740
Journal of the Royal Society of Medicine Volume 85 December 1992
The role of the fifth digit
D K O'Donovan MD FRCP
in music: discussion
paper
Santa Barbara, Killiney Hill Roacl Co Dublin
Keywords: fifth digit; music; functional evolution
Summary The increasing digital skill made manifest in the development of instrumental music is reviewed and supports the hypothesis that the fifth digit was belatedly used even when a suitable instrument had already become established. With notable exceptions, such as the harp, it appears that progressive improvements in instrument design was influenced by the need to utilize the fifth digits. Its greater use was accomplished in overlapping stages of increasing dexterity, of which the highest is exemplified by the left hand of the violinist. The apparent evolutional background of these observations is discussed. It is proposed that man has an inherent atavistic tendency to ignore the fifth digit and this view agrees with its neglect in gesture and sign language. Introduction Since the dawn of civilization man has shown, when using his hands, a preference for the thumb and two adjoining fingers. This view is based on sound anatomical evidence and agrees with evolutionary reasoning. The relative importance of the thiumb in early music is illustrated by the ancient Jewish tradition that, when in Babylonian captivity, they were commanded to play their music, which was of a religious origin, the Levites disabled their thumbs to avoid outrage'. By contrast, a cursory survey of how and for what the fifth digit is used supports the view that it has been neglected, or tardily recognized, during the advance of civilization. Dismissively called the little finger, its functional insignificance was emphasized by being. named by 17th century anatomists auricularis, or ear-finger, suggesting it was useful merely to remove wax from the ear2,. In the artistic world it has been and remains almost ignored or perhaps represented as a useless object in striking contrast to the prominence given the thumb in even early Egyptian Art - the first source of such evidence. Also in common salutations and expressions of emotion the fifth digit is and has been persistently overlooked3. The ring finger suffers similarly but to a lesser degree. If there is a tardy recognition ofthe functional role of the fifth digit it should be revealed by an historical review of the progression in design of the musical instruments requiring digital skill and how they were, and are, played. The increasing mechanical complexity of instruments through the ages should reflect the degree of manual dexterity as well as the demands of composers and the available manufacturing materials and techniques. The influence of all three and their interaction must be remembered in the following account of some relevant instruments. The data presented are mostly culled from the generally accepted views of music historians.
Figure 1. The limits of stretch for a court musician of Henry VIII playing a pipe freproduced w'ith p'ermission'-from Neville' William's 'Henry VIII and his Coure', Weidenfeld 'and Nicolsor*,1973)
Winmd instruments The miost primitive pre-historic musical wind inistrument, which is still in use, is the didjeridu of Northern Australia. It is a simple wooden tube, 1-1.5 m in -length, which allows a Very clumted variation of the dominant note. Finger-holes appeared more than 10 000 yenarsago in Southern France and Spain long bones of animals being used as whistle flutes with one to four fingerholes. Thesumerans andEgyptians, in the period 5000 to 1500 BC usually used three holes4. The lmttosof the finger-holes were acknowledged when the Egyptians used a- type of double -clarinet, one being a drone pipe and the other"poducing the melody. The Greeks played panpipes consisting of tubes of different length, whicliwmere ppular for folk
-of music became more music, but as the theory developed they used the aulos, a single or,doulereeded tube, usually made in pairus afu with four or even up to 16 fingerholes3. They were held at about the horizontal position so it is likely all fingrs were used. With up to six finger holes there was little need to use the little finger, but the renaissance recorder
Journal of the Royal Society of Medicine Volume 85 December 1992
certainly made use of it, as in 1413 AD a special lever was incorporated in the large recorder to overcome the shortness of the right little finger5. This may have been the first adaptation for this finger. Figure 1 shows a pipe played in the Court of Henry VIII: the limitations of stretch are apparent. Modern woodwind instruments of the symphony orchestra evolved later, using elaborate fingerkeys to allow the use of all fingers. One of the slowest to develop was the oboe, where in the 19th century keys were added to allow the use of both little fingers6. The present standard clarinet now in general use requires additional keys to facilitate playing a trill by either little finger. Most modern brass wind instruments (tuba, trumpet, french horn), in which the length of tube is normally controlled by just three valves, do not require the little finger. The trumpet has a special grip for the little finger to control the third valve tuning slide, which was introduced in the 19th century. Harp The harp is one of the oldest string instruments and has remained relatively unchanged throughout the centuries. It is remarkable that in all modern harp music the little fingers are never used. It is difficult to assess how much, if any, this has contributed to its limited repertoire. In contrast the thumb is given a prominent role, as in the production of harmonics and the usual angle of the hand places the shorter little fingers at a disadvantage.
