THE PATHOGENIC AND THERAPEUTIC ACTION OF RHUS TOX. UPON THE EYE.
BY CHARLES DEADY, M. D.
In the collection of provings of rhus toxicodendron made by Samuel Hahnemann, and published in Vol. II. of the Materia Medica Pura, the number of symptoms relating to the eye and its neighborhood is so large as to lead to the supposition that, if the theory of homeopathy be a correct one, this drug should prove of special value in the treatment of diseases of the visual organs. Never did an hypothesis receive better support when reduced to practice; and if the efficacy of the law of similia similibus curentur were compelled to rest upon a single test to demonstrate its truth, few better selections could be made than that of rhus tox. in the department of ophthalmology.
Many of the symptoms contained in the Materia Medica Pura are indefinite, and the great majority of them point to apparently superficial diseases, but when we consider the fact that at the time these provings were made the science of ophthalmology, as understood at the present day, actually had no existence, that the principle of the ophthalmoscope had not yet been discovered, and that the methods of precision in the examination and diagnosis of diseases of the eye now available were at that time unknown, this is little to be wondered at. And we are compelled to admire the industry and energy of the men, some of them of our own day and generation, whose tireless labor has sifted and arranged the numerous symptoms of this and other drugs and indicated the method of their proper application to the various pathological processes.
When the New York Ophthalmic Hospital was placed in charge of the adherents of the homeopathic school, they were confronted by the fact that no definite materia medica of diseases of the eye and ear, as such, was in existence, and in order to ascertain the remedy for a given case of disease they were obliged to take the conditions throughout the body, and by comparing these with the general materia medica find a suitable drug for the totality of the symptoms. Had they been content with simply curing their cases in this routine way little would have been gained, but they made it a rule to take down the special eye or ear symptoms in each case with great care, and when a drug had cured a certain case of disease the eye or ear symptoms which had disappeared under its use were carefully noted. With a multiplicity of cases, and a systematic verification of symptoms, a valuable special materia medica of these diseases was compiled, and the curative properties of drugs in the various pathological entities of the eye and ear were definitely demonstrated and their characteristic symptoms for each disease mapped out.
Under this methodical procedure the relative value of drugs apparently indicated in these diseases gradually became better known; some, although presenting many and varied symptoms, were found by experience to be superficial and evanescent in their action, while others proved of the greatest efficacy in the most serious lesions, and became indispensable in the armamentarium of the physicians of the hospital staff.
In the latter group, rhus tox. speedily assumed prominence as a drug of special value in ocular disease, and this was enhanced by such a large measure of success in its application over a wide range of affections that it came to be regarded (at least in this hospital) as a veritable sheet-anchor in ophthalmological work, and as time passed it was used more or less in almost all the acute diseases to which the eye and its adnexa are subject.
A prominent symptom of rhus is great swelling of the eyelids. This it has in common with a number of other remedies, but differentiation becomes less difficult when we remember that rhus is specially indicated when swelling and œdema of the lids are the result of the deeper and more serious lesions. After the operation for cataract, one of the first symptoms indicating danger is œdematous swelling of the lids, and no drug in the materia medica compares with rhus for insuring the safety of the eye. When the pathological process becomes advanced, even to the appearance of pus within the eyeball, still we may confidently rely on this remedy, which has cured many such cases when they were apparently hopeless. In all postoperative complications it is of the greatest value, and too much emphasis cannot be placed upon this statement.
When a sound eye takes on sympathetic irritation from its diseased fellow, the fact is first manifested by a certain amount of swelling of the lids and more or less profuse lachrymation, the latter another valuable indication for rhus tox. In this condition I have personally used it many times with complete success, and it is the first drug to be thought of in this extremely dangerous complication.
It is a well-known fact at the present time that rhus is particularly applicable in rheumatic conditions, especially where these are resultant upon a wetting or exposure to dampness. This, together with its nightly aggravation, points to another sphere of usefulness in rheumatic iritis, where it will prove all-sufficient when the characteristic symptoms exist. In suppurative iritis and cyclitis it is very serviceable, no matter what the cause.
