Pulsatilla

Lecture XXXIV — Pulsatilla

Pulsatilla. { f Blood-vessels.

Mucous membranes.

Synovial membranes.

^ Organs.

Compare with Bryonia, Nux vomica, Antimonium crudum, Ipecac, Sulphur, Sulphuric acid, Arsenicum, Colchicum, Kali bichromicuvi , Caulophyllum , Ignatia, Actea racemosa, Helonias, Hamamelis, Sepia. To-day we shall study Pulsatilla. The species which we shall consider is the Pulsatilla of Hahnemann, the Pulsatilla praiensis, and not the American plant, the Pulsatilla Nuttalliana. There is some little difference in the action of the two drugs. The " pratensis" has been better proved. The concordant remedies of this drug are almost without number. The reason for this is that it is a well-proved remedy, and one, too, that is often indicated. Its complementary remedies are Sulphuric acid and Lycopodium.

Its antidotes are Chaviomilla, Coffea, Ignatia and Nux vomica. The relation of Pulsatilla or Sulphuric acid calls for particular notice. The latter remedy follows the former in gastric troubles. Pulsatilla is also antidotal to Sulphuric acid. When this acid has been used for the cure of the appetite for liquor, Pulsatilla has been proposed as the remedy best suited for the diarrhoea which ensues.

Pulsatilla pratensis is a pretty little flower belonging to the anemone. It has been called the wind-flower, and its name is in keeping with its symptoms, as they are as fickle as the wind. Changeableness of the symptoms is characteristic of the drug. This is especially marked in the haemorrhages, which apparently stop and in a few hours return. It is also true of the diarrhoea, the stools continually changing their appearance—at one time being green, at another mixed with yellow, and at still another slimy.

The mental symptoms are of the same fickle nature, the patient now being irritable, then tearful, and again mild and pleasant. These are illustrations of the changeableness that I have described. Pulsatilla seems to be especially adapted to the female organism, although it affects men as well as women. It is one of those remedies which we are apt to select by the predominance of the mental symptoms. It is especially indicated in patients of a mild, tearful disposition, having a rather slow, phlegmatic temperament. They are never irascible, although at times peevish. Thus, in the case of a child with some gastric ailment, Pulsatilla may be used when it is peevish, pale, chilly, and satisfied with nothing. This is not the Nux vomica condition, nor is it like Chamomilla, both of which remedies have decidedly more violence with their anger.

The Pulsatilla woman is tearful and easily discouraged. Sometimes she is full of anxiety, with forebodings of some impending disaster. This anxiety comes from the epigastrium and is very likely to be associated with indigestion. It is often accompanied by chattering of the teeth, palpitation of the heart and flushes of heat. These are the main mental symptoms of Pulsatilla. They are present, more or less, in every disease in which it is the remedy.

In these mental symptoms you should compare Sepia, which, you will recall, has a similar mental state; but it differs from Pulsatilla in the presence of irritability and anger. There is also indifference to her household affairs, to which she was formerly attentive. Natrum muriaticum also has tearful disposition similar to that of Pulsatilla, but consolation under Natrum mur. aggravates, while under Pulsatilla the patient seeks consolation.

Stannum metallicu?n likewise has this tearful disposition. The patient is very much discouraged, or is tearful over his chest symptoms. He fears that he will go into a decline.

The Ignatia patient is sad, but she hides her grief from others. Pulsatilla is especially suitable for chlorotic or anaemic women, when they complain constantly of a feeling of dulness, but in spite of this find relief for many of their symptoms in the open air. They cannot tolerate a close room. The pains from which they suffer seem to be accompanied by chilliness. This chilliness is more marked the more decided the pains are. The mental symptoms already mentioned are present. Especially is Pulsatilla the remedy when chlorosis has been complicated by the abuse of iron and quinine. Chlorotic patients, coming to you from allopathic hands after iron and quinine have failed to relieve, thus showing you that these remedies are not suitable to the case, will find their first, if not their only remedy, in Pulsatilla. You will frequently find this hint of service to you in practice, not only in chlorosis, but in other affections as well, when they arise, not so much from local disease, as from a general defective state of nutrition; the whole system is worn out; ever}' tissue is relaxed. The woman suffers from mal-position of the uterus. The menses are late and scant}', dark, clotted or changeable in character. Pulsatilla does not always cure after the abuse of iron, but it stands in the same relation to this substance that Nux vomica does to the abuse of drastic purgatives, and Camphor to cantharides.

To understand how these phenomena of Pulsatilla are caused — whether in women, where they are most frequently met with, or more exceptionally in men—you must remember that the drug acts upon the vascular system, especially upon the right heart, and upon the veins and capillaries. Thus we find that whatever weakens the venous portion of the circulation, whatever retards the return of blood to the heart, must of course provoke just the class of symptoms for which Pulsatilla may be indicated. We know, for instance, that a warm, close room will provoke these symptoms. If a person sits in a close room or in one where the temperature is too high, the veins will become tortuous and there will be some oppression about the chest and retardation of the heart's action. When these symptoms occur in disease they suggest Pulsatilla. It acts on the right heart more than on the left, consequently, despite the chilliness which arises from the anaemia, the open air acts as a stimulus to the venous circulation, and this improves the symptoms depending upon the sluggish flow of blood. You will find many symptoms throughout the entire body calling for Pulsatilla when there is this disturbance in the venous circulation.

