By T. C. Fanning, M. D., Tarrytown, N. Y.

Miss -, aged about 26 years, with brown hair, quick nervous temperament and rather thin in flesh, called on me June 29th, 1863, and gave the following history: about two years ago, took cold by getting wet feet, affecting the right kidney and bladder; the trouble soon subsided, however, to be renewed with every new cold until last August (1862), when it became permanent.

In November, 1862, went to the Woman's Hospital, Madison Avenue, and remained there three months. The first operation here was for contraction and curvature of the cervix uteri, which resulted in inflammation of the parts and complete amenorrhoea. Failing here they turned their attention to the bladder and first used injections of Ferri per sulphur which stopped the discharges of blood, which for four months previously had followed urination. Applications of Chromic acid and Glycerine were made to the inflamed os uteri. Blisters were applied over the right kidney, and a seton was established over the right ovary. “Everything had not yet been done” however for the poor patient; but, alas, she was mortal, her strength was failing and it was feared would not suffice to sustain her through an operation which had been successfully performed in other cases, and would certainly cure her bladder which was still inflamed and ulcerated near the cervix. The operation proposed was to make a vesico vaginal fistula, then cure the ulceration and inflammation, and then cure the fistula. She was advised to leave the hospital and return when her general health should be sufficiently re-established to justify the operation. She left Madison Avenue in February, and in March went to St.“ Luke's Hospital. - Here Dr. – made a vaginal examination, and condemned the operation which had been performed; said there was a tumefaction on the right side (ovary?), which ought to be reduced; tried to pass the sound but could not; thought there was occlusion of the os internum, and that nothing could be done for her until she should be stronger; did not examine the bladder.

She left St. Luke's in May and, confessedly faithless, at the solicitations of friends, applied to me June 19th. I made no vaginal examination (a procedure which I always avoid, if possible), but elicited the following symptoms: Soreness of bladder and feeling as if a sharp instrument had been thrust into the neck of the bladder in micturition. Once in two or three weeks a discharge of yellowish matter with each evacuation of the bladder for twenty-four hours, and micturition is then particularly painful. Feeling of soreness at cervix vesicae, especially on right side. Urination every half to one-and-a-half hours. Sometimes pain in right kidney, removed by warmth to feet and back. Urine turbid. Great pain in the bladder attended with afternoon fever, which lasts until she goes to bed and subsides with profuse sweat, especially on the back. Aching, apparently in cervix uteri about every two weeks, lasting three or four days, relieved by lying with right thigh flexed, in which position she always sleeps now. Inability to lie on right side on account of pain in the right iliac region, low down. Menstruation reappeared about five weeks ago for the first time since the operation at the Woman's Hospital, lasting (as usual) seven days. Flow dark, very offensive, sometimes clotted (not so last time), acrid (last time only) preceded by pain in back, uneasiness and inability to sleep, and aggravation of pain and aching in the bladder (and ovary?), attended by the same with nausea. Occasional slight leucorrhea. General weakness. Decided mental depression; hopeless as to relief from her sufferings.

On comparing these symptoms with the following, contained in the proving of Lithium carb. (Review, vol. iv., p. 9), the applicability of that drug will readily be perceived:

1. Disposition to weep about his lonesome condition.

2. The whole night, anxiety and feeling of helplessness.

106. Violent pain transversely in the abdomen in the upper part of the vesical region.

125. Restlessness in the region of the kidneys.

127. Sensitive pain, sharp pressure in the vesical region, more on the right side; about ten minutes after passing water.

129. Pain in the region of the neck of the bladder on the right.

138. Frequent urination.

141. Urination painful.

148. Turbid urine with much mucous deposit.

150. Urine more scanty and dark, very acrid; it pains when being passed, like lye upon an irritable surface.

153. *Very frequent urination, disturbing in sleep.

164. The menses are three or four days later and diminished.

165. When taken before the menses, the symptoms were most violent on the left side; when taken after the menses on the right side.

231. Prostration of the whole body, especially in the knee-joints and sacrum.

251. Very copious sweat.

252. Sweat on the back of the hands.

July 4th. Menses appeared again yesterday (after six weeks), flow dark with bright clots, and the aching was relieved by it. Gave Lithium carb., to be dissolved in half a tumbler of water, and a spoonful taken three times daily after the cessation of the menses.

13th. Better; can retain water three or four hours; less pain and soreness. Appetite better and feels stronger.

30th. Continued to improve till July 25th, when she took cold and again passed what seemed to be matter, and since then there had been more burning and pain in the bladder. Water now clear and passed about four times daily. Gave Ignatia ³⁰⁰ to be taken every third hour.

August 1st. Better; burning about gone, some pain still. Lithium once daily.

6th. Still better; burning all gone; pain only momentary in passing water. Spirits good. Sleeps well, only rising twice to micturate.

September 17th. Has menstruated regularly, three or fonr days late, and without pain in back, for the first time in more than two years. For three weeks past has suffered much from soreness at the cervix vesicae, right side, especially when walking, going down stairs or lying on right side. Urine has a slight deposit (purulent?). Suspecting that the Lithium might have been continued too long, I now gave Sach. lact.

28th. For past two days has been decidedly better; last night lay for the most of the night on the right side only, rising once to urinate and only once the night before. Urine clear.

The above is the last entry in my note book in regard to this case. In November, Miss – went to New York to remain for the winter, and while there consulted another physician who, to my application for information respecting the case, makes the following reply:

“Miss – came under my care November 21st, 1863. Her symptoms indicated inflammation of the urethra, in which I discovered a polypus at the meatus. I removed it with a ligature and she was much relieved in three days. The uterus was enlarged and prolapsed, ulcerated at the os, showing where Dr. Simms had scarificed it severely, which scarifications had not healed. The case passed from under my hands before the uterus was perfectly cured.”

As a summing up of the case, so far as it was under my care, I may say that the very speedy improvement following the administration of the remedy leaves no room for doubt as to its beneficial effect; but in consequence of the removal of the patient, there is an uncertainty as to the extent and permanency of its action in the case. I think I have good reason, however, to believe that Lithium cured the ovarian inflammation, including dysmenorrhea and the trouble remaining in the right kidney, and so far relieved the vesical difficulty that the patient regained her usual appetite and spirits, and was able to enjoy life which, before taking the remedy, had been only a source of continual agony for months and from which she longed to be relieved by death, if no other means could be found. Referring to the symptoms, Nos. 2, 5, 6, 7, 8, 9, 12 and 13, were entirely removed, and material relief was afforded to Nos. 1, 3 and 4. The menstrual function wail restored to its normal condition.

Without doubt my want of more complete success in this case arose from neglect of Hahnemann's third precaution. Had I prescribed Sach. lact. on or before August 6th, I do think I should have had cause to complain of the report of September 17th.

---