Tetany following extirpation of the thyroid / by Francis J. Shepherd.

  • Shepherd, Francis J. (Francis John), 1851-1929.
Date:
[1912]
Catalogue details

Licence: In copyright

Credit: Tetany following extirpation of the thyroid / by Francis J. Shepherd. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    That there is truth in our first hypothesis of a toxic mate- rial in the blood produced when the parathyroids are removed or destroyed is evident, for if a dog in tetany be bled and an indifferent salt solution be transfused, the symptoms of tetany are at once relieved by thus reducing the amount of poison circulating in the blood. This does not greatly reduce the hyperexcitability of the motor nerves. Simple bleeding in tetany will also have a beneficial effect. The idea advanced by the earlier observers that the para- thyroids are really embryonic remnants or portions of fetal thyroid has been almost entirely given up, and most observers admit that the parathyroids are organs of vital importance to the economy. There are still some, such as Vincent and Jolly, Forsyth, Kishi, Halpenny, and others, who assert that the parathyroids take the place of the thyroid when that gland is extirpated and that there is thus an intimate relationship between the thyroid and parathyroids, for if the parathyroids be left after thyroidectomy the hypertrophied parathyroids to all intents and purposes become converted into thyroid tissue with vesicles containing colloid, so that it is likely there is some interdependence between the thyroid and parathyroids. The same changes occur in the pituitary body after both thy- roidectomy or parathyroidectomy (Herring, Rogowvitsch). Now as to the recognition of parathyroids during opera- tion on the thyroid in the human subject. This is by no means easy in my experience and I do not think any one can be certain of recognizing positively a parathyroid gland with- out a microscopical examination. I have removed inadvert- ently what I thought without doubt was a parathyroid, but it was found to be only a small lymph-gland. Rulison (Anatomical Record, July, 1909) says that after an extensive investigation on the dead human subject only 41 per cent, of the probable parathyroids identified as such by gross inspection actually contained parathyroid tissue when examined microscopically. Rogers and Ferguson, out of 189 supposed parathyroids examined, found that only 61 were true parathyroids. The gross appearance is often misleading. Many of the supposed parathyroids were adenoid or thyroid