Stories From the Clinic
by Emily C. Lierman. Истории из клиники.
PARTIAL PARALYSIS OF THE THIRD NERVE
GEORGE, aged five years, was sent to me by a physician, who diagnosed his case as paralysis of the third nerve of the right eye. A number of eye specialists said that he could not be cured. One gave him internal treatment for about six months and used electricity on the eye without much permanent benefit. When a nerve is paralyzed, its function is lost. In other words, the nerve is not able to bring: about a contraction of the parts supplied by the nerve. To explain further, that branch of the third nerve distributed to the muscle which raises the lid, had lost its function. In general it has been believed for many years that a paralyzed nerve is relaxed. After many years of observation and experimental work, it was demonstrated that a paralyzed nerve was under a great tension. Treatment which relieved the tension and brought about a sufficient relaxation was a cure for the paralysis.
In Dr. Bates' book is an illustration of a patient with paralysis of the seventh nerve. One of the functions of the seventh nerve is to close the eyelid. When it is paralyzed, the eye remains open. Not only does the eye remain in this way, but the lips are separated. The patient is not able to close the lips sufficiently to whistle. By palming and swinging, a relaxation is obtained,—the patient becomes able at once to close the eyelid, and to close the lips sufficiently to whistle. These cases of paralysis do not need electrical or other stimulation. They are cured by rest. I believe that electricity is a valuable remedy, but it has lost much of its prestige by being employed in cases where it was not needed.
Georgie's mother has unusual intelligence, and she came to us confident we could relieve or cure Georgie's eyes. This is the history of his case as she described it: When he was born his right eye was wide open, and the child was unable to close the eye. About three months later the eyelid closed, and the child was unable to open his eye. Several eye specialists in Brooklyn told the mother that the eye could not be cured.
From the very beginning, Georgie was a source of pleasure to me. He seldom spoke above a whisper and preferred to go through each treatment without speaking at all, if possible. At such tunes he was given the card with the letter E pointing in different directions. When I asked him which way the E's were pointing as I pointed to each one with my pencil, he would say left, right, up, down. But if he were not in the mood, he would raise his hand and indicate the direction in which the E was pointing. In the beginning this card was the only one used in his treatment, because he did not know all the letters of the alphabet. After he was admitted to the kindergarten school, he asked for the alphabet card, and also a figure card, which children favor a great deal for testing their sight. When Georgie's first test was made, he was unable to open his right eye. The left eye was normal, or 10/10.
I taught him to palm, and while he sat quietly, I began to talk to his mother. The conversation was solely for his benefit, so I talked about him. Like all mothers of her type, she praised her little boy and informed me of all the wonderful qualities of his mind, and that he was most obedient. I saw him smile, and for a moment he peeped a little through his fingers. After he had rested his eyes for ten minutes, I told him to keep his left eye covered, and look at the card with his right eye. His mother sat facing him, with her eyes wide open with astonishment, as she saw the eyelid open just a trifle. He was able to keep his right eye open long enough to read 10/70, then the eyelid dropped again. His mother obtained a number of different Snellen test cards and used them at home for the dally treatment of the paralyzed eye.
I treated Georgie again, one week later, and I immediately had him practice the palming. So many patients have failed to palm successfully, became they start even with their eyes closed. Georgie palmed successfully because, at my suggestion, he remembered the things that were pleasant and easy to recall. If I could not think quickly enough of a story to tell him, I would show him something in my room, which pleased him. Then he would palm and describe it to me. At one time I showed him a box of bonbons, which were attractively arranged, and promised him some if he would sit and palm for a long time. His mother and I were amused, because he was unusually quiet when he remembered the candy. After he had palmed a while, I suddenly asked him what he was thinking about. He opened his eyes long enough to say the word "candy" and then closed them again. The vision of his right eye improved from 10/70 to 10/50 that day, and the eyelid was more open than before. The left eye improved to 12/10.
At every visit his vision was improved, while the paralysis diminished with the increased relaxation of his eye. I noticed that occasionally he would forget to blink, and then he would stare and strain, which lowered his vision and increased the paralysis. His eyelid has opened more and his vision has improved since he became the owner of a little puppy. Whenever he played with the little dog, his mother noticed that both eyes would blink. This is evidence that things seen in motion are seen beat. The vision of his right eye was unproved to more than 10/10, while that of his left eye to 18/10, which is very unusual in a child six years of age. He had been under my treatment for about a year.
PARALYSIS OF AN EYE MUSCLE
One of our patients was an old colored mammy who came all dressed up with a faded red rose in her hat, which was gray with age. Her white apron was starched so stiff that it rustled every time she moved and she walked very slowly with the aid of a cane. When I asked her what her name was she answered, "Mah name is Annabelle Washington Lee."
Poor mammy had squint in her left eye and evidently was in pain. When I asked what her age was she answered: "Now, Ah don't know, ma'am, just 'zackly, but mebby Ah is fifty and mebby Ah is sebenty. But Ah do know Ah's cross-eyed and man head hab sech pain Ah can't sleep nohow."
