L. is afflicted with abrupt blinking of the eyelids, retraction of
the head, and elevation of the lip. Once the tic is established, it
persists on an average for from eight days to a month, and during
this time no effort on his part will check it. Sometimes he makes
peculiar growling noises; sometimes he cannot prevent himself from
stooping down as if to pick up stones; sometimes he is unable to
restrain himself from touching everything within reach.
From the age of five, C. exhibited frequent blinking movements, and
gestures which seemed to indicate that his clothes were
uncomfortable. No attempt at modification was attended with
success. The tics steadily increased, till he found himself
uttering cries and letting obscene words escape his lips. For a
long time they remained in abeyance, then reappeared in his face
and trunk, in the form of salutation movements. His propensity for
clastomania, pyromania, and kleptomania necessitates his being kept
under strict supervision, and though he is intelligent and has a
good memory, he is also lazy and inattentive.
Other tics of still greater complexity and peculiarity are met with
among those whose psychical imperfections are very pronounced. Some
"co-ordinated tics" are remarkable for their intricacy; they consist of
a series of movements which mimic some act of everyday life. In this
group may be specified various rhythmical movements, such as those of
balancing, head rotation, and striking or beating oneself--the
krouomania of Roubinowitch; they may be compared to the mother's rocking
of her infant, inasmuch as they have a soothing effect on their subject,
however brutal the movement itself sometimes may be.
In most cases the patient is seated and rocks himself to and fro in
an antero-posterior direction. Or it may be the head only that is
rhythmically moved from side to side, and the performance may go on
indefinitely. A mere touch or a word, on the other hand, is
commonly sufficient to interrupt its sequence.
There remains a final class of co-ordinated tics, which Noir
distinguishes by the epithet "large," tics which are confined to idiots
of good physical development. They consist of a movement or series of
movements of considerable amplitude, and constitute the predominant
clinical feature of the patient's idiocy. Here we find subjects who
jump, or climb, or turn round and round; in other cases they are reduced
to the level of mere automata, and go through a long series of actions
in a mechanical way.
Their memory for recent occurrences is very poor, but in their
minds are stowed away vague souvenirs of events long past, which
they translate into action, and which they are incapable of
modifying, even as they are unable to add to their mental store or
to alter their mental routine.
Public-domain text, read in full here on John Shaqi.
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