Fretted strings The fretted string instruments have been extant for at least 5000 years. Their earlier history was associated with an increasing number of strings and frets, and were played with a plectrum, hence using the first two digits of the right hand. The classical guitar is the best guide to progress in skilful execution as it has become increasingly popular in the last century. The five course Spanish guitar appeared in the early 16th century and was played with the right fifth digit resting on the wood, presumably to steady the hand. This entailed a limitation of movement in the other digits and that the fourth was rarely used6. During the latter part of the 18th century the transition of the modern 6-string instrument took place. It has since been played with great freedom of the right hand as the fifth digit is no longer fixed. Tarrega (1854-1909) introduced new techniques, including the use of the fourth digit7. Irrespective of whether the finger nails or pads are used, or which side of the fingers are applied, the shortness of the fifth digit prevents its use. It is surprising that one authority in 1954 has stated that A Segovia 'did much to introduce new technical devices, such as the use of the little finger'6. One must presume this refers to the right hand, but there appears to be nothing published since then to substantiate this opinion. So, the guitarist before the Renaissance usd the first two digits when the third was added and more recently the fourth, but never the fifth. The left fifth digit must have been used from at least the early renaissance when the number of strings were five double and one single. The fingers on the left hand are placed at right angles to the strings and, as the purpose is to press the string to make contact with the fret, the movement is a mechanically simpler
one than that used with the unfretted instruments, although a wide spreading of the fingers is required. Modern guitarists can achieve with all four fingers a limited vibrato, but, in general, the major musical skill is demanded from the right hand.
Keyboard instruments The keyboard was introduced in the lth century for organs, displacing the slide used,to control air entry. The keys were wide and struck with- clenched fist reflecting the primitiveness of design. The medieval portative organ, which survived into the 16th century, was sometimes suspended from the neck'and played with only two fingers (presumably index and middle) of the right hand as the keyboard projected forward. With the left hand working the bellows it must have been like trying to play the piano with one hand while seated at the end of the keyboard. This practice may explain why even up to the 18th century keyboard scales were performed using only two fingers, although no longer necessary5. By the 14th century the keys were narrow and controlled by finger pressure. This assisted the evolution of the clavichord, but even in the 17th century the thumbs and fifth digits were seldom used because of the shortness of the keys, probably in turn due to difficulties in the construction of the percussion mechanism5. The idea of using digital pressure may not have been an obvious procedure, as early string instruments usually had been plucked with a plectrum and the dulcimer, which resembles a piano without a keyboard, was played with two small hammers. The basic piano appeared in 1709 and was later improved by some ingenious technical innovations. It soon displaced its older rivals and, with Mozart, Beethoven and Liszt composing for it, a new era of music began. Because of the length of the keys all 10 digits are readily involved. Modern composers, such as Messiaen, made increasing demands on the power of the hands and the spread of fingers, so that general finger exercises, particularly ofthe little fingers, are essential. For many, the piano demands the most supreme application of digital dexterity and this is due to the remarkable mechanical efficiency of the instrument as well as the achievement of pianists.
Violin The origin of the violin in the middle of the 16th century is uncertain, but it was belatedly welcomed for its loud clear tone and for its tuning a fifth above the viola. Perhaps because of poor technical handling its potential remained unexplored until the end of the 17th century with the advent of Corelli in Italy and Purcell in England. Then followed, in the 18th century, aflood of compositions, includingthe works of JSBach and Vivaldi. Composers continue to demand even greater virtuosity, calling for more digital skill, requiring hypertrophy of muscles particularly obvious in those of-the fifth digit (Figure 2). Two technical features of modern violin playing are identified to show how they contrast with those used in the earlier periods and how they freed the use of all four fingers. Firstly, the violin is held horizontally and gripped between the chin and clavicle or shoulder, hence leaving the left hand free to move up and down. Its predecessors had been held in a variety of sometimes bizarre ways, the Asiatics using a vertical and the Europeans a horizontal position. They were held by
741
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Journal of the Royal Society of Medicine Volume 85 December 1992
Figure 2. Kyung Wha Chung illustrates the hypertrophy of hypothenar muscles (photograph by Jean Pierre Leloir)
