THE THYROID AND PARATHYROIDS 297 



Endemic Tetany. Endemic tetany, as it occurs in Europe, 

 seems to be a disease of large cities, usually appearing in the 

 spring ; it has a tendency to assume epidemic proportions, and 

 it is very local in its distribution. 



In India there is an endemic tetany in rural districts. 

 Attention has been specially called to this affection by 

 McCarrison. 



The distribution of tetany in India is peculiarly local, and 

 appears to correspond more or less with the distribution of 

 goitre. Sufferers from tetany appear to be able to rid them- 

 selves of it by going to a locality where it does not prevail. 



In India tetany is a disease of child-bearing women, and there 

 is a marked family tendency to the disease. The children 

 of women who suffer from tetany are frequently cretinous. 



Menstruation appears to increase the frequency and the 

 severity of the attacks of tetany, especially so when this 

 function is in any way disordered. 



The seasonal prevalence of tetany its practical limitation 

 to the spring months is very striking. " Chill," fright, and 

 mental distress often provide the stimulus which produces the 

 spasms. The patients are nearly all goitrous, and incomplete 

 myxcedema may be present. 



McCarrison finds thymol very useful in treatment, and this 

 affords proof of the now generally accepted opinion that the 

 spasms of tetany are due to the action of toxic substances 

 absorbed from the alimentary canal. Goitre is an important 

 cause of tetany, because it reduces the efficiency of the thyroid 

 gland. 



In various forms of tetany lesions of the parathyroids have 

 been found, but in many cases no such changes are discoverable. 



There is no definite syndrome which can be clearly associ- 

 ated with increased function of the parathyroids. 



J. Early Views as to the Functions of the Thyroid 



According to Handfield- Jones, Galen does not give any very 

 distinct account of the thyroid, but seems to allude to it in his 

 work " On the Use of the Parts of the Human Body." In 

 speaking of the glands of the larynx, he says these " are always 

 found more loose and spongy than others, and which, by the 

 common consent of anatomists, have been created for the 



