Therapeutics of eye, ear and throat diseases.
HERBERT T. WEBSTER, M.D., OAKLAND, CAL.
Little things in practice are those which go far toward making the success of the medical man. Of course, the big money comes from surgical operations, but the surgical practitioner who is incompetent in small matters is not liable to attract a very large clientele, and his important cases are, therefore, apt to be far apart. It might seem that in these days of specialists there will be little use for a knowledge of remedies in the eye, ear, nose and throat specialty by the ordinary or family physician, but even in these piping times the family physician is a lame duck if he neglect such matters, for it is an unfortunate fact that few specialists, especially among the elect or old school, are at all informed on this important subject.
Many cases of eye disease, in the hands of specialists, are allowed to drag along for months on local treatment, when the properly selected internal drug will either alone or in conjunction with local measures speedily bring them to a successful end. The essential matter is in the knowing how, and the knowing how consists in a study of the therapeutics of the eye, ear, nose and throat—the specific therapeutics. Of course, specific therapeutics can not be applied with the positive knowledge that attends mechanics or other arts, but it may come so near perfection as to prove of great assistance. I believe many cases drag along under the management of specialists that may be speedily cured by the family physician if he is well up in his materia medica. True, there may be some failures, but who is there among specialists who does not frequently fail with his best applied local measures?
In all cities and many of the larger towns the specialist has almost entirely removed eye, ear and throat cases from the hands of the family physician, who speedily refers them to that authority in order to escape censure if good results do not follow his efforts; but after a failure in such hands the family physician may win laurels with his remedies attempting so-called hopeless cases. I know of at least one case of total blindness pronounced hopeless by the highest specialist authority, completely and permanently cured with drugs, and in a very short time, by an ordinary country practitioner. It will be impossible in an article of this kind to carry the subject out in all its details. I propose here to merely offer some hints and call attention to some remedies which should come to mind in these cases.
I fear my title is something of a misnomer, for a full discussion of the subject would fill a small volume. It is my intention to only briefly refer to a few of the principal remedies to be employed in this direction. Space for more than this would not be allowable in an article of this kind. I shall, therefore, content myself with the grouping of a few remedies for each of these specialties, with brief remarks upon their applicability.
EYE REMEDIES.—I do not expect to mention all the useful remedies in the treatment of ocular affections. My experience is only one in many thousands. If all the knowledge possessed by many observers were recorded a long list would be at our service. Only those which have been of striking benefit to me in my experience will be referred to. Possibly results in my own practice may not coincide with the experience of others, though they may at least serve as hints upon which to draw when the practitioner is confronted with similar cases. The first trial with a remedy in a given case will often decide its fate with a novice. If it fail, then it is usually discarded for good. If it succeed in the first instance it is given further trial, and several successes with it give it a standing which can not be undermined by an occasional failure. By long use, then, a diligent practitioner gradually becomes attached to a line of remedies in which his faith is so firm that no skeptic can disturb it.
In this article I will limit my remarks to the following eye remedies—aconite, bryonia, conium, euphrasia, kali mur., phytolacca, pulsatilla and rhus tox.
Aconite.—Aconite, alone, is rather a feeble eye remedy. It acts best in combination with other agents, though it is of benefit in all cases of acute inflammation. In conjunctivitis it combines well with rhus tox., phytolacca and pulsatilla, and in rheumatic ophthalmia with macrotys, rhamnus cal. and other agents. In painful affections of the eye it is soothing, assisting in relieving spasmodic action of the ocular muscles, and thus aiding in relieving the acuteness of intense inflammatory pain. However, we can not expect much except auxiliary aid. Some Homeopathic authors consider it highly in sudden inflammation of the eyes, with great swelling of the lids and watery discharge. This would differentiate it from rhus tox., which is applicable to conjunctivitis without much pain and with mucous or muco-purulent discharge. In the first place, aconite would combine well with euphrasia, and in the second with rhus.
Bryonia.—This remedy possesses a specific affinity for the retina, and has made some wonderful cures of retinitis hemorrhagica. In my own case, a partial loss of sight following a severe attack of grippe, in 1889, was entirely removed with it in a few weeks after persisting for several months before its use. It seems to exert a reparative influence, promoting the nutritional power of the part. The practitioner will seldom require it, but when called for it is a remedy of great importance.
Conium.—This remedy is valuable in lack of proper accommodation. Headaches arising from this cause demand it. Sensitiveness of the eyes to light from the same cause will be much benefited by it. It is thus a fine remedy for some cases of photophobia. Aching in the occipital region referable to the optic centers call for its administration. It also exerts a curative action in nutritive faults of the eyeball, and has cures of corneal ulcer to its credit. Tired feeling about the eyes with slow ocular movements and giddiness. I believe that high attenuations often do better than material doses; at all events, the dose should be very minute.
