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vision was lost; with the left eye the patient saw fiery rays with rainbow colours."
Guided by this observation, Dr. Hermel gave the medicine, in the 6th and 12th dilutions, in a case of choroidal congestion, of six weeks standing, causing excessively painful shootings in the eyeballs, copious lachrymation on gazing at any object, and appearance of a blue and red halo around flames. It speedily removed the symptoms. Dr. Jousset conducts the treatment of most cases of strumous ophthalmia with Ipecacuanha and Apis.
The bichromate of potash,
is so potent an irritant of mucous membrane wherever found that it can hardly but inflame the conjunctiva. It has 128 eye symptoms in Allen's Encyclopedia, and most of these speak of conjunctivitis, which in the chrome workers is seen to involve yellow discharge from the eyes, granulations and pustules, and even leucomata of the cornea. Burning was the chief subjective sensation experienced. Kali bichromicum is also an irritant of fibrous tissue; and accordingly we have some slight evidence of hypersemia of the sclerotic. "Several bright red spots and streaks in the white of the left eye*" appeared in Koth, who proved the second trituration.
Instances of the efficacy of Kali bichromicum in catarrhal, strumous, and rheumatic ophthalmia, are given by Dr. Drysdale in the appendix to his arrangement of the drug in the Hahnemann Materia Medica. In the two former affections it appears to occupy no distinctive place, and is hardly wanted; but for rheumatic, especially catarrho-rheumatic, ophthalmia it is a remedy of much importance. It resembles Hepar here, but is more suitable when the sclerotic and iris than when the cornea is affected.* Such
* Travers has described a form of iritis to which it is peculiarly suitable. "There is," he says, "a slow inflammation of the iris which differs from the acute form, chiefly in its very gradual access; its comparatively moderate pain, and that affecting only the ball and the region of the orbit; the very would be my own conclusion from experience and recorded results; but I am bound to mention that Dr. Allen reports a case of pannus from granular lids, in which the eyes cleared up wonderfully under the medicine, and Dr. Norton has found it useful in opacities of the cornea. He also commends it in descemetitis and in croupous conjunctivitis.
has of late years received a very thorough proving in America. Those who took part in it experienced a good deal of injection of the eyes, burning and pain in them, and blurring of vision; but there was so much general derangement concurrent therewith, that these might have been set down as occasional and sympathetic, save for one singular circumstance. It was, that a prover of the drug, a married lady, who took two doses of the 3rd dilution daily for six days, after suffering much inconvenience in the eyes, found that an astigmatism, under which she had laboured for a twelvemonth past, had disappeared. The attention of the late Dr. Woodyatt, of Chicago, was thus drawn to the medicine, from the special study he made of the action of drugs on the accommodatory apparatus of the eyes. At first he thought that it caused ciliary paresis, like Argentum nitricum; but, later, came to the conclusion that it rather resembled Physostigma and corresponded to spasmodic conditions of the ciliary muscle. Astigmatism, however, was always his special indication for it; and he has published several cases in which this condition, co-existing with other disorders of the sensations and functions of the eye, has disappeared under its use. We shall see that astigmatism has been induced by Physostigma; there is no reason, therefore, why it should not be removed, when
slight degree of superficial vascularity; the membranous form and sparing quantity of lymph effused, or its actual imperceptibleness; and the frequent concomitant affection of the cornea with minute and superficial herpetic ulcers of a brown colour." This last symptom reminds us of the " brownish spots of the size of pinheads" noted by two provers of the bichromate.
dependent on the muscular irregularity which must be assumed to be present in such a case, by a similarly acting medicine like Lilium.
I now enter upon rather an important inquiry on the action upon the eyes of
in its various forms.
That this metal can cause conjunctivitis I conceive to be beyond doubt. I would not lay too much stress upon the symptoms of this kind which appear in Hahnemann's pathogenesis of M. solubilis. They are all credited to his son Friedrich, and there is somewhat very suspicious about this gentleman's contributions to the pathogenesis in question. Hahnemann himself, however, records "inflammatory swelling in the region of the lachrymal bone," "the upper lid is thick and red like a stye," "eyes agglutinated in the morning," and "burning in the eyes, as after reading too much at night; one eye is red;" which, so far as they go, point in this direction. To the same effect are Hering's symptoms obtained from the biuiodide, which, though the vague "inflamed" is the only phrase used, pretty certainly point to irritation of the conjunctiva. Overbeck found the surface of the eyes inflamed in the animals he poisoned by mercurial frictions,* and those exposed to the chronic influence of the metal, as miners and workers in it, experienced the same effect. "Eyes inflamed, with swollen inverted tarsi, and very sensitive to light," "blennorrhcea of both eyes," "chronic conjunctivitis, with a fine, rosy-red injection around the cornea,"—such are some of the recorded effects of it in these subjects. M. corrosivus, also, has some plain symptoms— objective and subjective—of the same irritation (S. 69, 72, 75, 81—83, of Allen).