In the chest there is a feeling of soreness referred to either the right or the left sub-clavicular region, or to the apex of one or the other lung. This soreness is felt when the patient lies on the affected side or presses against the chest. It seems to involve the muscular structures about the shoulder and even down the arm of the affected side. This symptom indicates venous congestion, or, at least, sluggish circulation through the upper part of the lung. It has been a valuable symptom to me and to many physicians in the incipiency of tuberculosis, especially in women of the Pulsatilla temperament. Along with this soreness in the lung there may be some cough with expectoration. Although there may be no symptoms indicating the positive existence of tuberculous infiltration we will have other symptoms indicating the onset of the disease. Pulsatilla has several times relieved these cases. Then, too, we have Pulsatilla indicated in varicose veins, whether occurring on the limbs or about the testicle (varicocele). The affected parts are bluish and annoy the patient by the soreness and stinging pains in them.

The epistaxis of Pulsatilla is of a passive character. The flow comes steadily, but it is not .bright red and does not come in gushes as it does in epistaxis dependent upon arterial lesions. It often occurs vicariously, taking the place of the menses. The same is true of the blood-spitting or haemoptysis, which is either associated with this soreness or passive congestion of the chest or is dependent upon suppressed menstruation.

Pulsatilla has an important analogue, namely, Hamamelis, in these venous symptoms. Before Hamamelis was proved Pulsatilla was the only remedy we could depend upon in the class of symptoms enumerated. Hamamelis is the preferable drug in varicose veins unless constitutional symptoms call for Pulsatilla, especially in the case of varicocele. Varicocele has been cured by Ha?namelis applied externally and taken internally. The great characteristic of this drug, and that which makes its choice certain, is soreness of the affected part. It is a soreness which is not exactly the bruised feeling of Arnica; it is not the sensitive soreness of Lachesis; nor the stinging soreness of Apis; but it is that sore feeling which belongs to venous congestion. You may apply Hamamelis successfully in any condition in which that is present. I have often made use of the drug in pregnancy, when varicose veins appeared over the abdomen, and when the patient could not make any motion without experiencing a bruised sore feeling. Hamamelis is not the panacea which druggists would have us believe. It does not cure everything, sprains, etc., but it does cure the class of symptoms I have mentioned.

Another concordant remedy of Pulsatilla is Lilium tigrinum, which, like the former, affects the right heart', producing engorgement of the veins, relief in the open air, scanty menses, and taste of blood in the mouth. But it differs from Pulsatilla in the decided tendency to prolapsus uteri, with bearing down, relieved by supporting the abdomen, or by crossing the limbs; and in the mental state, which is one of irritability and restlessness with constant desire to hurry. Furthermore, when Lilium is indicated, a sharp pain, extending from the left nipple through the chest to the back, is apt to be present.

Another analogue is Sepia, which has many of the Pulsatilla symptoms. Sepia, also, is indicated in anaemia and chlorosis, and it also has the mild tearful temperament, but there is a difference in the mental symptoms. With Sepia there may be irritability or at times vehemence.

The Sepia patient has complete aversion to her usual household duties.

Let us now consider the action of Pulsatilla on mucous membranes. This is easily remembered. It produces a catarrhal inflammation of the mucous membrane, which ends in the production of bland yellow or yellowish-green mucus. You have here an indication which you may apply to any mucous membrane.

Conjunctivitis calls for Pulsatilla when the discharge is thick, yellow or yellowish-green, and bland; hence it is not indicated in the beginning of the disease, but later in its course, when the symptoms have matured. It is an invaluable remedy in ophthalmia after measles, in purulent ophthalmia, and in ophthalmia neonatorum (whether these troubles are of gonorrhceal origin or not), when the discharge is of the character just described. Its analogue here is Argentum nitricum, which has precisely the same symptoms in more marked degree, and is to be used after the failure of Pulsatilla. The latter in turn sometimes serves as an intercurrent to spur on the action of Argentum nitricum.

Mercurius corrosivus is suitable in cases which, despite the use of Argentum nitricum, threaten to ulcerate and perforate the cornea. These are not by any means the only eye symptoms of Pulsatilla. Dr. George S. Norton, of New York, published in the Hahnemannian Monthly, some years ago, a paper on the use of this remedy in diseases of the eye, which covered some six or eight pages. In addition to the conjunctival inflammation just noticed, Pulsatilla causes obscuration of vision, with vertigo and nausea, diplopia, starry apparitions, circles of fire, etc. (these generally being reflex symptoms); pustules on the cornea, with very little dread of light, but with lachrymation, worse in the open air; pressing, stinging pains in the eye; swollen lids; styes, relieved when in the open air; margins of the lids inflamed and swollen, but not excoriated.

