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"the instant that the patient's gums and breath acknowledge the specific influence of Mercury upon his system, a welcome change becomes apparent: the red zone surrounding the cornea begins to fade; the drops of lymph to lessen; the iris to resume its proper tint; and the puckered and irregular pupil once more to approach to the perfect circle; till at length the eye is restored to its original integrity, and beauty, and usefulness." It is the general testimony of the oculists of the old school that this can be accomplished by the induction of mercurialisation, and, in severe cases, cannot be attained without it. Unless those who practise homoeopathically can bring forward rebutting testimony, we seem to have before us an instance in which the rule "let likes be treated by likes" must be temporarily superseded. It would be with pain that we should have to admit the necessity, in any case, of so objectionable a proceeding as mercurialisation; but the eye is so precious an organ that most patients would willingly submit to a temporary sacrifice of general health, if really necessary for its restoration.
In all this, of course, I have been speaking of plastic iritis, i.e. of its occurrence as a sequela of syphilis. When resulting from "rheumatic" exposure, and rather of "serous" character, I see no reason why Mercurius should not be homoeopathic to it, though I myself prefer other remedies.
There is better evidence of the action, pathogenetic and curative, of Mercury, when we penetrate still deeper into the eye, and come to the retina and optic nerve. Impaired vision is a common symptom among the workers; and the frequent occurrence in these subjects of degenerative inflammation of the nervous centres suggests a similar condition as set up in the nervous element of the visual organs. The "incipient amaurosis" in which Hartmann speaks so highly of M. solubilis was presumably of this nature; and Drs. Allen and Norton say of retinitis albuminurica that "no remedy has been employed with better success in such a large number of cases" as M. corrosivus; "the inflammatory process is often seen to rapidly subside, and exudation into the retina disappear" under its action.
The symptomatic indications for the mercurial medicines in these disorders are that the discharges are profuse, burning and acrid, and thin; and that the pains are all worse at night, and for warmth, the heat of a light giving more inconvenience than its luminosity. They are thus especially useful in the affections, both of the mucous and nervous structures of the eyeballs, which occur in those much exposed to the glare of a fire, as workers in foundries.
is another substance whose action on the nervous centres is so keen and profound that it can hardly fail to influence the retina and optic nerve. Our knowledge of its physiological effects thereon are but slight, as the amaurosis with dilated pupils observed in cases of poisoning may be the result of failure of the heart's action, as in haemorrhage; and Hahnemann's symptoms in his Chronic Diseases were observed upon patients. Such as they are, however, they correspond very fairly to the kind of impaired vision Phosphorus would be likely to cause, and to that which it cures. "She was obliged to hold objects near in order to see distinctly; at a distance everything seemed enveloped in a smoke or mist: she could see better when the pupils were dilated by shading the eyes with the hand "—" a green halo about the candlelight, in the evening "—" it seems as though a black veil were before the right eye." Muscae volitantes, also, are more than once noted by him.
Phosphorus is our leading remedy in simple amblyopia, when brought on by exhausting causes, as excess in venery or tobacco, watching, grief, and so forth. A certain amount of hypersemia and irritability of the retina would not counter-indicate it, though it is equally effective when the condition is of a more torpid kind. Hahnemann mentions (possibly led by his 330th symptom, which I have quoted) "glaucoma" as one of the morbid conditions in which it is indicated. The name was given, in his day, to the bluish-green appearance of the fundus sometimes (not always) seen in this disease. There are several cases on record in which, given on account of the pain present, Phosphorus seems to have restored soundness and vision to undoubtedly glaucomatous eyes.* I can speak from personal observation of its power of abolishing pain in such eyes, though in both cases to which I refer the mischief was too far advanced, and the patients too elderly, for sight to be regained. A cherry-red colour before the vision is said by Dr. Allen to indicate it.
