Apis Mellifica

For this remedy we have two names, according to the manner in which the preparation is made. It is either Apis mellifica, the honey- bearing bee, or Apium virus, the poison of bees. The original prepar- ations of the remedy were made in the following manner: A large white dish was placed under a bell jar, in which there was a perfora- tion through which a stick was inserted. Several hundred bees were then placed beneath the jar.

The stick was then moved about, and, irritating the bees, caused them to sting the jar and the dish. After a while the bees were allowed to escape, and on the bell jar and plate were seen numerous specks. Alcohol was poured over these, and thus was obtained a powerful extract of the poison of the bee. This is Apium virus.

Subsequently the whole bee was used. Triturations were made of the entire insect. Thus we obtain Apis -mellifica. The symptoms of the two preparations have not been separated.

Apis mellifica is an invaluable acquisition to our Materia Medica. In order to understand its symptomatology let us look at its toxi- cology. Take, if you choose, a sting on the hand or finger as an illustration. Just after the sting, which causes a sharp sticking or

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burning pain, there commences, very promptly, swelling of the part, with extreme soreness. The part feels as if it had been bruised or pounded. The swelling is at first of a rosy pinkish hue. It spreads very rapidly; the pains become intense.

They are of a burning, sting- ing or shooting character, seldom throbbing. Heat of the part in- creases with the burning and stinging pains. This may end very speedily in resolution or it may go on. If it pursues the latter course, you will notice that this ros>r appearance becomes more intense, in fact, assumes an erysipelatous appearance.

Still later, it changes its color and takes on a pale but bluish hue, and the swelling pits on pressure, showing that the parts are cedematous. After a while, if the condition of the system is such as to permit it, gangrene of the part takes place.

Experience teaches us that some such dermal or cellular symptoms are usually present in ever}' case for which Apis is the remedy. They, therefore, deserve to be emphasized. The soreness is as important as the more frequently described burning, stinging pains, and varies from a bruised, sore feeling to an exquisite sensitiveness to contact. The swelling is the result of a rapid serous effusion into the cellular tissues. It is a universal symptom.

The inflammation produced by Apis is, therefore, not of a sthenic type. It is not, for instance, such as would be cured by Aconite, wTith sudden swelling of the part coming on rapidly and ending in resolu- tion; nor is it such as would be cured by Belladonna, with bright red swelling accompanied by throbbing pains and ending either in resolu- tion or suppuration. The Apis inflammation is distinctly asthenic, with whitish discoloration and a tendency to gangrene and destruction of tissue. In one case, where the sting was on the hand, the patient suffered also from a carbuncle on the back of the neck.

The vitality is speedily and sometimes alarmingly reduced by the action of Apis. This is shown in the severe prostration, desire to lie down, deathly faint feeling, premonition of approaching death, nerv- ous trembling, coldness and loss of consciousness, especially in erup- tive diseases. The heart is weak, beats slowly or almost impercep- tibly, with pulselessness at the wrists.

In the majority of cases calling for Apis the nervous system is irri- tated notwithstanding the accompanying prostration. The patient is excitable and dances with excessive joyousness; she laughs at the greatest misfortune as she would at a comedy; she is always changing her occupation, and will not keep steadily at anything.

IOO A CUNICAL MATERIA MEDICA.

As will be inferred from the symptoms mentioned, Apis may be em- ployed in states of mind resembling hysteria. The fidgetiness, rest- lessness, excitability and ill-timed laughter, together with fickleness at work, have led to its successful use for nervous girls. In addition, it has been observed that they are awkward, dropping things and then laughing in a silly way at their clumsiness. The sexual passion is too active, and they are prone to jealousy.

The confusion of mind and unconsciousness just noted indicate the remedy in severe adynamic forms of disease, such as malignant scar- latina, diphtheria, typhoid fever, etc. A complete stupor after apo- plexy is said to have yielded to Apis when Opium failed.

In scarlatina the fever runs high, and the attending restlessness is one of nervous agitation. The mouth and throat are very red, with blisters on the borders of the tongue, and swollen puffy fauces; there are burning, stinging pains and a scalded, raw feeling in the mouth and throat. The skin pricks as from needles, the rash being inter- spersed with a miliary eruption. There is always puffiness of some part of the surface. Prostration comes on early, with scanty or sup- pressed urine, high fever and drowsiness.

In meningitis or in meningeal irritation Apis holds a prominent posi- tion as a curative agent. It is often the remedy, no matter what the^ ailment, when shrill outcries in sleep lead to the suspicion of cerebral irritation. Such cases frequently begin with the nervous fidgetiness so characteristic of the bee poison, and advance to more serious condi- tions. In tubercular meningitis, or in acute cerebral effusions, a sup- pressed or undeveloped eruption is a good guide to the choice of Apis.

We may profitably compare Apis here with Bellado?ina, Helleboius, Arsenicum, Bryonia, Zincum, Sulphur, Cuprum, Glonoine, Lachesis, Rhus tox., Hyoscyamus, Natrum mur., Bovista, etc.

Belladonna is doubtless frequently employed when Apis would suit better. A little care, however, will enable the practitioner to distin- guish the fidgety nervousness of the latter from the more intense cere- bral irritation of the former. The congestions of Belladonna are more violent, with throbbing of the carotids, injected red eyes, and drowsi- ness broken by starts and frightened outcries. The adynamia is much less than in Apis.

If the disease is scarlatina, the rash is smooth and bright red, but not miliary. The skin is hot and the face red, or, in some cases, pale; but not pale and cedematous as in Apis. The cer- vical glands may be swollen, but there is not the cellular infiltration, with an erysipelatous blush, as in the bee-poison.

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If there is meningeal irritation, Belladonna is needed when the con- gestive symptoms are intense; Apis, when the nervous agitation pre- dominates, with the shrill cry, which betokens stabbing, piercing pains or excitement. In meningitis Belladonna is decreasing^ indicated as the symptoms of effusion increase, while Apis is increasingly indicated as long as symptoms of irritation obtain and the cephalic c^ is marked.

Helleborus claims precedence when the irritation of Apis gives place to mental torpor, with want of reaction. The forehead is wrinkled, the pupils dilated, and the lower jaw tends to drop; the sopor is com- plete. There are automatic motions of one arm and one leg; the fore- head is bathed in cold sweat. In such cases Helleborus may bring about reaction so that another remedy will cure.

In typhoid fever they differ widely. Apis, although it has great weakness, apathy and stupor, has a dry, blistered tongue and exquisite soreness of the abdo- men. Helleborus has complete sensorial apathy, dark, sooty nostrils, slow pulse, and no response to touch or pressure.

Bryonia bears some slight resemblance to Apis, especially as it may be needed, like the latter, for cerebral effusions following suppressed exanthemata. The sensorium is benumbed, but the senses are not so perverted as in either Apis or Helleborus. There is a constant chewing motion; the face is dark red, the lips parched; when offered a drink it is taken hastily and impatiently. If the child is moved, it screams with pain.

Later, when the sensorial depression amounts to sopor, Helleborus follows well, even if the chewing motion and hasty drinking continue. Apis follows if the sopor is accompanied by a more shrill cephalic cry than in either of the other remedies.

