PARATHYROID GLANDS 679 



nerves. When these are associated with muscular weakness, or paralysis, 

 they may be very confusing (see below: Motor Paresis in Tetany). 



d. Tics and Habit Spasms 



It is characteristic of the tetany contracture that the persistent tonic 

 spasm lasts, usually, for hours or even longer. A tic is characterized, on the 

 other hand, by short, violent movements, frequently repeated. Occasionally 

 in tetany one sees spasms of brief duration that suggest a tic. Patients 

 with tic can temporarily resist the impulse, though they suffer marked dis- 

 comfort in doing so. The spasms in outspoken tetany cannot be controlled 

 by the will. Moreover, motor tics and habit spasms are not associated 

 with the other symptoms of tetany. 



e. Convulsive States (Fits) 



Fits, or convulsions, consist of violent motor discharges or explosions 

 that are, as a rule, associated with disturbance of consciousness. When the 

 fit is of cerebral origin, it may be psychogenic, as in hysterical attacks or 

 in psychasthenic fits; or it may be toxic, or epileptiform (non-psychogenic) 

 in nature. 



General convulsions, or fits, are sometimes met with in tetany and are, 

 apparently, sometimes actually due to the tetany itself. It must also be 

 remembered that tetany may occur in combination with other diseases that 

 cause fits. When tetany is demonstrably present, it may be exceedingly 

 difficult to say whether a fit is due to the tetany or to some complicating 

 disorder. Fits not due to tetany may closely resemble those that are due 

 to it. 



Hysterical Convulsions and Major Hysterical Attacks. Hysterical 

 contractures simulating the tonic contractures of tetany have already been 

 referred to above, but hysteria may also be the cause of a general con- 

 vulsive seizure that may be accompanied with loss of consciousness and 

 have associated with it contractures that are suggestive of tetany. The 

 influence of suggestion in producing, and in abolishing, the attacks is 

 helpful in differential diagnosis. I am inclined to think that some of the 

 cases reported as hysteria simulating tetany have been true combinations 

 of tetany with hysteria. With so many criteria now available for the rec- 

 ognition of tetany and parathyroid insufficiency, there should rarely be 

 any difficulty in deciding whether or not a true tetany exists in addition 

 to hysterical phenomena. 



Psychasthenic Fits. These have been described by Oppenheim, 

 Spiller, and others. They differ from both epileptic attacks and hysterical 

 attacks, appearing as attacks of unconsciousness, with or without convulsive 

 seizures, and often as equivalents of a psychasthenic anxious state. Some- 



