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He speaks of the unmerited disuse into which it had fallen in his day; and it is not otherwise in our own, save in the school which calls him master. There the drug has found and still finds constant employment. Its chief action is upon the conjunctiva, which it affects in connection with the whole upper part of the respiratory mucous membrane. It is a catarrhal process which it sets up there, with the usual objective and subjective symptoms. The irritation seems to extend to the lachrymal glands, as the tears are very abundant, and in one observation of Hahnemann's are characterised as "biting." I cannot find in the pathogenesis of the drug that which Dr. Dunham describes—" the tears are very acrid, excoriating the lids, which swell and ulcerate on their margins, and causing inflammation and even suppuration of that part of the cheek which is kept wet by themthough such phenomena, when occurring in disease, may well indicate it. For me, Euphrasia is the one remedy for simple acute conjunctivitis when the eye is moist, Belladonna taking its place when dryness is present; and Jousset, Angell, and to some extent Allen and Norton, agree with me in this estimate of the medicine. Euphrasia acts upon the cornea only when this is secondarily involved in conjunctivitis, but under such circumstances is highly efficacious in removing its active ulcerations and secondary obscurations. It thus plays an important part in the treatment of strumous ophthalmia,—lachrymation (which may be acrid) and profuse secretion here as in catarrhal inflammation being its characterising features. In this it resembles Arsenicum, but its discharges are thicker thau those of that drug.
The indications in the pathogenesis of Euphrasia of deeper action than on the conjunctiva are obscure. But Dr. Dudgeon has communicated to the British Journal of Homoeopathy* two cases in which a rapid cure of rheumatic ophthalmia (sclerotitis and iritis) was effected by it, after other remedies had failed. I would refer you also to an interesting paper by Dr. Robert Jackson in the * Vol. ixii, p. 355.
Medical and Physical Journal for 1810. He there relates several cases where chronically impaired vision, co-existing -with signs or feelings of disorder in the eyeballs of various kinds, was greatly benefited by an infusion of the plant.
My next medicine is one of comparatively recent introduction into homoeopathic practice, but which has already taken a high rank therein, the yellow jessamine,
The effects of this drug have been ascertained by many (American) observers of the school of Hahnemann, whose results (with symptoms from cases of poisoning) are collated by Dr. Allen in his Encyclopedia: they have also been studied of late in this country by Drs. Ringer and Murrell.* They closely resemble those which we have lately seen in Conium, and—as with that drug—the ocular muscles are among the earliest to feel the paralysing influence. Ptosis, however, is more marked than defective power of accommodation of vision, and diplopia is far more constant. This last has been found to depend upon loss of power of the sixth nerve, which (as you know) animates the rectus externus, and is specially affected by the drug. Its paresis probably accounts for the "confused vision" so often mentioned by the provers (S. 152—159 of Allen). The symptoms come on about an hour and a half after administration.
The behaviour of the pupils under the action of Gelsemium seems at first sight somewhat puzzling. In poisoning cases, they are dilated and insensible to light. Drs. Ringer and Murrell found the same condition set up by dropping the fluid extract into the eye; but its internal employment, in the moderate doses used by them, caused the pupil to contract. This would at first seem like an opposite action of large and small doses; but the observations of Dr. Tweedyf suggest a different explanation. He found the application of the alkaloid Gelsemia to cause
* See Lancet for 1875-6.
at first ciliary (not conjunctival) injection, with slight contraction of the pupils: then ensued dilatation, whereupon the hyperemia disappeared. Putting this together with the pain in the brows and eyeballs experienced by Drs. Ringer and Murrell's provers, it would suggest that their contracted pupils were connected with a certain approach to congestion of the ciliary vessels, of which we have several analogous symptoms in the brain and spine.
Dimness of sight has often been experienced after full doses of Gelsemium, and even blindness. Except in cases of poisoning, the disorder of vision is probably due to paralysis of accommodation, which is caused by the drug, though not so actively or for so long a period as by Belladonna. From toxic quantities, however, actual amaurosis may ensue, as under these circumstances the sensibility in general is destroyed.