Dr. Bates examined her eyes, stated that she had a hemorrhage of the brain, and suggested that resting her eyes would be the best treatment for her. Mammy bad a strong desire to talk and before I could tell her that we had no time for conversation she said: "You know, ma'am, Ah sees you twice. Yes'm, Ah sees de letters twice, Funny, but you hab two heads."
Then mammy laughed. Finally she sat quietly with both hands covering her eyes as she was directed. I began to praise her to other patients who were not willing to palm more than a minute or two, when all of a sudden mammy's hands dropped to her lap and we found her fast asleep. The joke was on me all right. Mammy practiced palming faithfully at home, however, and the third time she came to the clinic, Dr. Bates examined her eyes again. He said that the hemorrhage must have been cured by palming or keeping her eyes closed a great deal, for the retina was entirely clear and there seemed to be no more trouble.
Mammy's eyes soon became straight and she no longer complained about seeing double. The last time I saw her she said: "Ma'am, de world is bery different since mah eyes is better and Ah wants to smile all de time."
Mammy would do anything for me but read the card. I really believed her when she said, "Ah is plum lazy and Ah jes don' care 'bout readin', nohow; Ah gets along bery well widout it."
The best she was able to do for me with the test card was 12/20 with each eye, whereas in the beginning her squinting eye was 12/70 and the other eye 12/40.
Little curly-haired Sarah, aged twelve years, was a very interesting case. As she stood among patients who were waiting for treatment, I noticed how pretty she was. She was standing sideways with her right side toward me, and as I did not see her enter the room, I received a shock upon discovering that the left side of her face was distorted. She deemed so sensitive that I pretended not to notice anything wrong. Her left eye appeared ready to pop out of its socket any moment, and both upper and lower eyelids were terribly inflamed.
Dr. Bates explained the history of her case, and the cause of her affliction, and then left her entirely in my care. She told me that at the age of four, owing to an attack of cerebro-spinal meningitis, the left side of her body had become paralyzed. Until she came to us she had been receiving treatment from nerve specialists; both in England, where she was born, and also in New York. Electric treatments were given without success. Money was not spared; her family sacrificed every penny for medical treatment to bring about Sarah's cure. When one doctor failed, another was recommended by their friends. Finally the family bank account dwindled, and Sarah stopped treatment, believing that she could never be cured.
Later, as I learned to know her better, I noticed that she was ever conscious of her trouble and would always turn the good side of her face toward me. For one thing, Sarah was never downhearted. She was a good scholar and graduated at fourteen from the public school.
I tested her sight and found that she had normal vision, 10/10, with her right eye, and 10/50 with the left.
Placing her in a comfortable position, I showed her how to palm and told her not to remove her hands from her eyes while I was testing the sight of other patients. After a few minutes I noticed that while Sarah had her eyes covered her face became terribly red, and I wondered if she were comfortable. I spoke to her and she complained that she did not like to palm, that it made her nervous. I thought that she was not doing it tight and explained to her again how easy it was. To cover her eyes with the palms of her hands would help her to obtain the relaxation which was necessary to improve the condition of her left eye. She faithfully tried again but I noticed that she was getting more uncomfortable all the time. Since her vision failed to improve by palming, I tried the long swing, which proved successful.
I thought that in time Sarah would become able to palm with benefit and thus improve faster, but I was mistaken. For two years Sarah came to us at the clinic quite regularly, but in all that time I could hot induce her to palm. She insisted that it made her nervous. In all the years that I have been assisting Dr. Bates, this was my first experience with a patient who could not be made comfortable by palming.
However, the slow swing of her head was very helpful to her. She held her left forefinger in front or to the left side of her face, about six inches from her eyes, and then slowly moved her head from shoulder to shoulder, blinking all the time. At the first visit the vision of her left eye had improved to 10/30. Sarah was encouraged to practice the swing as many times during the day as it was possible for her to do so, and she was reminded to blink her eyes often, which she was not able to do at all with her left eye at the first visit. The upper lid of her left eye seemed stationary, and she could not close this eye even in sleep, a condition which gave her a strange appearance.
As I never had a case like hers before, I was deeply interested and studied hard to find every possible way to help her. She was a dear, bright little girl and was willing to do everything that we wished to help in the cure of her eye. I asked Dr. Bates for permission to try to improve the condition of her left cheek and mouth, as well as her eye, thinking that our method of relaxation might possibly do something for her face. Doctor smiled and said, "Well, you might try."
On Sarah's second visit to the clinic her left eye had improved to 10/15, which was most encouraging to me. She told me that she had tried to palm at home just to please me, but every time she tried, it made her strain. The swing, however, helped a lot. As time went on, I told her to shorten the swing and move her head slowly from aide to side, teeing everything move opposite from the way her head was moving. This also gave her a great deal of benefit. She had had a month's treatment when I noticed that the upper lid of her left eye was beginning to move, and that the inflammation, which caused Sarah so much discomfort, had almost entirely disappeared. Her vision stayed about the same, left 10/15, right 10/10.
