Tics are constantly varying in amplitude, degree, and frequency; as O.
remarked spontaneously, "We have our good days, and we have our _mauvais
quarts d'heure_." The sedative effect of rest, solitude, silence, and
obscurity may be contrasted with the detrimental results of fatigue,
noise, fear of ridicule, etc.
However incapable S. is of rotating his head to the right when
requested to do so, the movement is executed with the utmost
readiness should his attention be drawn in that direction. But if
he hesitates, even momentarily, before looking round, he cannot
then do so without the preliminary performance of all sorts of
contortions, ending in a twist of his body through a half circle to
the right. Sometimes he actually turns round two or three times,
after the fashion of a dog chasing its tail. Let him have a
pleasant visit, on the other hand, let him engage in a discussion,
or be engrossed in a play, let him administer a rebuke to some one,
and immediately his trouble is forgotten, his speech is accompanied
with animated gestures, the vicious position of his head
vanishes--in short, he becomes normal.
An intercurrent affection may act either as a deterrent or as a
stimulus; with convalescence, however, there is usually a
re-establishment of the mischief. The most potent influence over the
phenomena of tic is wielded by a sense of well-being, to employ Janet's
discriminating expression. Well-being is a panacea for the _tiqueur_ no
less than for the hysteric. The tic of the worried financier disappears,
as we have had occasion to note, under the magic of a rise in stocks or
a knowledge of solvency. The child's happiness is bound up in his
freedom, which explains the cessation, in Tissié's little patient, of
all convulsive movements during the holidays.
Much evidence is forthcoming to support these points, but we must admit
that the why and wherefore of a tic's amelioration or aggravation often
escape us, nor must we forget that both in the child and the adult
spontaneous cure is not unknown.
As has been remarked, the evolution of tic does not lend itself to
systematic description, but there are cases that form an exception,
their course being regularly progressive. Strictly speaking, they are
instances of Gilles de la Tourette's disease.
GILLES DE LA TOURETTE'S DISEASE
Under the title, "Study of a nervous affection characterised by motor
inco-ordination, and accompanied with echolalia and coprolalia,"
Tourette[131] grouped together, in 1885, a certain number of cases
presenting features in common and so enabling him to describe a morbid
entity, specially remarkable for its progressive evolution. He was
followed in the same line by Guinon, who supplied an account in
nosographical form, and since then the disease has figured in all the
text-books.
To obtain a schematic picture of the condition we shall borrow from
Tourette's[132] last communication on the subject:
Public-domain text, read in full here on John Shaqi.
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