Sepia

Lecture X — Sepia

Belonging to the Mollusca is an animal called the Sepia, or cuttlefish. A hard calcareous substance belonging to the cuttle-fish is, you all know, used for the feeding of birds. The animal itself possesses a little sac or pouch which contains a dark brown, almost black, fluid. When pursued by larger fish it ejects this fluid, thus clouding the water and protecting itself from its foe. This was for a long time supposed to be the only use for this fluid. It was supposed to be entirely inert when taken into the human system. Since Hahnemann's experiments have shown the fallacy of this belief, it is safe to suppose that the cuttle-fish uses it also to kill the smaller fry upon which it preys.* The name Sepia is the common term used to designate this remedy in our Materia Medica, the juice just referred to being the part employed. This juice is used by artists. The history of the introduction of this substance into our Materia Medica is as follows: It is stated on the authority of Dr. Hering that an intimate friend and patient of Hahnemann, an artist, was in the habit of wetting his brush, containing India ink, with his saliva. Failing to cure him of his chronic ailments, Hahnemann suggested the ink as the probable cause of his persistent symptoms. The artist doubted this, but nevertheless modified his custom by covering the lips with a thin layer of sponge moistened with water, the mouth being protected by an impervious though pliable shield, and his obscure illness shortly passed away. Hahnemann then instituted provings with the Sepicz succus. All the symptoms observed by him have since been confirmed. In 1874 the American Institute of Homoeopathy, acting under the notion that our old remedies should be reproved, performed this task for Sepia. There were made some twenty-five provings of the drug in the third to the two-hundredth potencies. These were reported at the meeting of the Association in 1875. They testify to the fact that the provings left us by Hahnemann cannot be improved upon. Sepia is a remedy of inestimable value. It acts especially on the female' organism, although it also has an action on the male. It is particularly adapted to delicate females with rather fine skin, sensitive *See also Teste, Materia Medica, page 299.

to all impressions, usually with dark hair, although not necessarily so; the face is apt to be sallow, and the eyes surrounded by dark rings. It acts upon the vital forces as well as upon the organic substances of the body. It very soon impresses the circulation, which becomes more and more disturbed as the proving progresses. Even as early as the fourth hour there are developed flushes of heat and ebullitions. These flushes end in sweat, with a weak, faint feeling. Any motion or exertion is followed by hot spells and free sweats.

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

These two sets of symptoms indicate the disturbing influence of the drug upon the nervous system of animal life, and also upon the vasomotor nerves. Thence arise headaches, various local congestions, etc. Quickly following these symptoms are those marked by relaxation of tissues and nervous weakness. The prover becomes languid, prostrated, faint. The joints feel weak, as if they would easily become dislocated. The viscera drag downward, and thus originate the wellknown goneness, etc. Venous congestions still continue, and, indeed, on account of vaso-motor weakness, increase. The prolapsed uterus becomes more and more engorged, the portal stasis is augmented and the liver is heavy and sluggish. The bloodvessels are full, "and hence the limbs feel sore, bruised and tired. The general depressing influence upon the vital powers is further displayed in great weakness, faintness and trembling. The limbs feel heavy, as if paralyzed; stiffness and unwieldiness of the legs, especially after sleep. The sphincters, as well as all structures depending for power upon non-striated muscles, are weak. Hence the rectum becomes prolapsed, evacuations of bowels and bladder are tardy and sluggish, and yet there is no complete paralysis.

Organic changes are produced as exhibited in the complexion, which is yellow, earthy; in the secretions, which are offensive, sour, excoriating, etc.; in the condition of the skin, which has offensive exhalations, and is disposed to eruptions, discoloration, desquamation, ulcers, etc. Among the conditions which modify the Sepia case, none is so important as the effect of motion. Two or three provers experienced decided relief of the symptoms (one prover excepting horseback riding) from violent exercise. But man} 7 symptoms are made worse from exertion. How, then, are we to discriminate? Since many of the symptoms arise from lax tissues, with torpidity, and, above all, with surcharged veins, exercise, by favoring the return of blood to the heart, relieves. The aggravation from horseback riding or from the motion of a ship, since it jars the sensitive parts and even tends to increase venous fulness, necessarily augments the troubles. But the headache, faint, exhausted condition, the sacro-lumbar pains, and often, too, the prolapsus uteri, are naturally intensified by walking. Briefly, it has been found that Sepia acts well in menj or, more often, in women who are puffed and flabby, less frequently emaciated; who have a yellow, or dirty yellow-brown blotched skin; who are inclined to sweat, especially about the genitals, armpits and back, suffer with hot flashes, headaches in the morning, awaken stiff and tired, and are the subjects of diseases of the sexual organs. The man has sexual erethism, but without energy, and coitus induces great exhaustion (neurasthenia). The woman is erethistic, with hysteria, or with prolapsed uterus, palpitation, orgasm of blood, faintness, etc. In both cases, there may be portal stasis, with imperfectly acting liver, with atonic dyspepsia, sluggish bowels, uric acid deposit in the urine, and attending evidences of impaired digestion and assimilation. The general attitude is never one of strength and healthful ease, but rather of lax connective tissue, languor, and easily produced paresis. It is to be further remembered that the Sepia symptoms are notably worse in the forenoon and evening, the afternoon bringing a time of general mitigation. Of this fact there are numerous confirmations. We are now prepared to review the symptoms in detail, and to determine whether they sustain the assertions thus far made. To understand the symptomatology of so prominent a drug as Sepia, which has in its pathogenesis some two thousand symptoms of more or less importance, we must consider the action of the substance upon the various tissues. First of all the blood. Sepia causes great disturbance in the circulation; many of its symptoms seem to depend upon venous congestion, and this is especially noticeable in the portal circulation. Reviewing some of the symptoms based on this pathological condition, we find flashes of heat which seem to begin about the trunk and go upward to the head, with anxiety, and, of course, an oppressed feeling, ending in perspiration; throbbing all over the body, particularly in the epigastrium, in the hepatic region, in the uterine region, and in the small of the back. This symptom is very common in hysteria and chlorosis. Nose-bleed, either from mechanical causes, as a blow or a fall, from being in a hot room, or from suppressed menses. Throbbing pain in the uterus; the uterus when examined is found to be swollen, engorged with blood, sensitive to the touch, and as we shall see when speaking of the local symptoms, displaced. The hands are hot and the feet are cold; or, as soon as the feet become hot the hands become cold. This is an excellent indication for Sepia.

