番茄社区

Perhaps it should be called Petit-Hare-Mitchell-Bernard-Horner syndrome?

Although oculosympathetic palsy has been referred to as Horner syndrome -- for Swiss physician Johann Friedrich Horner, who published a famous clinical description of the disease in 1869 -- others had described its constellation of symptoms several times prior.

That's what a group of doctors at University Hospitals Case Medical Center in Cleveland found out after a patient presented with the syndrome.

"We were talking with some med students about the history of this syndrome, just for educational purposes, and we read how it was first described in 1869," , corresponding author of a , told 番茄社区. "But then we came across an obscure reference far previous to that."

That odd reference opened the door to a more thorough search of the literature -- leading to many long nights in Case Western Reserve University's Allen Memorial Medical Library.

Miller and team worked with the library's archivist to find any and all references to the condition, combing through dusty volumes sequestered away in the sub-basement.

"We came across 200-year-old books that no one had checked out for 100 years," Miller said.

Inter-library loan helped, too, as did translation services, since many of the relevant texts were in French.

Miller's group noted that physician Claude Bernard identified and described all the major symptoms of the condition -- including constricted pupils, droopy eyelids, and a lack of facial sweating -- in two animal studies published in 1852, nearly 20 years before Horner's publication.

Miller noted that in Europe, Bernard's contributions are recognized and it's known as Bernard-Horner syndrome.

Other researchers also contributed to the literature on oculosympathetic palsy, going as far back as Francois Pourfour du Petit's work on animals in 1727.

They found two other reports of ptosis and miosis (droopy eyelids and constricted pupils, respectively) due to sympathetic nerve damage -- one by in 1838 and another by in 1863. Hare's work stemmed from observations of a brachial plexus tumor, while Mitchell's arose from gunshot wounds to the neck sustained by soldiers in the U.S. Civil War.

Rarely did any of these authors cite each other, Mitchell said. It could have been that they simply weren't aware of each other's work, given that medical information didn't disseminate as rapidly or as far as it does today. In addition, the basic science and clinical communities were not as entwined as closely as they are now, making the chances of communication between disciplines even smaller, he said.

However, Miller's team noted that Horner knew one of Bernard's students very well. Albrecht von Graefe was Horner's mentor, but he was also Bernard's student.

"A single person is almost never responsible for any single discovery," Miller said, adding that anatomical nomenclature has moved away from the use of eponyms for that reason. Indeed, the International Anatomical Nomenclature Committee voted to do away with them in the 1950s, according to Miller's group.

Horner did make other substantial contributions to medicine. He is responsible for routine eye testing in school children, Miller said, and he was the first person to establish that color blindness is an X-linked trait, passed to a male grandchild from an affected male grandfather through an unaffected mother. It was only the second known X-linked trait at the time, following John Hay's description of hemophilia in 1813.

"It's interesting ... that Horner did all of these things that were just as impressive, or maybe even more so," Miller said, "but he's remembered for the one thing that he didn't really do."

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