It is quite appropriate, therefore, to find Dr. Angell and Drs. Allen and Norton in complete agreement as to the high place occupied by the mercurial preparations in the * Merc, und Syph., 1861.
treatment of the inflammations of the surface of the eyeball. They concur in praising the ordinary preparations of the drug in blepharitis, where the lids are red, thick, and swollen, in superficial keratitis, and in episcleritis. Both keratitis and scleritis, I should say, have been observed among the workmen in Mercury. Corrosive sublimate is highly esteemed in strumous ophthalmia, where the inflammatory and ulcerative symptoms run high ;* and Dr. Jousset—and with him Dr. Dekeersmaecker—treats purulent ophthalmia by instillations of its third decimal dilution.
A more difficult question arises when we come to the relation of Mercury to iritis. It is generally given in the homoeopathic treatment of the disease, either as M. solubilis or M. corrosivus, and is supposed to act upon the principle of similarity. It had certainly been often observed that mercurialised patients are especially apt to have iritis, and it was natural to connect the two as cause with effect. Travers is the author most frequently cited by the advocates of this doctrine, and he indeed seems at first sight to bear them out. "The occurrence of iritis," he says,f "during the use of Mercury is so well established and familiar a fact, among persons who see much of ophthalmic diseases, that their first inquiry of a patient labouring under it is, not whether he has recently contracted syphilis, but whether he has taken Mercury." So clear is he as to this causation, that—advocating as he does the free use of the drug in the treatment of iritis—he discusses at length the apparent paradox that it should act both as bane and as antidote. But when we look further, we find him admitting that "with one exception" he "cannot call to mind a well-established case of primary iritis occurring during the constitutional action of Mercury for a disease in which the genitals had had no concern, as enlargement of the liver, &c." He moreover states that the inflammation does not come on during the continuous
* See Brit. Journ. of Horn., vols, iii and xxii. Others of the irritant mercurials, as the biniodide, the red precipitate, and the nitrate, are also recommended here.
t Surgical Essays, i, 67.
anti-syphilitic treatment, while the patient is shut up in the hospital, but subsequently, and generally as the result of exposure to cold and damp; and that it is less frequent among the better classes, who are not so liable to these Icedentia.* It appears, therefore, that for Mercury to cause iritis, two other factors are requisite, either of which is sufficient (as we know) to develope the disease without its aid. On the other hand, we have the extreme improbability that an antiplastic agent like our present drug, all whose inflammations are erythematous and suppurative, should set up an adhesive one such as syphilitic iritis is; and the still greater anomaly that it should cure, in physiological doses, the very affection it had caused on the same subject. Kussmaul, moreover, tells us that "no case of iritis, in any form, has been noticed among the workers" in Mercury, among whom, if anywhere, it might have been expected to appear.
I think, then, that as here there can be no question of insufficient proving, we must conclude that Mercury is incapable of causing iritis, and is not homoeopathic thereto. Drs. Allen and Norton, indeed, seem to warrant its efficacy; but when their language is scrutinised, it hardly smacks of the personal experience with which they often speak, and which I should always receive with respect. Dr. Angell speaks of Mercury only as one of several remedies—Aconite, Bryonia, Belladonna, &c., which he uses in the treatment of iritis; and all these physicians conjoin the instillation of Atropia, with the aid of which many cases of the disease will get well of themselves. I am, therefore, justified in advising you not to rely upon Mercury as a homoeopathic remedy in the treatment of this affection of the eyes. You must either treat it with other remedies, or—as in the syphilitic form of iritis you will sometimes have to do—you must administer Mercury so as to induce its physiological action, which is directly antipathic to the morbid condition present. You may remember the vivid description of Watson:
* Graves, who also notices the occurrence of iritis in mercurialised patients, refers it solely to these atmospheric causes.