MAY 21 1886

LIBRAT

'N.

CINCINNATI

Medical and Dental Journal.

It is not our intention, in this article, to give a description of the various kinds of ulcers that implicate the cornea. We intend to give the history and treatment of a case that came under our charge, with a few remarks in reference to the latter as it presented itself in this particular case.

There would be nothing of especial interest in an article on an ordinary ulcer of the cornea, for the readers of this journal are, doubtless, all familiar with the condition that exists in such cases, as well as the treatment. However, so far as the lesion of the cornea in our case is concerned, it would not be considered rare or important. There are other conditions that will bear a little investigation.

On the 29th of August, 1879, G. A. presented himself at the office for treatment. He is a young man, gardener, æt. 24, and has always enjoyed good health. His habits have been good and

he has no specific history.

About ten days previous to the time that he called on me, his left eye began to get red and painful. Various remedies were suggested by his friends and used without any benefit. On the con

trary, the pain and irritation gradually increased. By this time vision was so much reduced in this eye that he could not see with it, hence he became alarmed, fearing that it might be lost altogether, and sought medical advice.

On examination the following condition was observed. There was a large, irregular, dirty-grayish ulcer on the left cornea, extending from the center of that organ two-thirds of the distance to its inferior margin, being about one-half as wide as it was long. There was considerable conjunctival and sub-conjunctival congestion with the attending circum-corneal rosy zone. He had the sensation of sand or dirt under the eyelids; lachrymation, the weeping being very profuse, with intense photophobia, so that he could scarcely bear the examination in ordinary light, or even use the sound eye in a moderate degree of illumination without an increase of irritation. There was considerable pain, which, as would be expected, was increased by light. He stated that for the past few days he "had been feeling bad generally," his appetite being poor and occasionally having some fever.

The treatment prescribed was the ordinary atropine solution, three drops every four hours, a compress bandage, opiates to relieve the pain, especially at night, and to remain in a dark room. He then went home, some eight or ten miles from the city, I saw him on the 31st, but there was no change in the condition of the ulcer. The opiates relieved the pain that had annoyed him so much at night, The febrile condition still existed but less marked.

I saw him on the following dates, Sept. 4th, 9th, 14th, 19th, 22d, Oct. 3rd, 7th, and 11th. During nearly all of this time he would have a chill followed by fever, every other day, signifying a tertian type of intermittent fever. The pulse varied from eighty to 130 beats per minute. The temperature ranged from 99° to 103.4° Fahr. During this period I gave him quinia freely, and when that did not have the desired effect, arsenic was added to it.

The ulcer of the cornea did not change very much. Part of the time it looked very well and seemed to be improving. Then it wouid remain the same or get worse. It looked best before he had a chill, but was almost always worse afterward. The rise in bodily temperature increased the congestion and aggravated all of the symptoms. It did not extend down to Descemet's membrane, so there was not the slightest tendency to keratocele. There

was some infiltration, but not any more than would naturally be expected from this kind of a ragged, irregular ulcer. There did not appear to be any special increase of tension, yet there was no disposition on the part of the infiltration to become absorbed, or of the ulcer to clear up. Cold applications were used, being apparently of service at first, but they soon appeared to increase the pain, and then warm applications were used.

During this period I endeavored to find a cause for these effects, but without success. I made a physical examination of the heart and lungs, but found nothing that would account for his condition. He had no cough but occasionally had some functional disturbance of the heart. No especial evidence of disease could be located in the abdominal organs, yet there was that vague feeling in them that told him that there was something wrong, but he did not know what it was. The urine was examined with a negative result.

On the 11th of Oct. the condition of the eye was about in statu quo, while his general health was worse. He continued to have chills followed by fever, which, instead of being intermittent, had become remittent. He had no appetite and simply took his food in a mechanical manner without any desire for it. He was restless, had headache, with some nausea, nervous, with a vague, indefinite, undefined feeling of discomfort that he could not locate nor explain.

The search for the cause was resumed, and I asked him if he was in the habit of using tobacco. He stated that he had smoked moderately and chewed almost constantly from the time that he got up in the morning until he retired at night. But, he added, in an explanatory tone, "I have not touched tobacco since my eye got sore." When he made this statement, I was satisfied that I had the key that would open this Pandora's box that had been locked up in his system. I'told him to get his tobacco and commence chewing it at once. The expression that glowed on his countenance signified that he would do so with pleasure.