the left hand and pressed against the shoulder or chest. Such positions may have been easier for the bow arm but created fingering difficulties. Even as late as 1756 Leopold Mozart, while in favour of the chin position, recognized that the chest position was still much in use8. Perhaps the advent of the chin rest aided the final acceptance ofthe chin-grip and it must also have hastened the abolition of the old habit of holding the right side ofthe tailpiece against the chin, which was in use even up to the middle of the 19th century. This must have been awkward for fingering, particularly for the fifth digit. Secondly, as a corollary to the chin grip, the violin rests in the cleft between the thumb and index finger. The general position of the left hand is of particular interest: it comes from below the fingerboard and curves over, particularly when the little finger is being used. Its shortness is no longer a mechanical disadvantage, but it has some disability, which mostly concerns power. If it- is considered particularly weak special exercises have been prescribed9 and fingering is sometimes adopted to avoid using it, as in a climax of special intensity'0. The major advantage of the modern left hand control is that stretching is no longer a feature, as by movement of the forearm, the hand shifts up or down into the next position. Stretching is not easy and is still used only if necessary and its excessive cultivation is condemned9. The violinist stretch, as the thumb is fixed, is very dependent on the abduction of the fifth digit; those who have slack ligaments are more adept in using it, such as Paganinill and possibly Asiatics. It appears that this modern violin technique was not generally adopted until the second half of the 18th century. The earlier techniques and the changes which took place over four centuries are recorded by artists12. It must at firt have been considered an unusual even awkward posture with the arm adducted towards the chest and the hand in a fully supine position, but its success has been established by its acceptance over the past two centuries. Cello The cello became available almost as early as the violin, but took longer to settle down to the standard form with four strings. Its application and progress was even slower, partly because of the continued popularity of older instruments. The modern technique for playing it was established in the early 19th century by Duport6. Previously the fingering of the scales
was that used by violinists and was unsuitable because of the wider spaces between notes, inhibiting the easy rapid flow, particularly in the lower register. He developed fingering whereby the scales can be played with speed and facility, allowing wide abduction of the fingers, particularly by the fifth digit, to overcome distance in the lower register. In the higher register, where the strings nearer the bridge are more elevated above the wood, the weaker fingers cannot readily press down the heavy taut cello strings. He overcame this by using the thumb as a moveable clamp across the stings, not only to shorten the length of vibrating string, but to bring the strings near the wood. Hence the fifth digit can be used effectively, but all fingers are also assisted to a lesser degree and it allows the violin fingering to be used as the notes are closer together. The presence of a callosity on the side of a cellist's thumb is a reminder of Duport's influence and of the unusual use of the thumb to help the weaker finger. The full potential of the cello was not recognized until P Casals (1876-1973) established its present musical stature leading to a belated appreciation of older music, such as the Bach suites.
Discussion The history of the instrumental music reflects the interwoven influences of the expectations of composers, the refinements of instruments and the achievements of performers. This historical review appears to show a progressive increase in the appreciation ofthe fifth digit, which once established for an instrument is retained, in contrast to passing fashions in technique. The delayed recognition might simply be attributed to its poor musculature and the mechanical inefficiency due to its size, but its ultimate success indicates that they cannot entirely explain its long history of neglect. They certainly provide an explanation why clinical syndromes of pain, weakness, drooping etc., affects the fourth and fifth digits with greater frequency, particularly with pianists13. Its fuinctional integration is not without penalties. Increased fifth digit recognition cannot be explained just as a consequence of an increasing interest in music in general, as classical instrumental music developed more slowly than either vocal or theoretical music. Pythagoras, before 500 BC, had identified the basis of the diatonic scale, notation began with Greek lettering and the present staff notation has been in use since the 16th century. It is recorded that King Henry VIII, in 1547, left a collection of 381 instruments of 14 varieties and C Sachs has observed that 'never before and never since has the palette of musical hues been as rich as in the 16th century' 16. Many of the instruments then available were inaduate by present standards and the fifth digit was only rarely used except to perform a simple movement, such as to control a lever or a finger hole. The slower progress of instrumental music must in part have been due to the promotion of choirs by the churches, but it cannot be attributed to an inadequate understanding of theory, nor because of lack of interest. Technical difficulties in construction sometimes were an obstacle, as with the piano, but poor appreciation of how to use the fifth digit appears to have been a factor, even when such instruments as the violin and cello had already become available. The belated incorporation of suitable mechanisms appears to have been a major stimulus to progress with the woodwind instruments.
