From a clinical, bacteriologic, chemical and pathologic standpoint, one can conclude that Ekiri is mostly bacillary dysentery complicated by tetany, that the diagnosis of Ekiri may occasionally apply to children suffering from tetany and some other infection or perhaps a noninfectious gastrointestinal upset or even tetany alone.
Manifest tetany as seen in hot summer weather, secondary for the most part to bacillary dysentery infection, is a far more serious disease than rachitic tetany without infection. It is characterized by hyperventilation, lethargy or delirium, tonic spasms of the muscles, vomiting, disturbances of the autonomic nervous system and severe clonic or tonic convulsions. The child may die in a sustained tonic spasm or the tetany may aggravate the fever and dehydration caused by the infection, so that circulatory collapse and cerebral anoxia ensue. Early and strenuous treatment of the tetany, the infection and the accompanying dehydration is necessary if the present high death rate of Ekiri is to be greatly reduced. Prevention of tetany in Japanese children by supplementation of their diet with calcium and of dysentery by improved sanitation would be a far better approach to the problem.