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quite amenable to local treatment. He had seen many cases disappear under Hydrastis, but always used locally as well as internally. He thought that syphilis Unguce was often called carcinoma. In connection with the allusion to the use of lunar caustic by one of the speakers, it is interesting to note that Argenlum is administered internally by homoeopaths for one form of follicular throat. In reply to Mr. Kyngdon, Dr. Blake said that it was during the spasmodic stage that sublingual ulceration had been observed. It was quite a mistake to suppose, as observed by Drs. Hale and Kyngdon, that hay-asthma did not occur on board ship; it was a problem to the exclusive pollen school to explain it, they had been compelled to such ingenious explanations as that pollen might be carried over the sea in "dust clouds,'' or that hay might be on board to feed the cows! Dr. Blake would remind Dr. Hale that it was at the sea-side, in the Island of Thanet, that Dr. Bostock fell a victim to this besetting calamity, where he was not in the way of pollen from grass. When insolatio produces profound disturbance of the nutritive function, as in the sad case of his own child detailed by Dr. Hale, more was to be hoped from Argentum and its salt than aDy other known remedy. Anthoxanthum might be a remedy in some cases, but to the homoeopathic it should be employed in just those cases which simulate asthma from hay, but are not caused by pollen irritation. In Mr. Kyngdon's interesting instance it is quite possible that the disturbing cause was an emanation from the scrotal follicles of the deer. Tou know that musk will induce asthma in certain persons, and it was unnecessary to remind the members how nearly allied are the Moschidas and the Cervidae.
CASES ILLUSTRATIVE OF DISEASE OF THE URINARY ORGANS.
By Henry Harris Esq., M.R.C.S.
(Read before the British Homoeopathic Society.)
The first case I have to bring before the Society to night I have called tubercular disease of prostate. It is not my intention to preface it with any remarks upon the nature of the disease it professes to illustrate, but to let it
tell its own tale, and at the close point out the grounds upon which I found my diagnosis.
W. C—, aet. 32, a strongly built man, five feet eleven inches in height, and weighing fourteen stone, in early life a bookbinder, latterly a gas inspector. Comes of a consumptive family, but has always had good health with the exception of occasional attacks of gout in the feet.
At the end of the year 1870 he consulted me, complaining of an increased frequency of micturition, with some little pain after passing water, which was occasionally tinged with blood, or perhaps it would be more correct to say contained streaks of blood. The urine on examination appeared to be normal, with the exception that it contained a rather larger quantity of mucus than is usual. He received Terebinthina and Belladonna, and in a fortnight all the symptoms were removed. He remained free from any trouble till January, 1873, on the 27th of which month he again came under treatment for the same symptoms but in an aggravated form. The water at this time contained a considerable quantity of muco-pus, very little albumen, no casts, and varied much iu character on different days. The pain was mainly at the commencement and after micturition. Thinking it possible he might be suffering from calculus I carefully sounded him, but failed to find a stone. This examination did not appear to cause much pain. On the 24th of February he had an attack of gout, which yielded in a day or two to Bryonia and Colchicum. At the beginning of March, as no satisfactory progress had been made, he by my advice took another opinion; au examination by catheter was made, which gave excessive pain and was followed by rigors. No stone was discovered, but a roughened sensation at the neck of the bladder was felt; examination per rectum revealed no enlargement, and but slight tenderness of prostate. The case was pronounced one of cystitis. The treatment recommended was steadily pursued till the end of the month without any benefit accruing. At this period I noticed that the patient was losing flesh and had him weighed on the 2nd of April; he weighed 12 stone, he was weighed each week up to the 9th August, when his weight was 9 stone 10 lbs.; the decrease was steady and uniform and appeared quite uninfluenced by any of the circumstances of his illness. On the 5th of May he saw a physician in consultation with me; by this time his countenance had acquired a haggard worn look, and he complained of a dull aching pain immediately above the pubes. The urine now contained more pus, but still no casts, and there had not for some time been any blood passed. The opinion given was that it was a case of cystitis depending probably on some malignant disease of bladder. No chest mischief could at this time be detected. On the 25th of August the bowels which up to that time had been confined became much relaxed, and continued so in spite of medicines for ten days; this greatly prostrated him, he also now began to suffer from nausea, vomiting and pain at stomach after food, and for the first time complained of distress in the lumbar region.