Journal of the Royal Society of Medicine Volume 85 December 1992
The evolving use of the fifth digit can be better appreciated by identifying progressive stages, sometimes overlapping, ofthe increasing dexterity of finger movements in the history of music. The first stage was a simple downward pressure on fingerholes, the fifth digit not being used at first and by which trills were later performed; levers, valves and slides were subsequently added. The second stage consisted of an expansion of the finger-span, necessitating extreme abduction ofthe fifth digit to reach fixed points (frets and keys). It was aided by the reputed increase in the size of man's hand over the last two centuries. The third stage was the fingering and stretch on bowed string instruments, where there is a total dependence on the proprioceptive or spatial sense, there being no exact objective, such as the piano key, to guide the hand. Such a guide must, at least to the learner, be helpful, until by practice a propoceptive programme has been acquired by the higher centres ofthe brain. A further embellishment of this stage is the ability to perform vibrato, which was- lacking in Baroque music. In all the above stages the hand is prone, the harpist being an exception with both hands in a midway vertical position. The violinists' left hand is the final stage and represents a new approach, with the hand supine and the arm in an unnaturally adducted position. This may have been first adopted in the second half of the 18th century, but it fially results in- an equal and easy use of all fingers. Extreme adduction, with the elbow towards the anterior aspect of the body was, used by Paganini, who in the early 18th century was recognized as the supreme performer"'. When combined with the chin holding the volin horizontally, the hand assumes a natural shape, the fingers folded over to control the strings and the tip ofthe 5th digit in line with the others so that itssize is not a disability. The posture is a close resemblance to the hand,of maximum rest (Figure 3), as described by EllisI4, The main difference is that he described the hand as mid-way between pronation and supination. This is not an essential feature as it depends on the position of the elbow; if the arm is adducted, the relaxed hand tends to become supine andtheTeverse ifabducted Th adoption ofthe positionof reat may explainwhyviolinis rarely complain of-finger disabilities unless they attempt excessive and perhaps unnecessy stretching9. The left hand also offers a fair representation ofthe position ofpower grip as described by Napier, in which the fingers are folded radially on, for example the handle of a hammer; with--the thumb extended for purely directional purposesi5. Here the third, fourth and fifth digits contribuite most of the power, as distinct from either the simple primal grips of theclenched fist, or the hooked fingers, where the fif digit is of minor importance. This facilitation of relaxation and contraction of_the- fingerm is what is considered a cardinal advantage for the violinist. The hypothenar musciulature is onec of the obvious manifestations of evolution -in the humanh hand, contributing to the expansion of spain. Another feature is the folding on flexion,ptowards the radial side,-of the fourth and fifth digits Tand which- helps to form the ulnar side of the metacarpal archiS. This oblique folding of the fingers is du.tb rotation of the fourth and fifth metacarpals -and the curved shape of the distal palmar crease expeses tha same movement. Hence the left hand of the- violinist adopts an interesting evolutionary eature of the human ha.nd.
\~ Figure 3. The hand in repose as drawn by F W Jones2 (reproduced with the permission of the publisher)
In general it appears that there is evidence of an inherent atavistic trait in man to ignore the dormant potential oftliefifth digit. This may have abasis in our very distantpast and was continued in the more immediate millenia of pre-history, when the thumb and the two adjoining fingers took precedence in an everyday life which deiiianded more power thaii skill. The recent expansion o°f npusical skills shows that the'trait can be controlled with advantage in the world of musical achi0vemenet and the left hand of the violinist fully efxempies its rejection, during'the last two centuries.' The above views reflect the digital mechanics of musical expression. A MbzarL piano 'sonata can be played with precise accuracy, but to give enjoyment the executant must add his, or her, interpretation of the composer's genius.'The violinist's right hand and arm make the notes, but the co-operation of both hands produce the music.
Acknowledgment The author is indebted to the staff of the medical library of University College, Dublin.
RItferences 1 Yalkiut Shimoni. Circa 200 AD. Commentary on Psalm 137. Chapter 137. 2 Jones FW. The principles of anatomy as seen in the hand, 2nd edn. London: Bailliere, Tindall and Cox, 1944:134 3; Morris D. Manwatihing. London: Triad Panther Books, 1979:29-70 4 Bwhner A. Colour encyclopedia of musical instruments. London: Hamlyn, 1980:19-47 5 Sachs C. The history- of nwsical instruments. London: Dent, 1942:310,286,332-298 6 BlomE,ed. Grove'sdictionaryofmusandMusiias,5th edn. London: Macmillan, 1954:6.148; 7.685; 348; 8.822 7 Birch A.-In: Baines A, ed. Musical instruments through the ages. London: Penguin Books, 1982:175 8 Mkoart L. Quoted in Blom E, ed. drove's dictionary of music and -nusicians, 5th edn. London: Macmillan,
1954.8..15-816 9 Flesch C. Art of violin playing, 2nd edn. New York: Fischer, 1939; 117:24 120-122 10 Flesch C. Violin finugering- it theory and -practice. London: Barrie and Rockliff, 1966:317. 11 Smith RD, Worthington JW. Paganini. JA 1967;
199:156-60 12 Baines'A, ed. Musical instruments through the ages. L-ondon: Penguin, 1982: plates 8 and 9 13 Hochberg FH, Leffert RD. 'Hand'difficulties among
-muicians. JAMA 1983;'249:1869-72' 14 -Ellis TS. The position of rest in fatigue and pain.'-BMJ
