In other cases, if the opportunity is afforded to observe the develop ment of the disease, " it is found that in a great majority the movement is a coordinated forced movement, which is at first performed voluntarily, usually to get rid of some unpleasant localized sensation, and that long after the object for which it was performed has ceased to exist, the move ment continues and is repeated again and again in an involuntary and altogether automatic manner. The presence of a foreign body in the conjunctival sac or a phlyctenula first causes the child to blink, and this blinking movement, long after the foreign body has been removed 01 the phlyctenula has healed, persists as tic" Pick). In many other cases the first beginning of the convulsive tic can be traced to an origi nally normal, purposive movement.
The pathologic feature of the process consists iu the persistence of the movement as an automatic and forced phenomenon, which is much more pronounced than the subcortical character of movements which have been learned by practice—a process which is quite normal, parti cularly in children.
The development of the so-called stereotypic's depends on a similar psychic mechanism leading to automatism. These movements, however, lack the convulsive character and are quite frequently- observed in children who exhibit no signs of degeneracy. Among these we may mention biting of the nails, scratching the head, picking at the fingers and the lips, and sucking movements. Special forms of stereotypia occurring during sleep have been mentioned on page 351 tSwoboda, Zappert, and others). Similar rocking or turning movements, called pagoda movements, are often observed in imbecile children and may be kept up for hours in monotonous repetition; like the sucking inoN ements in normal children, these movements are often accompanied by obvious signs of well-being. Perhaps this feeling of pleasure which appears to
be produced by stereoty-pe movements of this kind, and which may go on to a veritable orgastn, is responsible for the fact that these movements have been identified with the onanism of infants and young children.
The prognosis of tie, so far as recovery is concerned, was pronounced by Chareot and his followers to be practically unfavorable; but their pessimistic view is probably to be explained by the profoundly degenerate character of their clinical material. Pitres and others, on the other hand, reported a number of favorable results, and to-day we may say that some cases—which thereby, reveal their hysterical character—are susceptible to suggestive treatment, and that many of the cases which are due to inherited degeneracy can be greatly improved or even cured by suitable educational treatment.
with the most favorable assumption, namely, that the condition is clue to hysteria, antihysteric measures (iso lation, intentional neglect, etc.), should be instituted at once. Tf these measures fail, and the neees.sity for educational treatment be comes apparent, the child should be placed in a suitable institution, as that offers the only prospect of ultimate success. It is only by sur rounding the child with influences calculated to improve its general psychic condition that we can hope for any results from special treatment of tic, either by res.piratory gymnastics (after Pitres) or by the use of mirrors (after Brissaud).