which is no more than the superlative expression of a neuropathic and psychopathic disposition entirely akin to that favouring the development of the most harmless tic. Its earliest exhibition is a series of apparently insignificant bizarre convulsions; but its indefinite prolongation, its gradual involvement of one limb after another, its association with grave mental symptoms, and its frequent termination in dementia, are reason enough for eyeing the first little premonitory tic with mistrust, and combating it with vigour.

From the motor aspect a tic is only a "bad habit," and the checking of bad habits, especially in the predisposed, must be our goal from the outset. And, should we succeed, there will be reason for congratulation, not on the happy issue of appropriate treatment for a particular tic, but because the result is a step towards the habit of correcting bad habits. Reinforcement of the will is the prime therapeutic indication, but the physician has no need to resort to mysterious subterfuges or occult practices; let him borrow the virtues of the successful teacher. The amelioration consequent on this procedure is seen not only in the recovery of lost aptitude for work, but also in the simultaneous restoration of self-confidence and will-power in patients who had appeared deprived of them for ever. The treatment of tic is evidence of its nature and curability. Since 1893 MM. Meige and Feindel have subjected their cases to the educational discipline of systematised movement and of immobilisation. In contrast to the tendency of ordinary exercises to render certain useful acts automatic, this method aims at the suppression of automatic acts that have become useless. The development of the general principles of the method, as well as an exposition of recent modifications and their application to particular cases, will be found in the volume. Suffice it here to say that the results have been favourable enough to discountenance the prevalent idea of the incurability of tic, and to prove that persistence in treatment, as has been demonstrated in many other neuroses, will assuredly be crowned with success. Common misconception represents therapeutics as helpless in the presence of nervous disease; but if the doctor may count on the collaboration of his patient, he has no right to despair.

I should like, in closing, to be allowed to praise the authors' production; but I can do so only under great reserve, for after so many years of co-operation I can no longer distinguish the work of MM. Meige and Feindel from my own. I think, however, that from many points of view the book which they have written is a most useful one.

E. BRISSAUD.

AUTHORS' PREFACE

OUR object in publishing these studies has been twofold: first, to make known various facts of clinical observation, which will always possess at the least an intrinsic value; secondly, to endeavour to assign to the tics their due place among the numerous motor affections consequent on nervous or mental disease. With this end in view we sought to free ourselves of preconceived notions, avoiding at the same time the other extreme of eclecticism. Independently we have been led to adhere to the doctrine hallowed by the authority of Charcot, and since advocated by Professor Brissaud—a doctrine that seems to us to be in harmony with accepted clinical data.

We have thought it advisable to indicate, by the way, more than one misconception whose perpetuation is but a stumbling-block in the path of progress.

Since the eighteenth century the word tic has faced the perils of definition many a time, and has as often all but succumbed. The limits of its application have been alternately enlarged and narrowed to an excessive degree; its original signification has been so obscured that the inclination to-day is either to hesitate in the use of the word at all, or to employ it indiscriminately through ignorance of its real meaning. But if its interpretation be not specified, everything that is said or written on the subject will remain fatally open to dispute. Want of precision in words leads inevitably to confusion of ideas and endless misunderstanding. In this respect the word tic is a great culprit; its promiscuous use implies looseness in its connotation—a fruitful source of controversies which, when all is said and done, are nothing more than regrettable quid pro quos. On fundamental points there is almost complete unanimity of opinion; any divergence is purely superficial, and to be ascribed to disagreement in terms.

Hence it has seemed to us essential to adopt a vocabulary, and to employ any term only after clearly particularising the sense we attribute to it. Our verbal conventions will not meet with universal acceptance, it may be, but we shall be the first to abandon them if common consent assign to the expressions that replace them the exact shade of meaning we meant to convey.

Our work will not be superfluous if we succeed in allotting to the word a definite position in medical terminology, or if any information we have amassed prove of service to future observers. And should we be enabled to demonstrate how unmerited is the reputation the tics enjoy of being irremediable, how they may, on the contrary, be mitigated and sometimes even cured under appropriate treatment, the practical value of the conclusion will, we hope, justify the importance we have attached to the subject.

NOTE BY THE TRANSLATOR

OWING to the kind co-operation of M. Meige, it has been possible to embody in this English version of Les tics et leur traitement his latest definitions and views, as expressed in his monograph Les tics (July, 1905). The passages thus derived are enclosed in brackets. In the making of the translation some of the clinical cases have been slightly abridged, and one or two omitted. The Bibliography has been revised, largely supplemented, and brought up to date. In a short Appendix reference is made to various matters in regard to tic on which discussion has recently centred, subsequent to the publication of Meige and Feindel's book. Indices of names and of subjects have been added.

CONTENTS