Head-nodding is much rarer than head-shaking. Occasionally these alter nate in the same patient.
If it be desirable at this time, with our limited knowledge of this condition, to classify them under any particular head ing, hysteria in childhood would seem to present the greatest claim, for in hys teria there are frequently salaam move ments, pure and simple. Until more is known of the essential nature of those conditions, and their relation to the few different lesions which have been found in the brain at death, it will be an impos sibility for us to go further than to offer surmises as regards a classification. They are so frequently associated with defect ive mental development that the sus picion of their being significant of some deep-seated developmental error is When a combination of motor impulses by their cross-action imparts a rotary mo tion to the head, this is known as gyro spasm (Peterson). These spasmodic con ditions sometimes increase during sleep. According to Peterson, the number of excursions of the head in these affections rarely exceeds two or three a second. The child may only have an attack dur ing the night, or it may be so persistent that it suddenly awakens him every time he composes himself for sleep.
[The following is a case of gyrospasm of my own hitherto unreported: B. S., aged 6 months, female, Russian Hebrew, of excellent family history,—mother a large, vigorous woman with abundant breast-milk,—was brought to Polyclinic Dispensary for relief of gyrospasm. One older child, perfectly strong, was also breast-fed. This infant was regarded as exceptionally vigorous, had never been ill, held up its head at three months, and had no convulsions. Automatic movements began ten days ago without ascertainable cause. The first movement was forward-and-back nodding, alter nating with a slight rotary action, no ticed from time to time during the morn ing only. On the second day movement was more marked and constant, the series consisting of two or three nods, followed by fifteen or twenty rapid rota tions, then a quiet interval. In all there were perhaps twenty paroxysms during the day; these are now continuous, and do not altogether cease during sleep.
On examination the infant seems per fectly normal in other respects; is cheer ful and intelligent, of good color, and well nourished. On endeavor to make
the child fix its eyes or converge them the movements cease for a few seconds, and are replaced by lateral nystagmus, but soon the gyrospasm recurs with in creased force. Lowering the eyes, the head leaning forward, also brings relief. The case recovered entirely in a short time. J. MADISON TAYLOR.] In eclampsia nutans and rotans there is a bowing, or salaaming, movement of the neck. Hadden differentiates those conditions from head-nodding and banging, and calls eclampsia nutans and rotans a variety of epilepsy.
In anomalous or aberrant forms of epilepsy there is a salaaming, but also there are other signs of epilepsy.
A perfectly analogous condition to all the above automatic imperative ments may be induced by suggestion under hypnotism.
Other motor neuroses—snch as habit chorea, habit spasm, convulsive tics, echolalia, coprolalia—are dealt with else where.
A curious case was reported by See (St. Barthol. Hosp. Rep., 'SG) in which the brother of a case of head-banging was similarly affected while sleeping in the same bed. The symptoms disappeared immediately on the separation of the children.
Treatment.—The treatment of head movements is change of air and climate, and nutritious food and out-of-door life, as much as possible; in short, improved hygiene, careful search being made for and correction of any source of reflex irritation, such as post-nasal adenoids, adherent prepuce, phimosis, dentitional disturbances, intestinal disorders, intes tinal parasites, etc.
_Most of the sufferers are too young to warrant the correction of errors of refrac tion, though they may readily exert an influence. The condition of any of the aforesaid irritations may solve the diffi culty. It is safe, nevertheless, to begin at once on a treatment by sedatives. Bromides, valerian, chloral, etc.; nutri tive tonics, such as codliver-oil, iron, phosphorus: fatty and albuminous foods, and the organic nucleo-albumins are likewise indicated. H. C. Wood likens these conditions to those of chorea, which is due, in his opinion, to depression of the inhibitory cents-es governing the anterior corneal cells of cord. He ac cordingly recommends quinine as an in hibitory stimulant.