Tics and Their Treatment. Feindel Eugène

as has been demonstrated in many other neuroses, will assuredly be crowned with success. Common misconception represents therapeutics as helpless in the presence of nervous disease; but if the doctor may count on the collaboration of his patient, he has no right to despair.

      I should like, in closing, to be allowed to praise the authors' production; but I can do so only under great reserve, for after so many years of co-operation I can no longer distinguish the work of MM. Meige and Feindel from my own. I think, however, that from many points of view the book which they have written is a most useful one.

E. BRISSAUD.

      AUTHORS' PREFACE

      OUR object in publishing these studies has been twofold: first, to make known various facts of clinical observation, which will always possess at the least an intrinsic value; secondly, to endeavour to assign to the tics their due place among the numerous motor affections consequent on nervous or mental disease. With this end in view we sought to free ourselves of preconceived notions, avoiding at the same time the other extreme of eclecticism. Independently we have been led to adhere to the doctrine hallowed by the authority of Charcot, and since advocated by Professor Brissaud – a doctrine that seems to us to be in harmony with accepted clinical data.

      We have thought it advisable to indicate, by the way, more than one misconception whose perpetuation is but a stumbling-block in the path of progress.

      Since the eighteenth century the word tic has faced the perils of definition many a time, and has as often all but succumbed. The limits of its application have been alternately enlarged and narrowed to an excessive degree; its original signification has been so obscured that the inclination to-day is either to hesitate in the use of the word at all, or to employ it indiscriminately through ignorance of its real meaning. But if its interpretation be not specified, everything that is said or written on the subject will remain fatally open to dispute. Want of precision in words leads inevitably to confusion of ideas and endless misunderstanding. In this respect the word tic is a great culprit; its promiscuous use implies looseness in its connotation – a fruitful source of controversies which, when all is said and done, are nothing more than regrettable quid pro quos. On fundamental points there is almost complete unanimity of opinion; any divergence is purely superficial, and to be ascribed to disagreement in terms.

      Hence it has seemed to us essential to adopt a vocabulary, and to employ any term only after clearly particularising the sense we attribute to it. Our verbal conventions will not meet with universal acceptance, it may be, but we shall be the first to abandon them if common consent assign to the expressions that replace them the exact shade of meaning we meant to convey.

      Our work will not be superfluous if we succeed in allotting to the word a definite position in medical terminology, or if any information we have amassed prove of service to future observers. And should we be enabled to demonstrate how unmerited is the reputation the tics enjoy of being irremediable, how they may, on the contrary, be mitigated and sometimes even cured under appropriate treatment, the practical value of the conclusion will, we hope, justify the importance we have attached to the subject.

      NOTE BY THE TRANSLATOR

      OWING to the kind co-operation of M. Meige, it has been possible to embody in this English version of Les tics et leur traitement his latest definitions and views, as expressed in his monograph Les tics (July, 1905). The passages thus derived are enclosed in brackets. In the making of the translation some of the clinical cases have been slightly abridged, and one or two omitted. The Bibliography has been revised, largely supplemented, and brought up to date. In a short Appendix reference is made to various matters in regard to tic on which discussion has recently centred, subsequent to the publication of Meige and Feindel's book. Indices of names and of subjects have been added.

      CHAPTER I

      THE CONFESSIONS OF A VICTIM TO TIC

      AT the time when the plan of our book was being sketched we decided to introduce the subject with several characteristic clinical documents, since it appeared to us indispensable to preface our definitions with an illustration of the type of affection and of patient that we had in view. The choice was rather bewildering at first; but towards the close of 1901 one of us was put into communication with an individual who is a perfect compendium of almost all the varieties of tic, and whose story, remarkable alike for its lucidity and its educative value, forms the most natural prelude to our study. The history is neither a fable nor an allegory, but an authenticated and impartial clinical picture, whose worth is enhanced by no less genuine facts of self-observation.

      O. may be said to constitute the prototype of the sufferer from tic, for his grandfather, brother, and daughter have all been affected, and he himself has not escaped. His grandmother and grandfather were first cousins, and the latter, in addition to being a stammerer, developed tics of face and head; his brother stammers too, while both his sister and his daughter have facial tics, and one of his sons was afflicted with asthma as a youth. The family history therefore more than confirms the existence of a grave neuropathic heredity, an unfailing feature in cases of tic.

      O.'s fifty-four years lie lightly on him. His physique and general health are excellent, and devotion to bodily exercise and outdoor sports has enabled him to maintain a vigour and an agility above the average; nor is his intellectual activity any less keen.

      His earliest tics – simple facial grimaces and movements of the head – made their appearance when he was eleven years old; notwithstanding, his recollection of their mode of onset is very exact.

      I have always been conscious of a predilection for imitation. A curious gesture or bizarre attitude affected by any one was the immediate signal for an attempt on my part at its reproduction, and is still. Similarly with words or phrases, pronunciation or intonation, I was quick to mimic any peculiarity.

      When I was thirteen years old I remember seeing a man with a droll grimace of eyes and mouth, and from that moment I gave myself no respite until I could imitate it accurately. The rehearsals were not prolonged, as a matter of fact, and the upshot was that for several months I kept repeating the old gentleman's grimace involuntarily. I had, in short, begun to tic.

      In my fifteenth year I was at school with two boys whose hair was rather long, and who had acquired the habit of tossing it back by an abrupt shake of the head. It is true I cannot recollect endeavouring to ape this, but in any case it was at the same time that I found myself exhibiting an identical gesture, and I have little doubt it is the source of one of the tics from which I suffer at present.

      I enlisted at the commencement of hostilities in 1870, and had already begun my military instruction, when a personal review of the company was made by a new colonel. As he passed he came to a sudden halt before me, and proceeded to harangue me on my far from military bearing; but his invective had no other effect than to aggravate my facial contortions, and the affair might have proved serious enough for me had not my captain come to the rescue and explained the involuntary nature of the spasms. The colonel, however, would have none of them and after a fortnight's sojourn in hospital I was discharged for "choreic movements of the face."

      O.'s tics were at the first confined to the eyes and lips, but others were not long in appearing. He happened to be out one day for a walk with his sister during a snowstorm, and a flake entering his nostril made him sneeze and sniff half a dozen times. Long after the snow had ceased falling and the tickling sensation had vanished he repeated the performance, till it passed into a sniffing tic that continued for some months. His sister thoughtlessly set herself to mimic him, and speedily evolved an identical tic, which still persists.

      In their turn, neck and shoulders were implicated in the affection. The most inveterate of all his tics is a somewhat complex twist of the head, whereby the occiput is depressed jerkily, and the chin advanced and elevated, occasionally to the right, though more commonly to the left. Such is the clonic form of the tic, at once frequent and obvious; but it may assume a tonic form, distinguished by an almost permanent retrocollic displacement of the head, the chin being carried in the air.

      If, now, we approach these tics in greater detail, we notice, first of all, a blinking tic, more marked on the left side. Apart from abrupt and intermittent contractions of the orbicularis, which close the eye completely