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 Artful Virtue: The Interplay
of the Beautiful and the Good in
the Scottish Enlightenment
For Bob
 Artful Virtue: The Interplay
of the Beautiful and the Good in
the Scottish Enlightenment

Leslie Ellen Brown

Emerita Ripon College, USA
© Leslie Ellen Brown 2015

All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise without the prior permission of the publisher.

Leslie Ellen Brown has asserted her right under the Copyright, Designs and Patents Act,
1988, to be identified as the author of this work.

Published by
Ashgate Publishing Limited Ashgate Publishing Company
Wey Court East 110 Cherry Street
Union Road Suite 3-1
Farnham Burlington, VT 05401-3818
Surrey, GU9 7PT USA
England

www.ashgate.com

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

The Library of Congress has cataloged the printed edition as follows:

Brown, Leslie Ellen.
Artful Virtue: The Interplay of the Beautiful and the Good in the Scottish Enlightenment /
by Leslie Ellen Brown.
pages cm
Includes bibliographical references and index.
1. Philosophy, Scottish – 18th century. 2. Enlightenment – Scotland. 3. Aesthetics, Scottish
– History – 18th century. I. Title.
B1402.E55B765 2015
170.9411–dc23 2014033503

ISBN 9781472448484 (hbk)

ISBN 9781472448491 (ebk–PDF)
ISBN 9781472448507 (ebk–ePUB)

Printed in the United Kingdom by Henry Ling Limited,

at the Dorset Press, Dorchester, DT1 1HD
 Contents

List of Plates   vii

Acknowledgements   ix

Introduction   1

1 The Senses   9

2 Virtue   31
Virtue as “Lovely Form”   31
Civic Virtue   35
Virtue into Art   38
Providence   45

3 Beauty   53
Beauty Defined and Dissected   53
Sublimity   64
Beauty and Truth   70
Beauty and Pleasure   76

4 Sentiment   87
Passions and Affections   87
Imitation   97
Expression   105
Imitation and Expression in Music   108

5 Taste   119
Sense of Taste, Delicacy of Taste, Standard of Taste    119
Judgment and Criticism   131
Imagination and Genius   137
Custom and Fashion   142
British Taste, the Scotch Taste, and the Genuine Scots Taste   144

6 Experience   151
Analogy and Induction   151
Association of Ideas   158
vi Artful Virtue

7 Cultivation   169
Utility and the Useful   170
Improvement and Progress   178
Education   187

8 Traditions   197
The Antique   197
Recovering History   205
Primitive Voices   215

Afterword   227
Select Bibliography   229
Index   239
 List of Plates

The plate section appears at the end of this ebook.

1. Self-Portrait with John Brown, by Alexander Runciman, courtesy

of the Scottish National Portrait Gallery
2. Alexander Carse with His Mother and Sister, by Alexander Carse,
courtesy of the Scottish National Portrait Gallery
3. Design for Ante-room Pavement for Syon House, by Robert
Adam, The Works in Architecture of Robert and James Adam
(Mineola, NY: Dover Publications, 1980)
4. Cora Linn, by Jacob More, courtesy of the Scottish National Gallery
5. A Prospect of Edinburgh from the West, by Alexander Nasmyth,
courtesy of the Trustees of the British Museum
6. A Lady’s Left Hand Holding a Rose, by Allan Ramsay, courtesy of
the Scottish National Gallery
7. Thomas Reid, by Henry Raeburn, reproduced by kind permission
of the National Trust for Scotland
8. Margaret Lindsay, Mrs Allan Ramsay, by Allan Ramsay, courtesy
of the Scottish National Portrait Gallery
9. And Yonder’s Mause, from The Gentle Shepherd, by David Allan,
courtesy of the National Library of Scotland
10. Section of Great Hall for Syon House, by Robert Adam, The
Works in Architecture of Robert and James Adam (Mineola, NY:
Dover Publications, 1980)
11. Plan for Principal Floor, New Building for the University of
Edinburgh, by Robert Adam, The Works in Architecture of Robert
and James Adam (Mineola, NY: Dover Publications, 1980)
12. Frontispiece for Domenico Corri’s A Select Collection of the Most
Admired Songs, courtesy of Harry Ransom Center, the University
of Texas at Austin
13. Plan and Elevation for Garden Seat for Montague House, by
Robert Adam, The Works in Architecture of Robert and James
Adam (Mineola, NY: Dover Publications, 1980)
14. The Connoisseurs, by David Allan, courtesy of the Scottish
National Gallery
15. Dawkins and Wood Discovering Palmyra, by Gavin Hamilton,
courtesy of the Trustees of the Victoria and Albert Museum
viii Artful Virtue

16. Agrippina with the Ashes of Germanicus, by Gavin Hamilton,

courtesy of the Tate Gallery
17. A Highland Dance, by David Allan, courtesy of the Scottish
National Gallery
18. William, 17th Earl of Sutherland, by Allan Ramsay, courtesy of
the Sutherland Dunrobin Trust
19. Colonel William Gordon, by Pompeo Batoni, reproduced by kind
permission of the National Trust for Scotland
20. Ossian Singing, by Alexander Runciman, courtesy of the Scottish
National Gallery
 Acknowledgements

I began conceptualizing this book and harvesting information a long, long time
ago, as I imagined bringing together the four beloved areas of inquiry which
have fascinated and inspired me since a young person and throughout my
professional career: the arts, the eighteenth century, Scotland, and ethics. To
that end, many persons and institutions over the decades are deserving of my
thanks and appreciation.
Funding for research came from numerous sources: the National Endowment
for the Humanities, Louisiana State University, the Southern Regional
Education Board, The Pennsylvania State University Institute for the Arts and
Humanities, and Ripon College’s Board of Trustees.
The expert staffs of various research libraries have been extremely helpful,
without which I could never have accessed the reams of material that I’ve
surveyed and used. These are: the Library of Congress, the Folger Shakespeare
Library, the National Library of Scotland, Glasgow’s Mitchell Library, and the
libraries at the University of Edinburgh, the University of Wisconsin, and Penn
State. These last two proved especially valuable in allowing me access to that
phenomenal database which all researchers of eighteenth-century documents
have come to know and love, Eighteenth Century Collections Online (ECCO).
I wish to thank certain individuals for their contributions: Charles Stewart-
Robertson for sharing Reid manuscripts from the Birkwood Collection,
and Kathleen Holcomb for providing lists of discourses for the Aberdeen
Philosophical and Glasgow Literary Societies, as well as a document proving
the connections between John Holden and Thomas Reid; the readers of various
chapters of my book who provided many helpful comments and corrections,
Samuel Fleischacker, Henry Fulton, Paul Jeffries, Douglas Northrop, and
Rachel Zuckert; and especially Simon Grote, who read and critiqued the
entire manuscript. I also wish to thank the very able editorial staff at Ashgate
Publishing, in addition to the anonymous readers whose comments proved
quite valuable.
-
L.E.B.
Spring Mills, Pennsylvania
November 2014
This page has been left blank intentionally
 Introduction

He only, is the wise and able Man, who with a slight regard to these Things, applies
himself to cultivate another Soil, builds in a different Matter from that of Stone or
Marble; and having righter Models in his Eye, becomes in truth the Architect of his
own Life and Fortune; by laying within himself the lasting and sure Foundations of
Order, Peace, and Concord.1
– Lord Shaftesbury

The Scottish Enlightenment was an age of intellectual fervor that encompassed

nearly every aspect of human endeavor of the eighteenth century. Government
and public service, economics and commerce, education, jurisprudence, science
and medicine, philosophy and theology, social sciences, arts and culture—the
Scots advanced in all to the degree that one could hardly look for a more vibrant,
more progressive, more ingenious populace, astonishingly remarkable in that it
was small, about 1.3 million persons nationwide at mid-century, centered mainly
in three geographically separated urban centers, and flourishing in a time frame
of a mere seven decades, between the 1720s to nearly the end of the century.2 Not
to be surpassed by their neighbors in England and on the European continent,
the Scots in particular made a worthy contribution in the realm of philosophical
inquiry known specifically as moral philosophy which, in turn, had a significant
impact on intellectual and social developments well into the nineteenth century,
in Britain, Europe, and North America. To the Scots moral philosophy was a
mighty idea, no less than the science of human nature. It was the application of
a set of rules for the careful study of the internal world of the human mind as
deduced from human nature and circumstances, in the same fashion that the
natural world was empirically investigated. The Scots believed that they could
explore rationally and systematically—from which they could draw a body of
conclusive organizing principles—how mental processes transpired, that is, as a
science of the mind. What this actually meant was that from the study of human
systems—as applied to most disciplines in the humanities, social sciences, and
fine arts—behaviors, actions, attitudes, character, feelings, values, intuitions, and

