Apis mellifica

Lecture VIII — Hymenoptera — Apis mellifica

From the order Hymenoptera we derive Apis mellifica, Vespa crabro, Formica rufa and Bombus. The local effects of the poisons from these insects are well known. The skin becomes red and swollen, with burning pain; finally, even sloughing may ensue. In susceptible persons, or after the injection of considerable quantities of the poison, general symptoms may develop, such as fainting, prostration, chills and coldness; great restlessness, or insensibility, and even death may result. The stings of certain ants {Formica, not Termites, which are neuropterous) contain a poison, the chief ingredient of which is called Formic acid. This highly irritating acid is also found in the glands attached to the hairs of stinging nettles, in some caterpillars and in old oil of turpentine.

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 honeybearing bee, or Apium virus, the poison of bees. The original preparations of the remedy were made in the following manner: A large white dish was placed under a bell jar, in which there was a perforation 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 toxicology. Take, if you choose, a sting on the hand or finger as an illustration. Just after the sting, which causes a sharp sticking or 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, stinging or shooting character, seldom throbbing. Heat of the part increases 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, w Tith sudden swelling of the part coming on rapidly and ending in resolution; nor is it such as would be cured by Belladonna, with bright red swelling accompanied by throbbing pains and ending either in resolution 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, nervous trembling, coldness and loss of consciousness, especially in eruptive diseases. The heart is weak, beats slowly or almost imperceptibly, with pulselessness at the wrists.

In the majority of cases calling for Apis the nervous system is irritated 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. As will be inferred from the symptoms mentioned, Apis may be employed in states of mind resembling hysteria. The fidgetiness, restlessness, 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 scarlatina, diphtheria, typhoid fever, etc. A complete stupor after apoplexy 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 interspersed with a miliary eruption. There is always puffiness of some part of the surface. Prostration comes on early, with scanty or suppressed urine, high fever and drowsiness.

In meningitis or in meningeal irritation Apis holds a prominent position 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 conditions. In tubercular meningitis, or in acute cerebral effusions, a suppressed or undeveloped eruption is a good guide to the choice of Apis. We may profitably compare Apis here with Belladonna, 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 distinguish the fidgety nervousness of the latter from the more intense cerebral irritation of the former. The congestions of Belladonna are more violent, with throbbing of the carotids, injected red eyes, and drowsiness 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 cervical glands may be swollen, but there is not the cellular infiltration, with an erysipelatous blush, as in the bee-poison.

If there is meningeal irritation, Belladonna is needed when the congestive symptoms are intense; Apis, when the nervous agitation predominates, 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 complete. There are automatic motions of one arm and one leg; the forehead 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 abdomen. 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 suppressed 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 constantly 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.

Zincum produces cerebral irritation; the child awakes with fear, rolls the head ; cries out and starts in sleep. There is constant fidgety motion of the feet. The drug is indicated in anaemic children who are too enervated to develop an exanthem. In typhoid states the prostration is very great, with impending cerebral paralysis. Unconsciousness 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 symptoms. 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 restlessness 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 halfopen 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 transparency of the skin and the thirstlessness. Now as to cause. Apis is especially useful in dropsies of renal origin, whether the result of scarlatina or not. The urine is scanty and highly albuminous, and contains 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 hydrothorax Apis may be the remedy, especially when the trouble is of cardiac 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 suffocative 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 restlessness 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, w 7ith tension, and they are better from the warmth of the bed, while the Apis pains are better from cold applications.

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 hydrocephalus. 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 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 slowness 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 provoked 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 disease 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 preponderance 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 meningitis 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 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 eruption 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, before the stupor is profound, you will find Helleborus indicated by these symptoms. This corrugation of the muscles of the forehead is present, 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 developed disease. If the premonitory symptoms are violent, however, you may use Belladonna in tubercular meningitis in the stage of hyperemia 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 Belladonna and Apis, and that is Bryonia, which acts on serous membranes, 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.

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 assuming a pinkish rosy hue. The soreness soon becomes severe, and burning 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 throbbing 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 nervousness, 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, compare 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 eruption may come as a result of cold or during the course of intermittent 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 diseases.

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, commonly called acute inflammatory rheumatism. The affected parts feel very stiff and exceedingly sensitive to pressure. There is often a sensation 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 devitalizing affections, such as diphtheria or typhoid fever, and also when meningeal effusions remain after inflammations. In all such cases suppressed 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. Sulphur 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 service when this type is found in the sick. The chill occurs characteristically 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 account 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 appearance of the chill; at ten o'clock in the morning in the case of Natrum mur t , 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 burning 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 prostration, but with the characteristic acid diathesis.

In scarlatina most of the indications for Apis have already been 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 identical 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 drowsy 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 albuminuria.

Again, we find Apis of service in diphtheria. The disease advances so insidiously that its presence is not suspected, or, from the very beginning the child is thoroughly prostrated, with high fever and drowsiness. 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 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 external throat is swollen and erysipelatous. The above symptoms may indicate 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 inside and outside is swollen and oedematous, the breath is horribly offensive, and a thin discharge issues from the nose. The great characteristic 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 employment of the drug in hydrothorax, hydropericardium, oedema pulmonum 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. Compare: Lachesis, Arsenicum, Sulphur, Belladonna, Kali card., Spigelia, Digitalis, Aspai'agus, Apocynuvi cannabinum .

