5th October 2018, Volume 131 Number 1483

By Dr. Ritchie

October 1918 

Dr. Ritchie first saw the case about three months ago. She complained of headache, which had been troubling her for some months, especially after using her eyes much.

On examination nothing definite could be found to account for the headache. Both pupils reacted to light and accommodation, and she did not appear to be markedly myopic.

Patient appeared to be unduly nervous during examination and a well-marked tremor of the limbs was apparent.

Knee-jerks were greatly increased with a psuedo-knee clonus, but no ankle clonus; no Babinski. Abdominal and epigastric reflexes present. No ataxia. Palatal reflex appeared to be absent. No nystagmus or staccato speech present; no history of vomiting. Tachycardia present, but no doubt due to nervousness, as the heart was quite normal, not enlarged, and no other sign of Grave’s disease was present.

Patient was advised to see Dr. McBride, who reported double optic atrophy, but no apparent cause.

Patient was then sent into hospital and was observed for some weeks, but no other symptoms than the above appeared.

Blood was examined by Wassermann test and found negative. Cerebro-spinal fluid was examined for globulin content, cytology and Wassermann; the latter one week after provocative injection of kharsavan. (Some recent work had shown that provocative injection of kharsavan did react on cerebro-spinal fluid.)

Dr. McBride’s report;—

Mrs. J. McK., aged 27, consulted me on 22nd April, 1918, complaining of sore eyes and aching sensation behind the eyes. She also complained of difficulty in seeing at night and the glare of bright light troublesome. On examination I found her vision 6–12 in both eyes and a refractive error of +2 in each eye, also well-defined optic atrophy in both discs. Correction of refractive error did not improve vision. However, I gave the patient her refraction correction in Crooke’s glass “A” shade with the object of eliminating the trouble caused by the glare of strong light and sent her into hospital under care of Dr. Ritchie for observation. When admitted to hospital there were no retinal changes, but in three weeks’ time there was a well-marked retinal degeneration in the right eye on nasal side of optic disc.