If we look at the symptoms of the skin, again we find the action of Sepia due to defective venous circulation. We know that when the vaso-motor nerves are inactive the skin is more sensitive to the effects of irritation, and is particularly apt to develop herpetic eruptions, especially about the elbow and knee-joints. Ulcers may form about the joints, particularly about the joints of the fingers. Under Sepia these are generally painless. There are only two other remedies that I know of with this symptom, namely, Borax and Mezereum. Sepia has been many times confirmed as a remedy in herpes circinatus. Sepia also causes yellowish-brown spots, itching, redness, vesicles, humidity and rawness, scaling pustules. The warm room makes the urticaria patient feel comfortable; but the warmth of the bed aggravates the pricking of the skin. Dunham, guided by the tendency to scaling, recommends the drug as an antidote to Rhus \ oisoning. Sepia stands well in the treatment of psoriasis, though inferior to Arsenicum and Arsenicum iodatum.

These yellowish-brown spots have also been removed by Lycopodium, Nux vomica and Sulphur. Curare is used by Dr. Baruch, of New York.

Besides Sepia, Calcarea ostrearum, Baryta carb. and Tellurium have been recommended for ringworm. Baryta carb. has never been successful in my hands. Tellurium is useful for ringworm over a great portion of the body in intersecting rings.

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

Sepia has a marked action on connective tissue, weakening it, and thus producing a great variety of symptoms. Thus, there is weakness of the joints, which give out readily when walking; weakness about the pit of the stomach, not relieved by eating and evidently the result of a sagging down of the viscera. This effect of Septa may be utilized in cases in which the joints are readily dislocated.

Now, taking up the organs seriatim, we find Sepia to have a marked action on the mind. It produces a mental state which' is quite characteristic, and which ought to be present when Sepia is the remedy. The patient, usually a woman, is low-spirited, sad, and cries r:adily. This sadness is usually associated with irritability. It will not do to find fault with the Sepia woman. At other times she manifests a condition of perfect indifference. She does not care for her household affairs or even for her own family.

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

Pulsatilla is without doubt the nearest analogue. Like Sepia, it develops a state of weeping, anxiety with ebullitions, peevish ill-humor, solicitude about health, etc. But only the former has the mild yielding disposition, clinging and seeking consolation.* There may be moroseness and peevishness, or irresolution, but there is the angry irritability and the cool indifference of the latter.

Natrum muriaticum is complementary to Sepia; they agree in causing weeping mood, depression of spirits, persistent recalling of past unpleasantnesses, irritability, indifference, loss of memory, and alternation of mental states. The former has prominently, "worse from consolation." Clinically, we may say the same of Sepia. Both remedies, too, have ailments aggravated by vexation or anger. The two are evidently similar in causing weak and irritable nerves, but their complemental relation consists in the fact that Sepia causes more vascular erethism; hence it is that under Sepia, disturbed feelings induce congestion of the chest and head, animated conversation causes hot face, and sweats follow excitement. In Natrum mur., the symptoms point more to nervous excitement or weakness alone, hence emotions induce headache, and drawing up the spine; and unpleasant thoughts cause sadness, paralytic weakness, or irritability without ebullitions. If hypochondriacal, it is a state of melancholy from mental depression, caused by inert bowels; while in Sepia the same state depends also upon portal stasis, and therefore is more persistent and associated with more irritable temper. Natrum mur. may be called for when the mental state depends upon uterine disease or menstrual irregularity, but this will be only a prolapsus, never the uterine engorgement of Sepia. The indifference of Natrum mur. is born of hopelessness and mental languor; while that of Sepia includes an undisguised aversion to those nearest and naturally dearest. Causticum induces sadness, especially before the menses.- The face is yellow; but the anxiety is more a timid, fearful state. She is full of forebodings. She dreads the possibility of accidents to herself and others.

Lilium tigrinum stands very near to Sepia. It affects the circulation, particularly of venous blood, and, as reflex symptoms from uterine and ovarian irritation, there are nervous irritability; desire to be busy, yet cannot do much; hurried manner. Depressed, full of apprehension of incurable disease, of accidents, etc. Feels that she will go crazy; weeping mood.

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

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

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

But this latter condition is not quite the indifference of Sepia. It arises more from a contrary mood. And, further, only Hepar has such violent outbursts of passion.

Platina is similar in its depressed moods. "Indifference; he does not seem to care whether his absent wife dies or not." But the digression is into haughtiness; or into anxiety, with fear of imminent death; or into that contracted mental state akin to the feeling of personal superiority, in which "everything seems too narrow; with weeping mood." And, besides, as we shall see anon, the uterine symptoms differ materially.

