On the Action of Very Dilute Solutions of Eserine, and their use in the Treatment of Weakness of the Ciliary Muscle

J. C. Uhthoff
1883 BMJ (Clinical Research Edition)  
Juy 7, 1883.] THBE BRBITISE MEDICAL JZOURNAL. 5 by a river of considerable size-one of those numerous rivers arising in the noble Drakensberg close by, and which intersect the colony so plentifully. A rest of three weeks or so, awaiting orders to resume march from Sir T. Shepstone, was useful; and then the force set out for Pretoria, distant about two hundred and twenty miles. For the first thirty, the country traversed presented a series of mountaini-spurs, each ravine having its
more » ... m fresh from the hills on the left. It is quite possible that, had a microscopic examination of the water been made, algae and diatomes could have been discovered; but, as Professor De Chaumont says: "To condemn water on account of the presence of these living creatures, would be really to condemn all water, even rain." They may, therefore, be said to have contained pure water. Soon, however, this hilly country ceased, and a flat uninteresting plain took its place; a few stagnant pools supplanted the beautiful running mountain streams, and precautions had to be taken to prevent the men from using them. This was not difficult, as they did not suffer greatly from thirst. Night marching was resorted to; the men carried their rifles and ammunition only, and hourly halts were called. The result was little or no sickness, except the usual abrasions and excoriations. Diarrhcea was almost unknown, and sunstroke absolutely so. Even on this high flat plain -3,000 feet above the level of the sea-one of those mountainstreamns was met with about every ten miles, when the men coulcl dritnk their full with impunity, and replenish their water-bottles. I cannot imnagine campaigning under more favourable circumstances. Tihe heat certainly was great at mid-day in the bell-tents; but the nights were cool-so cool, in fact, that I often marched on foot in preference to riding. A fortnight sufficed to cover the two hundred and twenty miles, and Pretoria was reached on May 4th, 1877. Our camp was pitched above and on a higher level than the town, and had running through it a clear mountain-stream, contamination being out of the question; the sanitary state of the camp and neighbourhood receiving special attention. We arrived at Pretoria on May 4th. On the 14th of the same month, there were nine cases of enteric fever in hospital, and two officers down with it, and this in a force of a thousand men all told. That it was enteric fever I will answer for, for I made post mnortem examinations on all fatal cases with a small bush-knife; ancd the truth of the diagnosis was demornstrated by the condition of thlC small intestines, which were extensively attacked by the characteristiculcerations. Itwas a suiddenoutbreack,andas suddenlyceased, but the cases were numerous enotugh in proportion to warrant the application of the termn epiderm-ic to it. Some positively affirm that for the production of cateric fever a specific agent must be present, and that common fiecal matter may produce diarrhlla, even of a febrile character, but not enlteric fever. If this be correct, whence did the specific agent come in this case? The Transvaal had only been inhabited by Boers for a quarter of a century, and, as far I know, enteric fever was unknown arrmong them. It comes to this, then either there was a specific germ carried withl the troops from one knows not wlhere, awaiting certain favourable circumstances for its growthl, in wlich case this germ would be virtually everlasting, indestructible, capable of retaining vitality under almost any and every circumnstance, in air, clotlhes, etc., capable of conveyance any distance an(d in any climate; or, there is no special germ producing enteric fever, but producingvaried forms of fever wvith enteric complicationis, wvhich fevers can be produced without specific agents, provided certain elements are in force dependent upon, and inseparable from, campaigning in tropical zones, or under somewhat similar states wlhen ani individual gocs frorn a hometoa tropical climate. We will now lookatthe enteriefeverwhichaccompaniied the Zulu war. It must be remembered that the men forming this force (twenty-five thousandl strong) came out straight from Englandl. Operations were carried on in a comparatively young country, so far as European residents were concerned, and( a persistence of this fever was not ascertained. Wlhetnce did the specific germ come from in this case? The large force was dlivided into several columns, one as Lower Tugela, one at Ilelpmakaar, and another at Utrecht. In all these columns, enteric fever showed itself; yet tlhcy were totallyseparatefrom onrcanother, and thelittlecommunicationbetween them that did exist was of the imnost indir'ect and roundabout formn. Again, cases occurre(d at MIaritzburg; men were left behind just after landing, before the p )ison, if it hadl been absorbed