§ 281. Arthritic ophthalmia.

This kind of inflammation is principally seated in the sclerotica, iris and conjunctiva, and lastly reaches the cornea. The pain is violently boring, digging, either in the eyeball or bones of the skull; it is changing, subject to the influence of the weather, aggravated by feather-beds. The eye is of a rose colour, less in the canthi than towards the cornea, which is surrounded by the injected and varicose vessels as by a wreath. This wreath of varicose vessels furnishes a characteristic distinction between arthritic and syphilitic iritis. In the latter affection the wreath is close around the iris, from which it is separated in arthritic ophthalmia by a narrow, whitish band. There is much photophobia, and sometimes even scintillations. If the inflammation be not speedily arrested, the iris changes its colour, and the pupil contracts; it becomes dim, extravasations are seen through the pupil, and the cornea becomes dim and opaque. Pan-nus may set in, or else an ulcer with a varicose ulcerated border is observed on the cornea. A mismanaged inflammation of this kind may, beside pannus, lead to bypopion, chronic corneitis, atrophy of the eyeball.

In some cases the inflammation commences from within, and extends towards the front part of the eye. The sclerotica and iris are violently inflamed. The pains are less intense than in the former variety, there is less redness, only single vessels appearing injected. The pupil however is dilated and distorted, the margin of the pupil is indented, with a greenish-white colour behind, showing that the capsule is invaded (cata-racta glancomatosa.) In this case the visual power disappears entirely, the periodical pains become violently tearing, and spread over the whole side of the head; profuse lachrymation is present. An abscess is apt to form behind the lens, with increase of pain, and breaking anteriorly sooner or later. In ordinary and not too violent cases, the disease terminates in atrophy of the eyeball. Arthritic ophthalmia runs a chronic course.

This inflammation arises from anomalous gout, whether it have shown itself already or make its appearance afterwards. Sometimes, however, the disease, particularly the internal inflammation, sets in, without any symptoms of arthritis being present.

In regard to treatment, we can only furnish a few indications on account of the great variety of the symptoms, and invite the practitioner to obtain as comprehensive a knowledge of the Mat. Med. as possible, in order to be prepared to meet every case of such inflammations by an appropriate remedy.

The treatment should be commenced with Aconite, if the usual inflammatory phenomena, fever, bounding pulse, etc,, be present. If Aconite should not be clearly indicated, if there should be much lachrymation and photophobia, with arthritic pains around the eyes, and symptoms of violent congestion about the brain, Belladonna would be the most appropriate remedy.

Spigelia is more particularly suitable when the inflammation has reached the more deep-seated tissues of the eye. It is indicated when the above-mentioned wreath of vessels around the cornea is distinctly perceptible, when the eyeball exhibits a number of varicose vessels, the patient complains of a sensation as if the eyeballs were swollen, the power of vision is undiminished; the pain is a violent sticking, boring, digging pain, proceeding from the interior of the eye towards the inner canthus; the pain obliges one to keep one's eyes closed, and, on opening them, objects seem to be floating in fire.

Colocynthis is an excellent remedy when the pains are seated in the eyeball itself, not in the surrounding bones, and of a burning-cutting character. Particular indications for Colocynthis, are: Congestion of the head, photophobia, lachrymation, pressing and tearing pain in the whole brain, which is most violent in the forehead on moving the eyes ever so little; anguish, which drives the patient from one place to another.

Chamomilla is of not much use, except in very mild cases; and Nux vom. helps "when the inflammation arises in the first place from excessive living.

If ulcers should have formed on the cornea, if the pupil should have become contracted, and should exhibit the above-mentioned whitish-green colour in the back-ground, Euphrasia is the appropriate remedy, especially when a rash has broken out around the eyes.

In internal arthritic inflammation. Belladonna is the principal remedy. The inflammation of the retina which frequently attends this disease, likewise yield most readily to Belladonna, when, beside the symptoms which have already been mentioned, the patient complains of a distressing, aching pain over the eyes, with pain in the eyeballs as if they would be torn out of their sockets or pressed into the head; the patient sees flashes and sparks before his eyes, particularly when congestions of the head are present, with more or less •amblyopia; muscae volitantes make their appearance, surrounded with a bright, fiery border, and gradually disappearing as the amblyopia increases. If these phenomena should be accompanied with inflammation of the choroidea, iris and sclerotica, if the pupil should be indented and dilated, the physician should not consider those symptoms as a counter-indication to Belladonna, and employ Euphrasia, Pulsatilla, Sepia or Calcareain its stead. If the inflammation threaten to terminate in amaurosis, Belladonna sometimes averts the danger. Phosphorus, Caustic, Hepar sulph., Aurum, Rhus tox., Silic, Natrum mur., Sulphur, etc., are very efficient agents in this inflammation. Beside the cases which have been mentioned as indicating Bellad., this remedy is likewise useful when this kind of inflammation set in suddenly, or after simple ophthalmia, or after taking cold in the eyes when they were heated. In the latter case, Dulc. and Tartar emet. are likewise useful. Under such circumstances amaurosis sets in gradually, the patients see things as if covered with a black gauze, black points or flocks or spots with various colours hover before the eyes, which go and come; the patient is frequently seized with violent vertigo, which generally terminates with considerable diminution of the visual power and violent headache. When amaurosis thus threatens to set in, the following remedies should be thought of in conjunction with those mentioned above: Puls., Dig., Sepia, China, Capsic, Ruta, Secale, Zincum, etc.

Sulphur, which is an admirable remedy in all kinds of arthritic affections, is likewise eminently useful in arthritic ophthalmia, and frequently requires to be given immediately after Aconite.