AMBLYOPIA 
FROM THE 
ABUSE OF TOBACCO AND ALCOHOL 
A CLINICAL PAPER BASED UPON CASES IN THE 
PRACTICE OF 
C. R. AGNEW, M.D., and DAVID WEBSTER, M.D, 
[Head before the Medical Society of the County of New Yopk, NWvfm- 
ber 29, 1880.] 
By DAVID WEBSTER M.D.. 
Reprinted from The Medical Record, December 11, 1880. 
NEW YORK: 
TROW’S PRINTING AND BOOKBINDING CO., 
201-213 East 12th Stbeet. 
1880. AMBLYOPIA 
FROM THE 
ABUSE OF TOBACCO AND ALCOHOL 
A CLINICAL PAPER BASED UPON CASES IN THE 
PRACTICE OF 
C. R. AGNEW, M.D., and DAVID WEBSTER, M.D. 
[Read before the Medical Society of the County of New York, Novem- 
ber 29, 1880.] 
DAVID WEBSTER, M.D., 
Reprinted from The Medical Record, December 11, 1880. 
NEW YORK: 
TROW’S PRINTING AND BOOKBINDING CO., 
201-213 East 12th Street. 
1880. AMBLYOPIA FROM THE ABUSE OF 
TOBACCO AND ALCOHOL. 
Mr. President and Gentlemen—In coming before you 
this evening with some remarks upon the amblyopia 
or impairment of vision, which arises from the abuse 
of alcohol and tobacco, I believe I have selected a 
subject which will prove to be of interest to the 
general practitioner as well as to the specialist. 
Probably every physician has to deal with the poi- 
sonous effects upon the nervous system of alcohol 
and tobacco in one form or another. And, I think, 
the careful medical man, when called to a case of 
chronic disease in the adult male, and even in some 
cases of acute trouble, rarely omits to inquire into his 
habits as regards the use of tobacco and spirits, and 
often finds it necessary to regulate, or to forbid en- 
tirely the use of these drugs. 
That the abuse of alcohol alone, or of alcohol and 
tobacco combined, may produce impairment of vi- 
sion, ranging all the way from the slightest blur- 
ring to total blindness, no physician acquainted with 
the subject will, I think, venture to deny. 
Some, however, doubt that tobacco alone ever 
causes impairment of vision. And indeed it is dif- 
ficult to demonstrate, beyond all controversy, that it 
ever does. Such cases seem to occur very infre- 
quently in this country, and when we meet with one of 
them we often find it very difficult to exclude all other 
causes of amblyopia. Take, for instance, the case of 
J. A. (No. XII. of the cases herewith presented). He 
was sixty years of age, and had smoked a strong pipe 
most of the time when awake, for over forty years. 
He had rarely tasted liquor. He had never had 
syphilis nor malarial disease. In short, no other 
probable cause could be found for his impairment of 4 
vision than his being perpetually subjected to the 
poisonous influences of his pipe. On the other hand, 
how often do we meet with cases of amblyopia for 
which we can find no probable cause ! May this case 
not have really belonged to that category, and the 
excessive use of tobacco merely a coincidence ? We 
think the sequel goes to prove that it was really a 
case of tobacco amblyopia. The patient’s tobacco 
was cut off, and, at the end of a week, without any 
treatment or medication, his sight had doubled it- 
self in one eye and nearly doubled itself in the other. 
Dr. Edward T. Ely, of this city, recently examined 
the eyes and tested the vision of 102 workers in to- 
bacco, chiefly cigar-makers. The doctor sums up 
his results in the following words: “My own im- 
pressions, gathered from these examinations as well 
as from other experience, are, that tobacco has of 
itself only a comparatively slight influence in im- 
pairing the vision ; that -working in tobacco is as 
healthful as most other sedentary occupations ; that 
in certain persons peculiarly susceptible to it, or, 
when combined with other noxious influences, it may 
impair the vision or the general health, just as has 
been claimed for it; and that constant contact with 
it, as with other poisons, may beget a tolerance of it 
sufficient to contradict all theory.” The doctor also 
says, and, I think, correctly: “A tobacco ambly- 
opia is mentioned in all modern text-books on the 
eye, and most ophthalmologists believe in it, and on 
good and sufficient evidence, so far as we can judge.” 
Mr. Jonathan Hutchinson, of London, seems to 
have no doubt of the effect of tobacco in producing 
amblyopia. In the Ophthalmic Hospital reports, 
vol. vii., he publishes twenty-nine cases that have 
come under his care. Of these cases he says : “ For 
myself, I may briefly avow that I have scrupulously 
investigated other possible causes, and that I feel no 
hesitation in believing that in most of these cases 
tobacco is the real one.” In two of Mr. Hutchinson’s 
cases there was white atrophy of both optic disks 
with total blindness. In one case the disks were 
very white and the patient had only perception of 
light. The other cases had vision ranging from per- 5 
ception of light to two-thirds the normal. Mr. H. 
states in this article that he has long held the opin- 
ion “ that when tobacco causes blindness it does so 
in virtue of an idiosyncrasy,” and that “it is by no 
means improbable that such idiosyncrasy will be 
found occasionally in several members of the same 
family.” 
As regards such family idiosyncrasies, I have seen 
several instances of optic nerve atrophy occurring in 
adult males who were brothers, but, in these cases, 
the disease could not be attributed to the use of to- 
bacco, nor could any very probable cause be assigned. 
