One other matter may be shortly alluded to. In Cruchet's terminology, a
tic is an anomalous gesture, and cannot be applied to an anomalous
attitude, since the latter is tonic rather than clonic. For an anomaly
of attitude he suggests the use of the word "deformity." Hence "habit
deformity" is comparable to habit tic, and "convulsive deformity" to
convulsive tic. As a habit tic may develop into a convulsive tic, so a
habit torticollis may degenerate into a convulsive torticollis. There is
no reason why the operation of habit as a factor should not effect the
latter transformation exactly as it does the former; and as habit is
held to be a psychical phenomenon, it is easy to conceive why the term
"mental torticollis" should have arisen, and been so widely accepted.
But it will be readily understood that while Cruchet affirms that no
mental torticollis can ever be a tic, in his sense of the word, this is
due solely to his refusal to consider any movement which is tonic as
partaking of the nature of tic. In all other respects, the description
which he gives of mental torticollis shows that it is nought else than a
tic in Meige's sense.
In an article on convulsive torticollis which has been contributed by
Meige to the _Pratique medico-chirurgicale_ (1907) he emphasises afresh
the distinction between torticollis-spasm and torticollis-tic. The
former is provoked by an irritative lesion in the motor nerves supplying
the muscles of the neck, or in their nuclei of origin, and the character
of the contractions ("contracture frémissante" [Meige], "contractions
parcellaires," "contractions paradoxales" [Babinski]) in a definite
peripheral nerve area is not likely to be mistaken. In other cases the
objective phenomena distinctive of spasm are awanting: the
characteristics of tic, on the contrary, are conspicuously present, and
among these cases, where psychical disturbance plays a preponderant
rôle, are to be found those described by Brissaud as mental torticollis.
It is to be noted that these writers alike decry the surgical treatment
of torticollis, and perhaps not without good reason. Nevertheless the
method must not be condemned on theoretical grounds merely, and it is
permissible to believe that their experience may have been unfortunate.
The records of the National Hospital provide many instances of surgical
interference in torticollis and allied conditions of the neck, the
results of which make one hesitate in expressing a dogmatic opinion. It
is, however, impossible to enlarge further on the subject in this place.
S. A. K. WILSON.
BIBLIOGRAPHY
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