XXVIII.

Gonorrhoeal Ophthalmia.

By J. C. HARRINGTON, M. D.

This case may be of little interest to the older practitioner, but believing it to be one of some import, I send a statement of what was prescribed, and the result of treatment.

About the 13th of September I attended a lady in confinement. The babe, a healthy male child weighed about eleven pounds. The ninth day after birth I was asked to prescribe for the babe, the nurse remarking that one of its eyes was quite sore.

On examining the eye quite hastily (as physicians are apt to do when pressed with business), I discovered considerable redness of the conjunctiva, with some inflammation of the lids. I formed the opinion, and so expressed it, that it was a case of ophthalmia neonaPrescribed aconite and belladonna, first dilution of each, to

be given, the usual way, every hour.

The next day called; found the child much worse, and was at once convinced that I had made a wrong diagnosis. It was an unmistakable case of gonorrhoeal ophthalmia, progressing with all the rapidity and virulence this terrible disease is capable of.

The palpebral conjunctiva was intensely red, swollen and villous, discharging a copious secretion of pus about the consistency of thick cream. I say copious, because a teaspoonful of it could be pressed from the eye several times a day, besides the large quantity that was constantly escaping.

I will not give in detail the symptoms, or a minute description of the disease, as any one may find all very perfectly described in Druitt's System of Surgery (pages 354-356), but will simply state the treatment and the result.

Took five grains of nitrate of silver, put it in one ounce of aqua pura, which, after having dissolved, I applied very thoroughly to the eye twice a day with a camel's hair pencil, and gave directions to the nurse to cleanse the eye once an hour with decoction of calendula I had prepared for that purpose, also to keep cloths saturated with the calendula laid on the eye during the intervals.

Gave the child a small powder of mercurius viv.3, and put ten drops of cantharides in half a glass of water, half a teaspoonful of which was to be given, in alternation with mercurius viv., every hour.

The next, or third day, found that the treatment had made but little if any improvement in the little patient. I had been employing chlorate of potassa in ordinary cases of gonorrhoea, and it occurred to my mind that it would be quite as useful in the eye as in the urethra. I accordingly prepared a solution, fifteen grains to the ounce, of aqua pura. Dispensed with the calendula, and used the potassa as the decoction had been used (except the application with the cloths), in conjunction with the argenti nitras, and gave, as internal remedies, euphrasia" and cantharides. Gave the cantharides to regulate the urinary organs, as there appeared to be considerable stranguary.

On the fourth day I called, and found the secretion of pus had somewhat diminished, and, as yet, no ulceration of the cornea had taken place. Continued the treatment.

Fifth day, found the secretions gradually but slowly diminishing; but the sclerotica was so intensely inflamed that the iris could hardly be discerned, and, although the disease was in some respects under control, I could hardly hope to succeed in saving the child's eye. Continued the treatment until the eighth day, when the argenti nitras was discontinued, and a solution prepared, of sulphate of zinc, two grains to the ounce, of water, and used twice a day, at the same time continuing the chlorate of potassa. Gave belladonna1 and aconite', in half teaspoonful doses every hour, alternately. Continued the treatment four days, when the other eye became similarly affected, through the negligence of the nurse, although specific directions had been given as to the necessity of keeping the virus from the other eye. The other eye received similar treatment, and the result was most gratifying, as the child's eyes appear now perfectly well.

XXIX.

Case of Prolonged Constipation.

By G. Z. NOBLE, M. D.

The following case, treated by my father (Dr. O. E. Noble) while I was yet a student with him, is given, not so much for the treatment pursued, as for the unusual length of time during which there was no evacuation of the bowels. The report is made mostly from notes given by the father of the patient.