Let us now consider the head symptoms of Sepia. There is a disease of the head called hemicrania, for which Sepia is one of our main remedies. The symptoms which indicate it here are the following: pains over one eye (usually the left), of a throbbing character; deep, stitching pains which seem to be in the membranes of the brain; the pains almost always shoot upward or from within outward; they are so severe as to extort cries, and frequently culminate in vomiting. The paroxysms are renewed or aggravated by motion, light noise or by a thunderstorm and are relieved by sleep or rest in a dark room. Usually, with women, there are soreness of the face, uterine malposition, or disturbance of menstruation. We find, too, that the patient may have a jerking of the head backward and forward, worse while sitting and in the forenoon. This has been utilized in nervous women (with hysteria for instance), and also in children with open fontanelles. In these cases you should not give Sulphur, Calcarea, or remedies of that type. Study the symptoms and you will find that Sepia is indicated. Sepia is also useful in arthritic headaches, especially when, like those of Nux vomica, they are worse in the morning, with nausea and vomiting. The liver, of course, is affected, and the urine^ is loaded with uric acid.

In headache from brain-fag Sepia is to be selected by its general cachectic condition. It is said to be particularly efficacious when a one-sided occupation has led to brain exhaustion. Compare Natrum mur., Nux vom., Sulphur, Picric acid.

In hemicrania you may compare Sepia with Belladomia, Sanguinaria, Iris, Pulsatilla, Nux vomica, Arseiiicum, Theridion, Silicea and Thuja. Belladonna is to be selected in hemicrania when there are violent hyperemia, with throbbing carotids, red face, intolerance of the least jar, light or noise. It is indicated, you will see, in plethoric patients, and not in the cachectic, as with Sepia.

Sanguinaria produces a right-sided headache, the pains coming over from the occiput. They increase and decrease with the course of the sun, reaching their acme at mid-day. The paroxysms end with profuse urination (as in Silicea, Gelsemium and Veratrum albuni). They recur every seven days. Sanguinaria also has a menstrual headache which attends a profuse flow. In Sepia the menses are scanty. In Sangui?iaria the pains are on the right side; in Sepia they may occur on either side.

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

Pulsatilla is very similar to Sepia. Both are indicated by scanty menses; bursting, throbbing, boring or stitching pains on one side of the head; obscuration of sight, white tongue, nausea and vomiting. Pulsatilla has more vomiting, and a thickly-furred tongue with clammy mouth, and relief from cold air. The pains are shifting in character, and are associated with chilliness. They are worse in the evening. In Sepia the pains recur in shocks or flashes, with proportionate increase of heat in the head; the blurring of sight is associated with heavy eyelids; and the face, though red with headache in either remedy, is ordinarily yellow with Sepia and pale with Pulsatilla. Nux vomica is more suited to men than is Sepia. It cures a drawing, aching feeling as of a nail driven into the head, or as if the brain were dashed to pieces. The face is pale sallow, or sallow on a red ground. The attacks commence early in the morning, and generally increase to a frantic degree. As under Sepia, the exciting causes maybe haemorrhoids, abdominal plethora or brain fatigue. In general,, however, the two drugs are very different.

Arsenicum will cause a throbbing, stupefying headache over the left eye. In this particular it resembles Sepia, but the prostration and restlessness of the two drugs are very different, as is also the intensity of the angry irritability, even to swearing, which Arsenicum induces. The Arsenicum headache exceptionally derives a temporary relief from the application of cold water to the head.

Theridion has, more accurately speaking, nickering before the eyes, then blurring The nausea of this remedy is made worse by closing the eyes, and also by noise. The effect of noise is more intense than in Sepia. It seems to intensify the pains, and, as it were, penetrates to the teeth, so sensitive are the nerves to this sort of vibration. Silicea may be needed after any unwonted exertion, if moderate. The pains excite nausea and fainting, and are followed by obscuration of vision.

Sepia is very useful in diseases of the eyes. You will find it indicated in asthenopia attending uterine diseases. You may differentiate Sepia from other remedies by the time of its aggravation, the patient generally being worse in the evening; in the morning and afternoon she is quite free from symptoms.

In conjunctivitis you will find Sepia indicated when the inflammation is of a sluggish type, occurring generally in scrofulous children. The symptoms are subacute. There is muco-purulent discharge in the morning. The eyes feel comparatively comfortable during the day, while in the evening there is an annoying dryness of the conjunctivae. The remaining eye-symptoms of Sepia we may summarize as follows: cataract; trachoma, with or without pannus; scaly lids; pustular lids with eruptions on the face; eyes irritable to light, lids close in spite of him; eyelids droop; aching, sticking pains, worse from rubbing. Causes: uterine or liver diseases, scrofula, tea drinking. Worse morning and evening, in hot weather; better from cold washing, and in the afternoon.

I have for years employed Sepia in blurring of sight, etc., with prolapsus uteri. I have likewise found it efficient in asthenopia, associated with exhaustion dependent upon loss of semen, whether of voluntary or involuntary occurrence. In these respects the drug is similar to Natrum mur.

} Lilium tig .

, Jaborandi , Kali carb. The first of these superadds muscular weakness (internal recti), stiff sensation in the muscles of the eyes on moving them, etc. There is running together of letters or stitches, but not the sudden vanishing of sight so marked in Sepia.

Lilium tigrinum causes smarting of the eyes; blurring with heat in the eyelids and eyes; sharp pains over the left eye; thus symptomatically resembling Sepia. It has also burning, smarting in the eyes after reading, better in the open air, like Pulsatilla. Spasm of accommodation (studyJaborandi).

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

Under Pulsatilla, which you may also use in conjunctivitis, there is a discharge of muco-pus, but it is bland and is worse at night, with agglutination of the lids in the morning. There are fine granulations on the lids. The patient is subject to repeated highly-inflamed styes. Graphites you may employ when the canthi crack and bleed, and the edges of the lids are pale and swollen as well as scaly. Thuja is indicated in eye affections of tea drinkers. Brown, branlike scales accumulate about the cilia, and there are little tarsal tumors like warts.