I have now to speak of the Calabar bean,
This substance shares with Opium the power of contracting the pupil, though—as we shall see—it effects the change by a very different process. It acts in this way whether locally or internally exhibited; and von Graefe and Robertson have shown that the ciliary muscle is contracted as well as—and even before—the iris, so that accommodation is impaired, and myopia induced. There is set up in the eye a condition precisely opposite to that caused by Belladonna, which produces dilatation of the pupil, paralysis of accommodation, and far-sightedness. Is the causation, then, also precisely opposite? Does Physostigma paralyse the sympathetic and excite the ciliary branches of the third? I am disinclined to answer affirmatively as to either point. I find none of the evidences of depressed sympathetic energy, as I do in the pathogenesis of Opium, which I believe in this way to contract the pupil; nor can I think that a drug which causes general paralysis can stimulate one of the nerves of the crauio-spinal axis. I should rather ascribe the condition to a direct action of the drug on the muscular substance of the iris and ciliary muscles, an action which it seems also to exert upon other muscles, as those of the intestines. This is also Binz's view. Von Graefe says that on carefully watching the progress of the myosis, the iris is seen to contract convulsively with little jerks and twitches, which
* See Brit. Jonrn of Hom., xxxii, 6—11.
are so small and rapid that they easily escape observation. These seem analogous to the tremors observed in the voluntary muscles and the peristaltic agitations of the intestines caused by the drug. The action on accommodation (which tends to approximation of both the far and the near point of vision) progresses by the same spasms and jerks; and oscillation of the eyeballs has been observed. Besides myopia, Mr. Bowman found when experimenting on himself that astigmatism was produced.
When eyes so affected are used for binocular vision (as in reading), pains, blurring and sense of straining are experienced. Nervous achings may occur in the eyeball to which the drug has been locally applied, extending along the supra-orbital nerves atid over half the head; and towards the height of the myosis there is experienced, even without provocation, a painful tension, partly in the equator of the ball, and partly in the ciliary region.
There are of course two possible applications of these powers of Physostigma over the eye, one on the principle of contraria contrariis, the other on that of similia similibus. In the former of these ways it has been used for the counteraction of the effects of Atropia, and for the relief of mydriasis and weakened accommodation when otherwise arising. Dr. Woodyatt initiated the homoeopathic employment of the remedy, by giving it in acquired myopia, resulting from ciliary spasm, which he considered a frequent and important factor in the affection. From Physostigma, in the third decimal dilution taken four times a day, he has reported "results favorable beyond expectation," many of which he has related in detail.* They show the symptoms often relieved without glasses, or the use of these abandoned, under its influence. His theory and practice were called in question by one of his colleagues, but I think that he abundantly vindicated the soundness of his position. He might have quoted the corroborative testimony of Soelberg Wells, who wrote (for of him also we must now speak in the past tense): "Dobrowolsky and others find that rapid increase of myopia is often due to spasm of the ciliary * See United States Med. Investigator, ii, 375; v, 390; vi, 4A.
muscle, which also causes asthenopia," and again, " spasm of the ciliary muscle (apparent myopia) is not of such unfrequent occurrence as is often supposed. We have already seen that it may accompany myopia and astigmatism: but it is most frequently observed in youthful hypermetropes who have strained their eyes much in reading, sewing, &c., without using convex glasses,—this continued tension of the accommodation producing a spasmodic contraction of the ciliary muscle, or apparent myopia. Such patients complain chiefly of two sets of symptoms: viz. those of marked asthenopia during reading and fine work, and also that they are short-sighted."
Drs. Allen and Norton say—" Twitching of the lids should attract our attention to this drug, especially if combined with spasm of the ciliary muscle, as in one case in which there was twitching around the eyes, patient could not read at all without much pain, frontal headache aggravated by any light. Physostigma gave quick relief."
Eserine, the active principle of Physostigma, has of late found a good deal of tentative employment in ocular affections. Dr. Knapp, of New York, at one time proclaimed it as useful in acute glaucoma as Atropine is in iritis; and he still makes habitually a corresponding employment of it, though he admits that it only exceptionally cures. He also says that, as with Atropine, its use in chronic glaucoma may set up an acute attack; and that, in irritable eyes, its myotic effect is liable to induce iritis.* Mr. Walker, of Liverpool, has suggested the rationale of the action of Eserine in glaucoma to be as follows. He considers that long-continued over-use of the ciliary muscle is the most frequent, if not the invariable, precedent cause of the disease; and finds that section of it (cyclotomy) at once removes all the symptoms. He supposes that a spasmodic and inflammatory state of at any rate the circular fibres is present, and suggests that the mischief done by Atropine is due to the strain put upon
* Dr. Park Lewis with reason suggests the use of Physostigma in iritis, as more homoeopathic than the mydriatics.