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these by its excitation of their antagonists. Still more injurious, therefore, would seem the action of Eserine, which works in the same direction with the causa mali; and such he finds it to be, if used in the ordinary strength before cyclotomy has been practised. After this, however, he employs it with the utmost advantage to check any return of irritability and tension. He supposes it to act by opening the discharge-pipes of the anterior chamber; but the not unfrequent aggravation which occurs, and the very small doses he has come to use (from gr. T'Bth to gr. ^th to the ounce), suggest that the action is a homoeopathic one.
The amaurosis frequently observed in lead-poisoning makes it necessary for us to inquire into the action of
upon the eye. Examination of the facts shows that this failure of vision is often secondary to the renal mischief (granular kidney) which the metal sets up. It is here either temporary, where it would seem to depend upon anaemia of the retina from contraction of the arterioles, an analogous symptom to the well-known "renal asthma or it is more permanent, when retinitis albuminurica will be found to exist. But plumbic amaurosis may occur as a substantive change; and this appears to consist in an optic neuritis, with its central scotoma. This is well illustrated by two cases related in the London Medical Record for 1875 (p. 277). The indications for treatment thus afforded are very obvious, but they have not yet been applied to practice.
I will conclude to-day with some remarks on the rdle of
in affections of the eye.
Storck, who first introduced it into medicine, reported it very useful in such chronic diseases as cataract, spots
VOL. XLI, NO. CLXIV. APRIL, 1883, I
on the cornea, and amaurosis. His experience, however, was not sustained by that of others; and the drug soon fell into the disuse in which—in the old school—it has continued almost to this day. Dr. John Brunton's communication to the Medical Society of London, designed to revive interest in Pulsatilla, spoke of it only in relation to catarrhal conjunctivitis. Dr. W. H. Miller, however, of St. Paul's, Minnisota, U.S., using (in full doses) the Pulsatilla Nuttalliana of his own country, reports both general results similar to those of Storck, and, with respect to the eye, speaks as he does of "cataract, amaurosis, and opacities of the cornea" as benefited by it. One would have liked rather more information as to such results.
The provings and applications which have been made of Pulsatilla in the school of Hahnemann have not reached to these deeper actions. From the former, which have been carried out very thoroughly both with the German and with the American variety of the plant, it has displayed its affinity for the eyes mainly by affecting the lids, which it inflames greatly, making them swell up (in one case in the form of a stye), become agglutinated in the morning, and pour out quantities of mucus. It has, however, sometimes excited sharp pains in the balls, though you will see from my notes in Allen that the two most striking symptoms of this kind which Hahnemann gives are untrustworthy. More constant are its disturbances of vision. Temporary obscurations of sight are often noted; in one case fiery circles were seen, and in another a starry halo surrounded the flame of a candle; and after sleep there is a feeling as if something were hanging over the cornea which could be wiped away. The sensation is only subjective, and disappears spontaneously. Dr. C. Wesselhoeft, in proving the P. Nuttalliana in substantial doses, was much annoyed by twitching of the lids and brows.
The more modest claims to usefulness made by these experiments can be amply sustained. Pulsatilla is of course especially serviceable when the subject of the eye affection is of the mild, passive, lymphatic temperament to whose troubles it is suited. Locally, it is indicated where the discharges are thick, profuse, and black, and where there is not much pain or photophobia. Under these circumstances it will do much good in catarrhal, scrofulous, and even purulent ophthalmia. In the last-named trouble, occurring in infants, Drs. Allen and Norton recommend it as reinforcing the action of Argentum nitricum. They also praise it for superficial ulcers of the conjunctiva cornea? in ophthalmia scrofulosa. It is especially suitable when the lids are the seat of the ophthalmia. It will blight a stye as effectually as Belladonna will a boil. For the twitching, also, of the lids, with dazzling of sight, with which some persons are annoyed, I have several times found Pulsatilla useful. It seems occasionally to have been curative in choroidal congestion and dimness of vision connected with menstrual insufficiency.
