A young man of twenty-six suffered from melancholia and hypochondriasis. He used to complain that his limbs were hopelessly rotten, that his hands, feet, legs, were gone, vanished; his head and neck had ceased to exist. So easily was he irritated that to most questions he vouchsafed no answer. His sentiments of affection were much blunted; a visit from his mother evoked no pleasurable sensation. All day long he used to lounge on a couch, his head sunk on his breast, and inclined somewhat to the right. The attitude was exaggerated if he was addressed, but while he could raise his head, by the help of his hand, to regard his interlocutor, it resumed its position of flexion as soon as he withdrew the support. Confined to the left side of his face was a tic which consisted in abrupt and jerky elevation of the corner of the mouth. On request, he would gain his feet laboriously and walk with abdomen protuberant, back arched, and legs apart. From time to time the neck musculature on the left side was the seat of convulsive movements. The left sternomastoid and trapezius were in a state of tonic contraction, and on any attempt being made to correct this vicious attitude, spasm occurred, and the patient resisted to his utmost.On March 10, 1900, treatment was begun; an effort was made to gain the patient's confidence by explaining that a cure was within the bounds of possibility, and by demonstrating to him that his limbs, which were in a state of slight contracture, could be moved by his hand. The procedure was renewed three times a day, and followed by baths and massage.By April 15 the contractures had disappeared, and he could perform any movement of relaxation himself. His attention was now drawn more particularly to his head, which was still in a faulty position, and annoyed him considerably. Advantage was taken of an improvement in his tractability to make him perform some movements of his neck. At first the mere effort produced a spasmodic contraction, but he was able to move his head very slightly up and down. After five months of such treatment, occupying on an average three hours aday, his mental torticollis was finally reduced to subjection, an interesting feature of the case being the parallelism between the physical and the psychical improvement.On three occasions since we have noted a recurrence of the torticollis, but each time it has been both brief and easily overcome. The cure has been maintained now for upwards of a year, and four months ago the patient resumed his work.
A young man of twenty-six suffered from melancholia and hypochondriasis. He used to complain that his limbs were hopelessly rotten, that his hands, feet, legs, were gone, vanished; his head and neck had ceased to exist. So easily was he irritated that to most questions he vouchsafed no answer. His sentiments of affection were much blunted; a visit from his mother evoked no pleasurable sensation. All day long he used to lounge on a couch, his head sunk on his breast, and inclined somewhat to the right. The attitude was exaggerated if he was addressed, but while he could raise his head, by the help of his hand, to regard his interlocutor, it resumed its position of flexion as soon as he withdrew the support. Confined to the left side of his face was a tic which consisted in abrupt and jerky elevation of the corner of the mouth. On request, he would gain his feet laboriously and walk with abdomen protuberant, back arched, and legs apart. From time to time the neck musculature on the left side was the seat of convulsive movements. The left sternomastoid and trapezius were in a state of tonic contraction, and on any attempt being made to correct this vicious attitude, spasm occurred, and the patient resisted to his utmost.
On March 10, 1900, treatment was begun; an effort was made to gain the patient's confidence by explaining that a cure was within the bounds of possibility, and by demonstrating to him that his limbs, which were in a state of slight contracture, could be moved by his hand. The procedure was renewed three times a day, and followed by baths and massage.
By April 15 the contractures had disappeared, and he could perform any movement of relaxation himself. His attention was now drawn more particularly to his head, which was still in a faulty position, and annoyed him considerably. Advantage was taken of an improvement in his tractability to make him perform some movements of his neck. At first the mere effort produced a spasmodic contraction, but he was able to move his head very slightly up and down. After five months of such treatment, occupying on an average three hours aday, his mental torticollis was finally reduced to subjection, an interesting feature of the case being the parallelism between the physical and the psychical improvement.
On three occasions since we have noted a recurrence of the torticollis, but each time it has been both brief and easily overcome. The cure has been maintained now for upwards of a year, and four months ago the patient resumed his work.
We must impress ourselves with the importance of recognising the proneness of tics to relapse. Any triviality which may have a prejudicial effect on the patient's will-power is calculated to facilitate the reawakening of a bad habit. Such relapses are commonly transient, and are instructive in so far as their manifestation sometimes differs from the original tic and entails alterations in treatment.
L., for instance, whose condition was one of permanent rotation of the head to the right, had a fit of depression after eight days of treatment and noteworthy improvement, a depression so severe that she questioned the practicability of a cure, and forthwith her head began to turn to the right again. On this occasion, however, the tic was an intermittent one, consisting of clonic contractions of the cervical muscles chiefly, without antagonistic gesture. For five days the fit persisted, and was sufficiently acute to render omission of the exercises advisable.After some days' rest a beginning was made with the treatment again, under the direction of one of us and in the presence of her father. We took care to place ourselves always in front and to the left of the patient, on the side opposed to her torticollis. The position allotted her at table was such that in order to converse with her parents she had to turn to the left.Not long thereafter a second fit of depression occurred, but on this occasion her head began to rotate to the left. She had been under treatment for six weeks, when she made the remark one day that her head seemed once more to be drawn to the right. She hastened to add, moreover, that she had discovered a means of remedying the mischief—viz. by putting her left hand to her left cheek—a corrective proceeding nothing short of paradoxical.It was about this time that the pains and dragging sensations in the muscles of the neck subsided. On the other hand, for days on end, then for gradually diminishing periods, there existed a slighttrembling of the head, due to muscular exertion, and explicable by the contraction of small cervical muscles on one side and their antagonists on the other.
L., for instance, whose condition was one of permanent rotation of the head to the right, had a fit of depression after eight days of treatment and noteworthy improvement, a depression so severe that she questioned the practicability of a cure, and forthwith her head began to turn to the right again. On this occasion, however, the tic was an intermittent one, consisting of clonic contractions of the cervical muscles chiefly, without antagonistic gesture. For five days the fit persisted, and was sufficiently acute to render omission of the exercises advisable.
After some days' rest a beginning was made with the treatment again, under the direction of one of us and in the presence of her father. We took care to place ourselves always in front and to the left of the patient, on the side opposed to her torticollis. The position allotted her at table was such that in order to converse with her parents she had to turn to the left.
Not long thereafter a second fit of depression occurred, but on this occasion her head began to rotate to the left. She had been under treatment for six weeks, when she made the remark one day that her head seemed once more to be drawn to the right. She hastened to add, moreover, that she had discovered a means of remedying the mischief—viz. by putting her left hand to her left cheek—a corrective proceeding nothing short of paradoxical.
It was about this time that the pains and dragging sensations in the muscles of the neck subsided. On the other hand, for days on end, then for gradually diminishing periods, there existed a slighttrembling of the head, due to muscular exertion, and explicable by the contraction of small cervical muscles on one side and their antagonists on the other.
On more than one occasion we have remarked this trembling as the forerunner of a cure. It vanishes spontaneously as the amelioration of the patient's condition becomes more definite.
Several months may intervene between relapses. Descroizilles cites a case of convulsive movements of the head and shoulder of three years' duration, which yielded to exercises in a few weeks. The tic reappeared six months later, and, resisting treatment by gymnastic discipline, was cured by suspension. Three months later it returned once more.
Facts of this description emphasise the desirability of considering rapid cures with reserve; where the improvement, on the contrary, is insensible, the results are much more likely to be permanent. Unforeseen complications, again, may arise once a cure is affected.
