582 LEWELLYS F. BARKEE 



phenomenon now generally recognized to be the most constant of all the 

 signs of tefany. In 1878, Chvostek, senior, of Vienna, described the 

 mechanical hyperexcitability of the motor nerves in tetany, giving the 

 "facial phenomenon," especially, a permanent place in the semeiology 

 of the affection. It was somewhat later, in 1888, that Hoffmann (a) de- 

 scribed the increased response also of the sensory nerves to electrical and 

 mechanical stimuli. Thus, all four of the well known signs of latent tetany 

 Trousseau's phenomenon, Erb's phenomenon, Chvostek's phenomenon, 

 and Hoffmann's phenomenon were described in the four decades preced- 

 ing the year 1890. 



About 1880 tetany began to be very prevalent in Vienna and it is not 

 surprising, therefore, that during the last two decades of the nineteenth 

 century many important contributions to our knowledge of the subject 

 were made by Viennese physicians. Perhaps the most important of these, 

 aside from the excellent clinical descriptions of Chvostek and of von 

 Frankl-Hochwart, was the observation by Weiss (a.) in Billroth's clinic of 

 the occasional appearance of tetany in patients after operations for the 

 removal of goiter. Though Weiss was wrong in his idea that the tetany 

 after strumectomy is due to injury to the sympathetic nerves at the 

 operation, his observations upon the occurrence of 'tetania strumipriva' 

 were the starting point of a whole series of important clinical and experi- 

 mental investigations upon the relations of tetany to the thyroid gland 

 and to the structures in its neighborhood. 



It is an interesting coincidence that during the same year, 1880, in 

 which Weiss's publication appeared, a Swedish observer, Sandstrom, 

 described the existence in human beings and in certain mammals of cer- 

 tain structures that lie described as "hempseed-sized glands near the 

 thyroid gland.' 1 ~No one had a glimpse of the idea at this time, however, 

 of the importance that this temporarily unnoticed discovery of Sand- 

 strom \s was, later on, to have for the pathogenesis of tetany. For at 

 least ten years after Sandstrom's discovery, tetany and these 'parathyroid 

 glands' were studied entirely independently of one another and without 

 the slightest guess that they were in any way related to one another. 



In 1800, an experimental physiological research that marks an epoch 

 in the history of our subject emanated from France. Gley (a) of Paris, in 

 that year, called attention to the physiological significance of the glands 

 that had been described as existing near the thyroid gland by Sandstrom 

 in 1S80. ^Meanwhile they had been almost forgotten. He stated that 

 when the thyroid gland and the parathyroid glands are simultaneously 

 extirpated in rabbits, the animals react with tetany, whereas when the 

 thyroid gland alone is removed, tetany does not occur. He expressed the 

 opinion that the parathyroid glands must stand in some peculiar relation 

 to tetany, and suggested that perhaps these glands can hypertrophy and 

 take over certain of the functions of the thyroid gland. Gley was handi- 



