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.

    1201/1256 (page 1159)
    PATHOGENESIS The question of tathogenesis has just been touched upon. A few words more are necessary: it is very questionable whether this is the same for all of the varieties. It has already been stated that peripheral causes may be at fault; but this is merely the case in the minority of instances. On the other hand, it is sometimes the impression of “ not being able ” in addition to disagreeable peripheral sensations which are the causes of the affection. Between these extremes there are transitional forms; but I shall not discuss this very difficult subject; the causes which have been given by Benedikt, of which there are numerous adherents, at the very least are not applicable to every case. TREATMENT A successful treatment of all forms of occupation neurosis depends upon complete rest for a long time. This requirement, unfortunately, very often meets with insurmountable difficulties. The chances of lasting results are greatly decreased by this fact; but, nevertheless, treatment must be attempted. Different forms of the affection require a varied management. The cases in which the neurosis depends upon a general, neuropathic predisposition—and we have seen how often this is the case—require observation of this fact in the therapy: general exhaustion as well as irritability is to be combated by hydriatic measures, tonics, and a change of climate; we cannot enter upon a detailed description of these measures here. In writer’s cramp—and also in other neuroses with proper modification— it is necessary to note whether the manner in which the pen is held, the nature of the pen and penholder, are responsible for the origin of the malady. I have mentioned that stiffness in holding the pen is injurious; the same is true of very thin penholders and very pointed pens. All this is. to be avoided or altered if necessary. In addition, definite exercises are necessary; these are very advantageous. Zabludowski1 has given explicit advice on this sub- ject as well as Konindjy,2 who speaks of a “ reeducation de Vecriture ” Zabludowski begins by having the patient make circular figures in the air, such as are employed in large initial letters. In milder cases exercises in writing may be begun at once upon paper, in which, at first, an apparatus, Nussbaum’s bracelet or Zabludowski’s penholder carrier, may be employed. This apparatus prevents the fingers from assuming the faulty position. Writ- ing exercises, with the inverted hand, so that the volar surface of the hand is placed upward, is also advised; this gives the hand an entirely new base of support. These writing exercises should be practiced 3 times daily, the duration of each being 5 minutes. Konindjy emphasizes the necessity of writing slowly, many pauses being introduced, so that the pen may be dipped frequently into the ink. The movements of the arm necessary for this pur- pose causes the contraction of other muscles than those required in writing. In very severe cases, in which the pen can no longer be used, it is sometimes * Zabludowski, “ Ueber Schreiber- und Pianistenkrampf.” Volkmann*s. Samml. klin. Vortr., 1901. 2 Konindjy, “ La crampe professionelle.” Nouv. Icon. d. 1. Salpetr., 1905, p. 521.