Arsenicum and Apis have many resemblances. So apparently alike are the restlessness, changing of place, and dyspnoea, that one remedy is often given when the other should be. The best distinction lies in the fidgety restlessness peculiar to Apis. If dropsy obtains, both may be needed in pale, tensely swollen limbs, but Apis often has redness, itching or an erysipelatous condition present, as well as thirstlessness. 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 debility, 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 trachea; but there is a rough, scraped feeling in the throat. Bryonia 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 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 redness.

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

Now, the action of Apis on the genital organs. Apis is often indicated in diseases of the female organs. Nearly all the provers experienced symptoms referable to the uterus and ovaries. There is increased sexual desire with stinging in the ovaries. This is sometimes a symptom in widows, and Apis will often relieve it. Tendency to abort at or before the third month. Apis produces and will check abortion when the symptoms agree. Therefore it must be given cautiously during pregnancy, because if given in low potency and frequent dosage it may bring about a miscarriage, especially before or at the third month. We may use it in amenorrhcea when we have congestion of the head as a result of the suppression of the flow, bearing down in the uterine region, thirstlessness, and intolerance of heat. Particularly is it indicated in girls with this amenorrhcea at the age or puberty. They are nervous, hysterical, awkward and silly. It is not a natural awkwardness, but one that comes from incoordination of the muscles. With these s3'mptoms there is flushing of the face. We may also use Apis in affections of the ovaries, especially of the right side. It holds the same relation to the right ovary that Lachesis does to the left. It is indicated in ovaritis with extreme soreness in the right ovarian region, together with burning or stinging sensations, and some tumefaction, detectable either over the pelvis or, more characteristically, through the rectum or vagina.

In ovarian cysts, Apis is an excellent remedy to control the growth, especially in the incipient stages. We have here, in addition to the burning and stinging pains, numbness down the thigh and over the right side of the body, and a feeling of tightness across the chest, with cough. This is not a symptom of lung disease, but is reflex from the uterus.

Now there is a combination of honej^ with salt, known as Mel cum sale. This was for years a popular remedy in Germany for bladder troubles and for diseases peculiar to women. I have used this remedy in prolapsus uteri and even in chronic metritis, especially when associated with subinvolution and inflammation of the cervix. The special symptom which leads to the selection of the remedy is a feeling of soreness across the hypogastrium from ilium to ilium.

Apis may be of use in diseases of the eyes. I have seen several cases of asthenopia cured by this remedy, when reading caused smarting in the eyes, with lachrymation and itching of the eye-lids and some burning and stinging. Apis is also a remedy for staphyloma, whether of the cornea or sclerotic coat. In external diseases of the eye, it is not without value. The eyes are over-sensitive to light. The conjunctiva is reddened or puffy and chemotic. But this swelling of the palpebral conjunctiva under Apis is more from congestion than from a true chemosis, as under Rhus tox., which is very similar, especially in cedematous swelling of the lids, chemosis, hot, gushing lachrymation; erysipelas. But Apis has less tendency to the formation of pus—a symptom highly characteristic of Rhus tox. In the former the pains are stinging, the time of exacerbation is the evening, and cold water relieves the inflamed lids. If erysipelatous, the lids are a bluish red, looking watery, as if semi-transparent. In the latter, the pains are worse at night, particularly after midnight; warmth relieves; the erysipelatous lids are of a dusky red, and, together with the cheeks, are studded with small watery vesicles. The pains in Rhus tox. are usually of a drawing, tearing character, although in erysipelas they may be burning or stinging, but with more itching than in the bee-poison. The eyelids often feel heavy and stiff. Arsenicum compares with Apis in hot tears, violent pains and cedematous lids. But the lachrymation is more acrid. The cedematous lids are pale, not bluish-red. The palpebral conjunctiva and the edges of the lids are very red. The restlessness is more pronounced. Relief is usually obtained from warm applications, though the scrofulous patient can open his eyes in the cool open air, but not in the room, even if dark. The symptoms are worse at and after 12 p. m. To return to the eye symptoms of Apis, the lids are swollen, red and cedematous. There is burning of the tarsi, with agglutination of the lids. Sudden and very severe pains shoot through the eyes, and these are relieved by the application of cold water. The eyes are generally worse in the first part of the night. Apis is often indicated in scrofulous ophthalmia, in which affection it is often followed by Kali bichromicum .

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.

You will find it useful in the diarrhoea of children who are very much debilitated. Irritability of the brain is generally present with the condition known as hydrocephaloid. The symptoms are much like those indicating Apis in hydrocephalus. The child wakens with a scream. The stools are thin, watery, yellow in color, and usually worse in the morning. At every motion of the body the bowels move, as though the sphincter ani had no power. The stools may or may not be offensive.

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.

Modalities: Apis has general relief from cold applications. Many complaints are worse evenings and night, though diarrhoea increases in the morning. Motion generally aggravates, as does a w rarm room.

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

Ledum was proposed by Teste as an antidote for the stings of insects. Dr. Drysdale has cured nightly itching of the feet with it. 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.