Then it is that even slight defects of the eye may cause vertigo, which if usually slight and transient, coming and going as the eyes are used or rested, is sometimes severe and incapacitating. I have over and over seen vertigo with or without occipital pain or distress in persons whose eyes were supposed to be sufficiently corrected with glasses, but who found instant relief when a more exact correction was made; and this is, I think, a matter which has not yet generally received from oculists the attention it demands.
When vertigo, essential, gastric, or aural, is present, the use of the normal eye becomes a common source of trouble. Bright lights, things in irregular motion, reading or writing, and especially rapid changes in accommodation, as watching the retreat or approach of a moving object, are prone to cause or increase the dizziness.
Vertigo in old age, if not due to the stomach or defective states of the portal system, kidneys, or heart, is either caused by atheromatous vessels or multiple minute aneurismal dilatations of vessels, or in full-blooded people by some excess of blood or some quality of blood which is readily changed by an alteration in the diet, of which I shall presently speak. Whatever be its source, it is in the old a matter of reasonable anxiety.
Laryngeal Vertigo.—Under this name J. R. Gasquet,8 and later M. Charcot, have described a form of vertiginous attack in which irritation of the larynx and a spasmodic cough invariably precede the onset. I have never seen such cases, nor do they seem to me entitled to be called vertigo. The symptoms are these: After bronchitis, gout, or rheumatism there occurs an irritation of the larynx or trachea, or of both, which at times is expressed in the form of a tickling cough, simple or in spasms. With these arises a slight sense of vertigo, or else in the grave attacks the patient falls insensible, without convulsion or with no more than one may see at times in fainting. The face is flushed, even deeply, and the attacks last but a few moments. The term vertigo seems to have in such a group of symptoms but little application, nor do these attacks ever bring upon the sufferer the status vertiginosus.
8 Practitioner, Aug., 1878.
Vertigo in Anæmia and in Neurasthenia and Hysteria.—A passing vertigo readily caused by abrupt changes of posture, felt even in health, at times is far more profoundly experienced in grave anæmic states, while in neurasthenic conditions, with deficiency of globules or defect of hæmaglobin, it is still more common. In well-pronounced neurasthenic states, where there is no measurable lack of red corpuscles, but where hæmaglobin is apt to be deficient, it is a frequent symptom, and is then either an immediate result of functional central disorder or of gastric or optical troubles. While the dizziness of neurasthenia is never profound, certainly never repeats the agony of Menière's vertigo, it is apt to be but a too constant symptom, and to be, like the other disqualifying cerebral symptoms of neurasthenia, almost the last to get well. Usually there is little, often no, tinnitus, no deafness, no nausea, slight but a pretty constant sense of unsteadiness, and rarely or but for a few moments any false subjective visual illusions. This, at least, is the type, but, on the other hand, in extreme cases and within these limits the brain is liable to be confused, and the sense of need for difficult controlling volitions called out by almost any use of the eyes in near vision, owing usually to oculo-muscular paresis. Even looking at a mirror or at persons passing by, or the least distinct mental effort, may reproduce it. There is, too, in most of these cases an extreme sense of mental confusion, and more often a false sense of movement within the head than without, while in no other patients is the sexual act so apt to increase all of the symptoms in question.
Hysteria, as might be expected, offers now and then examples of vertigo. It does not exclude the presence of true aural, optic, or gastric dizziness, which is then apt to become the starting-point of a long train of hysterical disorders. On the other hand, we meet with hysterical vertigoes which, in a sense, may be said to simulate any of the more usual types. I have certainly seen hysterical girls with deafness, tinnitus, and a great development of equilibrial disturbance, in whom the disease passed away without leaving a trace behind it, so that in these cases some caution is needed as to prognosis. They become far more difficult to deal with when they are found in old women or women in advanced middle life, since it is then hard to know what share senile changes may have in the production of the symptoms.
Vertigo from mechanical causes, such as sea-sickness, railway sickness, swinging, etc., it is hardly worth while to deal with here at length. The research of Prof. James has made it probable that disturbances of the labyrinth are responsible for the vertigo of sea-sickness. Certainly, deaf-mutes seem to have lost the power to be made vertiginous from rotation, and do not suffer at sea.
It is, however, worth recording here that I have more than once seen enduring vertiginous status, with occasional grave fits of vertigo, arise out of very prolonged sea-sickness. In the last example of this sequence seen by me there was, after a year or more, some deafness.
The elevators in use in our hotels sometimes cause, in those who live in them all day and control their movements, a cumulative vertigo, and I have known such persons to be forced on this account to seek other occupation.