CHAPTER XIX. Treatment by Re-Education

TREATMENT BY RE-EDUCATION

The author of the article "Tic" in the Dictionary in Sixty Volumes of 1822 urges the necessity of care and perseverance in the correction of the involuntary movements characteristic of the disease. In 1830 Jolly recommended different exercises in the treatment of convulsions, as a means of interrupting the sequence of certain spasmodic phenomena. Blache's adoption, in 1851, of medical gymnastics in cases of "abnormal chorea" was attended with excellent results; and Trousseau, as we have seen, extolled the value of exercises systematically applied to the muscles involved in non-dolorous tic. The principle of the treatment consisted in the regular execution of given movements by the muscular groups affected, to the rhythmical accompaniment of a metronome or the pendulum of a clock.

In these instances we have a forecast of the modern methods of re-education, so successfully employed to combat tic.

Letulle advises an appeal to the intelligence, good sense, and will of the patient in the endeavour to provoke an inverse effort at the moment when the tic begins, or even before. It is the prerogative of the physician to indicate suitable exercises and to encourage and aid the patient in his attempts. Even the most inveterate of tics may thus be controlled and made to disappear. On the other hand, the Traité de médecine ignores the subject, while Lannois' paper in the Traité de thérapeutique contains the statement that in the treatment of myoclonus--under which term various indefinite convulsive movements are comprehended--no method has hitherto been of any avail. Yet in another section of the same book we discover some sound advice anent tics and choreas of hysterical origin, emanating from the pen of Pierre Janet.

It is well to study the influence of the attention on these conditions; some tics are contingent on the direction of the patient's attention to them, others appear solely during times of distraction.... Education of movements by some form of drill may be of the greatest utility.

These general therapeutic indications are applicable to all kinds of tic, independently of their form and localisation. Moreover, they conform to the procedures advocated by Brissaud since 1893.

So long as tic is regarded as a purely external phenomenon, treatment is bound to be insufficient; but recognition of the relations between the convulsion and the mental state of the subject has made possible a rational therapeusis. There can be no doubt, thanks to the laborious work of Bourneville, that systematised mental discipline has sometimes a surprising effect on congenital psychical imperfections; and where the patients have attained a higher level of mental development, re-education has shown itself to be the method par excellence.

The credit of initiating treatment by forced immobility is due to Brissaud, who in the year 1893 first utilised the method in cases of mental torticollis. In the face of the risks of surgical intervention and the unsatisfactory nature of existing therapeutic measures, Brissaud emphasised the value of motor discipline in tic, and it was not long ere rules were formulated and precision introduced into the application of the method. The results were certainly encouraging, so much so that improvement could be promised if treatment was sufficiently protracted; cure, indeed, followed in various instances.

Brissaud's method is a combination of immobilisation of movements with movements of immobilisation. Speaking generally, the patient is directed to perform certain appropriate exercises under given conditions. Some of these exercises are intended to teach him how to preserve immobility, while the object of others is to replace an incorrect movement by a normal one. In the case of the former, immobility is alike the goal in view and the means of attaining it, while by recourse to suitable movements, in the latter instance, the same end is sought.

It is essential to remember that the exercises must be graduated. To begin with, the subject of tic is required to remain absolutely motionless, as for a photograph, for one, two, three seconds--in fact, as long as he can without fatigue. Very gradually the period is increased, for patients have their good and their bad days, and too great a demand on one day is apt to be succeeded by a relapse on the next. One must rest content with even the most insignificant gain at first, and soon the seconds will grow into minutes, and the minutes into hours. It is desirable to specify on each occasion the duration of the expected immobility. Place the patient at the outset in the position in which his tic manifests itself least often, and do not cease to encourage him by affirming that he can and must remain immobile. Once the séance of immobilisation can be maintained for as much as five or six minutes, begin to modify the patient's attitudes. If he has been comfortably seated during the opening performances, try him when he is standing, and as soon as he has accomplished this, vary the position of his head, arms, trunk, and legs, repeating the séance in each case. Eventually he will learn to maintain immobility of certain parts of his body while he is walking, or while he is executing given movements with his arms or legs. In all these performances direction must be specially directed to the patient's tic. The method is obviously simple, so much so that he may be inclined to question its utility and may fail to grasp its import. One must not hesitate, however, to explain its purpose; indeed, the rapid and intelligent appreciation of the method on the part of the patient is a sine qua non for success. Patient and doctor most co-operate in defence and attack; and their union will culminate in triumph. Simultaneously with this discipline of immobilisation the subject must be taught the discipline of movements. The idea is to make him perform slow, regular, and accurate movements to order, addressing oneself to the muscles of the area in which the tic is localised. They must be very simple at first, and the exercises must be very short. The séance should never be prolonged beyond a few minutes, making, with the immobilisation, not more than half an hour. This time will, of course, soon be increased, but it is of prime importance to avoid fatigue. The performances should be gone through three, four, or five times a day, and always at the same hours. One of them at least ought to be under the personal direction of the physician, whose duty it is to modify, instruct, exhort, reprimand, as the case may be. In his absence the supervision of the exercises must be left to some responsible individual, who has an eye for faults as well as for progress. Statements by the patients themselves are to be considered with reserve.

The repetition of the prescribed exercises should take place in front of a looking-glass, whereby the patient may be exactly informed of any mistakes in gesture or attitude. He cannot otherwise judge of the degree of immobility attained, and may deceive himself, although he has the best intentions in the world, as to the real state of affairs. He does not know whether he is holding himself straight or not, as a general rule, but a glance in the mirror will correct his fault. A careful register must be kept of the progress he makes. Little by little the jurisdiction of the physician will be reduced, provided the patient maintains his interest in his own treatment. Indifference and discouragement are fatal, and it must be the physician's aim to prevent their occurrence.

Séglas has reported the history of a woman with mental torticollis, who submitted to treatment by Brissaud's method, and a remarkably quick alleviation was the result. At the end of three weeks, however, she allowed her interest to slacken, and ere long the benefits obtained were entirely frustrated.

It cannot be too often repeated that even though the tic disappear, the patient must not be abandoned to himself, but must be persuaded to continue his exercises. This is the price of success. As time goes on, it is true, he encounters fewer difficulties in his way, and once he is conversant with the method, he may be able to work out his own salvation.

In the case of children, the efforts of the medical man may often be seconded by parent or teacher, who has assisted at the first lessons and is in a position to superintend their repetition. On the other hand, treatment may be nullified by deplorable weakness on the part of father or mother. One of the reasons for the existence or at least the persistence of tics in children is that there has been no attempt at their correction when they were still "bad habits." Neglect or indulgence is an etiological factor of the first importance, as we have already seen. Many a time we have had occasion to note this, notwithstanding the protestations of the family. Fear of aggravating the mischief is sometimes advanced as a reason for non-interference. Nothing could be more misleading.

The method which seeks to check the youthful tiqueur by the multiplication of threats and penalties is not to be countenanced; it produces the opposite effect to what is intended. Clearly the educational therapeutic measures we have been advocating demand a patience and an ingenuity on the part of both doctor and patient which we have no desire to minimise, but it is along these lines that success is to be reached.

A noteworthy adjunct to treatment is to sketch out a daily routine for the patient to follow regularly and punctually. His mental disarray is patent not merely from his disorders of motility, but in the unmethodical and changeable habits of his everyday life. To introduce discipline into his manner of living is a most wholesome step. To find something with which to employ his leisure time, to direct his energies into suitable channels, will prove to be eminently beneficial, not merely for the child but also for the adult. Those who tic ought to be able to contract good habits as readily as bad, provided their instructor be sufficiently persevering and inventive.

There is an infinity of occupations for the patient to put his hands to, and this variety suits his unsettled mood and his wavering attention; but longer efforts will be secured from him if his interest in his task can be engaged and stimulated as well. It is a good plan to make him write down each day what he does and how it is done, and to have him rehearse from time to time. Such pedagogical details are far from being superfluous; adults, moreover, are quick to gather their significance and to demonstrate their advantages in practice. That their fickle will must be reinforced they know well; how to achieve this end they are unaware. This fact explains their eager acceptance of the support furnished by these "moral crutches."

Generally speaking, there is no call to interrupt treatment once it is commenced, although occasionally we have found this desirable. The fatigue of the first few days, almost unavoidable as it is, and accompanied by new sensations, need occasion no alarm. We should acquaint our patient of its explanation, and so obviate the mental depression which its existence is apt to engender. Its ephemeral nature will soon become plain, for a rest of a few days suffices for its disappearance.

In some instances resort to procedures reminiscent of antagonistic gestures seems to have been of avail.

One of our patients, suffering from facial tic, was directed to perform, as far as practicable, the opposite movements to her grimaces. If her mouth was drawn to the right, she forthwith made a corresponding twitch to the left; if her mouth was shut spasmodically, she was instructed to open it widely and quickly. By such simple methods, applied to all her tics, speedy control was regained, and once she had mastered the theory of the process, the practice of regular exercises and the development of antagonistic movements soon effected a complete cure.

Training of the antagonists has also been recommended by Hartenberg, in a case of scratching tic. The patient was urged to approximate the hand to the affected cheek very slowly, and almost at the moment of contact the order was given to extend the arm briskly; this gesture of opposition, moreover, was stimulated by faradisation to the extensors of the forearm. The method, of course, is practically identical with that adopted by Frenkel, of Heiden, who provoked energetic contractions of antagonistic groups by teaching the patients to overcome increasing resistances. Prudence, however, must be observed in carrying out these ideas, otherwise we run the risk of replacing one tic by another.

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After the above general sketch of the essentials of the method, we may give examples of its application to particular instances.

For a tic of the eyelids, in especial for blinking tics, we make the patient open and shut the eyes to order, keep them closed or apart for a space, shut one eye and then the other, and repeat the same sequence in different positions of the head. It is a good plan to enjoin simultaneous action of the oral musculature. The cessation of tonic contractions of the eyelids with opening of the mouth has been remarked several times, and Oppenheim finds an analogy in the observations of Gunn and Helfreich, who have seen ptosis disappear as the mouth is opened.

If the eyeballs are involved in a tic, insist on dissociating the movements of head and eyes; make the patient follow an object slowly with his eyes while the head is stationary; or let the head deviate to right or left, up or down, while the eyes remain fixed on some particular point.

When the lips are the seat of involuntary muscular action, have the patient show his teeth, open and shut his mouth, purse his lips; make him speak and conform his expression to his speech; let him read aloud slowly, and fix his attention on his subject.

