evolved, as the spinal cord became a complicated reflex mechanism and the brain the dominant organ of consciousness, the various receptors became more numerous and complicated, and parallel with this there arose rhythmic states of activity alternating with rest or sleep.

It is well known that we cannot get along without sleep and yet the important question arises why is sleep biologically necessary? Genuine sleep only exists in organisms with a developed nervous system, and it has been shown that the motionless states in lowly organisms, when in shadows or in darkness, is not sleep. Sleep also seems to be due to a cessation of activity of the receptor organs and this in turn causes a diminished activity of the central nervous system. In sleep, the brain and spinal cord alone seem to be the seats of diminished activity, for the body metabolism during sleep does not differ much from that of the waking. state. Sleep is an organic need, in the same way that hunger is an organic need. The effect of complete sleeplessness, as shown by experimental evidence, is to cause severe changes in the nerve cells. Therefore, the activity of the nerve cells furnishes the key to sleep. The Nissl bodies of the nerve. cell accumulate during repose and disappear in activity, particularly under conditions of fatigue. In the brains of chickens and dogs which have been suddenly killed during sleep, there has been found an increase of the Nissl bodies. This substance, therefore, accumulates in the nerve cells during their functional inactivity, when the sensory stimuli pouring into these cells from without are greatly diminished. Normal nerve cells, or nerve cells in a state of rest, show these Nissl bodies with great clearness. It is only in the fatigued cell or the cell which has been poisoned by toxic substances. or through the influence of increased temperature in fever, that these bodies are disintegrated and in many cases completely disappear, giving the cell a washed-out appearance (chromatolysis). Therefore, sleep is a mechanism for the repair of nerve elements which have become disintegrated from the bombardment of stimuli received by the various surface receptors and receptor organs of the special senses. Those organisms, which by reason of rest and immobility when they went into darkness or shadows, showed the

greatest repair, were the very organisms which survived in the evolutionary struggle and sleep evolved out of these motionless states. This reparative power is absolute, for, no matter how great the fatigue or long the insomnia, only a few hours of complete sleep is necessary, as demonstrated by some exact experiments on the loss of sleep in man.

Much of the same principle may be applied to the evolution of hypnosis. Many animals seem to furnish examples of spontaneous hypnotic states, for instance, the simulation of death, or still better, the fascination of birds by snakes, which seems to be a kind of hypnosis with catelepsy. Many animals show motionless states in reaction to fear. While motionless states of the nature of genuine hypnosis or cerebral inhibition may be produced artifically in certain animals (birds, frogs, guinea pigs, cray fish), yet probably in the phylogenetic scale, such states were made possible of artificial production because spontaneously the normal defense reactions of these animals showed similar phenomena. If we assume that these motionless states arose in animals our of stationary reactions while waiting for their prey or for purposes of defense, we must also assume that this was an intelligent experiment on the part of the animal. Thus hypnosis had probably a biological origin like sleep, but since the former was unnecessary for the preservation of the species, it became only incompletely developed spontaneously and could only be artificially produced. Even then, it did not appear until the animal began to show intelligent reactions, a defense or instinctive action on one hand and a hunger reaction on the other. These reactions, however, while of great value, did not have the biological importance of sleep, namely, a repair of nervous tissue, and therefore they did not become like sleep, automatic and spontaneous.

THE TREATMENT OF WRITER'S CRAMP AND OTHER OCCUPATIONAL NEUROSES

TOM A. WILLIAMS, M.B.C.M., EDIN.

Corresponding Member Paris Neurological Soc., Psychological Soc., etc., Neurologist to Epiphany Dispensary, Washington, D. C.

T

THE TREATMENT OF WRITER'S CRAMP

O a clear-minded person who realizes that the "grip is being lost," as the telegraphers call it, the psychogenesis of occupational cramp is apparent. The resulting treatment is illustrated in the following cases:

AUTOTHERAPEUSIS OF AN OCCUPATIONAL NEUROSIS

An exceedingly efficient sender for a metropolitan newspaper one day found that he was failing to send properly the five short taps which in the Morse code represent the letter P. Knowing the risk of telegrapher's paralysis, he at once set to work to conquer the sending of the letter P, and spent his intervals between sending and receiving messages in practising that letter, until at the end of two or three days, he found he could accomplish it as well as before.

