612 LEWELLYS F. BARKER 



death that occurred ahout two weeks after the operation may possibly 

 have been due to tetany of the heart, but since the patient had a moderate 

 grade of arteriosclerosis with hypertension and complained of pain in the 

 left shoulder, it is possible that we had to deal simply with a case of 

 angina pectoris independent of the tetany. No autopsy could be obtained, 

 which was unfortunate, for it would have been interesting to have learned 

 the condition of the aorta and of the coronary arteries. 



Falta and Kalm have called attention to the increased action of the 

 heart manifested by loud tones at the apex, and by slight tachycardia on 

 mental excitement and on exertion in the acute stage of tetany. They 

 think it certainly established that, in the acute stage of tetany, the heart 

 muscle, at least in very many cases, contracts with increased force, but 

 they are unable to decide whether this state of excitation is localized in 

 the autonomic heart ganglia or in the extracardiac heart-regulating nerves. 

 They think it very probable that, owing to hyperexcitability of the nerves 

 regulating the heart, its action is sometimes markedly influenced in tetany, 

 and they adduce Ibrahim's observations of three fatal cases in which he 

 supposed that death was due to tetany of the heart in favor of their view. 



Vasomotor Disturbances. Falta and Riidinger (1909) called atten- 

 tion to their observations showing that all tetany patients, in the acute 

 stage, exhibit outspoken vasomotor disturbances. Among these may be 

 mention: (1) Outspoken dermographismus ; (2) abnormally marked 

 variations of tonus on psychic stimulation, and, especially, on emotional 

 stimulation; (3) facial pallor, even when the blood shows an abnormally 

 high red cell count and when there is no diminution in hemoglobin (in one 

 case with facial pallor the red blood count was 7,808,000) ; (4) eclema- 

 tous swellings due to angiospasm ; (5) dead fingers; (6) complaints of 

 congestion in the head; and (7) "pudgy" look to the face, but without the 

 lividity in the middle of the cheeks seen in inyxedema. 



Functional Disturbances in the Gastrointestinal Tract. On making 

 careful functional tests in the domain of the digestive apparatus most 

 patients with tetany will be found to exhibit milder or more severe 

 functional disturbances of the stomach, of the intestines, or of both. 

 These include gastric hyperchlorhydria, pylorospasm, and other forms 

 of gastrospasm, intestinal hyperperistalsis, and diarrhea. 



CJiaiifjes in the Blood Count. Friedrich Miiller, Fleiner (a) (&), 

 Falta, and others have reported increased red cell counts in acute tetany, 

 and especially during the tetany attacks. The polyglobulia that follows the 

 injection of epinephrin seems to be greater in tetany than in normal per- 

 sons. It has been suggested that these polyglobulias may be due to 

 vasospasm with passage of the fluid plasma into the tissues. In this con- 

 nection, the experimental work of Paul Lamson on the outflow of red 

 corpuscles from the liver after the injection of epinephrin should be 

 borne in mind. 



