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 HYMENOPTERA. 99 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. HYMENOPTERA. IOI 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, HYMENOPTERA. 1 03 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 HYMENOPTERA. IO5 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 HYMENOPTERA. 107 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 108 A CLINICAL MATERIA MEDIC A. 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