1878;i84-6 15 Napier,JR. The prehensile movements of the human
hapd. J Bone Joint Surg 1956;38B:4910 16 Litiler JW. The physiology and dynamic function of the hand. Surg Clin N Am 1968;40:259-66 (Accepted 25 November 1991)
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Journal of the Royal Society of Medicine Volume 85 December 1992
The role of the fifth digit
D K O'Donovan MD FRCP
in music: discussion
paper
Santa Barbara, Killiney Hill Roacl Co Dublin
Keywords: fifth digit; music; functional evolution
Summary The increasing digital skill made manifest in the development of instrumental music is reviewed and supports the hypothesis that the fifth digit was belatedly used even when a suitable instrument had already become established. With notable exceptions, such as the harp, it appears that progressive improvements in instrument design was influenced by the need to utilize the fifth digits. Its greater use was accomplished in overlapping stages of increasing dexterity, of which the highest is exemplified by the left hand of the violinist. The apparent evolutional background of these observations is discussed. It is proposed that man has an inherent atavistic tendency to ignore the fifth digit and this view agrees with its neglect in gesture and sign language. Introduction Since the dawn of civilization man has shown, when using his hands, a preference for the thumb and two adjoining fingers. This view is based on sound anatomical evidence and agrees with evolutionary reasoning. The relative importance of the thiumb in early music is illustrated by the ancient Jewish tradition that, when in Babylonian captivity, they were commanded to play their music, which was of a religious origin, the Levites disabled their thumbs to avoid outrage'. By contrast, a cursory survey of how and for what the fifth digit is used supports the view that it has been neglected, or tardily recognized, during the advance of civilization. Dismissively called the little finger, its functional insignificance was emphasized by being. named by 17th century anatomists auricularis, or ear-finger, suggesting it was useful merely to remove wax from the ear2,. In the artistic world it has been and remains almost ignored or perhaps represented as a useless object in striking contrast to the prominence given the thumb in even early Egyptian Art - the first source of such evidence. Also in common salutations and expressions of emotion the fifth digit is and has been persistently overlooked3. The ring finger suffers similarly but to a lesser degree. If there is a tardy recognition ofthe functional role of the fifth digit it should be revealed by an historical review of the progression in design of the musical instruments requiring digital skill and how they were, and are, played. The increasing mechanical complexity of instruments through the ages should reflect the degree of manual dexterity as well as the demands of composers and the available manufacturing materials and techniques. The influence of all three and their interaction must be remembered in the following account of some relevant instruments. The data presented are mostly culled from the generally accepted views of music historians.
Figure 1. The limits of stretch for a court musician of Henry VIII playing a pipe freproduced w'ith p'ermission'-from Neville' William's 'Henry VIII and his Coure', Weidenfeld 'and Nicolsor*,1973)
Winmd instruments The miost primitive pre-historic musical wind inistrument, which is still in use, is the didjeridu of Northern Australia. It is a simple wooden tube, 1-1.5 m in -length, which allows a Very clumted variation of the dominant note. Finger-holes appeared more than 10 000 yenarsago in Southern France and Spain long bones of animals being used as whistle flutes with one to four fingerholes. Thesumerans andEgyptians, in the period 5000 to 1500 BC usually used three holes4. The lmttosof the finger-holes were acknowledged when the Egyptians used a- type of double -clarinet, one being a drone pipe and the other"poducing the melody. The Greeks played panpipes consisting of tubes of different length, whicliwmere ppular for folk
-of music became more music, but as the theory developed they used the aulos, a single or,doulereeded tube, usually made in pairus afu with four or even up to 16 fingerholes3. They were held at about the horizontal position so it is likely all fingrs were used. With up to six finger holes there was little need to use the little finger, but the renaissance recorder
Journal of the Royal Society of Medicine Volume 85 December 1992
certainly made use of it, as in 1413 AD a special lever was incorporated in the large recorder to overcome the shortness of the right little finger5. This may have been the first adaptation for this finger. Figure 1 shows a pipe played in the Court of Henry VIII: the limitations of stretch are apparent. Modern woodwind instruments of the symphony orchestra evolved later, using elaborate fingerkeys to allow the use of all fingers. One of the slowest to develop was the oboe, where in the 19th century keys were added to allow the use of both little fingers6. The present standard clarinet now in general use requires additional keys to facilitate playing a trill by either little finger. Most modern brass wind instruments (tuba, trumpet, french horn), in which the length of tube is normally controlled by just three valves, do not require the little finger. The trumpet has a special grip for the little finger to control the third valve tuning slide, which was introduced in the 19th century. Harp The harp is one of the oldest string instruments and has remained relatively unchanged throughout the centuries. It is remarkable that in all modern harp music the little fingers are never used. It is difficult to assess how much, if any, this has contributed to its limited repertoire. In contrast the thumb is given a prominent role, as in the production of harmonics and the usual angle of the hand places the shorter little fingers at a disadvantage.