in the country, could have hbad time to (levelop. Others, again, were attacked after a lengthenedl life in tents, when thev came back into the towns and took up their resi(lenice. Ilow is this accounted for, if the specific agent theory be correct, or arnenable to modern views s Rather was it not, as has been suggested by others, that " the altered circumstances under which the men lived led to an excessive phy-siological actioni, showing itself primarily on the intestines, and, overstepping the bounds of health, became pathological, expending its force in the form of a fever with the above manifestations 1" The water in this case could hardly be blamed, for it was practically pure. True, the streams before reaching us had to pass through a few Kafir villages, for it follows that they must live near this commodity as well as other people; still, I venture to repeat, that they are as cleanly in their habits, and as refined in their tastes, according to their liglts, as the most refined civilian of the day. Contamination, therefore, was unlikely from them, even supposing, for the sake of argument, that faecal matter could produce enteric fever. In my notes on this fever made at the time, I find my impression then was that the epidemic was caused by drinking stagnant water. Subsequent experienice has led ine to doubt this impression, for it is very doubtful if much stagnant water was used by the men, even if it could have produced true enteric fever. It comes to this: either the germs, if this theory be entertained, were carried from afar, or it is not necessary to have the presence of a specific poison to produce a fever, under special circumstances, manifesting intestinal complications. Here was an epidemic of enteric fever with pure water and fairly good sanitation. In Egypt, we also get it with impure water, but with other conditions similar. One thing was common to both: service under canlvas, in a tropical or subtropical climate, under altered conditions from those in force in the native country of the men employed. hlas the water so much to answer for? Are tlhere not other and important factors at work producing similar results, an(d with equally fatal force ? I offer no opinion, but ask others to make their own deductions. Surgeon to the Sussex Eye lIospital. SOLUTIONS of tho extract of Calabar bean,/or of its active principle eserine, have for some years been used for the purpose of contracting the pupil or stimulating the ciliary muscle; but, as far as I can ascertain, these solutions have always been of a strength far greater than that of those, the use of which it is the object of this paper to advocate. Apparently, also, they have been recommended only in cases of decided paralysis of the pupil or the accommodation. 'I'wo important papers oni the subject lhave been published. The first was reac by Dr. Argyll Robertson before the Edinburgh Medico-Chirurgical Society in February 1863, when the use of solutions of the extract of Calabar bean vas first recommended for cases of weakness or paralysis of the ciliary muscle. The second was by the late Mr. Soelberg, Wells, in the Medical Times and Gazette for Mav 16th, 1863, recounting the effect on the pupil and accommodation of a strong solution of the -extract .(one minim corresponding to four grains of the bean; I may here mention that the yield of eserine is uncertain, so that the relative strength of it and the extract of the bean must be reckoned by the results of their application). Experiments were made ulpoil Mr. Bowman, who graphically relates his own experience, and upon a patient with paralysis of the ciliary muiscle and iris. Irregular and somnewhat painful spasms of the muscle commenced after ten m-ninutes, and continued for some hours, causing the nearer approaclh of both far and near points of vision. In Mr. Bowman's case, the pupil remained fully contracted for eighteen hours, and did lnot return to its normal size for three days. Attempts to use the eye while the drug was in full action caused much distress and paini in thc eyeball. M%r. Wells ends his paper with the followinig remarks: " My nexit experiment will be to test the curative influence of the Calabar bean upon paralysis of the pupil and acconmmodlation; and( to ascertain whethler we cannot succced, by periodic applications of a ver-y weak solution of thec bean, in exciting the sphincter pupilke and ciliary muscle to gentle contraction, without fatiguing and weakening them by over-stimulation." Accordingly, on reference to thie last eclition of his work on Dsseases of the fye (1873), I find that he relates his experience of the drug applied in cases of ciliary paralysis. But 1-he seems to have used comparatively strong solutions, for he says that the drug should be applied of " a strength sufficient to cause considerable contraction of the pupil, and should be used at intervals of several days." Mr. Nettleship, in the appendix to his work on Diseases of the 24y,
doi:10.1136/bmj.2.1175.5 fatcat:qz676pt6rnhanlsitwaozg25me