One of our patients[231]had been rather quickly relieved of a mental torticollis by the usual therapeutic measures, and we had allowed him to resume his avocation, when he suddenly appeared in a depressed and despairing mood a month later to say that he was worse than ever. The rotatory tic had not returned, it is true, but its place was taken by another phenomenon. If, as he walked along with head straight, his attention was suddenly directed to the right, he seemed at once to become "crystallised"; he halted, and could not deviate his head as he wanted, and at the same moment something appeared to choke him; in three or four seconds all was over, and his action unimpeded. As a result of these attacks he sank into a wretched state of more or less permanent anguish. A visit to his country home was of little avail; no sooner had he arrived than his head began to twist about in every direction, although, try as he would, he could not move it backwards. We accordingly prescribed absolute rest in bed, a strict regime,hydrotherapy, and unfailing regularity in the performance of gymnastic exercises. Not long after a fresh torticollis developed, by which the chin was deviated to the left and the head tilted to the right. Once more we initiated a scheme of regular drill, and in the course of a short time a satisfactory cure ensued. During the last three years we have had frequent opportunities of seeing our patient, and can certify that he remains mentally and physically normal.
One of our patients[231]had been rather quickly relieved of a mental torticollis by the usual therapeutic measures, and we had allowed him to resume his avocation, when he suddenly appeared in a depressed and despairing mood a month later to say that he was worse than ever. The rotatory tic had not returned, it is true, but its place was taken by another phenomenon. If, as he walked along with head straight, his attention was suddenly directed to the right, he seemed at once to become "crystallised"; he halted, and could not deviate his head as he wanted, and at the same moment something appeared to choke him; in three or four seconds all was over, and his action unimpeded. As a result of these attacks he sank into a wretched state of more or less permanent anguish. A visit to his country home was of little avail; no sooner had he arrived than his head began to twist about in every direction, although, try as he would, he could not move it backwards. We accordingly prescribed absolute rest in bed, a strict regime,hydrotherapy, and unfailing regularity in the performance of gymnastic exercises. Not long after a fresh torticollis developed, by which the chin was deviated to the left and the head tilted to the right. Once more we initiated a scheme of regular drill, and in the course of a short time a satisfactory cure ensued. During the last three years we have had frequent opportunities of seeing our patient, and can certify that he remains mentally and physically normal.
Facts such as these teach us two things: the task of the physician is not ended with the disappearance of the tic, for it is the pathological mental state of the patient which renders him so easy a prey, and if we can modify that state by re-education, we may count on the cure being permanent. For a long time, however, we shall be well advised to talk simply of improvement. In the second place, relapse or slowness of progress is no reason for despair; treatment may have to be persevered with for a year or years, till the patient learns how his muscles act, how to maintain immobility, and how to effect a voluntary movement—notions which his fickle mind has hitherto neglected to grasp. Education of the will in the direction of control is calculated to bring him into line with normal individuals.
A radical cure is not without the bounds of possibility, but it depends greatly on the patient himself; his success is contingent on his faithful repetition of exercises long after the tic is gone; for while a cure results whenever the tic ceases to incommode its subject, fatigue or emotion on some future occasion may reawaken the tendency to involuntary movements, and only a methodically trained will can triumph over the temptation to relapse.
With this reservation, one may expect permanence in the cure, provided the affection is of recent date and the patient gives evidence of his assiduity and desire for relief.
Among various re-educational procedures which are worth mentioning for their practical value, a place must be given to what has been called mirror drill by one of us.
We all know that the term mirror writing is in use to specify that mode of caligraphy which looks exactly like ordinary writing when it is reflected in a mirror or if the paper is held to the light and seen from the reverse side. Mirror handwriting may be done with either hand. If the right hand be employed, the characters are traced from right to left and are centripetal in relation to the axis of the body. If, on the contrary, it is the left hand that we use, the letters go from right to left, but they are centrifugal.
Innumerable examples of this condition have been described and various theories elaborated. Apart from such cases, it is a matter of common observation that if any one be asked to write synchronously with the two hands, his left hand will tend spontaneously to adopt the mirror form.[232]The experiment may be tried on some one who has never made the attempt to write with the left hand, and has never heard of mirror writing. Ask him to abandon his left hand completely to the movements it may be constrained to fashion while the right hand is tracing the required words, and let his eyes be closed; in practically every case the left will make mirror characters. It may therefore be contended that mirror writing is the natural writing of the left hand, an opinion supported by Vogt, Durand, etc., and more recently by Ballet,[233]who remarks thatthis variety of writing for the left hand is natural in left-handed people who have not been influenced by education.
The actual form of the characters is of little significance. We have often repeated the experiment and substituted Greek, German, typographic and stenographic letters, but always with the same result. It is perhaps worthy of note that in simultaneous writing considerable modification of the letters traced by the right hand occurs; they become hesitating and childish; the lines are sinuous and irregular, and the characters themselves ill distinguished. The same holds good for drawings.
On the other hand, the first attempt of the left to make mirror writing to order is frequently laborious. Mingled with true mirror characters will be found ordinary letters automatically traced, for automatism of left-hand movements is not the inevitable sequel of automatism of right-hand movements. From time to time the visual image of a normal letter rises in the mind, an image which does not correspond to that which the hand is endeavouring to express, whence doubt, reflection, arrest, and, usually, error. If, however, the subject allows his left hand to write, without preoccupying himself with the shape of the letters it is making, or with his eyes shut, automatism reasserts its sway and mirror writing results.
Of course a person who is asked for the first time to use his left hand in writing may force himself to trace ordinary characters, but to do so he must evoke the visual image of each letter and seek to reproduce the contours of this image slowly, yet often inaccurately. There is nothing automatic in this. Hence it is that ordinary writing with the left hand demands prolonged education and patient effort, and may never attain any rapidity, whereas mirror writing with the samehand is acquired with facility in a more or less automatic manner.
It may well be that the natural left-hand mirror writing of which we are speaking is a purely motor phenomenon, since the calling up of the visual images of letters, so far from proving of assistance, is calculated rather to obscure and hamper it.
It has been pointed out by Ballet that variations in the aptitude for left-hand mirror writing exist, especially in the case of those who cannot write without the aid of the visual image of letters. Since they copy this image in using the right hand for caligraphical purposes, they are tempted to do the same when the left is in use. In fact, the facility with which one learns mirror writing seems to depend on one's power of writing without recourse to these images. The explanation of the ease with which the left hand reproduces, in the guise of mirror writing, the movements of the other, is to be sought in the symmetrical arrangement of the muscles in relation round the body axis. Physiologists tell us, further, that the simultaneous contraction of two symmetrical muscles is more readily attained than that of two asymmetrical muscles. The law of symmetry and the law of least effort correspond.
What is true of writing is no less true of all other forms of motor activity. In physical exercises the surest results are achieved by the synchronous contractions of symmetrical muscles, whereas education is much more arduous should this lesson from experience be ignored. For instance, nothing is easier than to make the arms describe circles in the same direction, but rotation in opposite directions is very difficult. Few people can revolve their thumbs in opposite ways. This is a matter of common observation among teachers of physical culture. The rapidity with which the action of swimming can be learned is in strikingcontrast to the slowness with which the art of fencing is apprehended. Little effort is required of the music beginner if his pianoforte exercises demand the activity of symmetrical muscles for their execution; on the other hand, the playing of a scale by the two hands in unison comes only with long practice, since it entails the simultaneous use of asymmetrical muscles.
Facts such as these are of more than passing interest. One cannot afford to neglect their import where muscular education is concerned, whatever be its nature, whatever be its object. Yet there is an unfortunate tendency to concentrate attention on the development of the skill of one arm only, and that the right. Sometimes the use of the left arm for certain purposes is criticised adversely, and of course most people are congenitally less able to work with it. But habit, example, and even fashion, combine to render the right arm preponderant in everything, to the detriment of the other. It is a common occurrence to attribute awkwardness to this left arm, when its inferiority is really nothing else than a sign of faulty education. In many cases the left is as good as the right; its apparentgaucherieis because of its attempt at executing movements which are similar to those of the right, instead of those which are correspondingly opposite.