In ophthalmia, with very little photophobia, it resembles Graphites, but has not the cracks along the lid-edges.

Pulsatilla is also an excellent remedy in small central corneal ulcers, with no vascular supply, especially when occurring in scrofulous subjects. It may still further be used in lachrymation from disease of the lachrymal duct when the symptoms just enumerated are present, and for lachrymation worse in the wind.

Pulsatilla also affects the nasal mucous membrane, developing here symptoms which indicate it in the advanced stages of a cold. It should not be given in the beginning of a cold unless the temperament and other symptoms decide, because sneezing and serous excoriating discharge are not characteristic Pulsatilla symptoms. But when you find a nasal catarrh "ripened," that is, when the nasal discharge is thick, muco-purulent, yellowish or yellowish-green, and not in the least excoriating, you have a perfect picture of Pulsatilla. In chronic nasal catarrh you may give Pulsatilla if the discharge is of this character. You must give the drug frequently and persistently, in order to cure. In addition to the symptoms already enumerated, there is still another symptom, namely, loss of taste and smell. There is a remedy known as Cyclamen, which is very similar to Pulsatilla in its symptomatology. It seems to be suited to nasal catarrh when there are loss of taste and smell, and this thick discharge just like that of Pulsatilla; but it has, in addition, spasmodic sneezing and aversion to the open air.

Pentkorum sedoides is useful in the incipiency of coryza when there is rawness in the nose and throat. The patient complains of a constant wet feeling in the nose, but without coryza. I^ater, there is a formation of thick purulent discharge, just as in Pulsatilla. Spigelia is one of our best remedies for catarrh of the posterior nares. The symptoms indicating it are profuse discharge of mucus through the posterior nares; nasal mucus passes off only through the posterior nares. This drug has accomplished some good cures in the hands of Dr. Aug. Korndoerfer, who also recommends Theridion for this affection.

Hydrastis is also suited to post-nasal catarrh. The discharge is of a thin watery character, and is attended with a great deal of burning and rawness, together with a sensation as of a hair in the nostrils. Pulsatilla is an invaluable remedy in affections of the ears. In otitis externa you may use it when the external ear is hot, red, and swollen, and there are darting, tearing, pulsating pains, which are worse at night.

In otitis media also it is useful when there is a profuse thick yellow or yellowish-green discharge from the ear.

Pulsatilla is one of our leading remedies in catarrhal otitis. There is deafness, with a feeling as if the ears were stopped up, with rushing noises in the ears, isochronous with the pulse. Silicea is the nearest remedy to Pulsatilla in catarrhal otorrhcea.

Belladonna and Mercurius have a deeper action than Pulsatilla, acting on the cellular tissues.

Chamomilla is similar to Pulsatilla in the ear symptoms, but the pains are more violent, and are attended with red cheeks; the patient cannot bear pain.

Plantago major is to be thought of when earache is associated with toothache.

Tellurium causes catarrh of the middle ear, which may penetrate into the cells of the mastoid process and establish an abscess there, or may even involve the internal ear or the brain. Pus forms in the middle ear, and finally, perforating the membrana tympani, escapes externally. The resultant discharge is thin and acrid, causing blisters wherever it touches, and smells like fish-brine.

In catarrh of the throat you will find Pulsatilla sometimes, though not frequently, the remedy. It would here be indicated by the appearance of -the parts. There are a marked redness of the tonsils and a varicose condition of the blood-vessels of the parts, and the fauces have a dark red or purplish hue. There are also stinging pains in the throat (here reminding you of Apis), worse usually from swallowing saliva or after eating food.

Leaving the pharynx we next come to the stomach, where we find Pulsatilla indicated in catarrhal conditions. The tongue is coated with a thick rough white fur. The mouth feels dry, and yet there is not much thirst, thirstlessness being a characteristic of the remedy. There are also nausea, and sometimes vomiting, the vomited matters consisting either of food or mucus, and also of bile. The food vomited may have been that eaten a long time before, thus showing the weak digestion of the remedy. There is a feeling of fulness and heaviness in the stomach after eating, sometimes associated with a feeling of rawness in the stomach as from ulceration. The latter is merely a subjective symptom and is a common sensation in Pulsatilla. Usually there is diarrhoea, with slimy or watery stools, worse after midnight. Attending these gastric symptoms is heartburn and sometimes, though rarely, water-brash. When water-brash calls for Pulsatilla there is a putrid taste in the mouth in the morning, better after drinking. The patient craves lemonade. He may complain that his mouth is dry, yet it seems to contain plenty of mucus. Other symptoms experienced are: feeling of weight in the epigastrium an hour after eating, relieved by eating again; feeling in the oesophagus as if food were lying there (also China, Abies)-, throbbing in the epigastrium; much flatulence which moves about, causing pinching pains and rumbling, worse on awaking or just after supper. Now these are the symptoms calling for this remedy in gastric catarrh. What are the exciting causes ? First of all and most important, Pulsatilla is called for when the trouble has arisen after partaking of fatty food or of pastry. It is also indicated in gastric catarrh arising from a mixed diet, as turkey, vegetables, coffee, etc., especially if eaten at night; also after chilling the stomach with ice-cream or ice-water, especially if the stomach is warm. In still other cases it may be indicated after getting wet, especially after getting the feet wet when suppression of the menses ensues. Let us now differentiate this remedy from the others commonly used in these dyspeptic symptoms. The most important remedies besides Pulsatilla, having aggravation from eating fatty foods, are Ipecac, Thuja and Carbo veg. Arsenicum and Carbo veg. have aggravation from eating ice-cream, and Nux vomica and Ipecac, from partaking of a mixed diet, or aggravation from eating at night; in this condition^ you may think also of Cinchona. In desire for lemonade, compare Cyclamen, Sabina and Belladonna; nausea at the thought or smell of food, particularly if rich or fat, Sepia and Colchicum; in vomiting of food long after eating, Kreosote.