Cuprum compares with Apis when meningitis results from a sup- pressed exanthem, but the symptoms are very diverse. Cuprum causes loud screaming, followed by violent convulsions; the thumbs are clenched, and the face is pale with blue lips; the eyeballs are con- stantly rotating. If convulsions occur in the Apis case, they are less violent, consisting of restlessness and twitching of one-half of the body; the other half is lame and trembles.

Much more closely related in suppressed eruptions is Sulphur. The two follow each other well.

Glonoine, like Apis, has the cephalic cry; there is a sensation as if the head were enormously expanded. Spasmodic vomiting of cerebral origin is most prominent in the former, as is also intense congestion and throbbing.

102 A CLINICAL MATERIA MEDICA.

Zincum produces cerebral irritation; the child awakes with fear, rolls the head ; cries out and starts in sleep. There is constant fidgety mo- tion of the feet. The drug is indicated in anaemic children who are too enervated to develop an exanthem. In typhoid states the prostra- tion is very great, with impending cerebral paralysis. Unconscious- ness develops, with blue hands and feet, coldness, weak pulse; lower jaw dropped. Here the Oxide has been successfully employed.

Rhus tox. , though incompatible with Apis, has many similar symp- toms. In scarlatina, for instance, both suit in adynamia, swollen throat, erysipelatous inflammation of the skin of the neck, miliary rash, drowsiness and oedema. In Rhus, however, the eruption is darker, the erysipelas dusky red, and there is great bodily restlessness — not the fidgetiness of Apis.

Arsenicum is similar to Apis in many respects. Both have anxious change of place, fear of death, restlessness, great weakness. (See also in several instances below.) Irritability of mind occurs in both, but it is more an anxiety and fear in Arsenicum; more a nervous restless- ness in Apis.

If they meet in cerebral affections, as possibly they may, especially in hydrocephaloid, Arsenicum is to be selected by hot skin, pale and hot face. The child lies in a stupor; suddenly it twists its mouth and a jerk goes through the body; or the child lies as if dead, with half- open eyes, dried mucus on the conjunctivae, and no response to touch upon the eyelids.

Hyoscyamus and Lachesis are similar in jealousy.

Natrum mur., Bovista, Lachesis, ALthusa, Ignatia, Nux vom. have awkwardness; the first is most similar to Apis.

I have already hinted that Apis may be of use in dropsies. The symptoms calling for it are briefly these. In general dropsies we find it indicated by the peculiar appearance of the surface of the body. The skin has a transparent, waxen look, with a whitish or perhaps slightly yellowish tinge.

The urine is scanty, and there is almost always absence of thirst. The characteristic symptoms are the trans- parency of the skin and the thirstlessness. Now as to cause. Apis is especially useful in dropsies of renal origin, whether the result of scar- latina or not.

The urine is scanty and highly albuminous, and con- tains casts of the uriniferous tubules. There is a swelling about the eyelids. The surface of the body feels sore and bruised; in some cases the pain is of a burning character. If the dropsy is of cardiac origin,

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the feet are cedematous, especially after walking. This is attended with almost intolerable soreness and burning.

Even when the dropsy has invaded the chest and we have hydro- thorax Apis may be the remedy, especially when the trouble is of car- diac origin. The patient is unable to lie down. He has the same constrictive feeling about the chest that we find under Lachesis. He has a dry cough, which seems to start from some place in the trachea or larynx, usually the trachea, the cough not ceasing until a small quantity of phlegm is loosened.

Thus far the remedy is exactly like Lachesis. But Apis has, in addition to these symptoms, a mental symptom which conies from the chest, namely, a constant feeling as though he could not live. It is not a feeling of dyspnoea, but appears to be a sort of anguish of mind; the patient cannot understand how it would be possible for him to get another breath, so great is this suffo- cative feeling. Associated with these chest symptoms, the patient often has a strange feeling as though he were going to die, but there is not the intense fear and sthenic fever of Aconite, nor the great rest- lessness of Arsenicum, but more of a fidgety anxiety.

In pleuritis with exudation Apis is one of the best remedies we have to bring about absorption of the fluid. Apis and Sulphur will cure the majority of these cases.

Apis also acts on the synovial membranes, giving a perfect picture of synovitis, particularly when it affects the knee. It is indicated when there are sharp, lancinating, stinging pains shooting through the joint, with aggravation from the slightest motion.

Bryonia affects the joints and their synovial membranes, but the pains are stitching in character, w7ith tension, and they are better from the warmth of the bed, while the Apis pains are better from cold ap- plications.

Iodine is useful in dropsy of the knee, and has followed Apis well, especial^ in scrofulous children (compare also Kali iod.).

We have still another form of dropsy in which Apis is a remedy, namely, dropsy of the brain, a condition which used to be called hy- drocephalus. It is not so often indicated in true hydrocephalus, that is, when from some mechanical cause there is inflammation set up in the membranes of the brain, followed by accumulation of serum; but it is in tubercular meningitis that this remedy is useful. Apis is here indicated in the first stage. The symptoms which call for it are these.

The child bores its head backward into the pillow, and rolls it from

104 A CLINICAL MATERIA MEDIC A.

side to side; every little while the child arouses from sleep with a shrill, piercing cry. This peculiar shriek is due to pain. One side of the body twitches and the other lies as if paralyzed. Strabismus is usually present.

The pulse is rapid and weak, and the urine scanty. There is no remedy which can do any good in this stage if Apis does not. Apis has a peculiarity which I should mention, and that is slow- ness of action. Sometimes you will have to wait three or four days before you notice any effects from its administration.

The favorable action of the remedy is first shown by increased flow of urine.

In dropsies, Apis may be compared first of all with Arsenicum^ which has the same transparency of the skin, and is also of use in dropsies of renal, cardiac or hepatic origin. The differences between the two remedies are the.se. Arsenicum has intolerable thirst, but the patient usually drinks only a small quantity at a time, because water annoys the stomach. Eating and drinking both cause vomiting.

I have seen cases in which even a single teaspoonful of medicine pro- voked vomiting. The patient exhibits marked restlessness.

Another remed}T for comparison is Apocynum canabinum. This is much used in the West for general dropsies, swelling of any part of the body, ascites, hydrothorax, etc., usually without any organic dis- ease as a cause. The patient cannot tolerate any food. Food or water is immediately ejected. There is a sunken, gone, exhausted feeling at the pit of the stomach.

The next remedy similar to Apis is Acetic acid. This is useful in dropsies when the face and also the limbs have this waxen or alabaster appearance. It is especially indicated when the lower parts of the body, that is, the abdomen and limbs, are swollen, hence it is useful in ascites. Thus far it is similar to Apis.

But it has thirst, which Apis has not, and gastric disturbance is almost always present; sour belching, water-brash and diarrhoea. Acetic acid is an undeservedly neglected remedy in dropsy. You see how it stands between Apis and Arsenicum. It differs from both of these remedies in the preponder- ance of gastric symptoms.

