Prostatitis is rarely seen save as a complication of gonorrhoea or gleet. When so occurring, as a recent thing, opinion seems divided as to the superior value of mercurius and pulsatilla; but all authorities agree that these are the two leading remedies. The only exception is Jahr, who would have us rely upon nitric acid 30. If the inflammation tends to linger in a sub-acute form, Dr. Yeldham recommends the administration of grain doses of kali iodatum. Chronic prostatitis may be helped by pulsatilla, or again (according to Jahr) by nitric acid; but it finds a still more efficient remedy in thuja, on which—in varying dilutions-its subject should be kept for a long time.† A fresh candidate for honour in chronic prostatitis has lately appeared in the saw palmetto, sabal serrulata. Dr. E. M. Hale's pamphlet on the drug sets forth its claims to confidence, and a discussion in the British Homœopathic Society, which you will find in the eighth volume of its Journal, shows how these have been received and tested by practitioners in this country. It seems to act much as Mr. Wright has found ferrum picricum to do, relieving symptoms of irritation without altering the fundamental evil. The treatment of prostatitis must be somewhat modified if suppuration is probable, or has actually occurred, which often happens in strumous subjects. Here, whatever other remedies. may be given, sulphur becomes of prime importance. Yeldham recommends the tincture in the acute stage to aid mercurius ; and Jahr relies on the 30th dilution, in concert with his nitric acid, in chronic suppurations of the gland. We have lastly to consider the diseases affecting the penis and scrotum. We have already discussed gonorrhoea, but have yet to speak of Chancroid.-Soft chancre, with its suppurating bubo, is now generally recognized as a local, though specific and contagious affection. The very reasons which have led me to maintain that mercurius is antipathic in relation to the hard chancre show that it is homeopathic to the soft; and you may rely upon it with the utmost confidence, and in quite moderate dosage. It cures, not because of the influence it exerts upon the syphilitic virus, but in virtue of its power of causing ulceration generally and at this particular spot. Nitric acid is here, as in ulcers of the mouth, an effective ally to it; and the two medicines often come in usefully to reinforce one another's action when it is flagging. The bubo which accompanies chancroid calls for no change. in medication when mercurius is being employed, and Yeldham * See M. H. R., xxxix., 632. † See B. J. H., xxiv., 499. and Bähr concur in recommending persistence with it. Hepar sulphuris may be substituted if suppuration appears inevitable. The former was in the habit at one time of opening the abscess early, but he had so frequently seen it disperse without breaking that he latterly gave it a longer chance of doing so. Jahr and Caspari have had corresponding good results from carbo animalis. Balanitis is not a very serious matter; but any one will thank you for telling him how promptly it may be subdued by mercurius solubilis or cinnabar. In neglected cases the local use of calendula (as advised by Yeldham) is most helpful. * Elephantiasis of the penis and scrotum, and prurigo of the latter, belong to cutaneous diseases; but I must speak of the form of cancer which affects the parts, and which is nearly always Epithelioma.—If this could be seen and treated early, good results might be obtained from thuja. Later, arsenic-internally and locally-would probably do all that could be expected from medicine. Inflammation of the Scrotum is either of the diffuse form, affecting the abundant cellular tissue; or one threatening mortification, analogous to the noma pudendi of the other sex. Apis for the former, arsenicum for the latter, would be the suitable medicines. In a case of erysipelas appearing in the abdominal parietes, and involving the scrotum, the latter was found enormously swollen, dark, and superficially ulcerated. Delirium, high fever, rigors and dry blackish tongue were present. Arsenicum 3x arrested the gangrenous process, and completed the cure in four weeks.† * See J. B. H. S., vi., 299. † N. A. J. H., Nov., 1892, p. 656. LECTURE XLVII. DISEASES OF THE FEMALE SEXUAL SYSTEM. The Ovaries and Menstruation. The disorders peculiar to the female sex will next engage our attention, and from the frequency with which they come under our notice will demand a careful consideration. For the same reason, I shall have abundant material on which to draw. Besides the sections devoted to this subject in our systematic works, we have several special treatises on gynæcological therapeutics, among which I may specify those of Ludlam, Guernsey, Leadam, Matheson, Jahr, Croserio, Hale and Peters. Dr. Ludlam's "Lectures, clinical and didactic, on the Diseases of Women" have deservedly reached their third edition. Though "clinical," and therefore occasional, they are so numerous as to embrace nearly the whole range of the subject: they are brimful of practical observation, and are couched in language which makes them most pleasant reading. The Obstetrics of Dr. Henry N. Guernsey (which is also in a third edition) is of a different type. It represents the choice of remedies upon the grounds of minute symptomatology and key-notes," of which this physician was a leading advocate, and for this purpose may constantly be consulted ; but it is hardly to be read continuously. Dr. Leadam published some forty years ago a volume entitled "The Diseases of Women, homoeopathically treated"; and a second edition of 1874 embodies the results of his experience since that time. Dr. Matheson