medicinal treatment, and especially all chronic and recurrent cases like red and crusted lids, and styes. In order to get some definite data the writer has looked over 100 consecutive cases of eye strain. Patients over 36 years of age were not considered, and only those cases counted where consultation was had on account of headache, pain in eyes, or some well recognized symptom of strain. Of the 100 cases thus considered 36 had normal visual acuity; 14 had .9 normal visual acuity; 50 had reduced visual acuity. A majority of the 14 had normal visual acuity in one eye, so that it would be fair to say that in nearly one-half of the cases the acuity test would not have suggested the diagnosis. It might, on the other hand, have been really misleading if one did not appreciate fully that strain is entirely indepenIdent of the amount one sees. It may be that a large number of cases might show somewhat different results, but as the purpose of this paper is not so much to give exact percentages as to establish the fact, it seems fair to conclude that eye strain is just as liable to exist if the patient pos sesses good vision as when the sight is poor. THE LOCAL USE OF ARSENIC IN MALIGNANT BY GEORGE L. VAN DEURSEN, M. D., LOWELL, MASS. In our present age of brilliant surgical work, where the skilful operators may be counted by the score, instead of marking here and there a solitary individual who has achieved distinction in this direction, we are many times inclined to call in the services of the knife in conditions where the proper medicinal treatment would give more permanent if less immediate results. In malignant growths of the epithelial class, Epitheliomas, Carcinomas, etc., where they come to us sufficiently early to permit of their complete excission, the operative treatment is generally advisable; but in that large number of cases where the patients consider their trouble as only a simple matter, till ulceration is far advanced and the surrounding tissue deeply infiltrated with the growth, or in case of recurrence after removal, we must look to medicine rather than to surgical interference. In the use of arsenic in these conditions I have nothing to present which is either original or novel. You are all familiar with the general therapeutic action of the remedy and with its specific action on the skin. My only excuse for this paper is to recall the method of employment introduced and advocated by one of the most careful observers of our school (I refer to Dr. J. S. Mitchell, of Chicago), and to record several cases which have been successfully treated by that method. Dr. Mitchell is not the pioneer in the local use of arsenic, nor does he claim any such position, for the drug has been used in pastes and powders since the beginning of the practice of medicine. His only claim to originality is in "the use externally of homoeopathic triturations of sufficient power to cause disintegrating effects, combined with continuous internal medication." The relation existing between arsenic and various forms of epithelial hyperplasia, malignant ulceration and tubercle formation has been understood and noted by writers of all schools of practice, but it has remained for the fathers of our own school to properly interpret this relationship and to apply the remedy according to the law of similars, where properly indicated, Whether the continuous use of arsenic will produce true cancer, as has been claimed by some eminent old school authorities, is not essential, but the provings of the drug show unmistakably the tendency to ulceration and gangrenous sloughing, accompanied by the intense stabbing, burning pains which characterize carcinomata and kindred growths. In addition to this intense action of the drug we have the milder manifestations seen in the waxy parchment like skin, so closely simulating the late cancerous cachexia, and the dry, scaling, itching eruptions with which we are all familiar. Allen, in his "Handbook of Materia Medica," says: "Arsenic is above all a tissue drug, ranking with phos. and antimony. An irritant poison . . . the skin is irritated, and violent itching and burning are followed by eruptions and finally ulceration. Glandular action is first excited then diminished." In studying the symptomatology of the drug we find, "Skin white and pasty, or dark and livid, dry and rough. Eruptions around the mouth, burning and painful, itching, worse from scratching. Red herpetic eruptions around the mouth. Ulcers on face with burning pain. Fleshy excressences spring from ulcers, soon became gangrenous. Ulcers with thin bloody pus coming from under thin scab. Indurations and tumors becoming ulcerative." Farrington, in his wonderfully written "Clinical Materia Medica," tells us that arsenic alters the blood. It is useful in low types of disease when blood changes are serious. The inflammations of this remedy are characterized by their intensity and by the tendency to the destruction of tissue. In these local inflammations of ars. you will find burning, lancinating pains the characteristic sensations. It tends to produce induration or hardening of the skin, rendering it a valuable remedy where there is thickening of the skin with copious scaling." With such authorities before us the homoeopathic use of the drug in these cancerous conditions is readily understood. It is not necessary at this time to go into any of the various theories in regard to the cause of epithelial growths; the fact which does concern us is that there are certain new growths springing from embryonic tissue, developing to a certain point, then undergoing retrograde changes instead of going on to full development. In the treatment of these growths many methods have had their advocates the knife, chemical or actual cautery, pastes, ointments, internal and external medication. In many cases of primary growths where the affection is well localized, a clean incision, involving sufficient of the healthy tissue to preclude the probability of recurrence, may be effective; but even then the constitutional condition needs correction by proper medication. The actual cautery and the stronger caustics are extremely painful, they involve a large area of healthy tissue in connection with the growth, and their employment does not prevent recurrence. The caustic pastes are open to the same objections and the irritation produced by them in many cases causes the growths to take on a new activity. Electricity in its various forms has been used to a greater or less extent, but its practical utility has not been fully demonstrated. The method to which I wish to call your attention, and with which many of you are no doubt familiar, is the use of a homœopathic trituration of arsenic, giving the 3x internally, usually about three times a day, and applying the 2x locally, three to six times a week according to the conditions. It is advisable to cleanse the surface thoroughly with peroxyde of hydrogen, then apply carbolized linseed oil freely over the raw surface and dust on the 2x trit., covering all ulcerating tissue. The carbolized oil is a preparation of one part pure carbolic acid in twenty parts linseed oil. It is recommended by Dr. Mitchell for cleansing and disinfecting purposes and helps hold the powder in place. In places where an outside dressing is required, after dusting on the powder cover with a layer of gauze, moistened with carbolized oil, and over this a layer of absorbent. cotton held in place by adhesive straps. Dr. Mitchell speaks of the use of hoang. nan, chloride of chromium, and other remedies to assist the action of the arsenic in some cases, but in the following cases it was not necessary to call on any of these supplementary agents. Case I. W. T. Expressman. When first seen was suffering with an epithelioma of the right side of the lower lip. It was a typical "smoker's cancer," having undoubtedly been caused by the irritation of the heated clay pipe held constantly in the one position. He came under observation the first week in January, 1894. At that time the growth involved nearly one-half of the lower lip, the ulceration exposing an area as large as a quarter of a dollar, and the surrounding induration caused a thickening of the lip to at least five-eighths of an inch. The sanious discharge had been weeping down over the chin, setting up a severe irritation and threatening a general spreading of the condition. The ulcerating surface was at once cleansed with peroxyde of hydrogen followed by a thorough application of carbolized linseed oil and a free dusting with ars. 2x trit. As the ulceration extended over on to the inside of the lip, pieces of cotton saturated with peroxyde were placed between the lip and teeth to prevent the irritation from the teeth and to keep the surfaces as clean as possible. These were renewed several times a day as conditions required. Internally he was given tablets of ars. 3x tid., and was furnished with a vial of the carbolized oil and another of the 2x trit. with instructions for its local use at home. He reported at the end of a week, at which time the growth showed noticeable improvement. It was again cleaned carefully with the peroxyde of hydrogen and the oil and ars. applied as before. He was seen twice after this at periods of two weeks; improvement was marked at each time and he was discharged, cured, the latter part of February, having been under treatment, practically, two months. He was given another vial of the tablets and continued taking one every day for about a month. The growth was entirely removed, |