It is of course in cases of spasm and other convulsive phenomena dependent on structural disease of nerve centres or conductors that such trophic disturbances are most liable to occur. Gaupp[152] has described a case of partial congenital myotonia localised in the muscles of the forearm and hand, and associated with atrophy, in a patient presenting certain stigmata of infantilism; but the condition can scarcely be classed with the tics. As for actual paralysis supervening on a tic, the case recorded by Grasset[153] of a young girl in whom a tic of the right leg was succeeded by a trailing movement of the same limb in walking can hardly be considered conclusive, inasmuch as such incidents usually indicate hysteria or functional disturbances akin to tonic tics. Biting tics are more apt to be accompanied by various sequelæ, such as mutilations, excoriations, ulcerations of all sorts. By constant nibbling at his lip J. produced an erosion of the mucous membrane, which became infected and developed into an ulcerative stomatitis. The accident, however, had a salutary effect on his tic. We may quote another illustration from the history of the same patient to show how complications may sometimes be of curative value. In January, 1901, in consequence of excessive cudgelling of one fist by the other, the back of the left wrist became inflamed and painful, but the bruise soon disappeared. In April of the same year, however, a large reddish ecchymosis made its appearance in the neighbourhood of the left elbow, with a painful swelling of the whole arm on the proximal side, and a few days later the discovery of a hard, cordlike mass along the border of the biceps made it clear that phlebitis had set in. With proper treatment the symptoms gradually diminished in intensity, but there can be no doubt of their origin in the reiterated violence of J.'s onslaught on his left arm. The immediate outcome of the event was to put a brake on his exuberant gestures, and although the impulse was still sometimes urgent enough to tempt him to recommence, the thought of his phlebitis and fear of the dangers of a relapse were sufficient to recall him to his senses. Apropos of complications the case of O. occurs to the mind, his biting tics ending in the premature loss of all his teeth, while his habit of rubbing his nose and his chin against the back of a chair led to the development of callosities. Tonic tics of the neck may in cases of long duration result in permanent deformities. Apart from such complications, the vast majority of the accidents that accompany tics are attributable to various concurrent affections. A case reported by Féré[154] of rotatory movements of the head passing some years later into the initial symptom of epileptiform convulsions ought not, in all probability, to be placed among the tics.