Optic Neuritis: Another Dickensian Diagnosis

Abstract

The clinical diagnosis and natural history of optic neuritis was established in the late 1880s by the ophthalmologists von Graefe and Nettleship. The earlier, accurate and insightful description of transient, bilateral visual loss of Esther, the main character in the Charles Dickens novel Bleak House (1852--1853), suggests optic neuritis as a Dickensian diagnosis. Remarkably, Dickens’ observations, also preceding the earliest clinical description of multiple sclerosis by Charcot in 1868, described many clinical features such as a prodromal phase; a nadir; gradual recovery over weeks; glare disability; reduced contrast sensitivity; possibly Uhthoff’s phenomenon; and visual fading. All this with an accuracy that, to quote Russell Brain, “would credit a trained physician.”

• Charles Dickens
• history
• optic neuritis

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

The MS Center, VU Medical Center, is partially funded by a program grant of the Dutch MS Research Foundation.