Bryonia produces a catarrh of the stomach with white coated tongue, putrid taste in the mouth and a feeling as of a heavy load in the stomach. It may also be indicated in gastric catarrh brought on by chilling the stomach, although it is more suitable when the trouble has been brought on by the heat of summer weather. Bryonia usually, however, has constipation as an accompanying symptom, or if it has diarrhoea, it has not this yellowish-green or watery stool. Instead of this, the stools are papescent and have a putrid odor like old cheese. Nux vomica resembles Pulsatilla. Both are serviceable in catarrh of the stomach arising from overeating or from a mixed diet. Especially is Nux indicated after indulgence in alcoholic drinks. Dryness of the mouth with little or no thirst and uncomfortable feeling about the stomach, are also found under Nux vomica. The bowels are constipated. Comparatively speaking, we may say that heartburn is more characteristic of Pulsatilla and water-brash more characteristic of Nux vomica. The mental symptoms of the two remedies differ widely, and they should be easy to distinguish on this account. Antimonhim crudum resembles Pulsatilla, but the tongue under this remedy is coated white as though it had been whitewashed. Vomiting predominates over the other symptoms. A slight quantity of food excites nausea and vomiting. It is an excellent remedy in children. Ipecacuanha is a first-class remedy in these gastric catarrhs caused by chilling the stomach with ice-water or by eating pastry, confectionery or other indigestible substances. Usually the tongue is clean. It seldom has the thick coating belonging to Pulsatilla or Antimonium crudum, and nausea predominates over every other symptom. Arsenicum is complementary to Pulsatilla when gastric catarrh arises from chilling the stomach with ice-cream or ice-water. Under Pulsatilla there is a sensation as of a stone in the epigastrium. You will find a similar symptom under Abies nigra, which has been successfully used in gastric troubles when the patient experiences a sensation as of a hard-boiled egg in the stomach after eating. You may use Pulsatilla in constipation occurring in pregnant women or following the abuse of Cinchona and its preparations. The stools are large, with much urging and backache, or they are insufficient and finally consist of nothing but yellow mucus. You may also use it for diarrhoea when the stools are of a greenish-yellow color or are very changeable. The trouble is usually caused by partaking of a mixed diet late the night before, and the symptoms are apt to be markedly worse after midnight.

Here you should compare Iris versicolor, which is one of the best remedies we have for cholera morbus, coming preferably at two or three o'clock in the morning with vomiting of food and sour, bilious matters, accompanied by purging. It differs from Veratrum album in the absence of coldness and symptoms of collapse.

In cystitis or catarrh of the bladder we find Pulsatilla indicated when there is frequent urging to urinate from pressure on the bladder as if the bladder were too full. There is pain in the urethra. The urine itself is often turbid from the admixture of mucus. Clinically, we have not found Pulsatilla a first-class remedy in cystitis, but we have found it almost always the remedy in cystic symptoms accompanying pregnancy. It yields to Cantharis, Equisetum and Dulcamara in cystitis.

Gonorrhoea calls for Pulsatilla when the discharge is thick, bland and yellow or yellowish-green. There are usually pains in the groins when this drug is indicated, and I have noticed, too, pains going across the hypogastrium from side to side, a symptom that has sometimes been produced by overdosing with Pulsatilla. After giving it a few times in these cases, the patient returns, complaining of this aching across the stomach. This symptom occurring thus, calls for the lengthening of the intervals between the doses, or else for its stoppage altogether.

In suppression of gonorrhoea, Pulsatilla is indicated if orchitis, or rather epididymitis, ensues. The testicle is retracted, enlarged, very sensitive to the touch and the skin of the scrotum is dark red. There are sharp dragging pains following the course of the spermatic cord. Unless some other symptoms contra-indicate it, Pulsatilla will restore the discharge and relieve the distressing pain, but the patient must be kept quiet and the scrotum must be supported in a suspensory. In some cases I have used hot water locally as an adjuvant. While it seems to increase the swelling, it relieves the pain.

