Dystonia in a prolific medieval scribe

Abstract

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