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