1
Anthony Ashley Cooper, third Earl of Shaftesbury, Characteristicks of Men, Manners,
Opinions, Times (1711; 3 vols, ed. Douglas Den Uyl, Indianapolis: Liberty Fund, 2001), 2: 238.
2
Richard B. Sher, Church and University in the Scottish Enlightenment: The Moderate
Literati of Edinburgh (Princeton: Princeton Univ. Press, 1985), 8-9, takes into account this
time frame, anchored on one end by Francis Hutcheson and on the other by Dugald Stewart.
2 Artful Virtue

ethical judgments emerge as the sources of evidence. All of these things dealt
with perceptual consciousness as a moral subject, which invited the Scots to ask:
What holds us together as a society? Why do we associate with one another?
What stimulates us to develop institutions? Ultimately moral philosophy was
about duty to and conduct in society, that is, what we call “ethics” or “morals”
(which is how I usually approach these terms in the following pages).3
It is no surprise that the Scots then applied the vast landscape of moral
philosophy to the specific territories of beauty—in nature and in the fine arts,
that is, aesthetics (though they did not at first use the term), and in character,
or ethics. They held forth about these subjects enthusiastically—in treatises,
academic lectures, essays, institutional records, personal correspondence, and
public discourses and debates. For the most part, these enthusiasts were the
Scots literati, a professional class of men of letters and learning who were civically
and humanely engaged and fascinated with the Enlightenment ideals that were
in play in Britain, Europe, and North America.4 Most of their biographies
and major writings are well known to today’s scholars of eighteenth-century
Scotland. They were by no means solely academics, and they excelled in a wide
range of disciplines and professions. The vast landscape of human endeavor
and understanding excited them, for they sought to demystify the unity of
cumulative knowledge. Their writings go beyond formal texts, the scholarly
discourses intended for university students and other moral philosophers. They
wrote about these various endeavors and disseminated their ideas in ways that
an educated, middle-class, general populace could access and appreciate—in
newspapers and magazines, encyclopedias, pamphlets, and method books.
Additionally many persons engaged with the ideas of aesthetic theory were
connoisseurs of the arts and artists themselves, so it is hardly surprising that
theories of beauty and virtue are echoed in the creative accomplishments of
the age, mostly in painting, architecture, and poetry, but not only within those
realms. This approach is what Hume recommended: the study of polite letters
is a glimpse into human affairs, and an artist is the best qualified to provide that
window.5 In our time, Richard Sher has invited investigation in just this way,
opposing a definition of the Scottish Enlightenment based on formal academic
texts alone.6 Thus here marks the purpose of my study: to reveal within the
landscape of human affairs the interdependency of aesthetics and ethics in a
3
I highly recommend as a starting place the Moral Philosophy article in Encyclopaedia
Britannica, or a Dictionary of Arts, Sciences, and Miscellaneous Literature, 3rd ed., 18 vols
(Edinburgh, 1787-97), 12: 272-318.
4
I depend on the definition provided by Sher, Church and University, 8.
5
David Hume, Enquiries concerning Human Understanding and concerning the
Principles of Morals (rpt 1777 ed. L.A. Selby-Bigge; 3rd ed., P.H. Nidditch, Oxford:
Clarendon, 1975), 9-10.
6
Sher, Church and University, 7.
 Introduction 3

broad context, as discovered in a varied mixture of primary texts, mostly written

ones but also artistic.7 This revelation proposes that the ideas of an intellectual
elite were transformed, such that they entered the mainstream of public
pronouncements regarding beauty and the arts. It proposes that the strength of
these ideas grew as they became entwined with Scottish sociability and sympathy
that defined a culture of feelings, good will, and humanity. Finally it proposes
that these ideas elevated the role of the moralist, not as a superior being but as an
educator, and connected the world of the academic to a Scottish reading public
which sought educational authority. After all, these moral philosophers wanted
to demonstrate how beauty and the arts make us better persons.
Yet I want to begin this book about eighteenth-century Scotland’s fascination
with the interplay of art and virtue by first discussing an Englishman who
lived mostly in the seventeenth century: Anthony Ashley Cooper, third Earl
of Shaftesbury (1671-1714), the author of the diverse collection of writings
brought together in Characteristicks of Men, Manners, Opinions, Times. A student
of John Locke, he was an early moral philosopher who posited a theory of the
intrinsic good,8 and he is regarded as the first really original neo-Platonic thinker
standing in opposition to Newtonian methodology. Especially important to
my purposes, Shaftesbury thought of the arts as one way of portraying moral
truth. He was certainly not the first to do this, since for centuries artists and
theorists had been concerned with how the arts instruct us, and especially
instruct and move us towards the good and away from misconduct. As Robert
Norton has demonstrated in an investigation of the ideal of moral beauty in the
eighteenth century, aesthetic morality itself was a key aspect of moral science.9
But Shaftesbury accomplished this specifically by aligning similarities in sense
perception and value judgment, that is, the aesthetic sense is one of ethics. These
faculties are innate because they come entirely naturally and are not the result
of artifice. This is a notion that the early eighteenth-century Scottish moralists
found entirely satisfactory and in keeping with their understanding of God’s
provision of numerous forms of generosity and benevolence.
To understand his legacy to the Scottish Enlightenment, I want to consider
how Shaftesbury sees a standard of taste: simply, the concerns of form, order,
and unity are the affairs of the workings of the universe. Both morals and beauty
operate on fixed standards; a correct taste applies to both life and manners and
artful masterpieces; and ultimately right and wrong tastes are taken in respect
7
Again it is Sher who defines the Scottish Enlightenment multi-dimensionally and
culturally, which goes beyond a strictly philosophical interpretation but includes all of the
important issues concerning the actions and improvement of society and culture. Ibid., 11.
8
See Vincent M. Hope, Virtue by Consensus: The Moral Philosophy of Hutcheson,
Hume, and Adam Smith (Oxford: Clarendon, 1989), 20.
9
Robert Norton, The Beautiful Soul: Aesthetic Morality in the Eighteenth Century
(Ithaca: Cornell Univ. Press, 1995).
4 Artful Virtue

to inward characters, behaviors, and actions.10 The essay “The Moralists,”

which plays out to some degree as a dialogue between the voices of reason and
emotion, reveals the idea that unity, design, systems, and the relationship of
parts to the whole lead to virtue and perfection, and their contraries to vice and
imperfection.11 The beautiful in nature corresponds to virtue in the moral world,
though few persons have looked at these two in such a way. In doing so,

We shou’d then see Beauty and Decorum here, as well as elsewhere in Nature;
and the Order of the Moral World wou’d equal that of the Natural. By this the
Beauty of VIRTUE wou’d appear; and hence, as has been shewn, the Supreme and
Sovereign BEAUTY, the Original of all which is Good or Amiable.12

The same qualities that enhance beauty also enhance morality. In the third of
the “Miscellaneous Reflections” we find a fine taste for beauty joining a relish
of what is decent, just, and agreeable, sources for the improvement of a person’s
character.13 Such is part of the larger issue of art and ethics shaping character,
and character itself validating a just taste and admirable morals. Order in the
universe is understood in part through moral actions (virtue) and through
the senses (beauty), thus beauty and virtue become forms of order. Improving
taste would improve the manners and ultimately the happiness of Shaftesbury’s
countrymen, for instance.14 Obviously he is aware that taste’s yardstick is a
matter of being a good person in polite company, of relishing artistic beauty, and
supporting what is an expectation of excellence in behaviors. Because a moral
sentiment is not a simple reflex but involves reflective judgment, he is a strong
supporter of criticism as necessary for developing a just taste.
But Shaftesbury goes far beyond a love of order and the support for a standard
of taste in explaining the relationship between the good and the beautiful. For
that reason it is important to understand the intensity of his ideas on self-interest.
In opposition to selfish egoism, rather, he favors an attitude of disinterest: the
intrinsic good existing for its own sake. The good and the beautiful, in an object
perhaps, happily coexist and need not serve anything beyond that. The true good
is in the enjoyment of beauty, yet no true enjoyment of beauty exists beyond
what is good.15 Shaftesbury’s way of thinking is integrative: when he considers
disinterestedness, he accepts both individual and public good. Certainly
persons are motivated to seek happiness for themselves through the sense of
pleasure. Nevertheless, the good of others, the general good, is the ultimate
10
Cooper, Characteristicks, 1: 207-8, 217-18.
11
Ibid., 2: 165.
12
Ibid., 2: 166.
13
Ibid., 3: 99-100.
14
Ibid., 3: 103.
15
Ibid., 2: 235.
 Introduction 5

goal, in which the individual can play a part. In “The Moralists,” for instance, he
demonstrates that the natural state of humankind is social.16 Through the affairs
of disinterestedness Shaftesbury affirms that art has everything do to with moral
truth: the pleasure from beauty is linked strongly to the pleasure from virtue and
intrinsically so.
Last, take note that it was Shaftesbury who convincingly extended to the
philosophical discourse of the Scottish Enlightenment the importance of beauty
or deformity in both sensible and moral objects: the senses and the reflected
senses are the natural conduits for the beautiful and the good respectively.17
From “An Inquiry concerning Virtue and Merit,” it becomes clear that objects of
affection operate on the mind in similar fashion to objects of sense. Shaftesbury
compares the former to the latter, making special note of the active nature of
both:

The Case is the same in mental or moral Subjects, as in ordinary Bodys, or the
common Subjects of Sense. The Shapes, Motions, Colours, and Proportions
of these latter being presented to our Eye; there necessarily results a Beauty or
Deformity, according to the different Measure, Arrangement and Disposition
of their several Parts. So in Behaviour and Actions, when presented to our
Understanding, there must be found, of necessity, an apparent Difference,
according to the Regularity or Irregularity of the Subjects . . . Now as in the
sensible kind of Objects, the Species or Images of Bodys, Colours, and Sounds,
are perpetually moving before our Eyes, and acting on our Senses, even when we
sleep; so in the moral and intellectual kind, the Forms and Images of Things are
no less active and incumbent on the Mind, at all Seasons, and even when the real
Objects themselves are absent.18

Here within these parallel faculties lies Shaftesbury’s idea of harmony, that is,
harmony as “interior numbers” or moral perception. It is innate, meaning it is
instinctive and not taught or learned. It is the core of both virtue and beauty,
key to both ethics and aesthetics, as described in “Soliloquy, or Advice to an
Author”:

For HARMONY is Harmony by Nature, let Men judg ever so ridiculously of

Musick. So is Symmetry and Proportion founded still in Nature, let Mens Fancy
prove ever so barbarous, or their Fashions ever so Gothick in their Architecture,
Sculpture, or whatever other designing Art. ’Tis the same case, where Life and
MANNERS are concern’d. Virtue has the same fix’d Standard. The same Numbers,

16
Ibid., 2: 176-7.
17
Ibid., 2: 16.
18
Ibid., 2: 16-17.
6 Artful Virtue

Harmony, and Proportion will have place in MORALS; and are discoverable in
the Characters and Affections of Mankind.19

