PATHOLOGICAL ANATOMY AND HISTOLOGY 569 



one or more are involved. When the hemorrhages are slight, absorption 

 of the extravasated blood takes place, leaving behind little or no evidence 

 of its occurrence, or again, the removal of the blood may be accompanied 

 by deposition of the pigments which will remain for considerable periods 

 of time. 



Erdheim and his school claim that the hemorrhage leads to such dis- 

 tortion of the parathyroids and their function that a state of hypopara- 

 thyroidism is induced. The deficient parathyroid activity has as a sequel, 

 disturbed calcium metabolism with increased calcium excretion, as demon- 

 strated by MacCallum and Voegtlin. 



Hemorrhage Secondary to Degenerative Processes. In not a few 

 cases of hemorrhage, secondary processes of degeneration fatty, colloid 

 and hydropic take place, and, furthermore, fibroses and atrophy of the 

 glandules are later to be observed. The manifestations of tetany may 

 occur during any of these periods, at a time when hypofunction of a 

 sufficient grade has. occurred. It is evident, of course, that hemorrhage 

 into the parathyroids is to be encountered in greater frequency in infants 

 of tender age than are instances of tetany. There is, however, no adequate 

 explanation for the occurrence of hemorrhage. It would seem that the 

 parathyroids of the fetus late in pregnancy, as well as of the newborn 

 child, are susceptible to some mechanical or circulatory factor making 

 hemorrhage into them easily induced. Later in life this is but rarely 

 seen. A single case is reported by Diller wherein, following a severe 

 accident, tetany developed one week later. At autopsy all of the glandules 

 showed extensive hemorrhage. In the remaining number of the rather 

 infrequent cases of adult tetany, hemorrhages have not been observed, 

 but various authors have commented upon a state of atrophy, fibrosis 

 or degeneration as the cause of an assumed deficient function of the 

 parathyroids. It is suggested that these late cases of tetany have their 

 inception in hemorrhage at an early period of life, and that the incom- 

 petency of the parathyroids makes its appearance only when the progres- 

 sive degeneration has destroyed a considerable bulk of the glandules. 



Our present knowledge of infantile tetany requires the addition of fur- 

 ther study, to explain the vagaries which appear in the lesions of the 

 parathyroids. We are still at a loss to explain the occurrence of the hem- 

 orrhages, and it would appear as if a further secondary factor were neces- 

 sary to bring about a state of tetany, even when hemorrhage and other 

 lesions occupy these glands. In a certain number of instances, the hem- 

 orrhage appears to be a late event in the disease, occurring in conjunction 

 with petechial hemorrhages of other tissues. Parathyroid hemorrhages 

 also occur incidental to acute and chronic nephritis, acute bacterial intoxi- 

 cations, syphilis and severe blood diseases. 



