Permit me to call your attention to a Homoeopathic remedy that I do not find mentioned in Dr. Wilson’s list, but which I have found useful in cases of hyperopic astigmatism combined with various forms of heterophoria; I refer to Santonine. The special symptoms calling for its exhibition seem to be: A flickering before the eyes; objects seem to waver and dance; photophobia and lachrymation; all of which are induced by use of the eyes at close range. It seems to serve in those cases where Ruta is indicated, but with the additional symptom of “unsteadiness of objects.”
DR. LINNELL: I have listened to Dr. Wilson’s paper with very great interest. This matter of muscular errors is one which attracts a great deal of attention in the last few years, and is certainly of much importance. I have given the matter careful attention, and much has been written of the experience of others. I have had the satisfaction of curing several cases of Dr. Stevens’s and he has operated a number of times and left the patient in a worse condition than he was at first. It seems to me that the tendency to operate in these cases is sometimes too great.
Surgery is more brilliant than the treatment by internal medication, and I think the tendency is to operate in many cases where a cure could be effected as well by other means. Moreover, it seems more scientific, if, by any means of treatment, or combination of treatment, we can produce two strong muscles, rather than by crippling one muscle to relieve two weaker ones. For that reason it has always been my end ever to treat these cases by remedies, by suitable exercise, leaving tenotomy as a last resort.
Dr. Wilson, in his paper, makes the statement that we are too apt to trust our won experience, even if it is not supported by the experience of other people; and I wish here to simply reiterate and emphasize what I have said elsewhere in regard to the cure of heterophoria by means of internal medication in connection with exercise and electricity. I have treated a great many patients of this kind, and where patients have been willing to persevere for a length of time, I have seen only a few cases where I considered tenotomy advisable, and the results obtained, even with such operators as Dr. Wilson and Dr. Stevens, makes me still more conservative in this respect.
In regard to trusting one’s own experience, it is a matter of positive conviction in my mind that certain remedies are helpful in these muscular troubles; and I especially think it true of Senega. I regard Senega as probably the most important remedy in the treatment of hyperphoria.
I am in the habit of making careful examination, with various instruments of precision, and keeping an accurate, detailed account every day, watching the progress of results intelligently; and I know, from my own experience-from the records of my books-that hyperphoria can be cured by Senega alone, or by Senega in connection with other treatment; and it does seem to me that this very scientific practice is what we should aim to attain, and that surgical methods should be left to a secondary importance. Of course, I don’t mean to say that tenotomy is not the best treatment in some cases, but I don’t think it is the treatment for the large majority of cases.
DR. KING: It is not my desire to get between these two gentlemen in this pleasing argument. I agree with both of them in some points, and disagree with them in other points. With reference to the cure of hyperphoria in its various phases by remedies alone or in connection with systematic exercise and other remedies, such as electricity, etc., I must throw my experience in the balance with Dr. Linnell; that is, I feel satisfied that a number of cases of more or less hyperphoria-not high degrees though, however annoying-are decidedly relievable and curable by means of treatment outside of operation.
I don’t believe that I can stand up and say that therapeutic treatment alone will cure those cases, because I haven’t given it enough attention. I have not had confidence enough, perhaps, to allow my patients to get along with the remedy alone, with anything like a degree of hyperphoria that was practically admissible; but I do use the remedies in connection with exercise and the prism and the currents of electricity also.
I have used those methods of treatment alone without electricity, and I have used the treatment with the remedy in similar cases, and I have decided that the remedy assists most positively. I believe that in low degrees the remedy alone will perhaps in many cases relieve; but if the exercise and electricity and what not will hasten the cure, why not apply it? Dr. Wilson says it interferes with scientific decision. If we have certain cases in hospital practice outside of private practice, it may be well to make that experiment.
With reference to the application of remedies, I simply want to make a suggestion-something that I cannot say much as to its actual usefulness; that is, I cannot absolutely tell you that it is helping me much, but I believe it is and I think it is perhaps worth a trial. That is, the application of our remedies for muscular insufficiencies locally, directly to the eye, in the conjunctival sac. Gelsemium two or three times a day, applied externally, helps the patient decidedly. I have used the tincture of Nux vomica in exophoria, and tincture of Senega in the same manner. I have read, and have been told, that it is given in hyperphoria.
I am speaking now of the empirical use of these drugs, for in many cases you must prescribe them empirically. I t has been suggested to me, in a general way, to use some of our other remedies, and I have taken these means, and I know that I have had some good results by the application locally of Gelsemium. Now, we know, if we instil a solution of Atropia into the eye, and prevent its passage through the caruncula, that we may give a great deal before we obtain constitutional symptoms.
We can go further than that. We know that if we inject Atropine into the foot, ankle, knee, etc., we will soon have dilation of the pupil, and it seems to me that in the application of remedies to the eye, if we restrict the action of the remedy to the organ in which it is placed, we can push the remedy much further without obtaining physiological symptoms.
DR. STEWART: I would like to ask Dr. Wilson how the instrument here compares with the test made by the Stevens’ instrument. I believe that may be recognized or called the standard or point of departure at the present time. There is an instrument of this kind made by Hardy & Co., of Chicago. Those of you who may be interested in this kind of instrument may be glad to know of this other one.
The question of internal remedies calls to my mind two cases, one of exophoria-a symptom of a ball running around in the base of the brain, and it gave the patient so much distress that he did not want any examination and would not put up with it. I, however, got an examination, and found a certain degree of deviation there, and then gave him Kali carb. Later, he came back, and the exophoria wasn’t so great. We can get these changes by the use of remedies, but what the drug has to do with it I don’t know. Another case: the patient came for an examination for refraction or muscular troubles, and I had given her Crocus, and got relief from that; that is, a diminution in the amount of her trouble, which was also an exophoria.
This brings to my mind Dr. Savage’s prisms, placed base to base. A year ago he left that subject in an unsatisfactory condition. He had demonstrated that he could tell with reasonable certainty which oblique muscle of either eye, the inferior or superior, was the weak one, but at that time he did not know any relief for it. However, that was in 1891. A year ago he read a paper before the American Medical Association, in which he says he can with prisms exercise these muscles by putting this prism before one eye with the axis vertical and looking at it in a horizontal line.
We see the lines, and, on opening the other eye, we see third line, and if that third line is situated obliquely muscles. Of, course, it depends upon which eye is covered or which eye has the prism. Then, by putting that eye on the two- diopter cylinder (which is quite strong) and revolving it to make that eye open a little more, we are working that muscle which is at fault, and by then turning it up in the other line we can exercise the oblique muscles.
DR. CHAMBERLAIN: I am very much interested in this part of the subject, as I suppose I have had my share of experience in this kind of work, and I know that we do not yet fully understand all the causes that may be at work upon these muscles. We find so many reflex symptoms from other organs which may come under the same influence, especially in the oblique muscles. I have been much interested in this movement. We have a field yet that is somewhat unexplored. I have been using for the last year, nearly, Savage’s prism, and following somewhat his methods of relieving eye-strain; that is, I correct by correction of the hyperphoria or the exophoria.
