CHAPTER XX PsycuicaL Symptoms ASssocIATED WITH THE SENSE OF VISION (Part 1)

CHAPTER XX PsycuicaL Symptoms ASssocIATED WITH THE SENSE OF VISION Reference has been made already to several conditions that may be termed psychical, as no lesion can be found in the eye to explain their existence, such as scintillating scotoma, and some faults in the field. In addition to these a number of curious phenomena have been met with occasionally that appear to involve certain of the connec- tions between the sense of vision and various centers in the brain, and consequently may be brought to our attention when the eyes them- selves appear to be organically and functionally perfect. The sub- jective symptom is striking in each case, whether it is blindness, an inability to name objects that are seen, or visual hallucinations, and is of diagnostic value, but it is not necessarily related to any other in this group. PSYCHICAL BLINDNESS Occasionally a child or an adult comes to us who appears to be blind, although he presents no lesion in his eyes that can explain the loss of vision. In a child we may detect some scars on the cornee that can be recognized as having been caused by ulcers, and we in- quire into his history. If we learn that he has recovered recently from a very prolonged attack of sore eyes during which he kept his lids tightly closed, we make a diagnosis of psychical blindness, and expect it to pass away before long. We know that when little chil- dren have suffered for months from a phlyctenular keratitis which maintained a constant blepharospasm, they sometimes appear to be blind for a while after the disease is well and they have begun to go about with their eyes open. The reason is unknown, but is sup- posed to be that they have temporarily lost the power to appreciate the meaning of the images formed on their retine, so that they have to learn again to see, just as they did in infancy. The prognosis is good. | We rarely find blindness in an adult which is not congenital, cannot be accounted for by the presence of objective symptoms, and has 467 468 DIAGNOSIS FROM OCULAR SYMPTOMS lasted a longer time than would be necessary for symptoms to appear in the optic nerve if it were produced by poisoning, or by a lesion in either the orbit or the brain. It is then commonly associated with anomalies in other senses, such as those of touch, pain, temperature, taste, hearing, or smell, that guide us to a diagnosis of hysteria, or, if such a cause is indicated by the history, to one of psychosis due to traumatism. VISUAL HALLUCINATIONS Hallucinations occur most commonly in delirium and in certain types of insanity, but they are seen occasionally by persons who are sane, and in such cases the eyes should be examined. Swanzy states that he met with a case in which hallucinations occurred in connec- tion with glaucoma, so the tension should be taken, and the papilla examined for a glaucomatous excavation. After this disease has been excluded the field should be tested for homonymous hemianop- sia, and if this is found we may conclude that some sort of a cerebral lesion is irritating the visual memory center. If this is absent it is possible that we may find the hallucinations to have a homonymously ~ hemianopic character, and it is said that such have been known to persist for years. We must bear in mind also that hallucinations may be one of the prodromal symptoms of epilepsy, and that they may appear after an attack of this disease. CONDITIONS IN WHICH VISUAL CONCEPTION SEEMS TO BE DISSOCIATED FROM OTHER MENTAL FACULTIES The conditions about to be described are far more apt to come under the observation of the neurologist than of the ophthalmolo- gist, the number of reported cases does not appear to be large, and the author can lay no claim to personal experience with them. He has gleaned the descriptions from such neurological textbooks as were available, with the few references he has found made to them in works on ophthalmology. In nearly every case they are focal symptoms of lesions in the brain that interfere with the connections between the center for vision and such other centers as those for memory, speech, and color. The accuracy with which they guide us to the site of the lesion depends to a great degree on the exactness of our knowledge of the location of these centers. PSYCHICAL SYMPTOMS ASSOCIATED WITH THE SENSE OF VISION 469 Visual Aphasia A patient may be able