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pupils with a one fifth solution of the mother-tiucture 01 Belladonna,* and Rossbach and Frolich, who have obtained similar results in animals with very minute quantities of Atropia (from about gr. -00005 to -0001 ),f believe the difference to be a question of dose. I am not prepared to pronounce upon the question; but from what we shall see of the action of Gelsemium, I am rather inclined to think that any contraction of the pupil which Belladonna can effect is a symptom of commencing hyperaemia, either in the eye itself or in the brain. In the one symptom of this nature supplied by Hahnemann it was associated with rather severe frontal headache (comp. S. 649 and 434 of Allen).
II. The effect of Belladonna upon the circulation of the eyes is more closely connected with its cerebral influence. An injected conjunctiva and a glossy brightness of the ocular surface is present in the active congestion of the brain induced by this drug, as it is in the same condition otherwise occurring, and constitutes a valuable indication for its choice in cerebral disorders. But Belladonna can also inflame the eye by direct irritation. That Atropine, in the minutest doses, is capable of causing conjunctivitis when locally applied is generally known; and Mr. Soelberg Wells states that its continued use may induce vesicular and even true granulations. But the mother-plant itself can produce the same action from within. This was seen to some extent in Hahnemann's provings, as S. 508, 509 and 599 of Allen's pathogenesis show; but it was most strikingly manifested in a case where the porter of the Moorfields Ophthalmic Hospital took by mistake half an ounce of the liquor Belladonne of the Pharmacopoeia.:]: When first seen it was noted that "the palpebral of the left eye were puffy, and redder than those parts on the right side," and that "the upper left lid was prolapsed as in ptosis." Next day it is noted: "the sight of the right eye had become rather clearer, but that of the left eye more
* Essays in Medicine, p. 770.
t London Med. Record, i, 786.
% See Med. Times and Gazette, June 15,1848.
impaired; the upper lid more tumefied and prolapsed; the conjunctiva more vascular, and raised above the margin of the transparent cornea, which in a few days became opaque; and a small quantity of a puriform fluid had accumulated in the anterior chamber of the eye." "The sight of the left eye," remarks the reporter, "was perfectly nutural previous to the accident; and as no mechanical injury had been since done to it, its inflammatory state may be fairly attributed to the virulence of the Belladonna."
There is an obvious suggestion here of action extending deeper than the conjunctiva, and we have other evidence of the same kind. No weight, indeed, can be allowed to Allen's 505th symptom, "eyes inflamed, red and bloodshot, even to the iris "—as it is one of the counterfeit coins of Houat's mint. But there is a case reported in the Lancet for 1844 (i. 251), by a Dr. Williams, in which Belladonna, given internally, produced "pain in the eyeballs, intolerance of light, and conjunctival inflammation; these symptoms soon followed by dilated pupils and loss of sight, paralysis of iris and blindness being permanent." More than conjunctivitis and mydriasis seems to have been present here.* Still more certain is the retinal hyperaemia (arterial) induced by the drug. Ophthalmoscopically, it has been seen by Harley and Aldridge;f and many subjective symptoms, as pain at the back of the eyeball, flashes of light before the eyes, photophobia, and some of the derangement of vision present, suggest the same condition.
I am surprised to find Drs. Allen and Norton saying that "the use of this drug in inflammatory affections of the eye is much more limited than is generally supposed." Their own list of its applications of this kind is not very limited, and homoeopathic literature teems with instances of its efficacy. Besides the acute aggravations of chronic diseases (as granular ophthalmia) in which they commend
* Dr. Dudgeon (Joe. cit.) adds, "irregular pupils" and "a white flake in the pupil of the left eye, which is much dilated;" but I know not the source from which he has taken these symptoms.
t West Hiding Asylum Reports, vol. it,
it, I have the utmost confidence in it in the severer forms of catarrhal ophthalmia and in the inflammatory varieties of ophthalmia scrofulosa. Sense of burning and dryness of the eyes (which is very marked in its pathogenesis) is characteristic of it here. I have seen it act admirably in two cases of traumatic iritis. Its local use (now generally in the form of a solution of Atropia instilled into the eye) in the "rheumatic" and syphilitic forms of this disease is mainly a mechanical expedient for dilating the pupil, and so preventing the formation of adhesions; though it may act also by contracting the blood-vessels and keeping the iris at rest. Belladonna is also our prime remedy, as all admit, in acute affections of the fundus. Two well-diagnosed cases of optic neuritis,* and two of retinitis,f are on record in which it proved curative. Drs. Allen and Norton commend it in chronic retinal hyperaemia, " if a red conjunctival line is very marked along the line of fissure of the lids."