In hydrocephalus, the most similar remedy to Apis in the stage of exudation is Sulphur. Sulphur is indicated more on general principles than for its particular affinity for the meninges. Tubercular menin- gitis cannot occur in an otherwise healthy child. There must be a diathesis at the bottom of the trouble. Sulphur helps in the same stage as Apis when Apis fails to bring about a reaction, particularly

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when the child is scrofulous aud has other Sulphur symptoms The child lies in a stupor, with cold sweat on the forehead, with jerking of the limbs, particularly of the legs, with spasms of the big toes and sometimes of the thumbs also. The urine is suppressed. Sulphur is all the more indicated if there has been a retrocession of some erup- tion before the disease displayed itself.

Helleborus is also similar to Apis in hydrocephalus. Apis is useful while there is still some irritation of the brain, as indicated by the cephalic cry. Helleborus comes in when torpor predominates and the child lies wholly unconscious. The eyes do not react to light.

The urine is suppressed. There is automatic motion of one side of the body. You will notice, too, a peculiar corrugation of the muscles of the forehead, particular^ the occipito-frontalis. In milder cases, be- fore the stupor is profound, you will find Helleborus indicated by these symptoms.

This corrugation of the muscles of the forehead is pres- ent, together with a constant chewing motion of the mouth. The child seems to have no wants. It asks for nothing; yet, when given water, it drinks with avidity.

Now, a word respecting the difference between Belladonna and Apis. Belladonna is not usually indicated in tubercular meningitis. It is the remedy above all others for simple meningitis, but not for the tubercular form of the disease. Belladonna has the very essence of acuteness in its symptomatology.

Every symptom appears suddenly and with great intensity. But tubercular meningitis is a slowly de- veloped disease. If the premonitory symptoms are violent, however, you may use Belladonna in tubercular meningitis in the stage of hyper- emia with acute pains, restless tossing about, crying out in sleep, and boring the head into the pillow; but it ceases to be a remed)^ when the exudation is established. The range of action of Belladonna is at an end when that of Apis begins.

There is another remedy which sometimes comes in between Bella- donna and Apis, and that is Bryonia, which acts on serous mem- branes, causing copious exudation. It is indicated after Bcllado?ina. The child becomes more stupid from increased pressure on the brain. The face suddenly flushes and then pales, usually a bad symptom.

The child cries out, particularly when moved, even the least bit; this is a characteristic symptom. The abdomen is distended and the tongue is usually coated white down the middle. So much for Apis and its concordant remedies in dropsies.

106 A CLINICAL MATERIA MBDICA.

The next use we may make of Apis is in erysipelas. It is useful particularly in erysipelas of the face, when the eruption commences under or about the right eye, and spreads thence across the face to the left side, the parts quickly becoming cedematous, and at first assum- ing a pinkish rosy hue. The soreness soon becomes severe, and burn- ing stinging pains follow. There is high fever, with dry skin and usually no thirst.

Now, if the disease is not checked, and the face assumes a purplish livid hue, as in phlegmonous cases, in which the inflammation involves the deeper structures, causing destruction of tissue, Apis may still be the remedy.

There are several concordant remedies in erysipelas. First of all, Belladonna. The difference lies in this: Belladonna is required when the swelling of the face is smooth, bright red, streaked red, or, from intensity, deep dark red. There is not much tendency to oedema or to the formation of vesicles.

The pains are always acute, with throb- bing in the affected parts. The brain almost always sympathizes markedly, causing throbbing in the head and visions as soon as the patient closes his eyes. The patient jerks in his sleep. The pulse is full and hard.

Another remedy, more similar to Apis even than Belladonna, is Rhus tox. You should be particular in differentiating these two remedies, because they are inimical, and one cannot be given after the other. Under Rhus tox. the color of the face is dusky red and not the bright red of Belladomia, nor the rosy or purplish livid hue of Apis. There is almost always a formation of blisters, which burn and sting.

They are distinguished from those of Apis by the preponderance of itching. Under Rhus tox. the disease usually travels from left to right when attacking the face. Apis stands between Rhus and Belladonna in nerv- ousness, partaking somewhat of the former's restlessness, with the latter' s cerebral excitement. Neither produces exactly the livid or blue-red hue noticed in some Apis cases.

Here Lachesis is nearest. The other symptoms will enable you to decide.

When the nose is mainly attacked Apis compares with Cautharis, but the latter has larger blisters and more burning.

When the face, after a spell of erysipelas, is sensitive to cold, com- pare Rhus tox., Belladonna, Hepar, Silicea, Sulphur, etc.

Apis may be of use in urticaria when there suddenly appear on the surface of the body long pinkish- white blotches raised above the skin. The itching, burning and stinging are almost intolerable. The

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eruption may come as a result of cold or during the course of intermit- tent fever.

Here Apis is similar to Arsenicum, which also produces hives, and to Urtica urens. This latter remedy is indicated in hives when the welts are smaller than in Apis. The itching and burning are intolerable. It is especially indicated when the disease has been produced by eating shellfish.

Terebinthina and Copaiva are also useful in urticaria after eating shellfish.

Kali bromatum is indicated when the hives occur with nervous dis- eases.

Rhus tox. is to be thought of when they are an accompaniment of ague or rheumatism.

Bovista is required when they are attended with diarrhoea, the stools being followed by tenesmus and burning.

Pulsatilla comes in when the hives are of gastric or uterine origin.

Calcarea ostrearum is especially suited to chronic cases, and Sepia and Rumex are indicated when the trouble is worse in the open air, the latter especially if worse while undressing.

Apis may also be given in variola when there are intense itching and swelling.

Apis may be used in rheumatism, whether of articular or muscular origin, but it is more frequently indicated in the articular type, com- monly called acute inflammatory rheumatism. The affected parts feel very stiff and exceedingly sensitive to pressure. There is often a sen- sation of numbness. The joint or joints affected are swollen and give the patient a kind of ' ' stretched-tight feeling. ' ' The swelling is rather pale red in color, and some fluctuation may be detected about the joint.

There are burning, stinging pains, worse on any motion.

Apis has often been successfully employed in paralysis following de- vitalizing affections, such as diphtheria or typhoid fever, and also when meningeal effusions remain after inflammations. In all such cases sup- pressed or preexisting exanthemata constitute a leading indication for the bee-poison, and the re-appearance of skin symptoms calls for its discontinuance as long as the improvement thus instituted lasts. Sul- phur is a great aid here.

In these cases of prostration the patient is either nervous, restless and oversensitive, or hot and drowsy, whether thirsty or not.

Apis produces an intermitting type of fever, and is therefore of

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service when this type is found in the sick. The chill occurs charac- teristically at 3 P.M., and is accompanied by thirst and an oppression of the chest as if it were too full, which may be actually the case on ac- count of congestion of the thoracic viscera. The chill is worse in the warmth. It is followed by burning heat of the whole body, with an increase of the oppressive feeling of the chest, drowsiness, but usually no thirst, and the warmth of the room becomes intolerable.

Then comes the sweat, which may, however, be imperfect. There is never any thirst during the sweat. This is characteristic.

During the apyrexia many characteristic symptoms are present. The patient often complains of pains under the ribs on either side. The feet are swollen and oedematous, the skin is sallow or waxen, the urine is scanty, and urticaria breaks out. Such symptoms are found in rather severe forms of this affection when excessive use of quinine has spoiled the case, and in chronic forms which have undermined the general health and produced disease of the liver, spleen, etc.

