Clinical lectures on important symptoms. On giddiness / by Thomas Grainger Stewart.

  • Stewart Thomas Grainger, Sir, 1837-1900.
Date:
1884
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Licence: Public Domain Mark

Credit: Clinical lectures on important symptoms. On giddiness / by Thomas Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    with which he was frequently seized. On examining him I found no evidence of central nervous disease, but observed that when he took his giddy turns there was always a rapid oscillating movement of his eyes. It occurred to me that this oscillation or nystagmus might cause the giddiness, and I held his eyes fixed by slight pressure. This cured the giddiness in a moment, and while it was kept up the giddiness never recurred. On further inquiry I found that the patient was a miner, and that his case was a typical one of what has been described as miner's nystagmus. The patient continued under observation for some time, but no good was done except by the mechanical treatment. The giddiness in that case was manifestly not due to any central disease, but was simply a result of the contradictory impressions resulting from the movement of the eyes. The disease is now pretty well known. It is due to spasm from long continued muscular strain—is indeed a form of trade spasm. The miner while at work lies on his side, and opens up the coal-seam above and beyond his head. He works also in a dim light. He has, therefore, to strain his eyes greatly, and to keep them in an unnatural position, and this nystag- mus, with its attendant giddiness, occasionally follows. You may ask me whether nystagmus always induces giddi- ness. Certainly it does not. It sometimes is merely asso- ciated with giddiness, the two depending upon a common cause, as in cerebellar disease. Sometimes, again, it results from cerebral disease, sometimes from disease of the retina, sometimes from disease of the cornea, occurring in childhood. In such cases, giddiness does not result, because the sight is so much impaired that the patient learns not to be dependent on the visual impressions for guidance. This is especially the case when the cause comes into operation in early life. Paralysis of the external rectus, when of recent origin, frequently leads to giddiness from double vision ; and even if the one eye be closed, a sensation of vertigo is experi- enced, because the muscular sense contradicts other impres- sions. You will often see this fact illustrated in the eye wards, but I may mention an example of it which occurred m the case of a patient whose illness I shall describe to you