As a specimen of treatment for a facial tic, we may cite the subjoined programme:

Every day, and three times a day, at the same hours--nine, one, and six--the patient is to look at himself for two minutes in a mirror, preserving absolute immobility the while; to read aloud for two minutes, to speak in front of the glass for two minutes, to walk backwards and forwards in front of the mirror for two minutes. During the ten minutes of these exercises he will endeavour to keep his facial musculature under control. If the tic assert itself in the course of one of the exercises, he will recommence the latter, if necessary twice; the third time he will leave it till the next séance.

For tics of the head and neck, such as tossing tics and mental torticollis, inclination and rotation movements are indicated, of which an instance may be quoted:

Mademoiselle R. is quick in learning how to correct her muscular faults. Her actions are gradually becoming more complete and ample, and if she performs her allotted task with little animation, at the least there is no question of her indefatigable willingness. In less than a month she has been able to fix her regard, open her eyes widely, turn her head, uninterrupted either by halts or twitches; she can remain motionless in front of a looking-glass for as long as a minute. Equally satisfactory progress hat been made in the art of reading aloud; she breathes more regularly, and articulates more distinctly.

Thus the patient has come to realise that she need but give her attention to the involuntary movements for them to cease, and there has been a synchronous advance in her mental activity and power of concentration. Her nonchalance and timidity have diminished; she is no longer indifferent to her surroundings, nor furtive in her glances; she enters into conversation with zest, and her movements are characterised by decision.

Take another example of treatment, for a case of mental torticollis:

Stand or sit in front of a mirror and endeavour to maintain an absolutely correct position of trunk and shoulders.

Lift the arms vertically and turn the head to the right, then lower the arms while the head remains as it is.

Bend the body forward, and stretch the arms out till they touch the ground, the head meantime being rotated to the right. Then rise up again with the head in the same attitude. After two or three efforts it will be found that the head can be kept straight for a few seconds.

In tics of the limbs, shoulders, hands, feet, innumerable movements will suggest themselves for practice. The young girl with a tic of genuflexion, under the care of Oddo, supplies an excellent proof of the value of Brissaud's method:

The immobilisation of movements was realised by the mother forcing the child to remain motionless in a fixed position for augmented periods. As for movements of immobilisation, the patient made peregrinations of increasing length under the mother's eye, the order being repeatedly given to suppress the genuflexions. At the same time, massage and passive movements to the limbs and joints were prescribed, with a view to diminishing the articular cracks--the exciting cause of the bizarre tic from which the girl suffered.

In the course of ten or twelve days the genuflexions had entirely vanished, and a return of the pain in the coxo-femoral articulation aided materially in consolidating the effects of the treatment.

Tics of speech should be handled in the same way as stammering. "We do not treat stammerers, we educate them," says Moutard-Martin. There can be no gainsaying the convincing results obtained by Chervin's technique.

For years there has been unanimity of opinion on the value of respiratory gymnastics in the treatment of stammering. The plan is to make the patient inspire deeply and quickly, and follow this with a prolonged expiration. Difficulties of articulation and phonation may be overcome by recitation, by declaiming, by scanning utterance, by dwelling on the vowels, etc. Various authors have laid stress on the advisability of concomitant therapeutic treatment.

In cases of stammering (says Olivier), all surgical interference is to be deprecated. Operations on the nose or throat are directed toward the removal of obstructions in the air-ways, but they are merely a preparatory step to the adoption of the education method. No one of the vaunted "cures" for stammering is infallible, since all depend in the last resort on the will power of the patient, nor is there anything mysterious about them. Isolation is not always indicated; what is indispensable is reinforcement of the will.

The intimate relation between tics of speech and various kinds of stammering has led to the application to both of the same re-education methods. Pitres, in particular, bases his line of treatment for tics in general on regulation of respiratory activity, as he has observed that tics diminish or die away with a deep and regular respiratory rhythm. His plan is as follows:

Supported against a wall, with shoulders braced back, the patient is instructed to take slow and deep inspirations, raising his arms the while, and letting them fall with expiration. This performance is repeated three times a day, for ten minutes at a time.

The method has been elaborated by Tissié, and Cruchet also has thereby obtained excellent results, which he has put on record in his thesis.

The patient is placed upright against some support, his heels together and his arms by his side. For the first three minutes he recites aloud, drawing a slow deep breath at frequent and regular intervals. Then he proceeds to make similar long inspirations and expirations, elevating his arms synchronously with the former, and depressing them with the latter. The exercises may advantageously be repeated every three hours to begin with, then their duration may be increased and the intervals lengthened, until the séances are extended to fifteen minutes three times a day. Their continuance will vary with the individual, but the ultimate aim is to reduce the period and to spin out the interval still more, until eventually their object has been attained and they may cease.

A concrete example may be given:

A young man had suffered for eleven years from generalised tics of peculiar intensity. Every few seconds violent twitches of an electric-like rapidity seized the muscles of his head, trunk, and limbs, to the accompaniment of abrupt cries and inarticulate growls. A sojourn of a few weeks in hospital, and the acquisition of the most elementary technique in athmotherapy, resulted in a complete cure ere many months had passed.

Tissié explains the action of this method on tics by a special action of regular respiration on psychomotor centres. Raymond and Janet incline to the opinion that attention depends on respiratory activity, but Tissié argues there is antagonism between deep respiration and maintenance of attention, and Cruchet supports this hypothesis.

If we prescribe respiratory exercises, we are temporarily suppressing the attention, and reducing psychical activity to a minimum. Thus tic, which is a reflex of thought, does not occur, and if the exercises are renewed often enough, the habit will gradually be lost.

In our opinion, it is precisely the bestowal of the attention on the allotted task that has such a salutary effect. Whatever be the movements, they demand of the patient a momentary halt, a momentary interruption of those ill-timed motor reactions that make concerted action impossible. Observation shows that the degree of successful control is in proportion to the degree of concentration of the attention. The novelty of the exercise in itself acts as a stimulus, but when this novelty wears off, faults are prone to reappear. Hence the necessity of varying the procedures, and of rendering them always interesting; in the end the habit of supervision is contracted, and the patient feels increasing satisfaction in watching his physical infirmities daily diminish and the resources of his will daily widen.

Respiratory drill is an admirable method of procuring this result; it acts in the same way as any of the other exercises. Its use is not confined to tics of speech or of respiration, for thoracic muscles are involved in tic much more frequently than is commonly supposed. By resort to this technique Madet cured an expiratory hiccough in a man of forty-six, who was afflicted in addition with twitches of head, trunk, and hands.

Systematized exercises have of course the advantages of exercise in general; motor, sensory, and psychical functions alike are stimulated and regulated, and tend to become normal. In particular, muscular exercise is a striking way of disciplining volition. Accordingly, we never fail to prescribe such pastimes as gymnastics, in any of its forms, rowing, fencing, cycling, lawn tennis, etc.; games which demand attention, skill, and decision are useful auxiliaries, and manual occupations of a more delicate nature ought not to be forgotten, provided they require of the patient a certain amount of immobility. Every case, needless to say, must be treated on its merits, but the general indications we have supplied can easily be modified to suit the individual.

The various procedures directed, under different names, to the suppression of tic by re-education, are all modelled on the same plan. Köster attributes the disease to exhaustion of higher co-ordinating centres, and counsels their reinforcement by appropriate exercise. Oppenheim, in his Lehrbuch der Nervenkrankheiten, adduces evidence of the value of what he calls Hemmungstherapie, which is merely an application of the principles and therapeutic rules laid down by Brissaud in 1893, and described by one of us in 1897, apropos of mental torticollis. The same may be said of the line of treatment pursued by Dubois, which appears to be based on the pathogenic interpretation given by Oettinger, according to whom the brain of tic patients is incapable of conserving the image of sustained immobility, and thereby loses the habit of voluntary immobilisation. The essence of treatment, therefore, consists in habituating the subject to rest motionless like a statue in a position conducive to repose, and for a given time.

As has been already remarked, the polymorphism of tics is such that the plan of treatment selected must be necessarily elastic if it is to be altered to suit individual cases. What is the point in enjoining absolute immobility on a patient whose blepharotic is never in evidence unless he is walking about?

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We may now proceed to narrate the details of various cases of tic treated by the combined method of disciplinary movements and immobility, taking the history of O. as our first example.

October 15, 1901.--Séance of absolute immobility in the upright position, with the head straight, for five seconds; to be repeated in front of a mirror for five minutes, with intervals for rest of fifteen seconds. Movements of rotation of the head to left and right, with progressively lengthening pauses in each of the extreme positions. Respiratory exercises with elevation and depression of the arms eight times a minute, decreasing steadily to four a minute. These exercises are to occupy a quarter of an hour morning and evening. Explain to the patient the action of the sternomastoids and how they combine to fix the head. Make the patient lie on his back and move his head antero-posteriorly.

October 19.--O. has still his tics, but he can already remain motionless on command, and is conscious of satisfaction in so doing. Just as his exercises come to an end there is always a momentary recrudescence of the tics, but a very appreciable calm follows.

October 21.--Immobility is maintained well for half a minute. The patient is to resume his cycling and fencing, physical exercises which he has abandoned for more than a year.

October 25.--O. considers himself greatly improved. He has gained insight into the way of combating his tics, and his self-confidence is on the up grade. For several days he has devoted his attention to his tic of blinking, with the result that he can open his eyes longer and more easily.

October 28.--He evinces a preference for certain of the exercises: if they please him, he performs them accurately; if they do not, they are neglected.

November 20.--The head tics are still rather violent at times. A period of intellectual and bodily fatigue has supervened, but he tries his fencing again, and to his profound satisfaction he has managed to keep free of tics during the bouts. He is recommended to avoid all possible causes of cerebral and physical exhaustion.

December 3.--He continues to make satisfactory progress. His habit of supporting his chin on his cane is abandoned, though an attempt to dispense with the latter entirely, when he is out in the street, has ended disastrously. He is content to hold it in his hand and strike his leg with it from time to time.

December 13.--Whenever O. is tempted to tic again, he stands in front of a mirror and commences to sing, and while the song lasts his tics remain in abeyance. His trick of sitting crossways on a chair and rubbing his chin against the back is also discarded, with the result that the callosities have vanished. As far as his walking is concerned, he has adopted the plan of endeavouring to get from one point to another without allowing his tics to assert themselves, and his efforts have been crowned with success.

