Katharine Marshall looks at the work of physician Hubert Airy on migraine auras, or scintillating scotomas.
You might be forgiven for thinking that the following illustration is a piece of twentieth-century abstract art, with arching zigzag lines of white pastel against a black background, highlighted with flashes of primary colours:
Sinistral teichopsia, lithograph from a drawing by Hubert Airy, 1870
In fact, it’s a visualisation of a migraine aura or scintillating scotoma by the physician Hubert Airy (1838-1903). The composition shows the stages of the visual disturbance as it grows and expands across the left-hand field of vision. The phenomenon can be a precursor to the onset of a migraine headache, although it only presents in a small number of sufferers.
Airy’s paper, ‘On a distinct form of transient hemiopsia’, was published in the Philosophical Transactions of the Royal Society in 1870. It brings together his own personal experience of the cloud-like aura with earlier accounts from fellow migraine sufferers. These included his own father, Sir George Biddell Airy FRS (then Astronomer Royal and later President of the Royal Society), and Sir John Herschel FRS, whose symptoms were mentioned in an earlier blogpost. Airy noted that ‘no one can fail to be struck by the amount of attention that this obscure malady has received from so many writers of such high scientific attainments.’ Given that the onset of the condition can be induced by ‘toilsome reading’ and ‘want of exercise’, this coincidence is perhaps less surprising.
Airy’s own description of the condition offers a vivid account of the blind spot, describing it as a ‘fortified town with bastions all round it, these bastions being coloured most gorgeously … All the interior of the fortification, so to speak, was boiling and rolling about in a most wonderful manner as if it was some thick liquid all alive.’ It is the distinct form of the scotoma which led Airy to rename the condition sinistral teichopsia to describe the left-handed, ‘town wall’-like vision. Airy was not alone in noting the beauty of the phenomenon, and although not painful in itself and only lasting for up to half an hour, it can be a precursor to debilitating migraine and hence a cause of great distress to the sufferer.
While preparing his paper, Airy wrote to John Herschel in 1868 to share his experience of the ‘strange appearances which visit my eyes’. Along with his detailed account is a chalk sketch very similar in composition to the later published version, with the stages of the aura developing over time. The drawings were kept by Herschel with permission from Airy, who was delighted that he wished to retain them. Airy was subsequently emboldened by Herschel’s support to publish his account. The illustration is now in the Royal Society’s Herschel correspondence; since the original paper is not present in our manuscripts of published papers, it’s nice to see that we still have an artwork of what has become the iconic image for the scintillating scotoma, still used as a reference in clinical settings.
Transient hemiopsia by Hubert Airy, 1868 (HS/19/307)
It’s clear from his letter that Airy was deeply troubled by his condition, often referring to it as morbid. He correctly deduced that the cause was located in the brain rather than the optic nerve, since both eyes are affected simultaneously. Airy was never elected a Fellow of the Royal Society, and his only other contribution to our journals was a handful of papers on leaf arrangement, in which he applied the theory of evolution to established facts of phyllotaxis. Perhaps the pleasing spirals of plant matter were a tonic to his headaches!
The leaf order of acacia and spinach by Hubert Airy, 1872, from his unpublished paper 'On leaf-arrangement' (AP/55/1). The picture at the top of the article is another diagram from the same paper.
