The Secrets of Specialists/Chapter 27

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The diseases incorporated under the above caption have constituted the oldest of single or combined specialties, and there are so many valuable and exhaustive text books upon the subjects that no attempt will be made, in this chapter to cover the field. I will, therefore, only point out what may be considered some of the unusual methods of treatment, which will be of much service to the general practitioner. No physician

should think of conducting an office practice, or sanitarium, without installing a nebulizer or atomizer outfit; or some may prefer the more elaborate apparatus known as the Inhalatorium. These may be obtained at prices ranging from $12.50 to several hundred dollars. The small nebulizer, represented here, will render equal service to the more expensive apparatus, but is not as convenient for the physician, or elaborate to please the eye of the patient. In connection with either of these apparatus, the physician should provide himself with a trial case for fitting glasses. This is a very "profit​ ​able" branch of office work, which really belongs to the physician, but has been monopolized by jewelers, who know little or nothing regarding the anatomy, physiology, and diseases of the eye; but tinker eyes upon the same principle they do watches. Any physician can acquire a skillful knowledge of refraction in a short time, which will be the means of adding several hundred dollars to his yearly income. Physicians can like-wise treat many of the simple diseases of the nose and throat, with equal results, to the city specialists, and the time devoted to the study of these chronic diseases will prove to be one of your most valuable of professional assets.

If I were only allowed one remedy for the treatment of the diseases of the eye, I would unhesitatingly choose oil of thuja, as it will accomplish better results, in a larger range of eye diseases, than any one remedy in our possession.

Although thuja has been extensively used by our eclectic brothers for years, very little has been said regarding its use in diseases of the eye, except by Homeopathic physicians. This, no doubt, has been due to the difficulty in finding a suitable form in which to dispense this drug to the sensitive and delicate membranes of the eye. Alcoholic extracts have, of course, been excluded on account of the irritation they produce, and the oil of thuja I refer to is not the volatile oil of camphoraceous odor found on the market, which is produced by the distillization of thuja in water, but an artificial oil, prepared by distilling thuja in olive, or other vegetable oils, by a special process. This gives us a suitable menstruum in which we may receive the full value of this drug, without producing an irritation, as is characteristic with other preparations of thuja. One of the earliest uses of thuja was its action for restraint, and reduction of hypermetrophic changes in mucous and cutaneous tissues. It will deaden and repress fungous granulations, and has a marked action on such granulations as those of trachoma.

​In this disease, thuja cannot be overestimated; as one drop of this oil, applied to the eye three or four times a day, will often produce the most remarkable results. Corneal ulcers and opacities are often, apparently, absorbed, and vanish like magic, as do cystic growths and pterygium, sclerotic and palpebral conjunctivitis. In fact, it is the first remedy I think of in all forms of acute or chronic inflammation, and as a solvent for corneal opacities, growths, etc.

I sometimes think that physicians become stereotyped in their methods of treatment, and this would well describe my attitude in the use of oil of thuja in the treatment of many diseases of the eye.

When the therapeutic action of any single remedy becomes so firmly fixed upon a physician's mind, that he considers it almost a panacea, the practice of medicine loses its scientific aspect; yet after prescribing this remedy for the large variety of classified diseases, in which it seems indicated, and observing its therapeutic value, we must accept the truth, and I believe the oil of thuja will not disappoint reasonable expectations, in the treatment of a large number of the diseases of the eye than any one remedy in our possession. Thuja is slightly anodyne, stimulant, antiseptic, alterative and tonic, and when applied to the eye in the form of a non-irritating oil, it will remove the granulations, and subdue inflammation in trachoma and conjunctivitis. It will often remove pterygium, and the diffuse nebula, or the more dense form called macula, which follows corneal ulcers. In fact, it is the first remedy to be thought of in all acute and low forms of inflammation, and corneal opacities of the eye, and the best of all, it can be applied by the patients at their own home with little or no inconvenience. I usually provide patients with a drachm vial, and a medicine dropper, and instruct them to apply one drop, three times a day. The patient should lie down, to retain the oil in the eye, and after it has been applied, massage the eye over the closed lids.

