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.

    1202/1256 (page 1160)
    possible to have these exercises practiced with a lead pencil, progress being attained in this manner. Massage of the entire arm and hand may be used in addition to the exer- cises. This treatment is especially advisable in cases in which there are in- flammatory changes. Zabludowski advises energetic vibration massage. I have attained excellent results with vibration massage, gradually increasing the intensity, special muscles in the arm and hand being treated separately. I have used this treatment in combination with resistance movements; this method is especially indicated in the occupation neurosis of typewriters. The same apparatus may be employed for resistance movements. Electricity may be used according to general principles. The galvanic current is most often applied, the anode being placed upon the brachial plexus or upon the elective points of the different nerves of the arm. The strength of the current should be 4-6 ma. Galvanization of the cervical cord has also been advised. Most authors (Gowers, Bernhardt, Oppenheim and others) report but slight favorable results from electricity. The faradic current is applied when there is great muscular debility: strong faradic currents should, however, never be used. Faradic hand-baths have been employed with ad- vantage (Laquer) as well as the static machine, arc light, and the incan- descent light (Laquer). Where local changes are present these should be relieved if possible with- out surgical intervention. Cutting the flexor and extensor tendons of the fingers, which was formerly practiced (Dieffenbach) is now quite properly rejected. In those instances in which it was impossible for the patient to write with the previously mentioned apparatus, an attempt was occasionally made to use the left hand for the purpose; in some cases this has been successful for a number of years. Often, however, difficulties soon appear in the left hand which render writing impossible. The use of the typewriting machine is now urged. That this remedy may also fail in some cases was to be ex- pected; in a case of Simpson’s, writer’s cramp also originated from the use of the type machine. It cannot be doubted that suggestion plays an important role in the therapy of writer’s cramp and the other occupation neuroses. That its influ- ence will vary in the different forms is obvious. The treatment of the other varieties of occupation neurosis may be de- duced from what has been advised for writer’s cramp. I have already called attention to some of the modifications. Patience and perseverance on the part of the physician and patient and certain favorable circumstances in the social position of the sufferer are of the greatest advantage in procuring favorable results in the treatment of these maladies.