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scientific rather than a practical interest. But Dr. Dyce Brown, whose quickness at seeing the therapeutic inferences to be drawn from pharmacological investigations I have already noted, has done this good work for Santonine. In conjunction with an oculist, Dr. Ogston, he put the drug to the test as a remedy for several of the deeper-seated affections of the eye. The results, which were published in the British and Foreign Medico-Chirurgical Review for 1871,* are very striking. Of the forty-two cases treated (grain doses being given) thirty-one were cured or improved; and these included choroiditis, retinitis, atrophy of the optic disc, pure amblyopia, and retinal anaesthesia. The ultimate influence of Santonine on the brain was manifest, for cerebral amblyopia and paralysis of the motor oculi were greatly benefited, and concomitant headaches removed. In one case, moreover, of undoubted double cataract, vision was greatly improved after some months' use of the Santonine, and with reference to this Dr. Brown tells us that in some experiments of Dr. Ogston's " it several times happened, especially when young kittens were employed, that within a few minutes after the animal was killed, a dense cataract developed itself in the lenses of both eyes. Within half an hour these parts became very opaque, the opacity remaining very marked after the removal of the lens from the eye." "It seldom," he says, "occurred in the eyes of adult animals," nor has it ever been observed to occur during life. Nevertheless, unless cataracts are of spontaneous origin in recently defunct kittens, the tendency of Santonine to produce them is evident; and that is enough for homoeopathy.
I am not aware whether any further testing of the power of Santonine in eye disease has been carried out. Dr. Norton hardly mentions it. I myself rely on it with much confidence in that hyperaesthetic and hyperaemic condition of the organs which comes on from continuous fine work, as in seamstresses. As far back as 1862, moreover, MM. Guerin and Martin had recommended it in amaurosis, especially in that following acute choroiditis and iritis. * See also Brit. Journ. of Mom., xxix, 445.
Apropos of this it is worth mentioning that Stille cites a case in which a child of six months took five grains of it, instead of three which had been ordered. It became amaurotic, and did not recover its sight for two months.
And now of
This drug, also, first displayed its affinity for the visual organs when employed as an anthelmintic. Pain in and over the eyes, redness and injection of the whites, sparks before the sight, and distortion aod irregular movements of the balls, are symptoms cited by Hahnemann from several older writers (Linning, Chalmers, Wright, and Browne). His own provings confirm them, and add fresh evidences of the power of the drug to excite pain in the eye—this being either a sense of pressure and distension, aggravated on movement, or a shooting in the eyebrow, lids, or ball.
These facts, and the general power of the drug over rheumatic affections and neuralgiae, have caused it to be largely used by homoeopathists in rheumatic and arthritic ophthalmia, when the pain is severe and of a shooting character. Dr. Angell commends it in several inflammatory affections of the eyes in scrofulous children, where, with photophobia, there is much ciliary neuralgia. It is the presence of this last trouble, whether alone or in association with inflammatory affections of the eye, which chiefly indicates Spigelia and which leads to its best results. The pains radiate from a point, are darting, shooting, stabbing, or lacerating, and are increased by movement of the eyeballs, and at night.
I have not said anything of the action of Nux vomica or of Ignatia upon the eyes, as the power of both seems to depend upon their common possession of
with which we will now occupy ourselves.
The most marked ocular effect observed by the provers of Ignatia was a disturbance of vision, which Hahnemann compares to the "spurious vertigo" of Herz:—a circle of white, shining, flickering zigzags being perceived around the point of vision, while at the same time the letters at which one looked became invisible, those which are close by becoming so much more bright. Nux vomica occasioned a similar symptom, and also considerable sensitiveness of vision. Dr. Anstie has observed the latter as an effect of Strychnia on patients taking it; they complained of photophobia, with flashes of fire before the eyes when looking towards a bright light, or even in comparative darkness after each dose of the medicine. Dr. Anstie observes that there is no increase, but rather a diminution, of the power of discriminative perception in these cases; to which corresponds Hahnemann's symptom of Nux vomica—" intolerance of the daylight, in the morning, with obscuration of vision."
