The ophthalmic practitioner of our school has had, until the last few years, but little to aid or encourage him in his adherence to the tenets of his faith, owing to the fact that the basis of his knowledge of drugs in their active relation to eye diseases has been uncertain, as too often the pathogenesis, as set forth in the provings of the remedies was found thoroughly unreliable when applied to the treatment of the eye.
Hence, the older ophthalmic surgeons of our school have had to acquire from close study and observation of the clinical effect of our drugs, a system of ophthalmic therapeutics derived from our knowledge of our Materia Medica, and their own clinical observation, which is now rapidly being augmented by the increased number of workers in this department.
Eventually, in the coming years, when the true laborers in the field of Homoeopathic, ocular therapy have brought in the harvest of pathogenetic, clinical, and curative symptoms, we shall find, when the grain is separated from the chaff, that but little remains to desire, save the proper application of this accumulated knowledge to the scientific Homoeopathic cure of all ophthalmic diseases.
It is difficult supplement the careful resume of the verified action and indications of the homoeopathic remedies which have so ably been demonstrated in the paper which is before us for discussion. Dr. Linnell has, with the utmost care, culled from our literature the most valuable verifications of Homoeopathy as applied to the treatment of ocular diseases. It remains, then, only for me to add what may have come to may knowledge as result of my own individual experience and observation in ophthalmic practice; amplifying here and there, and presenting perhaps, now and then a grain of pure gold, which years of study and observation have enabled me to separate fro the dross which surrounded it.
The poverty of the armamentarium medicum of the Old-School, in its application to ocular therapeutics is manifested, not so much in its lessened number of drugs for internal medication, as in the want of specific indications for their use. The richness of our drug armament stands out in glittering contrast, not perhaps by the greater number of remedies, but by the knowledge of our Homoeopathic law which enables us to prescribe these drugs with an assurance of the curative results which inevitably must follow their proper administration.
It is not necessary to discuss seriatim the list of verities of Homoeopathic ocular therapeutics which Dr. Linnell has presented, as they are no longer in doubt. We should all endeavor, as soon as possible, to increase their number by adding to those mentioned other rich in possibilities, but which yet lack that confirmation which must come from repeated trials.
In the list presented I desire to emphasize the actions of Homoeopathic so-called constitutional remedies in lessening and dissipating the various dyscrasias mentioned, and thus enabling us to cure the alternate effects as exhibited in the eye.
The actions of those remedies mentioned as controlling inflammatory effects of the eye, we all daily prove the truth of in our practice.
In reference to the action of Rhus tox. in promoting, controlling, and limiting various traumatic and surgical inflammations, perhaps little need be said, but for Hepar sulph. which has exhibited such marvelous action in controlling, limiting, and absorbing pus within the eye, too much praise cannot to given.
With these two remedies eyesight and eyeball have been saved time and again, when no other known treatment could possibly have controlled the inflammation, lessened the pain, saved tissue, and caused the absorption of the products of inflammatory attacks. To watch the action of either, when indicated in these affections of the eye makes one feel that our remedies have an action only short of the miraculous.
In iritis the action of Terebinth, which, in the Old School, finds a place of value, is with us too often neglected, as, like Asafoetida, it has a specific action upon the inflamed iris, and both not only lessen the ciliary neuralgia but shorten and cure the attack.
In controlling the inflammatory and degenerative changes in the lens which result in cataract, the action of our remedies presents often in my experience the further proof of the Homoeopathic law of cure.
In the lens, as well as in the cornea, iris, vitreous, retina, and choroid, we can watch from day to day the limiting, absorption, and sight-restoring effects of our remedies.
Glaucoma, when presenting a mechanical obstruction of the excretion of the fluids of the eye, cannot come under the domain of medicine; but for those glaucomatous conditions which are dependent upon the hypersecretions resulting from neurotic irritations, the remedies mentioned by Dr. Linnell often afford us brilliant results. In simple non-inflammatory glaucoma of chronic type, Sulphur, Nux vomica, and Phosphorus have controlled the disease and saved the vision in cases where neither iridectomy, sclerotomy, or myotomy had been allowed, and also in cases where some or all of these operations had been made without control of this sight-destroying disease.
In addition to those that have been mentioned in the paper, there are some affections of the eye and the therapeutic means for their relief to which I desire to call attention as exhibiting the desired action of our remedies.
Hyperaemia of the retina, while usually symptomatic, is, I believe, more often idiopathic than we are inclined to think. While this condition is difficult of diagnosis, owing to the variableness of the circulation of the retina within physiological limits of the individuals, and in cases where such immediate causes as refractive errors, foreign bodies, or inflammation of the contiguous tissues of the choroid and iris have been excluded, we are justified in making such a diagnosis.
I find that taking the increased capillary circulation of the optic disk as an indication, rather than that of the retinal vessels, together with the subjective symptoms of asthenopia, a safe guide to the diagnosis of a condition which often presents a series of symptoms extremely annoying to the patient and often difficult of relief, unless we find in such remedies as Belladonna, Cactus, Cimicifuga, Duboisia, Amyl nit., and Phosphorus the similimum.
Cases of temporary amblyopia which arise from spasm of the retinal arteries or result from vaso-motor irritation of the cerebroretinal circulation, and thus temporarily disturb the nutrition of the optic nerve and retina and destroy its function, more frequently once to the notice of the general practitioner than to the ophthalmologist.
Such amblyopias, while often temporary and symptomatic of the cephalalgia which follows, sometimes tend to be persistent, and even when the amblyopia has disappeared we may find scotomas, which become sources of discomfort or causes of subjective symptoms, which make difficult the diagnosis of the eye condition.
In these cases, where there is found a migraine history, recent or remote, there are three remedies which cover a multitude of discomforting symptoms, namely, Gelsemium, Physostigma, and Strychnia phos. .
For the amblyopia which precedes the attacks of headache, and which itself is often preceded by symptoms, more or less marked, of irritation of the retina, perhaps no remedy is more valuable the an Amyl nitrite by inhalation, which, while shortening the attack as far as the disturbance of the vision is concerned, yet lessens not the tendency to recurrence nor removes the cause.
As an example of what may be accomplished by remedies which, as far as we know, have shown in their pathogenesis no direct action upon such conditions yet exhibit their curative powers in a remarkable degree, I take from my case book the following record of Miss P. aet. 23, who consulted me in 1888, with a history of temporary amblyopia, which usually occurred only in the right eye, but occasionally in the left, the attacks coming or in the morning after breakfast of on awakening, if she had suffered from insomnia. During the years before consulting me she had had six attacks, whose duration lasted from an hour to four or five.
At the time I saw her a central scotoma of the right eye was evident, but a diagnosis of circulatory changes in the eye was doubtful in the inception of the attack, a point of light was observed by her on the temporal side, which increased until it became a wave of light. In some of the attacks modified by lying down. Her eyes were emmetropic and the vision normal. Has no special headaches. Bryonia was prescribed, and there was no return of the trouble for a year, when she again had a recurrence of the trouble, and came for some more of the remedy. In the four years since there has been no return of the troubles.
Some sixteen years ago, after reading the experience of Bell and Kuhne in their efforts to demonstrate the retinal purple, I was impressed with the fact that Muscarine and Pilocarpine seemed to have the peculiar property of increasing the secretions of the light discoloring matter which is formed about the base of the rods of the retina. Acting upon the suggestions thus presented by the physiological provings of these drugs, I have use them for many years with success in cases of amblyopia, where I have been able to determine by exclusion of other causes that the deficient vision was dependent upon a probable functional derangement of the retina and optic nerve.