In vol. viii. (ibid.) Mr. H. publishes tables con- 
taining the “ facts as to progress” in sixty-four cases 
of tobacco amaurosis. ‘ ‘ Recovery or great improve- 
ment took place in seventy-five per cent. In four 
cases the disease was arrested, sight remaining sta- 
tionary after a certain degree of failure. In seven 
cases sight became worse while under care, and five 
others were quite blind when first seen, and are be- 
lieved to have continued so.” 
The fact that so careful and so competent an ob- 
server as Mr. Hutchinson has made a diagnosis of 
tobacco amaurosis in so large a number of cases is, 
of itself, one of the strongest of arguments in favor 
of the existence of such a disease. At the same time, 
it would appear that it is met with much more fre- 
quently in England than in any other country. This, 
according to Mr. Hutchinson, seems to be accounted 
for by the fact that the poorer classes of English- 
men usually smoke a kind of tobacco called shag, one 
of the strongest and worst of its forms. 
As regards the ophthalmoscopic appearances found 
in amblyopia from alcohol and tobacco, I think all 
ophthalmologists will agree that “ there is no spe- 
cial lesion of the fundus of the eye that would at once 
enable one to diagnosticate the nature of the disease 
as depending upon the excessive use of alcohol or 
tobacco.” 
Before making a diagnosis of amblyopia from to- 
bacco and alcohol, we must get in all the facts which 
go to make up the case—the clinical history, the 
symptoms, subjective and objective, the various 6 
complications, the habits of the patient, as well as 
the ophthalmoscopic appearances. 
I must confess, however, that when a man comes 
to me on account of failing vision, and I find the 
characteristic “ chloroform odor” on his breath, and 
the scent of tobacco issuing from every pore of his 
skin—a condition which is quickly appreciated while 
making an ophthalmoscopic examination by the di- 
rect method—I at once suspect that I have discov- 
ered the cause of his affection, and am only likely to 
have my opinion changed by positive evidence, oph- 
tlialmoscopically, or otherwise. For instance, if I 
found such a patient had choroidal atrophy, or choked 
disk, or incipient cataract. I would hardly refer these 
to alcohol and tobacco as a cause. 
The ophthalmoscopic appearances in this disease 
are, however, within a certain range, quite constant, 
and are always referable to the optic neiwe and re- 
tina. When seen in its earlier stages, there are the 
appearances of a low grade of neuritis, or, at least, 
of hyperaemia of the optic disk. Later on, there are 
appearances of incipient optic-nerve atrophy. 
In the cases herewith presented, the ophthalmo- 
scopic lesion most frequently noted was “ incipient 
atrophy of optic nerves.” This was noted in seven 
cases out of the twenty. In two cases, “ optic disks 
too pale;” in two cases, “ optic-disks of a dirty, 
brick-dust color ; ” in two cases, “ nasal half of disk 
too red and temporal half too white; ” in one case, 
“ disks too pale, and white bands by the sides of some 
of the retinal vessels,” showing the existence of a 
perivasculitis. 
In some cases, not well enough recorded to be in- 
cluded in this paper, we find it noted : “Fundushas 
a smirched, dirty look, but no lesion,” or, “ smirched 
condition of optic disks ; surface of disks red and 
outline seen with difficulty, yet an abnormal white- 
ness shining through from beneath the surface ; ve- 
nous pulsation.” Of course, it is only possible for 
those skilled in the use of the ophthalmoscope to 
appreciate these nice distinctions in the ophthalmo- 
scopic appearances, but the physician will readily 
understand us when we say that they all refer to dif- 7 
ferent degrees of vascularity, of inflammation or 
atrophy of the optic nerve and retina. 
In eighteen of the cases herewith presented, both 
alcohol and tobacco were used in excess ; in one case 
tobacco was used excessively, from ten to fifteen 
strong cigars daily for ten years, and alcohol mod- 
erately, only an occasional glass of gin being taken ; 
and in one case, as before stated, the amblyopia 
seemed to be wholly due to the abuse of tobacco. 
In this case the vision rose from to 7 0 in each 
eye, the patient abstaining from tobacco, and being 
subjected to appropriate treatment. 
In some of these cases we omitted to note the 
length of time during which the patient had been ad- 
dicted to the habitual use of spirits and tobacco ; but 
in most of the cases it was many years—in one case ten, 
in one case thirty-eight, and in one case forty years. 
The time that had transpired since the patient 
first noticed impairment of vision varied from three 
weeks to over a year. 
In nearly all the cases the impairment of sight had 
been gradual, although in one case it had been ush- 
ered in suddenly “ after prolonged exposure of the 
eyes to glare on the water.” In this case, however, 
the sight continued to deteriorate gradually after the 
first onset of the disease. In all the cases there was 
simultaneous decay of vision in both eyes. In nine 
cases, or in nearly fifty per cent., the amount of im- 
pairment was exactly the same in both eyes. The 
greatest difference of vision in the two eyes of any 
one patient was where one eye had vision and the 
other -^oV 
In several cases it may be doubted whether the 
impairment of vision was wholly due to alcohol- and 
tobacco-poisoning. Several of the patients had been 
subjects of malaria ; one said that his sight began to 
fail during an attack of “ bilious diarrhoea; ” one 
had had syphilis, but there was no evidence of any 
syphilitic disease of his eyes, and on the other 
hand he was habitually saturated with spirits and 
tobacco, and recovered his vision when these were 
cut off, and he had been under treatment for a few 
weeks. 8 
The patients were all men, their ages ranging from 
thirty to sixty. Two were physicians, two were gen- 
tlemen of leisure, one a sea-captain, one a lawyer, 
one a merchant, one clerk, one speculator, one auc- 
tioneer, one machinist, one equestrian, one mechanic, 
one watchman, one coachman, and one laborer. 
