Apocynum cannabinum

Weak and dropsical. Scanty discharges. Irritation. .................... Bewildered. Can't think. Faint. Thirst, but water distresses; vomits every drink. Uræmic vomiting. Sinking at epigastrium. Noisy, yellow, painless, gushing stools. Diarrhœa; with dropsy. Bed-wetting of old men. Enlarged prostate. Uterine hæmorrhage, then dropsy (Chin.). Oppression of chest. Rough, dry skin. Can't sweat. Sleepy. Pulse slow, fluttering, irregular or intermittent.

COLD: Weather. Drinks. Uncovering. Lying.

Warmth.

URINARY ORGANS. Heart. Digestive tract. Uterus.

Related: Chin-ar. Nux-v.

Apocynum cannabinum

Indian Hemp. Apocynaceae.

Excretions diminished, especially urine and sweat.

Dropsy of serous membranes ; acute, inflammatory.

Dropsy: with thirst (Acet. ac.), water disagrees or is vomited (Ars.) ; most cases uncomplicated with organic diseases; after typhus, typhoid, scarlatina, cirrhosis; after abuse of quinine.

Acute hydrocephalus, with open sutures; stupor, sight of one eye lost; constant and voluntary motion of one arm and one leg (left arm and leg, Bry. ) ; forehead projected.

Amenorrhoea in young girls, with bloating or dropsical extension of abdomen and extremities.

Metrorrhagia : continued or paroxysmal flow ; fluid or clotted ; nausea, vomiting, palpitation ; pulse quick, feeble, when moved; vital depression, fainting, when raising head from the pillow.

Cough, short and dry, or deep and loose, during pregnancy (Con.).

Relations., — Similar: to. Acetic acid. Apis (no thirst), Ars., Cinch., Dig., in dropsical affections.

Blatta orientalis has cured bad cases of general dropsy, after Apis, Apoc. and Dig. failed. — Haynes.

Lecture XIV — The Vegetable Kingdom — Apocynaceae: Apocynum cannabinum, Oleander, Vinca minor and Alstonia scholaris

I have now reviewed the majority of the medicines derived from the animal kingdom, and also the most important of the nosodes. We come next to the second grand division in natural history, the vegetable kingdom. The vegetable kingdom offers us many varieties of medicinal substances, some of great practical utility and others having but a limited sphere of usefulness. Drugs obtained from this kingdom owe their medicinal effects to the juices which they contain, or to certain properties which reside in the roots, flowers, or seeds. The medicinal qualities of a plant may be obtained from various parts of it, and these qualities may vary with the part. It is said of Belladonna, for instance, that one part of the plant gives us more of the acrid qualities of the drug, while another gives us more of the narcotic properties. We must be careful then in making a proving of a vegetable drug, that we are certain of the part of the plant we are using; and in publishing our proving, we should state whether the whole plant was used, or only a single part of it. If but a single part was utilized, we should state accurately which part, as the root, the flowers, the seeds, etc.

A study of the vegetable kingdom involves to some extent a study of the mineral kingdom, because many of the medicinal properties of vegetable remedies owe their existence to substances derived from the minerals in the soil in which they grow. The principal effects of some of the grasses are the result of the large quantity of Silica they contain. Xinet3 T-nine one-hundredths of the effects of Lata-ocerasus come from its Hydrocyanic or Prussic acid, which is commonly classed with the inorganic compounds. The same may be said of Amygdala persica. Now these substances derived from the mineral kingdom and contained in the vegetable kingdom, become more active in their new environment; that is to say, a given chemical substance, if made synthetically in the laboratory, would possess less marked medicinal virtues than if it were obtained from a plant. The above remarks also apply to the animal and vegetable kingdoms. Substances existing in the animal kingdom and found also in the vegetable, are far more ii active in the former. Thus the Colorado potato bug, which feeds on potato-plants and derives from thence Solanine, presents more powerfully the symptoms of the latter than does the Solanine itself. We shall study the remedies derived from the vegetable kingdom according to the classification of botanists. There are some incongruities in the botany of to-day; for instance, in the leguminous order of plants from which we get peas and beans, which are very nutritious, is also placed the I^athyrus, which has very poisonous properties. Because there is an outward resemblance between the Lathyrus and sweet-pea, it seems not a little incongruous to put them together, when their effects are so different.

