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marked, never being preceded by any local irritation, of which the patient was conscious. During some of these attacks she was occasionally so much in possession of the faculties of the mind and of speech, as to be able to reply appositely to questions put to her by the attendants ; but of these conversations she retained no recollection whatever after the termination of the attack. Certain paroxysms were productive of convulsions so violent as to require coercion; whilst others were attended merely with mild delirium. In the latter, impressions made by surrounding objects upon the retina, were transmitted to the brain, as usual inverted, and were represented to the mind in that position so forcibly, that the young woman could not resist the impulw she felt to place the chairs in the room horizontally, lest they should fall, finding they would not stand on the other end. She expressed her surprise, and laughed heartily, on seeing the attendants all standing, as she thought, upon their heads. The illusion immediately subsided with the fit, both lasting generally about an hour. This, therefore, was not a singular occurrence in one particular fit, but recurred repeatedly. The disease yielded, at length, to the ordinary treatment of hysteria, no defect either in the organ of vision, or the faculties of the mind, remaining.’

Romberg relates the particulars of the following case of hyperaesthesia of vision connected with disease of the optic {llalanzus.-—“A widow of eighty-five years of age, and of a robust constitution, was affected eight years previous to her death with cataract of both eyes. She underwent an operation which appeared at first to prove successful; after a few months, however, her sight became impaired, the left bulb was atrophicd, the right pupil closed, and the patient was only able

. “ Medical and Physical Journal," vol. xiv. p. 117.

to distinguish light from darkness. At this time she first began to complain of seeing long rows of worms, strips of coloured linen, or threads of worsted constantly passing upwards. An artificial pupil was now made in the right eye. The phantasms ceased for a time, but returned after eight weeks; first assuming the old shapes, and subsequently new ones. High walls rose up before her, heavily-laden carts surrounded her, or human figures hovered about her, generally threatening and alarming, rarely with a friendly aspect. These phenomena generally occurred only during the waking state; they soon became so vivid, that the patient felt convinced of their real existence, and, though continuing in the full possession of her intellectual faculties, made defensive movements with her hands whilst conversing. Her forehead was hot, the face much flushed, the pulse full and hard, and there was a sense of anxiety and oppression which, with the other symptoms, became aggravated towards night. The phantasms continued with occasional remissions and exacerbations during six years, until death ensued. Fits of vertigo and unconsciousness supervened, associated with weakness, and subsequently with paralysis of the left arm; these recurred several times during the year without exerting any influence upon the visual phenomena. In the month of January, 1837, the patient was seized with a violent apoplectic attack, the symptoms of which were deep coma, continuing for four-and-twenty hours, stertorous breathing, slow, full pulse, paralysis of the left arm and leg, and involuntary discharges. She recovered also from this attack, and lived for a year and three months without further inconvenience.

“ On the 16th March, 1838, after feeling particularly Well and happy during the previous day, she was seized during the night with another apoplectic attack, accom



panied by complete hemiplegia of the right side. She died in the evening of the following day.”

In the right hemisphere of the cerebrum, not far from the external edge of the posterior lobe and the surface, there was discovered a cavity of the size of a plum, invested with a reddish membrane, containing a small quantity of ochra fluid. There was fresh extravasation of blood in the middle and posterior lobe of the left hemisphere, near the corpus slrz'atum and the optic thalamus. The latter was converted into a greyish pulp. The optic nerves and the chiasma were in a normal condition. An examination of the retina was not permitted.

DERANGEMENT, PERVERSION, on ABERRATION or SIGHT. These morbid phenomena will be found more frequently symptomatic of disease of the brain than impairment, loss, or exaltation of the function of vision.

Such morbid states of the eyes vary from slight disturbances and irregularities of sight to actual illusions, ocula spectra, and phantasms. The physiognomy of the eye is peculiar in these cases of brain disease. This symptom should be accurately observed. The eyes present occasionally an unnatural brightness, and the vision an intensity of power, when the patient’s attention is concentrated upon any object, or if engaged in exciting topics of conversation.