We thus find a double sphere of action for Gelsemium in affections of the eyes.' Its paralysing influence makes it an apt remedy for ptosis, and other affections due to loss of power on the part of the ocular muscles. It receives general praise here. Among the testimonies in its favour, I may cite that of Dr. Vilas, of Chicago, who says :* "Gelsemium has been of great value in my hospital and private practice in cases of this nature. Morbid states which failed to respond to other means have been ameliorated or cured by it; and electricity has ceased to be the specific for such troubles." But Drs. Allen and Norton have carried the use of the drug a step farther, viz.: to inflammatory affections of the retina and choroid. Retinitis albuminuria, coming on during pregnancy, chorio-retinitis, in which there seemed to be a bluish snake before the vision, and serous choroiditis, have been cured by them with it; while the latter physician has put on record several cases of recent detachment of the retina in which it seems to have greatly aided in recovery.f Dr. Park Lewis, at our late International Convention,! spoke
* Amer. Momoeopathist, i, 5.
t Ohio Med. and Surgical Reporter, July, 1877.
X Transactions, p. 123 of Minutes.
of Gelsemium as almost specific in serous iritis, and Dr. Norton now makes claims for it as influencing the whole uveal tract when this form of inflammation is present.
I have next to speak of the sulphide of calcium,
The pathogenetic symptoms of this substance, as recorded in the fourth volume of Hahnemann's Reine Arzneimittellehre (not in the Chronischen Krankheiten, which are of more dubious character), speak plainly of its power to inflame the eyes and lids. "Inflammation, redness, and swelling of the upper lids, with rather pressing than shooting pain," "eyelids closed on waking, so that for some time she cannot open them/' "eyes sore, agglutinated at night," "eyes sore, inflamed, and swollen, with redness of the whites,"—so he describes them; he speaks also of mucopurulent matter forming in them.
The composition of Hepar sulphuris, and its close analogy to Mercury, have naturally led to its being employed in those obstinate affections of the eyes which are connected with the scrofulous diathesis. It has been found to act chiefly on the lids and on the cornea. It is very useful in blepharitis, especially when the Meibomian glands are much involved, and in acute phlegmonous inflammation of the lids. In Peters' Treatise on Diseases of the Eye you will find collected many recorded instances of its value when the cornea was affected; and will see that it has cured cases where onyx, hypopion and prolapsus iridis were present. It is in "catarrho-rheumatic ophthalmia" that such troubles are especially seen, so that the power of Hepar over suppuration makes it specially available here. It has also shown great influence over recurring ulceration of the cornea in ophthalmia scrofulosa. Drs. Allen and Norton fully confirm its value in every form of keratitis save the syphilitic, mentioning great photophobia and relief of pain by warmth as characteristic of it.
of which I have now to speak, would hardly have been thought to affect the eyes. Two authors are indeed cited by Hahnemann as having observed "inflammation of the eyes" caused by it; but one is speaking of the local effects of the powder, which is well known to be very irritating, and the other merely mentions "eyes a little inflamed/' as part of a general catarrh induced by its inhalation in one very susceptible to its influence. But a physician of Halle, Dr. Tamhayn, has published in the Journal fur Pharmacodynamik for 1877 a.striking case in which a druggist's assistant experienced, on four successive occasions after pounding ipecacuanha, an attack of what I think we can only call acute choroiditis. You may read it at length in the twenty-eighth volume of the British Journal of Homoeopathy; but here it is, as epitomised by Allen.
"Awakened at 3 a.m. by raging pain, more severe in the right, less in the left eye, with excessive lachrymation which soaked the pillow, and loss of vision (1st night).— Intense tearing pains, especially in the right eye, extending but a little way towards the temple; on opening the right lids, which were swollen, a copious gush of tears; the conjunctiva of the bulb was injected and infiltrated, the tunica vaginalis swollen, the cornea dim and infiltrated. On close examination there were noticed a number of small depressions; the iris seemed congested and had a dull look, the pupils contracted, reacting but little or not at all to the light, vision completely lost. After eight weeks these symptoms appeared in the left eye, after again pounding the drug, but this time associated with nausea and inclination to vomit. A third time, after several months, from the same cause, he was awakened in the night by intense pains in the eyes, lachrymation, loss of vision. A fourth time he experienced a slight biting and pressing pain in the eye, light blinded him and increased the pain, the conjunctiva became red and chemosed, and again there was copious lachrymation: this time the right eye was most affected,