2l6 THE DISEASES OF THE PARATHYROID GLANDS 



It is certain, however, that in many cases, the tetany promptly disappears on 

 combating of the stagnation (for example washing out of the stomach). 

 The explanation of this subject has as yet received no elucidation from 

 pathologico-anatomical investigations. Erdheim found the parathyroids 

 entirely normal, first in a case of severe gastric tetany, then in a second case 

 with slight gastric manifestations, and third in the case of tetany in the 

 course of enteritis. MacCallum in a case of gastric tetany found five rather 

 large parathyroids whose cells showed abundant mitoses. This he re- 

 garded as hyperplasia. Kinnicutt found in a case of gastric tetany the 

 parathyroids normal. It seems, therefore, that in a group of these cases 

 there is present only a relative, insufficiency of the function of the para- 

 thyroids with, however, markedly increased demands on them; we should 

 consider further the possibility that in high-grade stagnation in the gastro- 

 intestinal tract substances are formed and absorbed that increase the ex- 

 citability of the nervous system so markedly that under circumstances the 

 action of the parathyroids no longer suffice; we must also assume, however, a 

 certain predisposition of the individuals affected, as conditions of stagna- 

 tion in gastrointestinal conditions are rather frequent, while complication 

 with tetany is very rare. 



If we pass in review what has been said concerning the individual forms 

 of tetany and their etiology, we find that we cannot deny that the view that 

 all forms of tetany may be grouped together from the point of view of 

 relative or absolute insufficiency of the parathyroids is, as a result of 

 pathological anatomy, not sufficiently proved. All the rest of the patho- 

 logico-anatomical findings that up to the present have been brought into 

 relief in tetany, findings such as alterations in the ganglion-cells of the spinal 

 column, in the marrow, or in the nerve fibers themselves, have been incon- 

 stant. As yet unelucidated as to its significance is the finding of a premature 

 sclerosis of the fine and finest cerebral vessels, especially in the medulla 

 of the cerebrum and in the cerebellum, such as A . Pick pointed out in four 

 cases of chronic tetany. 



Differential Diagnosis. We distinguish an acute relapsing and an acute 

 recurring form of tetany. We should also appropriately distinguish be- 

 tween a manifest and latent tetany unattended with spasms, and finally 

 between fully developed form of the formes frustes (the expression tetanoid 

 I regard as less to the purpose) ; it is the latter differentiation that is attended 

 with differential diagnostic difficulties. In general, the diagnosis of tetany is 

 easy, as its most important criterion, the galvanic hyperexcitability, has as 

 yet been observed in no other condition. As has previously been mentioned, 

 Erb's phenomenon may be temporarily absent even in the acute stage. In 

 such cases great value can be attached to Chvostek's phenomenon only 

 when it is pronounced. If in addition there are present paresthesias in 

 the territory of the ulnar nerve and complaints as the sensations of tension 