It is here that Shaftesbury constructs the foundation of morals as both an

“art” and a “science,” that is, moral philosophy as the science of human nature.
Moreover, the relationship goes far beyond analogy: beauty is the sensible
manifestation of virtue; the imitative arts represent the actions of a virtuous
mind; and the successful artist must deeply understand morals and virtues. So it
is that aesthetic experience is indispensable in making value judgments.
This was Shaftesbury’s legacy to the Scots, and as a whole they worked
with the theories from all three of the above areas. They saw taste as both an
aesthetic and ethical form of judgment. In the standard of taste (and I speak
in generalities with a degree of caution), they recognized the important roles
of natural and social systems and order but like Shaftesbury ultimately saw a
standard of taste as but one way, albeit a major one, in which to approach art
and morals. They managed the affair of disinterest, which might at first appear
out of place for a society focused on purpose, usefulness, practicality, and
expediency; but in pursuit of the common good the Scots justified it because
that which is aesthetically disinterested is not only beautiful but can and may
be virtuous, without concern for private advantage. The Scots also developed
further Shaftesbury’s idea of internal faculties as the way of perceiving both
beauty and morals. From sense theory they moved into an extended study of the
operations of the mind, considering the ways that sense, judgment, and memory
formulate our perceptions and ideas. Fundamentally they accepted that ethics
were positioned in the realm of human psychology which enabled them to
discern the good as evident in behavior. They also translated the relationships of
aesthetic and moral truths into a social forum and considered what these meant
to understanding the nation’s past, its present identity, and its future. Even when
expanding the roles of the imagination at play, delight, and pleasure, aesthetic
theory in Scotland in the eighteenth century retained its primary direction of
a moral goal. For many of the literati the greatest source of pleasure was a rich
moral life.
Finally, what is so important regarding this subject is that the statements
or ideas of individuals are not the primary thing but, rather, an entire body of
teaching is. Many eighteenth-century Scots wrote about the interplay of arts
and ethics, at times in support of opposing philosophical currents. A number
of these represent the famous voices of the Scottish Enlightenment, such as
Francis Hutcheson, David Hume, George Turnbull, Adam Smith, Thomas Reid,
Alexander Gerard, and Archibald Alison. But there were also lesser lights and
common practitioners who made some lively additions to the conversation, often

19
Ibid., 1: 17-18.
 Introduction 7

blurring the lines between high and popular cultures. I looked at everything I
could find before making my selections for more detailed inspection, based not
only on the prominence of seminal statements but for the broad acceptance
of core ideas. I don’t wish to imply that all were of equal weight, and in the
following pages I do attend more fully to the ideas of George Turnbull and
Alexander Gerard, for instance, than to those of an Alexander Campbell. But in
recognition that eighteenth-century Scottish society was relatively participatory,
my choice of materials depicts a wide acceptance of and broad enthusiasm for a
big idea. Almost all of the discussions of art and virtue are contextual, and many
are layered within the larger currents of philosophical discourse. Philosophical
analysis is not what is at the forefront in my study, however, and I don’t pretend
to approach it as a philosopher. Rather, I sketch general attitudes and frames as a
way of gaining insight into the phenomenon of time and place. To that end, that
is how I have approached them, as significant common threads played out again
and again and in various ways. These are: the senses, virtue, beauty, sentiment,
taste, experience, cultivation, and traditions. My manner of working, which
avoids organizing by individual philosopher or school, provides a historical
phenomenology that shows how virtue and beauty became an interwoven theme
in all aspects of the Scottish Enlightenment. Indeed it became the commonality
of discourse.
Some years ago when I first became intrigued with eighteenth-century
Scotland’s arts and culture, primarily with its writings on music, I consulted
the music division of one of Scotland’s most significant collections of primary
holdings. In response to my inquiry about eighteenth-century music theory
and criticism, I was told, “Those sources simply don’t exist. They never existed,
there was no culture for it. Why, it certainly was a good thing that Beethoven
hadn’t been born in Scotland!” The librarian I spoke with was incorrect; the
sources are abundant, varied, and approachable. However, they are not found as
writings on music in their own right but as pieces of evidence of a much larger
issue. One simply needs to know where to look and to position them within the
surrounding circumstances of enlightened Scotland.
This page has been left blank intentionally
 Chapter 1
The Senses

It is appropriate, perhaps obligatory, to begin any discussion of the partnership

between the beautiful and the good with the senses, and likewise to enter into
that topic with the ideas of Francis Hutcheson. The formation of Hutcheson’s
theory of parallel aesthetic and moral senses, it is often agreed, was one of the
most influential and far reaching contributions of Scottish Enlightenment
thought in general. Taking up where Lord Shaftesbury left off, Hutcheson (1694-
1746)—whose famous voice as chair of moral philosophy at the University of
Glasgow had a profound effect in formulating Scotland’s intellectual stature
internationally—presented his argument in favor of sentiments, as opposed to
reason, as the basis of morals, that moral disposition and actions stemmed from
feelings, not from propositions that are either true or false. But to Hutcheson, the
senses are even more complex than the conduits of sentiment. The moral sense,
one of the five internal senses which he identifies, is an operation supplemental
to the external senses that allows us to perceive virtue and vice in ourselves and
others. The internal senses, like the external ones, are natural to human nature
and operate independently of the will, but internal and external senses are quite
distinct from one another. Hutcheson gives them separate labels:

For there are many sorts of Objects, which please, or displease us as necessarily
as material Objects do when they operate on our Organs of Sense . . . These
Determinations to be pleas’d with any Forms, or Ideas which occur to our
Observation, the Author [Hutcheson] chuses to call Senses; distinguishing
them from the Powers which commonly go by that Name, by calling our Power
of perceiving the Beauty of Regularity, Order, Harmony, an Internal Sense; and
that Determination to be pleas’d with the Contemplation of those Affections,
Actions, or Characters of rational Agents, which we call virtuous, he marks by the
name of Moral Sense.1

The act of perception, then, marks the internal sense. The moral sense is but one
such operation for the perception of pleasure and pain, as is the aesthetic sense
which allows us to receive pleasant perceptions from that which we consider

1
Francis Hutcheson, An Inquiry into the Original of Our Ideas of Beauty and Virtue, in
Two Treatises (1725; ed. Wolfgang Leidhold, Indianapolis: Liberty Fund, 2004), 8-9.
10 Artful Virtue

beautiful. Both of these internal senses are immediate, allowing us to make

judgments with no process of rational inference.
Though Hutcheson’s theory of aesthetic perception owes much to the
empirical methodology of John Locke, Hutcheson himself acknowledges his
great debt to Shaftesbury, who provided a basis for primacy of the internal
senses.2 Hutcheson’s approach should not surprise, as it is within the human
constitution to be attentive to the affairs of virtue as we are to matters of beauty.
It is something that we tend towards quite naturally. Persons known for their
good taste recognize a variety of internal faculties that assist us in appreciating
the fine arts, Hutcheson tells us, “and may not we find too in mankind a Relish
for a Beauty in Characters, in Manners?”3 Both moral and aesthetic judgments
are perceptual and emotive, just two, but the most important two, of a number
of striking similarities between these internal senses.
Following the presentation of the internal senses, Hutcheson examines those
various pleasures which we receive by way of human nature, an investigative
approach quite different from the course of the philosophy of his day, he
contends, and specifically from those theories of cognitive actions of the mind.
The sensible pleasures particularly have been given short shrift by modern
philosophers, explained only by examples relating to tastes, smells, sounds, and
the like,4 a significant justification for An Inquiry into the Original Ideas of Beauty
and Virtue. This important publication, Hutcheson’s first, sets forth the parallel
between beauty in arts and beauty in character, positing that perceptions from
these two internal senses create pleasure or displeasure in the same way as when
our external sense organs are stimulated.5 The perceptions of the internal senses,
however, are regarded as “superior,” and they are the faculties at work when
humans grasp both aesthetic beauty and moral beauty. There is often agreement
among persons as to what they perceive internally, such that what follows is a
common understanding of pleasure or pain, delight or disgust. It is logical, then,
that if persons “be convinc’d of such Determinations of the Mind to be pleas’d
with Forms, Proportions, Resemblances, Theorems, it will be no difficult matter
to apprehend another superior Sense, natural also to Men, determining them to
be pleas’d with Actions, Characters, Affections. This is the moral Sense.”6
It is telling that in the line up of beauty and virtue, Hutcheson gives first
place to aesthetics and compares morals to it. What’s more, he is using a theory
of beauty, which was perhaps already somewhat known to his readers, to set
the course for a theory of morals, solidified by the placement of “An Inquiry

2
Ibid., 9.
3
Ibid.
4
Ibid., 7.
5
Ibid., 8.
6
Ibid., 10.
 The Senses 11

concerning Beauty, Order, Harmony, Design” as the first treatise of the Inquiry.
Hutcheson disavows any reference to the natural constitution of the intellect or
the idea of innateness, to him a “principle of knowledge,” but rather, sees both
internal and external senses as “natural power[s] of perception,” which is the
ability of the mind to obtain ideas from the presence of objects. The aesthetic
sense, for instance, is the passive power of expressly receiving ideas of beauty from
those objects that emit “uniformity amidst variety,”7 a description about which
I will say much more in a later chapter. Unlike the external senses, however, the
superior senses of beauty and virtue must be cultivated, although it is easy to
see how positive moral sentiments give rise to pleasure as readily as something
sensual, such as taste or sound.8
Though Hutcheson’s second treatise, entitled “An Inquiry Concerning
Moral Good and Evil,” is ostensibly about the ethical sense, he nevertheless does
not neglect the aesthetic in this portion of An Inquiry into the Original Ideas of
Beauty and Virtue; rather, he reinforces it. This time the tie between aesthetics
and ethics is driven by the sense of morals. He explains its connection: “We
shall find this [moral] Sense to be the Foundation also of the chief Pleasures of
Poetry. We hinted, in the former Treatise, at the Foundation of Delight in the
Numbers, Measures, Metaphors, Similitudes.”9 Though to a lesser degree than
moral objects, art is more powerful than natural beauty in affecting us towards
virtue. In poetry one of the chief foundations of pleasure derives from the
moral sense, in that the passions are linked to how characters are represented.
For instance characters appearing in dramatic and epic poetry represent quite
vividly either good or evil, and these are what stimulate the feelings of the
spectator.10 In addition the depiction of a moral idea is more powerful than
the mere narration of it, and thereby the epic and tragic drama give greater
pleasure than philosophical writings whose intent is to advise in favor of virtue.
Natural and lively representations have the effect of making us admire what is
good and abhor what is vile. It is our moral sense which accomplishes this, not
any proposed intentions of the dramatist.11 Poetic imagery as well is rooted in
the moral sense, as moral language is a way of enhancing beauty. Arguing on
behalf of the moral epithet as a way of enlivening poetry, Hutcheson regards
moral qualities joined with natural objects as a way to “increase their Beauty or
7
Ibid., 67. Another view of innateness does enter into Hutcheson’s theory of the
senses when he acknowledges that pleasure comes from within and for its own sake and is
not tied to principles of utilitarianism; to perceive a work for mere enjoyment is to have an
innate knowledge of that sense. See Peter Kivy, The Seventh Sense: Francis Hutcheson and
Eighteenth-Century British Aesthetics, 2nd ed. (Oxford: Clarendon, 2003), 36-7.
8
Hutcheson, Inquiry into the Original of Our Ideas, 10.
9
Ibid., 174.
10
Ibid.
11
Ibid.
12 Artful Virtue