Thus experience shows that the education of the right upper limb is reflected on the left upper limb, although the subject may be sublimely ignorant of the fact. But though this influence be latent, it is none the less real, and may prove of service if occasion arise. Weber, Fechner, and Féré[234]have all devoted attention to this subject.
From the therapeutic point of view, considerable significance attaches to these facts. Temporary disablementof the right arm, such as follows fracture or arthritis or writers' cramp, need not be disconcerting, for the patient can proceed to utilise the faculty for mirror writing which his left hand has unconsciously acquired. In all affections which are accompanied by troubles of motility it is an excellent plan to apply the prescribed muscular exercises to both sides of the body, and the regularity with which they are performed on the sound side will have a corrective influence on the mirror movements of the affected side. We assume, of course, that there is no irremediable destructive lesion which interferes with the continuity of paths joining functional centres, otherwise the education of the normal limbs could not be expected to produce any beneficial effect on the other. It is especially in motor disorders of functional origin that mirror movements prove useful, and the frequent unilaterality of these disorders readily allows of the institution of a re-educative mirror drill. Speaking generally, the faculty of writing supplies us with the best means of attaining our end, for the variety of exercises it offers is likely to rivet the patient's attention, and he has proofs of his progress under his eyes. The goal in view is not, of course, the attainment of caligraphical perfection—the subjects of tic are seldom guilty of bad penmanship; but the execution of the required movements demands a voluntary constraint that cannot but be profitable.
After the séances of absolute immobility, then, our custom is to set daily exercises in writing, drawing, painting, tracing, ornamentation, etc., varying the indications in accordance with individual tastes and aptitudes. At the same time, we insist on the patient's devoting both hands simultaneously to his task. It will be found advantageous to devise movements for the fingers, then for the hand, the forearm, and so on, and to instruct him in each successively. Thus, one maybegin by having him make the movements in space, then with chalk on a blackboard placed vertically, then on the same placed horizontally, or on the ground; or he can be asked to trace symmetrical designs and ornaments on a wall. The essential points are that he use both arms simultaneously, symmetrically, and accurately, and that all inopportune gestures be inhibited.
In several of our cases procedures such as these have been adopted. O. was not long in acquiring the faculty of writing with both hands, the left tracing mirror characters. The object of the exercise was to oblige him to maintain tranquillity and a correct position of his head and neck, while his hands were simultaneously employed. By this means, as well as by synchronous drawing exercises, he soon became so deft that he learned to conserve almost complete immobility during the performance, to his great satisfaction. No less creditable results were attained with L. and with young J.
The method appears to us to be indicated above all in cases where the left arm is the seat of tic. Any one who can use a pen with his right hand is not long in acquiring the faculty of mirror writing with his left. In this way the simultaneous execution of a normal movement with right hand and left is facilitated, and the sound limb imposes regularity on the other. Whatever be the localisation of the tic or tics, this is the technique to adopt. It presents this advantage, that its combinations and permutations serve to stimulate the patient's interest, and he, at the same time, is required to keep a watchful eye on his involuntary actions; so is his will disciplined.
In the majority of cases absolute rest in bed is not desirable, but a youthful patient should always be sentto bed early, and be allowed to lie long; twelve hours in bed is not excessive. This rule is one which must not permit of exceptions; whatever be the excuses invented by the parents, we should see that it is rigorously obeyed. Two or three hours' rest some time in the course of the day may be enjoined, provided the period be fixed and uninterrupted. To break in on frequent siestas with little promenades or with times of unrest is not productive of any good.
If it is impossible to maintain discipline during the day, absolute rest in bed for a longer or a shorter period may be counselled; the sedative effect of this measure cannot be gainsaid, especially when, for no apparent reason, exacerbations develop, with increase of emotional, obsessional, or other psychical phenomena.
Isolation is a rather severe proceeding, which, however, one must not hesitate to utilise in rebellious cases, or if the patient's mental state precludes the possibility of prolonged application of systematic discipline. Wyemann[235]cites a successful case, where a youth of seventeen, with a bad family history, suffered from convulsive movements in association with coprolalia, and was cured of the latter by isolation. Some would even recommend the removal of the patient to a hospital for mental disease. Such a step, however, is rather premature, for he may already have begun to improve where he happens to be, and it is not always certain that a sojourn of this character will be beneficial.
Before isolation is resorted to, it is important to familiarise oneself with the patient's mode of life, toascertain whether it is capable of modification in accordance with one's ideas for treatment, and to determine the exact influence of his environment on him. We have frequently had occasion to remark how potent is this environment as an etiological factor; with young people, in particular, negligence on the part of parent or guardian places the child in jeopardy. To combat this unfortunate tendency must be our aim, as soon as we are convinced of the risk.
Sometimes it is sufficient to draw the attention of the parents to the disastrous consequences of indulgence or indifference; but we shall show our wisdom in not relying too much on promises, however sincere and solemn. These parents may be perfectly honest in their protestations, but they are often as changeable and weak as their offspring, and lack that very firmness and perseverance which they imagine themselves capable of exhibiting. Thus, in spite of their undoubted intelligence and good will, their efforts at control are unsatisfactory, and under such circumstances the withdrawal of the patient from his family circle is urgently indicated.
We cannot think, nevertheless, that the asylum is the ideal—there is risk in the contiguity of other neuropaths or psychopaths; and while the value of rigorous isolation consists in its stimulating and quickening effect on the patient's self-control, whereby the day of his return to ordinary life is hastened, yet it too frequently happens that the old temptations are as powerful as of yore, and that the same causes which operated when his tics first made their appearance reawaken vicious tendencies more or less imperfectly masked.
Most subjects learn to still their tic during the physician's brief visit; further, most achieve a similar result while they remain inmates of a special institution;but as soon as they find themselves in their old quarters, so soon does the impulse to tic dominate them again. In fact, their victory is incomplete; the ground they gain is not held. The goal to strive after is the repression of their tic under all conditions, apart from extraneous intervention and influence. Once he has been instructed in the methods of inhibition, thetiqueurhas no one but himself to fall back on when face to face with the allurements of his daily life.
These reserves made, it is clear that removal of the patient from his environment has its advantages, but it is better to maintain only a degree of isolation, and to allow him to come into his own circle from time to time, under a wise supervision. The ideal measure would be to consign him to the care of an attentive and devoted teacher, whose superintendence would be permanent. In this respect, unfortunately, all that we can do at present is to indicate what we think a desideratum, for while well-to-do families may have their tutor, we do not know of any one who has held a corresponding office as an instructor of children with tic. The realisation of this novel proceeding might present genuine difficulties in practice, but we may hope that once parents, patients, and physicians are acquainted with the nature of tics and the efficacy of the re-education method, many prejudices against that fruitful therapeutic contrivance will vanish.
Immobilisation and regulation of exercise and occupation do not constitute the whole of the treatment; they form merely its objective side. Psychotherapy is another factor, of capital importance.
In the words of Brissaud, psychotherapy is anensembleof agencies calculated to demonstrate to the patient where his will is at fault, and howto exercise to the best advantage what of it is left. To come to particulars, his defect lies in his inability to check a cortical caprice. These are not rhetorical unrealities, nor is there anything mysterious about the method; it demands no special competence beyond the gentle and encouraging firmness of the ideal teacher. The physician can constitute himself instructor without having to borrow from the more or less occult practices of hypnotic suggestion. In fact, we must make it clear to the patient that the co-operation of the latter is indispensable, and that it is his will which is to come into action. The personal influence of the teacher will be exerted in sustaining his pupil's efforts, in making him take note of the progress effected, in keeping him to the allotted times for exercise and drill.