The symptom “while he turns the eye or it is pressed, the eyeball is painful, can hardly move it,” indicates its use in acute retrobulbar neuritis, which causes this symptom exactly and is well known to be frequently due to a rheumatic diathesis. The same symptom may call for its use in tenonitis, in which the stiffness, difficulty of and pain on moving the eye are specially prominent and which also has swelling and œdema of the upper lid, chemosis of the conjunctiva, and protrusion of the eyeball; all symptoms of rhus tox. The idiopathic form of this disease is almost always rheumatic or gouty in origin, furnishing still another indication for the remedy. In orbital cellulitis we have swelling of the lids, chemosis, protrusion of the eyeball, almost complete abolition of motion with pain on the attempt and also on pressure, aching in and around the eye, with the probable formation of pus in the deeper structures, all conditions curable by rhus tox., which is one of the best remedies for this disease whatever may be its origin, traumatic or otherwise, and has cured many of the most desperate cases.
In panophthalmitis, or suppurative inflammation of the eyeball, we find the swollen lids, difficulty of, and pain on motion, chemosis of the conjunctiva, severe pain in the eyeball, lachrymation, etc., again indicating the remedy. Rhus tox. is one of the few drugs that have cured this most fatal of lesions, and its success in restoring the integrity of the eye, in some cases where this result has seemed almost impossible, is a matter of record.
The symptom “heaviness and stiffness of the eyelids, like paralysis, as if difficult to move the eyelids,” would seem to indicate its use in ptosis, and this condition as well as paralysis of certain of the ocular muscles, is curable by rhus tox., especially if due to wetting or dampness. Such cures have been made frequently in the clinics of the Ophthalmic Hospital. Erysipelas of the eyelids often presents the characteristic symptoms of rhus. Of course the swelling of the lids is always present, but many of these cases have in addition the chemosis, hot lachrymation, the characteristic pains and aggravation, restlessness, vesicular eruptions, etc., and it is a valuable and efficient remedy when these exist.
Although rhus tox. is specially useful in the most serious inflammations of the deeper and more important structures of the eyeball and surrounding tissues, its sphere is not confined to these conditions alone, but seems to cover almost all the acute diseases to which the visual organs are subject. Given a rheumatic origin, especially if it be from exposure to damp or wet weather, with profuse lachrymation (pain in and about the eye) a tendency to chemosis of the conjunctiva, œdema of the lids, photophobia, and the characteristic aggravation and restlessness at night, and this valuable drug will rarely be found wanting in any of the inflammations of the conjunctiva, cornea, or lids.
I have many times cured with it acute catarrhal conjunctivitis, phlyctenular conjunctivitis and keratitis and ulcers of the cornea, and have subdued the acute aggravations of conjunctivitis trachomatosa, where the above symptoms, or some of them, were present. It is also frequently successful in the treatment of abscess of the lid, which, while not a serious, is an extremely painful disease.
Dr. W. A. Phillips, in an article published in the Jour. of Oph., Otol. and Lar., July, 1899, page 224, recommends the use of rhus tox., “when the ciliary muscle itself seems to be the special seat of trouble; when its muscular tone is disturbed from previous straining, and when inability is present after using the eyes for reading any considerable time, notwithstanding optical correction.”
He has had much success with the drug in these cases and considers that its action here is on a plane with that on lameness or soreness due to rheumatism. In my opinion another factor may be spoken of. One of the differential points between arsenic and rhus is that the arsenic patient is actually so weak that he cannot do what he would wish, while the rhus patient feels so weak that he cannot do it, but by making the effort he can overcome his weakness and accomplish what he desires. This seems to indicate in the rhus case an indisposition to exertion due to want of tone of the muscular system, and this explanation applied to the ciliary muscle would account for the successful action of this drug in the class of cases indicated.
I would not have it understood that I consider rhus tox. an universal panacea for all the inflammatory diseases of the eye; all of these affections are many times extremely variable in their presenting symptoms and other remedies are frequently called for, but the drug under consideration is one of the first importance and is most reliable and efficient when accurately prescribed.