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Compliments of the Author.
ASTHENOPIA
-»)>a‘%,,<<\/*——"
I
N’;
wow
’IL\‘
A MONOGRAPH
‘I Q‘! \'I
=%~'éWe2\i$ =/Ré Egq,s*A‘\='
__BY__
E. T.~ ALLEN, A. M., M. 1).
OMAHA.
cr-use & EDDY, PRINTERS,
1887.



f. w ~£-‘-::-k-41’.-I-;'.‘-,:.~.: n>..:.-“:w “
0 I 4 .
L -~-..
7 U H _ I ,-2"
".~-.';m\-> ;~ -' '

(';®n1‘erzi‘§
' PAGE
I. GENERAL C01\'SIDERA'I‘IONS..... 3
- II. MYOPIA,
Near-Siglztcdmss ................ .. 6
III. HYPERMETROPIA,
Far-Svlghtedness .................. .. 12
IV. PRESBYOBIA,
Old-Sightedness ................... .. 19'
V. ASTIQLIATISM,
Irregular Refraction ............ .. 21
VI. INSUFFICIENCY,
Muscular Weakness ............. .. 25
‘ VII. RETINAL ASTHENOPIA,
Over-Se1zsit'z'-veness ............... .. 28
VIII. SPECTACLES ......................... .. 29
IX. TEST TYPE ............... ........ .. . 32

E
v
{I
‘THE HOMCEOPATHIG PRQFEQSION

OMAHA, NEBRASKA.

J. AHMANSON, M. D.
Frenzer’s Block, Room 6,
(Opposite Post Office).

MARY J. BRECKENRIDGE, M. D.
Oflice and Residence,
1809 Farnam Street.

S. M. CAMPBELL, M. D.
1237 Park Avenue,
Hours: 10 to 12 A.M., 3 to 5 and 7 to 8 P.M.

EMMA J. DAVIES, M. D.
Residence and Ofiice,
322 North Sixteenth Street.

W. H. HANCHETT, M. D.
323 South Fifteenth Street, Tel. 526,
Hours: 11 to 12 A.M., 2 to 4 and 7 to 8 RM.

GEO. H. PARSELL, M. D.
Ofiice, Cor. Capitol Ave. and Fifteenth St.
Charity Patients, 11 to 12 A.M.

C. G. SPRAGUE, M. D.
Office and Res., 1704 Capitol Avc., Tel. 393,
Hours: 8 to 9 A.M., 1 to 3 and 7 to 8 RM.

O. S. WOOD, M. D.
N .W. Cor. Fifteenth dz Capitol Ave., Tel. 239,
Hours: 8 to 10 A.M., 1 to 4 and 6 to 8 P.M.


CQUNOIL BLUFFS, IOWA.

W. A. EDMONDS, M. D.
533 Broadway,
Hours: 9 to 11 A.M., 1 to 3 and 7 to 8 RM.


A. P. HANCHETT, M. D.
12 Pearl Street,
Hours: 10 to 12 A.M., 2 to 4 P.M. Tel. 10.


W. L. PATTON, M. D.
Cor. Main Street and First Avenue,
Telephone 14.

E. T. ALLEN, A. M.; M. D.
William’s Block, Room 9,
.Cor. Fifteenth and Dodge Streets.
AMELIA BURROUGHS, M. D.
1617 Dodge Street,
Hours: 2 to 5 P.M. Tel. 144.
B. W. CONNELL, M. D.
313 South Fourteenth Street,
Telephone 589.
0. M. DINSMOOR, A. M.; M. D.
111 North Fifteenth>Street,
Hours: 8 to 10 A-.M“-., 2 to 4 and 7 to 8 RM.
A. W. HARTUPEE, M. D.
Residence,
1812 Chicago Street.
W. H. PARSONS, M. D.
Cor. Fifteenth and Harney Streets,
Hours: 10 to 12 A.M., 3 to 5 and 7 to 8 RM.
G. W. WILLIAMS, M. D.
Ofiice and Res., Arlington Block, Room 17,
Telephone 838.
H. A. WORLEY, M. D.
1419 Dodge Street, Telephone 482,
Res. 1712 Capitol Ave.
0. W. GORDON, M. D.
556 Broadway.
J. P. MONTGOMERY, M. D.
9 North Main Street,
Hours: 9 to 12 A.M., 2 to 4 and 7 to 8 RM.
W. D. STILLMAN, M. D.
615 Willard Avenue. Tel. 145.
Hours: 8 to 9 A.M., 12 to 2 and 6 to 8 P.M.


TO MY
PROFESSIONAL
BRETHREN OF THE CITIES OF
OMAHA AND COUNCIL BLUFFS, IN GRATEFUL
ACKNOWLEDGMENT OF THEIR MANY
KIND FAVORS, THIS LITTLE
EFFORT IS INSCRIBED
B Y
THE AUTHOR .
EYE AND MUSCLES.
(FROM GRAY), Page 244.


THE EYE IN , SECTIONS.
(AFTER ANGELL).




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X


TENBQN or mzvrus
ASTHENOPIA;
A MONOGRAPH ON WEAK EYES,
BY
E. T. ALLEN, A. M., M. 1).,
SPECIALIST IN DISEASES OF THE EYE, EAR,
NOSE AND THROAT-
I.——GENERAL CONSIDERATIONS.

Asthenopia, from the two Greek words ’asthenes and ’0ps.
signifies “weak eyes,” or weakness of sight.* As such it is to
be differentiated from dimness of vision, due to ulcers of the
cornea, or their cicatrices (scars), from cataract,T from cloudi-
ness of the aqueous or vitreous humors and from disease of
the optic nerve, all of which render sight difficult or poor.
The complaints of an asthenopic patient are various and
significant. He says: “My eyes are weak; they burn and
feel badly on reading, sewing or writing,” or, “they blurr, water and
give out; have a strained feeling;” or, “they become trouble-
some on use and make my head ache." The patient may be
dizzy or nauseated, or have constant pain in the back whenever
the eyes are employed. There may be “sensitiveness to light,”
or “floating specks.” The lids are “dry, become red and stick
together in the morning,” and vision is worse by artificial light.I
In former times, for such troubles as these, blisters and bleed-
ings, emetics and setons were used until the poor sufferer pre-
'< Dunglison.
T An affection of the crystalline Lense.
l Vida “1,060 Cases of Asthenopia,” C. R. Agnew, M. D., New York.
4 ' ASTHENOPIA ;
ferred, in silence, to “ endure the ills he had, than fly to others
that he knew not of.” But thanks to those great reformers,
Helmholtz, Donders, Von Graefe and Hahnemann, the blind
may see by the gentler methods of our modern day. Yet, alas!
too many, ignorant of the meaning of these symptoms, con-
tinue to abuse their eyes, or neglect the remedy, until the mis-
chief done is almost irremediable.
To successfully deal with these affections it is necessary that
not only the specialist, but the regular physician as well, should
be able to form a correct diagnosis in each case. Thus he can
advise his patients wisely, treat them understandingly, and, when
necessary, send them to the expert oculist. \
To prevent the onset of these troubles, or to delay their
coming, to maintain the eye in health and aid the physician in
his efforts to cure, it is necessary that the laity, also, be well in-
formed as to the strength and weakness of their organs of sight:
for a defect in the eye greatly influences the system at large, and
in turn the visioih is affected by remote troubles, such as indi-
gestion, general debility and uterine dieaseq; and to know and re-
move the cause of the trouble is half the battle.
IThe causes of Asthenopia are principally six:*
Myopia (near-sightedness).
asses?
Hypermetropia (far-sightedness).
Presbyopia (old-sightedness).
Astigmatism (irregular refraction).
Insufficiency (weakness of the internal recti muscles).
Hyperaesthesia (over-sensitiveness) of the retina.
In the earlier stages of some of these forms of Asthenopia,
medicine and hygiene may accomplish a great deal—indeed, es-
tablish a cure. In other forms the defect is congenital, and can
only be remedied by applying a lens in front of the eye to aid
in focusing images exactly upon the retina, instead of allowing
them to fall behind or in front of it. I
The normal eye is emmetropicT—i. e., it is so shaped as to
bring rays of light which come from distant obj‘ects to a focus
exactly on the retina.
*A and F are sometimes called apparent Asthenopia; B, C and 1), true or ac-
commoelatvlve Asthenopza ; E, muscular Asthenopia.—[Dunglison.]
1‘ Diseases of the Eye. Wells’; p. 621.
A MONOGRAPH on WEAK rnzns. 5
FIG. 1.
W 1%
EMMETBOPIO Ern.—(After Hartwldge.)


It also possesses the power of “accommodation,” by which
is meant the ability to adjust itself unconsciously for different
distances,—at one moment regarding a book but a few inches
from the eye; at the next, clearly beholding distant objects, and
sweeping the horizon at a glance.
The power of accommodation lies in the ciliary muscle (see
Plate 1), which controls the shape of the crystalline lens, mak-
ing it more or less convex as is needed. How marvelously ac-
curate is this little muscle in the performance of its functions,
which regulate to such a nicety the most important of our special
senses! And what wonder that it is deranged and embarrassed
in its action by improper and excessive use!
But it may be asked, are not all eyes shaped alike‘? No. A
large percentage are too flat from before backward, making the
possessor far-sighted; others are too long, causing near-sighted-
ness. According to the best authorities, not over ten per cent.
of all eyes are really emmetropic, and Hartridge remarks* that
emmetropia, in a strictly mathematical sense, is exceedingly
rare."f

'~ The Refraction of the Eye. p. 24.
Jr “ Optical Defects of the Normal E3/e.—The eye is sometimes spoken of as if
it were a perfect optical instrument. This, however, is very far from being the
case. It is, it is true, wonderfully adapted for its purpose, . . . but the
perfect adaption to all the requirements of vision does not so much depend
upon its perfection as an optical instrument as on its free mobility, the great
sensibility of the retina, and the readiness with which the mind interprets the
impressions conveyed to it.
“Spherical aberration is, to a great extent, but not entirely, obviated by the
iris, and chromatic aberration is considerable. The cornea is not aperfectly
spherical surface. Strictly speaking, it is not a portion of a spherical surface
at all, but forms the extremity of an elipse. . . . The media of the eye,
moreover, are not perfectly clear, for in the lens are numerous striae and spots,
. . . and in the vitreous are a large number of floating cells and fibers.
6 ASTHENOPIA ;
Still ninety per cent. of the people do not have trouble with
their sight, because the defects are overcome or completely hid-
den by a strong ciliary muscle; and Dr. Agnew, of New York,
says: “Many subjects unconsciously overcome physical defects
in their visual organs without experiencing any abnormal sensa-
tion, . . . and are carried along in the daily use of their eyes
without pain or inconvenience, even though they have a decided
error of refraction or accommodation.“< n
Let us now briefly consider the conditions above referred to
sem'atz'm—their etiology, diagnosis, treatment and prognosis.
II.—MYOPIA.





(N ear-Sightedness.)
Myopia is that condition of the eye in which it is impossible
to see distant objects clearly. An eye so affected is sometimes
called a microscopic eye, 'us., the telescopic, as in Hypermetropia.
Myopia is classed under false or accomodative Asthenopia, since
the weakness is due to inability to relax the accommodation for
distance. Hence parallel rays (those coming from a distance,)
are focused in front of the retina, thus causing the image formed
to be confused and indistinct.
The optical defect is that the eye-ball is too long from before
back, due to its bulging posteriorly, at the entrance of the optic
nerve.T
FIG. 2.
MYOPIO EYE.
The retina, too, has a large hiatus, formed by the entrance of the optic nerve—~
the ‘blind spot.’ Most people are quite unaware that they have in each field
of vision a gap sufiicient to include a man’s head at a distance of seven feet.”-—
Opthalmic Science and Practice. J uler, p. 342.
"< Ten Hundred and Sixty Cases of Asthenopia.
T Diseases of the Eye, Angell, p. 58, Id. Wells, p. 629. Ophthalmic Science
and Practice, J uler, p. 346. Refraction of the Eye, Hartridge, p. 22.
A MONOGBAPH on WEAK EYES. 7
This anomaly requires especial and considerate attention as
“its tendency is constantly to progress, until it may terminate
in complete blindness.”* The myopic eye is always a diseased
eye. [Hartridge.]
Myopia occurs but rarely in infancy or among the illiterate,
while with savage races it is almost unknown. The disease
develops in childhood and adolescence. as the eyes are used for
near work, and, according to German ophthalmologists, in-
creases in direct proportion to the amount of education.]L
ETIoLoGY.—(Gauses.)—1. Myopia is sometimes congenital
and often hereditaryi
2. It is generally due to the prolonged and close application
of an individual to work of a very fine character, which causes
congestion of the tuhics of the eye-ball and their consequent
weakness.
3. The strong convergence of the eyes for near work. and
the resulting pressure upon them by the tendons of the eocternal
recti muscles cause the eye-ball to bulge posteriorly.—(Wells.)§
4. The stooping position which myopes assume, increases
the chronic congestion of the eye tunics, resulting in further
softening and still further bulging of the posterior pole.h
5. Work in a defective light, which necessitates the holding
of the book close to the eyes.>l<>’-<
6. Overuse of the eyes in youth when the tissues are yielding.
7. Spasm of the ciliary muscle in Hypermetropia.—[See p.
19.]
8. Gloudiness of the cornea.
9. Lamellar cataract.
10. Too strong glasses.
Draenosrs.——The patient finds it diflicult to see well at a dis-
tance; he may be unable to recognize people across the street;

\ Ophthalmic Therapeutics. Norton, p. 311.
T Vida Dr. Cohn’s “ Untersuchung der Augen von zehn Tousen u11d sechzig
Schulkindern.”
I Diseases of the Eye. Wells, p. 629.
Q Watchmakers and jewelers, who use but one eye, are seldom affected,
proving that close work without convergence does not produce Myopia.-—
[I-Iartridge.]
ll Diseases of the Eye. Angell, p. 63.
““ Ophthalmic Science and Practice. J uler, p. 349.
8 ASTHENOPIA. ;
the child at school cannot read what is written on the black-
board; yet both see well enough if the object is near at hand.
There is liable to be pain and fatigue, with intolerance of
light, and after prolonged use, especially in the evening, the eyes
become irritable, red and hot. Vision, too, is apt to be interfered
with by “mustece eolttanes” (floating specks before the eyes), or
by fixed scotomata (dark spots).
Objective ,S't'gns.——The lids, which are held nearly closed, to di-
minish the circles of diffusion, (whence the name muo, I close,
and ’0ps, the eye,) are generally found congested. The eyes
themselves are usually prominent, and the pupils, especially in
young people, quite large. The patient leans over his work, and
holds his book close to the eyes.
With the ophthalmoscope, of which, in this enlightened age,
every scientific physician should be master,>'~< the appearances are
quite characteristic.
The fundus is hyperaemic, and white spots of choroidal atrophy
are seen, one of which is crescentic-shaped and lies on the outer
side of the optic nerve disc. '
Tests.—With the Opthalmoscope we can see the details of the
fundus at some distance from the eye, if the degree of Myopia
be at all great. When regarding the optic disc, if we move our
head slightly to one side we notice that the image moves in the
contrary direction.T If we bring the instrument close to the eye,
the weakest concave glass with which we see the fundus clearly
is the measure of the myopia,I the accommodation being at rest.

*’ “In the whole history of medicine there is no more beautiful episodethan
the invention of the ophthalmoscope, and physiology has few greater triumphs.
With it, it is like walking into Nature’s laboratory and ‘seeing the infinite in
action,’ since by its means we are enabled to look upon the only nerve in the
whole body, which can ever lie open to our inspection under physiological con-
ditions, and to follow in a transparent membrane, an isolated circulation from
its entrance into the eye through the arteries, to its exit in the veins. We are
further enabled to watch and study daily, morbid processes in every phase,
from simple hyperaemia to absolute stasis; while oftentimes through its agency
also we get the first intimation of disease in remote and seemingly unconnected
organs, so as to read, as if in a book, ‘the written troubles of the brain,’ the
heart, the spleen, the kidneys, and the spine. . . Nor is it surprising that
the student, once entered upon its investigation, finds the study as fascinating
as it can be made profound.”—Loring’s Ophthalmeseopy, p. 1. D. Appleton
& ‘o.
L T Diseases of the Eye. Wells’; p. 633.
3 Refraction of the Eye. Hartridgc; p. 133.
A MONOGBAPH ON WEAK EYES. 9
By Retinoscopy, or “the Shadow Test,” the image moves with
the mirror. The great advantage of this method over all others
is that by it the refraction of little children and the illiterate can
be tested most accurately and defects detected which no other
test reveals. It is so simple, too, that anyone can master
it in a very short time.>’-< Placing the patient with his
back to the light, which is two inches higher than his
head. and taking your station four feet in front of
him, have him look slightly to your right as’ you examine
his right eye, and vice tersa. Looking through the hole in your
ophthalmoscope, as you reflect the light into his eye, you
will perceive the red fundus reflex. As you now rotate the in-
strument very slightly you will see a shadow come out from be-
hind the iris and partly cross the pupillary space. If this shadow
moves with the mirror, or in the same direction that the reflected
light on the face moves, the case is one of Myopia. If the shadow
is well defined, and moves slowly against the mirror, Hyperme-
tropia is indicated. If the shadow moves obliquely, or if, instead
of a solid shadow, dark and light lines cross the pupillary space,
Astigmatism is proved to exist.
With the Test Type (see p. 33) each eye should be examined
separately, the other being covered. as often a great difierence
exists between the two eyes. The Myopia Eye can never read N0.
XX. at twenty feet, bat, as a rule, can read even diamond type if held
close to the eye. Distant vision is improved by concave lenses.
Myopia is very often simulated by spasm of the ciliary
muscles in a hypermetropic eye; and unless atropine has been
used, the tests above given may not detect it; but, as the treat-
ment depends entirely upon the cause of the asthenopia, an er-
ror in diagnosis might lead to grave results, so that it often be-
comes necessary in children and young people to thoroughly par-
alyze the ciliary muscle with atropine, when the fault can no
longer be hidden. (See p. 16.)
TBEATMENT.——Th6 aim in the treatment of Myopia is five-fold.
1. To prevent its onset.
2. To prevent its increase.

< See Hartridge’s admirable article on Retinoscopy (Chap. iv.; Refraction
of the Eye). Also one by Dr. Jackson, in the American Journal of the Zlfedical
Sciences (Philadelphia), for April, 1885.
~\Ivu
L4
0
Jbuu
'I
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-I
J
10 ASTHENOPIA ;
3. By suitable glasses to enable the patient to see at a greater
distance.
4. To remove any muscular asthenopia.
5. To combat secondary disturbances.
First. We cannot too forcibly impress upon all who have to
do with the education of the young, the importance of prevent-
ing Myopia, by removing all conditions which are likely to cause
it; and it is the duty of physicians everywhere to enlighten par-
ents and teachers as to the fatal defects in school-room furniture.
The seats and desks should be so arranged that no stooping is
necessary, or even possible, but the children be compelled to sit
erect and hold their books high. The light should be good, but
never facing the 1ou1o't'ls.* Children should not be allowed to
read too much in the evening, especially by a weak light. When
in poor health, after passing through the measles or scarlet fever,
or when affected with any cloudiness of the cornea, increased
caution is necessary.
Second. To carry out the second indication, the prevention
of an increase of Myopia, patients should be instructed never to
read in a moving train or carriage; to avoid all fine work, such
as crocheting——at least temporarily; to use books printed in
good, bold type; to write in a large hand, and sit erect when
so engaged; to sit so that the light may come in over the left
shoulder, and to use artificial light as little as possible; never to
hold the book nearer than twelve inches to the face, and always
rest the eyes as soon as they become tired. “It is desirable that
patients discontinue work and rest their eyes from two to five
minutes every half hour.”T Patients should exercise daily in the
open air and practice looking at distant objects.
Third. The correct prescription of glasses for Myopia is a
delicate matter, and requires an exact knowledge of the intra-
ocular conditions present. Patients, if left to choose for them-
selves, always select glasses which are to strong; and there is
nothing which so rapidly increases an existing near-sightedness
as the use of such improper lenses.1j Patients, therefore, should
/
* Vide Juler’s Ophthalmic Science and Practice, p. 351, and Augell’s Dis-
eases of the Eye, p. 77.
T Ophthalmic Therapeutics. Norton, p. 311.
I Norton, p. 312. Wells, p. 635. Angel], p. 74.
‘J L
A ,- r c
I (
I
l
A MONOGBAPH ON WEAK EYES. 11
never buy their spectacles at random of opticians or itinerant
venders, but should always have them accurately prescribed by a
competent physician or oculist. The evil result of random
spectacle-buying may be seen in Dr. Oohn’s report. Of 1,004;
near-sighted children in the German gymnasia, only 107 wore
glasses at all. Of these, 99 had selected their own “and 11,
only, wore those which were not injurious to the eye.”
To-day, alady came to me suffering with inflammation of the
optic nerve and retina, induced by glasses which she had chosen
for herself and which were two dioptrics too strong. She also
had astigmatism, which, of course, her glasses failed to correct.
Sometimes no glasses at all are needed, but if found necessary
we give the weakest concave lenses, which removes unpleasant
symptoms and renders distant vision easy, though not usually
perfect.
Glasses are often prescribed for certain distances, as two feet
for reading music. In high degrees of Myopia, two pairs may be
employed, one for distance and a weaker pair for near work.
The patient should be impressed with the fact that the glasses
given him for reading are not to enable him to see better, but to
“increase the distance at which near objects may be seen," and
thus relieve the eye of the necessity of strong convergence.
Fourth. For the treatment of the muscular asthenopia, if any,
see Sec. VI.
Fifth. To combat the secondary disturbances, great atten-
tion must be given to the general health. Regular out-of-door
exercise should be taken, and the system built up by suitable
diet, tonics and medicines. Sa1isbury’s beef and hot water
regimen is excellent. Iron is often useful, and also jaborandi,
physostigma, ruta and sulphur. For pain and inflamation com-
pare belladonna, phosphorus, prunus spin, spigelia and thuja*
cactus and macrotin.T
In case the disease progresses steadily we must give the eye
entire rest by the installation of a one grain solution of Atropine
three times a day for some weeks. We may also apply dry cup-
ping to the temples with decided benefit. Often a wash of tepid
milk and water is grateful to the eye. If there is much conges-

* Norton’s Ophthalmic Therapeutics, p. 311.
T Ange11’s Diseases of the Eye, p. 70.
12 ASTHENOPIA ;
tion, add a few drops of hamamelis and administer the same in-
ternally.
Pace-Nosrs—-(Expected Results.)——-Myopia may (exceptionally)
remain stationary from childhood to old age; or it may
temporarily progress to the age of thirty and then stop,
if the general health be good; or, again, it may progress
steadily and constantly. It never decreases—a'. e., the globe
never resumes its normal shape, and the “far point” can
never recede from the eye; but, due to the influence of age, the
near point does recede, as that we oftentimes find old people
who at sixty are able to read without glasses. This is proof
positive that they have Myopia,* though you would probably be
unable to convince them of the fact.
If the near-sightedness is of high degree, amblyopia (poor
vision, due to nervous defect or injury,) is the invariable result.
The patient is greatly troubled with floating specks and black
spots in the field of vision. When Myopia is progressive from
the first, changes take place in the back of the eye, causing in-
fiammation, and sometimes resulting in the complete disorgan-
ization of the part.T In youth almost all Myopia is progress-
ive, and “prog¢~esstoe Myopia threatens bZz'ndness.”I It does not
always result in blindness by any means, but it may do so. Hence
we see the necessity of giving early attention to this affection,
and making every effort to check its progress.
III.-—HYPERMETROPIA.
(Far-Stghtedness.)
Hypermetropia (hg/per, in excess; metron, measure; ’ops, eye;)
is that condition of the eye in which rays of light from distant
objects are brought to a focus, behind the retina, the eye being
at rest.
This condition gives rise to true or accommodative Asthenopta,

‘ Hartridge Refraction of the Eye, p. 124.
T These changes are, choroidal atrophy, opacities and disorganization of
the vitreous, intraocular haemorrhage, detachment of the retina, and cata-
ractous condition of the lens.
I Angel], p. 68.
A MONOGBAPH on WEAK runs. 13
since the eyes cannot be used continuously for near vision even
in the best light without pain and confusion of sight, although
for the first moments the patient can see easily and distinctly.
The optical defect is that the antero-posterior diameter of
the ball is too short, or the refractive power is too low, so that,
O





Fre. 3.
HYPERMETROPIO EYE.
instead of getting clear images upon the retina, the patient per-
ceives everything as confused.*
The hypermetrope, therefore, has to use some of his accommo-
dation to see distant objects distinctly, and hence starts with a
deficit for all other requirements. Hence to see print at the or-
dinary distance requires all the eifort of the emmetropie eye,
plus enough more to overcome the amount of his Hypermetro-
pia.
The defect is a congenital one, and due to an imperfect de-
velopment of the eye-ball, but is seldom discovered until the
child begins to read.
In youth the hypermetropie eye is strong, since the constant
efiort put forth to see, gives the ciliary muscle increased growth
and power. But some overuse of the eye, some excessive strain,
especially in a period of ill health, so weakens it that thenceforth
it is unequal to the task it has to perform. For this reason we
find nearly twice as many cases of weak-sight in hypermetropie
eyes among women as among men, not because more of them
are hypermetropie, but because they are weaker physically, their
hours of work are more, and their occupation, especially sewing
by artificial light, requires greater exertion of their power of
accommodation. Men naturally endowed with great power of
* Hartridge, p. 103. Juler, p. 351. Wells, p. 640. Etc., etc.
14 ASTHENOPIA ;
accommodation may escape Asthenopia altogether. Thus, the
American Indians are almost universally hypermetropic and yet
they are possessed of the keenest sight and strongest eyes. A
physician of this city, well along in years, having a hypermetro-
pia of high degree, is yet able to see very fine print close to the
face. Among men, we find the most cases;of true asthenopia
in students, clerks, book-keepers, and professional gentlemen,
who use their eyes constantly for near work.
While Far-sightedness resembles Old-sightedness (Presbyopia)
in many of its symptoms, the two must not be confounded. The
former is due to the shape of the globe, the latter to a gradual
loss of power of the accommodation. rThe former exists in child-
hood and continues through life. The latter only exists as the
result of age. Both, however, are relieved by convex glasses.
E'rIoLoGr.———The causes of Hypermetropia are :
1. Heredity. Several members of the family being usually
affected.
2. The result of disease, the cornea having become flattened.
8. Absence of the lens, as after cataract operations.
4. Detachment of the retina, from tumor or exudation be-
hind it.
5. Reduction in the power of refraction of the lens.
The defect is as a rule, congenital, and an over-strain brings
it to light; but general debility, fevers, dissipation, worriment,
etc., may do the same.
Hrsronr AND Drxeuosrs.—The onset of the trouble is at first
gradual. The eyes become tired more and more easily. The
lids are irritable. Headaches are common. The remedy is at
flrst neglected, as such people object to beirig laughed at, by the
ignorant, for “wearing glasses so young!” Hence the patient
continues to overuse and strain his eyes, determined to accom-
plish given amounts of work in certain times, till there comes_
a day in which his eyes suddenly give out. He “cannot see !” the
letters are blurred. He has moments of blindness, and in alarm
he bethinks himself of the oculist he should have consulted
long ago.*
The patient states to you that he‘ can see distant objects very
well, but that, after reading a little while, the print becomes in-

=‘~ The author’s own experience.
A MONOGRAPH ou WEAK turns. 15
distinct and the letters run together; the eyes ache and fill with
tears, and there is such a feeling of discomfort that he must
rest them for a time. The symptoms then quickly subside, but
reappear when work is resumed. If relief is not given, the eyes
become bloodshot, and upon the least service are fatigued and
painful, so that they can scarcely be kept open, and the lids ad-
here in the morning. In other cases reading may invariably be
followed by‘such headaches that cerebral trouble is apprehended,
and the patient is condemned to spend her time in idleness, when
the whole trouble might be removed by correcting the hyperme-
tropia with suitable glasses. [Juler.]
If young, the patient’s friends may think him short-sighted
because he holds the book close to his face. This is owing to a
spasm of the ciliary muscle, which produces a temporary myopia.
This condition is exceedingly common, and physicians must
always be on their guard against it. Such a patient selecting
glasses for himself would choose concaves, and thus bring on a
confirmed myopia, whereas he ought to have the spasm relaxed,
and wear convex lenses.
Objective Sz'gns.—Frequently a fiat-looking face, with eyes
small, and seemingly far apart, are indications of hypermetropia.
[Hartridge] The lids look irritable, and may even become
granular from this cause alone. Hence, in all chronic ophthal-
mic troubles, the refraction should be tested, as “frequently com-
plaints which have been intractable are easily and quickly cured
when the proper glasses have been prescribed.”< The pupils are
large and sluggish,’[ in cases accompanied with irritation or dis-
turbances of the uterine or digestive functions. Convergent
squint in a child is an almost certain sign of hypermetropia.
Test Tr/pe.——The manner in which the patient reads the type
at twenty feet is often an indication of the trouble. It takes
some time for him to make out each line, but, if not hurried, he
reads it all correctly. If, however, the degree of error be high,
or there is much spasm of the ciliary muscle, he may fail to read
No. XX at twenty feet. Except in this last condition, a weak
convex glass before the eye aids his vision, and the glass with
which he sees best is the measure of his manifest hypermetropia.

> Refraction of the Eye; p. 111.
T Diseases of the Eye. Angel]; p. 88.
16 ’ ASTHENOPIA ;
Owing to the tonic contraction of the ciliary muscle, some hy-
permetropia is usually concealed. As age advances, however,
this also becomes manifest.
To discover the entire error of refraction in young people
and children, it is necessary to relax the ciliary muscle with atro-
pine. By this, also, we are able to diagnose a spasm of the mus-
cle in hypermetropia from the simulated myopia. Under 35
years of age no harm need be feared at the hands of an expe-
rienced physician, a 4-grain solution being used three times a day
for three days. Above the age mentioned it is seldom necessary
to use a mydriaticfi<
Pin-Hole Test.-—This simple test may be used when the proper
convex and concave trial lenses are not at hand. The patient is
to look through a large pin-hole in a blackened card at a light
twenty feet away. Vision is at once improved. When the card
is moved rapidly before the eye the light seems to dance. If
two holes are made an eighth of an inch apart he sees two lights,
“the second at the left of the other.”T
Opthatmoscopic Test.-—The patient’s accommodation having
been paralyzed, and your own entirely relaxed, find the strong-
est convex glass in your ophthalmoscope, with which you can
clearly see the vessels and nerve. This is approximately the
measure of his total hypermetropia.
By Retinoscopy the shadow moves against the mirror. The
greater the error of refraction, the slower the movement and the
less distinct the outline. As it is often important to find the
exact error in cross-eyed children too young to read, this method
gives it to us very easily and perfectly.
TREATMEN'r.——The primary and most important indication in
the treatment of hypermetropia is the selection of proper
convex lenses, which should be prescribed on the first appear-
ance of asthenopic symptoms. These obviously relieve the
strain upon the ciliary muscle, since they produce the same
effect upon the eye as increased accommodation—i. e., they
adapt the eye for nearer vision, allowing it easily to bring diver-
gent rays of light to a focus upon the retina.

>" The pupils may be contracted again with eserine sulph. 4 gr. to the ounce
water, applied every three hours.
1- Dr. Thompson, in the American Journal of the Medical Sciences.
A MONOGRAPH on WEAK nrns. 17
One might, at first, suppose that the proper glasses would be
those_which would exactly correct the error present; but this is
far from the case, since the eyes are unable at once to accustom
themselves to so great a change of refraction. People selecting
spectacles for themselves generally choose those which are too
strong. Even the most experienced oculists sometimes have
“ considerable trouble in finding glasses which can be worn with
comfort; and yet, if the eyes are to be used at all, the help of
glasses is absolutely required.” [Angell.] Again, so many cases
are complicated with astigmatism that it is unsafe for anyone
except an occulist to risk a prescription.
If the hypermetropia is of high degree, it may be necessary
to begin with weak glasses and increase the strength every few
weeks, in order to effect a perfect cure.
For young people it is best to prescribe for reading only,
since, if glasses are worn constantly, they become indispensible.
Nevertheless, there are cases in very young children, possessed of
marked hypermetropia, where we should insist upon their con-
stant use in order to avert the change to myopia, which often
occurs as the child begins to readfl< And again, if the eyes are
crossed, the patient should wear glasses all of the time.
Aged people, with much hypermetropia, and those who have
endured the operation for cataract, must have two pairs of
glasses—one for distance, and the other a stronger pair, for near
vision. In uncomplicated cases, eye-glasses may be used.
Regimen.-—Certain cases, in which the error of refraction is
slight, and the trouble has been brought on by muscular debility,
may be relieved without the use of spectacles by restoring the
patient to vigorous health through a change of air, a generous
diet and the proper internal medication.
In all cases great benefit may be derived from graduated
exercise of the eyes, to be pursued as follows: Abstaining from
all other near work let the patient practice the reading of some,
not-too-fascinating, book printed in clear, large type, and held in
a good light. The first day he should read till his eyes tire;
noting the time, let him add one minute to its length daily, per-
forming the exercise ter die.
In all cases of Asthenopia work should be interrupted every

* liqtde J uler’s Opthalmic Science and Practice, p. 407.
18 ASTHENOPIA ;
half hour to rest the eye and enable it to resume with vigor
and case. In obstinate cases “it may be necessary to completely
paralyze the accommodation for some weeks by the instila-
tion of atropine, simply for the purpose of resting the eyes.” *
If, under the use of the glasses prescribed, all symptoms of
Asthenopia do not disappear, the fault probably lies in the
power of convergence, (Muscular Asthenopia).
Jldedtctnallg/, we may often greatly benefit our patients by the
use of macrotin, nux vomica, spigelia, or gelseminum. If re-
tinal hyperaemia coexist, cactus or belladonna may be called for.
Irritability from over-use is relieved by joborandi; and ruta may
be of service in restoring the strained musculus ctltow~is to its
normal tone.
P:aoeuosrs.—By the proper treatment, attended to early, we
may hope for the most favorable results; otherwise the follow-
ing sequelae often occur:
Convergent Strabismus.
Spasm of the ciliary muscle.
Myopia.
Premature Presbyopia.
Disease.
First. Convergent Staabismus (Gross-eye) is very frequently
due to hypermetropia, at least 80 per cent. of all cases being
traceable to it.']' The trouble may, however, be checked in its
very beginning, at the age of three or four years, by paralyzing
the accommodation for a length of time, and the using of
proper spectacles.
Second. Spasm of the Ctltary Muscle is more often found in
slight Hypermetropia than in that of high degree. It causes
dread of light (photophobia), watering at the eyes (lachryma-
tion), pain, contracted pupil and hyperaemia of the retina. Its
treatment consists in paralyzing the muscle by “ the methodical
use of atropine (gr. iv. to the ounce) applied two or three times
daily, until the accommodation is quite relaxed. It sometimes
yields in a few hours, in other cases not for several days.”I
Glasses must immediately be applied that the patient may be-
¢"':“E"~"E°!"
Angell, Diseases of the Eye, p. 92; Wells, Diseases of the Eye, p. 645, etc.
1‘ Refraction of the Eye, Hartridge, p. 181.
l Wells, Diseases of the Eye, p. 630.
A nronoenarn on WEAK EYES. 19
come accustomed to them while the effect of the atropine is
wearing off, as otherwise the spasm will return. If the refrac-
tion is not corrected this spasm of the ciliary muscle will change
a hypermetropic to a myopic eye, or cause myopic astigmatism.
Third. Myopia.—-Many children, who are hypermetropic at
birth, become myopic when they begin to use their eyes contin-
uously for reading, sewing or fine work. [Angell.] This is
especially apt to be the case if the child is not robust.
Fifth. Disease.—Hypermetropia, when combined with astig-
matism tends to produce certain morbid changes in the fundus
like those which occur in myopia. Nearly three-fourths of all
cases of that dreaded affection, Glaucoma, which so often result
in blindness, occur in hypermetropic eyes.
IV.-—— PRESBYOPIA.
(Old-Sightedness.)
[.Presbus, old; ’0ps, eye.]
Several changes take place in the eye as the result of increas-
ing age. The acuteness of vision diminishes as the media lose
their transparency, and the retina its sensitiveness. The power
of accommodation gradually diminishes, and hence the near
point of vision steadily recedes. This is due to the lens becom-
ing firmer, and so losing its elasticity, and also to a loss of
power in the ciliary muscle. The condition is entirely physiolog-
ical, no anomaly of refraction being present.
When nine inches is the nearest point at which we can see to
read No. 1 type, we consider Presbyopia to have begun. In the
emmetropic eye this occurs at 45 years of age: with myopia
later, and hypermetropia earlier.
Since, however, all of the accommodation cannot be used
continuously for reading, when the near point is nine inches, the
book is always held at a much greater distance from the eye.
Erronoc+r.-——The chief cause, as already mentioned, is
Old Age; but
Broken Health,
Prostrating Disease,
20 ASTHENOPIA ;
Hypermetropia, and
Incipient Cataract
may precipitate the trouble. ,
Drseuosrs.——-The presbyope enjoys good sight for distance,
but finds it difficult or impossible to maintain clear vision for
near objects, especially in the evening, Print is indistinct and
confused. The eyes become tired and perhaps painful. In
reading he places the lamp between his eye and the page so as
to have the strongest possible light upon what he is reading, and
at the same time to make his pupils contract, and thus shut off
the circles of difiusion.
Objective Signs.——The patient’s distant vision may be §-E}, i. e.,
he reads No. XX at twenty feet, but he cannot read small print
as near the eye as he should. Convex glasses are not needed for
distance, but they greatly improve near vision.
THE TREATMENT consists in furnishing artificial accommo-
dation——i. e., in adjusting such convex lenses as bring the near
point back to the normal distance. Tall people naturally work
at longer range than those short of stature, and the glasses
should be adjusted to the distance at which the patient’s occu-
pation requires him to work. For reading they should render
the type clear without magnifying it. Patients selecting glasses
for themselves almost always choose those which do magnify, and
are hence too strong. These not only fail to give relief, but
cause increased weariness of the eye.
It is not best as many imagine, to defer to the latest the
wearing of proper lenses. Discomfort and fatigue of the eyes
are sufficient indications that the time has come when they need
relief. Suitable glasses, then prescribed, instead of increasing
the Presbyopia, tend to prevent it. Where Presbyopia exists in
an eye strongly hypermetropic, or myopic, the patient will re-
quire two pairs of glasses, one pair for reading and another for
distance.
Pnoeuosrs.——In the emmetropic eye, Presbyopia increases
about one dioptric every five years from the age of 45 to that of
70. At 75, as a rule, all accommodation is lost.
If the glasses have to be changed much oftener than every
three or four years, it is not a favorable symptom, as rapidly in-
creasing Presbyopia is a precursor of Glaucoma. When this
A MONOGBAPH ON WEAK mans. , 21
disease exists no glasses at all should be used, as it is necessary
to avoid all tention in the eye.
Second Sight, is a popular term to indicate that one who has
worn glasses, no longer needs them. This condition is due to a
contracted pupil, admitting only the central rays of light, which
do not need much focusing. Or it may be due to cataract begin-
ning at the edge of the lens, (cortical,) by which the refractive
power is increased. Elderly people who never seem to need
glasses give, thereby, positive evidence that they were near-
sighted, unless the conditions just mentioned are present.
V.—ASTIGMATISM.
(Inregiilar Refraction.)
Astigmatism is a condition of the eye in which the rays of
light emanating from a point are not brought to a focus at any
place within the eye, so that a dot appears as a line, an oval or a
circle, but never as a point; hence the name: ’a, privative, (with-
out,) stigma, a point.
The optical defect lies in the cornea, which, instead of being
round, is egg-shaped, or curved like the bowl of a spoon, having
different degrees of curvature in its two principal meridians,
which latter are always at right angles to each other. This un-
equal curvature produces unequal refraction, so that rays are
brought to a focus by one meridian in front or behind the place
where they are focused by its conjugate. In this way we account
for the letters of a printed page seeming to “ overlap each other”
and their outlines appearing so indistinct.
Astigmatism is the most common of all the refractive errors
of the eye, as it complicates very many cases of Hypermetmpia,
and still more of Myopia. Indeed, all eyes are very slightly
astigmatic, but the asymetry is usually so little that it occasions
no annoyance.
The forms of Astigmatism are principally two,-—the regular
and the irregular. Of the second but little need here be said, as it
is almost irremediable with glasses, though it may be improved
by various other devices.
22 ASTHBNOPIA ;
Of the regular Astigmatism there are five varieties:
Simple hypermetropic Astigmatism.
Compound hypermetropic Astigmatism.
Simple myopic Astigmatism.
Compound myopic Astigmatism.
Mixed Astigmatism.
In the simple forms one meridian is emmetropic, and that at
right angles to it, hypermetropic or myopic. In the compound
varieties both principal meridians are hypermetropic or myopic,
but unequally so. In mixed Astigmatism one meridian is hy-
permetropic and the other myopic; this form is quite rare, how-
ever. Usually both eyes are affected symmetrically, but this does
not always hold true. In most of the marked cases of Astig-
matism vision is somewhat impaired by an associated defective
retina or nerve (amblyopia).
, E'rroLoGx.-—Regular Astigmatism is congenital, and often her-
editary. Occasionally it may be caused by ulcers, or wounds of
the cornea, as the cataract operation.
The irregular variety when acquired is due to ulcers, injuries,
maculae, conical cornea, or a displaced lens; when congenital, to
irregularities in the refractive power of different sectors of the
lens.*
DIAGNOSIS-—Whi16 the patient is young but few symptoms
are manifest, as he is able largely to overcome the defect by un-
equal contractions of the ciliary muscle. With increasing years
the lens becomes less plastic, the eyes are more constantly used
and vision is noticed to be defective. w'Qbiects appear differ-
ently as he tips his head from side to side,‘ and the eyes become
wearied if he use them too long for near work. The letters run
together, and distant objects are indistinct in outline. The pa-
tient has probably tried many pairs of spectacles, but never
found one to suit.
Headache is a very prominent symptom. It may be frontal
or occipital; is often nervous, attended with nausea; a headache
for which the patient has “tried everything!” Nothing perma-
nently relieves it, because nothing has removed the cause.
Some refer their symptoms to the spine, and complain of
$"'."‘S”E°£"‘
* Wells’ Diseases of the Eye, p. 150. Hartridge, Refraction of the Eye,
p. 139.
A MONOGRAPH ON WEAK EYES. 23
severe aching in the neck and down the back, with great weari-
ness on slight exertion, as knitting, crocheting or reading.
Objective Signs.—In the astigmatie subject we frequently note
a lack of symmetry in the two sides of the face. To see better the
patient often tips the head to one side, and whenever we observe
him so doing we may be sure Astigmatism is present.
Tests.—Having failed to bring the vision up to normal with
convex or concave lenses, and suspecting Astigmatism, we direct
the patient to look at a disc of radiating lines in groups of
threes.
FIG. 4.
~~\\\
90




got
Placing it first at a distance of 30 feet, we gradually approach
the patient and find out whether at any point he is able to see
some of the lines clearly while others are indistinct. If this be
the case the presence of Astigmatism is proved, and the direction
of the most distinct line is also the direction of one of the
24 ASTHENOPIA ;
principal meridians.“< Of course each eye is to be tested seper-
ately. In some cases the above method is not reliable.
Hence, it is best to resort to Retinoscopy, which immediately
reveals the nature of the error and the direction of the princi-
pal meridians, with the approximate amount of error of each.
I cannot too strongly urge upon all physicians to make them-
selves master of a method of diagnosis at once so simple, so
easy, so accurate. In Astigmatism the red fundus reflex is
crossed by bright and dark lines, which indicate the direction of
the principal axis.
Opthalmoscopic Test.—By this the optic nerve disc appears
oval, instead of round,]L the long axis corresponding to the mer-
idian of greatest refraction, when we pursue the indirect method,
and vice rversa when the direct.I As all are not supplied with the
requisite appliances for trying the tests already described, we
will give another and very simple one: Have the patient look
through a large pin-hole in a blackened card at a light thirty feet
away. If, on moving the card back and forth in one way, the
light seems to dance, while it does not do so when the card is
moved in the contrary direction, Astigmatism is proved to exist.
Various other methods are in use among specialists for the
detection and estimation of astigmatism by means of the sten-
opaeic slit, the prisoptometer, Tweedy’s optometer, and the ophthal-
mometer of Javal and Schiotz.
TREATMENT.-—NO one but an oculist should attempt to pre-
scribe glasses for an astigmatic eye, since it requires great
nicety in locating the angle of the principal axis and a thor-
ough understanding of the theory of irregular refraction. The
glasses required are cylindricals—i. e., those which are per-
fectly straight in one direction, but ground convex or con-
cave in the opposite. When the astigmatism is combined
with hypermetropia or myopia, a lens which is cylin-
drical on one side and spherical on the other is used, while
for the correction of mixed astigmatism, crossed cylinders, or
combinations equivalent to the same, are to be prescribed. Eye-

* For measuring the amount of error, see the large works on this subject.
1- I t may have this shape from other causes.
I For the estimation of refraction by this method see Ophthalmic Science
and Practice Juler, p. 393, or Loreng’s Ophthalmoscopy, p. 118.
A morzocnxrn on WEAK mus. 25
glasses should never be used, as with them it is impossible to
preserve the proper axis, but spectacles should be ordered for
constant use. Medicinally, agaracus, jaborandi and physostigma
are beneficial where unequal contraction of the ciliary muscle
exists. Atropine will relieve the headaches temporarily.
Pno<mosrs.—-Recent investigations have shown that uncorrected
Astigmatism threatens the integrity of the eye. In myopic Astig-
matism we most frequently find distinct lesions in the back of the
eye, while hypermetropic Astigmatism produces posterior chor-
oiditis and atrophy around the optic nerve disc. “Astigmatism
predisposes to Myopia,” said J uval, since it is eyes affected with
hypermetropic Astigmatism, which pass over and become pro-
gressively myopic.
Hence, Astigmatism in early life may truly be said to be a
most dangerous optical defect. In school children, therefore,
whenever there is a doubt in regard to the optical condition of
the eyes, “it is the duty of the family physician to advise that
they be carefully examined by a competent ophthalmic surgeon.”
[Angell.]
VI.—INSUFFICIENCY.
(Muscular Asthenopia.)
Insufficiency is a form of Asthenopia, characterized by very
troublesome symptoms, due to an inability to maintain converg-
ence of the eyes for near objects for any length of time.
rThe trouble consists in a weakness of the internal recti mus-
cles (those which turn the eyes to the median line), so that they
are unable to oppose their antagonists, the eacternal recti; and
the extra exertion constantly put forth, in the effort to retain bin-
ocular vision, wearies the eye and compels rest.
The occurrence of this trouble is not at all infrequent, and it
should be suspected in Hypermetropia if symptoms of Asthen-
opia persist when using the right glasses. In Myopia, also, it
complicates many cases, especially those of high degree.
ETIOLOG-Y.-—By far the most frequent cause is Myopia. If, in
that trouble, the far point of perfect vision is twenty inches, to
26 ASTHENOPIA ;
see an object there the patient must relax all of his accommo-
dation, and yet use considerable power of convergence to cause
both eyes to bear upon the object. This disturbance in the
relation of the two functions (accommodation and convergence)
which should go together, and the constant, painful struggle to
disassociate the two, wearies the eye and enervates the internal
rreeti.
Again, the trouble may co-exist with hypermetropia, since
here again a disturbance in the equilibrium of accommodation
and convergence is readily developed. In this case the accom-
modation is in excess.
Other causes are general debility, wasting diseases and par-
turition, since the eye suffers with all the other organs. The
excessive use of tea also has been found to enervate the internal
recti and produce Insufliciency.
DIAGNOSIS.——AS in accommodative Asthenopia the usual com-
plaint is that the eyes become tired; especially at night, there
is pain in, and around the eyes when they are used; vision is
indistinct; the letters seem unsteady, and at times appear
double. Sometimes there is a sensation as of the eye deviating
outward, “which may really be the case, the patient finding re-
lief by closing one eye.”* Oertain forms of headache. resisting
all treatment, are due to troubles of the ocular muscles, and dis-
appear when these are relieved. The pain in these cases is over
the eyes, through the forehead and temples, and is aggravated
by using the eyes.
Objective Signs.—Although the trouble is often associated
with Hypermetropia and Myopia there may be, in some cases, no
error of refraction and the eyes appear perfectly normal.
If the finger or a pencil is gradually approached to the face,
when within six inches one eye may be found to diviate or turn
outward. This only occurs in marked cases, however.
Hartridge’s Test.——The patient is directed to look at the
point of‘ a pencil, held about fifteen inches from the face, with
one eye, while the other is excluded by a card. The pencil is
now gradually approached; the covered eye being watched, at a
certain point will be seen to deviate slightly outward. As soon
as it is uncovered it makes a corresponding movement inward

>~ Hartridge, Refraction of the Eye, p. 194.
A MOEIOGBAPH on WEAK EYES. 27
to again fix the object.* The reason of this is that FIG- 5-
when one eye is covered the stimuleus to binocular
vision is wanting, and the covered eye is left to the
control of the stronger muscle.
Another and better test is to place a prism of
10 °, base down, before the right eye, and have the
patient look at a dot on a vertical line (fig. 5). He
will see two dots, one above the other. If both are
on the line, there is no Insufficiency present; but
if the upper dot is to the right, the internal recti
are deficient; if to the left, the external recti have
been overcome.
TREATMENT.-—Th6 treatment must be directed at the cause
of the trouble. When this is general debility, we must build up
the system; if an error of refraction, that must be corrected;
if excessive tea-drinking, that must be stopped. Weak prisms,
with the bases toward the insufficient muscles, give speedy re-
lief, as a rule. We must, however, be on our guard, lest, in wear-
ing them, our patient’s internal recti deteriorate from want of
sufficient exercise. To prevent this we have him practice sys-
tematically looking at the finger or a pencil as it is carried back
and forth, away from and near to the eye, and far to the right
and left.
In Myopia the simple correction of the refraction often re-
lieves the entire trouble. Sometimes, however, it is necessary
to combine with the correcting lens a weak prism, in order to
give entire satisfaction. Where the health of the patient is good
and a 2° or 4° prism does not effect a cure, it becomes neces-
sary to divide one of the external recti, as in squint operation.
Internally the following remedies have proved riseful, accord-
iug to indications: Iron, salt, arnica, ruta, conium, jaborandi,
phosphorous, calcarea and argentum nitricum.T The judi-
cious use of the galvanic current is also beneficial. We should
encourage only a moderate use of the eyes until the weakened
muscles have regained their normal tone.


* Refraction of the Eye, p. 194.
T Ophthalmic Therapeutics. Norton.
28 ASTHENOPIA ;
VII.—RETINAL ASTHENOPIA.
(Over-Sensitiveness of the ‘Retina.)
An irritability of the retina, accompanied by hyperaemia
(congestion) of the optic nerve and retina, frequently exists in
young persons, especially young ladies of delicate, nervous tem-
perament, in ill-health. The sensitiveness of the visual nerves
is increased to a painful degree, and the condition thus caused
closely resembles accommodative Asthenopia, although no error
of refraction is present.
ETIOLOGY.—A slight blow upon the eye, a violent shock to the
nervous system, a bright flash of lightning, exposure of the eyes
to strong light, and especially prolonged use of the eyes by arti-
finial light, as reading when in bed, are fruitful causes of the dis-
order. It also occurs as a complication of hypermetropia, or
is. consequent upon a severe inflammatory attack.
Frequently, however, it is a reflex in nature, and arises from
spinal afections, indigestion, decayed teeth, uterine troubles, etc.
If, in young subjects, leucorrhoea co-exists, masturbation is to
suspected (Hartridge). Retinal Asthenopia may also arise with-
out any apparent causes except general debility.
Dmenosrs.—The most marked symptom is aversion to light.
This is sometimes intense and accompanied by ciliary neuralgia,
the pain shooting into the face and head. Usually some soreness
of the eyes is present, with itching and an increased secretion of
tears.
Vision is perfect, although sight is easier in a dim light. If
any object be intently regarded for a few moments the impress-
ion is retained upon the retina for some time, and by slightly
pressing the eyeballs the patient sees flashes of light or bright
rings (photopsies).
Objective Signs.—The pupils are enlarged; the field of vision
is diminished, yet the presence of the photopsies prevents our
mistaking this for incipient amourosis. [Von Graefe.] To the
ophthalmoscope the eye appears natural, though the retina may
be injected and the edges of the disc hazy.
TBEATMEN'1‘.——-All over-use of the eyes is to be avoided. If
the trouble is due to an error of refraction, that must be cor-
rected by the proper glasses.
A MONOGBAPH on wnxx nrns. 29
As the condition of the retina is a good index of the condi-
tion of the general nervous system, treatment must be directed
accordingly. The patient needs encouragement, and must be
kept cheerful. The general health also must be built up and any
local trouble relieved.
Where photophohia is excessive, it may be necessary to con-
fine the patient in the dark for some days, and then gradually
accustom their eyes to the light. [Von Graefe and Norton.]
But, as a rule, the patient needs the air and sunshine; and, if
the eyes are closely bandaged, or protected by blue glass, he
may be allowed out of doors much of the time. Even enforced
exposure to the light is recommended by certain high authori-
ties {Agnew and Webster.]
Remedially, depletions are to be avoided, but dry cuppings on
the temples are beneficial. Tonics are often indicated, especially
zinc lactate, beginning with gr. ss. and increasing to gr. iv., twice
daily; also, steel and quinine. Macrotin has proved useful, es-
pecially with women, as have also jaborandi and lilium. Gel-
seminum, ignatia, nux vomica, conium, belladonna, lactic acid,
mercurious, pulsatilla and scutillaria are all highly esteemed by
some authorities. G-alvanism, a mild current, with the — pole
on the eye, and the + at the back of the neck, is very benefi-
cial.
The Prognosis is usually favorable.
VIII.-—SPECTACLES.
The use of spectacles to correct optical defects is one of the
greatest achievements of the present age. No organ in the
body is so precious as the eye, and it seems strange that so many
centuries should have passed before its anomalies of refraction
and accommodation were understood, and their remedy scientifi-
cally prescribed.
Until very recently few physicians, and still fewer of the laity
had any true conception of the nature of Asthenopia, of the
great benefit to the eyes of accurately fitting glasses, and of the
evils resulting from those unsuited to the case. At the first,
prejudice, detering the needy from their use, and later fashion,
30 ASTHENOPIA ;
luring the thoughtless to their random purchase, have each pro-
duced disastrous consequences.
How many, many eyes the oculist examines, which, by the
timely use of glasses, might have been reserved! And if this
little work convinces some of the profession that delay is danger-
ous, it will not have been prepared in vain. It will have been
successful, if it has further revealed the danger of the hazardous
practice of buying spectacles of any jeweler or street vender,
_who, though perfectly ignorant of all the laws of optics, claims,
for the sake of a bargain, that he can fit any eyes, that his goods
are “genuine Scotch and French pebble,” that his glasses “will
draw the eye out to its right shape,” or that his “blue glass is a
panacea.” In eight cases out of ten, the person choosing
selects the wrong glasses, not knowing that each eye should be
fitted separately, or ignorant of the amount of Astigmatism
present.
On this point the great Dr. Wells, of England, speaks as fol-
lows: “I have no hesitation in saying that the empyrical, haz-
ardous plan of selection generally employed by opticians, is but
too frequently attended by the worst consequences, and that eyes
are often permanently injured which might, by skillful treatment,
have been preserved for years. For this reason I most strongly
urge upon medical men the necessity of examining the state of
the eye, and ascertaining the exact nature of the affection of re-
fraction and accommodation.”>l< This being done, they can de-
termine whether the patient really needs glasses, and, if so, send
him to the scientific oculist, who will prescribe them accurately.
The proper prescription having been given, a few other points
need attention. Care should be taken that the frames fit well,
that the glasses are on the same level, and that the centre of
each lens is exactly opposite the pupil. This last point is of
great importance, as otherwise the glasses act as prisms and
give rise to annoying diplopia, or muscular Asthenopia.
Concave glasses should be worn close to the eyes, while with
convexes this is not at all necessary.
The Ben Franklin glasses are used in Myopia combined with
Presbyopia, as the lower half is convex. for reading, and the up-
per concave, for distance. Painters and lecturers often find this

1’ Diseases of the Eye; p. 667.
A MONOGRAPH ON WEAK EYES. 31
form very useful. Some, however, prefer to use spectacles for
reading, and folders for distance.
Folders (pince-nez) may be used where there is no Astigma-
tism, provided we are sure that the lenses are well centered.
Where, however, constant use of the eyes for a long time is re-
quired, it is better to have spectacles, as they are more firm and
steady.
Single eye-glasses are not to be recommended.
Stenopaeic glasses (those in which one sees through a narrow
slit only) are of use in cloudy co'rnea or high degrees of Myopia.
Blue-tinted glasses are useful when the retina is sensitive, as
it is the orange rays in sunlight which hurt the eye, aud blue ab-
sorbs these. Smoked glasses are not good, as they simply reduce
the whole amount of light received- into the eye, and thus ren-
der all objects indistinct.
Goggles heat the eye, and therefore should yield to large
curved glasses, which are better. To shield eyes exposed to fly-
ing splinters, chips or bits of stone, clear mica protectors are
the best.
The physician is often asked by the patient whether he should
order lenses made of pebble or glass. The only advantages of
the former are that they are a little lighter and cooler, while, on
the other hand, being cut the wrong way of the crystal, they are
very seldom free from flaws, which, though invisible to the eye,
still irritate it by causing irregular refraction)‘< Beside, pebble
is harder than glass, and hence more diflicult to cut accurately,
cylindrical lenses never being made of it. It is possessed of a
double refraction, which is a decided objection; it does not re-
fract regularly, and is much more expensive. On these accounts
experienced oculists no longer advise the use of pebble, though
it is still hawked about the country by wandering charlatans.
The respectable manufacturers of the country use nothing
but the best crown plate glass, whose cost accrues from the care-
ful grinding to make it accurately conform to the prescription
-Of the scientific oculist. '

" Opthalmic Science and Practice. J uler, p. 409.
32 ASTHENOPIA ;
TEST TYPES,
CORRESPONDING TO THE SOHBIFT-SOALEN OF EDWARD JAEGEB, OF
VIENNA.
No. 1, PEARL.
In using the reading tests, the patient should endeavor, with each eye, separately, to read the
smallest type that he can, at the nearest and farthest pomts possible. This type should be read
easily at 9 to 12 inches. If1t is necessary to hold it farther away, the eye needs attention, as presby-
opia is probably present.
No. 2, he ATE.
The perfectly normal eye is able to read this type at 8 to 16 mches from the
face for some time, without tiring. If reunal asthenopm be present, it will be
seen best in a dim hght.
No. 4, NONPARIEL.
A person with normal vision can read this type without difiiculty at 7 and
also 25 inches from the eye. If unable to read it at both these distances, a
physician should be consulted.
No. 6, BREVIER.
This type should be read at 6 and also at 40 inches. In
near-sightedness the latter is generally difficult, if not impossi-
ble, while in Hypermetropia the first will severely test the accom-
modation.
No. 8, LONG PRIMER.
Although a person may be able to read this
print at 48 inches, if the eyes become tired and
seem weak when used for a short time for near
work, the internal recti muscles may be at fault.
No. Io, PICA.
When marked Astigmatism is present it
will be difficult to read this print at 7 feet,
by each eye, separately.
A MONOGBAPH ON WEAK runs 33
No. 12, GREAT PRIMER.
* This type should be read 9
feet from the face, though, if able
to do so, the patient may be hyper- -
metropic.
VZYAFEGILPN
NPRRUDBZ
RXPXXNCB
F Z~B E




34 ASTHENOPIA ; A monocnnn on WEAK mzns.
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PATHOLOGY,


DIAGNOSIS, AND
TREATMENT.
OCULAR DISEASES,
E.~T. ALLEN, A. M., M. 1).,

Diseases of the Bethe and Me Nerve.





OMAHA:
wssrsau mmrme COMPANYI
1888-
COl\l'l‘I—IN'1‘S..
; PAGE
5 H yTDQ1‘zl’ll1l2l Actha .lleI';. ct. N. O . . . . . .. 3
Hyneraeinia Passiva Re-t. ct. N. O. . . . _. I
-A'p-npiexia Retina‘ . . . . . . . . . . . . . . . . . . . . .. 5 ,'
IsclniriniaZltetinug . . . . . . . . . . . H lietinitis Scrosa... . . . . . . . . . . . . . . . . . . . .. 7 1
Betinitis lEx11dat-iva . . . . . . . . . . . .. V . . . . . R !
lictinitis Apoplectica. . . ...... .. u {
R_etinitis.AlbumiI1urica . . . . . . . . . . . .. _. . . 10 ,
Rctinitis Syphilitica . . . . . . . . . _ . . . . . . ll
ltetinitis Pigmentosa . . . . . . . . . , . _ . . . . . . . . . . 12 }
Rot-init-is Leuoaeinic-a . . . . . . . . . . . . . .. 13 ‘f
N.euro-Iietinitis . . . . . . . . . . . . . . . . . . . . . . . .. 14 {
Ncuritis Optica . . . . . . . . . . . _ . . . . . . . . ._ . . . . 1:3 T .
. Ncuritis Optica Orbitalis . . . . . . . . . . . . . . . .. 16 ‘
Atrophia Rot. ct N. O . . . . . . . . . . . . . . . . .. 1'7
Embolia Arteria Cont. nee . . . . . . . . . . . . . . . . 18 \
Amotio Retin: ~_ ................ ....... .. 19 l
Glioma R(~.‘t-llliD. .', . . . . . . . . . . . . . . . . . . . . . . 20
Cyst-icorcus . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21 A
Commotio Rotimr‘. . . . . . . . . . . . . . . . . . . .. 22 ‘
l{y_pe1':est-hcsia Re-tin-.1>.. .. . . . . . . . . . . . . 23 g
Aneestliesia Rotiiue. . . . . . . . . . . . . . . . . .. 24
Am-blyopia . . . . . . . ..‘. . . . . . . . . . . . . . . . . . . . . . ..
Aclironiatopsia . . . . . . . . . . . . . . . . . . . . . . . . . .. :26,
I-lomeralopia . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . 27
z Hemiopia . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. 28
'Malingering../ . . . . . . . . . . . . . .. .* . . . . .. :29
‘ Index . . . . . . . . . . . . . . . . . . . . ..; . _ . . . . . . . . .. 30

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C()IP~RESPOI<I'IIDEl\TCE SOLICITEID.
PREFACE.
ln placing this little work before the profession, I claim nothing as
original, except the arrangement of the matter in such a form that a glance
suffices to bring before the mind a complete picture of each affection.
Mistakes there may be, for, as a rule, l have inserted whatever has been
written by each author. Where contradictions occurred, l have followed
the dicta of the majority, especially if my own observations have agreed
therewith.
In compiling the work, I have drawn on the following authorit es:
Ilom/oeopa/thic ---Norton, Angel, Vilas, Buffum. ./fllopathio---Wells,
Noyes, Juler, Loring.
It is hardly necessary to explain that the numbers set opposite the
homoeopathic remedies refer to corresponding numbers placed before symp_
toms on the same page.
I shall esteem it a favor if my effort be deemed worthy of corrections
and criticism. These will be thankfully received and duly acknowledged.
309 Ramge Block, Omaha. E. T. ALLEN,
May I, 1888' ‘
Copyrighted, May, 1888.
by
E. T. ALLEN, M. D.
3
HYPERZEMIA ACTIVA RETINE ET NERVI OPTICI.
[Active Uongestz'on of the Retina and Optic Nerve.]
PATHOLOGY. Arterial congestion with retinal hyper-
msthesia.
ETIOLOGY. 1. *Errors of refraction, especially hy_
permetropia and astigmatism.
2. Spasm of accommodation.
3. *Fine work by artificial light.
4. Prolonged exposure to bright light.
5. Foreign bodies on the cornea.
6 Excessive weeping.
DIAGNOSIS. 7. Photophobia.
8. Flashes of light.
9. Vision unaffected.
Io. Inability to use the accommodation long
at a time.
II. Lachrymation.
I2. Subconjunctival redness.
Op/zz‘/z. I 3. Fundus uniformly reddened.
14. Disc reddened. I5. Outlines indistinct.
Io. *Vessels increased in size, especially in
the region of the macula.
17. New vessels on disc.
PROGNOSIS. Favorable.
SEQUELA. Retinitis parenchenatosa.
TREATMENT.
General Measures.
Entire rest for the eyes,
especially by artificial
light.
Remove cause.
Properly fitting glasses.
Blue or smoked glasses.
Radical change of occu-
pation.
Hommopathic.
Aui'um., 8.
*Bell., 1, 7, 8, 11, 13, 14, 15,
16, 17.
Bry., 7, 11, 12, 13, 14. 16.
Cactus.
Con., 7, 10.
*Dub0isia, 1, 3, 10, 13, 14,
15, 16, 17.
G1on., 3, 4, 7, 8.
Macrot., 1, 7, 11.
Nux v., 3, 7, 11. 12, 14.
*Phos.. 3, 4, S. 14, 15.
Puls., 1, 6, 7, 8, 11, 13, 14,
15, 16.
Sant., 1.
Ver. vir., 7, 8, 14, 15.
Allopathic.
Eye-douche.
Artificial leech.
Dry cup.
Hot pedaluvia.
Mildly purgative mineral
waters.
4
HYPERAEMIA PASSIVA RETINZE ET NERVI OPTICI.
[Passice fbnyestion of the Retina and Optic Nerve]
PATHOLOGY- Venous congestion, with oedema. TREATMENT.
I
' y c I M .
ETIOLOGY- I. Disorders of the heart. °“°"‘ “sures
Arrest the cause.
2. D1SOI‘d€1‘S Of 11116 l1V€1‘. Suitable glassesif needed.
- >“Rest of eyes, especially
3. Disorders of the uterus. by ,,,.,,fiC,a1l,g.ht_
- Q Moderate exercise in open
4. Intracramal tumors. air with eyes protected
5. Glaucoma.
. Homueopathic.
6. Errors of refraction.
Bell., 3, 4, 6, 9, 10, 13, 15.
7. Alcoholism. Bry., 2, 5. 15.
'1 C€tCt.., 1
D|AGNOS|S_ 8. %N0 I)lf;)OlSl&, 6, 8, 9, 10, 11, 13,
9. N0 lachrymation. Lept..3-
_ _ _ , Macrot., 8.
IO. Vision impaired. Merc..2,13.
. . Nux v., 2, 7, 10, 11.
0/J/zz‘/2. II. Dull red disc with hazy border. *P,,1s_,3,6,10,13,
. r 1.2, 3.
[Alcohohsm.] bu 1
I2. Larger vessels seem to be fringed. (1/. s. Allonathic.
Hypertrophy.)
I 3. *Veins dilated, dark, tortuous.
14. Venous pulsations.
I 5. Oedematous condition of the retina.
PROGNOSIS. Favorable.
SEQUELA. Retinitis Serosa.
5
APOPLEXIA RETINE.
[Hwmorrhage into the Retz'na.]
PATHOLOGY. Non-in-flamatory extravisations of TREATMENT-
I
blood into the Retina. Genera‘ Measures-
_ _ , Rest.
ETl0LOGY- I. 'X‘Haemorrhag1c diathesis. Avoid light.
. . . Wea s oked glasses.
2. Pern1c1ous an&m1a. Remf,,;‘,,u,e_
3. *Disorders of menstruation. ,
. Homceopathw.
4. *Degenerat1on of blood-vessels. Be1L,3,12, M
-><- - h *Crot., 1, 4.
5. Cardiac hypertrop y. G1On_
6. Valvular disease. *L*kll@h--11~2:1 9 10 1 1
*P OS" 1 5 7 1 2') 41
7. Pulmonary emphysema. 15,16.
8. Severe coughmg. A"0pa,h,c_
9. Retinitis. Digitalis.
- Leeches.
IO. Choroidal atrophy. TOnics_
. T raumatism; results of iridectomy and Di“1‘eti<>S-
H
)-1
reduced intra-ocular tention.
DIAGNOSIS. 12. Everything seems red.
13. Injury to vision depends upon the location
of the effusion; if at macula there is a
dense central scotoma.
Op/22‘/2. I4. Vitreous clouded if haemorrhage is
abundant.
15. *Hmmorrhagic spots smooth, uniform,
under vessels. [In deep layers]
16. *Haemorrhagic spots striated, edges irreg-
ular, lie over vessels, and occur near disc.
[In superficial layers]
17. Metamorphopsia, late.
PROGNOSIS. Extravisation absorbed, leaving no
trace, if small. Leaves pigmented spots or
causes z'nflammatory c/zcmges, if large. Vis-
ion rarely regained, if at macula.
SEQUEL/E. Retinitis.
May be forerunner of cerebral disease.
6
ISCHZEMIA RETINZE.
PATHOLOGY. Sudden, total arrest of the retinal cir- TREATMENT.
Culation. General Measures.
' Invigorate the general
No tissue changes. health
_ Paracentisis.
ETIOLOGY. I. Epilepsy. Iridectomy.
2. Obstruction to circulation. [Ernbolism.]
Homoeopathic.
DIAGNOSIS. 3. Rare occurrence. Asar-.1-
V_ , Calc. c.
4. "‘Bl11’ld1'l6SS complete, sudden, both eyes. Ch,,,,,,8,9_10,11,12_
. 0 - Fer.,4.
5. Tent1on normal, (6) later Increased. Phosq 4’ 5, 10_
7. Balls very white. Puls'
8. Pupils dilated. Allopathic.
Op/zz‘/z. 9. Disc white, transparent.(r/.s.Atrophy.) Stimulants.
IO. Arteries reduced to threads, bloodless.
II. Veins reduced, or irregularly hypereemic.
I2. *PuZse 2/cry rapia’.
PROGNOSIS. Favorable.
Generally recover entirely in a few days.
7
RETINITIS SEROSA.
PATHOLOGY. An aedematous infiamation, sometimes TREATMENT-
accompanied by slight haemorrhages. General Measures.
The poor vision is caused by compression of Absolute rest of the eyes
until cured.
nerve elements. . Dark blue glasses
ETIOLOGY. 1. *Prolonged exposure to very bright
light Homoeopathic.
- - *Bell., 6. 7, 9, 11.12.12, 14,
2. Neglected passive hyperaemia. 16’ 18, 21, 22, 23, 25, 26.
Diseases of (3) heart, (4) liver, (5) kidneys, Bry.,12.
*Duboisia, 2, 9, 11, 16, 21,
(6) uterus, (7) brain. 22, 23_ 26_
8. Pregnancy. Merc., 4. 12. 13, 16,18, 20,
_,(_ - 22, 24, 25, 26.
DIAGNOSIS. 9. N0 lachrymatmn. PhOs“12, 13_ 15‘ 18, 22 23
1o. *No pain. 25.26.
-><- T - Plumb.
II. ./to photophob1a.
I2. Sees a thin gray film before eyes. Allopathic.
13. Vision mich impaired, especially central. Local depletion.
14. May become blind.
15. Eye looks well externally.
16. Pupil dilated and sluggish at times.
Op/at/l. 17. No marked changes.
18. *Under dim illumination a delicate uni-
form bluish veil over fundus (z/. 5. R. exu-
dativa), shading off toward the periphery.
19. Retina swollen; not granulor (2/. .s R. ex-
udativa).
Fundus reflex reduced.
20.
21. Macula reddened.
22. *Disc swellen; sometimes reddened.
23. Disc outlines indistinct.
24. *Arteries normal or enlarged; slightly
veiled.
25. *Veins large, dark, tortuous ; at points
covered by effusion.
26. Small extravisations of blood along the
vessels.
PROGNOSIS. Guarded.
Often bad results.
May last a long time.
SEOUEL/E. Atrophy.
R. exudativa.
Disease of choroid or vitreous.
Detached retina.
8
\
RETINITIS EXUDATIVA.
PATHOLOGY. Paranchematous inflammation, with
hypertrophy; blood stasis; proliferation of
cells; fatty degeneration; sclerosis; extra-
visations; derangement of rods and cones;
involvement of charoid.
ETIOLOGY. I. Neglected hyperaemia.
2. Bright’s disease, or, (3.) diabetes.
4. Syphilis.
5. Cerebral affections.
DIAGNOSIS. 6. Vision good until macula becomes
involved.
7. Micropsia [late]
8. Field generally normal; possibly, (9.) sco-
toma, and (10.) dimness at the periphery.
Op/zz‘/z. 11. Vitreous sometimes hazy.
12. Disc swollen; (I3.) red.
I4. Disc gray, if there is serous infiltration.
15. Disc outlines irregular; (16.) indistinct.
I 7. Arteries diminished in size; <18.) later
like white threads, with thick walls. 1/. s.
Embolia Art. Cent. Ret).
19. Red blood current visible, if light is
thrown near one side of artery. (7/. s. Em-
bolia.)
20. Veins swollen, dark, tortuous.
21. Vessels hidden in spots, by exudation.
22. *Exudation white; or, <23.) gray dots or
patches.
24. Blood extravisations.
PROGNOSIS. Depends on the cause and severity;
often unfavorable.
Sight may be restored and the exudations
absorbed.
SEQUEL/E. *Atrophy.
Detached retina.
Sclerosis of arteries.
TREATMENT.
General Measures.
Blue glasses.
Hygienic t/reatment.
Hommpathic.
Ars., 2, 22, 24.
*Bell., 5, 11, 12, 13, 15, 16,
20, 21, 22, 24.
G1on., 7.
*Merc., 4, 9, 10, 11, 12, 15,
20, 21, 22, 24.
Phos., 2, 9, 10, 11, 12, 13,
15, 17,_24.
Puls., 2, 12, 13, 15, 16, 17,
20, 21.
Zinc, 5, 10.
Allopathic.
9
RETINITIS APOPLECTICA. "
[Syn Retinitis Haemorrhayz'm.]
PATHLOLOGY. Fatty or atheromatous degeneration TREATMENT-
of the blood vessels. Genera‘ Measures-
. . . - gu -. 1 1.
Slight serous infiltration. §§1?,‘j,.;1,.‘,),y ({,1:e]:a1,%,it]s(?a1t 1
Extravisations of blood. Dark glasses.
. , *Absolu.te rest of the eyes
ETIOLOGY. 1. Disturbances of the general circula- and brain.
tion. Change of air, etc.
2. Embolic obstruction of a retinal artery. If hgemorrhages Ire h.'e'
. . . quent, bandage eyes
3. Tumors in orbit or cranium. and confine patient to
4. Degeneration of coats of vessels. bed-
5. Alterations in quality of blood. *1‘“lf)1‘11°:i‘1 use of Stimu-
6. Syphilitic; 7. rheumatic ; or 8. gouty an S‘ _
diathesis. Homueonathm
9_ Injuries. A1‘I1., -L, 5, 9, 13, 16, 23.
13611., 1, 13, 15, 18,19, 20,
DIAGNOSIS. IO. Adults and old peopie. 22, 23» $-
11. Often only one eye. ](;1;?,§;i:,’a241'9 20 22
12. Tendency to relapses. * L,,.,;,__ 5: 16: 20,’23_'
I 3. *Attacks very sudden. *Mer. cor., 4, 6, 12. 18.17.
I4. Vision good, unless, 15. macula involved. Pigs 4 10 16 17 N 20
16. Black spots in field of vision. 211%, ’ ’ ’ " ’
0/§/ll‘/Z. I7. Dense opacities, if blood has es- Pu1s.,12,19, 20, 21, 22.
caped into vitreons. S12-» 12, 16, 17, 19» 2°» 22-
18. ""'Retina looks watery. [Serous effusion] M3‘ _
19. Disc faintly hyperaemic or deep red. _ Allopathm
20. *Disc swollen and edges indistinct. B1.°.m1d.°S
’ O D1Q1t€l11S.
21 Arteries normal or reduced. Alkalies.
22. *Veins dilated, dark, tortuous. Artificial leech.
23. *Haemorrhages, especially at division of
vessels.
24. ""‘Many small heemorrhages parallel to
vessels.
25. Heemorrhagic spots round, sharply de-
fined, under vessels. [Lie deep]
26. Heemorrhagic spots, striated, cover ves-
sels. [Superfiicial.]
27. Heemorrhagic spots retain color for a
long time.
PROGNOSIS. Depends on cause.
Time, three to twelve months.
Tendency to relapses.
Effusion ‘ generally absorbed, but leaves its
traces in dark lines.
Unfavorable, if involve macula, or frequently
recur.
SEQUEL/E. Glaucoma.
Atrophy of nerve.
Pigmentary deposits.
Total blindness.
IO
RETINITIS ALBUMINURICA.
[lnflammatz'on of the Retzfla, from B7’Z1f/76278 Dz'smse.]
PATHOLOGY. Bright’s disease.
Serous infiltration of nerve and retina.
Patches of fatty degeneration.
Hypertrophy and sclerosis of nerve fibres and
connective tissue.
Arterial walls thickened.
Capillary haemorrhages.
ETl0LOGY- I. “Contracted granular kidney.
2. Pregnancy.
3. Scarlatina.
4. Heart hypertrophy.
5. Atheromatous condition of vessels.
DIAGNOSIS. 6. *Both eyes.
7. *Impairment of vision; but it does not
correspond with the opthalmoscopic ap-
pearances.
8. Vision slowly deteriorates. (Suddenly in
uraemia.)
9. Field not limited. 1o. Scotoma sometimes.
II. Hypermetropia developed (?)
Op/22%. I2. Early, over fundus a dull, gray
haze; I 3. striated.
I4. Disc bluish-gray. (2/. s. red, in Neuro-
Retinitis).
15. *Disc swollen slightly. (2/. 5. greatly, in
Neuro-Retinitis).
16. *Disc outlines indistinct.
I7. Arteries narrowed; hidden in places.
18. Arteries as white lines [perivascularitis]
19. *Veins full, tortuous; 20. hidden in
places.
21. *Hmmorrhages small; or, 22. large; 23.
yellowish-red.
24. .rzzda2‘z'07zs,- a broad, 10/22%, gZz'sz‘¢’1zz'/lg,
irregular ring around disc, at little distance.
25. *Pzzz‘r/265 white, soft-edged, covering ves-
sels.
26. *Small, sic//ate, w/1220, gZz'sz‘mz'l2g 579015 az‘
1/zacula. (2/. 5. near disc in Neuro-Ret.)
27. Later, general exudation.
PROGNOSIS. Seldom leads to blindness.
Seldom regain perfect vision.
Favorable in fevers, pregnancy, and if exud-
ations lie behind blood vessels.
SEQUEL/E. Atrophy of nerve.
Detached retina.
TREATMENT.
General Measures.
Remedy cause.
Best to eyes.
Protect from light.
Skim-milk diet.
Avoid all exposures.
\ Homoeopathic.
Apis., 2, 3, 12.
*Ars., 1. 4, 7, 8, 24.
Bell., 2, 3, 7. 12, 15, 16, 1!),
20, 21, 25.
*Gels., 2, 8, 12, 14, 16. 21,
24, 25.
Hep.
Kali. acet.
Kalmia, 2, 24.
*Me/re. 001:, 1, 2, 5, 7', 21,
24, 25, 26, 27.
Pbos., 1, 5, 7, 8, 10, 12, 15,
16, 17, 21.
Plumb.
Zinc.
Allopathic.
Tonics.
Diaphoretics.
Purgatives.
Muriate of iron.
Citrate of iron and steel.
Artificial leech.
Dry cup [in anaemia].
II
RETINITIS SYPHILITICA.
[Sg/n. (]horio-Retinitia]
PATH0l-0GY- Serous infiltration of retina. TREATMENT-
Hypertrophy or sclerosis of connective tissue. General Measures
Inflammation and degeneration of choroid. Cure syphilis.
' O _ Build up system.
ETIOLOGY- I. Secondary or hereditary syphilis. (Jod-liver 011.
. Dilate pupils.
DIAGNOSIS. I. History of case.
.. H ur .
3. XTendency to relapses. °"“B°pa ‘°
. A‘g. ‘t.
. One eye at a time. A;af_m
. Scintillations and *phosphenes. *Aurum-i 14-
*Kali jod, 1, 3, 9. 13, 14, 15,
4
5
6. Muscm. 7. Metamorphopsia, 8. Micrpsia. 18, 27, 28,
9
. *Vision poor, even in good light. ('2'. 5. *Me1*- e0r-.1T. 28-
. Sul.,1,3. 6, 9,13, 14, 20.
R. pigmentosa.)
IO. Vision improves and retrogrades. Allopaihi<=-
I I. Scotomata appear and disappear. Bi-chloride of mercury-
I2. Field not limited. Iodlde Of Potash-
I3. Traces of old iritis.
Op/zz‘/z. I4. Vitreous hazy, with black specks.
I5. Retina and disc hyperaemic, at first.
I6. Fundus striated, especially near disc.
17. Faint haze at center of fundus.
I8. *Stellate spots in macula appear and dis-
appear, but do not glisten. (11. s. R. album.)
I9. Sometimes macula is red-brown.
20. *Disc slightly swollen, ill-defined.
2 I. Bluish-gray film at disc and along vessels.
22. Arteries diminished in size.
2 3. Sometimes vessels appear as white lines,
but do not glisten. (21. 5. R. albumin.)
24. Haemorrliages, very mre.
25. White or hazy patches, not glistening. (21.
s. R. albumin.)
26. Gray dots, intermixed with white dots.
27. *Gray patches, fringed with black zone.
28. Gray patches, showing choroidal vessels.
PROGNOSIS. Generally favorable.
*Great tendency to relapses.
Vision may be permanently impaired.
Unfavorable, if macula is involved.
SEQUELIE. Atrophy of nerve.
Blindness.
Forerunner of brain disease.
I2
RETINITIS PIGMENTOSA.
[Syn Pelr/mentary Degenerafion of the Rete'na.]
PATHOLOGY. Proliferation of connective tissue. TREATMENT-
Atrophy of nerve elements. General Measures.
Deposit of pigment around vessels. Sustain general health.
Hyaline thickening of arterial walls. nfy3S1:ig_ht
T orpid condition of retina. light.
Degeneration of choroid. BO W"-U g'““"d"d in the
, , . use of mercury or
Vitreous may be filled with fioatmg specks. iodide of potash.
. Galvanism.
ETIOLO Y. 1. Heredity.
. . H ih .
2. Consangumeous marriages. °'"°e°pa ‘°
. hilis. *Lycop.,11, 13.
3 . . _ Nux.v.
4. Long residence 1n hot chmates. Plms,13,14.19,22.
5. May be congenital. A"opa,h;c_
DIAGNOSIS. 6. Witl1 deaf-mutism: 7. microphthal P,,1h,,t,,,e_
mus; and, 8. nystagamus. “U11i1\'ai1iI1s‘-”
9. Begins at 15-20; complete after 35.
10. Both eyes affected.
11. 'X'[Vz;g/zz‘-é/2'/M72653, but central vision is good
in bright light. (2/. s. R. Syphilitica.)
12. Later, total blindness.
I3. "V"F2'c/ti c07zccnz‘7'z'ca//y (0/zz‘maz‘ra’, both for
white and colors, so that it is difficult
to walk without stumbling, and patient
must turn to see surrounding objects.
14. Pupil small. Anterior chamber shallow.
0/2/1272. 15. Opacity at posterior pole of lens.
16. *DOZs and nrz‘zc/07'/e of pig?/zczzz‘ at /)(’7'z'/9/zcry
of f2//zdus, and along 1242'/ea! 11655515.
17. *Large, irregular patches of pigment.
18. "“"Black lines in place of vessels. (21. s.
Black circles in R. syphilitica.)
19. Disc red; or, 20. gray; later, 21. yellow,
waxy.
22. Arteries reduced; small ones obliterated.
23. Veins enlarged; later, 24. reduced.
25. Choroidal vessels visible.
26. Yellow or buff, marbled appearance of
fundus.
PROGNOSIS. Blindness at age of fifty or before.
Rarely arrested.
SEQUEL/E. Atrophy of nerve.
Irido-choroiditis.
Cataract
I 3
RETINITIS LEUCEMICA.
PATHOLOGY. Diffuse inflammation, with haemorrh- TREATMENT-
ages. General Measures.
Hypertrophied and sclerosed nerve fibres, Treat the general disease.
[white spots]
Masses of fat granules.
Homceopathic.
Orot., 2, 3, 5, 9, 10, 13.
- A‘ .
ETIOLOGY. 1. Leucocytheemia. Ip1::e"' l
2. Previous haemorrhagic effusions. Nat. mur.
Nat. phos. (‘?)
DIAGNOSIS. 3. Bilateral. II‘)I;;Xa‘;'

