BY B. F. JOSLIN, M.D., NEW YORK.

It is only within a few years, and under homoeopathic treatment, that this disease has begun to be regarded as curable. It has been called “Bright's disease,” from the name of the late physician who first specially called the attention of the profession to albuminous urine, as connected with degeneration of the kidneys and to the fatal dropsy which ensued.

My plan is to state the symptoms, so far as time allowed their record at the hours of prescribing, and such extracts from the provings, of at least the principal remedy, as show the extent to which it is here clinically confirmed, and how far the prescriptions were in accordance with the homoeopathic law. I have seen no demonstration of special rank among symptoms of the materia medica, Independent of their relative verification and their similitude to the case or malady. Who is prepared to give one, illustrated by provings and practice?

The dilutions and intervals are stated, from a conviction that uniformity in regard to them must ultimately be effected, if at all, by clinical experience. There are agents which, in large doses, are pernicious in the very diseases in which they are specific.*[Some who have used only low dilutions of Mercury in Diphtheria, hare found it hurtful. In my practice there have been a dozen cases, all of which have recovered. Merc. 6, 12 or 30 has been chiefly relied on. Lach. and Bell. according to the symptoms, have also been valuable. I have not resorted to any combination of Iodine.]

Case I. — A New York Merchant of abstemious and exemplary habits, began to manifest the characteristic symptoms of this formidable malady at the age of thirty-three, in November, 1857. On the 13th of this month, the urine was examined by heat-and nitric acid: either occasioned a brownish white precipitate, which occupied one-fifth of the test tube, when this had been previously filled with the liquid. What led to this examination of the urine, was an anasarcous tendency most manifest in the feet.

Some months earlier, he had spent the nights at his country seat in a malarious district, and after removing to the city was attacked with intermittent fever, from which he had recovered under Bry.²⁰, a month previous to the time when the present attack of albuminuria was identified.

After the dropsical symptoms began to appear, the patient was treated for a month with Bell., Sulph., China, Arsenicum, Bryonia, and Pulsatilla, with but partial and transient relief from either. About half this time he was at a distance, and the medicine sent by mail. A week before the end of November he wrote, that the clothes which he usually buttoned around his waist could no longer be made to meet; and on the 25th of the same month, that the feet, legs, and abdomen were becoming more distended; breathing difficult when ascending and when lying on the left side.

The apprehension of an accumulation in the cavity of the peritoneum, which these communications would naturally excite, was in a few days enhanced into conviction by the personal examination, of which the patient's return afforded an opportunity.

The ascites was evidently progressing in spite of the medicines employed. For this reason as well as for the absence of the patient during half this time, a greater amount of definite and practical information can be communicated within a given compass, by confining myself to the history, of the case under the effectual medicine next selected.

December 13th. The face pale and yellowish; the abdomen much distended, and the pressure of the liquid, especially against the diaphragm, rendered the respiration laborious No edema of the abdomen, but it had pervaded the whole subcutaneous areolar tissue of the inferior extremities, feet legs and thighs; urine reddish brown, and after standing turbid; cough in the morning.

The following symptoms, which are present in this case. have, according to Dr, Hering, been produced by Apis mellifica: —

Paleness of the face; abdomen full, swollen; with swollen feet and scanty secretion of urine; scanty, highly colored urine; cough in the morning; breathing difficult.*[The provings of Apis I shall quote chiefly from the translation in the British Journal of Homoeopathy, vol. xi.] Apia mel ³ in water, every four hours.†[Where the dose is not stated, it is always f 3 ii of a solution or a few pellets dry. The medicine dissolved is in small globules and in one gill of water, unless otherwise stated.]

14th. Circumference of abdomen increased in one day day by three-fourths of an inch under Apis.³ Another effect of its primary or pathogenetic action, was a general aching through the head, which was a very unusual symptom with him, and was probably caused by the medicine.

The redness of the urine was a little lighter and the quantity somewhat increased. These last appear to be secondary or curative effects. Apis ² f 3 ii. every two hours.

15th. Heaviness at the stomach after meals.

The therapeutic symptoms are: — A general improvement in his feelings; a reduction of half an inch in circumference; urine less brown and not so turbid on standing. 5 Apis³ to be taken evening and morning, in ounce doses of the aqueous solution.

17th. Circumference diminished half an inch in last two days. Apis mel. 1/16, gtt. iij. in one ounce of water to make four doses; a quarter of it is to be given evening and morning.

