From a general point of view, the deductions are entirely reasonable.
There is a suggestive analogy between these conditions and the muscular
dystrophies in the persistence with which their multiplicity seems to
defy the efforts of classification. The analytic stage witnessed the
rapid evolution of such clinical types as the facial, the
facio-scapulo-humeral, the juvenile, the pseudo-hypertrophic, not to
mention others that bear the name of their observer; but it has been
succeeded by the synthetic stage, whose function it is to incorporate
all the former myopathies in the comprehensive group of "muscular
dystrophy."
Yet here, again, peril lurks in too hasty a generalisation. To give the
disease a name is not equivalent to pronouncing a diagnosis. The
denominations "myoclonus," "muscular dystrophy," "degenerate," are alike
inconvenient. Their scope is at once too inclusive and too exclusive.
They may be indispensable; they are assuredly not sufficient.
The possibilities of misapprehension do not end here.
The manifestation of each and every tic--be it a flicker of the eyelid,
a turn of the head, a cry, a cough--is through the medium of a muscular
contraction. On the very nature of this contraction opinion is divided.
To its distinctive features of abruptness and momentariness is due the
epithet "convulsive" habitually assigned it, but the qualification is
not secure. Since the time of Willis the word convulsion has been
employed in a double sense, to signify _clonic_ muscular contractions
(the "convulsion" of popular parlance) and _tonic_ muscular contractions
(a meaning attached to the term only by the scientist).
For our part, we can raise no valid objection to the specification of
tics as convulsive, provided always that the existence of clonic
convulsive tics and of tonic convulsive tics be recognised. As a matter
of fact, clinical observation supplies instances of both sorts.
Nevertheless, attention has been confined by a majority of authors to
the consideration of the former variety only, so much so that a whole
order of facts which in derivation, essence, and external
characteristics ought to be identified with the tics has been passed
over in silence. Even on the assumption that the proposal to recognise
the two classes cannot be entertained, at the least it is advisable to
predetermine the import of the word convulsion, and to speak of _clonic_
convulsive tics. This is the formula of Ferrand and Widal in their
article "Convulsion" in the _Encyclopædic Dictionary of the Medical
Sciences_. Similarly, Troisier[6] says that the convulsive tic properly
so called is characterised by clonic movements, in which opinion Erb and
most German observers concur. Tonic tic appears to have been forgotten,
and we have thought it our duty to resuscitate it.
Cruchet has quite recently approached the subject in a critical fashion:
Public-domain text, read in full here on John Shaqi.
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