Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1193/1256 page 1151
    than a few words. The local condition in this case was also entirely negative. Motion and sensation are quite intact, there is nowhere sensitiveness of the nerves or muscles upon pressure, no thickening or other pathologic condition. The patient was an abnor- mally large man—nearly 6 feet—with poor constitution, his mother being of a nervous temperament and suffering from headache; in addition the patient complained of gen- eral neurasthenic symptoms. For some years he has been compelled to write for eight hours daily in his occupation besides having to do similar work at home. These pains usually show no exact localization, they do not follow the course of a nerve, but radiate from the point of greatest pain in a diffuse manner both distally and proximally; the pain is present in the fingers, sometimes reaching the shoulder and the back. Pain upon pressure is not present in the majority of cases, but it is not uncommon to find one or more nerves abnormally sensitive upon pressure at one or the other point. I have already insisted upon the fact that, according to Oppenheim, this painful- ness upon pressure is quite common in neuropathically predisposed persons, without any local affection being present. Objective, sensory disturbances, according to general experience, are not present; they do not belong to the symptoms of this or any other form of occupation neurosis: this is one of the points by which these clinical pictures differ from occupation neuritis. Pain may be the only symptom of the disease—then we no longer refer to writer’s cramp but to writers pain: but Symptomatologie transitional stages between both groups, which apparently have identical pathogenesis, give us the right to speak of “ writer’s pain.” In many persons the pain which appears during writing and which soon prevents a continuance of the act is the only symptom; occasionally there is pain upon pressure over some of the nerve trunks. Remak and Bernhardt have shown that this pure, sensory, neuralgic form of occupation neurosis is even more common in piano players. The pain more often than the spasm is the cause of the disturb- ance in function. I must add that typewriters, as might be expected, show disturbances which are closely allied to those of piano players; here, also, the pain is the significant factor; but we shall return to this subject. Vasomotor symptoms are usually not prominent; only in rare instances is there a report of local syncope or local asphyxia. In a case reported by Brissaud, Hallion et Meige,1 which presented many unusual features, the acrocyanosis was a symptom of coördinative importance. More often the patients complain of acroparesthesia, of tingling and numbness in the finger tips. That in some of the other forms of occupation neurosis nervous symp- toms of the kind just mentioned are very prominent and that in these in- stances the decision whether we are dealing with acroparesthesia, in the restricted sense, or occupation neurosis, is exceedingly difficult will be de- scribed later on. In addition to the spastic and the neuralgic forms of writer’s cramp there are also tremor and paralytic varieties. The tremor form is quite rare. A court clerk, aged 48, presents a disturbance in writing characterized by tremor, which appears after the patient uses the pen for a short time. The patient states he has a sensation as if he grasped the penholder too firmly, almost spasmodically. The tremor is especially severe when the patient knows that he is being observed; this i Brissaud, Hallion et Meige, “ Acrocyanose et crampe des gcrivains.” Arcli. gene- rale d. medec., 1903, 37.
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