Fretted strings The fretted string instruments have been extant for at least 5000 years. Their earlier history was associated with an increasing number of strings and frets, and were played with a plectrum, hence using the first two digits of the right hand. The classical guitar is the best guide to progress in skilful execution as it has become increasingly popular in the last century. The five course Spanish guitar appeared in the early 16th century and was played with the right fifth digit resting on the wood, presumably to steady the hand. This entailed a limitation of movement in the other digits and that the fourth was rarely used6. During the latter part of the 18th century the transition of the modern 6-string instrument took place. It has since been played with great freedom of the right hand as the fifth digit is no longer fixed. Tarrega (1854-1909) introduced new techniques, including the use of the fourth digit7. Irrespective of whether the finger nails or pads are used, or which side of the fingers are applied, the shortness of the fifth digit prevents its use. It is surprising that one authority in 1954 has stated that A Segovia 'did much to introduce new technical devices, such as the use of the little finger'6. One must presume this refers to the right hand, but there appears to be nothing published since then to substantiate this opinion. So, the guitarist before the Renaissance usd the first two digits when the third was added and more recently the fourth, but never the fifth. The left fifth digit must have been used from at least the early renaissance when the number of strings were five double and one single. The fingers on the left hand are placed at right angles to the strings and, as the purpose is to press the string to make contact with the fret, the movement is a mechanically simpler
one than that used with the unfretted instruments, although a wide spreading of the fingers is required. Modern guitarists can achieve with all four fingers a limited vibrato, but, in general, the major musical skill is demanded from the right hand.
Keyboard instruments The keyboard was introduced in the lth century for organs, displacing the slide used,to control air entry. The keys were wide and struck with- clenched fist reflecting the primitiveness of design. The medieval portative organ, which survived into the 16th century, was sometimes suspended from the neck'and played with only two fingers (presumably index and middle) of the right hand as the keyboard projected forward. With the left hand working the bellows it must have been like trying to play the piano with one hand while seated at the end of the keyboard. This practice may explain why even up to the 18th century keyboard scales were performed using only two fingers, although no longer necessary5. By the 14th century the keys were narrow and controlled by finger pressure. This assisted the evolution of the clavichord, but even in the 17th century the thumbs and fifth digits were seldom used because of the shortness of the keys, probably in turn due to difficulties in the construction of the percussion mechanism5. The idea of using digital pressure may not have been an obvious procedure, as early string instruments usually had been plucked with a plectrum and the dulcimer, which resembles a piano without a keyboard, was played with two small hammers. The basic piano appeared in 1709 and was later improved by some ingenious technical innovations. It soon displaced its older rivals and, with Mozart, Beethoven and Liszt composing for it, a new era of music began. Because of the length of the keys all 10 digits are readily involved. Modern composers, such as Messiaen, made increasing demands on the power of the hands and the spread of fingers, so that general finger exercises, particularly ofthe little fingers, are essential. For many, the piano demands the most supreme application of digital dexterity and this is due to the remarkable mechanical efficiency of the instrument as well as the achievement of pianists.
Violin The origin of the violin in the middle of the 16th century is uncertain, but it was belatedly welcomed for its loud clear tone and for its tuning a fifth above the viola. Perhaps because of poor technical handling its potential remained unexplored until the end of the 17th century with the advent of Corelli in Italy and Purcell in England. Then followed, in the 18th century, aflood of compositions, includingthe works of JSBach and Vivaldi. Composers continue to demand even greater virtuosity, calling for more digital skill, requiring hypertrophy of muscles particularly obvious in those of-the fifth digit (Figure 2). Two technical features of modern violin playing are identified to show how they contrast with those used in the earlier periods and how they freed the use of all four fingers. Firstly, the violin is held horizontally and gripped between the chin and clavicle or shoulder, hence leaving the left hand free to move up and down. Its predecessors had been held in a variety of sometimes bizarre ways, the Asiatics using a vertical and the Europeans a horizontal position. They were held by
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Journal of the Royal Society of Medicine Volume 85 December 1992
Figure 2. Kyung Wha Chung illustrates the hypertrophy of hypothenar muscles (photograph by Jean Pierre Leloir)