4. Scotomata in visual field, corresponding Thuja. J
to retinal patches.
Op/at/z. 5. 'X‘Fnna’zzs pale yellow.
6. Haziness near disc, radiating in fine lines
near vessels.
7. Striate opacity near disc.
8. Disc pale; outlines indistinct, hidden by
serous effusion.
9. Vessels clouded and pale.
IO. Veins pale; 11. dilated ; I2. tortuous.
I3. *Haemorrhagic effusions, pale yellow.
14. Small irregular pale patches near macula.
15. *Round white spots, with red areola, pro-
ject into vitreous, at periphery.
Allopathic.
“ General.”
PROGNOSIS. Unfavorable.
I4
PATHOLOGY.
ETIOLOGY. I ,
2.
0
J-
4.
rl
D0
DIAGNOSIS.
NEURO-RETINITIS.
[ Syn.
Nearitis Optica Descenclena]
Inflammatory proliferation of connec-
tive tissue elements, with serous infiltra-
tion.
*Intra-cranial tumors.
Spinal irritation.
Neurosis of the symphathetic.
Catamenial disorders.
Heredity in males.
6. Both eyes.
7. Photopsies, and chromopsies.
8. Letters look red.
9. *Vision greatly
suddenly.
IO.
II.
Op/zz‘/z. 13.
15.
impaired, sometimes
*Field greatly contracted, [late.]
Pupil dilated, and (12,) sluggish.
albuminurica.)
*Disc swollen.
(1 6.) oedematous.
*Retina hazy; (14) swolen (21. s. R.
(1/. s. R. albuminurica.)
17. Disc red early, later (18) dull gray, (i9.)
20.
2I.
22.
23.
24.
25.
26. Exudations close to disc.
27.
PROGNOSIS.
striated.
*Disc outlines indistinct, “woolly.”
In macula symetrical group of highly
refractive globules.
*Arteries small, hardly visible.
*Veins large, dark, tortuous.
albuminurica.)
Heemorrhages.
*Exudations, as white or yellow dots or
(7/. 5. R.
patches, cover vessels in places.
minurica.)
Headaches.
V er guarded.
(1/. s. R. albu-
Favorable if from uterine derangement, or
of rapid development.
Unfavorable in children; or with greatly
SEQUELIE.
contracted field. ~
Atrophy.
*Total blindness.
Death.
TREATMENT.
General Measures.
Remedy the cause.
Galvanism of the sympa-
thetic.
Dry cupping.
Incision of the o p ti 0
nerve.
Homoeopathic.
*Ars., 9, 11, 25, 26, 27.
*Aurum, 9.
*Bell., 2, 4, 7, 9, 11, 12,14,
15, 17, 20, 23, 24, 25.
Cact., 23.
Con., 4, 9, 11.
Crocus, 9.
Gels., 11, 13, 14, 24, 25, 27.
*Kali¢jod, 9, 23.
Lach,, 9, 24.
Macrot., 4.
*Merc., 6, 9, 11, 13, 15, 23,
24, 25, 27.
Nux v., 2, 3, 9.
*Ph0s., 3, 7, 8, 9, 10, 15,
17, 20, 22, 24.
Sang., 9.
*Zino., 1, 7, 9.
Allopathic.
Seton in temple.
Leeches.
Ice applications.
Bichloride [inunction].
Diaphoretics.
Bromide of potash.
I5
NEURITIS OPTICA.
[Syn Engorged Papilla, Pepillitis, Oholced Disc, Ste./,uung‘.s Przpillc//.]
PATHOLOGY. Inflammation begins in papilla and is TREATMENT-
generally confined to it. Serous infiltra- General Measures.
tion; haemorrhage. Nerve strangled by Remedy the cause.
scleral ring. Connective tissue increased; Resteyes'
. Smoked glasses.
nerve fibers atrophied. Hygienic regulations.
ETIOLOGY. 1. *Intra-cranial disease, in 80 per cent. Homeopathic.
2. Renal disease. 8. Acute myelitis. A,.S,,2,3,18,38,
3. Corneal ulcer. 9. Amenorrhoea. Aumm-
. _ _ Bell., 1, 6, 12,17, 18, 19, 25,
4. Alcholism. IO. Orbital lesion. 31, 33, 36, 37, 38,
' ' ' >-<Duboisia, 3, 6, 15, 18, 25,
5. Lead poison. II. Syphilis. . 81133136.
6. Ametropia. I2. Facial erysipelas. Kali jod.
7. Traumatism. I 3. Cellulitis. *L,§§1";;;3*11"1S’24’2°*33*
DIAGNOSIS. I4. Any age. Nu"-~4=-18~30~
. . . . *Phos.,2,17, 18, 24, 25, 31,
15. Both eyes if from 1ntra-cranial disease. 35, 3~;_
16. One eye if from orbital lesion. P318-536* 1388* 25- 29* 30*
17. Phosphenes. (P) Verat.vii:.,8:17,18,19,25
. . . _ 28, 33.
18. Vision deteriorates greatly, perhaps (19) ZiI1C‘,1,2,l7, 18.
suddenly.
20. Color-vision for green and red often lost.
21. Color field reduced concentrically. (21. 5. *;Vf)r‘(”,’1:‘;“,"\’;’“(’)"fpOtas,1_
Tobacco amaurosis.)
22. Enlarged blind spot without interference
of vision.
23. Hemianopsia. 24. Scotomata.
0/9/zf/2. 25. *Disc red or livid at first; (16)
with fine lines radiating into the re-
tina; later (27.) opaque, (28.) gray; (29.1
striated, or <30.) part red and part gray.
31. *Great [perhaps partial] p7'0mz'72c7zcc’ ofdisr.
32. Swelling may be at margin, centre de-
pressed.
33. *Disc 02/z‘Zz'/ws [7[Z¢7’7’€6i, “ 2000/Zy.’
34. Central vessels obscured.
35. Arteries very small, almost bloodless.
36. *Veins congested; bend as they leave
disc.
37. “" Hmmorrhages on and near disc striated.
38. Exudations like R. albuminurica[chron-
ic menigitis.]
PROGNOSIS. Generally unfavorable. Better if
rapidly developed. Time, months.
SEOUEL/i Atrophy.
Blindness.
Allopathic.
!
I6
NEURITIS OPTICA ORBITALIS.
[S3/n. Retro-bnlbar optic neim"itis.]
PATHOLOGY. A small spot of low ,inflammatory ac- TREATMENT-
tion on the temporal side of the optic General Measures.
Il€I‘V6. Cut oflf all alcohol and to-
bacco.
ETIOLOGY. I. Exposure to cold and wet. Stop debauchery.
2. Alcoholism. 5. Fevers. Remedy cause'
3. Nicotine poisoning. 6. Rheumatism. "°m°BPalhi°-
4. Menstrual derangements. 7. Syphilis. B3111-.254. 9. 14. 15. 19. 20.
Fer? plios.
DIAGNOSIS. 8. Onset insidious, or (9,) rapid.
. Phos., 3. 8, 13, 15, 20.
IO. Adults, especially males.
Al’opath‘ .
II. One eye, or ( 12,) both. w
. Local depletion.
I3‘ :NO.P.a-1n- I4-' Headache‘ Stimulant foot-baths.
15. *Vision partly or completely lost. Turkish baths.
* Tonics.
16. Central scotoma. Iodide OfpOt,,sh_
I 7. * Central color scotoma, especially f or red.
18. Pupil active; ( I9) dilated.
Op/ah. 2o. At first sight nothing abnormal,
except by hyperaemia of disc.
21. Sometimes slight haziness of retina.
22. Later temporal half becomes bluish or
white; inner half normal. (At times this
appearance is physiological.)
23. *$11/zall w/iz'z‘e opaque stria 0/2 disc, /lz'riz'izg
crriz‘ of vessels, arm’ e:rz‘ma’z'rzg rz/072g vessels 072-
to rez‘z'na.
24. Retinal vessels may be reduced.
25. Small blood extravisations.
26. No brain symptoms.
27. No albuminurica.
28. No hysteria.
PROGNOSIS. Guarded.
May lose all vision.
SEQUEL/E. Atrophy.
Blindness.
I7
ATROPHIA
NERVI OPTICI ET RETINAE.
[Atrophy of the Optic Nerve and Retz'na.]
PATHOLOGY. Diminished blood supply.
A. Parenchematous; fibers soft, granular; be-
gins at periphery, with spinal trouble.
B. Interstitial; increase of connective tissue;
nerve fibers chocked; sclerosis.
ETIOLOGY. I. Disease of brain and spinal cord.
2. Alcohol, tobacco or lead poisoning.
3' *Optic neuritis. 9. Heredity.
4. Retinitis. 1o. Fevers.
5. Syphilis. II. Rheumatism.
6. Diabetes. I2. Traumatism.
7. Erysipelas.
8. Menstrual derangements.
nmeno s. 13. Both eyes, as a rule.
I4. At first hypersensitive to light; later,
(I 5) seek intense light.
16. *Vision impaired, even to blindness.
I 7. Red-green blindness.
18. Field limitations concentric, [A.] (19) hem-
iopic, or (20) central. 21. Symetrical.
22. Limitations begin on temporal side (21. s.
Glaucoma).
Op/zz‘/z. Use direct method, dim light.
23. *Disc always opaque.
24. Disc pale white [cerebral amaurosis] ;
[also at times normal ;] (2 5) bluish-green
[spinal amaurosis; changes in nerve tu-
bules]; (26) grayish-white [optic neuritis];
[old age ;] (27) outer half white [tobacco
amaurosis.]
28. Disc level [cerebral amaurosis]; (29) con-
cave, saucer-like [change in tubules] ; (30)
swollen [optic neuritis); (21. s. abrupt exca-
vation of Glauconla, or central, 2'. 0., physi-
ological.)
Disc outlines ill-defined [early, and in op-
tic neuritis]; later, (32) s/zarply defined, but
may be (33) irregular.
34. Choroidal ring distinct.
3 5. Lamina cribrosa conspicuous as mixture
of white and dark dots, or (36) intersect-
ing lines.
37. Nutrient vessels of disc diminished or
(38) absent.
39. Retinal vessels generally attenuated, es-
pecially the arteries.
40. Vessels may be bordered with white lines.
PROGNOSIS. Unfavorable if slowly developed, or
with symetrical loss of visual field.
Better if disease remains stationary.
SEQUELA. Blindness.
31.
TREATMENT.
General Measures.
Stop cause.
>*Nutritious but light diet.
Plenty of sleep.
*Avoid injurious amuse-
ments, stimulants and
tobacco.
Galvanism.
Homceopathic.
*Arg. nit., 16, 23.
*Nux. v., 2, 13, 14, 15, 16,
23, 24., 27, 32, 37.
Strych.
Verat vir., 8, 14, 16, 23, 24,
26, 31, 32, 37.
Zinc phos.
Allopathic.
“ N 0 benefit."
Aperionts.
Tonics, especially iron.
Steel and quinine.
Strychnia.
Zinc lactate or sulphate.
*Leeches to temple.
*Seton in back of neck.
Bichloridc of mercury.
Iodide of potash.
Bromide of potash.
* H ypodermic injections
of strychnia.
18
EMBOLIA ARTERIA CENTRALIS RETINZE.
[Embolison of the Central Artery of the Retina]
PATHOLOGY. The blood clot generally lies just be- TREATMENT-
hind the lamina cribrosa, but may occupy General Measures.
one of the branches. A serous exudate
occurs at the macula.
. _ Homceopaihic.
ETIOLOGY. 1. Cardiac disease.
Am. (2)
2. Haemorrhages in the optic nerve sheath. Cr0ta1us,4_ 21_
3. Anurism of the aorta. ](;‘i’*)§11:f:_iS£?)12’ 21-
4. Atheroma of large vessels. Prunus.
5. *Bright’s disease. A",,pa,|,,c_
6' Fevers“ “Little can be done.’
7. *Pregnancy. “Dietetic advice.”
DIAGNOSIS. A rare affection,
8, One eye.
9. *V2'si0n Zest szuidenly/, often totally.
IO. Size of scotoma depends on location of
embolus.
II. Impossible to excite phosphenes.
Op/zt/z. I2. *A bluish or gray-white opacity
around macula, [gd to 18th day.]
13. *A bright red spot at fovea centralis.
14. *Disc pale, transparent, may be surround-
ed with haze; later ( 15,) atrophic.
16. *Vessels, especially arteries, very small;
( 17,) at points look like w/zite threads.
18. Veins irregularly filled with blood, com-
pletely empty in places.
19. Irregular movements of column of blood.
2o. *Pressure does not cause pulsations.
21. Sometimes a few small haemorrhages.
PROGNOSIS. Very bad. May recover so as to
read. Generally become totally blind.
SEQUEL/E. *Atrophy of the optic nerve.
Glaucoma.
I9
AMOTIO RETINE.
[Detachment of the Retz‘na.]
PATHOLOGY. Partial or total displacement of the
retina by fluid effused between it and the
choroid.
The fluid, blood, pus or serum. Atrophy of
the nerve elements.
ETIOLOGY. 1. *Elongation of the optic axis in
jkrogressh/e myopia.
2. Posterior sclero-choroiditis.
3. Irido-cyclo-choroiditis.
4. Retinitis albuminurica.
5. Retinitis serosa. 6. Traumatism.
7. Tumors of orbit or eye.
8. Cysticercus. 9. Haemorrhage.
DIAGNOSIS. Premonitory; (1o.) muscm; ( II.)
phosphenes; <12.) fluid vitreous.
I3. Occurs generally near equator at lower
half. 14. Suddenly.
15. One eye.
16. No pain as a rule.
17. *Decreased tention. (71. .1‘. Tumor.)
18. Vision impaired; at first a, ( I9.) cloud or
dark spot surrounded with a lighter halo.
2o. *Wavy outlines of objects.
21. Objects fringed with red, violet or blue.
22. Sometimes photopsies.
23. *Field z'mpaz'1'ed 2'72 one pan‘ of eye; (24.)
later, actually contracted.
Op/'zt/z. Use dz'recZ method, at ten or twelve
inches after atropine.
Vitreous sometimes clouded.
Part of fundus red, the rest dark.
*Gray-blue waving cloud. [detached part.]
Detached part reflects light strongly.
Shadow of detached part on fundus.
If entire retina detached, appears as
opaque bluish mass behind lens.
31. Fovea bright red, (as in embolism.)
32. Vessels day’/é, crooked, undulating; no
light streak in arteries; disappear abrupt-
ly at fold of detachment.
PROGNOSIS. Unfavorable. Better if limitations
of field exactly correspond to detachment.
Generally leads to total blindness.
25.
26.
27.
28.
29.
30.
TREATMENT.
General Measures.
*If recent, confine to bed,
chiefly on back, with
eyes bandaged.
Abstain from all use of
eyes.
Protect from light.
Proper glasses.
Atropine.
Keep up general health.
Out-of-door life.
bimple puncture through
sclera, at seat of de-
tachment. (?)
Homtnopathic.
Apis., 5.
*Arn., 1, 6, 14, 18.
Ars., 4.
*Aurum, 5, 10, 23, 25.
Bry.
*Dig., 23.
*Ge1s., 1, 3, 6, 25.
Hep.
Kali jod.
Merc., 10, 12.
Rhus.
Allopathlc.
Mercury.
Artificial leech.
Injections of hydrochlo-
rate of phylocarpine.
Sequelce.
Cataract.
lrido-cyclitis,
Phthysis bulbi.
Atrophy of nerve.
Metamorphopsia.
Other eye is in danger of
same.
2O
GLIOMA RETINZE.
[Syn Fungus Hcematodea]
PATHOLOGY. Round-celled sarcoma which has a
tendency to metastases.
A very vascular encephaloid.
ETIOLOGY. Obscure.
I. *Heredity. 2. Traumatism.
DIAGNOSIS. 3. *Children under twelve.
4. Several of the family.
5. No history of previous inflammation of
brain or cord. (7/. 5. Choroiditis metast.)
6. At first no pain ; later intense pain.
7. *Vision lost early.
8. *At first eye looks healthy, except a
ewe: yellow or pin/2 reflex, (11. 5. dull yel-
low of Suppurative Hyalitis.)
9. Ball may appear atrophied for a time,
with insensibility of cornea, (7/. s. Atrophy
of Irido-Cyclitis.)
IO. Later exophthalmus; movements curtail-
ed ; palpebral fissure obliterated.
ll. *Tention increased. ('0. 5. Detached Re-
tina. and Suppurative Hyalitis.)
12. *Eye bursts; (13.) tumor dark and en-
crusted; (14.) saneous foetid discharges.
I 5. *Pupil dilated and sluggish.
16. Lens opaque. 17. Anterior chamber
shallow.
0;?/ez‘/2. 18. Circumscribed part of retina dark
and thickened ; later protrudes into the vit-
reous, as a yellow-white mass; grows rap-
idly.
19. White patches lying partly behind retin-
al vessels ; ez'1’e2zZa7', s/zazp/y defined, rzoz‘
striate nor punctate. (e. s. Retinitis ;) me-
talic white. (v. s. Cream tint of Retinitis.)
20. Retina may become detached.
21. Cachexia late.
PROGNOSIS. Gear/e.
Favorable if removedvery early.
Fatal unless removed early.
Certainly fatal if it returns after removal.
Death fro1n exhaustion or cancer of brain?
Time three years.
SEQUEL/E Sarcoma of brain. Encephalitis. Gen-
eralization.
TREATMENT.
General Measures.
*Enucl,eate at the very be-
gtrtrttng, clear back to
the optic foramen, and
apply chloride of zinc
paste. '
Homeopathic.
Garb .ac. Tx., in water af-
ter enucleatrlon.
Allopathie.
21
CYCTICERCUS.
PATHOLOGY. This entozoon is considered to be the “TREATMENT, ,
offspring of _the tape-worm in one stage Genera, Measmes_
of lts (zieveloprnent _ Remove by an incision
Deposited from the blood under the retina over the seat of the
0 O - e . t 1 .
it gives rise to effusion and inflammatory La,§§lf1be‘:1uc1eatiOn may
€:lCl'.lO11. be demanded.
DIAGNOSIS. I. Vision steadily diminishes.
2. Visual field interrupted where the para-
cite is or has been.
Op/at/2. 3. Vitreous becomes turbid.
4. At first the spot affected is transparent
and the animal may be seen ; later. opaque.
5. Violent inflammation.
PROGNOSIS. Unfavorable.
SEQUEL/E. Detachment of the retina.
Destruction of the eye.
NOTE. Tumors of the optic nerve are very rare. They gen-
erally cause neuro-retinitis and exophthalinus, Enuclea
tion is generally demanded.
22
COMMOTIO RETINPE.
' [ Concussion of the Retz'na.]
PATHOLOGY. Shock. TREATMENT.
General Measures.
ETIOLOGY- I. Blows upon the eye-ball or neigh-
. At 0 ‘ e.
bormg parts, Re:t_p1n
‘ ' 2. Stroke of lrghtenrng. Bandage-
. . . Homaeopathic.
DIAGNOSIS. 3*Sudden loss of vision; entire, or
A ., 1, 3.
only central. . Oglum, 5_
4. Vision gradually rmproves. B11118-
Verat. alb., 5.
5. *Pupil contracted.
6. Pupil resists atropine.
Opkt/z. 7. Gray dots appear in the retina.
coalesce change to white and disappear.
PROGNOSIS. Generally favorable.
SEQUELE. Rupture of the retina.
Panophthalmitis.
23
HYPERPESTHESIA RETINZE.
[0cersensiticeness of the retina]
Syn. Retinal Asthenopia.
PATHOLOGY. Irritation of the ciliary plexus. TREATMENT-
ACt1V€ hYP€I‘£I'IIiEl.. General Measures.
. . . Atrop'ne.
ETIOLOGY. I. Hysteria. 2. Hypochondriasis. Blue gasses.
3. Error of refraction. C°1‘PectYef1'a<>fi0n-
. . Improve general health.
4. Catamemal disorders. Asswre pat/wntof f/M1,], -,-6-
covery!
5' Confinrnent _ , _ _ Moderate light, but note.
6. General nervous irritability. dark room.
‘X’ ' Accustom eyes gradually
7. Prolonged use of the eyes. especially on to daylight
bright Ob_]€CtS.
I-lommopathlc.
8. Flash of lightening. 12 16 18
.ACOD.., , s '
9- Accldent Ars.,12,16,17,18,21.
. . *Bell., 3, 6,10, 12, ,16,17,
DIAGNOSIS. IO. Occurs in young delicate females. 18,21.
* . . . . . China, 4‘ 5. 6, 171
I I. Retinal impressions retained a long time. won” 12,13’18,
I2. *Ser/ere photop/zohza. *Gels..3,5,10, 21.
0 . ° Ht‘/p., 79 141-
I3. Photopsies, stars, (14.) colored rings. HYOS_
15. Can produce ph'otopsies by pressing on *Isn-.1.10.12.18.16-
J abor., 7, 11.
H
09
as
the eye. (2/. s. Amaurosis.) ,,Mam,Ot_, L 4, 6, 10,12, 16,
I6. 'X'C1liary neuralgia. 17.22-
., - Merc., 2, 18, 17, 18.
17. ' Lachrymation. Nah mm.“ ,,,10,12_
18. Spasmodic closure of eye. *I\]181x v-.1.2.6.12. 16. 17.
19. *Vision good. Can read the smallest phO'S., 6. 7, 10, 18, 19, 20,
rint in dim li ht r ith . 23-
p g 0 W blue glasses Puls.,1, 2,3, 4, 8, 10, 12,14.
2o. *Field usually contracted concentrically. 16,17.
(6. f. Amaurosis.) gglts-.89.12.17.18.
2 I. Pupils dilated. Scut.
22. *No ophthalmoscopic changes. Se1I,’7'* 1’ 3’ 4’ 6* 7’ 1°’ 13’ 14’
Suh, 7, 12,16, 17.
PROGNOSIS. Favorable. Zinc., 12,13,14.
Allopathic.
Tonics.
Quinia.
Zinc and steel.
Dry cupping.
Blisters.
Nora. Snow-blindness and Nyctalopia or day-blindness are
forms of Hyperaestlmsia. The former is caused by pro-
longed exposure to the bright reflection from the snow.
It is characterized by great irritability of the eyes with
conjunctival hyperwmia, pain and photophobia. Dura-
tion, a few hours to several months. Treatment as above.
4
24_
ANZESTHESIA RETINE.
[See Amblg/opz'a.]
PATHOLOGY. Defective inervation and hence di-
minished supply of visual purple.
ETIOLOGY. 1. Exposure of eyes to extremely
bright light for long time.
2. Continued application of eyes under
strong artificial light.
3. Rariflcation of air in high altitudes.
4. Smoking. (P)
5. Anaemia.
DIAGNOSIS. 6. Phosphenes in those parts of the
retina which are insensitive. (1/. 5. Am-
aurosis.)
7. *Vision diminished greatly.
8. Haze or cloud before eyes.
9. Impossible to see except in bright light.
Io. No ophthalmoscopic changes.
PROGNOSIS. Favorable.
TREATMENT.
General Measures.
Rest.
Avoid cause.
Homuepathw.
Agaric. [low], 5, 6, 7, 8.
Ars., 5, '7, 8.
China, 5, 6, 7, 9.
Fer., 5.
>*Hep. \high], 1, 6, 7.
Ign., 7.
J abor. [low], 2, 7, 8, 10.
Lyc. [high], 6, 7, 9.
Zinc.
Allopathic.
“ Blisters.
Artificial leech.
Injections of strychnia.
25
AMBLYOPIA.
[(/trllecl ArImm'0sz's, when totally bZe'nd.]
PATHOLOGY Often entirely functional. Diffuse in_ TREATMENT-
terstitial sclerosis of neuroglia. General Measures.
- - Stop tobacco and liquors,
ETIOLOGY. I. High degrees of ametropia. short!
Nutritious food.
2. Non-use from cicatrix or squint. Plenty Of sleep
3. Passive congestion of the nerve, brain, Exercise body and eye,
- Tinted glasses.
llver OT uterus; Operate for squint or cat-
4. Disturbance of nervous function. aract in children.
- Turkish or sea baths.
5. Exposure to wet or cold. 6. Xf£I§1?. Galvanism.
7. *Tobacco. 8. co 0. _
Homrnonalhrc.
9. Lead. IO. Mercury.
. . Arg. 11.
11. Quinine. 12. Si ver._ ,,Ars, 7, 23, 24, 27, 28, 31,
I 3. Neuralgia. 14. Hysteria. $341,137,182. )9 31 38
. e.,,,2, ,8"',.
I5. Gestation. 16. Confinment. B,.y_,5131_3,,. ‘
I7. Lactation. I8. Haemorrhage *C31;in2e;~8-17,18-23.38.24.
I9. Heredity. 20. Sexual excesses. 1.-e,.f,2?'_
21. Fright. 22. Shock. §iI;—84~20-2‘3~31-
. 1‘., .
23. Anaemia. 24. Fevers. Nux Va 3, 4, 75 8, 20‘ 26,
2 5. Amenorrhoea. 26. Indigestion. §77r4129r 31» 32» 34» 34, 35-
. *Phos., 3, 4, 7, 18, 2O, 2*,
DIAGNOSIS. 27. Men over thirty-five who have 28,31’;-,4,,40_ ‘
been great smokers and drinkers. Puls-~ 1» 3-4414-23-22 26-
. 31, 34, 37.
28. Onset slow, or (29.) sudden, according to Scut"22_
cause. S113l~.,Z,)19, 26, 28,31, 64, 36,
. . 1, .
30. Both eyes. [One if from squint]
31. Vision impaired or suspended.
. . - - ~ Opium. Morph.
32. Central vision poor even in bright light. Strychnine[injectiom]
(2/. 5. Glaucoma and R. pigment.) Bromide of potash.
.X. - - - - Tonics. Wine.
33. Pinhole -test does not improve vision. Stmycllnine and iron.
34. Vision misty and hazy. [Alcoholism] Artifieialleech.
35. ""Central scotoma for colors. [Tobacco.]
36. Weakness of accommodation. [Alcohol.]
37. Dry irritable conjunctina. [Tobacco]
38. Pupil moderately dilated, (contracted in
uraemia.)
39. Pupil reacts to light. [Intermittents.]
Allopathic.
Op/zz‘/2. Nothing important.
40. Disc hyperaemic, or (4i.) pale or normal.
PROGNOSIS. Extremely guarded if from optic
neuritis. Better if onset was sudden, and
pupil reacts to light. May recover after
years of blindness.
26 .
ACHROMATOPSIA.
[S3/n. (blor Blimlness.]
PATHOLOGY. Unknown. TREATMENT.
General Measures.
ETIULOGY. I. Over-use of color sense.
2. Myelitis. 6, Syphilis‘ Education. (ll)
2. Neuritis. 7. Detached retina. “°"‘°e°Pa"“°-
4. Retinitis. 8. Pregnancy. Con., 16. (i)
5- Atrophy 9. Heredity. Sant'(?)A 1
llopa hic.
DIAGN08lS- IO. Occurs more often in males than “ T _ females. l\Othmg'
II. In lower classes of society, and in the
Socity of Friends.
12. Congenital, or (13) acquired.
14. Both eyes.
15. Inability to distinguish red from green.
16. Inability to distinguish any color, rare.
I7. No disturbance of other functions of the
eye.
I8. Central scotoma for red. [Tobacco]
PROGNOSIS. Unfavorable.
27
HEMERALOPIA.
[Syn Nright Blz'ndness.]
mruoroev. '><'FunctiOna1_ TREATMENT.
Torpor of the retina. General Measures.
lnsufficient blood supply. *Build up the general
Impoverished blood. health-
"‘N0urishing diet.
ETIDLOGY. 1. Prolonged exposure to glaring Protect eyes against
. bright light.
llght. Dark smoked glasses.
‘ - Rest.
2‘ DebI11tY' Change of climate.
3. Sclerosis of lrver. *Cod-liver oil.
4- SCuTVY- Homuaopaihlc.
- - - Bell.
DIAGNOSIS. 5. Frequently occurs with 1nterm1t- China”, 4‘ 5‘ 6‘ 71 10_ 1,-,_
tent fever in ill-fed, ill-housed peasants. Hyos.
6. Sailors with scurvy, in tropics. ‘i;’§’(;:2' 9‘1°'13‘
7. Both eyes always affected. Tobac.
8. After-images, but no phosphenes. Allopalhlc.
9. *Vision perfectly good in strong light. Tonics_
10. *Can see scarcely at all in dim light, as a Quinine.
. . . . s 1.
cloud seems to render Ob_]€CtS 1nd1st1nct tee
II. Time of day makes no difference.
I2. *No limitations of field. (7/. s. R. pigment.)
I 3. There may be scotomata.
14. Color-blind for red, blue and violet in
dim light.
15. *Impairment of accommodation.
16. lnsufficiency.
I7. Conjunctivitis.
I8. *Silver-gray scaly I patch of epithelium,
at outer portion of ocular conjunctiva.
Op/12‘/1. Nothing.
PROGNOSIS. Favorable under good circumstances.
Tendency to recurrence.
Unfavorable if with hepatic cirrhosis.
28
HEMIOPIA.
[Half-sight]
Syn. Hernianopsia.
PATHOLOGY. Lesion at or beyond the commissure, TREATMENT-
[both eyes affected.] General Measures.
Lesion in front of commissure, [one eye Discover cause, and rem-
afr'ected.] edy “-
Lesion at commissure, [temporal half of Homwopathia
each field lost.] *Aurum, 2,10.
Lesion behind corpora geniculata, [nasal g?1g°'§b’9'
half of each field lost.] Ge1s., 7,10.
. . . *L'th. . ' hth lf t-
Lesion on opposite side of head from want- i:1g_]° [mg *1 wan
ing field. *Lyc0p, [di_tto.]
. M h. 1.9.
Lesion unknown when upper or lower M§),I§ao,s_11,,_
half is lost. Plumb-. 9.
. Rhus.,9.
Functional. (P) Sepqgv
_ _ _ Stram., 9.
ETIOLOGY. 1. Distubance of circulation. Bov.Lob. Nat. mur.
2. Syphilitic or tubercular disease of brain. Qulma Vloaodor
3. Intra-cranial tumors.
4. Apoplectic clots.
Allopalhic.
DIAGNOSIS. 5. One, or both eyes.
7. Onset sudden, [apoplexy,] or (8.) slow,
[tumor.]
’ 9. *Loss of lateral half of field.
10. Upper, or (11.) lower half very rarely
lost.
Op/ah. Nothing unless it be, (12.) contraction
of arteries, or <13.) hyperaemia of disc.
14. Later atrophic appearance of disc.
PROGNOSlS- Grave, especially if both eyes are af-
fected.
SEQUEL/E. Atrophy of nerve.
Death.
29
MALINGERING.
[S3/n. Simzelcetion of Blz'ndness.]
occumzuce. Nervous hysterical people.
Conscripts.
Prisoners.
Beggars.
That one eye, generally the right one,
or both eyes, are “defective.”
CLAIM.
oanzcnow IF omz EYE. 1. Hold narrow ruler midway
between eye and page, and it will not
interrupt vision.
2. Place a—2o. D. lens before the good
eye, and he can still read.
3. Can see better with stereoscope.
4. Prism base down, causes double images.
5. Prism base in, or out, causes change of
axes when removed.
IF BOTH EYES. 6. Pupil responds to light. (7/. s.
Amaurosis, unless from intermittents.)
7. Pupils may be excessively dilated by
atropine. (Amaurosis moderately.)
8. Pupils may not be dilated at all.
Amaurosis.)
9. Lids close to protect from pretended blow.
(7/. 5.
TREATMENT.
Do not let patient suspect
your motive in making
the examination, 10 ut
cause him to think that
the desire is only to de-
termine the cause of
his misfortune.
30
INDEX.
A
_ Con 0estion assiv 4
‘ D , p‘ I- 0, - . . . . - - . . . . . . . . . - . .
. . . . . . . . . .. .6 ‘
Accolnodatlon impaired, . . . . . . . 8 25 27 CgE§I~iInIIeI‘IiI1IiIIIII I I I I I I I I I I I I I I I IIIIIIII
Accomodation, Spasnis of, . . . . . . .8I CornIea.IIIfoiI(3I3>~Ii1IIbIilIdié;II<II;IIriI I I I I I I I I I I I II:°>II
.2E311111I1‘;);Il2l,l'.‘().p-Slit, . . . . . . . . . . . . . . . . . . gorneai irisenbsible, . . . . . .I.I .I . I .
After images, ................ I I. .............. . .I.27 I CIvIfIcI’IiiIcIIIIel'IcIu(SIIII I I I I I I I I I I I I I I I I II ‘I I‘I>5I
Alcoholism, . . . . . . . . . . . . .4, 15, 16, 17 25 “ I I I I I I ' ' I' ' ' ' ' ' ' ' ‘III III‘
Amblyopia, . . . . . . . . . . . . . . . . . . . . . . . .I.25. D
Amaurosis, . . . . . . . . . . . . . . . . . . . . . . . .25. Day "blindness \ - - - - - - - ‘)3
Amotio retinae,..... . . . . . . . . . . . . ..19. Deblmys ~ - - - - - - - - - -.
Anaem1a,._L . . . . . . . . . . . . . . . . . . . . .5, 24, 25. Dgaf-Inulisln, - - - - - - - - - - . - - I12I
Anaesthesia retinae . . . . . . . . . . . . . . . . . .24. Dental I16111“(l-lgiil. - ~ - -- - - - - - -I -I ignterlor Clprmber, $11-,1]1()w‘, _ _ _ 20, 12_ Degeneration of coats of vessels,. . . . . .9.
A§101l1;1]SeI(1:1ti<(); Ct1l(1)psaorta., . . . . . . . . . . . . . . . Ilgetilcltlment of the retina, . . . . . .19, 21, 26.
., _ , , _ , _ _ , _ _ __ , _ raaees, . . . . . . . . . . . . . . . . . . . . . . . . ..
Apoplcxia retinae . . . . . . . . . . . . . . . . . . . . .5. Disc a$1'OP11iC, - - - - - - - - - - - - - - - - 1%
Arteries as white lines , . . . . .. ...8, 10, 18. Disc, bluisll-.s‘1'ay,~ - --- - ... . . . I I10I 11I
Arteries diminished in size, 6, 8, 9, 10 11 Disc, bluish green . . . . . I I I l'7I
A _ [12,14,15,18j<,>,8i Disc choked,. . . . . . . I. I.I. I. I. .I .I I I I .Ii5.I
Iellélraglgpd, _ , , _ _ _ _ _ _ _ _ _ _ , _ qoncave saucer-lil\c.. . . . . . . . . . . .17.
_ , . . . . . . . . . . . . . . »c,‘l'a, . . . . . . . . . . . . . . .. s 2 "
ArteI'}6s bloodless, . . . . . . . . . . . . . . . . .6 15.‘ Disc §‘1'e:sI’IiS11-Wllile ---- - - I I I III
Arteries veiled, , _ . , , _ _ , _ _ _ _ _ _ _ _ , _ _ _I_ _7_ Disc hyperazmic, . . . . . . . I.9I I1I1I I I2 I
Arteries without light streak.. . . . . . 19. Disc 1@V61, - - - - - - - . - . . . I I I l7I
Astigmatism, . . . . . . . . . . . . . . . . . . . . . . .8. DiS0, 116W VGSSP-18 OH. . . . .. . I I I I I I I 8
Atheroma of large vessels, _ _ _ _ _1g, Disc ccdematous, . . . . . . . . . . . I I I Atrophy of the optic nerve, . . . . . . .17, 26. Disc opaque, - - - - - - - - - - - - - - - - - - - I -I1I5 I17:
Attacks very sudden, _ _ _ _ _ _ _ , _ _ _ _ _ _ _9. Disc, outer half Wlllt6.. . . .. . . .. . . .. . .I.l'7.
B Disc outlines indistinct, .13, 4, 7, 8, 9, 10.
‘ _ ' _ _ 1,18, 14, 15,17.
]B3il.E}‘i:];l’l‘(é%Tr(2:l.1]€)3IS)‘(3‘€)..l.8LlfI:C1hlll6(1, . . . . . . . . ougllines li‘11'€g‘lll211‘, . _ . . . . . . . . . . . .8, 1'7.
Black lines in place of vessels. . . . . Disii IdiitlIiIl.dI;I:l S“vIlIrI(>IZ>IlIlIrII’I’IIIIIeIII I I I I I I I IIZI
Black spots in field of vision, .... .. Disc pale II IIII III I Bhndness, . .' . . . . . . . . . . . . . . . .6, T, 12, 17. Disc pa1'iIIcolIoIrIeIdI I I I I I I I I I I I I I? Bhndness, Simulation of, . . . . .29. DiscIred I I ITI I1llI ’”I
Bhnd spot enlarged, . . . . . . . 15. Disc striIaIted I I I I I I I I I II I I 14:I 15I
Blood. altel'atio1ls in quality of, . . . .9. Disc swollcnI I I I I I I I I I I I I 9I 11IlI 1'”I
Blood, irregular movements of, . . . . . .18. Disc swollenI(I2I'eatIl I I I I I I I I I I I I II
Bram, diseases of. . . . . . . .7 8 25 28 Disc sw ll I/l'O'l I I I I I I I I I I I I I I I I II5I
Brights disease , 8, IO, 18. _ . 0 en s 1,7 it y,... . . . . . . . . . . .10, 11.
,.... . . . . .., , . Dlseswollenatmargm,....
O Disc waxy, . . . . . . . . . . . . . . . .
u ' . . . . . . . .12.
Cachexia, ‘ _ . _ . . I I . . . 90 Disc white opaque, . . . . . . . . . . . . . . .15, 17.
Cellulitis, _ . _ . . ' ‘ . . . _ ‘ _ I . _ _ - - - - - - - -1~r;- Disc ulnte, transparent, . . . . . . . . . . . . . .6.
Children undm twelve, - _ . _ i ' D 0- - - - 20- Disc yellow. . . . . . . . . 1 . . . . . . . . . . . . . . .12.
Choked Disc, . _ _ _ - - -15- Discharge saneous lcetlcl. . . . . . . . . . . .20.
Chromopsies, . . . . . . . . . . . . . . I142 E
8€g;i)(;g;itl;ltl1l\):).S1; . . . . . . ll). 1li11rr,b01Zz'swt of the centml (m5e7',?/, . . .6, 9, 18.
Choroidial ring distinct, . . . . . . . . El1I(,'I;]I)Il:t(IlI(§IlI(IlI IIIIIIIIOIIIIIIIIYI I I I I I I I I I I -I I I IOIIIII
Choroldal vessels visible, . . . . . . . .12. Epilepsy I I I I I I I I I I I I I I I I I I I I I I I
Ciliary neuralgia, . . . . . . . . . . . . . . . . . Erysipel:isI I I I I I I I I I I I I I I I I I I I I I I I I T I IIII
Cloud surrounded with halo,. . . . . . . .19. Errors of lI'eIflI'actIiIoIllI I I I I I I I I ‘III
Color‘-blindness . . . . . . . . . . . .15, 16, 26, 27. Exophthalmus II I II I I I II I ’ 98’ 35
. - . ‘ . .27. s , . . . . . . . . . . . . . . . . - . .~ , I15.
0 orec I‘1Il"'-9, sees,. . . . . . . . .23. E: . ' ‘I I I I‘ I I I I I I I I I I I I I I II I II
Color field Feclucecl concentrically, . . . . .15. I I I I I I I I I I I I I I I
g((.:l;)1:I3)(‘i;(1'):.')O1I‘l(:'i\i,l]ti)GDtl'%ll, . . . . . . . . . . . . . Exudations (‘Z05-eu to disc, . . . . . . . . :14:
Concussion of H38. . . . . %XLl(1l)‘clllllOllS at distance from (lisC, . . . . . .10.
Congenital . . . . . . . . . . . .I.I . I I I I I5§fIL:.IbILITl‘:t;IIIIy WIIIICI I I I I I I I I I I I I I I I I.>I6I
Conj_uncti_va., irritable,. . . . . . . .25. Eye looks IcIxI[IcII'ilIqll I I I I I I I I I I I IIIOI
Congunctlva, silver gray patch on ‘>7 E T: 0 9 HI - I -3’ ' ' ' ' ' ',' L ' ‘ ' ' ' '7'
. .,...T.). . .~‘. _JT’., 1,... , v, I, , , ,17,2III
Congestion, actiic, . . . . . . .3 [26, 27) 28,

31
F
Females, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23.
Fevers . . . . . . . . . . . . . . . . . . . .16, 17, 18, 25.
Field contracted . . . . . . . . . . . . . . . . . .14, 19.
Field contracted concentrically. .12, 1'7, Field t'mpai"recl in one part. . . . .19, 21, 28.
Field limitations begin on temporal
s1 e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Field not limited . . . . . . . . . . . . . .10, 11, 27.
Fright . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fovea bright red . . . . . . . . . . . . . . . . . .18, 19.
Fundus marbled . . . . . . . . . . . . . . . . . . . . .12.
Fundus hazy . . . . . . . . . . . . . . . . . . . . . . . . .10.
Fundus reflex reduced . . . . . . . . . . . . . . . . .7.
Funrlus, shadow of detached part on.. .19.
Fundus striated . . . . . . . . . . . . . . . . . . .10, 11.
F undus uniformly reddened . . . . . . . . . . .
Fundus veiled . . . . . . . . . . . . . . . . . . . . . . . .7.
Funclue yellow . . . . . . . . . . . . . .. . . . . .12, 13.
Fzlngztsliremrttode-<: . . . . . . . . _ . . . . . . . . . . . .20.
. . D . ' G
Gestation. ; . . . . . . . . . . . . . . . . . . . . . . . .25.
Glaucoma . . . . . . . . . . . . . . . .‘ . . . . . . . . .4.
Glioma reti_n_ze . . . . . .. p . . . . . . . . 20.
Gray dot-s_ appear in 1'elin-a. . . . . . . .22.
Gray dots inteI'iiiixed with white dots . .11.
Gray ,patch'es'_'fring'ed with black zone. .11,
Gray patcliessliowing choroidal vessels, 11.
~ H
Iltemorrhage into the 7’6Z"l7Z(t, .5.. 7 . 8, 9, 10,
‘[11, 13,14,115, 16, 18, 19
Haemorrliagic di-atliesis,. . . : . . . . .' . . . . . . .5.
Hznmorrhagie effusions, pale yellow, . . . I-Iaemorrliage, general, . . . . . . . . . . '. . .
Haemorrhages, small, . . . . . . . . . . . . . . . .18.‘
Half-sight, . . . . . Q . . . . . . . . . . . . . . . . . . . . .28.‘
Haze or cloud before eyes, . . . . . . . .24.
Haziness of retina, . . . . . . . . . . . . .10, 13, 16.
Haze at center of fundus . . . . . . . . . . . . . .11.
Headaches, . . . . . . . . . . . . . . . . . . . . . . .14, 16.
Heart, disease of, . . . . . . . . . . . . . .4, 5, 7, 10.
Iiemeralopia, . . . . . . . . . . . . . . . . . . . . . . . .27.
Hemianopsia, . . . . . . . . . . . . . . . . . . . . .15, 28.
Hemiopia, . . . . . . . . . . . . . . . . . . . . . . . . . . . .28.
Heredity. . - .. . . . . . . .12, 14, P7, 20, 26.
I-lyperzemia, . . . . . . . . . . . . . . . . . . . . . . . . . .8.
Hyperaemia activa, . . . . . . . . . . . . . . . . .3,
Hypercemia passiva, . . . . . . .4, 7.
Hyperaesthesia retinas, . . . . . . ' ' ‘3, 23.
Hypermetropia, . . . . . . . . . . . . . . . . .3, 10.
Hypocliondriasis, . . . . . . . . . . . . . . . . . . . .
Hysteria, . . . . . . . . . . . . . . . . . . . . . . . . .23, 25.
N‘
Nervous irritability . . . . . . . . . . . . . . .23, 25.
N euralgia . . . . . . . . . . . . . . . . . . . . . . . . . . .
Neuritis optica . . . . . . . . . . . . . . . . . . . .15, 26.
Neuritis optiea descenclens . . . . . . . . . . . .14.
N euritis optica orbitalis . . . . . . . . . . . . . .16.
Neuro-retinitis . . . . . . . . . . . . . . . . . . . . . . .14.
N eurosisof the sympathetic . . . . . . . . . . .14.
Night-blindness . . . . . . . . . . . . . . . . . . .12, 27 .
~Nyctalopia . . . . . . . . . . . . . . . . . . . . . . . . .
Nystagamus . . . . . . . . . . . . . . . . . . . . . . . . .12.
Q
Objects fringed with red, violet or blue, 19.
Occurs in young delicate females . . . . . .23.
Oedema of retina,. . . . . . . . . . . . . . .4, 7.
Onset insidious . . . . . . . . . . . . . . . . . . . . . . .16.
Onset slow . . . . . . . . . . . . . . . . . . . . . . .25, 28.
Onset sudden . . . . . . . . . . . . . .16, 19, 25, 28.
Opacity on lens . . . . . . . . . . . . . . . . . . . . . .12.
Opaque bluish mass behind lens . . . . . .19.
Ophthalmoscopic charges, No. 23, 24, 25,
[26, 27, 28, 29.
Optic neuritis . . . . . . . . . . . . . . . . . . . . . . . .17.
Orbital lesion . . . . . . . . . . . . . . . . . . . . . . , .15.
Oversensitiveness of the retina. . .\.. . . .23.
P
Pain, intense . . . . . . . . . . . . . . . . . . . . . . . . .20.
Pain, no . . . . . . . . . . . . . . . . . . . . . ..7, 16, 19.
Palpebral fissure obliti-1-alcrl . . . . . . . . . . .20.
Papilitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15.
Panophthalmitis . . . . . . . . . . . . . . .21, 22.
Patches, gray, . . . . . . . . . . . . . . . . . . . . . .8.
Patches of pigment . . . . . . .' . . . . . . . . . . . .12.
Patches, white, . . . . . . . . . . . . . . . . . . .10, 20.
Peasants, ill—fed . . . . . . . . . . . . . . . . . . . . . .27.
Perivascularit-is . . . . . . . . . . . . . . . . . . . . . .10.
Phosphenes . . . . . . . . . 11, 15, 19, 24.
Phosphenes no . . . . . . . . . . . . . . . . . . . . . . . .27.
Phosphenes impossible to excite . . . . . . .18.
Photophobia, . . . . . . . . . . . . . . . . . . . . . .3, 23.
Photophobia, no . . . . . . . . . . . . . . . . . . . .4, 7.
Photopsies . . . . . . . . . . . . . . . . . . . .14, 19, 23.
Pigmented spots. -. . . . . '. . . . .‘ . . . . . .5, 9, 12.
Pregnancy .. . . .‘ . . . . . . . . . . . ..7,-10, 18, 26-.
Prolonged use of the eyes. . . . . . . . .23.
Pupil contracted . . . . . . . . . . . . . .12, 22, 29.
Pupils dilated . . . . . .\.- .. .16,23, 25,29.
Pupils dilated and sluggish .. . . .7, 14, 20.
Pupil reacts to light . . . . . . . . . . . . . . . . . .25.
Pupil resists atropine . . . . . . . . . . . . . . . . .22.
Pulsations venous . . . . . . . . . . . . . . . ' . . . . . .4.
Pressure does not cause pulsations. . . . .18.
Pulse -very rapid . . . . . . . . . . . . . . . . . . . . . .6
Q
Quinine . . . . . . . . . . . . . . . . . . . . . . . . . .25.
R
Rarification of air . . . . . . . . . . . . . . . . . . .
Red. everything seems . . . . . . . . . . . . . . .5.‘
Red letters look. . . . . . . . . . . . . . . . . . . . .14.
Red-green blindness . . . . . . . .15, 17, 26, 27.
Redness, subconjunctival . . . . . . . . . . . . Reflex bright yellow... . . .. . . . . . . . .20.
Reflex reduced . . . . . . . . . . . . . . . . . . . . . .7.
Retina part of dark . . . . . . . . . . . . . . . . . . .20.
Retina, dark lines in, . . . . . . . . . . . . . . . . . .9.
Retina detached . . . . . . . . . . . . . . . . 20.
Retina, gray dots in, . . . . . . . . . . . .
Retina hazy . . . . . . . . . . . . . . . . . . . . . .14 ,16.
Retinahyperaemic.......... . .. ...11.
Retina oedernatous . . . . . . . . . . . . . . . . . 4.
Retina, opaque patches in,. . . . . .21.
Retina, rupture of, . . . . . . . . . . . . . . . . . .22.
Retina swollen . . . . . . . . . . . . . . . . . . . . .7, 14.
Retina torpid . . . . . . . . . . . . . . . . . . . . . . . .12.
Retina watery . . . . . . . . . . . . . . . . . . . . . . . . .9.
Retinal asthenopia . . . . . . . . . . . . . . . . . . .23.
Retinal impressions retained . . . . . . . . . . .23.
Retinitis . . . . . . . . . . . . . . . . . . . . . 17, 26.
Retinitis albuminuriea . . . . . . . . . . . . . . . .19.
Retinitis apoplectiea . . . . . . . . . . . . . . . . . . .9.
Retinitis exudativa . . . . . . . . . . . . . . . . . . . . .8.
Retinitis lcucaemica . . . . . . . . . . . . . . . . . . .13.
Retinitis pigmentosa . . . . . . . . . . . . . . . . . .12.
Retinitis scrosa . . . . . . . . . . . . . . . . . . . . . . .19.
Retinitis syphilitica . . . . . . . . . . . . . . . . . . .11
Retro-bulbar optic neuritis . . . . . . . . . . . .16.
Rheumatism . . . . . . . . . . . . . . . . . . . . ..16, 17.
32

S - ‘U’
Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20. Urzemia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25.
Scarlatina . . . . . . . . . . . .‘ . . . . . . . . . . . . . . .10. Uterus, disease of,. . . . . . . . . . . . . . .4. '7, 25.
Scintillations . . . . . . . . . . . . . . . . . . . . . . . . .11. V ;,
Sclero-choroiditis . . . . . . . . . . . . . . . . . . . . .19. _ ‘
Scotoma, _ _ _ , _ _ _ _ _ , . _ _ _8, 9) 13, 18, 21, 27_ Venous pulsations, . . . . . . . . . . . . . . . . . . . .4.
Scotoma central . . . . . . . . . . . . . . ..5, 16, 22. Vessels a»tteI111_a-ted_, - - - - - - - - - - - --16, 17, 18-
Scotolna; central for C0101-S _ _ _ _ _ . _ _ _ . _ Vessels as Whlte 1111.68, . . ... . . .' . . . . . . . .
Scotoma, centra1 for red _ _ _ _ _ _ _ _ _ _ _ . _ _ _26_ Vessels bordered With wlnte l1nes,. . . ...1'7.
Scotomata appear and disappear . . . . . . .11. Vessels da/"I6, Crooked, 11I1d\11a't1n8‘,-
-19-
Scurvy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27. Vessels, degenemtloll Ofw - - - - - - - -5. 10-
Serous efiusion . . . . . . . . . . . . . . . .10, 13, 14. %GSSQ]S <I?i§a»pp(§ar abruptly. - . - - - - - . - - .12.
Sexual excesses . . . . . . . . . . . . . . . . . . . . ..25. e-SS9 S Tlnge , - . - - - - - - - - - - - - - - - - - - - - -
Shock,. . . . . .’. . . . . . . . . . . . . . . . . . . .22, 25. Vessels hidden in spots. 7. 8. 10,14, 15, 16;
Silver, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25. Vessels increased in Size, - - - - - - ~ - - - - -3. 19-
Smokin , . _ . _ _ . _ _ _ _ _ _ _ _ _ _ _ _ , _ _ _ .24, Vessels pale, . . . . . . . . . . . . . . . . . . . . . . . .13.
gn0w_b1g[ndneSS, _ _ _ , _ _ _ _ _ _ _ , _ _ _ _ _ _ _ _ . _23 Veins attenuated,.. .' . . . . . . . . . . . . . . . .6, 12.
Spasms of accommodation, . . . . . . . . . . . . .3. Veins empty in Places, - - - - - - - ~ - - - - - - - -18-
Spasmodic closure of eye, . _ _ _ _ _ _ . _ _ _ _ Veins irregularly Willi] b1()Od, . . . . . . .
Spinal irritation, . . . . . . . . . . . . . . . . . .14, 17. Veins dilated, dark, t01‘131101‘S‘_, 142, 71,38,159}, ]l'Q,
Stlllllt, . . . . . . . . . . . . . ..' . . . . . . . .. _ . ._ 2 2 2 0'
St1anung’s papilla, . . . . . . . . . . . . . . . . . . .15. Vlslon good, - - - - - - - - - - - - - - - - -3. 9, 21, 97-
Striate opacity near disc, . . . . . . . . . . . . ..13. Vision impaired, 4. 7. 9, 10, '11, 14, 15, 16-
Syphilis, . . . . . .8, 11, 12, 15, 16, 17, 26, 8. Visio p .0 _ d_ 1_[gl7t. 19. 21. 24. 25.
norm 1n111, . . . . . . . . . . . ...
T Vision dim at peripherv,. . . ; . . . . . . . . 8.
Tendency '30 relapses, - - - ~ - - - - - - - - - - -9, 11- Vision lost early . . . . .T . . . . . . . . . . . . . .20.
$31311 $1eC1'e;1SS:(<i1, - - - - - - - - - - - - - - - --5(1), 12% ‘T;z's'J0nZ0stsudde,72Z(1/, . . . . . . . . . . . . . .18, 22.
11 1 11 1110113 , - - - - - - - - ' - - - - - - -- , - ision im r ve. and r troorades, . . . . ..11.
"¥@I1;ti0I1 I101‘ma1,- - I - - - - - - - - - Visual pu]1;‘)pl)e, . . . . . .8. . . . . . . . . . . .. . .24.
0 91300, -- - - - - - - - - ~ - - - - - - - - - - - - 1 1 - iterous fluid, . . . . . . . . . . . . . . . . . . . . . . .19.
TOTPOI‘ 0_f 113131116, - - - - - ~ - - - - - -A - - - - - - - -27- Viterous filled with floating specks, 11, 12.
%'fi1)11n~‘<Lt11-%m,(i, - . - - --5. 9. 15, 11. 20, 22, Viterous hazy, . . . . . . . . . . ..5, 8, 11, 19, 21.
ercu ar isease, . . . . . . . . . . . . . . . . _ -W
Tumors of nerve, . . . . . . . . . . . . . . . . . . . . .21. , ,
Tumor dark and encrusted . . . . . . . . . . . .20. Wavlfi Ollthnes Qf Oblects - - - - - - - - - - - - - -19-
Tumors of orbit, . . . . . . . . . . . . . . . . . . .9, 19. Weeplng excesslve. - - - - - . - - - - - - . - - - - - - -3-
Tumors intm_C1-anial, - _ _ _ _ _ ‘ _ _ 4 9, 23_ VVh1te spots, With red areola, . . . . . . . . . .13.
nmmsou nuuta C0.





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These several Railroads ‘owned b_v the same people, constitute
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OMAHA. OMAHA. OMAHA.
[Reprinted from the HAHNEMANNIAN MONTHLY, October, 1894.]
EYE-STRAIN :
A CAUSE OF FUNCTIONAL NERVOUS DISEASES.
BY
H. BALLOU BRYSON, B.S.D., M.D.,
PITTSBURG, PA. I

TANTALUS, at the table of the gods, aptly represents those who
are free from the effects of eye-strain ; while Tantalns tantalized is
a type of such as suffer from eye-strain. For, just as Tantalus,
under normal conditions regaled himself with the ideal food arid
drink of immortals, and obtained them at will, so does the eye,
under normal conditions, feast itself upon clear visual perceptions—
ideal retinal pietures—-and obtains them at will, with a minimum
expenditure of muscular energy. And, too, just as Tantalus, under
abnormal conditions, had his nectar and ambrosia turned into
the ordinary and imperfect water and fruit of mortals, and was
compelled by his innate thirst and hunger for these, to constantly
struggle to obtain them, so the eye, under abnormal conditions, has
its ideal sense-perceptions transformed into blurred and broken
images, and is compelled by its énborn, Tantalus-like hunger and
thirst for perfect retinal images, to make an interminable muscular
struggle to obtain them. So ust as we see Tantalus tantalized by
his bootless efforts to ‘possess the will-o’-the-wisp water and fruit, so
do we see the eye, defective as to its foeus- or image-forming power,
tantalized by its often vain efforts to possess what is to it an ignisfatuas,
the perfect retinal image. For, if we have given, or granted (1) this
inborn craving after perfect visual perceptions; and (2) an existing
focus- or image-forming defect (it may be one of malformation; it
may be a paretic ciliary muscle; or, it may be a want of equilibrium
of the extrinsic ocular muscles), and the result, eye-strain, is inevi-
table—it will follow just so surely as effect follows cause.
Knowing now the meaning of eye-strain, and granting its exist-
ence in any given case, what are the possible, probable, and even
necessary consequences of it in relation to the aetiology of reflex
_._2__.
neurosis, or functional nervous diseases? This we may establish
both from a priori, and from a posteriori evidence.
From the a priori standpoint the consequences of eye-strain are
manifestly and rationally such as follow the inordinate strain of any
muscle. Artificially induce strain or fatigue of any muscle, or of any
set of muscles, by imposing work of more than normal constancy or
degree, and we get a proving of muscle-strain which ought to be as
instructive to us as the proving of any remedy in our materia medica.
As underlying these considerations it has been found that, in order
to obtain from a muscle a series of contractions, each one of which
shall be as good as the first one ; in other words, that no fatigue, no
strain may follow, there must be a certain, definite weight; and that
the interval between the contractions necessary to lift such weight, be
of a certain length, long enough to allow complete recovery of the
muscle-tone. And it has been shown, further, that, if the weight be
increased, the interval between contractions remaining constant; or,
that, if the interval between contractions be shortened, the weight
remaining constant; or, that, if the weight be increased, and the in-
terval between contractions shortened simultaneously, muscular
fatigue, or strain follows in a short time. Hence we have the phy-
siological law, that, for each muscle, there is a given load with which
the maximal amount of work can be obtained——regard being had
both to the degree and constancy of the exertion. Violate this law,
either as to the degree or constancy of the muscular exertion——as the
hypermetropic, astigmatic, and heterophoric eye must do, simply
because it does not involuntarily obtain clear focal images, and yet
will make the utmost effort to obtain them, and muscle-strain, fatigue,
or exhaustion is the logical and practical result.
But muscular fatigue, in itself, is not the only or final result of
excessive muscular action ; as, since there is, or can be, no voluntary
muscle-contraction save in response to the application of nerve-
stimulus, it will be granted, as an axiom, that all muscular exertion
involves an expenditure of nervous energy, co-ordinate, at least, with
the degree and constancy of such exertion. This granted, it also
follows that muscle-fatigue, as it comes on, under normal conditions,
implies not only fatigue of the muscle, per se, but also fatigue of the
centres innervating the muscles. A constant output of nervous
energy is necessary to maintain any muscle in constant contraction ;
and a condition of voluntary tetanus, in any muscle, can be main-
tained only so long as the centre innervating that muscle is capable
of maintaining it in a state of constant contraction ; then comes in-
_3__
voluntary muscular relaxation, which implies antecedent exhaustion
of its innervation. That the nerves suffer first from muscle-strain
and that the centres of innervation are directly responsible for the
first loss of power in a muscle, has been clearly demonstrated by ex-
periments of Mosso, Maggiora and Lombard. They have found
that a muscle, after having been brought into a condition of com-
plete fatigue by repeated vohintary contraction, will still respond to
direct, artificial (induced current) stimulation of its substance, or of
its nerve supply; thereby proving that the power to contract still
remains in the muscle, and that the inability to do so is solely for
want of “ power behind the throne,” exhaustion of the innervation.
Hence, we are forced to conclude, both from theoretical and practi-
cal considerations, that muscle-strain, fatigue, or exhaustion, means
and is tatamount to, nerve-strain, fatigue, or exhaustion.
But, continuing our lead, we are led to inquire: Wl1at are the
consequences, local or constitutional, of this resultant nerve-strain?
Wl1at facts can be adduced, direct or indirect, which, more or less
completely, give us a proving of eye-strain, or muscle-strain, and
establish its causative influence in the production of functional ner-
vous diseases? In considering these facts let it be remembered that
cye-strain means muscle-strain ; that muscle-strain means nerve-
strain, and that what is demonstratedly true of muscle-strain, or
muscle-fatigue, as applied to any of the voluntary muscles, is
equally true of the ocular muscles.
A direct proving of eye-strain is obtained by placing upon the
normal eyes of a healthy child, or of many such adults, a pair of
presbyopic glasses, thereby inducing an eye-strain where, normally,
there is none. In a few minutes, varying with the strength of the
glass, and the more or less neuropathic predisposition of the subject,
results are apparent; smarting, burning and aching of the eyes;
aches and pains in various parts of the head ; dizziness; confusion ;
vertigo; nausea; vomiting; in short, all of the symptoms of an ordi-
nary headache; a migraine, megrim, or clavus; or a typical sick
headache. Perhaps all of us have made such a proving, to some
extent, by wearing, for a short time, our grandmother’s spectacles,
or the glasses adapted to the eyes of some person other than the ex-
perimenter. So we see the syinptom-producing power, or pathoge-
netic influence of a refracting piece of glass ; and its power, in this
direction, should be on a par with that which any drug may exhibit
under similar conditions.
As directly bearing upon the causation of graver functional neu-
__4___
roses, through muscle-strain, and indirectly showing that the same
conditions will result from prolonged strain of the ocular muscles,
many facts are presentable from every-day life; and these are ‘not
without scientific demonstration. Underlying them all, and having
an important bearing upon the aetiology of neurasthenia, is the princi-
ple that fatigue of one muscle, or one set of muscles, will produce
partial fatigue in all other muscles. We have all noticed that the
fatigue induced by a long walk soon becomes systemic, although but
a few muscles are used in walking; and Maggiora has indisputably
demonstrated, by means of the ergograph, that after a walk pro-
longed to the point of fatigue the muscles of the finger have become
partially fatigued, i.e., their fatigue-curve, as taken by the ergograph,
is much shorter than under ordinary conditions. Many other facts
of similar import are presentable; and if it be true that fatigue of
one muscle, or one set of muscles, is soon communicated to all, and
that muscle-fatigue is ultimately nerve-fatigue, we can see at once
how eye-strain—-prolonged, as it must be, if it exist at all—must,
in a neuropathic subject, superinduce general nerve-fatigue, nervous
prostration, or neurasthenia.
Bearing directly upon the origin of chorea, epilepsy, hysteria,
hystero-epilepsy, and catalepsy, and deserving our most thought-
ful consideration, are the remarkable experiments of Drs. Dercune
and Parker, of the University of Pennsylvania. These investiga-
tors have carried the proving of muscle-strain to almost the ex-
treme limit. I quote from the published account of their experi-
ments: “ The subject being seated, the tips of the fingers of one or
both hands were so placed upon the surface of the table as to give
merely a delicate sense of contact, i.e., the fingers were not allowed
to rest upon the table, but were maintained, by a constant muscular
effort, -barely in contact with it. Any other position, involving a
like effort of constant muscular adjustment, was found to be equally
efficient. Any one object in the room was now selected, and the
mind fixed upon it; or some subject of thought was taken up and
unswervingly followed. After the lapse of a variable period of
time, extending from a few minutes to an hour, and depending on
individual peculiarities . . . . the subject was frequently thrown
violently to the ground in a general convulsion, preceded by tremors,
which rapidly became more violent. Seizures equalling in violence
a general convulsion were by no means induced in all subjects, and
were generally the result of experiments repeated many times during
the same evening. In the experimenters the convulsions became
_5__
so easily induced that it was thought advisable to desist for a long
period.” .
This experiment is scarcely short of startling as showing the pos-
sibilities—-in some subjects the necessities——of protracted, physio-
logical musculo-nervous strain. The homoeopathicity of this patho-
genesis to the main features of the more or less convulsive functional
neuroses is certainly apparent and instructive.
If such manifestations as the foregoing, all of which are the
result of perverted nerve-action, can be and are the result of burdens
artificially and temporarily imposed upon certain muscles, will not
and do not similar burdens imposed upon the muscles of the eyes by
refractive, accommodative, or heterophoric errors, induce similar
results ‘? Obviously, yes. And, too, there are the best of reasons for
suspecting, and expecting, that graver results must follow abnormal
tension or adjustment of the ocular muscles, than from strain of any
other muscles: (1) Because, if eye-strain exist at all it is constant
and unavoidable, save when the subject is asleep. Think of a con-
tinuous, unremitting muscular strain of from twelve to eighteen
hours duration, and of varying intensity, day after day; compare its
possible, probable, and even necessary results, with those here shown
to result from strain of but a few minutes’ or a single hour’s dura-
tion; and we get some adequate idea of the disturbing influence of
eye-strain. (2) Because this excessive strain falls upon the most
intricately arranged and delicately adjusted (normally) system of
muscles in the body ; and upon organs whose wonderful nerve-supply
renders them the source, par excellence, of reflex functional nerve-
disturbances: for, of the twelve pairs of cranial nerves, the second,
third, fourth, and sixth are distributed exclusively to the eyes; in
addition, they also receive the ophthalmic division of the fifth pair,
and this, through its ganglionic connections, brings the eyes into re-
lationship with the seventh and eighth pairs of cranial nerves, and
with the great sympathetic system. From these anatomical con-
siderations, we would naturally expect to find the eyes, when subject
to such musculo-nervous strain as the aforesaid errors impose upon
a neuropathic predisposition, just what they are, viz.: the storm
centre for the generation of functional nervous diseases.
So much for the a. pviori evidence in the case. To strengthen this
we have a vast mass of a posteriori evidence-—cases of headache,
sick headache, migraine, neuralgia, neurasthenia, chorea, hysteria,
epilepsy, hystero-epilepsy, melancholia, and insanity which have
been cured by simply relieving the co-existing eye-strain. This
__.6_
phase of the evidence is interesting and valuable (1) as corroborat-
ing the preceding facts; and (2) as indicating how frequently eye-
strain is a cause of this class of diseases——if the term disease may at
all be applied to conditions having no recognizable pathology or
known pathognomonic lesion. With this clinical evidence all are
doubtless familiar; and I will not here review it, choosing rather to
rest the case upon the almost neglected homceopathic evidence already
presented. ~
Let it be remembered that the only claim of this paper is that
eye-strain is a cause of functional nervous diseases--not that it is the
or the only cause; for, in making this presentment of the subject, we
are not unmindful of the other sources of peripheral nerve-irritation
which may and do give rise to these neuroses: and we have no
thought of underestimating or attempting to eliminate them as
causative factors; But, in order that the treatment of these condi-
tions may be rationally and successfully applied, much (I had almost
said everything) will depend upon the search for and recognition of
the cause in any given case. To facilitate us in this, we should
have in mind the relative importance of the various aetiological
factors; and here our knowledge of clinical results serves us well by
pointing to eye-strain as the paramount factor. Upon this point,
Ranney, who is not an oculist gone daft upon this subject, but a
neurologist interested only in that method of ‘treatment which yields
the most direct and permanent results, says: “Eye strain is a fre-
quent cause, and perhaps, the most important of all factors that
tend to produce functional nervous diseases.”
But if eye-strain were a less important factor in the causation of
these disturbances the pitiable and protracted character of the suffer-
I ings of these patients, the very great disappointment which often at-
tends their treatment by any system of medication, and the eminently
satisfactory results of non-medicinal measures appropriate to the
cause of the trouble, would still entitle the patient to an ocular ex-
amination for the determination of a possible source of nerve-
strain, unless some other plainly palpable cause were manifest. And
surely every conscientious practitioner is bound to give every such
patient such a thorough physical and scientific exami.nation as will
tend to the discovery of every possible source of nerve-irritation in
order that the chances of relief may be enhanced. I lay particular
stress upon the determination of the cause in any given case because
I believe that many of the disappointments following the use of
medicine and all of the professional and lay skepticism as to the re-
__.7__
m.edial power of medicine in general is the result of trying to do
impossibilities with medicine, depending on them when,‘ in view of
the cause, they are not indicated and satisfactory results cannot fol-
low. On the other hand, I regard the very satisfactory and even
brilliant results attending the treatment of these conditions by re-
lieving the eye-strain, when it co-exists, as wholly due to the recog-
nition of the cause and adapting the treatment thereto. I know
that these results, as Bo-uchard says, when speaking of the interpre-
tation of infection, in his recent work on Auto-Intoxication, have
“caused, according to temperament, enthusiasm or sarcasm, infatua-
tion _or dread. Infatuation or dread—-these are two sentiments which
science repudiates. She will continue, in spite of resistance and in
spite of intemperate displays of an exaggerated enthusiasm, to march,
serenely and unmoved, toward truth.”
I do not believe that we have reached the ultimatum of medical
truth and progress, but I do believe that we shall progress, both in
the treatment and prevention of diseases, and that our progression
will be measured by our success in penetrating into and recognizing
the causes of disease and adapting our curative and preventive meas-
ures to them. It is an encouraging sign, and presages much, that,
as Bouchard says, medicine “after having devoted herself during
many long years to the verification of symptoms, to the research of
anatomical lesions, to the study of pathological physiology, she ~
comes at last to study the origin of disease. \Vhat is characteristic
of these modern days, so far as medicine is concerned, is the high
place we assign to the study of the origin of disease.”
Personally, I believe that tolle causas morbi is the only universal
law of therapeutics, greater even than our ta-lismanic szbnilia simili-
bus cwra'nt'Lw'—-greater‘ because it is more comprehensive, includes, if
you please, both medicinal and non-medicinal medicines. I would
not disparage medicines when indicated and homoeopathically ap-
plied, but there are non-medicinal measures which, when indicated,
I would place upon a parity with medicines.
Hysterical Amblyopia.

_BY_
JAMES A. CAMPBELL, M. D.

A PAPER READ BEFORE THE
AMERICAN INSTITUTE OF HOMOEOPATHY.
June, 1890.
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I V as/z z'ngto7z A 120.


[Reprint from the CLINICAL Rsronrnn, October, 1890.]

HYSTERICAL AMBLYOPIA.*

BY JAS. A. CAMPBELL, M. D., ST. LOUIS, MO.



’ HE obscurity as to the causes upon which it depends, the un-
' ~ certainty and irregularity in reference to the sequence of its
symptoms, coupled with the remarkable and varying phe-
nomena which attend that general functional neurosis of the
nervous system known as hysteria, must always make it an
_ ~ interesting topic to medical men.
The object of this paper is to briefly present for discussion that
phase of this complication known as hysterical amblyopia.
Authority tells us that it is questionable to make the diagnosis
-of hysteria dependent upon the presence or the absence of a partic-
ular symptom. The same difliculty in reference to the diagnosis of
hysterical amblyopia will always be present.
" A temporary, partial or total loss of vision may be the result of
-several direct causes. It may be a part of general debility and sub-
sequent to fevers. It may follow any exhausting illness or hmmor-
rhage. It may appear during parturition. It has followed digestive
and intestinal irritation. Toxic influences may likewise produce it.
Temporary loss of vision may occur as the aura of an epileptic at-
tack. These, with others which might be given, will represent some
of the varied forms of temporary amblyopia.
Hysterical amblyopia can only be diagnosed by exclusion. The
history of the case will always greatly aid in arriving at a definite
conclusion. The defective vision results from retinal anaesthesia,
which, strange to say, is generally associated with marked hyperaes-
thesia or sensitiveness to light.
It is principally found in hysterical females, whose histories
will develop a gradually accumulating series of visual aggravations,
which resist every form of optical correction,prismatic exercise, local
or internal treatment. There is usually intense photophobia, partial
ptosis, neuralgic pains in and around the eyes, flashes of light before
, the eyes, even in the dark, and phosphorescent waves and dark
shades from the periphery toward the center, with the disappear-
ance of the object looked at.
Hysterical amblyopia may be partial or total. It sometimes
affects one eye, generally both. Again, it may manifest itself by
hemianopsia.
The temporary loss of vision may occur at stated times. Noyes
relates a case where the vision went out every twenty-four hours,

*‘Read before the American Institute of Homoeopathy, June, 1890.
__2__ -
when everything was perfectly dark for ten or fifteen minutes. I
have a similar case under my care at the present time, a young girl
of sixteen, who has a periodic disappearance of vision for ten or fif-
teen minutes. This comes on without any premonitory symptoms,
but it is followed by severe headaches.
Hysterical blindness may suddenly disappear and be supplanted
by other hysterical symptoms in other parts of the body.
In some cases there is a partial color blindness; in others a
peculiar hypersersitiveness to certain colors. I met a lady some
years ago who was acutely sensitive to red. She would not wear,
could not look at, or touch anything red, without great nervous irri-
tation. So sensitive was she to it, that she affirmed her ability to
determine the irritating color, red, by the sense of touch alone.
It has been suggested that these hysterical amblyopia conditions
are caused by a partial ischaemia or anaemia of the retina, resulting
from a reflex spasmodic contraction of the arteries supplying the
visual apparatus, a vaso-motor neurosis through the sympathetic
nervous system. This is indeed quite in keeping with the existing
condition. I have repeatedly examined cases of hysterical ambly-
opia with the ophthalmoscope, and have almost invariably found
contracted retinal arteries, though at times no fundus changes could
be detected.
Hysterical complications are generally presumed to belong to
womankind alone, but this is not always so. Briquet states that in
1,000 cases of hysteria, 50 were in men. He points out that it is
more frequent in women on account of congenital peculiarities, ac-
quired conditions, physical functions and social environments. He
likewise says that in 93 cases of anaesthesia in different sensory
organs, amblyopia was found six times. Of the cases of hysterical
amblyopia I have seen, only one ill-defined case was in a man.
There is a prevailing impression that all hysterical complica-
tions have their origin exclusively in the genital organs, but this has
been denied by excellent authority. Scanzoni and Amann state
that they found the genitals in a healthy condition in 20 per cent of
the cases examined. Still it is, without doubt, true, that many
cases of hysterical disease find their origin in the generative organs,
and are cured when these irregularities are removed. The view that
it has its root in the whole nervous system, and that it may be de-
veloped by the most varied external influences, seems to be a very
consistent one.
Most writers agree, however, that it is closely allied to, and may
be followed by various other phenomena, such as epilepsy, chorea,
or insanity. A case under my care some time ago favors this view.
In 1883, a young married woman, age twenty-five, was brought
to me from a distance with both eyes tightly bandaged, not being
able to tolerate the least exposure to light. Her vision was very de-
fective. She had been in this condition for five weeks, but her eyes
had been sensitive and painful for several months. Owing to the
extreme photophobia and irritability of her eyes, an examination
was made with much difiiculty, and it could only be accomplished
_3__.
nder the weakest illumination, through a blue-tinted lamp chimney.
‘he pupils were medium in size, reacting poorly, and after a slight
ontraction went through a quick elastic expansion. The arteries
rere small; veins full. The optic disc was red, but clearly outlined
nd normally defined. Her spine was supersensitive. She had
requent light flashes before the eyes. Under galvanism, Ferr. phos.,
lonium, Puls., Calc. phos., and by the correction of an anterior
terine flexion (by her physician), she made a rapid and excellent
ecovery. A few years afterward, she began to show signs of gen-
ral nervous disorder and mental aberration. Last fall she was taken
3 a sanitarium, and was thought to be much improved; but re-
ently, while on her way home, with her husband, she walked to the
oor of the car, which was going at a high rate of speed, and delib-
rately threw herself from the car, and was killed.
We should carefully differentiate between transitory hysterical
mblyopia and the temporary obscurations of vision which may
ccur in the beginning of glaucoma; and likewise not confound it
ritll a paresis of the accommodation which always obscures near
rork, and also distant vision, in hyperopic subj ects, although even
his condition may have a hysterical basis.
One year, ago, Mrs. 11., age thirty-four, was brought to me from
outhern Illinois. For more than a year she had not been well;
me nervous ; had frequent sick headaches, but no especial eye trouble
ntil about one week before ; then, while sewing, the left half of her
isual field disappeared. There was no pain, but intense photopho-
>ia. Since then the eyes had pained some, and the lids were so
reak that she could hardly raise them. Even in the dark she could
nly hold her eyes open for a moment. She had a very sensitive
pine, and some pains from the ovarian regions down into the limbs.
The thick bandages were removed from the eyes, and after much
ifficulty, a brief view of the fundus was obtained. The arteries
rere contracted, but otherwise the condition was normal. She could
ount my fingers at three feet.
My diagnosis was hysterical amblyopia from reflex ovarian irri-
ation. She returned home and was treated by her physician in
.eeping with this view, according to suggestions agreed upon, and
he made an excellent recovery ; at least for six months she thought
he was well. In January of this year her eyes began to trouble her
gain. She returned to me in last March, stating that from January
st to that time, her sight had temporarily disappeared six times,
nce for over an hour. Each attack was preceded by a severe pain
>etween the shoulders. The intense photophobia, partial ptosis, de-
ective vision (%%§- , etc., were all present. Her vision was carefully
Xamined under atropia, and very little optical error was found.
lnder galvanism, Onosmodium, Macrotin, and general massage, she
iade rapid progress, and returned home in three weeks very much
mproved, with vision -,1--(5,-.
Hysterical amblyopia will call for the same general line of treat-
ient that is indicated in hysteria proper, for it is merely one mani-
estation of general hysteria. Such well known remedies as Phos..
._4._
Ferr. phos., Aurum mur., Puls., Platina, Macrotin, Onosmodium, Ig-
natia, Sepia, etc.,will frequently be called for. Combined with them
I have found galvanic electricity of the greatest value. But while
remedies are useful, we must not forget a very important truth, well
stated by Erb, who says : “ In the treatment of hysteria special pre-
cautions must be employed. In scarcely any other neurosis do
psychical factors play so important a part. Confidence in the phy-
sician and the remedy is the best guarantee of success.” It is prob-
ably owing to this psychic influence that such remarkable results
were obtained by metalloscopy and metallotherapy by the Com-
mission appointed by the French Biological Society in 1877, an
account of which will be found in the first and second volume of
“ The Brain.” They remark upon“ expectant attention ” and “ trans-
ference phenomena,” now so familiar in the present popular hyp-
notic treatment of the same complication. The experiments of
Oharcot and others prove that hypnotism undoubtedly has a won-
derful influence in controlling hysteria and hysterical amblyopia,
but it should never be employed, except within guarded limits and
under intelligent precautions.
It is indeed strange that so little has been written on hysterical
amblyopia, many authorities on nervous diseases barely making
mention of it. This may probably be accounted for by the fact that
these cases are generally recorded in a curious rather than in a
scientific temper. In this respect they are interesting, but beyond
this the subject well deserves close attention and study. It is too
often the case that hysteria is regarded as a fanciful rather than an
actual disease. It is a serious something, a positive and actual dis-
ease, and should always be so regarded, studied and treated.
OCULAR REFLEX NEUROSESF
BY
JAMES A. CAMPBELL, M. D.,
ST. LOUIS, MO.
.-_-—__-_
Medical literature of all ages is full of recorded cases of
ocular reflex neuroses. In former times they were recorded
more as peculiar and not understood phenomena; as curi-
osities, rather than in a scientific sense admitting of expla-
nation. Each year as conducted experiment and investiga-
tion is carried on, and as the nervous, physical, and psychi-
cal functions and their intricate relationship are gradually
unraveled and become better understood, the curious gives
way to the matter of fact, and the former phenomena to
natural and fairly well understood laws.
The subject is very extensive and far reaching. We
have neither time nor space to attempt exhaustive treat-
ment. Ours is a duty to schedule and classify; to record
action and reaction; to collect authentic cases of every
possible variety, and from this maze and aggregation
endeavor to deduce, in the future, some general and well
established laws.
Defim'z‘z'orz.——Nerve reflex is a direct transference of
centripetal excitations to centrifugal paths, or vice versa,
without the co-operation of the will.
All animal activity and functional force depend upon and
are the result of physiological reflex action, whose general
laws and pathways are understood.
The reflex is physiological as long as it is in harmony
with normal functions and activities.
When the reflex excitations result either in over or
* Reprinted from the _/ournal of 0;)/zz‘/la//uology, Otology, and Laryggo/ogy,
July, 1893.
2 Ocular Reflex N eu reses.
under activity, it then becomes an abnormal reflex, or a
neurosis.
Physiological reflex action, as well as reflex neurosis, may
be manifested either as motor, sensor, or functional phe-
nomena.
The contraction of the pupil to light is an example of
physiological reflex; here impression is conveyed by the
nerves of special sense (retina and optic nerve) to the brain
centers, and then reflected back through a motor nerve
(third nerve), producing contraction of the pupil. Or the
sight of a disgusting object may produce nausea; here the
pathway of the nervous reflex is through the same nerve of
special sense to the pneumogastric, and hence the conse-
quent nausea, a neurosis. Or the fluttering, increased
rapidity of the heart beat; or the blanching of the cheeks,
in the presence of great danger, will again represent the
functional features of a reflex neurosis.
The fact that these nerve impulses, originating in one
system of nerves, may be transmitted to another system
and reflected back again, from sensor to motor or func-
tional, presupposes a close connection and intimate corre-
lation between the cerebrospinal and the sympathetic sys-
tems of nerves. Such intimate relationship and blending
are anatomical and physiological facts.
The great sympathetic system of nerves is a series of
closely connected ganglia, extending along each side of the
spinal column, from the head to the coccyx, communicating
with itself from side to side, as well as with both roots of
the spinal cord as they emerge. lt communicates likewise
with all the other nerves of the body, uniting with the
fourth and sixth nerves, in the cavernous sinus; and with
the olfactory and auditory at their ultimate expansion, as
well as being in close connection with all the other cranial
nerves, through their cranial ganglia; forming thus the great
blending and binding pathway and influence ; while at the
summit of the spinal cord is the medulla oblongata, a con-
gregation of ganglionic centers, and series of sensory ganglia
from which arise the seventh, eighth, ninth, tenth, eleventh,
Ocular Reflex Ne2¢r0ses. 3
and twelfth nerves; and also gives root to fibers of all the
remaining six cranial nerves in its center, "the fourth ven-
tricle. In addition to this, it is united by commissural
bands to all parts of the brain proper, and contains most
of the fibers, which are distributed to the other parts of the
encephalon; and hence it transmits both the motor and
sensory impulses, as they pass from and enter the
cerebrum.
In the light of this intimate blending and interpenetra-
tion of the cerebrospinal and sympathetic systems of
nerves, their mutual influence, one upon the other, would
seem to be not phenomenal, but almost an anatomical and
physiological necessity.
Since the normal processes and pathways of reflection
are so numerous and complex, it is easily intelligible how
numerous and complicated the disturbances of motility,
sensation, and function may be, and from how many differ-
ent points abnormal influences may be excited and re
flected, in motor, sensor, and functional, as well as in psy-
chic centers. The form and character of the neurosis may
thus be extremely numerous, and hence the recognition of
the primary cause may be not only difficult, but, at times,
impossible to locate.
Starting out with the above statements clearly in mind,
the discussion of ocular neuroses resolves itself into a
simple statement of observed and recorded facts, without
the necessity of delay for extended and elucidating
argument.
Ocular reflex neuroses may be considered under two gen-
eral headings.
I. Reflex neuroses from the eyes to and implicating other
parts and organs.
II. Reflex neuroses from other parts and organs, affect-
ing the eyes.
These reflex activities may be variously manifested, for
the same cause may result either in sensory, motor, func-
tional, or organic disturbances, and there is no known fixed
law to determine which it will be; in fact these groups
4 Ocular Reflex N euroses.
often present no sharp lines of demarcation, but frequently
overlap each other at many points, so that, in certain cases,
we meet with symptoms characteristic of two or more
groups.
Under the first heading, or reflexes from the eyes pro-
ducing disturbances in other parts and organs, the most
important, and the most frequently met with, are those re-
sulting from optical anomalies, viz., myopia, hyperopia,
astigmatism.
Various and distinctly different results may follow from
the same apparent cause, such as pains in and about the
eyes; headaches; neuralgia; photophohia; nictitation;
diplopia; nausea; vertigo; dizziness; restlessness; in-
somnia, and mental aberrations.
Local infiammations may follow same cause, as conjunc-
tivitis; blepharitis; styes; corneal inflammation or ulc_era-
tion; retinal hyperaemia or optic nerve congestion, etc.
These are all the direct results of irritation produced by
eye-strain transmitted through the optic nerve to and
through the cerebrospinal and sympathetic systems of
nerves, finding outlet either as a perverted sensation, a
motor impulse, or causing functional disturbance and, may
be, organic changes in various parts.
Under this heading we must also place heterophoria
and its disturbing consequences, for it is not the deviations
in direction of the eyes themselves, directly, which cause
such unpleasant results, which are almost identical with
those caused by optical anomalies, but it is through the
resulting lack of visual equilibrium, and the difficulty, or
impossibility of forming retinal images and impressions on
the necessary “identical points,” which is the prime cause
of the long list of troubles which may follow in the wake
of this lack of muscular equilibrium of the eyes.
If we ask why the same apparent condition may produce
such widely different results, we should remember, as be-
fore remarked, that the laws of reflex action are not uni~
versal. -The same irritation, functional or organic, may
produce radically different reflexes in different subjects, or
Ocular Reflex Nezzroses. 5
in the same subject at different times, while in other
cases the same apparent optical or muscular error does
not seem to be attended by the lea-st irritating reflex re-
sults. There must be some nervous predisposition exist-
ing in the subject afflicted, aside from the local points of
irritation. This would seem to be proved by the fact that
they in whom. reflex troubles are most common are usually
of a neurasthenic temperament.
To illustrate this variety of susceptibility coming under
my personal observations a few brief cases, which are
familiar and numerous, may be given. '
A scholarly minister, about fifty, had for years suffered
with neuralgic pains in and about the eyes, frequent
nausea, nervous prostration, etc., etc.—the familiar pic-
ture. A—|—.25 D. c. ax. 90° brought perfect relief and
restored health.
In another case, a neurotic boy, age fifteen, had frequent
epileptoid attacks, which a -75 D. c. ax. horizontal removed;
thus showing the small amount of error producing aggra-
vated results in predisposed neurasthenic subjects.
A typical case, showing an utter lack of susceptibility,
may now be examined. A gentleman, age thirty, applied to
me for aid in defective vision. He had never seen as well
as other people. I-Iad never been subject to headaches,
neuralgia, or other signs of reflex irritation: only “could
not see well.” _
Examination showed V.= -§-3-. With + 6 D. s. O + 1.25
D. c. ax. 45° in R. eye and same combination, with ax. 135°
in L. eye, gave him V.:%%. He continues to wear this glass
with great physical comfort and personal satisfaction.
Under ordinary circumstances we would have expected
much nerve reflex irritation to be associated with such an
optical condition.
Again, a young lady, eighteen years old, wore a + 2 D.
for six or eight years with great relief to former sufferings.
At the end of this time she again began to have reflex
irritation symptoms, to a very annoying degree. The
addition of a + .25 D. c. ax. 90° brought instant and perma-
6 . Ocular Reflex Neuroses.
nent relief; thus showing that the neurasthenic predispo-
sition may be different in the same individual at different
times; influenced, no doubt, by other general conditions
and nerve irritations, originating at parts other than the
eyes.
Under peculiar reflex symptoms may here be mentioned
the case of a lady, with myopic astigmatism, who felt a
severe pain run down her right leg every time she tried to
read more than a few minutes.
In the consideration of the resulting sensory neuroses,
above given, as pain, neuralgia, headaches, etc., we
should remember, as Erb well states it, that pain is a
common sensation that belongs, not to a peculiar kind, but
only to a certain degree of sensation; and it thus has no
specific quality. It is only a question of intensity; hence
pain is but the aggravation of normal sensations; and this
is the chief difference between a physiological reflex and
an abnormal or reflex neurosis. The sensation of pain
depends upon two factors, its intensity and individual sus-
ceptibility.
The various forms of reflex neuroses, which may result
from optical anomalies, will illustrate the different reflex
pathways through which perverted nerve action may be
exhibited.
While the attention of the ophthalmologist is principally
directed to the various forms of reflex neurosis originating
in the eyes, he should carefully keep in mind that, in keep-
ing with the laws of reflex nerve action, irritation of any
character, having origin in any organ, or at any part of the
body remote or near the eyes, may be transmitted back to,
and affect the eyes through the same pathways which the
first mentioned efferent neurosis traveled. Indeed many
of the most obstinate and annoying cases of eye trouble we
meet can only be remedied by the discovery and mastery
of the remote causes which produce them. The eye is in
a state of responsive sympathy with every organ and region
of the body. A '
Tabes dorsalis or allied diseases are accompanied by con-
Oeular Reflex Neuroses. 7
tracted pupils and at times by paralysis of the eye muscles.
Paresis of the oculo motorius and abducens occurs in the
early stages of locomotor ataxia.
In 70 cases of locomotor ataxia reported by Grani-
ger Stewart (c. + Med. W. 1882), there were 20 cases of
squint; 3 of ptosis; 4 of diplopia, without manifest squint ;
7 of rnyosi_s; 4 difference in pupillary diameter; 8 with
Argyll-Robertson pupil, etc.
On the other hand irritation of the cilio-spinal region
will often be associated with partial mydriasis and optic
nerve congestion ; while paresis or paralysis of the cervical
sympathetic will produce myosis, as well as partial ptosis.
This is through the sympathetic system of nerves. Accord-
ing to Hensen and Volckers the pu'pillary fibers of the
sympathetic leave the cord at the upper dorsal and lower
cervical vertebrae, going through the superior cervical
ganglion and entering the carotid plexus. They then pass
through the ciliary ganglion, in the orbit. The whole of
the fibers do not take this course, because it is found that,
when the ciliary ganglion is extirpated, irritation of the
trunk of the sympathetic will still dilate the pupil. The
ophthalmic branch of the fifth nerve, and probably other
nerves connecting with the inner eye, also furnish channels
of access for other sympathetic fibers. The partial ptosis
is caused by paresis or paralysis of the sympathetic, which
sends motor fibers to the musculi palpebrales. This form
of partial ptosis is not uncommon in women, and is fre-
quently associated with reflexes from the uterine or ovarian
system.
Hystero-neuroses form a special and frequently met with
group. It is noteworthy, however, that the severity of the
uterine disease does not predicate the presence or absence,
the severity or the mildness of the reflex. Authority tells
us that structural diseases of the uterus and its appendages
are not so apt to be followed by reflex phenomena as are
functional troubles.
In his very interesting discussion of“ Visual Disturbances
and Uterine Diseases,” A. Mooren (A. F. A., vol. x.) de-
8 Ocular Reflex Nezrroses.
clares from his large experience that there is no part of the
eye which, either from physiological or pathological point
of view, is beyond the influence of the uterine system. He
assigns the reflex theory as the direct cause.
The suppression of menstruation has frequently produced
eye complications. McKay (journal Med. Sciences, 1882)
gives twelve cases of ocular affections from suppressed
menstruation, numbering among them choked disk, diplo-
pia, asthenopia, defectivevision in some, etc.; while M. F.
Comes (Am. Med. Herald, October, 1882) gives four cases of
menstrual amblyopia, varying from slight loss of vision to
almost total blindness; deep-seated pains in eyes, with
burning, stinging, etc., all of which were restored after
menstruation had been re-established.
Sexual excesses, and especially masturbation, are fre-
quent causes of reflex ocular trouble. The latter is a pro-
lific cause of much irritation and it is generally very diffi-
cult to trace, especially in females. It is a frequent cause
of spasm of the accommodation, hyperaemia of the fundus
and optic disk, obstinate néruralgic pains in and about the
eyes and, in some cases, paresis of the accommodation.
Connected with hysteria, that general neurosis of the
whole nervous-system, there are frequent and various forms
of eye complications, embracing partial or complete ambly-
opia, hemiopia, scotoma, phosphenes, floating clouds, myo-
sis, mydriasis, ptosis, photophobia, spasm or paresis of the
accommodation, neuralgic pains,'ctc., etc., all of which are
purely reflex ocular neuroses, a part of the general neu-
rosis.
Orificial irritations are frequent causes ofreflex tr-oubles.
This includes hemorrhoidal and other anal diseases, phi-
mosis, stricture of the urethra, or cervex uteri; all of which
are, without question, frequent causes. Recent current
medical literature is filled with cases fully illustrating this.
Intestinal irritation, either from inflammation or from
worms, has been followed by ocular reactions. Both of
these conditions mayproduce similar eye reflexes, such as
temporary strabismus, diplopia, myosis or mydriasis, ptosis
Ocular Reflex Neuroses. 9
or wide open eyelids. Many remarkable cases have been
reported from time to time. Lawrence (Am. Ed., 1854, p.
607) gives case of a child seven years old, who had intoler-
able paroxysms of pain in left eye, recurring at uncertain
intervals, without visible changes in the eye, which was en-
tirely relieved by purgatives, bringing away a coral bead,
which had been swallowed. I -
M. Wishart gives a case of complete amaurosis of the left
eye, in a boy nine years old, of four months’ duration, who
made immediate recovery after free purgative.
Another case is given of a boy eight years old, who could
not see large print, who was rapidly restored after turpen-
tine enemata brought away quantities of worms.
In a recent case of my own, a young man of twenty-
six, who had a very persistent and annoying diplopia, caus-
ing vertigo and disagreeable head symptoms, recovered
promptly after passing several yards of tape worm.
There are many cases similar to those related on
record.
The great trifacial nerve is very intimately connected
with all parts of the visual apparatus, both directly and in-
directly, through the sympathetic nerves and the ciliary
ganglion. From this we might expect that all the neces-
sary conditions to favor frequent and varied forms of ocu-
lar reflex neuroses were present; and such is the case.
Many authentic cases of defective vision following irrita-
tion of the fifth nerve have been reported. Mackenzie
(Am. Ed.,. I855, p. 997) gives case of a man who had a small
tumor on the crown of the head, which had been ten years
coming. It was not painful or sensitive to touch. He
had much headache and quite defective vision. > It proved
to be a cartilaginous cyst, filled with a yellowish fluid.
Its -removal restored his vision and remedied his head-
aches.
Within the past year a patient of mine had a tumor size
of a filbert,about one-half an inch above the supra-orbital
foramen of the left eye. It had been gradually developing
for some years, and the vision of that eye had been as grad-
IO Ocular Reflex Neuroses.
ually growing less and less. The removal of this growth '
perfectly restored the sight.
Many cases of partial or nearly total loss of vision caused
by diseased teeth have been published. I discussed this
topic in a contribution, “The Eye-tooth and the Eye ” in
the C/zlcago Medical [m/estzlgatar (July, 1875) and gave then
the accepted explanation for it, which is that it is a reflex
neurosis through the ciliary ganglion and the other sym-
pathetic connections of the great trifacial nerve. Since
then a number of interesting cases have come under my ob-
servation. One case is well worthy of comment. A lady
had a large cavity in the left upper bicuspid tooth. The
diseased contents were thoroughly excavated and removed,
and the nerve was killed by a dentist. The tooth was filled
with gold. A month or two afterward the vision of the left
eye began to fail, growing less and less as the weeks went
by. The tooth was not sensitive, but the gum at one side
of it seemed painful to pressure. The tooth was extracted,
and the sight was rapidly restored. Examination of the
tooth showed that, in the filling of it, the thin side wall had
been perforated at one point, and a little plug of gold had
forced through it, extending about one-tenth of an inch
outside, and pressed against the wall of the socket; and
this had set up the reflex neurosis, through the well-known
pathways, to the seeing nerve.
In the above brief examples of various forms of ocular re-
flex neurosis, no attempt has been made to explain why
the reflexes should be so varied in their nature; why the
phenomenon is at one time sensor, at another motor, then
functional, and again organic; for, as mentioned before,
there does not seem to be any known law regulating the
direction which the reflex may take. They may thus be
manifested as :
I. Sensor. III. Functional and
II. Motor. IV. Organic.
Under sensor reflex neuroses may be grouped all forms
of abnormal or perverted se_nsations—-hypersesthesia, anaes-
thesia. '
Ocular Reflex Neureses.‘ I I
Under motor reflexes will be included all forms of spas-
modic action (tonic, clonic, spastic), paralysis or paresis.
Under functional reflex ocular neuroses will be numbered
all interference with the proper nutrition of the eye, or
its vaso-motor supply, affecting as a result either the seeing
nerve, retina, dioptric media, accommodation apparatus;
or the proper support of any of the other eye tissues.
Closely related to this last heading is the reflex neurosis
which may result in organic changes: anaemia, hyperaemia,
inflammation, tissue or anatomical changes, hyperplasia,
neoplastic formations, degenerative processes, hypertrophy,
or atrophy. Eye literature is full of examples of the above
statements.
Mackenzie relates a -case of a man, age forty-five, with an
old discharging ulcer on his leg, which was suppressed by his
getting wet. This was followed by blindness in fourteen
days afterward. The ulcer was restored, and vision then
returned. The same authority tells us that Beer claimed
to have 'cured twenty such amaurotic patients by restoring
suppressed ulcerations. Such conditions can only be ex-
plained by reflex sympathy from the sentient surfaces -to
the cerebo-spinal center, transferred to the sympathetic
system, and through this to the optic nerves and retinal
expansion, or their brain centers.
A. Moore has discussed this question in his paper, “In-
fluence of the Skin and its Diseases upon the Eye.”
An important additional heading should be likewise
mentioned, which, while distinct from the others, is very
markedly influenced by any one or all of the above sub-
divisions given. It may be introduced under the term
psychic, or the influence of ocular neurosis upon the brain
centers proper, which may result in illusions, aberrations,
chorea, epileptoid seizures, vertigo, and even insanity.
Both optical anomalies and heterophoria have been fol-
lowed by such results.
Experiment has demonstrated that section or paralysis
of the cervical sympathetic will be followed by hypotony,
~ and that irritation of the same nerve will produce the reverse
I 2 0cu[a1~Reflex Neuroses.
effect, hypertony; thus proving conclusively that tension
of the eye is largely influenced, if not entirely regulated, by
the sympathetic nerve. The well-known fact that the irrita-
tion of the fifth nerve may cause increased T. and its paraly-
sis a reduced T., does not disprove it, for this latter effect
may be‘explained by the intimate relationship and reflex
blending of these nerves, brought about through the ciliary
ganglion. Hence, -since it is thus proved that T. of the
eyes may be increased by irritation of the sympathetic
nerve, and decreased by its partial or total paralysis, and
since the nutrition of the eye itself is largely influenced by
the same sympathetic; and finally, since the sympathetic
may be irritated by reflex action from other nerves, it
would seem reasonable to assume that glaucoma is merely
a reflex neurosis, arising from a continued irritation of the
sympathetic nerve, connected with the eye, which irritation,
as we have seen, may have origin in any part of the body
near or remote from the eyes. Indeed the frequency with
which we find glaucoma associated with other bodily dis-
eases gives emphasis to this proposition. I have been
struck with the frequency of the coexistence of especially
rheumatism and similar disorders and glaucoma. It has
followed sudden shock, fright, fear, and even joy. The
suddenness of its onset, at times again, points strongly to
its reflex nervous origin.
Following this same line of thought in the light of the
phenomena presented, it is not difficult for me to believe
that sympathetic ophthalmia is likewise a reflex neurosis,
from a diseased eye to similar and corresponding parts in
the other eye. This, to me, seems more reasonable, and in
accordance with facts and conditions, than the strained
effort to explain it by any microbian meanderings or con-
tagious inflammatory transmission, or through the lym-
phatics.
In the discussion of this subject I have -realized
thoroughly its immensity, and the utter impossibility of
describing and including all the numerous phenomena
connected with it, in the limits of a paper on such an
Ocular Reflex Neurcses. I 3
occasion as this. My effort has been to bring out for
discussion, in a brief and simple way, some of the most
salient points connected with the topic, and to offer a cer-
tain few debatable propositions for discussion.
A brief notice of a new book, “The Relation of the
Visual Organ and its Diseases to the other Diseases of the
Body and its Organs,” by Dr. Max Knies, has recently
attracted my attention. I very much regret my inability to
secure a copy of it, for it is, no doubt, a most valuable con-
tribution to the subject I have endeavored to introduce.

