In the case of spasms properly so called, efforts directed to the removal of the exciting cause--should it be known--are often crowned with success. Conjunctivitis, rhinitis, odontalgia, may occasion grimaces and contortions which cease with the disappearance of the irritation. In 1884 Fraenkel showed to the Medical Society of Berlin a woman, forty-five years old, with mimic convulsions of four years' duration, attributable to a rhinitis. Every time the mucous membrane of the left nasal fossa was touched a violent spasm ensued; but a few applications of the galvano-cautery brought the phenomena to an end. Oppenheim has seen facial and masseter spasm checked by the extraction of a carious tooth, and in another case by an operation on the ear. Emphasis must once more be laid on the fact that any success achieved has been in reference to spasms; as much cannot be said of tics and analogous affections. The surgical treatment of stammering has long since received its quietus. * * * * * We may bring this discussion to a close by applying to tics in general certain considerations of Brissaud[217] anent mental torticollis: "Instead of proceeding to operate at once and being content thereafter to enjoin on the patient, whenever the wound is healed, a course of exercises to be persevered with over long months or even years, better give the same good advice long months or even years before inflicting him with the operation." ORTHOPÆDIC TREATMENT The use which has in some instances been made of various forms of apparatus for temporary fixation or for gymnastic purposes is, as a rule, rather hurtful than otherwise. The patient is disconcerted by their withdrawal, and prone to recommence his inopportune movements. It is preferable to allow him to adopt his own attitudes independently of the physician. An accessory not always at hand must not be allowed to become indispensable to the control of his tic, else he may make its absence a pretext for the discontinuation of his exercises. Excellent results, it is true, have been obtained in chorea by recourse to apparatus of restraint. According to the recent descriptions of Huyghe[218] and of Verlaine,[219] after the administration of a few whiffs of chloroform to the patient, the affected limbs are massaged vigorously enough to enable him to have some conception of what is being done. Light anæsthesia is continued while they are immobilised in duly padded splints and covered closely with bandages. At the end of five or six days the dressings are removed, when all choreic twitching will be found, as a general rule, to be gone; should it persist, the treatment must be repeated. In numerous instances the method has been eminently successful. So favourable an issue is scarcely to be looked for in the case of tics. Rather are these forms of apparatus liable to do harm in the direction of fresh outbursts. CHAPTER XIX TREATMENT BY RE-EDUCATION