliary muscle above 

 referred to, spasms have been observed in the esophagus (esophagismus) ; 

 in the stomach (gastrospasm) ; in the intestines (enterospasm) ; in the 

 sphincter and detrusor of the urinary bladder, causing, in the one instance, 

 unit fir i/ retention,, in the other, enuresis; and in the smooth muscle of the 

 bronchi, causing asthmatic attacks. Even spasm of the heart muscle, 

 due to tetany, has been described by Ibrahim (a-) (1911). During the 

 present year I saw with Dr. Sydney Miller a patient who suffered from 

 postoperative tetany, and who died suddenly in the night with a severe 

 pain referred to the left shoulder. As the patient had also a moderate 

 grade of chronic arterial hypertension, we thought of death from angina 

 pectoris, though death from spasm of the heart due to tetany had also 

 to be considered as a possibility. 



Spontaneous attacks of muscular spasm in manifest tetany are usually 

 bilaterally symmetrical in the extremities, as has already been stated. 

 Cases of hemitetany do, however, occur, though they are rare. Yon 

 Frankl-Hochwart described two such cases. In one of them the extrem- 

 ities on the right side entered into the contracting positions, whereas those 

 on the left side remained free from spasm; on one occasion, however, the 

 patient stated that lie had noticed, simultaneously, paresthesias in the left 

 hand. \ on Jaksch lias also described a case of tetany, in which the spasms 

 atlWted only the left upper and lower extremities. In Fig. 4 I have 



