In this time our materia medica has received a large number of most important additions, amongst which may be noticed, morphia, quinia, strychnia, iodine and the iodides, bromides, cyanohydric acid, cod-liver oil, chloroform, chloral, nitrite, amyl and a long list of preparations from the vegetable kingdom and from the hydrocarbon series.
The physical diagnosis of disease has been facilitated to an extent far beyond what the most sanguine physician of the last century could have deemed possible, by the discovery and practical application of the stethoscope, the pleximeter, the speculum in various forms, the ophthalmoscope, the laryngoscope and the thermometer; while chemistry and the microscopy have been applied successfully to the investigation of the various excretions, and especially of the urine, bile, and in the study of digestion where the process could be observed in its various stages in the person of Alexis St. Martin.
But the field for the medical historian broadens immensely and can best be appreciated by study of a catalogue of medical books and periodicals of the present century.
CASE OF HYSTERICAL BLINDNESS.
BY D. B. SMITH, M. D.
Professor of Diseases of the Eye and Ear in the Medical Department of Western
Reserve University.
On the fourth day of June I was called to see Miss C. R., aged nineteen years, a clerk, who told me that she had gone to bed the night before perfectly well, and that when she awoke in the morning she found herself totally blind, and had remained so up to the time of my visit, about eleven o’clock. This blindness she said had come on without the least pain or bad feeling, and the eyes were not in the least degree uncomfortable, nor had they been during the morning. No cause on the part of the patient could be assigned for the attack, and nothing of the kind had ever happened to any member of the family before. The external examination gave not the slightest evidence of any disease of the eyeballs or lids. The conjunctiva was perfectly normal, as were also the cornea iris and pupil. The ophthalmoscope revealed a perfectly healthy retina and optic nerve and clear media. The tension of the eyeball was normal. There was not the least constitutional disturbance, if we except a marked nervousness caused by the fear that she would be permanently blind. The patient declared most positively that she could not see the lamp even when held close to the eyes. From the fact that the pupils were perfectly normal and moveable under the influence of light, and that the patient put out her hand to shake hands with me in a way that I felt she could not do if she did not see, I diagnosed a case of hysterical blindness. It was more than a simulated blindness, for all the anxiety and mental distress of actual blindness were present; and I am satisfied the patient was honest in her belief that she could not see. The ordinary remedies for hysteria were given and were taken faithfully and regularly, and although for several days she took large doses of the bromide, valerianate of ammonia, hyoscyamus, assafœtida, and kindred drugs, there was not the slightest improvement in her vision. These remedies were continued from the fourth to the fourteenth without any perceptible effect. After ten days I began to give her tonics instead, and although she took the elixir cinchona with dilute hydrochloric acid, tincture of nux vomica, quinine, iron oxid of zinc, and finally stimulants, there was no improvement and the patient said she remained in total darkness. This tonic course was continued up to the twenty-ninth, and had been followed out thoroughly for two full weeks without effect.
During the nearly four weeks treatment the patient said that when the eyes were shut she could discern the position of the lighted lamp, but when the eyes were open she could not see the lamp or the slightest object, or even tell daylight from darkness. At various intervals during this time her pastor visited her and offered her his most heartfelt sympathy. Her friends were becoming exceedingly anxious least the sight would never return, although I could assure them that there was not the least danger of permanent blindness. I became satisfied at this time that medication was not going to dispel this peculiar attack of hysteria and that it would need something besides medicine to produce such an impression upon her mind that she could overcome it, so I told her that I was going to do something the next day that would surely make her see before night, and that she should be of good cheer for her sight would return very soon. The next morning I went down about nine o’clock armed with my ophthalmoscope, my case of trial glasses and my Hearteloup’s artificial leech. The patient seemed to be quite confident that she would soon see, and was very hopeful as to the result of what was to be done. I looked into the eyes with my ophthalmoscope, and then applied the cylinder of the artificial leech to the temples without scarifying and used considerable traction, first on one side and then on the other, having previously told her not to open the eyes until I told her to do so. In about half an hour I told her to open the eyes gradually so as not to let the light in too suddenly and then tell me what she could see. The instant she opened them she said I can see the light and the position of the window. I then told her to close the eyes again and I reapplied the cylinder and commenced the suction as before. By this time the temples had become red and so sensitive that she now complained of some pain when the cylinder was reapplied. After twenty minutes she was told to open the eyes again and she said she could see objects about the room distinctly. She was then tried with large letters but she said she could not see to read them, but could see the black objects. Told her glasses would help her and placed a No. 72 convex spherical glass before the eyes when she could see Jaeger No. 20, then told her she needed other glasses and replaced the No. 72. She now saw to read No. 16. I continued taking off and putting on this same No. 72, with good effect and whenever she came to a standstill in reading reapplied the cylinder with uniform benefit until finally after two hours constant work she could read Jaeger No. 1. During all this day she was able to see distinctly. The next day she was again unable to read but a short repetition of the same course brought her vision back again. There was no return of the blindness after that except occasionally for a short time at intervals of two or three days.
In the course of ten days all trace of the difficulty had passed by and since has never returned. This case was diagnosed as one of genuine hysteria and not one of simulating blindness or malingering, and is reported as the most marked case I have ever had illustrating the effect of hokus pokusing (to call it by a mild name) which produced such a strong mental impression that the patient lost sight of her own peculiar mental condition, and by which a perfect cure was effected.