LEWELLYS F. BARKER 



convulsions, indicating the existence in them of spasmophilia in childhood. 

 It would be interesting, in view of Uhlenhuth's ideas, to know how many 

 of them, if any, have presented evidences of a status thymicolymphaticus. 

 It is said that patients among the working classes in Vienna suffering 

 from idiopathic tetany, get rid of their tetany symptoms in one or two days 

 if they are admitted to a hospital. 



2. Tetany in Diseases of the Digestive Tract 



At least four groups of cases of tetany occurring in association with 

 diseases of the digestive tract have heen described in the literature: (1) 

 Cases of gastric tetany; (2) cases of tetany in duodenal dilatations; (3) 

 cases of colonic tetany; and (4) cases of tetany in association with 

 helminthiasis. 



Gastric Tetany (Tetania gastrica) 



Kussmaul (a) (1869), in his article on the treatment of dilatation of 

 the stomach, reported the occurrence of tonic spasms (tetany) in association 

 with marked gastric dilatation. This form of tetany was especially well 

 studied by the French observers Bouveret and Devic (1892), and by 

 Fleiner (1900 and 1903) . Karl Wirth has collected all the cases published 

 up to 1910 and lias subjected them to a critical analysis. 



In the majority of cases of gastric tetany reported, there was marked 

 dilatation of the stomach, due to pyloric stenosis. This form of the disease 

 occurs generally in older people and shows a high mortality. Medical 

 treatment is unsuccessful, though surgery is curative, if the stenosis be 

 benign. 



Among the benign gastric stenoses observed in association with tetany 

 may bo mentioned (1) stenosis due to scar from old ulcer of the pylorus or 

 of the duodenum, (2) that due to hourglass stomach with marked dilatation 

 <;f the part proximal to the constriction, (3) that due to peripyloric adhe- 

 sions, (4) that due to obstruction of the pylorus by foreign bodies, and (5) 

 hypertrophic stenosis of the pylorus. The malignant stenoses have been 

 mainly carcinomatous in origin, though occasionally round cell sarcoma 

 was the cause of the obstruction at the pylorus. 



Only a relatively small number of the hosts of patients with gastric 

 dilatation ever develop tetany. A disposition to tetany must therefore be 

 assumed in addition to the stenosis. According to the current view, a 

 parathyroid insufficiency exists and toxins absorbed from the dilated stom- 

 ach further injure the parathyroid glands or interfere with the exertion 

 of their normal influence and thus call forth the tetany. If this view be 

 correct, gastric tetany would fall in the larger group of cases of tetany 

 due to intoxications. 



Recently, the attempt has been made to explain gastric tetany on the 