Euphrasia.—This remedy applies chiefly to acute inflammation of the conjunctiva attended by profuse lachrymal discharge accompanied by extension of the inflammation to the nasal passages. Fluent coryza calls for its administration, and it relieves many of the attendant conditions, and where such cases lead to such chronic affections as corneal ulceration the incipient stages may be controlled by it. In the early stages of what was termed strumous ophthalmia in olden time, its action is often of service, though its most reliable place is in the early stage of fluent coryza. The catarrhal stage of measles, when the eyes and upper nasal passages are coincidentally involved is an appropriate place for its exhibition. I regard it as a remedy for superficial affections of the conjunctiva attended by much lachrymation, and seldom employ it in other cases, for I believe we have better remedies when deep tissues are involved. We have better nutritional remedies and better remedies when the connective tissue, or even the deep part of the conjunctiva is affected.
Kali Mur.—This agent can hardly be considered a specific eye remedy, though it is often almost indispensable in inflammatory conditions of the eye involving connective tissue. We might better term it a specific for inflammation of connective tissue. In eye inflammation accompanied by chemosis and attended by invasion of the cellular tissue of the cheeks and other parts, kali mur. is an important medicine. I employ it in such conditions in alternation with rhus tox. with perfect confidence that early good result will follow. Even alone in such cases one may pin his faith to it.
Phytolacca.—Few practitioners appreciate the value of this common remedy in eye affections. It is a remedy for chronic or subchronic states. Its action in the early stages of trachoma or granulation of the lids is prompt and satisfactory, the granulation soon disappearing without local treatment through the systemic action of the drug. I have observed this effect in many cases and invariably prescribe it when children are brought to me with such a condition. It is almost as reliable in blepharitis ciliaris, and even when ulceration is present in such cases I expect much from it. It should always be given during the treatment of trachoma and chronic lid troubles, even though local measures are being employed. Well diluted, it serves a valuable service as a collyrium in such case, though I have usually depended upon its systemic or specific effect. Cures of fistula lachrymalis have been reported with it, though I have never had occasion to give the remedy such a trial.
Pulsatilla.—Pulsatilla, in its specific ocular action, affects especially the eyelids, though obscurations and hallucinations of vision may call for it. It differs from rhus tox. in acting best where the conjunctival discharge is thick and yellowish green in character, the catarrh in rhus tox. being less agglutinous. It is a great favorite with some in the stye habit, though I consider rhus tox. its superior. Marginal affections of the lids. with pustules and isolated granulations, have been benefited by it. Differing from rhus tox., it is more often adapted to chronic than acute affections and slower in action.
Rhus Tox.—I use this remedy more frequently than all other eye remedies known to me. In general practice it comes into requisition so frequently as to be a common standby. It is almost invincible in ordinary acute untraumatic conjuctivitis. As an illustration: Less than a year ago while visiting the family of an old and steadfast patron, the father of several children, I was informed that one of the boys had brought a case of pink-eye from school and it had spread to all the children in the family. I had been called for another purpose, for the parent did not suppose that in this day of specialists I could do anything in the eye matter, and had a fortnight before consulted a specialist, who had supplied him with an invincible collyrium, supposed to act promptly and cure every case, but no improvement had followed and discouragement was rampant. All were surprised when I informed them that I believed I could prescribe a remedy which would cure without delay. I was urged to do so and left rhus tox. in appropriate doses. Much satisfaction was expressed later, for marked improvement was manifest in three or four days, and before the end of the week all were well. Much astonishment was expressed that an internal remedy could thus speedily accomplish a cure without local measure.
Rhus speedily removes the stye habit. Rhus has cured it for my cases after years of persistence in a few months. I always speak with confidence when prescribing it for such cases, because it has never failed me. Not long ago a mother called with her little girl, a child of about seven years, with a complication of troubles, among which sore eyes was one of the complaints. A conjunctivitis of several weeks' standing had at length brought on a small granular growth over the sclerotic, not far from the cornea, the growth being on the conjunctiva. Phytolacca and rhus were prescribed for this, and when the child appeared a fortnight later the eyes were entirely well. The remaining ailments were banished by the later prescription.
Not only does rhus manifest a surprising influence upon the eyes, but the tissues of the face surrounding them respond to its influence. I have cured erysipelatous eczema of the face of years' standing with it, without any local application.
EAR REMEDIES.—The list I shall offer here is not very extensive, and could probably be much extended by those who have had a wider experience in aural affections. The general practitioner, however, will find it worth study. I will mention aconite, belladonna, calcium sulphide, mercurius, pulsatilla, phytolacca and silica.
