614 CHEMICAL PATHOLOGY OF THE DUCTLESS GLANDS 



spasm of tetany result from hypocalcification of the nerve tissue is at present 

 unproved. Calcium does diminish nervous irritability, as shown by J. Loeb, 

 and hence when administered it may favorably influence the symptoms of tetany 

 parathyreopriva, but this does not establish the theory. That numerous experi- 

 menters have been able to stop these symptoms, both in man and animals, by 

 feeding of parathyroid,^^ or parathyroid nucleoprotein, esiablishes the relation- 

 ship of this gland to the tetany, but not the calcium deprivation hypothesis. A 

 critique of this hypothesis by Berkeley and Beebe" brings out the follo\s'ing 

 points: Strontium, magnesium and barium have the same effect in tetany as 

 calcium, whereas severe calcium loss in diabetic acidosis does not cause tetany. 

 The fact that bleeding reduces the symptoms is against the calcium deprivation 

 theory and supports the intoxication theory. Wiener^^ even states that it is 

 possible to secure an antitoxin for the poison of tetany thyreopriva by immuniz- 

 ing with the serum of animals in tetany. On the other hand, the marked changes 

 in dentition and bone repair observed in parathyroidectomized animals by Erd- 

 heim^'' indicate an abnormality in calcium metabolism, which,|however, might be 

 secondary to an intoxication. Also, in osteomalacia and osteoporosis the para- 

 thyroids are said to show hyperplasia,^* and Howland and Marriott have found a 

 definite decrease in the calcium of the blood in human tetany and in parathyroid- 

 ectomized dogs.^^ Injection of phosphates reduces blood calcium, and when the 

 reduction has reached 6 mg. per 100 c.c, symptoms of tetany appear.^" 



MacCallum^^ has found evidence that in parathyroidectomized dogs the blood 

 contains something which greatly increases the irritability of the nerves, possibly 

 by abstracting calcium from the tissues. Removal of calcium from the blood by 

 dialysis results in nerve hyperexcitability resembling that seen in tetany. W. F. 

 Koch^- found guanidine and methyl guanidine in the urine of dogs deprived of 

 parathyroids. Burns and Sharpe'^ corroborated this, and also found the same 

 bases in the urine of children with idiopathic tetany. Salts of guanidine produce 

 typical symptoms of tetany, including the liypoglucemia, calcium loss and acidosis 

 observed in this disease.^* After parathyroidectomy there is a fall in the guanidine 

 content of the muscle (Henderson).'^ Apparently the parathyroids control the 

 metabolism of guanidine in the body by preventing its development in undue 

 amounts, in this way exercising a regulative action on the tone of the skeletal mus- 

 cles (Paton and Findlay). Administration of guanidine to dogs produces much 

 the same symptoms as removal of the parathyroids (Burns). 



Cooke states that the metabolic changes precede, and presumably incite the 

 tetany. Implantation of parathyroid tissue in persons with tetany parathyreo- 

 priva has been successful in removing symptoms in a few cases. ^^ The relation 

 of the parathyroids to tetany of infants is not so well established,^^ although 

 several observers have found hemorrhages in the parathyroids in these cases. 

 Some cases of "gastric tetany" have improved under parathyroid feeding, which 

 is ;also said to be beneficial in paralysis agitans,^^ although there seems to be 

 no anatomic basis for assuming a parathyroid deficiency in this disease. 



The Relation of the Parathyroids to Exophthalmic Goiter. — This has not yet been 

 definitely established. As nei-vous manifestations are prominent after parathy- 

 roidectomy, it has seemed probable that these organs may Ijo more closely 

 associated with exophthalmic goiter than is the thyroid itself.^'* Against the hypo- 



■' See Halsted, Amer. Jour. Med. Sci., 1907 (134), 1. 

 "Jour. Med. Res., 1909 (20), 149. 

 26 Pfliiger's Arch., 1910 (136), 107. 

 "Frankfurter Zeit. Pathol., 1911 (7), 175. 

 28 Todyo, Frankf. Zeit. Pathol., 1912 (10), 219. 

 2» Trans. Amer. Ped. Soc, Vol. 2S, p. 202. 

 '0 Binger, Jour. Pharmacol., 1917 (10), 105. 



'1 Verli. Deut. Path. Ges., 1912 (15), 26(5; Jour. Exp. Med., 1914 (20), 149. 

 32 Jour. Biol. Chem., 1913 (15), 43; Jour. Lab. Clin Med., 1916 (1), 299. 

 33()uart. .lour. Exp. Phvsiol, 1916 (10), 345. 



^* See Watanabe, Jour. Biol. Chem., 1918 (33), 253; 1918 (36), 531. 

 36 Jour. Pliysiol., 1918 (51), 1. 

 36 Danielsen, Beit. klin. Chir., 1910 (66), 85. 

 3' See Haberfeld, Vircliow's Arch., 1911 (203), 282. 

 38 Berkeley, Med. Record, 191() (90), 105. 



3» This subject is thoroughly reviewed by MacCallum, Med. News, 1903 (83), 

 820; Iverscn, Arch. Internat. de Chir., 1914 (6), 255. 



