| Unequally sized pupils in combination with a drooping | | | | that I remember was a very remarkable one, and |
| eyelid on the side of the smaller pupil and decreased | | | | the first of its kind ever recorded. It occurred while I |
| sweating on the same side of the face is known as | | | | was executive officer at the Satterlee Hospital, West |
| Horner's syndrome, named for Johann Friedrich | | | | Philadelphia. As executive officer it was my duty to |
| Horner, a Swiss ophthalmologist who wrote up a | | | | assign new patients to the wards, and also to |
| case in 1869. When present, Horner's syndrome | | | | transfer the cases in the specialties, such as the eye, |
| indicates interruption of the sympathetic nervous | | | | nervous diseases, and injuries, etc., to the special |
| system on that side of the body and is still a valuable | | | | hospitals. One morning, as I sat at my desk, a soldier |
| tool in modern diagnosis.The sympathetic nervous | | | | applied for assignment. On looking up at him I said to |
| system helps govern various functions outside | | | | myself: 'You are Dalton's cat.'"Those familiar with |
| conscious control, like pulse, blood pressure, sweating, | | | | Dalton's good old textbook of physiology will |
| etc. The portion of the sympathetic pathway | | | | remember a cat whose right cervical sympathetic |
| influencing the eyes and face follows a convoluted | | | | nerve [the portion in the neck] had been severed. |
| pathway that starts in the brain and flows down | | | | The left pupil is very large, the right one very small, |
| through the brainstem to the spinal cord. At the base | | | | and the moment I looked at this man I was struck |
| of the neck, the pathway passes outward from the | | | | by the similar condition of his pupils. I quickly asked |
| spinal cord and through the top of the lung. From | | | | him, 'Where are you wounded?' and when he pointed |
| there it rises through the neck again and into the | | | | to his neck I said to myself again, 'That ball |
| head where it finally reaches the eye and face. A pair | | | | destroyed the sympathetic nerve.'"In the autumn of |
| of otherwise identical sympathetic pathways serves | | | | 1864 I took a copy of [our] book to Claude Bernard, |
| each side of the head.While Horner's observations | | | | in Paris, [a legendary physiologist and] the discoverer |
| were valid and the syndrome has been known by his | | | | of the function of the cervical sympathetic and the |
| name ever since, he was not the first to recognize | | | | effect of its division [cutting] upon the pupil and the |
| this condition. Instead, an American physician by the | | | | blood vessels. He exhibited true Gallic enthusiasm |
| name of William Keen first diagnosed a case of | | | | when I showed him the first recorded case in the |
| "Horner's syndrome" in an injured Union soldier during | | | | human subject, which confirmed his brilliant |
| the American Civil War. The soldier, Edward Mooney, | | | | researches.""Dalton's cat" was a drawing in John Call |
| had been shot through the right side of his neck at | | | | Dalton's "A Treatise on Human Physiology." Keen |
| the battle of Chancellorsville.In 1864, along with fellow | | | | attended Jefferson Medical College in Philadelphia |
| physicians, Silas Weir Mitchell and George Morehouse, | | | | between 1860 and 1862, and may have seen the |
| Keen published a small book, "Gunshot Wounds and | | | | drawing in either the first edition (1859) or second |
| Other Injuries of the Nerves," that included Mooney's | | | | edition (1862). At a time when medicine was |
| case report under the title "Wound of the | | | | struggling to gain a scientific footing, Dalton's writings |
| Sympathetic Nerve." Fresh out of medical school | | | | were notable for being based on experimental |
| when he entered military service, Keen made the | | | | observations. Dalton was one of America's first |
| diagnosis upon recognizing the similarities between the | | | | physiologists and had studied with Claude Bernard |
| soldier's face and that of a cat illustrated in a | | | | after graduating from Harvard Medical School in |
| textbook of physiology.In 1905, near the end of | | | | 1847.(C) 2006 by Gary CordingleyGary Cordingley, |
| Keen's career as a pioneering neurosurgeon, the | | | | MD, PhD, is a clinical neurologist, teacher and |
| College of Physicians of Philadelphia published his | | | | researcher who works in Athens, Ohio. |
| reminiscences about the case:"The first nervous case | | | | |