THE MERSHON PRINTING COMPANY RAHWAY, N. L
. Compliments of the Author.

llELATlUN OF PllYSlClAN AND UCULIST.
BY
PETER. COOPER, M.I).,_
WILMINGTON, DELAWARE.
Reprinted.from the HAHNFMA.\u\'1AN MoN'1‘HLY,'Jammry,1894.

94l'R‘MN 8; Cu. PR8 NRA
THE
RELATION OF PHYSICIAN AND OGULIST.
BY
PETER COOPER, M.D.,
WILMINGTON, DELAWARE.
GENTLEMEN: It occurs to me that it would be of very little
interest to you should I recite at this time a list of cases in my cho-
sen work—the eye——with a long and tedious detail of conditions,
treatment and results. But there is a subject that should be both
interesting and profitable to you; and through you I would like to
address the whole general profession upon it. I state it thus : there
should be a more general understanding of the aid an oculist can
render the general practitioner, and a closer relation between them.
\Vithout doubt there is no subdivision of medicine of which so
little is known by the great body of doctors we call “the general
practitioner,” as that of ophthalmogy. The oculist is looked upon
much as a fifth wheel in the running gear under the medical body,
and of no utility. This lack of appreciation on the part of medical
men is due: first, to the fact that in the college days of the majority
of those now practicing, the study of ophthalmogy was perfunctory
and of minor importance ; that after having acquired a busy general
practice, no time is found to give the subject further study. It is
due, second and chiefly, however, to the fact that the ophthalmolo-
gists have been so intent upon the subject—have so absented them-
selves from the congregate body of the profession into a little expe-
rience meeting of their own, that they have neglected to keep the
profession informed of the beneficent aid of ocular work.
The ophthalmic journals (and how numerous have they become ?)
you do not take, nor need you. They are written in a language
you would not comprehend unless you read the journal with one eye
and a dictionary with the other : a bifurcated action, termed hyper-
phora, which oculists are constantly trying to prevent. I maintain
it to be a mistake for the ocnlists to confine their really voluminous
writings to their special journals. They should pour a part through
the journals of general practice, in a tongue that all read, to the
__4_._
Volumes enough to make a library are written upon the subject——
works which you in general practice never see——which you would
never read if you should see, nor understand if you should read.
It has become, like branches of surgery, a subdivision--a science in
itself sufficient for one man’s mind. He who masters it has little
time for other studies in medicine ; none for general practice.
I do not deem it necessary to relate to you in detail specific cases
of refraction that have come under my observation, whether for
glasses or gymnastics, in order to prove the far-reaching benefits of
such treatment, but would suggest that you select a few of the many
and tantalizing headaches you meet in practice, and send them to an
oculist. The proof will he manifest. It is diliicult to cite you
symptoms that indicate invariably which is or is not an “eye case.”
The symptoms are so erratic-—seldom manifest to you in the eye,
often not even in the head. I have seen obstinate chlorosis suddenly
improve after correction of errors of refraction, and go forward to a
rapid cure under the doctor’s care who sent the case. In a case of
chorea in a school girl the physician could make no impression until
he had the vision tested and corrected. Some writers claim that
cases of epilepsy have been cured by the same means. It-is good
practice, however, to have all cases of obstinate pain and neuralgia
about the eyes, head and neck referred to the oculist to settle the
question for you.
There should be in every physician’s oflice a simple astigmatic
chart, and a card of test-type to be used at a distance of twelve to
twenty feet. After a little practice you will be able to judge for
yourself whether errors of refraction exist in a given case, and to
demonstrate it to the satisfaction of the patient. You will not be
able to determine the kind of error always, and the degree never,
but you will ascertain enough to quickly convince the patient of the
necessity of consulting an oculist. There are exceptions, however,
and cases needing the specialist, in which you cannot detect any
error and must be guided by your failure to relieve. This prelimi-
nary examination of yours pleases the patient greatly, will please
you, and bear you out to a certainty in the majority of cases you
may advise to be refracted.
In all obscure ailments-—I might say all illnesses except the estab-
lished fevers——you now invariably examine the urine to establish or
eliminate the kidneys as a factor. My closing admonition to you is
to give to the eyes the same thoughtful consideration.
AUTO-TOXIS IN ITS EFFECTS


UPON THE EYES.
—_
BY F. PARK LEWIS, M.D.

Buffalo, N. Y.
—--
Reprinted from the NORTH AMERICAN
JOURNAL OF HOMCEOPATHY.
April, 1896.


Reprint from THE NORTH AMERICAN JOURNAL OF HoMoeoPATHY, April, 1896
AUTO-TOXIS IN ITS EFFECTS UPON THE EYES.*
BY F. PARK LEWIS, M.D.
Buffalo, N. Y.
HE most important advance in medicine during the last decade
is not, perhaps, in the determination of any special fact in
diagnosis or therapeutics, as much as in the mental attitude
of the scientific physician toward the general aspects of diseases. It
is evident to those who have followed the new thought with lively
interest, that specious conclusions based on hypothetical conceptions,
have no place in the new methodology ; but that our truest knowl-
edge is obtained through instruments of possession and through
chemistry and microscopy, in the study of progressive and retrogres-
sive changes. In other words, the questions which must be answered
as fully as may be when the physician is confronted by his patient is
not alone “ What must be done to get this man well? ” but predicat-
ing this, “ What have been the conditions that have disturbed the
health balance? What have been the errors of habit or diet, that
have made disease possible? What the dyscrasia or diathesis that
have made him vulnerable to the action of germ or ptomaine? What
the condition of the vital fluids, the chemical reaction of gastric
secretions, the blood fraction, the proportion and character of the
blood cells, and the presence or absence of certain elements that
belong to normal urine ?' ’ These are questions that must be answered
before the careful physician can advise with precision in any of the
graver chronic maladies which he may meet. When I was invited
by this society to present for its consideration some of the more
recent views of the manifestation of disease resulting from the re-
sorbtion of poisons generated in the body, I was reluctant to do so
because of the extent of the subject, and more especially because of
my lack of personal fitness for a kind of work that comes neither
within my experience nor training. Since that time, however, I
have had my attention so strongly directed toward certain autotoxic
effects, which I have not found elsewhere touched upon, that I am
constrained to point out a field ripe for investigation, and which can
scarcely be entered upon seriously and studiously with other than
profitable results. I refer to the effects of autoxis upon the eye.
*Written especially for the NORTH AMERICAN.

2 Papers in /l[ea'z'cz'1/ze.
Pupillary Occlusion Following Rheumatic Iritis.—
HEMORRHAGE OF IRIS FOLLOWING IRIDECTOMY. —-Some months
ago, an elderly man was helped into my oflice so deformed and
crippled in consequence of years of inflammatory rheumatism that
it was with difficulty he succeeded in walking on the level floor.
His back was bent, his knees could not be straightened, almost
every joint in the body was more or less anchylosed. He had
had for years recurrent attacks of iritis, and he came from a neigh-
boring town to see if surgery could in any measure restore the
vision which had been almost completely lost. I found in examin-
ing his eyes that the small pupils were almost completely occluded,
and quite adhered to the capsules of the lenses. The lenses, however,
as far as could be discovered appeared to be tolerably clear, and I
suggested a double iridectomy in the hope of giving him an opening
through which he might have somewhat better vision. He was sent
to the hospital, and the operation made without any noteworthy
incident occurring except that the iris when divided seemed to bleed
very freely. A tolerably clear pupil was obtained in each eye, but
instead of recovering promptly, as usually happens after such an
operation, the anterior chamber continued partially filled with blood,
and it was weeks before absorption was complete ; when finally the
normal condition had been restored it was very doubtful whether
the small gain was enough to compensate the suffering which the
poor fellow had undergone. In fact, the structures had so changed
their character from years of inflammatory action, that they were no
longer those of normal iris tissue. All muscular irritability had dis-
appeared and when the iris was divided there was not enough con-
tractility to close the bleeding ends of the vessels.
Now, such conditions as these are not of infrequent occurrence.
They suggest much. What was the condition that produced these
changes in the eye, leaving such profound effects? Every structure
in this poor fellow’s body was undoubtedly to a degree in a like con-
dition of degeneration, and aside from the mechanical adjuvants that
would be employed in the eye, notably atropine, the same consti-
tutional measures must be employed in the treatment of the eye, as
in the treatment of that condition upon which the disease of the eye
was dependent. It becomes necessary, therefore, in the study of local
manifestation of general disease to go back of that which may be
most prominent to the domain of general pathology, and the ques-
tion that arises first to our mind is, Can any measures be adopted
that will prevent the development of such serious conditions, and if
so, what are they? That there are such measures, and that they
may be eflective if take11 sufiiciently early, a second case will
illustrate.
Rheumatic Iritis.-—One of our busy lawyers, a man much in
demand, with large responsibilities, after occasional threatenings of
Eflects of A .1/cf0— T oxzls upon 1‘/ze Eyes .' Lewis. 3
rheumatism for a long time found himself suffering, after a slight ex-
posure, to an attack of iritis. It was controlled without difficulty
by the ordinary measures, but the fact of having his eyes threatened
alarmed him so seriously that he immediately began to cast about
with a view to determining what were the conditions that made such
an attack possible, and why this having once come, the cause being
present, it might not be repeated, and from subsequent attacks he
might not so happily escape. So he had immediately instigated a
careful examination of his entire physical condition with the result
that urea, it was found, was being excreted in insuflicient quantities.
It was consequently being stored up in the system until such time as
an aggravating circumstance would precipitate an inflammatory
attack ; and the condition remaining the same, it was a question of
time merely before some such manifestation must be produced. He
immediately, therefore, cut down the ingestion of nitrogenous food,
eliminating from his dietary, as far as possible, the Zanthine group.
The supply of urea being thereby diminished, the excess in his
body gradually disappeared, and with it not only every suggestion
of rheumatic disturbance but such a condition of well-being resulted
as he had not known for years. He lost flesh in some measure, but
very shortly he reached a weight which remained stationary. The
flesh became firmer, the appetite more even, the brain clearer, and
all that malaise of which he had been before partially conscious was
lost in a sense of exhilaration which made work a pleasure. The
excess of urea never reappeared while his dietetic restrictions are
maintained, neither have there been any manifestations of further
disturbance of the eyes.
~_
Now, if in what are known as rheumatic conditions the finer cir-
culation in the eye is as profoundly influenced by the chemical con-
dition of the blood as are muscles and joints, it is obvious that there
can be no exclusive nor routine treatment of the local inflammation,
but we must recognize and direct our treatment toward an improve-
ment of the general metabolic disturbance upon which the special
derangements are based, and the specialist must be in very close
accord with the generalist if the greatest good to the suffering patient
is hoped to be obtained. That the deeper tissues are sometimes
affected in a like way has several times been demonstrated in my
experience.
Uraemic Hemorrhagic Retinitis.——A woman in middle life,
who, from my note book I find, had suffered at one time from des-
seminite choroiditis, while seated at her table sewing, raised the
head to look out in the street and suddenly noticed an obscuration of
sight that came as a gradually descending curtain. Three hours
later when I saw her in my oflice there was little 1nore than percep-
tion of light. Fingers were counted with diflficulty at about two
feet. An examination of the fundus of the affected eye showed
hemorrhagic retinitis, and great streaks of blood were scattered
4 - Papers in Medzezeze.
throughout the retina. Such a condition could come from but one
of several causes; either degeneration of the capillary walls, or
change in the blood plasma, or a combination of both. It was im-
mediately recognized, therefore, that the condition was not one for
which the care of the specialist was required, but the cause of the
difficulty must be discovered. A cursory urinary examination gave
no evidence of abnormality of the kidneys, neither was any organic
disease of the heart apparent. A more exact test being necessary,
she was sent to the hospital and a careful general investigation,
was instituted. In a note sent to me the next day her physician said:
“Mrs. Blank shows urine containing fifteen grammes of urea in
twenty-four hours. It contains albumen, together with hyalin and
granular casts with kidney epithelium. Also her heart showed the
characteristic left valvular changes, and although the heart pressure
just now is not very great the aortic closure sound is greater than
the pulmonary, and the relative arterial pressure is increased beyond
the proper point. The conclusion with your discovery seems to be
obvious.” This patient was placed on her back in bed with carefully
restricted diet, and daily hot air baths; the roon1 being partially
darkened; gradually the hemorrhage was absorbed although the
destruction of tissue had been so great that vision must always re-
main imperfect. A month later the following note came to me
from her physician: “I have examined our patient carefully and
find her heart sounds have improved and would be practically nor-
mal save that they are slightly weak. My notes showed that on
December 3d, she had a defective beat slightly to the left of the
nipple line, no bruit; slow heart, second sound accentuated. It is
somewhat unusual to find the aortic closure sound so marked with
weak heart. Her pulse was infrequent and slow, but a fair strength.
She did not appear to have an endocarditis. I am increasing Mrs.
Blank’s diet, and also allowing her to sit up a little and still con-
tinuing her baths. Her urine is very much improved under the
treatment, and I am sure her general health will be better.”
Here there was a case in which the most serious retinal changes
resulted from a failure to eliminate through the blood, the excessive
urea taken in the system and it is only when the vascular condition
was changed by eliminating from the dietary, the zanthine products
and otherwise disposing of the toxic materials, that a state resulted
more nearly approaching the physiologically normal.
Purpuric (?) Hemorrhagic Retinitis.—One of the most
obstinate and inexplicable cases of hemorrhage in the vitreous in a
young man of twenty found a like explanation. After exhausting
all usual methods of investigation in search of the cause of the
hemorrhages, at my suggestion be consulted his physician, by whom
a most careful examination was instituted, at first futilely, finally, how-
ever, with the following result: “Something has been found,”writes
the doctor, ‘ ‘namely,an excess of acid ( hf drochloric) in the stomach,
and contingent delayed starch digestion; an excess of acid in the
Efleets of Aut0- Taxis upon [he Eyes .' Lewes. 5
urine (uricacidemia suggested) a hyperplastic state of the red cor-
puscles of the blood with perineuclar basophiles such as are said
to be present in peliosis rheumatica. True he shows no other
hemorrhages, but purpura may show itself in limited ways, and
why not in the retina.”
Blake, in his valuable little monograph on septic intoxication,
makes the following important suggestion: “Some association has
long been suspected between sepsis and glaucoma, more especially
that form of increased tension which is prone to follow serous cycli-
tis, or iridocyclitis, the cases which are not benefited by iridectomy.
Long ago, Lenox Brown observed glaucoma depending on a septic
condition of the nose. This is unconsciously confirmed by Dr.
~Tohn Brown who cites a case of acute glaucoma in a woman forty-
five years of age. A fortnight after confinement she had pronounced
symptoms of plumbism; the water supply containing nearly one
grain of lead per gallon. Iridectomy was performed and a fair
amount of vision was restored.” These suggestions have led me to
institute an analysis of urine in a patient of my own who had lost
an eye through absolute glaucoma, the other being saved by an
iridectomy which I had myself made. Although vision has re-
mained good there has not been evidence of general well-being. An
analysis of the urine showed a marked diminution in the excretion
of urea with slow pulse and high arterial tension.
Gla11CO1na.——(I) On the assumption that the Glaucoma might
be dependent upon the evident toxaemia in this patient I placed her
upon a diet from which meat, fish, tea, coffee and acids were ex-
cluded, and an accident of such a peculiar nature followed that it
should be mentioned. Following the iridectomy made over a year be-
fore in the remaining eye there had never been any disturbance
of vision. Ten days after beginning her exclusive diet she presented
herself with a—2 tension in this eye. Examination disclosed the
fact, that a pin-hole opening existed in the cicatrix through which
the aqueous was flowing. An attempt to close it by means of the
galvano-cautery failed because of the constant moisture at the mouth
of the fistula. A probe, on the point of which crude silver nitrate
had been fused, was then introduced in the opening, and the eye
bandaged, considerable pain naturally followed but the caustic
proved effective and the leak was stopped. The break soon recurred,
however, and a scleral stitch was necessary to permanently close
the opening.
The high tension in the other eye had in the meantime been
reduced. ,
6 Papers in Medztzlze.
The only explanation that could be given was that she had
sneezed once or twice a few evenings before, but not especially
forcibly. Could it have been possible that the change in the con-
dition of the blood had so affected the rigidity of the scleral cicatrix
as to make it more easily rupture?
A prominent ophthalmologist said to me not long since, that
while in acute glaucoma an iridectomy was necessary it was at the
same time a confession of defeat; surgery does not cure the condition
upon which the disease depends. It will prove to be not only ex-
tremely interesting, but exceedingly important to humanity, if along
these lines may be found means for making surgical interference
unnecessary in this dreadful disease.
I have not in this paper touched on the topic suggested by the
president of our society namely, the varieties, the general symptoms
and the results of auto-intoxication, but I hope that this may be
done by some one more fully qualified to do such work,because I be-
lieve that there is no subject of more vital importance in medicine
to-day;but I wish to suggest as a conclusion to these observations that
while it has long been recognized that the general condition cannot
be understood nor properly treated without special knowledge con-
cerning the conditions of the eye, conversely no diseased condition in
any measure involving the vascular structures of the eye, except
those of traumatic origin, can be judiciously treated without a
knowledge of the general condition upon which such local inflam-
mation may be based, and the truest and most valuable work can
only be accomplished when the knowledge of the specialist is supple-
mentary to and not exclusive of the physiological relationships of the
entire organism.
(1 ) Directly bearing upon this subject and in the discussion follow-
ing, Dr. P. W. Neefus reported an interesting case. A patient hav-
ing a glaucomatous eye from which vision had been lost had twice
had operations made for relief of pain which had continued uninter-
ruptedly for two months.
Finally, the patient was put on an absolute milk diet with the
effect of wholly relieving the pain in three days. While there is no
accurate record as to the actual condition of the eye, of the urine, or
of the blood, the result is hopefully suggestive; and we are war-
ranted in making further investigations to determine whether in the
condition of the blood, rather than in the nervous system, we may
Efleats of AuZ0- Taxis upon the Eyes .' Lewis. 7
not find the cause, and with that the remedy that may render un-
necessary an operation that at least is sometimes dangerous, often
uncertain, and never essentially curative in that dreaded malady
glaucoma.
Compliments of the Author.



USSICULAR MASSAGE‘
BY MEASURED VIBRATIUNS Ill DEAPNESS AND TINNITUS Allllllllll. X
BY
WILLIAM R. KING, M.I).,
WASHINGTON, D. O.
(Opthalmologist et Otologist National Homoeopathic Hospital, Washington, D. 0.)
Reprinted from the HAHNEMANNIAN MONTHLY, May, 1898.

SHERMAN & OLPR8. HHLA
OSSIOULAR MASSAGE
BY L/IEASURED VIBRATIONS IN DEAFNESS AND TINNrrUs AURIUM.
BY
WILLIAM R. KING, M.D.,
WASHINGTON, D. 0.
AT the last meeting of the American Institute of Homoeopathy in
Washington, D. (1, Dr. Garey, of Baltimore, presented a paper on
the subject of the treatment of partial deafness and tinnitus aurium
by means of massage applied in a natural way through the applica-
tion of sound waves made to impinge with varying degrees of force
and rapidity on the membrana tympani and through this to the
ossicles. The article attracted considerable attention at the time,
and was discussed at some length.
Having had considerable experience with several methods of
massage of the sound-conducting apparatus of the human ear, I have
been greatly interested in Dr. Garey’s experiments, and have fol-
lowed him closely.
My attention was first called to this method of treatment, as I
have already described in this journal, by reading Mr. J. A. Ma-
loney’s paper recounting his experiments with his so-called otophone
(see THE HAHNEMANNIAN, July, 1890). Many good results fol-
lowed the application of this method of aural “massage,” but it
failed in cases where it seemed quite well indicated.
Following this, Dr. Garey suggested the use of the Edison phono-
graph, with the aid of properly constructed cylinders for the applica-
tion of other sounds than those of the human voice, which latter
sound was the limit and extent of the use of the otophone. This
proved, by experience, to be a step in the right direction, in some
cases quite flattering results being obtained ; but again disappoint-
ment confronted us, for very many cases still failed to yield to the
mild blandishments of wizard Edison’s erstwhile toy. The principal
objection to the phonograph, and one which it was thought impor-
tant to surmount, was the inability to procure any wide range of
_._2__
pitch thereon, and as Dr. Garey’s theory was based largely on the
importance of the application of the similar sound, that is the sound
most nearly simulating the pitch of any existing tinnitus, it may
readily be seen how important an obstacle was presented.
After considerable experimentation on the part of a skilled con-
structor of musical instruments under I)r. Garey’s instruction and
direction, the vibrometer was ultimately presented to the profession.
An instrument designed and devised for the production of varied
sounds of an infinite variety of pitch, and the conduction of the same
to the ears of the patient.
A short description of the instrument and its methods of applica-
tion will here perhaps be of importance.
As first placed before the profession it was comparatively crude,
but as experience in its use has accumulated, numerous suggestions
making improvements in the instrument have been submitted to
and adopted by the company engaged in its manufacture; these are
of a minor mechanical nature, but have added decidedly to the effi-
ciency of the insrutment.
Briefly, it now consists of a wooden case on a light truck or sup-
port, this case containing the instrument proper, viz., a banjo-shaped
affair with a heavy neck fretted somewhat similarly to a guitar or
banjo. The head or diaphragm of this quaint instrument is of thin
wood, and above or over the face of this head is erected a metal
framework supporting a carriage, movable to and fro over the face
of the instrument; this carriage conveys a shaft connected by a belt
with a small electric motor. In the centre of the shaft is a “ cam ” or
eccentric, which in revolving strikes the “central attachment”
which in turn is connected by means of a lever with the diaphragm
below, from which via of an air-tight space beneath this wooden
head proceeds the rubber tubes to convey the sounds to the ear. At
the upper end of the shaft is a small wheel armed with four small
“ picker.-‘,” which, as the shaft revolves and the carriage is lowered
strikes as rapidly as we require the string selected for producing
the tone or pitch desired. The instrument is equipped with four
strings from a fine treble piano string toa heavy bass “cello ” string.
The space between the frets are lettered to facilitate the recording of
pitch used at each setting. A small clamp is provided which can
be screwed down on the strings at the desired point and held in
place as long as desired.
The arrangement of the strings is such that the “pickers” can
be made to strike two strings at once, thereby varying still farther
___3__
the pitch possible of procurement. An eflbrt will be made to have
an improvement immediately added, in the form ofa clamp, that will
permit of the clamping of one or two strings simultaneously with-
out necessarily clamping all four. This will permit of the produc-
tion of harmonic tones, which will, it is believed, aid materially,
especially in conditions of nervous deafness and tinnitus.
This, then, is the vibrometer, designed to produce many sounds of
varied pitch and effect and their transmission to the membrana tym-
pani and ossicles, thereby producing massage of these portions of
the hearing apparatus, stimulating secretion and motion where rigidity
exists, improving circulation, and in many cases, I believe, stimulat-
ing the perceptive tract to more natural response.
Much has been written, and many experiments have been made,
on this line, showing that the profession, especially otologists, are in-
terested. It matters not what means are used to produce the tones
and pitches so long as they are properly produced and conveyed,
and the principle of close study of each case presented is fol-
lowed, in which event much can be done to aid many suffering
beings. '
The method of treatment, as applied by this instrument or any
other, does not reach all cases. We have failures recorded as well
as cures and partial cures, but I am not prepared to say these
failures are all due to the fact that the method is not adapted to these
cases; failure often comes because we have not yet mastered it in its
perfect application.
In applying the instrument to a given case, I expect prompt, good
results if I find a hypertrophic, active, catarrhal condition of the
pharynx and post-nasal space, with Eustachian tubes nearly or
quite impervious, thickened and retracted membrana tympani, and
some sclerosis, with ankylosis of the ossicles.
I expect less prompt and not quite as good results in proliferous
catarrh, and lastly I have experienced many failures and few suc-
cesses in those suffering with an atrophic catarrhal condition.
WVhen the internal ear is seriously involved, I have always failed
to get any appreciable good results. \Vhere bone conduction is lost,
or nearly so, I have found the treatment a failure.
It is my practice to inquire as to the exact effect on any existing
tinnitus immediately after the first treatment. In some cases it has
entirely ceased, in many it is much reduced, in a few it has been
materially aggravated for a time, and I have known many where no
immediate change whatever was noticeable.
.._4_
So far as ultimate results are concerned, the fact of immediate
aggravation seems to have little weight. A number of such cases,
in my practice, have received a good measure of improvement.
To sum up, I would say, according to my experience, the oto-
phone was good; it was a step in the right direction. The phono-
graphic treatment was better, and up to date the application of mas-
sage to the sound-conducting apparatus, by means of the vibrom-
eter, is best. Undoubtedly we will have improvements added to this
method of application. Each investigator can and should add some
practical ideas. For instance, Dr. A. B. Norton, of New York
city, who is doing good work in this line, first suggested to me
the advantage of adjusting the strings so that the pickers could
strike two strings simultaneously, thereby vastly increasing our range
of pitch.
For the benefit of any reader who may have the instrument as
originally constructed, I will briefly recount the principal items of
improvement:
First. The shaft carrying the “ cam ” and “picker” wheel can
now be adjusted with one hand, the double-threaded screw arrange-
ment being superseded by a single control—screw.
Second. The central attachment or “thumper,” instead of rising
above the shaft and curving over, is now entirely below the car-
riage, and consists of a metal post tipped with tough fibre, which is
struck by the revolving “cam.” The lower end of this post is con-
nected ata right angle to a lever, the position of the fulcrum of
which is movable by means of a small metal pin, which can be ad-
justed along its length at will. The distal end of this lever is in
immediate contact with the diaphragm, and the vertical movements
of this lever drive the diaphragm up and down as rapidly as we may
desire, this motion being conveyed to the membrana tympani by the
column of air between the vibrating diaphragm and the membrana
tympani through the conducting tubes.
The present position of the post below the shaft enables the car- ,
riage to be swept across the face of the instrument to any desired
position without the necessity, as heretofore, of detaching this central
post.
Third. The fret spaces are lettered, and the strings numbered to
facilitate recording the pitch applied at each treatment.
Fourth. The tuning-keys are an improved pattern, set firmly in
the wood-work and held strongly in position by a nickel-plated
metal face; this does away with the annoyance of loose keys, which
_5__
have been a former source of worry. To give a brief idea of the
character of the work, being done with the aid of the vibrorneter, I
herewith append a few cases taken from my office record-book :
Mrs. H. M. B., act. 56, consulted me about her hearing and a
tinnitus on January 24, 1893. History of long-standing deafness
and tinnitus ; has had the classical treatment without success. She
has naso-pharyngeal, tubal and middle ear catarrh, proliferous stage.
On the first test A. D. H. : 5-2-6 A. S. H. :: O. B. O. good. She
was immediately placed under the influence of the vibrometer, and
has continued, rather irregularly, at average intervals of seven days.
Improvement has been steady and gradual as well as satisfactory to
her, notwithstanding an acute attack of influenza and tonsillitis in
February. On April 10, 1893, the occasion of her latest treatment,
A. D. H. : -%—S- A. S. H. :: light contact. The tinnitus entirely
gone. She is still under treatment.
Mrs. J. M. O., set. 41 ; in general bad health, snfi°ering from a spe-
cies of nervous prostration. Hypertrophic catarrh of naso-pharynx,
Eustachian tubes and tympanic cavity. Membrana tympani re-
tracted, sclerosed, with undoubted ankylosis of the ossicles. Almost
constant distressing tinnitus, aggravated by fatigue. She has had
several sieges of the usual methods of treatment for such cases, in
every instance followed by aggravation, until quite recently, when
she consulted one of the most celebrated aurists in the homoeopathic
profession, and she claimed to have received much benefit from him,
though he held out little hope. First test, January 19, 1893. A.
D. H. :59; A. S. H.:F5U. Treatment was begun with the vi-
brometer, together with inflations of ether vapor through the Eusta-
chian tubes, and some attention to the naso-pharynx; this was con-
tinued at average intervals of four or five days. Condition, March
29, 1893: A. D. H. —— A. S. H. : The tinnitus only annoys
her now when tired and nervous. She has expressed her delight
with the result, and states that her friends have all remarked the
great change. She has ceased treatment for the present to go to her
home in the West.
Mrs. C. R. D., set. 46. November 14, 1892. A. D. H. : O. A.
S. H. :: O. History: Has been gradually getting deaf for a year
or more, but in the past month has grown rapidly worse. Hyper-
trophic naso-pharyngeal catarrh, with involvement of tubes and
tympanum. Four treatments with the vibrometer, with the usual
attention to the nose and throat, produced the following result:
December 5, 1892, A. D. H. : 3--l} A. S. H. : At this point
0
___6__
she ceased treatment, and has since reported that she appears to hear
as well as ever. A very distressing tinnitus entirely disappeared
after three applications.
Mrs. A.G.D.,2et. 42. June 2, 1892. Consulted me regarding a
considerable deafness and distressing tinnitus. History: Right ear
now hears watch only on close contact ; has been quite deaf for twelve
or fourteen years, and has no hope of assistance for this ear. The
left ear now hears the watch 3%, and has only been involved suffi-
ciently to annoy her for a few months. This ear she hopes to have
relieved. She is a fashionable modiste, and her afiiiction is so annoy-
ing to her that she threatens to give it up. She has a general hyper-
trophic catarrh of naso-pharynx and larynx, with tubal involvement,
the tubes are impervious, the Ant. retracted and dry, with ankylosis
of the ossicles. The tinnitus is terribly annoying and has “ made
her quite nervous.” At this time the Edison phonograph was in use
by me, and in this case it was applied twice a week for three months.
October 7, 1892: A. D. H. -5-86 A. S. H. : the tinnitus is better,
but a low, constant hum is still heard, and there remains much con-
fusion and inability to catch words clearly in a conversation. Sepa-
rate sounds seem to be heard quite readily, but spoken phrases are
often misunderstood. On October 14, 1892, treatment with the
vibrometer was substituted; treatment applied once a week. On
April 11, 1893, date of last treatment A. D. H. : 18 A. S. H. ‘-59'
00 50’
almost no tinnitus, and no confusion for conversation, except when

very tired and nervous.
M. O. F., aet. 46. Otitis media catarrhalis chronica. She com-
plains of considerable deafness and an annoying tinnitus. On Sep-
tember 30, 1892, A. D. H. A. S. The phonograph
was applied for one month with little or no resulting improvement.
The vibrometer was then used and continued for five months; pres-
ent record is A. D. H. : %—S, H. S. H., light contact. The tinnitus
has been persistent and has only recently begun to subside. I can-
not account for the slight loss of power in the left ear in the face of
the material gain in the other. This result affords food for reflec-
tion and practical study.
It is but right that the other side, viz., complete or partial failure,
should be reported; hence I will append a few failures, for purpose
of comparison.
Judge J. S. P., set. 58. Actively engaged on the bench of one of
our courts. Is in good health and fair spirits, but considerably an-
noyed by a constant tinnitus, high pitched and persistent. It is ap-
__7__
parently of nervous origin, for it is decidedly aggravated by mental
work, with some attendant confusion in the left temporal region.
Semi-weekly treatments with the vibrometer, from March 19th to
April 15th, has produced no effect whatever. There is no deafness,
and I have discontinued treatment by this means for the present.
Mrs. J. D. S., act. 52. History of deafness in right ear for over
ten years. A. D. H.:: O. In left ear for three years. A. S. H. :
O. The tinnitus is distracting, and she is becoming intensely ner-
vous. Marked atrophic catarrh of the nasal cavity. Ant. retracted
and tympanum dry. Treatments with the vibrometer and stimu-
lating applications to the nose, throat, and tubes every five or six
days, from October 22, 1892, to April 11, 1893, has produced no
material change in the hearing power, and the tinnitus has only be-
come slightly less marked within the past two weeks, this probably
being largely due to the improved climatic conditions.
So far, the cases of absolute failure are few. In some cases, the
gain made being slight and progress slow, the patient becomes dis-
couraged, and gives up active treatment or becomes irregular in re-
porting. Many of these cases must be classed with the failures at
present, though in some instances undoubtedly capable of material
improvement if the treatment was faithfully persevered in. In the
larger number of cases that present themselves I am convinced that
when study and individualization are resorted to, results will soon
appear that will encourage both physician and patient to renewed
effort.
It is of little or no avail that we simply look on this instrument
as an accurate machine, and turn it on and let our patient receive
its effects, hit or miss; each case that seems to present any hopeful
aspects whatever should be studied, and the method applied as care-
fully as any other scientific effort toward the relief of human suffer-
ing or distress.
I have frequently been asked the question, “Are the results per-
manent where improvement is obtained ?” I cannot, of course,
answer that by actual experience, as my use of this instrument only
dates back to October last, but I will say that in my experience,
covering six years, all cases that have been materially improved by
means of ossicular massage through sound vibrations, however ap-
plied, have retained that improvement to an almost entire degree.
To close, then, I am convinced that the method of treating this
large class of sufferers by means of aural massage is a correct and
scientific one; it only remains for us to find the suitable method in
_8___
each case. At present, I believe the vibrometer is the very best me-
dium at our hand, though perhaps still capable of much improve-
ment.
Passive motion and massage of stiffened joints and tissues of the
body is the accepted common-sense method now universally applied
for their relief. In these cases we apply the same means through a
different force, viz., vibrating force or sound, which is by nature
adapted for treatment of like conditions existing in the delicate
joints and tissues of the organ of audition.
Compliments of the Author. I


THE IMPORTANCE
OF THE
Early Correction of Errors of Refraction
OF ALL CHlLDREN
BEFORE ATTENDING OUR PUBLIC SCHOOLS.
BY
J. s. KIRKENDALL, M.D.,
ITI-IACA, N. Y.

REPRINTED FROM THE HAHNEMANNIAN MONTHLY, JULY, 1895.

SHERMAN 8: GQPRB. FHM.
THE IMPORTANCE
OF THE
EARLY CORRECTION OF ERRORS OF REFRAGTION
or ALL CHILDREN
BEFORE ATTENDING OUR PUBLIC SCHOOLS.
BY
J. s. KIRKENDALL, M.D.,
ITHACA, N. Y.

IN selecting this subject for our mutual consideration, I would
not have you feel that I have a selfish motive in what I have to
say, should it be ever brought about; but it is purely on hu-
mane grounds that I stand before you to advocate this very
important but neglected subject or prophylactic.
Before we select the remedy, let us get at the symptoms de-
manding the specific. In the first place, we are born to die,
z'.e., death or metamorphosis begins at a very early stage; and
we live according to our resistance, and die for the want of
the same. We are born with tendencies which are hereditary,
and none of us are ideal anatomically or mentally, or in any
other way; but some are more nearly perfect than others.
In order to treat this subject specifically, I will liken our bodies
to a large mill, for example, with many small intricate pieces
of machinery contained therein, some of which call for more
power or force than others. Wl1e11 we consider the difi'erent
organs of our body, we must admit that the nervous tissues are
distributed to the eye in very great profusion; and, in classify-
ing we must concede that it is first in rank, z'.c., of the twelve
cranial nerves, four are especially designed for and two send
branches to it.
__2_
In all we, or nature, give to the eyes, almost one-half of their
nerve force direct from the ccrebrum, besides the numerous
filaments from the great sympathetic, which unites it to all the
other organs of our bodies. We rarely find ideal organs an-
atomically; in fact, only 15 per cent. of the people are born
with perfectly round or ideal eyeballs, and the same may be
true of other organs, but it does not interfere with the sense
peculiar to it; for instance, the fingers are rarely ever ideal,
yet the tactile sense is not interfered with. The same may be
said of the ears, nose, and tongue, yet their function is per-
fect for what they are designed for, and all goes well; but, you
let a child be born with a deformed eyeball, not round, and
study its effect through life. A cause or injury, exactly the
same, in different individuals, produces as many different
effects; so it is, that when the eyes are naturally abnormal, and
objects must be seen the same with either eye, exactly of the
same size, and at the same time, be the eyes alike or other-
wise, we must believe that the great reservoir of nervous en-
ergy which nature intended to give every one of us will be
exhausted on account of this constant unconscious effort to see
things distinctly, on the part of the ciliary muscles which act
the same, and for the same purpose, that the thumb-screw
produces in an opera-glass or photographer’s camera, every
thing must be focused by either eye, the same on the sensitive
plate or retina, before the brain will or can receive it; hence,
the expenditure of nervous energy to keep these deformed
eyes going, as during waking hours they never see anything
without effort, even at a distance, when the ideal or perfect eye
is at rest.
Now the question comes, and honestly so, how long will this
reservoir of nerve force last before a11 explosion must needs
come to this person? Answer, according to his or her amount
of resistance. Some are able to carry the load much longer
than others, and only to be brought to the surface by a sec-
ondary or exciting cause; for example, some acute disease, or
perhaps some cause external to the body, like grief, or financial
reverses, etc.; but it comes to the majority in some form, either
from the exciting or secondary cause stated above, or by the
natural eking out of its supply, and when gone, and we have
the nervous manifestation, be it of any kind, diagnosed as func-
__3__
tional or without pathology, then it is often too late for repair,
or it has gone on until the effect has practically become a
cause in itself by molecular change, and in the very true words,
slightly modified, of the distinguished neurologist, S. Weir
Mitchell, of recent date in the Medicccl News, says: “ Conditions
or causes like this existing, all through the years of develop-
ment, before being displaced, may make permanent effects which
no glass will do more than partially relieve.” Hence, the title
of this essay and its importance.
Let me relate the manifold manifestations, which we believe
are the remote effects of this primary (I say primary because it
is born with us) cause, and we will take them almost in order;
myopia, squint, chorea, stupidity or slow to learn, headaches,
blinking, most of the neuralgia, some cases of epilepsy, spinal
curvature and irritation with the sore points at the apex of the
scapulee, and at the seventh cervical vertebra; also at the base
of the brain, clavus, nervous dyspepsia with its remote effects to
adjacent organs, aphonia in some cases, dizziness in some cases,
chalazia, styes, chronic conjunctivitis, or so-called, granulated
lids, and heterophoria, with its varied amounts, which causes
amblyopia, or loss of one eye from non-use; and last, but not
least, inebriety, would say, here, that I never have examined the
eyes of a periodic drinker, but that I have found large amounts
of astigmatism which I believe is the cause of the explosion,
unresistable, as a headache or attack of epilepsy.
I would not have you believe, that if the title of this paper,
were carefully complied with, that in time we would see none
of these nervous troubles. Nay, nay; not so. I do not believe
in one cause to produce a given effect, any more than we as phy-
sicians believe in specifics, yet we do know that certain drugs
have a particular aflinity for a certain part, and spends most of
its force there, yet it is not infallible as you all know; so it is
with the subject dealt with i11 this paper. The eye is the pri-
mary source of most of these functional nervous troubles, I
believe, and in lieu of this generally accepted, demonstrated
theory (clinical facts are stubborn things), why not give these
unfortunate children the benefit of an early displacement of a
deformity, which if left alone may cause any of the foregoing
troubles, also by its weakening tendencies may bring to the sur-
face a latent tuberculosis, a spinal curvature or a solution of
__4__
continuity of any other organ deprived of its staying force.
Effects never precede causes, so it is in these neurotic cases.
Physicians are never called until after the smoke is seen by the
layman, and then too often he spends his force on the smoke,
andiallows the fire to burn. As long as we know that about
85 per cent. of the people have deformed eyes at birth, that it
is primary (being born with the patient), that the natural, ana-
tomical, and physiological function of the organ demands nearly
as much nervous energy as all the rest of the organs of our
body put together, why not anticipate this formidable antago-
nist to health, strength, pleasure and education, as we do small-
pox, which when compared with eyestrain is no more than a
drop in the bucket in the country districts. Think of your
child having chronic chorea developed at his seventh year of
age, during his first term at school, or squint or epilepsy; think
that if he chance to have an astigmatic or hyperopic eye at
birth or both combined, sent to school with a neighbor boy,
who chance to have a slight amount of myopia or emmetropia.
The two latter sees without effort; the images are received 011
the retina, telegraphed to the nerve centres, and indelible im-
pressions made, and the child can’t help it; he is lauded to the
skies, stands at the head of the class, and he is called bright.
WVhy? Simply, because he can’t help it. According to Dr. S.
I). Risley’s latest investigations in Philadelphia, he has demon-
strated that by correcting the error in all ametropic eyes and
especially astigmatism, which he found to be the essential cause
of the pathological state underlying the myopic or near-sighted
eye, it decreased the amount of myopia after twenty years of
this correction.
As practitioners of medicine you know more about near-
sightedness than any other anomaly of the eyes, simply because
the child can’t see, and tells you so, and you ask his parents to
see some optician or jeweler who practically allows the child to
fit himself ; he sees better and is satisfied, but the slight amount
of astigmatism combined with it, the underlying cause, is left
behind uncorrected, and so the myopia develops, and is laid
either to habit on the part of the child, or to faulty desks in
our school houses.
Ill;/op/a .- Myopia, is an effect and not a cause, per se. The
explanation of this assertion is, up to the present century, the
__5__
work of the eye was adapted to its mechanism, and the eye
of animal, savage or child is naturally hyperopic. But now,
printing, schools, cities, sewing and commercialism have
brought tasks to the eyes for which they were never made, or
to which they were never habited.
“ The Deity of natural selection never foresaw civilization.”
Great interest attaches to the inquiry, how this is to adapt itself
to meet this extra demand suddenly thrust upon it. As Dr.
George M. Gould, of Philadelphia, says: “ One fact is evident
when the recognition of the enormous body of ill results finally
succeed in battering down professional and popular prejudice,
spectacles will be almost as common as noses, and, nearly every
one would be better, intellectually, morally, and physically from
their use.”
The time is sure to come, when a conscientious parent will
never permit a child to grow to puberty, however apparently
healthy, without a scientific examination of the eyes having
been made, and repeated at intervals thereafter, by an oculist.
The myopia, which I briefly referred to a few moments since,
and which stands out so boldly to most laymen and physicians,
means very little, to bring about the writing of this paper. I
believe, if the adult had been carefully examined when a child,
and this effect apprehended in its infancy, that we should rarely
see a case of progressive myopia; but this effect, if effect it
is, is the one which, in itself, when it becomes a cause, never
produces any nervous trouble, the important question which
demands this essay.
Patients who have myopia are called book worms, and bright,
brilliant, etc. This effect, the result of civilization and uncor-
rected astigmatism, is the simplest of the lot, yet pathological,
and puts the paticnt’s eyes in such a condition, whereby it re-
quires no nervous energy to see close objects, but does for dis-
tance, which he positively avoids from lack of energy, or is too
lazy. He acquires proficiency because he cannot help it, only
in books; he never goes gunnirg or engages in athletics, because
he can’t see without effort, so he sits down and contents himself
by reading about it; but the effect which is most important to
be avoided by this plan or method is the one inflicted or trans-
mitted to the general nervous system by the hyperoptic or astig-
matic eye, causing irritation (functional) of every other organ
____6-_
of the body, and by this depletion renders it susceptible to
pathological tendencies by reducing its resisting powers. Mal-
nutrition and assimilation are very common effects of this re-
mote cause. Unbalanced eye muscles external to the eye
(heterophoria) which is, I believe, the effect of this uncorrected
trouble, and if left alone through the years of development, and
be allowed to remain in tonic spasm, causes diplopia or tendency
thereto, which is by far the worse, and the tendon becomes
chronically shortened as in talipcs, and to relieve we perform
tenotomy.
The object of this paper is to relieve the ciliary muscles, the
hardest worked muscles in our bodies, anticipating what is sure
to come to pass in the great majority of the children, and espe-
cially so in the weaker sex, the ladies, they being less resisting.
These ciliary muscles are sphincters, normally acting equally
upon all sides by a common innervation, but in astigmatism the
corneal asymmetry being unequal, they are obliged to meet this
demand by unequal contraction; hence, friction to this small
piece of machinery with its manifold manifestations, as a result.
The only comparison of over-worked muscles, is in the hand, and
is known as “ writer’s cramp,” but here the spasm is confined
wholly to the part which does the work, because the muscles
are wholly voluntary, and derive their power from the great
nerve centres, whereas the ciliary muscles are, according to
WVilder, only slightly voluntary, mostly involuntary, and are
governed by the great sympathetic.
Now, what might be the effect if this abnormal condition
could be put to rights before the child is subjected to this ex-
citing cause, going to school? The study of functional nervous
troubles is in its infancy. The best of our neurologists all over
the world to-day are sending their patients to oculists, after a
careful examination has been made by them, and finding no
pathology. I have relieved patients of headaches with glasses,
after they have taken bushels of quinine they say), and tried
other headache cures, and of the many unique cases, I will
mention a few which I could relate in detail. One, a case of
hysterical stricture of the oesophagus, lasting for three years,
and during that time she lived wholly on liquids, and it would
take her three hours to eat. Another case of persistent anaemia,
which had lasted for four years. Another case of stammering.
_7__
Another case of so-called recurrent erysipelas. Another case of
neuralgia. Another, a case of acute melancholia. Another, a
case of severe recurrent neuralgia of the stomach.
Why not prevent these many troubles by prophylaxis, as we
do small-pox, cholera, diphtheria, etc., thereby increasing our
longevity ‘Z
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UNITED STATES PATENT OFFICE.
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jAMES A. MALONEY, OF WASHINGTON, DISTRICT OF COLUMBIA.
AURIPHONE.
SPECIFICATION forming part of Letters Patent No. 862,100, dated May 3, 1887.
Application filed December 27, 1886.
T 0 all w/10212 ll‘ may concern .-
Be it known that I, JAMES A. MALONEY, a
citizen of the United States, and a resident
of the city of Washingtoii, in the District of
Columbia, have invented certain new and
useful Improvements in Auriphones, and I
do hereby declare that the following is a clear
and exact description of the invention, which
will enable others skilled in the art to make
and use the same.
My invention relates to improvements in
an instrument designed to assist persons of
defective hearing in receiving ordinary eon-
versation, or to convey such conversation to
other persons over comparatively long dis-
tances: Such instruments consists, in the
main, of a suitable mouth-piece, and ear-
piece, and a membranous or other diaphragm
intervening between the two. I have called
such instruments “Auriphones,” and vari-,
ous improvements in the same are shown,
described, and claimed by me in other pend-
ing applications.
The present invention relates more espe-
cially to improvements in the mouth-piece
of an Auriphone, and to the combination
of the same with the other essential parts of
the instrument.
In the accompanying drawings, which
form a part of this specification, I have illus-
trated in Figure 1 the completed Auriphone
partially in section; Figs. 2 and 3,, sectional
_ views of the mouth-piece; Fig. 4, a front
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45
50
55
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65
70
view of the same, and Fig. 5 a perspective
view.
Referring to Fig. I, B is an ear-piece, of
any convenient form, projecting from the
case E, in which the diaphragm D, con-
structed as described in another application,
Serial No. 221,762, is mounted.
A is my improved mouth-piece, which is
hereinafter more fully described, and from
which projects rearwardly a tube, F, corru-
gated upon its outer surface, and to which is
applied a tube, C, of suitable length and
preferably made of soft rubber. The other
end of said tube C is applied to a short tube,
G, corrugated upon its outer surface simi-
larly to tube F. The mouth of the speaker
is applied at A, and the ear of the listener
at B, and words spoken in a very low tone of
voice are distinctly heard, even if the tube
C, which conveys the sound to the diaphragm,
be of considerable length. This is due
mainly to the peculiar construction of my
improved mouth-piece.
The general form of the mouth-piece is
that of a section of a hollow sphere, as is
clearly indicated in the drawings; but pro
vision is made to so adapt it to the face of
the speaker that none of the sounds uttered
by the same will escape from the conveyer-
tube C, and that no external or disturbing
sounds can enter the same. This purpose is
achieved by two curved notches, H and I,
cut into the edge of the mouth-piece, and on
diametrically opposite sides of the same.
The notch H is the smaller both in width
and in depth. It is delineated to adapt it-
self to that portion of the face which extends
below the septum of the nose, and to both

Serial No. 222,611. (No model.)
sides of the same. The notch I is somewhat
deeper and considerably wider than notch
H, and is delineated to adapt itself to that
portion of the face which extends between
the lower lip and the chin. Between these
two notches portions K K of the edge of the
mouth-piece are circular and concentric with
the tube F. These circular portions of the
edge adapt themselves well to the face of the
speaker, to the right and left of his mouth.
It will thus be seen that when the mouth-
piece is used in the manner indicated, it will
tightly inclose the mouth of the speaker, so
that no portion of the sounds uttered by him
can escape from the conveyer, and that no
foreign disturbingd sounds can enter the
same.
While I have found the semispherical form
of mouth-piece to be very effective, I do not
mean to limit myself to such form, as the
mouth-piece may also be constructed in the
general form of a cone or cylinder, so long
as the edge of the same is shaped to inclose
hermetically the mouth of the speaker. By
preference, I use for the mouth-piece a
material of low resonating power, such as
soft rubber; but wood or ebony may also be
used.
The diaphragm which I employ is so
stretched between two rings, a and 6, that
both faces of the same are held under ten-
sion, and it is cemented in the case E by the
edge x, as is clearly described in my appli-
cation No. 221,761, above referred to, and
which I disclaim in this application, except
in so far as it is of peculiar advantage in
combination with the other parts of my
Auriphone, herein described.
Having now fully described my invention,
what I claim, and desire to secure by'Letters
Patent, is-—
1. A mouth-piece for an Auriphone, con-
sisting of a hollow shell having in its edge a
small curved notch delineated to fit the por-
tion of the human face between the septum
of the nose and the upper lip, and a larger
curved notch delineated to fit the face be-
tween the lower lip and the chin, substan-
tially as described.
2. In an Auriphone, the combination of a
mouth-piece having an edge delineated to
conform to the shape of that portion of the
human face which immediately surrounds
the mouth below the septum of the nose
with an ear-piece and diaphragm and a flexi-
ble sound-conveyer extending between mouth
and ear-piece, substantially as described.
3. In an Auriphone, the combination of a
diaphragm stretched between two rings with
a mouth-piece which hermetically incloses
the mouth of the speaker, and a sound-con-°
veyer tube extending between the two, sub-
stantially as described.
In testimony whereof, I have signed my
name to this specification in the presence of
two subscribing witnesses.
JAMES A. MALONEY.
Witnesses:
JOHN C. ATHEY,
O. M. BALL.
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Sound Waves in the Treatment of Deaf-
ness and Tinnitus Aurium.
'
The following appeared in the Washington Sunday Post of No-
vember I, 1891:
“New Use FOR PHONOGRAPHS.
“Prof. H. F. Garey, of the Department of Eye and Ear Dis-
eases in the Southern Homoeopathic Medical College, Baltimore,
has been experimenting for several months with the phonograph
as an instrument of treatment for deafness caused by catarrh. The
results so far have been highly satisfactory, and Dr. Garey’s ex-
periments may revolutionize cures of that character.”
And on Monday, November 2, 1891, another article appeared in
the Washington E1/em'¢zg Star as follows:
“NEW WAY TO CURE DEAFNESS.
“Prof. H. F. Garey, M. D., of the Department of Eye and Ear
Diseases in the Southern Homoeopathic College, Baltimore, has
been engaged for the past three months experimenting with the
phonograph in the treatment of deafness caused by catarrh. The
large clinic in the dispensary of the college is being utilized with
results, it is said, which promise to revolutionize the treatment of
deafness. Dr. Garey says that while it is yet too soon to present
to the profession his results achieved so far, because time enough
has not elapsed to confirm the cures already made, yet he feels
warranted in stating that those who are deaf and harassed by
noises in the head (tinnibus surium) have much to encourage
them to hope that Edison’s wonderful phonograph will prove the
greatest benefactor to the human race in this age of progress.
(Tinnibus surium was as'printed in original article.)
As I was the first to discover and apply sound as a therapeutic
agent in deafness and tinnitus aurium, I was anxious in view of
facts referred to later on in this article to learn who had caused
the issuance of said paragraphs. To that end I visited the office
of the Sunday Post, and upon inquiry was told the name of the
2
party. Upon visiting the individual and asking if he was respon-
sible for them, he replied, “no, I am not responsible for them,
they were sent from Baltimore by Dr. Garey to me for publication,”
whereupon I wrote the following to Dr. Garey :
“WASHINGTON, D. C., [V07/ember 2, I89I.
“ Dr. H. F. GAREY, BALTIMORE, MD.
“ DEAR SIR: The following appeared in the Sunday Posz‘, of
this city, yesterday : ‘Prof. H. E. Garey, of the Department of
Eye and Ear Diseases in the Southern Homoeopathic College,
Baltimore, has been experimenting for several months with the
phonograph as an instrument of treatment for deafness caused by
catarrh. The results so far have been highly satisfactory, and
Dr. Garey’s experiments may revolutionize cures of that character.’
As I was the first discoverer and first to apply the human voice
through an instrument to relieve deafness, the same having been
for years designated by me ‘ Otacoustic Treatment,’ and known to
leading practitioners of both schools of medicine, I think the lan-
guage ‘instrument of treatment for deafness’ caused by catarrh,
coupled with an agent utilizing the power of articulate sounds for
results, and the further language, ‘Dr. Garey’s experiments may
revolutionize cures of that character,’ are unfair to me. Upon read-
ing the article I was about to write an answer thereto that laymen
might know where credit for this discovery belongs, and for evi-
dence of priority I intended publishing Dr. Drane’s letter to me.
“Upon reflection I determined first to write to you and state
my objection to other parties making statements in your interests
which are not borne out by the facts.
“ Yours, etc.,
“(Signed.) ]. A. MALONEY.”
This was written before the article in the Sfar appeared, but
was not mailed. Upon reading said article I appended a post-
script calling Dr. G’s. attention to it, and again stated I would
await his answer.
Dr. G. did not reply, and on December I2, 1891, I addressed a
letter to Dr. Henry Chandlee, Registrar of Southern Homoeo-
pathic Medical College, Baltimore, Md., as follows:
“DEAR SIR : On November Ist and 2d, advertisements ap-
peared in the E'0e1zz'7zg Star and Washington Posz‘ in which Dr.
Garey, of your city, and a member of your faculty was announced
as the discoverer of an instrument of sound for deafness and tin-
nitus aurium. Upon investigation I was told by the party pub-
lishing said matter ‘that they were sent from Baltimore by Dr.
Garey for publication.’ I then addressed a letter to Dr. Garey
against his assumption, because I was known as the discoverer of
8
O
*Otacoustic Treatment’ (the title speaks for itself ), and the fact i
was known to Dr. Garey because of his being present in Washing-
ton with Dr. Drane on December I7, 1890, when I_examined Dr.
D. and prescribed ‘ Otacoustic Treatment.’ Dr. Garey paid no
attention to my letter, but stated to a mutual friend that you
would answer it. Not having heard from you, and learning that
an employé of my informant had written a letter assuming respon-
sibility for said publications, which had been accepted as conclu-
sive evidence of Dr. Garey’s innocence, I prepared an article for _
publication, and it went so far as ‘ galley proof,’ when my friends
in your school of medicine prevailed upon me to withhold said pub-
lication until after the meeting of ‘Clinical Society,’ when Drs.
Drane and Garey would call the matter up. This has not been
done, and before I issue said pamphlet I desire to day the follow-
ing facts before you:
“ I. By said publications a wrong was done me by Dr. Garey
arrogatiug to himself originality of idea already vested in me.
“ 2. No disclaimer of intentional wrong to me upon part of Dr.
Garey up to this date.
“ 3. In the investigation of said advertisements the proceeding
was ex-pa?/z‘e and no chance given me to present facts unknown to
you.
“ 4 Accepting the statement of the agent in Baltimore alone for
purposes of exoneration. .
“ 5. The indifference to a wrong done, and silence upon every
thing save that which would exonerate Dr. Garey a_nd fair name
of your college.
“6. Between man and man I was entitled to some consideration
in the matter, not expecting it upon professional grounds, because
I am known as an old-school graduate. '
“ 7. Because your reputation for fairness should not have allowed
you to be a party to settlement of a question entirely on ex parte
proof.
“ Aside from the foregoing, which is personal to me, I have heard
that Dr. W. R. King, who is of your school of medicine, has been
charged with having an interest in my method of treatment. This
treatment speaks for itself, and for Dr. King I will say that a more
honorable man does not live. When I first met him (occasion of
seeing first patient for him) I tendered him a portion of my fee,
which he firmly but in a dignified manner declined, saying: ‘I
shall select from my practice typical cases for your treatment. If
successful I shall publish them for the benefit of Homoeopathy;
that is the‘ only interest I care to have.’ His publication in the
.Ha/memannzkvz /Mom‘/zly for July, 1890, proves the truthfulness of
Dr. K.’s position as defined by him after my seeing the first patient
sent by him. I shall not comment upon this act of injustice to
Dr. King, but will only say that in regard to wrong done me I
4
propose some reparation shall be made. If not, I shall take steps
to present my side of the case to the fair-minded members of your
school of medicine.” Yours, etc.,
“ (Signed) ]. A. MALONEY.”
On January 1, 1892, I received the following reply :
“THE SOUTHERN HOMCEOPATHIC MEDICAL COLLEGE
OF BALTIMORE, MD.
F. C. DRANE, M.D., Dean, HENRY CHANDLEE, M.D , Registrar,
1001 W. Lauvale St I019 Linden Ave
“BALTIMORE, fanuary I, 1892.
“Dr. J. A. MALONEY.
“DEAR SIR: Your communication of December 12, 1891, was
duly received, and all the facts in the case were carefully con-
sidered at a special meeting of the Faculty held December 28.
“ The evidence was conclusive that Dr. Garey was not guilty of
intentional or other injury to you. Should you persist in pursu-
ing the matter further, as intimated, or should you in any manner
attempt to injure the name of the college by attacks upon the
Faculty or individual members thereof, you will be held to strict
account for the same and also for the false charges made against
Dr. Garey in your communication of December I2.
“Yours, etc.,
. “ (Signed) HENRY CI-IANDLEE,
“ Registrar.
“ By direction of the Faculty.
“Decevnlier 28, 1891.”
In the january, 1892, number of Soul/zern journal of Horrzce-
opal‘/zy appears an article by Dr. Garey entitled—
“SOUND WAVES IN THE TREATMENT OF AURAL DIsEAsEs.
“ BY HENRY F. GAREY, M.D., BALTIMORE, MD.
“Owing to a premature publication in the public press by the
Columbia Phonograph Co., of Maryland and District of Colum-
bia, without my consent, the necessity presents itself of announc-
ing to the 1nedical profession, through the Southern Hommopathic
Medical Association, that for some time past I have been experi-
menting with sound waves in the treatment of tinnitus aurium
(the result of catarrhal deafness), especially, but in other forms
of internal ear trouble as well.
“The results attained so far have been very gratifying, and in
some cases almost marvelous. The phonograph of Edison has
been the medium used to produce the sound waves adapted to
each case (but arz‘z'culaz‘ed sound of Z/ze /zuman voice is never used),
5
and the clinic of the Southern .Homoeopathic Medical College
affords abundant material for experimentation.
“Being desirous that the Homoeopathic profession shall receive
the credit of this discovery, based as it is upon Homoeopathic
principles, this announcement is made in order to establish
precedence. ’ ’
It will be observed that the publications in Washington papers
on November 1st and 2d, respectively, are stated in the fore-
going article to -have been premature and without Dr. Garey’s
consent. On February I5, 1892, one month later, the following
appeared in Philadelphia papers:
[From AT/ze Press, February I 5, 1892.]
' “ NEW CURE FOR DEAFNESS.
“A Balfimor/e Prrfessor ciemozzsz‘z/ates arzoz‘/zer use for the P/zorzogmp/z.
“BALTIMORE, Feb. I4.——At the Southern Homoeopathic Medical
College a public demonstration wasgiven yesterday of the uses
of the phonograph for the cure of deafness, a discovery made by
Dr. H. F. Garey, a professor in the college.
“Seated at a phonograph, with rubber tubes in their ears, were
a number of persons of both sexes, and an exposition of the
principles of the treatment was given. It is the massage of those
parts of the ear which transmit sound into the brain. The pho-
nograph produces this result by giving continuous and successive
vibrations at regular intervals. This it does with certain degrees
of intensity and frequency, according to the exigencies of the
case under treatment. '
“In bad cases a series of intensified shocks, at the rate of one
to the second, is produced against the membraneous tympanum,
or drum. In cases of not over five years’ standing the vibrations
are given with more frequency and less intensity. The noises or
thumps so made are given by means of depressions made with a
stylus at regular intervals in the wax surface of the phonographic
cylinders. ' \
“Every depression causes the little transmitter needle in the
instrument to strike the diaphragm connected with the phono-
graph, and to produce the same distressing noises which a deaf
person continually. hears within his brain. The intensity of the
noises is regulated by the way that the depressions are made in
the cylinder and their frequency by the number of revolutions per
minute given the latter.
“All patients who are under treatment for deafness at the col-
lege reported that they are greatly benefited.”
6
[From T he Rem-ea’, February 15, 1892.]
“DEAF HEAR BY Pnonoenarrr. _
“ N02/el Method of vTeae/zzhzgl T /zose W/zose Ears are DumZ7.
“BALTIMORE, MD., Feb. I4.——At the Southern Homoeopathic
Medical College, a public demonstration was given yesterday of
the uses of the phonograph for the cure of deafness, a discovery
made by Dr. H. F. Garey, professor in the Eye and Ear division
of the college. The deaf patients seated themselves about the
phonograph, holding the rubber tubes to their ears. The sounds
and vibrations in the phonograph were made slowly and very loud
and repeated until the patients caught the sense.”
N0 7’6]§07’L‘ of 2‘/zis appeared in Baltz'more jbajbei/s, alt/zoug/2 the
elivzie was /zela’ z‘/zez/e. I V
Having presented Dr. Garey’s attempts to pose as a discoverer
of a “New Cure For Deafness,” of “Massage of those parts of
the ear which transmits sound into the brain,” and further, “ and
sound wave in the treatment of tinnitus aurium,” I will now lay
before the reader the reasons for my protests against the pretense
set up by Dr. Garey for his broad claim as discovering “Sound
\7Vaves in the Treatment of Aural Diseases.”
On April 6, 1887, I addressed the College of Physicians of
Philadelphia (by request), and in the course of my remarks I stated
that the Otophone (means employed by me) “was a 1/estoraiz'r/e
agem‘ by means of exercise through the natural means, 2'. e., the
voice, which at the same time overcomes the sluggishness or dull-
ness of the percipient tract. I will refer in conclusion
to the advantages in both training and constant use of the instru-
ment from stimulating the auditory nerve. The mechanical
stimulation by the wave motion of the lymph of the labyrinth can
not be brought about in many merely by dependence upon the
-power of the unaided voice.” (See Transactions of the College
of Physicians, Third Series, Vol. IX, Phila., 1887.)
Did I not refer to “Massage of those parts of the ear which
transmit sound into the brain” P
Was not this “Sound Waves in the Treatment of Aural Dis-
eases”?
On july 19, -1887, the results of my tests were laid before the
“American Otological Society,” at their annual meeting, New
London, Conn. During the discussion which followed, Dr. C. H.
-Burnett, of Philadelphia, spoke as follows of one case tested by me
at his office :
7
“ When he came into the office he heard absolutely nothing when
the mouth was placed near the ear. He heard -very imperfectly
through the ordinary tin tube which he had in his hand. We then
tried the Otophone and he immediately heard fairly well. Afier
exercz'sz'ng with this for fifteen or twenty minutes he heard ze/it-/2' /zz's
6_]/65‘ closed the unaided voice when the mouth was at least a foot
from the ear. This person is entirely beyond self-deception. A fizz
the ossicles /zaa’ z‘/zus éeen passzr/ely moved Z0 a cen‘az'n exteni /2e cer-
.z‘az'n/y /zeard the voice afooz‘ from 1726 ear.” (The italics are mine.)
(See Transactions of the American Otological Society, Twentieth
Meeting, July I9, I887, Vol. IV, Part I.)
Did I not refer to “Massage of those parts of the ear which
transmit sound into the brain” P
Was not this “Sound Waves III the treatment of Aural Dis-
-eases ” ?
In I888 I issued a pamphlet to the medical profession, entitled
, “Relief for the Deaf by means of Otacoustic Treatment,” copies
of which were sent to physicians in all the large cities (certainly to
the sister city, Baltimore) in which I stated :
“Since the introduction of my method and means for relief of
the deaf I have addressed myself exclusively to the medical pro-
fession, and the encouragement received from some of the most
eminent specialists and general practitioners in this country, and
particularly the success attending the use of No. 3 Otophone, in
-connection with treatment as a restorative agent, has exceeded my
expectations, improvement being marked in cases ranging from
fifteen to thirty years standing. *
“My aim is to have instrument meet requirements of sound to
sensation in each case” * >1‘ *
(Dr. Garey seems to lay great stress upon requirements of sound
to sensation, but here was suggestion made four years ago.)
“ In many cases belonging to that large class of middle ear dis-
eases of catarrhal origin there is to be found a condition of immo-
bility which is not due solely to tissue changes resultant upon the
inflammatory process, but is largely dependent upon disuse; and
also where the immobility results from z‘z’ss‘z¢e c/zangas, a judicious
use of the instrument as effecting ,z>assz"ve motion is of great sex-v2'ce. ”
Among the cases cited are two in particular.
“ Mrs. Mc.C.——Her physician reports it a comfort to her family
and improvement to patient by its use. [12 1‘/zz's case z‘z'zzm'z‘w aur~z'um
reasea’. ”
(_ Italics were used in original.)
8
“Mrs. R.—After one month’s use of instrument as a thera-
peutic agent, could /zear e07z'0e7’saz‘z'01zs az‘ fable and Zz'nnz'Zus auflum
eeased.” 4
(Italics were used in original.)
After-the publication of proceedings of the American Otological
Society before mentioned, Dr. W. R. King, of Washington, began
sending his intractable cases, and after eight cases had been
treated he published the results under heading——
“ OTACOUSTIC TREATMENT As AN ADJUNCT TO FORMER
METHODS or TREATING DEAFNESS.
-“ BY w. R. KING, M. 1)., OTOLOGIST AND OPHTHALMOLOGIST TO NATIONAL
HOMGEOPATHIC HOSPITAL, AND HOMCEOPATI-IIC FREE
DISPENSARY, ‘WASHINGTON, D. C.” K
In opening the article Dr. King says :
“Some two years since, my attention was drawn to an account
of a meeting of the College of Physicians, Philadelphia, at which
this subject was presented to that body 6y 2‘/ze dz'seooea/er, /Ur. /.
A. /lialmzey, of z‘/zz's eiiy, and afterwards my attention was again
drawn to it by a publication of its presentation and discussion be-
fore the American Otological Society at New London, Connecti-
cut. As the discoverer resided in this city, I determined to have
a personal interview with him, and, at my request,‘ he called and
explained his method and means. It having been presented with
clearness and a knowledge of physiological acoustics satisfactory to
me, I determined to give it a fair and impartial trial, and with
that end in view I selected cases of a typical nature as they pre-
sented themselves, believing that the best mode of procedure for
a crucial test. The results of which, up to this time, I am pleased
to report as follows : ”
After enumerating cases,'with results, Dr. King closes as fol-
lows:
“The above cases were selected mainly because they are strictly
typical and many of them represent profound degrees of deafness,
in the most common class-of cases; these wherein the conducting
apparatus of the ear is at fault; and because in the ‘majority of
these cases careful local and medicinal treatment had been given
for a longer or shorter period with little or no result; benefit of a
marked and permanent nature only following the addition of ota-
coustic treatment to that already in use.” (See T/ze 1’-[aknemam
mkm /110121‘/zly, ]uly,.I89o, Vol. XXV, No. 7.) .
9
Following this article of Dr. King I published a new edition of
my pamphlet in October, I890, in the opening of which I say:
“To THE MEDICAL PROFESSION.
“Several years since, while experimenting in the field of acous-
tics, it occurred to me that a special field of labor was open- in
‘physiological, acoustics,’ and that I might by a new field of exami-
nation discover wherein the ear fails to convey to the auditory
nerve composite-sound sensations, and compensate for the same by
the scientific application of the principles of aural mechanics; and
after months of experiment the Otophone was developed, and from
its marvelous power of awakening latent hearing grew its thera-
peutic value. This then was reduced to a system, and is known‘
as ‘Otacoustic Treatment.’ ” ~
I herein give a reprint from Dr. King’s article, and it will be
found upon examination of the cases referred to that results were
not confined to improvement of hearing; but referred to tinnitus
aurium as well, and in conclusion I say:
“ Otacoustic Treatment supplies a long-felt want, inasmuch as
it addresses itself not only to the perceptive tract, [rut to z’/ze lraus-
uziz‘lz'ng mec/zanz'srn, thereby stimulating the auditory nerve and '
overcoming atrophy due to disuse. Again, adhesions or partial
anchylosis of ossicula are gradually diminished a11d mobility re
stored, z‘/zus reac/zing z‘/ze z‘ransmz'z‘z‘z'ng uzec/zauz'srn.” -
(The italics were in original.)
Following the article by Dr. King and issuance of the last cir-
cular came the following letter from Dr. F. C. Draneof Baltimore,
now Dean of the Southern Homoeopathic College in that city:
“ DR. F. C. DRANE,
“ IOOI West Lanvale Street,
“BALTIMORE, MD., Aug. 18, 1890.
J. A. MALONEY, Esq,
Vi/'ashington, D. C.
“DEAR SIR: I wrote you some months ago relative to your ‘. Ota-
coustic Treatment,’ and suggested that you make so1ne arrange-
ment with our leading specialist here in eye and ear diseases, Dr.
H. F. Garey, No. 411 North Charles street, but he tells 1ne he
never heard from you, although he knows there is a large field
here for you if you have ever as good a thing as Dr. King repre-
sented in his article in the ffa/zuenzanuian -flJO7Zl/ll]/, and I would
again advise you to write Dr. Garey, as he has a large private and
dispensary practice here. Yours truly,
“ (Signed) F. C. DRANE, M. D.”
IO
On December 17, 1890, I received a telephone message from Dr.
W. R. King, 812 Eleventh street, this city, to call at his office
within an hour and see a patient. Upon going there I found Dr.
F. C. Drane, of Baltimore, Dean Southern Homoeopathic Medical
College, accompanied by Dr. Henry F. Garey. I was informed by
Dr. King that Dr. Diane was the patient. After examination and
tests I prescribed “ Otacoustic Treatment” and gave written in-
structions for same.
In the article by Dr. Garey in January, 1892, number of South-
em journal ffomceopal/zy, already referred to, appears this sentence
in italics and used parenthetically, “ but articulated sound of the
human voice is never used.”
This is the method which has been preferably used by me, and
I presume is the reason for being set up in italics.
In the same article he says:
“ I have been experimenting with sound waves in the treatment
of timzitus amdum (the result of catarrhal deafness especially), but
in other forms of internal ear troubles as well.”
My treatment of z‘z'rmz'z‘zes am/irmz, before quoted, was by means
of sound waves, unless Dr. Garey holds that sound waves are not a
factor in articulate sounds.
Again he says:
“The phonograph of Edison has been the medium used to pro-
duce the sound waves adapted to each case.”
In the Medz'eaZ Record for November I7, 1888, page 589, will be
found an article by me, “A STUDY IN PHYSIOLOGICAL ACOUSTICS,
PRELIMINARY NOTICE,” which sets forth the use of a sound-re-
cording instrument or phonograph as applied to defective audition,
and in my concluding remarks I say:
“The second part of my investigations, which is not yet com-
plete, will, I hope, prove more interesting as an attempt to solve
some of the mysteries of audition by addressing the unexplained
working of the mechanism of the middle ear for clues to abnor-
mities which maybe due entirely to changes in the middle ear
hitherto unsuspected. ”
Also the following from the Nere Yer/c /Wedz‘ealfoumal, August
I I, I888:
II
“ THE Srnenom Bonn: Some or rrs Possrsu-3 Funcrrons.
“BY J. A. MALONEY.
“ In making tests to ascertain the conditions of those with im-
paired audition, preparatory to applying an Otophone in the case,
either as a restorative agent or simply as an aid, I have been very
much impressed with a singular effect in some cases of profound
hardness of hearing when I had reason to suspect partial anky-
losis of the ossicula, or adhesions of the same resulting from ca-
tarrh of the middle ear.”
In view of the foregoing I desire to call attention to the following:
I. That in 1887 I announced to the world the discovery by me
that sound systematically applied was a therapeutic agent in deaf-
ness and tinnitus aurium.
2. That sound was applied by me for relief of deafness due to
catarrh and so stated by me in circular of 1888 addressed to the
medical profession as follows:
“ In many cases belonging to that large class of middle ear dis-
eases of catarrhal origin, there is to be found a condition of immo-
bility which is not due solely to tissue changes resultant upon the
inflammatory process. ”
3. That sound as a therapeutic agent in tinnitus aurium was
used by me before the issuance of said circular, as the following ex-
tract shows :
“ Mrs. McC.-—Her physician reports it a comfort to her family
and improvement to patient by its use. [a z‘/zis ease z‘z'aaz'z‘as aarizmz
ceased.
“ Mrs. R.——After one month’s use of instrument as a therapeutic
agent, could bear eomuei/saz‘£07z az‘ table and tz'mzz'z‘as aurium ceased. ”
4. Confirmation of these statements by Dr. King’s article in
ffa/uzemamzian /Wom‘/zly for ]uly, 1890.
5. Dr. F. C. Drane’s letter of August 18, 1890, on behalf of Dr.
Garey.
6. Dr. Garey’s visit with Dr. Drane to me December 17, 1:890.
7. I was the first to use sound waves adapted to each case, as in
said pamphlet I stated : “ My aim is to have instrument meet re-
quirements of somza’ to seasafiovz in each case.”
8. I was the first to use a phonograph in defective audition.
I2
I leave the fair-minded reader to determine what Dr. Garey has
discovered, and regret being forced to adopt this course of making
known a wrong perpetrated and persisted in. I desire to call
attention particularly to the phrasing of the articles in Dr. Garey’s
interest, they being misleading, in that they attempt to clothe him
with originality of idea in the use of sound waves in the treatment
of aural diseases.
Dr. Garey has simply made an adaptation of “ Sz'mz'Zz'a Sz'mz'Zz'bus
Cm/am‘ur” to sound as a therapeutic agent first discovered and
used by me; but even in that he is met for originality of idea by
the genius of his school of medicine, Hahnemann, for his credit
can not be limited any more than mine by mere appZz'caz‘z'02z.
In the four years of my labors in “ Otacoustic Treatment” I
have never said anything relative to it except through the medi-
cal press or to the profession through a pamphlet, and have never
attempted to reach the laity through the lay press by such subter-
fuges as “an interview ” or “inviting a reporter to be present.”
I. A. MALONEY, M.D.
I424 Q Street N. W.
WASHINGTON, D. c.
March 1, I892.
IV'ith~ the Colnplimemfis of -I.‘-he ./filuthor.
ACUTE
GL-AU'C()l\/IA

BY
A. B. NORTON, M. D.
Surgeon to the New York Ophthalmic Hospital; Professor of Ophthalmology and Secretary of the
‘-“Faculty of the College of the New York Ophthalmic Hospital; Ophthalmic Surgeon to
Protestant Half Orphan Asylum; Chairman of the Bureau of Ophthalmology
and Otology Am’encan Institute of Homoeopathy, etc.
READ BEFORE THE HOM(EOPATHIC MEDICAL SOCIETY OF THE STATE OF
NEW YORK, OCTOBER, I890.
[REPRINT FROM THE NEW ENGLAND MEDICAL GAZETTE.]
BOSTON:
OTIS CLAPP & SON,
1890:
ACUTE

