PARATHYROID GLANDS 611 



believe, that, in tetany, the site of the hyperexcit ability for sympathico- 

 tropic stimuli is the myoneural junction. 



Pilocarpin Hypersensitiveness. As was shown by Eppinger and Hess, 

 pilocarpin is a substance that stimulates especially the craniosacral por- 

 tion of the autonomic nervous system. Symptoms due to such stimulation 

 include hyperhidrosis,. salivation, lacrimation, goose skin, vasodilatation 

 in the skin, and feelings of heat and of congestion in the head. All these 

 signs that follow the injection of pilocarpin are much more marked in 

 patients suffering from acute tetany than they are in normal persons. 



Injection of pilocarpin also increases the ordinary signs of tetany and 

 may call forth the tetany spasms in different muscle domains. Thus, 

 spasm of the glottis and of the muscles of deglutition have been observed 

 to follow pilocarpin injection. Hypersecretion of the stomach juice, and 

 hyperperistalsis of the intestine with diarrhea, may also follow pilocarpin 

 injection. 



Certain Symptoms Indicating Hyperexcitability of the Vegetative 



Nervous System 



Observations of spontaneously occurring signs of hyperexcitability 

 in craniosacral and sympathetic vegetative domains have been assembled 

 in the articles of Ibrahim "and of Falta and Kahn. These interesting 

 signs may be briefly referred to. 



Spasm of the Intrinsic Muscles of the Eye. In this domain there 

 have been noted: (1) spasm of the M. ciliaris and (2) spasm of M. dilator 

 iridis, usually of one side only, with resulting anisocoria. 



Lacrimation,, Salivation, and Hyperhidrosis. In a man of thirty- 

 one Falta and Kahn observed outspoken lacrimation in the tetany at- 

 tacks, with slight hyperemia of the conjunctivas ; and these symptoms 

 were associated with increased flow of saliva. Hyperhidrosis was also 

 observed by them in three cases, but as one of the patients was tuberculous 

 and the others had slight signs of hyperthyroidism, it is not certain that 

 the increased tendency to sweating was due to the tetany. 



Disturbances of Respiration. Tachypnea in tetany has been described 

 by Ibrahim, and by Finkelstein (a). Dyspnea is also frequently observ- 

 able. 



Disturbances of the Action of the Heart. Ibrahim observed three 

 cases of sudden death in tetany in sucklings without spasm of the glottis 

 and without any signs of asphyxiation at autopsy. In two of the cases, 

 the heart was dilated. In one of them, the right heart was relaxed, 

 whereas the left ventricle was markedly contracted and firm. Ibrahim 

 assumed that he had to deal with tetany of the heart, perhaps called forth 

 by hyperexcitation of the vagus or of the sympathetic. 



In a case of tetany following strumectomy, recently observed with Dr. 

 Sydney Miller, of Baltimore, and already referred to above, the sudden 