The most similar concordant of Apis here is Natrum mur. This is indicated in exactly the same type of intermittent fever as Apis; the chief difference between the two remedies lies in the time of appear- ance of the chill; at ten o'clock in the morning in the case of Natrum murt, and at three o'clock in the afternoon in the case of Apis.

In typhoid types of fever Apis is to be selected primarily by the mental state. The delirium is not of an active type; the patient lies in a stupor, with muttering; the face is either flushed red, or, more frequently, pale and waxen, wearing a look of anxiety as from visceral disease or a happy expression. The skin in this type of fever is burn- ing hot in some places, while in others it is unnaturally cool; it is almost always dry; should there be sweat it is usually of a transient character; the prostration is so great that the patient slides down in bed; he cannot exercise sufficient muscular force to retain his position on the pillow.

The tongue is dry, cracked and red, and, like that of Lachesis, it catches on the teeth when the attempt is made to protrude it, and it trembles; there is often a whitish or darker coating on the dorsum of the tongue, while the edges, especially about the tip, are red and covered with little blisters and vesicles. Very important is the bruised soreness of the swollen abdomen.

In these cases Apis resembles Muriatic acid, which has this prostra- tion, but with the characteristic acid diathesis.

In scarlatina most of the indications for Apis have already been

HYMENOPTERA. IO9

given. Here, too, we find the same defective effort on the part of nature to produce a fever. The body is very hot in some places and cool in others. The rash is deep-red in color, very much like that of Belladonna, but differing from that remedy, you remember, in the presence of this miliary eruption which Belladonna does not have.

The child is drowsy, sleeping most of the time, or he is drowsy but cannot sleep. This symptom you must remember because it is iden- tical thus far with one of Belladonna. Associated with this sleepy or wakeful state the patient is fidget}' and restless. You notice, too, that he is peevish, and manifests every symptom of being very irritable.

This restless state of Apis must be distinguished from those of Rhus tox. and Belladonna. In Rhus tox. it is a general restless state of the whole body, and of the mind as well. The patient lies first on one side and then moves to the other, but is not affected with anxiety as in Arsenicum. In Apis the restlessness or desire to move comes from a general nervous feeling.

The inabilit}' to go to sleep in Belladonna comes from inflammation or congestion of the brain. The hyperemia produces this drows}^ state, and the brain is so exhausted that the patient cannot go to sleep.

In addition to the symptoms already mentioned for scarlatina, we have Apis further indicated when the condition advances to effusion of serum about the brain. The throat symptoms are unimportant. You often find patches on the tonsils. The throat inside is swollen and rosy-red, while externally it is engorged, with an erysipelatous blush to it. Apis may also be used late in the disease for the sequelae — that is, when the kidneys become affected and dropsy appears with albu- minuria.

Again, we find Apis of service in diphtheria. The disease advances so insidiously that its presence is not suspected, or, from the very be- ginning the child is thoroughly prostrated, with high fever and drow- siness. The pulse is rapid, but not strong. At first the throat has a varnished appearance, as though the tonsils and fauces were coated with a glossy red varnish.

The membrane forms on either tonsil, oftener on the right than on the left, and it is thick, looking like wash-leather. The tongue is often swollen, so that the child can scarcely swallow. If the child is old enough, he will complain of a feeling of fulness in the throat which necessitates swallowing, but makes it very difficult. The explanation of this is found in the next symptom, that is, the uvula hangs down like a sac of water, and

IIO A CUNICAI, MATERIA MEDICA.

consequently there is a feeling of fulness. If you examine the throat thoroughly, you will find the rim of the glottis swollen, red and oedematous, and breathing is labored owing to the narrowing of the entrance of the larynx. In some of these cases the breath is very foetid, while in others there is little or no foetor. In still other cases you will find as characteristic of Apis a red rash over the surface of the body, making the case appear like one of scarlatina.

The exter- nal throat is swollen and erysipelatous. The above symptoms may in- dicate Apis in non-diphtheritic oedema of the glottis also.

Now, there are several remedies similar to Apis in diphtheria. One of them is Arsenicum. Arsenicum is indicated, as you might expect, in rather severe cases of diphtheria when the throat is very much swollen inside and outside, the membrane has a dark hue, and there is great foetor. There is a thin, excoriating discharge from the nose.

The throat is oedematous, just as it is in Apis; the patient is restless, especially after midnight; the urine is scanty, and the bowels are either constipated or else there is an offensive, watery diarrhoea.

In still other cases, when, despite the dark purplish hue of the throat, and the marked swelling and great prostration, there is not much pain, Natrum arseiiicosum is the remedy. Here, also, the uvula is infiltrated with fluid.

Still another remedy is Kali permanganatum. This remedy, which is seldom used in the high potencies, is indicated when the throat in- side and outside is swollen and oedematous, the breath is horribly offensive, and a thin discharge issues from the nose. The great char- acteristic is the extreme foetor.

Apis causes an irritation of the mucous lining of the larynx and trachea, and also soreness in the chest-walls.

It has been found most useful when laryngeal symptoms accompany erysipelas, oedema of the throat, glottis, or larynx, or suppression of eruptions; less often in simple laryngitis or laryngeal catarrh.

Difficult breathing, and especially the unique symptom, " he does not see how he can get another breath, ' ' has led to the successful em- ployment of the drug in hydrothorax, hydropericardium, oedema pul- monum and asthma.

The lancinating, darting pains, palpitation, orthopncea, etc., render Apis valuable in cardiac inflammations and dropsy. The essential symptoms seem to be oedema or sudden mucous swelling, dyspnoea, sudden, lancinating or stinging pains, restlessness and anxiety.

HYMENOPTERA. Ill

Lachesis, Arsenicum, Sulphur, Belladonna, Kali card., Spig- elia, Digitalis, Aspai'agus, Apocynuvi cannabinum .

Belladonna is too often mistaken for Apis in laryngeal affections. The latter has more oedematous swelling, with consequent dyspnoea; the former more spasmodic constriction.

In cardiac affections Arsenicum, Apocynum cannabinum, Digitalis , and Aspai'agus bear some similarity to Apis, especially in great debil- ity, and dropsy. Apocynum cannabinum is needed when the pulse is small and weak, the heart-beat irregular, now weak, now stronger; and there is sinking at the epigastrium. Asparagus suits in the aged, with weak pulse and pain about the left acromion. Digitalis causes a doughy appearance of the skin; the pulse is slow or weak, quickening with every bodily movement; a gone, deathly sick feeling develops in the epigastrium soon after eating.

The cough of Apis is frequently encountered in cases where this remedy is needed. It resembles, more or less, Lachesis, Carbo veg., Rumex, Belladonna, Chamomilla, Crotalus horridus, Nux vomica, Bryonia, Ignatia, Arsenicum, Hyoscyamus.

Lachesis, Nux vom., Bryonia and Hyoscyamus agree in adherent mucus.

But Lachesis has intolerance of touch, even clothing, about the neck, a symptom not marked in Apis, except with the sense of suffocation.

