PAKATHYKOID GLANDS 617 



Pineles (&) (1905), in a collective review, brought together from the 

 literature all the cases of cataract reported as occurring in the different 

 forms of tetany. The cataract following tetany may be either perinuclear 

 or central. Peters, in the course of a single year, observed no less than 

 thirty tetany cataracts, and Zirn (1905) reported having observed six 

 tetany cataracts in the course of four months work. Five of the patients 

 exhibiting tetany cataract also suffered from falling out of the hairs and 

 nails; four of the cataract patients suffered from pregnancy tetany. It 

 seems probable that the cataract in tetany is due to toxic changes in the 

 ciliary epithelium rather than, as was earlier thought, to spasm of the 

 ciliary muscle. 



Conjunctivitis. It was pointed out by De Quervain that parathyroid- 

 ectomized dogs very often suffer from marked conjunctivitis. Falta and 

 Kahn found conjunctivitis almost constantly in dogs and cats that had 

 been deprived of their parathyroids. The same authors have described 

 a human case of tetany, in which conjunctivitis occurred ; the conjunctivi- 

 tis regularly underwent exacerbation at times when the tetany was worse. 



7. Psychoses in Tetany 



Attacks of tetany are, as a rule, accompanied neither by loss of con- 

 sciousness nor by marked disturbances of consciousness. In some in- 

 stances, however, clouding of consciousness has been met with in tetany 

 (Miiller) and combinations of tetany with outspoken psychoses have 

 several times been reported (Arndt and others). 



In 1889 von Frankl-Hochwart published a careful description of 

 certain cases in which hallucinatory confusion accompanied tetany, and 

 Krapelin made several observations on cases in which psychoses occurred 

 in combination with typical signs of tetany. In such cases the tetany 

 seems to have appeared at first in only moderate severity. With exacerba- 

 tion of the spasms, the hallucinatory confusion set in, to disappear later 

 as the spasms passed off. Even in the intervals between attacks the 

 patients sometimes complained of disturbances of mood or of excitement. 



In chronic tetany mental dullness and enfeeblement of memory are 

 not uncommon, especially in the form of chronic tetany that sometimes 

 follows strumectomy; in these cases, however, hypothyroidism may play 

 a part in the origin of the psychosis. 



An important paper by A. M. Barrett of the State Psychopathic 

 Hospital at Ann Arbor, entitled "Psychosis Associated with Tetany," was 

 published in the American Journal of Insanity in 1920. On a careful 

 review of the literature, Barrett found no less than sixty-seven references 

 bearing upon the subject. He concludes that there is no specific tetany 

 psychosis, but that the neuromuscular disturbances and the psychosis are 