Besides these effects upon the retina, Nux vomica and Ignatia, with their alkaloid, cause spasmodic actions of the muscles of the eyeball, with twitchings and distortions.
In old-school practice Strychnia has of course teen used antipathically—for amaurosis and ocular paralyses. Applied in the neighbourhood of the eyes by the endermic and (later) the hypodermic method, it is said to have done great things in these troubles; and Mr. Walker reports* better results still from the instillation of a solution of a neutral sulphate (gr. iv to the ounce). Where simple functional deficiency is present, I can quite conceive that good may be wrought in this way; the modus operandi seems akin to that of galvanism. Homoeopathy has employed both Ignatia and Nux vomica in spasmodic affections of the ocular muscles: the former being very effective in some cases of morbid nictitation. Nux vomica takes a high place in the treatment of strumous ophthalmia for the relief of the photophobia. Morning aggravations are regarded as characteristic of it here (thus distinguished from Conium), and Dr. Dunham says that when this circumstance is present, the digestive disturbances of the drug will generally be found * Op. cit., p. 149.
coinciding in the patient. Drs. Allen and Norton commend it in amblyopia potatorum, to which it is obviously homoeopathic, the amaurosis of alcohol being much more irritative in character than that which results from tobacco. Another observation of theirs forcibly recalls a case of my own in which Nux acted finely:—" Hypersesthesia of the retina,'' they say, "with frequent pains to the top of the head, sleepless nights, and awakeniug cross in the morning, was promptly relieved by Nux vomica." The "pains to the top of the head " remind one of Dr. Ferrier's localisation of the ultimate visual centres at that point. My patient had, on first looking at daylight in the morning, a dazzling, blinding distress extending just to two spots on each side of the sagittal suture, and use of the eyes at any time caused pain there. It was a case of brain-fag.
The last of my eye-medicines is
In Allen's Encyclopedia this drug has nearly 200 eyesymptoms, most of which were obtained by the Austrian re-provers, in their very useful and thorough experiments. The conjunctiva is the tissue most affected; visible redness is not great, but the sensations of burning and itching, and sometimes of pricking, are very frequent. Dryness is present rather than lachrymation or mucous discharge, and photophobia has occurred; while obscuration of vision is mentioned by several as a marked effect of the drug.
Therapeutically, as well as pathogenetically, Sulphur acts most on the conjunctiva, and from its "anti-psoric" properties is best indicated when inflammations of this membrane take place in unhealthy subjects. Its chief place, accordingly, is in strumous ophthalmia, for which at some time in the treatment it is indispensable, which it will indeed at times cure single-handed. But it also, says Dr. Dudgeon, possesses in acute catarrhal ophthalmia an efficacy almost magical; and has been used with more or less success in inflammation of nearly every texture of the visual organs. I refer you to his able series of papers in the sixth and seventh volumes of the British Journal of Homoeopathy for cases illustrative of its value. Drs. Allen and Norton rather minimise its efficacy in affections of the deeper parts of the eye; but their experience has been mainly gained with the higher dilutions, while the older observers who have reported its power in "arthritic ophthalmia" have given it in the lower triturations. The American authors, however, bear high testimony to its value in every form of strumous ophthalmia, whether affecting the lids, the conjunctiva, or the cornea; and also in acute and chronic ophthalmia catarrhalis. Sharp pain, as if pins were sticking into the eye, and dislike to the use of water, which aggravates all the symptoms, are their chief subjective indications for it. It has removed, to their knowledge, pterygium, pannus, hypopion, "ground-glass" cornea, the adhesions of iritis, and opacities of the vitreous.
We have now completed our survey of the principal drugs which act upon the eye; and it remains that we consider them together, for purposes of grouping, of comparison, and of discrimination. We shall best do this, I think, by studying them in relation to the several tissues of the organ, and to the morbid states to which these are liable. The catalogue raisonnee you will see* on the board
* The following is the list to which reference is made.