Deformity; and we affect the Hearer in a more lively manner with the Affections
describ’d, by representing them as Persons.”12
Hutcheson’s “An Inquiry concerning Moral Good and Evil” expands the
notion of pleasure, namely that pleasures through the senses are a first cause and
a foundation to behaviors. The pleasure acquired from the sensible perceptions
of all kinds creates initial ideas in us of natural good or happiness, and thereby
the objects that incite the pleasures, including artistic works, are perceived
by our senses to be good.13 Thus sense perception can establish social value.
Nevertheless, Hutcheson does separate the sorts of good that derive from the
external senses from those of the moral sense: the former is unable to promote
any public good or the happiness of others and is thereby lacking.14 He does
commend pleasures from beautiful objects, yet even here insists that they require
moral pleasures to really move us. The pleasures of beauty, order, and harmony
are weakened if they should be deficient of friendship, love, and beneficence.15
Aesthetic pleasures, then, are capable of changing behavior by affecting one’s
moral disposition. To that end, aesthetic pleasures are expected to influence
temperaments, even before they serve as sources of delight. “The internal
Pleasures of Beauty and Harmony,” he specifies, “contribute greatly indeed
toward soothing the mind into a forgetfulness of Wrath, Malice or Revenge; and
they must do so, before we can have tolerable Delight or Enjoyment.”16 One’s
mood cannot be tempered at the same time that it is awash with distress.
Hutcheson does recognize the moral effects of various external beauties,
associating the physical attributes of a person with admirable character. Our
minds are greatly affected by what we perceive as a lovely face, for instance,
because it seems to bear qualities that please. He identifies the source as moral:

some natural or imagin’d Indication of concomitant Virtue, which gives it this

powerful Charm above all other kinds of Beauty. Let us consider the Characters
of Beauty, which are commonly admir’d in Countenances, and we shall find them
to be Sweetness, Mildness, Majesty, Dignity, Vivacity, Humility, Tenderness,
Good-nature; that is, that certain Airs, Proportions, je ne scai quoy’s, are natural
Indications of such Virtues, or of Abilitys or Dispositions toward them.17

It is our tendency to conflate beauty of face with beauty of character, but there
is indeed a great deal more beyond the physical. Whereas beauty may presume
favorable moral disposition, genuine love of aesthetic and natural beauties
12
Ibid., 175.
13
Ibid., 86.
14
Ibid., 91.
15
Ibid., 164.
16
Ibid.
17
Ibid., 167-8.
 The Senses 13

derives from moral sentiments, such as benevolence, that stimulate a sort of

universal goodness. First, one’s soul is touched, opening up possibilities to be
moved by other sorts of pleasure. Next, as one’s heart is softened, we turn to the
joys of poetry, music, and the beauties of the natural landscape. Finally we let
go of selfish pleasures and take delight in generous and friendly pastimes.18 It
is in these discussions of aesthetic and moral pleasures—and aesthetic as moral
pleasure—that we anticipate Hutcheson’s theory of disinterest, stimulated
in part by Shaftesbury: the arts need not necessarily depend on philosophies
of imitation (referenced by Hutcheson as relative or comparative beauty) or
expression, as long as they convey pleasure. For Hutcheson artistic pleasure,
especially when tied to moral pleasure, is pure; it stands on its own merits and
does not require a further degree of utility. It is unrelated to our interests. Thus
the spectator abandons any ulterior purposes of self and focuses on the art object
for its own sake.
Hutcheson also drew together the aesthetic sense and the moral sense in
his treatise on the passions, published soon after the volume containing his
first two inquiries. Here he defends his earlier stand on moral understanding as
dependent on the senses. An Essay on the Nature and Conduct of the Passions and
Affections articulates a number of different sorts of senses with their applications
to both moral and aesthetic value. The focal point, however, is on the moral
sense as the foundation of actions and behaviors, the reinforcement of which
may be precipitated by artistic representation. It is a representation that survives
through the imagination, often as a deed considered morally good is conveyed
through drama, the epic, and the romance. We are compelled to want to act
similarly, as our temperament is shaped by feelings of generosity and virtue. Such
is an imagined type of adventure that can allow us to feel an internal “Triumph
of Joy.”19
Hutcheson’s treatise on the passions also addresses a hierarchy of various
kinds of pleasure. A highly developed moral sense will not interfere with acuity
of the other senses and predicting the delight that these produce. In fact, those
persons who possess keen sense perception know that their reliance on the moral
sense is an aid in enhancing pleasure, which Hutcheson allows as attributable to
only one fit for judging, that is, a virtuous person. He predicts that

Temperance never spoiled a good Palate, whatever Luxury may have done; a
generous affectionate publick spirit, reflecting on itself with delight, never
vitiated any Organ of external Pleasure, nor weakened their Perceptions. Now all

18
Ibid., 171.
19
Francis Hutcheson, An Essay on the Nature and Conduct of the Passions and Affections,
with Illustrations on the Moral Sense (1728; ed. Aaron Garrett, Indianapolis: Liberty Fund,
2002), 55.
14 Artful Virtue

virtuous Men have given Virtue this Testimony, that its Pleasures are superior to
any other, nay to all others jointly; that a friendly generous Action gives a Delight
superior to any other; that other Enjoyments, when compared with the Delights
of Integrity, Faith, Kindness, Generosity, and publick Spirit, are but trifles scarce
worth any regard.20

The context for this recital of pleasures comes as Hutcheson struggles to

compare the intensities of various sorts of delights and discomforts. Despite the
challenge, he arrives at a simple, straightforward conclusion: pleasures of a moral
kind are superior to all others.
Conceiving the internal senses in relationship with the external senses,
especially in terms of the moral sense as the foundation for approval of what is
morally beautiful, is an idea that Hutcheson fashioned and developed throughout
his career. His posthumous publication, A System of Moral Philosophy, reaffirms
the context of human nature and the supreme good as a basis for drawing in the
senses in making moral judgments. As the first natural principles are the external
senses, these serve as signals that introduce our minds to perceptions of pleasure
and pain, thereby presenting our earliest notions of natural good and evil.21 An
analysis of the various sorts of enjoyments of life clarifies the kinds of pleasure
and pain associated with the imagination: a high degree of pleasure comes
from beauty, harmony, and ingenious works of art, whereas pain comes from
deformity of objects, dissonance, or crudely done works of art (although the last
is a trifling pain that is more disappointment than anything else).22 Focusing on
the pleasures of the finer senses, the internal ones, Hutcheson lists their merits,
outlining their worth first for those in positions of wealth and power, if not in
the present but at some future state and for their posterity. For those who possess
an elegant taste, the finer pleasures represent ends unto themselves. And for the
greater part of society, they signify a logical course of direction when one’s basic
needs are met and may be cultivated by nations at peace.23 The finer pleasures
result in enjoyments far superior to the sensual pleasures. These are identified as
beautiful forms, intricate works of art, and the loveliest scenes of natural beauty.
They are the workings of harmony and imitation, as well as exact measurements
and proportions. In short, all of these provide dignity to the experience of
pleasure.24 It is evident that Hutcheson is solid in his belief in an internal sense
which is indicative of the affections of the soul. And an aspect of its peculiarity
is the pleasure from virtue.

20
Ibid., 89.
21
Francis Hutcheson, A System of Moral Philosophy, 2 vols (Glasgow, 1755), 1: 4-5.
22
Ibid., 1: 144.
23
Ibid., 1: 18-19.
24
Ibid., 1: 128.
 The Senses 15

My intention in the previous paragraphs was to introduce Hutcheson’s theory

of the senses, allowing that I will return to it throughout this book. Now I want
to present evidence of just how powerful the idea was throughout Scotland’s
Age of Enlightenment, realizing that it was an idea accepted by some, modified
by others, and rejected by still others. To begin, Hutcheson’s voice was the most
prominent one, but other early literati worked through a theory of the senses.
Theologian and professor George Turnbull (1698-1748), the teacher who
significantly influenced Thomas Reid, his most famous student while regent at
Marischal College, Aberdeen, was in turn influenced by Hutcheson in correlating
moral and aesthetic beauties. From the first, Turnbull reaffirms Hutcheson in his
Principles of Moral Philosophy by adopting the moral sense explicitly as a sense of
beauty and deformity.25 Moreover, his work on aesthetics, A Treatise on Ancient
Painting, is founded on an internal moral sense as necessary for virtue, that it is
an obligatory principle of being human. And as in Hutcheson’s writing, morals
take their cue from aesthetics:

Had we no sense of moral beauty and perfection, no sense of harmony and

decorum in life and manners; no moral sense, shewing us the subordination in
which all the inferiour merely sensitive or animal appetites and affections ought
to be maintain’d, we could not be capable of virtue, we could not approve or
disapprove affections and manners. Without a sense of beauty and harmony,
greatness and becomingness of affections and actions, we could no more have any
sense of the dignity of our natures, and of acting a right part, than a blind man
can have of colours.26

From this passage alone, it is obvious that Turnbull’s notion of sense as inherent
does not split the ethical from the aesthetic. It would seem that he is arguing for
Hutcheson’s two internal senses as one in the same.
Close consideration and reflection of the human condition, accordingly,
reveal that the moral sense is so deeply ingrained in our natures that meaningful
gratification or pleasure from the external senses answer to this principle. Any
worthy principles derived from the senses, Turnbull argues, provide evidence
that our moral being is tender and human.27 This concept serves as the basis
for Turnbull’s oft-reiterated theme that the greatest satisfaction and pleasure
attained from artistic manifestations depend on what is sociable, sympathetic,
and generous.

