i INTERNAL PEOTECTIVE SECBETIONS 37 



remained, and that was necrosed. These three cases, therefore, 

 verified what experiments on animals had indicated. To-day 

 every surgeon agrees with Vassale's conclusions that in thyroid 

 excisions it is essential, in order to avoid a fatal tetany, to spare 

 at least one or possibly two of the parathyroids (the two inferior 

 parathyroids). 



Another form of human disease which is also characterised by 

 violent convulsions, and which is known as eclampsia gravidica, 

 has recently been attributed by Vassale and his pupils to 

 functional insufficiency of the parathyroid apparatus. To support 

 this theory Vassale invokes the following facts : 



In the first place, he observed and described a case of tetany of 

 lactation and pregnancy in a partially parathyroidectomised bitch, 

 in which after some five years of apparently normal life after the 

 operation, suckling and pregnancy provoked violent convulsive 

 epileptiform fits, which were cured by specific organo- therapy. 



Other authors had already observed independently that the 

 female of dogs or cats, in which the thyroid apparatus had been 

 partially extirpated, are attacked during pregnancy and parturition 

 with acute convulsions (Verstraeten and Vanderlingen, Lange). 

 According to Yassale, the convulsions in this experiment also, in 

 which thyroidectoniy involved para thy roidectomy in the dog or 

 cat, were due to parathyroid insufficiency. 



Another no less valid argument in favour of the parathyroid 

 theory of the pathogenesis of eclampsia gravidica is seen, according 

 to Yassale, in the beneficial effects observed in certain cases of 

 spontaneous eclampsia gravidica with specific organo- therapy, on 

 administration of parathyroidine. 



More recently, Vassale has found further evidence for 

 the parathyroid theory of eclampsia in the following observa- 

 tions : 



(a) Pathological, the post mortem showing alterations or con- 

 genital loss of one or two parathyroids in the bodies of eclamptics 

 (Pepere, Zanfrognini). 



(&) Clinical, since it has been found possible to prevent and 

 even overcome the spasm by the administration of parathyro- 

 iodine (Zanfrognini, Stradiviri, Brun, Vicarelli, Kaiser). 



(c) Experiments on cats, on female rats, and gravid bitches, 

 which show that in latent parathyroid insufficiency convulsive 

 phenomena regularly break out in the final stage of pregnancy 

 (experimental eclampsia of Zanfrognini, Erdheim, Thaler, and 

 Adler, Vassale, Massaglia and Sparapani). 



Lastly, it should be added that certain workers (Pineles, 

 Chvostek and Yanase) express the opinion, on clinical and ana- 

 tomical grounds, that all the varied pathological forms of tetany 

 in man are in pathogenic relation with insufficiency of the 

 parathyroid glands. 



D 2 