GLAUCOMA
B Y
A. B. NORTON, M. D.
Surgeon to the New Yolk Ophthalmic Hospital; Plofessoi of Ophthalmology and Secretary of the
Faculty of the College of the New York Ophthalmic Hospital; Ophthalmic Surgeon to
Protestant Half Olphan Asylum ;~ Chairman of the Bureau of Ophthalmology
and Otology Amcncan Institute of Homoeopathy, etc.
READ BEFORE run l~IoMu;orATHIc MEDICAL SOCIETY or l‘flE S'1‘ATE OF
NEW YORK, OCTOBER, 1890.
LREPRINT FROM THE NEW ENGLAND MEDICAL GAZETTE]
BOSTON:
OTIS CLAPP & SON,
I890.
ACUTE GLAUCOMA.
BY A. B. NORTON, M-D., NF.\V YORK CITY.
/95111:’ 01‘ Mr Sr/21/-Amzzmd /Wee/1/ze 0 z‘/ac ffomwo at//zc ./l[eu’1'az/ Soczeiy 0 Me S/air
-.5 _ J
of /Vcw Y0?’/e, />’1'00/e/J/n, Odo/26¢’ Ist]
Glaucoma is “the expression of a disturbance of equilibrium
between secretion and excretion, with increase in the contents
of the eye, and increased tension.”——De I/Verlaer.
PATHOLOGY.
Different authorities attribute glaucoma to either one of the
three following conditions or to them all combined, viz., Ist.
A hypersecretion of the inflamed ciliary body. 2d. Impeded
outflow caused by pressure of the enlarged ciliary body upon
the periphery of the iris, or 3d. From impeded outflow from
the vitreous chamber by enlargement of the lens. Owing to
this diversity as to the initial cause, the pathological changes
are imperfectly understood, but the following conditions have
been sufficiently often noticed to be placed under this heading.
An inflammation and enlargement of the ciliary body in the
early stages which later becomes atrophied. The iris which at
first is slightly inflamed, becomes as the disease advances adher- ,
cut to the cornea, thus partially blocking up the ’flow of the
aqueous to the canal of Schlemn, and finally the iris may be-
come atrophied. The entire surroundings of Schlemn’s canal
are infiltrated with cells. The optic nerve is at first somewhat
inflamed, while in the advanced stages the nerve fibres are
shrunken with hypertrophy of the intervening connective tissue,
together with hypertrophy of the pial sheath of the optic nerve
and the lamina cribrosa. The choroid and retina become atro-
phicd in the later stages from pressure. The retinal vessels
become degenerated and the walls of the arteries thickened.
The vitreous shows externally an increase of consistence, and
internally liquefaction.
SYl\IPTOMATOLOGY.
In about one—half of all cases of glaucoma, careful inquiry will
elicit the history of prodromal symptoms, recurring at longer or
shorter intervals for a period sometimes extending over months
4 ACUTE GLAUCOMA.
or years, and seeming to result from mental or physical fatigue.
These premonitory symptoms consist of increased tension, pre-
mature recession of the near point (a higher degree of presbyo-
pia than the age of the patient would indicate), the appearance
of haloes around a light and periodic dimness of vision, while in
some cases the pupil may be dilated and sluggish, the field of
vision contracted and the retina hyperaemic.
These prodromal symptoms may occur from time to time, the
intervals between the attacks becoming shorter and shorter, un-
til suddenly an attack of severe pain will usher in the onset of
acute glaucoma. This is apt to occur at night and is often the
result of some sudden excitement or great grief. An examina-
tion will reveal a part or all of the following symptoms. The
lids somewhat swollen may be oedematous. The conjunctiva
reddened, possibly chemosed; scleral vessels injected and en-
larged, eyeball protruded, lachrymation, photophobia. Cornea
hazy, and may have lost its sensitiveness to touch. Iris discol-
ored, pupils dilated and inactive, greenish reflex from the pupil.
Aqueous, cloudy. Anterior chamber shallow. Vision impaired.
Eyeball hard. Field of vision contracted. An ophthalmoscopic
examination will be difficult to make on account of the haziness
and generally inflamed condition of the eye, but should show a
pulsation of the retinal arteries, which are diminished in caliber,
while the veins are large and full; excavation of the optic disc,
and there may be extravasation of blood.
An analysis of the chief symptoms of glaucoma proves in-
structive as well as interesting, and hence is detailed. One of
the first symptoms is the diminution of the range of accommo-
dation, and although glaucoma is a disease especially found in
elderly people in whom we would naturally have presbyopia, still
it is much greater than should exist at that time of life, and is
-due to the increased pressure causing greater tension upon the
choroid and suspensory ligment of the lens, thereby keeping the
lens flatter.
The halo around light appears like a rainbow with the colors
of the solar spectrum, the usual arrangement being with the vio-
let end inwards and separated from the light by a non-luminous
space, with the red end of the spectrum outwards. This arrange-
ment is probably due to the refraction, because this is the
arrangement in hyperopic eyes and is reversed in myopia, (the
majority of cases of glaucoma occur in hyperopic eyes.) Priestly
Smith considers the iridescent vision to be due to an exaggera-
tion of the latent physiological chromatic aberration of the eye,
while Donders considers it due to a diffraction of the rays enter-
ing the eye, owing to the opacity of the cornea. The halo seen
is always circular in shape, and its size, and breadth of each col-
ored ring increases the further the light is from the eye.
ACUTE GLAUCOMA. 5
The increased tension is best determined by palpation with
the index fingers of both hands applied to the upper lid of the
closed eye, when the eye is turned downwards. It is customary
to determine three grades in the variation of the tension, either
above or below normal, and are designated by the signs T+ or——
I, 2, 3. A marked increase in the hardness of the eye is noted
as T+I, a greater increase but still admitting of some dimpling
of the eyeball is noted as T+2, but an eye that admits of little
or no impression is noted as T+3. This system of notation,
while but relative and varying with different examiners is suf-
ficiently accurate for all practical purposes, as the difference in
the degree of hardness is of less importance than the demon-,
stration of the fact that hardness exists. Instruments called
tonometers have been devised for measuring the tension, but
experience shows that no more delicate information can be
obtained from their use than by the z‘acZus erudz'z‘us of the
skilled surgeon. To determine the tension when but one eye is
affected, it should always be compared with its fellow. The
normal tension of the eye is noted as Tn-; this is apt to vary
under certain conditions ; a large eye is apt to yield more than
a small one; the elasticity of the sclera may be increased or
diminished by disease, and is more elastic in youth than in old
age, and hence the tension would be greater than in an old
person. The palpation should always be made when the eye
is turned downwards, as it varies when made over the cornea
from that made over the sclerotic.
The haziness of the cornea is peculiar in that it is quite uni-
form and most intense towards the centre of the cornea. The
seat of the opacity is the parenchyma of the cornea, with some
dotted appearances of the surfaces ; the opacity soon disappears
upon the return of the tension to the normal. The cause of the
opacity seems to be, according to the investigation of Fuchs,
an oedema of the cornea which takes place through the nerve
channels. Others have attributed the haziness to a disturbance
of the nutrition of the cornea brought about by the pressure,
and still others claim it is due to a compression of the cell ele-
ments of the cornea, and thereby changing their relations.
Anmsthesia of the cornea is usually present in chronic cases
and may be found to a greater or less degree in acute cases;
this is due to a paralysis of the corneal nerve fibres resulting
from the distention and pressure upon them by the increased
amount of fluid in the nerve channels and the infiltration around
the same.
Dilatation of the pupil together with inactivity is usually pres-
ent. The dilatation is not always circular, and when of an oval
shape is believed to be due to a greater amount of adhesion of
6 ACUTE GLAUCOMA.
the iris to the sclera at that point. There are several theories
as to the cause of the dilatation, none of which have been satis-
factorily demonstrated as yet, it is most probable, however, a.
result of some vascular constriction of the vessels of the iris..
The greenish reflex from the pupil is dependent upon the hazi-
ness of the cornea and aqueous humor, combined with the phy-
siological haziness of the lens. .
The shallowneiss of the anterior chamber is due to the in--
creased pressure from the vitreous pushing forward the iris and
lens.
The haziness of the humors is a very slight, diffuse haziness,.
and is due to an increased amount of fluid in the eye.
Dilatation of the anterior ciliary veins is the result of com-
pression of the venae vorticosae causing a damming up of the
blood, which then has to pass off through the anterior ciliary
veins.
Enlargement of the anterior ciliary arteries is due to an im-
peded entrance of blood. '
Pulsation of retinal veins is a phenomenon occasionally found _
and is not a true pulsation, as the arterial wave cannot be trans-
mitted through the capillaries, but is due to the external pres-
sure upon the veins produced by the incoming arterial wave and
transmitted to the vein through the vitreous humor. It also
may be occasionally noticed in a normal eye when an artery
crosses over a vein and the pulsation is then sent direct to the
vein.
Pulsation of the arteries of the optic disc. The physiological
pulsation of the retinal arteries is so slight that it is not recog-
nizable except in extremely rare instances, but it may often be
produced in the normal eye by pressure on the globe with the
fingers. In glaucoma, the increased tension causes a stoppage
of the blood at the optic disc, and extra force is required to push
it forward into the retina, which is done by the next systole of
the heart. This pulsation disappears after an iridectomy is per-
formed. The pain of glaucoma may be very slight or it may be
the most intense ciliary neuralgia, and is due to pressure upon
the ciliary nerves.
Contraction of the field of vision, is one of the most charac-
teristic signs of glaucoma. The contraction is first seen at the
inner (or nasal) and later at the lower, then the upper, and lastly
at the outer side of the field; thus showing that the temporal
side of the retina, then the upper and lower are first affected,
and is probably due to the fact that there is less blood and
nerve supply to the temporal than to the nasal side of the retina,
and in consequence the result of increased pressure would be
first noticed at the temporal side. It has also been shown by
ACUTE GLAUCOMA. 7
Leber that the periphery of the retina receives its nerve supply
from the centre of the optic disc, and as it is these central
fibres that are first and mostly affected by the excavation of the
disc, the contraction of the field may be the result of the exca-
vation.
Excavation of the optic disc. The cupping of the optic
disc in glaucoma involves the whole of the nerve, is very abrupt
at the edge, the vessels are lost sight of as they pass over it and
the nerve has a greenish appearance. It is due to the increased
pressure upon the lamina cribrosa, which gives way, is pushed
backwards, and finally passes into an atrophic condition.
./ETIOLOGY.
Glaucoma averages about one per cent. of all eye cases. Its
frequency varies somewhat in different countries, and the sex
seems to cause little or no difference. It is especially a disease
of advanced life and is very rarely found under the age of forty.
Usually affects both eyes although rulably one eye is further
advanced than the other. Chronic glaucoma is more frequently
met with than acute, the proportion being about three to one.
Heredity seems to have some influence. Hyperopia is found to
exist in about 50 to 75 per cent. of the cases, and is considered
by some to act as a cause of glaucoma owing to the excessive
thickness and prominence of the ciliary muscle in hyperops,
and also to the shallowness of the anterior chamber, owing
to the more anterior position of the iris and lens in hyperops.
Trigeminal neuralgia is in some cases a precursor of glaucoma
and is also considered as an exciting cause, as in animals, irri-
tation of the fifth nerve will induce a temporary increase of the
intraocular pressure. Irritation of the fifth nerve from decayed
teeth will cause glaucoma in some cases. Convulsions, hyste-
ria, anxiety, excitement, grief and mental depression have been
recorded as causing glaucoma. Gout may predispose to it.
Climatric changes and other disorders causing a vascular turges-
ence may cause, as intoxication, indigestion, strain of the eyes,
sleeplessness, fever, etc. Atropine has often been the cause.
COURSE.
Acute glaucoma is as a rule extremely sudden in its onset and
will often run its course to complete blindness in a few days
and sometimes in a few hours ; occasionally a case will be met
with in which the disease has been very slow in its attack, and
in these there has been usually no pain or inflammatory symp-
toms directing attention to the eye, so that careless people will
often allow of an almost total destruction of sight before seek-
ing a physician.
8 ACUTE GLAUCOMA.
PROGNOSIS,
depends upon the time it has existed before coming under treat-
ment ; if seen within a few hours after its onset the use of eser-
ine and our homoeopathic remedies will often cut short an attack
and vision be restored, but even in any stage treatment either
medicinal or operative should be expected to save the existing
vision with more or less improvement.
DIAGNOSIS.
Acute glaucoma should present no especial difficulty in its
recognition, as its symptoms are so characteristic that they
should be appreciated by any careful observer. When you find
an inflamed eye with dilated pupil, intense ciliary neuralgia,
haziness of the cornea, rapid loss of vision, etc., your attention
should at once he directed to the tension and glaucoma be sus-
pected. In glaucoma simplex, where there is no inflammation,
pain, etc., it may be confused with atrophy of the optic nerve,
but the duration, tension, excavation of the disc, etc., will at
once clear up the diagnosis.
TREATMEl\'T.
This should vary according to the stage of the disease; taken
in the premonitory stage where the patient suffers from only oc-
casional attacks of temporary blindness, pain, etc., while in the
interval the vision is good, we may look for benefit from the use
of remedies. The only local remedy to be considered is either
the sulphate or salycylate of eserine, which is usually employed
in the strength of a half per cent. solution and may be instilled
into the eye as often as every hour or even oftener, and should
in itself speedily cut short an attack. Even in some cases of
acute glaucoma, if used early and often, the necessity of an oper-
ation may be postponed, if not permanently avoided. In alt
cases the use of eserine should be early, very early, hence we
believe it best in cases once having had a premonitory attack,
that the patient should be supplied with the eserine with direc-
tions as to its use that no time should be lost. The action of
the eserine is by causing contraction of the iris, it is drawn
away from the iritic angle and the filtration passages opened, it
also by constriction of the vascular system of the eye diminishes
secretion.
IRIDECTOR/IY.
The introduction of this operation for the relief of Cdaucoma
was empirically made by von Graefe, in 1857, and is still the
operation for this disease. Iridectomy has been the means of
ACUTE GLAUCOMA. 9
saving useful vision in thousands of patients who would other-
wise have been hopelessly blind. While iridectomy is the most
valuable remedial agency extant for this disease, still it is not
infallible, as in some cases or forms of glaucoma even this oper-
ation will not check the disease. In operating, the previous use
of eserine is advisable, as it renders less liable accidents from
sudden relief of the tension, and it has also been advised by
Arlt and others, that it be used in the sound eye as well, for the
mental anxiety caused from\ the dread of an operation has been
considered not infrequently to have been the cause of an attack
in the good eye. Ether should, as a rule, be used in this opera-
tion, as thorough anaesthesia cannot be obtained from cocaine
in a glaucomatous eye. The incision should be made entirely
in the sclera, the iridectomy large, and care taken that the es-
cape of the aqueous be ver gradual, and that no remnants of the
iris remain in the wound.
Sclerotomy has been strongly advocated by DeWecker, but it
has not seemed to have met with the hearty support of the
other authorities. In certain cases, especially the ha-zmorrhagic
form of glaucoma, sclerotomymay with advantage take the place
of iridectomy. The writer has had the best of results from this
operation in a few instances. Other operative procedures have
been suggested for the relief of glaucoma, but thus far have not
proved worthy of notice.
REMEDIES.
The results from the use of internal remedies in glaucoma
seem to me somewhat problematical, chiefly because the reports
of cases cured by remedies alone, seem sufficiently unreliable to
warrant a question as to the diagnosis. In the majority of
cases recorded, where no operation was made, the local use of
eserine was employed as well as the remedy, and in consequence
it is unscientific to give the credit to the remedy alone.
Aconite may be of service at the commencement of an acute
attack when we have much heat, redness and burning pain in
the eye, together with fever and other symptoms of the drug
generally.
Belladonna may occasionally be indicated in severe throbbing
pains aggravated by noise and light, together with the flushed
face, etc.
Bryonia is a remedy to which much credit is given. The
eyes feel full. Sharp shooting pains through the eye and head‘
Eyes sore to touch and on moving them. Halo around the light.
Cedron may relieve a severe shooting pain over the eye.
Colocynth has a severe cutting pain in and around the eye
which is relieved by pressure.
I O ACUTE GLAUCORIA.
Gelsemium is one of our principle remedeis in this disease
and is perhaps more frequently used than any other, and yet
there seems to be no especial characteristic symptoms upon
which it is given, hence we come to the conclusion that its use
has depended upon the fact that clinically it has proven its
value, as many favorable results are recorded from its use.
Nux vom. has been used more in the later stages of the dis-
ease when atrophy of the nerve is present, the morning aggra-
vations, and the other symptoms of nux.
Osmium is a remedy that has proven of value in the hands of
some, and from its symptoms should be given a more thorough
trial. It has sudden, sharp, severe pains in and around the eye.
Dimness of vision, objects seem in a fog. Halo of various
colors around a light.
Phosphorous is useful after an iridectomy and in some cases
is of value early. Halo around light. Objects appear red.
Prunus spinosa has a very severe pain in the eye as though
it were being pressed asunder, sharp, shooting pain in the eye
and side of head.
Rhododendrum has severe periodic pains in the eye aggra-
vated before a storm.
Spigelia will also often relieve the sharp, shooting pains in the
eyes and head of glaucoma. The pains are worse on motion
and at night. Among other remedies we would note apis, escr-
ine, mere. and thuya.
CASE. I. Mrs. B , aged fifty-six years, came to me Oct.
I0, 1885, to have her eyes examined for glasses, stating that for
three or four months had noticed that she could not see as
well with her glasses as formerly. Examination gave O. D.
: 1,-(;—l-I. D. Vzlfi. O. S. dif.—l—I. D. V=%,;-8 slight
difficulty. Has been wearing +3. 25D. for near vision, but now
requires +4. 5OD. States that she has suffered from more or
less headaches of late, with occasionally neuralgic pains around
the eyes. Says that at times vision seems to be very much
poorer than usual for a day or two, and at these times cannot
see to use the eyes at all. In answer to the question, says that
she has noticed colors, especially red, around the light at times,
but had supposed it was due to biliousness or something of that
kind and had paid no attention to it. Has had sickness in the
family for the last six months causing her a great deal of physi-
cal fatigue as well as worry. Had been in the habit of reading
aloud for hours at a time. Ophthalmoscopic examination re-
veals a slight dilatation of the retinal veins, arteries normal.
The slightest pressure on the eyeball produces a pulsation of
the retinal arteries. The pupil slightly dilated and T+I ?. The
diagnosis was made of prodromal glaucoma. The patient

ACUT-E GLAUCOM A. I I
forbidden all use of the eyes, was advised to get as much rest as
possible, combined with moderate exercise in the fresh air, and
placed upon a nutritious diet. Eserine sulphate one-half per
cent. solution, was prescribed to be instilled into each eye every
two hours and gelsemium given.
Oct. 14th. Reported as feeling better in every way. Vision
was found to be dif. with —l—ID. O. U. Pupil contracted.
Tn. Headache and pain is better yet has still seen the red color
around the light at times. The eserine was ordered to be in-
stilled but twice a day and the remedy continued.
Oct. 24th. Still improving, none of the colored vision since
the last date, and other symptoms disappeared. Tn. Eserine
to be used once a day and the remedy repeated.
‘Nov. 20th. Seems to have been all right since the last date,
and can now read as well as ever, she thinks,_with her old
glasses, but +3. 75D. are clearer and easier for near vision and
were ordered for her. Distant vision the same as Oct. 14th.
Patient was discharged at this date without further treatment,
except that a solution of eserine was given her with directions
to use it upon the return of any of her symptoms and to report
at once.
Jan. 8, 1886. Mrs. B. returned with the report that she
seemed to have been all right until four days ago, at which time
the death of her daughter was followed by a return of the halo,
dimness of vision and very severe pain in the eye which was in-
flamed. The eserine was at once used with a relief of her
symptoms, and now beyond a slight irritable condition of the
eye with an occasional ill-defined halo and some headache,
seems to be all right. She was seen a few times after this until
wholly recovered, and since which time has had no recurrence
of the symptoms. In this case, I believe had it not been for
the use of the eserine together with the remedy, that this lady
would have continued to have these premonitory attacks, until
the sudden grief from the loss of her daughter would have re-
sultedin an onset of acute glaucoma with probably more or less
destruction of sight. '
CASE II. Mrs. W., aged seventy years, was first seen on
July 31st, of the present year, when she gave the following his-
tory. Four days ago she began to have very severe pain in the
eyes and extending into the top of the head, with poor sight in
the right eye. Could ascertain no prodromal history. Says the
attack seemed to have come on suddenly one night. Has one
daughter that had glaucoma in both eyes a few years ago and
was relieved by an iridectomy. Has been under a severe physi-
cal and mental strain, caused by serious sickness in her family,
which a few days later resulted fatally. Examination gave O. D.
I 2 ACUTE GLAUCOMA.
V: fingers at eight feet with +14. glass \/':T‘1,-"1; O. S. I/T:-d>1;;5—.,—
+14. V:-}-3 dif. Pupil dilated, cornea hazy. T—|—2. Conjunc-
tiva congested, lachrymation. Ophthalmoscopic examination
could not be made on account of the haziness of the cornea.
Diagnosis of acute glaucoma was made and an iridectomy to be
made at once was advised. In the mean time eserine sulphate
half per cent. solution was to be instilled into the eye every
hour and gelsemium given internally. The eye the following
day was about the same, but vision was reduced to the counting
of fingers at seven feet. An iridectomy was then made under
cocaine, with no pain from the operation. This patient made a
very quick recovery, and on August 15th, two weeks after the
iridectomy, all inflammatory symptoms had subsided and the
eye was apparently as well as ever, with a vision of J7-#8-—-l—I4.,
V=%;3- and two letters of §%. ’
These two cases are merely detailed as illustrating the most
favorable results that may be expected from the treatment of
cases of acute glaucoma when taken early, and not as displaying
any especial skill in the treatment or brilliancy of operation.
In all cases of glaucoma it may be considered as favorable re-
sults to prevent further loss of vision, than that which exists
when the patient first comes under treatment. My records,
like those of all oculists, will show many other favorable cases
where the disease has been checked and vision improved, but
not to such an extent as in these, because not seen as early. In
the first case the operation was avoided because the disease was
simply in the prodromal stage when first seen, and the treatment
undoubtedly prevented an attack of acute glaucoma. The re-
sult in that case we believe may be considered as extremely
favorable, and yet probably no more so than should be had in
any similar case, 2'. e., seen at the same early period.
In the second case the condition had progressed to such an
extent, that we believe had the iridectomy been delayed while
trying other treatment, no such favorable results could have
occurred, as I think the improvement after the operation was
unusually good, and was simply due to the fact that the opera-
tion was made early. ‘
A. B. Nonrox, MD.
752 I/Vesz‘ 341!/z Sfree/, I/Vac I/0/'/c.
;61X)4'l>fI' the @014/tP'BH/VtGM lb‘ ,i3f\'(Z/.€w11,Li3fI<I>f’6.
” i _' ' l_5tI1-.flt}dtl&Gll€8§and\r AsttIe- A
' I nepia, Resulting Ilfllll
»Hyipere‘pia, -be‘ Relieved
WithoiIt' Glasses-R‘ I B
BY
AQR NoR'roN,\ 1VIiD., _
‘, SURGEON TO THE NEW YORK OPI-I,THA\Iv.M1’C HOSPITAL, PRQEESSOR or
OPHTHALMOIDGY IN THE (:'of.LE‘cis OF THE NEW YORK‘
' A OPHTHALMKJHOQMTAL,OPHTHALMKISURGEONTU
.eRornsTANT HALF oRPnAN'AsYIuNL ETC:
Rap7"z'm‘ed from t/2e,_/aurgzal of Opfit/ml/iialogy/,fl JOlology, and Lazy/ngology. I
- NEW YORK? r
LL eHATffERToN &\co.,
I890.
Can Headaches and Asthenopia, Resulting
from Hyperopia, he Relieved Without
Glasses? ‘ .~ '~ ~
BY
A. B. NORTON, ~M.D., NEW YORK CITY.
The query propounded in the title of this paper would
probably be answered in the negative by a very large ma-
jority of all oculists of to-day, and even but a short while
ago the writer would also have responded “no”_; but in
the light of present knowledge and experience we believe
that in -a great many instances it can be done. I am also
prepared to go still further, and make the assertion that, in
my opinion, even the correction with glasses of what is un-
derstood as manifest hyperopia, in cases associated with
exophoria, will, in many instances result in no permanent
relief, but rather, ultimately, in positive harm. Further-
more, in ‘cases of hyperopia in which convex glasses are
necessary, we believe that, as a rule, proper discrimination as
to the strength of the glasses required is uoz‘ made, and as a
result some cases are given too strong a glass and others too
weak. _ ~ '
I do not wish to be understood as making the claim that
no case of hyperopia needs glasses, or that all cases of head-
aches in hyperopic patients can be cured without glasses,
but simply desire to point out a new factor, which, in my
opinion, renders the need of glasses unnecessary in many
cases that have heretofore been considered as demanding
thei-r.use ; and-further, that those cases in which the neces-
sity of glasses still seems ‘to be imperative, that improper
glasses may be prescribed from a lack of careful examina- _
tions as to the condition of the recti muscles.
2 Headaches Reszr[tz'ng from H yg/oeroj>z'a.
The foregoing opinion is based upon the careful study of
over 2OO cases of errors of refraction, occurring in my private
practice during the past year, together with the associated
conditions of the extrinsic muscles of the eye, as shown by
the phorometer.
The loss of the normal equilibrium of the ocular muscles,
heterophoria, is now admitted by nearly all oculists to be a
potent factor in the causation of headaches and asthe-
nopia.
Of the several forms of heterophoria, but one variety will
be especially considered as bearing principally upon the
subject of this paper, viz., exophoria, or a deviation of the
visual lines outward. This condition must necessarily be
due to either a weakness of the internal recti muscles, to a
preponderance of strength of the external recti, or to both
combined. As esophoria will also be referred to in this
article, we would say that it is a condition directly opposite
to exophoria, or a deviation of the visual lines inward, due
either to a weakness of the external recti, to increased
strength of the internal, or to both combined. It is the
accepted theory that, as a rule, either of the above condi-
tions is usually due to a weakness of one muscle, rather
than to increased strength of its opposing muscle.
My attention was first directly attracted to the relation
existing between the external and internal recti muscles
and hyperopia by the following case:
CASE I.——-Dr. H., aet. forty-four, came to me in July, I888,
with the following history: Has been wearing glasses for the past
six years, having first noticed his eyes causing him trouble while
engaged at the close work of his profession, dentistry. He then
consulted a prominent oculist of this city, who prescribed a weak
convex glass for near work. This glass seemed to give him relief
for a time, but after a while the old symptoms returned, and by
advice of his physician he began using a stronger glass, with
the same result——-temporary relief, with, later, a return of his
symptoms.
After some while his eyes began to trouble him for distant
vision, and he was ordered weak convex glasses for distant vision,
Headaches Resaltingfzom H;/,eer0pz'a. 3
with a similiar relief of the discomfort of the eyes, followed later
by a return of the distress and an accompanying increase in the
strength of his glasses.
Thus a change in his glasses had been made a number of times
during the preceding six years until, when he came to me, he was
wearing convex 30 for distant vision and convex I8 for near
vision. At this time he was nearly incapacitated for work, from
a tired, strained feeling of the eyes on continued application, with
an almost constant, heavy, confused feeling of head, smarting
and itching of the eyes and eyelids, photophobia, and a generally
run down feeling. -
Examination revealed vision 1% o.u. Hm. T515 V. %%- o.u. He
could read 4,-% with a convex 30 glass, but it was clearer with the
60. The doctor was told that his glasses were too strong, and
upon my advice they were reduced to a 60 for distance and 20
for near vision.
In April, 1889, Dr. H. returned, reporting that his eyes had
been much better for several months but of late were beginning
to trouble him again. At this visit an examination of the muscles
revealed an exophoria of 1 ° and exophoria in accommodation of 3°,
with an adduction of 22° in each eye. Systematic exercise with
prisms to strengthen the internal recti was advised, and followed
out faithfully, until an adduction of 48° in each eye was obtained,
with a considerable improvement in the comfort of his eyes. At
this point the phorometer showed orthophoria at distance, but
an esophoria in accommodation of 8°, with an abduction of 8°.
Thinking then that we were overdoing the exercise of the inner
muscles, because the phorometer showed a deviation of the visual
lines inward, I thought it advisable to try and strengthen the
outer muscles by exercise with prisms in order to -correct the
esophoria. _ This was followed out for over two months, until an
abduction of 12° was reached _and the esophoria reduced to 4°,
but, all the time we were exercising the outer muscles, the eyes
and head felt very much worse, and we were evidently making no
progress toward the cure of his eye strain. Then, upon one
examination, a test of his muscles was made with his glasses on,
and the mystery was at once solved ; for it was found that, while
he had orthophoria at a distance without his glasses, with the
convex 60, which he was wearing, there was an exophoria of 1°;
and in accommodation, while there was an esophoria of 4°
4 Headaches ResuZz‘z'ng from H yperopia.
without his glasses, with the convex 20, he was using, there was
an exophoria of 6°.
The use of all glasses at a distance was now stopped, and for
near work they were reduced to a 24 ; systematic exercise, with
prisms of the internal recti was again commenced and followed
out until, in December, I889, he had reached an adduction of 72°
in each eye, which he still maintains.
The phorometer at this time shows orthophoria at a distance
and esophoria of 3° in accommodation, but with the convex 60
glass he is now wearing for near vision, there is orthophoria in
accommodation.
Outside of the use of glasses and prisms he has had, from time
to time, various remedies and electricity used, but none of these
have been employed at all regularly.
The strength of his glasses for all near work has been success-
ively reduced, so that he is now wearing a convex 60 glass for
near vision and none for distance. His eye and head symp-
toms have disappeared gradually under the treatment, and his
general health has very much improved over what it was at the
time he was first seen in 1888.
This case has been detailed at length on account of its
peculiar course, and as an illustration of the pernicious
results from the use of too strong glasses.
First. We find a case which would be generally con-
sidered by all oc‘ulists, at the time his eyes were first troub-
ling him, as requiring glasses, and the gradual increase in
their strength as was followed would have probably been the
treatment of nearly all; and yet we find the eyes steadily
growing worse from their use.
Second. It demonstrates the necessity of examining the
muscular condition, both with and without the glasses,
which correct the refractive error, and that the treat-
ment should depend upon the condition existing when the
eyes are prepared for work, that is, with the glasses they
are to use.
Third. The permanent relief found after a course of
training of the ocular muscles together with the steady re-
duction in the strength of the glasses used.
Headaches Resulting from Hyperopzkz. 5
Fourth. The fact that after the strength of the internal
recti muscles has been increased from 22° to 72°, we find a
gentleman, now forty-six years of age, whose manifest hy-
peropia is 60, and who was over two years ago wearing a
+18 for near vision, now wearing with perfect comfort a
convex 60 glass for near work; in other words, making no
correction of the presbyopia.
One fact demonstrated in this case, viz., that in this
patient a convex 20 glass would convert an esophoria of
4° in accommodation into an exophoria of 6°, or an equiva-
lent to changing an orthophoria in accommodation to an
exophoria of 10°, led me to note the result of glasses in
other cases, and I found that in many cases of hyperopia
with esophoria, we could correct the esophoria by the use
of convex glasses, as for example :
CASE II.-——Miss G., aet. thirty-six years, came to me June 14,
I890, complaining of almost continuous headaches for the pre-
ceding two months, usually on top of head or at the occiput.
She thought the headaches were somewhat worse upon use of the
eyes at near work. Examination showed vision %§- o.u. No Hm.
Orthophoria at distance, esophoria in accommodation 4°, abduc-
tion 8°, Convex 72 glass gave orthophoria in accommodation.
This glass was then prescribed for near vision and at once gave
relief of her headaches, which have not returned up to the present
time.
The prescription of a convex glass in this case was made
simply because there existed esophoria in accommodation,
and was given to relieve the undue convergence of the
internal rectus muscle. The benefit to be gained from the
use of glasses in hyperopia with esophoria was first shown
by Dr. George 5. Norton, in THE JOURNAL OF OPHTHAL-
MOLOGY, OTOLOGY, AND LARYNGOLOGY, vol. 11., No. 1, in
which he formulates the most excellent rule: “ In mzmzl
fesz‘ /zyperopzkz ze/z'z‘/z esop/zorzkz (git/e stronger glasses Zkarz in
the same degree of emmifesz‘ /2)/peropzkz walk exep/zorz'a, for one
can depend upon there being a higher degree of latent
hyperopia in the former than in the latter.”
6 H eadac/zes Resulzfzhg from ff)/per0pz'a.
One more case in illustration will be all that I shall
detail, although many others could be taken from my case
records in demonstration of the points it is desired to make,
but, as they would prove merely a repetition of the features
detailed in these, it is not considered necessary.
CASE III.—Miss H., aet. twenty years, was recommended to
me on February 27, of this year, for an obstinate blepharitis,
which had existed for a year or more; edges of the lids were
covered with dry scales and crusts, with, at some points, small
pustules, from which exuded sufficient discharge to cause an
agglutination of the lids each morning. On reading, eyes ached
and felt tired and the lids became inflamed.
Had been subject to occasional headaches for years. Exami-
nation gave V. —% o.u. Hm. %; V. %--3 o.u., exophoria 2°, exo-
phoria in accommodation 10°; with convex 72 there was
exophoria in accommodation of 14°, adduction 16° each eye.
She was told that she did not require glasses, and that exercise
with prisms would relieve her.
This was followed out for about two months on an average of
twice each week, when she was discharged with the inflammation
of the lids entirely healed; no headaches, vision %-1% o.u. and not
benefited with glasses ; orthophoria both for distance and in
accommodation.
In this case I believe that the majority of oculists, find-
ing a case of obstinate blepharitis, with a manifest hypero-
pia of 72, would have at once ordered glasses for near
vision at least. At all events, I should have done so pre-
vious to my discovery that convex glasses would increase
exophoria, as it would have done in this case, with, I
believe, an ultimately increased and permanent weakness
of the already weakened internal recti.
Now, as to the rationale of this treatment, Donders has
pointed out that the function of accommodation and con-
vergence is associated in such a way that, for a given degree
of convergence, there is always a nearly equal degree of
accommodation, and vice versa. This relation is perhaps
due to the fact that the muscles of accommodation and
convergence both receive the same nerve impulse, as the
Headaches Resulz‘z"ngfrom H}/per0pz'a. 7
action of each muscle is governed by a branch of the same
nerve, viz., the third pair, or oculomotorius. The most
anterior filaments of this nerve arising from the floor of
the third ventricle, supply the ciliary muscle, while the
filaments of the nerve arising from the z'z‘er e Zerz‘z'o ad
guartzem 7/erzz‘rz'ezrlzmz go to supply the internal rectus
muscle. Landolt, in his “ Refraction and Accommodation
of the Eye,” says, “that a continued effort of the ciliary
muscle is practicable only when it calls for but two-thirds,
or at the utmost, three-fourths of the total power of accom-
modation,” and, on the other hand, “that the quota of
convergence, which can be utilized for continuous work,
ought not to amount to more than one-third or even one-
fourth of the positive convergence power ; hence, that two-
thirds or three-fourths of the latter should be kept in
reserve.”
The ciliary muscle is composed of three sets of fibers ; the
meridional, running parallel to the sclerotic; the circular,
forming a ring parallel to the cornea; and the radiating
fibers. Iwanoff has shown that, in certain myopic eyes, the
circular fibers may be entirely lacking, and, on the contrary,
in hyperopic eyes are so highly developed, that they form
one-third of the ciliary muscle.
As to the action of this muscle Heinrich Miiller ascribes
a different action to each set of fibers:
I. “ The circular fibers of the ciliary muscle exert a pres-
sure upon the edge of the lens, by means of which the lat-
ter becomes thicker.”
2. “The longitudinal fibers of the muscle cause an in-
crease of tension in the vitreous humor, on account of which
the posterior surface of the lens is prevented from shifting,
and the action of the peripheral pressure is chiefly confined
to the anterior surface” ; and also, that, “ The arching for-
ward of the center of the anterior surface of the lens is ren-
dered possible and favored by the recession of the periph-
eral portion of the iris, which is accompanied by a con-
traction of the deeper (circular) layer of the ciliary muscle
and the iris.” Thus we see that the circular fibers of the
8 Headaches Resalz‘z'agfrom H)/,1>er01’§z'a.
ciliary muscle are the ones by which the act of accommoda-
tion is chiefly caused, and, further, that these circular fibers
are especially developed in hyperopic eyes.
These facts should be considered in connection with the
fact that hyperopes require a much greater accommodation
than myopes who have little or no need of it.
To summarize a little we have first found that there is a
positive relation between accommodation and convergence;
second, that at the utmost there is but one-third of the
power of accommodation held in reserve, while, on the con-
trary, there is at least two-thirds of the power of conver-
gence remaining unused; and third, that the act of accom-
modation is especially required in hyperopic eyes.
Now, the query arises, Why is it not right to assume
that, by increasing the power of convergence, we can relieve
the strain upon the accommodation, with its resulting
asthenopic symptoms and headaches? This theory, to my
mind, is supported by the fact that when we put on a con-
vex glass in hyperopia, with exophoria, or a weakened
power of convergence, we cause a greater exophoria with a
diminished incentive to convergence, and thereby diminish
the power to converge, with the result that the more deli-
cate ciliary muscle, with but a small fraction of its full
power still left unused, is called upon to perform a certain
portion of the work of its much stronger associate muscle,
the internal rectus, and thus, by increasing the demand
upon an already weakened muscle, I believe serious harm
may be done.
Experience has demonstrated that, by systematic exer-
cise, we can increase the strength of any of the voluntary
muscles of the body. The internal rectus muscle is a volun-
tary muscle, and its power can certainly be increased by
exercise, but the ciliary muscle is an involuntary muscle,
and it is, so far as I know, beyond our power to increase its
strength; but as the action of these two muscles bear a
fixed and definite relation to each other, is it not sound
reasoning to believe that, by increasing the power of the
one we can reach, we are benefiting both?
Headaches Resulthzgfrom H J/]§e¢'0_.pz'a. 9
Hy/iperopia is a congenital defect of the eye, and generally
attributed to an imperfect development. Landolt states
that in children, under eight years of age, hyperopia is the
rule. The preponderance of hyperopia in the eyes of the
newly born has been shown by the examinations of Ely
(Arefziz/es of Op/zz%almology, vol. ix., p. 29), who found, from
the examination of I00 eyes of children under eight weeks
of age, that emmetropia was present in 17, myopia in II,
and hyperopia in 72.
Now, as hyperopia is seen to exist from birth, and as we
all know that the headaches and asthenopic symptoms do
not come on as a rule, in these cases, until from the eighth
to the twentieth year, or until the child has reached the
period of life when from his studies there is an unusual
requirement made upon the accommodation, we may safely
attribute the cause to either accommodative or muscular
asthenopia, i.e., a weakness of either the ciliary or the
internal rectus muscle, or both combined.
We have seen that these two muscles may be considered
as working together, and we may, therefore, draw the con-
clusion that by increasing the power of either the ciliary
or the internal rectus, or both, we are going to relieve the
symptoms resulting from the strain upon either, and, in this
way, by removing the symptoms for which the use of glasses
is generally advised, we will avoid the necessity of glasses
in these cases of a low degree of hyperopia. I say the low
degrees of hyperopia because there is, of course, a limit to
the possibilities of increasing the power of any muscle, and
and my limited experience in this direction will not warrant
even a suggestion as to the limit of the degree of hyperopia
in which we can forego the use of glasses.
We will now turn to a brief consideration of another con-
dition, viz., presbyopia, which is simply a recession of the
near point, due, according to some authorities, to a decrease
of the accommodation, and by others to a change in the
lens by which it becomes more firm, and in consequence of
this increased consolidation, the same amount of muscular
action cannot produce the same change on the form of the
I0 Headaches Resulz‘z'ngfrom I-fyperopzfl.
lens as formerly. The writer is inclined to believe it ‘to be
due, at least partially, or in some cases, to a decrease in the
power of accommodation, because we will often find the
degree of presbyopia varying very materially in persons of
the same age and of the same refraction; this, we believe
depending upon the use made of the accommodation by
various individuals; as, for example, the farmer, in his
occupation, does not make the same use of his accommo-
dation as the book-keeper.
Therefore, if presbyopia is the result of decreased power
of the accommodation, why will not the treatment to
increase the strength of the internal recti, or the power of
convergence, so as to perform in part the work of the
ciliary muscle, thereby reserve a greater power of the
accommodation to a later period, and in this way postpone
the age at which presbyopia would set in P
I make no claims as to having discovered an elixir of
life, but merely offer a suggestion as to a possible method
of postponing, to a moderate degree of course, the onset
of old age in so far as it applies to the presbyopic changes
of the eye.
All of the preceding portions of this article refers to
cases of hyperopia in which there exists exophoria. If,
however, we have hyperopia with esophoria, as in the sec-
ond case reported, my experience leads me to believe that
the use of glasses is imperative, and I have found that in
the majority of cases we can correct the esophoria by use of
the convex glass, and it has been my custom to prescribe
the glass which corrects, or nearly so, the esophoria; and
this will usually be the glass that represents the manifest
hyperopia, or a little stronger one, and should be used con-
tinuously. In some cases, in which the esophoria is of a
high degree, the convex glass necessary to correct the
esophoria will be too strong to be worn with comfort,
when we should only approach as near as possible to a cor-
rection and yet give comfort and clear vision to the
patient. If presbyopia exists with hyperopia, and we
have an esophoria in accommodation greater than that at a
Headaches Resulting from H J/peropia. I I
distance, a much stronger glass (sufficient to correct the
esophoria in accommodation) is given for near vision.
To conclude, the following deductions may be drawn:
I. Always examine the muscular deviation with and with-
out the correcting lenses, as convex glasses will increase
exophoria and decrease esophoria.
2. If exophoria exists with hyperopia, always prescribe
the weakest glass possible or none at all.
3. If esophoria is found with hyperopia, prescribe the
glass that corrects the esophoria, or as nearly so as possible.
EHHB iljz gorgplirgegls 6f lijz élulljom
he Homoeopathic Treat-
,ment of Incipient Senile
‘ ' Cataract, with Tabulated
' Results of One Hundred
° (Iases.
6-:
BY
A. B. NORTON, M.D.,'
Surgeon 10 Me New York Op/ztkalmic Hospzital, Professor qf Opkt/zalmology
Z/cc College of Ike New York Op/zfkal/m'c Hospital, Ojfikt/zalznic
Szzrgeon to Laura Franklin Free Hosyital for Ckildren,
and Protestant H00‘ Orphan Asylum, etc.
ffead before tke Homazepat/'zz'c Medical Society of z‘/ze County of 1Vew York,
Octoker, 1891.

REPRINTED FNOM THE NORTH AMERICAN JOURNAL OF HOMCEOPATHY.

NEW YORK :
M. J. ROONEY,
I891.
he Homoeopathic Treat-
ment of Incipient Senile
' ' Cataract, with Tabulated
' ' Results of One Hundred
° ' Clases.
BY
A. B. NORTON, M.D.,
Surgeon to t/ze A/ew I/or/e Op/zt/zalncic lfospcta/, Professor of 0,0/at/cal/no/ogy
in the College of t/ce 1V'ew Yor/e Op/zt/cal//tic ffosjfltal, Op/at/cal/mic
Surgeon to Laura Fran/etin Free Ho.s/>ttaZ for C/atdrm,
and Protestant flat]r Orp/zan Asylum, etc.
Read before t/ze Ho/lcozopat/1z'c 1k/ea’z'cat Society of t/ze County of ./Vew York,
October, 1891.

REPRINTED FROM THE NORTH AMERICAN JOURNAL OF HOMCEOPATHY.

NEW YORK:
M. ]. ROONEY,
1891.
THE HOMCEOPATHIC TREATMENT OF INCIPIENT SENILE
CATARACT, WITH TABULATED RESULTS OF ONE
HUNDRED CASES.
By A. B. NORTON, M.D.
OR the past two or three years I have been more and more con-
vinced that homoeopathic remedies will check the progress of
incipient senile cataract and prevent blindness, so‘ that when
the Chairman of this Committee requested me to contribute a paper
for this meeting, Ireplied that I would give my experience in the
treatment of commencing cataracts with remedies. . My intentions,
at first, were simply to use those cases coming under my own per-
sonal observation, as taken from the records of my own private
patients, as well as those treated in my clinic at the New York Oph-
thalmic Hospital; but, finding that out of the 73 cases treated in
private practice, many of them had not been under observation for a
sufficient length of time to form any positive data therefrom; and as
all the hospital cases had necessarily been carried through many
different case records, making it a difficult matter to trace them back
from year to year, I then decided to include, as being far more
valuable, all the cases of incipient senile cataract, 222 in number,
treated by my brother, the late Dr. Geo. S. Norton, during the last
ten years of his practice. This has been very easily and accurately
accomplished, because his case records, which are now in my pos-
session, have always been kept very complete. Many of these cases
are now under my treatment, and a great many of the others have
been frequently seen by me during the last ten years while associated
with him.
In the preparation of this paper, eoew case of commencing senile
cataract has been included, and all that have been under treatment
for more than three months have been tabulated in the order-in which
they first came for treatment. All cases of matured, or nearly matured,
cataracts, and all cases of other varieties of cataract, such as con-
genital, traumatic, zonular, polar, etc., have been excluded. This,
then, is a complete report, zozllzout selectz'orz,, of all cases of immature
senile cataract seen during a period of ten years, ending January I,
1891.
H
H
H
Fmsr EXAM-
INATION.
1 Apr. 27, ’81.
2 May 23, ’81.
3 May 26, ’81.
4 July 2, ’81.
Oct. 5, '81.
6 Nov. 22, ’81.
U1
7 Dec. 9, ’81.
8 Dec. 10, ’8I.
9 May 16, ’82.
0 May 17, ’82.
1 May 19, ’82.
2 June 7, ’82.
3 July 8, ’82.


AGE.
52
72
67
80
68
72
76
70
71
S4
SEX.
VISION. LAISI1‘AT];3,;<b‘:‘.M' VISION.
O D 15-100. Feb. 7, ’85. O U 15-30 d.
O S 15-40.
0 D 15-70 d + 12 15-30. Oct. 12, ’88. O U 15-200 d + 12 15-50.
0 S 15-50 cl -1- 12 15-30.
O D 15-50 (1. Jan. 29, ’oo. 0 D 2-200.
O S 15-40 (1. O S 15-40.
O U 15-100 + 14 15-30 d. Dec 29, ’83. O U 15-100 —|— 14 15-30 cl.
O U 15-100-18 15-50 cl. Nov. 1, ’83. O U 15-100 d—- 18 15-50 d.
O D 12-200—5 15-30. Oct. 6, ’86. O D --5 15-30 (I.
O S 3-200. Noimprovement.
O D 15-200-30 15-40 d. Dec. 3, '83, O D 15-70 d—30 15-40.
0 S 15-50 d-—-30 15-40. 0 S 15-50 d—-30 15-30 cl.
O U‘ 15-40. No improvement Apr. 15, ’85. O U 15-40 d.
O D 15-130. N0 improv. Aug. '22, ’83. O D 15-130.
OS15-50d-l-1415-30. OS15-40d-1- 1415-30.
0 D 15-40 -1- 48 15-40. Apr. 24, ’90. O D 15-50 + 48 15-40.
0 S 15-100 + 48 15-100. O S + 3 15-40.
0 D 15-200 + 12 15-20 (1. Feb. 10, ’83. O D + 12 15-130.
OS15-100+ 12 15-30. OS-I-12 15-50 d.
O D 15-100 cl-—5 15-50. Apr. 21, ’9r. 0 U — 5 15-70.
O S 6-200-5 15 50 .
Mar. 31, ’85 O D 15-50.
CO
D 1 -50 -l—_ 24 15-20 (1.
S 15-70 +20 15-20.



O S 15-100.
TR EAT-
MENT.

Reg.
None.
Reg.
Reg.
Reg.
lrreg.
REMEDY.
REMARKS.
Varied
None.
Sepia.
Caust.
Caust.
Caust.
Caust.
Varied.
Caust.
Striac in each lens, especially right.
No treatment, vision had failed in 7 years
from 15-30 to 15-50.
Somewhat similar case to N0. 2, this, un-
der treatment. 9 years later hadim-
proved slightly in the best eye and
failed in the other.
Strize in each lens.
Rheumath .
Stria: and spots of haziness in each lens,
especially at periphery.
Paresis Rectus Internus O.
O D vision poor for years.
Nitric ac. O S opacities of vitreous.
Slight haziness periphery of each lens.
Caust. O S cataract increased and matured.
Nux vom Lens extracted m ’89.
Conium.
Ruta. .\/Iacula cornea and posterior staphyl-
Caust. oma O. -
Sepia.
Caust.

H
U\
M
O
N
III
July 19, ’82.
Jan. 30, ’83.
Aug. 7, ’83.
Oct. 31, ’83.
Dec. I2, ’83.
Jan. I0, ’84.
Jan. 28, ’84.
Apr. 21, ’84.
Iuly I, ’84.
Oct. 18, ’84.
Oct. 23, ’84.

Mar. 17, ‘83.
May 31. ’83-
\Iar. 25, ’84.

70
SS
60
64
74
5o
78
15-40 (:1 + 20 15-30 d.
-I00 —|— 50 15-70 d.
3-zoo.
I5-I00 —|-- 14 15-30.
0 D I5-200-10 15-70.
0 S 6-20o.
O D I5-50 —|- 24 I5-I5 d.
O S I5-200.
O U I5-40 d -|- 36 15-15 d.
O D 6-200-9 I5-3o d.
O S I5-I30-—-I4 15-30 (1.
O D I5-30 d.
O S 15-40 —|- 24 15-15 d.
O D I5-3o d
O S 15-30.
0 S I5-5o d.
' O D I5-50 d—36 I5-30 d.
OS I5-I5 d -}- 60 I5-I5.
O D I -30 + I6 15-70.
0 S 15-30 -1- 16 15-30 (1.
O D I-200.
O S 15-20.
15-40 (1 + 20 15-20 cl.

Mar. I8, ’88.
Nov. 20, ’83.
Aug. I 7, ’89.
July 3. ’89-
Sept. 28, ea.
Ian I7, ’89.
Nov. 6, ’8g.
Jan. 30, ’89.
Feb. 23, ’85
Nov. I3, ’90.
Feb. 9, ’85.
May 24, ’9o
Apr. 3, ’88.
Apr. 6, ’89

O U I5-40 d.
O D 6-200.
0 S 3-200.
0 U I5-SO cl.
0 D 15-200 -10 I5-70.
+ 24 15-30.
200.
I5 50 —|— 36 15-20.
-Ioo —|- 36 15-20 (1.
O D I5-zoo.
O S I5-4o d. + 24 15-15 d.
O D 15-30.
0 S I5-40 cl.
0 S 15-100.
0 D I5 70 d.
O S I5-I5 d.
O D 15 200.
O S 15-200.
0 S 15-70 d.

Reg.
Reg.
Reg.
Reg.
Reg.
lrreg.
Reg.
Reg
Reg.
lrreg.
lrreg
None
Reg.
Reg.
Puls.
Sulph.
Caust.
Phos.
Nux vom
Caust.
Sepia.
Caust.
Caust.
Caust.
Caust.
Cale. ph.
Nux vom
Nux vom
Pulsat.
Caust.
Silicea.
Kah mur
Sepia.
Caust.
None
Caust.
Cale ph.
Caust.
Strict. Duct. Lachry. O. S.
Haziness of lens did not seem to increase
proportionately with the loss of vision
Cataract matured in left eye, and lens
extracted in I885 with resulting vision
of I 5-20 d.
Matnred cataract O. D.


2
U)
U)
U.)
4
(J)
0.)
U1
0.)
\!


No. FII:lsJ\T}I3(;{§.M' AGE. SEX Vision. LAIq;AT:IF"(‘;:,’_\M' VISION.
Nov. 14, ’84 76 NI. 0 U I5-15 cl. May 18, '90. O U 15-50.
Dec. 5, ’84. 69 F. O U 15-5o_ Sept. 2Q, ’9o. 0 U 15-40 d
Mar. 3, ’85_ 73 F O U 15-7o—4o 15-40 cl. Oct. 10, ’9o 0 U 15-7o.
.\Iar. 23, ’85. 68 F. O D 15-2o cl May 12, ’91 O D 1'- o.
OS15-3od OS15-30d
Apr. 16, ’85. 62 F. O D 15-50 + 20 15-15 cl. Apr. 28, ’9o. 0 D 15-40 d -|- 20 15-15 d.
O S 15-70 -]- 30 15-20 cl. 0 S 15-70 + 30 15-40 d.
Apr. 21, ’85. F. O D 2-200. June 21, ’86. O S + 36 11-30.
OS15-5od—|—3615-4od. J
Apr. 23, ’85. F. O D 15-70 + 15 15-20 cl Sept. 9, ’86. O U 15-40 d.
O S 15-70 + 36 15-20 (1
Apr. 27, ’85. 82 M O D 5-2oo—-7 15-7o. Apr. 7, ’91 O U-7 15-70.
0 S 9-2oo—7 r5-5o d
Jan 24,’85. F. OU15-5od—]—5o 15-15d Nov.zr,’85. OU-I-5015-15d.
July 13, ’85 70 O D 7-200. Aug. 17, ’91. O S6-200.
O S 15-70.
Oct 27, ’85. 59 F. () D 8-2oo—5 15-70. Nov. 2, ’88. O D— 5-200
O S 6-2oo—6 15-7o. O S —6 15-100
Dec. 5, ’S5. 80 F. O D 15-2oo + 20 15-50 d. July 6, ’86. O D +20 15-70
0 S 10-2oo+2o 15-5o cl. OS-I-20 15-10o.
Feb 17, ’86. 68 F. O D 15-2oo—i2 15-5o d. Jan. 8, ’91. O D 15-100 — 12 15-50.
OS122oo—815-50d. OS15-20o—i2 15-ioo.
Mar. 3, ’86. 66 F. O D 15-40 (.1. Mar. 25, ’9i. O D 1 -30 d
OS15-40 d. OS15-god
Apr. 8, ’86. 70 F O D 15-3o d july 2, ’88 O J) 15 20 d
OSi5-40d OS15-50d




TREAT
MENT.

Irreg
Reg.
Reg
Irreg.
Reg.
Reg
Reg.
I1-reg
REMEDY.
REMARKS.
Caust.
Caust.
Caust.
Nux vom
Caust.
Varied
Caust
Lach.
Sepia.
Caust.
Nat.mur.
Caust.
Sepia.
Calc. ph
Caust
Con
Caust.
\Tux vom
Gels.
Caust.
Sepia
Caust.
Calc ph

Did not commence treatment until Oct.
’88, when VlSlOl'l was 15-30
Large striae in periphery of each lens
e.\tending nearly to centre, which is
c ear. Rheumatic.
Diffuse hazmess in each lens. Rheumatic.
U)
June 4, ’86.
Iuly 29, '86.
’ Nov. 6, ’86.
Dec. 0, ’86.
Dec. 28, ’86
Jan. 10, ’87
Jan 17, ’87.
Ian. 19, ’87.
Jan. 20, ’87.
Feb. 7, ’87.

June 12, ’86.
Nov. 17, ’86.
Nov. 29, ’86.
Dec. 23, ’86.

60
76
79
79
46
67
64
O D 15-200-8 15-70.
0 S 15-20.
O D 15-40 d.
O S 15-200
O D 15-50 -1- 24 15-30.
O S 15-50 + 24 15-20 d.
O U 15-I5 cl.
0 D 15-20.
O S 10-200—8 15-200.
0 D 15-100.
O S 15-15 d.
OS 15-70d
O D 15-70 (1 —|— 20 15-20.
O S I5-70 d-i-20 15-20
0 D 15-30 cl + 30 15-15 (1
O S 15-20 d + 36 15-15 cl
O D 15-15 -|- 48 15-15
O S 15-200-14r 15-100
D 15-100-{-72 -l-60c 15-40d.
S 15-2 ,0. N0 nnprovem’t.
15-15 d -1- 30 15-15 (1.
Shadows.
15-100 d--7 15-70.
0-200-7 15-200.
July 24, ’86.
Oct. 18, ’89.
Jan. 6, ’91.
Dec. 6, ’87.
July 10, ’89
Oct. 22, ’90.
Oct 23, ’90.
July 5, ’87-
Sept 30, '90

Sept 10, ’91.
June 10, ’9o.
June 24, ’89.
Mar. 12, ’87.
Jan. 1 5, ’89.

O S 15-20 d.
O D 15-40 d.
OD-i-2415 50.
OS—[—2415-20d
O U 15-15 d.
O S 15-100.
0 D 15-100 d+ 20 15-20 d.
O S 15-70d -|- 20 15 20
0 U 15-20 d.
O D 15-15 Cl.
-}- 72 + 60 c 15-40 d.
+ 3 3-4 15-20 d-
O D 15-200 -1- 16 15-70.
0 D 15-100 d—7 15-70

Reg.
Reg.
Reg.
Reg-
Reg.
Reg.
Irreg.
Reg.
Reg.
Reg
Irreg.
Reg
Caust.
Caust.
Gels.
Phos
Caust.
Napth.
Caust.
Calc. ph.
Caust.
Sihcea.
Sulph.
Sepm
Vaned.
Cale ph
Caust.
Caust
Puls.
Caust .
Chm ars.
Caust
Napth.

Peripheral opacity in each lens.
Stnaa at periphery, each lens chrome
glaucoma O D Indectomy made
Dec., ’86.
Marked opacity at periphery.
O D striae at periphery.
O S very hazy. Rheumatic.
O D Central opacity oflens
Cataract mature O. D.
Stnae at periphery.
O D densely opaque at the periphery.
O S opacity both central and periph-
eral Rheumatic.
O S cataract matured and extracted
Nov. ’89, with v—15-20 d.
O D opacity below.
0 S stna: at periphery and Strict. Duct.
Lachry.
OD marked striaa. O S cataract ma-
tured. Entropion.
Glaucoma adherens and posterior staph-
yloma.


as
69
70
FIRST Ex AU-
INATION.
Feb 9, ’87.
Mar. 1, ’87.
Mar. 4, ’87.
Mar 5, ’87.
Mar. 29, ’87.
May 3, ’87.
June 10, ’87.
June 17, ’87.
July 25, ’87.
Sept. 23, 87.
Oct. 18, ’87.
Nov.
Nov.
10, ’87.
I3, ’87.
Nov. 20, ’87.
. I4, ’87.

AGE.
60
73
70
66
70
68
34
70
59
60
49
Ssx.
LAST EXAM-
TREAT-
VISION. [NATION VISION. MENT. REMEDY REMARKS.
O D 15-70 -|- 30 15-20 cl. Jan. 31, ’89. O U -|- 30 15-15 (1. Reg. Caust.
O S I5-40 cl + 30 15-20 Cl.
0 U I5-30 cl -1- 48 15-20 d. Dec 20, ’89. O U + 48 I5 20 (1. Reg Caust. Diffuse haziness in each lens.
0 D 15-70. No improvement. Mar. 25, ’90. O D 15 70 d Irreg Caust. Haziness in each lens like fine dotted
O S 15-30. 0 S I5-I00 veil.
O D I5-70 + 14 15-15. Mar. 30, ’87. O D I5-70 d --|- 1415-15 d Reg, Varied.
O S I5-I00 + 9 I5-50. O S I5-200.
O D 5-200. June 5, ’gr. 0 D + 3 15-20 d. lrreg O D Large spots of haziness not striat-
O S I5-I00 d + 10 15-20. 0 S 15-200 -1- 10 15-30. ed, Cataract matured and extracted
with v I5-20 d. 1
O U 15-50 d + 20 15-15 cl. Sept. 12, ’9o. 0 U 15-50 (:1 + 20 15-50 d. Reg Caust. Og Igluclear haziness and few striae in
O D I5-30 d Nov. 26, ’89. O D 15-20 d. Reg. Nux vom Striae in both lenses.
O S 15-40 —|— 60 15-15 cl. 0 S 15-50 (1. Caust.
O D I5-I00 d—C) 15-30. July 6, ’88. O D -—9 15-40 d. Irreg. Caust. O U Striae at periphery and posterior
O S 5-200. staphyloma.
O D 15-30 -1- 36 15-30. Sept. 3. ’9I. O U I5-30 d. Reg. Caust. Striae in both lenses.
O S I5-20 d-|- 36 15-20 d.
O D 15-70. Oct. 22, ’9o 0 D 15-100. Reg. Calc. ph.
O S 15-30. 0 S I5-30 cl
0 D 15-70 -|- 20 c I5-30 d. Sept. 30, ’89. O D 15 50. Reg. Calc ph. Large irregular opacities in both lenses.
O S 15-70 —|— 30 c I5-40. O S 15 70 d. lgnat.
O U 15-70 -1- 36 15-30 d. Jan. 16, ’89. O U 15-30 (1 -|- 36 15-20. Reg Caust. Nuclear haziness O. U.
0 U 15-20 May 27, 91. O U I5-20 d. Reg. Caust. Marked striae all through both lenses.
Rheumatic.
O D 15-2o0—14 I5-70. Apr. 29, ’90. O D — II 15-70 d. Reg. Caust. Irregular striae in both lenses.
O S I5-2o0—7 I5-I00 d. O S Shadows.
O D I5-I00 June 28, ’88. O U I5-I00 d. Irreg Sepia.
O S I5-200

72 Apr. 25, ’88. 65 F. O U 15-15 d Sept. 11, ’88. O U 15-15 (1. Reg. Phos. O U Peripheral opacities. Rheumatic.
Calc. ph.
73 May 28, ’88. 60 F. IS) 15-2ood+ 14 15-15 d. Oct. 2, ’8q. 0 U + 14 15-15 d. Reg Senega. O U Haziness at periphery.
15-100 -]~ 18 15-20.
74 May 29, ’88. 65 M. '0 D 15-40. Jan. 19, ’89. O D 2-200. Reg. Caust. O U Peripheral opacity.
IO S 15-100 + 30 15-15 d. O S 15-70 d -|- 30 15-15 d. O D Central Opacity. Rheumauc.
75 Aug. 20, ’88. M. O D Shadows. Aug. 2, ’go. 0 S — 3 9-200. Irreg. Phos. O U Post staphyloma and atrophy of
O S 2-20o—3 15-200. Con. choroid.
76 Oct. 31, ’88. F. é) 15-200;} 14 15-20d Aug. 27, ’90. O U —l- 14 15-30 cl. Reg. Caust.
15-200 14 15-20 .
77 Nov. 12, ’88. 55 F. !O U 4-2oo—5 20-100. Aug. 13, ’91. O U — 5 15-100. Reg Caust. O U Posterior staphyloma atrophy of
I Iodof. ; choroid.
78 Nov. 20, ’88. 68 F. IO D 15-20) -|- 12 15-15 cl. June 11, ’91. O D -|- 13 15 15 d Reg Calc. ph. IO D Peripheral opacity.
IO S 8-200 -|- 18 15-30. 0 S -|- 16 15 200 Arg. nit. O S Central opacity. Rheumatic.
79 Dec. 17, ’88. 48 M. I() D 15-200 Dec. 16, ’9o. 0 U 15-50 Reg. Calc. ph. Diffuse haziness of both lenses.
0 S 15-100 d. Kali iod
I Kali mur
.
80 Jan. 8, ’8g. 69 F, '0 D 15-50 cl + 36 15-30. Jan. 19, ’9o. 0 D —|— 36 15-30 d. Reg. Caust. IO S Retinitis haemorrhagma. "
,0 S 2-200 -1- 10 15-200. Lach I
I
81 Jan. 11, ’89. 76 F, O D 4-2o0—5 15-70. Mar. 8, ’90. O D—5 15-50. Reg. Arg. nit. Diffuse haziness in centre of each lens.
IO S 4-2o0—8 15-40. 0 S-8 15-30. ' Ii Rheumatic.
82 jan. 23, ’89. F. IS) 15-30 —l- 60 15-20. Oct. 18, ’8g. 0 U 15-20 d. Reg. Caust. Striac in both lenses.
15-40 d.
83 Feb. 11, ’89. 47 F, i0 D 15-200 -|- 16 15-15 d. Mar. 27, ’91. O U 15-200 + 16 15-30. Irreg Ignat.
O S 15-200 -|— 16 15-30 (1. on.
84 Feb. 14. ’8g. 78 F. IO U 15-200 -|- 12 15-70 d Aug. 12, ’89. O U 15-200 —|- 12 15-70. Reg. Varied. IBoth lenses opaque below. Rheumatic.
85 Feb. 22, '89. 74 F. !O D 15-30. Aug. 27, ’91. O D 15 30 d. Reg Phos. IO S Retinitis haemorrhagica.
'0 S 15-100 d. O S 15-100.
86 Apr. 22, ’89. 54 F. O D 15-200--10 15-20. Apr. 8, ’90. O U — 1015-30. Reg Nat.mur.
O S 1: 2"c—— 0 15 20. *1‘~rw








OI


- I x
ho. Finsi E A“
INATION
__I
I
87 I May 29, ’89.
88|June 7, ’89.
I
89'Ju]y I7, ’89
90 Sept. I6, ’89
91 Nov. 4, ’89.
92INov. 26, ’89
93 Dec I8, ’89.
94 Jan. 14,, ’90
95 Feb. 27, ’9o
96 Mar. 13, ’90.
97 Mar 29, ’90.
98 May 3, ’90.
99 May 21, ’90.
100 July 15, ’90.


Ace. I SE\.
75
50
70
60
68
71
63
82
F.
F
F.
VISION.
O D
O S
OD I5-I00 d.
OSI5-70 d.
O D I5-50 d —I— 15 15-40.
O S 15-40 —|- 20 I5-30.
OU
3—2oo—-6 I5-200
O D 15-40 (1.
O S I5-50.
O U I 5-40.
0 U I0-2oo—II-40 c I5-30.
6-200.
15-70 —I— 16 15-30.
0 D
OS
0 D I5-4.0 d.
O S 15-40.
0 U I5-70 cl.
0 D I5-200 -I- I2 I5-30.
O S 6-200.
0 U 15-40.
0 U 15-30.
0 D 2-200.
O S I5-I00 cl -I— I6 I5-30.
LAsI E\' \\I-I
TREAT-I



IN H-ION, VISION- MENT_ REMEDY. REMARKS.
I
I I
Jan. 2, ’9I. O D I5-50 Ii-reg. Caust. I
I0 S I5-30 cl I 1
Oct. 8, ‘go. 0 D 15 70 Reg. ]Calc. ph. Both lenses densely opaque at periphery.
IO S 15-50 I I
June I0, ’9I. O D I5-70 Ineg. ‘Cale ph. Large striae in both lenses. Rheumatic.
O S 15-40 I I '
Sept. 29, ’90. IO U 6-200 -—-6 15-200. Irreg Caust. IRheumatic.
Nov. I6, ’9i. 0 D 15 40 d Reg. ICaust. I
O S 15-50. I
I
Mar. 26, ’90. O U I5-50 d Reg. |Caust. IRheumatic.
I I
Aug. I9, '9'. O U—II— I6 c I5-30. Reg. ICaust. O U Dense opacity at peripheiy Rheu-
I I I inatic.
July I9, ’90. IO S I5 70 d -I- I8 15-40 Reg. Calc. ph O D Densely opaque striae In both lenses.
I
Sept. I2, ’9I IO U I5-20 d Reg. Caust Broad striae in both lenses.
Iodof.
June 26, ’9I. O U I5-70 cl. lrreg. Caust. Diffuse hazmess both lenses.
Sept. 3, ’9I. O D —I- 12 15-70. Reg. Iodof.
IO S Shadows. I
July 6, ’9I. IO U I5-40. Reg. Varied. Rheumatic.
Sept. 4, ’9I. IO U I5-20 Reg ICaust. Stria: both lenses. Rheumatic.
Apr. 27, ’9I. O S -I- I6 I5-30 d. Reg. I


ICaust. ICataI-actnearlymatured O. D. Rheu-
IIIQIZIC.
II
SUMM-\RY.——Tl'1€ records show a total of 295 cases, of which 1oo cases
have been under more or less treatment for a period of three months or
over, and are therefore included in the above table. Of the 195 cases
not included in the table, because not under treatment for three months,
many of them have undoubtedly been treated by their family phy-
sician, as oftentimes we have recommended the line of treatment in
these cases to be followed out by the general practitioner.
Under the heading of treatment those were classed irregular who
had been seen but a few times during the period between the
first and last examination, while those classed as having received
regular treatment were seen at intervals as frequently as from two to
six weeks during a part of the period at least. Under the heading of
remedies are given simply the principal drugs used. In some cases the
remedy given was the only one used throughout the treatment, but
in a great many of the cases other drugs have been given temporarily
to meet other indications or conditions that have arisen, usually re-
turning to the original remedy as soon as those indications had been
relieved.
An analysis of the table shows that there was an improvement in
the vision in 13 per cent. of the cases under treatment; remained the
same in 42 per cent.; became slightly less in 26 per cent.; and de-
cidedly less in 19 per cent; thus giving 55 per cent. of successes,
26 per cent. of what may be considered favorable results, and but 19
per cent. of failure.
Further, there were 34 cases under treatment about one year; of
these the vision in 5 cases was better at the last examination than
when first seen ; in 13 the vision was the same; in 8 slightly less, and
in 8 less. Of the 20 cases under treatment about two years, the
vision in 5 was better, 9 the same, 4 slightly less, and 2 less
Fourteen cases were under treatment about three years, and of these
the vision was the same in 8, slightly less in 5, and less in 1. Six
were seen for about four years, I had better vision, I the same, 3
slightly less, and 1 less. Eleven were seen five years after the first
examination, of which 1 had better vision, 4 the same, 4 slightly less,
and 2 less. Eleven examined six years later showed better vision in
1, the same in 5, slightly less in 1 and less in 4 cases. One case
seen seven years later had less vision. One after eight years had the
same vision, and of two seen nine years after the first examination,
1 showed the same vision and the other one slightly less.
In explanation of the classification as slightly less, I would say
that only those are included under this heading, where the vision had
I2
failed not more than one line of Snelling’s test type, as for example
from 16/L0 to 16/30 etc.; where the failure in vision was greater than this
they were classified as vision less, meaning that the progress of the
cataract was following the usual course of this disease onwards to
blindness without being checked by the treatment, although it is
possible the progress would have been more rapid had the treatment
not been followed out. This point is, of course, impossible to dem-
onstrate, because it is a well-known fact that all cases do not progress
alike, some leading to blindness within a few months while others
will require years. Another feature of these one hundred cases is that
nearly one-half of them, viz., 46, were seen over two years after the
first examination, and the table shows that of these, three had better
vision, 20 the same vision, in 14 it was slightly less, and in 9 less than
when first seen, showing that one-half of all the cases under treat-
ment over two years had had no failure in the sight, and in about
one-third more there had been but a very slight loss of vision, leaving
but one-fifth of the cases under treatment over two years, in which
the vision had materially failed—a result more favorable than I had
even suspected. One other interesting-analysis of this table will show
the results from the treatment in the different stages of the cataract,
as compared or based upon the vision at time of first examination
with that at the expiration of the treatment, viz:

VISION AT LAsT EXAMINATION.
VISION WIIEN
FIRST SEEN. BETTER. SAME. SLIGHTLY LESS. LESS.
15/15 0 8 3 2
15/20 2 8 7 I
I5/3O 3 9 6 5
15/40 4 7 2 2
15/50 2 2 2 3
15/70 2 3 2 6
15/100 0 4 3 0
I 5/200 0 I 1 0


From which we find that in all cases where the vision at the time of
commencing the treatment was better than 15/50, the cataract, as
shown by the vision, made no increase in 60 per cent. of the cases,
slight increase in 26 per cent. and decided increase in I4 per cent;
but that in those cases where the vision at the first examination was
not better than 1“ ,0, the cataract seemed checked in only 45 per cent.
of the cases treated, increased slightly in 26 per cent. and increased
13
decidedly in 29 per cent., thus showing that the possibility of check-
ing the growth of cataract by treatment is far better in the early
stages of the disease.
As to the refraction of these IOO cases, we find that 44 were hyper-
opic, 24 myopic, and 32 in which there was no record of any im-
provement with glasses.
One peculiarity noticed in looking over the records of these cata-
ract cases is that of the total number of cases, 295, there were 232
females and 63 males. This large preponderance of cataracts in
women seems to me hardly accounted for by the fact that more
women come for treatment of the eyes than men. I also find
that in the 100 cases recorded, 18 were noted as suffering more or less
from rheumatism, and as this feature was not particularly searched
for in the records of each case, I am positive that this number should
be considerably larger. What relation, if any, rheumatism bears to
the causation of cataract, I am unable to say, as it is certainly not
generally recorded as a cause of cataract, and is only referred to be-
cause noticed in so many of these cases. As to the remedies used
in this series of IOO cases, we find twenty-two different remedies
mentioned as being the ones principally used, although, as previously
stated, many others have been tried temporarily without any notice-
ably favorable results, or given to meet certain temporary indications
or conditions.
Causficum, of all the remedies used, has undoubtedly proven of the
most value in my hands, and, as the table shows, has been given in
64 of the IOO cases detailed, while in many of these it has been the
only remedy used. The principal indications for caus/icum seem to
be a feeling as if there was sand in the eyes, sensation of pressure in
the eyes, heaviness of the lids, burning, itching of the eyes, with a
desire to keep them closed, photophobia, flashes of light before the
eyes, winking and twitching of the lids. One case, illustrating the
action of CdZ¢S/fCLt7/L, was No. 47, Mr. H. H., first seen on November
17, 1886, with vision O. D. 15-20, no improvement with glasses, O. S.
Io-2oo—8 V. I5-zoo, states that for one and a half years eyes have
been growing worse, that they tire on using, feel sore and lame, are
sensitive to the touch, burning and smarting of the eyes as though
there was sand in them; eyes feel large and swollen, slight redness
of the left eye, left lens very hazy, diffuse at centre, and with striae
at the periphery, right lens centre clear, but with fine striae at per-
iphery; general health good, with the exception of some stiffness of
the joints of the hands.
14
This patient was given eaus/fcurrz on nearly every visit up to the
last, on January 6, 1891, at which time the vision was 0. D. 15-15d,
O. S.-61/2, V. 2-zoo. The lens of the right eye still showed the fine
striee at periphery, while in the left eye it was very nearly matured.
The treatment in this case was about as frequent as it should be, and
more regular than the large majority of those so marked in the table,
the case record showing 6 visits in the balance of the year 1886, 19
during the year 1887, 4 in 1888, 2 in 1889, 1 in 1890, and I in 1891.
Possibly there were a few other visits in the first two years of which
no note was made.
Calcarea p/2os., which seems to have been the next most useful
remedy. is noted as having been given in 15 of the cases. The only
reference to this drug in the Ophthalmic Therapeutics is, “In check-
ing the progress of cataract it has appeared to be of decided service.”
Our case records show it to have been given for the following
symptoms: headaches, especially of the right side, pain around the
right eye, aching pain in the right eye, tired feeling of the right eye.
These have all been relieved by ealc. j)/zos. Other symptoms noted
were: eyes feel stiff and weak, dizziness, rheumatic pains, etc.
Se/)z'a was given in nine cases on the following symptoms: Eyes
feel weak, worse towards evening and better in the middle of the day;
some sharp pains in the eyes, heaviness ofthe lids, twitching ofthe lids,
smarting of the eyes, relieved by eating; headaches which are worse
morrzhzg and eoemflg, perspires very freely, worse morning and eve-
ning. The morning and evening aggravation seems to be characteristic
of sepia, and it is a useful remedy in the cataracts of women.
P/zosp/zorus has proven of value in some cases of cataract. The
especial indication of the eyes seems to be the colors before ozlfion,
black floating spots before the eyes, flashes of light, and the con-
comitant symptoms of the drug.
Na/)/at/mime is another remedy I have used, simply because it was
found to have produced cataract in the eyes of animals, but my
success with this drug has been very indifferent.
[odoform is a remedy deserving of mention in this place, simply
because of the most favorable results attributed to it by Dr. Wm. R.
King, of Washington, D. C., who, in the April number of the “Jour-
nal of Ophthalmology, Otology and Laryngology,” reports six cases
of incipient cataract very much benefited by this drug. Since that
date l have used iodoform in a good many cases, but my experience
has extended over too short a period to lead me to form an opinion
as to its value. The other remedies named in the table as having
15
been used in incipient cataract are: Argent. nz'/., c/22'12. ars., c0n.,
gels, zlgna/., /'ab., /eaZz'i0a’., /ealima/'., /ac/z., na/r. ma/'., az'/ric acza’, nux
7/0112., palsa/., senega, szfitea, salph.
Galz/am'sm I have employed in a great many cases, but always
together with remedies. The cases in which it has been used have
shown no more favorable results than those treated with remedies
alone, so am undecided whether it has any value or not. I think we
are very apt to be deceived as to the true value of electricity in dis-
eases of the eye, for when properly applied it seems to leave a very
agreeable sense of relief in a great many conditions of the eye, and if
we rely upon the opinion of the patients are apt to give it, perhaps,
more credit than it really deserves. '
Massage of the eye in incipient cataract has been credited with
surprising results by some. I have employed it in three or four cases
only, with no apparent results.
REM./\RKS.——I desire, before closing, to say that I wish it distinctly
understood that I do not claim to care cataracts at any stage, that is,
when we mean by a cure the clearing up or removing of an already
existing haziness of the lens, 1. e., cataract, no matter what stage or
form the opacity may assume ; for in my opinion an opacity of the
lens once present will always remain, and in those cases reported, in
which the vision is recorded as better than when first seen, we have
been able to determine no change in the opacity of the lens.
This is stated because frequently patients will come for treatment
of cataract, saying that they did so because I had cured some one
else of a cataract, and in this way a false report is circulated of my
claiming to cure cataracts, while all that has ever been claimed, or
is asserted now, is that commencing cataracts, when taken early, can
usually be c/zec/zed by homoeopathic remedies.
The mere stopping the progress of a condition which, when left
to itself, inevitably leads to a more or less complete loss of sight, dem-
onstrates the superiority of our system of medicine over that of our
old-school friends, as in none of their works upon the eye is there
named any treatment to prevent the progress of cataract when it has
once commenced. De Wecker says: “I know of no means of
checking the growth of a senile cataract.”
Berry says: “Some cases, for instance, rapidly advance till a
considerable degree of opacity is reached, and then only progress
slowly to maturity, while others advance slowly at first, and, after
reaching a certain stage, very quickly end in complete opacity.
Probably, however, no cases remain absolutely stationary, etc."
16
As to the duration of treatment required, my method is to see the
case every two weeks for the first six months of treatment; if there
is then no increase of the opacity or loss in the vision, I will see
the patient once a month for the next six or eight months. If, at the
end of this period, there has been no progress in the growth of the
cataract, I then desire to see my patient only every second or third
month for another year, and if, at the end of this time, both the vision
and opacity of the lens remain the same as when first seen, simply
have them report about once a year for examination.
This has been my rule, because I do not believe we have any
right to say that the growth of a senile cataract has been checked
until it has been under observation, without increase, for at least two
years.
Our literature in past years has, unfortunately, contained too many
reports of cataracts cured within a short time and with a few doses of
medicine. These, as a rule, can be disposed of as a mistake in the diag-
nosis, and as the growth of cataract may be so variable and so slow,
there should be no credence placed upon any such report for a period
of less than two years, or when the report was unaccompanied by
the actual vision at the first and last examination, and, further, unless
the diagnosis was made by one competent to use the ophthalmoscope.
One other feature, that seems to me of great importance, is that
the treatment should be undertaken early, for the study of these cases
shows that in 60 per cent. of the cases treated, where the vision was
better than 15-50, the degenerative changes in the lens were stopped,
while with a vision of but 15-50 less, but 45 per cent. were held in
check. This difference, in my opinion, will as a rule probably be
greater than less than the above proportion, as I have often seen cases
where the cataract is further advanced in one eye than the other in
which it will be controlled for years in the eye least affected, while
the other will steadily progress to blindness.
152 \/Vhhl 54i‘H S'i‘R1.Ei‘.
N 1333110;
it
[NFLAJV[1l[ATIOZV OF TIIE OOZVJUNGTIVA.
BY G110. S. Nonrox, M. D., NEW Yonx.

