THE treatment of prostatic patients is a very difficult task, requiring exact knowledge of the pathological conditions of the urinary organs as well as of the whole constitution of the patient. Much patience must be exercised on the part of the physician and of the patient himself. Remembering that there was many prostatic patients who for their whole life never experience any trouble whatsoever, from an enlarged prostate we must take the greatest care to keep away from the patient all injurious treatment which might result in congestion of the prostate or of other parts of the genito-urinary system. We should advise him concerning catching cold, cooling, especially of the feet, excesses in meals, alcohol, too much of the armchair and too long holding up of micturition. The right diet is of the greatest importance; for many cases a lacto-vegetarian diet is the most suitable one, but it depends upon the whole constitution of the patient. The dietetic directions have to be given individually. Leguminous plants and spices are forbidden.
Regular action of the bowels and regular gymnastics are necessary, Independent from these prophylactic measures the real treatment of the prostatic patients has to be adapted to the special conditions in each case. We have to differentiate between cases to be treated homoeopathically and between cases in which a local treatment either catheterization or the radical operation should be resorted to. The conscientious homoeopath should never rely on the symptoms of the patient, but must know exactly the anatomical and pathological conditions; these conditions alone indicate the suitable treatment in an individual case. He should know that no homoeopathic drug whatever is able to cure a patient suffering from a considerable amount of residual urine in an overdistended bladder. He local treatment is indispensable.
Regarding the local treatment we have first to answer the question, in which cases and under what conditions catheterization is indicated. As a matter of course each case of an acute retention of urine has to be catheterized, provided that hot hip-baths or hot compresses upon the abdomen or upon the perineum have not relieved the retention. The greatest care in using the catheter is to be taken especially in patients suffering from their first retention and in patients with high blood-pressure. As already mentioned, the bladder has to be emptied very slowly, otherwise a fatal bleeding from the bladder- vessels or even immediate collapse of the patient may occur. I always combine the catheterization with a dose of Arnica 2x. I use a soft Thiemann catheter. Before introducing it, I anaesthetize the urethra by injecting a few c.cm. (3) of a 2 per cent. solution of Novocain or Alypin into it. By doing so we diminish the congestion of the urethra, enlarge its canal and facilitate the passing of the catheter. If we have to deal with a patient in which fruitless attempts to catheterize have lead to severe damages of the mucous membrane and haemorrhage, it is better to desist from further attempts and to empty the bladder by capillary puncture above the pubes. An absolutely harmless procedure and we may repeat it for several days, till the injury of the urethra is cicatrized and healed. Then the catheter as a rule passes without any difficulty.
Furthermore the catheter is indispensable in cases of chronic, complete retention as well as in cases of chronic incomplete retention, if there is a considerable amount of residual urine. If in such cases the introduction of the catheter, is very difficult and painful, it is advisable to treat these cases by a permanent catheter, especially in cases complicated by an infection of the bladder. In cases without any infection I would rather desist from a permanent catheter, because the permanent catheter often sets up a suppuration of the mucous membrane, resulting in a cystitis.
What amount of residual urine indicates the use of the catheter? It is impossible to answer that question by a generally valid quantity. It depends upon the quality of urine as well as upon the distension of the bladder. We can only say: the disproportion between the capacity of the bladder and the amount of the “residual” urine is the most decisive factor. Each practitioner, according to his own experience of it, may have a different point of view.
As soon as an acute attack of complete retention of urine has passed, enabling the patient to urine voluntarily again, the proper Homoeopathic treatment is called for, either supporting the effectiveness of the catheterization or replacing it.
Independent from the question of the use of a catheter the homoeopathic treatment of prostatic patients demands a thorough discussion. I have already stated that the homoeopathic treatment has to be based upon an exact knowledge of the anatomical and pathological conditions of the genito-urinary organs rather than upon the symptoms of the patient. Before administering a drug the following questions should be answered.
Is the condition: (1) A chronic or acute enlargement (congestion) of the prostate?
(2) Sterile or infected residual urine and what kind of infection?
(3) Constipation due to mechanical obstruction on the part of the prostate or a spastic or atonic constipation.
(4) The pules of the patient?
(5) The condition of the blood?
(6) The condition of the bowels regarding flatulence?
Hence the difficulties in finding the right drug.
The following Materia Medica may be helpful to the practitioner.