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rately, as, owing to lack of time in examination and the irregularity of attendance of Dispensary patients, their records are more meagre, and a full knowledge of the success of treatment is not always to be had. An examination of the seventy-six Dispensary patients shows that of these cases nine were males, sixty-seven were females ; the average age was twenty-one years and fourteen days. Of these, 52.8 per cent. had constipation, 46.9 per cent. had indigestion, 26.7 per cent. had both; 19.3 per cent. of the female cases had menstrual functional disorder; of this number, 13.4 per cent, suffered at the same time either with constipation or indigestion, leaving only 5.9 per cent., showing uterine derangement only. Of the fifty-one private patients, seven were males, forty-four, females. Average age, 26.3 years. 39.6 per cent. had constipation ; 59.4 per cent. had indigestion ; 25.7 per cent. had both; 24 7 per cent. showed marked errors in diet ; 22.7 per cent. showed menstrual derangement; of these, 11.3 per cent. suffered at the same time from either constipation or indigestion, leaving 11.4 per cent. with menstrual derangement alone, as the only discoverable exciting cause of the acne.
As far as the above statistics go then, we learn that menstrual disorders occupy a rather subordinate place in the etiological scale, inasmuch as in the Dispensary cases, while 73 per cent. had either constipation or indigestion, only 5.9 per cent. showed menstrual trouble alone, and in the private cases, 73.3 per cent. had derangements referable to the alimentary canal, and 11.4 per cent. suffered from uterine disorder only. If then functional derangements of the sexual system occupy a comparatively minor place as an etiological factor, what part does that developmental period called puberty play as a cause, or is the appearance of the disease at that time only a coincidence. Tilbury Fox, I believe, strikes the keynote to an explanation of this when he says, “Whenever a portion of the body is physiologically active, it is likely to become disordered if the general or local condition of nutrition is deranged.” Both these conditions are apt to be present at this time when acne is especially apt to first present itself. At the age of puberty, the whole system is in a condition of “physiological activity" and rapid development; the sebaceous glands of the face share in this general activity, and are, therefore, “especially liable to become disordered.” At this time the general condition of nutrition is very likely to be bad, for if at any period of its existence the human male may be said to be omniverous, it is at the age of from fourteen to eighteen ; and not only is it omniverous as regards quantity, but as regards quality and time, and every. thing else pertaining to digestion. The average healthy boy at this age does not know he has a stomach, except to know that it is empty. At this time, also, he is apt to essay the manly vices of tobacco and beer, and it is not long before " the general condition of nutrition is deranged ” in his case, and an obstinate, and persistent, and disgusting, and, oftentimes, permanently disfiguring acne is the result.
Girls of the same age are encased in a whalebone cuirass, are told that good, healthy running and playing is hoydenish, savors of the tom-boy, and is highly improper, are allowed to keep late hours, pay no attention to much-needed rest and quiet, and freedom from nervous excitement during menstruation, are permitted to indulge in a diet of confectionery and sweets, almost ad libitum, and soon the girl, too, has “the general conditions of nutrition deranged," and the result is indelibly written on her face in the appearance of an obstinate acne.
Not puberty, then, but the pernicious ways of living in which young people are allowed to establish themselves, are, I believe, mostly responsible for the appearance of acne at this interesting period, and failure to appreciate and recognize this fact often results disastrously to the patient. The anxious youth of either sex is dismissed with the knowledge that it is his age which causes it, and with advancing years he will get over it; so he may, and with a face as badly pitted, as though he had been a victim in an epidemic of small-pox. Acne taken in its incipience is not so intractable a disease as its representation would lead one to expect, and if not absolutely curable in a short time, it can be so controlled as to prevent any permanent disfigurement.
As seventy-three per cent. of these cases suffer with symptoms referable to the alimentary canal, it may be advantageous for us to consider.the character of these digestive troubles. An examination of the cases shows great uniformity in the symptoms, which may be thus enumerated: A large, broad, roundpointed, flat, slimy-coated tongue, marked by the teeth along the border; a flat, metallic or bitter taste in the morning ; feeling of fullness or distress in the stomach after eating, with eructations of gas; this last symptom, whether accompanied with any distress in stomach or not, was one of the most prominent and constant; abdominal flatulence; constipation, both in regard to frequency and character of evacuations. Associated with these are quite often symptoms referable to other parts, but due to these ; such as, a more or less constant headache, located across the forehead and back of the eyes, a relaxed, catarrhal condition of the throat, a feeling of malaise and general indisposition to physical exertion, or, sometimes, a state of great mental irritability. Such is the list, and it is a list as you will readily observe, such as results from chronic wrong habits of eating and drinking and living, rather than from a sudden and temporary indiscretion ; in point of fact, acute indigestion is: not prominent in these cases.
A recognition of the importance of these symptoms immediately points to the line of treatment best calculated to benefit the acne patient. No matter what the especial character of the lesion, whether it is papular, vesicular or pustular, whether it is disseminate, indurated or hypertrophied, if all or any of the symptoms to which I have alluded above are present, direct your medication to their removal, and I can assure you improvment in the leisons upon the skin, in a very large majority of cases will follow. Make your male patients stop tobacco and beer, restrict meat to once a day, direct them if they take tea, coffee or soups, to take them at a moderate temperature, never very hot; to abstain from fried foods, rich gravies, and desserts ; insist on regularity in their times of eating, and slowness in their manner. For the young lady, stop her candies and sweetmeats, denounce the corset or any modification thereof, insist on plenty of out-door exercise and little evening dissipation, plenty of time during the night to sleep, and plenty of soap and water on the face in the morning; regular and systematic gymnastic exercise, not too violent in character, is often of the greatest assistance in these cases.