Aconite.—Aconite will seldom be used except as an auxiliary. In acute otitis, due to sudden development from exposure, with high inflammatory grade, attended by severe pain, it combines well with pulsatilla to assist in controlling the first stages of the attack. It modifies the severity of the condition and assists the true specific—pulsatilla—in controlling the local inflammation. Under its influence the pain becomes less severe and the inflammatory action less acute.
Belladonna.—Belladonna will be a substitute for aconite where otitis is attended by evident cerebral complication. It exerts little influence except in such cases, and should be combined or alternated with pulsatilla to prove of much satisfaction.
Calcium Sulphide.—This remedy is applicable to suppuration of the middle ear, though not very reliable alone. In alternation with silica, I believe it hurries the cure where the otorrhea is profuse, suggesting breaking down of soft tissue. Involvement of bony structure is beyond its power for much good, but it acts on suppuration of soft parts more speedily than silica, and thus aids the action of that remedy. I would hardly think of depending on it alone.
Mercurius Solubilis.—In subacute otorrhea this agent will sometimes be found of excellent service. When the purulent discharge is mixed with blood, especially if there is nocturnal aggravation of the pain, attenuations of this remedy may be expected to render signal benefit, and even effect a cure. Such cases will be found following scarlatina and measles. After the discharge has continued for a long time we can not expect much from it. The 6 x attenuation, in small doses, at the strongest, should be employed.
Pulsatilla.—This is the stock remedy for all inflammatory diseases of the middle ear. More than that, it relieves pain when inflammation is not marked. It is the specific remedy for that rather common affection among children and some adults—earache. It relieves almost certainly without local application, though a pledget of cotton moistened with the same remedy undoubtedly assists. It is a better application than laudanum, a very common nostrum among a large run of the profession and an ordinary popular remedy. In acute otitis media, either alone or combined with aconite, belladonna or gelsemium, as indications suggest, it relieves the pain and controls the inflammatory action. Unless the mastoid cells are invaded it is the remedy to tie to throughout. In chronic suppurative otitis it is the remedy for painful aggravations, alternated with silica or calcium sulphide. With this remedy to assist the action of the remedies for suppuration one may feel very confident of managing such cases with the greatest satisfaction, even after most specialists have given very poor service.
Silica.—There is nothing like silica for chronic suppuration of the middle ear. Its continued use will hardly ever fail, if a cure is at all possible, and few cases will resist its action. It is the remedy in all cases of suppuration of bone, as well as of suppuration of the soft parts anywhere, and if it acted only in suppuration of the middle ear it would be a remedy of untold value to the practitioner. In early cases it might be well to alternate it with calcium sulphide, especially if the discharge be profuse and thick, but in long-standing cases it might be as well to depend upon it alone. Of course, one must expect to prolong its use for months in order to affect a cure, but the result will justify faith in it. Painful states of the ear arising from cold may call for the occasional alternation of pulsatilla until the pain ceases, and mastoid complication may call for surgical interference; but so long as suppuration continues the remedy must be persistently administered. The 3x or 6x attenuation should be preferred, the 6x often doing the best service. It is a remedy largely neglected by specialists.
Phytolacca.—Dr. Kent O. Foltz (Dynamical Therapeutics) referred to this agent under ear remedies as follows: "In hypertrophic non-suppurative otitis media, the internal administration of phytolacca has given good results in my hands; tinnitus has been relieved, and improved hearing has followed. In syphilitic cases also I have had good results from the use of this drug."
NOSE AND THROAT REMEDIES.—Aconite. The specific action of this remedy on the mucous membrane of the throat can be well demonstrated by anyone who will touch the tongue to a vial of specific aconite. It is an excellent auxiliary in all cases of acute inflammation of this part. While a valuable remedy alone in acute inflammation here, it is best to combine it with other remedies, for, though it controls inflammatory action, it is not reparative in its influence. While it does well in controlling inflammation, it does not impart so much of a healing influence as some which combine in therapeutic action with it. It exerts little beneficial influence in chronic inflammation, and we will do best to reserve it for acute cases.
Anemopsis.—While it can hardly be claimed that anemopsis is specific in action, its local influence in catarrhal inflammation of the Schneiderian membrane should be borne in mind. I have had the best of results in douching the nares with a weak solution of this agent. From ten to twenty drops of the specific medicine to the ounce of water constitutes the strength, the solution being poured into one nostril, while the head is thrown back, and allowed to escape through the nostrils while the throat it closed by the soft palate and the head tipped forward. In chronic cases, where granulations exist, the addition of a minute quantity of thuja assists.
