With a child's delight the worthy battalion commander gravely made
ready to speak. He readjusted his polished shako on his head, and
gave that twitch of the shoulder appreciated only by such as have
served in the infantry--that twitch which is meant to raise the
knapsack and momentarily to lighten its load; it is a trick of the
soldier's which with his elevation to officer's rank becomes a tic.
Another sip of wine followed this convulsive gesture, a kick of
encouragement in the little donkey's stomach, and he began....
The description could not have been more accurate. The passage from the
voluntary to the involuntary--the kick too may have been a tic--and the
obvious infantile traits in the old gentleman's character, make the
picture remarkably complete.
Apart, however, from the causes we have just enumerated, and others to
be noticed below, we must emphasise the fact once again that mental
predisposition is a _sine qua non_ for the development of tic.
CHAPTER VI
PATHOLOGICAL ANATOMY
Our ignorance of the pathological anatomy of tic is profound. Hitherto
all the cases labelled tic in which a post-mortem examination has been
made have in reality been spasmodic affections differing essentially
from the tics as we understand them, according to the ideas of
Trousseau, Charcot, and Brissaud. As far as we are aware, not a single
sectio of a genuine case of tic is on record where a lesion, of whatever
nature or whatever site it be, has been discovered to which the tic
might be attributed. Either an autopsy is not obtained, or if it is, no
special abnormality is remarked, or else the diagnosis has been
erroneous and the changes described have not been those of tic.
It would be premature, of course, to conclude that tic is a disease
_sine materia_. The affirmation is quite unwarranted. As is the case
with numbers of neuroses and psychoses, we must for the present rest
satisfied to observe symptoms; the mystery of their morbid anatomy will
remain unsolved until our methods of investigation attain perfection.
Magnan[39] says of "superior degenerates" that clinical observation
reveals functional disorders so distinct and so invariable that it is
impossible they should not be the outcome of some pathological
modification of the organism. It is true he declares in another
place[40] that the mentally unstable have all a family likeness,
consisting not in identity of well-defined anatomical lesions, but in
similarity of functional derangements. As it is, from the motor point of
view tic is a functional act, and the governing centre is a functional
centre that has become hypertrophied, so to speak, by being educated to
excess. This physiological centre must not be confused with the "centre"
of current anatomical terminology; it does not exercise an exclusive
control over a particular territory--several such may co-exist in a
single anatomical area.
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