« PreviousContinue »
superior margin of the cornea and the upper lid measuring nearly two lines. The characteristic innervation of the upper lids, whereby they are unable to follow the eyes when looking in a downward direction, was noticeable in both eyes. On the right side the exophthalmos was of such a degree as to render it impossible to completely close the lids, even with strong muscular effort. There was a chronic hyperaemic state of the ocular conjunctiva, and during marked abduction of the eye it would appear as a little roll or welt against the margin of the lids. This appearance was likened to "blisters" by the patient. The cornea, though lacking in sensibility, was not entirely anaesthetic. The optic axis deviated slightly outward. This lack of parallelism was measurable by prisms, though there was no diplopia or asthenopic symptoms from this muscular insufficiency.
The left eye was quite prominent, the sclerotic being visible above the superior margin of the cornea, but the eyelids could be closed. The sight was perfect, and an ophthalmoscopic examination showed nothing abnormal in the fundus.
The neck was unusually full over the region of the thyroid gland, though there was no well-defined tumour.
Hypertrophy of the heart existed, and the pulse ranged from 100 to 110. She suffered almost constantly from dyspnoea, and was obliged to be extremely cautious in regard to physical exercise or mental emotion. Any unusual excitement would be manifested by a deep red, angry flush, which would spread over the face and neck, and a greater prominence of the eyes. As the cutaneous redness disappeared, it would be followed by a copious perspiration. Nitrite of Amyl was administered by inhalation every alternate day for about four weeks.
At first the dose was three drops, which was poured on a small bit of cotton in a drachm vial and held to one of the nostrils, the other being closed. The influence on the heart could be noticed almost instantaneously, the pulse increasing from fifteen to twenty beats per minute. The breathing at the same time became laboured and more hurried; the face flushed and the conjunctivae injected. These inhalations would last from one to two minutes; in from ten to fifteen minutes after they were suspended the heart beat was slower, respiration easier, and a glance was all that was necessary to detect a marked diminution of the exophthalmos.
At the end of four weeks the protrusion was scarcely perceptible in the left eye; on the right side there is still some prominence, not only of the eye but the contents of the orbit. The eyeball has, however, receded so that no portion of the sclera is visible above the cornea; there is a normal sensibility of that structure; the innervation of the superior lid no longer exists, and the eyelids can be completely closed.
There is undoubtedly some existing hypertrophy of the orbital connective tissue, though I believe an early use of the Amyl nitrite would have prevented that. It must be remembered that the commencement of the exophthalmus dated fifteen months earlier on the right than on the left side. Three months later the patient was examined, aud there had been no tendency to any recurrence of the eye trouble. She suffered less from the dyspnoea, and there was a marked improvement in the action of the heart, the pulse being reduced to 90 beats per minute.
Dec. 14.—Dr. A. S. Hutchinson has had very favorable results in chronic nervous headaches with Zincum metallicum, 3rd to 6th trituration.
Dr. Arndt's translation of the Materia Medica Pura has ceased to appear since the hebdomadal issue of his journal.
Homceopathic Journal of Obstetrics.—Aug.—Dr. E. M. Hale reports some success with Jaborandi and its alkaloid in the salivation of pregnancy.
Nov.—Dr. P. P. Wells in the present number curiously enough employs this journal as a vehicle for expressing his thoughts about our International Convention of 1881. These, from his standpoint, can hardly be favourable, though his character robs them of bitterness. We must solicit his correction of one statement. He reminds us, that when the N. Y. State Horn. Society defined similia similibus as a rule instead of a law, he protested against it as "a crime against science." He continues—" my judgment was then objected to by the excellent and genial friend who has just presided at this last Convention, because, he said, 'that is just what I have been doing all my life.'" He goes on to say that he thought it needless to reply to such an objection, as no example, however excellent, can alter the complexion of a crime. Now if he will look again at Dr. Hughes' letter* Dr. Wells will see that the writer only cites his own practice as a reason why he should take up the cudgels on behalf of the " rule" view; but then goes on to support it by a series of arguments, among which was Hahnemann's own usage.