Rumex has a teasing, persistent cough, aggravated by cool air, or by anything which increases the volume or rapidity of the inspired air.

Chamomilla differs mentally.

Nux vo??iica cures cough from adherent mucus high up in the tra- chea; but there is a rough, scraped feeling in the throat.

Bryo7iia adds epigastric irritation to the suprasternal, and the pains in the trachea and chest-walls are sharp, stitching, as well as bruised, aching.

Ignatia induces a nervous cough, and the more the patient coughs, the more annoying is the irritation.

Arsenicum causes more of a burning tickling, referred to the

112 A CLINICAL MATERIA MEDICA.

suprasternal fossa; but since it so often concurs with Apis, it should be compared with the latter, especially when the cough accompanies dropsy, heart disease, etc.

Belladonna may be misapplied for Apis, but can be distinguished by its greater constriction of the throat, and deeper inflammatory red- ness.

Carbo veg. agrees in hoarseness, rawness, and tickling cough, but the irritation is as from vapor of sulphur.

HYMENOPTERA. 113

in prolapsus uteri and even in chronic metritis, especially when asso- ciated with subinvolution and inflammation of the cervix. The spe- cial symptom which leads to the selection of the remedy is a feeling of soreness across the hypogastrium from ilium to ilium.

114 A CLINICAL MATERIA MEDICA.

It now only remains for me to speak of the intestinal symptoms of Apis. It may be of value in diarrhoea, such, for instance, as comes on during the course of typhoid fever or scarlatina, or as the result of the debilitating influence of continued heat.

Apis differs from Bryonia, which has morning diarrhoea, worse from motion; in the diarrhoea of Apis the motion aggravates, not because of its general effects, but because the sphincter ani is so uncertain.

In bad cases you will find the urine scanty.

Apis may also be thought of in panaritium. The finger swells rapidly, with tense, glossy-red surface and violent burning, stinging pains.

In this respect it is very similar to Stdphur, and may be followed by Sulphur when its action is imperfect.

Apis is antidoted by Plantago and Lachesis, and is complementary to Natrum mur.

In closing, let me ask you to remember the relation of Apis to Arsenicum, Acetic acid, Belladomia and Sulphur. Remember, also, its inimical relation to Rhus tox.

LECTURE IX.

MOSCHUS.

The order of Ruminantia furnishes us with an article called Musk, which is obtained from the Moschus moschiferus ■, or musk-deer. It is found in a sac just behind the umbilicus, and probably consists of a secretion from the preputial follicles.

The second word, " moschiferus," is a necessary qualification, since several species of the musk-deer, as the Tragulus Javanicus and the Meminna Indica, are unprovided with the musk-bearing pouch.

So penetrating is the odor of this substance, that it is with great difficulty removed from a room, even after extensive cleansing and alterations.

In our own school, precise prescribing has had its influence in more clearly defining the power of Musk, and in thus limiting its action within reasonable bounds. The experiments of Joerg and Sunderlin, which Allen has seen fit to incorporate in the Encyclopaedia, are con- sidered by some to be contradictory. Still, they are not opposed to other provings obtained with potencies or by inhalation, and so are of value and deserve to be retained.

Homceopathically employed, Moschus is of use in various affec- tions when the nervous symptoms predominate. The disease, in

Il6 A CIvINICAIv MATERIA MKDICA.

consequence, does not follow its normal course, but remains uncured or develops serious symptoms, indicating nervous exhaustion. It is also sometimes called for in hysteria and hypochondriasis.

Moschus, then, produces numerous symptoms referable to the nervous system. The following are especially worthy of note:

Excited as from alcohol; pulse full and frequent; temperature slightly elevated; congestion of the brain; raves, speaks rapidly and con- fusedly; scolds until her lips are blue, her face pale, and she falls uncon- scious; anxiety; starts at any noise; anxious about death. Anxiety, with fainting; faints, with coldness, pale face, complete unconscious- ness; hysteria; cries one moment and bursts into uncontrollable laughter the next; delirium; sleeplessness; muscular twitching; ataxia; the face wears an expression of surprise; convulsions, more tonic than clonic.

Accompaniments: palpitation of the heart, as from anxious ex- pectation; nervous, busy, but weak; soon drops things; tremulous nervousness; fainting spells, with pale face and coldness; sleepy dur- ing the day; rush of blood to the head, with staring eyes; dizzy un- steadiness, as of something rapidly moving up and down; vertigo; headaches and pains in the back and limbs, which are described as a sensation of tension, stiffness, pressure or drawing; the muscles and skin are tightly drawn (tonic spasm).

She frequently complains of nausea, and there is cramping about the navel, or a jerk-like clawing. Uneasiness in the legs, worse while she is sitting; great tympanitis, with fainting; copious watery urine; spasmus glottidis. The menses are too early and too profuse, preceded by the tense, drawing sensa- tions, and also a drawing and dragging towards the genitals. Sexual desire is increased, with local titillation.

The most important hysterical symptoms of Musk are: attacks even to fainting or unconsciousness; coldness of the surface; pale face; suffocative paroxysms; scolding until she falls unconscious.

Compare Castoreum, Nux moschata, Asafcetida, Gum ammo7iiac) Valeriana, Ignatia, Magnesia muriatica.

Camphor antidotes many of the symptoms of Musk, especially if unconsciousness and coldness are present.

MOSCHUS. 117

Charge, for example, employs it for women who, during convales- cence from a prostrating disease, as typhoid fever, suffer from spas- modic affections, twitchings of muscles, with extreme exhaustion. The want of nervous reaction, therefore, tends to prolong convales- cence unduly, and Castoreum, by strengthening the nerves, hastens re- covery.

Abdomen distended with flatus; dragging in the groins, inclina- tion to stool during menses. Cutting about the navel.

A Spanish physician has confirmed the modality of Castoreum, re- lief of pains from pressure, and we may profit by French and Spanish authorities in their treatment of nervous affections, since from national peculiarities they have ample opportunities to treat such cases.

And we may say, in passing, only Castoreum has cured watery or green mucous stools in delicate, nervous children, who weaken under summer heat or during dentition, and who will not rally under the usual remedies.

Il8 A CLINICAL MATERIA MEDICA.

MOSCHUS. 119

From the order of Umbellifer<z we derive two gums which have often been used in nervous affections. I refer to Gum ammoniac, and, especially, to Asafcetida.

The latter acts most prominently upon the abdominal ganglia, and thence upon the whole nervous system. Its most characteristic effects are as follows: reversal of the peristaltic action of the bowels, stomach, and particularly of the throat; rancid eructations, with pro- fuse saliva, greasy taste; the head feels dull and compressed; burning in the stomach and oesophagus; enormous meteorism of the stomach; stools papescent, brown, offensive; spasmodic tightness of the chest, as if the lungs could not be fully expanded; oppression to an agoniz- ing degree; heart congested and distended, with small pulse.

Draw- ing and tightness, here and there; pulse small, contracted, with shiver- ing in the lumbar region. Pressure in various places, usually from within outward. Cutting, labor-like distress in the region of the uterus. Urine brown, of pungent odor.

Later, as the patient weak- ens, there are malaise, yawning, shuddering from time to time, verti- go, vanishing of sight and cold sweat.