In the words of Brissaud, psychotherapy is anensembleof agencies calculated to demonstrate to the patient where his will is at fault, and howto exercise to the best advantage what of it is left. To come to particulars, his defect lies in his inability to check a cortical caprice. These are not rhetorical unrealities, nor is there anything mysterious about the method; it demands no special competence beyond the gentle and encouraging firmness of the ideal teacher. The physician can constitute himself instructor without having to borrow from the more or less occult practices of hypnotic suggestion. In fact, we must make it clear to the patient that the co-operation of the latter is indispensable, and that it is his will which is to come into action. The personal influence of the teacher will be exerted in sustaining his pupil's efforts, in making him take note of the progress effected, in keeping him to the allotted times for exercise and drill.
Thus, and thus only, is psychotherapy to be applied to tic. Lucid and sincere explanations and kindly counsels are wanted, not ceremonies and mysterious paraphernalia. Resoluteness, patience, clemency, and good sense are the weapons in the physician's armamentarium; docility, faith, and perseverance, on the patient's part, will enable him to emerge victorious. As soon as the compact is made, the battle against bad habits, where there is neither truce nor quarter, commences in earnest. The victim to tic will speedily unlearn the habit of perpetuating bad habits; he will, in addition, learn the habit of not contracting bad habits. In this way a double benefit—physical as well as moral—will accrue.
As a consequence, psychotherapeutical treatment directed specially to the subject's mental condition is scarcely necessary. The plans adopted to inhibit inopportune motor manifestations will prove of value for psychical imperfections.
Education might almost be considered a species of prophylactic treatment, intended to obviate the possible development of tics. Bourneville has verified this statement in his experience at Bicêtre:
Gymnastic exercises, and other measures directed towards the development of the child's faculties, ought to be conducted with kindness andgentleness, and by the aid of boundless devotion and patience the methods of the authorities are bearing unexpected fruit every day. We are convinced that the infrequency of tic in such as have reached puberty is attributable rather to the zealous application of a sound pedagogical method than to anything connected with the age and physical development of the child.
Gymnastic exercises, and other measures directed towards the development of the child's faculties, ought to be conducted with kindness andgentleness, and by the aid of boundless devotion and patience the methods of the authorities are bearing unexpected fruit every day. We are convinced that the infrequency of tic in such as have reached puberty is attributable rather to the zealous application of a sound pedagogical method than to anything connected with the age and physical development of the child.
Results that steadfast and patient nurses and teachers are obtaining in an institution like Bicêtre may surely be obtained by the physician in his private practice, if the parents of a youthful candidate for tic would appreciate the importance of discipline and unite, intelligently and assiduously, in the task of education. How common it is to find them solicitous only of loading his tender brain with learning, instead of endeavouring, with all their mind and heart, to restrain deplorable bad habits that may one day blossom into tics, to the distress of all concerned! The physician's earliest duty is to warn the parents of the dangers of indifference, and thereafter to install himself as teacher, if the disease should manifest itself in spite of his precautions. He has no choice in the matter, and he should have the frankness to say so, indicating at the same time on what his convictions rest. He need have no fear of damaging his professional prestige by the simplicity of his methods. Let him not promise what he may not be able to perform; encouragement, not deception, must be his watchword. Along these lines lies his duty as a physician; there, too, will he find that his treatment will be fraught with success.
Les tics et leur traitement, of which an English translation is here presented to the medical profession, was published at the close of the year 1902. In it our knowledge of the vexed subject of tics and spasms has been summarised and reviewed, and its reception in France, together with the fact of its having been translated into German without delay, prove that it has been regarded as the standard work on a topic the importance of which is being daily emphasised. At all the recent Congresses on the Continent the tics in one or other of their aspects have provided fruitful matter for discussion, whereas in England they have hitherto been greatly neglected. In the brief space of time that has elapsed since the book was produced there have been many and varying contributions to the subject, as a reference to the Bibliography herewith appended will show. Without doubt the reawakening of interest is in considerable measure due to the stimulus provided by the labours of MM. Meige and Feindel, yet it cannot be maintained that they have said the last word. In order that English readers may have before them the latest available information on the tics, various paragraphs from Meige's monograph (1905) have been incorporated, as has already been remarked in the Prefatory Note.
It is desirable, however, to indicate briefly certain points on which opinion is still divided, points on which the results of the most recent observations help to shed some light. Probably it has not escaped the reader's attention that the authors have with commendable wisdom refrained from dogmatising on some of these, although they are always able to give reasons for their adherence to one or other view. But in one respect at least the attitude which they have adopted has been unmistakable,and that is in regard to the fundamental importance of agreement in the matter of terminology.
The amount of misconception that exists about what constitutes a tic is almost beyond credence; indeed, only those who have had occasion to examine the literature can have any adequate idea of it. Discussions at neurological and other societies not infrequently reveal how vague are the notions of many who must have more than a passing acquaintance with the disease clinically. Now, a great deal of this misconception would disappear if the distinction between a tic and a spasm elaborated by Brissaud were adhered to, as the authors so strenuously advocate. It is quite unnecessary to insist further on this point, but, on the other hand, it is only fair to state that even in France the views of Brissaud, Meige, and Feindel do not command universal acceptance.
M. Cruchet, of Bordeaux, to whom frequent reference is made in this volume, has in several communications on tic expressed himself at some length, and some of these have made their appearance since the publication ofLes tics et leur traitement. According to him, the original meaning of the word "tic" is a movement arising in a "bad habit," and there would never have been any confusion had the term "tic douloureux" not been introduced. We know well enough the exact significance of this term, but its use led to, the adoption of the cognate term "tic non-douloureux," and in the latter group two absolutely different conditions have been confused—viz. true tics, and spasms in Brissaud's sense. The difference between the two is now recognised everywhere in France; but in England and America, as Risien Russell points out in his article in Clifford Allbutt'sSystem of Medicine, tic is still applied to such conditions as facial spasm and the involuntary movements of trigeminal neuralgia, whereas it should be reserved for what we usually call "habit spasm" and "habit chorea." The advantage of the word "tic" over these rather cumbrous terms must be patent to the unbiassed mind.
It is, however, in his persistent affirmation that a tic, to be a tic, must be clonic, that Cruchet disagrees with the tenets of Meige and Feindel. He has abandoned the use of the term "organic tic" in favour of spasm; and he maintains that"tonic tic" and "tic of attitude" should give place to "habit attitude" and "convulsive attitude," as the case may be. His definition of tic is in the following terms:
Tic consists in the execution—short, abrupt, sudden, irresistible, involuntary, inapposite, and repeated at irregular but frequent intervals—of a simple isolated or complex movement, which represents objectively an act intended for a particular purpose.
Tic consists in the execution—short, abrupt, sudden, irresistible, involuntary, inapposite, and repeated at irregular but frequent intervals—of a simple isolated or complex movement, which represents objectively an act intended for a particular purpose.
Curiously enough, however much this definition emphasises the clonic element in tic, Cruchet makes a subdivision into habit tics and convulsive tics, of which the former "are exactly comparable to normal movements, except that they are involuntary at the moment of their execution, are performed for no reason or purpose, and their frequency is unusual." Their difference from convulsive tics is merely one of degree; a habit tic may become a convulsive tic, and some are convulsive from the beginning. A habit tic, if the movement be a slow one, is closely allied to the "attitude"; and it is not always practicable to draw a distinction between them.
Thus Cruchet himself admits that the clonic element in tic may be minimal, so that the differences between him and our authors are by no means so insuperable as might be imagined. What he calls a habit tic is equivalent to the stereotyped act of the others, who hold, it will be remembered, that the movement of tic differs from the normal movement not merely by being involuntary, irresistible, inapposite, and so on, but also by being exaggerated.
