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tion of the lids; and "right eye became much inflamed; lids glued together " is a symptom occurring in a young man who took the 30th attenuation under Dr. Robinson's superintendence.
We should have from hence but a slight warrant for the large use we make of this remedy in strumous ophthalmia, did we not know how much more important are diathetic than local relationships in many cases of this disease. It is of unquestionable value when the malady occurs in strumous subjects of the lymphatic type, with pale, flabby faces, and pot-bellies, and especially when the cervical glands are enlarged. The eye symptoms themselves may be of almost any kind. The medicine displays such power, however, in interstitial (scrofulous) keratitis, and to clear opacities of the cornea, that a special action on this membrane is suggested, and has lately been confirmed from an independent source. Dr. McDowell, of Baltimore, has recently described* what he calls an "oyster-shucker's corneitis and though he attributes the disease to "a specific toxic element contained in the slime and dirt which coats the oyster shell," I think we may fairly prefer to trace it to emanations from the shell itself.
Drs. Allen and Norton have found Calcarea valuable in conjunctivitis trachomatosa, pterygium, and keratitis, caused by working in the wet.
Let me now speak of the common hemp,
The use which has been made of this drug in affections of the eye has resulted from two symptoms in Hahnemann's pathogenesis, (S. 39) "the cornea becomes opaque, a follicle before the eyes," and (S. 41) "cataract." For the first he himself vouches; and though here also one would have liked to know the circumstances under which [it was supposed to have occurred, that one might judge for oneself of its validity, it cannot but be accepted. It is certain, moreover, that the medicine has some effect in removing corneal
* New York Med. Record, xvi, 83.
opacities left behind after strumous ophthalmia. The symptom " cataract" is referred to Neuhold. This author is recording effects of the effluvia of hemp before drying, so that his symptoms are valid enough. Hahnemann's "grauer Staar" represents "suffusiones oculorum" in the original; and there is no doubt that the phrase may mean this. Celsus uses it in such sense.* But when we find it occurring in a list of the observed effects of hemp without special mention or warrant, it becomes very unlikely that the author meant to hazard in this manner so strange an assertion as that the herb can cause cataract. We must wait for further information on this head.f No satisfactory clinical verification has been supplied here, as it has in the case of the previously named symptom.
The extensive use which has lately been made of this newly-discovered hypnotic has shown it to be possessed of several physiological properties beyond its sedative influence upon the cerebrum. Among these we find a power of irritating the conjunctiva. This membrane is not merely suffused by it, but hot, stiff, swelled, and tender (especially on the lids), and there is sometimes lachrymation.
Dr. Dyce Brown has shown us (as in several other instances) how to turn to account such observations, by giving a series of cases in which symptoms analogous to those which Chloral causes have yielded to its influence.J Among them are several of catarrhal and phlyctenular ophthalmia, in which the action of the drug (given in grain doses or less) seems to have been all that could be desired.
* Seventh Book, vii, 13,14.
f I have elsewhere cited Milton in illustration of Neuhold's term, where he says of his blind eyes (Par. Lost, B. iii, 1. 25):
"So thick a drop serene hath quenched their orbs, Or dim suffusion veiled." But it would seem that by " suffusion " he means opacity of the cornea, as distinguished from the "gutta serena" of cataract. % Brit. Journ of Mom., xxxii, 509.
Dr. E. M. Hale has since stated that in two cases of conjunctivitis in his practice its effect was simply magical.
was recommended by Hahnemann as useful "in several kinds of inflammation of the eye." Much burning and redness were developed in its provers (who have been many and thorough); in one the pupil was contracted, and in three the vision was indistinct, as if objects were seen through a gauze or fog. Hirsch recommends Clematis in "chronic inflammatory states of the borders of the eyelids, with soreness and swelling of the Meibomian glands, such as we find in young scrofulous subjectsbut the affection of the eyes in which it has done yeoman's service is iritis. Drs. Allen and Norton do not seem to speak from personal experience of it here; but they mention the high praise it has received from many, among whom was my own teacher, Dr. Madden. They consider it indicated where great sensitiveness to cold is present, as is Mercurius, to which they reckon it an analogue in point of its action in iritis. 1 myself have every confidence in it, in both the rheumatic and the syphilitic forms of the disease.*
My next medicine is also one of considerable interest, and no little importance, in relation to the eyes. It is
The neurotic action of hemlock, though well known to the ancients, had been almost forgotten in modern times until attention was recalled to it by the case of poisoning reported by Dr. Hughes Bennett in 1845, and the subsequent experiments with Conia instituted by Professor Christison. Nor did these, being conducted on animals, reveal the power of the drug upon the ocular muscles, which also Hahnemann's provings on the human body, from the
* "In one case of chronic syphilitic iritis of two months' standing, with deep ciliary injection, slight pain, especially at night, and posterior synechia, a cure followed the use of Clematis, for ten days after both homccopathic and allopathic treatment had failed to relieve."—(Norton, p. 70.)
