In this connection reference may again be made to the fixation attitude adopted by young J.[150] for his left arm, a subterfuge of his own invention which he considered a sovereign remedy. In essence it was nothing else than an efficacious antagonistic gesture, inspired by a tic and become its indispensable complement. Of other ingenious ideas of his brief mention may be made.

Convinced of the necessity and possibility of checking the movements of his shoulder, he sought the aid of his "immobilising mattress," an ordinary mattress spread in a corner of the dining-room, on which he flung himself and reclined from morning to night, making the wretched thing his companion, solace, and confidant, who alone understood and could alleviate his tics. In his anxiety to find some point of resistance for his left arm to work against, he had a second and much narrower mattress put under the first, so that prodigious efforts were required on his part to maintain equilibrium on the cylindrical surface. This was exactly what he desired, and for a time he ceased to tic.

An equally curious case is that of one of Raymond and Janet's patients afflicted with multiple tics.[151]

He was a man thirty years old, who denied having had tics for more than four years; he had always been eccentric, however, and came of a family some of whose members were dullards and others hysterics. His career at school and college was brilliant, but his vain and erratic disposition had prevented him from realising his boundless ambitions, and carrying into effect many ingenious schemes. For that matter, a prominent trait in his character was a curious scrupulousness that led him to seek an impossible perfection for all his actions. Anything he put his hands to he thought might be better accomplished if he had a system for the purpose; he had, for instance, all sorts of plans for improving his caligraphy, for holding the pen, interminable "tips" for correct punctuation, for learning, for reciting. To such an extent was he embarrassed by these procedures that he could not write two letters consecutively. Purposeless voyages to Africa ended in his contracting conjunctivitis, malaria, and dysentery, and he returned to France worn out and more eccentric than ever. Thereafter the state of his health, and above all his functions of respiration and digestion, became matters of absorbing attention. A system had to be thought out for breathing better and for avoiding possible suffocation. He next devoted himself to the question of alimentation, and conceived the idea of moistening each mouthful of food with water, soon finding it desirable to wet his lips, apart from meal time, in order to breathe better. One day during a journey by train he suffered agonies from want of his drop of water.

Examples such as these serve to illustrate how the misplaced ingenuity of the sufferer from tic complicates his misfortunes instead of banishing them, and indicate to what extremes his eagerness to obtain respite may lead him.

All these gestures and stratagems may be considered as manifestations of ideas of defence, comparable to what obtains among those afflicted with obsessions and delusions of persecution.

CHAPTER XIII
THE COMPLICATIONS OF TIC

FOLLOWING in the train of the tics may come a number of complications, insignificant enough as a general rule, the dread of which may in some cases actually be instrumental in stimulating the will's activity to rid the patient of his tic.

Dislocations have in violent cases been known to occur. Incessant repetition of a tic may lead alike to hypertrophy of certain muscles and atrophy of their antagonists, conditions which in aggravated instances may produce permanent malformation.

It is of course in cases of spasm and other convulsive phenomena dependent on structural disease of nerve centres or conductors that such trophic disturbances are most liable to occur. Gaupp[152] has described a case of partial congenital myotonia localised in the muscles of the forearm and hand, and associated with atrophy, in a patient presenting certain stigmata of infantilism; but the condition can scarcely be classed with the tics.