Mar: 13:03. Field for white Rose. Jr. June 1904. id ner eye symptoms were sufficiently quiescent to allow her resume her work. July 16th. No joint pains. Could open her eye well. This treatment was continued till July 28th.-Marked congestion of the conjunctiva of the right eye, with some ecchymoses of the bulbar conjunctiva below. Roseolar rash over the right side of face and neck. Ꭱ Lotio. Boracis c Sodii Bicarb. Guttæ cocain. c Suprarenal. less. Mist. Potass. Brom. c Valerian. August 29th.-Blepharospasm and conjunctival injection. As this indicated some spasm of accommodation, gutt. atropine. cocain and suprarenal were prescribed. October 31st. ) Conjunctival injection, and blephorospasm November 20th.persistent. R Gutt. cocain. and Suprarenal. Mist. Tinct. Ferri Perchlor., Liq. Arsen. Hydrochlor. and Liq. Strychnin. During 1901 and 1902 the patient was not able to do any regular work, as these symptoms kept recurring, every month or two, after periods of comparative quiescence. She attended at varying intervals during these two years, and received local and general treatment as above. In the beginning of 1903 she was considerably better, and got a situation as a domestic servant. The place was by no means a light one, as she had to be up at five o'clock every morning, except Sundays. She was anxious to stay on at this place as it was pleasantly situated in a healthy suburb, and as she had been unemployed for three years. After about three months her symptoms became aggravated, and she suffered from insomnia, dyspepsia. and right-sided neuralgia. She had all her teeth extracted by an enterprising dental firm, but not even a new set of teeth could give her relief from the neuralgia pains and dyspepsia. In November, 1903, she was admitted into the Queen's Hospital, suffering from gastric ulcer. After the rest and treatment there, she was much improved in general health, and her eye symptoms were sufficiently quiescent to allow her to resume her work. In January, 1904, she again broke down, and the eye symptoms, insomnia and dyspepsia returned. She had some hæmatemesis, and the papular rash on the right side of her face became pretechial in patches. Occasionally she had an evanescent urticarial rash all over the body. June 6th, 1904.-Slight conjunctival injection. Slight spasm of orbicularis. Pupil reflexes normal. Media and fundi normal. No numbness or tingling of the extremities. Knee jerks marked. Visual fields contracted for white and all colours. The field for colours was distinctly inverted in the right eyethat for red being the largest, and that for blue, which is normally the largest, being the smallest. At times she was unable to distinguish blue at all with the right eye. The red field is also slightly larger than the blue in the left eye. Case II.-Thomas L., aet 27, a collier. On the 2nd April, 1902, he was struck by a piece of rock on the external angular process on the left side. He stated that he was unconscious for half-an-hour after the accident, and that the stone was extracted from the wound in the skin by a fellow-workman. There was a scar to be seen at the external angular process. He was attended for this accident at a neighbouring hospital. Some time later he sought advice at the Birmingham Eye Hospital, but of this attendance there is no documentary evidence. Being unable to get a ticket to come again, he went to another eye hospital, where he said the surgeon wanted to remove his eye. Whether this was suggested or not, it was not carried On January 31st, 1903, he came again to the Birmingham Eye Hospital, and was anxious to have his left eye removed because it was painful and useless. Right eye: Some congestion of the conjunctiva. Pupils active but somewhat small. Media clear. Optic disc slightly hyperemic. R.V. Counts fingers at 1 foot. Left eye: Much congestion of the conjunctival and ciliary vessels. Blepharospasm and lachrymation. Pupil active and small. Media clear. Optic disc hyperæmic. L.V. No perception of light. R. Visual field contracted. The left field, of course, could not be taken. He was treated with Gutt. Coc. c Adrencelin. Mist. Potass Brom. c Valerian. Galvanism. February 10th.-Left eye in statu quo, except that Right eye by retinoscopy showed a myopia of -4'5. This refraction suggested spasm of accommodation, and L.V. Perception of light (not improved by any glass). On March 13th refraction, vision and field as on February 10th. I have not been able to trace this case any further, as he has left the district. These two cases—particularly that of the female patient, whose prolonged attendance gave me time and opportunity to make more careful notes—are fairly representative of ocular hysteria as described by Parinaud,* Borel† and others. I have confined my attention to cases of traumatic origin as they appear to me to be somewhat rarer and of slightly different character from the ordinary non-traumatic cases. Compared with the latter, traumatic cases seem to show a preponderance of vasomotor changes-flushings, congestions, erythematous rashes and localised sweatings whilst the nontraumatic cases, which I have observed, have shown more of the paralytic symptoms-ptosis (non-spastic), paralysis of accommodation, and external ocular muscles, anæsthesia of the cornea and skin areas. A marked failure of vision is always present, but though this was bilateral in these two cases, it has been my experience to find it unilateral in non-traumatic cases.. The fields of vision are practically always markedly and more or less. concentrically contracted, both for white and colours. The * Norris and Oliver, System of Diseases of the Eye. |