CASE III. Calculus Pyelitis.-Argentum nit.
A woman, 37, of lively temperament and healthy appearance, who was married and had given birth to one child, and had recovered well from her confinement, had suffered during the last three years, without any known cause, from attacks of so-called nephritic colic recurring periodically every three months. Attempts were made to relieve the excessive pains by the applications of leeches to the region of the kidneys on both sides, and by the use of purgatives, and it was only after the patient was reduced to the last degree by this treatment that the pains gradually remitted.
On account of her change of residence I was called in to see her in her last attack and found her in most acute pains in the regions of both kidneys, the pains extending down the ureters to the bladder. She was lying motionless on her back, since very motion of her body caused her inexpressible pain, and touching the region of the kidneys increased these pains in the highest degree. She was perspiring freely; pulse 130, she sought by frequent and short breaths to avoid deep inspiration, for this increased her pains insufferably. The urine contained blood, was scanty, passed often, but only a little at a time and by drops. It contained a visible sediment of crystallised uric acid and pus, with amorphous gravelly concretions, some as large as half a lentil. The clear urine above the sediment was acid and gave a deposit when heated with nitric acid. Thus it was clear that I had a case of calculus pyelitis to deal with. She begged to have leeches applied, as she had some ready and previously she had always experienced relief from them. But nevertheless, she was afraid to incur the pain of turning on her face, which the application would have necessitated. and so was dissuaded from their use on the promise of receiving relief in some other manner. This I could promise when I prescribed Argentum nit. 2, four or five drops every hour.
When I saw her again after six hours she was very grateful to me for such prompt relief and so easily accomplished; for a quarter of an hour after she had taken the first drops she felt greater relief from her pains than was previously the case under the use of leeches. She was able to urinate at once without hindrance, and more copiously, and she was already lying without pain, yet motionless, because the least motion renewed her pains again. On this account she restrained the urine as long as possible; this has been impossible before, but could now be accomplished with ease.
Next morning the pulse was 80 again, and she breathed as when in health. After eight days no more uric acid crystals were passed, but only small concretions. She showed me one of the size of a lentil, which she had passed without pain, and that was the last sign of her disease, which had lasted three years.
From curiosity I had taken some of the urine on the first day for further examination. Besides what has been already mentioned, it contained no trace of triple phosphates, but the well-known epithelia of the mucous membrane of the pelvis of the kidneys. Hence the pus could not have come from the bladder.
Three years have now passed without a relapse.
CASE IV.
Hydrogenoid converted by Treatment into Carbo-nitrogenoid and cured with Argent. nit.
A woman, 29, was thought when yet a girl of 15, on account of a pneumonia which she had at that time to be tuberculous on account of her brilliant eyes, white teeth, white, transparent skin, and because absorption of the exudation did not take place in connection with the cough which still continued and the purulent expectoration. Cough and expectoration, however, disappeared spontaneously in the course of a year.
The patient continued apparently well till she married in her twenty-first year, and had a miscarriage. From that time forward all sort of troubles broke upon her-at one time anomalies of menstruation; at another pains in the ovaries; now spasmodic cough, palpitation of the heart and symptoms of so-called anaemia. All these, however, were transient, and no medical aid was called in.
Four years after that miscarriage she sought my advice for hoarseness which had already lasted five weeks. A suspicious fluor albus was connected with this, and I gave her Nat. sulph. to be taken every three hours. The result was really remarkable, since even on the second day there was but little of the hoarseness left, and on the third day none at all. The fluor albus diminished and after a fortnight ceased entirely.
Six months later she sent for me in haste on account of a spasm in the chest.
It was a common dry asthma. On the lower part of the left side where she had felt the stitches during her former pneumonia, the sound on percussion was dull and no respiratory murmur could be heard. On the upper border of this spot there was a distinct fine crepitatory mucous rattle. Drawing a deep breath gave pain in the part, and a sound of bronchophony was heard. The middle and upper portions of the lung as well as the entire right lung were sound. The cause of all this was a violent mental emotion.
This woman had but little colour in her face and pale lips. She was not much emaciated, but well-formed and slender; had no phthisical appearance; the appetite and sleep were good. The menses have been regular for a long time; rather too copious and followed for a day or two by a mild fluor albus. Her parents, still living, are quite healthy. After her attack of asthma, which lasted half an hour, her pulse stood at 90, and her respirations 21. For eight days one dose of Phosphorus 6 was ordered every day.
Called to see her about a year after I found her suffering again with a violent attack of asthma. She merely complained of want of air and fear of suffocation. Her condition was substantially as before, and as she had been quiet well since, except for a few slight spasms of the chest, Phosphorus was ordered again as above. The spasms of the chest ceased, but a great weakness remained, lasting for several days and remarked that her whole left side especially was of little use to her. Objectively there was no anaesthesia to be discovered. She confessed that she became angry very easily, and whenever she did she always suffered for many days from stitching pains in the affected parts of the chest. I recommended her to take Aconite a few times after every such mental emotion.
A few weeks after this she had hoarseness again. Nothing was revealed by the laryngoscope. After taking Aconite every hour for three days profuse sweat set in, during which the hoarseness, which she supposed originated from a cold taken when washing, ceased.
Six months later, having been living for a year near the water, she had a quotidian fever in the autumn, with increase in the stitches in the side and with cough during the paroxysm. Both disappeared always with the sweat. Nux. and Ipecac. put an end to these attacks in three days; yet only temporarily, for the next summer she suffered a relapse; but now more expectoration which was clearly puriform, and which was mixed with light blood. China sulph.3 removed all these symptoms in ten days. it was remarkable that the stitches in the side, the cough and expectoration, and each time, lasted only so long as the paroxysm of the intermittent, and that during this time from the part of the left lung originally diseased, there was a coarse crepitant rale extending to the large bronchi manifest an auscultation.
However, as often as she got angry the chills returned as well as the stitches, cough and expectoration mixed with blood.
The patient could never be persuaded to take care of herself for any length of time, nor would she stay in bed except during the paroxysms of intermittent; and since these attacks of cough produced by passion were not seldom accompanied with vomiting also, i gave her Antimonium tart. 3, which always gave her prompt relief and deliverance from her sufferings; but they always returned again from the same cause.
Another half-year probably had passed, when this woman, in consequence of straining her eyes while sewing was taken with conjunctivitis with severe photophobia. Besides, i notices that the left eye-lid fell further over the bulb than the right. The pupil of this eye was contracted and reacted less to light. On enquiry she said she had often noticed this before, but it had always passed off by itself as well as the weakness of sight, which she had sometimes noticed in this the other eye wa very good, neither near-sighted nor far-sighted. But in the twilight or under a clouded sky reading or sewing was very difficult for her because a could was always hanging before the left eye. The use of the ophthalmoscope was prevented by the pain which the light caused, but I could observe no haziness of the media.
At this time it occurred to me that this woman had lately lost her strength very much without, however, losing flesh. Her declarations that she felt much worse in rest than when walking in the open air, where she could forget her acknowledged loss of strength, until she was obliged to go upstairs again, which for several years past had almost put her out of breath, was a striking proof that there was increased need of oxidation of the blood. On examination of the chest it was found that the vesicular respiration in all movable parts of the chest was more acute, and that the sound on percussion had become very clear.