In some of these cases there appears to be an absence of symptoms of a subjective character. All you can observe is that the testicle is swollen and exquisitely sore to the touch. The gonorrhoeal discharge has almost if not entirely ceased. In these cases Hamamelis is your remedy.

Clematis is an excellent remedy for gonorrhoeal orchitis when the testicle is indurated and is "as hard as a stone."

Rhododendron also is a useful remedy when the orchitis becomes chronic and the testicle is indurated exactly like Clematis. Under Rhododendron, however, the testicle tends to atrophy. There is also a feeling in the gland as if it were being crushed.

In induration of the testicle you may compare Conium, Arnica, Staphisagria, Spongia, Aurum metallicum, besides the remedies already mentioned. You may give Oxalic acid when there are terrible neuralgic pains in the spermatic cords, worse from the slightest motion, and even on thinking of them.

Ustilago and Hamamelis also cause neuralgia of the testicle. Mercurius is called for when the glands are swollen, and when what little discharge remains is greenish, and when there is phimosis. Pulsatilla is of use in enlargement of the prostate. It is indicated by the mechanical symptom, faeces, when they escape, are small and flat.

PULSATILLA PRATENSIS. 353, Hydrocele, especially the congenital form, may yield to Pulsatilla: Next let us study Pulsatilla in its relations to synovial membranes- Pulsatilla has not an affinity for the true serous membranes, as we found under Aconite and Bryonia, but it acts on the synovial sacs, which are slightly different from the pure serous membranes. The remedy is indicated in rheumatism of the joints, and in gouty, gonorrheal and traumatic synovitis. The joint is, of course, swollen, and the pains are of a sharp stinging character, and are accompanied by a feeling of soreness or of subcutaneous ulceration about the affected joint. The pains in these joint inflammations are usually erratic, nowhere and now there. The tearing pains in the joint force the patient to move the affected part. Pressure relieves. These tearing pains often extend down the limb, and are accompanied by jerking, probably through irritation of the muscular nerves, and are relieved by slowly moving about. I dwell upon these pains because the} 7 so frequently call for Pulsatilla. They are usually worse from warmth, and are relieved by cold. They are worse in the evening.

Pulsatilla rivals Apis in synovitis, but the latter drug has more effusion than the former, and is indicated when there is a great deal of oedema about the joint.

Ledum and Lac caninum have pains worse from warmth. In the former they travel downward; in the latter they shift from one limb to the other and back again.

In rheumatism with erratic pains, you may compare Kali bichromicum, Sulphur and Bryonia.

Chamomilla has stitching pains, jumping from place to place, worse in the knees and ankles, but they are accompanied by numbness and a sense of weakness. The temperament is totally unlike that of Pulsatilla.

Kali bichromicum is called for in gonorrhceal rheumatism. Thepains are better in a warm room.

By reason of its action on the digestive organs, Pulsatilla becomes of value in gout or in the gouty diathesis, especially when the trouble has been brought on by indigestion. If the disease persists despite itsuse, Colchicum follows well.

Now let us consider the action of Pulsatilla on the various organs. We have already studied the mental symptoms of the drug. We have yet to speak of its headaches. These we may summarize as being mostly frontal and supra-orbital. They are generally of uterine,. neuralgic, rheumatic or gastric origin. They are aggravated by mental exertion and by warmth. They are usually worse in the evening, although the gastric symptoms are worse in the morning. When of rheumatic origin, the pains are sharp and seem to go from the head into the face and almost drive the patient mad, so severe are they. In other cases they may be erratic, wandering from one part of the head to the other.

In some cases the headache accompanies menstrual suppression. The head is hot. The pain in the head is better in the open air and * is often accompanied by nose-bleed.

In these headaches you should compare Pulsatilla with the following remedies:

Ranunculus bulbosus, headache on the vertex as if the head were being pressed asunder, worse in the evening and on going from cold to warm air and vice versa.

Ranunculus sceleratus, gnawing in the vertex in a small spot. Cocculus Indicus, pain in the occiput as if it were opening and shutting.

Spigelia, sensation as if the head were open along the vertex. Carbo animalis, feeling on the vertex as if pressed asunder; must 'hold it together.

Veratram album, pressure on the vertex, with pain in the stomach; head relieved by pressing the vertex, and aggravated by motion. Menyanthes , compressive headache in the vertex and sensation when ascending steps as if a weight pressed on the brain, better from pressure, and accompanied by cold hands and feet.

Phellandrium, pain as from a weight on the top of the head, with .achixig and burning in the temples and above the eyes, which are congested; eyes water; can bear neither light nor sound.