February 3.--The patient has recovered his self-confidence, and the compliments of his friends prove an additional restorative. It is true the tics still recur, but their number is less, their duration shorter, their severity considerably diminished. What O. is best able to appreciate is the disappearance of the state of mal obsédant that accompanied them.

Take another example in the person of young J.:

In his case our object was to discipline him by successive modifications of his caprices. The first important result achieved was the suppression of his precious mattress--a result not obtained without difficulty, for the mere mention of it sufficed to provoke floods of tears and ebullitions of anger. He was then sent into the country for a few days to forget his heart's desire, but the labour was lost. No sooner had he arrived than he discovered another mattress in a barn, and transferred his affections to it.

Eventually the day came when he was finally convinced of the absurdity and inconvenience of his practice, and when the tender yet firm remonstrances of his parents prevailed. The prospect of congratulations awaiting him, and his own keenness to get better, stimulated him to fresh efforts, and the reward was success.

Not long after, however, he began to complain of mental suffering from the restraint laid on him, and the distress was undoubtedly genuine. We accordingly gave him permission to stretch himself on his bed at certain fixed times and for a fixed period, which was to be reduced each day by some minutes. He entered into the spirit of the regulations so happily that in less than a month the period spent in the horizontal position had sunk from two hours and three quarters to an hour and a half daily, and at last it was dispensed with altogether.

On his "nervous movements" re-education by immobility and methodical exercises had a beneficial influence, and he acquired the faculty of controlling his variable and attitude tics. Repetition of the séances under the eye of the physician, drill in front of a looking-glass, symmetrical and synchronous exercises for the arms, as well as ordinary practice in dressing and undressing, buttoning and unbuttoning clothes, eating, drinking, etc, with the left hand--all contributed materially to his progress. Many other re-educative prescriptions were enjoined on the patient; suffice it to say that in three months he was able to dress and feed himself, to behave properly at table, and to restrain himself generally, in spite of the obstacles provided by his babyish tricks and natural weakness.

Further, the advance he has made has reacted profitably on his mental condition, and if his fickleness and vacillation persist, at the least the trend of the educative exercises has been in the direction of reinforcement of the will. Hence is it that he is now more attentive, less introspective, less capricious; he is no longer overwhelmed at the gravity of his condition; he is conscious of having taken its measure, and of his power to master it.

We have also applied Brissaud's method to the treatment of variable chorea, with no less encouraging results. Its worth in cases of mental torticollis has been noted by several authors as well as by ourselves. A cure resulted in a peculiarly difficult instance recorded by Martin:

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 a day, 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 slight trembling 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 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.

MIRROR DRILL

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. 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, who remarks that this 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 same hand 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 striking contrast 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 apparent gaucherie is 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 have all devoted attention to this subject.

From the therapeutic point of view, considerable significance attaches to these facts. Temporary disablement of 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 may begin 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.

REST IN BED

In the majority of cases absolute rest in bed is not desirable, but a youthful patient should always be sent to 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

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 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, to ascertain 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, the tiqueur has 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.

PSYCHOTHERAPY

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 an ensemble of agencies calculated to demonstrate to the patient where his will is at fault, and how to 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 and gentleness, 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.

APPENDIX

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 of Les 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's System 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.

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 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 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 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 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.

BIBLIOGRAPHY

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(Contains references to early literature.)

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BATTELLI. See PRÉVOST.

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 AND BOSSI, "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 DE MALHERBE, "Tic rotatoire de la tête et du cou," Union médicale, 1876, p. 340.

BONNIOT. See LEVI.

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. See BEDUSCHI.

BOUCARUT, "Observation de tremblement hystérique," Revue de médecine, July, 1904, p. 601.

BOULENGER, "Tic clonique et tonique," Journal de neurologie, 1904, p. 132.

BOURNEVILLE AND NOIR, "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.

VAN BRERO ["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, 1re série, 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, 2e série, 1899, p. 516.

BRISSAUD AND FEINDEL, "Sur le traitement du torticolis mental et des tics similaires," Journal de neurologie, April 15, 1899.

BRISSAUD AND MEIGE, "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 AND TOULIÈRES, "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. See SABRAZÈS.

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 AND SONNEVILLE, "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 10e racines dorsales avec tic abdominal; lésion méningée localisée; résection radiculaire," Gazette des hôpitaux, March 20, 1902, p. 325.

CHOMEL. See RUDLER.

CLARK AND PROUT, "Nature and Pathology of Myoclonus-Epilepsy," American Journal of Insanity, October, 1902, p. 185.

(Twenty-two references to the literature of myoclonus-epilepsy.)

CLAUS AND SANO, "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," XIIe Congrès 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. See PITRES.

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. See TOURETTE.

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 AND ASTOLFONI, "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. See ABADIE.

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.

---- See BRISSAUD.

---- See MEIGE.

FEINDEL AND MEIGE, "Tic ou spasme de la face," Revue neurologique, March 15, 1898, p. 125.

---- "Revision iconographique du torticolis mental; trois cas nouveaux; traitement," XIIIe Congrès 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. See HUCHARD.

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. See RÉNON.

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.

---- "Spasme primitif du facial avec mouvements fibrillaires continus ('myokymie')," Revue neurologique, 1903, p. 609.

FRIEDREICH, "Ueber coordinirte Erinnerungskrämpfe," Virchow's Archiv, 1881, p. 430.

FUR (LE). See CHIPAULT.

GALLAVARDIN AND SAVY, "Sur un cas de torticolis congénital avec autopsie et examen histologique du système nerveux," Lyon médical, November 22, 1903, p. 767.

GARDNER AND GILES, "Neurectomy in Spasmodic Torticollis and in Retrocollic Spasm, or 'torticolis postérieur,'" Australian Medical Journal, December 15, 1892, p. 613.

GAUSSEL, "Spasme bilatéral des muscles du cou et de la face," Nouvelle iconographie de la Salpêtrière, Sept.-Oct. 1904, p. 337.

GAUTHIER, "Des mouvements automatiques rythmiques," Thèse de Paris, 1898.

GAUTIEZ, "Contribution a l'étude des spasmes du cou," Thèse de Paris, 1884.

GEHUCHTEN (VAN), "Mouvements spasmodiques du membre supérieur droit propagés au sterno-cléido-mastoïdien du même côté," Société belge de neurologie, October 29, 1898.

---- "Un curieux cas de tic," Journal de neurologie, 1899, No. 3.

GELLÉ, "Du torticolis ab aure laesa," Tribune médicale, 1894, Nos. 50 and 51.

GERHARDT, "Accessoriuskrampf mit Stimmbandbeteiligung," Münchener medicinische Wochenschrift, 1894, p. 181.

GIGLIOLI, "Del torcicolle mentale," Rivista critica di clinica medicina, February 13, 1904, p. 104.

GILBERT. See CADIOT.

GILES. See GARDNER.

GILLET, "Tic douloureux de la face," Thèse de Paris, 1903.

GILMOUR, "'Latah' among South African Natives," Scottish Medical and Surgical Journal, January, 1902, p. 18.

GONZALES. See ROSSI.

GOWERS, "On Saltatoric Spasm," Lancet, July 14, 1877, p. 42.

GRAFF, "Ein Fall von spastischen Krampfen der Halsmuskulatur," Deutsche medicinische Wochenschrift, March 22, 1900, p. 66.

GRASSET, "Un cas de maladie des tics et un cas de tremblement singulier de la tête et des membres gauches," Leçons de clinique médicale, 1891, p. 466.

---- "Tic du colporteur (spasme polygonal post-professionnel)," Nouvelle iconographie de la Salpêtrière, July-August, 1897, p. 217.

---- "Pathogénie du tic" (Congrès de Grenoble), Revue neurologique, 1902, p. 782.

GROLHOUX, "Le spasme facial," Thèse de Paris, 1904.

GUERTIN, "D'une névrose convulsive et rythmique déjà nommée; forme de chorée dite électrique," Thèse de Paris, 1881.

GUIBERT, "Crampe fonctionnelle du cou," Revue de médecine, 1892, p. 317.

GUILLAIN. See MARIE.

GUINON, "Maladie des tics convulsifs," Revue de médecine, 1886, p. 50.

---- "Tics convulsifs et hystérie," Revue de médecine, 1887, p. 509.

HABEL, "Ueber Fortbestehen von Tic convulsif bei gleichseitiger Hemiplegie," Deutsche medicinische Wochenschrift, March 24, 1898, p. 189.

HADDEN, "On Head-nodding and Head-jerking in Children, commonly associated with Nystagmus," Lancet, June 14, 1890, p. 1293.

HAJOS, "Ein Fall von Myospasmia Spinalis," Ungarische medicinische Presse, 1898, No. 34.

HALLION. See BRISSAUD.

HAMMOND, "Myriachit, nova malattia del sistema nervoso," La medicina contemporanea, March, 1884.

HANKE, "Ein Beitrag zur Aetiologie des Caput obstipum musculare," Inaugural Dissertation, Kiel, 1900.

HARTENBERG, "Traitement et guérison d'un cas de tic sans angoisse," Revue de psychologie clinique et thérapeutique, January, 1899, p. 17.

---- "Tic de déglutition chez un hystérique; traitement et guérison; considérations," Revue de psychologie clinique et thérapeutique, June, 1899, p. 175.

---- "La psycho-thérapie nouvelle," Revue de psychologie clinique et thérapeutique, February, 1901.

HASSLAUER, "Ueber phonischen Stimmritzenkrampf," Deutsche militär-ärtzliche Zeitschrift, 1900, p. 417.

HAUSER AND LORTAT-JACOB, "Contribution à l'étude des paralysies psychiques," Revue de médecine, November, 1901, p. 995.

HEATON, "Involuntary Rotation of the Head cured by continued Pressure on the Neck," British Medical Journal, February 17, 1879, p. 228.

HELDENBERGH, "Myoclonus fonctionnel intermittent et paradoxal," Semaine médicale, June 7, 1899, p. 194.

---- "Un cas de tremblement fonctionnel de la main droite," Journal de neurologie, November 5, 1901.

---- "Spasme tonique involontaire et intermittent du cou," Belgique médicale, 1902, No. 23.

HELMICH, Ueber Wesen u. Behandlung des Schreibkrampfes u. verwandter Krankheiten, Bielefeld, 1902.

HENOCH, "Ueber Chorea," Berliner klinische Wochenschrift, December 24, 1883, p. 801.

HERMANN, "Myoclonische Zuckungen bei progressiver Paralyse," Neurologisches Centralblatt, 1901, p. 498.

HEVEROCH, "Paramyoclonie de Friedreich, combinée avec l'épilepsie," Revue neurologique, 1902, p. 198 (reference).