The five relations of drugs, which I have already mentioned, apply here as in the animal kingdom. There is this to be remembered, that substances having the same origin generally do not follow each other well. For example, if you have given Ignatia, it is not well to follow it with Nux vomica, and vice versa, because they both contain Strychnia. Though they have many symptoms in common, they act too much in the same line. Another example may be noted in Glonoin and wine. When Glonoin was proved, it was found to have a decided action on the pulse. All the symptoms w rere aggravated when the provers took wine. Wine produces an excitement very similar to that of Glonoin, but its action seems to be in the same direction, consequently it intensifies the effects of the latter.

But the different orders, sub-orders and classes into which botanists divide plants are so extensive and cover such vague resemblances, that we cannot confine ourselves strictly to the above rule regarding the sequence of drugs. Take for instance the Ranunculaceae, from which we obtain Pulsatilla, Aconite, Helleborus, and Staphisagria .

Now the resemblances between these four drugs are not so close that they cannot follow each other without injury. If we find, then, from our study of symptomatology of the drugs that there are no marked resemblances between them, the rule does not apply. In the Anacardiaceae the rule does not apply with regard to Anacardium and Rhus tox. These drugs bear a family resemblance, but their points of divergence are so great that one drug may act as an antidote to the other. The rule, however, does apply to Ignatia and Nux vomica, and to Pulsatilla Nuttalliana and Pulsatilla pratensis. I will now take up the consideration of the individual drugs derived from the vegetable kingdom. Apocynace^E.

In the order of Apocynaceae there are a number of plants which we use as medicines. Among these may be mentioned Apocynum cannabinum and androscsmifolium, Gelsemium sempervirens , Vinca minor, Olea?ider, Nux vomica, Ignatia. Curare, Alstonia scholaris, and Spigelia. By some authorities Gelsemium, Nux vomica, Ignatia, Curare, and Spigelia have been included in another order, the Loganiace<z. This order of plants is very poisonous; they depress the nervous system, causing prostration, and even narcosis and paralysis; some of them cause death.

Apocynum Cannabinum.

Apocynum cannabinum was said by Pliny to be fatal to dogs, and from this circumstance its name was derived. It has a tough fibre, like hemp, which has been used for cordage.

Apocynum has a marked effect in increasing the flow of urine. It is not sufficient, however, in the present course, to study the drug simply as a diuretic, because it has such a decided action on the vital forces that it demands a more extended notice. It depresses the vital forces greatly, as evidenced in the relaxed sphincters, loss of muscular power, etc. This loss of power is an important general symptom, since it qualifies, as we shall see presently, the cardiac, renal and intestinal symptoms.

In the last few years Apocynum has come into very extensive use in the treatment of many forms of dropsy. When I give you a resume of its symptoms, you will see that its indiscriminate use in dropsical conditions is by no means strictly homoeopathic. When not properly indicated symptomatically, it is necessary to exhibit it in large doses in order to produce any effect. Scoparius (broom-corn) and also the pods of some of the Leguminosae, cause increased functional activity of the kidne}'s and so aid in the elimination of the dropsical effusion. But we have to deal with an art that admits of no such prescribing. It aims at definiteness, not generalization. It teaches the selection of a similimum, not of a temporary palliative.

