[Reprinted from THE MEDICAL NEWS, June 30, 1894.] 
FLEETING HEMIANOPSIA OF SYPHILITIC 
ORIGIN. 
By E. J BERNSTEIN, M.D., 
OF BALTIMORE,' Mb. 
W. C. N., thirty years old, a real-estate broker, came to 
me August 27, 1892, complaining of inability to read or 
write after a few hours' exertion. He presented slight 
marginal blepharitis, which had persisted, more or less 
constantly, from childhood. The eyelashes were sparse, 
those remaining being short and stubby. The lids were 
not stuck together in the morning. The tear-ducts and 
the rest of the lachrymal appendages were normal. 
Reading at night had been uncomfortable for five 
years, but the asthenopia (?) had been much worse for 
three weeks. 
V., R. E., 6/6? Sn. 0.5 from 18-33 cm. 
V., L. E., 6/6? Sn. 0.5 from 12-27 cm. 
There was no vertical hyperphoria, but there was an 
exophoria of i° in each eye. Distant vision : 
R. E., + 0.50 D., cyl., axis vertical, 6/6 full. 
L. E., + 0.75 D., cyl., axis vertical, 6/6 full. 
I ordered simple cylinders in accordance with this 
finding. On September 21st the man returned, saying 
that while vision lasted he could see better with the 
lenses than without them, but after working till 11 a.m. 
his vision became worthless, and he could only see to 
get about by closing one eye and tilting his head to one 2 
side. He had also discovered that if he could cast his 
eyes down and hold a book above their level he could 
still distinguish large letters. It was only then that I 
suspected more profound trouble. 
Accordingly, the field of vision was taken, when it was 
found that he could only distinguish large, bright 
objects in the entire superior portion of each field, while 
the inferior portion was still normal, so that the scoto- 
mata covered a part corresponding to a line drawn 150 
above the horizontal diameter on the nasal over the 
whole superior field to within about 150 below the hori- 
zontal on the temporal. 
As I could not complete my examination at this visit, I 
requested him to come again early the following morn- 
ing, when I found the field of vision normal in both 
eyes. The color-sense was found to be good on both 
occasions. 
The patient then told me again that this was the usual 
course, viz., that he saw well until about 11 a.m., when 
his sight "gave out.'' 
On further examination I found numerous enlarged 
glands in the cervical region and above the elbows, and 
also several large, characteristic syphilitic scars on differ- 
ent parts of the body. The patient then acknowledged 
having contracted syphilis in November, 1890, for which 
he had been actively treated and had been told that he 
was cured. 
He smoked some twelve cigars and drank three or 
four glasses of whiskey daily. 
I examined him at various times, and always found 
the same condition, that is, early in the morning both 
fields were normal, but after a few hours' work the 
scotomata made their appearance, the field being pre- 
served in the lower nasal portion, but the unnatural posi- 
tion of the eyes necessary to see with this portion of the 
field prevented further work. 
The ophthalmoscope showed perfectly normal fundi. 3 
The retinal veins seemed more engorged and tortuous 
in the temporal portions of the fundi in the latter part of 
the day than in the morning. As the patient was con- 
siderably run down in health and the weather was very 
warm, I deferred the use of mercury and ordered syrupus 
ferri iodidi in large doses and rest in the mountains, with 
abstinence from all attempts at reading or writing. On 
October 15th the patient returned, much improved in 
health and sight. The field of vision had increased so 
much that the temporal scotomata were only as large as 
the previously nasal good portion, and would not be thus 
complete till afternoon. As it was now quite cool, I in- 
stituted mercurial inunctions according to the plan of 
Finger, of Vienna. 
By December 1st the man had taken thirty inunctions, 
and the syrup of the iodid of iron was again given. 
From this time on his sight improved steadily until he 
was able to read almost all day, although compelled to 
rest at night. During January, 1893, the patient took 
neither mercury nor iodid. 
By February 1st vision was normal. The man was 
again given mercury (not on account of vision, but to 
combat the old syphilis), which he took for thirty days. 
Then he took potassium iodid in large doses for thirty 
days ; followed by a rest of like period ; and then going 
on with the treatment according to the plan of Finger. 
The point of interest to me was the peculiar recur- 
rence of the scotomata and the portion of the visual 
field affected. 
800 Madison Avenue.