The eye symptoms of Pulsatilla, and some of those of the ear, have already been considered. We shall now proceed with the remaining ear symptoms. Pulsatilla has long been known as a remedy for otitis externa or inflammation of the external auditory meatus. The pains are very severe, as indeed they must be from the confined nature of the canal, surrounded as it is by bone. The external ear is swollen and red. The pains are usually worse at night. The trouble may end with otorrhoea, which has the character already described. We come next to the action of Pulsatilla on the female organism. It is here that Pulsatilla has won its laurels. W T e find it indicated in •girls at the age of puberty, when the menstrual flow has not established itself normal^, or has not appeared at all. It is especially at this time that 3 Tou may find soreness of the apices of the lungs, calling for Pulsatilla, and you know that unless you remove this symptom and establish the menstrual flow, your patient will have some form of phthisis. When the menses are established the} T are apt to be too late and too scanty. The flow is fitful in its character, now coming on and now stopping, now appearing as dark clotted blood, and again as an almost colorless watery flow. It is preceded by menstrual colic. The pains are of a crampy, griping character, and so severe that the patient can hardly bear them. She almost smothers if the room is close. She has the Pulsatilla temperament well-marked. Amenorrhcea ma3' call for Pulsatilla when it occurs during the ordinary period of menstruation, or as a result of wet feet, and when nose-bleed acts vicariously for the menses. In some of these cases a single dose will bring on the menstrual flow, while in others you are obliged to give the drug repeatedly.

During pregnane)' you may find use for Pulsatilla. Soreness of the uterus and of the abdominal walls may call for it as well as for Hamamelis.

Then again it may correct malpositions of the foetus in utero, if the cause is not mechanical. Now I know that in making this statement I am venturing on debatable ground. I do not mean to say that Pulsatilla will make the foetus turn around. But I do mean to say that Pulsatilla will act on the muscular walls of the uterus, and stimulate their growth. Sometimes the uterus in its growth during pregnancy develops more on one side than another. Hence there is irregularity in its development, and the foetus must assume an irregular position. Pulsatilla, by alteriug the growth of the uterus, permits the foetus to assume its proper position.

During labor Pulsatilla is called for when the pains are slow, weak and ineffectual. Then, again, we may find the pains spasmodic and irregular, and they may even excite fainting, as in Nux vomica. The patient feels as if smothering, and calls on you to open the windows. Again Pulsatilla may be called for after labor when the placenta remains adherent. In these cases it w T ill not only bring about release of the placenta, but will so tone up the uterus as to avoid post-partum haemorrhage. Cantharis and Gossypium are also useful in this condition.

Again Pulsatilla is many times the remedy in simple retained placenta, which allies it with Sepia, Sabina, Secale and Caulophyllum. Pulsatilla may also be used for after-pains, the temperament agreeing. These pains, however, call more frequently for Chamomilla, Caulophyllum and Xanthoxylum. The last two remedies are particularly useful.

Cuprum metallicum is a good remedy for severe crampy after-pains in women who have borne many children.

Pulsatilla may also be used for scanty or suppressed lochia. It may also be indicated as frequently as Hamamelis in phlegmasia alba dolens, or "milk-leg."

The mammary glands are affected by Pulsatilla before, during, and after pregnancy. It is indicated when mechanical irritation, as, for instance, carrying school-books, excites the flow of milk. After labor you may still give this remedy when the breast is swollen and painful and the flow of milk scanty or absent, the patient being gloomy and tearful.

In this connection I may mention several remedies that are more important than Pulsatilla. I think that Urtica urens is the best remedy for non-appearance of the milk without any other symptoms, there being no apparent reason for the agalactia.

Still another remedy is Ricinus communis or castor oil. This has, when used externally, developed milk. It may also be successful when given internally in low potency.

Agnus castus is useful in agalactia when the mind is greatly depressed.

Causticum is called for in women of a rheumatic diathesis. The face is usually sallow and the patient gloomy and depressed. In its relation to diseases of women, Pulsatilla has a great many allies. First of all we may mention Actea racemosa or Cimicifuga. This remedy resembles Pulsatilla because it acts on the uterus. Both remedies favor normal labor. Here Actea is probably the superior of the two. It also resembles Pulsatilla in its action during labor, being indicated for labor-pains which are very distressing. The symptoms, however, are not intermittent, but rather continuous, and as to temperament, we find Actea racemosa differing from Pulsatilla. For instance, it is indicated in a high degree of nervousness, both during labor and out of labor, during which the woman has an intensely apprehensive mood. She has a dread or fear of something about to "happen, and this haunts her from day to day. At other times she has a dread of undertaking anything, even ordinary work. Actea racemosa is also indicated in any deviation from normal in the position of the uterus when there are sharp cutting pains across the hypogastrium from side to side. It is also to be used for neuralgia reflex from uterine irritation, and that, too, whether it be the nerves of the head, chest or limbs that are involved.

Another remedy to be compared with Pulsatilla is Caulophyllum . This is a remedy that we have not had many years, and yet it is so useful that we would not now be able to get along without it. Its main characteristic is intermittency of pains. If they are neuralgic and reflex from uterine disorder, they are intermittent in character. They are usually sharp and crampy, and appear in the bladder, groins and lower extremities. During labor Caiilophyllum is indicated when there is extreme uterine atony. The pains may be as severe as ever, yet there is apparently no expulsive effort. It is often indicated in nervous women in whom pain seems to be intolerable. The pains are spasmodic and fly about from place to place, now in the groins, then in the abdomen, and next in the chest, never going in the direction of the normal pains. The patient seems to be exhausted. There is great exhaustion of the whole system. She can scarcely speak at times, so weak is the voice. These are symptoms which indicate Caulophyllum. It has been used here by most physicians in the low potencies, although all potencies may be used. It may also be indicated during the last weeks of pregnancy when the patient suffers from false labor-pains, these consisting of painful bearing-down sensations in the hypogastrium. I have known a single dose to stop them after they had lasted for hours.

