Historical Note
Seneca and the First Description of Anton Syndrome
Charles André, MD, PhD
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Abstract: Seneca was a Roman philosopher, politician, and
mentor to the young Nero. He later fell in disgrace and was
sentenced to death by the Emperor. Seneca left many texts,
one of the most influential being his Moral Letters to Lucilius
(63 CE). In Letter 50, he describes the case of Harpaste, his
wife’s foolish slave who acutely became blind. She denied
her illness and argued irrationally about room darkness, con-
stantly asking attendants to change her quarters. Harpaste’s
case, consisting of acutely acquired blindness and anosog-
nosia in the presence of relatively well-preserved cognition,
fulfills the clinical criteria for the diagnosis of Anton syn-
drome, and probably constitutes its first description.
Journal of Neuro-Ophthalmology 2018;38:511–513
doi: 10.1097/WNO.0000000000000682
© 2018 by North American Neuro-Ophthalmology Society
D
eficit unawareness was initially described by a number
of authors such as Wernicke (aphasia) and Westphal
(hemianopic and proprioceptive deficits) (1). Von Monakow,
Déjerine and Vialet, Rossolimo, and F. Müller were among
the first to describe it after cortical blindness (2–4). However,
Gabriel Anton (1858–1933) and Joseph Jules François Felix
Babinski (1857–1932) were the first authors to highlight the
importance of anosognosia (“anosodiaphoria”) in patients with
specific deficits from acquired focal cerebral disorders and ex-
hibiting relatively preserved cognition. While Babinski concen-
trated on anosognosia in hemiplegic patients (5), Anton must
be praised for describing in detail the psychology of these focal
diseases and for attempting to develop a pathogenetic theory
based on neuropathology (6). He described patients with
acquired severe blindness or deafness who were unaware of
Department of Neurology (CA), Faculdade de Medicina, Universidade
Federal do Rio de Janeiro, Rio de Janeiro, Brazil; and Department of
Neurology, Sinapse Neurologia e Reabilitação (CA), Rio de Janeiro, Brazil.
The author reports no conflicts of interest.
Supplemental digital content is available for this article. Direct
URL citations appear in the printed text and are provided in the
full text and PDF versions of this article on the journal’s Web site
(www. jneuro- ophthalmology.com).
Address correspondence to Charles André, MD, PhD, Rua
Visconde de Pirajá 414, sala 821, Rio de Janeiro CEP 22410-002, RJ,
Brazil; E-mail: dr.charles.andre@gmail.com
André: J Neuro-Ophthalmol 2018; 38: 511-513
Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.
their deficits, attributing them to external factors despite being
confronted by reality (7–9).
I present evidence that the Roman politician and
philosopher Seneca the Young (c. 4 BC-65 AD) described
the case of Harpaste, a woman who was unaware of her
acquired blindness, at the start of the Christian era.
THE CASE OF HARPASTE
The “Moral Letters to Lucilius” were probably written in 63
AD, during Seneca’s political exile (10). Their main focus was to
discuss the principles that should guide a sage’s life. In Letter 50,
Seneca described how one of the maids of his second wife
—“my wife’s female clown” (uxoris meae fatuam), called Har-
paste— was kept in his house as “a burden incurred from
a legacy” (11) (see Supplemental Digital Content, http://
links.lww.com/WNO/A322). Although omitting particulars
such as age or any disease characteristics, Seneca clearly described
how “this clown” (Haec fatua) suddenly became blind. The
story sounds incredible, but I assure you that it is true: she does
not know that she is blind. She keeps asking her attendant to
change her quarters; she says that her apartments are “too dark.”
Seneca stated that we should not laugh at Harpaste because we
also tend to deny and give excuses for our defects and sins and
do not look for help to avoid these behaviors.
DISCUSSION
In a troubled period when the Roman Empire was suffering
economically, Britain was up in arms against it, and Roman
temples were being seized, Seneca fell in disgrace. He became
aware that Nero and the praetorian prefect Tigellinus intended
to kill him (Fig. 1). As stated by the Historian Publius Tacitus
(c. 56 AD-c. 120 AD): “According to some writers, poison
was prepared for him (Seneca) at Nero’s command by his own
freedman, whose name was Cleonicus. This Seneca avoided
through the freedman’s disclosure, or his own apprehension,
while he survived on a very simple diet of wild fruits, with
water from a running stream when thirst prompted.” (12).
