in consequence of a chill to the spinal chord occasioned by trying to do without the plaister, which brought on her last illness, commencing, no doubt, in congestion of the remnant of kidney.

She was first under allopathic treatment, then under my care for a fortnight; and subsequently, for the last few days of her life, again under allopathic treatment, and I was informed that, in accordance with the usual custom of allopaths to deny the accuracy of the diagnosis of homœopathists, it was at first denied that I was right in supposing there was congestion and abscess of the kidney, the latter not being considered to be seriously affected.

had been troubled with

I believe that for some years Mrs. frequent desire to pass water, while only a small quantity was passed each time; frequently she would have to rise from table from inability to retain the urine. It seems that when a girl at school she received a severe blow on the small of the back from a fall on some steps, and subsequently used to suffer much pain there at times. Probably this blow caused an inflamed state of the nerves supplying the kidneys, with subsequent paralysis of them on the one side, and from this may be dated the commencement of the disease which the timely administration of Arnica, Acon., Pulsat., &c., might have prevented at least this is the view I should be inclined to take of the case. I may add that, according to her own statement, during this last illness the only real relief she received was from the homœopathic remedies, and it was merely to satisfy friends and much against her own will that it was discontinued. It is now about four years since the case came under my notice.

Mrs., æt. 49. Appearances on post mortem. On opening the abdominal cavity the mesocolon came into view, thin as usual. Being lifted and the colon with it removed, there appeared a sac containing fluid, extending from the pubes almost to the left hypochondrium. This was believed at this stage to be the bladder. The jejunum and ileum being raised, they were found closely connected with one another, and to the hypogastric portion of the peritoneum by lymph recently effused; on detaching them fluid escaped from the interstices exactly like that mixture of pus and urine discharged from the bladder during life; this fluid was absorbed by sponge to the amount of half-a-pint. The stomach, with jejunum, ileum, and mesentery were then removed; they presented no abnormal appearance; the caput coli was enlarged; it contained some scybala, and partook of the inflammatory changes of the neighbouring parts; the rest of that

viscus from end to end was quite healthy. No kidney could be found in the right lumbar region, but only a rudiment of that gland, a portion of parenchymatous substance in breadth and thickness equal to a shilling; this was enclosed in a capsule of condensed cellular membrane, forming altogether a flattened mass as large as an ordinary sized Geneva watch. No especial artery or excretory duct was found. On the left side lay the kidney transformed into a cyst, extending from the eleventh rib, almost to the pubes; this cyst was constituted of glandular substance, attenuated and expanded, like a membrane, and of the pelvis distended, so as to form altogether a space capable of holding full twenty-four ounces of fluid-fluid to the amount of a pint (being pus and urine mingled) was found herein. The interior of this cavity shewed the polished surface of the pelvis studded with groups of petechiæ, and the four mamillæ in number differing much from the usual appearance. All prominency had departed; they were changed into very slight depressions, and formed three of them, each a circular patch as large as a shilling. The place of the remaining one, that at the pubic extremity of the kidney, was occupied by a perforation large enough to admit the finger, and which formed the only discoverable outlet of the kidney; here, from a defined margin, a suppurative surface was continued into what was concluded to be the ureter degenerated into an abscess; this latter space, large enough to hold an egg, had a definite boundary, except where it had become attached to the pubes; here there was undistinguishable confusion of parts, and certainly a breach which had led to the effusion of the urino-purulent fluid into parts extraneous to the ureter. The renal artery was larger than usual, and, instead of proceeding from the aorta transversely, it descended straight down upon the vertebral column full four inches, and then by a sudden turn entered the kidney. The cellular tissue in left iliac fossa was an inch thick, and much consolidated; there was a distinct collection of pus, to the amount of two ounces, in the left lumbar region close upon the psoas muscle. The iliac viscera were all perfectly healthy; the bladder was quite empty; the abdominal viscera, with the exceptions before stated, were also healthy. In particular, the liver was well formed, and healthy in colour; there was no gall-stone; the system was universally fat; thoracic viscera healthy, except that the right lung was universally adherent.

(Signed) J. E., M.D.
T. G., M.R.C.S.

Note appended to post mortem account.

and the symp

Twelve years ago, when Dr. P. attended Mrs. toms and external appearance led to the conclusion that there was an abscess forming, the swelling was exclusively on the left side. On the subsidence of the chief symptoms of disease, viz., pus and albuminous urine, Dr. P. expressed his belief that the left kidney had become atrophied and absorbed, and that the renal secretion was thenceforward supplied by the right kidney alone. In Mrs. 's last attack of illness, six weeks previous to death, Mr. S. P. concluded, from the nature of the pain and the situation of the tumour in the hypogastrium, that the uterus was the organ congested, and the main source of disease.

The appearances on dissection shew the right kidney to have been blighted, most probably from birth, and the enlarged and misformed left kidney to have been the sole secretor of urine-the situation so very unusual as to extend from the left hypochondrium, quite down to the left sacro-iliac symphisis, and forming a cavity capable of holding nearly a quart of fluid made it absolutely impossible to diagnosticate truly, according to the ordinary rules.

