OPHTHALMIC THERAPEUTICS


OPHTHALMIC THERAPEUTICS. IT is quite unnecessary, as it would be inappropriate, for me to present to this audience, composed as it is of representative Homoeopathic physicians gathered from all parts of the civilized world, any arguments to prove the superiority of Homoeopathic therapeutics over all other methods of healing. On the other hand, in this Columbian year, when all religious, educational, and scientific bodies are holding congresses, it is fitting that we should show to the world what Homoeopathy has accomplished, and what it has to offer in contrast to Old-School teaching and practice.


IT is quite unnecessary, as it would be inappropriate, for me to present to this audience, composed as it is of representative Homoeopathic physicians gathered from all parts of the civilized world, any arguments to prove the superiority of Homoeopathic therapeutics over all other methods of healing. On the other hand, in this Columbian year, when all religious, educational, and scientific bodies are holding congresses, it is fitting that we should show to the world what Homoeopathy has accomplished, and what it has to offer in contrast to Old-School teaching and practice.

It has devolved upon me to prepare to review of Homoeopathic therapeutics in our special department, that of ophthalmology. So much has been written lately upon this topic, that it is with diffidence I venture to discuss a subject so ably treated by other, and I crave your indulgence if much that I have to say seems trite.

This is an age of exact scientific investigation. Men demand facts, and not theories; and I propose to give you the facts of ophthalmic therapeutics, Homoeopathically considered, as compared with the treatment of the Old School.

It will not be inappropriate on this occasion for us to inquire what Homoeopathy has accomplished in this special department, and whether it offers any advantages over other methods. If Homoeopathy is, as the illustrious Dunham expressed it, the “Science of Therapeutics,” then the Homoeopathic specialist should be more scientific in the choice and application of curative agents than one who relies simply upon traditional, or physiological and empirical uses of drugs; and he should be correspondingly more successful. Does experience demonstrate this to be true? Our first duty is to our patients; our first motive is to cure them as speedily and as surely as possible. We should “prove all things, and hold fast that which is good.”

We want the best. Is Homoeopathy the best? If not, let us known it. And if it, then let us demonstrate it so conclusively as to compel universal acknowledgment. It would be interesting and instructive to compare the results of the treatment of an equal number of cases of a given disease under the two systems, were reliable statistics available. We can contrast the ordinary treatment of eye-disease, as recommended in recent Old-School treatises, with the Homoeopathic treatment outlined in the latest and best work on the subject-dr. Norton’s Ophthalmic Diseases and Therapeutics.

That we may intelligently discuss the question, let us first clearly understand what we mean by Homoeopathic therapeutics as applied to ophthalmic affection. If we mean only the application of those drugs for the cure of morbid conditions which have actually caused similar functional disturbances and pathological lesions, them our resources are very much restricted; although in this limited interpretation of the subject, we have a number of valuable remedies. There are several reasons why our armamentarium is so much curtailed in this particular.

In the first place, the records of poisoning furnish us with but few specific effects upon the eye, and our provings leave not, in many cases, been pushed to the extent of producing actual tissue changes. But the most important reason is the lack of skilled and accurate observation, which is apparent in the pathogenesis of drugs. Most recorded eye-symptoms are subjective, and frequently unreliable, because not rightly interpreted. Had every prover been subjected to a careful examination by a competent and experienced oculist, before and after a proving, and the condition of refraction, ophthalmoscopic appearance of fundus, etc, been accurately recorded, the provings would have been infinitely more valuable to the specialist.

The proving of Duboisin by Dr. Deady, published in the Trans. of Am. Hom. O. and O. Society, 1880, is a model worthy of imitation, although we cannot help wishing that the eyes of the provers had been previously examined, and conditions noted. Eye-diseases are rarely purely local, especially those serious affections which endanger vision; but are usually the result of some systemic disorder, and require constitutional treatment. Similarly drugs do not affect the eye alone, but produce, in connection with eye- symptoms, indications of disturbance of remote organs and general constitutional effects.

If, then, certain morbid conditions of the eye disappear under the exhibition of a remedy prescribed in strict conformity with the law of “Similia,” for general constitutional symptoms or for affections of other organs, is it not fair and logical to accept these eye-symptoms as reliable indications for that remedy in another similar case, even if the constitutional symptoms of the first case are lacking? is it not also probable that such a remedy, if fully proved in suitable doses, would cause the symptoms which it cures; and is not a verified symptomatology, acquired in the way suggested, a logical basis of Homoeopathic therapeutics?

