PARATHYROPRIVIC OR TRAUMATIC TETANY 2O"J 



tional disturbances of the epithelial bodies. Pineles supposed that the 

 toxin of tetany produced a latent predisposition to epilepsy; Curschmann that 

 it increased the excitability of the cortex and subcortex. Experimental 

 pathology has as yet furnished no reliable evidence. In a cat in which Kreidl 

 extirpated three parathyroids, epileptic attacks regularly followed operations 

 on different parts of the cortex. Redlich could not confirm the results of 

 this experiment when he repeated it. Only in one experiment, an opera- 

 tion on the brain cortex after total thyroparathyroidectomy, did he notice 

 the simultaneous occurrence of severe tetanic and severe epileptic attacks. 



Attempts have also been made to refer epilepsy without tetany to an 

 insufficiency of the parathyroids. As was to have been expected, pathological 

 anatomy did not substantiate this hypothesis. Erdheim examined the 

 parathyroid glands in two cases of status epilepticus; in one they were en- 

 tirely normal and in the other they were slightly sclerotic. Claude and 

 Schmiergeld found no constant change of tissue in thirteen cases. 



The relationship of tetany to eclampsia has not yet been cleared up in a 

 satisfactory manner. In the years of childhood tetany may occur under 

 the guise of eclamptic attacks, as has been mentioned already. It has been 

 held that children who have suffered with eclampsia, later became epi- 

 leptic. Birk could not find this in his material, to which are opposed the 

 statements of Potpetschnigg. The eclampsia of adults is as -a rule to be 

 separated from tetany; for in eclampsia the cardinal symptom of parathy- 

 roid insufficiency, the galvanic excitability, is absent. Erdheim could not cor- 

 roborate the statements of Pepere and Zanfrognini, who found a lessened 

 number of parathyroid glands in their cases of eclampsia. In four cases 

 of eclampsia examined by Erdheim the parathyroids were normal, except 

 for the fact that they were very hyperemic and were permeated with small 

 hemorrhages, which manifestations are certainly to be regarded as secondary. 



FORMS OF TETANY AND PATHOLOGICAL ANATOMY 



i. The Parathyroprivic or Traumatic Tetany 



It was first noticed by Nathan Weiss that in Billrotk's clinic the extirpation 

 of the thyroid gland was often followed by tetany. Since that time the 

 literature as to this subject has grown enormously. The question is handled 

 with especial thoroughness in the publications of v. Eiselsberg and Kocher. 

 v. Eiselsberg in his "Diseases of the Thyroid Gland" publishes a classic 

 description of tetany after extirpation of the thyroid gland. In Vienna tetania 

 " strumipriva " was observed much more frequently than in Bern. Among 

 forty cases of total extirpation of the thyroid gland, tetany was seen by Kocher 

 only nine times, of which number only three were pronounced cases; among 

 thirty cases of partial extirpation only six were acute tetany; among ninety- 