19th. Stationary as to size under these doses. No change in circumference as compared with the 17th; feels better except as to cough. 8 Apis 1\16, gtt. iv. in one gill of water. Dose, f 3 ss three per diem.*[This mode of distinguishing all dilutions between and, by a fractional expression, is exact and consistent, and avoids the confusion with which some are endeavouring to undermine and deform homoeopathic notation by the occasional use of the decimal scale. The fractional figure in the line, is a factor, agreeably to mathematical usage; small figures above the line are on the same authority exponents, unity the common numerator of the fractional exponent is suppressed for the sake of convenience. Regarded in this sense, both the factor and exponent express the part of the original drug contained in the preparation. An integer before the name of the medicine and in the same line with it, is also a factor and expresses the number of doses; as we never concentrate the medicine, and as the figure expressing its density is after, not before it. All this promotes convenience, brevity and exactness, and avoids the prevalent error of giving what are really indices, denote powers, the magnitude and situation universally accorded in the exact sciences, to multiplying numbers or factors.]

I requested a specimen of the urine to be sent me for examination, and on testing it with heat and nitric acid, found the bulk of the albumen to be only one-twelfth that of the urine. The reader may perceive that the ratio had been more than twice as great, and, can believe it probably still greater near the height of the dropsy when Apis was commenced.

Dr Joslin, jr., in examining the urine on the 19th with the microscope, “found tubes and epithelium, also, mucous and blood corpuscles, the latter having the characteristic appearance of rings. On adding acetic acid the granular appearance of many of the mucous globules was apparent. The blood corpuscles appeared diminished in size and irregular.”

21st. Visited the patient after five doses of Apis 1\10, and found his ascites decidedly improved; the circumference of the abdomen reduced by one inch, i. e., to thirty-one and one-eighth inches; walks with less inconvenience; cough pains the abdomen in some degree; urine somewhat, but not greatly increased. Apis² three times a-day.

24th. Improving decidedly as to ascites under Apis²; the circumference of the abdomen reduced to thirty and one-eighth inches, i. e., by one inch. Apis³ in same manner as last.

28th. In the last four days under Apis², the circumference of the abdomen was reduced to twenty nine and seven-eighth inches, which I regarded in his case normal, and subsequently made no further measurements. I believed that there was no longer any sensible accumulation of fluid in the cavity of the peritoneum. There was no dyspnea or other signs of dropsy in the abdomen, nor was there afterward any apparent change in its magnitude.

The patient had cough, which pained the chest and shocked the head. Expectoration sweetish and tasteless. No disease could be detected in the chest by percussion or auscultation. There was a slight redness of the velum palati.

In the same four days there had been commenced a decided improvement in the edema of the inferior extremities; that of the thighs was entirely removed, but it remained in the legs and feet. Medicine discontinued.

31st. Improving decidedly under the secondary action of Apis²; feet much reduced; abdomen and thighs continued normal; cough rather better, Apis¹², solution three times a-day. From this period the patient being able to walk to my office, was no longer visited at his house.

On the 2nd of January, 1858, Dr. J., jr., records in relation to this case: “Received a specimen which contained al bumen as shown by heat and nit-ac. tests.”

January 7th, 1858. The improvement of the edema continues to take place under Apis¹²; complete absorption effected in the upper half of the legs, and considerable reduction in the size of the feet; cough also better. 10 Apis¹² in solution, evening and morning.

The patient did not call again under thirteen days.

20th. Cough almost gone; dropsy gone except a very little between the ankle and calf; strength and flesh much increased. 10 Apis³⁰ evening and morning, in solution; then walt half a week, then the same medicine to be repeated in the same dilution and in a similar manner.

28th. Called before or at the commencement of the second solution of Apis.²⁰Dropsy entirely cured; cough and deep inspiration occasion shooting in one side of chest. Bry.¹² solution four times a day.

February 1st. Face rather pale; rheumatic pains gone; but cough remains, it pains chest and sometimes through to back; expectoration sweet; upper part of throat feels sore; urine brown, depositing after standing a red sediment; had a chill in the evening, a day and a half previous; has usually had perspiration at night for two months, of which I had not been previously informed.

In the pathogenesis of Mercurius we find this color of the face; approximate concomitants of the cough, i. e., cough with pain in chest and small of back; brown urine, depositing a sediment; a chill in the evening and disposition to sweat at night. Merc. v.²⁰ solution.

He called again on the 23rd, on returning after a trip to Savannah, Ga., made with my consent. Had more color in face; urine clearer; cough better; expectoration of disagreeable taste in the morning, during most of the day sweetish. Sore feeling in throat continues, and cough is caused by a tickling there. Some palpitation as well as dyspnea is excited by ascending a hill or a flight of stairs.

As results of the provings of Nitric Acid, we find: — Sore throat when swallowing, as if the throat were swollen, raw, and ulcerated; soreness of the pharynx; clear urine, at other times brown, at others dark, becoming turbid; titillation and soreness of the throat with cough; want of breath and palpitation of the heart when going up-stairs. Nitric Acid¹⁶⁰⁰.