HIRSCHFELD, Ueber die Maladie des Tics convulsifs, Berlin, 1891.

HUCHARD AND FIERSINGER, "Le syndrome myoclonique," Revue de médecine, October, 1905, p. 741.

(Thirty-four references to the literature of myoclonus.)

HUYGHE, "Du traitement de la chorée hystérique par l'immobilisation," Nord médical, August 1, 1901, p. 173.

---- "Chorée arythmique hystérique unilatérale droite; torticolis mental," Nord médical, December 15, 1903, p. 283.

INGELRANS, "Les spasmes de la face," Écho médical du nord, June 11, 1905, p. 277.

INNFELD, "Ein chronische, progressive Fall von Muskelkrämpfen," Wiener klinische Wochenschrift, 1898, p. 17.

IOTEYKO, "Un cas de tics de la face guéri par suggestion," Journal de neurologie, January, 1906, p. 1.

ISCOVESCO. See ROUILLARD.

ISIDOR, "Étude du torticolis spasmodique, et son traitement chirurgical," Thèse de Paris, 1895.

ITARD, "Mémoire sur quelques fonctions involontaires des appareils de la locomotion, de la préhension, et de la voix," Archives générales de médecine, July, 1825, p. 385.

JACCOUD, "Des impulsions locomotrices systematisées; spasmes rythmiques," Gazette des hôpitaux, 1886, p. 1185.

JACQUET, "Le tic de salaam," Thèse de Paris, 1903.

JANET. See RAYMOND.

JANKE, "Sur les mouvements musculaires conscients et inconscients dans le bégaiement," IIIe Congrès des médecins tchèques à Prague, 1901.

JANOWITZ, "Tic convulsif, paramyoclonus multiplex, et chorée électrique," Thèse de Paris, 1891.

JANTZEN, "Tonisch-klonische Krämpfe in Gefolge einer Zahnextraktion," Deutsche zahnärtz. Wochenschrift, 1900, p. 1399.

JAROCHEVSKY, "Sur l'étiologie et la thérapie de la chorée rythmique," Revue (russe) de psychiatrie, 1902, p. 736.

JOFFROY, "Des myopsychies," Revue neurologique, April 15, 1902, p. 289.

JOLLY, "Ueber die sogenannte Maladie des Tics convulsifs," Charité Annalen, vol. xii. 1892, p. 740.

KEEN, "A New Operation for Spasmodic Wryneck," Annals of Surgery, January, 1891, p. 44.

KENNEDY, "On the Restoration of Co-ordinated Movements after Nerve-crossing, with Interchange of Function of the Cerebral Cortical Centres," Proceedings of the Royal Society, 1900, p. 431.

KNAPP, "Functionelle Contractur der Halsmuskeln," Archiv f. Psychiatrie u. Nervenkrankheiten, 1905, p. 1263.

KNY, "Ueber ein dem Paramyoclonus Multiplex (Friedreich) nahestehendes Krankheitsbild," Archiv f. Psychiatrie u. Nervenkrankheiten, 1888, p. 577.

KODYM, "Une nouvelle espèce de spasme fonctionnel," Revue neurologique, 1895, p. 155 (reference).

KOPCZINSKI, "Un cas de névrose motrice sous forme du tic convulsif," Revue neurologique, 1902, p. 582 (reference).

KOPPEN, Ueber das psychische Moment bei der Beschäftigungsneurosen, im besonderen beim Schreibekrampf, Göttingen, 1903.

KÖSTER, "Ueber die Maladie des Tics impulsifs," Deutsche Zeitschrift f. Nervenkeilkunde, 1899, Hft. 3-4, p. 147.

LABBÉ, "Débilité mentale et tremblement," Presse médicale, 1897, p. 185.

LAGRANGE, La médication par l'exercice, Paris, 1894.

---- Les mouvements méthodiques et la mécanothérapie, Paris, 1899.

LAMBRANZI, "Due casi di policlonie nella demenza precoce," Rivista di patologia nervosa e mentale, 1901, p. 241.

---- "Su le policlonie nella demenza paralitica," Rivista di patologia nervosa e mentale, August, 1902, p. 360.

LAMY, "Myoclonie avec hémianesthésie sensitivo-sensorielle chez un sujet atteint de monoplégie infantile du membre inférieur," Société de neurologie de Paris, May 5, 1904.

---- "Hémispasme clonique facial; spasmes cloniques chez l'homme et chez le chien," Société de neurologie de Paris, July 6, 1905.

LANDOLT, "Torticolis oculaire," Bulletin médical, 1890, p. 573.

LANNOIS AND POROT, "Sur les hémispasmes de la face; hémispasme facial vrai, hémispasme hystérique," Lyon médical, February 7, 1904, p. 234.

LASÈGUE, "De la toux hystérique," Société médicale des hôpitaux de Paris, 1855, p. 269.

LEGRAIN, "Du délire des dégénérés," Thèse de Paris, 1885.

LEMAIRE. See LEMOINE.

LEMBO, "Paramyoclonus multiplex di Friedreich," Giornale di neuropatologia, 1887, p. 261.

LEMOINE, "Note sur un cas de paramyoclonus multiplex suivi de troubles psychiques et de l'écholalie," Revue de médecine, November, 1892, p. 882.

LEMOINE AND LEMAIRE, "Étude clinique et séméiologique du paramyoclonus multiplex," Revue de médecine, December, 1889, p. 1018.

(Thirty-nine references to the literature of paramyoclonus multiplex.)

LENTZ, "Rotation permanente de la tête à droite," Journal de neurologie, 1897, p. 502.

LERCH ["Tics convulsifs"], American Medicine, November 2, 1901.

LEROUX, "Du tic post-choréique," Revue mensuelle des maladies de l'enfance, June, 1891, p. 251.

LESZYNSKY, "Spasmodic Wryneck and its Treatment; Report of two Cases with Recovery," Journal of Nervous and Mental Disease, February, 1901, p. 103.

LETULLE, "Note à propos d'un cas de bégaiement compliqué de tics coordinés multiples," Gazette médicale de Paris, 1883, p. 536.

LEVI AND BONNIOT, "Un cas de myospasme clonique et tonique (myoclonotonie acquise)," Société de neurologie de Paris, May 11, 1905.

---- "Myoclonotonie acquise," Revue d'hygiène et de médecine infantile, 1905, p. 569.

LEVY, "Ererbte Mitbewegungen," Neurologisches Centralblatt, July, 1901, p. 605.

---- "Angeborenen Mitbewegungen bei willkürlichen Bewegungen," Archiv f. Psychiatrie u. Nervenkrankheiten, 1903, p. 927.

LEWIN, "Phosphaturie mit Tic convulsif bei einem 3-1/2-jahrigen Kinde," Archiv f. phys.-diat. Therapie, 1900, p. 281.

LINZ, "Ueber spastische Torticollis," Inaugural Dissertation, Bonn, 1897.

LONDE. See ROBIN.

LORENZETTI, "A proposito di alcuni casi di tic convulsivo," Gazzetta degli ospedali e delle cliniche, November 22, 1903, p. 1478.

LORTAT-JACOB. See HAUSER.

LUGARO, "Sulla mioclonia," Rivista di patologia nervosa e mentale, 1896, p. 389.

LUNDBORG, Die progressive Myoklonus-Epilepsie (Unverricht's Myoklonie), Upsala, 1903.

---- "Ist Unverricht's sogenannte familiäre Myoklonie eine klinische Entität?" Neurologisches Centralblatt, February 15, 1904, p. 162.

LUZENBERGER, Tic muscolari simplici, tic emotivi, e malattia di Gilles de la Tourette, Naples, 1897.

---- "'Absences' psichichi in isterici," Rivista sperimentale di freniatria, December, 1900, p. 822.

LYMAN, "Torticollis and Nodding Spasm," International Medical Magazine, vol. ii. 1894, p. 741.

MADER, "Myoklonie in der Art eines expiratorischen Singultus," Wiener med. Blätter, 1899, No. 30.

MALM ["Tic rotatoire"], Allgemeine medicinische Centralzeitung, 1899, No. 64.

MANNINI, "Policlonia ed epilessia," Gazzetta degli ospedali e delle cliniche, September 30, 1900, p. 1220.

---- "Coree, policlonie, tic e malattia dei tic," Riforma medica, July, 1902, p. 137.

MARÉCHAL, "Un cas de torticolis spasmodique," Journal de neurologie, May 20, 1899, p. 206.

MARIE (PIERRE), "Spasme névropathique d'élévation des yeux," Société de neurologie de Paris, April 18, 1901.

MARIE AND GUILLAIN, "Mouvements athetoïdes de nature indéterminée," Société de neurologie de Paris, April 17, 1902.

MARINA, "Delle miospasie in generale e della miospasia atetosica in particolare," Il policlinico, sezione pratica, 1902, p. 577.

MARROTTE, "Tic non douloureux de nature hystérique reparaissant sous le type quotidien," Société médicale des hôpitaux de Paris, 1851.

MARTAUD, "Étude sur le tic convulsif simple," Thèse de Bordeaux, 1897.

MARTIN (CLAUDE), "Tic congénital associé à du bégaiement," Journal de médecine de Bordeaux, 1900, p. 172.

---- See DAVESAC.

---- (ÉTIENNE), "Deux cas de torticolis mental chez les aliénés: observations relatives au traitement de cette affection," Écho médical de Lyon, September 15, 1901.

MASSALONGO, "Corea elettrica o mioclonia elettroide di origine gastrica," Riforma medica, vol. iii. 1892, p. 471.

(References to the literature of electric chorea.)

---- "Contribution à l'origine corticale des tremblements," Revue neurologique, 1903, p. 455.

MASSARO ["Vingt-six cas de géniospasme en cinq générations"], Il pisani, 1894, fasc. I.

MASSARY AND TESSIER, "Torticolis mental ou torticolis spasmodique (torticolis-tic ou torticolis-spasme)," Revue neurologique, December 30, 1904, p. 1204.

MAYER ["Tic convulsif remplaçant une névralgie sus-orbitaire"], Alienist and Neurologist, July, 1897.

MEIGE, "Tics variables; tics d'attitude," Société de neurologie de Paris, July 4, 1901.

MEIGE, "Les mouvements en miroir; leurs applications pratiques et thérapeutiques," Revue neurologique, 1901, p. 280.

---- "Histoire d'un tiqueur; tics variables; tics d'attitude," Journal de médecine et de chirurgie pratiques, August 25, 1901, p. 609.

