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lump from grit I found after the clotted blood had separated from it that it consisted of a fibrinous cast, resembling in shape more closely than anything else a segment of a ball enema with the tube attached ; the circular part was, as before stated, about an inch and a half in diameter, whilst the pipe was about an inch in length and of the diameter of a wheat straw; its structure was evidently fibrinous. I much regret that I have not now the specimen by me, but at the time I did not think of bringing the case before this society, and I gave it to a professional friend to exhibit at the Pathological Society.
On my arrival at the house I found the patient, a man about thirty, lying on his back, perfectly blanched, pulse very slow and thready, countenance expressive of great terror and anxiety; the bleeding had been in a measure checked by the application of the ice, but blood was still dripping from the urethra. I at once passed a No. 12 silver catheter into the bladder, and noticed that the water which came through the instrument was unstained with blood. The pressure of the instrument almost immediately stopped the haemorrhage. I fastened the catheter in, cautioning the patient to lie perfectly still on his back and to have the ice applied if the bleeding recurred. I left him Arnica and China to take alternately. The next morning I found that there had been no more haemorrhage, and on removing the instrument the urine passed per urethram was only slightly tinged with blood. He was kept quiet in bed for two or three days and made a good recovery. The history given by him was as follows: that a week before the evening I saw him '' he was larking," to use his own words, with a woman previous to having connection with her, when a sudden gush of blood from the urethra took place; this lasted some ten minutes and then ceased. Four days after, under similar circumstances, there was a recurrence of the haemorrhage, but in a slighter degree. On that evening on which I saw him he was walking to his home at Brixton, and whilst crossing St. James's Park had an erection, and at once there was again a rush of blood from the penis; this continued till he reached home and, increasing in quantity, they sent for me. Of the amount of blood lost it is difficult to form an estimate, but it must have been very considerable, as it continued for more than two hours, and the bed and bedding were quite saturated. Neither on passing the catheter nor by subsequent examination along the whole course of the urethra could I find any tender spot, and I confess that I have not been able to decide to my own satisfaction the source nor the real cause of the haemorrhage. The man at the time was suffering from a slight gleet for which he subsequently came under treatment and soon recovered. I ordered him to abstain at least for a time from all sexual excitement, and I think for a little while he obeyed the injunction, but being of a very erotic temperament he soon lapsed into his former habits, but had not when I last heard of him, a month or two since, had any return of the haemorrhage.
The last case with which I shall trouble you to-night will be stated in a very few words. A young man who had been under treatment for gonorrhoea returned in about a month with a profuse crop of warts on the glans penis and prepuce, the largest being of the size of a pea; he was ordered a lotion of Thuja 0 and Thuja 1st centesimal internally; at the end of the week he reported himself much the same. Medicine and lotion repeated; at the end of the second week there was still the same report. I now swept the surface of the warts with strong Nitric acid and gave him Nitric acid 1 st centesimal, internally ; on his next visit the largest of the warts were reduced in size, but the number was not diminished. The treatment was repeated for another week, but still very slight progress was made. I then gave him the Thuja lotion again and Thuja 12 internally. At the end of the first week of this treatment many of the small warts had disappeared and the larger ones were reduced in size. Thuja 12 was repeated but without the lotion; next time a very marked improvement was manifest; the whole of the warts save the largest were quite gone; he received another week's medicine and ceased to attend. He has since been under treatment for another attack of gonorrhoea, and tells me that all the warts had entirely disappeared before he finished his last medicine. This case is so slight in itself that I should not have brought it before you but that it appeared to me to have some bearing on the muchvexed question of the curative dose.
Discussion on Mr. Henry Harris's paper.
Dr. Ransfobd had a case very like Mr. Harris's first case with this important difference, that there were no tubercles in the prostate. The subject was an aged clergyman. The bladder was very irritable; the urine drawn off by catheter night and morning. Cannabis sativa 1 materially relieved him and prolonged his life, although the vesical paralysis was not cured. He has found Cannabis indica <p in one-drop doses more efficacious in curing acute gonorrhoea than Cannabis sativa, q>, but in gleet he has still more confidence in Sals, copaibce, of which he orders two or three drops of a saturated alcoholic solution three or four times daily.
Dr. Vattghan-hughes said that cases of tubercular hypertrophy of the prostate must be very rare ; he had never met with such pure and simple. He was of opinion that Mr. Harris's patient had tubercular deposits in the submucous tissue, and that these spots ulcerated through to the surface and discharged a matter, more or less purulent, bloody, and sanious, which gave rise to excessive irritation in the bladder, prostate, and urethra. Dr. Vaughan-Hughes considered that the haemorrhage from the urethra during violent and long-continued erection arose from an ulcer in some part of the urethral mucous membrane becoming suddenly torn up by the rapid expansion of the erectile tissues.