When indicated Apocynum demands that the following symptoms be present: bewilderment and heaviness of the head; drowsiness and debility or disturbed, restless sleep. The functions are sluggish. The pulse is slow. The bowels are constipated, although the faeces are not hard. The kidneys are torpid, or else the urine is copious and urination is almost involuntary from relaxed sphincters. The nose and throat are filled with thick yellow mucus on awakening. The patient has a sense of oppression at the epigastrium and chest; he can hardly get breath to speak, even after lighter meals than usual; he must take frequent deep inspirations. There are also fluttering of the heart, and dartings and prostrated feeling in the cardiac region. The pulse is irregular, intermittent and at times feeble, then slow. The heart beats regularly, then flutters and becomes feeble, then slow and labored, now and then losing a beat. This is just the group of symptoms characteristic of cardiac dropsy, and it shows what an affinity the drug has for the cardiac region. It will often palliate even in fatty degeneration of the heart, with dropsy, in old people.

Here you may compare several remedies: first, Arsenicum. This remedy has the same thirst and the same sinking at the epigastrium as has Apocynum, but it is indicated in more advanced cases, and the patient always presents more irritability of fibre.

I showed you the distinction between Apis, Acetic acid, and Apocynum when I lectured on Apis.

Helleborus and Digitalis are similar to Apocynum in causing torpidity, slow pulse, etc. But I think that Apocynum, as a rule, is the preferable remedy, unless the symptoms point very strongly to one of the other two.

Apocynum also has some action on the joints, producing a rheumatic condition. The joints feel stiff, especially on moving in the morning.

You may recall that I mentioned Apocynum as a remedy in hydrocephalus. The head is large; there is bulging of the frontal bones; the fontanelles are wide open; there is squinting, and, in extreme cases, the patient is blind; one side is paralyzed. The case closely resembles Apis, but lacks the cephalic cry. It is indicated in more advanced cases than Apis. One or two cases have been cured by the continued use of the remedy.

There is a diarrhoea which may call for Apocynum. The stools are copious, yellow, watery, or brownish, and sometimes contain undigested food. They are discharged with an expulsive force like a cork from a bottle. The sphincter ani is so weak that stools escape unbidden, or while the patient is passing flatus. After stool, he feels weak or has an " all-gone feeling" in the abdomen. The face is pale and covered with a cold sweat.

Aloe has a similar weakening effect on the sphincter ani, and great prostration after stool; but the stools under this remedy contain a jelly-like mucus, are apt to be worse in the morning, and there is a colic which is relieved by bending double.

Gamboge has stool preceded by excessive cutting about the navel. The stool is expelled " all at once" after considerable urging, and is followed by a feeling of great relief.

Apocynum also has haemorrhoids, which are associated with a feeling as if a wedge were being hammered into the anus.

Anaca?-dium is another drug which has a sensation as though a plug were being forced up into the anus.

Bewildered. Low spirited.

Indian Hemp Increases secretions of mucous and serous membranes and acts on cellular tissue, producing œdema and dropsy and on skin causing diaphoresis. Acute hydrocephalus. A diminished frequency of the pulse is a prime indication. This is one of our most efficient remedies, in dropsies, ascites, anasarca and hydrothorax, and urinary troubles, especially suppression and strangury. In the digestive complaints of Bright's disease, with the nausea, vomiting, drowsiness, difficult breathing, it will be found of frequent service. The dropsy is

characterized by great thirst and gastric irritability. Arrhythmia. Mitral and tricuspid regurgitation. Acute alcoholism. Relaxation of sphincters.

Worse, cold weather; cold drinks; uncovering.

Long-continued sneezing. Snuffles of children (Sambucus). Chronic nasal catarrh with tendency to acute stuffiness with dull, sluggish memory. Dull headache. Takes cold easily, nostrils become congested and blocked up easily.

Nausea, with drowsiness. Thirst on walking. Excessive vomiting. Food or water is immediately ejected. Dull, heavy, sick feeling. Oppression in epigastrium and chest, impeding breathing (Lobelia infl). Sensation of sinking in stomach. Abdomen bloated. Ascites.