With this understanding of our topic, and I think it is a reasonable one, we have an extensive armamentarium of specific- remedies. Allen and Norton’s Ophthalmic Therapeutics was compiled in this way from verified and trustworthy symptoms, and we owe an immense debt of gratitude to the authors and to the other faithful and skilful surgeons of the New York Ophthalmic Hospital, to whose labors we are largely indebted for the development of the resources of our school in this special department. In the possession of these specific remedies the Homoeopathic oculist has a great advantage over one of the Old School; but a thorough knowledge of drug effects upon the whale system, is a requisite for successful prescribing, as well as a familiarity with general diseases.

We cannot successfully prescribe for eye-symptoms alone, nor can we ignore the relationship between ocular affections and diseases of other organs or the frequent dependence of eye-diseases upon constitutional dyscrasiae. For this reason an extended experience in general practice is very desirable before undertaking special work. The Homoeopathic oculist, with these added means of cure at his command,-I say “added,” for of course all resources of the healing art, from whatever source, are his to choose or to refuse,-can achieve results impossible without them.

When all mechanical, local, and surgical measures are powerless, the suitable Homoeopathic remedy will often preserve or restore sight and cure disease, when Old-School medicine is confessedly of no avail. Many an operation can be obviated, and many an unfortunate sequence of operation can be obviated, and many an unfortunate sequence of operation be averted. Pain, in the large majority of cases, can be controlled without the use of narcotics, with their attendant unpleasant and sometimes dangerous effects, and the course of many diseases be materially shortened.

I promised to give you facts rather than theories, and in order to prove the truth of my assertions, let us critically examine and compare the therapeutic measures of the two schools in various affections. First, What does Old-School medicine offer for the relief and cure of eye diseases?.

In order to answer this question intelligently, I have carefully read and reviewed a recent text-book by a recognized authority-Noyes’s Diseases of the Eye-and noted every remedy recommended, with the indication for its employment. I have, of course, not noted local or surgical treatment, or the correction of refractive or muscular errors.

The purely therapeutic resources, as therein outlined, comprise forty-three remedies, almost all of which are prescribed upon the most general principles, and where specific indications are given, they are most meagre in contrast with our methods of careful individualization. To particularize: “appropriate” general or constitutional treatment, such as alternatives, derivatives, stimulants, etc., are sometimes advised without explicit mention, and in other cases Cod-liver oil, Iron Quinine, Arsenic, Malt and Hypophosphites, especially in anaemic debility, scrofulosis, etc.

The following table shoes a list of other medicines mentioned, and the diseases for which they are recommended.

Diuretics and Purgatives, especially Rhubarb and Sada, Sal sada, Rochelle salts.-Phlyctenular keratitis, scleritis rheumatica, iritis, cataract, retinitis (apoplectica and albuminurica), amotio-retinae, neuritis, neuro-retinitis.

Salicylate of Sada, Lithates, Liquor potash and other alkalies-Rheumatic and gouty affections generally, particularly in iritis, neuritis, neuro-retinitis, periostitis, tendonitis, acute phlegmonous eczema of the lids, staphyloma of the sclera.

Antifebrine, Antipyrine, Sulphonal, Morphia, Opium, Bromides, Chloral and Phenacetine.-To relieve pain.

Iodide of potash. -Spasm of orbicularis, episcleritis, iritis, to arrest development of cataract, to clear opacities of the vitreous, choroiditis, retinitis, atrophy of the optic nerve, periostitis orbitae, tendonitis, generally in syphilitic and rheumatic affections.

Mercury.-Syphilitic affections, diphtheritic conjunctivitis, interstitial keratitis, iritis, opacities of vitreous, sympathetic ophthalmia, choroiditis, acute and chronic, retinitis albuminurica. neuritis, neuroretinitis, atrophy of the optic nerve.

Arsenic, Zinc, Argentum nitricum, Phosphorus.-Various affections of the nerve and retina.

Strychnia.-Neuro-paralytic ophthalmia, cataract, retinitis pigmentosa, amblyopia, amaurosis (genuine and hysterical), exophthalmic goitre.

