Telegraphists' Cramp

By contrast, telegraphists' cramp, a form of "occupation neurosis" which became increasingly prevalent in the first decade of this century, was the province of the psychiatric literature. The first of two investigations in the Post Offices of Great Britain and Ireland (Thompson and Sinclair, 1912) adhered to the view that combinations of pain, spasm and incoordination of muscles involved in telegraphy were the result of a weakening or breakdown in some central controlling mechanism within the brain. This breakdown was attributed to the usual two factors, an underlying psychological instability ("predisposition") and repeated muscle fatigue occasioned by the complicated muscular movements in telegraphy, possibly induced by various psychosocial stressors ("commotion").

Meanwhile Janet (1925) considered crampe des icrivains to be a variant of psychasthenia. Thompson and Sinclair's report was criticised by Culpin (1924), a psychiatrist who favoured Janet's views, who maintained that, as the medical examination of affected telegraphists had not revealed any abnormality, the necessity to further investigate mental symptoms should have been recognised. Culpin considered that the use of such terms as "neurasthenic [telegraphists]", "highly strung disposition", "nervous temperament" and "nervous instability" implied that " 'nervous' and its synonyms [were] being used with a different connotation from that in the phrase 'nervous system', where, unless it is used metaphysically, the reference is to the actual organic nerves". After critically examining the widely held "central" theory, Culpin (1931) found that the "vagaries of cramp symptoms and their manifestations make such hypotheses quite inadequate".

In 1927 a second investigation into "telegraphist's cramp" was performed, in which Culpin took part (Smith, Culpin and Farmer, 1927). The investigators assessed both the speed and accuracy of "cramp" subjects and "normal controls" using three test instruments. Overall there was no significant difference in performance between the two groups. The members of the two groups were then examined for the presence of symptoms deemed psychoneurotic (anxiety, obsessions or hysteria). Psychoneurotic symptoms were found in 75% of cramp subjects compared with 32% of control subjects, but the investigators admitted to having some difficulty in categorizing their female "control" subjects. They felt that, in general, "the commonest picture of a cramp subject was the combination of severe psychoneurotic symptoms and poor muscular efficiency". However this conclusion must be doubted as the investigators later discovered that the control group contained some cramp subjects who had not been willing to report their symptoms.

Culpin (1931) also examined 100 students in the School of Telegraphy for psychoneurotic tendencies and found "neurotic reactions" in 46, 19 of which were classed as severe. Culpin and Smith (1930) maintained that in a single 20 minute interview an experienced investigator can elicit nervous symptoms or tendencies sufficient to enable classification of individuals. They diagnosed psychoneurotic disorders in 39% of a group of 1000 subjects of both sexes, made up of factory workers, clerical workers and students. Culpin (1948) thus became convinced that a predisposition to neuroticism plays a greater part in the development of occupational cramps than do occupational factors. This view was given a prominent place in the occupational health literature of the 1970s (Hunter, 1975).

That these studies not only depended upon the untestable tautological construct of psychoneurotic "tendencies" but also failed to include control groups seems to have gone unnoticed.

A number of pseudo-studies ensued, essentially following this teaching of Culpin. Halliday (1935) claimed that psychoneurotic disorders were the cause of incapacity for work in one third of the 1000 consecutive cases he examined who were receiving cash benefits under the National Health Insurance Act (1912) and in 39% of cases given a diagnosis of "rheumatism" by the certifying medical practitioner. Pai (1947) examined a sample of the handwriting obtained on admission of each of 1880 patients suffering from neuropsychiatric symptoms of sufficient severity as to require treatment by an emergency psychiatric service during the period 1941 to 1946. Some 171 patients who exhibited "some disturbance in co-ordination, resulting in temporary changes in handwriting" were divided into three diagnostic groups: those suffering from acute anxiety (the majority), those with organic diseases of the nervous system and those with chronic and mild neurosis whose predominant symptoms were connected with anomalies of motor functions (hysterical reactions). As very few of these patients presented solely because of their writing difficulties, Pai's conclusion that "writer's cramp" appeared to be only a symptom of neurosis, rather than being an occupational disease, appears to be seriously flawed.

Next: Myalgic and fibromyalgic forms of Occupation Neurosis

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