120 A CUNICAL MATERIA MKDICA.

Magnesia muriatica resembles the last remedy and also Musk. . Like other Magyiesia preparations it affects the stomach and bowels and the nervous system. Thus the Carbonate and Phosphate are indicated in neuralgia, especially in cases subject to repeated attacks by reason of nervous debility. The Muriate, however, has been proved to be emi- nently useful in hysteria.

We observe prominent abdominal symp- toms; nausea, with accumulation of water in the mouth; liver en- larged; tongue large, flabby and yellow; she must hurry to stool, which is crumbly as if burnt; and, as if to show a combination of ab- dominal and nervous symptoms, there are rumbling in the abdomen, with dragging, griping, cutting, tension, and then pain as if the bowels were cut to pieces; feeling of something rising into the throat like a ball, almost taking her breath; relieved by eructations.

Flatus collects in the stomach and abdomen, causing reflex spasmodic symp- toms through irritated nerves.

This is still further confirmed by the following: attack of faintness during dinner; anxiety with nausea and pale face; trembling of the body; relieved by eructations. Or, again, sudden heaviness on the chest during dinner, nausea, water in the mouth; heat mounting to the face; it seems as if eructations or vomiting would relieve her.

The menstrual flow is black, clotted, with pains in the back while

MOSCHUS. 121

Palpitation of the heart, not, like Musk, "as from anxious expecta- tion," but, nonetheless, non-organic, for it comes on while sitting and on rising from a seat, and disappears on moving about. This has been several times confirmed.

Briefly, by way of summary: Moschus, excited, scolding, fainting; coldness; spasm of the glottis and lungs.

Castoreum, exhausted, pains better from pressure; menstrual colic with pallor and cold sweat.

Nux moschata, errors of perception, drowsy; faints; enormous tym- pany; oppression of the heart and throat; skin dry, cool.

Valeriana, nerves irritated, cannot keep still; tearings, cramps, better when moving; taste of tallow or slime.

Asafcetida, reverse peristalsis, rancid eructations, offensive flatus; tightness of the chest; checked discharges.

Magnesia muriatica, faints at dinner; relief from eructations; head better from pressure and wrapping up; palpitation better on moving about; stools crumble.

Moschus, has been employed by allopathic physicians when, in the course of pneumonia, a purely nervous delirium obtains. The brain is violently excited and the patient talks nonsense with furious viva- city (Trousseau).

We need remedies for just such cases, remedies which will calm the irritable weak nerves, and permit the disease to proceed in its normal course.

The following may prove beneficial in diseases embarrassed by a con- dition of non-reaction from irritable weakness: Musk, Ambra grisea, Asafcetida, Valeriana, Castoreum, Coffea, Scutellaria, Cypripedium, Coca, Zincumox., China, CampJwra, Agaricus, Tarentula.

LECTURE X.

SEPIA.

*See also Teste, Materia Medica, page 299.

SEPIA. 123

to all impressions, usually with dark hair, although not necessarily so; the face is apt to be sallow, and the eyes surrounded by dark rings.

Hand in hand with this orgasm is an erethism of the nervous sys- tem, causing restlessness, anxiety, etc.

These two sets of symptoms indicate the disturbing influence of the drug upon the nervous system of animal life, and also upon the vaso- motor nerves. Thence arise headaches, various local congestions, etc.

The sphincters, as well as all structures depending for power upon non-striated muscles, are weak. Hence the rectum becomes pro- lapsed, evacuations of bowels and bladder are tardy and sluggish, and yet there is no complete paralysis.

Organic changes are produced as exhibited in the complexion, which is yellow, earthy; in the secretions, which are offensive, sour, excoriat- ing, etc.; in the condition of the skin, which has offensive exhalations, and is disposed to eruptions, discoloration, desquamation, ulcers, etc.

124 A CLINICAL MATERIA MEDICA.

Briefly, it has been found that Sepia acts well in menj or, more often, in women who are puffed and flabby, less frequently emaciated; who have a yellow, or dirty yellow-brown blotched skin; who are in- clined to sweat, especially about the genitals, armpits and back, suffer with hot flashes, headaches in the morning, awaken stiff and tired, and are the subjects of diseases of the sexual organs. The man has sexual erethism, but without energy, and coitus induces great exhaus- tion (neurasthenia).

The woman is erethistic, with hysteria, or with prolapsed uterus, palpitation, orgasm of blood, faintness, etc. In both cases, there may be portal stasis, with imperfectly acting liver, with atonic dyspepsia, sluggish bowels, uric acid deposit in the urine, and attending evidences of impaired digestion and assimilation. The general attitude is never one of strength and healthful ease, but rather of lax connective tissue, languor, and easily produced paresis.

It is to be further remembered that the Sepia symptoms are notably worse in the forenoon and evening, the afternoon bringing a time of general mitigation. Of this fact there are numerous confirmations.

We are now prepared to review the symptoms in detail, and to de- termine whether they sustain the assertions thus far made.

To understand the symptomatology of so prominent a drug as Sepia, which has in its pathogenesis some two thousand symptoms of more or less importance, we must consider the action of the substance upon the various tissues. First of all the blood. Sepia causes great dis- turbance in the circulation; many of its symptoms seem to depend upon venous congestion, and this is especially noticeable in the portal circulation. Reviewing some of the symptoms based on this patho- logical condition, we find flashes of heat which seem to begin about the trunk and go upward to the head, with anxiety, and, of course, an oppressed feeling, ending in perspiration; throbbing all over the body, particularly in the epigastrium, in the hepatic region, in the uterine region, and in the small of the back.

This symptom is very common in hysteria and chlorosis. Nose-bleed, either from mechan- ical causes, as a blow or a fall, from being in a hot room, or from

SEPIA. 125

Sepia stands well in the treatment of psoriasis, though inferior to Arsenicum and Arsenicum iodatum.

In scabies Sepia is indicated after Sulphur, when pustules intersperse the itch-vesicles.

Now, taking up the organs seriatim, we find Sepia to have a marked action on the mind. It produces a mental state which' is quite

126 A CLINICAL MATERIA MEDICA.

This mental state of Sepia is to be distinguished from that of Pul- satilla, Natrum mur. and Causticum.

Natrum muriaticum is complementary to Sepia; they agree in caus- ing weeping mood, depression of spirits, persistent recalling of past unpleasantnesses, irritability, indifference, loss of memory, and alter- nation of mental states. The former has prominently, "worse from consolation." Clinically, we may say the same of Sepia. Both rem- edies, too, have ailments aggravated by vexation or anger. The two are evidently similar in causing weak and irritable nerves, but their complemental relation consists in the fact that Sepia causes more vascular erethism; hence it is that under Sepia, disturbed feelings in- duce congestion of the chest and head, animated conversation causes hot face, and sweats follow excitement.

In Natrum mur., the symp- toms point more to nervous excitement or weakness alone, hence emo- tions induce headache, and drawing up the spine; and unpleasant thoughts cause sadness, paralytic weakness, or irritability without ebullitions. If hypochondriacal, it is a state of melancholy from men- tal depression, caused by inert bowels; while in Sepia the same state depends also upon portal stasis, and therefore is more persistent and associated with more irritable temper. Natrum mur. may be called for when the mental state depends upon uterine disease or menstrual irregularity, but this will be only a prolapsus, never the uterine en- gorgement of Sepia.

