been induced by this poison, as the bedroom and sitting-room of the patient were found to be lined with green paper, containing arsenic in large quantities. In the only case of the disease I have seen, however, this medicine was not of the least avail. A more hopeful method of treatment might be to attack the scrofulous process in the capsules as if lymphatic glands were in question, for which purpose iodine might come to our aid. Perhaps something might be done for the vomiting, as with kreasote or apomorphia; though the former failed in my case and the latter was of only temporary benefit in Dr. Blake's. Jousset has nothing but anti-scrofulous remedies to suggest for this malady, and Bähr and Jahr do not mention it. Payr has given a study of Addison's disease in the Allgemeine hom. Zeitung for 1870, and Dr. Lilienthal another in the twenty-fifth volume of the North American Journal of Homeopathy. The latter suggests argentum nitricum as a promising remedy, and mentions a case treated by it in the Ward's Island Hospital where great benefit resulted, though the malady was too far advanced for cure. Later experience has brought us little further aid here. Dr. T. E. Gilman reports a case, apparently of this malady, in the Clinique of July, 1898, in which recovery set in, when the patient was at a very low ebb, after a critical and most offensive exhalation from the surface. This supervened on the administration of hydrocyanic acid. Arsenicum iodatum and some of Schüssler's salts were later of value. Dr. Beclère presented to the Société Médicale des Hôpitaux, an undoubted case of Addison's disease, in which a definitive cure of three years' standing had been effected by hypodermic injection of a fluid extract of the supra-renal capsules themselves. Ingestion of these as fresh food had been previously tried without success.† As diseases of the thyroid I shall speak of the simple hypertrophy which we call bronchocele, and of the results of insufficient or excessive action of the gland-myxedema and exophthalmic goitre. And first of Bronchocele.-By this name, I say (as by its equivalents goitre and Derbyshire neck), I understand simple hypertrophy of this thyroid, excluding all cystic and other growths within it, which latter are in the province of surgery. The leading feature of the therapeutics of this disease is obviously the use of iodine. have gone fully into the question of its relation to thyroid * Translated in vol. xviii. of the N. A. J. H. I enlargement in my lecture on the drug, and have come to the conclusion that in all recent and soft goitres iodine is homœopathic, and may succeed in small and even infinitesimal doses; while when the tumour is hard and knotty it acts by its liquefacient properties, and must be given in substantial quantities or applied externally (best in the form of an ointment of the biniodide of mercury). But iodine will not succeed in every case of goitre; and homœopathy has other remedies upon which to fall back. I refer to spongia and calcarea. Of the former also I have spoken in my Pharmacodynamics. Dr. Jousset habitually uses it alternately with iodine, month by month about; commonly employing the 6th dilution of each. It, too, given in substance, and applied locally, can melt down an old and hard tumour, as may be seen from one of the cases reported by Dr. Barlow in the twentysixth volume of the British Journal of Homœopathy (p. 670). In another of these, indeed, the tumour is described as "lumpy, irregular, hard," and was of three years' standing; but spongia, in the 3rd and 12th dilutions, cured it in ten weeks. Dr. Midgley Cash reports a case where iodine, locally and internally, seemed rather to irritate, but spongia 3 cured in two weeks.* For the action of calcarea in goitre I would refer you to the valuable "History of Calcareous Preparations," by Dr. Imbert Gourbeyre, translated from L'Art Médical in the thirty-fourth volume of the British Journal. It had a great reputation of old in the form of powdered egg-shells; and it is the belief of many observers that endemic goitre and cretinism are traceable to the use of drinking-water containing lime in excess. Here, of course, you would not give calcarea; but in cases otherwise originating it may prove a useful adjunct to our remedial means. A new and enhanced interest in thyroid disease has been awakened during the last decade. Gull and Ord have described, under the name of "myxedema," a previously unrecognized form of disease in which a mucous exudation invades the body, causing a pseudo-anasarca of the surface, clogging the muscles and dulling the mental faculties. It was soon ascertained that in these cases the thyroid gland was greatly atrophied or completely absent; and experiment proved that a similar condition could be induced in animals by ablation of the organ. Myxedema was a cachexia strumipriva. Then occurred the happy thought of treating the subjects of the disease by administering healthy thyroids taken from animals, whether as medicine or as food. This was done with brilliant success. The large doses, however, in which the glandular substance was at first administered were found to produce evils of their own, and the morbid state * M. H. R., xxxix., 73. induced was essentially that present in Graves's (or Basedow's) disease, where as its present name "exophthalmic goitre" indicates the thyroid is enlarged and presumably over-active. I must not follow up the bye-paths, physiological and pharmacological, into which these facts invite us, but must confine myself to their therapeutic bearing. For Myxedema we probably have no remedy which can take the place of thyroid feeding as a rapid restorative of healthy function. It acts like lemon-juice in scurvy and iron in anæmia. Nevertheless it is a continuous palliative rather than a curative agent; and our aim should be to awaken the dormant activity of the patient's own thyroid, and not leave him for the rest of his life dependent on that of animals. That this can sometimes be done Dr. Clarke has shown