356 DISEASES OF THE PERIPHERAL NERVES. 



cramp are a feeling of slight fatigue of the hand, and a sense of inse- 

 curity as if the writer must grasp his pen more firmly. Sometimes the 

 affection does not advance beyond this stage. When the disease is 

 fully developed, the muscles of the first three fingers become convulsed 

 during writing, and, in bad cases, upon every attempt to write, some- 

 times the flexor muscles, sometimes the extensors, are the most con- 

 tracted. Various forms of this spasm have been recognized according 

 to the predominance of one or other convulsive movement, such as 

 convulsive flexion of the thumb, jerking of the index-finger, loss of 

 control of the hand, and a form made up from the last two of these 

 varieties. During these spasms the pen is rapidly twitched up and 

 down, but, hi stead of regular, distinct letters, it forms grotesque inter- 

 rupted scribbling. The occurrence of the paroxysm is favored by ap- 

 prehensive attention to the subject and fear of its arising. The harder 

 the patient tries to continue his writing, so much the stronger is the 

 spasm, as so much the more is it apt to extend up the forearm and 

 arm. It is usually painless, although sometimes it is attended by a 

 feeling of tension in the arm. The moment the patient suspends his 

 attempt to write, the cramp ceases, and he can execute all other move- 

 ments undisturbed. In a case of this kind, described by Romberg, a 

 nailsmith, as soon as he grasped his hammer and prepared to strike, 

 was seized by painful spasm of the forearm. He was obliged to give 

 up his trade, and afterward become a useful and skilled painter. Wri- 

 ters' spasm is a very obstinate and tedious disorder. Recovery is 

 very rare, and its uniform persistence is hardly ever broken even by a 

 temporary improvement of the symptoms. Some patients, who are 

 ready for any sacrifice in order to be rid of their burdensome disease, 

 and from their anxiety for this means of subsistence, learn to write 

 with the left hand. Unfortunately, however, sometimes in such cases 

 the left hand is also attacked by the disease. 



TREATMENT. The treatment of scriveners' spasm is as a rule unsuc- 

 cessful. Experience has shown that very little benefit is to be derived 

 from the long-continued prohibition of writing, and by only allowing 

 the patient to resume the practice cautiously, and only permitting him 

 to use goose-quills, or by the use of cold douches, sea-baths, and stim- 

 ulating friction. Division of the nerves is of no benefit to the patient, 

 as it causes paralysis of the finger. In one case only has section of 

 the muscles been followed by benefit. In all other instances there 

 was either no improvement at all, or it was a merely transient one. 

 In one case of scriveners' spasm, when, without hoping for success, I 

 applied the constant galvanic current in a manner almost rude, I 

 nave succeeded in curing the disease, so that the patient, who for years 

 had written with the left hand, now uses his right once more. The 



