214 THE DISEASES OF THE PARATHYROID GLANDS 



was tetany; then there were two more normal births, to be succeeded by a 

 sixth pregnancy in which the tetany recurred. A strikingly marked atony 

 of the uterus has been observed after the delivery in women who have tetany 

 (cases of Erdheim and of Neumann). The tetany during pregnancy tends 

 to have a very unfavorable influence on the fetus. The birth of macerated 

 fetuses has been reported several times (Pick, Neumann) ; or the statements are 

 that the children indeed were delivered, but soon died in convulsions (Kocher, 

 v. Frankl-Hochwart). These last statements are very important with respect 

 to the investigations of Iselin. 



The question as to why pregnancy calls forth tetany in predisposed in- 

 dividuals is not as yet fully explained. We may readily conceive that preg- 

 nancy makes increased demands on all the ductless glands and thus unmasks 

 a latent insufficiency. Perhaps similar relations are to be found with respect 

 to tetany combined with osteomalacia. In osteomalacia, Erdheim found 

 hyperplasia of the parathyroids. He assumes that in osteomalacia there are 

 especial demands made on these glands. The statement of Erdheim has 

 been often corroborated. Schmorl found the parathyroids normal in four 

 cases of rickets, but in a case of osteomalacia the parathyroids were markedly 

 hypoplastic. In three other cases the parathyroids were normal, although 

 Erdheim points out that the islands were not examined with the use of the 

 osmium stain. Strada found the parathyroids enlarged in a case of osteo- 

 malacia, and unaltered in two cases; in one case Bauer found in one para- 

 thyroid an adenoma, and foci of proliferation in three others. Finally the 

 parathyroids of twenty-four individuals were examined by Todyo. He found 

 hyperplastic processes as described by Erdheim four times. In seven cases 

 of osteomalacia they were, however, absent only once, and in six cases only 

 one parathyroid was examined. In eleven cases of senile osteoporosis he 

 found, on the contrary, hypoplasia eight times. 



7. Tetany in Gastrointestinal Diseases 



Tetany is observed in the most diverse gastric and intestinal affections. 

 I mention only acute dyspepsia, acute and chronic enteritides, and helmin- 

 thiasis. Especially are those cases brought into relief in which on account 

 of some obstruction there occurred a dilatation of the stomach, or (in rare 

 cases) a dilatation of the intestine, and a stagnation of the gastric and in- 

 testinal contents. From the great group of gastrointestinal tetany a number 

 of cases are to be singled out in which the gastrointestinal disturbances con- 

 stitute only one symptom of the tetany. I would agree with Chvostek that 

 these cases are not at all rare. This has been taken up in detail in the con- 

 sideration of the symptomatology. In a further group of cases an indisposi- 

 tion of the stomach or intestines may constitute the determining factor for 

 the tetany. 



