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writing, time, pens, cramp and treatment

WRITER'S CRAMP.—This is one of the most important of the so-called OCCUPATION NEUROSES (which see), owing to its frequency and obstinacy. It generally affects persons who write a great deal, and who at the same time pay attention to penmanship ; but less frequently those who, although writing much, are less careful of their handwriting. The disturbances may occur either in the form of cramp, or paralysis, or tremor. The first-named condition may appear very shortly after beginning to write, and consists in spasmodic contractions of the individual fingers or of the entire hand. This causes the pen to be either pressed hard against the paper or held away from it, or the writer may drop his penholder.

Writers' paralysis is usually accompanied by dull pains in the hand, radiating through the entire arm up to the shoulder. Writing may become impossible for some time. In the case of cramp as well as of paralysis, it is usually possible for the writer to resume work after a brief rest and with a supreme effort of the will. The disturbance, however, will soon recur ; and the frequency of the recurrences seems to increase with the persistency of the writer's attempts to overcome the difficulty.

Writer's tremor, as implied by the name, consists in a trembling of the hand, which gives the individual letters a serrated, or wavy appearance. If the disturbance he very pronounced, the writing becomes illegible. As a rule all these disturbances take place only during writing, and are not present when the same muscles perform other work.

The principal cause of this affection is over-exertion. A faulty position. holding the pen in a wrong manner, uncomfortable desks or tables, and unsuitable pens are contributory causes. Many hold the introduction of steel

pens responsible for the increased frequency of the affection in the present age. In opposition to this contention, it may, however, be stated that writers' cramp is observed also in persons writing with quills. Nervous diseases, alcoholic and sexual excesses, and injuries to the hands (sprains) may be causative factors. Insecurity, fatigue, and dull pain after writing may be premonitory symptoms.

The treatment of the disturbances here discussed requires great patience on the part of the physician as well as on that of the patient. Attacks of cramp may persist for several weeks, and are apt to recur. Since these patients usually earn their living by writing, only a few are able to comply with the principal requirement—namely, entirely to give up writing for some time. Under no circumstances should the patient allow valuable time to be lost by experimenting with various pens and penholders. Only a physician is able to decide on the plan of treatment best adapted for each individual case, not only with regard to the existing form of disturbance, but also with respect to the patient's state of mind, which is often greatly depressed. The physician will also select the pens and penholders most suitable for the patient. Treatment, which principally consists of massage, gymnastics, and writing-exercises of different kinds, has recently been so greatly developed by physicians that much better results are obtained now than formerly, and many cures are effected.