It is not within the province of this article to discuss the
symptomatology, etiology, etc., of diseases of the conjunctiva.
These points have been well described by various authors.
The treatment, by the so-called “Regular School,” has also
received sufflcient attention, but nowhere in our literature do
we find given the strictly homceopathic treatment of these
important affections; except, perhaps, i11 those excellent pa-
pers by Dr. Dudgeon, published years ago in the Br/it/is/L
./camel of [[0972/ceopcetlrz/, where the subject, however, was
only incompletely considered, owing chiefly to the want of
knowledge at that time of the efficiency of our drugs in these
affections. This void in our literature we shall endeavor to
fill, at this time, by giving the remedies which have been
found useful in these disorders and their indications as con-
firmed by clinical experience. In order not to occupy too much
space by repetition, and at the same time render this paper
practically useful, our divisions of the subject will be general;
while the special form of disease to which each drug is
adapted will be mentioned when giving the indications for its
use. i
The forms of conjunctivitis which we shall consider are
the catarrhal, purulent, granular and phlyctenular.
OoNJUNe'r1v1'r1s O.1'rAnRHAL1s, AeUTA ET OIIR.0NI(JA.—-~TllG
first point in the treatment will be the removal of any excit-
ing causes. To accomplish this, the lids should first be
everted and examined for the presence of a foreign body,
woRLn’s HOMCEOPATHIG CONVENTIQN. [2
which, if detected, should be removed. If the conjunctivitis
depend upon any anomaly of refraction, this should be cor-
rected. If due to straining of the eyes in reading, writing
etc. (especially in the evening), or to exposure to wind dust, or
any bright light, as working over a fire, directions to abstain
from overuse, or to protect the eyes from the injurious causes,
should be given. If the case be very severe, the patient may
be confined to his room, though this is rarely required in
pleasant weather. As direct remedies, cold applications are
especially recommended. But care should be taken that they
are not employed too constantly, particularly if there is
oedema of the lids, for they often prove harmful in these
cases. Great reliance should be placed upon the sensations
experienced by the patient, regarding the use of warm or cold
applications, as the beneficial results obtained vary in difierent
cases. Sometimes the same remedy that we employ internally
is used with benefit externally. Cleanliness should be espe-
cially required. To prevent the formation of crusts on the
lids, the edges may be smeared at night with a little Vaseline,
simple cerate, cream or the like. Astringents, such as
sulphate of zinc or copper, or nitrate of silver are chiefly
relied upon by the Old School, though not advised until after
the acute symptoms have subsided. Atropine should not be
used unless there be iritic complication.
The attendants should be warned that the discharge is
contagious, and that the sponges, towels, etc., used upon the
patient, should not be employed for any other purpose.
Acomlte-—Is especially indicated in the first stage of
catarrhal inflammation prior to exudation, when the conj L1IlC-
tiva is intensely hyper2emic and chemosed, with severe pain in
the eye, often so terrible that one wishes to die; or, as is fre-
quently the case, there is only a feeling of burning and general
heat in the eye, with great dryness ; there may also be an
aching or bruised pain, ora feeling as if the ball were enlarged
and protruding, making the lids tense. The eye is generally
very sensitive, especially to air. This is the first remedy to
be thought of for conjunctivitis dependent upon exposure to
cold, dry air.
3] INFLAMMATION or THE CONJUNCTIVA.
In inflammatory conditions of the conjunctiva, resulting from
the irritant action of foreign bodies in that tissue there is no
better remedy.
Alli/mn oepa.—Of use in acute catarrhal conjunctivitis,
associated with a similar condition of the air passages; the
lachrymation is scalding, profuse and not excoriating, though
the nasal discharge is so (reverse of Euphrasia).
Apia mel.-—Especially called for in the acute form of con-
unctivitis, when the conjunctiva is bright red and puffy, lachr 1-
mation l1ot and moderately profuse, and pains in the eyes of
a burning, biting, stinging character ; sometimes the pains are
very severe and darting through the eye, or may possibly be
around the eye and the brows.
Photophobia may be present. The oedematous condition
of the lids, especially the upper, which is usually present in
these cases when Apis is indicated, is an important symptom.
There is, generally, aggravation in the evening and fore part
of the night. Although the lachrymation is hot and burning,
yet it does not excoriate the lids, as in cases in which Arseni-
cum is indicated. The general symptoms of dropsy, absence
of thirst, etc., would suggest this remedy to our minds.
Argentum mIt.—Should be employed if the discharge becomes
profuse, apparently taking the character of purulent ophthal-
mia. It may also be indicated in the chronic form of conjunc-
tivitis, when the conjunctiva is of a scarlet redness and the
papillae are hypertrophied. The inflammatory symptoms
usually subside in the open air, and are aggravated in a
warm room.
ArrmIoa.—-In conjunctivitis resulting from blows and various
injuries Arnica is often beneficial.
ArsemImom.—-Occasionally useful in acute conjunctivitis
marked by chemosis of the conjunctiva, much hot, scalding
lachrymation, burning pains, especially at night, and oedematous
condition of the lids, particularly the lower lid. It is also
indicated in the chronic form when the lachrymation and
discharge from the eyes are acrid, excoriating the lids and
cheek, the balls burn as if on fire, especially at night; and
when the inflammation is especially marked on the internal
surface of the lids.
woRLn’s IIOMCEOPATIIIC eoNvENTIoN. [4
VVarm applications generally relieve. The attacks of in-
flammation are frequently periodic in occurrence and often
alternate from one eye to the other.
Bellaclonna.-—-Tliis is the remedy in the early stages of
catarrhal conjunctivitis, when there is great dryness of the eyes,
with a sense of dryness and stiffness in the thickened red lids,
and smarting, burning pains in the eyes. Pliotopliobia is often
marked. Much dependence should be placed, however, upon
the concomitant symptoms of headache, red face, etc., etc. It
will be seen that Bell. is similar to Aconite and that both
correspond to the early stages of the disease. The dryness
of the eyes exists equally under both drugs ; but tmder Acon.
we have much more heat and burning in and around the eye
than under Bell, therefore, the latter is not nearly so often
useful as the former (Aconite).
Uaéca/ca ca/°b.—-Occasionally useful in catarrhal conjunc-
tivitis caused by getting wet, especially when occurring in a
person having a calcareous temperament.
C/Iamomilla.-—Catarrhal conjunctivitis, occurring in peevish
children during dentition.
Conjunctiva so congested, that blood oozes out.
C’mnabcw"ds.——lVIay be called for in conjunctivitis, especially
when that characteristic symptom of pain above the eye,
extending from the internal to the external canthus, or around
the eye (usually above, though sometimes below) is present.
Ea]?/w'asc'a.—I11 this drug, we have a very valuable remedy
for both acute and chronic catarrhal conjunctivitis, especially
the acute. It is especially useful in catarrhal inflammation of
the eye, caused by exposure to the cold and also in that of the
eyes and nose found in the first stage of measles. In the selection
of this drug, we are guided chiefly by the objective syniptonis as
the subjective are not very definite, there being a variety of
different sensations. The conjunctiva is intensely red, even to
chemosis. The lachymation is profuse, acrid, burning, while the
discharge from the eye, wihch is also quite profuse, is thick,
yellow, muco-purulent and acrid, making the lids and cheek sore
and cxcoriatcd. (The secretion is also cxcoriating under Arsenic
and Mcrcurius, but is thinner.)Blurring of the vision, relieved
5] INFLAIHMATION or THE oomunerrva.
by winking, being dependent upon the secretion covering the
cornea temporarily, is especially characteristic of this remedy.
G/aya/za'tes.—Is sometimes indicated, especially in the chronic
form of catarrhal conjunctivitis, though it is more particularly
the remedy for phlyctenular ophthalmia. The redness, pho-
t<>phobia and lachrymation are usually well marked, but may
\ ary to a great extent. The discharges from the eye, if
present are thin and acrid, while the nose is sore, excoriated
and often surrounded by thick, moist scabs. Dry scurfs are
frequently found on the lids, while the external canthi crack
and bleed easily.
Ifepar s/alp/z. —This is another remedy more useful in
struinous ophthalmia ; though it is sometimes employed with
benefit in the catarrhal form, as when the conjunctiva is much
congested even to chemosis, with considerable photophobia
and lachrymation, while the lids are much swollen and very
sensitive to touch. The discharge is of a muco-purulent
character and often well marked. The pains are throbbing,
aching or lancinating and relieved by warmth, so that he
wishes to keep the eye covered most of the time.
Ir/natia.——I~Ias been successfully used in catarrhal ophthal-
mia. especially when found in nervous hysterical subjects,
consequent upon traumatic or even upon other causes, when
there is a sensation as if a grain of sand were rolling around
under the lid, with great dryness, and lachrymation only when
exposed to the sunlight.
Il[orc. soZ.—In Mercury, we possess an important remedy
for catarrhal conjunctivitis, and this preparation is most com-
monly required, though some other form may be employed, if
the concomitant symptoms so indicate. The redness and dread
of light are usually well marked, especially in the evening,
by artificial light. The lachrymation is profuse, burning and
excoriating and the muco-purulent discharges thin and acrid,
making the lids and cheek red and sore. The pains vary in
character and are not contined to the eye but extend into the
forehead and temples and are always worse at night, especially
before midnight, in extreme heat or cold and in damp weather,
and are often temporarily ameliorated by cold water. It is
wonLn’s nou(Eo1>AT1-110 CONVENTION. [6
especially indicated in syphilitic subjects, and when the
concomitant symptoms of soreness of the head, excoriation of
the nose, nocturnal pains, etc., etc., are present.
Ncax 'v0mc'ca.—-Is not very often called for in this variety
of conjunctivitis. It would be suggested to our minds if there
were much dread of light, marked morning aggravation and
accompanying gastric symptoms. Hartmann and Alts'chul
highly recommend its use in conjunctivitis, when there is great
tendency to hemorrhage.
PuZsatéZZce.—This is another of our standard remedies for
catarrhal conjunctivitis, especially the acute form, though it is
also useful in the chronic. It is particularly to be thought of
in conjunctivitis occurring in the colored race, as well as when
found in the mild, tearful female. Oatarrhal inflarmnations
resulting from a cold, an attack of measles, traumatic and ‘
various other causes, have been benefited. The redness is
variable and may even amount to chemosis. The pains are
burning, itching or lancinating in the eye, usually worse in
the evening, when out in the wind, and after reading, but
relieved by the cool open air. The lachrymation is often
profuse by day, with a purulent discharge at night; though,
generally, a moderately profuse muco-purulent discharge of a
white color and bland character, which agglutinates the lids
in the morning, is to be found. Gastric, biliousand other
concomitant symptoms if present will influence our choice.
R/ms. tow.-—-Is the chief remedy for ‘conjunctivitis caused
by exposure to the wet (Cale), especially when the conjunctiva
is much chemosed, and some photophobia, profuse lachryma-
tion and oedematous swelling of the lids are present. A rheu-
matic diathesis would especially suggest this remedy.
Scmgm'ncwe'a.—Benefit has been derived from its use in
catarrhal conditions of the conjunctiva with burning in the
edges of the lids, worse in the afternoon, and when the affec-
tion is dependent upon stricture of the lachrymal duct.
Sepc'a.—Ac11te catarrhal. conjunctivitis with drawing sensa-
tion in the external canthi and smarting in the eyes, amelio-
rated by bathing in cold water and aggravated morning and
evening ; and conjunctivitis with muco-purulent discharge
7) INFLAMMA’I‘I()N or TI--IE eomnnerrvx.
from the eyes in the morning and great dryness in the evening,
have been speedily relieved by Sepia. It is frequently found
useful in inflammatory' affections of the conjunctiva of an
asthenic character, the conjunctiva exhibiting a dull, red color
with some photophobia and swelling of the lids, especially in
the morning. '
Sg9z'gelz'a.-—-Ra-1*ely useful, though, according to Lippe, it has
benefited a case occurring in the left eye with severe lan-
cinating pains in the eye and left temple,'worse at night,
preventing sleep.
S’Z6Z]9]2/M”.——Tl1lS is one of our chief remedies in both the
acute and chronic forms of catarrhal conjunctivitis. The degree
of redness may vary greatly. It may be confined to one eye
or involve both. The lids may be swollen or remain unaffected.
The sharp, darting pains, like pins piercing the eye, occur-
ring at any time of the day or night, will furnish our chief
indication. A severe pain darting through the eye back into
the head, from 1 to 8 A.M., waking the patient from sleep,
is also an i1'nportant indication. A variety of other sensa-
tions may be present ; as pressing, tensive, cutting or burn-
ing pains, a feeling of sand in the eyes, etc. The patients
are usually feverish and restless at night.
. Zincwm.—I-Ias been useful in conjunctivitis especially
when confined. to the inner half of the eye, (usually without
photophobia) and much discharge; worse towards evening, and
in the cool air. Generally there is itching, and perhaps pain,
in the internal canthus.
The following remedies have also been used with benefit
or may be indicated in occasional cases: Alumina, Ohelido-
nium, Ohloral., Orocus, Ouprum al., Ouprum sulph., Digitalis,
Euphorbium, Eupatorium perf., Kali bichr., Natrum n1ur.,
Senega, Silicea and Thuja.
OoNJUNe'rrvrrIs PURULEN'rA.——Ur1der this head we shall
include gonorrhoeal ophthalmia and ophthalmia neonatorum,
which are only different forms of purulent conjunctivitis. If
the attack is very severe, the patient may be confined to a
darkened room, or even to bed; and if only one eye is
afiected,‘ the other should be kept closed, in order to pre-
woRLD’s HOM(EOPATHIO eonvnnrron. [8
vent any of the matter coming in contact with this eye,
for the discharge is very contagious, especially in the gon-
orrhoeal variety and in that found in new-born children. On
this account great care should be exercised, both by the nurse
and physician, to protect their own eyes and those of others
by providing that the sponges, towels, etc., are used only by
the affected patient and also that their hands are thoroughly
cleansed before touching another eye, for often the physician
and other patients have been inoculated and vision destroyed
through carelessness on this point. Fresh air and nour-
ishing diet are important aids to treatment. But the special
and primary point to be attended to in the treatment is
cleanliness. To ensure this, the discharges should be often
removed by dropping tepid warm water into the inner can-
thus, until all the pus has been washed away or by cleans-
ing with the palpebral syringe. This should be done at
intervals of from fifteen minutes to an hour during the day
and occasionally through the night, according to the severity of
the ease. The Old School rely chiefly upon the use of astrin-
gents : sulphate of copper and zinc and the nitrate of silver ;
the latter being the favorite remedy.
“Then the cornea becomes ulcerated, some operative mea-
sures or the use of Atropine, may be required; but as this
is a complication, we will not dwell upon it. Qanthoplasty
might be necessary to relieve the pressure upon the eye-bal.l,
if the lids were much swollen and very tense.
Aoomte.-—May be indicated in the very first stage, accord-
ing to the symptoms given under catarrhal. conjunctivitis ; but it
will be found of little or no avail after the purulent discharge
has once appeared. ‘
Apia me/Z. Is useful in violent cases of purulent conjunc-
tivitis and ophthalmia neonatorum when there is great swell-
ing (oederri-atous) of the lids and adjacent cellular tissue. The
conjunctiva. is also congested, puffy, chemosed, and full of
dark, red veins. The discharge is moderate, not profuse,
though the lachrymation is well marked. The character of
the pains, which are stinging and shooting, i.s an iinportaiit
indication. There is usually much photophohia a.ceoi'npa11y-

T 9] INFI.AMuA'rIoN or THE coNJUNcTIvA.
ing the hot lachrymation (Rhus). The symptoms are aggra-
vated. in the evening. Objectively, the Rhus cases are similar
to Apis, though the character of the pains will usually serve
to distinguish between the two.
A//'{/entum mIt.——Tliis is the remedy, par excellence, for all
forms of purulent opht-halmia. We have witnessed the most
intense chemosis with strangulated vessels, most profuse puru-
lent discharge and comineiicing haziness of cornea with a
tendency to slough, subside gracefully under this remedy
internally administered. )Ve believe that there is no need of
cauterization; but that all its beneficial results may be ob-
tained by its use in the potencies. The subjective symptoms
are almost none. Their very absence, with the profuse puru-
lent discharge and the swollen lids, swollen from being dis-
tended .by a collection of pus in the eye or from swelling
of the sub-conjunctival tissues and not from infiltration of the
connective tissue of the lids themselves (as in Ehus or Apis)
indicates the drug [Alle/n.’s O,/0/225/2,. Thempeuta'cs].
By its employment as a cauterizating agent, as used by
the Old School, there is no doubt that many cases of puru-
lent conjunctivitis are cured, though at a risk to the cornea,
as is attested by the results of this treatment. These sad
results, viz.: perforation of cornea, dense leucoma, etc., we
claim are, to a great extent, averted by the use of the
remedy in the poteneies, either internally alone or both inter-
nally and externally. We are in the habit of using the
thirtieth potency internally, and, at the same time, a solu-
tion of five or ten grains to two drams of water of the
first, third or thirtieth dilution as an external application,
all the time taking great care to ensure cleanliness; and
we have yet to see the first case go on to destruction of the
cornea. Of course this remedy will not cure every case,
though it will the majority, when simply purulent, goiioi-rlio\.al
or that form found in new-born children.
Calcarea ccar-Z).-—Tl1e discharges from the eye, under tliis
drug, are often profuse and therefore it has been used witli
advantage in some cases of purulent or infantile oplitlialniia,
characterized by profuse, yellowish-white discliarge, uiclciiia. of
woRLD’s HOMCEOPATHIC oonvnnnon. [10
the lids and ulceration of the cornea. It is, however, espe-
cially useful in the results of purulent ophthalmia, clearing up
the opacities of the cornea, etc.
It is specially indicated when the trouble arises from worl -
ing in the wet (Rhus). In the selection of this drug, great
reliance should be placed upon the general condition (cachexia)
of the patient, as the eye symptoms are not very characteristic.
Uhamor/2-2'/,Za.—-Is often of great service in ophthalmia
neonatorum as an intercurrent remedy, even if it does not
remove the whole trouble which it frequently does. It is in-
dicated when the child is very fretful and wants to be carried
all the time and when the usual symptoms of the disease are
present even though the cornea has been invaded. Some-
times the conjunctiva is so much congested that blood may
ooze out, drop by drop, from between the swollen lids,
especially upon any attempt to open them (Nux).
0/zeZz'cZom'wn.-—Buchmann reports a case of severe inflam-
mation of the eye, occurring in a man. 62 years of age, caused .
by getting the feet wet, and which was cured with Ohelido-
nium°. The lids were thick, red, swollen and the lashes par-
tially absent ; conjunctiva swollen and dark red; thick, yellow
discharge from the eyes; agglutinations in the mornings and
great photophohia, with burning, darting pains in the eyes.
But we doubt whether it will be often indicated in this
disorder. ~
U/dom°ne.——Aqua chlorinii, as an external application, has
proved a very valuable remedy in the various forms of puru-
lent ophthalmia. Cases have been relieved by it when used
alone, as well as when the indicated remedy has been given
at the .same time internally (which has generally been the
case). The strong solution is sometimes employed, though
we usually dilute it to one-half, one-third or use a still weaker
dilution.
Euyaferasz'a.-Is useful, especially in that form found in new-
born children and more often in the later stages of the disease
than at the beginning, as can well be understood by examining
the symptoms already given under catarrhal conjunctivitis,
where the indications have been stated.
11] INFAMMATION or TIIE CONJUNCTIVA.
Ifepar cull)/z.——-lVIay be indicated in any form of this dis-
ease, particularly when the cornea has become implicated and
ulceration has taken place. The lids may be swollen, spas
medically closed, bleeding easily upon any attempt to open
them and very sensitive to touch. The conjunctiva is much
reddened, chemosed and the discharge is considerable and of a
yellowish-white color. The photophobia is intense, lachryma-
tion profuse and pain severe, of a throbbing, aching character
and relieved by warmth ; any draught of air aggravating the
symptoms. Wl1e11 the ulceration is severe and hypopion has
taken place, Hepar is especially the remedy.
](re0s0te.—~ Blennorrhoea of the conjunctiva when the
discharge is moderately profuse and marked by much smart-
ing in the eyes.
1l[ercum'us. Has been employed with benefit, particularly
in ophthalmia neonatorum when the discharges are thin and
exeoriating and caused by syphilitic leucorrhoea. It is also
one of our best remedies for gonorrhoeal ophthalmia and for
purulent conjunctivitis found in syphilitic subjects, whether it
be acquired or hereditary. The discharge, as has been said,
is thin and excoriating, making the lids and cheek sore and
raw. Thd lachrymation and photophobia are usually marked
and the pains severe, though variable in character and always
worse at night. Is 1nore commonly called for in the later
stage of the disease and especially if the cornea has become
involved. The concomitant symptoms are important aids in
the selection. Mercurius corr., Mercurius sol. and Mercurius
prec. ruber have all been successfully used, though the eye
symptoms, we believe, vary little i11 these preparations, except
perhaps being more intense under the corrosiv us.
N it/"210 acv§d.—~Is especially advised for gonorrhoeal ophthal-
mia. Much benefit has been derived from its employment
in this affection. Lids much swollen, red, hard and painful,
conjunctiva hyperoemic and chemosed, cornea din1, great pho-
tophobia and lachrymation and copious discharge of yellow
pus, which flows down the cheek, pressing and burning pain
in the eye worse at night. The checks are also usually much
swollen and painful.

woRLn’s HOMOEOPATHIC oonvnnrrorr. [12
Pulsatilla.-—Tl1is remedy stands high in the treatment of
purulent conjunctivitis, when the discharge is profuse and
bland, especially when occurring in negroes as well as in women.
Benefit has been gained from its use i11 blennorrhoea of the
conjunctiva, caused by the gonorrhoeal contagion. It is how-
ever most frequently useful in ophthalmia n'eonatorum, cha-
racterized by the usual well-marked symptoms. Many cases
of this form of conjunctivitis have been cured by this drug
alone, though we believe that it is particularly called for, as
an intercurrent remedy, during the treatment by Argent. nit.;
for, often when the improvement under the latter remedy is_
at a stand still, a few doses of Pulsatilla will materially hasten
the progress of the cure. The symptoms are usually worse in
the evening and ameliorated in the open air.
R/tus tow-—Has been employed with great benefit in this
form of conjunctivitis, though it is particularly recommended
by Hartmann, Garay and others for ophthalmia neonatorum.
lVhen the trouble arises from exposure to the wet this
remedy suggests itself. The lids are red, oedematous and
spasmodically closed. The palpebral conjunctiva is especially
inflamed, so that when the lids are opened a thick, red swelling
appears with a copious, thick, yellow, purulent di§'cl1arge, or
the discharge may be less and a profuse gush of tears take
place. The child is usually cachetic, restless and its head hot.
It has been used both externally and internally.
Sui]?/mm—-Is not so useful in this variety of conjunctivitis,
as in the pustular or even the catarrhal form, though it has
been of service more frequently in that form found in new-
born children, especially when the trouble has become chronic
and when not dependent upon syphilis. The symptoms
observed are not characteristic, with the exception, perhaps, of
the sharp sticking pains, as if pins were sticking in the eye.
WVe rely, to a great extent, in selecting this drug, upon the
general condition (scrofulous caehexia) of the patient.
Tcwtar e/r/wt.--—Rosenberg reports a case of severe obstinate
gonorrhoeal ophthalmia. cured, though the urethral discharge
was increased by the use of th_is remedy. ' -
Other remedies, as Oon.,Oup. al., Oup. sulph., l‘)ule., Lye,
L3] INFLAMMATION or TI-IE OONJUNGTIVA.
N atrum -mur., and Nux vomica have been successfully‘ em:
ployed.
Comunerrvrrrs TRACHOMATOSA AOUTA ET GHRONIGA (with
or without pannus).—As this form of conjunctivitis is usually
found among the lower classes or those who are constantly
-exposed to wind and dust, care should be taken that these
exciting causes be removed as far as possible, cleanliness and
proper hygienic measures being very important aids in the
treatment of this affection.
' It should be remembered that the discharges from granular
lids are especially contagious and that whole families or a
whole school may be inoculated from one member, by an
iiicliscriniinate use of towels, e_tc.; therefore strict attention
should be paid to the prevention of its extension.
Acon/ZZ§e.——_In the first stage of granular conjunctivitis, when
the eyes are inflamed, hot, dry, burning and ver 1 painful,
Aconite should be given ; also in acute aggravation ‘of granu-
lated lids and pannus, with excessive liyperaemia, heat and
dryness, especially if the aggravation be induced by over-
heating from violent exercise or by exposure to dry, cold air.
Alumen eazs-iceatum.-—Tl1is remedy, first suggested, I believe
by Dr. Liebold, is of great value in -all forms of trachoma,
whether complicated with pannus or not. It is employed by
-dusting the crude powder on the inner surface of the lids,
allowing it to remain about a minute and then washing it off
with pure water and, at the same time, giving the lower
preparations internally.
Alur/mart. —Oases of chronic granular lids frequently yield
to this drug, when there is marked dryness of the lids and eye
especially in the evening, with burning, itching and pressure
in the eyes ; agglutination mornings; the upper lids are
weak, and seem to hang down as if paralyzed. The symp-
toms of loss of power in the upper lids are often met with in
old dry cases of granulation ; in these cases Alumina does good.
Argemimn m't.—Especially serviceable in the early stages
of acute granular conjunctivitis, when the conjunctiva is
intensely pink or scarlet red and the discharge is profuse and
i1'u:lined to be inuco-purulent.
woRLD’s HO1\/I(EOPATHIC ooNvEN'rIoN. [14
A¢sem'cum.—-Indicated in chronic granulated lids, when
the palpebral conjunctiva only is inflamed ; tl1e lids are painful,
dry and rub against the ball ; they burn and can scarcely be
opened. Chiefiy called for, however, when the pains are
intense, burning and the lachrymation very excoriating.
Aumwn met.——Is the appropriate remedy for many cases of
trachoma either with or without pannus (especially however,
when pannus is present) and there is probably no other remedy,
which has only been employed internally, that has cured more
cases. ~We therefore highly recommend its use, though the
symptoms which lead us to its selection have not yet been
found peculiar or characteristic. The pains may be burning
or dull in character, compelling the patient to close the lids.
They are usually worse in the morning and ameliorated by the
application of cold water. For the corneal ulcerations found
in pannus Aurum is of great value.
The Muriate of gold is frequently employed though the
symptoms, as far as known, vary but slightly from those of
the metal.
BeZZad0nna.—-As a temporary remedy in acute aggravations
of granular lids, may be beneficial; as when, after taking cold,
the eyes become sensitive to air and light with dryness and a
gritty feeling.
Ualccwect ccWZ>.~—Co11ju11ctivitis trachomatosa with pannus
(caused by working in the wet) with much redness and lachry-
mation has been relieved by this drug. The general condition
of the patient will, to a great extent, lead to its selection.
CaZcarea caust.—-—ls recommended by Dr. Hills for this
trouble, though we cannot see in what respects it differs from
the carbonica.
Cujyrmn aZ.—The Aluminate of copper has been successfully
used to a great extent in trachoma, either with or without
pannus. The results obtained are usually much more satis-
factory than those from the Sulphate of copper, which
is the main reliance of the Old School in the treatment of this
disorder. It is employed locally by application of the crystals
to the granulations, at the same time giving the remedy in the
potencies internally.
15] INFLAMMATION or THE CONJUNOTIVA.
- Kccli Z)z'o]z——Tracl1o1r1a with pannus ; much discharge ; every-
thing appears slightly red to him; usually not much photo-
phobia or redness of conjunctiva, though ulceration of the
cornea may be present; eyes seem to feel better when lying on
the face.
lllercurius praeo. /mcb.—In trachoma with pannus it is a
valuable remedy ; rarely of much use in acute cases, but seems
especially adapted to old chronic cases, when the cornea is
covered with pannus of a high degree with considerable red-
ness, discharge and photophohia. The granulations may be
present or may have been already removed by caustics.
ZVatrum mur.—-—Partieularly useful in chronic cases and
when the lids have been already treated by caustics (especially
the Nitrate of silver). The pannus or the irritable condition
of the eye resulting from, or kept up by the scarred palpebral
conjunctiva found after cauterization, is often greatly relieved
by this drug. The lachrymation is acrid and excoriating, as
well as the discharges which are thin, watery and make the
cheek raw and sore. The pains are variable, though some-
times we have a sharp pain over the eye, upon looking down,
which is very marked. The skin of the face round the eye is
often glossy and shining.
ZVatrum ]9/L08.-———Gr1'€tI1t1l8.1’ conjunctivitis, where the granu-
lations appear like small blisters, (Thuja.)
lVuw com.-—Of service in old cases of trachoma that have
had much treatment, especially when complicated with pannus.
Nux is frequently of great benefit in commencing the treat-
ment of granular lids with or without pannus ; also as an
intercurrent remedy, for the morning aggravation is particu-
larly marked under this drug and in the disease. It will rarely
however, effect a cure, unassisted by any other remedy.
Potrole/am.——Valuable in granular conjunctivitis with pan-
nus, especially when occurring in a scrofulous habit with
considerable white discharge from the eye, roughness of the
cheek, occipital headache, etc.
Pulsatallta.-—Cl1iefly adapted to trachoma, uncomplicated
with pannus occurring in anaemic arnenorrhoeic females. The
granulations are generally very fine (papillary trachoma) ; the
wonLn’s noutEo1>A'rII1c eoNvENT1oN. [16
eye is sometimes dry or there may be excessive secretion of
bland mucus. There may also be soreness of the ball to touch
and itching or pain in the eye, which is worse in the evening
and better in the cool air or by cold applications.
Rims tow.——ls frequently of use in relieving the intensity
of the symptoms found in con unctivitis granulosa with pannus.
The eye is quite red, with much photophobia and profuse
lachrymation. No remedy acts so powerfully as Rhus tox.
in diminishing the profuse secretion of tears.
SuZphur.—-T1"acho1na, acute and chronic, with and without
pannus, has been benefited by this drug and is often called
for as an intercurrent remedy, even if it does not complete
the cure alone. It is especially indicated when the pains are
sharp and lancinating in character and worse in the morning ;
and when the lids are glued together by the secretion during
the night. The application of water is not agreeable to the
patient and it often aggravates the disease.
T /mja occc'd.—-Favorable results have been gained by the
use of this remedy in conjunctivitis trachomatosa, when the
" granulations were large, like warts or blisters, with burning
in the lids and eyes, worse at night; photophobia by day, and
suffusion of the eyes in tears.
The following remedies have also been employed with
favorable results: Oausticum, Oinnabaris, Oonium, Ouprum
sulph., Hepar, Mercurius, Sepia, Tartar emet. and Zinc.
OPHTIIALMIA PHLYo'rE.NULAn1s (Syn, Op/zt/zeal/m'0; acre 16
Zesa, op/zthalonia ecccmt/zem.. Kercetétz'.s '7)/zlzyct, (/’owjuactc'm't/is
1)/lg/Zct.,etc.)—We have thought best to include under this
head the various forms of pustular inflammation of the eye,
whether affecting the cornea or conjunctiva, as the etiology,
symptomatology, course and treatment vary little in either
case; in fact these remedies which have been found useful
when the cornea is invaded, are also our chief reliance in this
form of inflammation of the conjunctiva.
The first points to be attended to are cleanliness and regu-
lation of the diet. The eyes should be bathed often in luke-
warm water, and any little scabs which have formed on the
lids immediately removed, as they only prove a source of irri-
17] INFAMMATION OF THE CONJUNCTIVA.
tation. If there is considerable photophobia and the child is
rubbing the eye much of the time, a compress bandage will
prevent this, and, at the same time, by keeping the lids closed
will relieve the irritation to the eye-ball occasioned by their
constant opening and closing; it also excludes the light, re-
lieving the photophobia, and soaks up the tears and so
prevents their running over the cheek, making it sore and ex-
coriated. The bandage if used, though it is not commonly
necessar T, should be removed every four or five hours and the
eyes cleansed. External applications should not, as a rule, be
employed, as we can usually cure better and quicker with in-
ternal remedies alone if we are careful in the selection of our
drugs, although sometimes they may be useful and n eeessary ;
thus, occasionally a case will be found which has proved very
obstinate to treatment, ciliary injection great, photophobia
intense and pupil a little sluggish—-where a weak solution of
Atropine dropped into the eye, once or twice a day, will be of
great benefit.
Apis ma Z.-—Pustular keratitis with dark chemosed conjunc-
tiva and swollen lids (oedematous). This puffy condition of
the conjunctiva and lids is very important, especially when
accompanied by burning, stinging or shooting pains in the
eyes. The discharges are slight, with the exception of the
tears, which are usually profuse and burning, with photopho-
bia (Rhus). The aggravation is usually in the evening, and
often concomitant symptoms, such as drowsiness, absence of
thirst, etc., are present. This remedy is not frequently called
for, though useful when the above indications are present.
Arsenécum.—Especially useful when the cornea has become
affected and the pustules have broken, leaving superficial
ulceration. The photophobia is usually intense at all times,
though it may be so relieved in the open air so that the child
will open its eyes easily. The lachrymation is profuse, burn-
ing and excoriating, as are all the discharges from the eye,
which are also thin in character. The conjunctiva] redness is
variable; it may be very great, even to chemosis. The pains
are generally of a‘ burning character and may be very severe;
the eye often feels very hot. The lids may be oadematous
wonLn’s H()M(E()PA'l‘HIO CONVENTION. L18
and spasmodically closed or else red, inflamed and excoriated
by the acrid discharges. The nostrils and upper lip are usual-
ly excoriated by the acrid coryza. It is especially indicated in
low, caehectic conditions and for the ill-nourished, scrofulous
children of the poor. Great restlessness and thirst for small
quantities of water are commonly noticed.
Aurum meI§.—-Scrofulous ophthalmia with ulceration and
vascularity of the cornea. Photophobia severe, lachrymation
profuse and scalding ; eyes very sensitive to the touch. The
pains are from without inward and worse upon touch (reverse
of Asafoetida). The cervical glands are usually swollen ;
patient very irritable and sensitive to noise.
Baryzfia,-—Botl1 the carbonate and iodide have been em-
ployed in scrofulous ophthalmia, especially when complicated
with enlarged cervical glands. ‘Vs have obtained better re-
sults from the iodide than from the carbonate.
BeZZcocZonrta.——l"ta1“ely useful except in acute aggravations
where there is great photophobia.
Ualoarea cart». - Particularly indicated in phlyctenular
keratitis, though it has also been successfully used in conjunc-
tivitis. Is applicable to this form of inflammation occurring
after the suppression of an eruption by Mercury, when there
is also deafness ; also when the disease can be traced to expo-
sure to the wet. \Ve usually, though not always, find exces-
sive photophobia and lachrymation (often acrid). The amount
of redness is variable, as is also the character of the pain,
though this is more commonly described as sticking than other-
wise. The lids may be red, swollen and agglutinated in the
morning. There is a general aggravation of the eye-symp-
toms during damp weather or from the least cold, to which
the patient is very susceptible. It is especially the remedy
for pustular inflammation, occurring in fat, unhealthy, stru-
mous children who have enlarged glands, distended abdomen,
pale, flabby skin, eruptions on the head and body, which burn
and itch, and cold sweat of the head. In fact, upon the con-
comitant symptoms we place our chief reliance, as the eye
symptoms are not characteristic. 1
Uoécarea /1,'o(Z.-—Tl1e indications are nearl~y the same as for
19] INFLAI\IMATI()N or THE OONJUNC'I‘IVA.
Calcarea carb., though it is preferable in cases where we have
considerable swelling of the tonsils and cervical glands.
(J/mmovmllla.—-ffas proved very serviceable in scrofulous
ophthalmia occurring i11 cross, peevish children during denti-
tion and will often relieve the severity of the symptoms, even
though it does not complete the cure. The cornea is usually
invaded and we have great intolerance of light, considerable
redness and lachrymation. '
Oinnabcwis.——The cornea is generally implicated in the
trouble and the symptoms of photophobia, lachrymation, etc.,
are severe. Pain from the inner canthus across the eyebrows
or extending around the eye is a very marked indication for
Cmnabaris.
0Ze9naz5c's.——Co11junctivitis pust with tinea capitis over the
greater part of the head and agglutination in the morning.
Uomlum mac.--VVl1en the inflammation is chiefly confined
to the cornea and we have intense photophobia and profuse
lachrymation upon any attempt to open the spasmodieally
closed lids. The pains are various, but are generally worse
at night. Witl1 all this intense photophobia, etc., there is,
however, very slight or no redness of the conjunctiva, not suf-
iicient to account for the severity of the symptoms.
Croton tz'g.——In both phlyctenular keratitis and conjuncti-
vitis is this drug useful. These are usually complicated by a
corresponding characteristic eruption on the face and lids; the
eyes and face feel hot and burning, especially at night ; the
photophobia is marked, ciliary injection like iritis often
present, and considerable pain in and around the eye, usually
worse at night.
Eup/vrasz'a.—-—A valuable remedy in phlyctenular ophthal-
mia when the lachrymation is excessive, acrid and burning or
when there is a profuse, thick, acrid, muco-purulent discharge
which excoriates the lids, making them red, inflamed and sore ;
from this discharge the cheek may look as if varnished. In-
tolerance of light is generally, though not always, present and
the conjunctiva may be red even to chemosis. The pains are
not marked, though usually of a smarting character from the
nature of the discharges. Blurring of the eyes, relieved by
woRLD’s HOMQEOPATHIO CONVENTION. [20
winking, dependent upon the secretions temporarily covering
the cornea, especially indicates Euphrasia. Fluent coryza,
acrid in character, often accompanies the above symptoms.
Gra]9le2Ites.——Tliis is one of the most important remedies we
possess for this disease, and its sphere of action is not limited
to any special variety, for excellent results have been gained
from its use in both the acute and chronic form, whether the
' cornea is involved or not; it is, perhaps, more often called for
in phlyctenular keratitis of the chronic recurrent form. Is
especially indicated in scrofulous subjects, covered with ecze-
matous eruptions, chiefly on the head and behind the ears,
which eruptions are moist, fissured and bleed easily. The
photophohia is usually intense and the lachrymation profuse,
though, in some cases, nearly or entirely absent; generally
worse by daylight than gaslight, and in the morning, so that
often the child cannot open the eyes before 9 or 10 A. M. The
redness of the eye is generally important (there may be pan-
nus) and the discharges of a muco-purulent character, constant,
thin and excoriating. The pains are not important and vary;
may be of a sticking, burning, aching or itching character.
The lids are red, sore and agglutinated in the morning or else
covered with dry scabs, while the external canthi are cracked
and bleed easily upon opening the eye. We often notice a
thin, acrid discharge from the nose accompanying the eye
affection.
[1/epa/' suip/2.——Is most useful in the severer forms of pus-
tular inflammation, especially when upon the cornea and
when ulceration has already commenced. The intensity of the
symptoms suggests its use such as intense photophohia, lachry-
mation and great redness of the eye, even to chemosis. The
pains are severe, generally of a throbbing, stinging character,
ameliorated by warmth, so that he wishes to keep the eye
covered and aggravated by cold or uncovering the eye ; also
usually worse at night or in the evening. The lids are often
swollen, spasmodically closed and very sensitive to touch;
also may be red, swollen and bleed easily upon opening.
Particularly indicated in scrofulous, outrageously cross children
who have eruptions and boils on various portions of the body.
2l] INFLA1\L\IATI()N on THE ooNJUNeT1vA.
[felt bio/w~0m.——Is adapted to phlyctenules on the conjunc-
tiva or to chronic cases of low grade. The chief characteristics
are absence of photophobia and of redness, or much less of
each than would be expected from the nature of the disease.
The pains and lachrymation are also generally absent or nearly
so. The eye is often quite sensitive to touch and its secretions
are of a stringy character. This form of potash has been
more often employed than any other, though the Iodide is
also useful in similar cases.
Me2“cum'/rm.-—Mercury, in some form, is a frequent remedy
for strumous ophthalmia, especially when the cornea has be-
come involved. As the symptoms are similar in all the
preparations, we shall at first, under this general head, give
those symptoms common to all forms and afterwards give the
special indications for each. This is the first remedy to be
thought of when this form of inflammation occurs in syphi-
litic subjects whether hereditary or acquired. Especially use-
ful when the cornea is invaded and the vascularity is great,
though sometimes there may be a well-marked grayish
infiltration around the pustnle or ulcer. The redness of the
conjunctiva is usually great, even amounting to chemosis, the
dread of light is generally great and often intense, so that the
patients cannot open their eyes even in a darkened room,
and it is more often aggravated by any artificial ]igl1t, as gas-
light, the glare of a fire, etc. The lachrymation is profuse,
burning and excoriating, and the muco-purulent discharges
thin and acrid. The pains are generally severe, vary in char-
acter, though more often tearing, burning, shooting or lan-
cinating and are not confined -to the eye but extend up to the
forehead and temples, seeming to lie deep in the bones; they
are always aggravated at night, especially before midnight;
by heat, extreme cold, and in damp weather and are tempor-
arily relieved by cold water. The lids are often spasmodically
closed, thick, red, swollen, excoriated from the acrid lachry-
mation and sensitive to heat or cold and also to contact. The
concomitant symptoms of excoriation of the nose, condition of
the tongue, eruption on the face, pain in the bones, etc., etc.,
are of the first importance in selecting this drug.
\
WoRLn’s HOMCEOPATHIO eonvnrrrron. [22
]l’[ercum'us c0rr.—Indicated in the erethistic form of inflam-
mation, occurring in strumous subjects. The pustules are
usually found upon the cornea, and hence the severity of the
symptoms so marked under this preparation of Mercury,
which is more useful than solubilis, esp.ecially in severe
cases, as the pains are more severe, photophobia more marked,
lachrymation more profuse and exconating and all the symptoms
more intense than under any preparation we have. Pustules
on the cheek, enlarged cervical glands, coated tongue and
excoriating coryza, etc., are usually present.
fllercum'us duZc.—-Oalomel dusted into the eye has been
employed for many years by the Old School in scrofulous
ophthalmia and even now is considered one of their chief
remedies. We also have found this remedy, given internally
in the potencies, very useful, especially in the severer forms
of this inflammation, when occurring in pale, flabby, scrofulous
subjects.
ll[ercum'us m§t.—This remedy seems to be particularly
adapted to this form of inflammation and has been used,
especially by Dr. Liebold, with remarkable success, in a large
number of cases. Severe as well as mild, chronic as well as
acute cases, superficial as well as deep ulcers have yielded to
its influence; in some cases there has been much photophobia,
in others none at all, in some severe pain, in others none. We
might thus go through a variety of symptoms differing as
much as the'above, where this drug has proved curative. It is
commonly used both externally and internally at the same
time ; and in the lower potencies, say about the first potency,
ten grains to two drachms of water (or even stronger) as an
external application, to be used in the eye, two, three or more
times a day, and the second, or third potency to be taken
internally.
Atroprnc is sometimes used with it, especially when there
is considerable photophobia present.
Me/"curita.s pwc. ’/'&6b.———TlllS varies little from the general
description given of Mercury, though it is often used in stru-
mous ophthalmia with great benefit.
Mercurcius ;0/=0t.—-Not as often required as the other forms
28] INF‘LAMMA'!‘ION or THE CONJUNCTIVA.
of Mercury, unless there be quite extensive superficial ulcera-
tion of the cornea, with much photophobia. and nocturnal ag-
gravation. There is also usually swelling of the glands, and .
the tongue has a thick, yellow coating at the base.
lllerewrch/,3 soZ.—Is very often employed in scrofulous ophth-
almia ; the indications correspond very closely in all points to
those found under the head of Mercurius.
IL/[ezerewn.—P11stular conjunctivitis, accompanied by ecze-
ma of the face and lids, especially when characterized by thick,
hard scabs, from under which pus exudes on pressure.
lVctru/m 97t’wo".‘—Especially useful in chronic cases and after
the use of caustics (Nitrate of silver). The eye-symptoms are
not particularly characteristic; we have itching, burning and
feeling of sand in the eyes, worse in the morning and fore-
noon; the pains are various though not severe, except perhaps
sharp pain over the eye upon looking down, a symptom which
we have frequently verified. The lachrymation is acrid and
excoriating, making the lids red and sore ; the discharges
from the eye are also thin, watery and acrid. Thephotophobia
is usually marked, and the lids spasmodically closed. The
skin of the face, around the eyes, is often glossy and shining,
while throbbing headache and other concomitant symptoms
are generally present. _'
lVuw oom.—-Favorable results have been gained in cases
which had been previously much medicated, both externally
and internally. Rarely of service when the conjunctiva only
is affected as the most characteristic indications are excessive
photophobia and morning aggravation of all symptoms, which
are indications that the cornea is implicated. The lachryma-
tion is usually profuse and the pains variable, as follows:
sharp, darting pains in_ the eye and over it, in some cases ex-
tending to the top of the head and always worse in the morn-
ing, burning pains in the eyes and lids; a sense of tearing in
the eye at night on awaking from sleep ; eye feels pressed out
whenever she combs her hair; sensation as of hot water in
the eye, pain in the lower lid as if something were cutting it, .
etc. Sometimes relief from the pain is obtained by bathing
the eyes in cold water. '
woRLn‘s HOM(EOPATIIIC oonvnrrrron. [24
.Psurz'ww72.—-Especially adapted to all chronic cases of re-
current scrofulous ophthalmia.
PaZsaic'ZZa.—-T his is one of our sheet anchors in the treat-
ment of this disease, especially when the pustules are confined
to the conjunctiva. It is particularly indicated in persons,
especially amenorrhoeic females of a mild temperament and
fair complexion, and is also very suitable to this class of ail-
ments when occurring in the negro. VVhen pain in the ear,
otorrhoea and other aural symptoms complicate the eye dis-
order, this remedy would be suggested to our minds. The
dread of light is often absent or quite moderate and the redness
varies. The lachrymation is not acrid, but more abundant in
the open air, while the other discharges are generally profuse,
thick, white or yellow and bland. The pams vary greatly,
but are more often of a pressing, stinging character. The lids
may be swollen, though not excoriated, but are very subject
to sties, for which Pulsatilla is one of our chief remedies.
The eyes feel worse on getting warm from exercise or in a
heated room and generally in the evening, but are ameliorated
in the open air and by cold applications. The concomitant
symptoms of stomach derangement, amenorrhma, etc., must
be taken into consideration.
R/ms toaa—Useful in pustular inflammation after it has
gone on to superficial ulceration of the cornea; for then we
have present the intense photophobia and profuse lachrymation
so characteristic of this, drug. The conjunctiva may be very
red, even to chemosis, and the lids oedematous, particularly
the upper, and spasmodieally closed, so that we are compelled
to open them by force when a profuse gush of tears takes
place. The skin of the face, around the eyes, is often covered
by a Rhus eruption ; especially suitable in a rheumatic diathe-
sis. The symptoms are usually worse at night, after midnight
and in damp weather; therefore the patients are restless at
night, and disturbed by bad dreams. Rhus rad. has been em-
ployed with excellent results in scrofulous ophthalmia when the
above symptoms were present. In what respect it differs
from Rhus tox., remains to be proven.
Se])ia.——-Especially of value in pustular inflammation found
25] INFAMMATION or THE CONJ‘UNCTIW/‘A..
in women, either occurring with or dependent upon uterine
troubles, and these disorders should receive due consideration
in selecting this drug. More often called for when the cornea
is affected than when the inflammation is confined to the con-
junctiva. The pains are usually of a drawing, aching, piercing
character; and aggravated by rubbing, pressing the lids toge-
ther or pressing upon the eye. The light of day dazzles and
causes the head to ache. The conjunctiva may be swollen,
with agglutination of the eyes morning and evening, consider-
able purulent discharge, edges of the lids raw and sore, feeling
as if the lids were too tight and did not cover the ball, eruption
on the face, etc. All the symptoms are worse in the morning
and evening and better in the middle of the day.
SuZphur.—-This is the remedy, par eacceltenoe, for pustular
inflammation of the cornea or conjunctiva. Its sphere of
action is very wide and adapts it to a great variety of cases,
especially when chronic and occurring in scrofulous children
covered with eruptions (and the majority of cases are found in
this class), or when otorrhoea and affection of the bones com-
plicate the difliculty; also to those cases which have been
caused by suppressing an eruption with external applications.
The pains var T, though usually of a sharp, lancinating character,
as if a needle or splinter were piercing the eye, and may occur
at any time of the day or night; or we may have a sharp,
shooting pain going through the eye back into the head, from
1 to 3, A. 11., which disturbs the sleep of the patients ;
although, besides these, there may be a variety of other sensa-
tions as smarting, itching and burning in the eyes, feeling of
pressure as from a foreign body ; burning, as from lime;
biting as if salt were in the eye; sensations as if there were a
number of little burning sparks on the lids, which cause them
to close spasmodically ; painful dryness as if the lids rubbed
the eye ball, bruised pain, etc., etc. The photophohia is
generally very marked and the lachrymation profuse, though
in some cases they may be almost or entirely absent. The red-
ness varies greatly, but is usually considerable, especially at
the angles; the secretions also vary both in quantity and quality,
being often, however, acrid and corroding and sometimes
wonr.n’s HOMCEOPATHIC eoNvENT1oN. [26
tenacious. Agglutination in the morning is commonly present.
The lids are often swollen, burn and smart as if bathed in
some acrid fluid, or there is an itching sensation compelling
the patient to rub them most of the time. They are frequent-
ly covered with an eruption, as well as the surrounding integu-
ment of the head and face. All the symptoms are, as a rule,
aggravated by bathing the eyes, so that the child cannot bear
to have any water touch them ; also usually worse in the open
air.
TeZZurc'wa.-—ITas proved successful in phlyctenular con-
junctivitis with eczema impetiginodes on the lids and much
purulent discharge from the eyes, especially when complicated
with an offensive otorrhoea, smelling like fish brine.
Zincmn.—I*‘avo1~able results have been obtained by its use
for the persistent redness of the eye remaining after purulent -
keratitis without any discharge, especially when the redness is
more marked at the inner angle and worse toward evening
and in the open air.
The following remedies have also proved serviceable in
scrofulous ophthalmia, though not so commonly called for as
the above: Antimon. tart., Argentum nit., Oaust., Ohina,
Ohloral, Ouprum al., Ferrum, Ferrum iod., Hyoscyamus,
Kreasote, Lachesis, Magnet, Magnes. carb., Nitric acid, Petro-
leum, Phosphorus, Sulphur iod., Thuja.
tiempliiiients sf
"-'“’ P Aiithor


~ is
THE EYE
HEADACHES AND UTHER NERVOUS DISTURBANCES.
BY
GEO. S. NORTON, M.D.,
PROFESSOR OF OPHTHALMOLOGY IN THE COLLEGE OF THE
NEW YORK OPHTHALMIC HOSPITAL.
READ BEFORE THE NEW YORK MEDICO-CHIRURGICAL Socmrx,
Dncsmsns 9, 1884. REPRINTED mom THE HARNE-
MANNIAN MONTHLY, JANUARY, 1885.

PRINTED ,FOR THE AUTHOR.
1 8 8 5.


THE EYE
rs AN AGENT IN OAUSING HEADAOHES
AND OTHER
NERVOUS DISTURBANGES.

WITHIN the past few years, the influence of errors in refrac-
tion and weakness of the ocular muscles in producing disturb-
ances in the nervous centres, has assumed more and more
importance; all of which is a natural sequence of our increase
in knowledge regarding the functions of these organs.
The intimate connection existing between the eye and the
brain by means of a nerve of special sense, nerves of sensation
and motion, and the blood supply, renders the transmission of
an irritation or inflammation in one organ to the other a not
unlocked-for consequence. This we see verified in various
instances; hyperaemia of the brain will produce congestion in
the retinal circulation ; tumors in the brain almost invariably
cause a “ choked disk ” or paralysis of one or more of the ocu-
lar muscles; and, vice versa, ocular diseases not unfrequently
extend to the brain. I f this be true regarding inflammatory
diseases, how much more certainly should we expect to find
symptoms of irritation extending from one to the other. There
may not be the same continuity of tissue as is found in the ear,
throat and lungs, yet the nerve and blood connection between
the eye and brain is closer, and so more conducive to the pro-
duction of irritation, if not also of inflammation.
The nervous disturbances most commonly brought on by
eye strain are various forms of headache, particularly in the
frontal region, though they may be confined to the vertex,
temples or occiput, may be periodical in character, may be
accompanied with vertigo and nausea, or may assume almost
1
2
any variety imaginable. Besides headaches, various mental
disturbances may be observed from this same cause, as depres-
sion, irritability of temper and inability to apply the mind;
or we may have insomnia, marked indications of spinal irri-
tation, general nervous prostration and even choreic symptoms;
all of which will be made more apparent as we proceed.
Let me, however, in the beginning be not misunderstood
and considered as one who is “riding a hobby.” This has
been done by some oculists, and injury worked thereby. It is
mere folly to assume that all diseases, or all nervous affections,
or all headaches, or even all headaches of a certain type may
be cured by attention to the eyes; though there is no doubt
that a far larger proportion of nervous headaches and other
disturbances are dependent upon the eye than the general prac-
titioner usually realizes.
This subject has been one of great interest to me for years,
and several thousand eases”< have been examined; and it is
from this experience that my conclusions will be drawn, and
clinical cases given to illustrate the various points brought for-
ward. In this article none of the inflammatory diseases of the
eye will be considered, only the effect of errors in refraction
and weakness of the muscles in causing the troubles under dis-
cussion.
By the term “ refraction ” is meant that passive power
which every eye possesses, when in a state of rest—-i.e., adjusted
for its far point—of bringing certain rays of light to a focus
upon the retina without any effort of the muscular apparatus
of accommodation. This power is due to the form of the eye
and its refracting media, the cornea, lens and humors.
By “ accommodation ” is understood the power which every
normal eye possesses of adjusting itself for different distances;
thus the accommodation is exercised whenever we change our
vision from the distant point by looking at an object near at
hand. This power of accommodation is due chiefly to the ac-
tion of the ciliary muscle, which increases the curvature of the
lens, thus enabling it to bring rays to a focus upon the retina]L
In connection with this we must also take into consideration
*4 By reference to my records I find that during the past three years over
1000 cases of errors in refraction have been examined in my oflice. This
with a practice of ten years previous to that time, and the constant experi-
ence in a large clinic at the New York Ophthalmic Hospital will easily
make up the “several thousand cases.”
i‘ I purposely omit here any consideration of the oblique and remaining
recti muscles, as their influence in adjusting the eye for the near point is of
little practical importance in comparison with the above.

3
another important factor, viz., the convergence of the optic
axes, which is brought about by the action of the internal recti
muscles. N ow there is a definite relation between the power
of convergence, and the power of accommodation—i.e., we can-
not converge our eyes, except within certain limits, without
also adjusting them for the near point, and vice versa. If
anything interferes with this relation, there will be a strain upon
one or the other muscle. Like all other muscles the ciliary
and internal recti may become weakened by overuse, when all
the symptoms of “eye strain ” and its consequences will follow.
In the emmetropic eye, parallel rays of light, viz., those
emanating fro_m a distance of twenty feet or more, are brought
to a focus upon the retina, without any effort of the accommo-
dation ; therefore weakness of the ciliary or recti muscles
could only be produced by long-continued use at the near point,
especially in low states of the general health. If, upon the
other hand, the form of the eye varies from emmetropia so
that there is a constant and, perhaps, irregular use of the
muscles even for distant vision, and, thereby, an increased
action for near vision, very soon we might expect to observe
indications of weakness, especially in those whose work de-
mands close application at the near point. The manner in
which various errors in refraction produce weakness of ac-
commodation or convergence, will be seen as we proceed.
Before examining into the different errors in refraction, let
us first consider how weakness, spasm or irregular action of
the ocular muscles can cause headache or other disturbances
in the nervous centres. The various muscles of the eye are
bountifully supplied with nerves, which preside over muscular
action, sensation and nutrition. The nerves of motion are
the third, fourth and sixth pairs. The third or oeulo-motorius
supplies the superior, inferior and internal rectus, inferior
oblique, sphincter of the pupil and ciliary muscle. The fourth
or patheticus supplies the superior oblique; and the sixth or
abducens, the external rectus. The ophthalmic division of the
fifth or trigeminus controls the power of sensation in all por-
tions of the eye, and especially acute is this sense in the ciliary
region, owing to the ample distribution of these nerve filaments
at this point. Sympathetic fibres will also be found in all
parts. It will, therefore, be seen that the nerve connections,
motory, sensory, and sympathetic, between the muscles of the
eye and the nerve centres, are abundant and intimate. Re-
membering, now, this nerve distribution, is it at all surprising
that a constant, regular or irregular strain on the ocular
4
muscles, week after week, month after month, and year after
year, will in time produce headache and various other nervous
disturbances by communication of the irritation to other nerve
origins? No ; it is more astonishing that we do not observe
more frequent and more varied complications from eye strain,
when we consider the great frequency of anomalies in refraction
and the outrageous abuse of the eyes in this intellectual age in
which we live.
Having now demonstrated how eye strain will bring about
nervous disturbances, let us turn to the various defects of the
eye which will cause a strain upon its muscular apparatus.
Hg/peropia.
In hyperopia the refractive power is too low, so that, when
the eye is in a state of rest-—adjusted for distance--parallel
rays of light are not brought to a focus upon the retina as in
emmetropia, but behind it. An effort of the accommodation
is therefore required, even to see objects in the distance dis-
tinctly ; and how much greater this strain upon the ciliary
muscle must be, in looking at a point near at hand, when the
accommodation is naturally brought strongly into action.
For the emmetropic eye there is a period of rest in viewing
distant objects, thus giving time to regain its lost strength
after long-continued use at near work, but there is no rest for
the hyperopic eye ; it must work for distant vision, when it
should rest, and must overwork for near vision. Is it, then,
to be wondered at that a constant strain is exercised upon the
ciliary muscle, which in time will produce various nervous
disturbances‘? The extent of the strain exercised upon the
accommodation will depend upon the degree of farsightedness,
the amount of work devolving upon the eye, and the general
condition of the hyperope. The higher the degree of far-
sightedness the greater will be the effort of accommodation at
the near point, but this does not necessarily hold good for the
far point, as they may unconsciously learn to sacrifice a certain
amount of distinctness of vision for the advantage of rest.
The amount of work is a very important factor in producing
asthenopic and nervous symptoms. Steady, long-continued use
of an hyperopic eye will invariably, in time, produce eye
strain, as will overuse of the muscular apparatus elsewhere
cause a corresponding weakness. This is daily demonstrated
in our hospital clinics as the poor seamstresses apply for relief
of eye and head symptoms due to hyperopia. Usually, the
complaint is only of pain in the eyes and headache over them,
after sewing steadily, but occasionally the symptoms become
more severe, as in the following :
CASE I.——Agnes M , aged 17, works at dressmaking
from early in the morning till late in the afternoon. She first
noticed that the eyes tired on sewing, then a mist would appear
before vision about 10 A.M., and continue the remainder of
the day ; every second day would have a headache over the
eyes. These increased in frequency and severity until they
came daily at 9 A.M., and continued till night. The pain was
severe in the vertex and temples, often shooting in character
and accompanied by nervous spells about 2 RM. Examination
showed: V. Hm. (manifest hyperopia) -5-‘T,-. Also, a small
degree of astigmatism. As spherical glasses seemed easier
than cylindrical, no attempt was made to correct the irregular
curvature, but convex 50 were prescribed. Bryonia was given
internally. About a month later she reported that she hardly
suffered from headache, and could use her eyes with comfort
with glasses. If the headache should return in this case, it
would be necessary to correct the astigmatism also, as is
usually done.
Sewing women are not by any means the only sufferers
from headaches due to hyperopia, for it is, comparatively, as
commonly, or perhaps more often, observed in school-children
or others who are using the eyes steadily (at the near point)
in study, or mental exertion. A few cases will give an idea
of the symptoms usually complained of by this class of pa-
tients, of the low degrees of hyperopia which may produce
these symptoms, and of the prompt relief obtained by correc-
tion of the error in refraction.
CASE II.—-Gracie F , aged 9, was brought to me in De-
cember, 1880, for examination of her eyes on account of head-
aches, from which she had been suH’ering for three months
since returning to school in the fall. The headaches were of
almost daily occurrence, and brought on by long study; V.
pg, Hm. -1-11;. Convex 40 seemed easier for reading, and so
were prescribed, to be always worn while studying. One
month later, received word that she was perfectly cured and
could use the eyes without producing headache.
CASE III.-—Lizzie S , aged 12, had been complain-
ing for some time of headache every afternoon while study-
ing, and also of ciliary blepharitis; V. {§, Hm. 5,7; as con-
vex 6O appeared easy for reading they were prescribed. The
headache was relieved for nearly two months, when it again
returned, being severe over the eyes. Examination was now



made, after paralyzing the accommodation with atropia, when
the whole degree of hyperopia was found to be -31%. Her
glasses were exchanged to convex 48, since which time (one
year) there has been no return of headache, or inflammation
of the lid margins.
CASE IV.——F rank E applied in January, 1882, for re-
lief of a constant severe headache in the temples, always aggra-
vated by any use of the eyes. He was very nervous; V. %,
difficulty; concave 50 improved distant vision somewhat.
There was no manifest hyperopia (I-Im.), but the ophthalmo-
scope showed that the refraction must be hyperopic, thus
indicating a spasm of the ciliary muscle. As convex 40 were
comparatively easy to the eyes, they were recommended, and
Jaborandi’“. was given internally. Two weeks later he re-
ported relief from headache, and that he could use the eyes
without trouble with glasses.
CASE V.--—-Esther “7 ,about 17 years of age, came to me
in February, 188-}. She complained that for several months
she had been unable to use her eyes for reading; any use of
them would produce a hot, burning sensation in the eyes, to be
followed by a headache over them, like a tight band, with a
dull heavy feeling in the occiput. Occasionally there would
be shooting pains through the head, and twitching of the eye-
lids. There was some photophobia, especially by gaslight,
and the conjunctiva would become injected on reading. She
had been treated by her physician for “ granular lids.” V. %,
Hm. rd-. Convex 48 were prescribed for near vision. In
a few days it was found that these glasses gave only partial
relief from the headache, and that prolonged use of the eyes
could not be undertaken, owing to the weakness of the ac-
commodation. Systematic exercise of the eyes, according to
“ Dyer’s method,” reading regularly twice a day, commencing
in this case with fifteen minutes (her limit), and increasing one
minute each day as long as it could be done with comfort, was
advised ; at the same time electricity was employed, and va-
rious remedies, as Con., Ruta, Nux, Bell., and Cale. phos., were
administered. She improved steadily and rapidly. In Cc-
tober she wrote that her “eyes had been well all summer ;”
had used her glasses as directed for near vision; could read an
hour and a half without discomfort, and only occasionally
suffered from a headache, which could always be ascribed to
some definite cause unconnected with the eyes.
CASE VI.—-Miss M. D was seen in October, 1883.
She said that reading ten or fifteen minutes would produce a



sharp pain through the right eye, followed by a drawing pain
in the head, and headache over the eyes, with occasionally
some pain in the occiput. V. %§, difliculty, Hm. 1'6. Convex
40 were given for near vision, and Ruta administered inter-
nally. In October, 1884, she reported that all the head-
symptoms had been relieved, and she could use the eyes by
day as much as she desired.
CASE VII.-—Fred. T , about 16 years old, came to my
office in September, 1879. He had not been able to use his
eyes for several years without producing headache, and for
six weeks had complained of marked spasm of the lids on
reading. After reading ten minutes there would be aching
around and behind the eyes, soon followed by frontal head-
ache. V. 3%, Hm. 416. Being satisfied that his hyperopia
was really much more than this, convex 50 were prescribed,
and systematic exercise recommended. For the spasm of the
ciliary muscle Jaborandi was given. wWithin two months he
was able to use his eyes without discomfort, and his headache
and nervous symptoms had disappeared. A little over a year
later it was necessary to change his glasses to convex 40, but
with this exception he has experienced no trouble.
In the above series of cases it will be noted that only those
have been selected in which the hyperopia has been of a low
degree, and in all of which the vision has been perfect (V. %%
or 5% . This has been done intentionally; for they more for-
cibly illustrate the importance of this error of refraction in
causing head symptoms, and therefore the necessity of suspect-
ing it even when the vision is normal. In the higher degrees of
hyperopia attention would be sooner directed towards the
eyes, as the sight is more or less involved, both for distant and
near objects. The train of head-symptoms is, however, very
similar to those given above, only perhaps more pronounced.
In all hyperopes the constant strain to correct the error in
refraction is necessarily chiefly exercised upon the ciliary
muscle. This strain will, in some instances, produce simple
weakness of the muscle; in others a condition of chronic
spasm. The latter is very common, and is a form of “ irritable
weakness,” the muscle being in a state of tension and irrita-
bility which especially induces headache and other nervous
symptoms. .In either condition the correction of the hyper-
opia is of first importance. Afterwards remedies may be re-
quired according to the character of the muscular affection.
The recti muscles are not so frequently involved in far-
sightedness as in nearsightedness, still their relative strength

must often be taken into consideration as will be shown further
on.
The general condition of the patient must not be over-
looked ; for the exciting cause of the head and nerve-symp-
toms will not unfrequently be found in a poor state of the
health. The muscles may have been so strong that they have
been able to withstand the extra amount of work laid upon
them until all at once some constitutional disturbance weakens
the overworked muscles, and develops the symptoms of eye
strain.
llfyopia.
Myopia is the opposite condition of hyperopia, i.e., the re-
fractive power is too high, or the antero-posterior axis too long,
so that parallel rays of light are not brought to a focus upon
the retina but in front of it. The effort of accommodation is,
therefore, even less than in e1nmetropia, both for distant and
near objects, so we would not expect to find headaches arising
from overwork of the ciliary muscle. Thus we must ascribe
the headaches which are observed, though less often than in
some other anomalies of refraction, to some other cause than
strain upon the accommodation as in hyperopia. First, in
high degrees of myopia, which necessitate bringing the book
nearer the eyes than usual, an extra effort of convergence is
required, thus occasioning undue strain on the internal recti
muscles, which is followed by weakness of these muscles with its
attendant train of asthenopic, nervous and cerebral symptoms.
Second, in the progressive myopia of young people, there will
be found congestion of the fundus and even of the whole eye,
sensitiveness to light and use, and other symptoms of irrita-
tion and weakness which may easily be transmitted to the
nerve-centres. Illustrative of these varieties are the follow-
ing cases:
OASE VIII.——Miss M. W , act. 27, school teacher, had
suffered for years from severe sick headaches. \Vould be con-
fined to the house (often in bed) for one or two days each
week. They usually came on about Friday, after teaching all
the week. The pains were intense throughout the whole head,
seeming as if they would drive her crazy, and were only
relieved by anodynes. The patient was very nervous and
delicate. V. rife. M. 4‘% with which V. 35%. The fundus
appeared normal, with the exception of a very slight posterior
staphyloma. The internal recti were weak. Ooneave 10
were prescribed for constant use, and Jaborandi was given

9
internally. She has been new under treatment about four
months, and reports wonderful improvement. The headaches
have not wholly disappeared, but are less frequent and less
severe; she is stronger, less nervous, and sleeps better than
formerly.
CASE IX.-—Ella L , age about 13, came for attention
to eyes in April, 1882. She complained of severe pain over
the eyes in the head on reading two hours or so. Relief
was only obtained by sleep. V. slat, M. T12‘, V. i—‘§. It was
a case of progressive myopia. The fundus was hyperaemic
and outlines of optic papilla blurred, though no marked pos-
terior staphyloma could be detected. Concave 18 were rec-
ommended for constant use. In October, 1884, she reported
herself as perfectly well, could read four or five hours without
discomfort, and did not suffer from her former headaches.
Again, in another series of cases, spasm of the ciliary muscle
will simulate myopia, and play a very prominent part in the
causation of nervous disturbances. These patients may be really
myopic, but of a lower degree than is apparent, or they may be
emmetropic, astigmatic or hyperopic. This condition must
always be borne in mind in myopia, especially when change-
able in degree, for it must not be neutralized by correcting
lenses, but relieved either by the local use of atropia or the
administration of internal remedies, particularly Jaborandi.
As examples of spasm of the accommodation, the following
cases are cited :
CASE X.——Mr. R , set. 28, for seven years had been
writing in a poor light all day. He thought his nearsighted-
ness had appeared within one or two years. He complained
of the myopia increasing, and the eyes tiring on using them
one and a half hours. Fundus normal. V. %—8—. Con-
cave 40, V. 3-8. Three weeks after using Jaborandifii, he
reported that he had used his eyes more than usual, and had
experienced no trouble, V. 13%. Concave 50, V. 3%. Thus
proving that we had a case of myopia with spasm of the ciliary
muscle.
CASE XI.--Mr. M , set. 32. V. Concave 42,
V. %8. For nine months had had spots before the vision and
aching of the eyes upon using them. In three days, under
Jaborandiii‘, the vision had become ;%j%, and the muscec
volitantes had disappeared, thus verifying the diagnosis of
emmetropia with a simulated myopia from spasm of the ac-
modation.
CASE XII.——James L




, set. 32, complained of every-
10
thing becoming black before the eyes on stooping ; aching of
the eyes on reading, and spots before the vision. V. frg. Con-
cave 42, V. %8. Ophthalmoscope showed slight hyperopia.
Three days after taking Jaborandi‘“, all the symptoms were
relieved, and V. -3%.
The influence of regular and irregular spasm of the ciliary
muscle will be further considered under astigmatism.
Astigmatism.
This anomaly is one in which the refraction varies in the
different meridians of the same eye, and is dependent chiefly
upon a variation in curvature of the cornea in its two princi-
pal meridians. Irregular curvature of the cornea or lens in
more than two meridians is purposely excluded from this clas-
sification. Under the term “ regular astigmatism” we may
distinguish six different forms, viz. : simple myopic astigma-
tism (Am.); simple hyperopic astigmatism (Ah.) ; compound
myopic astigmatism (M. -1- Am.) ; compound hyperopic astig-
matism (H. -|- Ah.); mixed astigmatism, with predominant
myopia (Amh.) ; mixed astigmatism, with predominant hyper-
opia (Ahm.)
Astigmatism will more frequently induce headaches and
various nervous disturbances than any other error in refrac-
tion. This is, however, no more than we could anticipate,
when we remember that the ciliary muscle must act irregularly
in the different meridians, thus sooner or later oceasioning eye
strain with its accompanying symptoms. The eye always
endeavors to obtain distinetness ofvision, and in small degrees
of irregular curvature it may approximately accomplish this
result, though at the expense of a strain upon theaceommoda-
tion. It is remarkable how small a deviation from the normal
curvature will, under favorable circumstances, produce serious
eye and head symptoms. Not many years ago, an astigmatism
of rd; was considered normal, and not necessary to correct.
Now, we know that an astigmatism of 7,92, or even ~1——l:., may
occasion very marked asthenopic and nervous symptoms. This
is especially true when the degree of abnormal curvature varies
in the two eyes, and in different meridians, as is quite com-
monly the case; for, in these instances, the strain upon the
ciliary muscle will be unequal in the two eyes, thus complica-
ting the difficulty. In the higher degrees of astigmatism the
patient generally applies for relief early, on account of the
poor sight, thus avoiding headache.
Definite knowledge as to the condition of the ciliary muscle,
11
is very necessary in prescribing cylindrical lenses; for this
muscle may have become so accustomed to acting irregularly,
that irregular contraction has become the rule, and its com-
plete relaxation impossible without artificial aid, thus prevent-
ing us from obtaining correct information as to the curvature
of the cornea. It is, therefore, always advisable to make an
examination after fully paralyzing the accommodation with
atropine ; particularly is this essential in low degrees of my-
opic astigmatism.
Let us now consider the different varieties of this error in
refraction.
Simple Jlfyopic Astitc/rncufisrn (Am.) is that state of refraction
in which myopia exists in one principal meridian, and emme-
tropia in the other. The influence of this abnormal curvature
upon the nerve centres is well de_monstrated in the following
case:
CASE XIII .——-Arthur F , about 17 years of age, came
to me in September, 1878, complaining of a constant aching
in the eyes aggravated upon reading, also a pain over them
after any use, followed by headache, nausea, and general feel-
ing of illness. V. No Hm., but as convex 60 seemed
easier to the eye, they were prescribed. At that time no test
was made for astigmatism, as it was not then thought neces-
sary when vision was perfect. The above glasses, with Ruta
or Nat. mur. internally, gave comparative relief for several
months. After which the patient was not again seen until
March, 1883, when he once more ca.me by the advice of his
physician, to see if there could be any trouble with his eyes.
He stated that he had never been wholly free from attacks of
headache, but, for the past two months it had been constant,
especially in the frontal region. At times it would be severe,
with nausea and vomiting. It was always increased by use
of the eyes, or from any mental exertion. He became despond-
ent, sleepless at night, generally “ run down ” in health, and
totally unfitted for his business (mercantile). He had been
under the best medical advice, 4‘ neurasthenia ” diagnostieated,
and a trip South recommended. He had taken the last pre-
scription, and been to Florida for three or four weeks, but
with only slight temporary relief while away ; all the symp-
toms returning in full force on his return to business. Exami-
nation now revealed R. V. %-3-, L. V. difficulty. N o improve-
ment from spherical glasses could be obtained. As straight
lines did not appear exactly the same in all meridians, it was
decided to test under atropine, which was to be instilled in both

12
eyes the night and morning before he again came. In a few
days he returned, with the accommodation fully paralyzed.
R. V. %;%, L. V. %-3; —— 40° axis 90° (vertical), R. V. -1%, and
lines correct in all meridians; —— 144° axis 90°, L. V. and
lines correct. After a further test, on his recovery from the
atropine, “ O. D. ~48“ axis 90°, 0. S. ——144° axis 900 ” were
prescribed for constant use. After wearing these glasses a few
days, the headache and all other nervous disturbances had
been relieved, even though business had been resumed. Three
months later, he reported “ complete relief from all headache,
sleeps well, and general health as good or better than ever ;”
also, that, upon attempting, for three weeks, to do without
his glasses, indications of his former troubles had returned,
which were at once relieved by putting on his glasses again.
In September, 1884, he came in to say that there had been no
return of former headaches, wears his glasses constantly, and
can use his eyes all he desires.
It must always be remembered that spasm of the ciliary
muscle will not unfrequently make a hyperopic astigmatism
appear to be myopic; it is therefore never safe to prescribe
weak cylindrical glasses without an examination under atro-
pme.
Simple Hypcropic A.9tigmatisin (Ah.) is that condition of the
refraction in which hyperopia exists in one principal meridian
and emmetropia in the other.
Illustrative of the results consequent upon this anomaly of
refraction, and of the benefit derived from its correction, the
following cases are given :
CASE XIV.-—Mrs. A. C , set. 36, dressmaker, was sent
to me in October, 1883. For eight months she had not been
able to use her eyes with comfort, and had much pain over the
eyes in head, especially at menstrual period. Dysmenorrhoea.
V. No Hm. She could not at that time have an examina-
tion made under atropine, so prescribed convex 50 which gave
some relief. Her headaches, however, increased in frequency
and severity; sometimes being constant over the eyes with
nausea, especially in the morning; again there would be a dull
feeling extending down the back of the neck; they were
always made worse from any use of the eyes, mental worry or
excitement. In January, 1884, the test was made under atro-
pine. V. %r‘[’;. O. D. -l- 30° axis 900 V. fig and lines correct.
0. S. + 48° axis 900 V. -,t% and lines correct. These glasses
were prescribed though not perfectly comfortable at first.
Within a few days, however, they were worn with ease, and

13
gave relief from all head symptoms. October, 1884, uses her
eyes all day without trouble. Does not suffer from the former
severe headaches, only occasionally a dull feeling in forehead
and vertex from overwork. She only uses glasses for reading
or sewing.
OASE XV.——Effie H , act. 15, had been sick for one and
a half years from “ nervous prostration and spinal irritation.”
She had received the best medical advice, but had obtained com-
paratively little relief. She suffered from headache and much
pain in the back, aggravated by any exertion physical or men-
tal, and especially by excitement or use of the eyes. On
reading three minutes there would be a blur before vision, fol-
lowed by pain in the eyes extending to head and back. R.
. -5%, L. V. —f—:§-. Oonvex 72° axis 1000 made vision —{-% in both
eyes and lines at first correct, but they soon changed. This was
in April, 1884. A further test was then made under atropine,
with this result: R. V. it, + 60° axis 95° R. V. if and lines
correct. L. V. fit, -I— 72° axis 90° L. V. as and lines correct.
Before recovering from the atropine, these glasses were pre-
scribed for constant use, and she was allowed to return to her
home in the middle of the State. In October, 1884, her father
wrote me that she was still wearing the glasses constantly, and
could read an hour with comfort; also, that “ the headache is
all gone, and her back is a great deal better. It does not ache
except when she is tired.”
That a still smaller degree of abnormal curvature may
cause very decided eye and head symptoms is shown in the
next case.
OASE XVI.-—Lucy E , about 17 years old, came to my
office in November, 1882. For one year had had much pain
in the eyes on reading. The eyes were weak, sensitive to light,
especially gaslight, which caused redness of the eyes the fol-
lowing day. The lids felt heavy, and she desired to close them.
On reading even five minutes, a blur would come before the
vision, to be followed by headache over the eyes. Nearly
every afternoon had pain through the temples coming and
going quickly. V. i%, with slight difficulty; -1- 144° axis
90° made vision if and corrected the slight blurring of ver-
tical lines. These glasses were at once given for both distant
and near vision. Immediate relief from headache and all eye
symptoms was experienced. October, 1884, she wrote that
she was still using the glasses, and could not read an hour
with comfort without them. N 0 pain in the eyes, or headache
unless she neglected to wear her glasses.


14
One more case under this heading will illustrate the impor-
tance of spasm of the ciliary muscle and the necessity of mak-
ing an examination under atropine.
CASE XVII.--Mrs. B , aged about 30, was seen for
the first time in August, 1883. Was of a nervous tempera-
ment, and had for years complained of headache, painful men-
struation, and various nervous disturbances. In 1881 an
oculist had given her —l— 36° axis 90O C —— 48c axis 1800 for
right eye, and —— 48° axis 1800 for left eye. These had given
perfect relief for a year, but when I saw her the old symptoms
were returning. There was sharp pain over and behind the
eyes extending into the head ; drawing sensation as if the eye
were being drawn back into the head; pain after sleeping;
darting pain down the nose ; tired feeling in the occiput ; some
photophobia ; considerable nausea and nervousness; print
blurred on any attempt to read. Use of the eyes for near vision
aggravated all the symptoms, and she was always worse during
menses. R. V. til, L. V. The glasses she was wearing
seeming to improve the vision more than any others, a test under
atropine was decided upon. After itsinstillation for twelve hours
R. V. ~.';,56, L. V. -I-16c axis 90° R. V. gg, -|- 24° axis 90°
L. V. , and lines were corrected in both eyes. After coming
out from under the influence of the mydriatic it was found to be
impossible to completely neutralize the irregular curvature, as
the ciliary muscle had so long acted irregularly that it could
not relax. +30“ O. D., and —l-48C O. S., axes 90°, were as
strong as could be worn with comfort. These were prescribed
for constant use, and after the eyes had become accustomed to
them, about five months later, they were changed to +200 O.
D., and +36“ O. S., axes 90°, which have been used to present
time with relief from all former symptoms.
Compound ill}/epic Asz‘igmat£.9m -l- A m.).—-In this form
myopia exists in both principal meridians, but it varies in
degree. This anomaly of refraction, as can be readily un-
derstood, will produce more serious complications than any of
the preceding varieties, for we have the “ combination strain”
from both the myopia and the myopic astigmatism. The for-
mer induces ovcruse of the internal recti muscles, while the
latter, at the same time, causes an irregular action of the ciliary
muscle. The following cases will show its importance in the
production of nervous disturbances:
CASE XVIII.-—Lucy D-——-, aged 18, was sent to me in
May, 1884, for examination of her eyes on account of severe
headaches. For three or four years she had not been able to

15
study or do any work without producing much headache and
pain in the back. For a long time the headache had been
constant, but made very much worse from riding in the cars
or from any excitement. She was nervous, despondent, and
complained of much backache. R. V. .2160-0-, L. V. 3-1656. Had
been using ——10 glasses. Examination revealed a high de-
gree of compound myopic astigmatism, but, as the test was
variable, a further examination under atropine was recom-
mended. Two days later it was made, with the following
result: R. V. -2%, L. V. 21-655; 0. D. -—9S 3 ——12° ax. 180°,
V. 51%, and lines correct; 0. S. ——1-is 3-12° ax. 20°, L.
V. .18, and lines correct. One week later, she reported that
her headaches were relieved while under the influence of the
atropine, but had now returned, so that she was suffering when
in my office. The following were now found to give the
most relief, and were prescribed for constant use: 0. D.
--—128 C ——12° ax. 180°, C. S. ——168 C -—12° 180°. Clear-
ness of vision for the lines had to be sacrificed for ease in the left
eye by changing the axis from 20° to 180°. Upon using these
glasses for fifteen or twenty minutes in my office, her headache
had nearly disappeared. One month later, her mother reported
that the result was marvellous. “ There had been no headache
since wearing the glasses, no pain in the back, and her general
health was rapidly improving.” The improvement has since
continued, I learn.
In this instance, all the astigmatism, but only a portion of
the myopia, was neutralized. This is usually advisable, but
occasionally all the error may be corrected, as in the next case.
CASE XIX.——Mrs. M , 41 years of age, was seen in
June, 1884. She had suffered for many years from headache,
and various nervous troubles. About five years ago the fol-
lowing glasses had been prescribed: C.D. --20S C —-36G ax.
180°, C. S. -128 C --24° ax. 180°, for distant vision; and
O. D. —30S C -—-2-1° ax. 180° ; C. S. -1-]? C --21“ ax. 180°,
for reading. These had given great relief until the past year,
when her former symptoms had again appeared. She could
not read fifteen minutes without smarting, burning, and aching
in the eyes, pain in the temples and back of the head, with
pain extending down the spine to the ovarian regions. There
was also nausea upon looking at objects when riding. Menscs
were early and profuse. The test under atropine revealed the
following: V. C. D. -—2lS C —-—‘200 ax. 180°, V. ,1-g,
and lines correct ; C. S. ——-13S C ——20° ax. 180°, -}§, and
lines correct. After recovering from the mydriatic, these

16
glasses were prescribed for distant vision, and O. D. -—-72s 3
—-20° ax. 180°, O. S. --—208 C ——20° ax. 180°, for near vision.
In October she wrote that the headaches and other symptoms
were almost wholly reheved, and that she could read for two
hours without discomfort. Regular exercise has been followed,
and Silicea given internally.
Again, it will sometimes be found advisable to only correct
the astigmatism.
CASE XX.-—Mrs. T for years had had ciliary ble-
pharitis, and firing of the eyes and head upon reading or sew-
ing. R. V. T1555, L. V. $655. Her M. was Tlg in the right
eye, and T1-5 in the left eye, with Am. in both eyes of g, in
vertical meridian. Under atropine the myopic astigmatism
was found to be the same; but the myopia was decreased to
,3, in the right eye, and -2% in the left eye, thus showing a
spasm of the accommodation. ——30° ax. 180° were prescribed for
constant use, but especially for reading. One month later, she
could use her eyes as much as she desired without trouble, and
the blepharitis was nearly well. Ung. hydrarg. ox. flav. had
been used locally, and Jaborandi administered internally.
Compowad I-Iyperopic Astigmatism (H. —i— Ah.) is that form
of abnormal curvature in which hyperopia exists in both prin-
cipal meridians, but more in the one than in the other. This
error in refraction is of frequent occurrence, much more fre-
qnent than is usually supposed; and many of the so-called
cases of simple hyperopic astigmatism would prove to be com-
pound were they examined under atropine. The strain upon
the ciliary muscle, which especially gives rise to headaches and
nervous symptoms, is more pronounced in this variety of as-
tigmatism than in any of the preceding, for we have the con-
stant overuse of the accommodation from the hyperopia in
connection with its irregular overaction from the astigmatism.
As examples of this form of anomaly of refraction the fol-
lowing cases are given :
CASE XXI.——-Mr. J. S , aet. about 35, came to me in
October, 1883. For years he had been subject to severe head-
aches, aggravated by any use of the eyes. About a year pre-
vious to his coming to me, cylindrical lenses of +36 O. D.,
and +48 O. S., had been given, and had afforded him partial
relief. Still, the headaches were severe, especially in the frontal
region, and were always aggravated on the day following over-
work of the eyes in the evening. The headaches seemed to be
congestive in character, with heat and flushing of the face.
The pain was sometimes heavy, and again “ pounding,” or sore
over the eyes, made worse by motion, noise, or light. The

eyes, at these times, would feel bruised and sore to touch.
Sometimes there would be nausea and faintness. An examina-
tion, made after instillation of atropine, revealed compound
hyperopic astigmatism. The following glasses, which cor-
rected all the astigmatism, and nearly all the hyperopia, were
prescribed: O. D. +488 3 +36c ax. 135°; O. S. -I-48‘I C
-}-48° ax. 45°. Remedies, as Ruta, Bell., Arg. nit., and Gels,
were given for a month or so. In October, 1884, he wrote
me: “I have little or no trouble whatever with my head.
The headaches have ceased entirely since undergoing treatment
for my eyes. Of course I have to wear my glasses constantly,
but that to me is of small account when I think of those aw-
ful headaches. I can truly say that I never felt better in my
life.”
CASE XXII.-—l\/Irs. V had not, for three or four years,
been able to use her eyes without pain in them, and severe
headache. On reading one day would awake the next morn-
ing with a pain in the occiput, and a feeling in the vertex as
if it were sinking in. On looking steadily, there would be
aching through the eyeball. The test under atropine was
O. 1). +36’ 3 -l-36° ax. 90° ; O. S. +36’ :3 —|—36° ax. 80°.
The cylindricals, which only corrected the astigmatism, were
advised for constant use. One year later she reported that she
wore the glasses constantly with great relief, and that she had
suffered from only one headache since wearing them. As the
eyes tired soon on reading, -I-40’ were combined with her
glasses for reading.
In the above case it will be observed that only the astigma-
tism was neutralized. This is often advisable in the begin-
ning, though later, when the ciliary muscle has become
accustomed to acting regularly, it may be necessary to also
correct the whole or a portion of the hyperopia. One case
more will show the result of a smaller error in refraction.
CASE XX1II.—Miss S came for examination of her
eyes on account of periodic sick headaches. The pain was
severe every week or so, in forehead and temples, accom-
panied with nausea and vomiting. Did not complain of eyes
except of a slight aching occasionally after reading one or
two hours or longer. The test under atropine made apparent
a compound hyperopic astigmatism, corrected by +72S C
-l—72° ax. 90°. Convex 72° ax. 90° were prescribed for
constant use. Three months later she stated that the glasses
had only been worn for reading, but that her headaches were
much less severe and less frequent in occurrence.


2
18
llfizrcd astic/inatism is a rare form in which one principal
meridian is myopic, and the other hyperopic. Two divisions
may be made of this class; in one the myopia predominates
(Amh.), while in the other hyperopia predominates (Ahm.).
This form of astigmatism naturally gives rise to more irreg-
ular action of the accommodation than any other, thus neces-
sarily involving greater eye strain.
One case of each variety will illustrate its influence on the
nerve-centres.
OASE XXIV.——Mrs. W’ had been suffering for two or
three years from dimness of vision, headache, etc., and had
been treated with benefit by an oculist for intraocular troubles.
In May, 1884, she came to my office, complaining of head-
ache in the occiput with nausea after long use of the eyes.
Often there was pain in the back of the neck extending down
the spine. The ophthalmoscope showed some floating opaci-
ties in the vitreous, but fundus otherwise normal. R. V. -1%,
L. V. 18. The test with glasses indicated compound myopic
astigmatism; but an examination under atropine was deemed
necessary, when the following state of refraction was found:
R. V. T1655, L. V. 51%. O. D. +40° ax. 90° C —-24° ax.
180°, V. -};§; and lines correct. O. S. -I-14-1° ax. 90° :
——48° ax. 180°, V. %% and lines correct. After recovering
from the effects of the mydriatic, this prescription was made:
O. D. +48c ax. 90° C) ——-30° ax. 180°. O. S. -—48° ax. 180°.
These glasses have been worn with comfort and relief from
headaches.
OASE XXV.——-Mrs. F. S had for years suffered from
severe periodic headaches and sleeplessness at night. Vision
was indistinct, and the eyes tired on using them long. R. V.
gg, L. V. %(5,. O. D. +48° ax. 115O C>———48° ax. 25°, V. ji-
and lines correct. O. S. +72° ax. 65° C ——72° ax. 155°,
V. -,1--Ԥ and lines correct. Under atropine the test was: O. D.
+24“ ax. 1150 C --1-/14° ax. 25°, . %% and lines correct.
O. S. -I-36° ax. 65°, V. -}§ and lines correct. In this case
the former prescription was made, as the glasses seemed more
comfortable than the latter, after recovery from the mydriatic.
They have given her great relief up to the present time, nearly
two years, but have not effected a perfect cure for she cannot
be induced to use them constantly. A change to the latter
test will probably be rendered necessary ere long.
1){:fi'6l'67tC6’I:’fl. the refraction of the two eyes is of not unfre-
quent occurrence, and requires some consideration. Usually
it is the same error, but differing in degree; thus there will
be hyperopia or myopia in one eye, and the same anomaly in

.. 19
the other eye, only more pronounced. Again, we frequently
observe cases with hyperopia or myopia in both eyes, and in
addition to this, an astigmatism in one but not in the other.
The difference between the two eyes is not, however, limited to
degree, for errors of the most reverse type may be found in the
same patient, as myopia in one eye, and hyperopia in the
other, or simple astigmatism in one, and a compound or mixed
astigmatism of a contradictory character in the other. But we
must not conclude from this variation in refraction of the eyes,
that there must necessarily be exercised a greater muscular
strain, for the patient will not uncommonly learn to suppress
the image in one eye, thereby limiting the strain to the least
ametropic eye. Sometimes the difference in refraction is even
an advantage, as for instance, if there is hyperopia in one eye
and myopia in the other, they may use the farsighted eye only
for distance, and the nearsighted one for near vision, thus
diminishing the strain to the minimum, and postponing the
wearing of glasses to a much later period in life. Binocular
vision is not always an advantage, though when it can be
brought about, with ease to the eyes, our endeavor should be
to make the two eyes act together, and thus divide the labor
and attendant strain. Theoretically, it would be advisable
to always correct the existing errors in both eyes, but prac-
tically it is not usually best to do so.
An almost unlimited variety of differences in refraction of
the eyes could be given, but two or three typical cases will
sufficiently illustrate the class.
CASE XXVI.—-Bertha V , 17 years of age, had for
years complained of headache, and for one year it had been
almost constant. The pain was usually dull, occasionally
sharp, and especially severe in the frontal region ; it was always
better when in the open air. She was very nervous, and the
general health was poor. V. 4-Z-. No manifest hypero-
pia or astigmatism could be detected. Under atropine, V.
-5%. O. D., H. 41,; —|— Ah. 4%, O. S., H. §16. Ten days after
the above test the following glasses were found most comfort-
able, and were prescribed. O. D. -|- 72° ax. 85°, O. S. -|- 60*.
Nine months later her mother wrote that the glasses had been
worn with great comfort, and her general health had greatly
improved, notwithstanding an attack of hay fever.
CASE XXVII.——Mabel L was brought to Inc in Oc-
tober, 1884, for indistinctness of vision, pain in the eyes, and
lachrymation, especially on any reading or studying, together
with some headache over the eyes. R. V. §%, L. V. -,1,%.
—-508 R. V. 4%, -408 L. .%g. She was using -48 for


20
distant vision, which gave partial relief, although the eyes
seemed to be growing worse. It was also noticed that she
held the book much nearer than could be expected in so low
a degree of myopia, so paralysis of the accommodation by
atropine was recommended. A very material change in the
test was then discovered. R. V. It-8-, L. V. T55 difficulty;
—}- 48C axis 90°, R. V. -1135, and lines correct in all meridians;
—- 144c axis 180°, L. V. -}-:2}, and lines correct. These glasses
were advised for constant systematic use, and Jaborandi was
given internally. Four weeks later, being then able to read
without any unpleasant symptoms one hour and a quarter
three times a day, she was allowed to return to school.
CASE XXVIII--Mr. B , aged 55, had, for two years,
experienced most intense headaches every week or ten days.
They would come on in the morning, and continue until the
sun went down. The pain would be worse on the left side,
and extend to the occiput ; it seemed, as he expressed it, “ as
if the head would go off,” from the severity of the pain. The
eyes would tire, and the headache be aggravated by reading
or writing. There was double vision on looking downward
and to the right. A concave cylinder combined with a prism
for left eye, and simple spherical for the right, had given him
some relief one year previous to my seeing him. R. . %%,
L. V. A careful examination revealed hyperopia in right
eye, and mixed astigmatism with paresis of the inferior rectus
muscle in left eye. It was corrected by the following pre-
scription: C. D. —|- 608, C. S. -|- 72° axis 45° 3- 144° axis
135° 3 prism 1°, base downwards. To this, for his presby-
opia, a -{-18“ was added for near vision. One year later, he
reported that he had had no headaches since wearing his
glasses. On account, however, of slight tiring of the eyes, his
spherical was changed to 48, and his prism increased to 2°.

