698 LEWELLYS F. BAKKEK 



ually leads to characteristic deformations (ape-like appearance, bowing 

 of the legs forward and lateralward, enlargement of the skull and of the 

 clavicles, cervicothoracic kyphosis, violin shaped body, and enlargement 

 of the lower aperture of the thorax). The stature of the patient may be 

 reduced by as much as 13 inches (Osier). Chronic bronchitis and myo- 

 cardial insufficiency are common complications in the later stages. E. A. 

 Locke, of Boston, has emphasized the extreme atherosclerosis that occurs 

 in this disease. The large arteries of the extremities are often seen calci- 

 fied in rontgenograms, which also reveal a peculiar cottonwool-like change 

 in the diaphyses and epiphyses of the long bones. 



The disease sometimes affects several members of the same family, a 

 fact brought to my notice by Dr. Marie Ingram of Baltimore, who pei> 

 mitted me to show at my clinic several members of such a family. 



The etiology and pathogenesis of Paget's disease are still obscure, 

 though two observations, at least, are suggestive of an endocrin, possibly 

 of a parathyrogenous, origin. Thus, Askanazy in one instance observed 

 a tumor, presumably of parathyroid source, attached to the left lobe of 

 the thyroid, and Higbee and Ellis have described absence (?) of the para- 

 thyroid glands and of the thymus together with 'extreme atrophy of the 

 thyroid gland, in another case. The mineral metabolism in Paget's dis- 

 ease has been examined by Da Costa, Funk, Bergheim and Hawk (1915). 



II. Neuropathies of Postulated Parathyro- 

 pathic Origin 



PAKKIXSON'S DISEASE. This disease, occurring usually in later life, 

 and known also as paralysis agitans, is familiar to every practitioner 

 The peculiar rigidity of the body musculature, the characteristic attitude 

 with the head and trunk bent forward, the arms adducted and flexed, 

 and the legs slightly bent at the knees, the slow, coarse tremor (especially 

 the pill-rolling movement of the thumb and forefinger), the facial "mask," 

 the slowed movements and disinclination to movement, the disturbance of 

 the finer movements (buttoning and unbuttoning), the peculiar gait (with 

 propulsion, retropulsion, and f estination) , and the micrographia are 

 marks that, once recognized, are not likely to be overlooked by any alert 

 diagnostician. 



In Parkinson's disease the functions of the extrapyramidal motor 

 neurons are markedly interfered with, and J. Ramsay Hunt, of New 

 York, has called attention especially to the degenerations that are 'demon- 

 strable in this disease in the cell bodies of neurons situated in the globus 

 pallidus. 



As early as 1904, II. Lunborg had suggested that paralysis agitans, 

 may be due to a hypoparathyroidism. 



