Objective: We evaluate the dated documents of a French scribe, which span the late 13th and early 14th centuries, in order to reach a diagnosis for his unusual handwriting. We review the differential diagnosis in the context of his 46-year-long and illustrious career.

Background: Bernard Blancard was a medieval notary, a professional writer with legal expertise and the authority to draw up contracts, who worked in Marseille, France. Progressive anomalies in his writing suggest that he had a movement disorder.

Methods: A multi-disciplinary team comprising a neurologist who specializes in movement disorders and two medieval historians analysed the content and characteristics of Blancard’s surviving documents dated from 1297 to 1343 and reviewed the relevant modern medical and historical literature.

Results: Blancard’s handwriting showed little deformation in his 20s and 30s but after the age of 40 it became progressively distorted. There is evidence of a jerky tremor intruding in letters and words – it has a variable frequency of approximately 4-8Hz, mild-moderate amplitude and a multi-directional axis. There are notable fluctuations between thick, heavy, ink strokes and thin, scratchy, lines that suggest upper limb posturing. His last surviving document was produced when he was approximately 71 years old, but there is no evidence of cognitive impairment, ataxia or micrographia. He retained good mobility throughout as the contracts record him travelling around Marseille to people’s houses and neighbourhoods to perform his duties.

Conclusions: Our study suggests upper limb dystonia as the likely cause – with evidence of significant posturing and a jerky tremor. We are unable to confidently sub-categorise the dystonia further as we have no additional descriptions of Blancard’s symptoms either in autobiographical diary entries or otherwise. This means that the dystonia may have been focal and task specific and hence the possibility of mild writer’s cramp cannot be excluded. Alternatively, it is conceivable that he had segmental (including cervical) or focal upper limb dystonia. Previous historical case studies and modern medical literature demonstrate the negative impact of dystonia on careers. In contrast, this study not only provides unique dated evidence for the progression of medieval dystonia, but also displays a scribe’s successful career in spite of a disorder that inhibited his writing abilities.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dystonia-in-a-medieval-scribe-analysis-of-bernard-blancards-handwriting-over-four-decades/