Digitalis, Phosphoric acid, Ergot, Atropia, Strophanthus, Tonics and Sedatives.-Exophthalmic goitre.

Digitalis.-Diseases characterized by feeble circulation and weak heart, such as ischaemia retinae, retinitis albuminurica, with vascular degeneration (also calling for Carbonate of ammonia), amblyopia, amaurosis.

Muriate of pilocarpine, Infusion of jaborandi.-Amotio- retinae, staphyloma of sclera (in gouty patients), iritis, sympathetic ophthalmia, acute choroiditis, neuritis, neuro- retinitis.

Quinine.-To check threatened inflammation after cataract operations, cellulitis, iritis.

Aconite, Gelsemium, Conium.-Blepharospasm.

Bromo coffein.-Hysterical amblyopia.

Nitro-glycerine in 1/100 gr. doses.-Retinitis apoplectica with high arterial tension.

Mineral acids.-Cellulitis orbitae.

Turpentine, Colchicum. -Iritis.

Phosphoric acids, Phosphates.-Cataract.

I believe this to be a fair and impartial resume of ophthalmic therapeutics from the Old School point of view. It is not difficult to recognize the unconscious Homoeopathicity of many of their more specific applications; at least, we use the same drugs in attenuated doses, with success, in the same disease, only studying the particular and minute indications for them according to the law of “similia.” The essential difference between their therapeutics and ours is noticed here as in all departments of medicine, viz., they prescribe for diseases while we prescribe for the individual. Which is the more scientific?.

In contrast with this array, I will simply call attention to the detailed and specific symptomatology of the one hundred and forty remedies mentioned in the latest and best Homoeopathic treatise, that of Dr. Norton, already mentioned. While this list does not comprise all the resources of our school-for almost every remedy in the Materia Medica may be found curative of eye diseases under appropriate conditions-I offer it as a fair exponent of Homoeopathic treatment in contrast with the resume of Old-School therapeutics just given. It is not a compilation of theoretical and empirical indications, but is made up of thoroughly trustworthy and, for the most part, verified indications.

Experience has demonstrated them to be reliable guides for the choice of the remedy. But it may be argued that this is mere assumption on my part. It certainly would be presumptuous to expect any one to accept such an assertion without satisfactory evidence, and while I cannot demonstrate to the sceptic here and now the truth of my statement by adducing overwhelming evidence in proof of the value of remedies prescribed upon such a basis, yet I can affirm what the Homoeopathic treatment of eye diseases has accomplished, what it is accomplishing every day in hospital and private practice, and what can be demonstrated to the satisfaction of any fair-minded investigator who cares to give the matter sufficient time and thought.

What, then, are some of the verities of Homoeopathic ocular therapeutics?.

I. -The action of constitutional remedies, such as Ars., Graph., Calc., Sulph., Nut.mur, and Sil. in hereditary or acquired conditions of malnutrition and in the various dyscrasiae.

II. -The action of Acon., Bell., Apis., Verat. vir. and Rhus in controlling inflammatory conditions, erysipelas, cellulitis, etc.

III. -The action of Hepar, Sil. and Rhus in suppuration, of Gels. in serous, and absorbing haemorrhages.

IV. -The action of Arnica, Crotalus, Ham., Lach., and Ledum in arresting and absorbing haemorrhages.

V. -The action of Sil., Calc., Aurum., Kali iodide, etc., in diseases of bone and orbit, morbid growths, periostitis, etc.

VI. -The action of Amyl nit., Ferrum., Lycopus, Spongia, Nat.mur, and Ars. in exophthalmic goitre.

VII. -The action of Puls., Apis., Alum., Merc., Ars., Euphrasia, Argent. nit., Rhus., etc., in catarrhal conjunctivitis, ophthalmia neonatorum, specific blenorrhoea, etc., arresting inflammation, moderating discharge, preventing corneal complications and averting many cases of blindness.

VIII. -The action of Aurum., the Iodides, Baryta, the Kalis, Sil., Graph., Hepar., and Merc., on corneal tissue, healing ulcers, resolving infiltrations, clearing nebulae, and thus often avoiding minor operations, such as scraping of ulcers and phlyctenules, the use of caustics and the galvanic cautery, and of paracentesis.

