The inconstancy of the therapeutic results hitherto obtained must not be allowed to act as a deterrent. Success achieved by medicinal means may not always be attributable merely to suggestion.
DIET—HYGIENE—HYDROTHERAPY
The details of the patient's diet are not to be neglected; he may be the victim of some caprice which is injuring his general health. In the case of children supervision is desirable, to obviate their eating either too much or too quickly.
General hygiene must be made the subject of special attention. We have often been convinced of the salutary effects of alteration in a patient's mode of life, or of modification of his environment, such as is ensured by holidaying, or by sea voyages, or by "cures" at watering-places and seaside resorts.
Hydrotherapy in one or other of its forms may also be utilised. Except in cases of hysteria, the tepid douche is preferable to the cold one. A morning and evening tub, followed by energetic friction of the skin, is a favourite prescription.
MASSAGE—MECHANOTHERAPY
In every case of tic the physician ought to assure himself of the integrity of the muscles involved by examining for developmental anomalies, atrophies, hypertrophies, etc., the presence of which might lead him to reconsider his diagnosis. He may then order massage, of special value in tonic tics as a prelude to passive movements, or counsel the employment of some form of instrument or apparatus to correct muscular insufficiency or to gauge the extent and rapidity of motor reaction.
As a general rule we deprecate these devices. They are open to the same objections that have been raised to all the mechanical arrangements ever invented to counteract stammering, from the pebbles of Demosthenes to the fork of Itard, or Colombat's interdental plate, or Wutzer's glossonachon, or Morin's marbles: the patient is relieved of his infirmity only to become the slave of his instrument.
ELECTROTHERAPY
Electricity in all forms has been requisitioned, but it does not appear to have justified its trial. In our opinion, moreover, it is contraindicated in convulsive affections.