AMBLYOPIA, Toxic.
The most common cause of this condition, which is also known amongst ophthalmic surgeons as Central Scotoma, is tobacco. As soon as the first symptom (which is commonly that of a sudden and progressive dimness of vision) leads the patient to seek advice, and the diagnosis being clear, total abstinence from the use of tobacco in every form must be rigidly insisted upon. This in most cases will effect a speedy cure without resort ing to drugs, but where the disease has been of long standing patient treatment prolonged over many weeks may be necessary. If, on examina tion of the disc in such cases, it is found to be already blanched and atrophied, drugs can only be expected to restore the acuity of the peri phery, the central vision remaining permanently damaged in both eyes. Strychnine hypodermically is the only reliable drug; gr. should be in jected daily into the temple region till symptoms of improvement begin to manifest themselves, after which the alkaloid can be given by the mouth. Iodide of Potassium assists its action, and should be administered three or four times a day whilst the hypodermic treatment is being carried out. Where the condition fails to respond to these measures, Pilocarpine may be injected, and Phosphorus in small doses administered at the same time by the mouth. Eliminatory treatment consisting in large draughts of water and free open-air exercises is also to be recommended, but they arc only of use in recent cases.
The patient, if a confirmed slave to the smoking habit, may he aided in his abstinence by being allowed to chew small fragments of Quassia, Calumba, Gentian or Cascarilla when the craving for a smoke is acutely felt.
incoho/ is not an uncommon cause of amblyopia, but it is rarely met with alone, being frequently an aggravating factor in tobacco scotoma; hence in every case of the latter the use of alcohol must be strictly pro hibited, and often no improvement in treatment results till this is given up completely.
Sometimes good results may be obtained in acute severe cases of the combined toxaemia by leeching the temples, and in very chronic cases by the administration of Chloride of Gold.
Quinine, Bisulphide of Carbon, Arsenic, Lead, Dinitro-benzol, Filix Alas, Indian Hemp, Stramonium, Iodoform, and Purified Wood Alcohol also produce the condition, and must he treated on the same lines. The
worst type of toxic amblyopia has unfortunately become common through the introduction of the craze for treating syphilis hypodermically by large doses of the new arsenical compounds, especially Atoxyl or Arsamin. In this type the amblyopia is prone to pass into total blindness or amaurosis, a condition also often seen in sleeping sickness when these drugs have been administered.
The amblyopia of pregnancy and acute Bright's disease should be treated vigorously by hot baths, Pilocarpine, and saline purgatives.
AMENORRHcEA.
It should always be remembered that amenorrlicea is a symptom, and not a disease, and that it is useless, and may be harmful, to give drugs for the purpose of evoking a menstrual flow, unless the cause which is responsible for its non-appearance or suppression is discovered and dealt with if need he.
Delay in the first appearance of menstruation need excite no alarm unless a periodic malaise has been noted without any corresponding dis charge from the vagina. It is in many cases due to constitutional causes which defy analysis, and the anxious mother may be reassured, while the patient, if of weakly habit and poor development, should be given a tonic such as Ferri at Qninin. Cit. 3j.
Inf. Calionbre ad F,vj. Misce.
Ft. mistnra. Cpt. ter in die post cibos.
R. Mist. Ferri Co.
Decoct. Aloes Co. rich Ft. mistura. Cpl. gss. ter in die post cib. ex (-kind.
Attention should be paid to personal hygiene. Warm clothing and abundant plain, nutritious food should be insisted on„ and the patient should be instructed to go to bed early, to have at least ten hours sleep, with plenty of fresh air and not too much exercise. In cases where thyroid insufficiency can be diagnosed, the tablets of the dried gland may be prescribed, commencing with c grs. once a day and carefully increasing the dose. The drug should be stopped on the appearance of unpleasant symptoms, such as loss of weight, headaches, and fleshings. If examina tion of the young patient reveals the presence of a disease such as tubercle, cardiac or renal trouble, the treatment appropriate to the affection is of course indicated.