has given us some valuable practical material in his four lectures "On some of the Diseases of Women, their pathology and homœopathic treatment," delivered in 1876 at the London Homœopathic Hospital. Jahr's "Homoopathic Treatment of Diseases of Females and Infants at the Breast," and Croserio's "Homoeopathic Manual of Obstetrics," represent an older and more limited homœopathy; while Dr. Peters has founded on Rückert's collection of recorded experi * More fully, "The Application of the principles and practice of Homoopathy to Obstetrics and the Disorders peculiar to Women and young Children." ence several of his useful treatises. Dr. Hale, in his "Diseases of Women," of which the second edition dates from 1880, deals mainly with dystocia and sterility. I shall also have to refer you to other contributors on a large scale to uterine therapeutics in the pages of our journals, among whom I may specify my industrious friend, Dr. Edward Blake. I begin with the diseases of the ovaries. Very little was known at one time of the action of medicines upon these organs; and we had to rely mainly upon their homology with the testes for the ascertainment of remedies suitable to their corresponding morbid conditions. Experience confirmed indeed the soundness of the inference; but we have now, from the large amount of usus in morbis on record, and from the many provings instituted by women, a number of well-defined ovarian remedies, and can use them with much precision. I will first speak of ovarian inflammation— Ovaritis.-There is much difference of opinion among pathologists as to the frequency of the occurrence of real inflammation of the ovaries, and as to its ever appearing save as secondary to uterine disease. My own judgment goes with Dr. Ludlam (who has devoted two excellent lectures to the subject) in favour of both the frequency and the primariness of ovaritis, at any rate in a sub-acute form. Sudden suppression of the menstrual flow, as from cold or coitus; inordinate sexual indulgence or ungratified sexual desire; mechanical violence or the irritation of emmenagogues-these are some of its most common causes, and suggest the form of disease I wish you to have in your mind as our object of treatment. In managing recent ovarian inflammation, whether acute or sub-acute, the most important indication for our choice of remedies is the presence or absence of involvement of the investing peritoneum. Should this feature exist as indicated by the character of the pains-you will do well to make it your first consideration. All our remedies for peritonitis are available here, and have been found useful, as belladonna by Bähr and Ludlam, colocynth by the latter, bryonia by Jahr and Leadam, mercurius corrosivus by myself. The general indications for these medicines regulate their employment here, and I need not repeat them. When, by one or other of them, you have eliminated the peritonitic element of the case, or when it is absent from the first, pulsatilla and hamamelis are our remedies, as in orchitis. Here also the former suits the sub-acute, the latter the more intense forms of the malady; and either may be aided by aconite if required. Of late, apis has received much commendation in parenchymatous ovaritis: "stinging pain" is said to be a special indication for it. Dr. Guernsey places cantharis also in the first rank among the remedies for this state. By these medicines, with suitable general management, you will generally succeed in preventing ovarian inflammation from becoming chronic. Should you find it, however, in this condition, you may undertake its treatment with good hope of success. The first question must be whether you have induration or abscess to deal with. In the former case conium, platina, and graphites are in most repute; sterility in the married, tardy and scanty menses in all, are indications for these drugs. Dr. Guernsey adds thuja, when the left ovary is affected, and there is much pain, with great aggravation at the catamenial period. Palladium is another medicine which, though little known as yet, seems to have a true ovarian action, and must not be lost sight of. In ovarian abscess lachesis, first recommended by Dr. Hering, has found several praisers; but you must not neglect our accredited remedies for suppuration elsewhere, as mercurius when it is threatening, hepar sulphuris and silica to moderate it when established, and china and phosphoric acid to combat the drain on the system. The foregoing is what I wrote on the subject in 1878. Since then Dr. Fralich has shown what a bolder use of palladium may do. In a case of chronic ovaritis and salpingitis, of many years' standing, the 3x trituration effected in three months a nearly complete cure. The mischief was on the right side.‡ In an equally good case, left-sided, with leucorrhoea, thick, white and acrid, iodine, given because of some concomitant symptoms, effected complete recovery. The dilution is not stated.§ Sabal serrulata also must be considered in this connexion. Its provings upon women show a marked irritant action on the ovaries; and Dr. Mullins, who conducted one of them, reports much success with it in diseases of the uterus and its appendages. He gives the third and sixth dilutions.|| Ovarian neuralgia.-Of all our authors, Ludlam and Guernsey alone devote a section to this malady. It is true that a large proportion of the cases so called depend on a chronic subinflammatory state of the surface of the organ and of the adjacent peritoneum (ovarian folliculitis and pelvi-peritonitis). When it is so (as suggested by the presence, in addition to the * See B. J. H., xxv., 157. N. A. J. H., Oct., 1896, p. 660. † See Ibid., xxxi., 183. UU |