The indifference of Natrum mur. is born of hopelessness and mental languor; while that of Sepia includes an un- disguised aversion to those nearest and naturally dearest.

Causticum induces sadness, especially before the menses.- The face is yellow; but the anxiety is more a timid, fearful state. She is full

SEPIA. 127

of forebodings. She dreads the possibility of accidents to herself and others.

Both remedies suit the weakened system, especially that of the female; fearful about one's health; hurried, nervous, fidgety; so nervous that the least excitement causes cold, clammy hands, palpita- tion, etc. In both, the cause of debility seems to be a relaxation of the ligamentous structures, serous sacs and veins. The first two ac- count for the empty, gone feelings; weak knees (even cracking in Lilium, from deficient synovial fluid); prolapsi, etc. The last ex- plains the readiness to portal stagnation {Sepia), fulness of the chest, heart, and the veins of the extremities.

There is, however, an essential difference in this, that the Lilium patient finds relief in diverting her mind by busying herself; while the Sepia patient has many nervous symptoms relieved by violent ex- ercise. It is, in the former case, a sexual erethism which is thus re- lieved; in the latter, relief is general, by favoring venous circulation, nervous erethism being buL slight, and being associated with lessened venereal passion, and aversion to coitus. Moreover, Lilium has a marked remission of its symptoms in the forenoon, while Sepia is more apt to find relief during the afternoon.

Hepar develops a mood which it may not be inappropriate to con- sider. Sadness; unpleasant events return to mind; sad in the evening, even with thoughts of suicide; peevish: the slightest thing makes him break out into violence; he does not wish to see the members of his own family.

Platina is similar in its depressed moods. "Indifference; he does not seem to care whether his absent wife dies or not." But the digression is into haughtiness; or into anxiety, with fear of imminent death; or into that contracted mental state akin to the feeling of per- sonal superiority, in which "everything seems too narrow; with

128 A CLINICAL MATERIA MEDICA.

weeping mood." And, besides, as we shall see anon, the uterine symp- toms differ materially.

In hemicrania you may compare Sepia with Belladomia, Sanguinaria, Iris, Pulsatilla, Nux vomica, Arseiiicum, Theridion, Silicea and Thuja.

Belladonna is to be selected in hemicrania when there are violent hy- peremia, with throbbing carotids, red face, intolerance of the least jar, light or noise. It is indicated, you will see, in plethoric patients, and not in the cachectic, as with Sepia.

SEPIA. 129

You will use Iris versicolor in hemicrania when the attack begins with blurring of sight and the paroxysms are attended with sour, watery vomiting. The pains involve the infra-orbital and dental nerves, with stupid or stunning headache.

Silicea may be needed after any unwonted exertion, if moderate. The pains excite nausea and fainting, and are followed by obscuration of vision.

130 A CLINIC AL MATERIA MEDICA.

The remaining eye-symptoms of Sepia we may summarize as follows: cataract; trachoma, with or without pannus; scaly lids; pustular lids with eruptions on the face; eyes irritable to light, lids close in spite of him; eyelids droop; aching, sticking pains, worse from rubbing. Causes: uterine or liver diseases, scrofula, tea drinking. Worse morning and evening, in hot weather; better from cold washing, and in the afternoon.

Cyclamen and Pulsatilla may also be considered with Sepia in sudden vanishing of sight; the first with profuse and dark menses, the second with scanty dark flow. But the Cyclamen blindness accompanies a semi-lateral headache of the left temple, with pale face, nausea referred to the throat, and weak digestion.

Graphites you may employ when the canthi crack and bleed, and the edges of the lids are pale and swollen as well as scaly.

Thuja is indicated in eye affections of tea drinkers. Brown, bran- like scales accumulate about the cilia, and there are little tarsal tumors like warts.

SEPIA. 131

Nux vomica will be called for in eye affections associated with liver diseases. The symptoms are worse in the morning, and some of them are relieved by cold bathing.

Natrum mur., like Sepia, is indicated in eye affections reflex from uterine disease; the lids droop. But under Natrum mur. there is more spasmodic closure of the lids in conjunctivitis; the discharges are thin and acrid; there are cracks in the canthi and also in the corners of the mouth; pains over the eyes are present, worse when looking down.

Alumiiia likewise has falling of the lids, dryness, burning, dim sight; but Alumi?ia has aggravation in the evening and at night. The inner canthi are affected.

Next we shall consider the action of Sepia on the abdominal or- gans. It is indicated in the form of dyspepsia mentioned above, and also in the dyspepsia incident to uterine diseases, when it is asso- ciated with a gone, empty feeling in the epigastrium or the abdomen, with sour or bitter taste in the mouth, and with a longing for acids or pickles, which seem to relieve these symptoms. The tongue is coated white, the bowels are usually constipated, the stools are hard, dry and insufficient, or, even if not indurated, they are expelled with difficulty.

The abdomen is swollen and distended with flatus, and there is almost always soreness in the hepatic region. On making a physical explora- tion you find the liver enlarged, not from fatty or amyloid degenera- tion, but from congestion.

Lycopodium is a worthy rival of Sepia in the condition just de- scribed. The distinction between the two remedies may be given in a very few words.

132 A CLINICAL MATERIA MEDICA.

For gone, empty feeling in the epigastrium, compare Sepia with Calcarea ostrearum, Cocculus, Kali carb., Stannum, Ignatia, Carbo an., Sarsaparilla , Niccolum, Oleander, Ipecac, Thea, Slap hi 'sag ria, Actea rac. and Hydrastis.

Kali carb. has empty feeling before eating, out of proportion to the feeling of vacuity caused by hunger, with undue bloating after eating, especially after soup in small quantity.

Under Stamium, the sensation continues after eating, and extends all over the chest.

With Ignatia, it is attended by sighing.

Under Carbo animalis, it arises from loss of vital fluids.

Sarsaparilla has it associated with rumbling in the abdomen.

Niccolum, without desire for food.

Oleander, with sensation of distended abdomen; the chest feels empty and cold.

Actea racemosa is excellent when, with the faint, empty feeling in the epigastrium, there is a trembling, wavy sensation spreading from the stomach over the body.

Hydrastis relieves when there is sinking sensation, palpitation of the heart, and mucus-coated stools.

Thea produces a gone, faint feeling; sick headache radiating from one point, and pains in the left ovary.

LECTURE XL

Sepia — {continued) .

134 A CLINICAL MATERIA MEDICA.

" Helonias," according to Dunham, "produces profound melan- choly; deep, undefined depression, with a sensation of soreness and weight in the womb; ' a consciousness of a womb.' Lilium dulls the intellect, produces a sensation of hurry, with debility, and distress based on an apprehension of having some fatal or serious malady." And, further, Helonias is an excellent remedy when there is a tired, aching feeling, and some burning in the back and legs. This is com- mon enough with women, and no remedy, unless it is Picric acid,

sepia. 135

Murex, like its relative, causes uterine congestion, epigastric " goneness," cystic irritation, muscular debility, and mental de- pression.

