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.

    1195/1256 (page 1153)
    Among the deleterious factors that may affect the patient, all that give rise to neurasthenia may be present: primarily over-exertion must be men- tioned. The work of a copyist is poorly paid, and as Seeligmiiller aptly re- marks, not authors hut copyists are attacked hy writer's cramp. The poor remuneration requires prolonged work, “ over-time ” and even in addition to this, very frequently, it does not even provide sufficient food; thus over-exer- tion and under-nutrition act together in the same individual. Night work, which is so common in these cases, is of especial import. In addition to writing there are also other occupations such as mental over-exertion, in pre- paring for examination, which are often of consequence in these conditions. After the malady has once developed, the fear of the social consequences (which are often quite serious) are a constant aggravating .factor both to the writer’s cramp and to the neurasthenia. The presence of other neuroses has also been noted: epilepsy, hysteria, tic convulsif, hemicrania, neuralgia. I saw a combination of graphospasm and meralgia paraesthetica. Oppenheim mentions an association with tabes and with poliomyelitis. It is, therefore, possible that organic diseases of the nervous system may prepare the ground for the development of the neurosis. On the other hand chronic intoxication, first alcoholism and then nicotin- ism, etc., may be important factors. Certain local changes appear to be of etiologic importance in some cases. Bernhardt reports the case of a policeman, aged 45, who for a long time had been occupied with writing; after having his right hand run over, he began to present tremor in the thumb and index finger while writing. In other cases injuries to the shoulder, the hand, the fingers, were the cause of the appearance of the affection. I have a patient with general well-developed neurasthenic symptoms, in whom a markedly developed Dupuytren’s con- tracture was present in addition to the tremor form of writer’s cramp. In- durations and thickening of the tendon sheaths have been regarded as the cause, as well as periosteal inflammation (periostitis of the external condyle of the humerus). Any of the changes may predispose to the development of the affection but they are hardly likely to develop it. The neurosis develops gradually under the influence of writing as an occupation upon the prepared groundwork. In some persons the regular work of writing 6-8 hours is sufficient, in others the frequent over-time has the injurious influence; upon the whole only a minority of those occupied with penmanship are affected. The malady is not very common. There can be no doubt that the style of pen and penholder may be of some influence in the causation of the affection; of most unfavorable import is the marked right angle position of the finger which fixes the pen. Writing teachers may do much to prevent the development of the malady in teaching their pupils a free position in holding the pen, avoiding too thin penholders, preventing the use of too pointed pens. The posture while seated during writing is also of importance. Although the development of graphospasm, upon the whole, is gradual, nevertheless in connection with exertion, psychical shock, etc., acute exacer- bations may occur. Oppenheim reports a case in which the affection ap- peared in immediate • connection with attendance upon a spiritualistic meeting.