---- "Sur les tics," Gazette hebdomadaire, May 1, 1902.

---- "Spasme facial franc," Société de neurologie de Paris, April 17, 1902.

---- "Tic et fonction," Revue neurologique, 1902, p. 383.

---- "Tic et écriture," Gazette hebdomadaire, June 12, 1902, p. 541.

---- "La genèse des tics," Journal de neurologie, June 5, 1902.

---- "La correction des tics par le contrôle du miroir," Journal de médecine et de chirurgie pratiques, October 25, 1903, p. 769.

---- "Micropsie chez un tiqueur bègue," Société de neurologie de Paris, January 15, 1903.

---- "L'aptitude catatonique et l'aptitude échopraxique des tiqueurs; les exercices thérapeutiques de détente," Congrès de Madrid, April, 1903.

---- "Tics des yeux," Annales d'oculistique, 1903, p 167.

---- "Neue Beiträge zur Prognose und Behandlung des Tic; die psycho-motorische Selbsterziehung unter Spiegelkontrolle," Journal f. Psychologie u. Neurologie, 1903, p. 53.

---- "Le phénomène de la chute du bras," Revue neurologique, August 30, 1903.

---- "Tics des lèvres; cheilophagie, cheilophobie," Journal de neurologie, October 20, 1903, p. 481.

---- "Le spasme facial; ses caractères cliniques distinctifs," Revue neurologique, October 30, 1903.

---- "Les tics," Revue scientifique, May 15, 1904.

---- "Migraine ophtalmique; hémianopsie et aphasie transitoires; hémiface succulente; photophobie et tic de clignement," Revue neurologique, September 30, 1904, p. 961.

---- "Génio-tics et génio-spasmes," Société de neurologie de Paris, April 6, 1905.

---- "Tics de sphincters," Congrès de Rennes, August, 1905.

---- See BRISSAUD.

---- See FEINDEL.

MEIGE AND FEINDEL, "Traitement des tics; traitement par l'immobilisation des mouvements et les mouvements d'immobilisation," Presse médicale, March 16, 1901, p. 125.

MEIGE AND FEINDEL, "Les causes provocatrices et la pathogénie des tics de la face et du cou," Société de neurologie de Paris, April 18, 1901.

---- ---- "Sur la curabilité des tics," Gazette des hôpitaux, June 20, 1901, p. 673.

---- ---- "L'état mental des tiqueurs," Progrès medical, September 7, 1901, p. 146.

---- ---- "Les associations du torticolis mental," Archives générales de médecine, February, 1902, p. 168.

---- ---- "Remarques cliniques et thérapeutiques sur quelques tics de l'enfance," Journal de neurologie, September 20, 1904, p. 341.

MEINERTZ, "Zur Casuistik der Myokimie," Neurologisches Centralblatt, February 1, 1904, p. 101.

MEIROWITZ, "A Case of Habit Spasm," The Post-graduate, 1900, p. 643.

METTLER, "Occupation Neuroses," Clinical Review, October, 1904.

MEYER, "Zur Casuistik des Tic rotatoire," Deutsche medicinische Wochenschrift, December 30, 1897, p. 849.

MILLER, "Three Cases of Head-nodding and Head-rotation in Rachitic Infants," Archives of Pediatrics, August, 1900, p. 561.

(Twenty-one references to the literature.)

MITCHELL (JOHN), "An Instance of Spasmodic Affection of the Tongue and Mouth successfully treated," Transactions of the Medicochirurgical Society, 1813, p. 25.

---- (WEIR), "On Functional Spasms," American Journal of the Medical Sciences, October, 1876, p. 321.

MOTT, "Tremors," Practitioner, September, 1904, p. 293.

MOURIER, "L'hémispasme vrai, non douloureux," Thèse de Lyon, 1903.

MOUSSOUS, "A propos de la chorée des dégénérés," Revue neurologique, 1902, p. 517 (reference).

MURRI, "Policlonie e coree," Il policlinico, November, 1899, p. 487.

NEFF, "Report of a Case of Myoclonus Epilepsy," American Journal of Insanity, January, 1904, p. 467.

NÈGRE, "Du torticolis fonctionnel," Thèse de Montpellier, 1883.

NEGRO ["Sur un cas de blépharospasme unilatéral, probablement de nature épileptique"], Archivio di psichiatria, 1904, p. 84.

NEWMARK, "Ein Fall von primaerem tonischen Gesichtskrampf mit Muskelwogen," Neurologisches Centralblatt, 1903, p. 461.

NOGUÈS, "Torticolis mental," Revue de psychologie clinique et thérapeutique, July, 1899, p. 215 (reference).

---- "Des tics en général" (Congrès de Grenoble), Revue neurologique, 1902, p. 766.

NOGUÈS AND SIROL, "Torticolis mental," Nouvelle iconographie de la Salpêtrière, Nov.-Dec. 1899, p. 483.

---- ---- "Un cas de paralysie associée des muscles droits supérieurs de nature hystérique," Société de neurologie de Paris, March 7, 1901.

NOIR, "Étude sur les tics chez les dégénérés, les idiots, et les imbéciles," Thèse de Paris, 1893.

---- See BOURNEVILLE.

NONNE, "Zwei Fälle von Maladie des Tics," Neurologisches Centralblatt, 1898, p. 327 (reference).

NORSTROM, "A Study of the Affection 'Writers' Cramp,'" New York Medical Journal, March 12, 1904, p. 491.

NOVÉ-JOSSERAND, "Torticolis spasmodique," Lyon médical, September 4, 1898, p. 12.

ODDO, "Le diagnostic différentiel de la maladie des tics et de la chorée de Sydenham," Presse médicale, September 30, 1899.

---- "Tic de la génuflexion," Marseille Médical, March 15, 1902.

OETTINGER, "The Disease of Convulsive Tic," American Journal of the Medical Sciences, September, 1899, p. 303.

OLIVIER, "Le bégaiement dans la littérature médicale," La parole, 1899, No. 10.

OPPENHEIM, "Bemerkungen zur Lehre vom Tic," Journal f. Psychologie u. Neurologie, 1902, p. 139.

OPPOLZER, "Krampf des Gesichtsnerven; Tic convulsif," Allgemeine wiener medicinische Zeitung, 1861, p. 73.

OWEN, "Spasmodic Wryneck treated by Resection of the Spinal Accessory Nerve," Lancet, June 18, 1892, p. 1361.

OZENNE, "Tic non douloureux de la face datant de trois ans chez un hérédo-syphilitique; guérison par le traitement hydrargyrique," Société de médecine et de chirurgie pratiques de Paris, February 6, 1902.

PAGET, "Cases of Morbid Rhythmical Movements, with Observations," Edinburgh Medical and Surgical Journal, January, 1847, p. 60.

(Contains many interesting references to the early literature.)

PARANT, "Les tics chez les aliénés," Congrès de Grenoble, 1902.

PARRY, "Cases of Spasmodic Torticollis," British Medical Journal, November 5, 1898, p. 1403.

PATELLA, "Studio anatomo, patologico e clinico sul policlono," Il policlinico, November, 1901, p. 535.

PATRICK, "Imperative Conceptions," New York Medical Journal, September 7, 1901, p. 445.

---- "Convulsive Tic," Journal of the American Medical Association, February 11, 1905.

PATRY, "De la chorée variable ou polymorphe, chorée des dégénérés," Thèse de Paris, 1897.

PAULY, "Spasmes fonctionnels du cou," Semaine médicale, 1894, p. 486.

---- "Théorie réflexe du torticolis spasmodique," Revue de médecine, February, 1897, p. 130.

PECKHAM, "Rhythmical Myoclonus," Archives of Medicine, April, 1883, p. 97.

PELI, "Lo stato mentale dei pazienti di tic," Rivista sperimentale di freniatria, May 25, 1903, p. 377.

PERRODY, "De l'aérophagie," Thèse de Paris, 1901.

PERSONALI ["La crampe idiopathique de la langue"], Clinica medica italiana, January 1, 1898.

PETERSON, "Gyrospasm of the Head in Infants," Medical News, October 1, 1892, p. 374.

PETIT, "Traitement du torticolis spasmodique par la résection du nerf spinal," Union médicale, 1891, p. 37.

PHOCAS, "Torticolis musculaire aigu; son traitement," Revue mensuelle des maladies de l'enfance, 1891, p. 448.

PICK, "Beiträge zur Lehre von der Echolalie," Jahrbücher f. Psychiatrie u. Neurologie, 1902, p. 283.

PITRES, "Spasmes rythmiques hystériques," Gazette médicale, 1888, p. 145, &c.

(Many references to the literature.)

---- "Tics convulsifs généralisés, traités et guéris par la gymnastique respiratoire," Journal de médecine de Bordeaux, February 17, 1901, p. 106.

---- "Étiologie et symptomatologie des tics," Congrès de Grenoble, 1902.

---- "Sur un cas de torticolis mental, traité sans succès par plusieurs médecins, et guéri à la suite des manOEuvres d'un rébouteur," Journal de médecine de Bordeaux, September 11, 1904, p. 665.

PITRES, "Note sur quelques cas de torticolis spasmodique," Journal de médecine de Bordeaux, August 13, 1905, p. 589.

PITRES AND CRUCHET, "Traitement des tics," Congrès de Grenoble, 1902.

PITRES AND TISSIÉ, "Tic oculaire," Journal de médecine de Bordeaux, July 9, 1899, p. 330.

PLAVEC, "Tic convulsif," Weiner medicinische Presse, 1904, p. 1622.

POGGIO, "Ricerche isto-patologiche sul paramioclono molteplice," Rivista di patologia nervosa e mentale, 1905, p. 175.

POLIDORI, "Un caso di 'chorea laryngea' in un' istero-coreica," Il policlinico, June 29, 1901, p. 1103.

POPOFF, "Contraction de longue durée des masseters," Revue neurologique, 1899, p. 611 (reference).

POROT. See LANNOIS.

PRÉVOST AND BATTELLI, "De la production des convulsions toniques et cloniques chez les différentes espèces animales," La policlinique, October 15, 1904.

PRINCE, "Case of Multiform Tic, including Automatic Speech and Purposive Movements," Journal of Nervous and Mental Disease, January, 1906, p. 29.

PROUT. See CLARK.

POWER (D'ARCY), "Cases to illustrate the Relationship which exists between Wryneck and Congenital Hæmatoma of the Sterno-Mastoid Muscle," Medico-chirurgical Transactions, vol. lxxvi. 1893, p. 137.

