196 THE DISEASES OF THE PARATHYROID GLANDS 



of calcium in the parathyroid insufficiency points also the finding of Schullcr 

 that the bones in chronic tetany show in the Rontgen picture a characteristic 

 rarefaction of the trabeculae and marked atrophy, an observation that we 

 could confirm in almost all the cases, in which we paid attention to it. We 

 found this, however, in cases that had never had tetany. 



Summarizing that which has been said as to the metabolism, we find that 

 in the acute stage of tetany there exists an appreciable increase of the metabolism, 

 that is related to very many factors of the same. As most probable, we may sup- 

 pose that only in experimental, but also in human, tetany there exists an 

 increased breaking down of albumin with disturbances in the intermediary 

 albuminous decomposition, increased exchange of carbohydrates, increased pro- 

 duction of calories, and apparently also increased elimination of calcium. A 

 part of these alterations in metabolism may well depend on increased 

 irritability in the vegetative nervous system. We may expect in the chronic 

 stages of tetany alterations of metabolism that to-day we cannot well 

 define. 



The trophic disturbances in tetany affect epithelial parts exclusively, 

 the hairs, nails, skin, enamel, and ciliary epithelium. In chronic tetany there 

 are frequent statements as to a thinned-out growth of hair (Hoffmann, 

 v. Frankl-Hochwart, and others}. An acute exacerbation may be introduced 

 with rapid falling out of the hair. Adler and Thaler in their experiments on 

 dogs found the falling out of hair a direct premonitory symptom of tetany. 



Also Pfeiffer and Meier observed in ectomized animals falling out of hair 

 as the direct symptom of tetany. Speigler in a case of chronic tetany found 

 that the thinned-out and very thin hair was split at the point (trichorrhexis) . 

 Also the nails frequently show trophic disturbances, they become brittle and 

 there may occur complete necrosis that leads to casting off of the nails; rapid 

 substitution occurs, however, after subsidence of the acute stage. In a new 

 attack the process may be repeated. An instructive case is reported by 

 Hoffmann. It is that of a woman who had passed through five normal de- 

 liveries. After the fifth pregnancy, she developed tetany with distinct 

 edema of the hands. The finger nails fell out. A year later tetany recurred. 

 This time the hair fell out. After a year, new pregnancy and tetany; after 

 the delivery again trophic alterations of the finger nails. After a half year, 

 at the time of a new pregnancy, again tetany, with which was associated loss 

 of nails and hair. In the tetany of children loss of the finger-nails seems 

 to be very rare. Pineles found in the literature only one observation by 

 Hoffmann, in a three and one-half-year-old child. 



The skin of the face and of the extremities shows in acute cases a puffy 

 appearance (angiospasm[?], see what is stated previously), causing a character- 

 istic expression of crying. 



Pigmentations of the skin are rare. Kocher states that after total ex- 

 cision of the thyroid gland in many individuals there occur, if the tetany 