25
George Turnbull, Principles of Moral Philosophy, 2 vols (London, 1740), 1: 40n.
26
George Turnbull, A Treatise on Ancient Painting (1740; rpt without plates, intro.
Vincent M. Bevilacqua, Munich: W. Fink, 1971), 135.
27
Ibid., 141.
16 Artful Virtue

Hutcheson’s theory of perceiving morality and beauty internally figured in

the writings of the next generation of literati, and may be traced to some degree
in the writings of philosopher, historian, and diplomat David Hume (1711-
76). Though not a student of the elder moralist, his writings in the empirical
tradition shaped the Enlightenment in Britain and abroad as an aspect of the
zeal for the scientific investigation of human nature. Like Hutcheson, Hume
accepted the senses, upon which sentiments depend, as the basis for moral
distinctions. Hume’s skepticism of the power of reasoning is well known: the
derivation of impressions that arise from the senses, for instance, are “perfectly
inexplicable by human reason.”28 Rational thought is not especially an agent
of the active principles of morality, and in the following Hume describes an
internal operation that pertains to both beauty and decorum:

Besides all those qualities, which render a person lovely or valuable, there is also
a certain je-ne-sçai-quoi of agreeable and handsome, that concurs to the same
effect. In this case, as well as that of wit and eloquence, we must have recourse to
a certain sense, which acts without reflexion, and regards not the tendencies of
qualities and characters. Some moralists account for all the sentiments of virtue
by this sense. Their hypothesis is very plausible.29

Both reason and sentiment may occur in making moral distinctions30—with

reason determining what we are to judge and sentiment to do the judging—but
not in equal measure.
It is good to remember that Hume followed Hutcheson’s premise that values,
such as “good” and “beautiful,” apply to both moral and aesthetic objects, which
come through the perception of sentiments and are experienced as pleasures.31
In fact for Hume it is assumed that pleasure and pain are the accompaniments
of beauty and deformity.32 He also seems to accept Hutcheson’s contention that
beauty is not in the object but in the idea raised in us, and likewise virtue and
vice are discoverable primarily through the senses, with morality more a matter
of feeling than of judgment. To make moral distinctions requires a moral sense,
not an act of reason alone or the comparison of ideas. Rather, impressions and
the feelings they generate are their sources: “Our decisions concerning moral
rectitude and depravity are evidently perceptions; and as all perceptions are
either impressions or ideas, the exclusion of the one is a convincing argument

28
David Hume, A Treatise of Human Nature (1739-1740; rpt, ed. L.A. Selby-Bigge,
Oxford: Clarendon, [1967]), 84.
29
Ibid., 611–12.
30
Hume, Enquiries, 172-3.
31
Kivy, Seventh Sense, 143.
32
Hume, Treatise, 299.
 The Senses 17

for the other. Morality, therefore, is more properly felt than judged of.”33 We
are able to possess a sense of virtue, for instance, because we feel that a deed or a
person is virtuous. After many years of working through this idea, Hume affirms
sentiment as that which determines morality and establishes virtue.34
In short, for Hume, approval of moral qualities comes about in two ways: from
a “moral taste” (the moral sense) and from consideration of feelings of delight or
disgust, pleasure and pain, that arise from our awareness of particular qualities
or characteristics.35 Like Hutcheson and in a similar context of discussing in
tandem the ethical attributes of love and esteem, Hume illustrates the second of
these ideas by relying on the role of the fine arts. His explanation is very simple:
“A very play or romance may afford us instances of this pleasure, which virtue
conveys to us; and pain, which arises from vice.”36 The pairing of pleasure with
virtue and pain with vice plays out in a major way in his discussions of beauty
and sentiments.
But Hume adds one more idea. He relies liberally on a quality that does not
seem to be part of Hutcheson’s initial vocabulary of sense theory: sympathy, the
chief source of moral distinction in Hume’s scheme of ethics. Moral sentiment
is accounted for by way of extensive sympathy among humankind. Moreover,
sympathy carries considerable weight in regarding the beauty of external objects,
as it does in judging morals; it has a profound influence on the aesthetic sense.37
It also creates an inviolable general standard for determining endorsements in
oratory, theater, and education.38 And it represents another way of considering
the relationship between the beautiful and the good, one which I will explore in
later chapters.
Moralist and political economist Adam Smith’s (1723-90) remarks on
aesthetics in the profoundly influential The Theory of Moral Sentiments owe
some things to Hume, as they also cover how sentiments entwine with the moral
sense. But he also recognizes Hutcheson, with whom he studied in Glasgow and
where he later assumed the moral philosophy chair after first having delivered a
series of public lectures in Edinburgh. Like Hutcheson, Smith identifies several
different types of sentiments and behaviors through the internal senses, such as
a sense of duty, a sense of merit, and a sense of propriety, and it is key that he
accepts Hutcheson’s interpretation of internal faculties of sense that determine
beauty or deformity and virtue or vice.39 It is also key that such works its way into
33
Ibid., 470.
34
Hume, Enquiries, 289.
35
Hume, Treatise, 581.
36
Ibid., 470-71.
37
Ibid., 618.
38
Hume, Enquiries, 229.
39
Adam Smith, The Theory of Moral Sentiments (1759; ed. D.D. Raphael and
A.L. Macfie, Oxford: Clarendon, 1976), 9, 67, 109. Smith, however, does not recognize the
18 Artful Virtue

Smith’s discourse on systems, in which sentiments act as a principle of approval.40

And though to Smith the external senses remain separate and distinct and
engender judgments only on their own individual objects of sense, nevertheless
all defer to the moral powers as a natural guidepost. Our moral faculties are
like the external ones in terms of what we wish to gratify and how far we might
go before imposing restraint. The moral faculties signal that correct and proper
acts provide what is agreeable and the opposing ones what is disagreeable. It is
entirely a matter of what pleases or displeases the internal senses.41
While building on Hutcheson’s important premise of pleasure as a derivative
of the senses, Smith advances this proposition by explaining beauty and morality
in tandem. By mid-century, this approach became a vastly important one when
discussing goodness of character and beauty of natural and art objects. He
parts company with Hutcheson, however, in determining where these qualities
lie—not within an internal sense, as Hutcheson contended (“The Word Beauty
is taken for the Idea rais’d in us, and a Sense of Beauty for our Power of receiving
this Idea.”42), but also within objects. Smith chides:

Who ever thought of calling the sense of seeing black or white, the sense of
hearing loud or low, or the sense of tasting sweet or bitter? And, according to
him, it is equally absurd to call our moral faculties virtuous or vicious, morally
good or evil. These qualities belong to the objects of those faculties, not to the
faculties themselves. 43

Nevertheless, moral sentiments that we admire still seem to us to be morally

good, although attention is now directed to the action or object and as good
as to the power. It is a matter of where the perceiver’s focus lands, for as human
beings we make judgments for ourselves.
Subsequent to Hutcheson and Turnbull, the primacy of the internal
senses—sense theory—ran its course throughout the eighteenth century but is
generally considered to have given way in academic and philosophical circles
following mid-century to the predominant philosophy of common sense, as well
as to the theory of association specifically in terms of aesthetics. Like Hutcheson,
Thomas Reid (1710-96), who established a reputation at both Marischal and
King’s Colleges, Aberdeen, and as Smith’s successor at Glasgow, connected the
sensible pleasures with certain actions or thoughts, recognizing that there is
a similar basis or application of aesthetic and moral perceptions through the

term “moral sense,” 326.

40
Ibid, 19-20.
41
Ibid., 165.
42
Hutcheson, Inquiry into the Original of Our Ideas, 23.
43
Smith, Theory of Moral Sentiments, 323.
Another random document with
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recommended. My own experience does not support that of
Wolfenden.46 Severe cases were treated by him with benefit. The
dose he recommends is half a grain, and not more than four and a
half grains are to be given in twenty-four hours. Headache and
dizziness attended its use.
45 Med. News, Dec. 27, 1884, p. 718.

46 Practitioner, June, 1884.

Erlenmeyer47 is an advocate of the mixed treatment, and his best

results have been obtained by combining the bromides of potassium,
sodium, and ammonium in the proportion of 1:1:½. He thinks much
greater permanency of effect follows such a combination. A curious
result witnessed by this author is the fact that the acne produced by
one salt given alone is apt to disappear when the combination is
administered.
47 Centralblatt für Nervenheilkunde, Psychiatrie, etc., No. 18, 1884.

A solution of hydrobromic acid, prepared after Fothergill and Wade's

formula, is recommended by H. C. Wood of Philadelphia,48 who
presented the record of its use in twelve cases of obstinate epilepsy.
It seems that in his hands large doses acted much better than when
the bromides were given alone. He recommends ounce iij per diem.
My own experience, which I detailed some years ago, was to the
effect that it possessed no virtues whatever in ordinary doses. The
solution is so difficult to take, and so disagreeable in every way, that
many patients prefer almost any other treatment. It cannot be
doubted that some cases of epilepsy are benefited by a change of
treatment, no matter what, and possibly Wood's cases belong to this
class.
48 Med. News, Feb. 23, 1884.