It differs, however, in that it causes sexual excitement; desire so violent as to fatigue the reason; venereal desire renewed by the slightest touch.

136 A CIvINICAIv MATERIA MEDICA.

Clinically it has been used for polyuria, with frequent urging at night. Kreosote has sudden urging; he cannot get out of bed quickly enough; he urinates with great haste, and passes a large amount of offensive urine.

Kreosote, moreover, bears some relation to Sepia. Both have inter- mittent menstrual flow, dragging downward in the back, and pressure outward in the genitals; painful coitus; vomiting of pregnancy; the urine deposits a red sediment, and is turbid and offensive.

This acridity of the leucorrhcea marks clearly the divergence of Kreosote from Sepia, as well as from Murex. This led to the employ- ment of the drug in cancerous and other ulcerations of the cervix uteri. And we now choose it when there are burning, sensitiveness and tumefaction of the cervix, with bloody ichorous discharges; sen- sitiveness to touch or to coitus; and a putridity, which is foreign to the other remedies mentioned.

SEPIA. 137

Coupled with heaviness and congestion, there is a weakness of the sphincters. The patient feels a lack of confidence in them; she fears lest some stool will escape with flatus — the faeces and urine will pass together — every time she passes urine, there is a feeling as if some thin stool would escape — sudden urging in the morning.

Podophyllum suggests itself here. It, too, acts on the liver, causes diarrhoea and prolapsus of the uterus and rectum; hollow feeling in the epigastrium; pains in the ovaries (right) and down the anterior crural nerve; burning in the hypogastrium and sacral region, with re- tarded menses.

138 A CLINICAL MATERIA MEDICA.

The prolapsus uteri of this remedy, however, is nearest akin to that of Stanmim, with bearing down as if the genitals would come out dur- ing stool. But in Stannum it is recorded as occurring during hard stool; hence Podophyllum causes the more relaxation in the pelvic region.

SEPIA. 139

There uia3T be spasmodic contractions of the os and upward-shoot- ing pains. Here it favors Gelsemium and Calcarea carb.; while Pulsatilla favors Caalophyllum and Sccale.

In temperament, Pulsatilla is tearful, mild, or peevish, whimsical, cross; Sepia is tearful, depressed, but easily irritated and excited, or indifferent.

140 A CLINICAL MATERIA MEDICA.

Neither Aurum nor Sepia compares with Platina in the pronounced nymphomania and voluptuous irritation of the genitals. The men- strual flow in the latter is profuse and clotted instead of scanty.

Platina and Sepia have uterine cramp, but in the latter it is clutch- ing, as if suddenly seized and then released; in the former it is a de- cided cramping followed by numbness — a symptom which is universal in this remedy.

The carbons should be compared with Sepia. They come into use when induration or ulceration is present, with "venosity," offensive excoriating discharges, and with gastric disturbances characterized by accumulation and passage of offensive flatus.

Carbo animalis has proved itself equal, if not superior, to Sepia in indurations of the cervix, with burning, tearing pain across the pubes. There are labor-like pains in the pelvis and sacrum; the leucorrhoea stains yellow; the menses are followed by great weakness, she is so weak that she can hardly speak; there is " goneness," not better from eating. She desires to be alone; she avoids all conversation; she is oppressed with anxiety and orgasms The carbons act on the veins, favor offensive flatus, offensive discharges and excoriations, the latter being superficial and irregular in outline. Inflammations are sluggish, and tend to suppuration or death of the parts, with burning pains, great weakness and collapse.

Carbo a?iimalis causes violent pressing in the back, groins, and

SEPIA. 141

Carbo veg. has caused bearing down in the rectum and vagina; the os is usually open; there is a feeling of weight in the uterus and right ovary; the menses have a strong odor; the leucorrhcea excoriates; the genitals are sore in places, and they smart, itch, burn, and are aph- thous. Anxiety, with distended veins; a wretched, nervous feeling in the uterus, which culminates in the thighs; nervous, fidgety. Mental depression before the menses.

Graphites is an impure carbon which contains traces of iron. It combines the offensive secretions, flatulency, and skin symptoms of the carbons, with anaemia.

According to Dunham the onset of the menses is accompanied by a variety of accessory symptoms, as with Sepia.

The remedy is not often required for prolapsus uteri, but it is clear- ly indicated when there is a feeling as if the womb would press out the vagina; the patient complains of a heavy load in the abdomen, and of lancinating-like electric shocks down the thighs (Leadam).

The leucorrhcea is profuse, coming in gushes, and is excoriating. The remedy affects the ovaries more decidedly than does Sepia; the left ovary is indurated and swollen, and pains are felt when the parts are touched.

Like Sepia- it causes the nipples to inflame and crack. It is very useful to soften or remove cicatricial tissue in the mammae (like Phyto- lacca ) .

142 A CLINICAL MATERIA MBDICA.

Graphites, by virtue of its effect upon cicatricial tissue and indura- tions, ought to prove useful for softening the cervix, when, as is often the case, a laceration has remained unhealed, acting as a source of irritation.

Natrum carbonicum and other soda salts are complementary to Sepia.

SEPIA. 143

144 A CLINICAL MATERIA MEDICA.

Kali fei'rocyanidum has relieved bearing down; pus-like leucorrhcea, profuse but not irritating; sadness even to tears; sinking sensation at the epigastrium; passive uterine haemorrhages with consequent de- bility (Bell, McClatchey).

SEPIA. 145

Among the remaining remedies I may briefly refer to the following:

146 A CLINICAL MATERIA MKDICA.

lady with uterine disease; passive flow of blood; the examining finger detects a soft, patulous cervix, and is stained with blood (Woodbury).

Inula and Hedeoma have been proved, but clinical experience is wanting. Iyike Sepia, they cause uterine pains and bearing down; the first, dragging in the genitals and spine; urging to stool and to micturition; the second, bearing down with great weakness in the legs.

Sepia, in a few instances, has relieved choreic symptoms; sudden jerking of the head backward and forward; twisting pain in the stomach rising to the throat.

When prolapsus uteri is a symptom of general defective nutrition, with little or no local congestion, Sepia yields to Aletris, Caulophyllum, Abies Canadensis, Lac defloratum, Calcarea phos., Natrum mur., Helonias, Natrum hypochlor.

This last symptom is unique, differing materially from the urging of Nux and Sulphur, the pressure of Lilium, and the fulness and weight of Aloe. The latter has also a sensation of a plug wedged in between the symphysis pubis and os coccygis.

LECTURE XII.

NOSODES.

Great objections have been made to the nosodes as remedies in homoeopathic practice. It is well that you should understand the prejudices which you will meet, both among the laity and in the pro- fession. Objections have been made to Psorinum, which you know is obtained from the itch eruption and also to Syphilinum^ the syphilitic poison, on the ground that they are nasty and filthy. This objection is certainly absurd, because nobody would for one minute entertain the idea of administering these substances in a low potency; and this being the case, no one will maintain that there is anything nasty or disagreeable to one's feelings in administering to a patient Psorinumy for instance, in the two hundredth attenuation.

I48 A CUNICAI, MATERIA MEDICA.