PARATHYROID GLANDS 613 



The total white cell count does not seem to be markedly altered in 

 tetany, but the differential formula is often changed in the direction of a 

 relative lymphocytosis with a relative and an absolute diminution of the 

 polymorphonuclear neutrophile cells. Whether this is due to a com- 

 plicating status thymicolymphaticus, believed by Escherich to be common 

 in childhood tetany, is not yet certain. In accord with Escherich's view 

 might be cited the experimental work of Uhlenhuth (vide infra). 



Sudden transformations of the differential formula of the white cells 

 are looked upon by Falta and Kahn as an expression of isolated states of 

 excitation in the domain of the vegetative nervous system, with pre- 

 dominance sometimes of sympathetic influences, sometimes of cranio- 

 sacral autonomic influences. 



Disturbances of Heat Regulation. Disturbances of temperature 

 regulation have been described in tetany by various observers since 1830. 

 In Dance's article elevation of temperature was mentioned; and, later 

 on, Hoffmann, von Jaksch, and von Erankl-Hochwart all called attention 

 to the subfebrile temperatures that may be met with in tetany. I refer 

 of course to the disturbances of heat regulation that are independent of 

 infections. The fever, as described by the earlier observers, was usually 

 remittent or, more rarely, intermittent in character. Slight fever in 

 childhood tetany has been described by Loos and by Cassel, in the absence 

 of gastrointestinal affections and of infectious diseases. 



In experimental tetany in dogs elevations, of temperature are com- 

 mon during the attacks. According to Falta and Kahn, certain patients, 

 in the acute stage of tetany, exhibit elevations of temperature after in- 

 jections of substances (antithyroidin, pituitrin) that in healthy persons 

 cause no fever, and they suggest that the disturbances of heat regulation 

 in tetany are probably an expression of states of excitation of the vegeta- 

 tive, especially of the sympathetic, nerves. 



Symptoms Pointing to Depression, Rather than to Excitation, of the 



Visceral Nervous System 



Interesting experiments made by A. J. Carlson (a) of Chicago (1912) 

 indicate that there may be depression, rather than increased excitability, 

 of the visceral nervous system in experimental tetany. Thus, he found 

 that no spasms, contractures, or other evidence of hyperexcitability, and 

 no tetany of the neuromuscular mechanisms of the digestive tract occur 

 in the parathyroid tetany of cats and dogs. The deviation from the 

 normal is, he asserts, in the direction of depression or paralysis, rather 

 than in that of overstimulation or hyperkinesis. He found, too, that the 

 gastric and pancreatic digestion, though usually retarded in tetany, may 

 be normal, but slowing of the digestive processes is the rule and there 

 may even be total failure of digestion in these animals in tetany. In 