Belladonna and ergot are remedies that have had many advocates,
Trousseau being the most pronounced champion of the former. Their
use in the lighter attacks is attended sometimes by the most happy
results, but they cannot be said to have any permanent effect. The
first is advantageous because of its power to diminish reflex
excitement, and in those undeveloped infantile convulsions which
are often grouped under the head of eclampsia its virtues are
decided. Belladonna or its alkaloid may be given in combination with
the bromides. Ergot or ergotin, in spite of its undeservedly bad
reputation, may be given in large doses, one to two drachms of the
tincture thrice daily, or five grains of the aqueous extract in the
course of the day. Of chloral there is not much to be said. At one
time it was thought to possess great virtues, especially in
combination with the bromides, but subsequent experience has
taught me that its use has many drawbacks, and only in exceptional
cases is it to be recommended—viz. in those in which there is a
disposition to excitement—either as a substitute for the attack or as
a sequel.

The use of the iodide of potassium in combination with the bromides

is of great service in symptomatic epilepsies or those of syphilitic
origin. The iodide should be pushed, so that the patient may take
three or four drachms daily, and its injurious gastric action and
unpleasant taste may be done away with by administering it in large
quantities of milk or some mild alkaline water, such as Vichy. Among
the other remedies used and advocated by various writers are
hyoscyamine, the salts of zinc, chloral, the ammonio-sulphate of
copper, picrotoxin, strychnine, curare,—all of which have little or no
effect in permanently changing the course of the disease. Cerebral
galvanism, if properly employed, is certainly worthy of a trial as an
adjuvant.

As abortants we may resort to diffusible stimulants—ammonia,

alcohol, or some carminative. If the aura be perceived, a drachm of
the aromatic spirits of ammonia or a glass of sherry will often prevent
subsequent developments, and the inhalation of ten or fifteen drops
of nitrite of amyl will avert the attack. Nitrite of amyl may be
conveniently used in the form of pearls, which may be first crushed
in the handkerchief. The nitrite of soda, which has been
recommended as a substitute, is an unstable and dangerous drug,
and is not to be recommended.

I called attention some years ago to the virtues of nitro-glycerin as an

abortant in epilepsy. It may be given in alcoholic solution or tablets
from 1/50–1/25 of a grain at a dose, to be perhaps repeated. Great care
should be taken to procure a reliable preparation.

When a sensory aura proceeds from a particular locality in

preference, the application of some local form of irritant is strongly
recommended. A blister or light touch of the button of the actual
cautery will do, and if the point of origin be one of the extremities a
circular blister or cautery-line, after the method recommended by
Buzzard, will be serviceable in the treatment of the case.

Buzzard has observed the fact, in several of his patients who

complained of a sensory aura in the biceps, that when an encircling
blister was applied just above this spot the attacks were aborted. In
more than one of his cases of partial epilepsy the extraordinary
result of a transfer of the convulsion to the other extremity is noted.
He found that the circle should be complete, for a blister which half
encircled the arm did no good. I have used the same treatment in
cases of writer's cramp with marked benefit.

Brown-Séquard has pointed out the good effects of forcible and

painful extension of one finger or toe if the aura is of sufficient
duration to enable the individual to resort to this procedure.

The condition known as the status epilepticus is best treated by amyl

nitrite, which can be administered frequently. Repeated doses of
nitro-glycerin, so that its full effects are produced, do more good than
chloroform or any of the well-known anæsthetics.

Of setons I have very little to say. At best, they are a barbarous and
painful mode of treatment, and, although cures have been effected, I
have never been much encouraged by their so-called influence.
Certain intractable cases are helped by surgical procedure, and
trephining has sometimes resulted in a cure. I know of one brilliant
result obtained by Leo of this city in an old epileptic, in which the use
of the instrument over the occipital region resulted in a complete
removal of the disease. It is especially recommended in cases in
which the form of the attacks bears some relation to the probable
disturbance of the cortical motor-centres; and even in such cases
there must be constancy in the method of expression of the
convulsion. So often do we find meningeal thickening of an extensive
district that it is manifest that trephining would do little or no good.
The statistics of the operation are unsatisfactory, for in the large
mass of testimony there is great want of exactness as to the
pathological suggestions of the attack, and a great deal about the
method of procedure and recovery from the operation itself, and very
little about the phenomena of the disease.

The diet of the epileptic should be of the most simple kind. Merson,49
whose carefully-prepared paper is full of valuable statistics, is
strongly in favor of vegetable diet, and his results are encouraging. I
am convinced that many children never would have become
hysterical or epileptic but for injudicious indulgence in animal food.
Whenever possible, I confine my patient to a diet of fish, poultry, and
fresh vegetables, with fruit. As an exciting cause the overloading of
the stomach has so often precipitated attacks as to lead Paget and
others to invent the term gastric epilepsy for this form of the disease.
The greatest care must be paid not only to diet, but to the general
habits of the patient—over-exercise, especially after eating, the
avoidance of hot places and high altitudes. A residence by the
seashore is preferable to mountainous places; and excitement, over-
study, and all agencies favoring cerebral congestion are to be
avoided.
49 West Riding Reports, vol. v. p. 1.
 THE NEURAL DISORDERS OF WRITERS AND
ARTISANS.

BY MORRIS J. LEWIS, M.D.

DEFINITION.—These neural disorders consist of a certain train of

nervous symptoms, such as spasm, paralysis, pain, tremor, vaso-
motor disturbances, etc., either alone or in more or less complicated
combinations, which follow certain muscular acts and are
occasionally accompanied by a marked condition of general
nervousness; they occur in many of the occupations of every-day life
that require for their performance a constant muscular strain
combined with more or less delicate movements of co-ordination
continued for long periods at a time.

SYNONYMS.—Among the terms used to designate the various forms

of the affections produced in the manner just stated may be
mentioned the following:

Special Terms.—Writers' cramp, Scriveners' palsy, Steel-pen palsy,

Chorea scriptorum, Paralysis notariorum, Graphospasmus,
Mogigraphia, Crampe des écrivains, Nevrose des écrivains,
Schreibekrampf, Le mal télégraphique, Crampe télégraphique,
Klavierkrampf, Pianists' cramp, Tailors' cramp, Loss of grip, etc.
General Terms.—Professional dyscinesiæ, Professional impotence,
Anapeiratic paralysis, Nevrose co-ordinatrice des professions,
Functional spasm, Fatigue diseases, Professional hyperkineses, etc.

None of these terms are satisfactory, and, in fact, it is difficult to fine

one that will include the various symptoms arising from the habitual
use of a muscle or group of muscles, in the same way for long
periods at a time, in the different occupations known to give rise to
these neuroses, without including diseases belonging to entirely
different classes.

It is with some hesitation that I suggest the term copodyscinesia

(κόπος, toil, weariness, fatigue; and δυσκινησια—δυς, faulty, difficult,
hard, and κινησις, motion, movement) as signifying difficult or faulty
motion due to constant repetition of the same act.

HISTORY.—Some of these neuroses have been recognized for years;

this is particularly true of writers' cramp, the earliest notice of which I
have been able to discover is in a small work by Ramazini,1 printed
in 1746.
1 Bern. Ramazini, Treatise on the Diseases of Tradesmen, etc., translated by Dr.
James, London, 1746.

Most of the articles upon this subject have been written during the
last fifteen or twenty years.

ETIOLOGY.—Many of our every-day actions, which we perform almost

automatically, are the result of months and even years of practice;
this is well exemplified in the act of writing. At first each letter is
made by a separate and deliberate act of volition, and considerable
thought has to be expended upon its formation; but little by little the
preponderance of the volitional element decreases, until at last we
write with but little consciousness of each separate movement, and
the act becomes almost an automatic one, the sentence being
conceived and the hand committing it to paper with but little thought
of the intermediate muscular acts. In a somewhat analogous manner
do we learn to walk, each movement being laborious and requiring
much thought for its execution: in addition to this, we must regulate
the amount of the movement and keep in abeyance all associated
muscular action.

This last is spoken of by Hasse2 as an important factor in the etiology

of these affections. When, however, any one of the various muscles
whose integrity is necessary for the automatic performance of any
act becomes affected, let the lesion be in the muscle itself or
anywhere in the nerve-substance between it and its centre, or in that
centre itself in such a way as to hinder its free response to the
nervous stimulus, then the will has to be especially directed to the
act in order to counteract the effect of the disability, and some other
muscle or group of muscles must be substituted in the place of the
one incapacitated. That which was previously performed easily and
without fatigue now becomes difficult and exhausting.
2 Handbuch der speciellen Pathologie u. Therapie, “Krankheiten des Nervensystems,”
1te A., Bd. iv., 1869.

It will be in place here to consider in detail the action of the muscles

concerned in performing one or two of the acts most prolific of the
affections under consideration.

The first of these that will be examined is the act of writing.

Generally speaking, the methods of writing may be divided into two:

1st, where the fingers do all the stroke movements, the arm
remaining quiescent except for the lateral movement; 2d, where the
pen is held steadily by the fingers and the letters formed by the
movement of the whole arm. In the latter the muscles of the hand
and forearm are used almost entirely for pen-prehension and
poising, although there is generally a slight finger movement for the
long strokes; the forearm is allowed to rest upon the bellies of the
flexor muscles as a sort of movable fulcrum, the pectorales, teres
major, and latissimus dorsi, together with the biceps and triceps,
being mainly employed in forming the letters.
This last method of writing is the one mostly taught in the public
schools at the present day; and as a large number of muscles are
brought into play, and as there is a more even division of the work, it
is claimed that fatigue is not so soon complained of as in the first or
older method.

The act of writing is primarily divisible, according to Poore,3 into three

acts: 1st, the act of prehension; 2d, the act of moving the pen; 3d,
the poising of the forearm and hand. The muscles concerned in the
act of prehension are—the first two dorsal interossei, the opponens,
abductor, and flexor brevis pollicis, and, to some extent, the flexor
longus pollicis and the extensors of the thumb. The adductor should
also be included in this enumeration.
3 G. V. Poore, Electricity in Medicine and Surgery, London, 1876.

The muscles employed in the movement of the pen differ somewhat

according to the method of writing. In the finger movement Poore
enumerates the following muscles as the ones used, viz.: flexor
longus pollicis, extensor secundi internodii pollicis, flexor profundis
digitorum, extensor communis digitorum, and also, to a lesser
degree, the interossei.

