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.

    1198/1256 (page 1156)
    There is great resemblance between writer’s cramp and another occupation neurosis, telegrapher’s cramp. This was first described by Onimus in 1874. Cronbach 1 a few years ago published a comprehensive study of the malady. I have seen a few cases of this kind. The affection usually occurs in men. Among the sensory symptoms there are pains of various kinds, dull, stabbing, pulling, boring. Further, there are sensations of cold, tingling, formication, hypersensitiveness and numbness, feelings of swelling and stiffness. Among the motor symptoms there are pareses of some of the fingers, fatigue of the entire hand, of the forearm as well as of the entire member. Spastic symp- toms are not prominent. Cronbach has reported a case in which the extensor tendons of the fingers revealed contractions. He emphasized the occurrence, in his cases, of vasomotor (cold, heat) and of secretory disturbances (abnor- mal sweating, abnormal dryness). He also noted pain and numbness of the hands in his cases even when the patient was not employed in his occupation. Among the objective symptoms there are pressure points along the nerves, the importance of which I have already considered. In some instances there were also pressure points in some of the muscles; in a case of Bernhardt’s, in the sheaths of the tendons. In some instances in addition to telegrapher’s cramp there was also writer’s cramp, or this appeared later. Cronbach was able to demonstrate that not merely Morse’s but also Hughes’s apparatus is capable of developing the neurosis; hence, it follows that the advice to pa- tients to give up the Morse apparatus and employ the Hughes (as was for- merly done) is absolutely valueless. Another form of occupation neurosis is piano player’s cramp. Here the activity of the muscles is similar ^to the previously mentioned forms, but the technic is very much more delicate and much more difficult, requiring a very much longer practice of a purely mechanical nature. Professionals are most commonly attacked, apparently oftenest during their student days. In addi- tion to intense and extensive activity they present the evidences of somatic and psychic symptoms. The clinical symptoms need not be described in detail. Among them are pains which are mosi prominent in the forearm, thence radiating upward and downward, these being the most important. The localization may vary, on the one hand, according to the technic em- ployed, and, on the other hand, according to individual circumstances (small hand, incomplete stretching of the fingers, insufficient power of individual muscle groups, etc.). Fatigue, which appears with abnormal rapidity, causes prolonged pauses; gradually fatigue, present even at the onset, renders play- ing impossible. In addition there are spasmodic conditions (extension of some of the fingers). Pain upon pressure is especially marked in those mus- cles which are implicated in the function. CRAMPS CAUSED BY PLAYING OTHER MUSICAL INSTRUMENTS The picture of the occupation neurosis in violinists, cellists, etc., is the same. In these the spasm may affect the hand that uses the bow or the left hand which comes in contact with the strings. i Cronbach, “ Die Beschäftigungsneurose der Telegraphisten.” Archiv für Psychi- atrie, XXXVII, p. 243.