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

Deborah E Thorpe,Jane E Alty

doi:10.1093/brain/awv232

Deborah E Thorpe, Jane E Alty

Open Access

https://doi.org/10.1093/brain/awv232

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Abstract

Scholars have recognized for some time that a prolific 13th century scribe had a tremor. He has become known as ‘the Tremulous Hand of Worcester’, or simply ‘the Tremulous Hand’, ‘hand’ being a metonym for ‘scribe’. He is important as the only widely-known medieval writer with a tremor, and for his unusual interest in translating documents written centuries earlier. This is the first time his writing has been investigated from a joint neurological and historical perspective. Certain or possible evidence of the writing of this man—likely a monk at Worcester Cathedral Priory—appears in at least 20 books (Franzen, 1991 p. 1). As he never wrote about his tremor, or dated his work, the only sources of information for this study are the handwriting itself and limited clues in its subject matter. The central question is: ‘what type of tremor did he have?’. We discuss evidence for essential tremor as the diagnosis by tracing the tremor through a series of handwriting samples, charting progression in tremor severity from ‘fine’ to ‘fine–moderate’ and as a correlate, present handwriting from a modern-day individual with essential tremor using a calligraphy pen. We scrutinize literary scholar Christine Franzen’s seminal monograph, reveal new information she has shared with us in personal correspondence, and offer the first analysis of essential tremor in a medieval context. To our knowledge, this is the first time medieval handwriting has been analysed by a neurologist with a specialist interest in movement disorders. Finally, we examine the lifestyle of a scribe in relation to the symptoms of essential tremor, making special consideration of alcohol consumption. Old English was the earliest form of English, spanning approximately the 6th to 12th centuries, which had been superseded by Middle English by this scribe’s lifetime. Thus, he translated older books into either Middle English or French, …

Highlights

Scholars have recognized for some time that a prolific 13th century scribe had a tremor
We conclude that essential tremor, dystonic tremor, and primary writing tremor are the main differential diagnoses for the Tremulous Hand’s tremor
Essential tremor is more prevalent than the other diagnoses

Summary

Introduction

Scholars have recognized for some time that a prolific 13th century scribe had a tremor. We can reveal that Franzen has re-evaluated her original chronology, stating in personal correspondence that distinguishing seven layers was perhaps ‘over zealous’ (Franzen, personal communication, October 2014) She notes a shift from early stage annotations in Middle English—upright and lacking signs of an obvious tremor—to later stage annotations in Latin, with their marked leftward lean and pronounced tremor (Fig. 1). The tremor frequency appears regular too, with the number of lateral crossings about the midline on downward strokes consistent between letters of roughly the same size within a word, or consecutive words This regularity of tremor amplitude and frequency makes dystonic tremor and writer’s cramp less likely. At least 6–8 Tremor amplitude increases Size of letters increases Possiblea Possiblea Speculative Speculative Yes (scribe)

5–7 No Sometimes Sometimes Yes No No Yes

Conclusions