Doctors performed a comprehensive neurological exam, but it was not revealing. An MRI showed patchy lesions in the brain’s white matter, but nothing definitive emerged – no tumor, no stroke, no anatomical quirk. The woman was prescribed an anti-epileptic pill and then a drug for Parkinson’s disease. The therapy was ad hoc and empirical – guided more by despair than by recognition of an innate pathological process – but the hallucinations subsided and subsided. And then, surprisingly, the relationship ended. There was no telltale blossoming of the magic of diagnosis. The doctor did not turn into a wizard; no rabbit was taken from a hat.
It was as if Sacks were projecting the puzzle into the future for someone else to solve: in a distant time, it seemed to imply, another neurologist would read this story and find resonances with another case involving another. patient and complete the circle of explanation. So far, however, there was no diagnosis, only a description, observations without explanations.
It’s difficult to pinpoint a date when physicians began writing individual case histories, but the very first medical history documents contain spectacular examples of the genre. This is Hippocrates, writing about a patient around 400 BC.
“In Thasus, a woman with a melancholy turn of mind, because of an accidental cause of grief, while she was still walking, was affected with loss of sleep, aversion to food, and was thirsty and nauseous. … The first, at the beginning of the night, fright, much chatter, depression, slight fever; in the morning frequent spasms, and when they stopped she was incoherent and spoke obscurely. … In the second, in the same state; did not sleep; more acute fever. The third … apyrexia, slept, well collected; had a seizure. … Towards the third day, the black, fine urine, substances floating in her generally round, did not sink to the bottom; about the seizure profuse menstruation. The case described here is still open; it is difficult to find an accurate diagnosis that encompasses all the symptoms.