Homoeopathic Physician.—This new journal, which we introduced in our last notice, continues to be published regularly. The character of its homoeopathy may be inferred from a statement in its July number (p. 280), that the conditions and concomitants of the sufferings induced by a drug "give a proving almost its entire value," and that it is "chiefly in these elements of morbific and drug action that the likeness is to be sought and found which cures "! That is, it is more important to secure similarity in your adjective than in your substantive. Again, in the same number, Leila M. Rendell, M.D., relates a proving of two doses of Amm. carb. 1 m. (Fincke), taken at an interval of 27 days. On the 72nd day, "being completely exhausted by the severity of the symptoms, and having become very thin and weak," she took Lachesis c. m. (Fincke) as an antidote, and soon regained her health. A list of 211 symptoms follows. The knowledge of British homoeopathy possessed by these gentlemen may be gauged by a statement of another of their leaders (p. 353)—" The disgraceful treatment of Lord Beaconsfield by Dr. Kidd caused the British Congress to repudiate him—not that they were less crude than he."
We have only to note, before leaving this journal, that its promoters are quarrelling among themselves about the use of "nosodes," Drs. Swan and Berridge being in their favour, Drs. Wells aud Lippe against them.
Medical Coll.—This miniature quarterly seems to meet a need, for it has continued to appear up to the present time, though the numbers for Oct., 1881, and for Jan. and April, 1882, have failed to reach us. In that of July, 1881—the only one therefore which comes under notice at present— we find the following real contribution to our knowledge.
* Law or rule? North Am. Journ. of Mom., Nov., 1878, and Brit. Journ. of Mom., April, 1879.
Tobacco Amaurosis. By James A Campbell, M.D., St. Louis.
The question as to what influence tobacco has upon the eye is one which frequently comes up. Without dissent it is generally admitted that tobacco smokers, snuff takers, and they who are engaged in the manufacture of tobacco, are liable to local conjunctival irritation and sometimes inflammation, directly traceable to the local influence of the weed.
Further than this, it is also believed by many high authorities on the subject, that the use of tobacco, from its toxic influence, may produce functional and, at times, organic derangement of the nerve of vision.
To this latter distinctive form of eye trouble the term tobacco amaurosis has been given. And although the existence of such a condition from such a cause has been warmly opposed by no less distinguished writers than Soelberg Wells, Carter, &c, the objections urged, which by themselves might seem quite convincing, are based altogether entirely upon theoretic grounds, and are opposed by such other high authorities, and an array of so many stubborn facts, that " Tobacco amaurosis " has earned a fixed place in the nomenclature of eye diseases.
Two recent cases coming under my care may be given in brief for example and confirmation.
Case 1.—Herman B—, art. 38, by occupation a bar-tender. Never had any trouble with his eyes until about six months before he came to me; then for the first time noticed that his sight began to be a little dim, as if a light shade were before him. He could not see at a distance as well as formerly. The eyes were a little sensitive to light, especially gaslight. Did not sleep quite well—was rather nervous. Smoked ten or twelve cigars each day, drank a little also, but not very much. Examination showed that his vision was -fg, which was not improved by any glass. The ophthalmoscope showed the optic disc a yellowish, dirty pink, with blurred outlines, fietinal veins full, arteries diminished in size, with a dark red fundus. The case was diagnosed tobacco amaurosis. The use of tobacco in any form was forbidden, and Nux vom., 3rd trit., given three times daily. He made rapid progress for the better, and when last examined, after about six weeks, was fast approaching a normal condition.
Case 2.—John D—, set. 42, cigar maker. Eyes began to fail him a few months before I saw him. A dimness before the sight, could not see things so well as before; not much, if any, pain. Appreciated that vision was gradually growing worse. Had used tobacco for many years, " smoked a great deal." Examination showed vision to be not benefited by any glass.
The ophthalmoscope revealed changes in the fundus similar to those described in Case 1, but the discs were not so discoloured, and were of a deeper red colour.
Tobacco was prohibited, and Nux v., 3rd trit., given as before. The result was a steady improvement for the better, until in about two months the vision was again normal.
Now comes the confirmatory part of it. The patient had always expressed himself against the theory that tobacco was the cause of his trouble, because he had used it all his life with no previous bad effects. Having full faith in his own views, strengthened probably by his own desires, he again commenced the use of tobacco, but found that after about six weeks his sight again commenced to be affected. Convinced at last, he applied for treatment a second time, which was followed by the same success which attended the first.
The Clinique.—As we have hitherto omitted to make excerpta from this excellent journal, and have a file of it on hand, beginning with January, 1880, we will keep it for the Index to the journalism of the past year which we propose to give in our next number.
The Homoeopathic Courier seems to have ended its existence with the "College " it was designed to represent.
[Dr. Elias C. Price asks us to correct an error in our report of a paper of his on p. 70 of our number for Jan., 1882. For " Potass, iod." there we should read "Ferr. iod."]