At the end of November another attack of diarrhoea occurred and was accompanied by such excessive prostration that the patient and his friends were counting the hours of his life, and it seemed impossible that he could last from day to day. After taking two doses of Apis the diarrhoea stopped, the appetite, which had completely failed, returned, and the patient recovered sufficient strength to move about the house and even to go out for a short walk. When the diarrhoea ceased the bowels again became much confined, the motions now assuming quite a new character, being hard round lumps coated with blood and slime, causing great pain in passing. An examination by rectum which gave excessive pain revealed no enlargement, but intense tenderness in the region of the prostate. The improvement lasted for a fortnight, when the appetite again failed, and he lost his newly acquired strength. At the beginning of last mouth cough came on and I found some dulness over the upper part of the right lung, by the middle of the month this had increased, and the cough was now accompanied by a greenish expectoration streaked with blood. Up to the present time the emaciation has continued to progress, so that now he lies a perfect skeleton. Takes but little food, which is more often vomited than retained, bowels much confined, and when relieved the motions are hard balls with much blood and pus, water scanty, depositing about one third of muco-pus, sp. gr. 1012, acid, the deposit insoluble in acetic acid. The state of the lung is much the same, the cough not very troublesome, profuse night perspirations, and hectic fever night and morning.
I believe this to be a case of tubercular disease commencing in the upper part of the prostate, extending from there to the bladder and kidney, and now invading the lower half of the prostate and causing ulceration into the rectum. I had fully expected before the time for reading this paper arrived that I should have been able to verify my diagnosis by a post-mortem examination; failing that I will state briefly the reasons which have led me to this conclusion. That it is tubercular disease I think the family history, the excessive wasting, the comparative absence of pain, and the occurrence at the close of symptoms of pulmonary phthisis, prove or at least make it exceedingly probable. That its primary seat was the prostate and its course that I have described is evidenced to my mind by the following facts: that the pain at the commencement of the disease was always referred to the position of the prostate, and was accompanied by the passing of streaks of blood, which as the disease progressed ceased, the gradual increase of the purulent deposit with the supra-pubic pain showed its extension to the bladder, and the lumbar pain and gastric disturbance its further progress to the kidney, while the ulceration into rectum proves the last step of the process.
Sir Henry Thompson in his work on prostatic disease, speaks of tubercular affection of that gland as very rare, and instances but eighteen recorded cases. He also says that it probably never is limited to the prostate and that the kidney is generally its primary seat, next to that the testicle; in my case for the reasons I have given, I believe it commenced in the prostate, and there has been no sign of any affection of the testicle.
Dr. Roberts, speaking of tubercle of the kidney, says, that in males it not unfrequently affects also the genital organs, and most frequently the prostate, but that in the female, tubercular diseases of the urinary do not spread to the genital organs, and vice versd.
Hitherto I have not mentioned the treatment pursued, for no medicine seemed to have any influence in stopping the progress of the disease. The list is a long one, and includes most, I had nearly said all the remedies which are credited with an action on the bladder and prostate or on the tubercular diathesis. The temporary rally after the use of Apis almost made me hope that I had found the specific medicine, though, having at that time fully made up my mind as to the nature of the disease, I could not endorse the sanguine expectations of the patient's friends; its failure to continue forced me to conclude that it was a post and not a propter hoc fact, and in this idea I am confirmed, for I find Dr. Roberts recording an almost similar instance of sudden improvement in a woman apparently dying of tubercle in the kidney, for the occurrence of which improvement he confesses himself quite unable to account. The medicine which always appeared to me to cover most of the symptoms and to be most indicated by the location of the disease was Thuja. I tried it in various dilutions, but without result; had I, however, another case to treat, I should give that medicine a more extended trial at an earlier stage of the disease, should I be so fortunate as to recognise the malady with which I had to cope sooner than I did in this instance.
My next case is one of haemorrhage from the urethra with expulsion of fibrinous cast. In the evening of the 7th of March last I was summoned to visit a man, who the messenger, his brother, stated had come home about an hour previously bleeding profusely from the urethra, and had passed just,before he started to fetch me amass looking at first sight like a globular lump of flesh about an inch or an inch and a half in diameter. Directing the man to be placed on his back and ice to be applied to the genitals, I promised to follow as quickly as possible. On washing the