(Thirty-four references to the subject.)

QUERVAIN (DE), "Le traitement chirurgical du torticolis spasmodique d'après le méthode de Kocher," Semaine médicale, 1896, p. 405.

RABOT, "La myoclonie épileptique," Thèse de Paris, 1899.

RAILTON, "Note on a Case of Involuntary Muscular Movements accompanied with Coprolalia," Manchester Medical Chronicle, April, 1886.

RAUDNITZ, "Zur Lehre vom Spasmus Nutans," Jahrbuch f. Kinderheilkunde, October, 1897, p. 145.

(Sixty-three references to the literature of spasmus nutans and eclampsia nutans, with analysis of recorded cases.)

RAYMOND, "Crampe des écrivains," Journal de médecine et de chirurgie pratiques, June 10, 1895.

RAYMOND, "Des myoclonies," Clinique des maladies du système nerveux, Ire série, 1896, p. 551.

---- "Exemple de spasmes hystériques et example de tics," Journal de médecine interne, September 1, 1902, p. 169.

RAYMOND AND JANET, Névroses et idées fixes, vols. i. and ii. passim.

----- ---"Note sur deux tics du pied," Nouvelle iconographie de la Salpêtrière, Sept.-Oct. 1899, p. 353.

RÉDARD, Le torticolis et son traitement, Paris, 1898.

REMAK, "Ueber localisirte Krämpfe," Deutsches Klinik, 1905, p. 775.

RENDU, "Hystérie chez un saturnin; hémispasme facial," Bulletin de la société médicale des hôpitaux de Paris, 1891, p. 618.

RÉNON AND FOLLET, "Hémispasme facial total d'une extrême intermittence chez une hystérique," Bulletin de la société médicale des hôpitaux de Paris, December 23, 1898, p. 920.

RENTERGHEM (VAN), "Un cas de tic rotatoire guéri par la psycho-thérapie," Journal de neurologie, May 20, 1898, p. 213.

REYNOLDS, "Paramyoclonus epilepticus," Review of Neurology and Psychiatry, January, 1906, p. 19.

RHODES, "Spasm of the Tensors of the Vocal Cords," New York Medical Journal, 1899, p. 267.

RICKLIN, "Sur le paramyoclonus multiplex," Gazette médicale de Paris, 1888, p. 19.

ROBIN AND LONDE, "Torticolis et lumbago d'origine articulaire et rhumatismale," Revue de médecine, 1894, p. 837.

ROGER. See CADIOT.

ROSE. See BALLET.

ROSSI AND GONZALES ["Autopsie d'un cas d'épilepsie avec myoclonie"], Annali di nevrologia, 1900, fasc. 4.

ROSSOLIMO, "Ueber Dysphagia amyotactica," Neurologisches Centralblatt, 1901, p. 146.

ROTH, Histoire de la musculation irrésistible ou de la chorée anormale, Paris, 1850.

ROUILLARD AND ISCOVESCO, "L'obsession en pathologie mentale," Gazette des hôpitaux, 1896, p. 503.

(References to the literature on the psychical side of the subject.)

RUDLER, "Tic tonique du membre supérieur droit," Nouvelle iconographie de la Salpêtrière, July-Aug. 1903, p. 218.

RUDLER AND CHOMEL, "Tic de l'ours chez le cheval, et les tics d'imitation chez l'homme," Revue neurologique, June 15, 1903, p. 541.

RUDLER AND CHOMEL, "Analogies entre les ties et stéréotypies de léchage chez l'homme et chez le cheval." Société de neurologie de Paris, January 7, 1904.

---- ---- "Des stigmates anatomiques, physiologiques, et psychiques de la dégénérescence chez l'animal, en particulier chez le cheval," Nouvelle iconographie de la Salpêtrière, Nov.-Dec. 1904, p. 471.

---- ---- "Une observation de 'tic du chiqueur,'" Société de neurologie de Paris, January 7, 1904.

RUSSELL (RISIEN), "An Experimental Investigation of the Cervical and Thoracic Nerve-roots in relation to the Subject of Wryneck," Brain, 1897, p. 35.

SABRAZÈS, "Mouvements involontaires stéréotypés des doigts s'organisant en tics dans le tabes," Congrès de Rennes, 1905.

SABRAZÈS AND CALMETTE, "Tics de doigts et mouvements athetoïdes des tabétiques," Gazette hebdomadaire des sciences médicales de Bordeaux, July 2, 1905, p. 315.

---- ---- "Tic d'attitude chez un aveugle," Gazette hebdomadaire des sciences médicales de Bordeaux, June 4, 1905, p. 271.

SACHS, "The Educational Treatment of Tics," Medical News, July 1, 1905, p. 3.

SAMAJA, "Le siège des convulsions épileptiformes toniques et cloniques," Revue médicale de la Suisse romande, February 20, 1903, p. 77.

SANO, "Tic de la face et du cou," Société belge de neurologie, November 26, 1898.

---- See CLAUS.

SARBO, "Ein Fall von clonischen Masseterkrampf," Monatsschrift f. Psychiatrie u. Neurologie, June, 1900, p. 493.

SAVILL, "De la crampe des écrivains et des autres affections nerveuses professionnelles," Nouvelle iconographie de la Salpêtrière, March-April, 1901, p. 149.

SAVY. See GALLAVARDIN.

SCHAPRINGER, "Zur Pathologie des Spasmus Nutans," Centralblatt f. praktischen Augenheilkunde, August, 1905, p. 225.

SCHEIBER, "Ueber einen Fall von durch Spleniuskrampf bedingten Torticollis," Wiener medicinische Wochenschrift, 1900, p. 261.

SCHELATOW, "Ein Fall von Paramyoclonus Multiplex," Münchener medicinische Wochenschrift, 1895, p. 696.

SCHERB, "Hémispasme tonique du côté droit constituant un tic mental professionnel; tic de la mendiante," Société de neurologie de Paris, May 3, 1900.

---- "Un nouveau cas de torticolis mental," Revue neurologique, September 15, 1902, p. 841.

SCHULTZE, "Ueber Poly-Para-und Monoclonien," Deutsche Zeitschrift f. Nervenheilkunde, 1898, p. 409.

---- "Ueber Chorea, Poly-and Monoklonie," Neurologisches Centralblatt, 1897, p. 611.

---- "Beiträge zur Muskelpathologie," Deutsche Zeitschrift f. Nervenheilkunde, 1895, p. 65.

SCHUPFER, "Sulle mioclonie," Il policlinico, 1901, p. 1.

(One hundred and sixteen references to the literature of myoclonus.)

SCHUSTER, "Tonische und klonische Krampf des ganzen rechten Facialis," Archiv f. Psychiatrie u. Nervenkrankheiten, 1904, p. 288.

SEE, "Des pseudo-chorées rythmiques, spasmes toniques et tics," Semaine médicale, March 26, 1884.

SEELIGMÜLLER, "Ueber Myoclonie (Paramyoclonus Multiplex) und Convulsibilität (Spasmophilie)," Deutsche medicinische Wochenschrift, 1887, p. 1117.

SÉGLAS, "Tic aérophagique et paralysie générale," Semaine médicale, January 11, 1899, p. 9.

---- "Un cas de torticolis mental," Revue neurologique, 1901, p. 114.

SÉRIEUX, "Les hallucinations motrices verbales dans la paralysie générale," Gazette hebdomadaire, June 19, 1898, p. 577.

SEVESTRE, "Un cas de spasme fonctionnel du sternomastoïdien," Union médicale, September 1, 1882, p. 383.

SGOBBO, "Un caso di torcicollo mentale," Il manicomio moderno, 1898, p. 424.

SICARD. See BRISSAUD.

SICCARDI, "Considerazioni su la fisiopatologia e su la teoria del tic," Annuario del manicomio provinciale di Ancona, Anno II, 1904.

(Eighty-eight references to the literature, chiefly Italian.)

SICURIANI, "Contributo allo studio del tonomioclono," Riforma medica, January 20, 1904, p. 57.

SILVESTRINI, "Spasmo clonico diffuso," Medicina contemporanea, 1884, p. 83.

SIMON, "Une nouvelle variété de spasmes musculaires fonctionnels," Thèse de Paris, 1875.

SINKLER, "Habit Chorea," American Journal of the Medical Sciences, May, 1897, p. 559.

SMITH (NOBLE), "Spasmodic Torticollis: its Cure by Operation," International Medical Congress, Rome, 1894, Section of Surgery, p. 273.

---- "A Case of Spasmodic Torticollis associated with Chorea," Clinical Journal, May 10, 1899, p. 41.

---- "Spasmodic Torticollis," British Medical Journal, vol. i. 1899, p. 908.

SOLGER. See STEYERTHAL.

SOMA, "Contributo allo studio delle mioclonie," Gazetta degli ospedali e delle cliniche, December 18, 1904, p. 1596.

SONNEVILLE. See CARRIÈRE.

SORGO, "Ueber subcorticale Entstehung isolirter Muskelkrämpfe," Neurologisches Centralblatt, July, 1902, p. 642.

SOUPAULT. See ACHARD.

SOURY, "Les myoclonies, physiologie pathologique," Annales médico-psychologiques, 1897, p. 398.

SPEHL, "A propos du traitement de la maladie des tics," Journal de neurologie, 1899, p. 289.

STEVENS, "Facial Spasm and its relation to Errors of Refraction," American Journal of the Medical Sciences, 1900, p. 33.

STEYERTHAL, "Zur Geschichte des Torticollis Spasmodicus," Archiv f. Psychiatrie u. Nervenkrankheiten, Bd. xli. 1906, p. 31.

(Many interesting references to ancient writers.)

STEYERTHAL AND SOLGER, "Ueber Torticollis Spasmodicus," Archiv f. Psychiatrie u. Nervenkrankheiten, Bd. xxxviii. 1904, p. 949.

STICH, "Zwei Fälle von Krampf im Bereiche des N. accessorius Willisii," Deutsche Archiv f. klinische Medicin, 1873, p. 525.

STILL, "Habit Spasm in Children," Lancet, December 16, 1905, p. 1754.

---- "Head-nodding with Nystagmus in Infancy," Lancet, July 28, 1906, p. 207.

---- "On Head-rolling and Other Curious Movements in Children," The Clinical Journal, November 21, 1906, p. 87.

TAGUET. See BALLET.

TAMBURINI, "Fisiopatologia e cura del tic," Rivista sperimentale di freniatria, December 15, 1903, p. 870.