It cannot be denied that in many cases of tic this exaggeration of the normal movement is anything but obvious; many conform absolutely to the definition of Meige and Feindel, except that the movements are not violent, or grotesque, or "caricatures." To withhold the term "tic" on this account would be rather unfortunate, especially since no standard exists whereby to estimate exaggeration. Enough has been said, however, to demonstrate how insignificant are the discrepancies between the rival definitions.
Another question recently raised by Cruchet is the possibility of the persistence of tic during sleep.
The evidence he has adduced in favour of this has now beenaccepted, as far as tics of the neck are concerned, by Meige. They are leas abrupt and less frequent, it is true; otherwise, they are identical with the movements of the waking hours. A case of a hiccoughing tic persisting in sleep has come under my own observation within the last few months. Now, it is not difficult to understand that a movement such as tic, which occurs during the conscious state in spite of the will of the subject, may arise when consciousness is diminished. In fact, one wonders why they are not more frequently remarked, seeing that they are habitual movements, and habit movements are by no means uncommon in sleep. It is highly probable, of course, that the observation of the watcher is not minute enough, but there is another reason. The peculiarity of all, or almost all, of these habitual movements in sleep is that they are rhythmical—we may instance the head nodding and head rolling of children; but it is a noteworthy fact that they are often regulated by respiration. When it is recalled how respiratory drill is eminently calculated to diminish the frequency and lessen the severity of very many tics, it will be admitted that the regularity of the respiratory movement in sleep is the most likely explanation of the infrequency of tic during that period.
One other matter may be shortly alluded to. In Cruchet's terminology, a tic is an anomalous gesture, and cannot be applied to an anomalous attitude, since the latter is tonic rather than clonic. For an anomaly of attitude he suggests the use of the word "deformity." Hence "habit deformity" is comparable to habit tic, and "convulsive deformity" to convulsive tic. As a habit tic may develop into a convulsive tic, so a habit torticollis may degenerate into a convulsive torticollis. There is no reason why the operation of habit as a factor should not effect the latter transformation exactly as it does the former; and as habit is held to be a psychical phenomenon, it is easy to conceive why the term "mental torticollis" should have arisen, and been so widely accepted. But it will be readily understood that while Cruchet affirms that no mental torticollis can ever be a tic, in his sense of the word, this is due solely to his refusal to consider any movement which is tonic as partaking of the nature of tic. In all other respects, the description which he gives of mental torticollis shows that it is nought else than a tic in Meige's sense.
In an article on convulsive torticollis which has been contributed by Meige to thePratique medico-chirurgicale(1907) he emphasises afresh the distinction between torticollis-spasm and torticollis-tic. The former is provoked by an irritative lesion in the motor nerves supplying the muscles of the neck, or in their nuclei of origin, and the character of the contractions ("contracture frémissante" [Meige], "contractions parcellaires," "contractions paradoxales" [Babinski]) in a definite peripheral nerve area is not likely to be mistaken. In other cases the objective phenomena distinctive of spasm are awanting: the characteristics of tic, on the contrary, are conspicuously present, and among these cases, where psychical disturbance plays a preponderant rôle, are to be found those described by Brissaud as mental torticollis.
It is to be noted that these writers alike decry the surgical treatment of torticollis, and perhaps not without good reason. Nevertheless the method must not be condemned on theoretical grounds merely, and it is permissible to believe that their experience may have been unfortunate. The records of the National Hospital provide many instances of surgical interference in torticollis and allied conditions of the neck, the results of which make one hesitate in expressing a dogmatic opinion. It is, however, impossible to enlarge further on the subject in this place.
S. A. K. WILSON.
[In one or two instances, where the original paper has been inaccessible, its title is reproduced as given in the French edition, but in brackets. Through the kindness of M. Cruchet, of Bordeaux, I have seen the proofs of his new volume of 800 pages onLes torticolis spasmodiques, which is at present in the press (Masson: Paris). It is a splendid monograph on the subject, and contains many references to the literature.—S. A. K. W.]
ABADIE ANDDUPUY-DUTEMPS, "Hémispasme facial guéri par une injection profonde d'alcool,"Société de neurologie de Paris, February 1, 1906.
ABT, "Spasmus Nutans,"Journal of the American Medical Association, February 3, 1900, p. 269.
ACHARD ANDSOUPAULT, "Tremblement héréditaire et tremblement sénile,"Gazette hebdomadaire, April 22, 1897, p. 373.
AIMÉ, "Un cas de tic élocutoire guéri par la méthode de rééducation et d'entraînement,"Revue médicale de l'Est, January 1, 1901, p. 25.
—— "Traitement de certains tics considérés comme des syndromes émotionnels,"Revue de psychologie clinique et thérapeutique, September, 1901.
ALDRICH, "Tic,"Medical Record, July 30, 1904, p. 169.
ALLARD, "Tics chez les aliénés,"Thèse de Lyon, 1886.
D'Allocco, "Parecchi casi di mioclonia, la maggior parte familiari,"Riforma medica, 1897, p. 223.
ALTHAUS, "Two Cases of Wryneck successfully treated by Electricity,"Medical Times and Gazette, May 25, 1861, p. 544.
AMUSSAT, "Torticolis datant de six ans; section du muscle sternomastoïdien; guérison,"Gazette médicale, 1834, p. 829.
ANDERSON, "Sternomastoid Torticollis,"Lancet, January 7, 1893, p. 9.
ANDRIANJAFY, "Le Ramanenojana à Madagascar (choréomanie d'origine palustre),"Thèse de Montpellier, 1902.
ANNANDALE, "Case of Spasmodic Wryneck successfully treated by Division of the Spinal Accessory, after Failure of Stretching,"Lancet, April 19, 1879, p. 555.
(Contains references to early literature.)
APPLEYARD, "Spasmodic Torticollis treated by Neurectomy,"Lancet, January 2, 1892, p. 26.
ASTOLFONI.SeeDOSE.
AUSCH, "Zur Casuistik des Spasmus Nutans,"Archiv f. Kinderheilkunde, Bd. 28, Hft. 3-4, 1899, p. 161.
BABES, "Myokymie in einem Falle von Bleilähmung,"Neurologisches Centralblatt, 1897, p. 684.
BABINSKI, "Contribution à l'étude du torticolis spasmodique,"Société de neurologie de Paris, February 1, 1900.
—— "Hémispasme et torticolis spasmodique,"Société de neurologie de Paris, July 4, 1901.
—— "Sur la paralysie du mouvement associé de l'abaissement des yeux,"Société de neurologie de Paris, June 7, 1900.
—— "Hémispasme facial périphérique,"Société de neurologie de Paris, April 6, 1905.
—— "Spasme du trapèze droit et tic de la face,"Société de neurologie de Paris, July 6, 1905.
—— "Hémispasme facial périphérique,"Nouvelle iconographie de la Salpêtrière, July-August, 1905, p. 419.
BALLANCE, "A Case of Spasmodic Wryneck treated by Excision of a Portion of the Spinal Accessory Nerve,"St. Thomas's Hospital Reports, vol. xiv. 1884, p. 95.
BALLET, "Tic non douloureux de la face datant de trente-sept ans, guéri par une paralysie faciale,"Société de neurologie de Paris, July 4, 1901.
—— "L'écriture de Leonard de Vinci; contribution à l'étude de l'écriture en miroir,"Nouvelle iconographie de la Salpêtrière, 1900, p. 597.
BALLET ANDROSE, "Spasme fonctionnel chez un ciseleur,"Société de neurologie de Paris, June 2, 1904.
BALLET ANDTAGUET, "Tic inhibitoire du langage articulé datant de l'enfance,"Société de neurologie de Paris, November 9, 1905.
BARR, "Some Notes on Echolalia, with the Report of an Extraordinary Case,"Journal of Nervous and Mental Disease, 1898, p. 20.
