Santonin in internal diseases of the eye / by MM. Guepin and Falck.

  • Guépin, Ange Victor, 1805-1873.
Date:
1860
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Licence: Public Domain Mark

Credit: Santonin in internal diseases of the eye / by MM. Guepin and Falck. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    PROGRESS OP MEDICAL SCIENCE. Srlrrlioiis from Jforn'sn Smmials. SANTONIN IN INTERNAL DISEASES OF THE EYE. By MM. GUEPm aud FALCK. Eepekiuno to M. Mai-tini's communication upon this subject (a), M. Gudpin, of Nantes, gives in the present paper ail accoimt of the results of the trials he has himself made Mitn this substance, These trials form part of others different modes of treatment since 1838. Ihese have led him to substitute for bleeding and leeching, cupping glasses, either dry or Avith scai-iffcations. ^ 1A the base of the cranium, the neck, or between the shoulders, and kept on always at least for ten minutes and sometimes for an hour, repeating them also as required He has also almost abandoned the use of the blister and seton at the nape, especially as regards mternal ophthalmias, only retaining hhstermg of the aims. He has also substituted for poiveiless flying blisters to the temples, forehead, and scalp very active and prompt vesicatories consisting of camphorated oil tivo parts, and ammonia one part. They act both as agents of revulsion and resolution, tlmough'the absorp- tion of ammonia. He has also employed frictions -nitli the various preparations of iodine and ammonia applied to the temples, forehead, and upper eyelids. Without proscribmg mercurials, he has much restricted them emplov- meiit, joiiung with them, when used, the allialine chorides and lodhydrate of ammonia, and taking care to expel them afterwai'ds from the economy. The narcotics, such as atropia and morphia, he has always largely employed By these methods he believes he has procui-ed arrest of progress, and even amelioration, in cataract. In pursuit of the vai'ious other means of modifying the endosmosis and capfllarv circulation of the tissues of the eye, the author has submitted santonm to an extensive trial in internal ophthalmias. San- tonin, m the author’s words, is a “ photographic ” substance which changes to a yellow colour under the action of the sun and in the interior of the economy, constantly renderino- the retma yeUow. Of about 100 persons, 3 only exhibit?d no modification in their vision, and one-half of the number per- ceived objects yellow for a short time only, about an hour after takmg the santonin. In the others the vision was more decidedly yeUow, and lasted so for a longer period. In one only it continued so for nearly twelve days after leaving off the santonm. In regaid to the therapeutical action of the substance, given to the extent of six grains divided into two doses, mornmg and evenmg, it exerts a tolerably power- ful action on the choroid and iris. In several patients who had been cured of iritis, but with exudations remaining, it ga^e rise to greater disposition to vomiting, or at least to nausea ; whUe, in affections of the choroid, it reproduced the choroidean pains of the head, which etre often confounded with craiual neuralgia. This has necessitated prudence, and has limited the number of cases in which the trials have been made. In general, after the first, or at most after the second dose, the urme has remained yellow', the vision being much less rapidly and less permanently modified. The action of the substance is in no wise proportioned to the doses given. The author interrupts the administration at the tenth dose, resuming it in a week or a fortnight, and goes on in the same manner for a second or thii-d administration. The action of the santonin appears in many cases to be proportionate to its effects on the vision; but, in other cases, no such relation can be observed. In the subacute stage of iritis, it is often useful, and that when there has not been the least sensible anatomical modification in the condition of the eye produced. In other cases a partial detachment of exudations, which, until then, had resisted, takes place; sometimes amelioration is pro- duced in the one eye, while the other gets worse without pain, the second eye improving, however, when other medicinal agents are combined with the santonin. Li irido- choroiditis the same results are obtained. In acute choroid- itis, which has been cured, but noth a great reduction of visual power, and with exudations of variable extent santonin may exert a favourable action, and may prevent the (a) Medical Tmes and Gazette, April 28, p. 427, formation of consecutive