acute stage of tetany. Also Ibrahim is of the opinion that the pylorospasm 

 can occur in the course of a tetany of childhood. 



Especially significant for this question are two observations that have 

 been reported by Kahn and myself. I would therefore go into the question 

 more accurately at this point. In the one case (Observation 'XXII Case 

 1 8 of Falta and Kahn), X-ray examination at the time that only slight signs 

 of tetany existed showed an elongated but otherwise normal stomach. 

 On a later examination, during an acute exacerbation of the tetany, there 

 was found a retraction of the greater curvature, completely the picture of 

 an hour-glass stomach (see Fig. 27). The tetanic spasms rapidly decreased 

 in intensity, the stomach assuming normal relations after a few days. In 

 the case there were no grounds for the assumption of an ulcus ventriculi. 

 In a second case (Observation XXIII Case 17 of Falta and Kahn) the 

 stomach, as found on X-ray examination at the time of an acute exacerbation 

 of the tetany and indeed during an attack, was small, markedly contracted, 

 divided in two parts like an hour-glass stomach; in addition there was 

 insufficiency of the pylorus; there was present therefore a total spasm of the 

 stomach, that affected also the longitudinal musculature. At the next 

 examination, this phenomenon occurred again, gradually decreasing in 

 intensity, however, with the amelioration of the tetany; and later, when the 

 tetany had disappeared entirely, the stomach showed normal relations on 

 X-ray examination (see Fig. 28). We regarded these manifestations as 

 conditions of tetanic spasms. 



Also in thyroprivic animals I several times observed that the spasm 

 was ushered in with vomiting and bowel movement. 



All observations detailed point to the fact that in the acute stage of 

 tetany the gastrointestinal tract may show symptoms of increased ex- 

 citability and a heightened tonus, which later may increase up to a spas- 

 modic condition. To which are added heightening of the secretory processes. 



Ibrahim further describes, in the case of suckling tetany, spasm of the 

 sphincter of the bladder that led to marked retention of urine, and mentions 

 similar observations of Sachs, Escherich and Hagenbach-Burckl.ardt. v. 

 Frankl-Hochwart had mentioned still earlier a retention of urine in tetany of 

 adults. Ibrahim further assumes involvement of the sphincter ani in the 

 tetanic spasms as he often observed in suckling tetany an intense gaseous 

 distention of the abdomen (flatulent colic). After introduction of an in- 

 testinal tube there were emptied large amounts of gas or even spontaneously 

 there occurred an "explosion-like expulsion of flatus with frequent clonic 

 twitchings of the abdominal muscles." Also Koeppe had already supposed, 

 as Ibrahim states, that the internal sphincter became contracted in the 

 eclamptic attack. 



Finally we mention the disturbances of the regulation of heat. In para- 

 thyroprivic dogs there often occur, during attacks, increases in temperature; 



