564 OSKAE KLOTZ. 



occasionally followed by an increase in the stroma, and a moderate atrophy 

 of the parenchymatous cells of the parathyroids. In a case of epilepsy, 

 Erdheim foifhd some sclerosis of all of the parathyroids. However, in an- 

 other instance, the glands were found to be normal, and he was unable to 

 correlate the sclerosis with clinical manifestations. Forsyth (a) found 

 marked sclerosis of the parathyroid in a case of myxedema with an atro- 

 phic thyroid. Others (Erdheim, Maresch, Peucker), studying cases of 

 myxedema with congenital absence of the thyroids, found the parathy- 

 roids in their normal position and without specific lesions. 



Parathyroid Involvement in Tuberculosis and Syphilis. Occasionally 

 the parathyroids may be the site of a tuberculous infection in association 

 with a general miliary dissemination. Verebely, in a study of the lesions 

 in 138 cases, found two involved in tuberculosis. Similar cases are also 

 described by Benjamins, Eggers, Winternitz and others. Fibrosis, atrophy 

 and hydropic degeneration of the parathyroids have been described by 

 Haberfeld in two cases of congenital syphilis. 



Decelerations in the Parathyroids 



Intoxications. Degenerations of organs are the outcome of the effect 

 of chemical substances in solution, harmful to the tissue, or alterations 'in- 

 duced by an inadequate nourishment. Both of these factors play a part 

 in injuring the quality of the parathyroid structures. Acute and chronic 

 intoxications, from local or disseminated infections, have their influence 

 upon the parathyroids as they do upon the remaining ductless glands and 

 other tissues. Occasionally, the intoxications associated with kidney reten- 

 tion in chronic nephritis, diabetes and cirrhosis of liver, give rise to paren- 

 chymatous degeneration of the parathyroids, which, although altering the 

 morphological character and chemical constituents of their cells, rarely 

 produce such advanced change as to interfere with function. 



Circulatory Disturbances. The anemias and leukemias are prone to 

 cause chronic but progressive degenerations of the fatty type, with the 

 deposition of extraneous pigments in the glandules. Progressive degener- 

 ations are also to be noted when spontaneous scleroses of vessels involve the 

 circulations of the parathyroids (Fig. 1). It has been shown that when 

 during the ablation of the thyroid the vessels of supply have been ligated, 

 the parathyroids which remain behind suffer a process of atrophy until a 

 compensatory circulation is reestablished. Halsted claimed that the para- 

 thyroids arc likely to be seriously encumbered by an inadequate circulation 

 following surgical interference with the thyroid. 



Acute Degenerations. The recognition of acute degeneration of the 

 parathyroid has been made in a limited number of instances. The small 

 size of the gland does not permit, of ready recognition with the naked eye 



