Crying Without Tears

When Miriam, aged 6 1/2, first appeared at Babies Hospital in Manhattan, there was not even a name in the medical dictionaries for what ailed her. She had repeated attacks of vomiting; reflexes like the knee-jerk were dulled or lacking; her hands and feet were blue and cold; she perspired so heavily that her bedclothes had to be changed soon after she fell asleep; her blood pressure skyrocketed and plummeted inexplicably; when she had a temper tantrum, which was often, she broke out in red blotches. But her strangest symptom sounded like something out of a fairy tale: no matter how hard she cried, there were no tears.

Gradually, Pediatrician Conrad Riley and a team of other specialists at Babies Hospital (part of the Columbia-Presbyterian Medical Center) collected a handful of other cases showing most of Miriam's symptoms. The one that appeared invariably was the absence or extreme scarcity of tears while crying. Another thing the doctors noted: all the children so afflicted were of Jewish parentage. (The first proved exception, a Quaker child, was reported only last week.)

Painstakingly, Dr. Riley and his colleagues sought for causes and cures of what they named dysautonomia (disorder of the automatic nervous system). From operations on the living and autopsies on children who died of infections, they ruled out adrenal tumors or physical damage to the brain. So far, they have found no cause, but there is no doubt that the disease runs in families, and susceptibility may be transmitted by both parents through a recessive gene.

So far, the doctors have not even a clue to a possible cure. A new and versatile drug, chlorpromazine, helps to control the attacks of vomiting that might otherwise last for several days each week. Beyond that, the best that the doctors can do is help the parents to establish a rigid routine in which the unhappy children can feel secure, with a minimum of occasions for emotional outbursts. Parents of dysautonomia victims have banded together to exchange notes on their children's progress and hints on how to handle them. They have raised $5,000 for research.

Last week, as Dr. Riley counted a total of 35 proved cases in the New York metropolitan area (with reports indicating a dozen more across the U.S. and Canada), the parents' group met to press its claim for a state charter. After incorporation, the parents hope to raise more money to help the doctor-researchers find ways to help their mysteriously afflicted children.

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