On Nov.29, 1933, a child of seven years, apparently normal in every respect except for the ocular defect, was presented to me,. after a well known local clinic had prescribed surgical interference as the only hope for cure. About two months previous to consulting me, the family of the child noticed that the left eyeball failed to rotate outward, while the right orbit went through its normal range of motion in all directions. The only sickness the child had had in the past was measles, recent history was negative; careful inquiry convinced me that the child had not had a sore throat recently; certainly there could not have been a pharyngeal diphtheria.
On attempting to look to the left, with the head held stationary, it was noticed that the left eye failed entirely to move in that direction, so that while the right eye turned to the left, the left eye remained looking forward. The motion of both eyes was normal in every other respect. The only complaint of the child was diplopia.
On studying the materia medica, two remedies stand out preeminently, namely Gelsemium which produces a paralysis of the abducent nerve, Gelsemium which supplies the lateral rectus muscle whose function it is to rotate the eyeball in an outward direction; and Causticum which has double vision with inability to turn the left eye laterally”. Both remedies, then, cause paralysis of the abducent nerve.
Gelsemium is useful in paralysis, especially when affecting single groups of muscles, especially about the eye, mouth, throat and larynx, also the muscles of the extremities and those of the sphincters. It is the most useful remedy in post diphtheritic paralysis, the tongue, throat and larynx being chiefly involved.
As in Causticum, these paralytic conditions may come on after fright or emotional excitement in any form. In children the paralysis of a part may be a sequel to severe scolding. Causticum, too, finds its most important clinical use in the treatment of paralytic conditions of single parts; when the glosso-pharyngeal muscles are involved there is difficult deglutition; paralysis of the lips tongue and larynx causes difficult speech; enuresis follows paralysis of the sphincter of the bladder. Facial paralysis, especially when involving the upper lids, and due to exposure to cold, dry winds, often calls for Causticum; rheumatic and post-diphtheritic paralysis are often cured by this remedy.
Causticum was chosen as the similimum in this cases for two reasons:.
(1) “Diplopia with inability to turn the left eye outward,” fits exactly the condition of the patient, and shows the specific action of the remedy on the left rectus lateralis.
(Gelsemium, though it produces paralysis of the abducent nerve, with consequent paralysis of the external rectus, has no such specific left sided action.).
(2) There is a strong sycotic taint in the mainly of this child, showing itself externally in the warty growths on the hands of three of the members. The child himself had no warts.
On No.30, 1933, Causticum in the 1M. potency was given, improvement in the eye began after a week and progressed; on Jan.11. the left eye was normal in every respect.
This case demonstrates clearly the action of a remedy on a single, isolated part; it has reached that part through its permeation of the vital energy, and having set that force in order, the external manifestation of its disturbance, in this case the paralysis, must disappear.
How much would have been lost to this child if surgery had been allowed to play its part. It is true that there would be a mechanical correction, but the internal causes of the disorder remain unchanged. Has not the sycotic miasm been here strongly attacked? Is it not reasonable to believe that there has been a safeguarding of the childs future life and health by decreasing, if not entirely eradicating the hereditary force of sycosis, slumbering, beyond doubt, in his being? NEW HAVEN, CONN.
DISCUSSION.
DR.BOGER:Harking back to the other paper, those that belong to the Kali group are very interesting as I had occasion to know lately. A man came to me with 4 per cent sugar in his urine and most of the rest of his symptoms consisted of partial paralysis of the left upper eyelid. The other symptoms fitted in pretty well and I gave a single dose of Kali phosphoricum, and six weeks afterward no sugar had appeared in the urine. At the end of six weeks, he had a slight return of the paralytic symptom but no return of sugar; I repeated the dose, and since then he has been well, and has no sugar.
