LEWELLYS F. BARKER 



and from hysterical spasm of the diaphragm. The general diagnostic sur- 

 vey should easily differentiate. 



Cramps in the Calf Muscles. These may be due to tetany, in which 

 event other signs of tetany can also he demonstrated to- he present. Cramps 

 in the calves may also be due to other metabolic disturbances (uremia, 

 gout, etc.). 



Hysterical Contracture. This may resemble the spasm of tetany very 

 closely, but it is generally unilateral, whereas, in tetany, the spontaneous 

 contractures are usually bilateral. Even bilateral spasm of the upper ex- 

 tremities and also of the lower extremities has been observed in hysterical 

 persons and designated "hysterical tetany.' 7 Some of these cases were 

 doubtless combinations of true tetany with hysteria, but if true tetany be 

 present, one or more of the signs of latent tetany should be elicitable 

 (Chvostek's phenomenon, Erb's phenomenon, etc.). 



Occupation Cramps. Cramps in the muscles concerned in the move- 

 ments that pertain to certain occupations are manifested by some persons 

 (writer's cramp, piano player's cramp, seamstress's cramp, telegrapher's 

 cramp, shoemaker's cramp, cigarette roller's cramp, etc.), and may be 

 mistaken for the spasms of tetany. The patients are neuropathic. 



As a rule, these occupation cramps are independent of tetany ; but shoe- 

 maker's cramp, especially, is most often due to tetany, as are the cramps 

 that occur in carpenters and tailors. It has been suggested that the atti- 

 tude in which the body is maintained during a large part of the day by 

 these workmen causes disturbances of circulation in the neck and so leads 

 to deterioration of function of the parathyroid glands. If an occupation 

 cramp be really due to tetany, the specific signs of tetany can be elicited. 



Myotonic Phenomena. The occurrence of myotonic symptoms in 

 tetany, and the occasional combination of tetany with true myotonia con- 

 genita have been fully described under symptomatology. 



c. Myoclonias and Fibrillary Twitchings 



Myoclonias. In the myoclonias there are dome contractions involv- 

 ing chiefly the muscles of the extremities and the trunk, the face usually 

 escaping. 



These clonic contractions affect muscles independently of synergisms. 

 They are sometimes confined to a single muscle that cannot be independ- 

 ently innervated by the will, such as the musculus brachioradialis. Xow 

 myoclonic contractions are sometimes met with in tetany, but they seldom 

 have the distribution of those seen in true paramyoclonus multiplex. 

 Moreover, myoclonic tetany is accompanied by the other signs of tetany. 



Fibrillary Twitcliings. Fibrillary and fascicular twitchings are some- 

 times observable in the muscles in cases of tetany and make one think of 

 some lesion irritating the anterior horns or the motor nuclei of the cerebral 



