Part 36 (2/2)

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 been accepted, 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 att.i.tude, since the latter is tonic rather than clonic. For an anomaly of att.i.tude 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 the _Pratique 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 fremissante” [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 role, 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.

BIBLIOGRAPHY

[In one or two instances, where the original paper has been inaccessible, its t.i.tle 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 on _Les torticolis spasmodiques_, which is at present in the press (Ma.s.son: Paris). It is a splendid monograph on the subject, and contains many references to the literature.--S. A. K. W.]

ABADIE AND DUPUY-DUTEMPS, ”Hemispasme facial gueri par une injection profonde d'alcool,” _Societe de neurologie de Paris_, February 1, 1906.

ABT, ”Spasmus Nutans,” _Journal of the American Medical a.s.sociation_, February 3, 1900, p. 269.

ACHARD AND SOUPAULT, ”Tremblement hereditaire et tremblement senile,” _Gazette hebdomadaire_, April 22, 1897, p. 373.

AIMe, ”Un cas de tic elocutoire gueri par la methode de reeducation et d'entrainement,” _Revue medicale de l'Est_, January 1, 1901, p.

25.

---- ”Traitement de certains tics consideres comme des syndromes emotionnels,” _Revue de psychologie clinique et therapeutique_, September, 1901.

ALDRICH, ”Tic,” _Medical Record_, July 30, 1904, p. 169.

ALLARD, ”Tics chez les alienes,” _These 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 sternomastodien; guerison,” _Gazette medicale_, 1834, p. 829.

ANDERSON, ”Sternomastoid Torticollis,” _Lancet_, January 7, 1893, p. 9.

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