TETANY IN GASTROINTESTINAL DISEASES 215 



An especial interest attaches to that form which occurs when the gastric 

 or intestinal disturbance has existed for a long time. Attention to this 

 form was directed first by Kussmaul. Since that time there have been pub- 

 lished numerous reports concerning it (Fleiner, Fr. Muller, Gerhardt, Bouveret 

 and Devic, Ewald, Albu, Schlesinger, v. Frankl-Hochwart, Rudinger and Jonas, 

 Wirth). The most various conditions have been found: Cicatrized ulcer of 

 the pylorus or the duodenum, hour-glass stomach, malignant processes 

 (such as carcinoma or sarcoma) in the neighborhood of the pylorus, or 

 tumors of the gall-bladder or of the pancreas that lead to stenosis, torsion 

 of the stomach, acute paralytic dilatation of the upper small intestines, 

 in children dilatation of the colon, etc. 



There has also been reported a group of cases of dilatation of the stomach 

 without demonstrable stenosis. I mention from the newer literature only 

 the cases of Ferrannini and of Fleiner. 



The tetany that occurs in all these conditions may be quite rudimentary. 

 Not rarely, however, it is of the most severe forms, forms that are attended 

 with universal spasms and loss of consciousness. 



Bouveret and Devic distinguish a simple form attended with paresthesia 

 and typical spasms of the extremities, and a " tetanisme plus ou moin general- 

 ise" that may lead to dyspnea and death from asphyxia principally through 

 involvement of the muscles of respiration, and a form attended with loss of 

 consciousness and coma. These severe forms of stomach tetany leave the 

 prognosis always somewhat doubtful. The present statistics show a mor- 

 tality of about 60-70 per cent. 



Numerous hypotheses have been brought forward to explain this form. 

 In a certain number of the cases perhaps an affection of the gastrointestinal 

 tract may play the determining role. This may be likely through the 

 circumstance that, as the figures of v. Frankl-Hochwart show, a great number 

 of these cases occur during the tetany months. On the grounds of this ob- 

 servation Rudinger and Jonas have upheld the supposition that the tetany of 

 gastrodilatation is nothing more than tetany acquired in the course of a 

 gastrodilatation. This explanation does not seem to me to be entirely 

 satisfactory. Before everything else, it is striking that this form of tetany 

 is less confined to the tetany districts. Kussmaul supposed that the tetany 

 was caused by a thickening of the blood, due to the frequent vomiting and the 

 diminished absorption of water. Fleiner has adopted this theory, pointing 

 to the hyperglobulia observed by Fr. Muller and also himself. This hy- 

 perglobulia is, however, as we have already seen, not the cause of tetany 

 spasms, but their effect. Gerhardt, Palliard, Ewald, Albu, and others have 

 supposed that toxic substances bring about the tetany, their origin being due 

 to the stagnation of the gastric and intestinal contents (autointoxication 

 theory). The finding of diamines in the stomach contents and in the urine 

 of such patients means nothing, as they are also found there in other diseases. 