us by his case recovering under arsenicum;* and where any such deep-acting medicine is indicated by the symptoms, as this was here, we may surely prescribe it with advantage. In connexion with this I may recall Dr. Guggenbühl's experience with cretinism-a morbid state closely allied to myxedema, and like that connected with obstruction or atrophy of the thyroid gland. When to the hygienic advantages he at first afforded the subjects of this disease he added homœopathic medication, he found a perceptible acceleration of their improvement. I am not sure, moreover, that the last word has been spoken about thyroid medication as distinct from alimentation. A series of experiments were made on eight subjects of mental disease, each taking from one to three five-grain doses daily of the fresh gland. The experimenter observed emaciation, tachycardia, cardiac weakness and mental or motor excitement in all; but two presented also a generalised infiltration analogous to myxedema. Conversely, Dr. Mersch had a case where the symptoms of exophthalmic goitre were accompanied with myxedema of the lower extremities. Lower triturations of thyroidin aggravated the cardiac and nervous symptoms; but when higher dilutions were given, not only did the tachycardia subside, but the myxedema disappeared also.‡ Exophthalmic Goitre, with its associated palpitation of the heart and protrusion of the eyeballs, is a very interesting disease. In the thirty-third volume of the British Journal of Homeopathy you will find three typical cases of it related by Dr. Wheeler at a meeting of the British Homœopathic Society, with the discussion which followed. His treatment in all three involved the continued use of substantial doses of iron, much * H. W., 1892, p. 443. † See B. J. H., xii., 696. Journal Belge d'Homœopathie, March-April, 1898. anæmia being present; as it was also in the case reported by Dr. Ker in the twenty-sixth volume of the same journal, and here too ferrum was the main remedy. Dr. Wheeler also gained much benefit from remedies calculated to quiet the excited cardiac action, especially cactus. I ventured to say, however, that I thought we should look deeper for a single remedy controlling the whole series of morbid changes involved in the malady; and that we might find this in belladonna. Dr. Kidd long ago put on record a cure effected by this medicine,* and you will see several others mentioned in the discussion which took place at the Society. Dr. Jousset also writes" Belladonna is the remedy for exophthalmic goitre." He gives the dilutions from the 6th to the 30th. Its use is being adopted to some extent in the old school at present, as Dr. Ringer tells us. I would also direct attention to the homœopathicity of glonoin and of amyl nitrite to the cardiac and vascular elements of the disorder. Dr. Edward Blake has communicated to the Practitioner a case in which the subjective symptoms were markedly relieved by minute doses of the latter medicine. Dr. Lilienthal has made this malady the subject of another of his useful studies of diseases.† He does not seem aware of the observations I have mentioned above; but gives some facts suggesting natrum muriaticum and lycopus as possible remedies. I have myself called attention to the homœopathicity of iodine to this form also of goitre; and I notice that Jousset mentions emaciation and bulimia as occasional elements in the cachexia accompanying it. The higher dilutions of the drug ought to be most serviceable here. Later experience with this disease has mainly affirmed the recommendations now given,-belladonna, iodine and lycopus being the remedies most frequently used, the two former in the medium dilutions, the latter in the lowest or the mothertincture. Thyroidin itself (the extract of sheep's thyroid) has been sometimes used with success. The remedy would be one of the isopathic order; but if the dosage be small enough should not on that account be put out of court. * B.J. H., xxv., 187. † N. A. J. H., xxv., 380. J. B. H. S., i., 91 ; iv., 347 ; vi., 305, 308, 399; vii., 222. LECTURE XLIV. DISEASES OF THE URINARY ORGANS. The Kidneys. In the present lecture I enter upon the diseases of the urinary organs. The affections of the kidneys will first engage our attention; and of these we shall begin with those morbid renal conditions with which albuminuria is associated, and which are known under the general name of "Bright's disease." Before proceeding to therapeutics, however, we must agree upon certain points as regards pathology and nosology. I was for some time accustomed to use the nomenclature of renal diseases which I learnt from Dr. George Johnson. Now so far as this recognizes the existence of (besides fatty and amyloid change) two distinct forms of Bright's kidney-the large, white, and smooth, and the small, hard and granular, each being of primary and independent origin, and having its own etiology and clinical history, so far, I say, it is entirely substantiated by all later investigation. The then German doctrine that these two varieties of the disease were but successive stages of the same process is now rarely held: it has been rejected by one of the latest and best writers on the subject from that country— Dr. Bartels, in Ziemssen's Cyclopædia. But Dr. Johnson used to call the first of the two maladies a "chronic non-desquamative nephritis," stating that in it the epithelial cells are not found detached after death, nor do they appear in the urine during life; and that, in fact, the enlargement of the gland consists of a real hypertrophy of its secreting structure. He considered that the disease only occasionally appeared in an acute form, of which, in his book on the subject,* he gives three instances. He does not connect it with the acute nephritis of scarlatina or from cold. The hard contracted kidney he considered the result of a "chronic desquamative nephritis," thinking that the diminution of the size of the organ was produced by the shedding of its epithelial cells. * On Diseases of the Kidney. 1852. |