We will close by stating the principal points we desire to make in our present paper.

As a rule operate upon both eyes.

You risk the correction of a slight convergence on one

may

eye. It will not do, however, to put the limit at 2.5 or 3 lines, as some of our writers do.

I am pretty sure that a line and a half, or even a line is best corrected by a double operation.

I submit the matter to your judgment.

XXXVI.

THE ABUSE OF ATROPIA.

By D. J. MCGUIRE, M.D., DETROIT, MICHIGAN.

HAVING in a few instances, in my own practice, observed what I believed to be bad effects following the topical use of Atropia, it has been suggested to me that we were not sufficiently alive to the evils which may follow the improper use of this drug.

Those cases occurring under my own observation are confined to subjective symptoms and conditions alone, but are supported by the warnings of Mooren and Sickel, and the indications, as earlier suggested by Von Græfe and H. Derby, that Atropia favors the outbreak of acute glaucoma in an eye already affected, and that retinal attachments and other affections connected with disturbances in the choroid may possibly be induced by the

same.

As we, as homœopaths, are not much given to its topical use in the external diseases of the eye, I will not refer to the evil results to external tissues-as the conjunctiva, for instance—which may follow its prolonged use there, but will confine my attention to its effects upon the uveal tract, and will first refer to its abuse in ophthalmoscopic investigations, as here it is generally thought to be followed by no bad results, to be perfectly innocent, etc.

This is unsafe teaching, and we are satisfied that evil may result to eyes in which there are no disease manifestations whatever, and that it will result to those having any of the premonitory symptoms of glaucoma.

Of course it will be apparent that we cannot divide by a close line the cases which may be injured by its use from those which are not susceptible to such effects, but will suggest and insist that Atropia shall have a very limited sphere in ophthalmoscopy, and in addition to the cases of glaucoma, or of glaucomatous tendencies, it should never be used in persons of hæmorrhagic tendencies, persons who suffer from hæmorrhoids, varicosity of veins, etc., in any part of the body.

In support of the theory that it should never be used in cases of glaucoma at any stage, I will cite a few examples furnished by our most celebrated observers.

However, referring first to the early view entertained by Von Græfe and Schneller, who thought it caused a diminution in the tension of ocular fluids, as evidence of the truth of that position they refer to the enlarged state of the retinal vessels as observed during its action.

This view being sustained by observations made by Coccius, Wegner, Grünhagen, and finally by tonometric observations made by Pflüger on a large number of cases, in 80 per cent. of which he found the tension diminished, in 16 per cent. no change, and in only three increased, it was accepted as true, and acted upon without suspicion of evil in any case, until Wharton Jones observed that it was positively injurious in all cases of acute glaucoma; but that a latent chronic glaucoma could be developed into an acute one by the use of this drug, was first observed by Von Græfe. In a work on intraocular tumors he remarked, that in eyes of a certain degree of increase of tension, where Atropia was used for examination purposes, frequently shortly after its use an acute glaucoma was developed.

These cases reported by Græfe were soon followed by others from Derby, Mooren and Warlomont; later, by a case by Hirschberg, of a woman who had never suffered from any eye difficulty, ɔut who, having made an application of Atropia to both eyes, ʼn afternoon of same day had developed headache and vomiting, together with reduction of vision. In eight days an unmistaka›le subacute glaucoma existed in each eye, for which iridectony was made with good results. Bezold saw, after two applicaions of Atropia, an acute glaucoma develop in an eye that

had only presented slight prodromic symptoms, as some sensitiveness and occasional scotomata.

From these observations we must conclude that, in eyes predisposed to glaucoma and in glaucomatous conditions, Atropia is positively contraindicated.

How are these conditions brought about, is a question which very naturally suggests itself, but which is not so susceptible of satisfactory answer.

*

We may, however, suggest, first, that through the action of the dilator of the pupil the iris is made to contain less blood, and as this takes place the choroidal vessels must become correspondingly hyperemic; and while in the normal eye, where no resistance is offered to the free exit of blood from the fundus, the condition of hyperæmia is soon relieved, it is different in the eye predisposed to or already affected with glaucoma, where, either from pathological changes at the periphery of the anterior chamber, or on account of a peculiar physiological construction of the organ, the larger choroidal veins are compressed as they pass through the sclerotica, thus interfering with the free circulation of the fluids of the eye. Then it may not be safe for us to confine ourselves to the mechanical theory alone, for it has been observed that the same condition occurs when the pupil is fixed by a circular synechia, so that a mydriatic effect was impossible.

So that here again we must seek another explanation for these phenomena, which, as suggested by Wegner, may be found in a paralysing action on the walls of the vessels, or according to the theory of Stellwag, who thinks that the relief produced by its use in spasm of the internal muscles supplied by the third pair, is only in part due to the paralysis, the other and chief factor being the vigorous contraction of the vessels in the anterior portion of the ciliary region.

In the light of this theory we must conclude that, with the subsidence of the hyperæmia of the fundus, we have also, at the same time, a minus quan tity of blood in the eye, which will explain the early observations of re duced tension.

XXXVII.

AUDITORY VERTIGO.

BY W. H. WOODYATT, M.D., CHICAGO.

LAST year it was my pleasure to present to this Institute a short paper on Glaucoma. Between that disease and the subject to be treated to-day, there are many points of resemblance, which may be studied with profit, although they cannot be considered now.

The name Auditory Vertigo will serve us for the introduction and study of a certain group of symptoms which may appear as primary or secondary expressions of pathological changes, occurring in the vestibule, semicircular canal and cochlea of the ear, one or more of them being involved at the same time. And this statement would seem to place the disease clearly and distinctly in the category of ear diseases to be treated almost exclusively by the aurist. So far from this being the case, however, the affection is one which is, as at present understood, more likely to turn the physician's attention to the brain or stomach as the origin of the disturbance, and is one which almost invariably first seeks relief at the hand of the general medical adviser. When it is added that affections of the stomach and of the brain are frequently the predisposing causes of the ear trouble, and may accompany and complicate it, the commanding interest of the subject will be fully appreciated. The comparatively few reports of cases, the meagre pathological data, the hitherto unfavorable results of treatment, the suddenness of the attacks, and the jeopardy of the important organ of hearing, combine to render the subject pre-eminently one of general interest.

That the true nature of the affection is frequently overlooked cannot be doubted; and with equal emphasis it may be said it cannot be doubted that a correct conception of the malady will lead to the promulgation, by our school, of a more clearly defined and successful treatment than is at present known.