Cold, hot, and tepid douches, warm fomentations, simple, medicinal, and
vapour baths, have all been prescribed. Resort has been made to rhythmic
traction of the tongue, to thoracic compression, to phrenic
electrisation, in all of which procedures, as Oppenheim observes, the
principal effect must be a psychical one.
The predisposition of the subjects of tic to mental disturbance renders
the administration of ether, morphia, or cocaine in their case
inadvisable. For a similar reason it is better to avoid antipyrine,
sulphonal, hypnotics generally, and above all opium in the form of
laudanum or thebaic extract.
If a sedative be really indicated, we prefer the preparations of
valerian, as their disagreeable odour is scarcely likely to encourage
abuse of the drug. Stimulants such as kola, coca, caffeine, etc., are
rather to be avoided. Hartemberg recommends the preliminary use of
lecithin to improve the patient's general condition.
The inconstancy of the therapeutic results hitherto obtained must not be
allowed to act as a deterrent. Success achieved by medicinal means may
not always be attributable merely to suggestion.
DIET--HYGIENE--HYDROTHERAPY
The details of the patient's diet are not to be neglected; he may be the
victim of some caprice which is injuring his general health. In the case
of children supervision is desirable, to obviate their eating either too
much or too quickly.
General hygiene must be made the subject of special attention. We have
often been convinced of the salutary effects of alteration in a
patient's mode of life, or of modification of his environment, such as
is ensured by holidaying, or by sea voyages, or by "cures" at
watering-places and seaside resorts.
Hydrotherapy in one or other of its forms may also be utilised. Except
in cases of hysteria, the tepid douche is preferable to the cold one. A
morning and evening tub, followed by energetic friction of the skin, is
a favourite prescription.
MASSAGE--MECHANOTHERAPY
In every case of tic the physician ought to assure himself of the
integrity of the muscles involved by examining for developmental
anomalies, atrophies, hypertrophies, etc., the presence of which might
lead him to reconsider his diagnosis. He may then order massage, of
special value in tonic tics as a prelude to passive movements, or
counsel the employment of some form of instrument or apparatus to
correct muscular insufficiency or to gauge the extent and rapidity of
motor reaction.
As a general rule we deprecate these devices. They are open to the same
objections that have been raised to all the mechanical arrangements ever
invented to counteract stammering, from the pebbles of Demosthenes to
the fork of Itard, or Colombat's interdental plate, or Wutzer's
glossonachon, or Morin's marbles: the patient is relieved of his
infirmity only to become the slave of his instrument.
ELECTROTHERAPY
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