Again, in some conditions of cerebral disorder, the patient is conscious of an inability to fix his eyes for many minutes, continuously, upon any one point or object. There is an evident want of control over the sight, the vision ceasing to obey the mandates of volition. Occasionally, the patient exhibits a propensity to stare at objects; there is a fixed expression of the eyes associated with an apparent immobility of the pupil.

There is often observed in these cases what has been termed by Romberg, a. destruction of the moior parallelism of the optic nerve; a deviation, in fact, from the optic

axis. I have been attending a case, with Dr. Birkett, of

obscure cerebro-spinal disease, in which there exists a singular irregularity of vision, the effect, it is presumed, of atrophy and impaired nutrition of the brain, possibly of the optic t/zalamus. There never has been in this case any marked headache. The patient has, however, complained of mental confusion, want of confidence in himself, and of severe paroxysms of vertigo. He appears to have lost the controlling power over the lower extremities. He has had for some time an impairment of sensibility in two of the fingers of his left hand. His intellect appears unclouded. The eyes are peculiarly affected. There is a marked difference in the dilatation of the pupils. The left pupil is contracted, and the right dilated. The left eye appears to be atrophied, and has the appearance as if it were flat, sunk in its socket, and much smaller than the opposite one. The vision is also defective in each eye. With the left he has short, and with the right eye long sight.

In some forms of brain disease the accurate observer notices a peculiar expression of the eyes, similar to that seen in some cases of strabismus, but without the muscular affection upon which that affection depends. The patient stares as if he were under the influence of an optical illusion. There is in these cases, as Dr. F. Devay pertinently remarks, “ a want of parallelism in Me oryan of vision. T/ie eyes are no! in the axis of reason.”*

* Dr. Mérier has lately called attention to akind of trembling, oscillation, and vacillation of the ocular globes among the insane threatened with dementia. It is, says this practitioner, a kind of permanent and continual convulsion, In consequence of which the small lateral movements are confined to the ocular globes. Sometimes they work up and down, but the last movement is much more rare. The observations of Dr. Mc'rier have led to these conclusions: 1. That the exhibition of convulsive movements, laterally and up and down,which he has observed in a great number of patients, has always coincided


INCIPIENT srmr'roms or APOPLEXY. 583

Portal predicated an attack of apoplexy in a gentleman (apparently in perfect health) from observing a slight fixedness of his left eye and a trifling weakness (incipient paralysis) on the same side of the body.

Previously to an apoplectic seizure, patients have been known to complain of objects appearing to be coloured red. Others fancy that a line of a like tint borders all bodies, or complain of a sensation similar to that experienced by the eyes when they have been exposed for some time to a strong light. Objects appear as if they were dotted with black or red spots, or the patient imagines that a mist or thin veil intervenes between the eyes and the objects at which they are directed.

Meningitis, congestion, or cerebral hyperzemia, and other acute diseases of the brain are occasionally preceded by double vision, strabismus, and other derangements of sight. These are also the well-recognised premonitory symptoms of acute inflammation of the substance of the brain.

Andral had an opportunity of observing a person who for several years was constantly tormented by the imaginary sight of small bodies of different forms and colours dancing before his eyes. If he looked steadily at an object, he saw it dotted with red or black points. These ocula spectra, which were permanent, prevented his reading or writing. He did not complain of vertigo,

with that period of the disorder marked by the change from an acute to a chronic state: for example, in the transition from mania to dementia; 2. That the existence and persistence of these ocular movements among patients give to the prognosis a very great gravity, justifying the notion that the insane Who were in a supposed favourable condition were already, or were about to become, incurable.

M. Morel (who refers to the previous facts), adds, that in these same patients the eye throws out an extraordinary and undefinable brilliancy; but this last phenomenon is scarcely ever remarked except during the period of transition. When dementia is confirmed, the eye is as it were extinct, and the gm: has that stupid and doltish expression quite in harmony with the weakness of the intellectual faculties.

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