IX. -The influence of Merc., Bry., Cedron, Rhus, Clem., Col., Spigelia and Potash in iritis, shortening very much its course under Old-School methods, averting sequelae and rendering narcotics unnecessary.

X. -The undoubted influence of Caust., Sulph., Sepia, Phos., Sil. and Iodoform in arresting and delaying the development of cataract, and even clearing opacities of cortex.

XI. -The influence of Bell., Bry., Gels., Aurum., Phos., Merc., Kali mur. and Kali iod. in various forms of choroiditis and retinitis.

XII. -The beneficial effects of many remedies, especially of Nux and Phos., in inflammatory affections of the optic nerve and in atrophic conditions, cerebral and spinal.

These are some of the solid facts of Homoeopathic therapeutics which cannot be controverted.

As our knowledge of Materia Medica increases, especially as the pathogeneses of drugs are more accurately and scientifically developed, our success will be measurably increased. There is some evidence as to the efficiency of Gels., Bry., Col., and other remedies in glaucoma, but the well-known influence of eserine and iridectomy makes it unjustifiable to withhold them in the majority of cases.

The symptomatology of Osmium gives us a very suggestive picture of glaucoma. It ought to be helpful, though I am not conversant with any positive clinical evidence in proof of its efficacy. When a careful record of the tension, of the acuity and of the field of vision and of the ophthalmoscopic appearance of the fundus appears in our provings, then we may hope to dispense with myotics and iridectomy in the treatment of this disease.

The influence of some of our remedies in checking the development of cataract, and of materially improving vision by the resolution of cortical opacities has been abundantly proved, and affords a striking instance of the superiority of Homoeopathic ocular therapeutics. Where do we find any such results from Old-School treatment as those published in recent years by some of our specialists of recognized ability, whose statements are trustworthy, and whose diagnoses are beyond question? The experience of Dr. Wm. R. King, [See Journal of O., and L., April, 1891.] of Washington, with Iodoform is especially noteworthy.

The treatment of cataract with remedies must, of course, rest upon a constitutional basis. Eye-symptoms alone do not afford sufficient data for the choice of a drug. The underlying condition is the important point to consider.

An interesting illustration of the value of such a method of prescribing, and also of the fact previously noted, that a remedy may cure an eye-affection when indicated by constitutional symptoms, even though its pathogenesis contains nothing to indicate its special action on the eye, is afforded by a case of ptosis cured with Bromine 6x by Dr. Bissell, of Rochester, reported in the Journal of O., O. and L., for October, 1889. Bromine was selected on account of diarrhoea, eructations, pain like needles at the epigastrium and physometra.

Bisulphide of carbon is worthy of trial in retrobulbar neuritis. Cases of poisoning suggest it Homoeopathically to this affection. It has produced in several cases, “diminution of vision, central scotoma, vision better in the evening, loss of appreciation of color, central scotoma for colors, and narrowing of eccentric field,” without ophthalmic changes in the fundus oculi. Hirshberge described in one case “an alteration of the macula characterized by the presence of whitish nodules.” These visual disturbances are associated with nervous symptoms, such as muscular weakness of the limbs, cramps in the legs and abdomen, diminution of hearing and headache. [See article by H.H. Crippen in O., O, and L., April, 1891].

Malignant growths of the eye and lids have seldom been materially influenced by remedies, yet we now and then see a gleam of light in this direction which encourages us to hope for better results in the future. Such hints from accurate observers should be carefully noted and remembered, and therefore I desire to call your attention to the report of a case of sarcoma by Dr. W.S. Searle, of Brooklyn. [+ Journal of O., O. and L., February, 1892.] A blind eye had been removed, and microscopical examination demonstrated the correctness of a previous diagnosis by Dr. H. Knapp, viz., spindle-called sarcoma of the choroid.

Ten days after removal, a secondary growth “of the size of a chestnut” was removed from the orbit, and Phos. and Tarentula cubensis were prescribed. The former was chosen on account of general constitutional indications, and the latter from its reputation in inflammatory affections of connective tissue, especially in boils and carbuncles. After their use there was no return for nine months.

Then the growth again returned to as light extent, but under a renewal of the former prescription the nodule shrivelled and dropped off within a week, and the doctor wrote me recently that there had been no recurrence of the disease up to present time, a period of two years since the second operation.