BASTIANELLI, "Sopra un tipo di mioclonia fibrillare,"Rivista di psicologia, psichiatria e neuropatologia, vol. i. fasc. 3, June, 1897. p. 33.
BATTELLI.SeePRÉVOST.
BAYLAC, "Un cas de torticolis mental ou tic du typographe,"Archives médicales de Toulouse, November 1, 1903, p. 481.
BEARD, "Experiments with the 'Jumpers' or 'jumping Frenchmen' of Maine,"Journal of Nervous and Mental Disease, 1880, p. 487.
BECHTEREW, "Ueber die psychischen Schluckstörungen,"Neurologisches Centralblatt, 1901, p. 642.
—— ["Sur deux cas de tic de la face,"]Oborenje psychiatrii, 1899, No. 12.
—— "Eine Neurose unter dem Bilde tonischer Intentionszuckungen,"Monatsschrift f. Psychiatric u. Neurologie, May, 1905, p. 460.
BEDUSCHI ANDBOSSI, "Sulla patogenesie del cosidetto torcicollo mentale,"Archivio di ortopedia, 1903, fasc. 2, p. 81.
BENEDIKT, "Zwei Fälle von Torticollis,"Wiener medicinische Wochenschrift, 1888, p. 1613.
—— "Ueber den Begriff 'Krampf,'"Wiener medicinische Wochenschrift, 1895, p. 505.
BENNET, "Case in which attacks of Intermittent Tonic Muscular Spasms, immediately followed by complete temporary Paralysis, have frequently and periodically occurred during the entire Life of the Patient, the Health in the Intervals being normal,"Brain, January, 1885, p. 492.
BERG, "Einige Reflexionen über die operative Behandlung des Torticollis spasticus,"Nord. med. Archiv., 1905, afd. 1, nr. 2, p. 1.
BÉRILLON, "Le traitement psycho-mécanique de la chorée, des tics, et des habitudes automatiques,"Société d'hypnologie et de psychologie de Paris, July 16, 1901.
BERLAND, "Traitement par le tartre stibié d'une forme de chorée dite électrique,"Thèse de Paris, 1880.
BERNARD, "Myoclonie du type Bergeron chez un dégénéré hystérique,"Nouvelle iconographie de la Salpêtrière, July-August, 1901, p. 316.
BERNHARDT, "Ein ungewöhnlicher Fall von Facialiskrampf (Myokymie) beschränkt auf das Gebiet des linken Facialis,"Neurologisches Centralblatt, 1902, p. 689.
BERTRAND, "Sur un cas de paramyoclonus multiplex,"Revue de médecine, November 10, 1902, p. 941.
BETTRÉMIEUX, "Contribution a l'étude des névralgies et des tics de la face considérés dans leurs rapports avec un état pathologique des voies lacrymales,"Archives d'ophtalmologie, April, 1899, p. 246.
BÉZY, "Laryngospasme et signe du facial chez les enfants,"Archives médicales de Toulouse, March 15, 1903, p. 121.
BIANCONE, "Contributo clinico allo studio della miokimia,"Rivista sperimentale di freniatria, 1898, p. 313.
BINETTI, "Contributo allo studio delle nevrosi professionali,"Gazzetta degli ospedali e delle cliniche, July 7, 1901, p. 844.
BITTORF, "Ein Beitrag zur Lehre von den Beschäftigungsparesen,"Münchener medicinische Wochenschrift, July 4, 1905, p. 1278.
BLACHE, "Chorées graves; guérison rapide par les massages et la gymnastique méthodique appliqués,"Gazette hebdomadaire, 1864, p. 787.
BOMPAIRE, "Du torticolis mental,"Thèse de Paris, 1894.
BONNET DEMALHERBE, "Tic rotatoire de la tête et du cou,"Union médicale, 1876, p. 340.
BONNIOT.SeeLEVI.
BONNUS, "Spasme fonctionnel du triceps sural gauche chez une harpiste jouant de la harpe chromatique,"Société de neurologie de Paris, May 5, 1904.
—— "Crampe des écrivains et torticolis d'origine mentale,"Nouvelle iconographie de la Salpêtrière, May-June, 1905, p. 285.
BOOTH, "Toxic Tremor and Hysteria in a Male,"New York Neurological Society, November, 1897.
BORCHARDT,Der Schreibkrampf und die ihm verwandten Bewegungsstörungen; ihr Entstehung, Bedeutung, und zwecktmässige Behandlung, Berlin, 1904.
BOSSI.SeeBEDUSCHI.
BOUCARUT, "Observation de tremblement hystérique,"Revue de médecine, July, 1904, p. 601.
BOULENGER, "Tic clonique et tonique,"Journal de neurologie, 1904, p. 132.
BOURNEVILLE ANDNOIR, "Idiotie congénitale; atrophie cérébrale; tics nombreux,"Archives de neurologie, 1893, p. 228.
BREITMANN, "Contribution à l'étude de l'écholalie, de la coprolalie et de l'imitation des gestes chez les dégénérés et les aliénés,"Thèse de Paris, 1888.
VANBRERO["Le latah, névrose des Indes néerlandaises"],Allgemeine Zeitschrift f. Psychiatrie, 1895, p. 939.
—— ["Observations sur les affections mentales des populations de l'archipel malaisien"],Allgemeine Zeitschrift f. Psychiatrie, 1896, p. 24.
BRESLER, "Beitrag zur Lehre von der Maladie des Tics convulsifs (mimische Krampfneurose),"Neurologisches Centralblatt, 1896, p. 965.
BRIAND, "Tics" (Congrès de Limoges),Revue neurologique, August 30, 1901, p. 790.
BRIGNONE, "Paramyoclonus multiplex,"Riforma medica, 1886, p. 1155.
BRISSAUD, "Tics et spasmes cloniques de la face,"Journal de médecine et de chirurgie pratiques, January 25, 1894.
—— "Tics et spasmes cloniques de la face,"Leçons sur les maladies nerveuses, 1resérie, 1895, p. 502.
—— "Contre le traitement chirurgical du torticolis mental,"Revue neurologique, January 30, 1897, p. 34.
—— "Chorée variable,"Presse médicale, February 15, 1899.
—— "La chorée variable des dégénérés,"Revue neurologique, 1896, p. 417.
—— "La chorée variable des dégénérés,"Leçons sur les maladies nerveuses, 2esérie, 1899, p. 516.
BRISSAUD ANDFEINDEL, "Sur le traitement du torticolis mental et des tics similaires,"Journal de neurologie, April 15, 1899.
BRISSAUD ANDMEIGE, "Trois nouveaux cas de torticolis mental,"Revue neurologique, December 10, 1894, p. 697.
—— —— "Tics, stéréotypies, aërophagie, catatonisme,"Société de neurologie de Paris, January 15, 1903.
—— —— "La discipline psycho-motrice,"Archives générales de médecine, May 26, 1903, p. 1319.
Brissaud, Hallion, and Meige, "Acrocyanose et crampe des écrivains,"Archives générales de médecine, September 15, 1903, P. 2305.
Brissaud, Sicard, and Tanon, "Essai de traitement de certains cas de contractures, spasmes, et tremblements des membres par l'alcoolisation locale des troncs nerveux,"Revue neurologique, July 30, 1906, p. 633.
Brouardel and Lortat-Jacob, "Aërophagie, hoquet hystérique,"Gazette des hôpitaux, October 25, 1902, p. 1191.
BROWN(SANGER), "A Neurologic Clinic; Spasmodic Torticollis, etc.,"Medical Standard, March, 1904.
BRUANDET, "Un cas d'hémispasme facial,"Revue neurologique, 1900, p. 658.
BRUEL, "Traitement des chorées et des tics de l'enfance,"Thèse de Paris, 1906.