Watery, flatulent, with soreness in anus; worse after eating. Feeling as if sphincter were open and stools ran right out.

Bladder much distended. Turbid, hot urine, with thick mucus and burning in urethra, after urinating. Little expulsive power. Dribbling. Strangury. Renal Dropsy.

Amenorrhœa, with bloating; metrorrhagia with nausea; fainting, vital depression. Hæmorrhages at change of life. Blood expelled in large clots.

Short, dry cough. Respiratory short and unsatisfactory. Sighing. Oppression about epigastrium and chest.

Tricuspid regurgitation; rapid and feeble, irregular cardiac action, low arterial tension, pulsating jugulars, general cyanosis and general dropsy.

Great restlessness and little sleep.

Cymarin is the active principle of Apocyn, lowers pulse rate and increases blood-pressure. Strophanthus (extreme cardiac depression with intense gastric disturbance; dropsy). Aralia hispida-Wild Elder-a valuable diuretic, useful in dropsy of the cavities, either due to hepatic or renal disease with constipation. Urinary disorders, especially with dropsy. Scudder advises doses of five to thirty drops in sweetened cream of tartar, (Solution). Apis, Arsenic, Digital; Helleb.

Tincture (ten drops three times daily) and in acute alcoholism 1 dram of decoction in 4 oz water.

Apocynum cannabinum

This remedy comes in as a good one to contrast with Apis. You will find it analogous in its symptoms and much like the complaints cured by Apis.

You will be astonished in going over the dropsical condition, the rheumatic condition, the tumefaction of the cellular tissues, the dropsy of the sacs, the scanty urine resulting in dropsy; the inflammatory swellings with oedema, at the great resemblances; and if you were to start in with two cases and work them out from their particulars, and if one feature were left out, the aggravation and the amelioration, the cold and the heat, in many cases you would not be able to distinguish between Apis and Apocynum, so near alike are their swellings, their bleedings, their distensions, and their disturbances.

Both are remedies for dropsy; routinists will try first Apis, and then they try Apocynum, and then they will try something else that is good for dropsy.

But all the way through this medicine is aggravated from cold, the patient himself is aggravated from cold. His complaints are worse from cold applications. In his distended, dropsical state, he is chilly, sensitive to air. He is sensitive to cold drinks.

He has a pain in the stomach, and even vomits, from cold drinks. Pain in the abdomen from cold drinks. Uneasiness here and there in the body when cold things are in the stomach; you see at once how different that is from Apis. Anyone who follows symptom hunting and does not distinguish between circumstances that relate to the patient and modalities that relate to symptoms cannot appreciate these two grand distinctions, where the one patient is aggravated from heat and the other one ameliorated by heat, in all complaints.

The excretions are all diminished. The urine is scanty. The skin is dry. No matter what his complaints are, he cannot sweat. He feels if he could only perspire he would get well. There is no out throw of water. He drinks plentifully, and it goes in-to the cellular tissues to distend them, and he becomes dropsical.

He has a water constitution, one that takes in water and lets out none. He passes little water, and he perspires scantily or none at all; his skin is dry, sometimes hot, yet he is chilly. The skin feels husky and rough, but he is chilly. Apis suffers dreadfully from dry skin, from scanty urine; yet Apis is aggravated everywhere from heat and ameliorated from cold. That is the grand distinguishing feature in the dropsies and rheumatisms and many internal complaints. "Dropsy of serous membranes."

Dropsy of the brain, pericardium, pleura, peritoneum; all of these are distended with serum. And there is great suffering, great uneasiness.

The inflammatory rheumatism is again like Apis, in that it takes on dropsy with it. Inflammation of the joints, of the ankles, joints, of the toes, of the fingers, inflammation of the joints all over the body.

The swelling about the joint pits upon pressure like Apis. But with the scanty urine, want of sweat, with the febrile condition, he is all the time chilly, and wants the parts well wrapped where Apis wants them uncovered. One might say, "Why, that is only one symptom."