In the second method of writing these muscles are comparatively

quiet, except in making the letters which extend far above or below
the line, while the muscles previously mentioned when describing
this method are the ones called into play. The poising of the arm and
hand is mainly accomplished by the supinator longus, supinator
brevis, and possibly by the extensors of the thumb.

From a study of what has been written it will be seen that there are
two classes of muscular actions concerned: 1st, the steady
contraction of the muscles that poise the hand and hold the pen; and
2d, the intermittent contractions of the muscles concerned in moving
the pen: both of these classes are equally important in the etiology of
writers' cramp.
Chronic fatigue of the muscles is undoubtedly, in some cases, a
precursor, if not a cause, of copodyscinesia, and, according to
Poore,4 is occasionally the expression of hyperæmia or mild
inflammation of a motor nerve. Acute local fatigue has symptoms
which are well known to us all after having taken violent exercise,
cramp and pain being the two most prominent ones.
4 “Writers' Cramp and Impaired Writing-Power,” Medico-Chirurgical Transactions, vol.
lxi.

Any student who has dissected much has experienced the intense
feeling of fatigue in the muscles required to hold the dissecting
forceps, particularly when the spring is a little too strong. Much the
same thing is noticed when one who has not been accustomed to
write much is for some cause compelled to do so; he will probably
notice that in a few hours he is exerting a greater amount of
muscular force in pen-prehension than usual, and may even find that
he is producing a disagreeable feeling in the distal phalanges by the
pressure he is using; he will also probably be aware of a burning
sensation between the shoulder-blades.

These symptoms are in all probability dependent upon, or are at

least coincident with, a hyperæmia of the nerves and spinal cord,
and, if persisted in for a long time without proper intervals of rest
must sooner or later interfere with the healthy condition of the spinal
cord, as well as of the nerves and muscles of the hand and arm.

Poore, while considering the symptoms of fatigue as in large part

peripheral in origin, readily admits that they must generally be
accompanied by central changes.

The manner of writing and of holding the pen is of considerable

influence in the causation of this trouble. Practically, the fluent writer
is more apt to contract this affection than he who writes badly, for the
latter seldom obtains a position where steady copying is to be done;
theoretically the reverse is true if the amount of work in the two
cases is the same.
When the pen-holder is allowed to drop below the head of the first
metacarpal bone the movements of the fingers are restricted; the
middle and fore finger upon one side of the holder and the thumb on
the other act upon the principle of the toggle-joint, so well known in
mechanics, and, as the pen-holder is drawn backward to make a
stroke, bind the distal phalanges tightly against the holder: this in a
short time causes fatigue and awkwardness in writing; but if the
holder is made to cross the proximal extremity of the first phalanx of
the fore finger the toggle-joint movement is destroyed.

These remarks apply of necessity more strongly to the finger

movements than to the conjoined finger-and-arm movement.

Writing with a pencil is not as liable to bring on fatigue and nervous

trouble as pen-writing, this being mainly owing to the fact that with
the former no particular angle is required to be maintained between
the point and the paper; there is therefore less effort at poising, as
the pencil may be rotated at pleasure, while with the pen one angle
has to be maintained. The same remarks should apply to the fluid
pencils (stylographic and Mackinnon pens) now so universally used;
in fact, they have been considered by Putnam5 as much easier to
write with than the pencil, as less weight need be applied upon the
tip in order to write.
5 J. J. Putnam, M.D., “A New Adjuvant in the Treatment of Writers' Palsy,” Boston
Med. and Surg. Journ., vol. ci. p. 320, 1879.

The idea that these troubles of writers were due to using steel pens,
as once thought, is manifestly without foundation, as the affection
was recognized before the time of the introduction of steel pens,
which was from 1800 to 1820.

Fine sharp pens are, however, more productive of evil than

composition pens or those with a broad soft nib, as they do not move
as easily over the paper, and therefore introduce a difficulty, although
a slight one, in the act of writing. The theory that the chemical action
between the ink and the metallic pens, and the friction of the pen on
the paper, generate sufficient electricity to affect the fingers through
the medium of the metallic portion of the pen-holder is too
preposterous to mention, except to show what curious reasons are
given in attempting to explain obscure and difficult subjects.

The next occupation which very frequently gives rise to these

affections is telegraphy.

The invention of the Morse telegraph in 1844, and its general

introduction, both here and abroad, a few years later, has proved a
most fertile source of copodyscinesia, although but little has been
written on this form of neurosis, Onimus,6 Robinson,7 and Fulton8
being among the few to describe it, although several later writers
mention its existence.
6 “Le Mal télégraphique ou Crampe télégraphique,” Compte Rend. Soc. de Biol.,
1878, 6, S. V. 92-96; also “Crampe des Employés au Télégraph,” Gaz. méd. de Paris,
1875, p. 175.

7 Edmund Robinson, M.D., “Cases of Telegraphists' Cramp” (4 cases), British Med.

Journ., Nov. 4, 1882.

8 Thomas Weymss Fulton, “Telegraphists' Cramp,” Edinburgh Clin. and Path. Journ.,
Feb. 2, 1884.

Telegraph operators, particularly those employed in large cities,

whose time is nearly all taken up with their work, are more exposed
to the causes of copodyscinesia than those following other trades.
They are not only exposed to the danger of contracting the affection
by using the telegraph-key in transmitting messages, but when not
so employed are receiving messages by sound and writing them
down, frequently at the rate of thirty to forty, or even more, words per
minute. Thirty words a minute is good telegraphy: this would require,
on the average, nearly 600 separate contractions. This would be
36,000 contractions per hour, while to write the same sentences
would require about 10,000 less.

The operators employed by the Associated Press, although

comparatively few in number, two hundred probably including all in
the United States, write for hours at a time, using a stylus and
manifold writing-books, making as many as twelve copies at one
writing; this obliges them to grasp the stylus very firmly and to press
with considerable force, making the act of writing much more difficult.

In addition to the work mentioned above, those who have large

numbers of messages to transmit become so expert that to save
time they make a record concerning the last message sent with the
left hand, while they are telegraphing the next one with the right
hand. A complicated act of co-ordination is thus being performed
with each hand, the difficulty of which may be appreciated by any
one if he but try to perform it.

An editorial in the London Lancet9 states that “telegraphers' cramp

will, we have little doubt, take its stand among the last-mentioned
curiosities” (milkers' cramp, hammer palsy, etc.), and "that the
telegraph clerk usually enjoys repeated intervals of complete rest,
and runs consequently hardly any risk.”
9 1875, vol. i. p. 585.

Hammond10 likewise states that telegraphers' cramp is rare in the

United States, but a slight investigation proves these two statements
to be, unfortunately, very far from the truth. According to recent
statistics,11 the Western Union Telegraph Company employs nearly
twenty thousand operators, who transmit annually over thirty-five
million messages, and as investigation seems to prove that a very
large number, if not the majority, sooner or later show some
symptoms of copodyscinesia, it becomes evident that this neurosis is
far from rare, although hitherto almost entirely overlooked by the
medical profession.
10 Wm. A. Hammond, M.D., Dis. Nervous System, 6th ed., New York, p. 789.

11 J. B. Abernethy, Commercial and Railway Telegraphy, Cleveland, Ohio, 1883, 2d

ed.
Operators are very loath to confess that they are suffering from loss
of grip, as they have termed it, for then they are considered as less
efficient than formerly, and may be asked to resign in favor of one
not affected, or be lowered in their salary—a point of great moment,
as telegraphy is their means of support. This accounts for the
apparent small number of the cases.

In telegraphing, the knob of the key, a circular disc of hard rubber

more than one inch in diameter, and placed about one and a half
inches above the level of the table, is grasped, as a rule, between
the thumb and middle finger, with the tip of the index finger resting
on top, the position being quite analogous to the method of pen-
prehension, the strain, although much less, falling on the same
muscles, but as all lateral movements of the key are impossible, the
muscles employed in poising are not brought into play as in writing.
The arm is either allowed to rest upon the table, upon the flexor
mass of muscles of the forearm near the elbow as a kind of movable
fulcrum, or is held with the forearm parallel to the table and a short
distance above it.

The movements of telegraphing are made by the alternate action of

the triceps, which depresses the wrist by extending the forearm,
assisted by the flexor carpi radialis, flexor carpi ulnaris, flexor
sublimis, and flexor profundus digitorum on the one hand, and the
biceps and supinator longus, which elevate the wrist by flexing the
forearm, assisted by the extensor carpi radialis longior, extensor
carpi radialis brevior, extensor carpi ulnaris, and extensor communis
digitorum on the other.

The movement of the key-knob, being about the one-twenty-fifth of

an inch, is so slight that it may be entirely ignored, so that with the
fingers upon the key and the forearm resting upon the table near the
elbow the motion must be a downward and upward one of the wrist;
when, however, the arm is held above the table and parallel to it, the
motion is more extended, the shoulder-muscles being used to
support the arm.
The wrist is held in a supple manner, and not rigidly, the momentum
of the downward movement being used to close the circuit; this, as
before stated, is made mainly by the triceps, and is checked by the
flexors and supinator longus.

The extensors of the wrist and fingers have a double duty to perform,
for, besides assisting in recovering from the downward stroke, they
have to support the hand during the whole act of telegraphing, in
order to prevent the weight from resting on the key, which would
prevent quickness in making and breaking the circuit.

On long circuits, particularly in wet weather, when much electricity

escapes from the line, the movements have to be made with much
more decision than usual in order to make the signals intelligible at
the distant station.

The accompanying diagram shows well the movement of the wrist as

above described, the hand and wrist moving into the position of the
dotted lines when the downward stroke is made.

FIG. 28.

Our hand is essentially a prehensile organ, and as such causes us to

educate the flexors the most; the extensors, being mainly used to
relax the grasp of the fingers, are weaker, and the constant strain
spoken of above, being thrown upon them, explains the fact that in
telegraph operating these are the muscles most frequently attacked
by cramp. (See Symptomatology.)