​DIONIN is another drug which has a unique position among ophthalmic remedies. This remedy is one of the products of opium, and occurs as a white, odorless, bitter powder, soluble in seven parts of water. This drug is a powerful optical analgesic and lymphagogue. It is superior to cocaine in the treatment of many painful affections of the eye, although it is not a local anaesthetic, as is cocaine, as sensibility is not affected but its analgesic effects, in the treatment of many superficial, and deep seated inflammatory and painful affections, as iritis iridocyclitis, glaucoma, ulcers, pain and inflammation of the cornea, gives it an independent, therapeutie value in a large range of application.

Dionin is also a lymphagogue. It produces redness, and a very marked vascular dilation, with abundant lacrymal secretions. The lymphatic channels become distended to several times the size of their normal caliber, thus removing inflammatory exudates, and replacing the tissue with healthy tissue. In this respect, it has been referred to as a counter irritant, and belonging to the same category as Jequirity, in increasing lymphatosis. Dionin is applied to the eye in the form of dry powder, or in aqueous solution, ranging from 2 to 10 per cent, according to the effect desired. When stronger than a five per cent. solution is used, Lacrimation and chemosis of the conjunctiva, and swelling of the eyelids, are characteristics of its use.

As an analgesic, in all painful affections of the eye, Dionin has no superior, in its action upon inflamed mucous surfaces, and is particularly indicated in the deep seated pains, such as accompany glaucoma iritis, iridocyclitis, etc., while in iritis it has a threefold effect; relieving the pain, hastens the absorption of exudates, and assists atropine in dilating the pupil.

In interstitial keratitis it will hasten resolution and rapid healing, and clear the cornea under its influence. Konigstein believes that Dionin is abortive of parenchymatous keratitis, if used in the early stages, but valueless in the later stages.

​In resuming the therapeutic value of dionin for the diseases of the eye, its first indication is for the relief of all pain in the eye, either the superficial or deep seated. One-quarter to one-half grain of the dry powder, or one to two drops of a five to ten per cent. solution, installed in the conjunctival sac, and followed with massage will be attended with some pain; this will subside, however, in a short time, and suppress all pain, which will last from four to eight hours, when the powder, or above a five per cent. solution is used. It will be followed with chemosis of the conjunctiva, which may frighten the patient, if not forewarned. This need cause no alarm, however, as it will rapidly subside, and is even an appearance to be welcomed, as it is in these cases we receive its greatest analgesic effects, and as the apparent irritation it produces subsides, it has a tendency to remove inflammatory exudates, and remove disease. We have, therefore, produced a mild form of disease for the purpose of removing a more serious condition, and this may be compared to the results of vaccination in the treatment of smallpox.

Cineraria Maritina has obtained quite a widespread reputation as a solvent for cataract. This remedy is imported from South America, by some concern in Georgia, and is sold to physicians at $1.25 per drachm vial, which is about one month's treatment. By placing one drop of this remedy in the conjunctival sac, and massaging the eye, there have been many favorable reports given, where it has restored sight by removing the obstruction to vision; while the principal sphere of action concerning this remedy seems to center as a solvent for cataract, it has been recommended for other ocular diseases, corneal ulceration and opacities, injuries to the eyelid, conjunctiva or cornea iritis, catarrhal or muco-purulent conjunetivis, inflammation of the lachrymal gland or of the cellular tissues of the orbit trachama, and in fact, any condition of the eye where an absorbent antiseptic is desired.

