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.

    1194/1256 page 1152
    report requires careful attention. He further states that recently, at night, his fingers become numb. He also suffers from general nervous symptoms. The patient is well nourished and other objective conditions appear to be normal. The character of the handwriting coincides with the tremor: it is zig-zag, but the individual lines are regu- lar, not elongated or interrupted. As a further and final form of writer’s cramp the paralytic variety may be mentioned. It is very difficult to separate this form precisely. True paralysis is not present; on the contrary, there is here as in the other form a sensation of fatigue which soon renders writing impossible; in addition to this there is pain; there is no tremor or spasm, “ hand and forearm appear as if chilled, the pen rests upon the paper without being moved” (Bern- hardt). Occasionally there is a direct impression of an inability to write which produces the difficulty as in the case reported by Brissaud, Hallion et Meige. Meige,1 in another article, refers to “ aboulie motrice .” At all events we are here very close to the Symptomatologie limits of our theme. The positive phenomena of the affection are exhausted by what has been stated: spasm of the muscles, in which, as has been very aptly remarked, not merely the muscles that are concerned in writing contract, but also those that should not contract are affected; tremor, paretic sensations of fatigue, and pain, eventually also a certain tenderness upon pressure of the nerves and muscles; in addition it must be stated that all these symptoms appear only while writing, and only during this function. Naturally there are a few exceptions to this last rule. There are other activities in which the finer movements are necessary, such as piano playing, sewing, etc., in which the same symptoms may be present, while coarser movements requiring greater power do not give rise to symptoms. These exceptions are even more fre- quent in other occupation neuroses than in true writer’s cramp. There are no exceptions to the rule that objective sensory disturbances, such as appear in neuritis, are constantly absent. A qualitative change of electric contractility such as partial DeR is foreign to the picture of grapho- spasm and in fact to all of the occupation neuroses. Slight quantitative changes of contractility are said to be present in rare instances, both as an increase and decrease of contractility, as well as an inversion of the normal formula, so that the anodal contraction is stronger than the cathodal. But this may be noted in the small muscles of the hand even under other condi- tions, for instance, when they are cold or cyanotic. The size of the muscles remains unchanged. In addition to writer’s cramp all three of the patients whose history has been given showed other general nervous symptoms which, to a greater or lesser extent, correspond to neurasthenia. This coincides with the general experience that the majority of cases of writer’s cramp develop from neuras- thenia. This neuropathic disposition may be congenital or acquired. A hereditary predisposition shows itself in the family appearance of the occu- pation neuroses. Gallard reported the cases of a notary, his mother and sister having also suffered from writer’s cramp. One of my patients, a lad aged 15, attending school, had the sensory form of writer’s cramp; his father, a piano teacher, had piano player’s cramp. 1 Meige, “ Cramps fontionelles et professionelles.” Traite de medec., X, p. 344.
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