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

Natrum mur., like Sepia, is indicated in eye affections reflex from uterine disease; the lids droop. But under Natrum mur. there is more spasmodic closure of the lids in conjunctivitis; the discharges are thin and acrid; there are cracks in the canthi and also in the corners of the mouth; pains over the eyes are present, worse when looking down. Alumiiia likewise has falling of the lids, dryness, burning, dim sight; but Alumina has aggravation in the evening and at night. The inner canthi are affected.

Next we shall consider the action of Sepia on the abdominal organs. It is indicated in the form of dyspepsia mentioned above, and also in the dyspepsia incident to uterine diseases, when it is associated with a gone, empty feeling in the epigastrium or the abdomen, with sour or bitter taste in the mouth, and with a longing for acids or pickles, which seem to relieve these symptoms. The tongue is coated white, the bowels are usually constipated, the stools are hard, dry and insufficient, or, even if not indurated, they are expelled with difficulty. The abdomen is swollen and distended with flatus, and there is almost always soreness in the hepatic region. On making a physical exploration you find the liver enlarged, not from fatty or amyloid degeneration, but from congestion.

Haemorrhoids are also an indication for Sepia when there is bleeding at stool, with a feeling of fulness in the rectum as though it were distended with some foreign material, which seems to excite an urging to stool. The urine has a peculiar fcetid odor, and is very turbid. When standing it deposits a uric acid sediment, which adheres tenaciously to the side of the vessel.

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

A sensation of emptiness in the epigastrium is more characteristic of Sepia; repletion after eating, of Lycopodium. Indeed, with the lastnamed drug, the repletion overshadows the other symptoms, often existing without any alterations in the appearance of the tongue. Sour taste and sour or burning eructations are, however, very common. The abdomen is in a state of ferment. After eating, the circulation is disturbed, with irresistible drowsiness. The urine contains a sediment of free red sand. The bowels are constipated, with urging and constriction of the anus. The urine, however, is not so offensive as under Sepia.

Sulphur resembles Sepia in. many respects. Both are suitable in torpid cases with defective reaction. There are abdominal plethora, congested liver, piles, constipation, hunger about n A. m. ; bitter or sour taste; eructations, sour or tasting like bad eggs; fulness from little food, etc. In Sulphur the face is more blotched, red, and at times spotted. Saliva nauseates him. He vomits food. He craves brandy or beer and sweets; but they disagree. He experiences hunger at n a. m.; while in Sepia it is more of a gone, faint feeling. The constipation is attended with ineffectual urging like Nux vomica. For gone, empty feeling in the epigastrium, compare Sepia with Calcarea ostrearum, Cocculus, Kali carb., Stannum, Ignatia, Carbo an., Sarsaparilla , Niccolum, Oleander, Ipecac, Thea, Slaphi'sagria, Actea rac. and Hydrastis.

Cocculus has the weakness extending all over the abdomen and chest. It tires her to talk. The feeling is renewed by over-exertion and especially by loss of sleep.

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

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

With Ignatia, it is attended by sighing.

Under Carbo animalis, it arises from loss of vital fluids. Sarsaparilla has it associated with rumbling in the abdomen. Niccolum, without desire for food.

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

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

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

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

Lecture XI (continued)

Sepia—{continued) .

Let us resume our study of Sepia. Going still lower in the abdomen, we find it exhibiting a very marked action on the uterine organs, causing, as I mentioned the other day, engorgement of the uterus with displacement. In a well-advanced Sepia case the uterus is enlarged and the cervix is indurated. The organ is either prolapsed or retroverted. Leucorrhcea is a very prominent symptom, the discharge being of a yellowish-green color and somewhat offensive. With these objective symptoms we find bearing-down pains in the abdomen and in the small of the back. This is so extensive at times that it seems to interfere with breathing. Sometimes the patient feels as if everything would be forced out through the vulva. This feeling is relieved by sitting with the limbs crossed. With the bearing down there is associated a backache, referable to the lumbar or sacral region. It is decidedly worse when the patient is standing or walking. There are burning pains in the uterus, and sometimes pains of a sharp character shooting upward; or there may be a sensation as if the uterus were clutched by a hand, a symptom to be found also under Cactus and Lilium tigrinum. The menses are usually late and scant} , although exceptionally they may be early and profuse.

The most similar remedy to Sepia is Lilium tigrinu?n, for the provings of which we are indebted to Dr. William Payne, of Bath, Maine. He was led to make the provings after learning that the flowers of this plant had caused convulsions in a child. He thought that it might prove to be a valuable remedy in the convulsions of children. In his provings he was assisted by Dr. Dunham and a number of ladies. He observed convulsions in the course of the provings, but in almost every instance some alteration in the functions of the uterus and ovaries was noticed. The uterine symptoms of Lilium tigrinum are those which often accompany or follow pregnancy and labor. It is indicated in cases of subinvolution. The uterus does not regain its normal size after confinement and the lochia lasts too long. When the patient rises to walk, the uterus falls by its own weight. The patient complains of a heavy, dragging sensation, principally in the hypogastric region. She feels the need of some support to hold up the abdominal organs. This is very similar to Sepia. In Sepia, as stated, the woman sits with her legs crossed, thus giving an artificial support to the uterus. The leucorrhcea, too, is very similar. Under Sepia it is yellowish-green or mill^, somewhat foetid, and often excoriating. Under Lilium I think the most characteristic leucorrhcea is watery, yellowish, or yellowish-brown, and excoriating. This excoriating property of [Jlium is characteristic. The provers of Lilium had in two cases prolapsus, and in one, retroversion of the uterus. There is urging to urinate under Lilium; when the urine passes it causes burning and smarting, the same kind of feeling at the meatus urinarius as the leucorrhcea causes at the vulva. Then, too, you will find urging to stool; morning diarrhoea, hurrying the patient out of bed, the stool being yellow, papescent, and causing an excoriating feeling at the anus. Here Lilium rubs against Sulphur, which has characteristically early morning diarrhoea. The Lilium symptoms are usually worse in the afternoon, while those of Sepia are worse in the forenoon.

