108 JOHN" T. HALSEY 



survive long enough for the parathyroid remnants to hypertrophy suffi- 

 ciently or for some other unknown compensating mechanism to develop. 



As all the known facts indicate the essential similarity of tetany, as 

 experimentally induced in the laboratory, and of the tetanies of various 

 causation observed clinically, there existed good grounds for the expecta- 

 tion that, in human cases of tetany also, parathyroid therapy would pro- 

 duce results similar to those produced by it in the laboratory, and this 

 expectation has been in large measure justified by clinical experience. 

 In the clinic as in the laboratory the results from oral and hypodermic 

 administration of various parathyroid preparations have been in the main 

 uncertain and disappointing while those obtained by implantation have 

 been more certain and valuable. Both successes and failures following the 

 administration of parathyroid substance to cases of tetany of various types 

 have been reported by various authors in fairly equal proportions. 23 

 Among those reporting more or less striking successes are Halsted (1907, 

 1900), Bircher (&) (1910), Marinescu, Vassale, and quite recently Haas; 

 while among those reporting failures are Frankl-Hochwart, Pineles (&), 

 Escherich, and Arntzenias. In Halsted's case, which has been reported 

 with considerable detail, the beneficial results of the parathyroid therapy 

 appear to have been incontestable and may be quoted as typical of the kind 

 and degree of benefit which may result from parathyroid administration in 

 cases of this type. In his patient, who was "suffering greatly from sub- 

 tetanic hypoparathyroidism as a result of strumectomy," tetany was 

 averted and the status thyreoprivns was made endurable by the feeding 

 of parathyroids, by the injection of Beebe's nucleoproteid, and for almost a 

 year by administration of calcium lactate. The dose given at first was 

 large, six dried (later fresh glands were used) ox glands every three hours 

 and the effect was "almost instantaneous and marvelous." After a few 

 days this dose was reduced to one gland thrice daily. 



Escherich's case of tetany in a nursling, aged 5 months, ended fatally, 

 although energetically treated with Vassale' s para thyroi din ; Frankl-Hoch- 

 wart observed no benefit from the same preparation used in five cases of 

 idiopathic tetany, nor did Pineles in three cases to whom horse para- 

 thyroids were fed; the last named author also quotes Rensburg and Key 

 as having seen only aggravation of the disease in cases of infantile tetany 

 treated by administration of parathyroid preparations. Haas observed no 

 eiTerts whatever in four cases to which he fed fresh and dried glands in 

 doses up to KM) grams at a dose; the cases, as shown by their fairly 

 satisfactory response to calcium lactate, do not appear to have been of 

 extreme severity. 



In attempting to form an estimate of the clinical value of the ad- 

 ministration of parathyroid in eases of tetany, two factors must be well 



13 As failures are much loss frequently reported than successes, this would indicate 

 that the failures have been more numerous. 