The second case is that of a physician who is now himself much interested in psychopathology; the account is written by himself.

TEMPORARY WRITER'S CRAMP IN A PHYSICIAN, AUTOTHERAPEUTICALLY ARRESTED

"Having occasion to stop in a newspaper office one morning when a case of great medico-legal interest was occupying public attention, the editor asked me for a statement of my opinion for publication. He showed me the statement of two medical men of prominence who had also been interviewed. As I was under some obligation to the editors, I consented. He asked me to hurry, as they were about to go to press, and handing me pencil and paper, told me to

sit down at his desk. He sat to one side and watched me as I wrote. The situation was a strange one, and the hurry and confusion of the office extremely distracting. I was obliged to think rapidly and to place my thoughts upon paper as quickly as possible. I wished my interview to compare favorably with the others. I was conscious that within an hour what I had to say would be read by thousands. As I substantially agreed with the statements of the other physicians who had been interviewed, I felt the need of saying the same thing in language sufficiently different to cause my statement to seem somewhat original. As I wrote, I became more and more dissatisfied with what I had to say. The point of the pencil broke twice, causing me much annoyance. My hand suffered a distinct cramp by the time I had finished the second page. I had begun my statement in a large, plain hand. Soon I saw that my writing was growing very illegible; and I thought the compositor would not be able to read it. All this caused me to be still more annoyed with myself. The hand was now painfully cramped, and I had difficulty in holding the pencil, and was obliged to write with an arm movement, which is not my habit. When I finished, the cramp lessened, but was followed by a distinct and complete paralysis, which lasted for about an hour. Later in the day, on attempting to use a pen or pencil, the cramp returned. The next morning the difficulty had disappeared.

"The paralysis was for all the finer movements of the hand. I remember that I was obliged to button my overcoat with the left hand.

"Fatigue was not a factor. My statement was brief, not more than four or five pages.

"The psychic factors were, as near as I can tell, fundamentally distraction and anxiety, although at the time I doubt if I were very conscious of either."

THE DIFFICULTIES

Very different is the result when a cramp arises in a person of credulous disposition, who is unfortunate enough. to be advised by a physician lacking in psychological good sense and imbued with the confused ideas regarding the

genesis of spasms, tics and other myoclonias which are all that can be found at present in the English text-books.

Such a physician only reinforces the patient's belief that his disability resides in some modification of bodily structure. This collusion of misinterpretation eventuates in the all too common course of massage, electricity, tonics, nerve excitants, or rest and calmatives, according to the theoretical predilections of the physicians. In spite of the suggestive effect of these measures in breeding self-confidence and hope, failure is the rule, and the patient may then have recourse to various charlatans. These, however, are no better informed of the pathology of occupational cramps than were the physicians who failed, and the patient gives up, believing himself incurable.

Hence, the first task of the therapeutist is often to convince the patient of the pathogenesis of his affection in order that he may be persuaded to undertake a treatment which will be neither short nor easy.

The keynote to this treatment is that the patient clearly understand the mechanism of his affection. Upon the basis of this understanding, physician and patient then develop precedures for the re-education of the perverted psychomotor succession which determines the abnormal movements. Before expounding the principles of this, the difficulties should be foreseen and explained to the patient. The first of these is the practical one of the length of the treatment, which is of course a serious inroad upon the time of both doctor and patient, and considerable expense to the latter.

The second difficulty is that the re-education consumes much energy; and a patient who is already working hard for his living may not be able to spare this, any more than can a physician with multiple duties. But if these difficulties are transcended, there remains the psychological one of the patient's willingness to undergo a discipline which may go to the extent of changing his mental habitus. Thus, a hyper-suggestible, impulsive individual will require a great effort to accommodate himself to the careful slowness of control needed in the mastery of a disorderly movement. On the other hand, a person of timid, hyperconscientious disposition, who takes the most trivial detail with an in