I am unable to state the number of doses, whether one or more. I limit myself to the records made at the several times of prescribing, both in regard to medicines and symptoms.

The symptoms remaining on February 23rd, were removed under Nit. Ac¹⁰⁰⁰. No prescription was made for the patient after this day.

On the 13th of April, 1858, the urine was tested and found to be free from albumen. The patient's health seemed to be good in every respect, and no prescription was made or needed.

Dr. J., jr., made the following record: — “April 13th, received this morning a specimen of urine of normal color. Added Nit. Ac. without any apparent effect; then applied heat to the specimen to which Nit. Ac. had been added, no effect except the usual deepening of color was produced; could not detect albumen. Two or three weeks ago, I received a specimen which I was unable to examine until it had stood some ten or twelve days; I could not ascertain that it contained any albumen.”

The cure was complete and permanent, as I have the means of knowing by being still the physician to the family of this gentleman, and having frequent opportunities of meeting him in relation to its other members. His own health appears to be still good after the lapse of two years.

No pathologist will doubt that the ascites and the edema were caused by albuminuria; and as the dropsy was at its maximum under the first prescription of Apis, and disappeared before the last and without any other medicine, it is sufficiently evident that the cure of the albuminuria, as well as of the hydropic affection, was effected by its agency.

Case II — On the 19th of December, 1858, I was called to visit a little girl five years of age, daughter of a captain in the navy. There was some swelling of the face; aching at umbilicus, worse in the morning; stool dark brown and offensive; urine red and turbid; a little cough; pulse frequent, 112, then at five p.m.; fever reported to be more at night. Merc. v.¹⁰ in solution three times a-day.

Dec. 24th. Face edematous, legs still more; fluent coryza; tongue red at tip; appetite deficient this morning, voracious previously; vomiting of mucus, with red specks; the abdomen swollen by effusion into the cavity of the peritoneum, but not edematous; urination infrequent; urine scanty and fetid; hoarseness; fetor of the breath.

The provings of Apis show, that the following symptoms, which belong to this case, have been produced by it: — swell-of the face; tongue red at tip; want of appetite; vomiting; pains in the abdomen; scanty urine; hoarseness; cough which ceases when the least quantity is detached; pulse frequent; abdomen full, with swollen feet and scanty secretion of urine; heat with cough. Gave Apis mellif.¹² in solution every four hours, and procured a sample of the urine for examination.

Albumen was found to be present in a remarkable quantity, for the white precipitate had half the bulk of the urine, whether acted on by heat or acid.

27th. Visited about noon. Face rather pale; tip of tongue red; appetite voracious; more dropsical swelling of abdomen and thighs, and in general the dropsy increased; circumference of abdomen twenty-four inches; urine scanty; sleepiness, more after meals; pulse rapid, 120. Apis² some pellets in a gill of water. Dose, two drachms; interval not stated, probably three hours. Sleepiness is an Apis symptom.

29th. Constipation removed; bowels now rather loose.

The following are the effects of Apis, in this case, which we may regard as therapeutic: — Thighs rather less bloated; urination more frequent — three times in night, a gill each; breath less fetid: pulse reduced to 104 in the erect posture of the patient, 99 when she is seated. The following seem to be morbid or pathogenetic effects: — Aggravation of fluent coryza and of hoarseness; circumference of abdomen increased by two inches, that is to twenty-six inches; at night dyspnea and restlessness; other symptoms unchanged. As the urine was previously much less than normal, and: still not in excess, the increase is to be regarded as a curative effect, although the ascites had advanced faster under Apis⁰ than in any equal time previously. The alvine effects being of a mixed character, are not included in either class. Apis² three drops in a gill of water, two drachms every three hours.

31st. When two days under Apis,³ was visited near one o'clock and found decidedly improved as to the dropsy, and cured of albuminuria. Circumference of abdomen one inch and three-fourths less than on the 29th; thighs, legs, and feet, less swollen; the urine presented one new and remarkable feature which I had never witnessed in this or any other case — it was of a reddish violet color. On being tested by heat and nitric acid, it was found to be entirely free from albumen, and none was subsequently seen. Three copious alvine evacuations occurred on the preceding day; sleep better. Apis³ + ¹; 3h, i. e., Apis² extemporaneously diluted a hundred fold, given once in three hours.

January 2nd, 1859. The patient much improved; the swelling of thighs, legs, and feet, decidedly less; circumference of abdomen reduced half an inch; the color of the urine violet red; no albumen. Pellets of Apis¹² in water once in four hours.

