In optic neuritis and retinitis Duboisin is no doubt often indicated for several cases have yielded promptly to its influence as the following will illustrate; A man aet. 42 had suffered from attacks of vertigo for three months. There was a history of syphilis twenty years and of a blow on the head seventeen years before. When first seen he complained of sleeplessness day and night, severe headache from the back of the neck over the head to be eyes worse at night over the head to the eyes, worse at night and eyes painful as if the balls were being pressed into the head. V. 20/40 u. with difficulty. The ophthalmoscope revealed a typical picture of “engorged papilla” in each eye, marked enlargement of vessels on the disc and extravasations on the right optic papilla and in the retina immediately around it. Bell 3 was given for ten days with slight change in the symptoms except that haemorrhages were found on both discs pain above the eyes with constant aching in them and heavy pressure on the vertex worse in the morning. Within two weeks under Duboisin 3 the pain in the head had been relieved, the haemorrhages in the nerves and retina had disappeared and the inflammation wad decidedly less. V. 20/20 o. u. There were one or two slight aggravation after this, but important when the patient was lost sight of.
True weakness of the accommodation may call for this remedy, as already suggested by the symptomatology (Compare Ruta, Con, Arg, nitr). I use term “true weakness, ” for I believe many of the so-called cases of asthenopia are dependent upon an “irritable weakness” of the accommodation which is controlled by Jaborandi or one of that class of drugs.
ELECTRICITY AND GALVANISM
Clinical.- The sphere of electricity in eye diseases, while at present limited is, we think, capable of much further extension. The reason of this limitation we believe lies in the fact that the oculist too little understands the true principles of electricity to try it in diseases where it might be serviceable, while the electrotherapeutist, not having the sufficient number of eye cases necessary to form scientific data, has not the opportunity to give this agency thorough trial it should receive in order to demonstrate its true in ocular diseases.
Commencing with the eyelids we find electrolysis of the utmost value in the very annoying and obstinate condition of trichiasis. Epilation gives but temporary relief of the condition and has to be frequently repeated. Plastic operations are not always successful and only usually made when there is complete incurvation of all the lashes. In those partial cases of trichiasis, when only a part of the hairs turn in electrolysis is the ideal treatment.
The use of electrolysis in trichiasis was first suggested by Michel, of St. Louis.
It is best to use a triangular platinum or gold needle which is to be inserted into the hair follicle and then connected with the negative pole of an eight to twenty cell battery, while the positive pole is applied to the temple. Minute bubbles of gas appear around the needle and the tissue whitens when the circuit is closed. The current should be continued for about a minute or until the hair can be removed without resistance. When properly applied the hair bulb is destroyed and the hair will not grow again.
Angiomata or vascular tumors of the lid or orbit are also better removed by electrolysis then by any other method or operation. When the growth is small the negative pole may be applied by a sponge to the temple, but if large both poles should be attached to platinum needles two or three inches in length, which are then to be inserted into the tumor. The positive needle should remain in one position while the negative may be inserted at different points for a few minutes at a time. The first sitting should be brief and careful notice taken of the reaction, as sometimes a too severe inflammatory reaction occurs. Other growths, even epithelioma, have been destroyed by electrolysis.
Blepharospasm has been successfully treated by galvanism. In this it is best to apply the positive pole behind the mastoid and the negative on the eyelid.
In strictures of the lachrymal duct, electrolysis has been especially advocated by some. We have used it in a great many cases with universally good result; it seems, however, to be particularly adapted to chronic strictures associated with blenorrhoea of the sac. The beneficial results are evidenced by an improvement in the blenorrhoea as well as in the stricture itself. My method of using electrolysis in these cases is to insert the ordinary lachrymal probe in the usual way until it comes in contact with the stricture, then attach the upper end of the probe to the negative pole, holding the positive on the temple; make gradual pressure until the stricture yields. The electrolysis, repeated at four or five sittings, is usually sufficient to keep the passage permanently opened.
Granular and Follicular Conjunctivitis.__ I have seen cases of true trachoma very materially benefited by the use of electricity, while in follicular conjunctivitis I believe all cases that followed the treatment at all regularly were wholly relieved. The cases of trachoma were treated with the double electrode applied directly to the conjunctiva after the use of cocaine. The follicular cases were treated by puncturing the follicles, which renders the course of such a treatment necessarily long and tedious.
George Lindsay Johnson, of London, describes in the Archives of Ophthalmology, vol. xix., a new method of operating upon cases of trachoma by electrolysis and claims for it very favorable results. His plan is to make incisions parallel to the free border of the lid through the whole breadth of the conjunctiva by means of a three-bladed scalpel, the depth of the incision to be regulated by the swelling or thickening of the conjunctiva. The electrolyzer, made of two platinum blades, is then drawn slowly along the furrows made by the scalpel, all the grooves being taken in turn. He says the best results are obtained by using a current of about thirty milliamperes and cautions against using a stronger current.
In diseases of the cornea we find at present only a limited sphere for the use of electricity. The galvanic current has a favorable effect in the rare disease of neuro- paralytic keratitis, and as other treatment has proven of but little value in this affection, its use should always be tried. In corneal ulcers, especially of the serpiginous and crescentic varieties, the use of the galvano-cautery has proven of great value. Its use in this disease is to destroy the septic material lining the base and sides of the ulcer. In using it the galvano-cautery loop is brought to a red heat and, with the lids opened and the eye steadied with the left hand, the red hot loop is applied directly to the zone of propagation. The eye, previously cocainized, suffers no pain. The resulting eschar is thrown off in about twenty-four hours and the cornea heals with a less dense macula than under any other mode of treatment. Care should be taken that the patient does not see the cautery before it is applied, as the knowledge that a red hot wire is to be applied to the eye is not generally conducive to steadiness of the eye. By continuing the application of the loop a moment longer the floor of the ulcer can be perforated when desirable and the hypopyon evacuated.
In exophthalmic goitre cases that seem well authenticated have been reported cured by galvanization of the sympathetic.
The use of the electro-magnet in removing particles of iron and steel from the eye has been very generally adopted by oculists and many successful cases have been reported.
The results as to vision are always far more favorable if used very soon after the injury. Various magnets have been used for this purpose, that of Hubbell being perhaps the best on account of its size, shape and power. If the particle has penetrated into the interior of the eye, as for example the vitreous, and the wound is still open, it should first be made somewhat larger, so that the foreign body will not be scraped off from the magnet when it is withdrawn. The needle of the magnet is then to be inserted into the wound and as near as possible to the foreign body, which can sometimes be located by the ophthalmoscope. In this way particles of steel weighing twenty milligrammes have been removed from the vitreous and the eye recover with perfect central vision.
In muscular troubles of the eye, we find, however, perhaps the most extended and general use of electricity. Cases of paralysis, both complete and partial, of ocular muscles, have been restored by this agency. It is usually applied by placing one electrode (some say the positive and others the negatives) over the affected muscle, while the other is placed upon the brow or at the back of the neck; it should be applied regularly every day or two and from one to three minutes at each sitting. The current should be constant at first and then interrupted a few times at each application. It should also be used as strong as possible without causing too much discomfort.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.