The telegraph key should be placed some distance from the edge of the table, so that the forearm may have sufficient support, resting upon the bellies of the flexor group of muscles, and thus relieve the shoulder-muscles, which otherwise would have to support the weight of the arm. Some operators prefer to hold the arm raised from the table, but this method is more liable to cause fatigue.
Several keys have been invented for the purpose of lessening the amount of force needed to manipulate them, and to avoid the jarring caused by the metallic contact; and, although everything that lessens the amount of labor should be adopted, the movements of telegraphing must remain the same no matter which key is used.
Tapping upon the key or attempting to operate by flexing the fingers while the wrist is held still should be avoided.
It is needless to enumerate the other forms of copodyscinesia, as the same general principles apply to the prophylaxis of all.
TREATMENT.—Rest.—It is an assured fact that as long as the patient continues without curtailment the amount of work he was performing when the symptoms of this trouble appeared, treatment will be negative in its results. Rest in itself is powerless to cure, except in the very earliest stages of the disease, for many sufferers have found, to their dismay, that after having given the arm complete rest, as far as the disabling occupation was concerned, for months at a time, the symptoms reappear upon returning to the accustomed work.
During treatment rest is essential, but this need not of necessity be complete; a curtailment of the work will often be all that is needed in the lighter cases. This may be effected by using the unaffected arm for a part of the work at least, but great care must be exercised lest the symptoms appear on this side also, as the left arm, from want of use, is wanting in strength and dexterity, and is more liable to be overtaxed by an amount of work that could be performed without fatigue by the right; for should this happen the end sought for is defeated, and the condition of the patient rendered far worse than before.
In writers' cramp the type-writer, as mentioned under Prophylaxis, is an important adjuvant in the treatment; unfortunately, it is not applicable to much of the work done by clerks.
The other means described in the last section are also useful in the treatment as affording temporary rest to the affected muscles. Hamilton101 has seen occasional benefit from forced rest by fastening the hand upon a splint.
101 Loc. cit.
In telegraphing, besides using the left arm, the key may be grasped in a different manner, or if the operator has been holding his arm raised from the table, let him rest it upon the latter, or vice versâ.