As regards internal medication, remedies will suggest themselves to you equally as to myself. The general line of remedies used has been the mercurials, nux vom., lycopodium, carbo veg., capsicum, podophyllum, arsen. iod., ferrum iod., hepar, ferri et strych. sulph., calc. phos., calc. iod.and sulphur. The local treatment has for the most part been stimulating by soap frictions, the various sulphur preparations, resorcin, ichthyol, etc. Treatment based upon the lines above indicated has shown 50 per cent. of cures, 42 per cent. of cases showing improvement, and 8 per cent, no improvement whatever.
REFLEX NEUROSES FROM EYE-STRAIN.
BY A. B. NORTON, M.D., NEW YORK. [Read before the Homeopathic Medical Society of the State of New York, Oct. 6, '92.)
It has been my intention for some time to make a study of the various reflex conditions that may originate from certain ocular defects, but, owing to lack of time, have been unable to consider the subject now with that thoroughness which it merits and which I shall hope to give it on some future occasion.
This, then, may be considered as merely a preliminary paper, in which I shall simply detail a few interesting cases that were relieved after correction of the eye-strain, or at least certain
defects of the eyes were found and corrected without remedial or other treatment and the reflex trouble disappeared. Further, these are not detailed to convey the idea that all diseases that flesh is heir to are the result of eye-strain, for I certainly recog. nize the importance of various other organs in the causation of numerous reflex disturbances. It is, however, my purpose to call attention to the fact that the eye may be the disturbing element in various peculiar or obscure cases, in hopes by so doing to incite further study of the eye as a cause of reflex disorders.
CASE I. Mr. L.; age, 26; was referred to me by Dr. R. Oliver Phillips, on Aug. 7, 1890, and gave the following history: Eight years previous his eyes had seemed to trouble him some, and he had then consulted a prominent oculist, who had prescribed glasses, which he says he could not wear with comfort, and in consequence had discontinued their use. Has occasional severe headaches in the temples which he thinks are neuralgic and due to bad teeth. The eyes become tired, with some blurring of the vision, and letters run together on reading for an hour or more. Is very nervous and has frequent twitchings of the face.
Mr. L. had on several occasions disappeared from his home and business for several weeks at a time, without any apparent cause or reason. When again communicating with his family, or found by them, he might be in an entirely different part of the country, at a great distance from his home. On questioning bim as to his doings during his period of absence, or his reasons for going away in this manner, he either could not or would not assign any reason for the same, and claimed to have no knowledge of where he had been or what he had been doing during the interval between the time of leaving and the time of coming to his senses again, when he would communicate with his family, which on some occasions had extended over several weeks.
It was for these peculiar attacks that he consulted Dr. Phillips, who, before commencing any treatment for his case, sent him to me to determine if any possible reflex condition of the eye was creating the disturbance.
Upon examination I found a slight blepharitis. The vision was if in each eye but with a convex 25D. cyl. ax. 90°. the astigmatic lines were made correct, and the vision is but a shade clearer. Under atropine the astigmatism was found to be the same and with iD. of hypermetropia.
On August 19th, convex .25D. cyl. ax. 90°. was prescribed for each eye, to be worn constantly.
I saw or heard nothing more from Mr. L. until June 9, 1892, when he called upon me with his wife to have her eyes examined. He then reported that he had worn his glasses con
stantly, that he had been in better health than ever before, had had no trouble with his head whatever, and had made none of his mysterious disappearances since using his glasses.
Remarks. Mr. L. has thus gone for two years with no trouble whatever, and has received no treatment at any time excepting a .25D. cyl. glass.
CASE 2. S. H.; age, 13; was sent to me by Dr. L. A. Opdyke, who considered the case one of epileptiform seizure, and to whom I am indebted for the following history of the case : “The boy would first complain of an intense nervous condition, head becoming full and dizzy, and he would then soon become unconscious, some twitching and frothing at the mouth, biting the tongue but not severe; the attacks lasting from fifteen to thirty minutes. When over them he was sleepy and entirely ignorant of anything following the dizzy feelings. His stomach would be out of order, and he would feel generally weak and tired out for two or three days afterwards. These attacks came every twenty-eight days for several months, and then every three, and finally every two weeks. We considered the cause to be his stomach at first, but were often at a loss to find any indiscretion in diet; then from over study, as he was a hard student, so took him from school without much benefit, but would say that he read books, and practised music, and used his eyes even more than when in school. He had one or two attacks on the street when shopping with his mother. What did I do for him? Well, everything I ever heard of; after going through the usual and unusual list of homeopathic remedies, I started in on bromides, which I pushed until the rash stopped me, would wait a few days and then try again. Gave him antifebrin, 15 grs. a day, so his lips were slightly blue all the time; this was kept up for two months. Finally, I circumcised him, and thought I had hit it, as he was having them every two weeks, but as the sixth week came around he had another attack, and was soon having them as frequently as ever."
When first seen by me the boy was so extremely nervous and frightened that no satisfactory examination could be made at that time. On January 10th, 1891, he was brought to me again, and after examination under atropine, compound hyperopic astigmatism was found, and the following prescription given for constant use: R+.50D.o+.50D. cyl. ax. 90° 0.D.+1.25D.at .50D. cyl. ax. 90° O.S.
August 4th, 1892, he called again, with the report that he had had no attack whatever from the last date until one week ago, when he had had one attack of much shorter duration than the old ones and of less severity.