Dr. Dudgeon- was not quite satisfied from Mr. Harris's description of his first case that the disease was really tubercle of the prostate. In that case would there not have been enlargement of the gland? It seemed to him that the disease might, in the absence of confirmatory evidence on the dissecting table, be assumed to be chronic cystitis with ulceration. As the patient had not yet died he might yet derive some advantage from Argentwm nitricum, which had not apparently been yet given by Mr. Harris.
Dr. Bayes thanked Mr. Harris for the very interesting cases so clearly and well related. Urinary haemorrhage was often a very obscure affection. Latterly he (Dr. Bayes) had treated two such cases, both of great severity; one progressed favorably, but the other proved fatal. The first of these two cases came under his treatment about twelve months ago ; he had been up till then under allopathic treatment: There were frequently recurring haemorrhages of very considerable extent, and in addition to clots passed on such occasions masses of villous growth, some of considerable siee, were occasionally to be detected in the urine. The microscope showed their structure, and a very good specimen is to be seen among the preparations at St. George's Hospital. The urine was always loaded with albumen and a very considerable quantity of blood-corpuscles, pus-corpuscles, epithelial scales, &c, were always present. He (Dr. Bayes) immediately withdrew all alcoholic stimulants, and slow improvement set in under a course of homoeopathic remedies. Fresh haemorrhages occasionally recurred (but less frequently than before), and a very severe attack came on in May, the patient being at that time in Bournemouth under Dr. Nankivell's immediate care. The bladder became distended with clots, and Dr. Nankivell washed it out very skilfully. After this the patient returned to London. The urine still albuminous and loaded with pus, still containing at times villous growth. He (Dr. Bayes) now gave him small doses of Sulpho-carbolate of Lime, a grain three times a day, and under this and the careful meeting of symptoms by other remedies the pus Bpeedily disappeared, the urine lost its albumen and became more natural in composition, the patient gradually assumed a healthful aspect, and appears well. No fresh haemorrhage (worthy of the name) has appeared during eight months, and were it not for the occasional appearance of a small clot in the urine the patient might be pronounced well. The second case alluded to was that of an officer. When he (Dr. Bayes) first saw him he was completely exsanguined, suffering much also from dysuria and irritable bladder to so great a degree as to force urination every twenty minutes, day and night. There was no considerable haemorrhage, but the urine was loaded with pus and albumen. The pain was so urgent that the patient took large and repeated doses of Morphia, but still no longer interval of sleep than twenty minutes to half an hour was yielded. A course of homoeopathic medication relieved the urgent symptoms, and the patient was enabled to sleep two or three hours at a time; so marked was the improvement for a time that the patient and his friends became very sanguine of ultimate recovery. The pus and albumen nearly disappeared under Sulpho-carbolate of Lime, but suddenly paralysis of the bladder set in. A surgeon was called in who very skilfully used the catheter, but this brought on passive haemorrhage. Constitutional symptoms set in, aphthous ulceration of mouth and throat followed, and diarrhoea and lienteria ended the patient's sufferings. There had been at one time great pain and discomfort in theprostate gland, but this was permanently relieved by a few doses of Aconite 1. In both these cases the effect of many of our medicines was well marked; and he (Dr. Bayes) may, at some future time, give the details, but the point he wished to bring forward at this time was the beneficial action of small doses of
Sulpho-carbolate of Lime in arresting disorganization, and, perhaps (in the first case), in destroying or controlling the development of growths of loose organisation within the urinary cavities.
Mr. Habbis, in reply, said that he was by no means prejudiced in favour of his diagnosis of the first case, and should be pleased if its favorable issue showed that he was mistaken. He would gladly avail himself of Dr. Dudgeon's suggestion as to the use of Argenti nitras, though he feared the case was now too far advanced for any treatment to be of much benefit. Dr. Vaughan-Hughes had suggested that the tubercular deposit might be in the submucous tissue; that no doubt was possible, but Mr. Harris was of opinion that it was really in the gland structure itself. Tubercular disease may exist without any . hypertrophy at the beginning; it is said there is sometimes a slight enlargement, but as the disease progresses the gland really diminishes in size. In this case there is certainly no hypertrophy, nor has there been at any time any difficulty in getting rid of the urine. That the haemorrhage in the second case was not due to stricture nor to ulcer in urethra is shown by the fact that a No. 12 catheter was passed without difficulty and without pain. The last case was not brought forward as a striking cure of warts, but simply to show that a cure appeared to be effected by Thuja 12, a similar result not having followed the use of that drug in the first dilution.
SPECIFIC MEDICATION IN RELATION TO
By Dr. W. S. Craig, of Scarborough.
(Head before the British Homoeopathic Society.)
Homoeopathy being a system of therapeutics is more intimately related to the practice of physic than to surgery, and consequently homoeopathic practitioners have a tendency to cultivate medicine to the neglect of surgery. The teaching of Hahnemann exerted an influence in the same direction since he inculcated the desirability of curing the external manifestation of diseases from within by medicine rather than attacking them from without. While acknow