These remedies are worthy of trial in similar cases, and i would also remind you of the published experience of the late Dr. George S. Norton and of Dr. French in the treatment of glioma retinae with Ceanothus Americanus, the fluid extract of red clover blossoms. [See O., O. and L., April, 1890, and Trans. Am. Inst, 1884.].

The value of Cinnabar as a remedy for ciliary neuralgias has been often demonstrated, where the indication of “pain extending from the inner canthus around the brow” is present, but we owe to Dr. H.C. French a confirmation of the following indication for its employment, viz., “a full, heavy feeling in the whole head, temporarily lessened by pressure.” “Shooting pains in the forehead.” “Sticking and itching in both canthi and in the forehead.” The patient had been under Old-School treatment for two years, and Dr. French gave him great relief in a few hours, and cured him in less than three weeks with Cinnabar.

The curative influence of Agaricus in spasmodic affections of the lids and ocular muscles has log been recognized, but its influence in amaurosis and hysterical amblyopia was first suggested to me by an article by Dr. Rounds. [+ See Journal of O., O. and L., October, 1891.] Some slight impairment of vision is suggested in the proving of the remedy, but that a total blindness of both eyes-“only slight perception of strong light remaining”-should be entirely cured, and perfect vision restored after the patient had been blind for several years, is certainly surprising and worthy of note.

The sight of the right eye was suddenly lost after a blow upon the head four years before treatment was commenced, and that of the left eye as suddenly and completely failed after exposure to rain. For two years she could not tell night from day. The only other treatment employed was galvanism, and as this was used without avail for two months before prescribing Agaricus it seems reasonable to attribute the recovery in large measure to the medicine, although electricity was continued at irregular and increasing intervals during the time of treatment. Nystagmus, nictitation and other nervous and hysterical symptoms led to the choice.

The ophthalmoscopic examination was negative. Fifteen drops of the tincture of Agaricus were taken daily in divided doses for a period of eight months, when the patient was discharged with perfect vision in each eye, and entirely free from nystagmus, etc. She has since earned her own living as a stenographer and typewriter.

Experience has repeatedly proved the efficacy of Gelsemium in various diseases of the eye, especially where serous exudation exists, and in paretic affection of the muscles, but Its Homoeopathicity to amaurotic affections is suggested by the following observation of Dr. W.A. Phillips. In a certain patient, 5 gtts. doses of the tincture invariably produced the characteristic symptoms of giddiness, headache and heaviness of the lids, followed by almost total loss of vision.

At one time the accommodation failed first, while at another the sensibility to retinal impression seemed to precede the loss of adjustment. In forty minutes after the five drops were taken the vision was reduced to 3/200. It could not be improved by lenses, and this diminution continued from five to fifteen minutes. Normal vision returned in from one-half to two hours. No ophthalmoscopic changes were observed. [See O. and O., April 1, 1890.].

Paris quadrifolia is a valuable remedy in certain cases of asthenopia. The sensation “as if the eyes were being drawn back into the head by cords” is a reliable indication for its employment, and led the writer to select it, and to effect a gratifying cure of chronic headache. Dr. French cured with Paris a paralysis of the external rectus where this symptom was present. He also emphasizes the following as trustworthy guides for its use, viz., “inability of fix the eyes steadily upon anything; eyes seem swollen, as if their orbits were to small, so that the eyes could not be easily moved.” [+ See Journal of O., O. and L., January, 1889.].

Kalmia is helpful is certain cases of asthenopia. Dr. Boyle has had gratifying success with it in episcleritis and tendonitis, [++ See Trons N.Y. State Sac., 1891.] where the patient complained of “soreness of the eyeballs to touch and motion” “Injection of the conjunctiva, chemosis around the cornea.” “Feeling of stiffness of the muscles.”.

The pathogenesis of Cannabis sat. and Cannabis ind. exhibit a striking similarity to pterygium, and they ought to be curative of that condition. They have been curative in vascular condition of the cornea, and Dr. Wanstall cured with Cannabis ind. a case of pustular keratitis, with pterygium-like injection of the conjunctiva. [See Norton’s Ophthalmic Diseases and Therapeutics.].

E H Linnell