Gastric Tetany. In the experimental study of the factors which may act as auto-toxins their resemblance to the bacterial toxins is continually in evidence, and the ability of many of these materials to produce muscular spasm and convulsions leads one to think that atypical cases formerly supposed to be of bacterial origin may be autogenous. Smith (44) reports a case in which a patient with dyspepsia and much gastrointestinal flatus failed rapidly in strength, and became troubled with insomnia. Occasionally tetanic attacks occurred in which the fingers were forced into the palms, there was trismus and the wrists were extended and rotated outwards to an extreme degree causing intense pain. There was much mental suffering and sleep was disturbed by spectral delusions. The stomach was found to be dilated and dependent, and the patient was exhausted almost to the point of death. These recurring attacks were entirely relieved by lavage and a non-nitrogenous diet, but when these measures were neglected, premonitory symptoms at once showed themselves.

Dujardin-Beaumetz reports a case of gastric dilitation with very similar symptoms, and Strong (45) reports seven cases characterized by spontaneous intermittent muscular contractions, of which only one died, and remarks their similarity to epilepsy.

Simpson (46) finds tetany a very common accompaniment of gastrectasis and quotes Kussmaul who found it in 92 per cent, of such cases with a mortality of 75 per cent. Monyhan (47) does not believe this disease to be as rare or as serious as it is usually considered. He reports five cases in which gastroenterostomy was performed with cure in each.

A case of gastric tetany observed by Amato (48) occurred in a man who had suffered with gastric dilitation and its many symptoms for five years, when he was suddenly attacked by tonic contractions of the upper limbs, trismus and coma which ended in death. By introducing fermenting materials into the stomachs of animals this observer was able to produce dyspnea, myosis, muscular contractions, anuria and trismus, a clinical picture closely resembling that of tetanus. Post-mortem the liver and pancreas showed lesions such as are usually found in poisonings and intoxications.

Thus it is made evident that substances other than the specific toxin of the bacillus tetani are capable of causing this much dreaded chain of symptoms, and that the dilated and dependent stomach is a source of real danger to the individual.