to see the various objects about him, and to know their uses, but be unable to call them by name, unless he can become cognisant of them through some other sense. He can see a spoon, a bell, or a lump of sugar, and be able to tell the uses of each, but cannot name any of them as long as he relies on his sight alone, and yet can name each as soon as he feels the one, hears the second, or tastes the third. Very few cases of this visual or optical aphasia have been reported, and some neurological writers seem to doubt the existence of one which was not associated with some other form of sensory aphasia. Right homonymous hemianop- sia appears to have been present in every one. Some of the patients had alexia, others had not. According to Bing the cerebral lesion is supposed to be so situated as to interrupt the connection between the centers for the recognition of objects in the occipital lobe and Wernicke’s sound memory center in the temporal lobe. Visual Amnesia Another patient is unable not only to name an object, but also to tell the use of it when he relies on sight alone, although he can do both when it appeals to one of his other senses. This is called by different writers visual amnesia, optical agnosia, and mind blind. ness. Sometimes the patient can describe the object from memory, although he cannot recognize it when seen, at other times he has lost all memory of it, even though he can describe the appearance of the object he sees. In the latter case the lesion is supposed to lie in the center for memory, in the former to be situated between that center and the one for vision. Alexia When a patient can name and comprehend the uses of the various objects about him, but finds written or printed letters or words to be meaningless symbols, we say that he has alexia, or word blind- ness, 2 condition which can appear more or less independently of other aphasias. If he can express his ideas in writing, or can write from dictation, although he cannot read what he has written, or copy written or printed words, he has subcortical, or pure alexia. When he cannot write at all, the other conditions remaining the 470 DIAGNOSIS FROM OCULAR SYMPTOMS same, he has cortical alexia. A rare form that is said to have been met with is an alexia for the written notes of music, perhaps asso- ciated with an inability to understand music at all. Patients with alexia commonly present other cerebral symptoms, among which may be hemianopsia. Cortical alexia locates the lesion in the center for the visual memory for words, which most writers seem to think is situated in the left angular gyrus. Swanzy quotes Dejerine and Wernicke to the effect that in right handed people this center is in the left angular gyrus and the inferior parietal lobule. A subcortical alexia indicates that the lesion is so placed as to interrupt the con- nection between this center and that for vision. Amnesic Color Blindness When we meet with a patient who can match colors, but has for- gotten their names, we shall probably find that he has a right homonymous hemianopsia, and say that he has amnesic color blind- ness, color aphasia, or color amnesia. The lesion probably will be found in such a place in the occipital lobe that it interrupts the path between the centers of color vision and of speech. Dyslexia A very few cases are on record in which a patient. was able to see and to recognize words perfectly, but could read only a few before he was seized with so strong a feeling of aversion that he could not continue. He might return to the task in a moment only to turn away again with the same feeling of disgust. This dyslexia was sometimes the first symptom excited by a cerebral disease, but was soon followed by others. It seems to have been temporary, and to have recurred in some of the cases. When an autopsy was obtained the lesion was usually found in the third frontal convolution, INDEX Abduction, 104 Ablepharia, 15 Abnormalities of the fundus, 324 Abnormal tension of the eyeball, 279 Abrasions of the cornea, 123, 162, 168, 184 Abscess, alveolar, 27, 222 of the brain, 22, 338, 340 of the cornea, 190 of the lacrimal gland, 74 of the lacrimal sac, 54 of the lid, 27, 37 of the orbit, 56 of the vitreous, 275, 307, 397 of the zygomatic fossa, 61, 74, 75 Absence, of a muscle, 94, 96 of canaliculi, 53 of puncta, 53 Absolute glaucoma, 195, 281, 291 Absolute immobility of the pupil, 208, 244 Accessory sinuses of the nose, 