A DEFENCE OF HAHNEMANN'S PHARMA-
Hahnemann gave very precise directions for the preparation of the attenuations of the medicines to be used in the homoeopathic treatment of disease. These directions, which will be found in detail as regards medicines to be triturated in the introduction to Arsenic, and as regards vegetable juices in the introduction to Pulsatilla in the Materia Medica Pura, and as regards both in §§ 270-271 of the Organon, he repeats in less detail over and over again. He evidently attached great importance to each step in the process of attenuation, the vehicle, the amount of trituration, the binary succussion, the preparation of each successive attenuation in a separate phial, the size of the globules, and the manner of their impregnation. He omits nothing from his description of his pharmaceutic processes, and evidently intends that his directions shall be followed exactly by his disciples and those who desire to test the truth of his system. Hahnemann's higher dilutions, as everybody knows, were made by taking a drop from the phial containing the previous dilution and adding it to ninety-nine drops of alcohol in a fresh phial, and giving two strong succussions to the bottle in order to ensure thorough admixture. Even after his adoption of his dynamisation theory Hahnemann made no alteration in his pharmaceutical processes, and though he admitted the medicinal power of the dilettante Korsakoff's infection globules, he never advised that his own pharmaceutic method should be superseded by Korsakoff's plan. Hahnemann wished particularly that his followers should use exactly the same preparations as he himself did "in order to obtain uniform results," and the only change he suggested was that the number of succussions to each dilution might sometimes be advantageously increased (Chr. Kr., pt. v). For many years no alteration was proposed by his followers beyond that of making the dilutions on the decimal (1 of medicine to 10 of vehicle) scale in place of Hahnemann's centesimal (1 to 100) scale. No one proposed to make any alteration in the vehicle for making the dilutions or in the technical details of the process. It was left for amateurs to rush in where professionals feared to tread. Graf von Korsakoff, a wealthy Russian nobleman, thought he could not better employ his aristocratic leisure than in improving the pharmaceutic processes which Hahnemann, after much consideration and with a perfect knowledge of the apothecary's art, had adopted. Korsakoff found that Hahnemann's favourite 30th dilution did not come up to his expectations in the cure of diseases, so the brilliant idea occurred to him that the attenuation was not high enough. Accordingly he diluted his medicines up to the 100th, 200th, and 1500th potency, and of course found that diseases which are incurable by the 30th, disappeared like magic before the higher potencies of his own invention. Moreover, he discovered that one medicated globule placed in a bottle with 1000 and even 10,000 unmedicated globules, made all of them as powerfully medicinal as itself. He communicated his grand discovery to Hahnemann, who, in place of telling him to mind his "ribbons, stars, and a' that," as became a great nobleman, to leave alone matters he did not understand, and to allow him (Hahnemann), to be the best judge of the mode of preparing and administering his own medicines, said there might be some truth in what his lordship was pleased to suggest, though on the whole he thought it might be best to stick to the old plan, which experience had shown to be not altogether a bad one. Rich noblemen naturally expect their opinions on all subjects to be treated with deference and consideration, but it would be no disadvantage to the world in general if these expectations were occasionally disappointed when they lay down the law on subjects they cannot possibly understand. If Hahnemann had treated the Graf's suggestions with the contempt they merited, and had told him that his innovation was a pernicious departure from the simplicity and precision of homoeopathic pharmaceutics, we should no doubt have been spared much of the extravagance that has followed Hahnemann's good-natured unwillingness to ruffle the intrusive conceit of his noble Muscovite patroniser.
Personally Hahnemann preferred to consider the 30th dilution as the normal standard of extreme dilution and though he was acquainted with higher dilutions and gave them occasionally, he does not recommend their use (see Organon, § 287 note) ; but he never altered his directions as to the preparation of the dilutions, to wit, the separate phial and the alcoholic vehicle; the only deviation he allowed in his latter days, was an increase in the number of succussions to be given to each dilution.
After Hahnemann's death, however, some of his disciples permitted themselves to propose great deviations from Hahnemann's simple and precise rules. The first and most notorious of these innovators was again an amateur, whose special medical education seems to have been obtained among horses, for he is variously described as a horsetrainer, a horse-breaker, a master of the horse, and an equerry. His name is familiar to all homoeopaths— Jenichen. He announced, or got admiring friends to