I have next to speak of Helonias dioica, or the false unicorn, one of the order of Liliaceae. This is one of the new remedies, and it is one which has proved itself worthy of a place by the side of the well-tried Pulsatilla. It is serviceable in females who are run down as to their nervous system; who are easily fatigued by any work and who complain of a tired backache, this tired feeling extending into the limbs. They seem to feel better when they are working than they did when they commenced to work. Now this is not the Rhus tox. condition. It is not due to a limbering up of stiff joints as under the latter remedy. The reason for the symptom is, that some of the languor passes off as the patient continues her labors. The backache is usually situated in the lumbar region just over the site of the kidneys, or it may appear lower down and affect the sacral region. Pain in either of these locations may accompany uterine disturbances. You will find also that Helonias is useful for suppression of the menses (here it is closely akin to Pulsatilla)

, when the kidneys are congested. It seems as if the monthly congestion, instead of venting itself as it should through the uterine vessels, has extended to the kidneys, giving rise to albuminuria. The urine is scanty and turbid. Then, again, you find Helonias called for after confinement, when there is a tendency to prolapsus and other malpositions of the uterus. The patient complains of heaviness and dragging in the pelvic region. There is a sensitiveness which has been expressed as ' ( consciousness of the existence of a womb." You know that we are not conscious of our internal organs. They move and perform their respective functions without any sensation. The minute our sensations tell us that we have a stomach or liver, that minute we begin to have disease there. Accompanying these symptoms of prolapsus and of uterine over-sensitiveness is apt to be too long-lasting lochia, if I may -use that term. To be more exact, I should say that there is a sanguineous discharge, which continues for weeks after confinement. I can recall a case which I treated last winter. It was that of a lady who gave birth to a very large child, and suffered afterward from prolapsus uteri. I gave her several remedies without relieving her, so that at the end of three months she was still uncured. About this time she began to complain of tightness across the chest, with cough and some little bloody sputum. Her mother had died of phthisis after giving birth to twins, so I feared serious lung affection. Phosphorus did no good; Nux did no good. I studied up the case more thoroughly. She told me that she felt as though there were a heavy weight over the chest on the sternum, and a feeling as though the chest had been gripped in a vise with the sore feeling which follows. This annoyed her when she awakened at night. These symptoms were symptoms which had been noticed only in the male provers of Helonias. Nevertheless I gave that drug, and it entirely removed both the chest symptoms and the prolapsus. Then, again, under Helonias you frequently find a tendency to inflammation of the vulva and vagina with formation of pus. You may also use it in ulceration of the cervix uteri. With this there is a leucorrhoea which has a bad odor, and every little exertion tends to produce a flow of blood. With these symptoms there is almost always. persistent itching about the genitals with or without the formation of blisters or sores. We know little or nothing concerning the value of Helonias during labor.

A drug to be placed by the side of Helonias is Senecio aureus. This drug causes inflammation of mucous membranes, hence it is useful when there is a tendency to catarrh of the nose, throat and lungs, particularly in women. It is especially suited to nervous, excitable women who suffer much from sleeplessness, traceable to uterine irritation, as from prolapse or flexion of the uterus. The patient suffers from scanty menstruation, and she is apt to be tearful. There is dry teasing cough, with stitching pains in the chest and blood-streaked sputum. The bladder sympathizes with the uterine disease. There is much pain at the neck of the bladder causing burning and tenesmus. After the onset of the menstrual flow the chest and cystic symptoms become modified or cease, thus showing how intimately they are related to the irregularity in the menstrual effort.

Another drug is Aletris farinosa. This is one of the most bitter substances known. It is closely allied to Senecio and Helonias. In allopathic parlance it is a "tonic." It is especially useful in women who, in addition to uterine trouble and leucorrhoea, have extreme constipation, great effort being required to effect an evacuation from the bowels. There is great accumulation of frothy saliva. Aletris is a remedy also for weakness of digestion; food distresses the patient and lies heavily in the stomach.

Cyclamen is very similar to Pulsatilla. The}- are both suited to chlorotic and anaernic women, and they both have some trouble with the digestion, and intolerance of fatty foods. The menstrual colic and irregularities are almost identical in the two drugs. The same kind of melancholy is common to both. Cyclamen may be distinguished from Pulsatilla by the following symptoms. Generally, but not always, there is more thirst with the Cyclamen patient. The Pulsatilla patient feels better in the open air, the Cyclamen does not. The Cyclamen patients suffer from a peculiar kind of torpidity, both of mind and bod}-, with languor. They cannot think. They are better when aroused and forced to exercise, something like Helonias. When they get up in the morning they feel so heavy and languid that they feel as though they could scarcely go through the day's duties, but when they once get to work they go on tolerably well until night time.. That is Cyclamen, and it is very much like Helonias. They suffer, too, from dulness of the senses with flickering before the eyes. You often find this in weak anaemic women. They see various colors before the eyes, very much as under Santonin, Conium, Kali bichromi- €um } etc. Sometimes they have half-sight. The indigestion with which they are troubled has this to characterize it: formation of flatus which causes colic at night, forcing the patient to get up and walk about till the flatus passes and gives relief.