He had

The rest of the history in this case is easily related. no more chills, the fever gradually but rapidly subsided, and a healthy action was soon observed in the corneal ulcer.

Here was a case that appeared to be enveloped in mystery like mist around a mountain. Nothing definite or plain, but all vague and obscure, yet all of the darkness was dissipated, I was about to say, by the light of tobacco.

At the next visit, which was the eighteenth, all internal medication was stopped, except, if necessary the narcotic at night. On Nov. 18th he was discharged having a clear cornea and good vision in the left eye.

Under the circumstances, I think a few remarks about the effect of tobacco on the system will not be out of place, and especially in connection with this case.

Tobacco is a sedative narcotic to those who are habituated to its use. Remove it from them and in a short time they become nervous, the heart's action increases and a febrile condition is developed. They generally complain of cephalalgia and a feeling of malaise, with an indifference to labor, mental or physical. When they commence using it again in the accustomed manner it exerts a soothing and calming influence upon the nervous system. The headache ceases, the fever disappears, the heart resumes its wonted action and the indisposition to exertion passes away.

A poison in a small dose is a tonic, while a medicine in a large dose may act as a poison. Arsenic and strychnia, although both are poisonous if given in sufficiently large doses, differ greatly in their effects upon the system. One is the alpha and the other the omega in the list, so far as the effect upon the nervous system is concerned. The one produces its effect by relaxation, the other by contraction.

Tobacco in its effect upon the system presents more of the properties of strychnia than of arsenic. When a person has been in the habit of using tobacco for a long time, the system becomes habituated to its use. It is not only a tolerance, but a person may become so accustomed to using it that it acts as a sedative to the nervous system. Withdraw it suddenly from such an one and we have headache, languor, nausea, nervous irritability, fever, loss of appetite and sleep. This is the condition that existed with our patient, the fever being first, intermittent and then remittent.

It must not be inferred from the above that we are advocating the use of tobacco as a tonic or stimulant to the system. We are simply presenting the other side of the question, as we conceived it to be in our patient.

We are aware that in some instances the slow and chronic form of producing a structural change is productive of more permanently injurious results than the more acute or active variety. In the same way tobacco may gradually produce its effect upon the system, more especially in those cases where there is rapid

In the youth who is

development of new tissues and structures. developing rapidly, we have presented a condition of activity; the energies of nature are exercised in the formation of new structures, and it is necessary that the nutrition should be healthy. Unless it is, we cannot expect a perfect cell to be formed, and as the latter is essential to perfect development, it becomes necessary that all agents that exert a baneful influence should be avoided. Not that nature will have to succumb to their influence in all cases, but it is an impediment in the way of progress. It is an obstacle that cannot always be surmounted, and consequently is incorporated as a compromise in the formation of the tissues.

That substance which is included in the compromise may become so intimately connected with the structures, and have such an influence upon them, that its sudden withdrawal cannot be accomplished without a severe shock to the nervous system. If the person, whose system has been easily led into a tolerance of this kind, so that, apparently at least, it acts as a sedative and tonic, should be attacked by disease, the question might arise, is the absolute and sudden removal of the agent from the patient the best course to pursue? Would such a proceeding assist in fortifying the system against the disease, or would it be detrimental under the existing circumstances? An enthusiast might say, stop it at once and hazard the result. The careful and scrutinizing physician would hesitate before he would follow the advice given by a visionary and fanatic, for, by weighing the pro and con, he might see that such a process woud tend to remove the patient from the disease, rather than the disease from the patient.

The most remote portions of the body are not exempt from the effect of any drug introduced into the system. So long as any part of the body is dependent upon the law of induction for its sustenance, so long must it respond to the source from which it derives its nourishment. While nature is provided with healthy nutrition she performs her functions easily and well. Every portion true to herself, continually building, accumulating and developing, the only destruction she knows is the waste or decay incident to growth. In this manner nature has carved her own steps in the rock of ages upon which she ascends the heights of progress.

The power of a cell consists in its ability to transmit all of the impression that has been made upon it. In order for it to do so, it is necessary that a certain amount of resiliency should exist.