PARATHYKOID GLANDS 651 



post partum, in twenty-nine during lactation. A portion of these patients 

 had earlier been operated upon for goiter. Some of the pregnancy patients 

 suffered from convulsive seizures, causing premature delivery, after which 

 the tetany ceased. When the tetany continued and lasted for some time, 

 trophic changes were common (falling out of the hair, cataract formation). 

 Children born at term of tetany mothers often exhibited tetany also, either 

 immediately after birth or later on. 



As has already been pointed out, maternity seems to throw an especial 

 burden upon the parathyroid glands, and parathyroid insufficiency easily 

 develops during the process. Even menstruation may be the cause of the 

 development of tetany, or an existing tetany may, in its course, be aggra- 

 vated by the occurrence of menstruation. 



Maternity tetany is much more common in the spring months than at 

 other times, and in tetany towns than in other places. 



6. Tetany alter Operations for Goiter (Tetania 

 strumipriva) 



Tetania strumipriva, so important for the development of our knowl- 

 edge of the relation of the parathyroid glands to tetany, is one of the 

 severest forms of the disease, often ending fatally. We have outlined 

 above (see Historical Notes) the history of the development of our knowl- 

 edge of this form of tetany. It is one of the brilliant chapters in 

 endocrinology. 



Tetany after operation for goiter, thanks to our newer knowledge, is 

 growing ever less common. Not only are the parathyroid glands now left 

 behind at the operation for goiter, but the technique of the operation is 

 being ever improved, so that injuries to the parathyroid glands from pres- 

 sure, from hemorrhage, from cutting off of the blood supply, and from scar 

 formation, subsequent to operation, are, as far as possible, avoided. Cases 

 of tetania strumipriva still occur occasionally, however, even in the hands 

 of the best operators. Should a surgeon by mistake, or by unavoidable acci- 

 dent, remove one or more of the parathyroid glands, or should the operation 

 be so extensive (on account of carcinoma) that the parathyroids must be re- 

 moved, they should, if not actually invaded by the neoplasm, be imme- 

 diately ^transplanted, while the patient is still under the anesthetic. 



7. Tetany in Children 



Two groups of cases occur, the first in sucklings (up to say the twen- 

 tieth month of life) and known as tetania infantum, the second in the 

 period from the third year of life on (tetania puerorum). The latter is 

 symptomatically much like the tetany of adults. 