It yet remains for me to speak of Hydrastis Canadensis. This is a remedy which acts even more powerfully on mucous membranes than does Pulsatilla. It causes catarrh of the mucous membranes of the nose, stomach, bowels, bladder, uterus and vagina, the discharge, however, being more acrid than it is under Pulsatilla, and of a thick yellow or bloody appearance; in uterine affections Hydrastis is indicated for prolapsus uteri with ulceration of the cervix. The leucorrhoea is watery at times, and a,t other times thick, yellow and excoriating; this condition being associated with gone, weak feeling at the pit of the stomach and well-marked palpitation of the heart. The tongue is moist, and coated a dirty yellow color, and takes the imprint of the teeth. The face is sallow, and the eyes are sunken and surrounded "by dark rings. The bowels are apt to be constipated, the stools being coated or intermixed with mucus.

lastly may be mentioned Lilium tigrinum, which helps in uterine complaints when there are sharp pains across the abdomen from one ilium to the other; in addition there are marked bearing-down pains, making the patient cross her limbs. She places her hand over the vulva to support the viscera.

Pulsatilla cures a fever with these symptoms: the head is hot and the lips are dry; the patient is constantly licking his lips to moisten them, yet he does not wish to drink. It may also be used in intermittent fever after the abuse of quinine when thirst appears at two or three o'clock in the afternoon; then comes chill without thirst, and anxiety and oppression from venous congestion of the chest. The patient is sleepy, yet she cannot sleep. Sometimes one hand is hot and the other cold.

Pulsatilla acts on the larynx, causing hoarseness which comes and goes capriciously. Such a hoarseness frequently marks the termination of a " cold," and this remedy may prevent its becoming chronic. It also cures purely nervous hoarseness appearing with every emotion. In the chest we again have symptoms of a catarrhal nature. Bronchitis with thick yellow expectoration; or dry, tickling cough from irritation in the trachea, worse in the evening and on lying down, with dry air passages or a scraped, raw feeling. Occasionally there is dyspnoea or constriction of the chest.

I warn you not to select Pulsatilla for a loose cough unless you are sure that all the symptoms of the case call for it. It often tightens such a cough without curing it.

Bloodspitting has already been mentioned. This may be vicarious or it may belong to incipient consumption. In the latter case there may be added soreness in the chest, worse under the clavicles; burning in the chest, especially in the region of the heart; stitches in the sides of the chest.

Pulsatilla Nuttalliana has sharp pains below the left arm-pit near the back.

In dry night-cough compare Hyoscyamus, Comum, Actea racemosa, Laurocerasus , B?yo?iia, etc.

Pulsatilla is indicated in measles, but I think that it is often given in the wrong place. It is indicated when the catarrhal symptoms are prominent and we have coryza and profuse lachrymation. The cough is usually dry at night and loose in the day time. The child sits up in bed to cough. It may also be used when there is earache. Do not give Pulsatilla in the beginning when the fever is high. You should begin the case with Aconite or Gelsemium. The eruption may come out to its full extent or it may have a dusky appearance. Kali bichromicum is to be used when, instead of simple catarrh of the eyes, you have pustules developed on the cornea. The throat is swollen and pains go from the throat into the ears; the saliva^ glands are swollen, and there is catarrhal deafness.

In neuralgia, Pulsatilla is indicated when the pains are jerking, erratic and paroxysmal, and as they continue they become more and more unbearable.

Spinal irritation is also an indication for the drug. The neck, and in fact the whole body, feels as stiff as a board. The small of the back feels as if tightly bandaged. There are pains in the sacral region, worse on sitting and when bending backward. The joints feel weak, as if they would become readil}* dislocated. Rest relieves these symptoms, hence the patient is better after sleep.

In backache, worse from sitting, you may think of Zincum, Cobalt, Sepia, Cannabis Indica, Agaricus, Berberis, Rhus tox., Valerian, etc. The sleep symptoms of Pulsatilla are very characteristic. The sleep is restless with frequent waking and troubled dreams; on waking the patient is dull and listless.

In sleep symptoms Pulsatilla and Nux vomica differ very much. While the former is wide awake and full of ideas in the evening, Nux is sleepy in the evening. The Nux patient awakes at three or four o'clock in the morning feeling rested. Then he goes to sleep again and awakes at the usual time feeling a great deal worse. Cocculus has sleeplessness from pure mental activity. Ailments follow very slight deprivation of sleep.

Sulphur has " slightest noise at night awakens the patient."