comparatively small doses used, failed to exhibit. It was not until Dr. John Harley combined Hahnemann's subjects with Christison's quantities that these became manifest. He found that, after taking five drachms and a half of the Succus Conii of the British Pharmacopoeia, if he remained at rest, the effect of the medicine first declared itself in his eyes. "Three quarters of an hour after taking the dose, on raising my eyes from the object on which they had been fixed to a more distant one, the vision was confused, and a feeling of giddiness suddenly came over me. That these symptoms were due to impairment of power in the muscular apparatus employed -in the adaptation of the eye, was obvious to me; for, so long as my eyes were fixed on a given object, the giddiness disappeared, and the definition and capacity of vision for the minutest objects was unimpaired. But the instant that I directed the eyes to another object, all was haze and confusion, and I felt giddy; and, in order to recover my vision and dismiss the sense of giddiness, it was necessary to lay hold on some object, as it were, with my eyes, and rest them securely upon it. It was clear to me that the adjusting muscular apparatus of the eye was enfeebled, and its contractions so sluggishly performed that they could no longer keep pace with the more rapid movements of the external muscles of the eyeball." Later, ptosis, both subjective and objective, came on, with dilated pupils. In another place Dr. Harley says: —" After moderate doses, the interference of vision is only such as results in haziness, as if a thin film of transparent vapour were floating between the eye and the object; the effect being identical with that observed on looking through a medium of unequal density, such as the mixture of hot and cold air enveloping a highly-heated stove. It occurs independently of any dilatation of the pupil, and is compatible with good definition for fixed objects. It is due to imperfect adjustment of the refracting media of the eye from partial paralysis of the ciliary branches of the third nerve. It is through these minute branches that the individual first becomes conscious of the effect of hemlock, and if he should be reading at the time, he will suddenly find the occupation fatiguing, and, very soon afterwards, it may be impossible; and he will be glad to close tbe eyes to relieve himself of the symptom. In full doses the depressing influence involves the other branches of the nerve, and the lazy movements of the eyeball, or dull, fixed, and occasionally divergent stare, indicate the partially paralysed condition of the external muscles of the eyeball; while more or less drooping of the upper lids expresses a similar condition of the levator palpebral." More rarely, there may be diplopia.
These phenomena imply paralysis of the third nerve, and as no preponderating action of the obliquus inferior or rectus externus muscles is manifest, of the fourth and sixth also. Their production by Conium has been confirmed by subsequent observers; and the ocular vertigo caused has been especially illustrated by Dr. Edward Curtis, who took half a drachm of Squibb's fluid extract, and noted the effects. The effort to adjust the vision, while under its influence, made him so giddy as to induce nausea and threatened vomiting, as in sea-sickness; but all passed away when the eyes were closed. "Fearing I should vomit, I got up to cross the room to the washstand, but at once the floor seemed to rock and waver, and I staggered against a table; not being conscious, however, of any real weakness of the legs, it immediately struck me that the uncertainty of step was purely because the eyes were playing false as guides for the feet; if so, I argued, walking ought to be steadier with the eyes shut than open. Accordingly, after getting the proper bearings, I shut the eyes, and sure enough found at once that I could now walk straight and steady, and, what was more, without any feeling of giddiness: securing a basin I repeated the little experiment on the return trip to the desk, and with precisely the same result,— giddiness, transient nausea, and staggering gait on trying to walk with eyes open, freedom from all trouble with them shut."*
I have quoted these observations at length as they throw so much light upon the meaning of vertigo, the place of vision as a factor in equilibration, and the causation of sea* * See Allen's Encyclopedia, iii, 527.