Presbyopict.
All our attention has hitherto been directed to errors in re-
fraction, which have caused the strain upon the accommoda-
tion ; but, independent of these errors, we may have disturb-
ances in the accommodation, which will produce cerebral
complications. First in order is presbyopia, in which the
power of accommodation is diminished by age, as indicated by
the recession of the near point, or the desire to hold the book
farther away. This is due to senile changes in the lens and
ciliary muscle, which render an extra effort of the accommo-
dation indispensable to see near objects distinctly, thus bring-
21
ing about eye strain. It is a condition that occurs not only
in the emmetropie eye, but in all anomalies of refraction. Il-
lustrative of its influence upon the head are the following cases:
CASE XXIX.--Mrs. T ,about 55 years of age, was
seen in May, 1881, for frontal headaches brought on by using
the eyes. Refraction was Em. Pr. 6;. Convex 21 were pre-
scribed with relief of headache. In December, 1883, the head-
ache returned. She would awake nearly every morning with
pain in the occiput, which would settle over the right eye, with
nausea and vomiting. The eyes would smart and burn on
reading, soon followed by pain in the head. Rest of the eyes
benefited the headaches. Convex 18 were then prescribed,
and Sanguinaria given internally. It is now one year, and
she writes that she has experienced no pain in the eyes or head
since last date.
CASE XXX.-—Mrs. I) , act. 52, came for treatment in
April, 1881. For four years the vision had been growing
dimmer, and the eyes weaker, so that, upon attempting to read
even a few minutes, there would be smarting and pain in the
eyes, with much nausea. R. V., %%3, L. V., Refraction,
Em. Pr. —I':_.r. The ophthalmoscope showed commencing cata-
ract in both eyes. Remedies were given to check the progress
of the cataracts most of the time, until February, 1883, when
R. V. —.l—8-, L. V. ff}. Still she could not read without great
discomfort, even with convex 10 glasses, which seemed cor-
rect. The cause of this was found to be weakness of the in-
ternal recti muscles. The convex 10 lenses were, therefore,
decentered inwards so as to obtain a prismatic effect, and thus
relieve the strain on these muscles. They gave immediate re-
lief, and, at this time of writing, she is able to read or write as
much as she desires, and with comfort.
A second form of disturbance in the accommodation is a so-
called “premature presbyopia,” or paresis (weakness) of the
accommodation. Here we may find a recession of the near
point in early life, or even this may not be apparent, as in the
following case:
CASE XXXI.—-Mr. M , a bookkeeper, had for a long
time suffered from daily headaches over and behind the eyes,
with dull pain in them. He was nervous and languid. No
error in the refraction, with the exception of a very slight
hyperopic astigmatism (-7-1,) in one eye, could be detected,
even under atropine. \Veakness of the accommodation was
diagnosticated, and convex 50 were given for his writing.
These glasses gave great relief, but he is still under treatment
directed to the “toning up,” not only of his ciliary muscle,



22
but also of his general strength. This class of cases may re-
quire the aid of glasses for a certain time, but our chief reli-
ance must be placed upon the remedial treatment in the ac-
complishment of a permanent cure.
The reverse condition to the above is spasm of the accommo-
dation. This subject has been well considered in the various
anomalies of refraction, so that very little need be said in this
connection. Its influence in producing disturbances in the
nerve centres has been apparent in a large number of the pre-
ceding cases. I/Vhen its origin can be traced to an error in the
refraction, this must first be corrected ; but often in these
cases, as well as in others in which no trouble of this kind can
be discovered, more than glasses will be required. It is often
here that the local use of mydriatics will render serviceable
aid, or we may place our reliance upon internal medication
either specially or generally indicated.
\
l/Veakness of the Errternal Ocular llfuscles.
It was my purpose to consider in detail the weakness of the
recti and oblique muscles in their relation to secondary dis-
turbances, as has been done with the ciliary muscle, but the
intended limits of this paper have already been exceeded so
that only a hurried glance can be directed to this division.
The internal rectus is more often at fault than all the others
combined. When the asthenopic or nervous symptoms are
not relieved after the correction of the existing anomaly of re-
fraction, it should be our duty to carefully determine the rela-
tive strength of the external muscles. This can easily be
done by an examination with prisms. If one muscle should
prove to be unquestionably weaker than normal, it may be
sufficient to produce the disturbance of which the patient com-
plains; in which case our attention should be turned to the
strengthening of this muscle or relieving the strain brought to
bear upon it. Correction only of the error in refraction may
suffice to accomplish this object, as has been demonstrated in
weakness of the internal recti dependent upon myopia. Again
we relieve the tension upon the weakened muscle by decenter-
ing the lenses as in case xxx., or by the addition of a prism as
in case xxviii. It is not, however, always advisable to di-
minish this strain, but rather endeavor to tone up the muscle
so that it will withstand the increased amount of work devolv-
ing upon it. This can often be done by systematic exercise
with stronger and stronger prisms, so arranged as to only
bring into action the enervated muscle; also by the employ-
23
ment of electricity and internal medication as adapted to the
individual case. In some instances tenotomy of the antago-
nistic muscle is necessary, but these are exceptional cases.
Summary.
In conclusion let me briefly summarize, for the benefit of
the general practitioner, the chief points which it has been
my object to elucidate in this article, and also state a few de-
ductions which may be drawn from my experience. Headache
in any portion of the head, but especially in the frontal region ;
headache in which the pain may be of any character whatever ;
headache severe or mild ; headache periodic or constant ; head-
ache with or without vertigo or nausea, may result from errors
in refraction. Various nervous disturbances, as mental dis-
orders, insomnia, spinal irritation, general nervousness, etc.,
may be dependent upon the same cause. The physician now
naturally inquires, how are we to know that the cause is ocular,
and what indications should lead us to send these patients to
a specialist for examination, providing we do not care to make
the test ourselves ? The following general rules are the only
ones that can be advanced : When headaches or other symptoms
are made worse or brought on by use of the eyes, even though
the aggravation is not experienced until the day following
overuse, an examination of the eyes should be made. If as-
thenopic symptoms are complained of after reading, writing,
or sewing, even though no direct connection can be traced be-
tween these symptoms and the headaches, an examination of
the refraction should be advised. In all cases of chronic
headaches and cerebral or spinal symptoms, in which the causes
are obscure and the treatment obstinate, a careful test of the
refraction may discover some error, or at least aid in the diag-
nosis by excluding the eye as an agent in causing the trouble.
To be positive in the diagnosis of anomalies of refraction, an
examination of the eyes when fully under the influence of atro-
pine is necessary. This test can, however, in the majority of cases,
be dispensed with if there should be any objection to its use.
Oorrection of the faulty refraction is often all that is sufficient
to produce a permanent cure. But frequently, upon the other
hand, this correction will only ameliorate the condition, and
other treatment will be required to complete the cure. This
further treatment may consist of regular systematic exercise of
the weakened muscle or muscles, the employment of electricity,
the administration of remedies for the local disorder, or, more
especially, internal medication directed to the toning up of the
I.”
QIQUO
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24
whole nervous system. Myopia more often occasions weak-
ness of the internal recti muscles, while the accommodation is
more commonly impaired in hyperopia, astigmatism and pres-
byopia. Astigmatism, particularly, causes derangements in
the nerve centres. It is surprising how low a degree of ab-
normal curvature will, in some cases, produce the most serious
complications ; and, again, it is just as wonderful how high a
degree may sometimes be present without developing any in-
dications of eye-strain or its consequences. It is not generally
advisable to wholly neutralize the full degree of myopia or
hyperopia, and even in astigmatism it is not always possible to
correct all the irregular curvature, though this should be done
as nearly as comfort will allow. Errors in refraction do not
as frequently induce secondary disturbances in adults as in
young persons, and they cannot usually be as fully corrected
in the former as in the latter; for the eye of the adult has be-
come so accustomed to working in an abnormal manner that
irregular action of the muscles has become its normal action,
and they (the muscles) cannot at once relax sufficiently to ac-
commodate their action to correcting lenses. Therefore, we may
meet with a case of headache really due to refractive error,
and yet its exact correction will not only not ameliorate, but
even aggravate the trouble. In these instances, repeated and
careful trials with glasses are very necessary, as oftentimes it
will be advisable to only partially correct the error, sometimes
to wholly correct, now and then to combine prisms, and again,
even an over-correction may be required.
Before closing, let me again say that no claim is made in
this paper that all, or even a majority, of headaches, or all
headaches or nervous disturbances of any particular type, even
though accompanied by asthenopic symptoms and aggravated
on reading, are necessarily dependent upon the eyes. I only
assert that the eye is a very important agent in causing these
secondary disturbances, and should be so recognized. The
reverse condition is also just as true, that uterine disorders, ce-
rebral or spinal diseases, and various constitutional troubles,
may cause eye complications. The consideration, however, of
this latter subject, together with the completion of the one now
under examination, by a study of the weakness of the other
ocular muscles, and the relation of inflammatory diseases of the
eye to cerebral and spinal disorders, must be postponed to fu-
ture papers, since the intended limits of this article have already
been far surpassed.
154 WEST 34TH STREET, NEW YORK CITY.
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A‘ Uomphlfmenfsfl of the Author.

THE
TREATMENT OF GRANULAR has BY MASSAGE
WITH Bone llcm.
BY
WILLIAM SPENCER, M.D.,
PHILADELPHIA, PA.
______-______..
READ BEFORE THE HOMG-ZOPATHIC MEDICAL SOCIETY, STATE OF PENNSYLVANIA,
SEPTEMBER, 1894.
Reprinted from the HAHNEMANNIAN MQNTHLY, November, 1894.

SHERMAN & Ga. I-‘RS. PHILA
‘B.
THE
TREATMENT OF GRAN ULAR LIDS BY MASSAGE
WITH BORIC ACID.
BY
WM. SPENCER, PHILADELPHIA, PA.

THERE are few practitioners but who have had, during their
practice, some cases of this intractable disease. I will venture to
say they have struggled harder and worked more, with poorer re-
ward for their efforts, than in most any other class of diseases——not
only because the large proportion of these patients are found in a
class of people of low vitality and have poor hygienic surroundings,
but because the prognosis for radical cure with good vision is ex-
tremely poor. Then any innovation in the old routine methods of
treatment that offers any merit ought to receive a hearty welcome.
“This being an age of exact scientific investigation, men demand-
ing facts and not theories,” I will attempt to prove the efficacy of
this method of treatment by showing the result of a few of the many
cases thus treated at the Eye Department of the Dispensary of the
Hahnemann Hospital of Philadelphia.
There is no disease of the eyes to which such a mass of literature
has been reared as that of trachoma. Historical researches have
shown the disease has been epidemic in Europe since antiquity.
Celsus mentions it and describes it, yet it was not until the latter
part of the eighteenth century that trachoma began to attract the
attention of physicians to any great degree. It became epidemic in
Europe about this time, following the return of Napoleon’s army
from Egypt. The European wars following, and the armies coming
in contact with each other, as well as with the civil population, the
disease became so widely disseminated that during the first half of
the present century the European armies, inmates of asylums and
schools, the poorer classes of people who lived in badly ventilated
and damp rooms, and, in fact, in all establishments where people
_._2.__
dwelt together, large numbers were affected. In some districts, as
many as 20 per cent. suffered. According to the description of
that time, Fuch says trachoma then ran a very acute course, and was
attended with profuse secretion, circumstances which explain the
rapidity with which the disease spreads. It seems that they then
had to deal with the acute form of trachoma, which, now that epi-
demics have ceased, has become rare. L At present, trachoma exists
in many countries as an endemic disease, but mostly occurs under
that chronic form under which, with scarcely any exception, we now
see it.
In the majority of these cases there is so little discharge that it
is scarcely noticed; the lids are not even agglutinated in the morn-
ing when awakening. There is, however, a slight discharge in
some cases, enough to produce by its evaporation thin crusts on the
lid edges or in the corner of the eyes. The different forms under
which trachoma shows itself now is regarded as the explanation
why it is not so prevalent. It being an infectious disease, infection
takes place by coming in contact with the secretions of a diseased
eye. ' The danger of infection being in direct proportion to the
amount of the secretion, contagion through the atmosphere is no
longer considered. The question of micro-organisms is not, as yet,
settled. At present, only the micrococcus of acute blenorrhoea, the
gonococcus, has been satisfactorily determined. Notwithstanding
we are not subject to epidemics of this disease, it becomes very
essential to cure the sporadic cases-—-not only on account of in-
creasing the susceptibility of the conjunctiva to acute inflammations,
but because it gives rise to deformities of the lid and serious damage
to the cornea.
Trachoma is characterized by slowly progressive changes in the
conjunctiva of the lids ; in consequence this membrane becomes hy-
pertrophied, vascular and roughened by firm elevations, instead of
being pale, thin and smooth. This hypertrophy of the mucous mem-
brane occurs under different forms, papillary, granular and, accord-
ing to Stellwag, mixed. The vision is injured by a complication
affecting the cornea, appearing under two forms, pannus and ulcera-
tiou, which very frequently occur together. In the treatment of this
disease it is only the mildest cases or those that are treated early that
are completely cured and the vision regained. In other cases there are
left sequelae, causing a permanent impairment to the cornea, the lids
or the conjunctiva. The secretory glands become obliterated, the con-
junctiva cannot supply the proper amount of fluid, and hence there is
_.3___
an unpleasant dryness and irritation of the lids. By the shrinking of
the tissues the hair follicles are distorted, the hairs become few, or
may be turned down upon the globe. The palpebral fissure is short-
ened, the lids cannot be suflficiently separated, the tarsi become promi-
nent and are shrivelled into dense ridges. The cornea loses its
transparency and the curve becomes altered into irregular forms.
The different methods of treatment are legion, many of the meas-
ures, such as searification of the conjunctiva, excision and expression,
or rupture of the traehomatous granules, cauterization, etc., were
known and practiced by the ancients. The most prevalent medical
treatment is directed to the reduction and absorption of the granular
formations. This is brought about by such astringents frequently
applied as will hasten this process without injuring the conjunctiva.
In the milder and less malignant cases, such caustics or astringents
as alum crystals, sulphate of copper, pyoktanin solution, tannic acid
and glycerine, nitrate silver, etc., are applied daily to the everted
lids. As the parts become accustomed to one remedy another must
be substituted. The patients are provided with some astringent
washes of alum, boric acid, sulphate zinc or acetate lead. In the
more malignant or chronic cases, after undergoing the above course,
other and more effectual measures are resorted to, such as to pick out
each granule with a needle or to squeeze them out with forceps or
puncture them with the point of a hot cautery needle or in the ex-
cision of the supra-abundant folds of the conjunctiva at the fornix
or curetting the conjunctiva according to the method of Peters, of
Bonn, or the method of grattage inaugurated by Manolescu, of Bu-
charest, of scarifying the conjunctiva horizontally and vertically and
scrubbing the scarified surface with a short bristled tooth-brush with
a solution of bichloride of mercury or the expression of them by the
sort of mangle process with the Knapp roller forceps, etc. VVith
all these many methods, surgical and medical, some of which have
been highly lauded, particularly the surgical, to cut short this tedious
and serious disease, yet the majority of the cases run along for years,
few caring to submit to surgical measures. According to such au-
thority as Mutermilch, it will take at least ten years to effect a spon-
taneous cure, and about the same time by the methods pursued by
many practitioners. What a dark outlook this presents to the per-
sons afliicted, to say nothing of the feelings and patience of the prac-
titioner who is unfortunate enough to get acase of trachoma that will
not submit to surgical measures.
VVe ought, therefore, to herald with much pleasure any other plan
._..4___
that will offer the slightest possible chance of relieving them, if not
making a complete cure, even though it be tedious, if the cure can
be made without the formation of cicatricial tissue and the distress-
ing sequelae. My attention'Was first called to the use of massage
with boric acid by an article which appeared in the Jou/rnal of
Ophthalmology, Otology and Laryngology, July, 1891, at that time
we were treating a number of cases at the dispensary of the Hahne-
mann Hospital, and deemed it worthy a trial. It has been, since
that time, used in all cases, acute and chronic, indiscriminately with-
out any other measures, except atropine, where the photophobia was
marked, or in cases of iritis or corneal ulcer complication.
The modus operandi is to thoroughly anaesthetize the eye with a
solution of cocaine, cleanse it with soap and water if necessary, dust
freely over the everted lids powdered boric acid, then with the tip
of index finger, rub it thoroughly, making considerable pressure.
When first applying the powder and rubbing it, a thick paste is
formed, the irritation to the conjunctiva producing a hypersecretion.
\V hen this paste is absorbed or dissolved, apply more powder and
continue the massage. This is done several times during the treat-
ment, until the secretions no longer form a paste and when stopping
the tissue and powder are perfectly dry. After treating the lids in-
direct massage is made to the cornea through the closed lids, if the
cornea is complicated with pannus. In the early part of this treat-
ment, the conjunctiva being hyperaemic, there will be some haemor-
rhage. This will cease after a few treatments. Very little reaction
follows this apparently harsh treatment and after washing the exter-
nal parts, the patient is able to attend to his vocation. The best
result attending this treatment is where it can be applied daily.
I will cite a few cases to show the success of this treatment, some
of which have been very brilliant.
The first case is that of Mr. J. 01., act. 42, a German fruit vender.
He had been treated in other charitable institutions of our city for
three years previous to coming to us. He presented the following
symptoms, as taken from the record book of the Hahnemann Hos-
pital Dispensary. Lids heavy, drooping, partial ptosis, marked
photophobia and considerable lachrymation. On everting the lids
the conjunctiva is congested and swollen, causing an unevenness
more in superior lid. The roughness and tendinous scars “ showing
the vesicular formations had been partially absorbed.” The upper
half of the cornea was so densely infiltrated and vascular, as to be
wholly opaque.
. N. V., R. fingers counted at three feet; L. fingers counted at
three feet.
_._5__
This case had all the old stereotyped methods of treatment, such
as topically applied sulphate copper, pyoktanin, nitrate silver, iodine
and glycerine, grain 40 to Sj, etc. He was put in the hospital and
operated, the grattage operation, according to Knapp’s method, all
without any decided improvement. His vision at this time. after
nineteen months treatment, was O. U. §%5, an improvement, of
course, but very slight for the length of time he was under treatment
and inconveniences he experienced. It was at this time, November,
1892, when I began to treat him with boric acid and massage, every-
thing else being stopped. He was treated daily for several months,
and then twice weekly. He began to improve at once, and, though
slow, his eyes assumed a more healthy, normal appearance. The
opaque cornea gradually cleared until March, 1894, sixteen months
after treatment had been started, the cornea of the left eye was so
transparent that all treatment on that eye was stopped.
The V. R. Q—§--0-, L. T1553, the cornea of right eye not having cleared
as fast or as much as that of the left eye, the treatment was continued
in that eye twice weekly until the vision became R. §%-0-, L. -1-1555.
This case, of course, took a long time; but for the first year and
a half but little or no progress was made, so I considered just that
much time lost. As soon as he was put on the boric acid treatment
he began to improve, and now attends to his vocation and duties very
comfortably. '
Mary E. K., act. 21, had sore eyes six years; when she came to
the dispensary the palpebral fissure was much contracted. Tarsal
conjunctiva injected and thickened; small elevations on upper lid;
cul-de-sac shallow; cornea hazy, having a ground-glass appearance,
mainly upper half, vessels running into corneal substance on mar-
gin. T. N. V., R. fingers counted 3 feet, L. After four weeks’
treatment, the V., R. -2-%U, L. Treatment was then stopped, pa-
tient going back to work in a factory.
Mrs. H. 13., act. 49. About five years ago left eye got sore, ap-
parently coming from cold. She has been treated in one of our
Ophthalmic Institutions for two years. Left superior lids droop.
conjunctiva palpebral, and of cul-de-sac, injected and thickened. Cor-
nea shows circumscribed gray elevations, opaque infiltrated upper
segment, ciliary injection. T. N. V., R. L. After five weeks’
treatment she was discharged with V., R. L. %-8-.
Miss Emma C., act. 21, came to us with trachoma et pannus. The
photophobia was so great that she had to be led in from her ward in
the hospital for treatment. Two years before, she says, her eyes
became affected. Now, the palpebral conjunctiva is granular in ap-
pearance, with cicatricial bands. Bulbar conjunctiva markedly con-
__6___
gested; ciliary injection ; upper part cornea hazy, more marked in
right eye, with a number of hazy spots at outer inferior portion of
cornea, right eye. T. N. V., R., fingers counted at 4 feet, L. 5%,.
Under treatment five weeks her V., R. -%-%, L. -é-56.
These four cases I have selected from many that have been treated
with just as good results, since the method was adopted, and hope
will help to prove that the method has enough advantage to merit its
trial in cases where surgical measures are not feasible.
1523 GIRAR1) AVENUE.
SCOPOLAMINE IN EEFRACTION.


BY WILLIAM SPENCER, M.D.,
Philadelphia.
Reprinted from
THE HOMCEOPATHIC EYE EAR AND THROAT
JOURNAL,
May, 1896.


SCOPOLAMINE IN REFRACTION.
BY WILLIAM SPENCER, M.D.
Philadelphia.
f]:'\HIS is an alkaloid of the scopolia atropoides, a plant
although not new, that has never received enough
attention to have risen above a footnote description
in works on Materia Medica.
It contains, according to Dr. A. Lauggaard, two alka-
loids, one of which, belonging to the group of tropeines,
has recently been more or less carefully studied.
Concerning this alkaloid, scopolamine, I wish to invite
your attention briefly to some observations I have made in
its use as a mydriatic in refraction work.
Scopolamineisa congener of atropine, hyoscine,duboisine,
and daturine, all being alkaloids of plants of the natural
order of solanacea; yet it differs from them in many of their
physiological actions. Atropine, hyoscine, duboisine, and
daturine are classed by Bartholow as excito-motors. They
are very diffusible, increasing very rapidly the heart’s action
as well as its vigor, thus increasing the supply of blood to
the periphery; stimulating the cerebral cortex; causing a
dryness of the mucous membrane of the mouth and fauces;
disturbing the appetite ; dilating the pupil of the eye ;
paralyzing the accommodation, and if long continued pro-
ducing a catarrhal condition of the conjunctiva of the follicu-
lar variety, especially atropine, which is the one most
frequently used.
Scopolamine on the other hand according to the re-
searches of Kobert and Réihlmann causes a cerebral paralysis;
retards the circulation and slows the pulse: not causing
dryness of the mucous membrane ornervous restlessness;
the worst effects being a giddiness, fatigue and sleepiness.
It dilates the pupil of the eye quickly and intensely, acting
with much more energy than atropine or any of the other
tropeines in use.
When instilled into the eye, the conjunctiva becomes
2 WILLIAM SPENCER, M.D.
pale, but not dry, as if it caused a stimulation of the fibres
of the sympathetic and thus producing a contraction of the
vessels.
The tension of the eyeball is also slightly diminished. A
most important feature, and valuable in cases where it is
important to dilate the pupil, without endangering the eye
by excitmg an increase in the intra-ocular tension.
In my use of this drug in refraction work, the results
have been most gratifying. To study its effect on the iris
and the accommodation in this work, fifty cases were
utilized, without discrimination as to their eligibility, rang-
ing in age from 9 to 52 years. A single drop of the T13 of I per
cent. solution was instilled, this one instillation was found
sufficient, where the patient was under observation, so as
to prevent the spasmodic closure of the lids and squeezing
the solution out. When administered under these circum-
stances more than one instillation was not found necessary
to increase or even hasten the effect. When prescribed to
be used at home by the patient, it is instilled twice at half-
hour intervals, thus insuring the retention of enough to get
the full effect.
It was observed 1n these cases that the pupil began to
dilate almost immediately, or as soon as the drug was ab-
sorbed, in from two to three minutes, reaching its maximum
dilatation in from ten to twenty-four minutes, an average
of thirteen minutes for the whole number of cases. The
total paralyzation of the accommodation resulted in from
fifteen to forty-five minutes, an average of twenty-six and
one-half minutes.
The great difference in the time in its action, seems to
be due to susceptibility, physical conditions and activity of
the iris.
The amount of accommodation not materially influencing
the action, some of the young subjects with full or strong
accommodation responded to the action more promptly
than some of the others, who had reached the time in life
to have two or three dioptncs of presbyopia.
The effect began to dimimsh after twenty-four hours,
during that length of time the accommodation in normal
subjects was completely under the control of the drug.
SCOPOLAMINE [N REF]?/1 CT]0N- 3
It required from thirty-six to ninety-six hours before
relaxation was complete, or until jager No. I type could be
read at twelve inches and the pupil fully contracted to its
normal calibre and reacted to light stimulus. It was an
average of forty-eight hours for the whole number, a much
longer time, to be sure, than from the effect of homatropine
hydrobromate, but about a third of the time from atropine
in the strength and manner that these drugs are generally
used.
It will be observed that the iris is first affected and the
maximum dilatation of the pupil is attained, long before
the accommodation is paralyzed.
The action on the accommodation is more pronounced than
that of any of the other mydriatics, except hyoscine, which
it about equals, without sharing its dangers and disadvan-
tages. Two cases in which under the effect of homatro-
pine hydrobromate gr. viij to gj, instilled every ten minutes
for an hour, slight degrees of astigmatism of 0.25 diopter
were not detected, were clearly brought out under the
effect of scopolamine.
Some old cases that had been refracted a year or more
before, with homatropine who were given the strongest cor-
rection suitable to their comfort, on first putting on lenses,
returned, suffering from asthenopic symptoms.
Instead of giving them the total correction according to
the previous examination, as is customary, they were again
refracted under scopolamine. The axes of the cylinder were
unchanged, but the hyperopia in both meridians was in-
creased. Whether this increase in the ametropia was unde-
tected, due to a weak mydriatic or whether it was the result
of a change in the eye, I will not pretend to say. An objec-
tion to be borne in mind in the use of this drug, is the
longer time the accommodation is in abeyance, when com-
pared to that of homatropine. This difficulty can be over-
come in persons, where the use of the eyes is imperative,
by the use of a myotic. Asolution of eserine sulphate (gr. j
to gj) instilled every two or three hours will so restore the
paralyzed sphincter and ciliary muscle, that the eyes can be
used with comfort within twenty-four hours.
In my experience with this drug, there are some points
4 WILLIAM SPENCER, MD.
that ought to commend it to our most careful consideration
and study in refraction work, which summarized are :
First. Its ease of application; a single instillation of a
very weak preparation proving efficacious, as well as being
painless. ‘
Second. Its rapidity of action; in the majority of cases,
the full effect and complete paralysis of accommodation
will be obtained in half an hour.
Third. The convenience, enabling you to apply it while
the patient waits and make not only the preliminary but a
thorough examination at a single visit, a very important
matter with patients who consult you from a distance, as
well as people in moderate circumstances who can ill afford
to lose much time.
Fourth. The condition as well as the appearance of the
eye; instead of having a congested, reddened and swollen
conjunctiva, you have a pale, anaemic normal condition.
Fifth. The safety ; there being no danger of exciting an
increase in the intra-ocular tension. This is particularly
valuable in cases where there is a predisposition to‘
glaucoma.
[Reprinted from the EIAHNED/IANNIAN MONTHLY, May, 1896.]
GLAUCOMA.
BY
WILLIAM SPENCER, M.D.,
_ PHILADELPHIA, PA.
THIS subject has been selected, not with the intention of offer-
ing anything new in the aetiology, pathology or treatment, but
because I feel that this disease is so disastrous and the damage
so irreparable that the symptoms and a picture of it should be
familiar to all of us.
Glaucoma is not a new disease; the inflammatory variety
has been known from antiquity. The non-inflammatory having
no external changes, can only be diagnosticated by making an
ophthalmoscopic examination, and therefore must date from or
after the discovery and use of the ophthalmoscope. The es-
sence of glaucoma lies in the increase in the intraocular pres-
sure, from which all the other essential symptoms can be de-
duced.
The first to recognize the increase in tension as the most im
portant symptom was Mackenzie, in 1830; later, Von Graefe.
The ophthalmoscope, discovered by Helmholtz in 1851,
opened up a new method of examination. Heretofore, the ex-
act pathological changes were not accurately known. The in-
flammatory variety was regarded as having connection with
gout, and was hence called ophthalmia arthritica. The blind-
ness of the non-inflammatory variety has been “lumped" to-
gether with other kinds of blindness under the common name
of that almost obsolete word, an1aurosis. Heinrich Miiller, in
1856, demonstrated anatomically the pressure excavation of the
optic nerve. Soon afterwards, ‘Vebcr and Fiirstcr diagnosti
cated itcaccurately in the ophthalmoscopic picture.
The following subdivisions of the disease are recognized:
primary or secondary. The primary may be with inflamma-
.__2__
tion. This may be acute, subacute and chronic, or “ an ad-
vanced stage of the 11on-intlammatory,” heemorrhagic and fulmi-
naus. By the secondary is meant increased tension, consecutive
to some other disease.
Glaucoma sets in with varying symptoms. If the pressure
rises suddenly to a considerable height, inflammatory symptoms
are excited, and we have to deal with an acute or inflammatory
glaucoma. On the contrary, if the increase in tension comes
on gradually and does not become intense, we have a non-in-
flammatory condition, or glaucoma simplex. I will speak of it
as inflammatory and non-inflammatory, without going into the
subdivisions.
Inflammatory glaucoma runs a typical course, especially in
acute cases. I will quote Fuch in giving the different stages,
with the leading symptoms.
First stage of prodromal.
Second stage-—attack of acute glaucoma.
Third stage-—that of glaucoma absolutum.
The prodromal stage, which in most cases precedes the in-
flammatory attack, is characterized, first of all, by attacks of
obscuration of vision; complains of a cloud or smoke conceal-
ing objects from him; lights are seen as if encircled with a
ring, having the colors of the rainbow; the eye feels tense, or
there is a dull frontal headache; on inspection, the cornea ap-
pears dull and clouded, like glass that has been breathed upon;
the anterior chamber somewhat shallower through advancement
of the iris; the pupil is dilated and reacts sluggishly; the ten-
sion of the eye is increased ; frequently, too, slight ciliary
injection is present.
Such an attack ordinarily lasts several hours, after which the
eye returns to the normal condition, both as regards its appear-
ance and as regards its function. The attacks at first make
their appearance at long intervals (of months or weeks); later,
they become more frequent. Often specific causes for their
existence can be demonstrated, such as hearty meals, lateness
in going to bed, causes of emotional excitement (card playing,
etc.). If the attacks come on in the evening, they always cease
when the patient falls asleep; even in the daytime an attack
may be cut short by his going to sleep. 0
In the interval between the prodromal attacks the sight is
.._.3__.
normal, but stronger and stronger glasses have to be employed
for reading; a rapid increase of presbyopia through diminution
of the power of accommodation. The prodromal stage lasts
only7 a few weeks, or may be protracted over months or even
years. The eye acquires externally the glaucomatous aspect,
and an excavation of the nerve forms in consequence of the
oft-repeated increase of pressure. Consequently, the sight is
no longer perfect.
The second stage of acute glaucoma, sets in suddenly, after
the prodromal stage has lasted a longer or shorter time. The
chief causes of an acute attack, are states of congestion of the
venous system, especially those due to enfeeblement of the
heart’s action. Also mental emotions, particularly of a depress-
ing character, and dilatation of the pupils. A drop of atropine
in an eye which is predisposed to glaucoma may excite an
attack. This danger, Dr. C. M. Thomas tries to guard against,
by warning his students never to use atropine in an eye with a
dilated pupil.
The symptoms of the acute attack are the same as those be-
longing to the prodromal attack, except that they are more
pronounced and are accompanied by inflammatory phenomena
(injection, oedema of the lids and conjunctiva, and pain). The
pain is violent, radiating from the eye along the first and second
branches of the trigeminus. The patient complains of pain in
the head, the ears and the teeth. Simultaneously with the
pain the visual power falls rapidly away, so that only large ob-
jects are seen.
The field of vision is contracted, mostly on the nasal side.
The cornea has a pronounced smoky cloudiness and is almost
or quite insensitive to touch. The tension is considerably ele-
vated and remains permanently so. Ophthalmoscopic exami-
nation is impossible, on account of the marked cloudiness of
the cornea.
WVhen the cornea clears the examination shows at the optic
nerve entrance the signs of the general hyperzemia. The exca-
vation of the optic nerve is not present directly after the attack,
because for its formation a long period of increased tension is
required. Cases which have had a long prodroma show it after
an acute attack.
After some days or weeks there is a subsidence of the acute
__4__.
symptoms and the patient gives himself up to the hope that he
is permanently cured. .
Then a new attack sets in. This, as far as inflammatory
symptoms and pain are concerned, is usually less intense than
the first, but results in a still further reduction of the sight.
These attacks follow each other at longer or shorter inter-
vals; the sight at length becomes entirely extinct.
The disease l1as then entered upon the third stage, that of
glaucoma absolutum. The eye is completely blind, and pre-
sents the following picture. The distended anterior ciliary
veins which unite around the cornea forming a bluish-red circle
of dilated vessels. The cornea is shining and transparent, but
insensitive; the anterior chamber is very shallow.
The iris is reduced to a narrow gray marginal band, and the
pupillary margin is encircled by a broad black border. The
dilated and rigid pupil is greenish or of a dirty gray. The lens
is cloudy (cataractous). The optic disk is deeply excavated
and the eye is as hard as stone. Later on, degenerative changes
make their appearance in the blinded eye; the final outcome is
usually atrophy of the eyeball. After the eye has been hard
for years it at length becomes softer, small and atrophic. In
other cases, abscess of the cornea develops with perforation and
consecutive irido-eyclitis, or even panophthalmitis, together
with phthisis bulbi. Not till the glaucomatous eye has become
shrivelled does it allow its unfortunate possessor to have any
lasting rest.
In the non-inflammatory or glaucoma simplex the increase
of tension sets in very gradually. The eye looks quite normal
externally, or it gives evidence of the lesion by the greater
prominence of the distended anterior ciliary veins, and also
through the dilated and sluggish pupil. The tension is slightly
increased ; often this is not detected on first examination. Some
cases of simple glaucoma in which the tension is never found
distinctly increased. Not having any marked external symp-
toms, and sometimes, indeed, any manifest increase of tension,
we are thrown back upon the opthalmoscopic examination for
the diagnosis.
Such an examination shows a total excavation of the optic
nerve, the depth of which corresponds to the duration of the
disease.
.._,")_._
The subjective symptoms, since the inflammatory attacks and
the pain are wanting, consist almost exclusively of the disturb-
ance of vision. The field of vision is contracted, there is a
diminution of central vision acuity. The latter develops late,
when the field of vision has become very small, patients are
still in condition to read, while they are scarcely able to go
about alone. The reduction of vision takes place very slowly
and gradually, so that the patient himself does not become
aware of the existence of his disease until late.
Glaucoma simplex, not infrequently changes into inflammatory
glaucoma. It always attacks both eyes, and sometimes occurs in
young people in contra-distinction to inflammatory glaucoma.
Inflammatory glaucoma almost always attacks both eyes-
They are rarely affected at the same time. The disease in the
second eye follows months or years after the first. It is a dis-
ease of advanced life, fiftieth to seventieth year, occurring in
women more than men. In some cases heredity is distinctly
influential. Hyperopic eyes are most frequently affected; about
two-thirds of the whole, while myopia gives about one-fifth of
the whole.
N euralgia of the fifth nerve sometimes is a cause. Rigidity
of the vessel walls (arterio-sclerosis), habitual constipation and
premature cessation of the menses predispose to glaucoma. It
occurs more frequently among the Jews than the Christians.
There are many theories advanced to explain the cause of
the intraocular tension. Whetl1er it is dependent upon either
a hypersecretion or diminished absorption ought to be a ques-
tion having considerable weight in the selection of our remedy
if we expect to make a cure according to the law of similia.
The secretion of the aqueous humor is almost wholly from the
uveal tract (l.c., iris, ciliary body and choroid). Absorption of
the intraocular fluids takes place through the filtration passages
iT1 the sclera, near the border of the cornea (the lymph pas-
sages and canal of Schlemm). Any disturbance, therefore, in
the equilibrium between secretion and absorption will of course
cause a change in tension.
As causes of hypersecretion, we may mention irritation of
the trigeminus nerve and serous inflammation of the uveal
tract. Especially is this true if the secretion is more in the
vitreous humor than in the aqueous, for the lens and iris are
___6__
thereby advanced, thus narrowing the iritic angle and interfer-
ing with absorption. A predisposition to hindrance in absorp-
tion is found in unusual rigidity of the sclera, which may be
more marked in one race than in another, or in one family than
another, and it is always found in old age.
Also the filtration passages may be closed by any localized
inflammation of the sclera or the iris, which causes an adhesion
of the periphery of the iris to the cornea or sclera.
Swelling of the ciliary processes will press forward the
periphery of the iris. An increased diameter of the lens will
narrow the space between the lens and the ciliary processes
through which the nutrient fluids pass, by osmosis, from the
vitreous to aqueous, and then out through the filtration pas-
sages. This would cause increased tension in the vitreous over
the aqueous, thus causing an advance of the iris and lens. It
therefore appears that there is no one cause for glaucoma, but
that several elements enter into the aetiology.
TREATMENT.
Glaucoma passed for an incurable disease until Von Graefc
discovered the curative action of iridectomy. Other operations
have been devised, such as sclerotomy, paraeentesis cornea,
myotomy, etc., but none have been able to displace iridectomy.
As regards the time for performing the operation, it is always
best to operate as early as possible. In the prodromal stage
some favorable results may be obtained from internal medica-
tion. By the use of the indicated remedy or the instillation
into the eye of a myotic (eserine or pilocarpine), an operation
may be postponed. In an acute attack of glaucoma it is very
difficult to decide how long we can safely delay operating, hear-
ing in mind 'that a high degree of increased tension may per-
manently destroy vision within a few hours.
It is, therefore, not only unwise but reprehensible in any
physician to delay the operation when there is danger of per-
manent injury to the eye.
The n1yotics, eserine and pilocarpine, are powerful agents in
combating increase in tension. They act only when the iris is
capable of contracting satisfactorily. Unfortunately, the effect
of myotics upon ocular tension is not lasting; therefore, they
___7___
cannot cure glaucoma permanently, andthus dispense with
iridectomy.
The other methods of medicinal treatment, which formerly
were very numerous, are now obsolete—-so say our friends of
the dominant school; but with us we have a number of reme-
dies that have been tried and found most efficacious in relieving
the severe neuralgic pains, as well as having a direct action in
relieving the increased tension. We should think of acon.,
bell., cedron, colocyn., prunus spin. and spigelia for ciliary neu-
ralgia; cedron and bryon. for supraorbital neuralgia; bryon.
and gelsem. for hypersecretion; pl1os., gels., kali iod. and sul.
for clearing up media after the subsidence of an attack. Every
case should have our careful study, and the remedy selected
according to the totality of symptoms present.
*3
ON THE IMPORTANCE
__OF_..
CORRECTING
ttlltlll DEFECTS lll llll llll,
IN THE TREATMENT OF CERTAIN
Neuralgic Pains in the Head,
WIYH OTHER SYMPATHETIC AFFECTZO/VS.

By CHAS. M. THOMAS, M.D.

Reprinted from the Ameflcan _‘70u7/nal of ffomwopaz‘/12‘: Materz'a
./1/fedzka, August, 1876.

PHILA DFlLPHI*. 2
WM. P. KILDARE, PRINTER, 734 8; 736 Smvson ST.
1876.
ON THE IMPORTANCE OF CORRECTING
OPTICAL DEFECTS IN THE EYE,
IN THE TREATMENT or CERTAIN NEURALGIC PAINS IN THE
HEAD, WITH OTHER SYMPATHETIC AFFECTIONS.

BY CHAS. M. THOMAS, M.D.

It is a familiar fact to the opthalmologist, that many neu
ralgic and hysterical headaches, as well as other sympathetic
affections of different organs, may be due to errors in the
refractive or accomodative power of either one or both of
the eyes. With the profession generally, however, this
fact is either entirely unknown, or so poorly appreciated
as to frequently subject patients to a protracted and useless
medication, for the removal of symptoms, which can only
be eradicated by the adjustment of proper glasses. With
the majority also, of those physicians aware of the fre-
quent relation of these symptoms to optical defects of the
eye, from a lack of knowledge as to the methods of pro-
cedure, no examination of this organ is made in the general
examination of the patient, and consequently the physician
is unable to give the only advice that is likely to bring the
patient relief.
With the view of bringing this subject more fully before
the profession at large, I desire to present the following
propositions, which I will support by illustrative cases.
I. Violem‘ headaches, and cam more Zrazrhlesome a’isor/ders,
such as 7/27/tzjgo, nausea, extreme ?té’7"UOZ£S7Z6SS, 651., may 1/esuli
from some ahzormal staie 0f the 2/z'sz'0h, and exist far a re-
marhahle /mgfh of time, wiz‘/zouz‘ e:ccz2‘z'/zg the slightest sus-
piaiorz that the eyes are the cause of the sz¢j‘erz'ug.
Men with a large experience, are constantly meeting with
cases of severe head symptoms, the cause of which they are
4
totally ignorant, and for which they seek in vain for a remedy
that will give relief. Now it is in just these cases, where,
a physical examination revealing some optical defect, the
probable cause of trouble becomes apparent, and the ap-
plication of the proper glasses will be followed by rapid
improvement; when, from a want of the proper knowledge
on the part of the attending physician, the actual state of
the case is not made out, the suffering patient may be
doomed to an indefinite continuance of his malady.
The following cases will furnish interesting examples of
this fact:
CASE I.—l\/Ir. S. consulted me some two years ago, after
having been under the advice of one of our most eminent
physicians (homoeopathic) for over a year; complained that
almost regularly every day, and particularly toward evening,
was troubled with a heavy wearied feeling in the forehead,
throbbing at the occiput, and a sensation as though some-
thing were being twisted inside his head. Mornings his
eyes would appear blood-shot, but with the unpleasant
symptoms nearly gone. I-lad never thought of his eyes
as at fault, as his business seldom required a close applica-
tion to fine work. Had often called the attention of his
former physician to the inflamed appearance of the eyes in
the morning, but as this was ascribed to the irritation pro-
duced by the headache, he had for some time taken but
little account of it.
On careful examination found that he was troubled with
simple myopia or short sight in the right eye, and com-
pound myopic astigmatism in. the left. He received for
distant vision the following glasses, Rt. -—-4—12—s, Lt. —I1§s C
--T,l4- cy. axis 70°, which increased his vision from -%- of nor-
mal to -3-; and for reading, Rt. 0., L. — i cy. axis 70°. Saw
him within a week after he had received his glasses, and
was informed that he had had no bad feelings in his head
since the third day after he had used them, but until then
had experienced a little of the screwing sensation each day.
He said, “Why, Doctor, I always supposed my sight was
5
as good as most people’s, but you have opened a new world
to me.”
He still remains free from his old complaint.
CASE 2.——l\/Iiss T , act. 30, a seamstress, had been
treated for “ chronic catarrh of the head and stomach” for
a year and a-half, giving rise, as her physician informed
her, among others, to the following symptoms: After
working at her sewing for some hours, and at times when
feeling too badly to touch her work, she would be har-
assed with a fulness and throbbing over the frontal
sinus, scratching and watering of the eyes, and increased
secretion from nose. If she did not desist from her work
at this time, nausea and even retching would set in. She
had no idea that her eyes were affected till one day, to
amuse her little sister, she put on a pair of “ old sighted”
glasses, when, much to her surprise, she found that she
could work with very much more ease
Found Hm. =;,l§, and prescribed glasses —l— -31? for sewing,
reading, and other fine work. In about three weeks she
reported that for the fiist week or so she was considerably
relieved, but since had been worse again, and thought my
glasses were hardly so good as the ones she had accidentally
tried. I now paralyzed her accommodation with atropine,
and made out her H = 1-13. Prescribed —l— -215, which gave
her immediate and permanent relief of all her symptoms,
including most of the so~called catarrhal. In this case,
had it not been for the merest chance, she might still be
under; somebody’s care for catarrh or what not.

II. A/2 0j>Zz'ca/ defect ma) exzki for 1/zalzy years ze/12‘/1025;‘
cm/52'/zg Me lean‘ 27260/at/2/zz?/are Z0 z‘/ze />assessor/, mm’, fi/za//J/,
ez'z‘kar wiz‘/z 01/ wit/@0212‘ rm (zppare/zz‘ r,rcz'z‘z'7zg m//se, $2/a’a’e7z/y
siart into moz‘z'wz a most a’z‘5z‘//esszflg Z1/az'/z of sy/mpaz‘/zez‘z'c 7267-
110213 syrizptoms.
Physicians are too apt to overlook the eye as a source
of certain nervous symptoms, because up to the beginning
of the present malady, they had never given the patient
6
the slightest trouble. Indeed, even where the eyes are
known to have been faulty in their refraction for years, this
very fact naturally leads to the supposition that, the anom-
aly having aiways been present, the trouble he now has to
deal with, is something quite foreign to the eyes. And it
is, too. in the most severe cases of sympathetic troubles, that
the physician is most liable to be led astray, he not sup-
posing for a moment that such distressing symptoms could
possibly be so suddenly brought about by an apparently
quite simple error ofsight. The following cases will illus-
trate the importance of an early examination of the eyes
on the sudden appearance of certain nervous or neuralgic
conditions. '
CASE 3-—lVlr. B., mt. 35, engraver; has never had any
trouble in working 6 to IO hours daily, until within a few
months past, when he began to notice an unpleasant misti-
ness and dizziness on looking suddenly up from his work.
This he ascribed, very naturally, to overstraining his eyes,
and began to allow himself more relaxation, in order to
spare them. In spite of this, the trouble increased, so that,
in addition, he became afflicted with a severe occipital
headache of a pulsating character, and with a sense of draw-
ing from the front to the back of the head Lately, he has
become so nervous as to oblige him to desist from work,
on account of the unsteadiness of his hands. Has been
told he is suffering from nervous debility, and has long
given up the idea that his eyes are at fault, and fears some
serious brain trouble.
I learned that a couple of years ago he had‘ used
glasses with some benefit, as he thought, for a short time;
but soon gave them up on finding that he worked fully as
comfortably without them. Careful testing showed left
eye V —— T)-8-, right eye Atropine reduced both eyes to
On testing with the stenopaeic apparatus, made out a
compound hyperopic astigmatism, which, on correction by
the following glasses, -}— s. :1 -1- 113- cy. ax. 90°, brought
his vision up to or normal. ‘Within a day or two after

7
receiving his glasses he was again at his work, and has
had no inconvenience since.
This man had been doing fine work as an engraver for
years, and yet his astigmatism had never made itself felt
until provoked into activity by perhaps a slight amount of
over exertion, and even then caused but little apparent
derangement in the eyes themselves.
CASE 4. Mrs. L., set. about 40, has never complained of
her eyes till the recent illness of her youngest child, when
as she supposes, she strained her eyes in night watching.
Tells me that whenever she attempts to read, write or sew,
she is seized with “ a deathly feeling,” starting from the
stomach and rising up to her ‘head; is certain that if she
were to go on with her work in spite of the feeling, she
would swoon. On this account has not dared to undertake
any sewing, and has not looked at a paper for weeks. A
few days before, had endeavored to write a letter to her
son, but was obliged to give it up. Made no complaint of
her eye balls, or indeed of anything but this indescribable,
“frightful sensation.” Had occasionally, during the past
year used a —l— 316 glass.
5z‘az‘us pmrsezzs. Left eye, V : %, a -|-
renders V
: Right eye, V : and not improved by either
plus or minus spherical lenses. On careful testing, found
for the right eye a mixed astigmatism which was corrected
by the following combination: -1-
cy. ax. 120° F ——I18- cy.
With this for the right, and an ordinary spherical for the
left, vision was jaeger No. 2 was read with perfect
ease and comfort at 10 inches, while before the correction,
jaeger No. 4 brought on a threatening of her old feeling.
The use ofthem was followed by the loss ofher troublesome
symptoms.

III. T/Z6 .S‘L’7/€7’[Z/ 2‘?/02rd/@3071/ze 5)/my>z‘o/1/zs /afar/r 21/¢'@/zz‘z'orzai
may la the 7/rsulz‘ of a var/z'ez‘y of 0,/n‘z'ml defeds.
Although, as has been claimed by Donders, the hyper-
epic eye is the one most liable to set up asthenopic symp-
toms, we are not to forget that there may exist other ab-
8
normal conditions of the eye, giving rise to symptoms very
similar to, and even quite as severe as those resulting‘ from
over strain of the muscle of accommodation. Among
these conditions may be mentioned the following:
1st. [72 hég"/2 grades of myopia zi‘/zaz‘ term’ to 1/apid ]97/0g1/es-
sion, we find complaints arising of pains over the eyes
and through the temples, with congestion of the balls them-
selves, indicating the beginning of secondary changes in
the choroid and retina,-which, if they do not receive im-
mediate attention, may terminate in some serious compli-
cation, still more difficult to relieve.
2d. The so-called 1//-zuscular ast/eenofla, which is not un-
frequent in occurrence, is accompanied at times by the
most disagreeable symptoms, requiring a particular line of
treatment for its relief. '
3d. There is also, sometimes, more or less variation in
the refraction of the two eyes, which frequently leads to
considerable confu_sion in the attempt to make use of both
eyes', and thus fuse the irregular images.
4th. Then, also, errors 2'12 2‘/ze an-0mm0a’az‘z'012 may give
rise to most distressing and irksome conditions. Pamlysis
of the ciliary muscle has been found to follow exposure to
sudden changes of temperature, severe attacks of illness,
etc., and is liable to be confounded with a weakness of
sight, accompanying the general ‘debility of the conva-
lescent. It is particularly annoying in the over-sighted
and normal eye, not so much so in the near-sighted.
Spasm of the accommodation, accompanied by neuralgic
symptoms, brought on from protracted exertion of the
eyes by insufficient. illumination, this tending to shorten
the focus of the lens, renders the case liable to be mis-
taken for one of myopia. The treatment, however, of
both these anomalies of the accommodation must be prin-
cipally medicinal, although the cure may often be mate-
rially assisted by the application of the proper glasses.
5th. Finally, astzlgmatz'srn, or that state in which two
meridians in the same eye will vary in their refraction,
9
may, as has already been shown in three of the above cases,
give rise to serious nervous derangements.
The following cases may serve as interesting illustra-
tions of the effect on the nervous system of several of the
anomalies above enumerated :
CASE 5. P7/ogr/essiwe my/opia. Mr. , act. 26, had
lost the use of the right eye when quite young, from ulcer-
ation of the cornea. His left had always been near-
sighted, obliging him to hold his book quite close to his
face in reading. Although he has of late used his eyes but
little, has hadmuch trouble from sore feelings about the
head, and burning pains at the occiput and through the
temples, tenderness of the balls on pressure, spots flying
before the eyes. Had taken medicine for neuralgia, but
without benefit. Ophthalmoscope showed congestion of
optic nerve, a very large irregular posterior staphyloma,
with hyperaemic appearance about its outer edge. _ Vision
without glasses barely, with a —- %— glass v. = -%-8-, but
states that letters look smaller than natural. Ordered
him clouded glasses and entire rest for one week, at the
end of which time, he feeling somewhat better, gave him
a —- 31,- glass, thereby placing his far point at about four-
teen inches, and instructed him to use his eyes with ex-
treme caution. In about three weeks’ examined him again,
and found optic disc much improved in appearance, staphy-
loma about the same. except with less redness at margins.
Head symptoms very considerably better. Six weeks later
the edgesof staphyloma were quite circumscribed and
without unusual congestion, papilla normal in appearance,
head symptoms entirely disappeared.
CASE 6.-—-Astzlgmm‘z'sm wiz‘/2 .z'12suficz'enc)/ of Rafi.-—
Miss L , aged 20, ~has always been near-sighted;
inherits it from her father, who now wears — %;
glasses. Since she was ten or twelve years old has had
trouble with her eyes, but within the past year or more
the difficulty has increased so much, as to oblige her to
desist entirely from fine work. Complains of flying pains

IO
' and neuralgic headache on attempting to use the eyes, and
disagreeable twitching of the lids, and occillation of the
eye balls. Eyes large and prominent, optic disc hyperaemic,
large atrophic crescent in both. She had worn concave
glasses of various strengths for years, but lately had ex-
perienced but little relief from them. Examination showed
for 1-'z;g"/zz‘ eye ability to count fingers at 3% feet; left eye,
fingers at about 5 feet. Suspecting insufficiency of the recti,
I examined the movements of the eye carefully, and found
it to be the case. A -— % glass gives V : T2,,-GU. Stronger
glasses render letters more distinct, but smaller. Testing
with the stenopaeic apparatus, found a compomm’ my/Iopic
¢zszz'g1//'/zrzz‘z'sr/2/z in both eyes, requiring the following glasses :
Rt. —— %s. C -— -1-1-g cy. axis 90°, Lt. -— %s : —- 115 cy.
axis 90°, which gave her for the distance V= For


reading I prescribed Rt. ——"Z1§s. -— T1-5 cy. axis 90°, Lt.
—— :3 —— 115 cy. axis 90°, hoping that this more accu-
rate correction of the sight might result in improvement,
in the tone of the recti without the use of prisms. Saw
her again at the end of three months, and found the nys-
tagmus or oscillation of the balls entirely disappeared, and
no sign of insufficiency of the recti; could then read and
do fine work with impunity. No return of the troublesome
symptoms at the end of one year.
CASE 7.——l7a1/z‘az‘z'012 in Refi/acz‘z'07/z 0f the T200 E)/es.-—-
Mr. VV , set. 27, has suffered as long as he can
remember with headache and confusion of sight on using
his eyes for any length of time, and is subject to periodi-
cal sick headache. Is very fond of reading, but has to
deny himself on account of his eyes. On applying for
advice, informs me that he has never had the use of his
left eye since childhood. Physicians had told him that it
was irremediable, since he was probably born without
proper sight in that eye. With the right eye closed, can
make out the form and general appearance of objects
about him, but could never distinguish the face of one per-
son from another, unless quite close to him. Can make

11
out the single letters in jaeger, No. 19 (4-line Condensed),
held at about 5 inches. Spherical glasses have but little
effect. After careful testing I discovered a mixed form of
astigmatism, which, on correction, gave him vision in that
,eye 1: No. I, and enabled him to read jaeger No. 2
(pearl), with tolerable ease, between 7 and 14 inches.
Right eye was perfectly emmetropic ; so that the glasses pre-
scribed were Rt., blank, Lt. -|— cy. ax. 95° I" 115 cy.
With this combination the relief in reading was very
marked. Of the permanency of the result I can hardly
judge, as but a short time has elapsed since the correction.

HINTS 1-‘on EXAMINATION.
Indicating, as the above cases do, the importance of an
early examination and proper diagnosis of affections of the
eye, I venture to offer the following simple methods for the
benefit of those who have given no particular attention to
eye diseases, and those who have not the appliances neces-
sary for a thorough examination—m,ethods which may
enable them to arrive, at least at an approximate idea of
the various conditions, in probably the majority of cases.
In determining the ordinary errors of sight, we have to
deal most generally with the far point alone ; but in order
to include in our examination all possible dc-viations, we
begin by placing before our patient the smallest type at
hand, noting the distance at which it is held for most con-
venierit reading. If it be found that fine type, such for in-
stance as that used in the market reports of the T-/démze,
is read much inside the usual distance, one of three abnor-
mal conditions may be present: myopia or near sight;
(6) spasm of the ciliary muscle, or (C) an actual impair-
ment of the acuity of vision from some disease.
Now, taking each eye separately, direct him to name
the letters backward in the title on the top of the inside
pages of the Tfllzmze, as it is held at about 6 feet. He finds
that he cannot make them out, unless he approaches to
within 4 feet. Standing at 6 feet, direct him to look at the
-12
test through a pin hole in a piece of card board. If it be a '
case of -my/opia, the letters will stand out clearer, and this
will be corroborated, if on moving the card from side to
side rapidly, the letters seen through the hole seem to
move in the same a’z'1’ecz‘z'07/z.
Spasm of the muscle of accommodation would be made
out from the history of the case. as from overwork by poor
light, sudden onset of symptoms, and by the contracted
state of the pupil.
[m/mi;//rze/zz‘ of the parcel’ of 7/lsio/2 would be shown by
the fact that the opening in the card caused no improvement
in the sight.
Again, we may find that there is trouble in reading
ordinary or even large type at any distance; there we have
the possibility of the presence of one of four different condi-
tions. presbyopia, (é) paralysis of ciliary muscle, (0)
hypermetropia, or, (d) impaired acuity of vision.
Unless the patient be nearly 50 years old, we may throw_
out /7/rs&,1/0j)z'a,' or, its presence-—withopt complication—-‘-
would be made out from the fact that his distant vision is
normal. and that the trouble in reading has been coming
on very gradually, obliging him to hold his book further
and further from him, etc. In pa;/ti/J/sz's of z‘/zr accommoa'a-
Zia/2 too, the vision for distant objects may be perfect, while
reading and fine work be impossible. It is, however, distin-
guished by its sudden onset, the dilated and immovable
iris, and by the fact that, (in case ofuncomplicated paralysis)
the finest type appear distinct when seen through a small
opening in a card. Whe11 however /4)/pemzeir/0pz'a is present,
the diagnosis is not so evident, for here the a’z'sz‘am‘ vision
will also be impaired.
In order to determine if kg/])e1'11ze’t7/0_pz'az exist, we use the
test with the pin hole, as in myopia. If vision is improved,
we are immediately led to suspect it, and if the test object
seems to move in a direction 0;9p0sz'z‘e to each movement of
the card, the diagnosis of oversight is confirmed, and par-
ticularly if we find that the iris is active, the ball small
in appearance, with a shallow anterior chamber.
13
Dz'mz'¢zz¢z‘;'07z in the power of 1/z'sz'01z is diagnosed as in a
previous paragraph. ' .
Finally, we may find that the reading distance of a
patient varies little or none from the normal. This should
not be allowed to mislead one into the idea that the eye
is not at fault, but the a’z'sz‘am‘ vision should be tested by
the stenopmic method, when a myopia or a hyperopiamay
be discovered.
Probably the simplest method of testing for a5z‘z'gmaz‘z'sm
is to place in the hand of the patient a small piece of black-
ened card board, in the centre of which is cut out an aper-
ture about to 13- inch long, and about I line wide. Looking
at the distant type, with one eye blinded, he is to hold this
slit close to the other eye, and turning it slowly around,
he is to mark if at any position of the slit he sees the letters
much clearer than others. Ifnow the slit be turned at right
angles to this, the letters will be seen more poorly than in
any other position. This showing an unequal focus in the
two meridians, proves the presenceof astigmatism.
Or again, two or three parallel black bars, a few lines
thick and 6-10 inches long, drawn or printed on white paper,
may be held at such a distance from the patient that they
can barely be made out. Now on turning these lines
slowly round, it will be found, if astigmatism be present,
that in a certain position the lines appear distinct, and can
be more or less readily counted, while at right angles to
this, they will be very much blurred.
Muscular astherzofl'a depends of course on a paresis or
insufficiency in one of the external muscles of the ball,
generally the rectus internus. To demonstrate such a con-
dition, one of the following methods may be made use of:
As the patient looks somewhat downward, direct him to
fixhis sight sharply on any small object, as it is slowly
advanced to his face in the median line. If there be a
weakness of the recti, it will be noticed that as the object
reaches a distance of 4”-_-5” from the face, one of the eyes
will begin to oscillate, finally lose its convergence and turn
out.
14
Or, while the attention of the patient is concentrated on
an object, say the nose of the examiner, 6 to 8 inches re-
moved, quickly slip a card, or the flat hand, over one of
the eyes, from below, in such a manner as to obscure the
view of the nose with that eye; observe if it shows any
movement outward. The amount of this movement will
indicate the degree of insufficiency.
As a matter of course, these simple methods of testing
the vision, can give only an idea of the rzatz/1/e of any anom-
aly that may exist, whereas a diagnosis of the degree of
the error would necessitate a more accurate knowledge of
the dioptric system of the eye, together with the careful
use of lenses and other appliances.

\f. :
j."L,~_
-2
"§'.'(\v:n€*

A REPORT
OF
FIFTY CASES OF GATARACT EXTRACTION.
BY
CHAS. M. THOMAS, M.D., PHILADELPHIA.

-_.._-__-_
Reprinted from the journal of ‘Op/L2‘/zalmology, Otolagy and Laryzgology,
January, 1891. '

A REPORT OF FIFTY CASES OF CATARACT
EXTRACTION.
BY CHAS. M. THOMAS, M.D., PHILADELPHIA.
The accompanying series covers all cases operated by the
writer since the first series of 120 cases, ending June, 1888,
and published in the first number of this journal, January,
1889. The present list closes with June of this year. As
in my first report, operations by solution are excluded.
In this series, it will be seen, that not a single case of im-
portant inflammatory reaction occurred, and there was no
failure to secure at least a moderate sharpness of vision,
except in one instance (29), and then the poor result was
(due to circumstances unconnected with the operation ; the
patient having injured the eye, while intoxicated, after dis-
missal from treatment.
In one instance the patient l1as not reported for adjust-
ment of glasses, but the eye was satisfactory in appearance
when discharged from treatment.
As there was no eye lost after the 65th case of my first
series, I am thus able to show 105 consecutive cases without
this serious mishap.
Examination of the visual results, following the usual
standard, shows :
Good, 44 cases, with V:=§3- to Q-26%.
Moderate, 4 cases, with V--—-2-’-5%'-' to 7%,.
Bad, I case, with V=motion of hand.
Unknown, I case.
4 A Repeal of Flfly Cases of Cataract Exz‘1’aez‘z'01z.


ULTIMATE V. I(\:I§éEos}T ULTIMATE V. 18255081? UL'r11\r.»\.'rE V.
2 0 1
3 at 8 W I as
7 %% 2 TBYTOF 2 sin;
I I -2% 2 231,01; I Motion of hand.
I I -2% I m1 5 I Unknown.


In considering the first and second classes we find that
the aggregate good vision is about 88 per cent. and moa’eraz‘e
V. about 8 per cent. against 70 per cent. and I2 per cent.
respectively as in my first series.
This marked improvement in results, while ascribable
no doubt, in part, to increased experience and strict ad-
herence to aseptic methods, I cannot but feel is mainly
due to the fact that a p1'elz'1/zzvzary z'rz'declomy was done in
all the cases except one.
That the performance of a preparatory iridectomy renders
the extraction not only simpler but safer, I am more than
ever convinced, and have no hesitation in asserting that at
least for those of us who are not almost daily engaged in
the extraction of cataract, it is the method par excellence.
My method of operation has varied in no essential par-
ticular from that of two years ago. In making the iri-
dectomy, the lance is entered well back in the sclerotic, and
a rather narrower coloboma is aimed for than formerly.
The section for the extraction is, as before, a low flap, along
the upper corneal edge, avoiding usually any conjunctival
prolongation.
The capsule is invariably opened at the equator of the
lens with a Knapp’s cystotome, and the lens expelled by
pressure of a tortoise shell spoon on the cornea. In most
cases I have used the bichloride, I-I0,000, for irrigating
the ball before and after operation, but lately have occa-
sionally depended on plain hot water.
In perhaps one half of the cases the eye was dressed with
isinglass plaster, after the method of Chisolm and others.
I can, however, see no special advantage in this covering
over the flannel or gauze monocular, except its greater com-
A Reporz‘ of Fzfly Cases 0f Cataract Extracflon. 5
fort in summer weather, and in a few instances, where I have
replaced it by the old monocle, the patient has expressed
himself as being more comfortable-under the latter.
Discission was practiced in 25 cases, and with decided
increase of vision in all but three (I4, 29, 33). In one of
these, however (29), the needling was unwisely done before
the eye was entirely free of irritation following an irido-
cyclitis.
Of operative complications, there is nothing to be said,
as no accident occurred beyond the loss of a small amount
of vitreous, and the help of the spoon in delivery was
required but twice.
The artificial maturation was done seven times, and with
uniformly good result, the opacity increasing with decided
rapidity within a few weeks after, and in one case, when
vision was still 226%, complete maturity was secured inside
of two weeks.
In the healing process there have been practically no
complications beyond an occasional tardy union or a mild
iritis, and the duration of treatment has, I believe, not aver-
aged more than ten days.




AGE,
HEALTH, OPERATION AND COMPLICATION. counsx OF HEALING. RESULTS.
EYE AND LENS.
1. 48 yrs. Smooth. Smooth. 3%
Good.
R1pc.
2. 60 yrs. Smooth. Smooth, %_g_
Good. .
Ripe.
3, 60 yrs. Forster's artificial ripening two Smooth. %_%
Good. months previous.
Immature. Smooth.
4. 78 yrs. Smooth. Smooth. %%
90¢ Disc.
Ripe. _‘2n(%
5. 65 yrs. Smooth. Mental hallucinations for %%
G°°d- .10 ¢l11>'.S- . Disc.
Ripe. Mild inns and slow heahng. 12%
6. 54 yrs. Unruly, much cortex left. Iritis. 5
I Good. WU
5, Ripe.
F7. 67 yrs. Smooth. Smooth. _§_g_
G9od' Disc
Ripe. ’
go:
or

6
A Report of Fifty Cases of Cataract Extraction.

AGE,
HEALTH,
EYE AND LENS.
OPERATION AND COMPLICATION.
COURSE OF HEALING.
RESULTS.
8.
IO.
11.
I2-
13.
14.
15.
16.
17.
19.
20.
21.
22.
23.
24.
6 yrs.
eeb
Ripe.
. 50 yrs.
Good.
Ripe.
62 yrs.
Good.
Ripe.
53 yrs.
Good.
Ripe.
5r yrs.
Good.
Ripe.
70 yrs.
Good.
Ripe.
61 yrs.
Good.
Eye very
prominent,
T. low.
55 yrs-
Good.
Ripe.
72 yrs.
Good.
Immature.
74 yrs-
Good.
Ripe.
. 68 yrs.
Good.
Ripe.
60 yrs.
Good.
Ripe.
58 yrs.
Good.
Ripe.
69 yrs.
Good.
Ripe.
62 yrs.
Good.
Ripe.
67 yrs.
Good.
Ripe.
67 yrs.
Good.
Ripe.

Smooth.
Smooth.
Smooth.
Smooth.
Some cortex left.
Smooth.
Smooth.
Vitreous in advance of lens.
Delivery with spoon; some
cortex left.
Forster 3 mos. previous.
Smooth.
Some sticky cortex left.
Smooth.
Smooth.
Smooth.
Smooth.
Smooth.
Smooth.
Smooth.
Smooth.
Slow healing.
Eye struck in sleep.
Capsulitis.
Smooth.
Smooth.
Smooth.
Smooth.
Capsulo-iritis.
Smooth.
Smooth.
Smooth.
Eye rubbed with pillow,
followed by irritation and
slow healing.
Smooth.
Smooth.
Sharp neuralgia for 3 days.
No mflammatory reaction.
Smooth.
Smooth.
Mild iritis.
Slow recovery.


%%
'221r'1r
Disc.
Hm
olo
32
- U43» UM
5!: gig gblc 3°‘ 2‘;
U
5!: 2: 2125; 2125-21: 2:: ..§-3: 212%: 225::
A Report of Fifty Cases of Catamcz‘ Extraction.

AGE
HEAL'i‘1-I, OPERATION AND COMPLICATION. COURSE OF HEALING. RESULTS.
EYE AND LENS.
25. 75 yrs. Forster 2 mos. previous. Smooth. 2 0
Good. U
Ripe.
26. 64 yrs. Smooth. Smooth. 2
Good. 7.8-
Ripe.
27. 80 yrs. Smooth. Smooth. %%
Good. Forster 1 mo. previous. Disc.
Ripe. %g_
28. 72 yrs. Patient unruly. Slow recovery. ma 0
Good. Some cortex left. Mild iritis.
Ripe.
29. 4 yrs. Smooth. Smooth. -130-%
n_temperate. Some cortex left. Mild i,.ido_cy_
R1P°» cliti_s while in-
toxicated.
. U _
D1sc.—Motion
of hand.
30. 68 yrs. Smooth. Smooth.
ood. %%
Ripe.
31. 60 yrs. Forster 3 mos. previous ; some Smooth. °
Good. cortex left. 15¢
Immature. gg '
32. 74 yrs. Smooth. Smooth. 8 0
g9°¢ Discie-_f0_ol. by
‘P°' iritis.
2 0
33. 7 yrs. Smooth. Smooth. 2 0
ood. D77-izsyc
R‘P“" 34. 8 yrs. Smooth. Smooth. 2 0
00d. T0‘
Ripe.
35. 64 yrs. Smooth. Smooth. 2
Good. g;§C
Rape. 2 0 ‘
T0‘
36. 7 yrs. Smooth. Smooth. 2 0
00d. W
Ripe.
37. 71 yrs. Smooth. Smooth. 2 0
Good. Some cortex left. DIICLUC
Immature. 2 0 '
'6"0'
38. 5 yrs. Smooth. Smooth. 2 0
R9°d° 83¢
1pe. _fi_g_ ‘
39. 60 yrs. Smooth. Smooth. _g_g
G9°d' Disc
Ripe. _g_g '
40. 53 yrs. Smooth. Smooth. 2 0
Good. T_6U
Ripe. ‘ Disc



alto
oio

8
A Refer! of Fz'fz‘y Cases of Caiaracz‘ Exiractzion.

AGE
HEAL'i‘H, OPERATION AND COMPLICATION. COURSE OF HEALING. RESULTS.
EYE AND LENS.
41. 62 yrs. Smooth. Smooth. %.%
G°°d' Disc.
Ripe. 2 0
III
42. 70 yrs. Some vitreous followed lens. Smooth. gt}
Good.
Ripe.
43. 5: yrs. Smooth. Smooth. 80
Good. No prelim. iridectomy. EEC.
Ripe. gg
44. 64 yrs. Smooth. Capsulo-iritis, -5165,,-
Good.
Ripe.
45. 64 yrs. Section too small ; difficult de- Slow recovery. §—8~
ood. hvery with spoon. Disc.
Ripe. 2 0
46. 5 yrs. Smooth. Smooth, slow. Did not report
ery feeble. for test of V.
Ripe.
47. 71 yrs. Forster 2 mos. previous. Smooth. -§-8
Good.
Ripe.
48. 73 yrs. Smooth. Smooth. 8 0
Good.
Ripe.
49. 65 yrs. Forster 2 mos. previous. Smooth. 9
Good. Smooth. T8-
Ripe.
50. 58 yrs. Smooth. Smooth. -§-3
Good.
Ripe.
efl‘“‘"“"


THE
EUSTACHIAN CATHETER.


CHICAGO:
BEPRINT FROM THE UNITED STATES MEDICAL INVESTIGATOR,
JANUARY 15TH AND FEBRUARY 1sT, 1876.
DR. C. H. VILAS,
of Chicago, has removed his office from its former 1oca.tion. (112 East
Randolph Street.) to
5 6 East Was/'7/'ngton Street,
near State Street, over Gossage’s store.
Homrs: 10 TO 1 AND 2 T0 4. EXCEPT SUNDAY.
When speaking one day to some of my medical friends about a simple device
which I had used in the treatment of ear disease, and which I thought would be a
cheap yet very eificient substitute for those of more expensive manufacture, I
mentioned that I intended to call the attention of our Academy to it at an early
day, and at the same time perhaps mention one or two points regarding the catheter
which I thought were not generally known. In response to a request then made I
prepared the following article—not to enlighten other specialists regarding the
catheter or suggest anything to them new or profound—but briefly to pass over
as introductory the ways that experience had shown to be the best and tell in plain
language the results we might hope to attain by its judicious employment, etc., and
then proceed with my original intention.
For the kind testimonials of their successful use which I have received since the
publication of their merits I am deeply indebted. and am led to express the hope
that the devices mentioned herein will accomplish all that has been so generously
accorded them in the way of simple practical aids to the treatment of a class of dis-
eases in which we are all so much interested.
CHICAGO. ILLS.
112 EAST RANDOLPH scr.
THE EUSTACHIAN CATHETER.
BY 0. H. VILAS, A. M., M. 1)., cnrcneo, ILL.
Read before the Chicago Academy of Homoeopathic Physicians and Surgeons.
"’ No instrument used i11 the treatment of aural diseases has been so
misjudged by a considerable number of the medical profession as the
Eustachian catheter. Notwithstanding its use by nearly all (if not all)
of our aural surgeons, there still lingers in the minds of some of our
medical men an unfavorable prejudice, implanted by those whose works
“ bear intrinsic evidence that the authors did not choose to be very
familiar with the details of the proper employment of the instrument.”
Believing that such prejudice may in a great measure be removed by a
candid consideration of its values and dangers, and an eflicient and
oftentimes necessary instrument be brought into more general use by
competent men, it is my intention to consider the catheter with its
substitutes and accessories, and endeavor to suggest the best ways of
using them, as well as explain some new apparatus of my own devis—
ing, specially calculated to remove several objections to the use of the
catheter.
The enquiry oftenest made, why should it be used when we have
other ways of accomplishing the same purpose, is readily answered.
We should not use it if we have other simpler and better ways of
accomplishing the same purpose. but should use every known sub-
stitute when more eflicacious. But there are aural diseases which will
not yield to those which are known as simpler ways, but which will
yield under appropriate treatment; and the duty of physicians to
their patients is not discharged when, after trying the simpler ways.
they abandon as incurable cases faihng to improve. In a majority of
such cases there is a scientific way of reaching them, which will greatly
benefit if not cure, and that way lies through the catheter.
Let us glance a moment at the anatomy of the parts we wish to treat.
So doing, we find a tube leading from an opening in the pharynx to the
tympanic cavity of the middle ear, called the Eustachian, which, with
the cavity, is lined by a continuation of the mucous membrane of the
pharynx. Through this tube only can we reach the tympanic cavity
in its normal state, it being the only accessible opening from within,
while there is none accessible from without, the membranum tympani
4
practically forming an impenetrable barrier. Opening into, attached
to, or p


walls and contents of this cavity are some of
the most important parts of the conducting
apparatus of the ear, a diseased condition of
which, sooner or later, impairs the hearing.
All these parts of the auditory apparatus are
extremely liable to become diseased in various
ways, and in their different pathological states
form a large proportion of the aural troubles
from which relief is sought.
We see then that we have a tube leading
from the pharynx into the tympanic cavity.
We desire to reach these parts with remedies;
how shall we do it? The simplest way would
seem to be to prolong this tube by artificial
means, from its opening into the pharynx to an
accessible point outside the head. This is
exactly what we can do, and the manner in
which we do it is known as “passing the Eus-
tachian catheter.” Once so prolonged, that
is the catheter passed, we attach directly to
the appropriately' made and exposed end such
apparatus as may be necessary to introduce
our remedies.
Two ways of prolonging this tube have been
suggested: one by Cleland, an English sur
geon, that of passing a hollow tube (catheter)
through the nostril and inserting the distal
end in the mouth of the tube, leaving the other
without the nostril; the other by Guyot, a Ver-
sailles postmaster, who passed the catheter
through the mouth, and in substantially the
same manner accomplished a like result. I
have never met with an aural surgeon who
made use of any method but the former, and
hence it must be understood that reference to
that method only is hereafter made, and I
shall not further describe the other.
In the accompanying illustrations we have
the actual size and shape of ()leland’s catheter,
one of alloyed silver, the other of hard rubber,
since his time somewhat modified in its manu-
facture, and from the description given we
have seen the object of its use. It will now be
appropriate to consider its substitutes, gene-
rally known as the simpler means, and see if
they can render its use unnecessary. They
are respectively known as those of (1) Val-
slva, (2) Politzer, and (3) Wilde.
5
The first consists of simply holding the nostrils tightly closed with
the thumb and finger, and making forcible attempts at expiration.
It has but a limited range and is but litle used; deservedly so if for no
other reason than that we have a much better way in Politzer’s.
The second, that of Dr. Adam Politzer, of Vienna, a very valuable
one, is based on two well-known anatomical facts, (1) that the pharyn-
geal orifices of the Eustachian tubes open, while (2) the uvula rests
upon the pharyngeal wall during the process of swallowing, thus sepa-
rating the upper from the lower pharyngeal space. In order to make
use of this method the patient takes a little water into his mouth
which he swallows at a given signal. At this moment air is blown by
the surgeon from a rubber bag-syringe into the upper pharyngeal space
through the nostrils, and thence into the opened mouths of the tubes,
and through the latter into the tympanic cavity, thus freeing those
parts from obstruction or proving their permeability. Frequently this
method will be sufficient for the purpose, but oftentimes we must resort
to other devices hereafter mentioned more fully.
As auxiliary to the methods just described and the catheter, Mr.
Toynbee proposed to auscultate these parts at the moment of their
inflation by means of an instrument which he called an otoscope. It
consists of a flexible rubber tube about two or three feet long, suitably
tipped at both ends so as tightly to fit the external ear. One end is
placed in the surgeon’s ear and the other in the patient’s. On forcing
the air into the upper pharyngeal space as described, the surgeon
listens to the sounds produced and from them judges of the condition
of the parts. Mr. Toynbee attached much importance to the sounds
so heard and arranged a compendium of them, showing what we might
diagnose from a “ dry sound, ” a “ crackling sound, ” etc., which was
extended largely by Kramer; but succeeding them several aural sur-
geons pointed out that they were often in error, and in consequence
his instrument has not proven as useful as was anticipated by him,
though still used within its range.
The third method, that of Sir William Wilde, takes advantage of the
fact that in its normal position a cone of light is formed on the mem-
branum tympani, which changes into a square, divided or irregular
shape with altered position, whenever the curvature of the membrane
is changed. The latter being largely under the control of pathological
changes within, this method becomes a valuable diagnostic aid, but
requires much practice and an extended physiological and pathologi-
cal knowledge to comprehend its indications.
Briefly summing up these three methods then, we see that neither
of the first two readily admit of the use of anything in diagnosis or
treatment of these parts aside from common air, and in many instan-
ces is this limited in value or wholly useless, and at times may be pos-
itively injurious; while the latter though valuable in diagnosis is
powerless in treatment. It is plain then there are no complete substi-
tutes, for in order to diagnose and properly treat the diseases of the
tubes and tympanic cavities, we must at times locally apply various
remedies, and in nearly every case free these districts from obstruc-
6
tions and adhesions impeding them in the discharge of their functions.
No plan by which the former may always be done aside from the
catheter has ever been advanced, though the methods of Valsalva and
Politzer, in combination with electricity have in a great measure ren-
dered it unnecessary for the latter.
The proper method of passing the catheter I consider necessary to
dwell on, or at the outset “ so many trifling things in the way will pre-
vent its accomplishment.”
Familiar with the anatomy and possessed of a steady hand, it is a very
simple matter to introduce the instrument, and in nearly all cases
without pain to the patient. This remark suggests itself because
within the past month two medical gentlemen of much experience in
surgery, while in my otlice expressed themselves as regarding its intro-
duction an exceedingly difficult and painful operation. Said one, “ I
have practiced nearly fifteen years in surgery but never attempted to
use it,” while the other remarked that he regarded its use as beyond
his capabilities. Such is the prejudice inculcated by the efforts of
some who have never fully understood its uses 1
In a healthy condition of the parts, it always should, and if properly
done always will, be entirely painless, though oftentimes somewhat
distasteful. But sometimes the inroads of disease have so affected
the membrane, and produced such pathological changes, that some
pain will result. When once in position however, it should occasion
no inconvenience whatever. These points I have not only frequently
tested on others, but on myself as I have shown you, and I assert them
confidently.
In selecting a catheter, if air is to be introduced the silver ones will
be found the best; if steam or hot medication in any form, those of
hard rubber are preferable, as the former soon become so hot as to be
intolerable. Those who keep their catheters in their general operating
case, and lay the latter widely opened and exposing its glittering array
of weapons before their patient and his friends, will doubtless have
some difiiculty in persuading their patient to submit to complete cathe-
terization, even it he allow the surgeon to attempt the use of one of the
instruments which to him are equally dangerous; but if the operator
with no unnecessary terrors or attempts at display, go about his
work with a confident and assuring manner, I believe he will experi-
ence none of the objections so often mentioned as reasons for its non-
use.
The suitable catheter having been selected, it should be ascertained
that it is permeable, clean and warm. These points are best attained
by pouring warm water through and over it. Then let the patient
blew his nose so as to free it of any collection of mucus and moisten
the membrane, and so seat himself that his head may be supported
from behind. I think it better not to put your arm around his head
as some recommend, for the idea of being held alarms the patient,
thus causing him to brace and strain himself, and interferes with the
proper use of one hand of the operator.
Holding the catheter perpendicularly with the thumb and forefinger
7
of the right hand near its funnel shaped end, the ring on the instru-
ment pointing to the mesial line of the body, the surgeon slightly draws
down the upper lip of the patient with the forefinger of the left hand,
and introduces the catheter into the meatus nasi. This being done he
should at once turn the instrument into a nearly horizontal position,
with its concavity downwards. Right here is one of the stumbling
blocks. The operator either does not turn the instrument into a hori-
zontal position as soon as it has entered the meatus, but strives to
get a “better hold ” by inserting it a little deeper, with the result that
the instrument wanders off into a wrong part of the nostril; or he
turns it before it enters at all, so that he really strives to insert it in a
horizontal position. Either of these errors will be fatal to success.
With the beak of the instrument closely embracing the floor of the
meatus and the columna nasi, gently urge the instrument forward. Do
not crowd it. I have seen a surgeon jam the catheter into the nostril
in a most painful manner. It is not only unnecessary to give it too
much force, but cruel, dangerous, and inimical to success. If it does
not enter readily wait a little, talk to the patient, and induce him to
relax his straining and open his eyes. Then slightly withdraw the
catheter, turn it a little, and on again advancing it will enter. Gradu-
ally raising it until it is in a completely horizontal position, urge it
onwards until it touches the posterior wall of the pharynx. Then raise
the funnel-shaped end, withdraw a little, generally from three-eighths
to half an inch, and turn the catheter from within outwards (guiding
by the ring near the exposed end of the catheter) about one-quarter of
a circle or ninety degrees. This movement will lift the beak of the
catheter into the mouth of the Eustachian tube if the catheter has
been withdrawn exactly enough. Sometimes it will be found that the
instrument seems to engage the mouth of the tube, and yet does not
open into the tube. In such case it has not been withdrawn enough,
and in consequence the beak has been lifted into the fossa just behind
the mouth of the tube. Once in position it is grasped tightly by the
muscles and you have prolonged the Eustachian tube as desired, and
there is a continuous channel from the funnel-shaped end of the cathe-
ter through it into the Eustachian tube, and thence into the tympanic
cavity of the middle car.
(In many cases the experienced operator will omit one step of the
manner I have described for the introduction, and turn the catheter at
once into the orifice of the tube as soon as it has passed through the
nasal cavity and before it has touched the pharynx. But only expe-
rience can render this possible, and even with it such a departure
cannot always be made and success follow.)
Probably there is no better way for the beginner to acquire the tactas
eruditus than by catheterizing himself. Judiciously done no harm is
likely to follow, and the feelings of the patient as well as the judgment
and skill of the operator can be combined. That he may know he
has actually engaged the tube, let him blow air into the tympanic cav-
ity with a bag syringe or the inflator hereafter described, using a mod-
erate degree of inflation only. '
8
With the careful operator there are but a few accidents liable to
occur during the introduction in the manner I have given. But there
are some, and they should be borne in mmd.
I. Laceration of the membrane is the most serious, as on inflation
by any method, emphysema of the submucous tissue may result, and
be accompanied by serious or extremely dangerous symptoms. Even
instant death is said to have been caused, perhaps by pressure on the
labyrinth of highly condensed air thus misdirected. (Diseases of the
Ear, by Joseph Toynbee). Such an accident, though, it should be
remembered is in no wise chargeable to the instrument itself. I have
seen false passage, extensive laceration and irreparable injury done the
mucous membrane by the use of the urethral catheter. But was that
the fault of the instrument, or should it lead us to abandon it ? Ought
we not to discountenance the surgeon who caused the injury by his
unskillful manipulations rather than the unoffending instrument ?
There is no tract of the whole mucous membrane more tolerant of the
use of instruments than that of the pharynx, and its behavior under
proper treatment is excellent.
II. You may miss the mouth of the Eustachian tube and engage the
cicatrix of some old ulcer. Such a case happened to one of the most
eminent English aural surgeons, Mr. Pilcher, who unfortunately hit
upon the cicatrix of an ulcer caused by small-pox, so that “ when air
was pressed into the catheter the cellular membrane of the whole side
became emphysematous, and for a time rather dangerous symptoms
ensued.’7 (Aural Gatarrh and Ourable Deafness, by Peter Allen).
III. You may engage the ulcer of some existing disease. I do not
remember to have seen this warning given by any author, but it
merits consideration.
IV. There may be some haemorrhage from too rough manipulation
or the irritation of the highly congested membrane.
These comprise all the accidents that can happen when reasonable
care is used. Happily all may be readily controlled and should be
avoided. With care and experience the first will not occur; the second
and third may be avoided by a pharyngeo-rhinoscopic examination,
which should always be made whenever there is occasion to suspect
any old cicatrix, any existing syphilitic ulcer, or any disease involving
extensive or deep-seated pathological changes; the fourth seldom
occurs to a considerable degree, but when it does may be easily con-
trolled by cold water or some other simple astringent.
With the catheter successfully in place it will develop a very
unpleasant tendency to slip out and you will early find your patience
tried to prevent this. Numerous bands, clamps, etc., have been
devised to retain it, but experience teaches that it is better controlled
by a gentle touch.
It may be unnecessary to employ any remedy through the catheter,
the simple introduction and consequent opening of the mouths of the
9
tubes being all that is necessary. The various remedies and medicines
which may with value be used in this manner I shall not mention, as
it would require more time than is allotted me. But there is one
remedy which I shall consider as it not only serves in such a capacity
but is also the vehicle by which many medicines are used. I refer to
atmospheric air, a consideration of which will show its value in both
respects. Nearly every disease of\ these parts will require its use as a
preliminary step (if it does not sufiice for entire treatment) if the other
devices mentioned have proven unsatisfactory. In many cases where
it could not be previously used advantageously, after the tubes have
been simply opened as mentioned, Politzer’s manner of inflation can
be successfully used, a mode of treatment which I often employ to
excellent advantage.
The various ways of using air are :
I. By the rubber air-syringe. If the patient has borne well all the
manipulations necessary for the introduction of the catheter, he will
cringe and draw away if you jar it in the least. This you will almost
certainly do if you force air into it in the way our text-books recom-
mend, thus rendering the patient very averse to a repetition of the
operation. To avoid this you should not place the nozzle of the air
syringe in the catheter as recommended, but use a soft, flexible-rubber
tube, about eighteen inches long, one end of which is provided with a
nozzle to fit into the catheter, while the other is attached to the air-
syringe. The latter should be made with a valve allowing immediate
inflation after an expiration, thus rendering unnecessary the removal
of the nozzle from the catheter until the operation is completed. With
such an arrangement the syringe can be freely compressed without
jarring the catheter in the least. Nearly every beginner gives too
much force to the current and endeavors to squeeze the syringe empty.
Amuch better result will be obtained by a succession of short and
sharp but gentle puffs.
II. By means of a condensing pump and metallic receiver. This
apparatus consists of a large metal reservoir into which for some
minutes air is condensed by a pump. To this is attached a flexible
tube from which the air is shut off by a valve. When it is desired to
remove some obstruction or adhesion the tube is attached to the
catheter and the compressed air turned on.
III. By attaching the pump to a tube connecting with the catheter
and forcing air directly into it.
Quite a number of accidents have resulted from the last two ways,
and it is well that the operator should know in what ways to anticipate
danger. A glance at the anatomy of the middle and internal ears
shows us that in the tympanic cavity are the three ossicles of the ear,
one of which is attached to the membranum tympani (or drum-head) ;
one presses against the oval opening (fenestrum ovalis) in such a
manner‘ that it will compress the contents of the unyielding bony walls
of the labyrinth and squeeze the delicate filaments of the auditory
nerve (the third forming the connection between the other two) ; that
10
the mastoid cells open directly into the tympanum; that the delicate
membranum tympani forms the only barrier between this cavity and
the external ear; and that all these as well as other delicate parts
of the auditory apparatus are exposed to the shock of a blast of air
driven through the catheter. Is it any wonder then that those
not knowing their anatomy, or ignorant or careless of the danger
should cause serious injury by dealing a heavy blow of air on these
delicate parts? Is it any wonder that they should have seriously
impaired hearing and rendered the catheter objectionable to many in
the profession ‘B And shall we therefore abandon it ‘B As well might
we abandon any other surgical instrument we have, for if misused it
will do injury. Let us not deprive the world of the benefits of modern
science because sometimes dangerous, or because ignorant men misuse
the arts that the learned have devised, but so educate ourselves that
no means human brains can devise go unused because they require
study and delicate manipulation. .
No operator should force air into the middle ear with unyielding
force by air-syringe, condenser, pump or any device, without under-
standing that such aecidents as have been mentioned are liable to
occur. Those who do so, believing it an eflicacious method of treat-
ment, will probably have their full share of such accidents.
But there are times when the gentle blast of the syringe will not suf-
fice, and when after a careful examination of the parts we are
warranted in using more force than obtained by the syringe, but not
as much nor of the same kind as compressed air gives. Singularly no
one has solved this great practical need, and given us such a device.
In the endeavor to fill so important a gap in our mechanical treatment
I believe I can suggest a device, simple as it is, which will answer all
such purposes, and therefore add
IV. By means of what I shall call an inflator.
In this device I claim not so much the manner of its arrangement
and manufacture, as it is but slightly my own, and may be modified
and changed hereafter by others as well as myself, butI believe I am
the first to suggest the idea ofusing rubber compression, arid driving the
air by the elasticity of rubber instead of by condensation or by direct physical
0-r mechanical force. It will be readily seen that ‘such a manner of
forcing air has a decided advantage in the softness of the current, and
that the air enters in a nearly normal state. These good points
cannot be conceded to condensed air, it being more of the nature of
steam-pressure and in an abnormal state, while the direct mechanical
or physical force allows no yielding whatever.
The simple device, which I have so far used, is shown in the opposite
cut. With slight modifications to adapt it to its different uses, it will
be recognized as parts of or very similar to several forms of apparatus
now in use. I first became aware of its value through combining these
various devices from time to time as emergency demanded, and with
such uniform success that I am led to offer it as a valuable aid in our
treatment.
11
A is a small air-syringe to force air into the air reservoir 0, which is
covered with netting to prevent it burstin , it being delicately made.
In its manufacture depends nearly the W ole success of the device.
(I cannot la too much stress on this point. I had several of these
inflators ma e in such a slip-shod manner that I could not endorse
them, and am sure that should such fall into the hands of any who
would use them,they would do much to injure and prevent their proper
employmentj1 E is a stop-cock to remain closed until it is desired to
let air from t e reservoir 0 through the tube F. G is the nozzle to be
placed in the catheter when in position. The tube from A to C is
about six inches long, D three inches, and F twenty inches. It is
cheap, simple, and can be obtained of any instrument maker, or readily
adapted by the surgeon himself.
To use, we close the stop-cock and fill the reservoir by means of the
air-syringe. The catheter being in position we insert the nozzle into
the funnel-shaped end and opening the stop cock the elastic resistance
of the distended reservoir causes a vigorous and somewhat prolonged
blast, forcing the air, or the medicine if the va orizer be attached, into
the catheter and thence into the Eustachian tu e.