The following figures are of interest as proving the great superiority,

in point of strength, of the flexor over the extensor muscles of the
wrist and fingers. The measurements were made by the
dynamometer of V. Burq, great care being taken to apply the
instrument upon corresponding points of the palmar and dorsal
surfaces of the hand. The grasp of the average man, which includes
all the flexor muscles of the fingers and thumb, equals 125 pounds,
while the power of the flexors of the wrist, exclusive of the fingers,
equals 40 pounds. In marked contradistinction to this the extensors
of the wrist register 35 pounds, and the extensors of the fingers only
7. The total power of all the flexors is therefore 165 pounds, and that
of the extensors 42 pounds, nearly four times less (3.92). In women
the ratio is the same, although the number of pounds registered is
about half.

From the foregoing enumeration of the muscles used in writing and

telegraphing it may be seen that the brunt of the work does not fall
on the same muscles in the two acts, so that operators are seen
utterly unable to telegraph more than a few words intelligibly who
can still write a fluent hand. The two forms of neuroses often
coincide in the same subject, as all telegraphers are of necessity
scriveners; in fact, the majority suffer from both forms, and as a rule
the most difficulty is experienced in telegraphing, and not in writing,
although the reverse is frequently seen. But rarely does one see an
operator who, unaffected as far as telegraphing is concerned, has
difficulty in writing on account of this curious neurosis.

Of the muscles enumerated in the foregoing discussion, six are

supplied, either wholly or in part, by the ulnar nerve—namely, the
first two interossei, adductor pollicis, flexor brevis pollicis (inner half),
flexor carpi ulnaris, and flexor profundus digitorum (inner part); and
seven by the median nerve wholly or in part—namely, the opponens
and abductor pollicis, flexor brevis pollicis (outer half), flexor longus
pollicis, flexor profundus digitorum (outer part), flexor carpi radialis,
and flexor sublimis digitorum.

The remaining important muscles are supplied by the musculo-spiral

and its branches, except the biceps, which is supplied by the
musculo-cutaneous.
The ulnar nerve supplies fifteen of the muscles of the hand; many of
these are not prominently brought forward in writing, but are more or
less used in keeping the hand in the required position.

Poore, after a careful study of 32 cases of undoubted writers' cramp,

found the muscles affected in the following proportions:

Interossei (supplied by the ulnar nerve) 18 times.

Extensors of the thumb (supplied by the musculo-spiral) 10 times.
Flexor brevis pollicis (supplied by the median and ulnar) 7 times.
Abductor pollicis (supplied by the median) 7 times.
Flexor longus pollicis (supplied by the median) 4 times.
Adductor pollicis (supplied by the ulnar) 3 times.
Opponens pollicis (supplied by the median) 2 times.
All the muscles of the forearm, more or less, 2 times.

—showing that the muscles supplied by the ulnar nerve were

affected more often than those supplied by the others.

The musculo-spiral and its branches supply the extensors of the

thumb, fingers, and wrist, besides the two supinators; and by
referring to the muscles most called into action in the act of
telegraphing it will be seen that the majority are supplied by this
nerve and by the median, which supplies the majority of the flexors.
This statement explains to a great extent the fact that telegraph
operators may be unable to telegraph and yet be able to write, as the
muscles most important in the two acts have not the same nerve-
supply.

The integrity of these nerves is therefore of the first importance in all

cases requiring the use of the fingers and forearm, and many cases
of copodyscinesia undoubtedly have a subacute inflammation of
these nerves, or at least a congestion of the same, as their
foundation, the neuritis or congestion being overlooked, owing to its
mild type.
S. Weir Mitchell12 states that subacute neuritis is often incapable of
distinct clinical discrimination when of a mild type and when there is
an absence of traumatic cause. Mills13 states that “a lesion of the
sensitive fibres profoundly affecting this power of conducting
impressions may not cause pain, and that pain is not a necessary
symptom of inflammation of a mixed nerve: this is an important fact,
as I think too much stress is often laid on pain as a symptom of
neuritis, leading to error in diagnosis and treatment.”
12 Injuries of Nerves, and their Consequences, by S. Weir Mitchell, M.D., Philada.,
1872.

13 F. T. Mills, M.D., “On Two Cases of Neuritis of the Ulnar Nerve,” Maryland Med.
Journ., vol. viii. p. 193, 1881.

Other Forms of Copodyscinesia.—In violin-playing the bow is held

steadily between the fingers and thumb for long periods at a time,
and the left arm is forcibly held in supination in order to bring the
fingers upon the strings—actions well calculated to cause trouble if
persisted in, not taking into account the rapid movements of the
fingers which are necessitated in playing and the movements of the
arm in bowing. The violinist is therefore liable to suffer in both arms,
but in a different manner in each, as different muscles are used in
bowing and in fingering.

The other musical instruments necessitating great education in the

movements of the fingers and wrist are also liable to cause these
neuroses, but this is not true of those wind instruments which require
education of the movements of the lips and tongue. Piano-playing is
a frequent cause of these troubles, which have been known to
appear quite suddenly during the practising of some difficult piece.

In fact, all occupations which require a muscle or a group of muscles

to be kept in a constant more or less firm contraction, together with
fine movements of co-ordination in themselves and in the
neighboring muscles, may be expected to furnish cases of this class
of disease; the muscles affected necessarily varying with the work
done, mere routine work being more liable to cause trouble than that
which is new and original, as in the latter case time has to be taken
to elaborate it, thus giving temporary rest to the muscles.

Besides the forms already mentioned these neuroses have been

known to effect compositors, engravers; seamstresses, tailors, from
using the needle or scissors; cobblers; bricklayers, from using the
trowel; artificial-flower makers; weavers; milkers; painters; dentists;
ballet-dancers, from standing on their toes; blacksmiths and those
using the hammer; carpenters, from using the saw and screw-driver;
electrical-instrument makers, from winding coils; turners;
watchmakers; fencing-masters; cigar-makers; makers of
photographers' gelatin plates; knitters and those using the crochet-
needle; billiard-players; counters of money; dressers of hides;
pedestrians; and a few others.

Writers, telegraph operators, and musicians are those which by far

are the most frequently affected, the others being almost curiosities.
Among the latter may be mentioned the case, recently coming under
my notice, of pain in the right forefinger and arm, with cramp in the
former, upon any prolonged attempt to read with this finger the
raised letters of the alphabet of the blind. The patient was a blind
woman depending for her living upon crocheting, which occupation
was also seriously interfered with by this trouble.

After inquiring, in factories, etc., I find that the disease is by no

means a recognized one among the workmen. Among telegraphers,
however, it is so well known that they have called it the loss of grip,
while in France it is known among them as le mal télégraphique.

Gardner,14 after a careful investigation, finds no proof that physical

disease originates in, or is even aggravated by, the use of the
sewing-machine, and he has “never even heard of a case of cramp.”
He comes to this conclusion after having visited many large factories
where sewing-machines are used and worked by foot-power; his
remarks apply to those machines where the feet are worked
together, and not alternately, which last has been known, according
to Down,15 to cause serious troubles, of an entirely different kind,
however, from the one under consideration, and with which this
subject has nothing in common.
14 A. K. Gardner, M.D., “Hygiene of the Sewing-Machine,” Am. Med. Times, Dec 15-
29, 1860.

15 “Hygiene of the Sewing-Machine,” London Lancet, 1866, vol. ii. p. 447.

PREDISPOSING CAUSES.—Tobacco and Alcohol.—Both of these

articles exert a powerful effect upon the nervous system, tobacco
particularly being a factor in the causation of many cases of
neurasthenia. The first effect of tobacco and alcohol in small doses
on the brain and spinal cord is, according to Boehm and Von
Boeck,16 that of an excitant; subsequently it acts as a depressant.
Eulenburg17 mentions tremor as of very frequent occurrence, and
states that he has frequently noticed it in young cigar-makers who
smoke to excess.
16 Ziemssen's Cyclopædia, Amer. ed., vol. xvii.

17 Ibid., vol. xiv.

Cigarettes are more injurious than other forms of tobacco used in

smoking, as the smoke is nearly always inhaled, a greater effect
being thus produced by a given amount of the drug. Besides this,
cigarettes contain a large amount of other substances deleterious in
their effects. Trembling of the fingers and hand is frequently seen in
those smoking cigarettes freely.

The majority of the cases of copodyscinesia that are in the habit of

using either of these articles acknowledge that their use increases
their disability; in very exceptional cases the moderate use of
tobacco appears to soothe and quiet, and thus relieve some of the
symptoms.

Age.—Copodyscinesia is a disease of early adult life; it is rare in old

age. In 39 out of 43 cases of telegraphers' cramp coming under my
notice the age of the patient at the outset of the disorder could be
accurately determined. The average was 23.94 years. The average
age of all cases of the various forms of copodyscinesia seen by me
up to the present time (1886) is 25.96 years.

Sex.—The influence of sex as a predisposing cause of these

affections has not been studied with sufficient care, although a few
authors allude to it.

Onimus18 states that women are more frequently affected than men
with telegraphers' cramp. Erb19 states that writers' spasm is met with
more frequently in men, much more rarely in women, and that
pianoforte-players' spasm occurs more frequently in women, and
particularly in neuropathic persons who belong to nervous families.
Hasse20 and Romberg21 consider that writers' cramp especially
occurs in men, women being affected very rarely. Of the 75 cases of
impaired writing-power reported by Poore,22 only 17 were women,
while of the 31 cases of undoubted writers' cramp included in the 75,
all were men.
18 Loc. cit.

19 “Writers' Cramp and Allied Affections,” Ziemssen's Cycl., Amer. ed., vol. xi.

20 Loc. cit.

21 Nervous Diseases, vol. i. p. 320.

22 Loc. cit.

It may be seen that the male sex has been employed far more
frequently than the female in most of the occupations previously
mentioned, so that a larger percentage of men would naturally be
affected; but now that women are being employed more generally a
larger number of the female sex may be expected to suffer in this
way.

Whether sex, per se, has much influence as a predisposing cause is

difficult to say, as statistics are wanting, but it is probable that with