the left hand and pressed against the shoulder or chest. Such positions may have been easier for the bow arm but created fingering difficulties. Even as late as 1756 Leopold Mozart, while in favour of the chin position, recognized that the chest position was still much in use8. Perhaps the advent of the chin rest aided the final acceptance ofthe chin-grip and it must also have hastened the abolition of the old habit of holding the right side ofthe tailpiece against the chin, which was in use even up to the middle of the 19th century. This must have been awkward for fingering, particularly for the fifth digit. Secondly, as a corollary to the chin grip, the violin rests in the cleft between the thumb and index finger. The general position of the left hand is of particular interest: it comes from below the fingerboard and curves over, particularly when the little finger is being used. Its shortness is no longer a mechanical disadvantage, but it has some disability, which mostly concerns power. If it- is considered particularly weak special exercises have been prescribed9 and fingering is sometimes adopted to avoid using it, as in a climax of special intensity'0. The major advantage of the modern left hand control is that stretching is no longer a feature, as by movement of the forearm, the hand shifts up or down into the next position. Stretching is not easy and is still used only if necessary and its excessive cultivation is condemned9. The violinist stretch, as the thumb is fixed, is very dependent on the abduction of the fifth digit; those who have slack ligaments are more adept in using it, such as Paganinill and possibly Asiatics. It appears that this modern violin technique was not generally adopted until the second half of the 18th century. The earlier techniques and the changes which took place over four centuries are recorded by artists12. It must at firt have been considered an unusual even awkward posture with the arm adducted towards the chest and the hand in a fully supine position, but its success has been established by its acceptance over the past two centuries. Cello The cello became available almost as early as the violin, but took longer to settle down to the standard form with four strings. Its application and progress was even slower, partly because of the continued popularity of older instruments. The modern technique for playing it was established in the early 19th century by Duport6. Previously the fingering of the scales
was that used by violinists and was unsuitable because of the wider spaces between notes, inhibiting the easy rapid flow, particularly in the lower register. He developed fingering whereby the scales can be played with speed and facility, allowing wide abduction of the fingers, particularly by the fifth digit, to overcome distance in the lower register. In the higher register, where the strings nearer the bridge are more elevated above the wood, the weaker fingers cannot readily press down the heavy taut cello strings. He overcame this by using the thumb as a moveable clamp across the stings, not only to shorten the length of vibrating string, but to bring the strings near the wood. Hence the fifth digit can be used effectively, but all fingers are also assisted to a lesser degree and it allows the violin fingering to be used as the notes are closer together. The presence of a callosity on the side of a cellist's thumb is a reminder of Duport's influence and of the unusual use of the thumb to help the weaker finger. The full potential of the cello was not recognized until P Casals (1876-1973) established its present musical stature leading to a belated appreciation of older music, such as the Bach suites.
Discussion The history of the instrumental music reflects the interwoven influences of the expectations of composers, the refinements of instruments and the achievements of performers. This historical review appears to show a progressive increase in the appreciation ofthe fifth digit, which once established for an instrument is retained, in contrast to passing fashions in technique. The delayed recognition might simply be attributed to its poor musculature and the mechanical inefficiency due to its size, but its ultimate success indicates that they cannot entirely explain its long history of neglect. They certainly provide an explanation why clinical syndromes of pain, weakness, drooping etc., affects the fourth and fifth digits with greater frequency, particularly with pianists13. Its fuinctional integration is not without penalties. Increased fifth digit recognition cannot be explained just as a consequence of an increasing interest in music in general, as classical instrumental music developed more slowly than either vocal or theoretical music. Pythagoras, before 500 BC, had identified the basis of the diatonic scale, notation began with Greek lettering and the present staff notation has been in use since the 16th century. It is recorded that King Henry VIII, in 1547, left a collection of 381 instruments of 14 varieties and C Sachs has observed that 'never before and never since has the palette of musical hues been as rich as in the 16th century' 16. Many of the instruments then available were inaduate by present standards and the fifth digit was only rarely used except to perform a simple movement, such as to control a lever or a finger hole. The slower progress of instrumental music must in part have been due to the promotion of choirs by the churches, but it cannot be attributed to an inadequate understanding of theory, nor because of lack of interest. Technical difficulties in construction sometimes were an obstacle, as with the piano, but poor appreciation of how to use the fifth digit appears to have been a factor, even when such instruments as the violin and cello had already become available. The belated incorporation of suitable mechanisms appears to have been a major stimulus to progress with the woodwind instruments.