About one-half the number were married and the 
other half bachelors. 
In all of these cases, or nearly all, the treatment 
by hypodermic injections of strychnia was pursued, 
and generally with great apparent benefit. Our rou- 
tine method of using the strychnia is this : We have 
put up, at a reliable apothecary’s, four grains of ni- 
trate of strychnia in an ounce of distilled water. Each 
minim of this solution contains one one-hundred- 
and-twentieth of a grain of nitrate of strychnia. We 
usually begin by injecting into the subcutaneous 
cellular tissue three minims of this solution, or one- 
fortieth of a grain of the drug. We then increase the 
amount injected by one minim daily, giving one in- 
jection a day until some of the physiological effects 
of the drug have been produced. 
. The most frequent of these we have found to be a 
kind of stiffening of the legs with a tendency to 
“kick out ” in an irregular manner. We have usually 
kept the patient sitting for fifteen or twenty minutes 
after the injection, in order to observe the effect. 
Frequently the first symptom of any effect upon the 
system would be this uncontrollable tendency to step 
higher, or to one side, or in some direction not in 
accordance with the wishes of the patient while go- 
ing down-stairs to go out. At the same time stiffness 
of the muscles of the thighs would be complained of, 
and sometimes slight spasmodic twitchings, or rigid- 
ity, of the muscles of the jaws or other muscles 
would be observed. The next most frequent symptom 
was vertigo, and sometimes headache. I remember 
that one man, who lived in Williamsburg, was at- 
tacked with a sudden dizziness, and fell down on the 
sidewalk when he had nearly reached his home. He 
soon recovered his self-control, however, and reached 
home without assistance. In a very few cases “ little 
knotty pains ” in the bowels were complained of, just 9 
such pains as I have heard some persons say they 
experienced from drinking lager beer. 
I may say, however, that although we have been 
using nitrate of strychnia hypodermically for over 
eight' years, and often in three or four different pa- 
tients a day, we have never yet seen any alarming 
symptoms from its use, and we do not think there 
is much danger attendant upon its use in the way 
we have described. Oases have been reported, how- 
ever, in which symptoms of decided strychnine-poi- 
soning followed its use in amaurosis and amblyopia. 
But I have not heard of any fatal results. 
One very disagreeable complication, however, arose 
in several cases, and that was a tendency to inflam- 
mation at the site of the puncture. 
In one case a small abscess formed and persisted 
for several weeks in spite of such treatment as was 
employed. When this complication occurs a change 
in the treatment usually seems to be indicated. 
We have commonly given our injections in the 
back of the neck, sometimes in the arm, and less 
frequently in the temple. 
The question naturally arises, How long should 
we continue these hypodermic injections of strych- 
nia ? Our practice has been to continue them up to 
physiological effects, and then to stop them if no 
marked benefit has ensued. If the vision continues 
to improve after physiological effects have been 
reached, the injections may be continued for an in- 
definite period, that is, as long as they seem to be 
doing any good. The quantity injected should be 
diminished, however, so as just to fall short of phy- 
siological effects. 
We have, in some cases, after reaching physio- 
logical effects, stopped the strychnia injections for a 
few weeks, and then resumed them again, going over 
the same ground as at first with decided benefit. 
The largest dose of strychnia I have injected in 
any one case was, to the best of my recollection, 
one-fifth of a grain. I have seen one patient, how- 
ever, who, under the care of a friend of mine, had the 
dose increased to one-half of a grain before physio- 
logical effects were produced. Usually pliysiologi- 10 
cal effects show themselves after you have increased 
the dose to from one-fifteenth to one-tenth of a 
grain. 
You must not suppose, gentlemen, that in these cases 
of amblyopia from alcohol- and tobacco-poisoning we 
do nothing for the patient but treat him with hypoder- 
mic injections of strychnine. The first and most im- 
portant thing of all in the treatment is entire abstinence 
from the poisons which caused the disease. We find 
it the best way to cut off the alcohol and tobacco at 
once and completely. The “ tapering-off system ” will 
not do here. If the patient be allowed to use either 
tobacco or alcohol at all, he will be almost sure to 
do so to the point of saturation or toxic effect. It is 
certainly much easier for a person accustomed to the 
immoderate use of tobacco and alcohol to drop them 
entirely than to limit their use short of satiety. And 
generally they are ready and willing to do so when 
the importance of such abstinence is fairly repre- 
sented to them, and they are told to choose between 
the continuation of the indulgence and their eyesight. 
Such patients have frequently told me that they were 
themselves surprised at the facility with which they 
dropped the habit, their “ hankering ” having con- 
tinued, to any unpleasant degree, for only a few days. 
I have known some of these patients to relapse into 
their habits of drinking and smoking, but strange to 
say, I do not recollect any patient who came to us 
for treatment a second time, having been once cured. 
Perhaps the amblyopia does not recur; perhaps such 
patients are ashamed to apply a second time to the 
same physician for treatment, being conscious of a 
sense of moral degradation in having neglected to 
follow his advice. 