BRUNON, "Tics et tiqueurs,"Normandie médicale, 1892, p. 169.
BUCHANAN, "Two Cases of Spasmus Nutans,"Annals of Ophthalmology, July, 1905, p. 435.
BUCK, "Quelques réflexions sur un cas de spasme fonctionnel du cou; torticolis spasmodique; tic rotatoire,"Belgique médicale, 1897, No. 51.
—— "A propos d'un tic,"Journal de neurologie, 1903, No. 6.
BÜHRER, "Ueber einen Fall von Unverricht'scher Myoclonie,"Correspondenzblatt f. Schweizer Aerzte, April 1, 1901, p. 201.
BURZIO, "Contributo clinico allo studio delle mioclonie,"Annali di freniatria, 1898, p. 165.
BUSS, "Beitrag zur Lehre von der Aetiologie des Tic convulsif,"Neurologisches Centralblatt, 1886, p. 313.
BUZZARD, "Case of Clonic Spasms of Neck and Shoulders treated by Liquor Arsenicalis,"British Medical Journal, 1881, p. 937.
CABANNES ANDTOULIÈRES, "Sur un cas de tic de la face à la suite d'une paralysie faciale,"Journal de médecine de Bordeaux, January 15, 1905, p. 46.
CADE, "Myoclonie à type de chorée de Bergeron,"Revue neurologique, 1903, p. 80.
Cadiot, Gilbert, and Roger, "Note sur l'origine bulbaire du tic de la face,"Revue de médecine, 1890, p. 431.
CAHEN, "Contribution a l'étude des stéréotypies,"Archives de neurologie, December, 1901, p. 476.
(References to the literature on the subject.)
CAILLAUD, "Contribution a l'étude des torticolis convulsifs,"Thèse de Paris, 1903.
CAILLÉ, "Two Cases of Nystagmus associated with Choreic Movements of the Head in Rachitic Babies,"Archives of Pediatrics, 1890, p. 171.
CALMETTE.SeeSABRAZÈS.
CANTILENA, "Ecolalia, emiplegia destra, cerebrale, corticale,"Lo sperimentale, 1880, p. 274.
CANTONNET, "Deux cas de goitre exophtalmique fruste avec troubles psychiques (torticolis mental et psychasthénie),"Société de neurologie de Paris, June 2, 1904.
CARRIÈRE, "Le paramyoclonus multiplex,"Presse médicale, August 7, 1901, p. 57.
—— "Sur un cas de paramyoclonus multiplex et de lordoscoliose hystériques chez un enfant,"Nord médical, May 1, 1902.
CARRIÈRE ANDSONNEVILLE, "La chorée arythmique hystérique de l'enfance,"Archives générales de médecine, September, 1901, p. 257.
CATROU, "Étude sur la maladie des tics convulsifs,"Thèse de Paris, 1890.
CAUDMONT,Le torticolis mental; état mental du tiqueur, Morel, Lille, 1904.
CHABBERT, "De la maladie des tics,"Archives de neurologie, January, 1893, p. 10.
CHARCOT, "Intorno ad alcuni casi di tic convulsive con coprolalia ed echolalia,"Riforma medica, 1885.
—— "Hystérie et tics; diagnostic,"Semaine médicale, 1886, p. 363.
——Leçons du mardi, 1887-8 and 1888-9.
—— "Toux et bruits laryngés chez les hystériques, les choréiques, et les tiqueux,"Archives de neurologie, 1892, p. 69.
CHATIN, "Note sur un cas de trismus mental,"Revue neurologique, May 15, 1900, p. 310.
CHAUFFARD, "Maladie de Friedreich avec attitudes athetoïdes,"Semaine médicale, 1893, p. 409.
CHAUVREAU, "Tics coordonnés avec emission brusque et involontaire de mots articulés,"Thèse de Bordeaux, 1888.
CHERVIN, "Du bégaiement et de son traitement,"Congrès périodique international des sciences médicales, Amsterdam, 1879.
CHIPAULT, "Sur une série de trente-neuf cas de chirurgie du sympathique cervical,"Travaux de neurologie chirurgicale, 1901, p. 220.
Chipault and Le Fur, "Névralgie des 8e, 9e, et 10eracines dorsales avec tic abdominal; lésion méningée localisée; résection radiculaire,"Gazette des hôpitaux, March 20, 1902, p. 325.
CHOMEL.SeeRUDLER.
CLARK ANDPROUT, "Nature and Pathology of Myoclonus-Epilepsy,"American Journal of Insanity, October, 1902, p. 185.
(Twenty-two references to the literature of myoclonus-epilepsy.)
CLAUS ANDSANO, "Spasme bilatéral de la face et du cou,"Journal de neurologie, 1899, p. 51.
COHN, "Facialistic als Beschäftigungsneurose,"Neurologisches Centralblatt, 1897, p. 21.
COLLIER(MAYO), "Spasmodic Torticollis treated by Nerve Ligature,"Lancet, June 21, 1890, p. 1354.
COLLINS, "The Clinical and Pathologic Interpretation of Tic, with special Reference to its Treatment,"Medical News, 1897, vol. ii. p. 747.
CONTI, "Nota clinica sopra un caso di spasmo clonico nel distretto dell' accessorio del Willis, da malaria,"Gazzetta degli ospedali e delle cliniche, January 7, 1906, p. 21.
(Twenty-eight references to the literature.)
CORNING, "Eleomyenchisis; or, the Treatment of Chronic Local Spasms by the Injection and Congelation of Oils in the Affected Muscles,"New York Medical Journal, April 14, 1894, p. 449.
COUDRAY, "Torticolis spasmodique; résection du spinal,"XIIeCongrès de l'association française de chirurgie, October 17-24, 1898.
CRAMER, "Tic de Guinon,"Deutsche medicinische Wochenschrift, September 14, 1899, p. 210.
CRISP, "Torticollis in the Common Fowl,"Transactions of the Pathological Society(of London), vol. xxvi. p. 252.
CRONBACH, "Die Beschäftigungsneurose der Telegraphisten,"Archiv f. Psychiatrie u. Nervenkrankheiten, 1903, p. 243.
CROSS, "Spasmodic Action of the Sternomastoid Muscles,"British Medical Journal, March 13, 1880, p. 425.
CROUZON, "Tic d'élévation des deux yeux,"Société de neurologie de Paris, January 11, 1900.
CRUCHET, "Étude critique sur le tic convulsif et son traitement gymnastique,"Thèse de Bordeaux, 1902.
—— "Délimitation du tic" (Congrès de Grenoble),Revue neurologique, 1902, p. 789.
—— "Formes cliniques des tics unilatéraux de la face,"Congrès de Pau, 1904.
—— "Sur un cas de tic de la tête et du tronc n'existant que pendant le sommeil,"Gazette hebdomadaire des sciences médicales de Bordeaux, July 3, 1904, p. 319.
—— "Hémispasme facial périphérique postparalytique,"Revue neurologique, October 30, 1905, p. 985.
—— "Tics et sommeil,"Presse médicale, January 18, 1905, p. 33.
—— "Sur deux cas de tics convulsifs persistant dans le sommeil,"Société de neurologie de Paris, March 1, 1906.
—— "Contribution à l'étude des rythmies d'habitude du sommeil,"Gazette hebdomadaire des sciences médicales de Bordeaux, February 18, 1906.
—— "Sur un cas de maladie des tics convulsifs,"Archives générales de médecine, May 8, 1906, p. 1180.
CRUCHET.SeePITRES.
CUGINI, "Un raro caso di policlonia,"Rivista sperimentale di freniatria, 1902, p. 112.
CUIGNET, "Des attitudes dans les maladies des yeux et du torticolis oculaire,"Revue d'ophtalmologie, April, 1874, p. 190.