Lilium has some chest symptoms which are worthy of note. Patients experience a full, crowded feeling in the chest, as though there were too much blood there; they want the windows open, as fresh air gives them relief. This oppression of the chest is caused by venous stasis. With it there is a taste as of blood in the mouth, reminding one of Pulsatilla and Hamamelis , both of which have that symptom. There is a feeling as of a rivet or a bullet in the mammary region; also a feeling of coldness about the heart. Natrum mur. cures this last symptom when it appears during mental exertion; Lilium, when it occurs as a result of uterine disease. Kali bichromicum , Kali chloratum, and Carbo animalis also have it and Dr. Richard Hughes reports a case in which he cured it with Petroleum.

" Helonias," according to Dunham, "produces profound melancholy; deep, undefined depression, with a sensation of soreness and weight in the womb; ' a consciousness of a womb.' Lilium dulls the intellect, produces a sensation of hurry, with debility, and distress based on an apprehension of having some fatal or serious malady." And, further, Helonias is an excellent remedy when there is a tired, aching feeling, and some burning in the back and legs. This is common enough with women, and no remedy, unless it is Picric acid, relieves more promptly. The debility of Helonias is the result of impaired nutrition. Experiments have clearly demonstrated the fact that a diminution of red corpuscles and a general impoverishment of the blood results from its use.

Sulphur is often needed to aid Sepia in a chronic case. The complementary relation lies in the common power of the two drugs to correct abdominal congestion and other vascular irregularities. Sometimes, when the latter is in use, a- forenoon "goneness" becomes marked as an eleven o'clock faint, hungry feeling; or, flushes of heat persist. Again, a one-sided headache persistently returns and weakens the patient. Piles grow worse. The bearing down becomes continuous, with a weak feeling in the genitals. Then Sulphuris substituted, and improvement is at once noticed. After awhile, however, the symptoms shift pointedly Sepia-ward; and so the two alternate. Several such cases have been observed. One patient from the West was entirely cured with these two drugs, and remains well. She had been an invalid for years.

Murex, also a mollusc, bears a family resemblance to Sepia. The provings are, as yet, meagre, but clinical experience has confirmed some of the symptoms. Dr. Dunham, and after him, Dr. B. F. Betts, have made comparisons between Murex and Sepia which are sufficient guides in their differentiation.

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

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

The secretions are more copious than is usual with Septa. Thus the menses are profuse instead of scanty. There is copious urination at midnight with pale urine; the patient wakes with a start, and a violent desire to urinate. This is not so marked in Sepia. Both, however, have intermittent menses.

Both remedies are useful in affections of the uterine cervix. Murex when there is a sensation of soreness, or " a feeling as though something was pressing on a sore spot in the pelvis"—(Betts). Lancinating pains extending upward to the abdomen or thorax; thick, green or bloody leucorrhcea. Murex agrees rather with Lilium and Platina in sexual erethism; and with Kreosote in the urinary symptoms. Clinically it has been used for polyuria, with frequent urging at night. Kreosote has sudden urging; he cannot get out of bed quickly enough; he urinates with great haste, and passes a large amount of offensive urine.

Kreosote, moreover, bears some relation to Sepia. Both have intermittent menstrual flow, dragging downward in the back, and pressure outward in the genitals; painful coitus; vomiting of pregnancy; the urine deposits a red sediment, and is turbid and offensive. But the menses are usually copious. They are accompanied by somewhat different reflex symptoms from those belonging to Sepia, notably, difficult hearing, with humming and roaring in the head. The dragging in the back is relieved by motion, not aggravated as in Sepia, and the leucorrhcea is more acrid and irritating; it excoriates the parts over which it flows. Sometimes it is yellow, and has the odor of fresh green corn.

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

Stannum resembles Sepia in simple prolapsus uteri et vaginae, with "goneness," bearing down and melancholy. But its characteristic is falling of the uterus and vagina during hard stool. Dr Hughes writes approvingly of its use in relieving the sensation of bearing down so common with womankind, and adds: " I have been astonished at its power over prolapsus. It seems to strengthen the uterine ligaments." (Pharmacodynamics, 4th edition).

Nux vomica agrees with Sepia in causing portal stasis; uterine congestion; haemorrhoids; urging to stool; backache, worse from motion; awakening at 3 a. m. But Nux produces a peculiar irritability of the tissues, rendering the patient over-sensitive, while the functions are performed fitfully, spasmodically, and inharmoniously. Gastric symptoms predominate and they are just those which result, in a nervous person, from abuse of stimulants, highly seasoned food, etc. Thus, after a meal the clothing feels uncomfortable; retching predominates over actual vomiting. There are nausea, weakness, and a faint feeling after eating, as if produced by a strong purgative, but never the ' goneness '

' of Sepia or Murex. There is frequent but ineffectual urging to stool, not inertia of the rectum. The menses come too early, bmt are not very profuse, and are accompanied by more spasmodic pains and spasmodic movements in the abdomen than in Sepia, and by less steady bearing down and dragging. Nux has one symptom, common after lacerated perineum, namely, internal swelling and burning of the vagina like a prolapsus.