TANON. See BRISSAUD.

TESSIER. See MASSARY.

TESTI, "Storia di un caso singolarissimo di spasmo muscolare diffuso," Giornale di neuropatologia, 1886, Nos. 3 and 4.

THOMAS, "Contribution à l'étude de la maladie des tics chez l'enfant," Gazette des maladies infantiles, October 21, 1901.

THORNTON, "Some Curious Facts concerning 'the Jumpers,'" New York Medical Record, 1885, p. 713.

TISSIÉ, "Tic oculaire et facial droit accompagné de toux spasmodique, traité et guéri par la gymnastique medicate respiratoire," Journal de médecine de Bordeaux, July 9, 1899.

---- See PITRES.

TOKARSKI, "Maladie des Tics convulsifs," Neurologisches Centralblatt, November 1, 1890, p. 662 (reference).

TOULIERES. See CABANNES.

TOURETTE (GILLES DE LA), "Jumping; latah; myriachit," Archives de neurologie, 1884, p. 68.

---- ---- "Étude sir une affection nerveuse caractérisée par de l'incoordination motrice accompagnée d'écholalie et de coprolalie," Archives de neurologie, 1885, p. 19.

---- ---- "Torticolis hystérique," Nouvelle iconographie de la Salpêtrière, 1889, p. 182.

---- ---- "La maladie des tics convulsifs." Semaine médicale, May 3, 1899, p. 153.

TOURETTE (GILLES DE LA) AND DAMAIN, "Un danseur monomane," Progrès médical, January 14, 1893.

UCHERMANN, "Ein Fall von alternirenden, rhythmischen, und clonischen Krämpfen der Glottisschliesser und der Glottisweiterer," Archiv f. Laryngologie, 1898, p. 326.

UNVERRICHT, "Ueber familiäre Myoclonus," Deutsche Zeitschrift f. Nervenheilkunde, 1895, p. 32.

VALOBRA, "Policlono infettivo; contributo allo studio delle mioclonie," Il morgagni, 1904, p. 774.

VANLAIR, "Myoclonies rythmiques," Revue de médecine, 1889, p. 1.

VARIOT, "Un cas de chorée électrique (variété de tic juvenile curable)," Gazette des hôpitaux, December 19, 1901, p. 1401.

VERGOZ, "Du torticolis spasmodique," Thèse de Bordeaux, 1888.

VITEK, "Paramyoclonus multiplex," Congrès des médecins tchèques à Prague, 1901.

VITEK, "Tic de la main; contribution a la question des obsessions motrices," Revue neurologique, 1905, p. 50 (reference).

VLAVIANOS, "Tic nerveux, traité avec succès par la suggestion hypnotique," Journal de neurologie, 1899, p. 318.

VOGT ["Les exercices dans la thérapeutique des affections nerveuses fonctionnelles"]. Psychiatrische Wochenschrift, Sept.-Oct. 1899.

VURPAS, "Les myopsychies de Joffroy; association des troubles musculaires et des troubles psychiques," Revue de psychiatrie, October, 1904, p. 413.

WALTON, "Nature and Treatment of Spasmodic Torticollis," American Journal of the Medical Sciences, March, 1898, p. 295.

WILLE, "Ueber einen Fall von Maladie des Tics impulsifs," Monatsschrift f. Psychiatrie u. Neurologie, 1898, p. 210.

WILLIAMSON, "Myokymia, or Persistent Muscular Quivering," British Medical Journal, 1900, p. 1705.

WYEMANN, "Ueber einen Fall von Tic de Guinon," Göttinger Dissertation, 1900.

ZABLUDOWSKI, "Zur Prophylaxe und Therapie des Schreib-und Musik-krampfes," Prager medicinische Wochenschrift, April 21, 1904, p. 195.

ZIEHEN, "Ueber Mioclonus und Mioclonie," Archiv f. Psychiatrie u. Nervenkrankheiten, 1888, p. 415.

INDEX OF NAMES

A., 166

Achard, 291

Aimé, 212

Allocco (d'), 286

Amussat, 169

André, 26

Appleyard, 308

Atkins, 308

Axenfeld, 26, 246, 299

B., 131, 134

B. (Séglas), 265

Babinski, 135, 136, 137, 152, 276

Bain, 60

Ball, 216

Ballance, 309

Ballet, 76, 152, 335, 337

Bamberger, 196

Beard, 196, 250

Bechterew, 143, 198, 288

Bergeron, 251, 284

Bernhardt, 98, 145

Biaggi, 209

Billot, 162

Blache, 99, 315

Blocq, 55, 64

Bompaire, 169, 175, 317

Bonnier, 127

Bouchut, 246

Bourneville, 27, 127, 257, 316, 344

Brener, 267

Bresler, 92, 267

Briand, 170, 182, 207

Brif., 149

Briquet, 246

Brissaud, 27, 37, 40, 55, 59, 67, 68, 74, 100, 108, 111, 119, 123, 124, 139, 166, 167, 172, 174, 177, 181, 210, 218, 220, 228, 229, 234, 238, 268, 271, 281, 295, 296, 312, 316, 319, 324, 328, 331, 333, 343

Brodie, 256

Bruandet, 275

Buck (de), 128, 169

Buss, 113

C. (Noir), 258

Cadiot, 112

Cahen, 264

Campbell, 307

Cantilena, 218

Cestan, 153

Chabbert, 225, 247

Charcot, 27, 34, 39, 40, 48, 58, 60, 62, 74, 75, 80, 87, 98, 108, 116, 125, 167, 207, 227, 246, 251, 281, 300, 304

Chatin, 162, 240

Chauffard, 278

Chervin, 325

Chipault, 111, 114, 310

Chomel, 94

Claus, 143

Cohn, 148

Collier, 307

Colombat, 303

Constant, 101

Corning, 312

Coudray, 308

Crouzon, 151

Cruchet, 25, 32, 39, 65, 68, 101, 102, 113, 115, 116, 122, 199, 220, 250, 257, 295, 326

D., 106

Dalwig, 311

Debrou, 110, 114

Déjérine, 171

Delasiauve, 99

Demosthenes, 303

Derevoge, 209

Descroizilles, 333

Desterac, 136, 276, 277

Dide, 252

Dornbluth, 301

Dubini, 284

Dubois, 53, 87, 328

Duchenne, 114, 167, 177, 178

Dufour, 296

Dupré, 54, 56, 86

Durand, 335

E., 186

E. (Noir), 289

Edel, 204

Ehret, 193

Eliot, 308

Erb, 32

Esquirol, 257

Etmuller, 33

F., 86, 150

Faure, 312

Fechner, 338

Feindel, 121, 123, 166, 169, 173, 185, 238, 239, 317, 321, 333

Féré, 111, 170, 234, 244, 253, 254, 338

Féron, 305

Ferrand, 32

Ferrier, 111

Flatau, 100

Flechsig, 301

Fornaca, 276

Fournier, 238

Fraenkel, 313

François, 26

Francotte, 162

Frenkel, 322

Freud, 267

Friedreich, 251, 285, 287

Fur (le), 114

G., 86, 98, 148, 155, 166

Gardner, 307, 308

Gaupp, 242

Gehuchten (van), 178, 291

Geyer, 213

Gilbert, 112

Giles, 307

Gintrac, 99

Gonzalès, 116, 253

Gowers, 98, 257, 281

Graefe (von), 147

Graff, 170

Grasset, 27, 60, 65, 66, 67, 68, 84, 91, 93, 106, 132, 169, 173, 175, 177, 214, 239, 242, 291, 301, 302

Graves, 26

Guibert, 169

Guillain, 181, 277

Guinon, 27, 39, 45, 46, 47, 51, 56, 58, 63, 80, 87, 90, 102, 104, 119, 156, 164, 189, 195, 196, 197, 206, 215, 216, 219, 224, 300

Gunn, 323

Hajos, 288

Hall, 33

Hallion, 270

Hammond, 196

Hartenberg, 198, 302, 322

Haskowec, 83

Hasslauer, 211

Heldenbergh, 287

Helfreich, 323

Hénoch, 251

Hermann, 286

Hitzig, 114

Holland, 216

Hoppe-Seyler, 201

Huntington, 281

Huyghe, 314

Ibsen, 213

Innfeld, 228

Itard, 76, 303

J., 52, 54, 76, 78, 81, 84, 98, 100, 105, 121, 131, 139, 155, 160, 183, 185, 186, 221, 240, 243, 330, 340

J. (Noir), 289

Jaccoud, 34

Jacoby, 193

Jancowicz, 287

Janet, 64, 65, 86, 121, 162, 169, 172, 173, 175, 183, 187, 193, 195, 199, 223, 238, 240, 241, 248, 305, 306, 316, 317, 326

Janke, 210

Joffroy, 269, 296

Jolly, 315

Jourdin, 26, 33

K., 239

Kaiser, 289

Keen, 309

Kennedy, 312

Kny, 288

Kocher, 162, 309, 310

Kopczynski, 212, 228

Koster, 227, 328

L., 58, 79, 105, 126, 135, 136, 178, 190, 233, 255, 273, 274, 292, 332, 340

L. (Noir), 258

Labbé, 291

Lam., 84

Lange, 159

Langlois, 39

Lannois, 170, 316

Legenmann, 170

Legouest, 169

Legrain, 28

Lemoine, 286

Lentz, 175

Lerch, 150, 198

Letulle, 27, 46, 47, 57, 63, 64, 91, 99, 158, 204, 208, 213, 264, 291, 315

Leube, 159

Lewin, 38

Linz, 310

Littré, 36, 45, 56, 102, 122

Luzenberger, 256

M., 78, 98, 100, 134, 145, 186

Madet, 327

Magnan, 27, 28, 30, 75, 108, 227

Malm, 253

Mannini, 252

Maréchal, 177, 306

Marie (A.), 266

---- (P.), 151, 153, 165, 181, 273, 277

Marina, 290

Martin, 175, 331

Massaro, 157

Mayer, 274

Mayor, 307

Meige, 124, 140, 169, 172, 185, 238, 239, 261, 269, 317, 335

Meirowitz, 145

Mills, 291

Mitchell, 281

Molière, 100

Monakow (von), 39

Montaigne, 44

Morel, 28, 296

Morin, 303

Morvan, 251, 284, 285

Moutard-Martin, 325

Muratow, 39

Murri, 116

N., 134, 173, 180, 185, 190, 239

N. (Noir), 257

Napoleon, 101

Nieden, 171

Niemeyer, 26

Noguès, 154, 169, 175, 203, 239

Noir, 27, 53, 55, 90, 93, 98, 109, 127, 148, 217, 218, 222, 227, 257, 259, 284, 291

