IQ4 THE DISEASES OF THE PARATHYROID GLANDS 



of the tolerance boundary. According to the experiments of Eppinger, 

 Rudinger, and myself the glycosuria after thyroparathyroidectomy depends 

 on the absence of the parathyroids. In a dog almost completely parathy- 

 roidectomized we found that when a diet rich in starch was administered 

 veen large amounts of sugar would appear in the urine for a long time. 

 After the extirpation of the pancreas and three parathyroids we found in 

 many experiments a higher D to N quotient than could be obtained on 

 extirpation of the pancreas alone. In human beings ill with tetany we 

 never found reduction of the assimilation limits for dextrose, and Kahn and 

 / can adduce an observation that shows that also in human beings the in- 

 sufficiency of the function of the parathyroids exercises an indirect in- 

 fluence on the function of the pancreas. In a case of Basedow's disease 

 complicated with tetany the test for alimentary glycosuria immediately 

 after the tetanic attack yielded 4.1 gm. of sugar. Later, after the acute 

 tetany had subsided, many tests for alimentary glycosuria resulted negative. 

 In the literature is found only a statement of Miller that he observed transi- 

 tory glycosuria after an attack of tetany. 



MacCattum and Vogtlin, and also we, saw the protein exchange in para- 

 thyroidectomized dogs appreciably increased. There do not exist similar 

 investigations on human beings. There also occur regularly disturbances 

 of the intermediate protein exchange. MacCattum and Vogtlin found in 

 thyroparathyroprivic dogs , increase of the elimination of ammonia in the 



NH 3 N 



urine and of the quotient ^ , and in addition increased creatinin elimi- 

 nation. In human idiopathic tetany Kahn and 7 found in the acute 

 stage the elimination of ammonia for the most part relatively and absolutely 

 increased. The amino-acid fraction was for the most part normal; on the 

 contrary, the peptid-N in our experiments was often even appreciably 

 increased. Administration of glycocoll increased this value mostly only 

 unessentially. Immediately after the decline of the acute tetany this value 

 for the peptid-N was mostly still high, but distinctly lower than in the 

 acute stage, or it had already become normal. Also the heightening of the 

 ammonia value can apparently outlast for some time the acute stage. The 

 findings described are to be distinguished from those in lesions of the liver in 

 that in the latter the amino-acid-N is ordinarily increased as much as, or 

 even more, than the peptid-N, and the administration of glycocoll almost 

 always causes an increase of these factors. Perhaps these disturbances of 

 the intermediary metabolism in tetany are the expression of a condition of 

 nervous hyperirritability of the liver. 



Systematic investigations as to the gaseous metabolism in tetany have as 

 yet not been made. That the exchange of calories in the acute stage, and 

 especially in the severe attack is markedly increased, needs no especial in- 

 vestigation. More interesting would be the investigation of the funda- 