Aloe acts on the liver, increases the bile, causes griping in the bowels, and diarrhoea. Its action on the bowels and uterus reminds one of Sepia, for it causes a determination of blood to the parts, w Tith repletion of the veins and consequent irritation. But the relaxation, which is expressed in Sepia by dragging and " goneness," with weakness of the sphincters, is described by the Aloe patient as a more complete atony—a paresis. It is expressed as heaviness, weight, with dragging down. This heaviness belongs to the pelvis, uterus, perineum, rectum, sacral region and the lower bowels. In fact, it is universal, characterizing even the headache; dull headache across the forehead, with heaviness in the eyes and nausea—she must make the eyes small with the pain—weight on the vertex. That the headaches belong to bowel and uterine affections is proved by the fact that they alternate with symptoms of the latter (like Podophyllum'). Coupled with heaviness and congestion, there is a weakness of the sphincters. The patient feels a lack of confidence in them; she fears lest some stool will escape with flatus—the faeces and urine will pass together—every time she passes urine, there is a feeling as if some thin stool would escape—sudden urging in the morning.

Aloe, then, is needed when, with uterine congestion and prolapsus, there are heaviness in the abdomen and back, and uncertain control of the rectum. The woman frequently suffers from loose bowels. Without any warning, she feels faint, with a sensation as if she were about to have diarrhoea. If the bowels move, there is more wind than substance, and she becomes prostrated and covered with a clammy sweat. If she has haemorrhoids, they protrude, and are relieved by cold applications.

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

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

Podophyllum, it would seem, affects first the stomach and liver, and then the uterus and rectum. We find it, therefore, most effective when its gastric symptoms concur with those of the uterine region. While it resembles Sepia in causing bearing down in the hypogastric and sacral regions, relieved by lying down; aching in the ovaries, etc., it differs in gastro-hepatic symptoms; fulness, weight, and dragging about the liver, soreness, better from rubbing. Diarrhoea only early in the morning or during the day; sometimes the passages are wholly fsecal, but they are too frequent. Watery, gushing diarrhoea, continuing from 3 A. m. into the forenoon. Prolapsus ani before stool. After stool a weak, faint feeling in the abdomen, weak rectum and prolapsus ani. This weakness resembles Aloe. It is the paresis of a violent purgative, not the general relaxation of Sepia. Pulsatilla nigricans is very nearly related to Sepia. It cures scanty y late menses; bearing down; uterine cramps; backache; fainting; hemicrania; clavus. It is especially suitable for women who are irresolute, yielding and lachrymose, or silent, peevish and difficult to please. There is anxiety, which seems to come from the epigastrium or from the heart, with qualmishness. Anxiety as if in a hot atmosphere; also at night, as from heat. The patient is faint, she must have air. She is chilly, yet is generally better in the open air; chilly with the pains; anaemia; chlorosis.

The uterine pains of Pulsatilla are cutting and pressing, with a feeling of heaviness, converging toward the pudenda. The weighty sensation is compared to that of a stone, and is observed in the hypogastric and sacral regions. Constrictive, colicky, cramping pains predominate; actual bearing down is not so marked. Hence we employ it frequently in delayed menses and in labor. It acts fitfully; hence the uterine pains come by fits and starts, as does the menstrual flow; labor-pains are spasmodic, irregular, and finally end in complete inertia. Thus there is want of power from the very beginning, shown in the fitful character of the contractions, and in their final utter failure. Sepia causes more bearing down with the cramp. If indicated in labor, it is when an indurated and unyielding cervix retards progress. There uia3 T be spasmodic contractions of the os and upward-shooting pains. Here it favors Gelsemium and Calcarea carb.; while Pulsatilla favors Caalophyllum and Sccale.

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

As already intimated, Sepia is of use in a congested or indurated state of the cervix uteri, with soreness and burning. Aurum met., Aurum mur. and Aurum mur. natronat. are similar. Gold causes hyperemia, but it acts very differently from Sepia. On studying its effects one is impressed with the prominence of two sets of associated symptoms, namely, nervous excitation and vascular irritation; and yet the first no more represents innervation than the second does true plethora. They indicate irritable weakness. Hepatic, renal and uterine congestion appear to arise secondarily to a cardiac irritation with hypersemia.

The prolonged action of Gold develops a fever not unlike that of Mercurius, with profuse sweat, salivation and copious urine. There is also a tendency to an overgrowth of fibrous tissue, whence result cirrhoses. The glands, at first stimulated, eventually become enlarged and indurated. The periosteum is diseased, and finally the bones become carious.

In keeping with these changes are its characteristic symptoms. Under its influence the emotions become greatly affected; the patient is easily enraged by trifling contradiction; there may be cheerfulness, but the most persistent state is one of melancholy and disgust for life, with a tendency to suicide She imagines she has lost the affections of her friends; the fates are against her; she is no longer fit for this world, and she longs to die. She is seized with precordial anxiety and tremulous fearfuluess. Rush of blood to the chest develops when walking fast or for a long time, with bursting fulness. There is bruised pain in the uterine region. She is oversensitive to pain, nervous, tremulous, and agitated. The uterus is congested and prolapsed by its very weight. Sexual desire is increased.

While, then, there are congestions, prolapsus and melancholy in Aurum, as in Sepia and Murex, the course of the symptoms is different, and the mental symptoms differ especially. In Aurum there is melancholy with depression, because of supposed loss of friendship; in Sepia there is indifference to friends. Anxiety in the former is precordial; she must move from place to place (as in Arsenicum)-, a mere noise makes her anxious. Anxiety in the latter comes, it is true, with disturbed circulation, but it is not especially cardiac, and is accompanied by flushes of heat. Both produce weariness of life, with desire to die, even amounting to suicidal tendency; Aurum, because she has lost the affections of her friends (Talcott); Sepia, from sheer loathing of life.