Besides stopping the use of tobacco and alcohol, 
and placing the patient upon injections of nitrate of 
strychnia, his hygienic circumstances should be care- 
fully looked into, and his whole manner of living 
should be properly regulated. Of course other medi- 
cines besides strychnia are frequently indicated, and 
should be used. 
Dr. Charles S. Bull, who published a paper in the 
American Journal of Medical Sciences for April, 1873, 11 
** On the Treatment of Various Forms of Amblyopia 
and Amaurosis,” in which he reports twelve cases 
which he had treated with hypodermic injections of 
strychnine, gives the following as his conclusions in 
regard to the value of the strychnine treatment: “ In 
all cases of functional amblyopia we may expect good 
and permanent results from strychnia; and even in 
some cases of organic origin, provided there be no 
extensive atrophy of the nerve-structures, some im- 
provement is gained by the use of the drug.” 
Some of our colleagues say that they have no con- 
fidence whatever in the strychnine treatment, and do 
not resort to it at all, or, having tried it, and failed 
to get such good results as others have claimed, 
have abandoned it altogether. 
Yet it seems to me that we may be reasonably sure 
that our patients of the class spoken of in this paper 
usually recover their vision more rapidly under the 
strychnine treatment than they would under any 
other. Look at Gase V. of this series, for instance. 
On his first visit he had vision ,l04n in each eye ; one 
thirty-sixth of a grain of strychnia was injected, but 
reeking as he was with alcohol and tobacco, there 
was no immediate improvement. On his second 
visit, one week later, he, having abstained from to- 
bacco and alcohol, had vision in right, and fj} in 
left eye. A hypodermic of strych. nitrat. gr. was 
then given, and vision rose in one minute to f ft. Five 
minutes later, vision was fft, the vision thus having 
doubled itself in one eye and more than doubled itself 
in the other within six minutes from the time of the 
injection. 
Also look at the case of Mr. McK (Case VII.). 
He came to us with vision TfS „ in each eye. We gave 
him a hypodermic of strvch. nitrat. gr. and a few 
minutes later his vision rose to each eye, the 
sight being more than quadrupled in each eye before 
leaving his seat. 
These cases would seem to demonstrate beyond a 
doubt that strychnia, used hypodermically, has a cer- 
tain specific influence upon the visual apparatus. 
Dr. Bull, in the paper above cited, says, concerning 
the influence of strychnia upon the sense of sight, 12 
“ the only point that we are sure of is that it pro- 
duces a distinct irritation or excitement of the ner- 
vous portion of the visual apparatus.” 
There can be no doubt that most patients who are 
the victims of alcohol- and tobacco-poisoning would 
recover a certain amount of vision by simple absti- 
nence from tobacco and spirits. Cases IX., X., XII., 
and XYI. bear out this assertion. Each of these pa- 
tients abstained for one week without treatment. 
The vision of Case IX. went up from to each 
eye ; the vision of Case X. rose from y,fu- to -12(ptr each 
eye ; the vision of Case XII. rose from each eye 
to Tnir right, and T left ; and the vision of Case 
XYI. rose in right eye from -ru°,r to §§, and in left eye 
from to ||. 
Of the twenty cases here reported the vision was 
improved, while under treatment, in all the cases 
except two, in which it remained unchanged. In 
seven cases, or in about thirty-four per cent., the vis- 
ion rose from various degrees of impairment to the 
normal standard, in one case going up from counting 
fingers at twelve and fifteen feet to each eye. 
If I were to formulate my conclusions drawn from 
these cases and from other sources of information, 
they would be about as follows : 
1. Amblyopia from poisoning by alcohol alone, or 
by alcohol and tobacco combined, is not uncommon. 
2. Amblyopia from poisoning by tobacco alone 
does occur, but, in this country, somewhat rarely. 
3. Cases of amblyopia from abuse of tobacco and 
alcohol will usually improve, perhaps to a limited 
extent, on simple abstinence from the poisons caus- 
ing the disease. 
4. They will improve much more rapidly under 
treatment by hypodermic injections of strychnia, 
this drug having a specific stimulating influence 
upon the nervous portion of the visual apparatus. 
My thanks are due to Dr. C. II. Agnew for his 
permission to make use of the following cases drawn 
from his case-books. 
Case I.—Dr. G , aged thirty-two years ; Amer- 
ican, married; came under observation in January, 
1873. His vision had been acute until the previous 13 
June, when it began to grow dim, without pain or 
other symptom, “just as a twilight sets in.” The 
failure of sight gradually increased until now. Right 
eye, V. = fingers at fifteen feet, and left eye, V. = fin- 
gers at twelve feet. He chew's and smokes tobacco 
freely, and takes two or three drinks of whiskey daily, 
occasionally more. 
Ophthalmoscopic examination, through dilated 
pupils, reveals “a dirty-looking macular region and 
whitish optic disk ” in both eyes. 
January 28th.—The patient was put upon hypo- 
dermic injections of nitrate of strychnia, commenc- 
ing with gr. 4*8 and increasing to gr. The strych- 
nia was then stopped for a few days, and the patient 
put upon iodide of potassium and bromide of am- 
monium. 
February 10th.—Urine examined by Dr. Edward 
Curtis, and pronounced normal. 
February 12th.—Patient examined by Dr. E. C. 
Seguin, who finds no evidence of intracranial or 
spinal disease. 
The strychnine injections were then renewed, and 
carried from gr. /4- up to gr. -,V, when the patient 
returned to his home, with only slight improvement 
of vision. 