Baryta Carb.—Carbonate of baryta is specifically adapted to tonsillar enlargement with patulous and irritated follicles, often filled with cheesy concretions. This is a condition frequently encountered and seldom benefited by ordinary throat remedies. In some of these cases abscesses may form about the bottoms of the pockets upon slight exposure to drafts and occasion frequent disagreeable complications. The fate of a child thus afflicted is commonly submission to excision or enucleation of the tonsils, but in my experience faithful adherence to small doses of baryta carb., 3 x, will result in a permanent cure without resort to surgical measures. The remedy should be continued for several months and improvement may not be marked at first, but perserverance will bring its reward. I can look back to many cases of this kind thus cured permanently, some of them now being the heads of families, with good and perfect throats. Not long ago the father of two growing children complimented me upon my success in his own case accomplished when he was a boy of fourteen. He is opposed, it is needless to observe, to removal of the tonsils in children.
As a remedy for the abortion of quinsy, baryta carb. is not to be despised. If begun early it will often cut short a threatened attack of this affection. Alternated with kali mur., in appropriate dosage, I have been well pleased with its action, and it serves alone, between attacks, to fortify the tonsils against the invasion of disease. However, a subject of quinsy seems a tough customer against any precaution in every instance.
Berberis Aquifolium.—This remedy comes in when we have a case of chronic pharyngitis with much catarrhal complication. It is also good to remember in granular or follicular pharyngitis. Its action is slow, but persistence with it will bring satisfactory results in many cases. Even where it is necessary to employ local measures to destroy granulations or enlarged follicles, the constitutional effect of this remedy is to be desired. It is a restorative to the mucous membranes of the pharynx and upper respiratory passages not to be despised.
Guaiacum.—This is the remedy for painful or aching cases of pharyngitis. It is an age-long remedy for rheumatism, and is supposed to be adapted to cases of pharyngitis in which rheumatic aches involve the throat, but whether it is superior or even equal to phytolacca here is doubtful. It has a reputation also in tonsillitis (acute).
Kali Bichrom.—This remedy is indicated where there is exudation from the mucous membrane of the throat. This may be stringy, tenacious mucus, white and glairy or tinged with blood, or a false membrane. Membranous diphtheria, or croup, with ulceration of the tissues calls for it. It is hardly a remedy for chronic cases, though syphilitic ulceration might be named as an exception. It is also a valuable remedy in subacute coryza, to follow the action of euphrasia in the earlier stage. I use the 2 x or 3 x trituration.
Mangifera.—This remedy exerts a speedy, soothing influence on the mucous membrane of the throat in pharyngitis when much burning or smarting attends. It is a good running mate with phytolacca, though it acts more quickly to produce a soothing influence, and lacks the property of relieving so readily the muscular pain which attends epidemic cases of follicular tonsillitis. I order the patient to gargle first and then swallow. Of course, in diphtheria the gargle ought not to be swallowed, but in ordinary cases of angina there is no objection. What I desire is the local action combined with the specific action. Many prefer mangifera to phytolacca in all cases, but there are many in which phytolacca is preferable. Minute doses of aconite combine well with mangifera in this use of it, and I usually join the two. I have treated numerous cases of acute sore throat with it in which the patients would afterward call for "that red medicine" when another attack occurred. Its beneficial action is so prompt that it impresses the subject with its importance. Add from one to two drachms of the specific medicine to four ounces of water, using a teaspoonful every hour.
Penthorum.—This was Professor Scudder's favorite remedy in chronic pharyngitis and is probably the most reliable one we possess, though its use must be persevered in a long time in order to get results. I have proven this to my own satisfaction. Probably the most adaptable cases are those of pharyngitis sicca, though it need not be confined to them. It influences the nutritional powers of the pharyngeal mucous membrane—a true restorative. The following extract from Scudder's Specific Medication covers the facts: "It has proven the most certain remedy in pharyngitis that I have ever employed and has given such marked benefit in disease of the superior pharynx, posterior nares and Eustachian tubes that I should not like to treat these cases without it. I have also used it with the spray apparatus in nasal catarrh with most excellent results."
Phytolacca.—Everybody knows about this grand old remedy in throat affections. However, an article of this kind would lack completion without a notice of it. The particular place for this remedy in preference to others is epidemic or seasonal cases of acute follicular tonsillitis. Such cases are attended by marked constitutional disturbance—fever and muscular pain. This does not exclude the remedy from adaptation to all forms of pharyngitis and tonsillitis, for it finds a place in all cases of angina. Enlargement of the lymphatic glands as a complication is also a particular indication for it. It reaches much farther than mangifera as a constitutional remedy, acting on the muscular system and cervical lymphatics. Aconite, I believe, enhances its action in acute cases, and I invariably combine it in instances of the kind.
Neither baptisia nor echinacea can be considered a throat remedy in a specific sense, except so far as constitutional influence is concerned, yet neither is to be forgotten where sloughy tendency is manifest, and in all cases of angina, echinacea in dilution of one to four or less, constitutes an excellent soothing and healing gargle.