Platina favors on the one hand Amum, and on the other Sepia. All three have weariness of life. Platina, however, has with the weariness, a great dread of death, which the patient believes to be near at hand. As in Aurum, the Platina patient feels as if she were alone, but she has a peculiar state of mind, which finds a physical parallel in her power of vision. She is out of sorts with the world, for everything seems too narrow. Things in her own home look strange on her return after a short absence. Persons are looked down upon as pitiful, insignificant and very inferior to her. And similarly, objects about her appear S7naller than natural.

Neither Aurum nor Sepia compares with Platina in the pronounced nymphomania and voluptuous irritation of the genitals. The menstrual flow in the latter is profuse and clotted instead of scanty. Platina and Sepia have uterine cramp, but in the latter it is clutching, as if suddenly seized and then released; in the former it is a decided cramping followed by numbness—a symptom which is universal in this remedy.

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

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

Carbo animalis causes violent pressing in the back, groins, and thighs during the menses, with unsuccessful urging to eructate. It is distinguished from Sepia by a throbbing headache, which follows the menses. It has also copper-colored acne on the face.

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

Carbo veg. may cure varicose veins of the genitals, with blueness and burning—bluish tumors {Carbo animalis being preferable if they are indurated), ulcers or fistulae. The vaginal discharges are excoriating, thin, and ichorous, while in Sepia they are less excoriating and are thicker. There is burning across the sacrum, dragging from the abdomen to the small of the back. Burning pain deep in the pelvis, increasing and decreasing (L,eadam).

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

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

The remedy is not often required for prolapsus uteri, but it is clearly indicated when there is a feeling as if the womb would press out the vagina; the patient complains of a heavy load in the abdomen, and of lancinating-like electric shocks down the thighs (Leadam). The leucorrhcea is profuse, coming in gushes, and is excoriating. The remedy affects the ovaries more decidedly than does Sepia; the left ovary is indurated and swollen, and pains are felt when the parts are touched.

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

But Graphites is best adapted to women who are anaemic, though obese, who are constantly cold, constipated, and subject to a rough, herpetic condition of the skin. The eruptions are moist, and the sweat is offensive, as in Sepia, but glueyness of the secretions is wellmarked only in Graphites. The skin grows hard, cracks and bleeds. There is less desquamation than in Sepia.

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

Natrum carbonicum and other soda salts are complementary to Sepia.

The carbonate is needed when there is bearing down as if all would come out. The patient is melancholy, apprehensive and over-sensitive to music. There is backache very much like that of Sepia; heaviness, worse sitting, better moving; bruised pain over the back at night, tension, boring from the tip of the left scapula forward through the chest. The skin is dry and rough.

Clinically, it has served when the cervix is enlarged, with ill-shaped os. Dr. Betts has had good results with it in congenital defective growth of the anterior vaginal wall, and this ill-shaped os. Natrum muriaticum is suited to anaemic women, with thin worn face and general emaciation. They are melancholy; easily angered; suffer from nervous weakness, with palpitation, trembling, anxiety, and predominant chilliness; inclined to sweat; sweat in the axillae with chilliness over the back; prolapsus uteri; cramps, scanty menses, urine with red sediment; painful coitus. It therefore resembles both Pulsatilla and Sepia. But consolation aggravates {Pulsatilla is easily pacified, and rather seeks consolation); the headaches are congestive, pseudoplethoric, with bursting pains, worse from the least motion, even of the eyeballs; the mucous membranes smart as under Sepia, but there is an abnormal dryness; thus, the tongue feels dry, the eyelids are dry, the rectum feels dry and smarts, etc. With this dryness there is a tendency to erosions, with smarting burning; thus the tongue is sore and ulcerated; the gums are sore and bleed. The skin is unnaturally dry. The prolapsus uteri is worse in the morning; she must sit down to prevent it, with backache, which is relieved by lying on the back. She complains of tension in the hypogastric and inguinal regions as if the skin were tight {Apis). There is greenish leucorrhcea with smarting and a feeling of dryness. Cutting in the urethra, which is most marked after urination. Menses scanty, or scanty a day or two and then copious.

Natrum hypochlorosum differs somewhat from its congeners. According to the prover, Dr. R. T. Cooper, it is useful in debilitated persons, of lax fibre and rather sluggish mentally and physically. The debility is accompanied by emaciation, nervous exhaustion and other evidences of deep-seated changes in the organism. There are vertigo with falling, associated with aching across the forehead and uterine bearing down; swimming feeling as if the top of the cranium were about to float off. Pains across the forehead and eyes or on the vertex, with uterine symptoms. The brain feels paralyzed, also the limbs; the fingers feel numb; fainting spells. The tongue is large, and takes the imprint of the teeth; flatulency, constipation, bloating after meals, flatulent asthma—all indicating abdominal plethora. These symptoms are met with in connection with uterine diseases. Black clotted menses; sleepiness; dark circles around the eyes. Bearing down in the uterus, which may be congested, enlarged and sensitive; constant oozing of blood, worse from any exertion. The womb feels as if it opened and shut, thus not precisely the clutching and relaxing of Sepia. She feels as if the womb were pushed up when she sits down (a symptom of Ferriim iod. also). Swelling low down in the abdomen, going up to the chest, and causing dyspnoea, worse after eating. A weight seems to fall from the chest to the abdomen, with aching on the top of the head. Swelling in the left ovarian region at the menstrual period. The drug appears to cause the prolapsed uterus to rise into its place, reminding one of the experiments of Dr. Jackson with Sepia. Pruritus; weak feeling about the chest; easily overcome with heat. The latter is also a symptom of Sepia, as well as of Natrum mur. and Natrum carb.

