Professor Marie[70] had failed to satisfy himself of the paralytic
nature of the phenomenon, and demonstrated the ease with which the
eyeballs moved downwards if the patient was made to hold his head
in the position of maximum extension, while in the attempt to look
at his feet--the head being held normally--they were forthwith
inclined violently upwards, and were so maintained for thirty or
forty seconds. The only view tenable was that he was suffering from
a sort of neurosis whose outward expression was this spasmodic
elevation of the eyes. Additional confirmation of the accuracy of
this hypothesis was supplied by a consideration of the
circumstances attending the commencement of the illness. The sudden
and unexpected apoplexy, of seventeen hours' duration, had been
accompanied neither by stertor nor by relaxation of sphincters, and
had been followed by an equally sudden return to consciousness, the
faculty of speech and the desire for food reasserting themselves
unexpectedly. The ensuing three or four weeks the patient had spent
in a curious delirious state, not unlike the post-seizure stage of
hysteria, a trace of which remained in the guise of certain
eccentricities of mind. The difficulty in his speech bore a
resemblance to hysterical stammering; and, finally, his visual
fields were concentrically and bilaterally restricted.
Of the subsequent history of the case some information was
forthcoming at a later date,[71] corroborating the opinion
originally propounded by Professor Marie. Simultaneously with the
diminution in intensity of the ocular spasm there had been grave
deterioration of the patient's mental level, as evidenced by the
development of ideas of persecution.
In the subjects of tic, and especially in cases of mental
torticollis, we have noted an analogous symptom, consisting in
inability to look down at the feet, except perhaps by the aid of
innumerable contortions, in contrast to the consummate ease of
upward glances. By making the person write at a blackboard, and
observing his action according as his hand is above or below a
horizontal plane through his eyes, one can soon convince oneself of
the reality of the occurrence, yet search will fail to discover any
sign of ophthalmoplegia.
Patients of this class evince a remarkable aptitude for elevation
movements, and the trouble they experience in depressing the
eyeballs is not of necessity to be construed as denoting paralysis
of the depressors, but rather indicates the presence of a tic of
the elevators, as Professor Marie says--a tic born of a habit, and
nourished perhaps by the dread such persons feel of witnessing an
exaggeration of their convulsive movements whenever they cast their
eyes down.
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