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A note on scrivener’s palsy
  1. J M S Pearce
  1. 304 Beverley Road, Analby, Hull HU10 7BG, UK; jmspearcefreenet.co.uk

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    For many years—before its recognition as a focal dystonia—writers’ cramp (scrivener’s palsy (from the Latin scribere: to write)) was regarded as an occupational hazard akin to repetitive strain. Lucire1 in a provocative book suggests that the only new aspect of repetitive strain injury (RSI) is its name.

    The first epidemics of writers’ cramp were reported in the 1830s among clerks of the British Civil Service, where it was attributed to the new steel pen nib. Sir Charles Bell gave a description of these disorders:

    “I have found the action necessary for writing gone, or the motions so irregular as to as make the letters be written zig-zag, whilst the power of strongly moving the arm for fencing, remained…“The nerves and muscles are capable of their proper functions and proper adjustments; the defect is in the imperfect exercise of the will, or in the secondary influence the brain has over the relations established in the body.”2

    Duchenne reported:

    “Functional spasm may occur anywhere, or affect a great number of voluntary and instinctive movements. Spasm of certain muscles of the hand which has been caused by abuse of writing,… and which shows itself in the exercise of that function, first received in Germany the name of “Schreibekrampf,” … In France, it is called “crampe des écrivains.”.”3

    Tenosynovitis was suggested as the cause in 1840 by GF Strohemeyer (1804–1876), whose device of cutting and separating tendons was a failure.

    Samuel Solly (1805–1871) first used the name scrivener’s palsy, which he reported in 1864, in a clinical lecture.4

    He warned fellow surgeons:

    “The paralyzed scrivener, though he cannot write, can amuse himself in his garden, can shoot, and cut his meat at the dinner table, indeed he can do almost anything he likes, except earn his daily bread as a scribbler… Upon your early correct diagnosis may depend the health and happiness of your subject. If you mistake its real nature and regard it as a sign of incipient softening of the brain, a mistake I have known to occur, you may destroy the happiness of your patient …”

    In 1870, Julius Althaus wrote: On scrivener’s palsy and its treatment. Several 19th century monographs described other occupational neuroses. Gowers regarded it as an:

    “Occupation Neurosis: a convenient designation for a group of maladies in which certain symptoms are excited by the attempt to perform some often-repeated muscular action, commonly one that is involved in the occupation of the sufferer …the pen does not move quite as intended....a slight involuntary movement causes an unintended mark....now and then there is a distinct spasm, which cannot be controlled.… a disease easily imagined by those who have witnessed the disorder”.

    George M Beard who invented the term “neurasthenia” described 125 such cases.5 In the early 20th century, telegraphists in the UK began experiencing “telegraphist’s cramp”, thought to be caused by the rapid, repetitive movements required to send Morse code, affecting up to 18 per cent of British telegraphists. The suspicion was of a poor constitution, neurosis, and neurasthenic temperament.

    Samuel Solly (1805–1871)

    Born in London, the son of Isaac Solly and Mary Harrison, Samuel Solly was christened on 13 May 1805 at St Mary Axe. He was educated at Higham Hill Northampton (Disraeli’s school). Solly was apprenticed to Benjamin Travers, a surgeon of St Thomas’ Hospital, and graduated MRCS in 1828. He started in practice at St Mary Axe in 1830.

    From 1833–9 he was a lecturer in anatomy and physiology at St Thomas’ Hospital. In 1836 he was elected a Fellow of the Royal Society. He set up practice in 1840 in Savile Row and in 1853 was appointed as surgeon and lecturer at St Thomas’, where he continued until illness forced resignation. He obtained the fellowship in 1843 and later became a council member and examiner at the Royal College of Surgeons of England. His publications included: The Human Brain, its configuration, structure, development, and physiology (London, 1836)illustrated by references to the nervous system in the lower order of animals; Surgical Experiences (London, 1865)—the substance of clinical lectures; and several of his watercolour pictures were hung at the Royal Academy. A marble bust was presented to St Thomas’ Hospital and the “Solly Prize and Medal” was established in its Medical School in his memory.

    He died on 21 September 1871 having fathered 11 children including Richard Harrison Solly who became a Professor of Botany, and Samuel Edwin Solly MD—a chest physician in Colorado Springs where he lived from 1900 having journeyed from England on account of chronic phthisis.

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