June 11, 1875.—Vision f# in each eye. Used no 
medicine but cod-liver oil after leaving New York, 
and took that only two months. He attributes his 
recovery of vision more to total abstinence from 
whiskey and tobacco than to any medication. His 
recovery was very slow, and he could see sufficiently 
well to shoot last fall for the first. 
October 4, 1878.—He has had no further trouble 
with his eyes. Vision remains 
Case II.—A. C. It , aged fifty-four years ; Am- 
erican, bachelor; officer in U. S. Navy ; came under 
observation June 16, 1875. First noticed sight was 
beginning to fail about two months ago, while in 
Savannah, during an attack of “ bilious diarrhoea,” 
which “ laid him up” for three weeks. Had chills 
and fever when a boy. Has never been subject to 
headache; never had venereal disease. No albumen 
in urine. 14 
Has used tobacco since sixteen years of age, and 
has smoked excessively this winter. Has used wine 
and spirits habitually all his life, never to excess; 
“ only five or six glasses of whiskey a day.” 
The patient is very thin. He says he never had 
much flesh, but lost much of what he had during his 
illness in Savannah. 
B. V., f ft ; L. V., fft. No improvement with 
glasses. 
Ophthalmoscopic examination : “ Apparently has 
incipient atrophy of both optic nerves.” Advised to 
stop the use of tobacco and spirits, and injected 
strychnine nitrat., gr. At- 
June 17th.—Injected strvch. gr. A>. 
June 22d.— Has smoked only three cigars daily, 
and has drank no spirits. Vision remains the same. 
Injected strych., gr. tV* 
July 6th.—B. V., fo j L. V., fft. Has had a daily 
injection of strych. nitrat., the dose to-day being 
gr. i. 
July 15th.—Vision remains the same as when last 
tested. Injected to-day strych. nitrat., gr. £, which 
produced some “ stiffening of his legs.” Sent into 
the country. 
September 2d.—Has been at Bichfield, N. Y., for 
three weeks, during which he gained 3f lbs. in 
weight. While at Bichfield he drank three large 
glasses of mixed milk and cream daily. He went 
thence to Saratoga, where he stayed three weeks, 
but gained no flesh while there. Vision, fft each 
eye ; visual fields normal. 
April 20, 1879.—Captain B. states that he has had 
no further trouble with his eyes. 
Case III.—Tlios. McS , aged thirty-one years ; 
Irish, married ; coachman ; came under observation 
January 8, 1874. A year ago had some redness of 
his eyes during the snowy weather. Never had pain 
in his eyes or head ; never had syphilis nor malarial 
disease. Noticed sight getting bad for the last five 
weeks. 
Smokes a pipe most of the time when not driving, 
and drinks freely of ale, and occasionally of whiskey. 
Vision each eye; no improvement with glasses. 15 
Ophthalmoscopic examination: Dirty, congested look 
of fundus and nasal half of disk; temporal half of 
disk too white. Injected strych. nit., gr. fa. No 
immediate improvement of vision. 
January 15th.—Has abstained from tobacco and 
spirits for a week, and vision remains the same. In- 
jected strych. nit., gr. fa, and before he left his seat 
vision rose to in each eye. 
Mr. McS was then sent to the Manhattan Eye 
and Ear Hospital, and placed upon daily increasing 
injections of nitrate of strychnia. These injections 
were continued for some days after the physiological 
effects of the drug had been reached. The patient 
states that his sight became much better while under 
treatment, but no note was made of the amount of 
improvement. 
February 10, 1879.—Vision each eye. The 
patient states that he smokes and drinks only oc- 
casionally. 
Case IV.—Doctor F , aged fifty-four years; 
married, Irish ; has noticed that his sight was failing 
for several months. Now, September 4, 1876, R. V., 
L. V., f|j. No improvement with glasses. He 
has for many years been addicted to an excessive 
use of tobacco and spirits. 
Ophthalmoscopic examination : “ Incipient atrophy 
of both optic nerves.” Advised to quit the use 
tobacco and spirits, and to place himself upon the 
use of nitrate of strychnia. 
February 24, 1879.—Dr. F , states that im- 
mediately after consulting me, his son, also a physi- 
cian, began to inject him with nitrate of strychnia, 
commencing with a small dose and increasing a little 
daily, until physiological effects were produced. He 
then began taking it in increasing doses by the 
stomach. He increased the dose up to gr. i daily, 
and this having affected his muscular system slightly, 
he stopped the drug. He has been taking it from 
time to time ever since, and has abstained from the 
use of tobacco and alcohol. His vision gradually im- 
proved from the first. Now, V. f§ each eye; visual 
fields normal. 
Case Y.—G. B. W , aged thirty-seven years ; 16 
married, clerk; came under observation October 23, 
1873. Blurring of sight came on suddenly after pro- 
longed exposure to glare on the water three or four 
months ago, and has since gradually increased. For 
several years has smoked on an average fifteen 
strong cigars daily, and has drank on an average 
eight or ten glasses of brandy a day. Had what his 
physician called a chancre fifteen years ago, but it 
was never followed by any of the constitutional 
symptoms of syphilis. 
Vision Aoly each eye; no improvement with glasses. 
No color scotoma, nor limitation of visual fields. 
Ophthalmoscopic examination: “ A dirty, ill-defined 
appearance of the optic nerve and retina.” Injected 
stryeh. nit., gr. fa. No immediate improvement of 
vision. 