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Dr. Carl Seller, of Philadelphia, has become very well known as the author of certain antiseptic preparations. Seiler's Antiseptic Wash is made after the following formula:

Sodium bicarbonate	8	dr.
Borax	8	dr.
Sodium benzoate	20	gr.
Sodium salicylate	20	gr.
Eucalyptol	10	gr.
Thymol	10	gr.
Menthol	5	gr.
Oil wintergreen	6	min.
Glycerine	8½	fl.oz.
Alcohol	2	fl.oz.
Water	q. s. ad.	16

Dr. Seiler gives these directions for preparing the compound: Dissolve all the volatile ingredients in the alcohol, rub up the solution with the sodium salts, and dissolve in the water, finally adding the glycerine. Allow to stand in a large bottle with occasionally shaking for at least two weeks before dispensing. Dr. Seiler has placed on the market also his Antiseptic Tablets, which, dissolved in water, produce a solution similar to the above.

Sod. bicarb.	1	oz.
Sod. chlorid	1	oz.
Sod. chlorid	1	oz.

Sig. Add a teaspoonful to a pint of lukewarm water and use with a syringe or atomizer to cleanse the nose from thick mucous and crusts.

Sod. bicarb.	15	gr.
Sod. biborate	15	gr.
Acid carbol	4	gr.
Glycerine	15	min.
Aquae	ad	1

Sig.: Dobell's solution. Dilute with equal parts of water and use with atomizer or snuff up the nose. Simple cleansing solution

Acidi acetici	2½	dr.
Glycerine	3	dr.
Aquae	10	oz.

Sig.: To be used as an antiseptic and stimulating wash in the nose and nasopharynx in the course of the exanthematous fevers.

Acidi carbolici	30	gr.
Ammoni carbonatis	1	oz.
Pulv. carbonis ligni	1	oz.
Olie lavandulae	20	min.
Tinet. benzoin comp	½	oz.

Sig. Uncork and inhale to relieve the congested condition of the mucous membrane in acute coryza and hay fever.

Acid carbolici	30	gr.
Ext. pini canadenis dest.	20	min.
Liq. vaselin	1	oz.

Sig. To be used in acute stage of hay fever for the anesthetic effect of the carbolic acid.

Acid chromici cryst	¼	gr.
Aquae	1	oz.

Sig. Ft. nebulae and use to check sneezing.

Eucalyptol	15	min.
Menthol	15	gr.
Camphor	15	gr.
Ol. pini compilonis	½	dr.
Ol. roasae.	2	min.
Liq. vaselin, q. s. ad.	2	oz.

Sig. Use in the nose with an atomizer in mild cases of hypertrophic rhinitis.

Ichthyol	48	gr.
Lanolin	4	dr.
Vaselin	4	dr.

Sig. Use on a cotton-wound applicator to massage the nasal mucous membrane in chronic forms of rhinitis.

Hydrarg. ammoniati	4	gr.
Pulv. sach. albi	½	oz.

Sig: Insufflate into the nose to stimulate the mucous membrane in ozaena.

Antipyrin	15	gr.
Aquae	ad	1 oz.

Sig. To be used in the nose and throat as a hemostatic.

Pulv. fol. matico.

Pulv. amyl. excic, aa equal parts. M.

Sig. To be insufflated into the nose for epistaxis.

Glycerit. acid, tannici.	3	dr.
Aquae	ad	3

Sig. One teaspoonful to a wineglassful of warm water, to be injected in the nose night and morning, as a remedy for post-nasal adenoids.

Iodini	10	gr.
Pot. iodidi	10	gr.
Ol. gaulther	5	min.
Glycerine	1	oz.

Make four solutions, varying the amount of iodine and potassium iodide between the limits given in the prescription.

Sig. In dry rhinitis, pharyngitis and laryngitis, begin with the weakest solution and gradually increase to the strongest to stimulate the glandular function of the mucous membrane.

Guaiacol	4	dr.
Olive oil	4	dr.

Sig. Apply to the fauces of pharynx in acute tonsilitis and pharyngitis.

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Argent. nitrat	4	dr.
Aquae dest.	4	dr.