A more complex question is the relation of Belladonna to glaucoma. It is considered by most observers (though Donders and Stellwag doubt it) that the effect of Atropia upon the eye involves diminution of the intra-ocular pressure. It was an obvious conclusion, therefore, that it might be of service in the disease just named, where pressure is so much increased. It had no such effect, however; and not uncommonly, in chronic glaucoma, its employment has been known to cause an acute inflammatory attack, while in one instance cited in Allen's Appendix (S. 517) it seems to have developed an acute glaucoma ab initio. It has thus fallen into disuse in ordinary practice; but we, upon the homoeopathic principle, might advantageously give it internally for these very exacerbations of the disease, and also for the first onset of the acute form, which the late Dr. Anstie says he has seen checked by the subcutaneous injection of a minute dose of Atropia in the neighbourhood of the eye.f Drs. Allen and Norton say
* Norton, p. 48.
f See Brit. Journ. of Hom, xxxi, 382; Transactions of Amer. Bom. Ophthalm. and Otol. Society, 1879, p. 76. % On Neuralgia, p. 189.
that it has wonderfully relieved the severe pains, when of a throbbing character. Moreover, the fact that glaucoma is often a trigeminal neurosis, of central origin, and liable to complicate neuralgia of that nerve, must be borne in mind. Belladonna is an esteemed remedy among us when prosopalgia is accompanied with peripheral hypersemic manifestations; and here (I think) we have the rationale of its influence, and the suggestion of its possible usefulness as a fundamental remedy for some forms of glaucoma.
III. The disturbance of vision induced when Belladonna or Atropia is locally applied is far-sightedness. It is hardly correct to call it either hypermetropia (as Dr. Harley does) or presbyopia (as it is generally styled), for both these names connote substantive alterations in the refracting media of the eye; while all that atropia produces is paralysis of accommodation for near objects. The " near point" of vision (as the shortest distance at which fine print can be read is called) rapidly recedes as the influence of the drug is established, until at last only distant objects [i. e. those giving off practically parallel rays) can be distinctly seen. Dr. Harley connects this effect of the drug with its dilatation of the pupil; and I was at one time disposed to follow his view, having regard especially to the fact that by looking through a pin-hole in a card near vision with atropised eyes became again practicable. But this is as readily accounted for by considering that by such a proceeding the rays entering the eyes are made nearly parallel; and there are fatal objections to the iridal theory of accommodation. The mydriasis and the far-sightedness of atropia are by no means coincident; and Mr. Soelberg Wells* has found that if an extremely weak solution of the drug (a grain to eight or ten ounces of water) be applied to the eye, the pupil will dilate without accommodation being affected. There is, moreover, an instance on record in which there was entire absence of the iris; and yet here accommodation was perfect, and atropia paralysed it. We must fall back, therefore, on the now generally accepted doctrine that the circular fibres of the ciliary
* Diseases of the Eye.
muscle are the means for effecting those changes (whatever they are) which permit of the vision of divergent rays; and that atropia paralyses them, through the ciliary nerves from the third which supply them. It is probable, moreover, that here also—as in the iris—the drug excites the antagonistic radiating fibres, and that their contraction contributes to the result.
But I cannot follow Fereira in asserting that the impaired vision of Belladonna poisoning, from within, "is chiefly or entirely presbyopia.1' Weakness and indistinctness of vision have been noted under its influence without any mydriasis being present, and therefore presumably without any paralysis of the accommodation.* I must explain some at least of the " blindness" so often noted from its ingestion f by a direct anaesthetic influence exerted by it upon the retina, analogous to that which it displays at other points of nerve-termination. Whether its occasional curative power in "amaurosis" is due to such an action I cannot say. Symptoms of hyperemia, with photopsies and chromopsies (such as red sparks, flames, bright spots, lights, &c.), or chromatic appearances of bright objects have generally been present in such cases; and suggest, as they do in the pathogenesis of the drug (where they frequently appear), congestion of the retina.
I have detained you a long time, but not longer than its interest and importance warrant, with the consideration of the ocular relations of Belladonna. We now pass to some less important medicines, the first of which is
Hahnemann's pathogenesis of this drug, as given in his Chronic Diseases, consists entirely of symptoms observed by him on patients taking it; none relating to the eyes were elicited by Rummel and Schreter, who proved it (in the 30th dilution) with him. One of Koch's provers of a tincture prepared from precipitated chalk reports some irrita
* See Hahnemann, Mat. Medica, Part iii, S. 545, 546.