SEFTON PARK.—“Musical stammering” is the same affection as “writer’s cramp,” the only difference between them being due to the different purposes to which the hand is put. There is a very large number of affections of the nervous system called “habit spasms” or “occupation neuroses.” An example will illustrate the cause and treatment of all. So let us take your complaint, “musical stammering.” A pianist discovers one day that she cannot play properly, that her finger persists in striking the same note constantly. Her arm undergoes spasms which prevent her from moving her fingers over the keys. She has an attack of “musical stammering.” What is the cause of this? Well, this question cannot be directly answered. Let us see what possible factors have led up to the present outbreak. Obviously the first is her occupation. Then she has been practising very long. The five-finger exercise is monotonous. The brain, which at first gave its attention to the notes, is now fagging. The mind no longer controls the hands. The exercise ceases to be a voluntary act. It has become a series of involuntary reflexes which require little effort to continue, but a considerable amount of volition to stop. The hand becomes tired and its muscles and nerves exhausted. Now, no longer will they respond rhythmically to the stimulus of striking the finger, they undergo spasms and twitchings. It is very difficult to say which causes the spasms—the brain or the nerves of the arm. But be this as it may, it is an affection which is most difficult to eradicate. It occurs chiefly in members of neurotic families, and, occasionally, is only present when the health is impaired, but it may develop in anybody who is in perfect health. Now for a few words about the prevention and cure of “musical stammering.” Of course we cannot give you any absolute cure for the condition, and you have not been unreasonable enough to demand one. Drugs may be put out of the question as being totally useless. The same may be said of dieting. Locally, mild electrical stimulation and massage of the arms are sometimes useful. The former agent is often quite useless, and sometimes makes the condition worse; massage never does any harm. The usual treatment adopted is to give up the occupation connected with the malady and do something else. This is not always possible, and, besides, it is rather fighting shy of the evil and not treating it. The best form of treatment, we feel certain, is mild and careful exercise. For instance, in your case, practise for five minutes; if this brings on “stammering,” leave off at once; if it does not, practise for the five minutes and then leave off. You might practise twice a day. Every week you should add one minute more to the time you practise, till you have got to practise for two separate half-hours daily. The chief points to remember are these:—on the slightest return of symptoms cut down the time by two or three minutes;