WRITERS' CRAMP. 589 



All his labour is thus thrown away, and his condition is, if anything, worse than 

 before. 



It is instructive to notice the changes that occur in the handwriting consequent 

 on the disease, and a comparison may be instituted with letters formerly written in 

 health ; it is often quite altered in character, because the patient has adopted a new 

 method of using the pen when writing is possible. The strokes are coarse, im- 

 perfect, and unequal, and numerous irregularities and false strokes are to be 

 observed ; in the highest degree of the affection, after a few scarcely legible words, 

 the writing becomes a mass of irregular strokes and curves, whilst in other instances 

 the letters are mere trembling, undulating, or zigzag strokes. 



In some instances the attempt to perform the special act produces spasm, not 

 only in the muscles brought into action, but also in other parts. For instance, the 

 attempt to write may bring on spasm, not only in the affected hand, but also in 

 the face or neck. As a rule, the general health in no way suffers, and the phy- 

 sical strength may be equal to or even beyond the average. A man may be the 

 victim of writers' cramp, and yet be apparently a perfect model of health. 



The affection we have been considering seldom occurs before the age of thirty. 

 As a rule, men suffer more frequently than women, but pianoforte-players' 

 cramp is more often met with in females. It is said, too, that the male 

 dancer never suffers from dancers' cramp. The principal cause of the disease is 

 usually supposed to be excessive writing, or playing, or what not ; but it must be 

 remembered that it is of not unfrequent occurrence in those who have never 

 over-exerted themselves in any way. It is most frequently observed in writers, 

 secretaries, clerks, merchants, and savants ; but it occurs also in those who write 

 but little, and who think they have done wonders if they have signed a score of 

 business letters. The spasm is said occasionally to arise from exposure to cold, 

 but this is very doubtful. It is obvious that inconvenient tables, a bad position 

 in writing, tight sleeves, and especially hard and pointed pens must favour the 

 development of the disease, since they all increase the demands made upon the 

 muscles and nerves employed in writing. It is certain, however, that steel pens 

 are not exclusively to blame for producing this form of spasm, since it was known 

 before they were invented, and occurs in those who use only quill pens. 



In cases where the symptoms have existed for only a short time, relief may be 

 confidently expected, provided that rest can be taken. If the symptoms have existed 

 for many months, or if rest be impossible, our opinion will be more or less unfavour- 

 able. Many who were seriously threatened with writers' cramp are now free 

 from the malady, because they rested ; many who could not or did not rest have 

 progressed from bad to worse. 



The treatment consists primarily in attention to the removal of the cause. The 

 discontinuance of all writing, playing, sewing, dancing, or whatever else may have 

 led to the occurrence of the disease, or at least the limitation of such occupations 

 to the greatest possible extent, is of vital importance. In recent and slight cases 

 this alone will often effect a cure in a month or two. In severe cases absolute ces- 

 sation from writing must positively be insisted on, and often enough nothing but a 

 long rest, say of six months, or even a year, will effect a cure. Something may 



