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.

    1199/1256 (page 1157)
    A cellist, aged 23, complained of pain in the last 3 fingers of the left hand, the pain having started in the middle finger. The pain resembled pin pricks and was most marked in the tips of the fingers; gradually a sensation of numbness and tingling appeared. The patient believed that there was some loss of sensation in the tips of the fingers but this oould not be demonstrated by objective examination. He com- plained of abnormal dryness in these fingers, in spite of the fact that there appeared to be an unusual amount of sweating. The difficulties were entirely limited to his cello playing. Remak has reported tenacious hyperesthesia of the pulpa of the left index finger in violin players; in a patient of Oppenheim’s there was paresthesia upon every attempt to play the violin, which prevented the continuance of the playing, the patient having no other difficulty. Remak reported a case of flute player s cramp in an aged musician, the patient showing spastic phe- nomena in the left thumb and little finger. Thus the professional use of any instrument may give rise to similar symptoms, which need not necessarily affect the upper extremity. Oppenheim has reported an occupation spasm in the muscles of the lips in a cornet player; as soon as the patient attempted to play, spasm appeared in the orbicularis oris and the patient was unable to produce a tone. Whether spasm or paralysis was present could not be determined. Strümpell reported an occupation spasm of the tongue in a clarinet player; similar conditions have been reported in trumpet players by Düms, Kalmus and Stadler. CRAMPS OF THE LOWER EXTREMITIES Meige reports a case of harp player’s cramp, due to using the pedal of the instrument. Occupation spasms of the lower extremity are otherwise quite rare; a patient of Aldrich’s was compelled to use the right foot daily for a number of years upon a pedal which worked a drum and kettledrum. Rigidity and stiffness, as well as fatigue and pain, appeared in the muscles thus employed. In workmen who are compelled to use pedals, lathe workers, knife grinders, sewing machine workers, similar conditions may develop. These cases must be carefully examined for the symptoms of occupation neuritis. In professional dancers, such occupation neuroses, affecting the lower extremity, are also found. I have often noted a pain in the heel which presented all of the signs of an occupation neurosis. In a man who was compelled to stand for several hours daily in the same position, there was pain in the heel, which was not present under any other circumstances, such as prolonged walking or mountain climbing; in shop girls I have observed similar conditions. No local changes could be observed. Discontinuing the occupation was always of favorable influence. Bernhardt1 has reported sim- ilar cases. OTHER FORMS OF OCCUPATION NEUROSIS As many forms of occupation neurosis are met with as there are occupa- tions. I must mention some of the most common. A patient, a jeweler, who was compelled to hold a tool firmly in his hand, i Bernhardt, l. c., p. 466.