Journal of the Royal Society of Medicine Volume 85 December 1992
The evolving use of the fifth digit can be better appreciated by identifying progressive stages, sometimes overlapping, ofthe increasing dexterity of finger movements in the history of music. The first stage was a simple downward pressure on fingerholes, the fifth digit not being used at first and by which trills were later performed; levers, valves and slides were subsequently added. The second stage consisted of an expansion of the finger-span, necessitating extreme abduction ofthe fifth digit to reach fixed points (frets and keys). It was aided by the reputed increase in the size of man's hand over the last two centuries. The third stage was the fingering and stretch on bowed string instruments, where there is a total dependence on the proprioceptive or spatial sense, there being no exact objective, such as the piano key, to guide the hand. Such a guide must, at least to the learner, be helpful, until by practice a propoceptive programme has been acquired by the higher centres ofthe brain. A further embellishment of this stage is the ability to perform vibrato, which was- lacking in Baroque music. In all the above stages the hand is prone, the harpist being an exception with both hands in a midway vertical position. The violinists' left hand is the final stage and represents a new approach, with the hand supine and the arm in an unnaturally adducted position. This may have been first adopted in the second half of the 18th century, but it fially results in- an equal and easy use of all fingers. Extreme adduction, with the elbow towards the anterior aspect of the body was, used by Paganini, who in the early 18th century was recognized as the supreme performer"'. When combined with the chin holding the volin horizontally, the hand assumes a natural shape, the fingers folded over to control the strings and the tip ofthe 5th digit in line with the others so that itssize is not a disability. The posture is a close resemblance to the hand,of maximum rest (Figure 3), as described by EllisI4, The main difference is that he described the hand as mid-way between pronation and supination. This is not an essential feature as it depends on the position of the elbow; if the arm is adducted, the relaxed hand tends to become supine andtheTeverse ifabducted Th adoption ofthe positionof reat may explainwhyviolinis rarely complain of-finger disabilities unless they attempt excessive and perhaps unnecessy stretching9. The left hand also offers a fair representation ofthe position ofpower grip as described by Napier, in which the fingers are folded radially on, for example the handle of a hammer; with--the thumb extended for purely directional purposesi5. Here the third, fourth and fifth digits contribuite most of the power, as distinct from either the simple primal grips of theclenched fist, or the hooked fingers, where the fif digit is of minor importance. This facilitation of relaxation and contraction of_the- fingerm is what is considered a cardinal advantage for the violinist. The hypothenar musciulature is onec of the obvious manifestations of evolution -in the humanh hand, contributing to the expansion of spain. Another feature is the folding on flexion,ptowards the radial side,-of the fourth and fifth digits Tand which- helps to form the ulnar side of the metacarpal archiS. This oblique folding of the fingers is du.tb rotation of the fourth and fifth metacarpals -and the curved shape of the distal palmar crease expeses tha same movement. Hence the left hand of the- violinist adopts an interesting evolutionary eature of the human ha.nd.
\~ Figure 3. The hand in repose as drawn by F W Jones2 (reproduced with the permission of the publisher)
In general it appears that there is evidence of an inherent atavistic trait in man to ignore the dormant potential oftliefifth digit. This may have abasis in our very distantpast and was continued in the more immediate millenia of pre-history, when the thumb and the two adjoining fingers took precedence in an everyday life which deiiianded more power thaii skill. The recent expansion o°f npusical skills shows that the'trait can be controlled with advantage in the world of musical achi0vemenet and the left hand of the violinist fully efxempies its rejection, during'the last two centuries.' The above views reflect the digital mechanics of musical expression. A MbzarL piano 'sonata can be played with precise accuracy, but to give enjoyment the executant must add his, or her, interpretation of the composer's genius.'The violinist's right hand and arm make the notes, but the co-operation of both hands produce the music.
Acknowledgment The author is indebted to the staff of the medical library of University College, Dublin.
RItferences 1 Yalkiut Shimoni. Circa 200 AD. Commentary on Psalm 137. Chapter 137. 2 Jones FW. The principles of anatomy as seen in the hand, 2nd edn. London: Bailliere, Tindall and Cox, 1944:134 3; Morris D. Manwatihing. London: Triad Panther Books, 1979:29-70 4 Bwhner A. Colour encyclopedia of musical instruments. London: Hamlyn, 1980:19-47 5 Sachs C. The history- of nwsical instruments. London: Dent, 1942:310,286,332-298 6 BlomE,ed. Grove'sdictionaryofmusandMusiias,5th edn. London: Macmillan, 1954:6.148; 7.685; 348; 8.822 7 Birch A.-In: Baines A, ed. Musical instruments through the ages. London: Penguin Books, 1982:175 8 Mkoart L. Quoted in Blom E, ed. drove's dictionary of music and -nusicians, 5th edn. London: Macmillan,
1954.8..15-816 9 Flesch C. Art of violin playing, 2nd edn. New York: Fischer, 1939; 117:24 120-122 10 Flesch C. Violin finugering- it theory and -practice. London: Barrie and Rockliff, 1966:317. 11 Smith RD, Worthington JW. Paganini. JA 1967;
199:156-60 12 Baines'A, ed. Musical instruments through the ages. L-ondon: Penguin, 1982: plates 8 and 9 13 Hochberg FH, Leffert RD. 'Hand'difficulties among
-muicians. JAMA 1983;'249:1869-72' 14 -Ellis TS. The position of rest in fatigue and pain.'-BMJ
1878;i84-6 15 Napier,JR. The prehensile movements of the human
hapd. J Bone Joint Surg 1956;38B:4910 16 Litiler JW. The physiology and dynamic function of the hand. Surg Clin N Am 1968;40:259-66 (Accepted 25 November 1991)
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