Sig. It may be used instead of the gualacol mixture. One or two applications of the above mixture are often sufficient to arrest acute inflammations of the throat and pharynx if applied in the first stage.

Guaiacol	½	oz.
Ol. amygdalae dulcis	½	oz.

Sig. To be applied with a cotton-wound probe in acute inflammation of the throat. It is also applied to relieve pain.

Tr. iodi	1	dr.
Glycerine	½	oz.
Aquae	3	oz.

Sig. To be used to moisten compress in laryngitis.

Eucalyptol	10	min.
Menthol	5	gr.
Camphor	5	gr.
Liq vaselin.	q. s.	5 oz.

Sig. To be used in acute laryngitis after cleansing the throat with aqueous solutions.

Menthol	48	gr.
Ol. olive	q. s.	1 oz.

Sig. To be applied to the larynx in laryngeal tuberculosis with a cotton-wound applicator or atomizer.

Ol. eucalyptol	2	dr.
Ol. terebinth	1	dr.
Magnesiae carb. levis	2	dr.
Aquae	q. s.	3 oz.

Sig. A teaspoonful in a pint of hot water. Inhale the vapor to loosen the secretion and allay the cough in tubercular laryngitis.

Quininae sulphatis	½	gr.
Acid carbollei	½	gr.
Extract krameriac	½	gr.
Pep.	2	gr.

Sig. Take one before each meal at which meat is taken in cases where there is sluggish digestion with flatulency. This is of special value for vocalists, actors and speakers, in whom the digestive system is frequently impaired by nervousness.

Potassii chloratis	2	dr.
Glycerin	2	dr.
Aquae	10	oz.

Sig. Use as mouth-wash in syphilis during the administration of mercury.

Liq. hydrarg. nitratis	4	dr.
Aquae	q. s.	1 oz.

Sig.: To be applied to the sloughing ulcers of tertiary syphilis. As the application is very painful, cocaine should first be applied.

Sig.: Drop in the ear three times daily to soften inspissated cerumen preparatory to removing with a syringe.

Hydrozone (15 vol.)	3	dr.
Aquae	3	dr.

Sig. Use same as preceding.

Acidii carbolic (1-5 per cent.)	1	oz.
Glycerine	1	oz.

Sig. Drop into ear to relieve pain in middle-ear inflammation.

Peroxide of hydrogen

1

oz.

Sig. A few drops into ear in middle-ear suppuration.

Camphor (reduced to a fine powder with a few drops of rectified spirits)	1	oz.
Chloral hydrate	1	oz.

Sig. To be applied externally as an anesthetic in neuralgic and other affections of the throat.

Hydrarg. oxidi rubri	4	gr.
Puly. sacch, albi	½	oz.

Sig.: To be blown into the nose after cleansing in ozaena.

Iodoformi	10	gr.
Menthol	5	gr.
Lanolin	½	oz.
Liq. vaselin	½	oz.

Ft. ung. Sig.; To be applied to the interior of the nose with a brush in ozaena or ulcer of the septum.

Creolin	4	min.
Aquae	1	oz.

Sig. Antiseptic and deodorant, to be used in atrophic rhinitis, syphilitic and other ulcerations, and in diseases of the accessory sinuses.

Sanguinariae canadens	1	dr.
Aquae tepid	1	oz.

Ft. lotio. Sig.: To be used with an atomizer or syringe morning and night for ozaena.

Zinc sozoiodol	48	gr.
Talc	q. s.	1 oz.

Sig. To be blown into the nose in atrophic rhinitis after cleansing the nose from crusts.

Menthol	48	gr.
Toluol	2	dr.
Sol. per chloride iron	1	dr.
Alcohol absolute	1	oz.

Sig.: To be applied locally in diphtheria or pseudodiphtheria.

Acid laetici	1	dr.
Aquae	1	oz.

Sig. To be used with an atomizer in diphtheria as a solvent of the membranous exudate.