catai’act. But wliile the subjective phenomena undergo a most favourable change, the objective continue very much the same ; still, as M. Gudpiii observes, the attainment of a subjective amelioration in these cases, or in cataract, is a very important matter. In retino-choroidean ; amaurosis with exudations, M. Gu6pin does not think very highly of the remedy. He has employed it when there have been slight amaurotic pupillary dilatation, diplopia, and partial resorption of pigment as a consequence of retino- choroidean congestion, using cupping of the neck actively at the same time. Tinder these circumstances there has been but slight visual coloration of objects from the use of the medicine. To sum up,—santonin given to the extent of thii ty grains, divided into ten doses to be talcen in five days, produces good effects in the later stages of iritis, irido- choroiditis, and choroiditis with plastic exudation, when the inflammatory condition no longer persists. In other diseases of the eye, the results have been either negative, trifling, or mischievous. It very w'ell admits of combination -with atropia and the alteratives and resolvents of use in diseases of the eye, and it w’ill be found of service providing iridian and choroidean amaurosis, accompanied by exudations, be not confounded w'ith other descriptions of amaurosis. Professor Falck, of Marbui-g, in relation to Dr. Martini’s observations, gives an account of a series of experiments upon the action of santonin, and “ santonin-soda,” instituted by himself and Dr. Manns, one of his pupils. The santonin was injected into the veins, or under the skin of animals, or was introduced into the stomach. The following are some of the conclusions which he di’aws from the consideration of the results of these experiments, and from a review of all the other publications which have taken place upon the subject: 1. Santonin, and santonin-soda (prepared by boiling together equal weights of santonin, crystallised carbonate of soda and w'ater), are two poisons undoubtedly possessed of medi- cinal qualities. 2. The direct introduction of a solution of santonin in w'eak spirit in a moderate quantity rapidly inducee the death of the animal. 3. The santonin, and santonin-soda gain access to the blood when introduced under the cellular tissue, or into the stomach. 4. Under conditions, not as yet W’ell ascertained, the santonin, and especially the santonin- soda, is transformed wholly, or in part, in the economy into a material which is discharged w’ith the urine, and is detectible in the latter by means of caustic alkalis, which immediately redden the urine. This substance the author provisionally terms Xantkopsin. 5. This conversion of santonin into xan- thopsin takes place, under certain conditions, in a very short time, while the elimination may be long continued. In one experiment the elimination commenced in thirty minutes; and in another, in w’hich no large quantity of santonin was introduced, it continued during sixty hours. 6. Under the influence of santonin the urine soon assumes a peculiar yellow colour, dependent upon the same material, w'hichis converted into a red colour by the action of the caustic alkalis. 7. After the evaporation of urine contaminated W’ith santonin, the red colour ceases to be produced on the application of caustic alkalis. 8. As under the influence of santonin saffron-coloiu’ed mine is excreted, this may assume a red colour' in consequence of the extrication of ammonia by the decomposition of the mea, or if alkalis are administered, with the santonin. Tliis position is not, however, a result of direct experiment, but merely an inference. 9. Santonm exerts on,the brain and visual organs a remarkable influence, inducing Ian incoherence of idea and chromatopsy. For the production of the latter large doses ai*e ahvays required. 10. The production of eliromatopsy is in close connexion Avith that of xjlnthopsin. The more xanthopsin mingled with the blood, the more marked is the chromatopsy, II. A direct introduction of a watery solution of santonin-soda into the eye does not induce chi'omatopsy. 12. The symptoms of poisoning by santonin vaiy much according to differences in proportions and conditions. Convulsions have almost always preceded the fatal results.—Comptes Rendus, tome 1. No. 17. Bulletin de Therapeutiquet tome Iviii. pp, 600-505-, and Deutsche Klinik, Nos. 27 and 28. CASES OF SUDDEN BIRTH, WITH DROPPING OF THE CHILD. Dr. Olshausen related some cases of this description to the Berlin Obstetrical Society. 1. Rosalie D., aged 23, aprimi. para, came to the Lying-in Establishment, e^ter ha-\dng had