Pica, treated by Dr. BLACK.

As marked cases of depraved appetite are not of frequent occurrence, the following case may be interesting. The depraved appetite, especially for brown paper, had existed fourteen years, and yielded completely in eight months treatment. As may be expected our Materia Medica does not offer much assistance, if the indication be drawn from the appetite alone; but fortunately in this patient there existed, as is often the case in this disease, marked derangement of the uterine functions. This, together with the state of the bowels, and sick headache, led to the employment of Sepia, Bry., Plat., Ign., and Puls.

M. A. C. consulted me Aug. 20, 1851. She is delicate looking, aged 28; is very subject to alternations of spirits; has frequent frontal headaches, and is habitually constipated. At 14 years of age she suffered from giddiness in the head, which caused her to fall, and was then bled twice, profusely: from that time she has suffered from sinking in the pit of the stomach, even after eating, and a constant longing for innutritious substances, especially brown

paper and cobbler's wax, and of the former she cats great quantities. The efforts she makes to deprive herself of the opportunity of gratifying this depraved taste occasion restlessness of mind. She has a dislike to animal food; milk agrees very well with her. She became regular at 17 years of age. The periods appear every six weeks, always accompanied with much pain in the back and bowels. After the period she is subject to sick headaches and vomiting of bile. Sepia 20 gtt. iv. sig. 1. Sepia 6 gtt. iv. sig. 2, 3, each powder to be dissolved in four tablespoonfuls of water; a spoonful taken morning and evening: wait two days between the powders. The treatment was after this conducted by correspondence.

Sept. 15. She states that she has altogether improved in health. Has finished the prescription. Her appetite is better, and she has felt less craving for brown paper; rests more comfortably at night. She cannot give a very favorable report of her bowels. They are relieved after taking the medicine twice, that is once night and morning, and at the same time she feels a good deal of pain and uneasiness, and the bowels continue in a very relaxed state throughout the day. Repeat Sepia.

Oct. 2nd.-Has taken the medicine as ordered, but does not feel nearly so well, her bowels are much constipated. Has suffered very much during the monthly period from headache, and on the first and last day of the period had severe sick headaches with violent vomiting of bile, so as to be confined to bed. Feels the same craving for brown paper, and the appetite is very uncertain. Nux v. 6, gtt. iii, sig. 1, 3; Plat. 6 gtt. iv, sig. 2, 4; to be taken like the Sepia.

Nov. 3rd.-Very much better; good rest and sleep; the bowels much more regular; no feeling of sinking in the pit of the stomach; the longing for brown paper has been much less. "I have had only one attack of headache, and that was when I took the powder marked No. 2 (platina); I was then very sick, and vomited a great deal of bile. Have taken very little paper, except on the day on which I was ill; I always find the longing for brown paper is worse at the period." Repeat Nux and Platina.

Nov. 20th.-Has not had a headache since her last account, nor indeed anything whatever to complain of; has scarcely eaten any brown paper, and thinks she will soon lose all longing for it. Does not remember when she has been so well. Repeat nux and platina. Dec. 16th." I have taken the medicines and am happy to say that my health still continues to improve. I have had but one

slight headache since my last report, which was after taking the powder No. 3 (nux v.). I felt nausea for a short time, but I was not sick. The longing for paper becomes less every day. My appetite is much better, and my bowels are much more regular. I never feel anything of the sinking at the pit of the stomach." Repeat Nux., Plat.

Jan. 7th.-"I have not been so well since my last report. I have suffered from my old complaint-sick headaches, and have had to keep my bed for a day twice since my last report. Cannot bear any excitement without getting a sick headache. I think I am very bilious." Pulsatilla and ignatia alternated with nux and platina.

Jan. 29th." I am happy to tell you my health has been much better since my last report. I have only had one slight headache. Every one says how well I look. I eat very little brown paper, and feel' much stronger than I did." Repeat puls. and ignatia.

April 19th.-Continues much better; would consider herself quite well, but for a sick headache which obliges her to keep her bed, about the time of the monthly period. In other respects is very well. Eats very little brown paper; sleeps well; and has a good appetite. Repeat pulsatilla and ignatia.

End of May. She sent another favourable report. Had been quite well for six weeks, but had to keep her bed, quite lately, for some days, with a sick headache. Repeat puls. and ign.

June 3, 1852.-She reports herself quite well, and free of all depraved appetite for brown paper, &c.

On enquiry (Oct. 1853) I find she continued to keep quite well. She has lately married and has a family.

A Case of Inflammation of the Urinary Organs, with Affection of the Brain, by Dr. OEHME, of Dresden.

Mad. K. R., æt. 24, of a robust constitution and healthy appearance, had an attack similar to the present one last autumn, immediately after her marriage, which I treated successfully in three weeks, including a relapse, with Acon. 1, Bellad. 1, Hyosc. 1, and Canthar. 2 (decimal scale). Since this time she has been in good health, with the exception of being subject to ardor urinæ when she caught cold, or after having eaten of pickles and suchlike

VOL. XIV, NO. LV.-JANUARY, 1856.

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