A romantic version of this event, by “Malachi Mouldi”
(actually Henry Godwin [1811–1874]) put Harpaste in the
center of this episode (13). Here, she was said to have
511
 Historical Note
FIG. 1. Nero and Seneca, by the Spanish sculptor Eduardo Barrón (Moraleja del Vino, Zamora, 1858—Madrid, 1911). Museo del
Prado, Madrid, Spain. The sculpture (1904) dramatically highlights the differences in character between the emperor and his tutor.
accompanied Cleonicus and the praetorian Julius Pollius in
their visit to obtain the venom from the famous Gallic hag,
Locusta. The visit terrified Cleonicus and only ended when
Locusta, after giving instructions on how to use the venom
(which had been useful on other occasions for Nero), danced
and chanted the last couplet of a dreadful Gallic chant, took
the venom herself and immediately died.
In the aftermath of this visit to Locusta, Harpaste would
have repeated short fragments of what had been said in an
unconnected manner. On the day of the planned poisoning of
Seneca, at the exact moment Cleonicus gave him a glass of
water with the venom, Harpaste, who was “winding some
silken cord for Seneca’s wife, Claudia,” unexpectedly sang Lo-
custa’s last couplet:
“To these four scores I add but one, and then
the sacrifice is done”
All this frightened Cleonicus so much that he “dashed the
cup to the ground; fell at his master’s feet, and confessed the
whole!” (13).
Mouldi described Harpaste as a young and blind idiot
girl, a half-witted jester whose singular fantasies some-
times provoked a smile in Seneca’s grave countenance.
She was capable of “extraordinary sayings”. Her malady
was said to be of recent origin. The famous Letter 50 to
Lucilius was reproduced with a short comment on the
philosophical implications of Harpaste’s denial of her
blindness. Also, the author mentioned that the witch,
Locusta, held a burning brand right in front of Har-
paste’s eyes and that the blind girl reacted exclaiming:
512
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“Tis lighter!-“tis lighter! I told you it was not dark out of
doors.”
There is no doubt that Harpaste is a historical personage (14)
and as such she was described by later authors (15,16). Seneca
does not give a clue as to her age at symptom onset. His short
report indicates an acquired disorder restricted to the nervous
system. Whether or not she would nowadays be considered
demented is controversial. Seneca considered her a jester. The
words used to describe her—fatuam, fatua are feminine deriva-
tives of fatuus, which does not mean demented, but foolish,
simple, silly (“Ego me ipsum stultum existimo, fatuum esse non
opinor:” I consider myself stupid, not silly.) (17). If we lend credit
to Mouldi’s description, Harpaste had no significant motor def-
icit, aphasia, or apraxia, and did not suffer from short-term
memory problems. Of course, no firm statement about executive
functions and a number of other cognitive aspects can be made,
but Harpaste apparently could take care for herself.
The core symptom in Anton syndrome is unawareness of
a major sensory deficit, for which a number of mechanisms
have been proposed (18,19). Patients may seem inattentive or
not fully aware of their deficits; or may exhibit anosognosia,
complaining of poor lighting, or giving confabulated descrip-
tions of scenes or faces (20). Anton justly emphasized the
specificity of the problem, stressing that patients should not
exhibit frank cognitive decline. However, all the patients
described by him exhibited additional neurological deficits
including language dysfunction, and these additional mani-
festations should not exclude the diagnosis (19,20).
Harpaste suffered from acutely acquired blindness and
vigorously negated her condition. Whether this was caused
André: J Neuro-Ophthalmol 2018; 38: 511-513

by a stroke or another disease process causing cortical
blindness (19–23) is a matter of speculation. Seneca’s
description, however, should probably be acknowledged as
the first case report of Anton Syndrome.
ACKNOWLEDGMENTS
The author thanks Professor Péricles Maranhão Filho, MD,
PhD, for insightful discussion and comments, and Dr. Sergio
Telles Ribeiro Filho, MD, for English editing.
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Historical Note
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