27, 29, 59, 60, 73, 74, 75, 77, 94, 120, 338, 431 Accommodation, paralysis of the, 296 reaction of the pupils to, 206 spasm of the, 296, 451, 452 weakness of the, 309, 450 Acne, 32 Acquired amblyopia, 410 Acquired color blindness, 424 Acquired conus, 359 Acquired eryptophthalmos, 40 Acquired nystagmus, 107 Acquired ptosis, 17 Acquired sclerosis of the choroid, 357 Acromegaly, 70, 332 Actinomycosis, 149 Acute catarrhal conjunctivitis, 27, 119, 122, 123, 124 Acute infectious diseases, 20, 74, 127, 337, 372, 375, 379, 393, 394 iritis in, 225 Acute inflammatory glaucoma, 217, 218, 282, 43 Acute plastic iridocyclitis, 119, 215, 218, 261, 283 Acute purulent dacryocystitis, 27, 54, 73, 119 Addison’s disease, 31, 194 Adduction, 104 Adenoma, of conjunctival glands, 37 of the Meibomian glands, 36, 37 Adenopathy of lymphatic glands, 58 Adherent leucoma, 169, 236 Adjustment of glasses, 444 Adrenaline, toxic amblyopia from, 414 ABtiology of iritis, 219 Affections of the color sense, 420 Agnosia, optical, 469 Albinism, skin of the lids in, 31 Albinotie fundus, 322 Albuminurie choked disk, 339 Albuminurie retinitis, 374 of pregnancy, 875, 393 Alcohol and tobacco, toxic amblyopia from 328, 411, 413, 415 Alcohol, methyl or wood, poisoning, 330, 332, 415 Alecholism, 20, 108, 116, 207, 239, 245, 276, 3 Alexia, 435, 469 cortical, 470 for music, 470 subcortical, 469 Alopecia, 45 Alternating mydriasis, 242 Alveolar abscess, 222 Amaurosis, 381, 408 partial fugacious, 432 Amaurotie cat’s eye, 395 Amaurotic family idiocy, 363, 888 Amaurotic immobility of the pupil, 243 Amblyopia, 408, 409, 418 : a cause of convergent strabismus, 83 acquired, 410 congenital, 348, 409 from bright light, 410 from disease, 411 from overwork, 416 hysterical, 412 reflex, 411 toxic, 413 toxic, from alcohol and tobacco, 328, 411, 413, 415 toxic, from quinine, 330, 332, 345, 413, 414 toxic, from wood alcohol, 330, 332, 415 traumatic, 410 Amnesia, color, 435, 470 optical, 469 visual, 469 Amnesic color blindness, 424, 470 Amyloid degeneration, 153, 168 Anemia, 52, 119, 217, 222, 276, 345, 348, 352, 378, 393 asthenopia and eyestrain from, 120, 459 iritis from, 234 of the conjunctiva, 120 of the fundus, 344 pernicious, 345, 352, 378, 379 Anemice retinitis, 378 Anesthesia dolorosa, 180 Anesthesia of the cornea, 158, 179, 183, 186, 341 Anatomical, faults a cause of convergent strabismus, 84 Angioid streaks in the retina, 353 47) 472 Angioma, of the choroid, 405 of the conjunctiva, 115 of the lid, 31, 38, 39 cavernous, of the lid, 38, 39 of the orbit, 72 Angiomegaly of the lids, 31 Angiosclerosis, 354 Angle y and strabismus, 87 Aniline oil, toxic amblyopia from, 413 Aniridia. (See Irideremia) Anisocoria, 205, 240 an early symptom of tuberculosis, 240 in diseases of the central nervous system, 241 Ankyloblepharon, 40, 151 Annular keratitis, 186 Annular scleritis, 196 Annular scotoma, 430 Anomalies, motor, without deviation, 101 Anomaly of deviation, congenital, 93 Anterior chamber, 198 deep, 200 obliteration of the, 199 shallow, 199 Anterior choroiditis, 389 Anterior ethmoidal cells, 59, 75, 463 Anterior lenticonus, 251° Anterior polar cataract, 169, 256, 259, 260 Anterior segment of the eye, infection of the, 306 Anterior staphyloma, 178, 195 Anterior synechie, 169 Anteversion of the iris, 211 Anthrax, 28, 32, 33, 35, 58, 74 Aphakia, 211 Aphasia, color, 470 optical, 469 visual, 469 Apical infections of the teeth, 222 Aplasia of a nucleus, 94, 96 Apoplexy, 118, 239 of the retina, 379 Aqueous, visible changes in the, 200 Are, light reflex, 206 Arcus senilis, 167 Areolar choroiditis, 389 Argyll-Robertson pupil, 245 Aridosiliquose cataract, 257, 271 Arsenical poisoning, 45 Arterial pulse, 321 Arterioselerosis, 117, 197, 236, 276, 331, 339, 340, 348, 354, 355, 366, 375 Artery, central, occlusion of the, 332, 336, 345, 363, 368, 383 central, occlusion of a branch of the, 370 persistent hyaloid, 255, 259, 272, 327 Aseptic purulent iritis, 235 Aspergillus fumigatus in corneal ulcers, 174, 177 Asthenopia, 440 from anemia, 459 from disease of the central nervous sys- tem, 460 from nervous exhaustion, 458 nasal, 452, 457, 461 nervous, 457, 458 reflex, 457 toxic, 460 Astigmatism, 156, 453 against the rule, 156 INDEX Astigmatism, irregular, 141, 156 regular, 156 with the rule, 156 Atavistic defects, 13 Ataxia, hereditary, 108 Atrophie cup or excavation, 318 eles: gyrate of the choroid and retina, nee optic, 332 of the eyeball, 62, 292 