568 OSKAE KLOTZ 



A variety of degenerations was observed by Benjamins. These includ- 

 ed atrophy with pigmentation, replacement fibrosis, colloid degeneration 

 of stroma a*id hydropic degenerations, which in his cases were at times 

 associated with the presence of goiter. Erdheim frequently noted the pres- 

 ence of glycogen and colloid. He also found small cysts present in the 

 glandules, the parenchymatous cells of which showed degenerative changes. 

 Verebely, on the other hand, observed the presence of fat, glycogen, hyalin 

 and pigment in the normal parathyroids. He also observed that small 

 cystic dilatations of the acini, with or without colloid content, may be 

 present in the normal glands. He found, too, that the cysts vary consid- 

 erably in size, and commonly contain a mass of colloid material not un- 

 like that observed in the thyroid. These cysts are usually surrounded by 

 oxyphil cells. Only occasionally did he observe, and this particularly in 

 small children, small quantities of blood within these cysts. 



Hemorrhage into the Parathyroids 



On Clinical Tetany. Of late years, the study of infantile tetany 

 has given considerable prominence to the occurrence of hemorrhage 

 into the parathyroid glandules. The possible relation between the 

 parathyroids and tetany in adults was first suggested by Jeandelize, 

 and later this was emphasized by Pineles and Chvostek for various 

 types of tetany and tetanoid conditions. Erdheim was the first to demon- 

 strate a lesion in the parathyroids of infants which was sufficiently severe 

 and constant to merit attention. In two children, with marked tetany, he 

 found extensive hemorrhage into the glands, and shortly following this, 

 his colleague, Yanase, made similar observations on two further cases. 

 Subsequently, Haberfelt, working in the same clinic, carefully analyzed 

 seven fatal cases of tetany and was able to demonstrate recent hemorrhage, 

 blood cysts and blood pigment in six of them. In one case there was com- 

 plete absence of either recent or old hemorrhage. 



Hemorrhage Not Associated with Tetany. Other observers have 

 likewise found hemorrhages into the parathyroids, but have not always 

 been able to correlate their presence with tetany or tetanoid manifesta- 

 tions (Verebely, Koenig-stein, Thompson, Petersen and Thiemich (c)). 

 The majority of cases of tetany occur during the first year of life, and it is 

 at this time when hemorrhage into the parathyroids is to be found. These 

 hemorrhages are of all gradations, from slight local leakage of the vascu- 

 lar sinuses to the extensive infiltration of the gland and an obliteration 

 of the functional tissue. It is not clear as to the manner in which the 

 hemorrhages are brought about, and it would appear that they are prone 

 to take place at the time of birth, or a short time preceding it. All four 

 glandules may be attacked simultaneously, but in other instances only 



