Anomalous Lacrimation

Abstract

A medical student, A. B. B., has been puzzled because during defecation and sometimes during urination, he has noticed a copious flow of tears. Inquiry has indicated that the experience was at least relatively rare, and he has been unable to find reference to this response in the literature.

He was persuaded to record carefully the intensity of the response in relation to the situation which elicited it. He has made 508 observations during 94 days, the salient facts of which are detailed below.

A “drop” is defined as the amount of fluid necessary to fill the eye and run over onto the cheek. If enough fluid was produced to cause one drop to fall off of the cheek, this was considered 2 drops, or if more than one drop ran off, each was added.

It appears that defecation is a much more effective stimulus (2.2 drops, average of 86 observations) than urination alone (0.01 drops, average of 255 observations) or urination during a desire to defecate (0.4 drops, average of 114 observations), that performing the 2 acts at the same time (2.3 drops, average of 57 observations) does not enhance the response to as great a degree as does defecation with effort to retain urine (3.7 drops, average of 7 observations). The passage of watery feces is much less effective as a stimulus to lac-rimation (0.6 drops, average of 5 observations) than is the passage of normal feces. In addition it may be remarked that straining alone has no effect. Warm soap suds enemata and mechanical stretching of the anal sphincter are also without effect.

That the response involves the normal nervous outflow (parasympathetic) is indicated by the fact that the lacrimatory response is eliminated as a result of a moderate dose of atropine.