of the iris, 227, 2836, 245 of the skin of the lid, 31 neuritic optic, 329, 337 optic, 182, 327, 416, 421 retinitic optic, 332 simple optic, 329 Attention reflex of pupils, 207 Atypical colobomata, 214 Aural nystagmus, 108 Autointoxication, 173, 196, 222, 393 Babies’ sore eyes, 130 Background of the fundus, 322 Bartel’s test for paralysis of the ocular muscles, 78 Basedow’s disease. goiter) ce appearance of the retinal vessels, (See Exophthalmic Bee sting of the cornea, 260 Benign follicular affections of the conjunc- tiva, 141 Berlin’s opacity. the retina) Binocular single vision, 84 ee to convergent strabismus, 84, Birthmarks, 31 Bisulphide of carbon, toxic amblyopia from, 329, 413 Black cataract, 271 luxated into ’the anterior chamber, 160 Black spots in the fundus, 346, 381, 387 Blastomycetic dermatitis, 33 Blepharitis marginalis, 46 Blepharitis ulcerosa, 48 Blepharochalasis, 27, 31 Blepharophimosis, 40 - Blepharospasm, 24, 467 clonic, 24 hysterical, 25 occupational, 25 senile, 26 tonic, 24 Blindness, amnesic color, 424, 470 color, 420, 422 mind, 469 psychical, 467 word, 469 Blind spot, 431 Blood eyst, 69 Blood stain of the cornea, 159 Blood vessels of the retina, 319, 350 Boil on the lid, 37 Brain lesions, 19, 22, 95, 99, 180, 238, 239, 246, 338, 340, 375, 434, 439, 468, 469, 470 Brain, lesions at the base of the, 95, 180 Branch of central artery, occlusion of a, 370 Brawny scleritis, 196 Bridge coloboma of the i iris, 210, 214 (See Traumatic edema of INDEX Bulbar paralysis, 21, 97, 98 Bulla, 181, 183 Bullous keratitis, 181, 183 Bundle of nerve fibers, disease of the papil- lomacular, 328, 376, 431 Buphthalmos. (See Infantile glaucoma) Burns, lime, 154, 1638 of the conjunctiva, 44, 117, 127, 146, 154 of the cornea, 154, 163 Bursa of the trochlea, distended, 69 Cachectie eataract, 263 Cachexie, 31, 378 Calcareous eataract, 252, 257 Calcareous degeneration of the cornea, 168 Calcification of the conjunctiva, 153 Calmette’s test, 189, 230 Canaliculus, closure of the, 53 mucocele of the, 53 Cannabis indica, toxic amblyopia from, 329, 413 Caput meduse, 291 Carbon bisulphide, toxic amblyopia from, 329, 413 Carbon dioxide poisoning, 20, 97, 348 Carbuncle of the lid, 38 Carcinoma, of the choroid, 402, 406 of the lid, 39 of the orbit, 70 Caruncle, 110, 111 Cataphoria, 101 Cataract, 230, 252 anterior polar, 169, 256, 259, 260 arilosiliquose, 257, al black, 271 blue punctate, 270 eachectic, 263 calcareous, 252, 257 caused by electric flashes and by electric shock, 258, 261 caused by X-rays, 258, 261 central, 254 ' complicated, 227, 252, 262 congenital, 253, 255 cystic, 257 degenerated, 252, 257, 271 diabetic, 259, 263 due to disease, 261 false, 262, 264 fluid, 252 fusiform, 255 glassblowers’, 258, 261 glaucomatous, 259, 262 lamellar, 253 luxation into the anterior chamber, 160 membranous, 254, 257 milky, 257, 258 Morgagnian, 257, 271 nuclear, 269 posterior polar, 255, 259, 383 punctate, 256, 270 pyramidal, 256 senile, 252, 262, 264 senile, hypermature, 257, 265, 271 senile, immature, 265, 268 senile, incipient, 256, 265, 267, 275 senile, mature, 265, 268 senile, subcapsular cortical, 267 A473 Det senile, subjective symptoms of, siliquose, 254, 257, 258, 271, spindle shaped, 255 supranuclear, 269 total, 254, 259 traumatic, 257, 262, 297 zonular, 258, 259 Catarrhal dacryocystitis, 53, 54 Catarrh, vernal, 134 vernal, bulbar, 135 vernal, mixed, 135 vernal, tarsal, 134 Causes, of convergent strabismus, 82 of divergent strabismus, 85 of iritis, 220 of secondary glaucoma, 289 of vertical strabismus, 82 Cavernous angioma of the lid, 38 Cavernous sinus, thrombosis of the, 73, 76, 343 Cellulitis of the orbit, 27, 37, 56, 60, 73, 119, 283, 339, 380 Central artery, anomaly of the, 273 occlusion of the, 332, 336, 345, 363, 368, 383 occlusion of a branch of the, 370 Central cataract, 254 Central choroiditis, 243, 269, 363, 364, 372, 373, 385, 389, 390 Central nervous system, diseases of the, 21, 209, 241, 243, 244, 246, 429, 430 Central retinitis, 366, 370, $372, 385, 390 Central scotoma, 298, 328, 339, 367, 376, 390, 430, 431 Central vein, thrombosis of the, 379 Centrifugal neuron, 206, 208 Centripetal neuron, 206 Cerebellar disease, 100, 108, 180 Cerebral syphilis, 241, 244, 245, 246, 331 Cerebrospinal meningitis, 20, 394 Chalazion, 25, 36, 116, 122, 146, 152 giant, 37 Chancre, of the conjunctiva, 58, 151 of the lids, 22, 33, 35, 36, 58 Chancroid of the lids, 34 Charcot’s tabetic mask,