5th. The urine has less of the violet tinge; the circumference of the abdomen has been reduced one and a quarter inches in three days under Apis ²⁰ and appears normal; no sensible bloating in the limbs or other parts; the dropsy appears to be cured under Apis¹². Pellets of Apis³⁰ in water, evening and morning for five days.

The history of this case is finished so far as regards dropsy and albuminuria. But it will be more satisfactory to follow the record to the establishment of permanent health.

A week later, on the 12th, had slight diarrhea preceded on the morning of the previous day by colic. 4 Ars²⁰⁰. twice a week.

Nine days subsequently, I was called to visit this patient, who, after over-exertion and eating mince-pie, had an attack of pain in the stomach and fever at night. Pupils slightly dilated; the urine reddish brown and turbid; heat produced a reddish brown deposit; nitric acid the same; both about one-eighth of the urine; a slighter deposit spontaneous; the microscope shows it to be uric acid.

In five days the urine had become normal and the fever nearly absent. Lach.²⁰⁰ evening and morning for five days.

A week afterwards had another attack of indigestion and consequent vomiting, fever and thirst, after eating oysters. The following symptoms producible by Calcarea were present: — Blueness under eyes; face yellowish and pale; fondness for salt; indigestion; pain in stomach; colic; red urine; yellowish skin and emaciation. 6 Calc.¹² in water, morning and evening.

Four days after this, on February 4th, 1859, the patient required no medicine.

In eight days from the last date, the little girl, in consequence of taking cold from playing in the snow, had the following Lachesis symptoms: — Face sallow; urine has lately been brown and turbid, but is now normal; fever; and cough which pains the stomach. Lach.²⁶pro re nata.

The cure was permanent: the patient required no other medicine, and her health, for the year past, has been unusually good.

RECAPITULATION AND REMARKS. — In case I, the ascites decidedly increased in the first day under Apis², then diminished by a greater amount on the next under the same. No change in size of abdomen in two days under Apis 1\16; in the next two, under the same, decidedly reduced; and by the same amount in the next three under Apis³. Under this last, continued four days longer, the ascites was by another slighter reduction removed, and the dropsy of the inferior extremities decidedly reduced, that of the thighs gone. In the three succeeding days, much reduction of swelling, especially in the feet, under the prolonged action of the Apis² previously given. In the following week the improvement continued under Apis,¹³ the upper half of the legs becoming normal and the feet reduced. In the next thirteen days, under the same, a great improvement in general strength and flesh, and limitation of effusion to the lower part of the legs, where only a very small quantity remained. In eight days more, the edema entirely removed under Apis.²⁰. Two years have elapsed and neither the encysted nor cellular dropsy have in any degree returned.

In case II, in which the urine was half albumen, the dropsy increased in three days under Apis¹²; in the next two days, under Apis ⁰, the peritoneal dropsy increased with a rapidity unprecedented in the case, whilst a little improvement occurred in the thighs and more in the urinary secretion. Two days afterward under Apis³, the albumen was found to have entirely disappeared, the ascites to be greatly, and the edema of the whole inferior limbs decidedly reduced, and the urine to present a remarkable violet hue. In the next two days under Apis. ² diluted a hundred fold, Apis.²⁺¹, the ascites slightly, and the edema decidedly reduced, the albuminuria remaining cured. In four days under Apis³⁰, the ascites and the dropsy of cellular tissue were entirely removed. Some tinge of violet was observed in the urine till after the action of Apis⁹⁰ but no dropsical symptom nor any evidence of albuminuria has since appeared in the year that has elapsed.

The morbid conditions which were common to the above cases and removed by Apis, were: — The albuminous character and scanty secretion of the urine, with the encysted dropsy in the cavity of the peritoneum and the edematous swelling of the inferior extremities. The magnitude of the doses employed for these, was from the twentieth to the decillionth of a drop.

The following remarks are in relation to the bearing, which the above cases have upon the efficacy of Apis.

First: These are the only cases of albuminuria in which I have employed this medicine; they are therefore not, in any objectionable sense, select.

Secondly: The period that has elapsed since their treatment, the easy circumstances of both families and my subsequent connexion with them to the present time, have given opportunity for learning the permanence of the cures.

Finally: There being no abnormal increase of the secretion of urine under its action, afforded a reason for presuming that this was specific and permanent, and not merely palliative and transient, like that of diuretics. If any one should resort to it on this mechanical principle and without reference to its symptoms, he would probably be disappointed, at least in the final result.

NOTE. — The author was appointed to make a Report to the American Institute of Homoeopathy on Rumex, and intended to give clinical confirmations on the plan of this article. But as his brethren have not yet furnished the requisite cases, he intends to offer this article. That the members who choose may previously consider it, and thus time be saved at the meeting, consistently with a proper selection and revision of papers for the Transactions, it is published here in advance agreeably to the request of the Institute.

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