therapeutic problem. It might fairly be doubted whether homœopathy had anything to say to such a condition (the renal or nephritic colic of the books), as the difficulty is mechanical, and the pain inseparable from the presence of the grains or concretions of solid matter. Certainly, if the pain demanded it, we should be quite justified here in giving repeated small doses of morphia or inhalations of chloroform. But the analogy of the power of calcarea over biliary colic suggests that here also homœopathically acting remedies may be found; and they seem to exist in berberis and pareira brava. The evidence for the value of the former I have mentioned in my Pharmacodynamics; I can myself add to it. The latter, long in repute for urinary troubles, has been tested in this affection by Dr. Turrel, and found eminently serviceable, in all strengths from the mother-tincture up to the 12th dilution.* Dr. Jousset confirms its efficacy from his own experience. I can since add that calcarea carbonica itself has been found effective in nephritic as well as hepatic colic; and in as high or higher dilution. Such was the testimony borne by Dr. Sands Mills in an essay presented to our Paris Congress of 1900, and substantiated by five illustrative cases, which you may read in the Transactions or in L'Art Médical for September in that year. Sarsa is an analogue of berberis: its pain is characteristically after urination. Ocimum canum is a Brazilian plant bearing a similar relation to pareira brava. It was introduced into our Materia Medica by Dr. Mure, upon clinical evidence solely; but more recent experience has seemed to show it effective in the dilutions.t * See his paper translated from the Bibliothèque Homœopathique for 1875 in the thirty-third volume of the British Journal of Homœopathy. † See J. B. H. S., iii., 208; iv., 336. Also iv., 77, compared with M. H. R., xl., 133. LECTURE XLVI. DISEASES OF THE GENITO-URINARY ORGANS. The Kidneys (concluded), Bladder and Urethra, and the I have hitherto been speaking of disorders in which renal mischief is but one element, however important; but I must now tell what we can do when the kidney itself is primarily and solely affected. Renal congestion, of active character and recent occurrence, is recognized by Bartels simply as a consequence of the elimination by the kidneys of certain irritating substances, as turpentine and cantharides. I think, however, that it is no very uncommon effect of cold. I have met with it several times, and have always found terebinthina (which I have usually given in the third decimal dilution) most effective in its treatment. Should we encounter it as caused by cantharis, as by blistering, camphor seems (from Dr. Reginald Southey's experience") to be as effective as for the strangury thus arising. The chronic and passive form of renal congestion is nearly always due to the embarrassed circulation of obstructive disease of the heart; and its therapeutics belong to those of cardiac dropsy. Renal congestion probably lies at the bottom of most cases of simple Suppression of urine; and terebinthina accordingly occupies the first place among our means of removing this perilous condition. Dr. Yeldham has reported a case cured with the first dilution, in which no urine had been passed for four days.† Suppression of urine has been also observed in cases of poisoning by mercurius corrosivus, arsenic, cantharis and kali bichromicum; so that we have some medicines on which to fall back, should turpentine disappoint us. I have mentioned the usefulness of the last-named in the ischuria which sometimes follows Asiatic cholera, and threatens the patient's death if not removed. * Ziemssen's Cyclopædia (Engl. transl.), xv., 196 (note). Hæmaturia is often another manifestation of renal congestion, and accordingly terebinthina takes the first place among its remedies, even old-school experience confirming it. I cannot say whether arnica is of service when bloody urine depends, as it frequently does, upon the mechanical irritation of renal calculi or gravel. Jousset says it is the remedy for such cases; but Bähr thinks that there is lack of evidence for its efficacy. On the other hand, when exposure to cold or rough weather can be ascertained, aconite is of undoubted efficacy. If hæmaturia is a part of general purpura, you will of course treat it on the principles laid down when we were speaking of that disease. But you will every now and then meet with cases which do not seem to come under any of the categories just mentioned, or do not yield to the remedies indicated; and you will wish to know where you can look for further help. You may find this from cantharis, which is certainly homoeopathically indicated, though it seems to require more than the usual homœopathic dosage. You may get it from arsenicum hydrogenisatum, the hæmorrhagic action of which is so well marked in poisoning by it. Dr. Majumdar relates two cases in which the sixth dilution was promptly curative. They were painless, but much prostration was present. Or you may dip into the bag of pure empiricism, and try the thlaspi bursa pastoris-the shepherd's purse of popular language. This is in all probability the "angioitico" of Mattei's list of specifics, and is described as "easily arresting hæmorrhage in general." The thlaspi had this repute of old, as may be seen from Gerarde's "Herball" of 1636; and its power as a hæmostatic has been vouched for in our own school by Jousset, Rafinesque and Harper, and also by several old-school (especially Rademacherian) practitioners.