GENETIC TYPE AND THE ENDOCRINES 479 



Yet in spite of extensive investigations by able workers on 

 this subject, the findings are very indefinite. The earlier 

 studies recorded either fresh hemorrhage or residues of 

 blood and pigment in the parathyroids, and associated this 

 with the tetany. Yanase ('07) studied eighty-nine cases, out 

 of which thirty- three showed either free blood or pigment 

 in the parathyroids and only indefinite changes in the epithe- 

 lium. It was thought that the hemorrhage not only inter- 

 fered with the function of the tissue but that, through 

 resorption of the blood, growth became inhibited in the new- 

 born gland and tetany followed after a short time. 



During the period when blood is being fully resorbed, 

 hypoplasia and low function of the gland results. Neverthe- 

 less, there are cases of fatal tetany in which no bleeding or 

 injury to the parathyroids could be found, and also cases of 

 hemorrhage in which no symptoms of tetany appeared. Auer- 

 bach ( '11) reported eight out of ten cases of tetany with bleed- 

 ing in the parathyroid, but he also found eight cases of definite 

 parathyroid hemorrhage among thirteen children with nor- 

 mal nerve reactions. Grosser and Betke ('10-'ll) recorded 

 similar findings from a study of more extensive material. 

 There is, therefore, very indefinite evidence in the histologic 

 picture of the parathyroid gland to indicate the cellular dis- 

 turbance which gives rise to the calcium deficiency bringing 

 about the violent nervous reactions of tetany. 



For more than 30 years a group of diseases involving the 

 bony skeleton has been directly attributed to disfunction of 

 the parathyroid gland and disturbed calcium metabolism. 

 These diseases involve the structural quality of bone and 

 thus bear very closely on our immediate problems. One of 

 the most typical of such disturbances is osteitis fibrosa cystica 

 generalisata, commonly known as Recklinghausen's disease, 

 which is a rarefying osteitis with fibrous degeneration and 

 cystic formation. This disease is attributed to hyperfunction 

 of the parathyroids. All cases show enlargement of the para- 

 thyroid bodies or organic hypertrophy and frequently distinct 

 parathyroid tumors. F. Mandl in 1926 first conclusively dem- 