Of its value I shall say nothing at present beyond that it has been in
use by me with uniform advantage, and that already a number of
endorsements have been received from those whose opinion is valuable.
With reasonable care and an intelligent understanding of the values
and dangers of catheterization, no harm can come from it, and it is a
cheap, efficient, and safe substitute for many now in use of expensive
and dangerous manufacture. In the words of a prominent aurist,
"‘ Your device is a good one, and certainly worthy of trial by all those
who are interested in the treatment of aural diseases.”
In all cases where the tissues of the membranum tympani (or drum-
head) are softened, or where there are cicatrices or thinned portions of
the same, caution in its use should be observed. Other morbid states
also will present themselves demanding a like care, but where any
pressure is admissible I believe this apparatus can be so controlled as
to offer the least danger.
As an efficient substitute oftentimes for the air-syringe in Politzer’s
method it also offers advantages self-suggesting on trial. I am
indebted to several surgeons for this as well as other suggestions of its
value. A tip suitable for insertion in the nostril can be readily changed
for the catheter tip shown in the cut. Its use should be governed by
the rules applicable to that method.
I am far from believing that local remedies are always necessary for
a cure. Internal medication should rende_r such means secondary in
our practice. But there are cases where at times the vapor -of different
fluids can, for its diagnostic or remedial effect, be used to advantage
12
through the catheter or nostril direct, a notable instance of the for-
mer being the use of Chloroform in tight stricture of the Eustachian
tube. Through its use in eastern hospitals I became accustomed to
Buttle’s inhaler for this purpose, but since coming west I have used
one of my own devising. It is sketched full size in the accompanying
cut, and will, I think, suggest its good points to all who have occasion
to use one.


It is so simple as scarcely to require description. It consists of two
turned hard-rubber hemispheres, tightly screwing together. One is
tipped suitably to closely fit in the funnel-shaped end of the catheter;
the other will closely receive the nozzle G of the inflator or the rubber
l(3111be E, or the tube attached to Politzer’s bag, can be ‘tted over it if
esire .
To use, saturate a small sponge, loosely fitting in the cups, with a
few drops of the fluid desired to be vaporized, place it in one of the
cups and screw both together. Place the proper tip in the catheter,
attach the inflator, and with a small blast the fluid is vaporized and
enters the catheter, and thence onward.
Itthink its improvement over Buttle’s inhaler consists in its change of
shape for convenient use as a vaporizer instead of an inhaler, the tube
tip closely fitting the catheter and insuring accuracy of vaporizing;
that it allows the nozzle of the inflator or the the air-syringe to be
attached without change; and that its round and serrated form allows
it to be easily held by the hand holding the catheter in position.
I would also briefly call your attention to the value of the catheter
as a sound in diagnosing the condition of the membrane, in the detec-
tion of nasal polypi, etc. You will also see that it affords a ready
channel for the introduction of tympanic catheters, electrical or elastic
bougies, or as a guide for any other remedy desired to be passed either
into or through the tube.
In conclusion permit me to say that the time has not been sufficient
for me to mention all ways by which remedies can be made to enter
the Eustachian tubes, though I believe I have considered all that can
be justly regarded as substitutes for the catheter, nor discuss any
theories. I have simply endeavored to explain, in a practical way, the
uses of the catheter, and lay out such a method of use as merits atten-
tion by all who would treat aural disease.
MALPRACTIGE IN ACUTE GLAUGOMA.
BY
HAROLD WILSON, M.D.,
DETROIT.

ALTHOUGH the subject of this paper is, in a measure an indict-
ment against the general practitioner, those of you who have had
the opportunity of seeing how important is the matter of which it
treats, will, I am sure, forgive the charge. Acute glaucoma is not
a common disease, but there is hardly any afi°ection of the eyes more
rapid and terrible in its destructive nature. Vision may be totally
destroyed in a few hours in some malignant cases, and no disease
needs clearer insight or better understanding as to what must be
done, and perhaps none shows more often the effects of mismanage-
ment. This is the excuse I offer for taking your attention for a few
minutes.
Glaucoma is not a self-limiting disease. Acute attacks will sub-
side eventually under bad treatment, or under no treatment at all.
Except under proper treatment, however, they always leave the eye
very much damaged, if not altogether ruined, and liable to a renewal
of the acute trouble at any time. For this reason it is important to
have a clear understanding as to what are the positive symptoms of
this disease, and an equally clear understanding as to what is its
proper treatment.
The value of diagnosis in the treatment of disease is a much
debated question among the members of our school. ‘We may find
not a few practitioners who prescribe for diseased conditions irres-
pective of the diagnosis, and who do not consider it of much value
in determining the proper means of cure. Others make the diagnosis
the basis of the prescription. Now from an ophthalmic standpoint,
not to open the entire question, this much may be stated with confi-
dence: The proper and intelligent treatment of eye diseases in general,
necessitates their accurate and careful diagnosis. I am aware that
this sentiment will not meet with universal approbation. Some of
you may consider it not very homoeopathic. It is not the province
of this paper to discuss it however, except in a very limited way, and
for the present, we shall assume it as proven, and shall show how it
obtains in cases of acute glaucoma, at least.
__2__
Much has already been written about this disease. It has been a
favorite topic for society papers for many years. The general practi-
tioner has been told about its aetiology, pathology, symptoms and
treatment, many times over. Nevertheless, I question whether he
has any but the most hazy notions about it, as a rule. The result of
these indefinite notions is, that when he has a case of acute glaucoma
to treat it is very apt to result in blindness. A lady, aged 65, came
from a small place in the country, a few weeks ago, to consult me in
regard to her eyes. Up to four years ago they had never given her
any trouble. At that time a violent inflammation came on first in
one eye, and later on involving the other. She was treated by her
physician from January until June, without much relief. Then
changing physicians, the inflammation rapidly subsided, leaving
her totally blind in one eye, and nearly so, in the other. VVhat little
vision there was in this eye had gradually grown worse, until when
I saw her, there was only the merest trace of light perception remain-
ing. An operation proved, as was expected, of no avail. It was
too late to do anything, and she had nothing to expect but absolute
blindness for the rest of her days. There is no doubt, that with
proper treatment four years ago, during the acute outbreak, this
patient might have had useful vision. The trouble was, her physician
did not know what was the matter with his patient. He did not
rightly diagnosticate his case. Had he done so, the slightest reference
to an ophthalmic text-book would have enabled him, in all proba-
bility, to have done her some good. Every oculist can report similar
cases.
If then, we have made the diagnosis of glaucoma in a given case,
what is its proper treatment‘? In the first place, the overwhelming
experience of homoeopathic oculists is, that it is not safe to rely on
the single remedy, prescribed on the totality of the symptoms. I
will not say that such a prescription will never cure a case of acute
glaucoma, but think it more than doubtful whether there can be
found a single specialist in our school who would so restrict his treat-
ment; at least, unless there were immediate and positive improve-
ment to be noticed. VVe may say then, with confidence, that in the
present state of our knowledge, the “indicated remedy ” alone, is not
the proper treatment. Something else must be done. In brief, this
something else is either the local use of eserine to contract the pupil,
or the operation of iridectomy, or both. Other methods or remedies
it is not necessary to discuss here. The experience of more than
thirty-five years has justified the profession in the dependence placed
DIAGNOSTIC TABLE OF ACUTE INFLAMMATIONS OF THE EYE.
No'rE.——This table is more or less imperfect, as the symptoms Of the various 001l1&1' inflamma-ti0l1$
often overlap. It is intended to assist in their diagnosis, but not to take the place of the fuller descrip-
tions of the
Eyeball r e d
an
inflamed.
text-books.
f Lids marked-
ly swollen.
Pains local-
ized and not i
v e r y i n-
tense.
' Discharge from
eye Watery,
with photo-
phobia. Pain
relieved tem-
porarily b y
cocaine. Lids
sometim’s but
little swollen.
Discharge from
eye mucous or
m u c o-p u r u-
tle pain or
photophobia.
Discharge from
eye purulent
and very pro-

-1‘
Lids not at all
or but little ,
L swollen.

L fuse.
’ Discharge from
eye In ucous or
m u c o-p u r u-
lent.
Discharge from
eye watery or
none at all.
P a i n very
marked, ex-
te n d in g to
s u r r ounding
p or t i o n s of

L head and face.
superfic’l and *
lent. Very lit- T
L
f

L
I,
l
l
A
( Cornea vascular
F Vision greatly
Vision moder-
or opaque.
Ulcers on cor-
nea.
Abscess in cor-
nea.
Cornea clear;
oedema of the
co njunctiva;
no discharge.
Conjunctiva
smooth or vel-
Vety.
Conj unctiva
r o u g h and
granular.
Symptoms in-
tense; c o n -
junctiva and
lids greatly
swollen.
Cfonj unctiva
smooth or vel-
vety.
}
l
l
l
l
impaired. l
L
atel y impair’d
(0 r w h e n
g r e at l y im- ,
p a i r e d , ob-
struct’ons may
be seen in pu-
piliary area).

L
Orbital Cellulitis.
} Vascular Keratitis.
} Ulcerative Keratitis.
} Suppurative Keratitis.
Catarrhal Conjunctivitis.
Trachoma.
Purulent Conjunctivitis.
Catarrhal Conjunctivitis.
Impairmentof vis- \
ion very rapid
and extensive;
pupil regular;
usually dilated ;
tension of eye-
ball increased ;
ciliary region
not specially
sensitive; great
pain al w a y s
present.
Impairment ofvis-
ion slow; pupil
fixed and irreg-
ular; tens ion
of eyeball not
(ordinarily) in-
creased; exquis-
ite tenderness
of ci li ary re-
gion ; s o m e -
ti m es little or
no pain.
p u pil contract-
ed, sluggish or
immobile; fine
red streaks ra-
diating from
cornea, in scle-
ra; ciliary con-
gestion.
J
f Iris discolored; l
L
\ Glauco-
ma.
Iride-
choroi-
ditis.
y Iritis.

_4_
upon iridectomy, and, until something equally good and reliable can
be demonstrated, it will not be set aside. As to the use of the sul-
phate of eserine, it is, of course, empirical, but abundant clinical
experience has shown its value. Any text-book will explain its ac-
tion and sphere of usefulness. In addition to these two measures,
it is the duty of the homceopathic physician to treat his patient ac-
cording to the therapeutics of his school. The indicated remedy
must not be forgotten, as it is capable of rendering much help, but,
if we must forget anything, let us forget this rather than either of
the measures above referred to. But if an iridectomy has to be
made, how can it be accomplished in the absence of a competent
specialist? It is not an easy operation, and yet, if a specialist can- '
not be summoned, or if the patient cannot be sent to one, the gen-
eral practitioner must do the best he can. Fortunately, in these acute
cases an imperfect operation will often suffice, and any intelligent
physician may, by a little study and practice upon pigs’ eyes, fit him-
self for such an emergency. A skilled operator should be secured,
if possible, and without delay; but, if this cannot be done, the emer-
gency must be met by the physician in charge himself.
If, then, the treatment of acute glaucoma is thus clearly marked, it
is evident that its diagnosis is a matter of the utmost importance. It
is not so necessary to operate upon other inflammatory affections of
the eye; in fact, it is only in special cases that an iridectomy is even
desirable. The chief distinctive signs of acute glaucoma are increased ‘
hardness or tension of the eyeball, rapid and great diminution of the
vision, and a dilated pupil. In order to make the diagnosis more
easy for the general practitioner, and, at the same time, to facilitate
the diagnosis of acute inflammations of the eye in general, I have
prepared the foregoing table, by the aid of which it will be found
easy to make not only the diagnosis of acute glaucoma, but also of
those acute inflammatory affections commonly met with. The mode
of using it will be seen at a glance, and it needs no further descrip-
tion. For convenience, I have had this table printed and distributed
to the members of this society, and I trust that it maybe found
worthy of study and preservation:
To summarize:
1. Acute glaucoma does not tend to spontaneous recovery.
2. If not properly treated it terminates in blindness.
3. The proper treatment consists in the local use of eserine; the
operation of iridectomy, and the homoeopathically-indicated remedy.
4. Its accurate diagnosis is indispensable.
""31 P


Foreign Sketches
- Cl-HEFLY NOTES mom I
BY
I HAROLD WILSON, M. D.
REPRINTED FROM THE MEDICAL ADVANCE. '
THE GERMAN EYE CLINICS.
FOREIGN SKETCHES.

BY HAROLD B. WILSON. M. D., ANN ARBOR, l\’IICI-IIGAN.

WIESBADEN.
I saw a newspaper paragraph the other day, to the effect
that there were more than 3,000,000 glass eyes made and
sold every year. At this rate they would soon get to be
fashionable, and their consumption would begin to rank
with that of whiskey and tobacco. But in truth we little
think how many one-eyed folks there are in the world.
The dread of that fearful and slightly indefinite something,
called sympathetic ophthalmia, has caused to rage in var-
ious places, and with varying fierceness, the habit of whole-
sale enucleation or evisceration, and this always, if to no
other good, at least to the benefit of those who manufac-
ture glass eyes.
In the well known and fashionable watering place of
Rhine Germany, Wiesbaden, there lived for many years,
and still lives in the persons of his sons, one of the best
known of these makers of artificial eyes, and since I, for
my part, never understood how these marvels of the glass-
blower’s art, were really made, I resolved to make him or
his descendants a visit, and if possible, to satisfy my curi-
osity.
A handsome brown-stone front on Rhein Strasse, bears
this legend: __
F. A1). MULLER,
I*‘Al3RICAN'l‘ DER KUNSTLICIIEN AUGEN
The windows looking out over the broad street with its
rows of trees and graveled walk, were filled with flowers,
and the whole exterior had that neat and exclusive air,
which German dwelling houses of the better cl ass are sure
4 Foreign Sketches.
to possess. Altogether, there was nothing about it that
looked like a factory of any sort, except the sign. This re-
assured me, and I walked into the court and rang the bell,
over which a modest porcelain plate was fastened, bear-
ing the same inscription as the house-front. A young boy
who answered the summons informed me that Herr M. was
at home, and ushered me, not into a shop, but into a well
furnished parlor instead, where stood a piano, and around
which were scattered books showing its possessors to have
taste and education. Presently Herr M. made his appear-
ance—-a tall, smooth faced, thin featured young man, with
a very kindly manner. He greeted me pleasantly, and after
a little preliminary skirmishing, wherein I explained the
object of my visit, telling him that his fame and his eyes
had reached me, clear across the Atlantic, and that I wanted
to see how such things as eyes were made, he expressed
himself as only too happy, and immediately led the way to
his work room. This was a long, rather narrow room, but
small, in one end of which, under the window, was a square
work-table, fitted with a couple of gas-blowpipe jets, and
littered with a profusion of tubes, rods, and fragments of
variously colored glass, half-made eyes, pieces of eyes, and
a lot of odds and ends, probably all arranged in that orderly
confusion which some persons affect, and the key to which
nobody else than they, can ever discover. He seated him-
self in front of one of the blowpipes, while I found a con-
venient post of observation at his elbow, and business im-
mediately began. There was to be made a glass eye of the
exact size and shape of one lying before us on the table,
but having its iris the size and color of another specimen
also lying there.
A tube of heavy milky glass was selected from a pile,
heated and a bit drawn out into a long small tube, and this
was detached, together with about a half inch of the orig-
inal tube, so that after a little heating, blowing and man-
oeuvering, there was a hollow bulb attached to a small tube,
by which it could be handled and through which air could
be blown and the bulb, if hot and soft, inflated. Now, after
a series of meltings and blowings and turnings, by which
T/Viesbaden. 5
the bulb was made to bulge here, and flatten there, an
irregularly shaped milky globe was produced, having the
general form of the eye-ball. The next step, which was to
construct the iris, was watched with great interest, for this
seemed to require the most masterly touches of the whole.
The center of the face of the bulb was heated, and a bit of
colored glass fused into it. More spasmodic blowing and
manipulating, and there was to be seen a round, colored
spot about the size of the iris, looking like an undifieren-
tiated visual speck of some of the lower animals. This was
only the ground work for the real iris, which was then
built up by a series of most artistic touches of a half dozen
or more tiny glass rods of different colors, from each of
which a bit was fused into the ground work, and the whole
softened and toned down by cunning little strokes. It was
really a sort of painting deftly done with melting glass. In
the center then, a drop of black glass was struck, and
melted in, and soon we had a dark pupil to that thing of
glass, which is so wonderful a copy of that beautiful tissue
nature has made for us. The cornea was next to be made,
for as yet, our eye lacked that essential part. Accordingly,
a thick rod of white glass was fused over the center of the
iris, and worked over and over, twisted and pulled until
finally a large mass of transparent glass was left on the
front of the eye, and a few dextrous touches of the flame
suflflced to develop from it a beautiful and clear cornea
and anterior chamber. This done, the work was inspected,
a tiny rod of red glass drawn over the sclerotic to make
blood-vessels, and the final work of shaping began. A
series of intermittent heatings and blowings, and compari-
sons with the model, soon developed the precise shape de-
sired, and now nothing remained but to transform the eye
—now a globe—to one of those delicate hemispherical
shells with which we are familiar. To accomplish this, a
narrow spot in the side of the globe was heated, until the
glass was soft, when a strong blowing through the tube
ruptured a small hole at this point. By heating the edges
of this hole, and by wiping off the small portions of melted
glass with a rod and carrying this process around the
6 Foreign Sketches.
globe, the little shell I was looking for, was detached, look-
ing as natural as life, and placed in a small I-Iessian cru-
cible to anneal. The whole thing took about three-quarters
of an hour, and seemed to be “just as easy.”
After finishing, we had a lengthy conversation about
eyes, and Herr M. showed me some of his curiosities. He
has made shells of vulcanite and of celluloid; but the
former become very much discolored, and the latter very
rough from use, and there is as yet no practical means of
utilizing either of these substances for artificial eyes. There
were boxes full of odd, little, irregular eyes for contracted
orbital spaces—eyes with conical corneas, for provisional
and preliminary insertion——eyes with edges reflected in-
ward, for tender stumps, or for children and hysterical
women; these are so strong that they can be thrown across
the room without danger of breaking, but they are olifficult
to make and hence expensive. Then there were numerous
specimens illustrating pathological matters—~conjunctival
and corneal inflammations, such as ulcers and phlyctenu-
les; iritic troubles; iridectomy; cataract, etc. One eye
previously worn by a Hollander had an iris 16 m. m. in
diameter, while that of another was so much smaller than
the iris of the owner’s real eye, that a convex spectacle
glass was worn before it to magnify it and thus equalize
matters.
From the number of eyes Herr M. had on hand, I felt
almost inclined to believe that if only the truth were
known, most of the community about us would be found
secretly to be wearing glass eyes, which looked so natural
as to deceive even the elect—and then I thought of a case
where, several years ago, I almost made an ophthalmo-
scopic examination of a glass eye, discovering its true
nature only in time to save my reputation.
The ophthalmologist knows Wiesbaden, however, as
the residence of the Pagenstechers; or now, since Dr.
Alexander is dead, of Dr. I-Ierman Pagenstecher. Here,
many years ago, they founded the Ophthalmic Hospital,
and here they have both done some of the best operative
work in Europe. Wl1e11 the hospital was first founded, its
Wiesbaclen. 7
capacity was for two patients; now it holds eighty, and, if
money were plenty, would be still further enlarged. It
lies on the side of a hill overlooking the city, and not far
from Dr. P.’s private office, and although it makes one out
of breath to climb up to it, once there, the pure air and the
spreading view repay the effort.
Dr. Pagenstecher makes daily visits, operating as the
cases present themselves, often with the assistance of
Carl Theodore, Duke of Bavaria, who is oculist and prince
at the same time.
I was especially anxious to see a cataract extraction with
closed capsule, for both he and his late brother have be-
come famous through this one operation; and a few days
after arriving in VViesbaden I was fortunate enough to
have my desires gratified. The operation was devoid of
accidents, except the loss of a small amount of vitreous.
The lens and its unbroken capsule came out easily and
prettily upon the spoon, and the pupil was left large and
black. Care was taken to ensure perfect cleanliness, rather
than fanciful antisepsis, in making the operation, although
a solution of sublimate, 1 to 5000, was used both for the
instruments and the wound. Speaking of extractions with
the capsule, and other matters, I)r. Pagenstecher said: “I do
not make it now as often as formerly, for the reason that we
do not have after ordinary extractions as much iritis as we
used to have. In making extractions with the capsule, we
do not get iritis as a complication. Prolapse of the vitre-
ous is not at all uncommon, but I do not mind this much.
I have seen as many cases of vitreous prolapse, probably,
as any one, a11d hence know something about it; and I do
not think that, as a rule, it is particularly unfortunate
when it occurs in extractions with the capsule. I generally
reserve the operation now, for cases of completely ripe,
hard cataract, and there are in general certain indications
for its use, as for instance, when the lens presses forward
during section, or shows a readiness to be dislocated. In
hypermature cataracts, also after iridochoroiditis, extrac-
tion in the capsule is the only proper method. When cat-
aracts have matured rapidly, then extract by the ordinary
8 Foreign Sketches.
method of lacerating the capsule. * * * I always make
as large a conjunctival flap as I can. My incision is usu-
ally wholly in the sclera, its size depending on the nature of
the cataract, and not to be determined by strict mathemat-
ical rules:* at * I believe we had but one unfortunate
result in our cataract operations last year, and also one so
far [July], this year. * I like to have one ward of
the hospital empty, so that it may be well aired, and then
to move the patients from another ward into it, airing and
cleaning the now unoccupied ward in its turn. Fresh air
is death to the bacteria. They cannot stand fresh air, and
so I want plenty of it in my wards.”
Cataract cases are frequently left entirely unbandaged,
at least after the first forty-eight hours. When there is
dacryo-cystitis as a complication, the canaliculus is slit, the
duct treated and closed with a cotton iodoform plug, which
must stay in place from four to eight hours after the oper-
ation, and then only to give way to a fresh one. These
cases are usually bandaged lightly with a cloth wet with
sublimate solution. The spray is no longer used, and the
dark room is one of the things of the past. I saw several
cases of optic nerve resection, and Dr. Pagenstecher and
his assistant both spoke highly of the operation. In one
case‘ of chronic absolute glaucoma, where the pain was
terrific, complete relief was obtained by the resection.
This operation tends to militate against the glass eye
makers, for it seeks to preserve the eye-ball, instead of
enucleating or eviscerating it, and at the same time
to secure all the beneficial results of either of these
operations, except in cases of malignant growths, of
course. .
Dr. Pagenstecher is a charming gentleman, and a splen-
did operator. I was quite converted to the determination
to give the capsule operation and the optic nerve resection
a trial, and was satisfied of brilliant results; and I left
\Viesbaden, with its numerous baths and promenades,
regretful that it was not possible to stay longer, and with
somewhat mixed dreams of trying to extract closed cap-
sules from glass eyes.
Strassburg. 9
STRASSBURG.
The University of Strassburg used to be one of the fore-
most seats of learning in France, not so very long ago.
Now, however, it is denationalized, just as Strassburg and
Elsass-Lothringen are, and figures as a part of the domain
of Kaiser Wilhelm.
The only traces of its former self are found in a course
or two delivered by Prof. Aubenas, on obstetrical subjects,
wet nursing, or something of that sort, and in some of the
old buildings still occupied by portions of the university;
such as the Bzirger Spital for instance, whose rather rick-
ety, and certainly very old buildings, with some half dozen
odd stories of windows in their roofs, afford a marked con-
trast to the elegant new stone structures the German Gov-
ernment has built for university and hospital purposes. In
this old Spital (or hospital), which belongs to the city, and
the use of which for a clinic on general diseases under
Kussmaul, and on the eye under Laqueur, is simply
accorded to the University, was given the first instruction
wet nurses in Germany ever received, and I believe the
same sort of instruction is still given. Some portions of
the Spital are devoted entirely to the use of the city and
are presided over by men not in any way connected with
the university. On the whole the university is pretty
thoroughly germanized, and has been so, ever since its re-
organization in 1872, and is well fitted to assist in putting
German ideas into Alsatian minds, as well as to carry on
its legitimate educational work.
For American medical students, I have no doubt, that
v. Recklinghausen is the most attractive figure in the fac-
ulty. To begin with, his reputation as a pathologist is
world wide, and then simply as a teacher, there are few
men in Germany his superiors. He looks quite like a
German-—has reasonable abdominal proportions wears
spectacles, and has a little bald spot on the top of his head
——but so far as mere looks go, might be anything else than
a university professor. His powers of observation in the
class room, are wonderful. I have seen him directing four
simultaneous post-mortems, in none of which, the slightest

10 Foreign Skeiches.
mistakes of any of the students, or abnormalities in any
organ of the subjects, escaped his eye, nor from which
the class did not get the greatest possible benefit. In his
courses in microscopical anatomy, if the student cannot at
last tell liver from kidney, it is no fault of v. Reckling-
hausen’s. I believe that he declares that there is no
man in Strassburg over 32 years of age, who has not
cirrhotic kidney, as a result of too much beer, but this
statement does not seem to have affected the manufacture
or consumption of this beverage, and there is the usual
amount of lmciping going on every evening among the stu-
dents and soldiers.
The names of Hoppe-Seyler, Liicke, Goltz, Jolly, Freund,
and others of the medical faculty, are likewise well known.
I saw Prof. Liicke, whose clinical amphitheater is a model
of most excellent, convenient and antiseptic construction,
perform or try to perform, the radical operation for the
relief of hernia, but by some anomaly no hernial sac was
anywhere to be found, and after a long and fruitless search
for it, the patient was finally sewn up and sent into the
wards.
The special interest for me, centered about the ophthal-
mic wards and clinic. Laqueur is the ordinary, Stilling the
extraordinary professor, both very pleasant and able gen-
tlemen, the latter known to us through “Stilling’s opera-
tion.” The clinic directed by Prof. Laqueur, is meanly
housed, in a part of the Bzzrger Spzifal. The hospital wards
are neat and clean, but the policlinic is obliged to get along
with very insufficient facilities. One of the interesting
cases I saw was the rare one of congenital hypertrophy of
the upper lid. The patient was a girl aged 17 years; one
upper lid had always been larger than the other, but during
the past four years it had very much increased in size, and
now measured 35 mm. from orbital ridge to ciliary margin
—was thick, soft and painless, with the globe and vision
normal. At the present time the patient could see only
through a very small space at the inner angle of the eye.
In the ophthalmoscopic room, Prof. Laqueur showed me,
what was to me at least new, a binocular microscope or
Strassburg. 11
telescope, as you choose to call it, designed for examining
the external portions of the eye, iris, and anterior chamber.
It gives very much magnified images, and affords the ob-
server a splendid means of studying gross pathological
changes, finding foreign bodies, etc. It is probably a
double Galilean telescope, with a working distance of 6-7
inches. For determining corneal astigmatism the ophthal-
mometer of Javal and Schititz was in frequent use.
This valuable instrument, in spite of the great aid it
affords in the study of this anomaly of refraction, is very
little employed, either in America or here in Germany. Its
cost is rather too great, in its present form, but its inven-
tors are at work, I believe, upon a simple model, to cost
somewhere in the neighborhood of fifty francs.
Prof. Stilling lectures upon the relation of constitutional
and eye diseases, on refraction, and the use of the ophthal-
moscope, and in addition to his university duties, has a
daily clinic at the Israelitish Hospital. By invitation I
called upon him at his home, and had the pleasure of look-
ing over the advance sheets of his forthcoming work on
Myopia, in which, upon the evidence of certain recent
pathological studies of his, the present and ordinarily ac-
cepted theories as to the pathology of this trouble, are very
much modified, if not done away with altogether. At his
clinic, I found antisepsis to play an important part as a
remedial agent; iodoform dusted into the eye——the iodo-
form bandage, if the case be severe—is largely relied upon
in the treatment of inflammatory afiections of the eyes, even
taking the place of nitrate of silver in the treatment of
ophthalmia neonatorum.
As a city, Strassburg is not particularly interesting, ex-
cept for its history. Still it has a beautiful cathedral and
wonderful clock; and some fifty storks, more or less, which
stand idly on their great nests, balancing themselves on one
leg, when they are not flying leisurely about to or from some
favorite frogging ground, and which, if German tradition is
to be believed, ought to bring babies enough with them
materially to enlarge Dr. Freund’s obstetrical clinic. It has
also world renowned pates of fat goose livers——prepared
12 Foreign Sketches.
with all the skill of Alsatian cooks, and displayed in the
most tempting little jars——plenty of the narrowest and
most crooked streets, and soldiers without end.

HEIDELBERG.
From Strassburg to Heidelberg is only a step, geograph-
ically speaking, but once there one breathes a very differ-
ent atmosphere. There is nothing Frenchy about this old
place, and no need of government interference to loyalize
its natives. There is a little too much of the English flavor
to the population—too much of one’s native tongue heard
in the Stadt Garlen concerts, to harmonize with one’s pre-
conceived ideas of the town, that is all. One wishes it to
be a trifle more thoroughly German.
The University is more than five hundred years old,
having celebrated its fifth centennial last year, and is
widely known; perhaps more through its philosophical
than through its medical faculty. Still this latter is of
high rank and embraces many well known names.
The hospitals are decent structures, largely built upon
the pavillion plan, and surrounded by well laid out grounds,
luxuriating in roses and other attractive flowers. The
Ange/i Iflinilc is a large and very handsome stone build-
ing, not owned by the University, but certain use of which
is given to the students. Its director, Prof. Geheimrath
Otto Becker, (Geheimrath, you know, is only a title), has a
scientific reputation which places him well in the front of
German ophthalmologists. In his company I visited the
various wards of the hospital. Everything is scrupulously
neat. The patients are divided, in true German style, into
three classes, on the basis of respectability and money.
Those of the third class, form the material for the public
clinics. They wear a sort of uniform, consisting of clean
linen suits and slippers, and thereby look vastly better and
more wholesome, than if they were allowed to wear their
own, generally dirty clothes. The wards are fitted with
hot water tubing and small coils for each bed, for the local
application of heat to the eyes, by which the application
may be made constant and uniform for as long a time as is
H cidelberg. 13
desired. It certainly is the best thing I ever saw for the
purpose. It would also be possible, though not so easy,
by any means, to use a similar system of piping for the
distribution of cold water, for cold applications. The wards
are provided with large shutters to the windows, by which
nearly absolute darkness can be secured. In this Egyptian
darkness, cataract and similar operated cases are made to
sit or lie out their times of probation. The hallways are
large and light, and in them, upon a “Heidelberg chair”
the cataract operations are performed. Large photographic
copies of the Soemmering bas reliefs to von Graefe’s mem-
ory hang in the halls leading to the clinic room. This room,
though small, is beautiful. A high arched ceiling—the
walls hung with elegant drawings and engravings, pro-
fessional, of course, —the light coming in through one
very large window, and the scrupulous cleanliness, con-
trive to make it one of the nicest clinic rooms in all
Germany.
There are treated here annually between five and six
thousand eye patients and Prof. Becker holds public clinic
five days in the week, before a class of twenty or twenty-
five students. Heidelberg is quite an ophthalmological
center, for every summer during the last of August, or
early in September, the ophthalmologists from all over
Germany and even from other countries, assemble for a
brief session of society work, and to exchange views on the
most recent advances in their specialty.
The Ear Clinic of Prof. Moos, is not so favored in the
matter of building, or rooms, and one has to mount some
three flights of stairs, past the scenes of various sorts of
domestic occupations before reaching it, for it is obscurely
set in the top story of an ordinary apartment house. How-
ever, plenty of good solid work in the ear emanates from
this almost inaccessible altitude.
Prof. Erb is a good clinician, and has the faculty of per-
cussing a chest so that the note may be heard all over the
clinic room or hospital ward. Arnold’s pathological courses
are sought after, like those of v. Becklinghausen in Stress-
burg, and it is not easy to gain entrance to his laboratory
14 Foreign Sketches.
courses after the semester has begun. One of the things-
worth seeing connected with the university is the famous
chemical laboratory of Bunsen, whose director, although
now seventy-six years old, is still in active service as a pro-~
fessor.
Another noteworthy feature of the university is its cele-
brated Career or prison, which has the honor of having once-
held Prince Bismark, as an offending student, and the walls
of which have been grotesquely decorated by the artistic
hands of generations of student prisoners.
There is a dreamy something in the air of Heidelberg,
tempting one idly to enjoy life; to row or float upon the
Necker; to clamber about the famous old castle; or to stroll.
in some of the thousand delightful walks of those wooded,
hills that overlook the little old town and its ancient uni-
versity. There are numerous little wine shops across the
river and in the vicinity, where, if you are so disposed, you
may play the part of Silenus, and in your mellower mo‘
ments wish that the great tun in the castle cellar were filled,
for the fourth time, for the especial and private use'of idle-
and pleasure-loving students.

MIRZBURG.
The popularity of VV1"1rzburg as a medical school may be
judged from the fact that out of a total of about fifteen
hundred students, over nine hundred are enrolled under
the medical faculty; The source of this popularity lies in
the excellent facilities offered, and in the numerous emi-
nent men who fill, and have filled, the professorial chairs.
The present faculty embraces such names as v. Kolliker,
Scanzoni, Rindfleisch, Schonborn, Michel, v. Troltsch,
Fi ck. etc. -
The university and Julius Hospital date from some-
where in the fifteenth or sixteenth century, when they
were founded through the goodness of Julius Echter von.
Mespelbrunn, who, as the student song runs, was prince,
bishop and duke in Franconia, a lover of Rhein wine and
Main wine, and quite a philanthropist withal. His statue
now stands in the Julius-Platz, directly across from the
l'/Vmwburg. 15
hospital his efforts reared. Originally, I believe, the vari-
ous faculties were composed only of Catholic professors,
and the founder’s intention was that this state of things
should always remain so; but the hand of Napoleon is
said to have upset this arrangement, and since his time,
although VVi1rzburg itself is rather intensely Catholic,
the university has supplied itself freely with Protestant
teachers.
The hospital is said to be very richly endowed, although
the buildings are old and plain. The other buildings
devoted to medical purposes, such as special hospitals,
anatomical, physiological and pathological laboratories,
policlinic, etc., as well as the physical laboratory and
botanical garden, are grouped about it, on what might be
called a campus, although anything like an American col-
lege campus is unknown in Germany. The grounds abound
in flowers, particularly roses, which seem to thrive to a
degree of luxuriousness quite unknown with us.
Near the center of these grounds is the eye clinic, pre-
sided over by Prof. Julius Michel, whose cordial and gen-
erous manners will probably be gratefully remembered by
every foreigner whose pleasure it has been to number him-
self among his pupils. The clinic is fortunate not only in
its able and earnest director, but also in its facilities for
work. The rooms at its disposal are numerous and unusu-
ally large, light and cheerful, abundance of space being
provided for class and individual instruction, and all
marked by scrupulous attention to cleanliness a11d order.
In addition to amphitheatre, clinical and ophthalmoscopic
rooms, etc., there is a spendidly fitted pathological labora-
tory, with a large collection of gross specimens and micro-
scopical slides, where special work on the pathology of the
eye may be pursued under the personal instruction of the
director. The examination room of the general clinic con-
tains a library of over three hundred volumes on the eye,
access to which is a decided privilege for the advanced
student, since it contains the most important of the Ger-
man works on ophthalmology. The eye-hospital is situated
a short distance from the clinic, and although the building
16 Foreign Sketches.
is old-fashioned, its internal arrangement seems to be most
admirable. Its inmates wear, as in Heidelberg, hospital
suits of clean linen, which contribute not a little to the
pleasing aspect of things. About five thousand patients
are treated at the clinic yearly, and compared with many
other clinics, it is somewhat surprising what a large num-
ber of cases of special interest are continually presented.
Prof. Michel is fine looking and young; he wears a
“mensur” scar on one cheek, and carries himself in mili-
tary style. In the lecture room his manner is often dram-
atic, and always full of nervous energy of a high poten-
tial. In general, I should say his activity was tremend-
ous. In addition to clinical and systematic lectures, at
which the attendance varies from one to two hundred
students, he also gives a course in eye operations to a class
of about a hundred, divided into sections. The course
involves between twenty-five and thirty of the most im-
portant operations, illustrated by lectures and practical
work upon cadavers and pig’s eyes. The sections meet once
a week, but owing to their size the amount of dexterity its
members acquire is perhaps next to nothing; yet since
very few of them intend to become specialists, this is of
no consequence. The amount of work each section accomp-
lishes, however, is somewhat prodigious. In one afternoon
session of some two hours in length I once counted a total
of eighty-six operations made by the members of a section
consisting of twenty-five or thirty students. It is easy to
see that this means unremitting diligence on the part of
the instructor.
Antiseptic cleanliness is the underlying principle in the
management of the clinic. Applicators for local remedies
are used but once, and one is spared the sight so frequently
to be seen elsewhere, of the same glass rod being employed
to carry ointments to the eyes of successive cases of in-
fiammatory affections, with all its possibilities as a conta-
gion carrier. Operations that involve opening the globe
of the eye are conducted under carbolic spray; the subli-
mate douche (12000) is freely used, and all operated cases,
even to strabismus and slight superficial operations, are
VI/iaerzémg. I 7
done up with a flannel roller and compress, for antiseptic
reasons. The cocaine and sublimate solutions are always
freshly made, and with boiled water, and great care is taken
to prevent all possible wound infection. Hospital patients
are operated upon in the clinical building, and either walk,
01' are wheeled in an ambulance carriage, from there to their
wards. Cataract operations are made by the v. Greefe method,
the incision lying wholly in the sclera, its apex slightly nearer
the sclero-corneal border than the puncture and counter‘-
puncture. The patients are kept in bed not usually more
than twenty-four hours, and the bandage—-the ordinary roller
—is generally removed in from thirty-six to forty-eight hours
after the operation, and the wards are not darkened. Under
this treatment the cases seem to do well.
Professor Michel has devised a procedure for certain cases
of muscular paralysis, which, in several cases where I saw it
tried, seemed to be of marked benefit. The eye is thoroughly
. cocainized, and then laid hold of by a pair of fixation forceps
with broad jaws, applied somewhere in the line of the
affected muscle. Firm traction is now made, extending and
relaxing the muscle somewhat in the same fashion as passive
motion of the extremities is made, and if the result is encour-
aging, this manoeuvre may be repeated daily, or perhaps less
frequently. The muscles are also to receive the additional
stimulus of the faradic current daily. In treating the ordinary
forms of eye diseases little or no attempt is made to depend
on any but local measures for their relief, and the list of
remedies used is not large. Many of them, such as yellow
oxide, sugar of lead, corrosive sublimate and boracic acid, are
prepared with vaseline in the form of ointments, and are
applied with a fusiform glass rod having rounded ends, by
the aid of which a bit of salve may be “jabbed” into the eye
with impunity.
Some idea of the interesting class of cases presented in the
clinic may be gathered from the fact that during a two weeks’
stay, I saw several cases of retinal detachment, tubercular
iritis, embolism of the central artery, muscular paralysis, and
acute and chronic glaucoma, besides individual examples of
neuro-paralytic keratitis, herpes zoster, cholesterin crystals in
the vitreous, exopthalmus from myxo-sarcoma about the optic
I 8 F0/jetgzz S/eett/zes.
nerve, black cataract, and a host of ordinary afilictions. A
very common form of conjunctival inflammation here receives
the name of conjunctivitis eczematosa, a variety not much
recognized in text books-—other than Michel’s-—but which
seems well characterized by the appellation. Curiously there
are almost no cases of trachoma to be seen, while at many of
the other German clinics, as at Goettingen for example, it is
exceedingly common.
While I was at Wuerzburg, the celebration of the seventieth
birthday of Professor v. Koelliker took place. He is the old-
est member of the medical faculty, and has been professor
for I do not know how many years. His reputation is world
wide, and many of our older practitioners will remember the
time when his work on “Microscopical Anatomy” was the
only thing of its kind in English. The celebration was made
up of several distinct events, each quite German. First there
came a birthday banquet, given him by his colleagues of the
faculty. Next day he responded by a morning reception to
his friends. This was followed by a torchlight procession
devised by the students, in which the torches were not of the
tin can yariety, affected by our political clubs, but were sturdy
sticks of resin and twine, the smoke and dirt from which were
something fearful, but which had the merit of being exceed-
ingly picturesque, and moreover very liable to set fire to their
bearers and the nearest line of spectators, from the continual
dropping of burning pitch. The crowning event of the cele-
bration, however, was a huge Comma;/s, given by students of
the Corps and Burschenschaften, at which, as is usual on such
occasions, innumerable “salamanders” were rubbed amid
deafening whacks of the “schlaegers,” and fabulous amounts
of beer were consumed. Professor v. Koelliker showed his
vigorous health not only by remaining until a shockingly late
hour in the morning, like the rest of the “boys,” but by deliv-
ering two loudly-applauded speeches. The various parts of
the celebration were entered into with great spirit, and
showed in what esteem this venerable teacher was held by
hisstudents and colleagues.
VVuerzburg does not offer the general tourist much that is of
interest. It is an old Bavarian city, and was once the royal
residence, but it has nothing of the quaintness of Nuremberg,
B07212. 19
nor the pleasures of Munich. Its gardens and public prome-
nades, which are especially fine, are well worth seeing, but
otherwise there are few attractions outside of the university.

BONN.
After a trip down_the Rhine, one stops at Bonn, as the last
spot from which some of its beauties may yet be seen. From
here the blue outlines of the “Seven Mountains” rise beauti-
fully against the sky, and the traveler may linger for a bit to
speculate on the romantic spots he has just passed, before all
of their glories have faded from view. Here also the musician
tarries, as the place is holy as being the birthplace of Beeth-
oven, although it must be admitted that it is rather startling,
even to an old traveler, to seek the exact spot in which this
important event occurred and find that two widely separated
houses both claim this honor, and bear tablets testifying that
the immortal master was born within their walls.
The university is the youngest of the Prussian universities,
having been definitely founded in 1818. Like Heidelberg, it
is known among students as a “pleasure university,” and con-
sequently has enrolled many members of the aristocracy
among its students, Prince Frederick VVilliam among others.
It occupies the old electoral palace; the surgical clinic, and
some of the medical department are fortunate enough to have
excellent new buildings, but the eye and ear clinics are meanly
placed and poorly accommodated. Professor Saemisch’s
lecture room is a moderate sized aifair, filled with small
rectangular tables, and with pronounced light-blue kalsomin-
ing on the walls, giving it a very ugly appearance. The
clinic is carried on in a small room, so small that it is easily
filled, the sad looking and rather dirty mob of patients crowd-
ing unpleasantly close on the little space allotted to their
treatment. The hospital wards, which adjoin the clinical
rooms, are not so bad, but operations have to be made in the
room used for opthalmoscopic examinations, the air of which
is not always especially pure, and the aseptic condition of
which would not be above suspicion.
Operations are made upon a very low couch, the operator
and his assistants either kneeling upon cushions, or else he
sits upon a chair at the head of the couch. Instruments are
20 Foreign Skate/zes.
disinfected with absolute alcohol, and dipped in water pre-
vious to use. The patient’s face, especially about the eyes, is
carefully washed with boracic acid, but irrigation of the
wound with sublimate or other antiseptic solution is not
attempted. Professor Saemisch always makes a preliminary
iridectomy for his cataract operations, using a broad v. Graefe
knife for the purpose, and making an incision about three
lines long in the sclero-cornea. For extraction the ordinary
v. Graefe incision is used, the capsule ruptured by vertical
and horizontal cuts, and the lens expelled by pressure of the
thumb on the lower lid over the cornea, the first finger of the
other hand raising the upper lid, and making a slight counter-
pressure on the upper lip of the wound. I saw several enucle-
ations made under cocaine, applied simply to the conjunctiva.
It would hardly do to say that these operations were pain-
less, for there was considerable manifestation of sufiering,
especially as the ciliary nerves were cut, but after all, not so
much as might have been expected perhaps. In the wards
were many cases of corneal ulcer; upon some of them
“Saemisch’s operation” had been performed, and all were
progressing finely.
Of remedies used in the clinic, nitrate of silver seemed to
take the lead, being applied in, I should judge, three-fourths
of the cases presented. The application of ointmcnts (chiefly
yellow or red oxide of mercury) was effected by means of a
flattened metal rod, which seemed to do duty for successive
cases, with never so much as a pretense of wiping it.
Professor Saemisch, whose name is well known among
ophthalmolgists, is a tall, large-chested man, of middle age,
thoroughly German in appearance, kind in the treatment of
students and patients, and a pleasant instructor. As an oper-
ator he is quiet, very deliberate and generally successful. It
is to be regretted that he has not better facilities for carrying
on his work. Some day perhaps the German government
will get around and re-organize the architecture of at least
this part of the university.

GCETTINGEN.
Heinrich Heine in his “Pictures of Travel,” says that Goet-
tingen is celebrated for its university and its sausages; that
Gcez‘z’z'agerz. 2 I
its population is made up of students, professors, philistines
and cattle, of which, the last class is most clearly to be recog-
nized; and further, that if he could have secured a piece of
paper large enough, he would have embellished his book with
a diagram of the feet of Goettingen ladies. This is all very
fine for Heine, and both the sausages and university are really
good, but after all it is rather rough on Goettingen, which is
only a quiet little German city, and except for its university,
no better nor worse than dozens of other similar small towns.
The university dates its origin from a century or two ago,
and has become justly celebrated in all its departments. Its
various portions are scattered over the town in one place
and another, the hospitals appropriately enough standing on
“Ghost” street. The eye clinic has an excellent, rather new,
stone building, of moderate size, devoted to its uses. Its
wards are not large, holding perhaps four to ten beds. The
windows are provided with a series of curtains, usually drawn,
so that the wards are kept darkened, more or less constantly.
In spite of the absence of sunlight they seem to be clean and
sweet enough, but they lack the cheerfulness of light rooms,
and cannot be comfortable places to stay in. Special quarters
outside of the building are provided for trachomatous cases,
so that the dangers of infecting other patients with their dis-
ease are reduced to a minimum. Professor Leber, who has
charge of this clinic, is one of the most delightful of men.
His manner of addressing and handling patients is rather
different from that of most German clinicians. In his hospi-
tal rounds he seems eagerly solicitous for their welfare, often
addressing them as “Liebe Frau,” “Lieber Mann,” etc., in the
most kindly and reassuring way. He is a small, active man,
somewhat bald, and with the pleasantest sort of a gray-
bearded, smiling face. In his lectures he is quiet and con-
versational, often leaning over the back of a chair, or sitting
with his legs crossed, while the tops of his shoes and stock-
ings peep from under his trowsers while he talks.
Operations are made in an ordinary operating chair, and
with antiseptic p1*ecai1tiqns of course. All cutting instru-
ments are placed in absolute alcohol, the others in carbolic
acid solution before using. For anaesthesia a five-per-cent
solution of Cocaine is used, applied four times, at intervals of
2 2 Forezlwz S/eels/zes.
one minute, by the watch. Cataract extractions are made by
the v. Graefe method, the iris excised by one snip of the scissors,
concave face downwa-rd;' Fmrster’s forceps are employed in
place of the cystitome, in cases of thickened capsule and in ~-
immature cataract, and ProfessorLeber spoke very highly of
them. In two cases of those in which I saw them used, the
entire lens, capsule and all, came away when traction was
made, but aside from a slight loss of vitreous in one of them,
there were no complications resulting from the accident.
After extractions the eye is washed with sublimate, Iodoform
‘ dusted into it, and the roller bandage applied, after which the
patients arise and walk to their wards. In a case of strongly
convergent squint, one eye only was operated on, swung into
position and kept there by a thread passing through the con-
junctiva near the cornea, and carried from there through the
skin at the outer commissure. Two days after, when this
thread was removed, the eye again deviated strongly inward.
Pterygium is removed by a special form of knife, having two
right-angled bends in its shank, making it bayonet-shaped,
and special pains are taken to detach it thoroughly from its
corneal attachment. Professor Leber showed me an interest-
ing case of cataract in an eye in which detachment of the
retina had previously been diagnosticated, but where the
light perception seemed almost normal, and in absence of any
previous knowledge of the case would have been suflicient to
justify extraction. Progressive corneal ulcers are treated by
the Paquelin cautery, concerning the use of which Professor
Leber said, that if one can be sure to cauterize the entire
body of the ulcer, and that only, the results are brilliant, but
the trouble is, there is no guide as to the depth the tissues are
to be cauterized. . In treating cases of la_chrymal stricture
after Bowman’s operation, the balloon and "hollow probe are
used, and the duct irrigated with Permanganate of Potash.
The upper canaliculus is that usually chosen for the opera-
tion. , Operations for secondary cataract are made by artificial
light. In refraction tests, the eye not used is covered with a
small black pad, held in place by a rubber about the head,
and although this is a simple and very convenient expedient,
curiously enough, I did not observe it used at a single clinic
other than here.
/fa//e. 2 3
' room
At the time I was in Gmttingen, everybody was busy mak-
ing preparations for the One Hundred and Fiftieth anni-
versary of the founding of the university, which event was to
be celebrated with all the holiday festivities and abundance
of beer that commonly mark such occasions. There were to
be dukes and princes, professors and students without end, to
assist; but my stay was too brief to permit my witnessing
the event. '
HALLE.
I hastened to Graefe’s clinic at seven o’clock the morning
after my arrival in Halle, took a seat in the lecture room, and
waited for the “academic quarter”.to expire and for the pro-
fessor to appear. While waiting I had time to admire the
its neat, comfortable seats, its large light window and,
most of all, the beautiful porcelain panels in the wall back of
the lecturer’s desk, copies of the Scemmering memorial to the
immortal genius of Albrecht von Graefe, whose bust stands

‘conspicuously-upon a bracket between them. At precisely a
quarter past seven Professor Graefe trotted into the room and
commenced business at once. He is a little above average
height, though not noticeably tall, owing perhaps to a slight
stoop in his figure. His hair, a charming mixture ‘of black
and white, is worn in a thick pompadour, and so far shows
no signs of growing thin. His heard is full, but short and ‘
sparse; perhaps you would call it grizzly. In talking to the
class, his gaze, for the most part, is directed down toward the
front seats, and is seldom allowed to wander over the room ;
_when it does stray a bit, however, a pair of kindly eyes look
out over his spectacles for an instant, and then quickly return
to their place on the front row. His conversation and lectures
are prertissimo, except when the loss of a word causes a sudden
stumbling for a moment. It was not easy to understand him,
everything was delivered so fast. His actions, too, seem to
be made in double-quick time, and there is little idling over
small matters. His assistant, Dr. Bunge, also affects the
pompadour, and has the face and manners of an actor, much
to the amusement of his patients. He is full of resistless
force and there is an energy about him that carries things
along in spite of themselves.
2 F01 62' 0/z S/@627/zes.
C5
The buildings of the university medical clinic are beauti-
fully situated on a high commanding piece of ground, and
occupy some twenty acres. They are built of yellow brick,
are new and splendidly equipped. One of these buildings
is devoted to the eye and ear clinics and hospitals. Pro-
sessor Graefe’s wards are large, roomy, clean and light, with
plenty of space between the beds, while all the appointments
are everything that could be desired. The operating room is
large and well lighted; the floor is tiled, and slopes toward
the centre of the room, where there is drain, thus permitting
thorough and easy cleansing of walls and floor. The operat-
ing bed is a low, leather-covered affair, so arranged as to per-
mit the free use of sublimate, with at most, only a moderate
drenching of the patient’s clothes. About it or on it the
operator and his assistants sit. Instruments are cleaned in
absolute alcohol, and dipped in sublimate just previous to use.
As a rule, the eye speculum is not employed, retractors
being used instead; in some cases, fingers only. Professor
Graefe is an earnest advocate of evisceration of the globe, in
place of enucleation, except in cases of malignant growths,
and has performed the operation over three hundred times,
without a single bad result. After abscission of the cornea,
the contents of the globe are evacuated by means of a sharp
spoon devised for the purpose, by the aid of which everything
is rapidly and accurately removed. In the hospital was an
interesting case, bearing on the question as to the contagious-
ness of tuberculosis : A woman whose hushand had recently
died of phthisis, showed marked tubercular conjunctivitis of
the left eye and tubercular infiltration over the left side of
the face, ear and neck; elsewhere there were no signs of
the disease. Now it was found that her husband had always
slept at her left, and his breath had been received, night after
night, on that side of her face, the obvious result being the
present infected state of that part. Dr. Bunge kindly showed
me a typical case of pemphigus of the conjunctiva, upon
which seven fruitless operations had already been made to
relieve the symblepharon. It is a rare enough disease to ren-
der every case of it interesting. But for the eye symptoms,
there were no signs of pemphigus, except in the throat, where
the characteristic bullae were to be seen. The comparative
I
German U12 z'?'c1'szz‘z'ey. 2 5
value of cutting off and cauterizing the granulations of trach-
oma were tested in a case coming under my observation.
Both procedures were very painful, and the former seemed to
give the better results. One curious case was shown, in
which the patient had for forty-five years considered the
vision of the right eye as lost, and having some trouble with
the other, had come into the hospital for treatment. Ex-
amination showed the lens of the right eye luxated into the
vitreous, media clear, and with the proper glasses, V—_—1.
The patient was greatly surprised to find the vision of that
eye made normal by glasses.
Leaving Halle I hastened to Leipzig and thence to Berlin,
paying my respects to the “Augen-Klinik” in both cities,
picking up odds and ends of information, which space will
not permit relating, and at last, turned my back upon the
German universities with a profound respect for their meth-
ods, which are certainly worthy of our sincerest admiration,
and the universal extension of which would, in some re-
spects, seem like a millennium in medical education.
GERMAN UNIVERSITIES.
There is something attractive in the idea of going abroad
to complete one’s medical studies. Primarily, there is the
charm that comes from the possibility of foreign travel, which
with all its novel pleasures and experiences, may be a form of
education in itself ; secondarily, there are the eminent teach-
ers, large clinics, generously equipped hospitals and labora-
tories, and the stimulus of scholarly associations to entice the
ambitious student ; and, lastly, there is the impression that it
is a pretty good thing to do on general principles. The
academic freedom of the German universities, the man? cele-
brated teachers upon their faculties, and the splendid facilities
for higher medical education which are offered, attract an in-
creasing number of American students every year. The hos-
pitals of London and Paris attract many of our foreign-going
students, but there is a flavor to the German universities that
is very alluring, and which, in spite of the difliculties an un-
learnable language sets up, continues to draw our students
within their walls. Doubtless not a few readers of THE
2 6 Foreign S/tete/zer.
ADVANCE are already beginning to feel the stirrings of that
spirit which, perhaps before the winter snows have melted,
will be hurrying them toward some out-going steamer, bound
for Germany. For the benefit of these, and specially for
such as intend to devote themselves particularly to the eye
and ear, I have gathered a few miscellaneous notes, avoiding,
however, the details of German student life, since these, as a
matter of literature, are open to the suspicion of being trite.
The university lectures extend nominally over about nine
months, divided into a winter and a summer semester; the
former beginning about the 1st of November, and the latter
about the middle of April, the year closing early in August.
In a few universities, such as Berlin, Vienna and Wuerzbiirg,
Ferlea, or vacation courses, extend over six or eight weeks,
from the 1st of September or thereabouts. The courses to
be offered in the various faculties and chairs during a semester,
are published in a printed announcement for each university
and sold in the book stores. The professors also place on the
bulletin boards of the various faculties notices giving the char-
acter of the courses they will offer, the times at which they
will be held and any other facts likely to be desired. A
general calender of all the universities (Uaioersitazts-Kaleizder)
is also published for each semester, containing the names of
the professors, etc., the courses to be given, and certain mis-
cellaneous information as to hotels, cost of living, fees, etc.
In order to enjoy the privileges of the university it is neces-
sary to matrieulate. For this purpose the student seeks the
Quaeslor, or secretary, whose office may be anywhere about
town, displays his credentials, signifies in what faculty he
desires to be enrolled, and pays a fee of four or five dollars.
For this he receives a number of documents, information as
to thefprofessors’ fees, etc., and after a visit to the Dean of
his faculty and his professors, and the payment of numerous
small and large fees, he is free to begin work. Students may
attend any course three times gratis, but further attendance,
unless the lectures are specifically “free,” must be paid for.
This gives them the chance of selecting those courses that
seem to be the most suitable, and of dropping those they do
not like, without being enrolled in any of them until their
selections are made.
German Z/112'?/e1'sz'z‘ze.v. 27
For the benefit of those readers interested in the eye and
ear, I have selected or compiled the following list of profes-
sors and PM?/az‘ Doeerzlen, the courses they give, and the num-
ber of hours per week given to each. All of the universities
of Germany are represented, together with those of Vienna
and Prague. The courses offered are practically alike for
each semester, so that the list may stand for either :
BERLIN.——Prof .' C. Sc/zwezlgger, On refract. and accom., I ; Eye clinic, 5.
A. Lucae, Lect. on the ear, pract. clinical work, etc., 3. H. L. Schazler,
Course in eye operat., I; Dis. of the eye, etc., 2. J. Hirsc/zéerg, Funct. and
dis. of retina, I ; Dis. of the eye, etc., 4. Priv. Doc. .' R. Sc/zelske, Dis. of the
eye, 2. M. Burefianiz‘, Dis. of the eye, 2; Ophthalmoscopy and fitting of
glasses, 2. F. Trautmann, Dis. of ear. C. Ho1'stman, On the methods of
exam. the eye, esp. ophthal. exam. and the tests of refract., 2; Theoret. ophthal.,
3. W. UZ/zqfi’, Methods of exam. eye, I ; Use of ophthal., etc., 2. ,
BONN.——P70f..‘ Th. Saemisc/z, On internal dis. of the eye, with pathol.
demonstrations, etc., I ; Eye clinic, 3 ; Ophthalmoscopy, 2; Diagnosis of funct.
disorders of the eye, I. H. Walt, Ear clinic, 2. Work in clinical lab., —.
BRESLAU.—-Prof. .- R. Fazrster, On the rel. of general dis. to those of the eye,
I ; Eye operat., 2; Eye clinic, 3%. H. L. C0/m, Descrip. ophthal. with pract.
work, I ; Ophthalmoscopy, 2. H. Magnus, Ophthalmos. course, 2; Clinical
work, 2. R. V0ltoZz'm', anat. of the ear, etc., I. Prat/. Doc. .' ]. Gottstein,
Diag. and therap. of the most important dis. of the ear, I. \
EBLANGEN.-—Pr0_/‘I.' O. E2/eréusc/2, Eye clinic, 3; Eye operat., 2; Pract.
course in anom. of refract. and accom., I-—2. P22‘?/. D0c.: W. ](z'esseZ6ac/z,
Dis. of the ear, 2; Meth. of exam. for beginners, 2; Pract. work in exam. of
ear dis. for advanced students, 5.
F REIBURG.——Prof. .' W. Mane, Eye clinic, 3; Diag. course in functional dis-
orders of the eye, 2; Eye operat., 2; Ophthalmoscopy, 3. Priz/. Doc. .' M.
.lYm'es, Rel. of gen. dis. to those of the eye, I. T/airy. Ear clinic, with
lect. on the ear, 2.
GIESSEN.——P?'0f .' A. 1/. Hzl;§_;§eZ, Lect. on the eye, I; Eye clinic, 5. H. Stein-
brugge, Lect. on the ear, with clinic, 2.
G(ET’I‘INGEN.-——1D?'0f. .' Th. Leéer, Eye clinic, 4; Eye operat., 2; R. Deuz‘e/z-
mamz, Anom. of refract. and accom. with practical work —-. K. Burkner,
On the practically important part of otology, with use of ear speculum, etc.,
2; Policlinic for dis. of the ear, for advanced students, 2.
GREIFSWALD.-—Prq/I .' R. Sc/zirmer, On the optical defects of the eye, I;
Dis. of the eye, 5; Eye clinic, 2; Eye policlinic, 6.
HALLE.—Pr0f. .' A. Graefe, Theory of movements of the eye, I ; Eye clinic,
3%; H. Scfiwartze, Methods of exam. ear, 1; Ear clinic, 2. Pris. Doc. .-
Bzmge, Pract. work in the measuring of refract., I; Eye clinic, 3; Ophthalmo-
copy, 4. N. Hessler, Otoscopy, etc., I ; Dis. of the ear, with practical work, 3.
HElDELBURG.——P7'0f. .' O. Becker, Ophthalmology, I ; eye clinic, 5; S. /I/loos,

28 Foreign S/eetc/zes.
Ear clinic, 3; Physical exam. of the ear, use of speculum, etc., 1%. Priz/.
Doc. .' ]. R. da Gama Pinto, Ophthalmoscopy, 2; Eye operat., 2.
]ENA.—-Prof. .' H. [fa/tut, Eye clinic, 3; Exam. of the eye, use of ophthal.,
etc., 2; Special work in lab., 12. ]. ffessel, Ear clinic, 3.
KIEL.—Pr0f.: C. Vwlckers, Eye clinic, 2; ditto for practitioners, 6; Ophthal-
moscopy, 3 ; Dis. of the eye, I. Priv. Doc. .' W. ffosegarten, Dis. of the ear, 2.
K(ENIGsBERG.—Pr0f. .- J. j’acobson, Diag. and phys. exam. in dis. of the eye,
I ; Eye clinic and policlinic, 5; Ophtha1mol., laboratory, —-. E. Bert/to/a’, Ear
clinic, 2. Priv. Doc. .' Th. Treitel, Gen. Ophthalmology, 2; ophthalmos., 2;
A. Vossius, Ophthalmos., 2; Eye operat., 1%.
LEIPZIG.——P7’0f. .' E. Coccius, Eye clinic, 6; Ophthalmos., 2; Spec. pathol.
therap. and surg. in dis. of globe, —. R. ffagm, Ear clinic, 9; Exam. of the
ear, etc., I. Prir/. Doc. .' P. Sc/zmeter, Ophthalmos., 6-week courses, 2; Eye
operat., 6 weeks, 2; Pathol. and therap. of dis. of the eye, 2; Private poli-
clinic for the eye, 3. W. Sc/tam, Ophthalmos.,4; Methods of exam., etc.,
with policlinic, 3. F. Kuester, Lect. on ophthalmos. and funct. exam. of the
eye, 2; Ophthalmos. and private clinic, 3-4. W. ./llotdm/muer, Use of ear
speculum, etc., 2.
MARBURG.—-Prof. .' H. Sc/imia’t-Rimpler, Exam. ophthal. subjects, I; Eye
clinic, 3% ; Eye operat.——; Ophthalmos. and eye operations, 3.
MUNICH.——Pr0f. .' A. v. ]r"ot/zmzma’, ]r., Eye clinic and policlinic, 4; Eye
operat., -—; Ophthalmos., —-. F. Bezola’, Dis. of the ear, with hospital visits,
2. Priz/. Doc. .' I. N. Oetler, Ophthalmos., 3; Eye operat., 3.
R0sTOCK.—Prof. .' W. v. Ze/zendcr, Dis. of the eye, 3; Pract. work in the
eye clinic, 4%; Eye operat. —-. f'm'v. Doc. : Chr. Lemke, Exam. of the car,
etc., 2. .
STRAssBURG.—-Prof. L. Lagueur, Eye operat., 3; Eye clinic, 3. ]. Still-
ing, Rel. of gen. dis. to those of the eye, 2; Anom. of refract. and accom.,
with pract. work in fitting glasses, 2. Ophthalmos, 2. A. [fa/m, Ear clmic,
Prir/. Doc. .' R. Ulric/2, Ophthalmos., 3.
TUEBIl\'GEN.——P7’0f.: A. Nagel, Eye clinic, etc., 2; Anom. of accom. and
refract. with pract. exercises, etc., 2; Ophthalmos., 2. St/zleic/i, On the
rel. of gen. dis. and of other organs to the eye, 2; Methods of exam., etc.,
2-3. Wagm/zausen, Pract. course on dis. of the ear, 2. Priw. Doc..-
Halm, Pract. course in funct. exam. of the eye, I.
maland pathol. anat. of the eye, I.
WUERZBURG.—Pr0f.: J. Mic/zel, Eye clinic and policlinic, 4; Systemat. lect.
on ext. and int. dis. of the eye, with pathol. demonstrations, 3; Eye opera-
tions, 6-8; Pract. work in pathol. lab. of clinic, —. v. Traeltsc/z , (not
able to lecture this year, I believe). F. He{freic/z, Tiheoret. and pract. course
on the ophthalmoscope, 2. Prir/. Doc. : W [fire/mar, Policlinic for dis. of the
ear, 4; Dis. of the ear, with retrospec. of legal medicine, I.
PRAGUE.-—Pr0f.: H. Sattler, Lectures on the eye, with clinic, 10; Eye
operat., 2. E. Zaufat, Ear clinic, etc., 3; Exam. of the ear, etc.. 2. Priv.
Doc: A. Sc/rental, Pathol. and therap. of dis. of the eye, 2. Haberneau.
Diag. and therap. of dis. of the ear.


KreysszIg, On nor-
German U722?/ersz'z‘z'es. 2 9
VIENNA.—Pr0f .' K. Stellwag 7/. Carion, Lectures on the eye, clinic, and
hospital visits, I2. E. Fur/zs, ditto, IO. Refract. and accom., I. A. Politzer,
Pract. otology with pathol. dem. and clinical work in 5-6-week courses. I.
Grader, Theoret. and pract. otology in 6-week courses. Doc. Vertr.: O.
.Bergmez'sz‘er, Diag. of dis. of the eye, 5; Theor. and pract. instruct. in operat.
ophthal. in 5-week courses. Prcf. .' A. v. Reuss, Policlinic for dis. of the eye,
in 6-week courses. Lect. on eye diseases, 1. v. Uréantsc/zitsc/z, Lect.
on the ear in 5-6 week courses. Systematic lect. on dis. of the ear, I. Priv.
Doc. .' Hock, Eye policlinic, with work with ophtha1mos., 5; Lect. on the
eye, methods of exam., etc., I. M. Borysz'e/aiewicz, Theor. and pract. instruct.
in eye operat., 2. A. Bing, Dis. of the ear, in 3-month courses, also in 5--6
week courses. L. Kwnzlgstein, Anom. of refract. and accom. etc., —; Pract.
exercises in the diag. and therap. of dis. of the eye., —; Ophthalmos. for
beginners, —; S. ](7ez'n, Eye operat. in 4-5 week courses; Anom. of refract.
and accom., ditto. F. Dimmer, Ophthalmos. in 5-6 week courses; Diag.
and therap. of ext. dis. of the eye, ditto. E. Bock, Ther. and pract. use of
ophthalmoscope, 2; Diag. and therap. of ext. dis. of the eye, in 6-week courses.

Lectures, although nominally an hour in length, as a rule
actually last only forty-five minutes, not beginning until fif-
teen after the appointed time; the “academic quarter” thus
allowed, suffices for the necessary changing of classes,
etc. They are usually delivered extemporaneously, and natu-
rally compass a wide range of oratorical styles, from the
heavy dramatic, to the most intimate conversational. During
the summer months, at least, they often begin as early as
seven o’clock in the morning, and not infrequently courses
are given from seven to eight o’clock in the evening. The
methods of clinical teaching are admirable. With plenty of
material to draw from, interesting and instructive cases are
constantly at hand, and each student is required several times
during the semester, publicly to examine, diagnosticate and
prescribeifor any given case to which he may be assigned,
and to suffer a searching quiz upon his opinions. By the
thorough insistence upon such a plan, the habit of careful
diagnosis is early established. Less attention is paid to the
number of cases presented, than to their quality, and the sort
of text each will ofier for a clinical lecture.
As is well known, the university doctorate does not carry
with it the privileges of practice. To obtain these, it is
necessary to pass the state examination. This takes place
after the university studies, extending over a period of four
years, are completed, and the accompanying examination
30 Forez'gu S/eetc/zes.
passed. Three failures to pass the state examination, exclude
the candidate from all further trials, and effectually shut him
out from the medical profession, at least so far as Germany is
concerned. Probably only a few American students take the
university degree, since the examination comprises a wider
range of studies than most of them care to go over, preferring
usually, to concentrate their work upon a few special branches
in which they desire to become proficient, and being, further-
more, almost universally graduates of American colleges, to
begin with, which for practical purposes is quite sufficient.
It must be confessed, however, that the significant value of
our own degrees suffers considerable shrinkage in our minds,
when contrasted with that of our German colleagues, and one
is lead rather to believe that the competent and intelligent
practitioners of medicine in America, have become what they
are, not by virtue of, but in spite of, an insufficient educa-
tion, and that far too much of their progress has been made
at the expense of a suffering public.
We have many eminent and able physicians, whose abili-
ties are quite on a level with those of their European breth-
ren, but it is none the less true that the great body of our
graduating students are poorly and inadequately prepared to
enter upon the practical duties of their profession. What-
ever may be said of the German medical man in other res-
pects, he is, at least, well educated.
)r,>'
S
[Reprinted from the JOURNAL OF OPHTHALMOLOGY, OTOLOGY AND
, LARYNGOLQGY, for Apfil, 1891.]
A\ CONTRIBUTION TO THE STUDY OF
OCULAR MUSCLES,
BY * -
HAROLD WILSON, M.D.,
DETROIT, MICH.
I.
THE INFLUENCE OF THE RELATIVE ACCOMMODATION,
WITH STATISTICS OF THE POSITION OF OCULAR
EQUILIBRIUM IN 114 CASES.
One of the earliest observations upon the anomalies of
the ocular muscles, was the fact that a non-squinting eye
sometimes deviated when screened, or when a vertical prism
was placed before it. These deviations were called “insuf-
ficiencies,” and for many years our knowledge of them
rested upon these simple observations. The invention of
the phorometer by Dr. Geo. T. Stevens made it possible to
substitute experimental methods of accuracy for the erudi-
ties of the original Von Grate test, and gave us the means
of exact measurements. The old terminology has given
wa to one that is com rehensive and involves no athe-
\ 7
logical hypothesis, and we are in a fair way to place our
knowledge of these muscular anomalies upon a secure
foundation.
It is assumed, in general, that binocular fixation being
abolished, the eyes will naturally come to occupy the posi-
tion of least resistance, or that which they can maintain
with the minimum amount of effort. If this position varies
from that habitually maintained when the eyes participate
in the act of vision, it is clear that this act is attended by
more effort than when both positions are identical. It is
further assumed that these extra efforts of some eyes, neces-
W
2 A C0m‘ri6uz‘i07z to the Sz‘uciy of Ocular Muscles.
Hi
sary to binocular vision, are strains, and productive of more
or less grave consequences to the human economy. A
proper inquiry therefore, is, what is the normal position of
the eyes in equilibrium, and upon what factors does it
depend P for it is quite possible that, as the average ordinary
eye is not emmetropie but hypermetropie, its normal posi-
tion of rest may be other than that generally assumed.
This, however, can be determined only by a long and care-
ful series of examinations,and the combined efforts of many
men may be necessary in order to arrive at satisfactory
conclusions. The present paper is an attempt to call atten-
tion to one of the important factors, not ordinarily taken
into account, which influence the position of the eyes in the
act of seeing. If binocular fixation be suspended, the posi-
tion which the eyes assume depends upon four factors:
First. The form and position of the orbits.
Second. The insertion of the ocular muscles.
Third. The essential and relative power of the ocular
muscles.
Fozcrt/i. The ratio of the positive and negative portions
of the relative accommodation for the point assumed.
It is the last of these factors with which we are now coh-
cerned.
The ciliary muscle is involved in the larger part of our
conscious visual acts. In the emmetropie and myopic
eye it is at rest only for vision at the far-point and beyond,
while in the hypermetropie eye it is called into play even
there. If then,the majority of eyes are of the latter sort,
it is clear that we do not usually escape from the influences
of this important muscle. The essential connection of ac-
commodation and convergence is a fact long established;
these two facts furnish the key to that variable personal
equation of the patient which enters into,even the most
exact muscular examinations. It is true that we may con-
verge the eyes without accommodating, and accommodate
without converging them, but it is no less true that every
increase in the accommodative effort is attended with an
increase in the tension of the muscles which converge, and
* \/ll C0m.‘m'buz‘z'0n to the Siudy of Ocular Mzzscles. 3
‘7/2.66 versa. It is only the necessities of binocular vision that
prevent this increase of tension from resulting in actual
deviation. This is easily shown by a simple experiment:
The writer’s eyes are practically emmetropic, and show at
far point an esophoria of 3°—-, although by an extra effort of
relaxation the manifest deviation disappears. When ac-
-commodating for a distance of I2 inches there is a manifest
exophoria of 1°. The following tables show the results of
-changing the accommodation for this point by means of
various convex and concave glasses:
I/Viz‘/z com/ex glasses, the object a small white cross on a
black background, at a distance of I2 inches from the eye :
Dioptries . . . . . . . . . . . . . . . . . . . . . . . . . .. . +1. +2. +3. +4. \
Exophoria . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3°-4° 5° 6°—7° 8°—9°
W z'z‘/z concaw glasses .'
\
Dioptries . . . . . . . . . . . . . . . . . . . . . . . . . .. —I. ——2. -3. -4.
Esophoria . . . . . . . . . . . . . . . . . . . . . . . . . .. 2°—4° 8°—(;‘’ 14° 26°
When the effort of accommodation was lessened the eyes
_-diverged; when it was increased they converged. Within a
range of eight dioptries of accommodation there was a dif-
ference of 35° in convergence. For far point, bringing more
or less accommodation into play, by means of concave
glasses: —3. produced a diplopia of 14°; —5. of 20°; --8.
of 38°. The prevalence of convergent strabismus as char-
acteristic of hypermetropia, and of divergent strabismus as
characteristic of myopia, is due largely to the fact that in
the former the positive part of the relative accommodation
is small, and the negative part large, while in the latter the
reverse is true. If the amount of accommodative effort re-
quired to secure distinct vision, at any given distance, is
greater in one instance than it is in another, the correlative
tension upon the recti interni must also be greater, and
consequently there must be a greater tendency to converg-
ence. Whether this tendency results in an absolute con-
vergence or not, depends upon the respective influence of
the other factors that have been enumerated. It is easy to
conceive that a tendency to esophoria, for example, from
\
4 A Contrzlutz'ou to t/ze Study of Ocular Muscles.
one cause might be antagonized and overcome by a ten-
dency to exophoria from another cause. Thus a state of
fatigue or ocular debility might produce even crossed diplo-
pia in eyes naturally tending to excessive convergence, or,
from an abnormally forward insertion of the recti interni,
esophoria might exist in eyes for a point at which the posi-
tive part of the relative accommodation was much greater
than the negative. In different persons, therefore, the esti-
mation of the ratio of\the positive and negative parts of
the relative accommodation furnishes no absolute guide as
to the position of the eyes at rest, or in equilibrium. In the
same eyes, where the other influences eliminate them-
selves by successive experiments. the manifest heterophoria
can be shown, as above, to be a function of this ratio.
Using as test objects the small dots of Burchardt’s Interna-
tional Test-type, Plate 2, No. 30, at a distance of I2 inches
from the eyes, the writer is able to count them quite; dis-
tinctly with glasses from +4.50 to — 1.75, under ordinary cir-
cumstances. At this distance there is normally an exophoria
‘of I°—. Arming the eyes with lenses of +3.25, carefully
centered, and fixing the gaze for a few minutes upon small
objects exactly 12 inches away, the phorometer showed with
the glasses on, an exophoria of6°; removing these and testing
the eyes at once, there was an esophoria of 4°-—. Now resting
the eyes until the normal esophoria of 1° was restored, and
using lenses of —-3.25 under the same circumstances, with
the glasses, there was an esophoria of 10°; without them,
an exophoria of 2°. Repeating these experiments several
times the results were always in the same sense, although
the same number of degrees of deviation was not always
recorded: With a prism of 7° before each eye, bases to-
ward the temples, vision was fixed upon near objects for
several minutes; removing the prisms, the normal balance
seemed to be undisturbed. With the same prisms, bases in,
there was also little or no change in the equilibrium. If, how-
ever, convex and concave lenses were added to the prisms,
the following results were obtained : with +3.25 and prisms
of 7° for each eye, bases either in or out, a pronounced
A Cdm‘m'éuzfz'on to W Study of Ocular ./Muscles. 5
esophoria was set hp, lasting fifteen minutes or more, and
from 10° to 20° in amount; with the eyes in this state, if
the small crosses in-the phorometer were brought vertically
over each other by a voluntary relaxation of the interni,
their outlines were badly blurred, and it was only by per-
mitting the high degree of esophoria that they could be
distinctly seen; with -1.50 and the bases of the prisms in
either direction, there was also an esophoria set up, but
only of 3° to 4°, and this rather quickly disappeared.
Such experiments as these are too crude and limited, to
afford sufficient. ground for any broad generalizations, but
they show at least how easily the findings of the phorome-
ter may be varied by certain changes in the convergence and
accommodation, and are suggestive of some lines of inves-
tigation which it might be profitable to pursue.
In both the above experiments, when the glasses were
removed and the ordinary convergence and accommodation
re-established, there was a change in the innervation of the
internal recti muscles, and an increase in their state of ten-
sion, so that binocular fixation was possible only by an ex-
tra effort on their part. This extra tension of the recti
must have had some effect upon that of the accommoda-
tion, and must have interfered with the healthy balance
between these muscles. Indeed, it is the loss of this bal-
ance that is the disturbing factor in many cases of asthen-
opia. It is not unusual to find hypermetropes of a low
grade, with “ muscular insufficiency,” whose asthenopia may
be cured by systematic exercise of the muscles, and without
any attention being paid to the refractive error. The late
Dr. Geo. S. Norton called attention to the fact that hyper-
metropia with esophoria may be more fully corrected
by glasses than when associated with exophoria, and this is
due to the influence of convex glasses upon the relative
accommodation. It is equally true that myopia with exo-
phoria will bear the use of stronger concave glasses than
when it exists with esophoria, and for a similar reason.
It is a familiar fact that the balance of the ocular muscles,
as shown by every day tests, is somewhat “variable. If it
6 A Confriéutz'an to 1/26 Study of Ocular Muscles.
can be shown that the relative accommodation for a given
point is also variable, the explanation of this fact is obvious.
It is also well known that the heterophoria for far and near
points may be of a contrary sort. Dr. Stevens seeks for the
cause of this anomaly in the existence of hyperphoria. If
this is so, we must add another to the causes enumerated
above for ocular position. It would seem more natural,
however, to attribute it to disturbances in the relative ac_
commodation, although perhaps it may not be possible, as
yet, to give the precise explanation as to the manner in
which it may be brought about.
Up to the present time, the statistics of muscular anom-
alies are not numerous. The labor of a systematic exam-
ination of the eyes is very great, when not only the refrac-
tion is to be made out, but also the character and amount
of the heterophoria, of whatever sort, the muscular power,
and the relative accommodation. The exigencies of an
ordinary practice forbid it, and we must content ourselves
with much less. Nevertheless, such completeness is very
desirable. The following tables represent the findings in
114 cases from the writer’s private practice, the majority
being cases of asthenopia. They are more or less imperfect,
although the examinations were carefully made and always
with the phorometer. In a number of cases the relative
accommodation was measured, but the methods employed
were hardly of enough accuracy to warrant incorporating
the results in this place:

(Eso. 30= 36 per cent. In Eso . . 9 = II per cent.
Exo. 41 = 50 “ accom. Exo.. 51 =61 “
Eso. with Exo. in accom . . . . . . . . . . . . . 8= IO “
“ “ 0° “ “ . . . . . . . . . . . .. 9=II “
HYPERMETROPIA.-3 0° “ Exo. “ “ . . . . . . . . . . . . 4= “
0° “ Eso. “ “ . . . . . . . . . . . .. I= “
Hyperphoria . . . . 2 . . . . . . . . . . . . . . . 46 = 55 “
Lateral orthophona . . . . . . . . . . . . . . . . . I2= I4 “
kVertical “ . . . . . . . . . . . . . . . . 37=44 “
rEso. 5 = 6 per cent. In Eso . . 2 = 2 per cent.
Exo. I3==I4 “ accom. Exo. . I2=I3 "
0° with exo. in accom . . . . . . . . . . . . . . . I = I “
MYOPIA ' ' ' ’ ' ' ' ' ' Hyperphoria . . . . . . . . . . . . . . . . . . . IO= I2 “
i Lateral orthophoria . . . . . . . . . . . . . . . 5 = 6 “
LVertical “ . . . . . . . . . . . . . .. IO=I2 “
A Coulrilmliou to 2‘/ze Sz‘uu’y of Ocular Muscles. 7
( Esophoria . . . . . . . . . . . . . . . . . . . . . . . . . o
Exophoria . . . . . . . . . . . . . . . . . . . . . . . 3 = 4 per cent.
EMMETROPIA. . . . l Hyperphoria . . . . . . . . . . . . . . . . . . . . . 5 = 6 “
I Lateral orthophoria . . . . . . . . . . . . . . . . 6= 7 “
[Vertical “ . . . . . . . . . . . . . . . . 6= 7 “
The real number of cases of orthophoria in these 114
patients ~would certainly be very much reduced if each
patient could have been subjected to more numerous ex-
aminations, for among them are included all those where a
trace of deviation was found, less than o.5°. The prevalence
of exophoria in hypermetropia is due perhaps to the effect
of the convex glasses used to correct the refractive error.
This may possibly likewise explain the preponderance of
exophoria in accommodation, although it would not ex-
plain the same apparent facts in myopia. These tables
represent rather too few eyes to enable an accurate judg-
ment to be formed as to the normal percentages of the
various forms of heterophoria to be found in eyes at large.
We need more facts, and when a sufficient number of them
have been accumulated, if they have been observed with
accuracy, we can erect upon them a substantial compre-
hension of the physiology and pathology of the muscles of
the eye.
II.
A REPORT OF T WENTY-TWO OPERATIONS FOR HYPER-
PHORIA.
The real value of a surgical procedure must be measured
by its results; the theories upon which it may be based
have no importance, to the patient at least, if the results
obtained do not justify them. The novelty of a partial
tenotomy of the superior or inferior rectus muscle for the
relief of asthenopia and reflex disorders of a more or less
grave sort, from headache to insanity, has been attractive
to many ophthalmic surgeons, but the influence of hyper-‘
phoria (or any other variety of heterophoria) in the produc-
tion of these disorders is a question of practical experience.
8 A C0m‘7’z'62zz‘z'07z Z0 z‘/ze Sfudy of Ocular _/Wuscles.
We must first get the results, and then reconstruct our
theories if necessary.
The correction of hyperphoria proceeds from the belief
that such a lack of balance among the ocular muscles
necessitates an undue effort on the part of the inferior
recti, and that this undue effort is responsible for any of
the effects eye-strain in general may produce. It is true
that this defect exists in a large number of eye-patients;
for example, as shown by the tables already given, it existed
in a positive degree (0.750 and more) in 61 out of I14
patients examined, and there was a trace of it in a far
larger proportion than this; but it ‘is also true that it exists
in very many entirely healthy eyes. Neither of these facts,
then, help us much in correctly estimating its influence,
except that they enable us to say that though it-may
coexist with asthenopia, it has no necessary connection with
it in general. Its importance in individual cases can be
shown only by the results which follow its correction, and
this is the reason why practical experience is the touch-
stone of our knowledge in the matter. For this reason, the
following cases are presented, as embodying my own
experience during the past two and a half years, with this
somewhat new departure in surgery. The methods em-
ployed in the examination, preliminary and after treatment,
and in the operatioh itself were those of Dr. Geo. T.
Stevens, and which through his courtesy I had been per-
mitted to study in his office. It seemed best first to give a
brief account of each case operated on, with the results
obtained, for the better understanding of these results,
and finally briefly to summarize and discuss them.
CASE I.——Emma H., age fifteen, sent to my office by Dr. M. J.
Spranger, August 24, 1886, with well-marked eczematous conjunc-
tivitis of six weeks’ standing. V311. Hm.:o. Exo.:I° to 3°,
in accom;-5° to 6°, R. Hyp.r-o.5°. I prescribed yell/ow oxide
of mercury locally, and Psor. cc. September 4, the eyes were
somewhat better, R. Hyp.-T-1°. September 6, R. I-Iyp.=z°.
September II, the eyes were still considerably inflamed, and/the
blepharitis rather troublesome. The hyperphoria was operated
A Coutrzhutz'ou to t/ze Study of Ocular ./Wuscles. 9
for. After the operation R. Hyp.=<>°. September 29, R.
Hyp.:-0° to 1° and the eyes were about well.
CASE II.-—Maggie F., age sixteen, consulted me September 3,
1888, through the kindness of Dr. O. R. Long, of Ionia. There
was a history of asthenopia for two years past. V.R.-*1.
Hm.-—-o. L.l-o.o6 with —|—-3.25:0.4. R. Hyp.=r° to 3°.
Exo.=O° to 3°, in accom.=;r2O to 16°. Glasses were prescribed
for near point, R.+o.75, L.—l—3.25, and the patient was directed to
return if they failed to relieve. February 5, 1889, the patient
returned, saying that until November I, her eyes had given her
very little or no trouble, but that at that time the smarting and
burning produced by any attempt to study were so troublesome
that she became discouraged and left school. Examination now
showed V.R.=r, Hm.==0.75 ; L.—-=o.r with —l— 3.Z5=O.7, R.
Hyp.=-1°, Exo.=g°, in accom.=ro°. A prism of 1°, base down,
was prescribed for the right eye. February 6, eyes much better,
read and used eyes for near work a great deal yesterday, R.
Hyp.=—-2,5°, Exo.= 1° to 2°, in accom.==8°. February 7, with
the assistance of Dr. T. P. Wilson, I operated for the hyperphoria,
after which the hyperphoria-=o°. February 11, no asthenopia
since operation, uses eyes (with glasses at first prescribed) freely
and with perfect comfort ; Hyp.=o°. Ex.=r°, in accom.=4° to 5°.
‘CASE III.-—Mr. T., age fifty-six, consulted me October 10, 1888,
for headache and asthenopia. He had consulted Dr. Stevens of
New York, who had operated for an esophoria of 2° to 3° and
had prescribed a temporary prism for R. Hyp. three months ago.
Up to the present time, however, there had been little or no relief
from the asthenopia. Present condition : R. Hyp.-==2°, Exo.=-2°,
in accom.=r5°. I then made an operation for the hyperphoria,
after which R. Hyp.=o° to 1°. October 13, asthenopia the same,
R. Hyp.=r.5°. October 16, R. I-Iyp.=Z°. The second operation
for the hyperphoria was now made, after which R. Hyp.-—=o°.
October 24, eyes same. April 24, 1889, L. Hyp.=r°. The use
of the eyes is quite comfortable and there is only occasional
asthenopia. The patient is convinced that the correction of the
hyperphoria had an essential relation to the relief of the asthenopia, ‘
although he has improved in general health meanwhile, and the
more easy use of the eyes may in part be referable to this.
February I, r89r, eyes and general health both better, I-lyp.=o°.
IO A C01zz‘1'z'6uz‘z'07z to the Stzrdy of Ocular Jlluscles.
CASE IV.—-Mrs. T., age forty-two, November 22, 1888. Has
had headaches for eight to ten years—-drawing pain through tem-
ples and eyes. Headaches usually come on from over-taxing the
eyes ; diplopia at times, V.R.=0.6, worse with glasses ; L.:o.3
with—-2. ax. I6o°.=o.6. R. Hyp.-12°, Exo.--'2o°, and crossed
images with red glass before one eye. A prism of 1° for the
hyperphoria was prescribed for temporary use. December 29,
the patient reported that she had had almost no headache at all
since wearing the glasses, and could use eyes much better ; could
go to church, etc., without headache following, as had been the
case before wearing them. I made an operation for the hyper-
phoria, which then measured 2°. After the operation, R. Hyp.=
" trace. December I, I89o.—-Since the operation a year ago, the
eyes have been quite comfortable and there has been very little
headache.
CASE V.——Mr. H., age forty-four, January 6, 1889, referred to
me by Dr. C. S. Morley. History of headache, pain in forehead
more or less for fifteen years, < by use of eyes. V.R.=o.4
with—r ax. 9o°= I. L.=O.7, with—o.25 ax. 75°=r. I pre-
scribed cemented bifocal glasses, as above for far point, and the
same with -1- 0.75 o.u. added for near point. February I, head-
aches much relieved by glasses. August 16, has had headaches.
as of old, for some weeks. Examination showed R. Hyp.= 1°,
for which a temporary prism of 1° was prescribed. August 17,
no headache; R. Hyp.=z°. August 31, no headache since
wearing prism ; R. Hyp.= z°,which was then operated for. Sep-
tember 4, R. Hyp.=o°. Glasses of R.—l-Ic——o.75 ax. 90°, L.—l—I,
were then prescribed for near point. The patient has not since
reported personally, although indirect information through
mutual friends leads me to believe that the headaches are very
much if not altogether relieved.
CASE VI.-—Mr. W. P., age thirty, came to consult me Febru-
ary 25, 1889, with a troublesome blepharitis which had existed‘
for some months. V.-——- I.o.u. Hm.-'—=? L. Hyp.=1°, Eso.=6°,
in accom.= 16°. I prescribed prism of 2°, base out, for tempo-
rary near use, yellow oxide locally, and sulph. 3ox. March 14,
eyes not materially better ; L. Hyp.= 1°. With the assistance of
Dr. T. P. Wilson, I operated for the hyperphoria, and prescribedl
+ 0.75 for near point, from the ophthalmoscopic examination-
March 23, blepharitis about well; hyperphoria=oQ, Eso-=2Q
A Com‘rz'buz‘z'on to z‘/ze Study of Ocular Mz¢scZes. I 1' i
to 3°, in accom.=6° to 8°. _Tune 25, eyes continue well.-
Is wearing the glasses prescribed for near point with comfort.
CASE VII.——Mrs. M. L. W., February 27, 1889. Headaches
and asthenopia for three or four years or more, pain beginning in
back of head and very intense over eyes and in forehead.
General health not good. Much pain in back and uterine
trouble. V.R.=o.8, with—|—o.5C—l—o.5 ax. 6o°=I; L.—l—o.1?“
Exo.-_'2° to 3°, in accom. 5°, L. Hyp.=r.75°. I prescribed
prism of 1° temporarily for the hyperphoria. March 5, eyes
somewhat better; L. Hyp.:1.75°—|—. March 10, operation for
the hyperphoria made, after which R. Hyp.==trace. March II, L.
Hyp.=trace. Glasses for near point, R.+2.75, L.+3.25, were
prescribed in place of the +2 which patient was wearing.
March 23, L. Hyp.=r°. Eyes again trouble her. Prism 1°
was prescribed temporarily for the hyperphoria. June 10, I
operated again for the hyperphoria; after operation Hyp.=o°.
Ianuary, I891, eyes have been quite well for a long time, and
also there is little headache. General health very much better.
Since the operation the backache has been much less troublesome.
CASE VIII.——-Mrs. D., age thirty-five. March 28, 1889. Had
diphtheria nine years ago, after which there was paralysis of
throat and limbs, then asthenopia. Has worn glasses for seven
or eight years, but never got any relief from them. Cannot use
eyes for near work more than a few seconds without drawing
pains in eyes. This has been so for nine years, and the patient
has consulted a number of oculists without avail. V.=1 o.u.
Hm.=I.75 ? L. Hyp.=r °, Exo.=o°—-2°, in accom.= same. Is
wearing +1. o.u. and has worn +2. o.u., but they afford no help.
I prescribed a prism of 1° for the hyperphoria temporarily, and
saw the patient every day. On April 2, I operated for the
hyperphoria, Dr. T. P. Wilson assisting, after which Hyp.=o°.
April 4, eyes no better ; Hyp.-—=o°, Exo.=o° to 2°. The patient
living out of the city, returned home, with the asthenopia as bad
as ever. I prescribed Ruta 3ox, and advised Dyerization, but
have never received any further report of the case.
CASE IX.——Miss A. G., age twenty-eight, consulted me in Ann
Arbor, November 23, 1887, having had a great deal of astheno-
pia for four or five years. Eyes “gave out” from over-study
five years ago. Retinal hyperaesthesia well marked. V.=o.3
o.u., with R.——o.5C+ 1.25 ax. 30°, L.+ IC—-2. ax. 75° (her pres-
I2 A Coiztriaulioa Z0 Z‘/ze Study of Ocular llluscles.
ent glasses). V.=r, o.u. The use of the galvanic and faradic
currents and Macrotin 3x internally over a period of two
months afforded some relief, and the eyes could be used with fair
comfort, except at times. May 3r, I889, eyes still trouble her as
before. L. Hyp.=1°, Eso.---—r° to 2°, in accom.=o°. A prism
of r° for temporary wear as usual afforded no relief, and on June
3 I operated for the hyperphoria, after which Hyp.=o°. June
6, L.Hyp.=o.75° and eyes [quite comfortable. February 20,
1891, the patient reports that following the operation the asthen-
opia entirely disappeared, and with the exception of an occa-
sional day or two when near work would be difficult, the eyes
could be used freely for very hard study, and had been so used
much of the time since the hyperphoria was corrected.
CASE X.——Mrs. B., june 25, 1889. History of spinal trouble
for years ; headache < by use of eyes. Has worn bifocal glasses
for two or three years. L. Hyp.=r". I prescribed cemented
bifocals and operated for the relief of the hyperphoria. No im-
mediate relief to the asthenopia and headache followed, although
word from the patient in january, 1891, reported her as declar-
ing that in general her head and eyes had been better since the
operation.
CASE XI.—Mr. G. H., age thirty-one, was sent to me Iuly 21,
1889, by Dr. Albert Lodge, with a history of asthenopia and
headaches. He was a strong myope, and had worn glasses for
twelve years, but never with much comfort. V. with present
glasses R.=r, L.=o.8, R. Hyp.==4°. After daily examinations,
on july 29 I operated on the rectus superior of the right eye,
after which R. Hyp.=z°. August 3, another operation was made
on the same muscle, after which R. Hyp.=o° to 2°. August 30,
eyes very much better. Even his temper is better; no headache,
R. Hyp.=3°. Glasses of R.—7.C—O.75 ax. 180°, L.-—-6.50
C—— 1.50 ax. 20°, were prescribed for far point. The patient
remains well up to the present time and wears his glasses
comfortably.
CAsE XII.—-Miss G. H., age seventeen, referred to me Septem-
ber 1o, 1889, by Dr. E. P. Gaylord, with the common history of
headache and asthenopia. L. Hyp.= 1°. I prescribed —|— 1.25 for
near point and examined the patient frequently for three months.
December 12, I operated for the hyperphoria, and the muscle
being very thin an over-correction was made, so that a stitch was
A Com‘rz'éaz‘z'on ZQ the Study of Ocular Mzcsclcs. I3
necessary. February 1, 1890, L. Hyp.== 0.5, eyes fairly comfort-
able, more so when glasses are used for near work. December 6,
her father reported that the patient still had some headache and
tr’ouble with the eyes, but less than formerly, -
CASE XIII.—S. ]. D., age thirty-six. September 23, I889.
Asthenopia, blurring, and some diplopia. V.= I, Hm.=-—-0.75,
Exo.=8°, in accom.=I4°. Diplopia with red glass, L.Hyp.
-_-1.5°. A month or two later, the hyperphoria was operated for,
and March 3, I890, eyes about the same ; Hyp.:o°. Exo.=8°.
Adduction weak. I prescribed gymnastic use of prism for the
internal recti, and —l—o.75 o.u. for near point. May 2r, asthen-
opia, etc., about the same; can read easier with glasses than
without.
CASE XIV.—Mrs. M. G., age fifty. October 30,--consulted me
with a history of many years trouble with eyes and headache <
by use of eyes. General health not good; has much backache
and spinal tenderness; V.= 0.6 o.u. No improvement with
glasses. For near point is wearing +2.25, which corrects her
presbyopia. R. Hyp.-—-—-trace. November 4, R. Hyp.=<>.75°.
November 6, R. Hyp.= I°, for which I operated. November 23,
thinks she can read easier. The patient then returned to her
home, which was in a distant State. A letter from her in Febru-
ary, I89I, reported her eyes as no better. ’
CASE XV.——Miss E. L., age twenty, consulted me November
21, I889,fb1‘ general asthenopic symptoms; none or very little
headache; some blepharitis; can use eyes only for a few min-
utes at a time. The patient was under my care for two weeks ;
glasses of +0.7 5 were prescribed for near point, and the gymnas-
tic use of prisms advised. The faradic current was used every
other day. Examination revealed Hyp.= 0°. The patient then
left tlre city for home, much improved. In July, 1890, she re-
turned for treatment. The asthenopia had been considerably
relieved during the winter, until a few weeks ago. Examination
now showed L. I-Iyp.=r°, which was corrected by an operation.
There was no immediate relief; subsequent reports from the
patient show her eyes improved although not entirely well.
CASE XVI.—Mr. A. C., age thirty-three, referred to me De-
cember go, 1889, by Dr. W. A. Polglase, had been subject to
epileptic paroxysms (both grand and ;§ez‘z'z‘ mal), varying in fre-
quency from a few days to a week or more. The patient has
~I4 A Coutrzlutlou to t/ze Study of Ocular Muscles.
rnever had any special eye symptoms. No asthenopia, not much
headache, and was sent to me to examine for hyperphoria, having
been under the care of several physicians without relief. Exam-
ination showed L.Hyp.=r°, Eso.= 2°, in accom. Exo.= 2°.
Ianuary 3 I operated for the hyperphoria, and rather strangely the
operation was not attended with a particle of haemorrhage, either at
(the time or afterward. January 7, Hyp.—-=O°, Eso.=1° to 2°.
.Had a convulsion, january 4, of usual severity. February 6,
Hyp.= 0°, Eso.= 1°. No change in frequency or character of the
convulsions. The patient was then lost sight of, but so long as
he was under observation, since the operation, there had been
no improvement in his condition so far as the epilepsy‘ was
concerned.
CASE XVII.-—-Miss K., age twenty-one, was sent to me by Dr.
W. A. Polglase, on account of frequent attacks of headache for a
period of three years. There had never been any trouble with
sthe eyes. V.=0.8, 0.11. No improvement with glasses. R.
Hyp.=1° after wearing a prism of 1° for a week, R. Hyp.=-2°,
which was operated for, March 12. April 30, the patient reported
no relief from headache R. Hyp.=o.75°.
Cass XVIII-—Mrs. F. B. was referred to me September, 1889,
for a case of wry-neck, which had existed for three years. L.
Hyperphoria of 1° was found to exist, and corrected by an opera-
tion, but the wry-neck was not improved.
CASE XlX.——Mrs ]. P., age forty-one. January 30, 1891. Had
a history of asthenopia extending over seven or eight years. For
days past has had a dull headache and cannot use eyes for near
work without much trouble with them; V. 0.8, o.u., Hm. =1.
L. Hyp.==1°, E°1s=1°. A prism of 1° was prescribed for the
hyperphoria temporarily, with the aid of which the asthenopia was
better, and on February I, L. Hyp.=z°. Dr. T. P. Wilson op-
erated, after which R. Hyp.=0.5°. February 2, Hyp.=o°.
February 4, eyes much better. Glasses to take the place of those
then worn were prescribed ; R-i-1.50 2+ 0.5 ax. 90° ; L.+
1o5 Cd-0.75 ax. 90°, for near point. February 6, the patient
left for home, with the headache and asthenopia much relieved,
_and has not reported since.
In these nineteen cases there were twenty-two opera-
:tions made. There was immediate and, so far as known,
A C01zz‘1'z'buz'z'0n to the Sludy of Ocular Muscles. 0 I 5
-.
permanent relief of the symptoms in nine cases; no relief
in five cases; some improvement more or less remote in
four cases, and in one case the result is doubtful. The
amount of hyperphoria discoverable at the last examina-
tion made was 0° in thirteen cases, o.5° in one case, 0.75°
in two cases, 0° to 1° in one case, and 3° in one case. In
‘three cases of those relieved by the operation there was still
hyperphoria, O.75°, 0° to 1°, and 3° respectively, while of
the five cases not at all benefited, the correction was per-
fect except in one case, in which 0.750 was left. Of the
nine cases which seemed to°receive immediate and perma-
nent benefit, seven found relief for their symptoms in the
prism temporarily worn for the hyperphoria, and in most
-of them this relief was unmistakable. In fact, every patient
who found this temporary prism of benefit secured the
same relief from the operation.
The technique of the operation is simple, provided the
first cut with the scissors is high enough. If it is too near
the cornea, the effort to grasp and raise the tendon of the
muscle with the forceps will be difficult and bungling. The
‘tendon will usually have to be pretty well severed, al-
‘though the operation will often have to be a matter of “cut
and try,” making what would seem to be a sufficient ten-
~otomy and testing it with the phorometer, and then increas-
ing or diminishing the amount of relaxation as may be
necessary.
Without presuming to be too enthusiastic over the re-
sults obtained in the cases here detailed, it would seem
_justifiable, from a consideration of them, to assign the opera-
tion for hyperphoria a worthy place among surgical methods.
There seems to be ample proof in some of these cases of its
positive efficiency where other means had failed, and equally
as good evidence that in a number of cases it has failed
entirely.
The practical lesson from any such record of failures and
successes, is the evident desirability of some principle by
which we may be able to say to our patients that in the one
case this operation will relieve, while in the other it will not.
16 Q A Couz‘rz'éuz‘z'ou to z‘/%e-Sz‘udy of Ocular Muscles.
The suggestion that my own experience leads me to make
is that when the temporary relief of the hyperphoria, wholly
or in part, by means of an appropriate prism, relieves the
patient’s symptoms, an operation will be of benefit, and that
when the prismatic correction of the hyperphoria is of
no avail, the beneficial effects of an operation are very
doubtful. As to the value of the operation in general, my
own personal belief is, that by correcting the hyperphoria,
either by exercise or by operation (and I prefer the latter),
we shall succeed in a large measure in relieving many patients
who cannot be cured in any other way, and that there is no
doubt that among the profession at large its value has been
overestimated by some and underestimated by others. At
the end, perhaps, we shall find that 2'12 ¢uea’z'o z‘uz‘z‘z'ssz'mz1s ibis.
' Reprint“ from the Cincinnati rlledical Advance.


OPHTHALMOLOGY
AND '
turaswraaaarisutwcts
By T. P. WILSON, M. D.
Together with the
FIRST ANNUAL REPORT
_ on THE '_
Cincinnati Eye and Ear institute.
CINCIN NAT] ,
_I. P. GEPPERT, .PRINT.E R;
MDCCCLXXIV.


. OPHTHALMOLOGY
AND
QTFER ‘ll/l‘f3,.D‘Elil\l 5fi£Nf£5-
‘-
vw

Isolation is an Obsolete term. At least it ought to be, for
there is no such thing in nature or art. It is because we are
short-sighted and uninformed, that we can not see the relation
which everything bears to everything else. The tiny needle
of the compass Which gives a trembling answer to the
cyclones that sweep across the face of the sun, is only a visi-
ble manifestation of that inscrutable sympathy that binds in
Unbroken cords all parts and particles of the known universe.
Poets and orators in their impassioned bursts of fancy have
always claimed just what every new fafit in science makes
more and more plain, viz: that truth in all its diversified forms
is one and the same. We may not always see it, but the faét
stands all the same, that nothing is so small or hidden or pe-
culiar that it does not affeét or is not affected by every other
existence.
There has always been an attempt made to isolate medical
science from its surroundings. It has been held as having
nothing to do with matters exterior to it. As a profession, as
I
2 Oplztlzrzlmology and
an art, as a system of truths, it has been kept apart from other
systems, arts and professions. The reason of this is clearly in
the pride, selfishness and ignorance of its practitioners.
But the spirit of modern times is breaking down these fac-
titious barriers and opening into the broad fields of universal
truth, wide doors of ingress and egress, and he is the man
truest to his calling who makes subsidiary to his wants the
largest part of the universe.
We used to talk ofthe “collateral sciences,” meaning thereby
two or three subjects that seemed to ally themselves to medi-
cine. But even these to the student were optional, because
in effect, they were more ornamental than practical. Now
we have new departments of science created and the old sci-
ences have been re-created and the whole world is alive and
bristling with new forms of truth. And none of them stand
isolated from medicine. They may hold a varied relation but
they are indisputably related.
Astronomy might seem a subject altogether too far re-
moved from medicine to be worthy of the physician’s atten-
tion. But when we consider what has been revealed to us of
late concerning the origin of some of the great epidemics of
disease, when we come to know how far these things are un-
der solar and lunar influences; we may Well push the question:
\/Vhat have planetary and stellar influences to do with them?
and what benign or baleful influences do comets and meteors
exert over the earth and its inhabitants?
This is no reversion to ancient superstition, but it shows us
how true after all was the instinét of the primal unlettered
man. What he vaguely guessed and what his posterity scorn-
fully rejeéted, science is now demonstrating to be true. Our
profession is to-day fighting some of its hardest battles. On
the one hand it is guarding from the attacks of a bitter foe,
and on the other it is pushing forward to victory. It behooves
us therefore to make a compact for both offensive and defen-
sive purposes with what are called the modern sciences. For
we will ultimately stand or fall by tests which these sciences
will apply to our doctrines and practices. We can no longer
isolate ourselves and build up and elaborate a system heedless
Other llloclern Sciences. I 3
and in defiance of other systems. Biology, sociology, psy-
chology, anthropology, possibly geology, botany, astronomy,
and for aught I know theology and paleontology present
faéts and principles with which our theories and practices
inust be made to square themselves.
And all this is ‘introductory to this particular statement I
desire to make and briefly illustrate. The statement is this: The
comparatively recent departments of Qphthalmology and Otol-
ogy which have been established and acknowledged as integ-
iral parts of medical science are more than any other depart-
ments closely related to general scientific subjedts.‘ On this
side of medicine, we reach out into vastly wider fields of
investigation than we do on any other side.
Amid the chaos and confusion of mingled error and truth,
Which filled the world and blinded and misled, astronomy
stood forth and became the pattern science in giving right
methods of investigation, and in showing how phenomena
could be traced to well understood causes. So Ophthalmic
science, yet in its infancy, is giving laws to medicine. It is
teaching the anatomist, the surgeon, the pathologist and the
physiologist how best they can get an accurate insight into
the puzzling problems that confront them.
First of all in our investigation of Ophthalmology, we enter
upon the study of light. And he who masters this, holds in
‘his hands the product of the labor of many centuries. He
holds the key that is able to unlock the mysteries of astrono-
my, that is able to unlock the secrets of geology, that can open
the door that shuts from our understanding the wonders of
botany; I may add ethnology; and it might puzzle us to say
what department of science it would not open and illuminate.
This done, we enter upon a study of the strudture of the
visual organ. ' We know that here as no where else, nothing
was made in vain. Every part bears a vital relation to the
design had in view at its creation. And for systematic mode
in study, we may ever hold to the anatomy of the eye as the
~highest known model. Both topographically and histologic-
ally, it -is the -eye that must take the highest rank.
4 Ophthctlmology and
Then we come to the study of the functions of the eye.
The funétion of the brain is not to day a more inscrutable
mystery than was the fundtion of the eye not many centuries
ago. True, we have not solved all the fundtional problems of
the eye, but only see what has been done toward this within our
recolleétionsl May we not hope that such patient investiga-
tions as have yielded us such a goodly result in the study of
sight, will yet give us noble results when applied to the phe-
nomena of mind?
The next step in our course of study carries us into the do-
main of psychology. We come to deal with perception of
sight and have for factors the objeétive phenomena already
alluded to, viz: the eye and light and their mutual interaction,
these on the one hand, and, on the other hand. we have the
snbjeétwe cerebral phenomena, by which these outer mani-
festations are transmuted into perception and thought.
Physiologists have long been searching for the “Northwest
passage,” by which the world of matter below could be defi-
nitely conneéted with the world of thought above. Might
we modestly suggest, that it is through the long neglected
avenue of sight this desired end can ever be reached. So far,
these investigators have sought for entrance by way of the
spinal nerves and cord. Since the time of Sir Chas. Bell they
have never ceased to search for an open sesame through me-
dulla oblongata and cephalic ganglia into the domain of mind.
How far they have fallen short of their hopes I need not stop
to tell.
But now if we turn to the admirable leétures of Helmholtz
on “The recent Progress of the Theory of Vision,” and then
study the chapters on the eye in Stricker’s Histology, and are
thus enabled to follow the ray of light as it sweeps through
the refraéting media-—confessing its vassalage by its obse-
quious bending—until it strikes upon the outward termini of
the rods and cones ofjacob, we find ourselves standing before
the hitherto veiled mysteries of thought, with but another step
to make before we are in the “holiest of holy” and are able to
comprehend the aétion of the mind.
Other Jlfodcrn S’ca'ences. 5
‘ But the subjeét of Ophthalmology presents itself under an-
other and more practical aspeét. It is not a study merely
pleasing or instruétive in its character, but of widely benefi-
cent use. Nothing is complete here until we have mastered
the pathology of the eye. Only he who has essayed the task
knows of its variety and complexity. And thank Heaven !
we can, nevertheless, say of it what can be said of no other
department of medicine: it is not often involved in obscurity.
It is not left for a tardy post mortem to make a revelation all
too late for the welfare of our patients.
There is no design on our part of setting up for this science
an unwarranted claim of perfeétion. It is only when we
compare the more precise and successful methods of Oph-
thalmology with the ruder methods of other departments of
medicine that we can fully appreciate its special excellence.
Iudged only by itself or brought to the test of a reasonable
ideal standard of excellence, we find much remains to be done
in placing this science and art at the wished for point of per-
feétion.
In illustration of the statement made a moment ago, that
Ophthalmology held a special kinship to the general sciences,
I desire to call your attention to the subject of
LIGHT.
God, who spreads out to our view and our understanding
the universe, forever hides himself from our sight. So light
the great revelator is never itself revealed. “lhat is light?
has been the one great puzzling question of the ages. \Ve
may never know what it is. But we have to-day a very
reasonable hypothesis which gives us a very satisfacrtory so-
lution to the question. So long as it holds good, when ap-
plied to all known phenomena, we may rest content until we
have a better hypothesis presented.
VVaves of water seem simple enough to be readily under-
stood. Still, as a scientific question, they have vexed wiser
heads than ours. A child may make or break them with a
pebble, but it might task a philosopher’s mind to comprehend
them. Let us represent them by a wavingline like this:
WWMMMMMWAW
6 Ophthalmology and
Any substance whose particles are easily displaced when
suddenly agitated, will move in this manner. There will be
a succession of rising and falling from a given line.
Agitate the air and you have the same result. Set it in
motion and it instantly assumes the to and fro, up and down
action. Let us comprehend another rm-. The gentle ripple
that creeps like a shudder over the placid stream, and the
mighty waves
“That thunder strike the walls
Of rock built cities, bidding nations quake
And monarchs tremble in their capitals,”
The half born sigh that ’scapes the lips of the sorrowing
soul, and the vengeful blast that uproots forests and devastates
the city are representative offorces similar in kind, but difl‘er-
ing in quantity. That is to say they are all waves only unlike
in their size and velocity. And in their results they are corre-
spondingly different.
Now to bridge over from these comparatively simple phe-
nomena to the complex phenomena of light, is an easy matter
if you do but allow us to make a trifling assumption. The
coarser the medium the coarser the Waves. \/Ve can not get
sound out of water, for it is too gross and clumsy. Air will
easily make sound, because it can be made to vibrate with
suflicient rapidity. But we could as soon transmute granite
into diamond as make light out of air. But we know of no
substance lighter than air and its analagous gases.
Besides, this air, is of the earth earthy; beyond, in the re-
gions of Space, we know there is no air. Hence, our assump-
tion of an imponderable omnipresent ether which knows no
limit save the boundary (if there be any such) of the uni-
verse. And if we say light is this ether set in motion, we can
readily compare it with the motions of water and air and so
come to a pretty clear understanding of its chara<§‘ter.
Therefore, what we have given to represent waves of water
answer quite well representing waves of air and we have in
it, also, a view of the waves of ether. It is proper to say that
as these substances—water, air and ether, differ in their na-
tures, so their waves are unlike. Practically thishas no effect
upon the point we have in view and I venture to ignore it.
Other Jlfodern Sciences. 7
Light presentsa complex idea. \/Ve have the agitating agent
the substance agitated and the multiform results. It is not
light which travels along the ether. There is no such thing
as an active principle called light. First, we have the force;
this force sets ether in motion and then under certain condi-
tions we have light as the result. What we are cognizant of
is the effect produced upon the b1ain.
We catch waves of water with our hands; we catch waves
of air with our ears and we can catch waves of ether only by
the most delicate of all known anatomical instruments the
eye. But our hands do not feel, our ears do not hear, nor do our
eyes see. They all catch a peculiar impulse and send, not
that impulse, but only a corresponding sensation to the brain.
Ears that are deaf to all ordinary sounds that have no ob-
jective perception, yet roar like the ocean, ring like fire bells
and give to the brain sounds like trumpet blasts. Eyes that
are blind and upon which the vibrating ether falls resultless
do yet see all the colors of the spectrum. Nay, if you do take
the eye ball wholly out, you have but to irritate the optic
nerve and you have veritable light. A blow, a scratch, an
electric current will give us sensations of light, quite as easily
though not so faultlessly as waves of ether.
There is no color to ether when either quiescent or active.
\/Vhat we deem colors have no objective existence—they are
simply our conscious modification of brain structure.
I hesitate to carry the statement further lest I trespass on
the domain of psychology. 1 only wish to insist upon this:
that. as scientific men, we must possess ourselves of this ab-
stract idea of light, and whenever we do, we find the subject
stripped of many of its popular fallacies.
All vibrations of the air are not audible to the ear. All vi-
brations of ether are not visible to the eye. That is to say,
there are sounds we can not hear and there is light we can
not see. These vibrations have to come within certain limits
before we are conscious of them in a given way. To speak
only of light; the largest waves of ether we can become con-
scious of are 36,918 to the inch and the smallest are 64,631 to
8 Ophthalmology
the inch Between these points are all the colors of the spec-
trum. And each color is determined simply by the size of
the wave or what is just the same, the rapidity of the wave,
or in other words, the number of waves to the inch.
So far, I have only touched incidentally upon a few of the
topics that spring out of this interesting subject. I must lca\ e
it, however imperfectly I have treated it, for your own inves-
tigations to complete.
The ancients worshiped the sun. Doubtless the Persian Fire
\Vorshiper of to-day, bows in adoration before the mighty
orb, as his chariot wheels mount up the Eastern horizon
and falls in supplication as they roll down the \Vestern verge
of heaven. But that which a blind superstition leads him to
do, we, who perchance are wiser, might well do in the light
of the revelations of modern science.
If the sun be not God, he is truly god-like. He warms, vivi
fies and enlightens throughout a universe, which neither the
eye nor the mind of man can fathom. I-Ie beats the invisible
ether with his shining wings and bids it brighten and flow in
endless streams of light. These multitudinous waves strike
the Earth’s dull face and waken from its cold clods the
wondrous creations of the vegetable world. And day after
day its beating pulses thrill and animate all the fair surface of
our great world.
It is well for us that these waves are not so vast and irre-
sistible as the waves of the ocean, else we would have been
long ago beaten to dust. It is well for our eyes that these
ether beats are not so material as those of the air, or our
retinas would under the ceasless impact, have lost all sem-
blance of organic form.
It is well for us that there exists this wondrous adaptation
of man’s complex organism to the operations of nature’s laws.
It is this which gives beauty to the eye and music to the ear,
which fills all the universe with glory and the soul of man
with happiness.
F/R87 /I/V/VU/IL REPORT
FROM JUNE 1st, 1873 TO JUNE 1st 1874.








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EYE AND EAR INSTITUTE
COR. MOUND AND SEVENTH.
CINCINNATI, onzo.
Bo/xan oy TRUSTEES.

OF THE

tflialriiirali firrr Qiaprilarrg.
vv
The Cincinnati Homoeopathic Dispensary and Poli-Clinic,
of which our Free Department is a part, is conduéted under
the patronage of the following gentlemen, who, also, are the
Trustees of the College:
HON. BELLABIY STORER,
President.
\/V. L. EVANS,
Sec1'etm"_z/.
I-ION. JOB E. STEVENSON,
HON. M- B. HAGANS,
G./-XZZAM GANO,
JOHN E. BELL,
HUGH MCBIRNEXT,
J. L. KECK,
S. R. BECI<\/VITI-I, l\/I. D.,
A. H. HINKLE,
J. \/V. BANNING,
ANIOS SI-IINKLE,
F. G. HUN1‘INGTON,
SURGICAL
T. P. \\/TILSON, M. D.,
Surgeon in Charge.
R. M. BISHOP,
Vice-President.
GEO. EUSTIS,
Treasurer.
I-ION. P. W. STRADER,
J. STACY HILL,
JOHN P. EPPLXT,
A. D. BULLOCK,
C. F. BRADLPTY,
JOHN CINNAMON,
J. H. PULTE, M. D.,
J. N. I<INNEXZ
VV. BAKER,
l\I. H. SLOSSON, Mi. 1).,
S. C. FOSTER,
STAFF-
H. A. WORLEY, 1).,
Assistant Surgeon.
have the pleasure of presenting, herewith, our
first Annual Report. The establishing, one year
ago, of a special Eye and Ear Clinic west of the
Alleghanies, and under control of a Homoeopathic Stall‘ was
a thing entirely novel. It was deemed by the physicians of
Cincinnati, and the friends of Homoeopathy, that no more
central place could be found in the \/Vest, and no city other-
wise better fitted for this purpose. Commanding a ready
access to all parts of the Ohio and l\/Iississippi valleys, and
standing at the entering door of the great South, it was justly
deemed that this place would eventually command a patron-
age not excelled by our Eastern cities. “
It will be very easy to see from the results of our initial
year what we may hope for in the future, provided the requi-
site energy and. devotion to the cause are not wanting.
It is a matter of profound astonishment to all, how rapidly
the study of Qphthalmic and Aural diseases has progressed.
Pre-eminent among all mechanical appliances, that the inven-
tive genius of man ever brought forth to aid us in the study
and treatment of disease is the


OPHTHALMOSCOPE.
Every day and hour is adding new evidences of its power
to explore and make plain what was before hidden and un-
known. And for much that we have gained in our present
knowledge of diseases of the eye we are indebted to this
simple instrument. And its simplicity makes it all the more
remarkable that so few physicians and surgeons make them-
selves master of its use.
12 First Annual Report
Another instrument of corresponding value in investigations
of diseases of the ear is the
I-IASSENSTEIN SPECULUM.
It is now two years since we had the honor of first intro-
ducing it to the profession. And yet even to aurists it is an
instrument almost wholly unknown. The latest works on the
ear contain no reference to it. Nothing but the trouble or
learning how to handle it successfully could deter any one
treating ear diseases from adopting its constant use. It is
more easily managed than the ophthalmoscope and will give
equally gratifying results.
“le desire to be recognized as squarely committed to the
Homoeopathic therapeutical idea. It is within our recollec-
tion when our school had no acknowledged rights anywhere
in the world, much less in the department of medical science
\Ve beg pardon, it was accorded a place among the delu-
sions and charlatanry of the world, bu.t that was of the pa_st
rather than of the present. But nevertheless by a persistence,
almost unparalleled, and in the face of opposition almost un-
surmountable, it at last won a name and a place in the field
of materia medica. V Following hard 'upon this important
vantage ground gained, Homoeopathy entered the field of
therapeutics, and there demonstrated its power to cope with
disease. '
Under the Allopathic regimen, the death rate for all diseases
stood, and for that matter still stands, atabout twenty-five per
cent. But Homoeopathy has, as with a hand of magic, reduced
that rate to at least ten per cent. And not only so, but in a
great measure it has changed what has heretofore been
considered the natural history of many diseases in respect to
their duration, cutting short their course by many days and,
in cases of continued fever, by weeks. _
To secure these triumphs, there have been expended the la-
bors of many men, extending through many years; but at last,
the recognition of the world was secured, and Irlomoeopathy
took its place among the acknowledged schools of medicine.
C¢"nsz'1‘z-nah‘ Eye and Ear I)28t£t'llt6. 13
Still, to use a military phrase, the fortress was not taken.
These obstacles overcome, left yet an objective point of great
value guarding the heart of the city. It was said (with re-
luctance however) that Homoeopathy might do for general
practice, but it could never secure‘ a foothold in the depart-
ment of surgery. The challenge thus defiantly given has
been accepted, and our surgeons have drawn the knife and
saw, and cut their way to an enviable pre-eminence.
Then came the last tug of a long and fruitful war. Spe-
_cialism as the Malakofl‘ of Allopathy presented a formidable
front. In this, were gathered the crown jewels and costly
prizes of an administration that claimed an unbroken dynasty
for more than 2000 years. “War to the knife” became. the
cry of besieged and besieger. .
Witll what success the contest for a place in the field of
specialism has been waged, and, all within the past five years,
we need not now stop to explain. Boston, New York, Phil-
adelphia, Pittsburgh, Cleveland, Cincinnati, Louisville and
Chicago are all richly sharing in the pleasing success. VVhat
‘is being done in our own city is briefly set forth in this Annual
Report.
Commencing one year ago as an adjunét to the Free Dispen-
sary, which had been wholly maintained by the generosity of
our citzens, it has suddenly grown into a separate and dis-
tinctive feature, and bids fair to become one of the leading
benevolent institutions of the city. .
No distinctions of any sort among patients are allowed, least
of all, distinction in regard to location. Our doors are open
to the poor everywhere, and we have during the past year
given relief to residents of Indiana, Kentucky and Ohio.
THE ROOMS FOR EYE AND EAR PATIENTS.
The rooms of the Institution are located in the College
Building, cor. l\Iound and Seventh sts. The entrance by a
wide Winding flight of stone steps, opens into a spacious hall,
and on the left hand are found several large, Well furnished
rooms, always cool and clean and inviting to the affiiéted.
The entire afternoon of every day is devoted to the wants
of the poor, laboring under disease of the eye and ear.
14 F»z'rst Annual Report
OUR GREAT NEED.
At present, patients from abroad are supplied, at pri\-*ate *
residences, with necessary board, nursing, etc. But we must
have an OPHTHALMIC HOSPITAL, where the most perfeét
accommodation, with all the needed modern appliances can be
obtained, and where patients can be constantly under our im-»
mediate care. Under this arrangement, the number of our
most important cases would increase ten-fold. And the results
in such.cases Would be enhanced. A matter of Ten Thousrmd
Dollars would_;sec,ure us ample accommodations. Some gen-=
erous man or woman of wealth might have the honor of
founding the first and only institution of the kind in the \/Vest.
It would be largely self~supporting from the pay of patients
able to contribute to their own support, and still leave a wide
margin for worthy indigent persons. But with an annual
deficit of one or two thousand dollars, it would still be consid*
ered as reaching a large and satisfactory measure of success.
Such an ophthalmic hospital as we have in mind, would be
freely entered and enjoyed by patients of wealth and high
social position. ‘ _
This report is made to include both indigent and pay pa-
tients, but they are rendered distinct enough for all practical
purposes. The ophthalmic room separates the departments
-severally occupied by these classes.
During the winter a complete course of instru<9tion, in dis-
eases of the eye and ear, is given to a large number of medi-
cal students. And during the balance of the year students are
privileged, without expense, to attend on the daily session of
clinics in the rooms set apart for the uses of the poor.
\/Vith additional means, we could greatly enlarge our ca-
pacity for benevolent work, and we trust such aid will not
be long wanting. The following tabular statement shows-the
amount of work done, number of cases treated, and operations
performed, during the past year.
\/Ve desire to express our special obligation to H. A. \/Vorley,
M. D., our efiicient and indefatigable assistant, whose com
stant and gratuitous labors have done much in carrying on
the work of our daily clinic for the past six months.
Respeé-°(f11lly', T. P. _\VILSON, l\/I. D.
CD1-C't')Z)Ztlll,' Eye and Ear Iastzfuzfe. 15
CLASSIFICATION OF DISEASES.
A.——EYE DISEASES.
I. Ajfeeéions of Lids.



I. Inflammation ofEyelids 7. Traumatic injury lids
(Blepharitis) . . . . 23 and Cornea . . 4
2. Hodeolum (Stye) . . 4 8. Trichiasis . . . . . 5
3. Inversion of lids . . 10 9. Phleg. Erysipelas oflids 4
4. Eversion of lids . . 2 IO. E-pithelioma of lid 1
5. Tumors of the lids . 3 ..._.._.
6. Abscess of the lids . 1 57
II. A_feetiorzs of the I.cz.eiw'3/mail Appcwcrtus.
I. Blennorrhoea of sac . 9{ 3. Fistula I.achrymalis 2
2. Closure of Puncta and I 4. Stricture nasal duét . 3
Canaliculi . .‘ . . . 1o]
2} -
III. Ayfe-etz'ozzs of the Orbit.
1. Tumor Orbit . . . 2} 4. Abscess supra orbital
2. Cancer Oculi . . . 2} ridge . . , , 1
3. Traumatic injury . . 2‘
7
IV. ]V[-rtseztla-2' and Nervous Aj/feeflons.
I.COl1Vt31‘g‘€l1tStl‘?ll)lSlTlt1S 9I 5. Spasm of the Orbicu-
2. Divergent " laris muscle . . . . 2
Insufficien-cy of Intern- -1 6. Paralysis Levator P31-
al Redtus . . ». . . pebraa (Ptosis) . . . 4
4. Paralysis 3d pair . . 3i
24
V. Anomalies of Refrcretion and Aceomorluz‘-¢.'0n..
1. l\/Iyopia . . . . . 4. Asthenopia . . . . 45
2. Hypermetropi.-. . .‘ . 7| 5. Astigmatism . . . . 3
3. Presbyopia . . . . 51
. 63
VI. Diseases of Conjztrzctiva.
I. Inflammation of Con- junétiva, purulent 3
junétiva, catarrhal . . 48 6. Pterygium 2. Inflammation of Con- 7. Symblepharon . . 2
junctiva, phlyctenular . 5 8. Subconjunétival hznm. 2
3. Inflammation of Con- 9. Foreign body on con-
junc°tiva, granular . . 4 junriliva . . . . . 5
4. Inflammation of Con- IO. Trachoma . 13
junctiva, neonatorum . 3 ~ __
5. Inflammation of Con- 33

16
First Annual Report
VII.
1. Inflammation of Cor-
nea, phlyctenular
2. Inflammation of Cor-
nea, ulcerus . . .
3. Inflammation of C
nea, pa'rench'ymato~u.s
4. Inflammation of Cor-
nea, tra‘um‘a'tic .- .
5 Inflammation of Cor-
nea, simple .
6. Pannus .
O1‘-
Diseases of Cornea an-(Z Scleroz‘ic.

VIII. Ajfliotéoaz-a of Iris, Cz'la'ary Body and Cfzoroz/‘d.
I. Inilam. of Iris, simple
2. “ “ serous"-'
3. “ “ syphi’tic
4. “ “ exudat’e
5. “ “ and ch0-
roid
“
7. Tumor of .
8. Hyperazmia of Choroid
9. Infl/am. of Choroid and

IX. A'fi‘ect£0ns of Retina and Optic .ZV'erve.
I. Inflam. of Retina, exu-
dative . . . . . .
2. Inflam. of Retina, pig-
mentary . . . . . .
3. Inflam-. of Retina, apo-
pl-ectic . . . . . .
4. Inflam. of Retina
Brightii . . . . . .
5. Inflam. of Retina, and
Optic Nerve . . . .


X. 'Afi"ections of Cry/.staZZ-z'ne Least
I. Cataraét, hard
2. “' soft .
3. milky .
(C
' 7. Opacities of Cornea '17
I2 8. Staphyloma of Cornea 2
9. Foreign bodies on Cor-
6 nea . 13
I0. Leucoma . . . 8
5 T I. Scleral staphylom‘-at, ant. 2
12. Conical Cornea 4
4 I3. Atrophy of Cornea 5
I4. Sarcoma of Cornea 2
35
16 13x
3 Retina . . . . .' 4
4 I0. Glaucoma . . . . 4
2 II. Sympat’tic Ophthalmia 5
3 I2. Coloboma of Iris (con-
genital) . . . . . I
4 I3. Anterior Synechia 3
1 14. Posterior “ . r:,
I 15. “" S-taphyloma 4
4 “'“.
I 42>
6. Hyperaemia of Retina 5
8 7. “ Optic‘
Disc . . . . . . 3
9 8. Detael‘nnent of Retina 5
9. Amaurosis . . IO
1 IO. Amblyopia . . . 13
II. Retinal Asthenopia 2
2 .
67
9!
7 4. Cataraét secondary 3
4 5. “ capsular 6
I.
2!

XI. Afibctions of V'e_'61'e0as" Bod;/.
I. Muscae Volitantes .
I
C I I I O 1 I I O U
Cincinnccti Eye and Ear Instztute. 17
\O
H
O\Q C‘/_)\T O\U'l—P~b-) N i—|
H
H
H
N
i-4+-ii-ii-ii-1""
m\To\u1-l>¢~
. External Auditory Canal, Acute Inflammation of
‘C ’
. Auricle, Eczema of . . . . . . . . .
. Membrana Tympani, Inflammation of . . . .
. Middle Ear, Acute Catarrhal Inflammation of .
.¢/N <F\U1-see .N H
. l\/Iembrana Tympani, perforation of, without discharge
1 1. . . . .
'12.
13.
14.
1:‘,
16.
. Strabismus
. Entropion
. Enucleation
. Cataract
. Canthoplasty
. Tattoo Cornea . . .
. Stricture of Nasal Duct
. Plastic Operation . . .
. Foreign Body in Cornea
. Slitting Punctum and Canal
. Fistula Lachrymalis
. Circumcision Cornea.
. Trichiasis . .
. Paracentesis Cornea:
.Ptosis . Foreign Body in Conjunctiva
. Tumor ofAuricle . . . . .
. Paracentesis Membrana Tympani
,.
B.-——EAR DISEASES.
6‘ C.
Furuncle in . . .
Inspissated Cerumen
6‘ K‘ ‘C
N
6‘ (4
Chronic “ _ ‘
Acute Purulent “ . . .
Chronic “ Inflammation of with
perforation, Otorrhoea . . .
(C 4‘
Ho?
'J\U1 O\t\->U1 O\Tb-3
(6 6‘
4;.
H u_t.~. to C/3Q\OU1
Deafness, Nervous .
IVIeniere’s Disease .
Closure Eustachian Tube
Tumors of Auricle . .
Artificial Tympanic l\/Iembrane
Aspergillus . . . . . . .
I-4

to
\]
4:.
V\lhole number of Cases treated
\Vhole number of Treatments
(7.)
O
\T
3116
OPERATIONS. '
i-1
QC/J
(A
H
Q,s_t>. to H [0 »-._ts to\T\r> N OCJ~)U'll)-3'u~)

H
O
\O
First Annual Report 18
A Statement of I\/Ionthly Attendance,etc._on the Free
Clinical Department.
N0. Cases. No. Treatments. N0. Opercztions.

June, 1873, . 31 I02 . , 3
July, “ 35 I 18
Aug., “ 50 I67 5
Sept., “ 60 240 9
O&., “ . 50 I81 9
Nov., “ 65 I80’ 6
Dec , “ 64 2o3 2
Ian., I874, 68 ‘ 227 I
Feb., “ 72 268 6
Mar., “ I I4 555 18
April, “ I03 497 I I
l\/Iay, “ I06 ' I 415 7
NOTES.
CHLOROFOP.M.—-—As a matter of special interest to the pro-
fession, we may mention that 'in all of our operations we ‘
have used only Squibb’s best chloroform, and ‘always with -
the happiest effeéts. \/Ve are disposed to hold with special
force to the use of the inhaling instrument, purchased some
years since of Geo. Tieman and Co., of New York. It con-
sists of an oval wire frame, over which is stretched a piece of
Canton flannel. The bottle containing the chloroform holds
six ounces, and is’ furnished with a rubber cork, tl1rough
which passes an inlet pipe for air and a fine outlet pipe for
the chloroform. This enables the operator to commence the
administration without preliminary -preparation; saves one-
half the usual amount of chloroform, and avoids the danger
of excluding the air or over-dosing the patient. This instru-
ment is no novelty to some surgeons, but it is almost wholly
unknown to the profession. WVe commend it to all who de-
sire to give chloroform with safety and economy as well as
comfort.
Uz'ncz'w.natz' EZJG and liar Institute. ‘ 19‘
CANTHOPLASTY.—It may seem a matter surprising to some,
that, among the operations made, there should be so many of
canthoplasty. But this is easily explained by the faét that the
operation has been largely relied upon to cure obstinate cases
of keratetis, pan-nus, superfiicial opacities of the cornea and
granular ophthalmia. In most of these cases, the result was
immediate and beneficial. lnveterate cases, that had in other
hands, resisted treatment applied many months, at once, be-
gun to recover after the operation had been performed. Fol-
lowing the canthoplasty, we have given both local and
general treatment, and are saisfied that the results with the
same agencies are widely different before and after the ope-
ration. '
SYRINGING THE EAR.-—CaS€S of inspissated cerumen oc-
cur so frequently that it becomes a matter of no small impor-
tance how easiest to dislodge the mass from the meatus. For
this operation, we have construéted’ a simple syringe that
gives a continuous gentle stream. It also keeps up‘ the tem-
perature a long time, and does not allow any of the water to
escape andydeluge the patient’s neck and shoulder. The con-
struction and operation have been presented to the American
Institute of Homoeopathy, and given in the pages of the first
volume of the M6(Z6CCtZ Advcmce. It is only necessary to add,
that at a trifling expense it may be made by any surgeon from
a tin cup and rubber tube and bulbs.
CINCINNATI
Homoeopathic Poli-Clinic,
MEDICAL DEPARTMENT.
Abstraét of Annual Report, Ending lune 1st, 1874.
Abscess . . . . . . 4 Amenorrhcea . . . . 2:
Abscess of Liver . . . 2 Apoplexy . . . . . 2
Angina . . . . . .. 20 Asthma . . ._ . . _ . I3,
Acne . . . . . . . 5Alcoholism . . . . . 9
%
17z'rst Ammal Report
Anasarca . ._ .
A11g. Curv. Spine . .
Bronchitis, Acute, Chron.
Burns -. . . . . . .
-Climaczeric
Confinements
Constipation . .
Cholera l\/Iorbus
~Catarrh . . .
Cephalgia
Colic
Convulsions .
Colds . . . . . . .
Diarrhoea, Acute, Cl1ron.
Dyspepsia . .
Dysentery
ebility
fDyspnoea
Dysuria
Enteritis
E1-ysipelas
Epilepsy
.Enures1s
Fever ephemeral
Haemorrhoids
Hepatitis
Hemoptysis .
Hysteria
Hernia . . . . .
Hypertrophy of Heart .
.Herpes . . . . . .
Helminthiasis
Injury . . .
Intermittent Fever
Impetigo .
Influenza.
‘Gonorrhoea
Leucorrhcna
Lead Colic
VVhole Number Patients
Whole Number Prescriptions
O\0~>\1L11L11\T
II
14
22
4
IO
24
27
3
Wl1ole Number Visits
0. W. LO UNSB URY, JII. D., Resident Physician.

Lithiasis
Lumbago .
Lichen Circum.
Laryngitis
l\/Iarasmus
l\/Ietritis
Meningitis
l\/Ietrorrhagia
Menorrhagia .
Nephritis, Acute,
Necrosis . . .
Neuralgia
Ovaritis . .
Paralysis Agitans .
Pertussis .
I?leL1ris)f
Pneumonia
Parotitis .
Phth. Pulm. .
Paralysis . . .
Prolapsus Uteri
Rheumatism
Rubeola .
Retroversion Uteri
Spinal Irritation
Syphilis, Primary .
“ Secondary
“ Tert.
Spermatorrhoea . .
Suppressed Mens_truation
Scarlatina . .
Scrofula .
Tonsilitis. . .
Typhoid Fever .
Torticollis
Uterine
Urticaria .
Ulcers. . .
Miscellaneous
hronic
I078
5295
828
N mCEioo <3\U1\T o\\T-P-a> r\>_;>~oq
I5
H
N—P-
\T 00 '
-;>\Ioo\r-P-PQQUI mow
--J
r~:?"*
A 0 UTE DISEASES OF THE EAR.--TIJEIR
H O1I[(EOPA TIIIU TREA TM’ EN T.
BY T. P. WILSON, M. D., CINCINNATI, OHI0.

For one to take definitely this ground and discuss it, to the
exclusion of collateral subjects, is to undertake a task of no
small magnitude or trifling difi‘iculty. The very nature of the
terms employed in the statement commits us to the doubtful
expedients and conveniences of the popular pathological sys-
tem of the day. First as to nosology.
We are obliged to recognize an artificial arrangement of
pathological conditions into a catalogue of names. These
names represent what are called diseases. It is needless to say
they are essentially human creations. But, as though to give
the lie to the accepted declaration, that a stream cannot rise
higher than its source, these human creations, factitious and
ideal though they are, rise into undue proportions and exer-
cise autocratic powers; and we stand powerless before them.
Two centuries ago, we might have found the American cou-
tinent stretching out from ocean to ocean, diversified in a thou-
sand ways, but unbroken. To-day, we find its map curiously
marked by dividing lines. From the original thirteen colo-
nies, we have multiplied into nearly a half hundred states.
Each state is a human device, as is evident from the absurd
shape of its boundary lines. Nature seems never to be con-
sulted in these artificial creations. But now we cannot fail to
observe, that no state can he made so small, that it does not at
once become autocratic. Each state, though a part of the
Q
woRLn’s HOM(EOPATH 10 CONVENTION. L2
general government, demands a maintenance of its individual
autonomy.
Suppose now, one were to write upon the subject of law, or
the principles of government as applied to this country, he
could hardly be expected to break away from this established
order of things. Each state has its own special enactments;
each administration and epoch its own peculiar legislation;
but who does not know that there are principles of law and
government that run deeper and more broadly than anything
a lawyer or statesman would be likely to discuss? Such a dis-
cussion would be sadly hampered by conditions we have indi-
cated.
This simile is not lacking in force of application to themat-
ter we have under consideration. Our nosology presents us
certain specified diseased states. These names are fanciful and
notoriously unscientific. They demand of us recognition ;
and no one can enter the field of therapeutics, and successfully
break away from these nosological entanglements.
Yet nothing can be made plainer to the human understand-
ing than, that a strict regard to the principles of homoeopathic
therapeutics, demands that we wholly ignore much, if not all,
that properly belongs to nosology.
This statement is not, perhaps, more unfashionable than the
words of Patrick Henry and his compatriots, in those memo-
rable days, when it was sought to wrest this country from
European domination. And we can say, as did he, “ If this
be treason, make the most of it.” But may we not hope to
see ourselves as a medical school, or what is more comprehen-
sive, as medical men, in this memorable centennial, emanci-
pated from the unjust ‘demands of artificial systems of teach-
ing and practice, that have been imposed upon us, partly by in-
herita,pce and largely by custom; for we are, as scientific men,
as are scientific men everywhere, the veriest slaves of what is
thought and taught to be the fashion in thinking and saying
and doing.
Equally absurd is the distinction sought to be maintained
between certain diseased states which we designate as acute
and chronic. To a thoroughly intelligent mind, it seems al-
most childish to set up such a dividing line.
8] ACUTE nrsnasns on THE EAR.
Secondly, our difficulty assumes no small proportion, when
we come to select the homoeopathic remedy. Compared with
the formation of our Materia Medica, our otology is modern.
When many of our most important remedies were developed
into their wonderful pathogeneses, so that we could ascertain
under what well-defined conditions they were indicated, and
to be applied, it was not known, if, in the provings made, the
inner parts of the external ear, or the middle ear, or the in-
ternal ear was the point affected. Amid the wealth of symp-
toms found in our provings, we are left within a poverty of
information as to the special pathological states which they are
designed to meet.
A third difficulty requires notice, namely, the assumed local
character of the diseases we propose to treat. Specialism, by
which the human body has been topographically divided into
departments, and over these set special classes of practitioners,
is not a child of the Homteopatliic School. The constitutional
relations of each individual pathological state, should not only
never be overlooked, but should always hold a foremost place
in our considerations. And so, in a strictly scientific sense,
there can be no special practice of medicine; and there can be
no special classification of diseases; and no grouping of reme-
dies with reference to one generally accepted nosology.
It will, however, be the duty of your committee, to adopt
the generally received mode of discussion, and enter with this
protest upon the work assigned it.
We shall not hesitate to assume in the first place, that, in
every case, the practitioner, though he applies the strictly
hommopathic remedy, is yet to be not only able to investigate
the case he has undertaken to treat, but that he does so inves-
tigate it, physically as well as symptomatically. To this end,
in needful cases, the fauces and nose are illuminated and ex-
plored; the meatus auditorius externus is carefully examined
throughout its entire extent ; the tympanic membrane is
brought clearly into view whenever this is possible, and its
condition carefully noted ; the permeability of the Eusta-
chian tube is ascertained; and the condition of the labyrinth
investigated, so far as to detect any existing modifications of
the auditory nerve.
woRLn’s I-IOMCEOPATHIC CONVENTION. \ Pt
This may not be homoeopathic treatment, but it is a most
necessary antecedent to it. I mean by this that, while one may
jump into the dark and land safely, he can only put it down
to good luck. Science demands light, literally as well as me-
tamorphically. No intelligent account of a case cured can be
given, no matter what the remedy or the attenuation employed,
unless the prescriber understands what he is dealing with. This
point needs emphasis, because we, as a School, have unfortu-
nately been always handicapped by a class of professed leaders,
who have boastfully discarded these things, and taught us to
rely upon symptomatology. It is some satisfaction to know
‘ that these misguided leaders have not touched upon this spe-
cial field of otology, so as to prevent our students in entering
upon it, from understanding the demands imperatively laid
upon them, to master the whole subject, its anatomy and path
ology, as well as its symptomatology.
The number of diseases of the ear that may properly be
classed as acute, is certainly not numerous; but, whether this
is due to their non-existence or their non-recognition by us, I
am not prepared to say. I shall venture to designate but two,
and those both of the middle ear:
1. Acute catarrhal ut]‘Zammutte'0u.
2. Acute suppurative inflaonvnatiou.
It may be best to state, that this distinction is not deter-
‘ mined by very broad lines. They are interchangeable condi_
tions, so far, that the former, by a simple increase in intensity,
often becomes the latter. They do, however, present them-
selves so frequently with such diverse symptoms, that we are
authorized undoubtedly to maintain this classification.
The symptoms of acute catarrhal inflammation of the mid-
dle ear, as laid down by a late writer, are worthy of notice.
Sy/m50t0'm.s.——Tl1e symptoms of acute catarrh may be enum-
erated in the following order: ‘
Subjective .' 1.. Pain referred to the depth of the ear. 2. A
sense of fullness in the same part. 3. Noises in the ear.
Objective.’ 1. Vascular injection (of the tympanic mem-
brane). 2. Bulging outward of the the membrana tympani.
3. Impairment of hearing. 4:. Gatarrh of the pharynx and
5] ACUTE msruxsns on THE EAR.
Eustachian tube. 5. Fever (St. John Roosa, Diseases of the
Ear, p. 239).
Observe the writer does not say these are a part of the symp-
toms, but he enumerates them as constituting the tout ensem-
ble of the disease. But in the pages following, he makes a
few additions to this picture; as “crawling along the Eusta-
chian tube ;” “ a puffing sound like the puff of a miniature
engine; ” “ringing or buzzing sensation.” And these are in-
cidentally introduced, so that we are impressed with the idea,
that they are almost immaterial. And so they are, and must
always be to the allopathic practitioner. What Roosa has
here laid down is a stifiicieiit guide to a physician of the he-
roic or expectant or physiological school.
To one who desires to employ the indicated homoeopathic
remedy, such a picture of the disease, compared with the dis-
ease as it presents itself to the more cultivated mind, is like
the rude drawings of an Indian, compared with the master-
pieces of the divine Raphael. That this is true, I will pres-
ently show.
Looking again at this picture, as drawn by Roosa, we are
obliged in “honesty to acknowledge, that a portion of the
objective symptoms, though of great value, are at present
quite beyond our use. VVe have no pathogenesis of a remedy
that corresponds with “ vascular injection” ; “bulging outward
of the membrana tympani,” etc., simply because these condi-
tions have not been observed by our pro vers. In good time,
let us hope, objective symptoms in our provings, will hold
equal rank with those that are subjective.
Suppose now, in order that we may get a better definition
of acute catarrhal inflammation of the middle ear, as expresses
by the subjective conditions, we study this picture a moment :
“Violent pressure on the mastoid process below the ear.
Behind the left ear the muscles are painful as far as the throat
as if they were violently pressed upon. Pressing tearing be-
hind the rigl1t ear, drawing pain from the ears into the nape
of the neck; sensation of heat with drumming in the ear.
Earache accompanied by great headache; otalgia in the left
ear ; a disagreeable pressure in the mcatus; tearing in the right
ear from before backward ; tearing in the internal and external
woRLn’s HOIVKEOPATHIO eonvnrrrron. [6
ear in a downward direction. A very chsagreeable feeling in .
the right car as if it would be forcibly torn out of the head ;
shootings in the internal ear with deafness on that side. Pul-
sation in the ears with increased sharpness ofhearing; very
sensitive to loud tones. Deafness as if skin were drawn over
the ears ; noises in the ears; roaring in the ears ; tingling and
humming in the ears. First, a din of trumpets and kettle-
drums in the cars and as of rushing wind; immediately
afterwards a humming and buzzing, worse when sitti11g, better
when standing and lying; still better when walking. ( Allen’s
Encyclopzedia Materia Medica, vol. ii., p. 87 - ~
Contrast this with the picture drawn by Roosa, and remem-
ber that his is as good as the best to be found in the Allo- I
pathic school. The ideas of his school are exhausted in his
brief statement. Increase your knowledge and multiply your
ideas of the condition under investigation, and then you must
necessarily enlarge your description. Just as when you bring
your object-lens to bear upon a given object, a remarkable
increase of details comes into view and invites description ; so
it- is with diseases viewed in the light necessary for strictly
homceopathic treatment.
But the picture drawn from Allen’s Encyclopaedia is by no
means perfect. It does not exhaust the details of “the disease.
It is in fact but a very small part of what comespunder our I
observation. I/Vhat we have quoted is from the provings of
Belladonna. We have more than a score of remedies besides
this, each one of which is rich in symptoms that are peculiar
to acute catarrhal inflammation of the middle car. We have
chosen Belladonna because it is the leading and typical remedy
to be employed. It is most frequently indicated and its use
will, in a large proportion of such cases, be followed by suc-
cess. ‘ i
I desire now to call attention to another‘aspect of this
subject. And, while insisting upon its importance, I am
pleased to be able to claim it, as essentially the product of that
school of pathology which belongs, because it can belong only,
to the homceopathic school of therapeutics. I mean con-
comitant conditions. Look again at Roosa’s picture‘ of
acute catarrhal inflammation of the tympanic cavity. The
fragmentary symptoms are, with one exception, all of the ear.
Tl ACUTE DISEASES or THE EAR.
The pathology of his school is thoroughly localized. Beyond
what the ear presents, lst, subjectively, and 2nd objectively,
he knows nothing and cares to know no more. More than that
would not help his therapeutics.
The homoeopathic investigator views the matter difierent-
ly. To him, concomitant symptoms have an important
value. To him, in connection with the local conditions spe-
cified, vertigo, headache, nausea, diarrhoea, fever, delirium,
lassitude, sleeplessness, etc., etc., and conditions of ameliora'tion
and aggravation all have their important relations to the
case.
In any given remedy you seek to apply, you cannot suppose
the remedy is exhausted by what you find under that part of
the rubric entitled ears. We1'e we to confine our view to this,
by which to estimate the range and applicability of the drug,
we should most likely miss its most important relations to this
disease.
Let us look now at another brief description, having the
appearance of acute catarrh of the middle ear.
“ Tearing in the left ear; pressure in the ears; pains in the
ear; pains in the right ear; pains behind the left ear as from
pressure of the thumb. Feeling as if a drop of water were in
the left ear. Sensation as if something stopped up the left ear ;
roaring in the ears; ringing in the ears; humming, hissing
noise in the ears ; continual dull buzzing before the ears, then
faintness.’7 (illen’s Encyclopmdia, vol. i., p. 19.)
This is from the pathogenesis of Aconite. But who would
give this as a measure of its power as a remedy in this disease?
Certainly no one intelligently acquainted with either the dis-
ease or the drug. The nose, the eyes, the head, the mouth, i11
short every part of the body, under varying conditions, con-
tribute to complete the picture which the physician studies
both in his pathology and his pathogenesis.
Finally under this head, there are remedies other than those
we have mentioned, applicable to this form of disease. Our
failure to mention them, must not be taken as an indication
of their want of value as therapeutic agents.
Our second head is :
Acute suppurative inflammation of the middle ear.
‘vV()l.‘.LD$S 1:l()MCEOl-’A'l‘H1O CONVENTION. [8
The writer begs to call attention to the fact, that he made, at
the last meeting of the American Institute of Homoeopathy,
an extended report upon this subject. The two reports are
supplementary to each other. .
To the descriptions we have already given, we have but to
add intensity of symptoms and the formation of pus in the
tympanic cavity. 9 It is proper, however, that mention should
be made of the fact, that not infrequently purulent inflamma-
tion of the middle ear occurs without noticeable subjective
symptoms; a discharge of pus from the meatus being the first
indication of trouble. These cases are mostly confined to per-
_ sons suffering from phthisis pulmonalis and but little amenable
, to treatment. We exclude them.
“ The usual origin of acute suppuration is however a violent
one. The severe pain of acute catarrh is unrelieved, pus is-
formed in the cavity of the tympanum, the lining of the mas-
toid cells is very much distended, the outer surface of the
process becomes red, tender and painful; the headthrobs and
the whole system becomes disturbed. In young persons, de-
lirium occurs; and in all subjects, there is general febrile
excitement; and the condition of the patient is one of in-
tense suffering. There is -probably no more severe pain to
which the human system is liable, than that due to the disten-
tion of the little space called the tympanum, with mucus,
serum or pus.” (St. John Roosa, p. 357.)
This author adds: “The membrana tympani has usually
lost its naturally transparent appearance, in a case of acute
suppuration. It has a boggy, sodden or swelled appearance
and has none of its normal distinguishing marks in the way of
light spot and handle of the malleus. Yet this is not always
the case.” And this completes his picture of a disease, that is
second to few in the Varied symptoms and complications which
it presents.
And here we stand facing a fact in pathology we cannot
avoid accepting. It is this: N0 disease can be represented by
less than ‘an almost infinitude of symptoms. The physiolo-
gical school may be easily satisfied with noting, in a general
way, the modification of structure and function, caring only to
correct these. But our homoeopathic therapy demands 1nuch
more. In outline and detail every existing feature of the
9] ACUTE msnasus or THE EAR.
case should stand revealed. Yet many of our writers on the-
rapeutics, commit the folly of attaching to such descriptions of
symptoms as they can copy from old school authors, our ho-
moeopathic indications of remedies. The absurdity of this
course seems never to strike them; yet it can easily be seen
that there is about as much likeness between the symptoms
said to represent the disease, and the pathogenesis of the re-
medy said to be indicated, as between a child in embryo and
a full grown man. How is it possible for a disease to indicate
a remedy except by its symptoms? And how can a drug
show its homoeopathic relations to a case, except as it presents
symptoms corresponding to those of the disease?
N ow what is the fact in regard to this? In every attempt
to run a parallel between these two classes of symptoms, I
mean in our text books on practice, the symptoms of the drug
vastly outrun the symptoms of the disease. And the reason
for this is evident. N0 disease (as understood in our accepted
nomenclature) can be represented by less than an almost infi-
nitude of symptoms. Add to this the fact already stated,
that concomitant conditions rank in equal importance with
local symptoms, and you have before you the problem of ho-
moeopathic therapeutics. '
This is by no means a problem always easy to solve, but
its solution is not only greatly enhanced by our possession of
fixed principles of investigation and those of the correct kind, ‘
but it is a fact, that, without these, we can only plunge into
' the quagmire of empiricism.
The incompleteness of our Materia Medica, when we come
to apply it to diseases of the ear, as our modern otologists un-
derstand them, is painfully apparent. But our Materia Me-
diea is so much better than the best we can find of the symp-
toms and pathology of the disease, as laid down by any of the
writers of either school, that we have reason to be proud of
what we possess. An intelligent application of it, will give us
very satisfactory results in the treatment of either of these
forms of disease we have under consideration.
In addition to --T-Xeoriite and Belladonna. already mentioned,
we might name Bryonia, Hcpar sulphnr., Mercur_ius, and
woRLD’s HOMCEOPATHIC‘ coiavunrron. [10
Pulsatilla as of chief importance ; and a half score of others.
each one being of more importance than all the rest when-
ever specially indicated. To show their homoeopathic rela-
tions to the disease, we would have only to quote their rich
and varied pathogeneses. . / a
By way of conclusion, it may be best to add, that, while we
aim to give to the strictly homoeopathic treatment of these dis-
eases its true value, we do not ignore the value of such agen-
cies as these : hot water, atropine and inflation. Our former
report upon this subject, gives all needed emphasis to their
use. But these agencies are adjuvants, and therefore secon-
dary in importance, but never to be discarded because they
do not fall within the province of our great unalterable law of
cure, Sdmilia Sémildbus Uurantur.
o PHTHA LMIO THERA PE mvos.
BY W. H. WoooYA'I"r, M.D, CIIICAGO.

In forming an estimate of I-Iomoeopathic Therapeutics, it
must be conceded that however perfect the law, or universal
the principle, the ability to apply it in all cases is not to be
found at the present time. The glory of a complete knowledge
and a control co-extensive with disease, are reserved for the
far future.
Especially may the branch of the subject with which this
paper has to deal—-namely, Ophthalmic Therapeutics——be
spoken of as in a partially developed condition. _ All are
aware of this who have attempted to treat a great variety of eye
diseases. Its very deficiencies, however, make the subject an
interesting one ; for they~ are due to no inherent weakness in
the system, but to the insufficiency of efforts made to elaborate
it. To flnd ourselves confronted with an expression of dis-
ease for the relief of which we have no specific guide to a rem-
edy, is not an unusual occurrence. Our first recourse is to our
symptomatolog ’ ; failing there we look to clinical experience. ~
Finding no parallel amongst recorded cases, we call to our aid
such pathological analogies as seem suggestive; and if still un-
rewarded, try to interpret the modus ojacrcmrli of allopathic
medication to find, if possible, an agent to be used on homoe-
/iipatliic principles. Sometimes, as a last resort, a broad gen-
er.-lization may suggest a dozen remedies, out of which to
choose one, it may be, hap-hazard. This is not the road
tnivellecl in ordinary prescriptions. As a rule the symptoma-
telogy suflices. But when interrogated for eye-symptoms the
woRLn’s HOM(EOPATII1O CONVENTION. [2
response is always indefinite, often meaningless; and when the
symptoms can be understood, we find them standing, in dif-
ferent cases, for wholly different pathological conditions.
When we attempt to translate into pathology the sensations
of smarting, pricking, burning, pressure, tension, scraping,
itching, etc., etc., we are simply lost. Yet these same vague
words are probably rich with significance if we had the wis-
dom to read them aright. Subjective sensations are essential;
but the objective demand equal attention for a complete pic-
ture of such gross disease as we can recognize. Had these,
too, been noted by provers, the hieroglyph might have been
accompanied by a key.
A close study of some drugs enables us to collect scattered
symptoms into groups and thus determine their relation. For
example, in Argentum nit. we find : “ Photophobia ; dilated
pupils; can only see by holding the book away from her], ,
These symptoms indicate that this remedy will be useful in
affections of the ciliary muscles; as also in weakness of the
recti muscles of the ball, which are supplied by the third
nerve; and clinical experience gives this drug a prominent
place as a remedy in some form of muscular asthenopia. If
the proving were being made now, the aid of convex, cylindri
cal and prismatic glasses would give us the exact pathological
values of these symptoms.
When clinical records are conned for help the student does
not get his wisdom unadulterated. The cases that attract his
eye may present a correct diagnosis, but the recorded symp-
toms will be few, and while the remedies given may be stated,
the potencies, frequency of dose, rotation of remedies and
time occupied are often omitted; or, the cases will present
evidence of incorrect diagnosis, such as those called “ Cataract”
in 1°eter’s work on “Diseases of the Eye," many of which ap-
pear rather to be cases of iritis and irido-choroiditis with
opacity of the lens capsule. These records afford no help in
the treatment of cataract, though they suggest the use of the
remedies in the conditions named.
More uncertain even than clinical records, is pathological
analogy ; yet this is not to be despised as :1 prompter. Some
OPHTHALMIC THERAPEUTICS.
successful treatment for inflammation of the lachrymal sac has
been suggested to me by a comparison of the discharge with
that from other mucous surfaces, and administering remedies
indicated in the latter cases. In dealing with diseases of
the choroid and retina, decided help has been obtained by
studying the remedies used in affections of other serous tis-
sues ; and the therapia of chronic meningitis has yielded its
quota of help in diseases of the optic nerve.
Wl1at is most wanting to supply the deficiency in our ther-
apeutics, is a reproving of the remedies, with a view to a care-
ful record of objective as well as of subjective symptoms.
The ophthal:moscope, the test-types and glasses——spherical,
cylindrical and prismatic—in short, all appliances known to the
profession for determining objective symptoms-should be
employed ; and general symptoms should, as far as possible, be
translated by the latest teachings of pathology. Meanwhile
much instruction may be gained by a full and free publication
of the cases daily demanding our attention; giving all the
symptoms, whether necessary to a diagnosis or not, the name
and potency of remedies, their mode and times of administra-
tion and the results. By grouping and comparing symptoms
thus derived, we may soon ascertain what sensations are pecu-
liar to each disease, and thus supplement our present imper-
fect symptomatology. The imperfection of the reports already
published, and the large class of diseases which have received
no mention at all, would require the fullest elucidation in the
proposed publications; and the end in view would be best
attained, if all contributions should appear in one journal.
For this proposition I entreat the favorable consideration of
the Convention. But there are practical points to be pre-
sented, to which the writer would now draw attention.
l/Vhat is now known as the uveal tract consists of the
choroid, ciliary body and iris. It is the middle one of the
three tunics of the eye-ball. An inflammation arising in any of
these and extending to the others, involving in time the scler-
otic externally, and the retina and vitreous humor internally,
was called by old writers “ Internal Ophthalmia.” Under this
general term was included a variety of diseases which now re-
WoRLn’s HOMCEOPATHIC CONVENTION. [4
ceive separate names. Choroiditis, cyclitis, hyalitis, and the
compounds irido-choroiditis, irido-cyclitis, sclero-choroiditis,
chorio-retinitis, and the term for general inflammation of the
eye-ball, panophthalmitis, have supplanted the one old name.
This new nomenclature is largely the outgrowth of modern
ophthalmoscopic investigation, and has been found necessary
for accurate description of pathological changes. Its value is
obvious to all who understand that a correct appreciation of
the value of our remedies depends upon the clearest possible
statement of the conditions for which they are given.
The division of internal ophthalmia into the parts named, is
in no way fanciful. It is as essential to a proper understand-
ing of the subject as are the divisions of the broad term con-
junctivitis to a full and correct knowledge of changes in the con-
junctiva. Thus, conjunctivitis includes hyperzemia, catarrhal,
purulent, granular, membranous and diphtheritic inflamma-
tion; each condition requiring distinct treatment although, in
a certain sense, the boundary lines are quite arbitrary.
There is a very intimate anatomical relation between the
several parts of the uveal tract, arid between this, as a whole,
and the cornea, which explains the complications so frequently
found. And the several parts are not only continuous, but so
dependent for nourishment upon a common supply, that what-
ever affects one affects all to a greater or less extent. The force
of the disease may, in some cases, be spent upon any two of
the parts without involving the others seriously ; or, the whole
tract may be invaded. Thus in irido-choroiditis we some-
times flnd the ciliary body unaffected, or so slightly disturbed
as not to attract notice. In other cases, of choroido-iritis,
where the inflammation has commenced in the choroid, the
changes in the cornea may be so marked as to monopolise
attention.
The two practical questions which we have to propound to
ourselves on meeting with these complicated cases are : What
is to be the termination? and what can be done to make the
end most favorable ?
E-acli case will be individualized by peculiar features, while
it presents typical ones, by which it is recognized. Our prog-
5] OPHTHALMIC TH ERAPEUTICS.
nosis will be influenced by these special features; but we must
depend upon personal or recorded experience in regard to the
general characteristics to aid our judgment. Information of
this kind is only, at present, to be found in our current litera-
ture ; and even there, the number of well reported, and there-
fore instructive, cases is very small. The cause of this is not
far to seek. In the first place, the classification of the diseases
named is comparatively recent; and secondly, but a small
number of practitioners have given them the study requisite
to their diagnosis. But with accumulating experience we may
reasonably look to overcome our present difficulties, reduce
the list of cases now deemed incurable, and produce perfect
restoration in others, where partial recovery is all that is
now deemed possible for medicine to accomplish.
Witl1 regard to treatment, our present knowledge of rem-
edies applicable to these isolated. diseases is so limited that I
have been led, in complex cases, to use remedies indicated in
morbid states of single parts of the structure. For instance,
remedies useful in ulcerated cornea, as an isolated disease, have
been used with benefit where such ulceration has been a prom-
inent though secondary affection. This way of using remedies is
of course open to objection ; yet it has often revealed the
scope of action of a medicine of which previously we knew
little. By way of illustration I subj oin some cases of a complex
character, with their t_reatment, taken from my case book.
‘ (Jase 1. (]h0r0icZ0-fritis.—lVIiss R. aged 20. After excessive
fatigue and exposure to strong colored ligl1ts, left eye became
inflamed nine weeks ago. Has grown worse under the
treatment she underwent; she has, pain in the eye-ball
and even the brow, photophohia, lachrymation, and occa-
sional bright flashes just outside the visual axis. Examina-
tion revealed slight pericorneal injection. Several small points
of ulceration of cornea at the lower and outer segment; iris
dim and reddish ; trabeculae indistinct ; pupil moderat-el y
dilated. Ophthalmoscope showed vitreous humor very hazy;
some large patches of iiifiannnation of choroid, with deposit
of pigment along edges ; situation corresponding to points of
ulceration in cornea. A few drops of a four grains solution of
~ \VOR~LD?S 1-IOl\ICIL‘Ol?A'i‘I~IIC CONVENTION. [6
Atropia dilated pupil fully in its upper half, and but partially .
in the lower; due probably to adhesions between iris and lens,
or infiltration of iris stroma with lymph, or to both. V : 525°,-,.
Patient exceedingly nervous; face pale, lips anaemic, tongue
white and flabby, pulse rapid and irregular. Prescribed Mere.
iod. 8 dec., every three hours. Sol. Atropine (4 grains to
1 ounce) applied twice daily. To use blue glasses out of doors,
and rest the sound eye. Four days later the vitreous was clear
enough to reveal the details of the fundus ;- arteries normal,
veins somewhat enlarged ; edges of choroidal patches elevated
and reddened, and well. supplied with pigment. In the centre
of the patches, atrophy of the choroid made the whitish color
of the sclerotic apparent; retinal vessels could be traced over
them. For a week further slow improvement ; then a relapse
from exposure of the eyes to strong sunlight ; the symptoms
reappeared, with some ciliary neuralgia. Patient complains
of weakness and want of appetite. Prescribed Ghinin. arsen.
3 dec., every three hours. The prominence of the corneal
symptoms suggested the remedy, which seemed also suitable
to the general condition. The cornea improved under its use,
and the constitutional symptoms disappeared. Silicea 6 dec.
was then given, four times daily, to the end, Duration of
treatment two -months. Results: Vision improved from
rs a
partially restored, but, where atrophied, the marks remained.
Case 2. ]7/"ic‘l0-0/toroiditis.-—M1'. (I, aged 50. Six months
ago had “chills,” and was heavily drugged. Then came in-
-526°, to 2 ° ‘ cornea aud iris restored to normal state; choroid
flarnmation of the eyes, which, when the acute symptoms-
subsided, left a case of irido-choroiditis. On examination:
left eye, no external redness; cornea and anterior chamber
normal; iris changed from a blue to a greenish tinge; pupil
slightly irregular from a- posterior synechia at the "lower
middle third; capsule of lens dotted with opaque spots, and
markedly turbid in the lower segment; ophthalmoscope re-
vealed haziness of vitreous; fundus but indistinctly outlined;
floating opacities in the partly liquid vitreons. Reads Snellen
3-} with + 24: glasses. Right eye: evidence of previous
inflammation; lens, capsule slightly dotted with pigment de-
7] ' OPHTHALMIC THERAPEUTICS.
posit; vitreous slightly hazy ; fundus normal, V : gg. Reads
Snellen 1?; with + 2-I. Prescribed four grains Sol. Atropine
to left eye twice daily to release synechia. Internally, Silicea
' 6 dec. four times a day. After a week’s treatment, was
attacked, while away from home, with diarrlioea for which he
took all that many advisers recommen'ded, and returned much
prostrated. Vision had sunk to 526°, in the left eye, and %% in
right. Prescribed Nux vom., every three hours for three days;
right eye regained its previous vision ; the left unameliorated,
. but the synechia had been partially detached. Prescribed,
Kali hyd. 3 dec. four times a day, continued for two months.
Résumé: Duration of treatment ten weeks. Result: Right
eye, v. emmetropic -Z,-g ; left eye, V _: %% ; could read Snellen
1%; with -I-. 24: with each eye. The‘ Silicea was chosen from
clinical experience in cases approximately similar ; the Kali
hyd., because of its observed action i11 like cases under treat-
ment at the time, '
Case 3. Im'clo-Ulc0z0?Icl?§cis.—-Miss L., aged 26. Eight years
ago noticed a drooping and l1eaviness of eyelids. After two
years found sight of left eye imperfect, and when this dimness
appeared the drooping of both eyelids ceased. N o redness,
pain, nor photophobia; but black spots and flashes of light
were sometimes seen. '_A year later, the right eye was affected
, and rapidly grew worse than the left. Two years ago the sight
failed entirely. Examination of right eye: no external red-
ness ; anterior chamber shallow; iris discolored, and crowded
forward by a swollen opaque lens, to the capsule of which it
was attached all around the margin of a_contracted pupil. Not
even quantitative sight existed. Left eye: anterior chamber
shallow ; iris dimmed and discolored ; pupil moderately dilated
and mobile. , Ophthalmoscope revealed pigment spots on the
lens capsule ; vitreous hazy tln-'ougl~1out ; lying in it, near the
retina, three greenish blue spots a little larger than the optic
nerve ; probably hemorrhagic effusions undergoing degenera-
tion. V : %%. Snellen 15- read slowly at 3 in. ; irregular dilata-
tion of pupil under Atropine. Patient in fair health and only
complains of black spots in the visual axis, inability to bear
strong light and to use her eyes continuously. Prescribed Mer-
woRLD’s HOMCEOPATHIO convmrrron. . [8
curius iod. 3 dec., four times a day ; to use protective glasses
and to abstain from “ near work.” Twenty days later V : %f’,,
Snellen 1?; read at 8 in. During the menses, two days after
this record, there was hemorrhage into the vitreous. For one
day sight was only quantitative,-but it rapidly cleared. For
ten days, V : gs emmetropic. Résumé : Duration of ' treat-
ment, .siXty days; left eye from, V. : %% to -3%.
Case 4. II;/alitis or Opacities of V?lt1'*e0us.—M1". R., aged
-39, had been treated for nine months, in diflerent ways, for
inflammation of left eye, and subsequent impaired vision.
Patient robust, no syphilitic history ; no external signs
of disease visible. Ophthalmoscope revealed a large floating
opacity in the vitreous, close to the posterior surface of the
lens ; vitreous hazy and partially fluid. Patient able to count
fingers at 6 in. with eccentric fixation. Prescribed Kali mur.
6 dec. four times a In eleven days could count fingers
at 11 in. Remedy continued for nearly a month without fur-
ther improvement. Prescribed Mercurius iod. 3 dec. four
times daily. One week after, fingers were counted at 18 in.
Three weeks later V : %%. No further advance for a month.
Prescribed Sulphur 6 dec., four times a day for three days,
then recur to Mercurius iod. One month later V : gs and
some words of number 8 Jaeger were read. In two months
following, under same remedy, : is as before, but Snellen
1% could be read at 6 in. Résumé : duration of treatment seven
months. Result : improvement of vision from counting fingers
at 6 in. or about 5%6 to %, and ability to read Sneller 1% at
6in. This case illustrates the advantage of persistent treat-
ment, for it had been considered hopeless by at least two
educated and able oculists.
Case 5. U/z0m'0-Rctz'mltis.——Mr. D., zetat. 36. Noticed two
years ago such dirnness of right eye that he could not read a
newspaper. Had observed no previous trouble. After a
month’s treatment he could read again ; but suffering a relapse
the same treatment for a year proved ineffectual and the case
was deemed hopeless. No history of syphili.s. Examination
showed cornea, iris and pupil normal. N 0 external redness.
By ophtlialmoscope: vitreous ratlier hazy, with some black
9] OPHTHALMIC TH ERAPEUTICS.
shreds suspended in it, having very limited motion on rotating
the eye. This would indicate that the vitreous was not fluid.
Optic nerve and blood vessels normal. Inside the disk, a large
irregular, atrophic spot, involving the choroid and retina, sur-
rounded by several small ones ; edges irregular and pigmented;
the sclerotic seen white through their centres ; choroid adja-
cent, congested and thickened; some vessels lost in the infil-
trated part to reappear on the other side ; a dull pain, occasi-
onally, in the eye and over the brow, with an ill-defined
feeling of contraction around the eye. V2525“-0-. Snellen 11,
slowly deciphered. Prescribed Kali mur. 6 dec., four times
daily. At the end of a month vision rose to %g and Snellen
3 was read at 5in. A year afterwards the man could read
Snellen 2%, distant vision %%, but under Kali mur. for a week it
was again gg. - The patient’s business engagements prevented
longer treatment. _
Case 6. Uhorz'o-Retrhm'tis.—Mrs. S., eetat. 40. For twelve
years has had “ blurring of sight ” durin.g summer, if exposed
to heat of stove, or otherwise overheated. Vision seemed un-
impaired between these attacks; also in winter. But, for
eighteen months a little use of the eyes for reading or sewing
causes pain ; and if indulged i11 during an evening, she would
wake from sleep with deep aching pain in the eyeballs, and
tenderness to touch, especially i11 ciliary region. Fixed
muscee very troublesome; eyes sensitive to ligl1t. Frontal
headache is frequent and severe; scalp nearly always tender.
Vertigo frequent, sometimes with nausea or vomiting. Look-
ing quickly at moving objects induces giddiness. Mood petu-
lent, irritable especially on rising in the morning ; easily
worried ; disposition to hurry things; time hangs heavily.
Constant sense of weakness ; perspires freely and is easily tired.
Palpitation and occasional distress in region of the heart; op-
pressive, suifocating feeling in sleep. Ophthalmoscope revealed
a fixed opacity just behind the left lens, resembling a line
about three lines long with a round dot in the centre. Optic
‘nerve bluish white, somewhat irregular from a slight posterior
sta-phyloma; vessels are attenuated but veins not tortuous.
In the right the disc is the same, but external to it (inverted
woRLD’s HOM(EOPATHIC oonvnnrron. [10
image)'are atrophic spots through which the sclerotic can be
seen; They resemble coalesced points of inflammation? the
edges are lined with pigment. Vision eccentric~; right eye,
5650-‘; left, 7165,. She reads No. 7 Snellen, slowly. By black-
board test field of vision seemscomplete; but she sees only
part of a large word‘ at a‘ time. ‘Prescribed Argeiituinnit.
6 dec., four times daily. Three weeks after, the report reads‘:
R.-' E. V: J,-%-, L.‘E.‘V : %%; ‘light as before. Deciphers
Snellen 3 as clearly as No. 7 on first visit. Oplithalmoscope
shows no change in left disc, but in the right the edge Ofthe
atrophic spots seems thinned and less pigmented.‘ '
- Case ]m'0Z0-O/toroiclit-is.—l\I1's.' T., aetat 32; lives in a
malarious district, and has taken"large quantities of Quinine'.
Four yea'.“rsago had icerebro-spinal meningitis.‘ Two years ago
hadiritis of left-eye, which recurred, after being cured, with
greater violence. Last year had ulcer of cornea of same eye.
Two weeks ago suffered as now. Examination: Pericorneal
injection of a violet red color; especially marked at upper
and outer segment. Cornea marked with opacity from former
ulceration. ‘ Iris dull, thick and discolored. Pupil contracted '
and sluggish. Eyeballvery tender to touch in the region of
ciliary body, upwards and outwards. Photophobia intense;
lachrymation free; ciliary n‘e-uralgia. Constant sensation‘ of
burning in conjunctiva. V : 55%; health generally; good.
Prescribed Arsenic 3 dec., every two hours ; Atropine lotion
twice ' a day; to wear protective glasses. A week after‘,
V : ag, other symptoms modified. Under same remedy the
neuralgia disappeared, the pericorneal injection grew faint;
the iris assumed a ~more natural appearance.‘ The ciliary body
was the last point to yield. Patient suffered arelapse on re-
turning home. Belladonna alternated with Arsenicum for a
week gave little relief. Thuja 3 dec. was then given alone
with good effect. Resumé :_ Duration of treatment eight
weeks. Result: Increase of vision from §2,)"_0 to gg. Restora-
tion of iris and ciliary body. The remaining impairment due
to corneal opacity. - ‘
(Jase 8. [ride-Uyeliti-9.—Master H., aged 9. Two weeks
ago was struck in the left eye with a piece of glass, which
11] OPHTHALMIC THERA PEUTICS.
ruptured the-cornea, near the sclero-corneal margin. Severe
inflammation supervened, involving the iris and ciliary body ;
followed by sympathetic inflammation in the right eye. On
examination : left eye virtually in a state of panophthalmitis,
lids swollen,somewhat oedematous; conjunctiva bulbi intensely
injected and distended (chemosis) with a sero-plastic deposit.
Cornea opaque in the region of the wound, which embraced a
portion of prolapsed iris. Iris thickened and discolored ; pupil
contracted and filled with lymph ; ciliary region intensely
sensitive; neuralgia severe, profuse lachrymation and photo-
phobia very marked. Right eye : pericorneal injection,
pinkish; iris inflamed, thickly infiltrated and discolored; pupil
contracted; neuralgia; photophobia; lachrymation and ten-
derness of ciliary body.
The injured eye was at once removed, to get -rid of a direct
and-continuous irritant to the other. As regards the right eye,
the prognosis was unfavorable. The condition was unfavorable
to a hope of benefit from iridectomy. Prompted by the relief
given by Belladonna and Silicia in cases of irido-choroiditis,
where inflammation had supervened, the two medicines were
prescribed, to be given alternately every two hours. The eye
progressed favorably and rapidly, notwithstanding a relapse
owing to a fall, in which the little fellow received a blow in
the region of the left eye. Before leaving my care, he could
count fingers at thirty feet; the external redness had disap-
peared ; the iris had approached a healthy look ; but there was
still some photophobia a.nd decided impairment of vision. A
‘month afterwards (the remedies having been continued) the
eye was quiet and sufficiently clear sighted to permit reading.

ll/. IH\fKJ1 31% .
lfi/ .