All who do not perceive the difference between symptoms predicated of the patient and symptoms predicated of the parts will see that as only one symptom with the rest of them. When he takes up a case and works it out in the Repertory he will use it as one symptom. Yet that feature will sometimes rule out all the rest, because it is predicated of the patient and not predicated alone of his parts.

We have many remedies where the patient himself is ameliorated from heat. He wants to be in the heat, he wants to be warm, and yet he wants cold applied to the part. But that which is the general is the ruling feature, and if we do not know and distinguish the things that are general from the things that are particular, we get our Materia Medica mixed up. We must distinguish the things that belong to the patient himself from the things that belong to his parts.

"Dropsy, with great thirst."

Dropsy: This is a great medicine for the low forms of disease, such as typhoid and scarlet fever, and is useful after lingering sicknesses. Patients become greatly prostrated, very chilly, very anaemic, have great thirst, the urine becomes scanty, the skin becomes dry. It is a bad convalescence; he has not recovered. Dropsy sets in; dropsy after scarlet fever, dropsy after typhoid fever. A low form of disease, like typhoid fever, has kept him in bed for four or five weeks, and he is emaciated and prostrated, and now he does not gain flesh, he has no appetite, but he drinks copiously; he seems to want nothing but water.

His skin commences to distended, fills up, and becomes dropsical. That is like Apis, and Apis would be indicated provided he was always hot, and wanted to be uncovered, and wanted cold things.

Mind: The mental symptoms of this remedy have not been brought out.

We only know a few clinical symptoms, and they are of little importance. It has cured that peculiar kind of stupor belonging to hydrocephalus, but we do not know what kind of a primary case of brain disease this remedy would fit, because of lack of provings.

We only know the condition after it has existed for a long time, that is, for weeks; rolling the head and tossing about, and he is greatly emaciated. The little one has chills and fever along with it, and his skull is beginning to distend, the fontanelles are growing wider; then we begin to think of some of those remedies capable of curing dropsy in the shut sacs, and this is one of them. But we do not know the beginning. We do know the beginning of Apis, but not of this remedy.

Hahnemann's provings are full of particulars. He cross-examined his provers as to their modalities, the time their symptoms began, and where they ended.

Many of the symptoms he felt upon himself, because he proved many remedies. Hahnemann had a sensitive constitution and deep perception, and his provings gave him an insight into medicines that he could not have obtained in any other way.

Those who prove medicines properly, conscientiously, prudently, learn more about materia Medica than anyone else.

They become inured to hardship and live longer thereform. They are hardened to their environnements, to their atmosphere, to their associates and their surroundings.

They are made better and they may be able to perceive something of what Hahnemann perceived.

But now-a-days provings are made and nothing recorded but common symptoms, that in stomachache, nausea, headache, pain in the back, cold feet. Many of our remedies are not proved much further than that.

What, when and how much, are left out. The modalities are left out, The finer sensations are not described because they are considered emotional.

"Low-spirited and bewildered. Feels as if she could do nothing but cry."

We do not know the affections of either the male or the female. We do not know the desires or aversions, mental or physical; and hence it may that this is only, a partial proving and suitable only for those complaints that show themselves upon the surface.

"Hydrocephalus, with great stupor."

That is the last stage of it where there is great prostration, loss of flesh, stiffness of all the limbs, with dropsical swellings. Many times in hydrocephalus pains shoot along the nevers and attack the joints.

Then it is that such remedies as Apis and Calc. carb. and this one take hold with wonderful depth. The first permanent and substantial indication - that the remedy is working in a hydrocephaloid case is that it increases the flow of urine, which has been scanty all the time. For hydrocephalus study Tuberculinum.

Face: The expression of the face is that of anguish.

