558 OSKAK KLOTZ 



Participation by the Parathyroids in General Reactions to Disease. 



It is well known that during severe infections and intoxications, not a few 

 tissues are injured in a secondary process, and often without significance 

 to the clinical symptoms which have been present. We are reminded of 

 the not uncommon presence of petechial hemorrhages in many tissues and 

 organs occurring as a late event in infections. Furthermore, an apprecia- 

 tion of the correlation of functional activities, particularly as have been 

 suggested for the organs of internal secretion, must be more thoroughly 

 obtained before we shall be able to interpret the deficiency or exaggeration 

 of function occurring in as minute structures as the parathyroid glandules, 

 when morphological change may be absent, or so slight as to escape our 

 attention. Whether the parenchyma of the parathyroids suffer fatigue or 

 exhaustion of function to a degree which will manifest symptoms, but 

 where the tissue elements have not suffered structural change, has as yet 

 not been clearly defined. That such may occur has been suggested by 

 many, but in the absence of a method whereby the active principle of the 

 parathyroid may be recognized in its physiologic and pathologic quantity, 

 such derangement can be suggested only in a tentative manner. 



Infrequency of Definite Parathyroid Lesions. Degenerative processes 

 have been shown to arise where the body suffers from an inflammatory in- 

 toxication, and in a few instances true inflammatory reactions localizing 

 in these structures have been described. It is unusual, however, that an in- 

 flammation resulting from bacterial localization, as observed in many 

 other tissues, takes place in these glands. It is less frequent than that 

 observed in the thyroid, and it is infrequent to note an inflammatory pro- 

 cess developing from contiguous structures. Broadly speaking, although 

 the parathyroids may suffer the various lesions, as seen in other tissues, 

 their actual presence is infrequent and localized to one or other of the 

 glands, permitting the remaining number to adequately carry out the 

 function belonging to these structures. 



Inconstancy of Parathyroid Lesions in Diseases. In not a few dis- 

 eases where analogy with the results of animal experimentation suggests in- 

 volvement of the parathyroids, the surmise has not always been verified 

 by postmortem analysis. In the lack of knowledge of the active secretion 

 of the parathyroid, and our ignorance of what constitutes a condition of 

 hypoparathyroidism, we are unable to give an adequate interpretation of 

 the disease manifestations in the presence of glandules which to the eye 

 possess a normal structure. In these analyses we are again brought face 

 to face with the fact that a morphological study gives little clue as to the 

 functional capacity of a given tissue. It is necessary that more data, be 

 assembled in order to give proper place to the lesions of the parathyroid 

 and their relation to conditions other than tetany. The progressive altera- 

 tions of these tissues with advancing age, and the changes concomitant with 