At each visit, we went through the usual treatment of seeing things move opposite, as she held her left forefinger to the left side or in front of her face. I sat before Sarah, going through the treatment with her, to encourage her to keep it up. During a period of eight weeks of this practice, her facial expression changed for the better. It was more noticeable when she smiled. When I first saw her, I observed that her mouth used to stretch over to the right side of her face.
Sarah seldom missed a clinic day, and she was very faithful in her treatment at home. Within a year's time, she became able to smile with her mouth almost straight. I decided to try out a few ideas of my own, and suggested to her that a mirror might be of benefit in helping her to speak and smile, with her mouth held straight all the time. This would help her to watch her mouth while she was talking or studying her lessons. I told her to go into a room by herself and practice for at least an hour every day. She was to study her lessons and recite poetry out loud, while looking at herself in the mirror. She was to see how straight she could keep her mouth during the performance.
As Sarah did not like palming, I had difficulty in getting her to imagine things perfectly with her eyes closed. I asked her to remember, while at school, how she appeared while looking in the mirror reciting her lessons. I was amazed at the result, and so were Sarah's friends, as well as herself.
She obtained the imagination of mental pictures by following my directions; for instance, I always asked her to repeat the alphabet very slowly every clinic day. After a while she became able to pronounce each letter of the alphabet with her mouth perfectly straight. She could never do this correctly unless she blinked her eyes for each letter. This may sound silly to the reader, but when Sarah did not blink before repeating a letter after me, she stared, and not only did she say the letter with her mouth crooked, but her left eye would bulge almost out of its socket.
Sarah noticed this wonderful improvement and very often had a surprise for me when she came. One day we were late for the clinic, but there was Sarah, sitting patiently with the rest, eager to tell me of some wonderful trick she was able to do. When her turn came, she whispered in my ear, "What do you think I can do now? I can wiggle my left ear." It sounded so funny that I wanted to laugh, but' Sarah was serious about it and I dared not. Strange to say, when I asked her to do it for me, before she did the swing, without first closing and opening her eyes, she was unable to move her ear But when she started to move her head slowly from left to right, and began to blink, she wiggled her left ear, which greatly amused the kiddies awaiting treatment. Two years had passed and Sarah still had hopes that we could cure her, and her mother and father were very grateful because of her improved condition.
On one visit she had a sty on the upper lid of the left eye. When I remarked it, she explained that she had been troubled with sties for many years, and at times they were very painful, t spoke to Dr. Bates about it, and he prescribed eye drops and salve, which gave her some relief, but the sties appeared again from time to time. At my suggestion, Sarah acquired the habit of closing her eyes frequently day or night, while she was awake, and was permanently relieved. She believed, as I did, that rest and relaxation helped in getting rid of the sties altogether.
At school one day, in the corridor, she passed a former teacher who had not seen Sarah for a year or more. She stopped and asked if she were not a sister to Sarah. "Why, no," the girl answered, "I am Sarah." The teacher looked at her in astonishment and said; "I did not know you, dear; your smile is so different, and your left eye looks so much better." Sarah told her about Dr. Bates and his method of curing people without glasses.
This teacher had had progressive myopia for many years, and suffered greatly with her eyes. What Sarah told her did not at the time convince her that she might also be cured, but about six months later sixteen girls from her class-room came to us at the clinic for eye treatment When she saw that their glasses had been removed from their eyes, and that they had improved faster in their studies, she called to see Dr. Bates at his office. In less than a year's time, she herself was able to see without glasses.
Every clinic day Sarah repeated the letters of the alphabet faithfully, until she could say them with her mouth perfectly straight. Then one day she had another surprise for me,—for the first time in her life she had learned to whistle with her mouth straight! What a wonderful stunt that was for Sarah. This she could not do unless she first practiced the swing. Rest or relaxation always relieves tension of the body as well as the eyes. I wish to emphasize the value of rest and relaxation, obtained by the swing and by blinking, in relieving or curing all diseases of the eye, no matter what the cause may be.
My experience in the treatment of this case demonstrated that many popular theories of the cause of paralysis of the motor nerves are wrong. For example, it is generally believed that when a motor nerve ceases to function properly, the recovery cannot take place until some disease or organic condition is relieved. Sarah became able to close her eyes quickly almost completely, after practicing the swing, which she could not have done if the paralysis of the nerves had been of a permanent nature.
I am aware that cerebro-spinal meningitis is caused by a germ, which is an important factor in the destruction of the nerves controlling the muscles of the eye and face. I do not think that anybody will maintain that the swing had anything to do, directly or indirectly, with the germs of the disease, or with the results of the inflammation caused by the germs.
My experience with the treatment of other cases of paralysis of the muscles of the eyes, caused by infection, confirms my belief that the paralysis is not due so much to local changes in the nerves as it is to mental causes. Sarah was pronounced incurable by many prominent nerve specialists. I believe that one reason why local treatment did not help her was because she had no trouble with the nerves sufficient to produce the paralysis. The only treatment which helped her was mental relaxation obtained by the swing. It was the strain of her mind which produced all the symptoms of paralysis. When her mind was at rest she suffered no more trouble.