CURCIO["Paramyoclonus symptomatique"],Annali di medicina navale, July, 1901, p. 86.
DALEY, "Primary Myokymia, with Report of a Case,"Medical News, July 2, 1904, p. 12.
DAMAIN.SeeTOURETTE.
DANA, "Myoclonus Multiplex and the Myoclonias; Report of Cases and an Attempt at Classification,"Journal of Nervous and Mental Disease, August, 1903, p. 449.
DEBOUT, "Torticolis par contracture des muscles splenius droit et sterno-cléido-mastoïdien du côté gauche, guéri par l'électrisation des muscles sains,"Bulletin de la société de chirurgie de Paris, 1854.
DEBROU, "Sur le tic non douloureux de la face,"Archives générales de médecine, June, 1864, p. 641.
DECROLY, "Contribution à la symptomatologie du spasme salutatoire (epilepsia nutans),"Journal de neurologie, October 20, 1904, p. 390.
DELVART, "Le paramyoclonus multiplex chez l'enfant,"Thèse de Lille, 1902.
DERCUM, "Spasmodic Torticollis and its Medical Relations,"Medical and Surgical Report, 1894, p. 39.
Derscheid-Delcourt, "Un torticolis d'origine oculaire,"La clinique belge, December 23, 1897.
DESCROIZILLES, "De quelques cas de tics convulsifs,"Revue mensuelle des maladies de l'enfance, August, 1890, p. 337.
DESNOS, "Spasme du sternomastoïdien gauche,"Union médicale, March 16, 1880, p. 422.
DESTERAC, "Torticolis spasmodique et spasmes fonctionnels,"Revue neurologique, 1901, p. 591.
—— "Syndrome du torticolis spasmodique,"Congrès de Toulouse, April, 1902.
—— "Le syndrome du torticolis spasmodique,"Nouvelle iconographie de la Salpêtrière, Sept.-Oct. 1902, p. 385.
DIDE, "La myoclonie dans l'épilepsie,"Annales medico-psychologiques, Sept.-Oct. 1899, p. 270.
DONATH, "Beitrag zu den Clavier-u. Violinspielerneurosen,"Wiener medicinische Wochenschrift, 1902, p. 355.
DORNBLUTH, "Zur Behandlung gewissen spastischer Neurosen,"Münchener medicinische Wochenschrift, February 11, 1896, p. 128.
DOSE ANDASTOLFONI, "Di un caso di miotonia essenziale,"Rivista sperimentale di freniatria, 1900, p. 420.
DREHER, "Tics im Kindesalter und ihre Behandlung,"Jahrbuch f. Kinderheilkunde, 1904, p. 253.
DROMARD, "Psychologie comparée de quelques manifestations motrices communément désignées sous le nom de 'tics,'"Journal de psychologie normale et pathologique, Jan.-Feb. 1905, p. 16.
DUBOIS, "Traitement des tics convulsifs par la rééducation des centres moteurs,"Bulletin général de thérapeutique, April 30, 1901, p. 617.
—— "Du trouble de l'attention chez les tiqueurs,"Bulletin de l'institut psychologique, 1902.
DUBREUIL, "Spasme fonctionnel du sternomastoïdien et du trapèze,"Gazette hebdomadaire des sciences médicales de Montpellier, 1882.
DUFOUR, "A propos des tics et des troubles moteurs chez les délirants chroniques; du syndrome musculaire comme signe pronostic,"Revue neurologique, 1901, p. 1069.
DUPRÉ, "Hémispasme tonique de la face,"Congrès de Bruxelles, 1903.
Dupuy-Dutemps.SeeABADIE.
EHRET, "Ueber eine functionelle Lähmungsform der Peronealmuskeln traumatischen Ursprunges,"Archiv f. Unfallheilkunde, 1897, p. 32.
ELIOT, "The Surgical Treatment of Torticollis, with especial Reference to the Spinal Accessory Nerve,"Annals of Surgery, 1895, p. 493.
FALDELLA, "Paramyoclonus multiplex,"Rivista sperimentale di freniatria, 1888, p. 193.
FAURE, "Traitement de la paralysie faciale d'origine traumatique par l'anastomose spino-faciale,"Presse médicale, November 6, 1901, p. 259.
FEINDEL, "Le traitement médical de torticolis mental,"Nouvelle iconographie de la Salpêtrière, Nov.-Dec. 1897, p. 404.
FEINDEL, "Le torticolis mental, et son traitement,"Gazette hebdomadaire, February 20, 1898, p. 169.
—— "Spasmes grimaçants de la face datant de trois mois; traitement et guérison en quatre jours,"Revue de psychologie clinique et thérapeutique, April, 1899.
—— "Le torticolis mental,"Gazette hebdomadaire, August 28, 1903, p. 805.
——SeeBRISSAUD.
——SeeMEIGE.
FEINDEL ANDMEIGE, "Tic ou spasme de la face,"Revue neurologique, March 15, 1898, p. 125.
—— "Revision iconographique du torticolis mental; trois cas nouveaux; traitement,"XIIIeCongrès international de médecine, section de neurologie, Paris, August, 1900.
—— "Quatre cas de torticolis mental,"Archives générales de médecine, January, 1901, p. 60.
—— "Torticolis mental surajouté à des mouvements hémichoréiformes; guérison du torticolis; amélioration générale,"Société de neurologie de Paris, November 7, 1901.
FÉRÉ, "Tic non douloureux de le face du côté gauche,"Archives de physiologie, 1876, p. 267.
—— "Tic de la face du côté gauche,"Comptes rendus de la société de biologie de Paris, 1876, p. 62.
—— "Le tic de salaam; les salutations névropathiques,"Progrès médical, December, 1883, p. 970.
(References to early literature.)
—— "Crampe fonctionnelle du cou,"Revue de médecine, 1883, p. 769.
—— "Contribution à la pathologie des spasmes fonctionnels du cou,"Revue de médecine, September, 1894, p. 755.
—— "Note sur un cas de chorée variable, avec contractions fasciculaires des deltoïdes,"Nouvelle iconographie de la Salpêtrière, Nov.-Dec. 1898, p. 454.
—— "L'épilepsie choréique,"La médecine moderne, 1899, p. 209.
—— "L'épilepsie et les tics,"Journal de neurologie, September 5, 1900.
—— "L'influence sur le travail volontaire d'un muscle de l'activité d'autres muscles,"Nouvelle iconographie de la Salpêtrière, Sept.-Oct. 1901, p. 432.
FÉRON, "Tic guéri par suggestion,"Journal de neurologie, 1899, p. 246.
FIERSINGER.SeeHUCHARD.
FILIPPO, "Mioclono multiplex in un lattante,"Gazzetta degli ospedali e delle cliniche, March 12, 1905, p. 329.
FISCHER, "Les chorées électriques; paramyoclonus; myoclonie,"Gazette des hôpitaux, May 2, 1903, p. 513.
FOLLET.SeeRÉNON.
FORCHHEIMER, "Torticollis intermittens,"Archives of Pediatrics, 1887, p. 96.
FORNACA["Observations cliniques sur le torticolis mental"],Clinica medica italiana, November, 1901, No. 15.
FOURNIER, "Quelques considérations sur le tic rotatoire,"Thèse de Strasbourg, 1870.
FRANCIS, "Case of spasmodic torticollis; section of spinal accessory nerve; recovery,"Lancet, November 11, 1893, p. 1184.
FRANÇOIS, "Essai sur les convulsions idiopathiques de la face,"Mémoire présenté à l'Académie royale de Belgique, 1843.
FRENKEL, "De l'exercice cérébral appliqué au traitement de certains troubles moteurs,"Semaine médicale, 1896, p. 123.