208 THE DISEASES OF THE PARATHYROID GLANDS 



seven operations in Basedow's disease, only five were tetany; one case of liga- 

 tion of all four arteries supplying the thyroid gland led to peracute tetany. 

 Epileptiform tetany has been observed by v. Eiselsberg, Kocher, and others, in 

 the wake of partial extirpation. Originally tetany was attributed to the fail- 

 ure of the thyroid gland. With the awakening knowledge of the significance 

 of the parathyroid function were heard loud voices referring thyroid-gland 

 tetany to the simultaneous damaging or removal of the parathyroids. 

 Fundamental for this view are the investigations of Pineles, and of Erdheim. 

 The latter observed three cases that had died of more or less acute tetany 

 after strumectomy. In the first case, which had shown a more chronic 

 course, the entire throat portion was cut in the serial sections; it was found 

 that all four parathyroids were missing, although two small accessory para- 

 thyroids were found in the midst of the thymus tissue. In both the other 

 cases, which had pursued a more acute course, parathyroids capable of func- 

 tionating were not to be found. Erdheim pointed out that the great fre- 

 quency of strumiprivic tetany in Vienna had its explanation in the fact that 

 there the operations on the thyroid gland were conducted according to the 

 old methods, while Mikulicz's wedge resection or Kocher 1 s resection enuclea- 

 tion are rather adapted to avoid the parathyroids. However, the genius 

 loci must not be entirely overlooked in the explanation of the fact. 



To-day, when we are well informed as to the significance and topography 

 of the parathyroids, tetany after operations belongs to the greatest of rarities. 

 A preparatory search for the parathyroids is not necessary; sufficient is 

 adherence to the propositions of Pineles and Erdheim to let remain both the 

 lower lobes; search for the parathyroids is directly indicated only when in 

 malignant struma, it becomes necessary to remove the entire thyroid gland, 

 v. Eiselsberg has reported a case in which the greater part of the thyroid 

 gland was removed for malignant adenoma. Myxedema developed, and 

 retrogressed after the appearance of metastases in the sternum. Ex- 

 tirpation of these metastases (healing by secondary intention) was fol- 

 lowed by a recurrence of the myxedematous symptoms and by tetany. 

 Erdheim explains this case by the fact that at the first operation there was 

 left behind one of the lower chief parathyroids, and that this became sac- 

 rificed at the second operation. 



The etiology of the thyroprivic tetany is thus clear. This form of tetany 

 depends on the loss or the damaging of the parathyroids at the operation. 



Proescher and Diller report a case of traumatic tetany in the adult. A 

 young man developed typical tetany eight days after a severe blow. At 

 autopsy there were found numerous small fresh hemorrhages in parathyroids, 

 which were in addition hypoplastic. Belonging to traumatic tetany are also 

 numerous cases of the tetany of sucklings, as we shall see later in the section 

 on tetany in children. 



