In the case of one of our patients, N., the prolonged and almost
exclusive use of certain muscles in the course of his business decided
their involvement in the condition of practically permanent torticollis
with which he was afflicted, and which was due to strong contraction of
the right trapezius and sternomastoid. It appeared that for eighteen
years he had been a cutter in a linen draper's, where it had been his
duty, for hours at a stretch, to cut rolls of stuffs with a large and
heavy pair of scissors, and in the execution of this work the right arm
was extended, the hand firmly pressed on the table, the shoulder
elevated, the head rotated and inclined to the left.
We cannot do better in this connection than recall the cases referred to
by Brissaud[90] when directing attention for the first time to this
variety of tics of the neck.
Here is a patient with energetic contraction of the muscles which
depress the head on the neck. She holds her head in her hands to
inhibit the movement, and succeeds. And she is quite convinced that
the force requisite for rectifying the vicious attitude is not
simply the power of her will acting on the muscles concerned, but
the strength of her hands. She has unconsciously doubled her
physical personality; her hands obey her will, her neck does not.
At least, this would appear to be the key to the situation, for it
can be well understood how much easier it would be to readjust the
position by action of the antagonist cervical muscles than by the
hands. The contraction, moreover, is entirely painless. It is a
trivial act of obsessional insanity, provoked by some or other
insignificant psychomotor hallucination.
Take this next man, who also must needs keep his head straight by
means of his hand--obviously no irritation of the spinal accessory
can be accused of originating the mischief, else would he be unable
himself to replace his head. It is merely the idea that is urging
him to its rotation. Try by force to prevent him from twisting his
head round, or try to twist it against his will, and the difficulty
of the thing will be at once comprehended. Or try to pull your own
two hands apart to see which is the stronger, and you will never
succeed, for the simple reason that abstraction of the will is
impossible. One hand can prevail over the other only if both
consent; the left cannot be in ignorance of what the right is
doing. A "partial" or "local" will is inconceivable; there cannot
be one for the head and another for the arm.
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