Anna P- was born May 14th, 1844. From her birth, she appeared to have suffered from a weak condition of the stomach. When about fifteen months old, an eruption made its appearance on the scalp and face, covering the whole of the right cheek, accompanied with much heat and itching. It also made its appearance on the right arm and thigh, and continued for several months. Various allopathic remedies were applied to remove it, and finally with success. During the time the eruption was out, the bowels were very much deranged, being loose and the discharges watery. So much relaxed were they, that prolapsus ani was the result. But when the eruption disappeared, constipation followed; and in order to remedy it, recourse was had to cathartics, usually purgative pills. These cathartics, however, gave only temporary relief, and a relapse into the same state, but more aggravated, was sure to follow. This state of things continued until she was five years old, when the bowels seemed to gain strength, and healthy evacuations were discharged. This was effected by a discontinuance of purging medicines, and by using enemas of water. After natural action of the bowels was established, all laviments were dropped.

In the fall of 1854, she began to give signs of illness; constipation followed, and the nervous system was greatly affected. She complained of pains in the epigastrium and hypochondrium, especially after eating and on going to bed; would often be filled with alarms and agitations; starting up in sleep, and crying out in anguish. To quiet these pains, carminatives were sometimes administered, and sometimes a few drops of paregoric. Constipation, however, became more obstinate, and resort was had to a compound pill of one-half

grain extract dandelion, one-half grain blue mass, two grains aloes, and two grains rhei. At first, two of them would move the bowels; but every dose rendered the next less efficient, until it took from six to eight, administered two at a time on going to bed, until they operated. Finally these doses produced no operation. Enemas of salts, castor oil, and of water, first one, then the other, were administered about the twentieth of January, 1855, and an evacuation of the bowels was produced. But from that time to the first day of April, nothing would move the bowels. The patient had become so thoroughly disgusted that she could not be compelled to swallow allopathic medicine and retain it even for a few minutes. Foiled in all their efforts to help her, and alarmed on account of the long retention of fæces, her father was induced to try homoeopathic remedies. As he said on the first visit to the patient, he had never examined the practice, and therefore had little confidence in it, yet it was the only hope left, and was applied to as a dernier resort.

On the second day of April, nux and sulphur were prescribed, and immediately a beneficial change was evident. The appetite was better; sleep was more sound; the spirits livelier; and the tongue, which for a long time had been red, smooth, and glassy (and the lips red, also), began to look natural. The skin upon the body, over the bowels and stomach, was of a dirty ash color, and the face pale, or of a leaden hue, and the veins about the temple and forehead deep blue.

On the twenty-ninth of April, just four weeks from the first visit, the patient passed a very large ball-like stool, the next day several others, and on the first day of May, there was a general moving out. During all the time, from the twenty-seventh of March, to the time above mentioned, she wore every night a wet compress over the bowels and stomach, and blood-warm enemas of water were administered on going to bed, and on dressing in the morning. As soon as a movement of the bowels was effected, the nux and sulphur were discontinued, but the enemas and compress continued. The bowels moved regularly for about five weeks, when they ceased to move. Resort was again had to nux and sulphur, and continued for four weeks, but no amelioration took place. These were discontinued and mercurius was administered for eight days. One week after, commenced administering causticum and natrum three times a day; and at the end of seven days, an evacuation was procured, yet not so thorough as the former. Eight weeks elapsed from the time of the cessation, till they were again moved. On the second day of

September, she passed a small hard ball, and then ceased. Natrum and causticum were administered as before, for eight or ten days, but no benefit from them. Mercurius was then administered; then bryonia for several days, but no amelioration. On the fifteenth of November, resort was had to lycopodium, giving three globules every other night, of the thirtieth dilution, until it was given five times, and to the astonishment of the parents, the bowels commenced moving, and were thoroughly evacuated. This was on the twentyfourth of November. The compress and enemas were daily continued. From that time, until the twenty-ninth of December (when the record ceases), there was no day, without a movement. Once or twice she showed symptoms of constipation, but the administration of lycopodium at bed time, produced an action the next morning, without the aid of an enema. The compress was still continued. The tongue looked healthy; appetite good; skin clear and smooth; rests well at night; spirits generally cheerful and countenance somewhat ruddy. The most she complained of was weakness as she called it, causing her frequently to draw a long breath; she remained passably healthy, without any return of the constipation, until the time of her death some two years after, from what her attending physician (they having removed to another locality), called typhoid fever.

The first period in which the patient had no movement of the bowels, was one hundred and five days; the second, fifty-seven days; the third, eighty-five.