October 30th.—Has abstained from tobacco and 
alcohol for one week without treatment. R. V., -ISS; 
L. V., IS- Injected stryeh., gr. fa, and one minute 
later V. fS both eyes. Pive minutes later V. IS both 
eyes. 
November 6th.—The injection has been daily 
increased, and the dose has reached gr. fa. Vision 
IS both eyes. 
November 7th.—Injected stryeh., gr. fa, which 
produced such decided effects that the patient had 
to lie down for an hour before he had sufficient con- 
trol of his limbs to leave the office. 
November 17tli.—Has had stryeh., gr. fa, injected 
daily since last note. Vision fft each eye. 
Case VI.—A. L —, aged fifty-eight years; Am- 
erican, married; speculator ; said that his sight had 
been failing for the last nine months. He had for 
many years smoked, chewed, and drank to excess. 
Ophthalmoscopic examination: “Disks dirty, atro- 
phic excavation, retinal veins enlarged and pulsating.” 
R. V., ; L. V., -uni; no improvement with glasses. 
Placed upon daily injections of nitrate of strychnia. 
After three injections, gr. fa, gr. fa, and gr. fa, 
vision rose to || both eyes. After five more injec- 
tions, R. V., ft; L. V., IS; and after three more, R. V., 
IS; L. V., IS. This patient was under treatment four- 
teen days, and received eleven injections, six of 17 
which were of gr. each. No physiological effects 
were produced. 
Case YII.—Colin McK , aged forty-nine years; 
machinist and engineer; could see well with spec- 
tacles up to three months ago, since which vision 
has gradually but rapidly failed. Has smoked from 
ten to fifteen strong cigars daily for ten years; oc- 
casionally drinks a glass or two of gin; drinks coffee 
four times a day. Vision, T§o each eye; improved 
by +iV, but not" to 
Ophthalmoscopic examination: “ Incipient atrophy 
of optic nerves.” 
Strycli. nitrat. gr. -2L4- was injected into the back of 
the neck, and within five minutes vision rose to 
each eye. 
He returned to his family physician with a letter, 
and we have not heard from him since. 
Case VIII.—C. S. P •, aged forty-six years ; auc- 
tioneer; saw well with glasses up to five weeks ago; 
read the newspapers up to nineteen days ago. Never 
had syphilis nor malaria. General health good. 
Previous to the commencement of his failure of 
sight he was constantly under the influence of alcohol 
and tobacco, and still has his pipe in his mouth at 
least half the time. 
Ophthalmoscopic examination: “ Incipient atrophy 
of optic nerves.” E. V., ; no improvement with 
glasses. L. V., §ft, with + -4V Central scotoma of 
both eyes, but no color-blindness. 
This patient was treated with strychnia injections 
from April 17th to May 10th, when he was discharged 
with vision unchanged, and has not been heard from 
since. 
Case IX.—E. E , aged forty-six years ; com- 
plains of gradual impairment of sight. Drinks and 
smokes excessively. V. -/0Qo each; no improvement 
with glasses. 
Ophthalmoscopic examination: “ Optic disks of a 
dirty, brick-dust color.” 
Advised to abstain from tobacco and spirits and 
return in a week. 
March 2d.—V. fo each eye, after a week’s absti- 
nence. 18 
March 13th.—He has had five injections of strych. 
nitrat., the last being gr. -jV V. fft each eye. 
March 19th.—R. V., fft; L. V., fft. 
Case X.—G. B , aged fifty years ; has long been 
addicted to the excessive use of tobacco and alcohol. 
Vision has been declining for several months, and is 
now 2laij each eye. 
Ophthalmoscopic examination: “Incipient atrophy 
of optic nerves.” 
January 15th.—Has abstained from alcohol and 
tobacco one week without treatment. V. each eye. 
January 25th.—Has had eight injections of strych. 
nitrat., the last dose being gr. -ft*. R. V., fft; L. V., §ft. 
Case XI.—E. L , aged fifty-five years; lawyer; 
came under observation June 16, 1875. Has smoked 
four or five cigars a day, and drank brandy and water 
in the evening for many years. Has had increasing 
mistiness of vision for three or four weeks. Puffiness 
of lower lids for years. Urine normal. Never had 
syphilis nor malaria. Never has headache nor pain in 
the eyes. Latterly he has “ lost stomach.” R. V., fft; 
L. V., f ft; picking out the letters slowly. Reads J. 4 
with glasses with difficulty. 
Ophthalmoscopic examination: “ Dirty disks.” 
June 22d.—Has smoked only one cigar a day, and 
drank no spirits, and has drank milk freely. Vision 
unchanged. 
July 6tb.—The dose of strych. nitrat. has been in- 
creased from gr. -fto to gr. ft. R. V., fft ; L. V., fft. 
July 15th.—The dose has been increased to gr. £. 
Slight physiological effects on arms and legs. 
August 23d.—R. V., fft; L. V., fft. Can now see the 
lineaments of faces across the street, while before he 
could see only the dark outline. He had twenty-two 
injections in all. 
Case XII.—J. A , aged sixty years ; Scotchman, 
married ; mechanic; came under observation January 
17, 1878. Has had failing eyesight for over a year. 
Has smoked a strong pipe most of his waking hours 
for more than forty years. Has rarely tasted liquor. 
No headache. Never had syphilis nor malaria. 
Urine normal. V. *ftu each eye. 
Ophthalmoscopic examination : “ Brick-dust atro- 19 
phy of both optic nerves.” Ordered to stop tobacco 
and return in a week. 
