By April 15 the contractures had disappeared, and he could perform
any movement of relaxation himself. His attention was now drawn
more particularly to his head, which was still in a faulty
position, and annoyed him considerably. Advantage was taken of an
improvement in his tractability to make him perform some movements
of his neck. At first the mere effort produced a spasmodic
contraction, but he was able to move his head very slightly up and
down. After five months of such treatment, occupying on an average
three hours a day, his mental torticollis was finally reduced to
subjection, an interesting feature of the case being the
parallelism between the physical and the psychical improvement.
On three occasions since we have noted a recurrence of the
torticollis, but each time it has been both brief and easily
overcome. The cure has been maintained now for upwards of a year,
and four months ago the patient resumed his work.
We must impress ourselves with the importance of recognising the
proneness of tics to relapse. Any triviality which may have a
prejudicial effect on the patient's will-power is calculated to
facilitate the reawakening of a bad habit. Such relapses are commonly
transient, and are instructive in so far as their manifestation
sometimes differs from the original tic and entails alterations in
treatment.
L., for instance, whose condition was one of permanent rotation of
the head to the right, had a fit of depression after eight days of
treatment and noteworthy improvement, a depression so severe that
she questioned the practicability of a cure, and forthwith her head
began to turn to the right again. On this occasion, however, the
tic was an intermittent one, consisting of clonic contractions of
the cervical muscles chiefly, without antagonistic gesture. For
five days the fit persisted, and was sufficiently acute to render
omission of the exercises advisable.
After some days' rest a beginning was made with the treatment
again, under the direction of one of us and in the presence of her
father. We took care to place ourselves always in front and to the
left of the patient, on the side opposed to her torticollis. The
position allotted her at table was such that in order to converse
with her parents she had to turn to the left.
Not long thereafter a second fit of depression occurred, but on
this occasion her head began to rotate to the left. She had been
under treatment for six weeks, when she made the remark one day
that her head seemed once more to be drawn to the right. She
hastened to add, moreover, that she had discovered a means of
remedying the mischief--viz. by putting her left hand to her left
cheek--a corrective proceeding nothing short of paradoxical.
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