~ ) CL Volume 708 Number 6 Ha'-'~ f'I-'" Al D~. '" t: C ~)! 'C' E <:- "-\,,1 ..., 8/BL!OTECA Colin G. Thomas,jr, MD, Chapel Híll, N.C 48 Apdo . 69 ¡ "_080 -BILBAO F h D .I S U "" .I N h C l " S h 1 V,zc;a Es ~ rom t e epartment o) urgery, nzverslty o) ort aro zna c 00 o pana University 01 North Carolina Hospitals, Chapel Hill, N.C. IT IS A DISTINCT AND CHERISHEDHONOR to be the ~pularity, much to the detriment of OUTmedical her- president of the American Association of Endocrine itage. Surgeons and to address you in this capacity. Previous Hyperfunction of the glands of Owen can be epito- addresses have covered a myriad of subjects and have mized by the presentation of some early patients who been witness to the erudition and catholicity of interests provide a perspective on diagnosis, natural history, and of our membership. management. Emphasis on patients seemsappropriate This presentation will relate to the glands of Owen, since the patients rarely receive credit for their Tole in their discovery, their physiologic significance, and the OUTundérstanding of normal and abnormal physiology. consequences of their hyperfunction. Parathyroid has Although this mar not be new information, 1 would re- always seemed an unimaginative and vapid term Cofa mind you of a quote from George Santayana 1, "That gland the function of which is so critical to our well-be- which is not too well understood is not too oft rt:peated." ing. Most endocrine glands were named for their con- DISCOVERY OF THE PARATHYROm figuration (pineal, thymus, thyroid), function (ovary, GLANDS pituitary, testes), or composition (pancreas). Only the adrenal, distinguished by its relation to the kidney, was The glands of Owen can be traced to a few courageous named because of its fortuitous location. For these amphibians that, some 100 million years ago, had suf- glands to be named after their discoverer has a more ro- ficient hubris to crawl ashore. At that time endocrine mantic implication and is as explicit as to function as the control of their calcium and .phosphate metabolism, term parathyroid. Unfortunately, eponyms have lost requisite for their bony skeletons, was maintained through steroids, vitamin D metabolites, and the peptide Presented at the Eleventh Annual Meeting of the American hormone calcitonin. A more terrestrial environment Association of Endocrine Surgeons, Cleveland, Ohio, April constituted a stimulus for the production of a hormone 22-24, 1990. adequate for maintenance of calcium and phosphate ion Reprint requests: Colin G. Thomas, Jr, MD, Department homeostasis.These glands were essentially the last to of Surgery, Universit) of North Carolina, 136 Burnetl- appear in the evolution of the vertebrate endocrine Womack Building, Campus Box 7210, Chapel Hill, NC 27514. system.la Despite their essentiality in mili ion s of speciesfor the 11/6/23350 SURGERY 939 .--:;7~ 940 Thomas Surgery December 1990 Fig. 2. Ivar Sandstrom(1852-1889). (From SeipelCM. Bull Fig. 1. Sir Richard Owen, KCB, FRS (1804-1892).(From Inst Hist Med 1938;6:179-222.) Cave AJE. Richard Owen and the discoveryof the parathy- raid glands.London: Oxford University Press,1953:217-22.) oats,rice, carrots artd bread in Brobdignagianquantities daily ever since,and might havegane on digesting,had he not by someclumsy fall or otherwiseinexplicable process,cracked a maintenance of the bony skeleton, the responsible endo- rib; said fracture injuring the adjacentlung and causingbis crine glands were not discovered until 140 years ago. demise.His anatomywill furnish forth an irnmortal Mono- "On the 24th of May, 1834, fue Zoological Society of graph,and so comfortcomes to me in a shapein which it can- London acquired it's first specimen of the Great Indian not be had by any of my brother Fellows."3 Rhinoceros (Rhinoceros unicornis)." This animal, a male, arrived at fue Society's menagerie on September The deteriorating clinical course of fue rhinoceros 20, 1834; it reached an age of about 20 years on was succinctly recorded in fue Head-keepers Minute November 19, 1849. It was "anatomized" by Sir Rich- Book4: ard Owen, Hunterian Professor and Conservator of fue "1849, November12th Rhinocerosvomited slimy mucus. Museum in fue Royal College of Surgeons of England 14th ditto ditto with blood (1827-1856) (Fig. 1). Owen welcomed fue opportunity 15th ditto ditto ditto to dissect fue anatomy of this rare species, wbich is ev- 16th ditto ditto ditto, & from the nostril ident in fue following excerpt from a letter to one of bis 17th ditto ditto ditto ditto sisters2: 18th ditto ditto ditto ditto 19th ditto ditto ditto ditto" " Amongst other matters time-devouring, and putting out of Today, this would not be an acceptable record of a memory mundane relatives, sisters included, has been the de- ceaseof my ponderous and respectable old friend and client the patient's illness or attending involvement. rhinoceros. 