January 24th.—E. V., , ; L. V., Tf(f Put upon 
strycli. sulph. gr. tAj thrice daily, by the mouth. 
April 4th.—V. tAu> each eye. Put upon a mixture 
containing bromide of ammonium, iodide of potas- 
sium, sesquicarbonate of ammonia, and tincture of 
columbo. 
July 23d.—V. each eye. 
Case XIII.—M. C , aged forty-eight years ; la- 
borer, married ; came under observation January 2, 
1879. Patient is partly deaf, and belongs to a fam- 
ily nearly all of whom are hard of hearing. Had 
malaria when fourteen years old. Never had vene- 
real disease. Five months ago went to Coney Island, 
where he thinks the glare of the sun on the water 
injured his eyes, for the sight has since gradually 
failed. 
Chews tobacco all the time. Smoked and drank 
excessively up to two weeks ago, when his physician 
ordered him to stop it. 
R. V., /(fo; L. Y., aSo -; noimprovement with glasses. 
Ophthalmoscopic examination: “Incipient atrophy 
of optic nerves.” 
January 8th.—The dose of hypodermic strychnine 
has been carried up to gr. -fa. 
RV • t. v 
Case XIV.—T. W , aged forty-one years; came 
under observation January 17, 1878. Stomach out 
of order. Is very nervous. Drinks, smokes, and 
chews freely. For years smoked ten or twelve cigars 
a day. Now averages five or six. Urine normal. 
R. V., §{}, with + h; L- V., !{}, with + c. ax. 
90° C- :fo C. ax. 180°. 
Ophthalmoscopic examination : “ Disks too pale ; 
white bands by the sides of some of the retinal ves- 
sels.” 
January 30th.—The strychnia injections have been 
carried up to gr. which produces some stiffness 
of the thighs. R. V., !#, Hm. -3V ; L. Y., with 
+ -3iff c. ax. 90° 3— 3*0 c. ax. 180°. 
Case XY.—J. M , aged forty-two years ; eques- 
trian ; married; came under observation September 20 
24, 1877. Blurring of eyesight has been going on 
for over three months. Contracted “ dumb ague ” 
in Georgia some years ago. 
Smokes seven or eight cigars daily, and drinks a 
great deal of whiskey. 
Vision i11 each eye, and no improvement with 
glasses. 
Ophthalmoscopic examination: “ Incipient atrophy 
of optic nerves.” 
Ordered to quit tobacco and whiskey, and put upon 
dialyzed iron, with strych. sulph., gr. -Jr, ter in die. 
September 28th.—V. 4o each. Appetite much im- 
proved. 
October 8th.—Has had nine hypodermic injections 
of strych. nitrat., commencing with gr. -4l0- and in- 
creasing to gr. -,V- Y. to each. 
October 9th.—Injected strych., gr. -Jo. Patient 
soon after became dizzy, and vision rose to §§ each 
eye. 
Case XYI.—G. M , aged fifty-one years ; mar- 
ried ; merchant; came under observation July 10, 
1876. At the age of seventeen he had scarlatina se- 
verely, which impaired his memory for a year. He 
had “camp fever” during the war, and chills and 
fever nine years ago. Never had syphilis. 
Has for many years smoked three or four cigars a 
day, and has always drank more or less brandy or 
wine daily, but “ never to excess.” 
Has had gradual impairment of vision for nine 
months, as though a vail were drawn over objects. 
Has for some time been under the care of a physi- 
cian for his eyes, and has been taking the bromides 
without appreciable benefit. 
E. V. ; no improvement with glasses ; L. Y. to, 
with + -7V. 
Ophthalmoscopic examination : “ A low grade of 
optic neuritis, with commencing atrophy of both 
optic nerves.” 
Advised to stop tobacco and spirits for a week and 
take no medicine. 
July 17th.—Has practised abstinence for a week, 
as directed. E. V., ft; L. V., |§. Injected strycli. 
nitrat., gr. -/4. 21 
July 24th.—The dose of strych. nitrat. has been 
gradually increased to gr. At- Has had pain in fore- 
head for three or four days. Vision each eye. 
July 27th.—Strych. nitrat., gr. produces “ leg 
symptoms.” 
August 11th.—Vision each eye. 
August 22d.—Vision 18 each eye. Is taking a 
daily injection of strych. nitrat., gr. -§■. 
September 25th.—Vision |{y each eye, writh +Vy. 
Case XVII.—J. M , aged thirty-eight years ; 
watchman; bachelor; came under observation March 
28, 1879. 
In the beginning of the winter got a pair of shoes 
that were a size too small for him, and he thinks 
wearing them affected his eyes. Three or four weeks 
after he commenced to wrear them he first noticed, 
while reading a newspaper, that his sight was fail- 
ing, and it has gradually grown worse ever since. 
He has smoked both pipe and cigars since he was 
fifteen years old. Smokes at least half a paper of 
tobacco daily, and drinks a glass of ale every day, 
and often whiskey. Had chills and fever five years 
ago. Not subject to headache. Never had venereal 
disease, but has been addicted to masturbation since 
the age of seventeen. 
Urine and heart examined by experts, and found 
to be normal. 
Vision each eye, and no improvement with 
glasses. Visual fields not contracted. Tension nor- 
mal in both eyes. 