Nonne, 283

Nothnagel, 112

Nové-Josserand, 310

O., 1 et seq., 52, 59, 76, 79, 121, 134, 135, 140, 144, 145, 155, 160, 183, 186, 189, 193, 222, 236, 243, 328, 329, 330, 340

O'Brien, 103, 196

Oddo, 89, 195, 279, 296, 324

Oettinger, 328

Olivier, 208, 325

Onanoff, 55, 64

Oppenheim, 32, 98, 112, 139, 144, 164, 169, 170, 175, 197, 204, 256, 276, 294, 302, 311, 312, 322, 328

Oppolzer, 114

Oxen, 308

P., 134, 139, 180, 186, 190

Parinaud, 147, 152

Patella, 117

Patry, 230

Pauly, 308, 309

Pearce-Gould, 307

Peter the Great, 100, 151

Pick, 212

Piedagnel, 99

Pinel, 257

Pitres, 27, 32, 33, 199, 200, 201, 215, 216, 221, 246, 247, 325

Ponagen, 201

Popoff, 310

Pujol, 26, 299

Quervain (de), 310

R., 78, 119, 126, 134, 144, 150, 323

R. (Noir), 257

Ramisiray, 196

Ranschburg, 159

Rauzier, 301, 302

Raymond, 30, 121, 153, 162, 169, 172, 173, 175, 187, 193, 195, 199, 233, 240, 241, 248, 251, 305, 306, 326

Redard, 177

Régis, 83, 138

Renterghem (van), 305

Ribot, 55

Richet, 39

Ricklin, 284

Rivière, 201

Roger, 112

Romberg, 26, 114, 145, 171

Ros., 259

Rossi, 116, 253

Rossolimo, 198

Roth, 83

Rudler, 94

Russell (Rizien), 309

S., 79, 88, 104, 125, 126, 134, 139, 140, 141, 155, 162, 180, 190, 222, 237

Sabrazès, 201

Saenger, 204

Saint-Simon, 100

Sano, 143

Sarbo (von), 159

Saury, 28

Sauvages, 33

Schapiro, 204

Scheiber, 125

Scherb, 248

Schultze, 111, 114, 288

Schupfer, 253, 287

Sciamanna, 227

Seeligmüller, 145

Séglas, 57, 63, 83, 173, 175, 188, 197, 199, 201, 202, 214, 215, 220, 265, 296, 319

Sgobbo, 169, 173, 175, 237

Siemerling, 197

Sinkler, 281

Sirol, 154, 169, 175, 203, 239

Smith, 309

Sollier, 257

Soupault, 291

Souques, 169, 172, 278

Southam, 307

Spencer, 60

Stewens, 312

Strümpell, 159

Sydenham, 279

T., 185, 186, 295

Thiem, 193

Thomson, 288

Tichoff, 311

Tissié, 99, 103, 129, 205, 223, 326

Tordeus, 284

Tourette, 27, 45, 196, 216, 219, 223, 224, 229, 232, 233, 293, 299, 300

Troisier, 32, 299

Trousseau, 26, 58, 108, 118, 167, 251, 298, 315

Uchermann, 212

Valleix, 26, 33, 147

Verga, 219

Verlaine, 314

Vigny (de), 107

Virchow, 41

Vlavianos, 305

Vogt, 335

W., 186

Walton, 171, 311

Weber, 338

Welterstrand, 305

Widal, 32

Wille, 92

Willis, 31, 33, 34, 167

Wolff, 193

Wutzer, 303

Wyemann, 341

X., 79, 231

INDEX OF SUBJECTS

Aerophagia, 199 et seq.

Affirmation tics, 163

Antagonistic gestures, 168, 236 et seq.

Aphonia, 211

Arithmomania, 87

Athetosis, 288

Attacks, 128

Attitude tics, 63, 122

Auditory tics, 145

Automatic movements, 41, 43, 259

Beating tics, 185

Beggar's tic, 248

Biting tics, 11, 159

Blepharospasm, 147

Blinking tics, 3, 148, 149

Blowing tics, 303

Catatonic aptitudes, 124

Cheilophagia, 160

Chin tics, 157

Chorea, Dubini's, 284

---- electric, 252, 284

---- fibrillary, 251, 284, 285

---- gravidarum, 283

---- Hénoch-Bergeron's, 251, 284

---- Huntington's, 281

---- hysterical, 282

---- of degenerates, 230

---- paralytic, 285

---- polymorphous, 230

---- rhythmical, 283

---- Sydenham's, 279

---- variable, 119, 228 et seq., 281

Clonic tic, 118

Colporteur tic, 106, 173

Complications of tic, 242 et seq.

Consciousness and tic, 63

Convulsion, 39

Convulsive tic, 31

---- ---- clonic, 31

---- ---- tonic, 31, 63

Co-ordination and tic, 46, 126

Coprolalia, 13, 219 et seq., 258

Coughing tics, 203

Curability of tic, 298 et seq.

Definition of tic, 260

Degeneration, 28, 29

Diagnosis, 264 et seq.

Diaphragmatic tics, 205

Diet, 302

Ear tics, 145

Echokinesia, 103, 124, 217

Echolalia, 216 et seq.

Echomimia, 124

Echopraxis, 124

Electrical reactions, 138

Electrolepsy, 284

Electrotherapy, 303

Epilepsy and tic, 251 et seq.

Eructation tics, 196

Etiology of tic, 96 et seq.

Etymology of tic, 25

Evolution of tic, 221 et seq.

Expectoration tics, 197

Eye tics, 146, 151

Eyeball tics, 150, 323

Eyelid tics, 146, 322

Facial spasm, 110, 111, 143, 268, 270 et seq., 312

---- tic, 143, 220 et seq., 312, 323

Fixed tics, 130

Folie du pourquoi, 87

Function, 70

Genesis of tic, 48 et seq.

Geniospasm, 157

Habit, 56

Heredity, 98

Hiccoughing tics, 203

Hydrotherapy, 302

Hygiene, 302

Hysteria, 246 et seq., 282

Idiocy, 256

Imitation, 2, 101

Immobilisation of movements, 317

Impulsive tics, disease of, 227

Insanity, 256

Isolation, 341

Jacksonian epilepsy, 38, 251, 263

Jaw tics, 169

Krouomania, 258

Laryngospasm, 212

Latah, 103

Leaping tics, 193

Licking tics, 157

Lip tics, 155

Massage, 303

Mastication tics, 159

Mechanotherapy, 303

Medicinal treatment, 301

Mental condition of the subjects of tic, 74 et seq.

---- infantilism, 76 et seq., 133, 171

---- tic, 94

---- torticollis, 121, 137, 167 et seq., 257, 267, 307, 313, 323, 324, 331, 333

---- triamus, 121, 161 et seq., 240

Mimicry, 60, 103

---- tics, 143

Mirror drill, 335 et seq.

---- writing, 335 et seq.

Monoclonus, 287

Motor reaction, 41

---- ---- classification of, 44

---- ---- localisation of, 130

---- ---- study of, 118

Movements of immobilisation, 317

Mutism, 211

Myoclonus, 30, 116, 252 et seq., 285 et seq., 288

Myokymia, 288

Myospasm, 290

Myospasmia spinalis, 288

Myotonia, 288

Neck tics, 5, 163, 323

Negation tics, 163

Neurasthenia, 250 et seq.

Nictitation tics, 146

Nodding tics, 163

Nose tics, 3, 154

Obsessions, 82 et seq.

Occupation neuroses, 70, 72, 159, 291 et seq.

Onomatomania, 87

Onychophagia, 161

Orthopædic treatment, 314

Palpebral tics, 147

Paramyoclonus multiplex, 252, 285

Para-tics, 6, 7

Pathogeny of tic, 36 et seq.

Pathological anatomy, 108 et seq.

Phobias, 20, 88

Polyclonus, 116, 117, 252, 256, 287

Polygon, 65

Procollis, 177

Professional acts, 69, 71, 291

Prognosis, 293 et seq.

Psychical tic, 29, 94

Psychomental tic, 68, 94, 250

Psychotherapy, 343

Re-education, 315 et seq.

Reflexes, 15, 134

Relapses, 332

Respiration tics, 203

Respiratory drill, 325 et seq.

Rest, 340

Retrocollis, 177

Rhincho-spasm, 204

Rhythm, 70, 127

Rhythmic tics, 127

Salaam tic, 164

Salutation tics, 163

Scratching tics, 186

Secretory affections, 138

Sensation, affections of, 140

Shoulder tics, 9, 183

Sniffing tics, 154, 203

Snoring tics, 203

Sobbing tics, 203

Spasm, definition of, 36

Spasms and tics, 36 et seq., 267 et seq.

Spasmus nutans, 127, 164

Speech, tics of, 206 et seq., 324

Sphincter tics, 140

Stammering, 208 et seq., 324, 325

Starting tics, 291

Stereotyped acts, 57, 122, 188, 264 et seq.

Striking tics, 185

Sucking tics, 155

Swallowing tics, 196

Thomsen's disease, 288

Tic and function, 68

---- idea, 59

---- will, 55

---- writing, 187, 190

Tic douloureux, 112, 275

Tic non douloureux, 110

Tics of idea, 94

---- idiots, 53, 256

---- wind sucking, 196

Tongue tics, 157

Tonic tic, 118, 121

Torticollis tic and spasm, 136, 137, 275 et seq., 307

Tossing tics, 163, 323

Tourette's disease, 92, 223, 228, 251, 258, 296

Treatment, 298 et seq.

Tremors, 290

Trunk tics, 182

Variable tics, 130

Visceral instability, 139

Vision tics, 146

Vomiting tics, 196

Whistling tics, 203

Writers' cramp, 69, 72, 192, 292

* * * * *

These typographical errors have been corrected by the etext transcriber:

which may be situate in peripheral end organ=>which may be situated in peripheral end organ

tennis without protuding his tongue=>tennis without protruding his tongue

The sectio showed a hæmorrhage of the dimensions=>The section showed a hæmorrhage of the dimensions

since the twitches are limited perferably=>since the twitches are limited preferably

Weiner medic. Blätter=>Wiener medic. Blätter

like a statute in a position conducive=>like a statue in a position conducive

Unforeseen complications, a again, may arise once a cure is affected.=>Unforeseen complications, again, may arise once a cure is affected.

* * * * *

FOOTNOTES: