114 ENDOCRINE GLANDS 



nature. They are produced by endogenous poisons nor- 

 mally destroyed by the glands or neutralized by their 

 secretions. Among these poisons, the most important 

 would be guanidine, one of the by-products of nitrogen 

 metabolism (N. Paton and Findlay). 



TREATMENT. 



Post operative tetany necessitates a preventative and 

 curative therapy. 



To avoid any accident the surgeons have devised various 

 manners of performing thyroidectomy so as to avoid the 

 parathyroids. The main idea consists in avoiding 

 any manipulation in the neighborhood of the glands. 

 When tetany does occur after removal of the thyroid, two 

 types of medication can be given: 



1. SYMPTOMATIC MEDICATION. Anti spasmotic (chlo- 

 ral and bromides), calcium medication has given good 

 results in the shape of the lactate or the chlorides (Mayo, 

 Grath, Meltzer). The daily dose is from 2 to 6 grams. 



2. SPECIFIC MEDICATION. This includes organo ther- 

 apy and parathyroid grafts. 



The ingestion of fresh glands, or the injection of para- 

 thyroid extracts have caused the various phenomena to 

 disappear in the patients of Callum, Pool, Halsted, etc. 

 We must, however, add that the majority of these cases 

 only had had a partial removal of the parathyroids. The 

 action of organo therapy is temporary and by preventing 

 the various symptoms developing, allows a compensatory 

 hypertrophy of the remaining glands until these are 

 capable of carrying on their function. 



Parathyroid grafts have the advantage, when successful, 

 of assuring permanently the glandular function. It un- 

 fortunately has many technical difficulties. However, 

 when during the course of a surgical operation, it is found 



