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THE EYE SYMPTOMS OF TRAUMATIC

HYSTERIA. By J. JAMESON EVANS, M.D., F.R.C.S., Honorary Surgeon

to the Birmingham and Midland Eye Hospital;

Ophthalmic Surgeon to the Workhouse, &c. IN view of the difficulty which is often met with in deciding between functional and organic disease on the one hand, and functional disease and malingering on the other, it is well to make use of all signs and symptoms which might help the investigator to decide as to the true nature of the case in hand. The eye symptoms are perhaps the most definite in that ill-defined group of symptoms which we call hysteria.

The more general recognition of these symptoms will, I hope, tend to lessen the conflict of medical evidence in some of those obscure nervous cases, following accidents and injuries, which find their way to the law courts. The two cases recorded below are fairly typical of the class, and the case of the man shows that the male sex is by no means free from a complaint which used to be considered a monopoly of young girls.

Case 1.-Rose J., aet 23, a factory hand, had a blow on the right eye in January, 1900, and came to the Eye Hospital as an “accident." The damage appears to have been insignificant, and she was given some boracic acid lotion and cocain drops and discharged. In the ordinary course such a case should have been well in a couple of days. As she did not get any better, she returned on the 14th February, 1900. At this time there was injection of the right palpebral conjunctiva, and also of the lower half of the bulbar conjunctiva on that side. There was marked photophobia and lachrymation, and the right eye was generally kept closed.

R.V.=0

L.V.=is. The pupil reflexes were normal in each eye. The media were normal, the optic discs were slightly blurred at the edges, but there was no definite papillitis or any other lesion of the

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fundus oculi in either eye. The fields of vision both for white and colours were much contracted, but more so in the right eye than in the left eye. (Unfortunately these fields have been lost, but more recent records are available.)

The same local treatment was adopted, and she was given a mixture of potass. bromide and iron.

March 28th.—The conjunctival injection was more pronounced, and there was a distinct zone of ciliary injection. The blepharospasm was increased, and photophobia and lachrymation were marked.

R Guttæ atropin. c Cocain.
Mist. Potass. Brom. c Ferro.

Galvanic current applied daily.

Smoked glasses.
April 1oth. She was much better.

R.V.= c +50 D.
Cocain drops were substituted for atropine and cocain.
Galvanism was continued.

R Mist. Pot. Brom. c Tinct. Valerian Ammon. May 12th. She had had severe headaches. The injection of the globe was slight, but the blepharospasm was pronounced.

R.V.=C+I. L.V.=.C + I.
R Guttæ atropin. c cocain.

Mist. Pot. Brom. c Valerian. Right upper lid painted with Nitrate of Silver. May 23rd.—A roseolar rash covered the right side of her face and neck, and on the slightest exertion her face (especially on the right side) became bathed in perspiration. There was some catarrh of the respiratory passages.

May 25th.—Congestion of the eye less. Complained of globus " and aphonia. Rash had disappeared.

May 28th.—She had a recurrence of the roseolar rash and sweating Numbness and tingling of right arm.

June 11.–Right ankle and hip joints fixed and painful. No swelling or redness.

R Gutt. cocain.c Liq. Suprarenal.
Mist. Pot. Iodid. c Sod: Salicylat.

Galvanism.

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man: 13:05. Field for white

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Rose. In June 1904

id her 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.

R Lotio. Boracis c Sodii Bicarb.

Guttæ cocain. c Suprarenal.

Mist. Potass. Brom. c Valerian. August 29th.—Blepharospasm and conjunctival injection less.

R.V.=4C - 1. L.V.= C - 1. As this indicated some spasm of accommodation, gutt. atropine, cocain and suprarenal were prescribed. October 31st.

Conjunciival injection, and blephorospasm November 20th.) persistent.

Ę 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.

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