1 call him 'client' because fifteen years ago 1 pa- The protracted and laborious dissection was carried tronized him, and took it upon my skill, in discerning through out at the Conservator's resident quarters of the Royal a pretty thick birle the infernal constitution, to ayer that the College of Surgeons. Owen's wife recorded in her diary beast would live to be a credit to the Zoological Gardens, and that "as a natural consequence" of this animal's death that he was worth the 1,000 guineas demanded for him. The there is a quantity of fue rhinoceros-approximately 2 Council had faith and bought him, and he has eaten their hay, tons-on fue premises. Owen performed fue dissection Volume 108 Presidential address 941 Number 6 during the winter months of 1849 to 1850 and indicated He emphasized the difference in these glands from that the rhinoceros had passed into an "offensive state accessory thyroid glands and suggested fue name glan- of decomposition." On Feb. 12, 1850, Owen presented dulae parathyroideae, which expressed the characteris- the resulting monograph to a meeting of the Zoological tic of being bye-glands to the thyroid. Sandstrom Society.4 emphasized that although "an accessory thyroid gland Owen's astutenessas an anatomist was evident from is found in only one of ten cases, every individual has his discovery of "a small compact yellow glandular body several glands of this kind."s Sandstrom's excitement attached to the thyroid at the point where the vein and reward must have been comparable to that of the emerged." He had no prior knowledge of the presence surgeon who, after much searching, identifies an elusive of this small organ, which was in diameter and circum- parathyroid adenoma. ference no greater than a sixpenny piece. Owen's pub~ Sandstrom did not postulate any particular function lication in March 1852, "On the Anatomy of the Indian but did speculate on clinical relevance. Rhinoceros,"4 is recognized as the classic paper on the "For the purpose of diagnosing a tumor of the parathyroid subject. gland, 1 want to point out the proximity of the glands to the Ivar Sandstrom celebrated his first birthday in March esophagus and the recurrent nerve, whereby in cases of a 1853. He matriculated at the University of Upsala in pathological growth process there mar easily occur a com- 1871, received his preclinical degree in 1878, and was pression of the former and a paralysis of the latter."6 appointed as "prosektor" in anatomy during 1879 to 1880 (Fig. 2). He obtained rus diploma as a physician Sandstrom's cornments in a letter to his family on the in 1887. Hispublication, "OnaNew GlandinManand presentation of his findings to a meeting of the presti- Several Marnmals-Glandulae Parathyroideae,"S was gious natural scientists at Stockholm are prescient today. published in the Upsala Liikarefórenings Fórhand- "Everyone seemedto be there with the intention of showing linger, 1880. This discovery was made in 1877 while what 'discoveries' he had made, and at the same time give the Sandstrom was sti" a medical student. astonished world the opportunity to have a look at the fortu- "About threeyears ago (1877),1 found onthe thyroid gland nate discoverer. 1 cannot help the sad and discouraging of a dog a small organ, hardly as big as a hemp seed,which impression that most of OUTscientists are more apt to work for was enclosedin the sameconnective tissue capsule as a thy- their own reputation than for the sake of science itself, and that roid, but could bedistinguished therefrom by a lighter color. the latter is regarded as a kind of modero album, wherein a A superficial examinationrevealed an organ of totally differ- lot of gentlemen compete to get their llames written. But for ent structure from that of the thyroid, and with a very rich the discovery itself, for the revealed truth the interesl was lit- vascularity evenin the cal and the rabbit similar glands tle or none."6 were found. However,time and material did not allow me to In searching the literature at that time, Sandstrom continue the investigationsand it was not until this winter also cites two authors, namely, Remak (1855) and Ru- (1880) that 1 have been able to take the problem up again. ...Although the probability of finding something dolph Virchow (1863), who mar had identified these hitherto unrecognizedseemed so small that it was exclusively glands earlier.6 Unfortunately, Sandstrom's academic with the purposeof completingthe investigations,rather than career was terminated by his suicide in 1889! with the hopeof finding somethingnew, that 1 begana care- The glandulae parathyroideae at this time were ba- fui examinationof this region. So much the greaterwas my sically structures in search of a function. A clue to their astonishment;therefore when, in the first individual exam- function was the development of tetany after thyroidec- ined,1 found on both sidesat the inferior border of the thy- tomy.