One patient's experience with two general physicians, one neurologist, one leading physician, one gastrologist, two ophthalmic surgeons, one diagnostician, and one refractionist / by George M. Gould.
- Gould, George Milbrey, 1848-1922.
- Date:
- 1905
Licence: In copyright
Credit: One patient's experience with two general physicians, one neurologist, one leading physician, one gastrologist, two ophthalmic surgeons, one diagnostician, and one refractionist / by George M. Gould. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![Careful inquiry elicited the fact that this patient had been examined by Dr. [a wellknown ophthal- mologist], who had reported that “nothing was wrong with hiseyes.” I only found intestinal indigestion, with the development of a dominant idea. There is no statement in this report as to the treat- ment ordered. 6. “The leading physician” in another city was visited. He, as of old, in such circumstances, pro- nounced the awful word neurasthenia, said the patient was “ bordering upon nervous breakdown,” advised him to go home, go to bed, to feed up, and to rest. 7. The diagnostician in still another city was reached in last resort. His report is as follows : Careful examination of the urine and other excre- tions led me to conclude that he was not suffering from any intoxication from the usual source of autointoxica- tion. The gastric analysis, after an Ewald test-breakfast, showed an acidity of 60, depending upon combined chlorids 12, acid salts 8, HCl 40, or 14.60^. On another occasion the total acidity was only 50, and free HCl 30, or 10^. Under the circumstances I could not admit that he was suflFeringfrom hyperchlorhydria. His diges- tion was excellent in every way. He complained of a sensation of burning in the stomach, and other symp- toms of sympathetic nerve distress which might be said to be due to gastric hyperesthesia. A careful ex- amination of the nervous system led me to exclude structural lesion of the brain and cord. His symptoms were too transitory and excited by events, which led me to exclude toxemia as the cause of his trouble. His symptoms were such as I have found to arise from brain irritation excited by eyestrain. He had symptoms which made me suspect his eyes, and I felt that I could exclude other sources of irritation of the cranial nerves. His case closely resembled a number of others which I have seen depending upon eyestrain. I felt that other causes could be excluded. 8. Ophthalmologist No. 2 now ordered the following spectacles: R. + S. 1.00, + Cyl. 0.25 ax. 50° L. -I- S. 4.25, + Cyl. 0.75 ax. 180°](https://iiif.wellcomecollection.org/image/b22409634_0007.jp2/full/800%2C/0/default.jpg)
