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  1. G D Perkin
  1. Imperial College School of Medicine, Charing Cross hospital, Fulham Palace Road, London W6 8RF, UK

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    The big sleep: Hamish Hamilton 1939

    Her hand holding the empty gun began to shake violently. The gun fell out of it. Her mouth began to shake. Her whole face went to pieces. Then her head screwed up towards her left ear and froth showed on her lips. Her breath made a whining sound. She swayed.

    Farewell my lovely: Hamish Hamilton 1940

    But naturally there are certain elements which would like to show me in a bad light. Psychiatrists, sex specialists, neurologists and nasty little men with rubber hammers and shelves loaded with the literature of aberrations.

    The high window: Hamish Hamilton 1943

    Her mouth was in a tight line at the corners, but the middle part of her upper lip kept lifting off her teeth, upwards and outwards as if fine threads attached to the edge of the lip were pulling it. It would go up so far that it didn't seem possible, and then the entire lower part of her face would go into a spasm and when the spasm was over her mouth would be tight shut, and then the process would slowly start all over again. In addition to this there was something wrong with her neck. So that very slowly her head was drawn around to the left about forty-five degrees. It would stop there, her neck would twitch, and her head would slide back the way it had come.

    Curiously Carmen Sternwood's epilepsy as described in The big sleep does not appear in the film starring Humphrey Bogart and Lauren Bacall. Nor indeed does the recent remake of Farewell my lovely refer to the rather deprecatory remarks made by Jules Anthor in that book regarding neurologists. Jules Anthor is described as a psychic consultant. Reading the book one has to say he seems to be more troubled by aberrations than most neurologists that I have met.

    The description of Merle Davis' movement disorder appears in The high window. Reading between the lines one is probably meant to infer that the movements were due to psychological stress. The description of the facial component of her movement disorder is intriguing and one that I perhaps would not immediately identify. It does not really fit with the clinical features of Meige's syndrome. The neck movements are more straightforward in suggesting a spasmodic torticollis. The book doesn't indicate the eventual outcome of the problem although the psychological issues are probably eventually settled.