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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    thyroids removed in operations for goitre in the human sub- ject. He examined 20 thyroids surgically removed. In nine cases where there were complete clinical histories the parathy- roids were found removed with the thyroid in five, in four cases no parathyroids were removed. Of the five cases four developed tetany, of the four not one. Erdheim did much experimental work on rats, but also examined histologically the neck tissues of three patients dying of tetany. In all three cases, though some thyroid gland was discovered, he failed to find any trace of parathyroids. From postoperative tetany and its supposed cause in the destruction of parathyroids, Jeandelize suggested that other forms of tetany, such as infantile, gastric, etc., were due to disease or insufficiency of the parathyroids, and this theory was accepted by Chvostek. Although most observers reported that com- plete excision of the parathyroids in dogs, rabbits, and rats proved fatal with few exceptions, Vincent and Jolly, Hal- penny and Forsyth held the contrary and reported obser- vations where the thyroids and parathyroids had been com- pletely removed and yet the animals lived, and when killed after many days no trace of parathyroids were found post mortem. Vincent and Jolly said that rats and guinea pigs do not seem to suffer at all as the result of extirpation (Jour, of Physiol., 1904-1906 ). However, notwithstanding the observations of the above mentioned, the weight of opinion tends to prove that post- operative tetany is dependent on the removal, or destruction, or injury of the parathyroids. I do not intend to go into the proofs of this contention, for in many papers by MacCallum, Erdheim, Vassale, Generali, Pineles, and others, and in the excellent treatise by Ochsner and Thomson on the “ Surgery and Pathology of the Thyroid and Parathyroids,” a full ac- count of the experiments may be obtained. Now there are two theories of the functions of the para- thyroids: (1) That an antitoxin is developed by the para- thyroids which neutralizes certain waste products of tissue metabolism (Berkeley), so that when the parathyroids are destroyed a toxic material is formed in the blood which causes