Deborah Ellen Thorpe

A History of Dystonia: Ancient to Modern

Before 1911, when Hermann Oppenheim introduced the term dystonia, this movement disorder lacked a unifying descriptor. While words like epilepsy, apoplexy, and palsy have had their meanings since antiquity, references to dystonia are much harder to identify in historical documents. Torticollis is an exception, although there is difficulty distinguishing dystonic torticollis from congenital muscular torticollis. There are, nevertheless, possible representations of dystonia in literature and visual art from the pre‐modern world. Eighteenth century systematic nosologists such as Linnaeus, de Sauvages, and Cullen had attempted to classify some spasmodic conditions, including torticollis. But only after Charcots contributions to clinical neuroscience were the various forms of generalized and focal dystonia clearly delineated. They were categorized as névroses: Charcots term for conditions without an identifiable neuroanatomical cause. For a time thereafter, psychoanalytic models of dystonia based on Freuds ideas about unconscious conflicts transduced into physical symptoms were ascendant, although there was always a dissenting “organic” school. With the rise of subspecialization in movement disorders during the 1970s, the pendulum swung strongly back toward organic causation. David Marsdens clinical and electrophysiological research on the adult‐onset focal dystonias was particularly important in establishing a physical basis for these disorders. We are still in a period of “living history” of dystonia, with much yet to be understood about pathophysiology. Rigidly dualistic models have crumbled in the face of evidence of electrophysiological and psychopathological overlap between organic and functional dystonia. More flexible biopsychosocial frameworks may address the demand for new diagnostic and therapeutic rationales.

What type of tremor did the medieval ‘Tremulous Hand of Worcester’ have?

The thirteenth-century medieval scribe, the ‘Tremulous Hand of Worcester’ is known for the tremor visible in his script. Thorpe & Alty combine historical analysis with the first neurological study of the scribe’s handwriting. After considering various differential diagnoses, they conclude that the balance of evidence favours essential tremor.

Dystonia in a prolific medieval scribe

Bernard Blancard was a medieval scribe, a professional writer with legal and contract expertise, who worked in Marseille, France. His handwritten, dated records are r emarkably extensive, spanning the years 1297 to 1343. Progressive writing anomalies in these documents suggest that he had a movement disorder. We formed a multidisciplinary team, including a neurologist specialising in movement disorders and two historians, one with expertise in historical writing processes and the other in medieval history and Latin palaeography, to study writing samples from across Blancard’s 46-year-long career. We found evidence of a progressive deterioration in Blancard’s handwriting and propose that he had upperlimb dystonia. Writing from his 20s and 30s presents only minor signs of distortion: letter strokes are smooth and consistent in shape and size, with only the slightest wave in the occasional stroke. By contrast, by his 60s, his handwriting displays a jerky irregular tremor in both horizontal and vertical planes. By age 70 years, strong evidence is seen for variations in quill pressure and posturing, which become a predominant feature of his script. The content of Blancard’s writing shows that there was no decline in his mobility and cognitive abilities, dissuading us from considering a diagnosis of Parkinson’s disease, generalised dystonia, or cerebellar tremors. Studies of later historical fi gures and modern people with adult-onset dystonia have reported negative eff ects of the disease on working lives. By contrast, deterioration of Blancard’s handwriting due to upper-limb dystonia did not aff ect his career as a professional scribe, which was long and prolifi c. Perhaps his established reputation and specialised legal knowledge and training, together with preserved mobility and cognitive abilities, enabled this success.

Historical Analyses of Disordered Handwriting: Perspectives on Early 20th-Century Material From a German Psychiatric Hospital.

Handwritten texts carry significant information, extending beyond the meaning of their words. Modern neurology, for example, benefits from the interpretation of the graphic features of writing and drawing for the diagnosis and monitoring of diseases and disorders. This article examines how handwriting analysis can be used, and has been used historically, as a methodological tool for the assessment of medical conditions and how this enhances our understanding of historical contexts of writing. We analyze handwritten material, writing tests and letters, from patients in an early 20th-century psychiatric hospital in southern Germany (Irsee/Kaufbeuren). In this institution, early psychiatrists assessed handwriting features, providing us novel insights into the earliest practices of psychiatric handwriting analysis, which can be connected to Berkenkotter’s research on medical admission records. We finally consider the degree to which historical handwriting bears semiotic potential to explain the psychological state and personality of a writer, and how future research in written communication should approach these sources.

How to use pen and paper tasks to aid tremor diagnosis in the clinic

When a patient presents with tremor, it can be useful to perform a few simple pen and paper tests. In this article, we explain how to maximise the value of handwriting and of drawing Archimedes spirals and straight lines as clinical assessments. These tasks take a matter of seconds to complete but provide a wealth of information that supplements the standard physical examination. They aid the diagnosis of a tremor disorder and can contribute to its longitudinal monitoring. Watching the patient’s upper limb while they write and draw may reveal abnormalities such as bradykinesia, dystonic posturing and distractibility. The finished script and drawings can then be evaluated for frequency, amplitude, direction and symmetry of oscillatory pen movements and for overall scale of penmanship. Essential, dystonic, functional and parkinsonian tremor each has a characteristic pattern of abnormality on these pen and paper tests.

Young hands, old books: : Drawings by children in a fourteenth-century manuscript, LJS MS. 361

Abstract This article scrutinises three marginal drawings in LJS 361, Kislak Center for Special Collections, Rare Books and Manuscripts, University of Pennsylvania Libraries. It first considers the provenance of the manuscript, questioning how it got into the hands of children. Then, it combines developmental psychology with close examination of the material evidence to develop a list of criteria to attribute the drawings to children. There is consideration of the features that help us estimate the age of the artists, and which indicate that one drawing was a collaborative effort between two children. A potential relationship is identified between the doodles and the subject matter of the text, prompting questions about pre-modern child education and literacy. Finally, the article considers the implications of this finding in both codicology and social history since these marginal illustrations demonstrate that children were active in the material life of medieval books.

Reply: Essential tremor in ‘The tremulous hand of Worcester’: additional comments

Sir, We thank Elan Louis for his interest in our article on the essential tremor of the medieval ‘Tremulous Hand of Worcester’. We are glad to receive his thoughtful comments in agreement with essential tremor as the most likely diagnosis. Unlike modern …

Heated Words: The Politics and Poetics of Work in 'A Complaint against Blacksmiths'.

‘A Complaint against Blacksmiths’, unique to BL, MS Arundel 292, may gesture towards fourteenth-century legislation against night-time work, yet is underpinned by delight in the sights and sounds of the forge. The smith’s smoke-smattered visage is simultaneously disgraceful and inspiring to its medieval audience. Many of us experience a different kind of unease in the digital age, as hours are converted into immaterial goods. For many, the clamour of physical labour has been replaced by the noise of automation. Looking back into the forge, the modern urban worker may yearn for its sonic landscape, with clattering hammers, grunting mouths, and hissing waters.