"Face bloated, puffed, swollen. Bloating under the eyes. Pitting upon pressure. Tongue dry; great thirst."

There is another remedy that comes into this sphere that will be very often misunderstood, too, and will be likely in most instances to be given before this remedy. It is Ars.

It has all the dropsical. conditions of Apis and Apocynum. It has all the coldness and distension of the abdomen and of the shut sacs. It, too, is ameliorated in all of its symptoms, and the patient himself is ameliorated, from heat, and intense heat is required for that purpose. He wants to be in a very hot room, but it has something else. It has a deathly prostration, a deathly anxiety and terrible restlessness, not found in either of these remedies. It has also such a cadaveric odor, discovered on entering the room, which is not common to either of these remedies.

In this way we have to take up our medicines and study them only one at a time, but we have also to study them by comparison.

The medicines that are similar in generals have to be compared as to heat and cold.

In that way we get a list of those that are ameliorated by cold and list of those that are ameliorated by heat and another nondescript list not ameliorated by either. That is the starting point, and we have to divide and sub-divide these, and so on.

"Thick, yellow mucus in the throat. Great thirst. Stiffness in the thoracis region. Fullness. A sense of distension."

You will think a moment and see that filling up the pleural cavity does not cause very much outward distension, because the ribs prevent it. They form a wall, and hence the growth or distension is towards the lungs, and downward towards the diaphragm. By this means we get increasing dyspnoea, with cough. This medicine, like Apis, must sit up; cannot lie down. You will find it is a common-feature in hydrothorax for the patient to be compelled to sit up. because lying down increases the pressure upon the lungs and narrows the breathing space; and hence, he must sit up in order to let this heavy water-bag, the pleural sac, hang down, against the diaphragm, and that produces pressure in the abdomen and distension of the bowels.

"Thirst on waking. Thirsty all day. Great thirst but water disagrees."

He likes cold water, but it so disagrees with his stomach, causing pain in the stomach, or causing him to vomit before it even gets warm, or causing distension, or causing uneasiness, so that he dreads to take cold drinks. He is more comforted by hot drinks. Warm drinks warm him up, make him more comfortable, cold drinks aggravate. Yet his thirst is for cold. Then come distension and vomiting. You will find patients so distended in all their cellular tissues with a general anasarca that it seems that no more water can be taken from the stomach into the blood. He is full.

The blood vessels are distended, his stomach is distended and he must vomit; and with this distension of his whole body he drinks and vomits. It is with difficulty he can eat; cannot keep it down; it will not digest. From this comes a part of these symptoms.

"Sense of pressure in the epigastrium, in the chest," so that it is almost impossible for him to get breath enough to move.

Very little food makes him feel distended. He wakes up and wants something in his stomach. There is a gnawing hunger, but every little thing, even a mouthful, makes him feel distended. His stomach is already full of water and he vomits up great quantities of water, of bile, and of undigested substances that he has swallowed. The stomach finally, in dropsical conditions, becomes very irritable. It seems as if nothing passes through him, He finally becomes paralyzed in the bowels. The kidneys are not acting, and scarcely any urine passes. The tongue becomes inflamed. The mucous membranes are all inflamed, and probably the stomach is. Abdomen very much distended; dropsy of the abdomen.

The another phase comes on. It seems that one by one each organ ceases to perform its functions.

The ovaries and uterus fail to perform their functions, and amenorrhoea comes on with dropsical conditions. Many times this seems to be the beginning of such troubles; a failure of these organs to perform their functions, and then dropsy sets in.

