200 THE DISEASES OF THE PARATHYROID GLANDS 



H ence there may be regarded as the symptom belonging to chronic 

 tetany at most the rarefaction of the bone trabeculae and the atrophy. It 

 is shown by the statistics of late years that a chronic tetany existing from 

 earliest youth may damage the development of the entire body. Disturb- 

 an ces of the development of speech and of the intelligence are especially 

 frequent (see prognosis). The development of the sexual glands does not 

 appear to suffer; in isolated cases we can find at least no remaining behind 

 in sexual development although tetany spasms may have existed for years, 

 from early youth or from just at the time of puberty. 



The symptomatology of tetany would be incomplete were I to neglect 

 to mention a series of symptoms that depend on a functional disturbance of 

 other ductless glands, but are very frequently combined with tetany. 



As has already been mentioned, Kocher states that after total extirpation 

 of the thyroid in human beings, there occur in individuals in whom the symp- 

 toms of tetany predominate, marked pigmentations progressing as far as 

 bronzed skin. Probably in such chronic cachectic conditions there is a re- 

 d uction in the activity of the chromaffin tissue. Oftenest occur symptoms 

 that depend on an alteration of thyroid function. Not so very rare in chronic 

 tetany are symptoms of myxedema. v. Frankl-Hochwart, in looking over his 

 cases, found symptoms of myxedema as many as thirteen times among 

 twenty-six cases. We saw this alteration once. These myxedematous 

 alterations of the skin occurring in chronic tetany should not be confused 

 with the pufnness of the face previously described, or with the edema of the 

 backs of the hands that occurs in the acute stage, which phenomena are 

 properly regarded as angiospastic. 



Kahn and / have reported an observation, which in the clinical sense is 

 not of less significance. In a series of our own cases we saw develop in the 

 acute stage or immediately at its close a slight hyperthyrosis. This con- 

 sisted especially in tachycardia, headache, slight rise of temperature, increase 

 in blood-pressure, sweats, slight tremor, and slight diffuse enlargement of 

 the thyroid. The connection between our observations and those of Frankl- 

 Hochwart is perhaps this: that in many cases of tetany at the conclusion of the 

 acute stage or during an acute exacerbation there occurs an increase of 

 thyroid activity and even an appreciable enlargement of the thyroid gland, 

 which is succeeded, in the stage of chronic tetany, by a slight degree of thyroid 

 insufficiency (see the section on the idiopathic form of tetany). 



Pathogenesis of Tetany 



It seems to me suitable first to set forth in detail the pathogenesis of 

 parathyroprivic tetany; and then later in the exposition of the individual 

 forms of tetany, to speak of their etiology separately. 



As I have already mentioned at the beginning, to-day we may regard 



