IV. The antagonistic muscles to those affected by cramp are made to hold the instrument, while the cramped muscles are left entirely free.
But one instrument acts in this manner—viz. the bracelet invented by Von Nussbaum,129 which consists of an oval band of hard rubber to which the pen-holder is attached. The bracelet is held by placing the thumb and the first three fingers within it and strongly extending them.
129 Aerztliches Intelligenzblatt, Munich, 1883, No. 39.
The inventor claims great success by its use alone, as the weakened muscles are exercised and strengthened and the cramped muscles given absolute rest.
Résumé of Treatment.—In the complicated cases of copodyscinesia rest of the affected parts, as far as the disabling occupation is concerned, must be insisted upon: this should be conjoined with the use of the galvanic descending stabile current, combined with rhythmical exercise of the affected muscles and of their antagonists, and massage. Where there is evidence of a peripheral local congestion or inflammation, this must be attended to; for instance, if there is congestion of the nerves, or neuritis, flying blisters or the actual cautery should be applied over the painful spots, followed by the galvanic current. Where there is paralysis of one or more muscles, with evidence of interference of nerve-supply, the faradic current may be used with advantage.
Evidences of constitutional disease should lead to the employment of the treatment suitable for those affections.
RÉSUMÉ OF 43 CASES OF TELEGRAPHERS' CRAMP.
| Age at time of onset: |
| | Under 20 years | 7 | |
| | Between 20 and 30 | 25 | |
| | Between 30 and 40 | 7 | |
| | Doubtful | 4 | —43 |
| |
| Average age | 23.94 years. |
| Average age of males | 24.22 years. |
| Average age of females | 20.66 years. |
| |
| Average length of time before the disease appeared after the commencement of telegraphing was— |
| | In males | 7.27 years. |
| | In females | 4 years. |
| | The shortest period being | 6 months. |
| | The longest period being | 20 years. |
| |
| Left arm implicated in | 21 | |
| (Not counting case with amputation of right arm) | 1 | |
| Never used left arm | 8 | |
| Left arm not affected, although used | 12 | |
| Doubtful | 1 | —43 |
| |
| Percentage with left arm implicated | 63 | .63 |
| |
| No. of cases with difficulty in telegraphing only | 9 | |
| No. of cases with difficulty in writing only | 0 | |
| No. of cases with difficulty in telegraphing most | 22 | |
| No. of cases with difficulty in writing most | 11 | |
| No. of cases with difficulty in both alike | 1 | —43 |
| |
| Use of tobacco or alcohol: |
| | No effect in | 14 | |
| | Bad effect in | 16 | |
| | Good effect (in moderation) in | 3 | |
| | Don't use either | 10 | —43 |
| |
| Flushings in arm or face during work in | 22 | |
| Brittleness of nails in | 5 | |
| Emotional factor present in | 29 | |
| Sympathetic movements in other parts in | 9 | |
| Pain in back during work in | 18 | |
| Trouble in performance of other acts in | 19 | |
| Pain on pressure over nerve or muscle in | 13 | |
| |
| Cramp of flexor group of muscles: |
| | In writing only | 0 | |
| | In writing most | 3 | |
| | In telegraphing only | 1 | |
| | In telegraphing most | 5— 9 | |
| Cramp of extensor group of muscles: |
| | In writing only | 0 | |
| | In writing most | 0 | |
| | In telegraphing only | 4 | |
| | In telegraphing most | 7—11 | |
| Doubtful as to character of cramp | 11 | |
| No cramp | 12 | —43 |
| |
| Manner of telegraphing: |
| | Arm resting on table | 22 | |
| | Arm raised from table | 12 | |
| | Alternating one with the other | 7 | |
| | Doubtful | 2 | —43 |
| |
| Manner of writing: |
| | Arm movement | 13 | |
| | Finger movement | 6 | |
| | Combination of the two | 24 | —43 |