696 LEWELLYST. BAKKEK 



the cures obtainable by surgical interference in this form of tetany were 

 referred to. Tetania gastrica treated by medical measures only has a 

 very bad prognosis. 



In other forms of tetany, however, surgical measures other than organ 

 transplantation should, as far as possible, be avoided. Even so simple 

 an operation as dilatation and curettement of the uterus has been known 

 to precipitate an acute attack of tetany. 



(b) Parathyropathies Other than the 

 Hypoparathyroidism of Tetany 



Several parathyrogenous syndromes other than tetany have been 

 mooted by clinicians, but the evidence that disturbance of parathyroid 

 function is responsible for these syndromes is far less convincing than that 

 in favor of the origin of tetany in hyoparathyroidism. Certain diseases 

 of the bones (osteomalacia, Paget's disease) and certain diseases of the 

 central nervous system (Parkinson's disease, Thomsen's disease, myo- 

 clonia, chorea minor, myasthenia gravis, and hyperparathyroid psychosis) 

 have been attributed by one or another to liypofunction, hyperfunction, 

 or dysfunction of the parathyroid glands. Finally, the relations of chronic 

 renal disease to hyperplasia of the parathyroid and of the latter to the 

 deposition of masses of lime salts in the body are worthy of consideration. 



I. Osteopathies of Postulated Parathyro- 



pathic Origin 



OSTEOMALACIA. In this rare disease, known also as mollities ossium 

 and spondylolistliesis, a softening of the bones of adults, not unlike that 

 seen in rickets in childhood, occurs. Women (in the reproductive period) 

 are more often affected than men. The patients tire easily and suffer 

 from severe pains in the back, hips, or extremities, especially on move- 

 ment. Marked distortions of the bones result from the effect of the body 

 weight upon the softened skeleton. The deformities of the pelvis due to 

 preceding osteomalacia are among the difficulties encountered by the ob- 

 stetrician. ] hiring the active stage of the disease there is difficulty in 

 walking, weakness of the legs, and often adductor spasm of the thigh 

 muscles. The nervous system often suffers also, the patients becoming 

 forgetful, apathetic, or irritable. Pregnancy is often responsible for 

 exacerbations of the disease. When males are attacked (virile osteomar 

 lacia), it is the bones of the spine and of the extremities that are mainly 