Ophthalmoscopic examination: “ The nasal half of 
each optic disk is too red, the temporal half too 
pale. There is visible pulsation of both the retinal 
veins and arteries, extending to a comparatively long 
distance from the disks, and in some of the larger 
branches it can be traced as far as the equator of the 
globe. In the veins the pulsation is of the usual 
character, except in its intensity, and the extraordi- 
nary distance to which it can be traced from the 
disks. The arteries, however, seem to start up, and 
move as a whole with each impulse of the heart, 
without apparent change of calibre. As the arteries 
start forward, the veins contract; and as the veins fill 22 
out again, the arteries recede to their former posi- 
tion.” 
This patient was exhibited to the New York 
Ophthalmological Society, the pulsation of the reti- 
nal arteries, without glaucoma, or embolism, or or- 
ganic disease of the heart, being considered almost 
unique. 
He was injected with nitrate of strychnia at irregu- 
lar intervals, until the 27th of April, the largest dose 
being gr. -jV- He was discharged with vision §£ each 
eye. 
Case XYIII.—W. C. P , aged thirty-two years ; 
came under observation February 6, 1877. Eyes 
began to blur on reading about eight months ago. At 
that time he could see well in the distance, but now 
he has difficulty in reading a sign across the street. 
Has long been in the habit of drinking and smoking 
without restraint. 
B. V., §§ ; L. V., ; no improvement with glasses. 
Eyes blur at times so that he cannot see and 
then suddenly clear up again. Urine normal. 
Ophthalmoscopic examination: “Optic disks too 
pale, especially the left.” 
Stopped tobacco and spirits, and commenced the 
use of strych. nitrat. by injections. 
February 9th.—B. V., ; L. V., 40. 
February 22d.—Is up to strych. gr. -jV. B. V., |« ; 
L. V., U- 
March 1st.—Strych. nitrat., gr. -J-, produced slight 
dizziness. 
March 2d.—Patient comes from a champagne sup- 
per, at which he drank wine and smoked nearly all 
night. He was ordered a Turkish bath, but did not 
report again. 
Case XIX.—J. B , aged thirty years ; American, 
gentleman of leisure, married; complains (May 8, 
1879) that he has been getting near-sighted. Drinks 
five or six times a day, and smokes at least four or 
five cigars daily. Guns and fishes much. Studies 
natural history and reads at night. Had rheumatic 
gout at nineteen or twenty. Six or seven years ago 
had chills and fever, and has since had occasional neu- 
ralgia of head and down back. Never had venereal 23 
disease. Urine normal. V. T{b each eye. With — -j1*-, 
V. -I'ifo each eye. Visual fields normal. 
Opthalmoscopic examination: “A soiled or dirty 
look of the optic disk and fundus.” 
To desist from tobacco and spirits, and to drink 
two quarts of milk daily. 
May 26tli.—The hypodermic injections of strvch. 
nitrat. have been carried up to gr. -J-, and “ stiffening 
of the jaws ” has been produced. 
R. VW; L. sfa}- 
May 28th.—Vision each eye. Em. 
June 20th.—Vision remains /0a0- each eye. 
Case XX.—D. A , aged thirty-two years; bach- 
elor ; American, gentleman of leisure; has lived a 
very dissipated life from early youth, indulging 
freely in tobacco, spirits, and venery. Has had 
syphilis, and has several times been in a state of 
great nervous prostration from alcoholism. 
Never had any trouble with eyes until about three 
weeks ago, when, having steered a boat twenty-two 
miles against a head-wind, the next morning his 
eyes were red and watery. They soon recovered 
from that attack, but four days ago a blur came over 
the sight of both, and is daily increasing. No pain 
in eyes, no headache. Had malarial disease thirteen 
years ago. 
Smokes from ten to fifteen cigars daily, and is con- 
stantly in state of semi-intoxication. 
R.V., In ; L. V., no improvement with glasses. 
Reads J. 11 with both eyes at once. 
Ophthalmoscopic examination: “ Optic disks too 
pale.” 
Advised to quit tobacco and spirits, to drink freely 
of milk, to rub himself briskly from neck to heel 
with hair mittens and strap every morning, following 
the friction with a sponge-bath, and to take potas. 
bromid., gr. xx., every night on going to bed. 
June 6th (two days later).—Vision unchanged. 
Had a night-sweat last night. Ordered quin, sulph., 
gr. ij., ter in die. 
June 7th.—R. V., ■&% ; L. V., H 
June 13th.—Has taken Marburg’s tincture, 3j., 
every four hours, and quin, sulph., gr. ij., every two 24 
hours, since four days ago, when his temperature 
rose to 103f. 
June 16th.—Has had, besides the treatment men- 
tioned, two injections of strych. nitrat., gr. each. 
E. V., ; L. V., 
June 25th.—Has had daily increasing hypodermics 
of strych. E. V., ; L. V., 
July 14th.—Took injections of strych. up to a 
week ago, when he had an acute development of 
tertiary syphilis, manifested by acute nodes on right 
tibia, and acute arthritis of right ankle-joint. Was 
put upon hydrarg. biniodid., gr. -,V, and sodii iodid., 
3 ss., ter in die. On the second day ran the iodide 
of sodium up to gr. xl., and continued at that dose 
for three days, and then dropped to one scruple 
three times daily. 
Six days ago had a severe chill lasting three-quar- 
ters of an hour, followed by fever and profuse 
sweating, with headache. Gave quin, sulph., 3j., be- 
tween meals. Is now taking brandy, 3 j., in each dose 
of Marburg’s tincture. 
E. V., n ; L. V.,