PARATHYROID GLANDS 15 



connected with the drinking-water. In the early 

 stages, iodides, thyroid feeding, or probably iodo- 

 form will work improvement, and the water should 

 be boiled, or the supply changed. Should operative 

 measures be adopted, we learn that the whole gland 

 must not be removed, or myxoedema may result, 

 and that the four small parathyroids lying behind 

 it must also be respected, or the patient may develop 

 tetany. In some cases the loss of the parathyroids 

 on one side only has caused this unpleasant sequel. 

 An attempt should therefore be made, in removing one 

 lobe of the thyroid for goitre or adenomata, to leave 

 these little glands intact and in situ, and to preserve 

 their blood-supply. They will not be injured if the 

 posterior part of the capsule of the thyroid is left. 



If myxoedema or tetany do .follow the operation, 

 they may be remedied by thyroid and parathyroid 

 feeding respectively. There is some evidence that 

 even the medical varieties of tetany are due to loss of 

 the internal secretion of the parathyroids ; according 

 to Kocher, this has been proved in the case of the 

 tetany of pregnancy, and other observations have 

 since been made in which the parathyroids were 

 diseased when tetany was present. Parathyroid 

 feeding should therefore be worth a trial in such 

 cases also. Macallum* recommends the adminis- 

 tration of calcium salts, or milk, which is rich in 

 calcium salts. He has shown experimentally, and 

 Edmunds f has confirmed the statement, that these 

 salts will cure tetany. Thyroid and parathyroid 



* Journal of Experimental Med., New York, 1909, vol. xi. p. 118. 

 t Journal of Path, and Bact., 1910, p. 288. 