§ This remedy, like cantharis, has to be given in the mothertincture. The endemic hæmaturia of Egypt, Mauritius and other semitropical countries seems to depend upon the presence of a parasite, the "bilharzia hæmatobia." Whether under these circumstances our remedies can check the loss of blood must remain a question. If they cannot, there seems no other resource; as all known parasiticides are said to have failed to do so. Hæmoglobinuria must be mentioned here, though the seat of the morbid process in it lies behind the kidneys in the blood * See J. B. H. S., ii., 91. † See M. H. R., xlii., 629. J. B. H. S., iv., 128. § See Bull. de la Soc. Méd. Hom. de France, vi., 721; xiv., 160; M. H. R. xxxii., 614; xxxiv., 735; L'Art Médical, July, 1888; J. B. H. S., i., 182. itself. Its interest to us is enhanced by its having followed upon the introduction into the system of several poisons, among which I may name chlorate and bichromate of potash, arseniuretted hydrogen and carbolic acid. We should naturally expect to find among these remedial agents for the malady when occurring idiopathically. We are most likely to do this when it constitutes the "black-water fever" of malarious countries, or occurs paroxysmally. In the former case certainly, in the latter probably, the arsenicum hydrogenisatum would be the best of the group to choose; while the others remain in reserve for unusual or obstinate cases. The only case I know of in homœopathic literature is one of the paroxysmal form furnished by Dr. Galley Blackley to the second volume of the London Homeopathic Hospital Medical Reports. Chininum arsenicosum and anilin were the medicines tried; both had some effect in postponing the attacks, but neither could be said to have proved curative. I will now speak of Suppurative nephritis.—The kidneys, like the liver, may be the seat not only of diffuse inflammation of the cirrhotic or liquefactive kind, but also of circumscribed inflammation tending to suppuration. Such a nephritis is that which results from mechanical violence, or from the irritation of renal calculi. Cannabis sativa receives a good deal of commendation from the older homoeopathists (as Jahr and Hartmann) in this affection; but I must agree with Bähr in doubting whether its action reaches so far as this. I also follow him in thinking mercurius corrosivus the most homœopathic and effective medicine for the disease. In cases threatening to be chronic, hepar sulphuris should be considered.* Perinephritis has no relation to the kidney proper, and must be treated with the remedies and other means suitable to suppurative inflammation of the cellular tissue. It is otherwise with Pyelitis, which demands a section of its own. This inflammation may also arise from injuries received from without or within. More frequently, however, it is secondary to vesical or urethral disease, and often manifests its existence mainly by symptoms of distress of the bladder. Sir B. Brodie, in his Lectures on Diseases of the Urinary Organs, has given a capital account of these cases. He believes that they often arise from "an injudicious use of large doses of copaiba and cubebs, especially the latter; and that it is here, and not in simple catarrh of the * See case in J. B. H. S., iii., 336. It is headed "Pyelitis," but it is difficult to draw the line between these two affections, especially in the absence of microscopical examination of the urine. TT bladder, that uva ursi and buchu exert the influence which has given them repute in urinary disorders." He also recommends the tincture of the muriate of iron. These hints may be of service to us. I am inclined to think uva ursi on the whole the most effective remedy here. If there is drain of pus from the kidney, you will of course keep your patient up by china; and some chemical influence seems exerted by the peroxide of hydrogen, which may be conveniently given in the form of Marchand's "glycozone." Of cancer and tubercle of the kidney, in their therapeutical aspects, I have nothing to say; and so we will pass on to the urinary passages, which we have already approached when speaking of pyelitis. Let us take first the diseases of the bladder. # Cystitis, in its acute form, is rarely met with. When we do have to deal with it—as in some gonorrhoeic cases—cantharis is confessedly its great remedy; and it should not (I think) be given lower than the third dilution. Bähr has seen immediate aggravation from the third decimal trituration. If there be much general erethism or fever, aconite may be given; but not otherwise. There is a sub-acute form of catarrh of the bladder which is apt to result from local damp and cold, and which is very liable to become chronic: here you will find dulcamara very effective, at least when the deposit is mucous rather than purulent.† Chronic cystitis is common enough, though generally secondary to stricture, stone, diseased prostate, &c. You are not the less to apply to it your specific remedies, while of course you will not neglect the treatment appropriate to the primary affection, or such emptying and washing out of the bladder as may conduce to your patient's comfort. But instead of drenching him with decoctions of pareira, buchu or triticum repens, study the symptoms of his case, and give him small doses of the remedy most homœopathic thereto. This may be cantharis, cannabis, lycopodium, terebinthina, copaiba, mercurius or pulsatilla; and if no definite indications for either are present, you may ring the changes upon them. A still greater favourite of my own is the chimaphila umbellata, which I have often used with advantage. It has to be given in the lowest dilutions or the mother-tincture. The following case so well illustrates what may be done in these chronic cases that I give it verbatim : * See J. B. H. S., iii., 442; iv., 224. † See Ibid., ii., 219. |