While, then, disturbances of the function of writing are seldom
ascertainable in those who tic, we have convinced ourselves on more than
one occasion of the truth of the converse, that the exercise of the
faculty is sometimes intimately combined with the evolution of tics of
neck and shoulder.
S. dated his mental torticollis from the time when he used to copy
figures for several hours a day. As a matter of fact, he wrote an
excellent hand, and experienced no difficulty in performing the
necessary movements, but continued writing increased the rotation. N.'s
torticollis was the sequel to long spells of office work, during which
he never laid down his pen. In the case of L., the wryneck and the
convulsions of the right arm were preceded by a sort of writers' cramp
of the right hand, and subsequently of the left.
In the accompanying instance, the development of which one of us has had
the opportunity of observing, the appearance of the torticollis was at
first confined to occasions of writing, but gradually it came into
evidence with other arm actions, and eventually established itself in a
permanent fashion.
P., fifty years old, occupies a responsible position in a big
railway company, is director in a large office, and performs his
duties with peculiar conscientiousness and zeal. Naturally an
emotional man, he was much distressed by an unusually sad family
bereavement about the middle of 1900, which coincided with a period
of great overwork. As he was obliged every day to arrange
innumerable papers and affix his signature to them, he began to
notice that each time he wrote his name his head turned to the
right involuntarily, and he felt a sensation of discomfort in the
neck and right shoulder. He tried to remedy the faulty position by
holding his chin with his left hand; nevertheless, in the course
of the next few months the movement began to assert itself not
merely as he wrote his signature, but also when he cut his food at
table, or sharpened a pencil, or trimmed his finger nails.
_October 14, 1901._--Whenever P. proceeds to write, his head is
immediately rotated to the right and maintained in that attitude by
successive contractions. Simultaneously, the right side of the face
is distorted by a grimace, the right eye blinks, and the right
corner of the mouth is drawn down by a strong effort of the
platysma. The state of affairs is unaltered so long as he is
handling a pen, though, curiously enough, his caligraphy itself is
flawless. The more firmly he grasps his pen, the more violent the
spasms; the substitution of a pencil abates them somewhat, as does
writing on the floor with a cane, while if he traces letters in the
air in front of him with his finger, they do not occur at all. When
both hands are occupied in writing, the head still turns to the
right.
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