A woman passes along to a low state of weakness and nervous excitement, no menstrual flow, tenderness of the abdomen, distension of the abdomen, and then distension of the limbs. Apocynum has been a curative remedy in diarrheic conditions alternating with dropsy. Sometimes a diarrhea will set in and all the other troubles go away. The diarrhea is copious, yellow, watery and involuntary. 1 once knew large doses to be given in a case of dropsy, and it established its own peculiar diarrhea and while that diarrhea lasted the enlarged spleen and the dropsical condition of the body all went away apparently, to the doctor, in a natural manner. It was brought to my observation, and I said, "Wait." Finally he was brought to stop, the poisoning by Apocynum, and heart failure followed at once. A similar effect is to be seen from the allopathic use of Digitalis. The time comes when the doctor will be compelled to stop Digitalis, and the patient dies of heart failure; Digitalis is never charged with the death, and the doctor never seems to learn that Digitalis will kill.

Everywhere the functions are impaired, in the skin, the kidneys, bowels, uterus, and all tends toward the formation of dropsy.

Urinary troubles are exceedingly troublesome. Scanty urine accompanies many complaints among the early symptoms. Retention of urine; painful micturition; urging to pass urine constantly.

The bladder is sometimes only partially full, but he cannot pass urine.

"Retention with great urging."

"Paralysis of the extremities. Urging to urinate." Numbness, tingling in the extremities, and finally entire loss of power. Some patients re this way for a while, and finally dropsy will set in. It has alternating conditions, as I have mentioned; dropsies, alternating with copious discharges. The dropsy may be relieved with copious watery discharges from the bowels or by copious spasmodic action of the kidneys, the urine being so profuse that he can hardly realize where so much water comes from. All at once it ceases. The urine becomes scanty, and then the tissues fill with serum, and the dropsical condition progresses. These conditions cease after a while, and the heart fails.

"Urine diminishes to one-third its usual amount, without pain or uneasiness about the kidneys or bladder. Urine suppressed. No urine at all in brain affections."

It was a routine medicine once, given to all children for wetting the bed, and as it cured many it must have that symptom, but that is a clinical symptom. It is not surprising, seeing its action is so marked upon the bladder, that it has cured involuntary passage of urine.

"Dropsy of the genital organs."

I have mentioned the suppression of the menstrual flow, the amenorrhoea, but it has also a marked hemorrhagic tendency. It will establish haemorrhage anywhere, but especially from the uterus. Copious haemorrhage. The menstrual flow may become copious, too frequent, last too long; but it will also establish a uterine haemorrhage at another time. It will cause the patient to bleed so copiously that she becomes anaemic from uterine haemorrhage; and then will follow dropsy.

The old practitioners were in the habit of giving China in most instances where dropsy followed a haemorrhage. It was so generally useful, and so commonly relieved, that they seldom used any other remedy.

But Apocynum is also a remedy for dropsy following haemorrhage. Many times it will fit the symptoms clearly in dropsy following haemorrhage.

"Prolonged menorrhagia, or haemorrhage from the uterus for six weeks. Blood expelled in large clots, sometimes in a fluid state."

Moderate flow for a day or two; suddenly sets in with such violence that she cannot be out of bed. Compels her to lie quietly.

"Shreds, or pieces of membrane with the fluid blood. Menorrhagia continuing, or paroxysmal," that is, a continuous flow until the patient is exhausted.

That is like Phos. and Ipecac. and Secale. In most instances, a uterine haemorrhage will cease after about so much blood has been lost. In medicines where the flow is so liquid as it is in this medicine that tendency to cease does not come until a state of profound exhaustion has come on.

Then the dyspnoea, as has been described, will not permit the patient to lie down. This is commonly from hydrothorax. It has also a hypostatic congestion of the lungs in patients that have been sitting up a long time, so that it fills up from below, gradually creeping up so that a large portion of the breathing space is destroyed.

"Great oppression about the epigastrium. Difficult breathing. Gasping for breath. Wheezing and coughing."

It has all the rattling that is found in Tartar emetic and Tartar emetic has a similar filling up of the chest, cannot lie down.

Pulse small and irregular; almost pulseless. Disposed to faint whenever she attempts to raise her head from the pillow. Small weak pulse. Dropsy of the pericardium. Palpitation very troublesome.