Actea racemosa is invaluable in the treatment of women. It is especially adapted to those who are predisposed to muscular rheumatism and myalgia. It causes hypersemia of the brain and cord, and even inflammation in the cervical and dorsal spine. Hence come its occipital pains, lightning-like pains, delirium, etc. (see below). Here it resembles Absinthe, Abrotanum, and Gelsemium; the last named remedy, however, has more drowsiness and muscular paresis with less excitement. Sepia also causes fulness of the spinal vessels, but it is less marked than in Actea, more passive, more torpid. The sensory nerves are excited in Actea, while, at the same time, they are weak, like the motor nerves and the muscles. The heart acts feebly and nervously, the pulse is either very quick and feeble or slow and intermittent. With this there is scanty urine, depositing a red or } Tellow sediment. There is a general feeling of uneasiness, restlessness and fidgets; or tremors, nervous chills. The muscles feel sore, bruised and stiff; there are severe myalgic pains, with numb feeling. The pains are violent and dart like lightning. Phillips recommends it even for anasarca, with the above condition of heart and urinary secretion, " even when Digitalis failed."

Actea, then, is preeminently a remedy for "irritable weakness." As with Sepia, there are nervousness, restlessness, melancholy, scanty menses with bearing down, etc. But Actea produces a more decided nervous excitement, amounting to delirium, with hallucinations of rats, etc. ; it develops an overwhelming apprehensiveness—without apparent cause—which the patient cannot overcome, and which reduces her to despair. In her excited state she feels as if the top of her head would fly off, and she would go crazy. She becomes suspicious, irritable and is dizzy, as if intoxicated. All these symptoms form a part of the general nervous state, which depends upon an irritated condition of the uterus and ovaries; or is, at least, perpetuated thereby. The disturbed state of the uterus seems to be based upon a rheumatic diathesis. She suffers more from neuralgia than the Sepia patient; dull aching from the occiput to the vertex; aching soreness in the eyeballs, sharp pains thence to the vertex, with red, congested eyes—all associated with flexed or irritable uterus. Very important, too, are neuralgic pains in and about the latter organ; the uterus is sensitive to touch, pains shoot across from side to side; there is bearing down, with tightness around the hips; scanty menses, with pain continuing after the flow begins. The epigastric faintness is not quite the '

' goneness " of Sepia. It is accompanied by nervousness; tremors; waves spreading from the epigastrium all over; a feeling as if frightened. Sepia may be needed in asthenopia, reflex from the uterus; Actea rather in hyperesthesia of the retina or in ciliary neuralgia, reflex from the uterus. Both are very useful at the climacteric; Sepia for the flushes of heat; Actea, according to Hughes, for irritability, pain at the vertex, and sinking at the stomach.

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

But these effects ought not to be confounded with those of Sepia. For the drug is an intense poison, acting on the muscles and heart, etc. The epigastric sinking is connected with weakened heart, the heart-beats becoming diminished in number and force, with consequent coldness, sinking, vertigo, numbness and tremors. The remedy, then, suits debilitated cases in which the heart is failing. It is closelyallied to Kalicarb. in weak heart.

Calcarea ostrearum causes a pressure in the lower abdomen on physical exertion. Bearing down, worse standing; aching in the thighs. Sore pain, tension when standing erect or bending backward. Stinging in the cervix; stitches. But the menses are profuse and too early, and the general symptoms are, as is well known, very different from those of Sepia.

Calcarea phosphorica (like Phosphorus) produces a weak, sinking feeling in the hypogastrium; empty sinking sensation at the epigastrium. The uterine prolapsus is worse during stool or micturition,, with a sense of weakness and distress. Aching in the uterus. Cutting through to the sacrum. Cream-like leucorrhoea. Burning in the vagina, with pain on both sides of the bladder and uterus. Burning like fire up into the chest. Flushes of heat, anxiety, faintness,. debility; she sweats easily.

But the menses are profuse and there is sexual excitement. She is weak and emaciated, perhaps tuberculous; she suffers from partial profuse sweats, but they are not offensive as in Sepia. Every exposure increases her rheumatic pains, and, with these, her distress in the uterus.

Among the remaining remedies I may briefly refer to the following: Mitchella repens has engorged, dark red, swollen cervix. This is associated with an irritation at the neck of the bladder, with urging to urinate. There are, however, no general resemblances to Sepia. The remedy is rather to be classed with Eupatorium purpureum in vesical irritability in women (Hughes); with Hydrocotyle in irritation of the neck of the bladder, with heat and itching of the vagina and red cervix uteri (confirmed by Dr. Mitchell); with Vespain ulcers around the os; and with Apis in dysuria.

Sepia ought not to be confounded with Secale cornutum or Ustilago; for although the three cause bearing down, congestion, aching distress, and prolapsus uteri, the conditions are quite different. The last two act on the muscular coat of the bloodvessels and on involuntary muscular fibres in general. Secondarily, from undue relaxation, they favor tumefaction and passive haemorrhages. Their "bearing down" is prolonged, and marked (like Caulophyllum) .

Ustilago has relieved uterine haemorrhage; also vomiting of blood in a lady with uterine disease; passive flow of blood; the examining finger detects a soft, patulous cervix, and is stained with blood (Woodbury). Viburnum opulus has caused and cured pains, occurring as in Sepia, around the pelvis and uterine region; also " goneness; " empty feeling at the stomach; bearing down; nervousness. But the bearing down is much more violent, and culminates in the uterus in intense cramp; thus favoring Caulophyllum, Actea rac., Secale, etc., rather than Sepia. Inula and Hedeoma have been proved, but clinical experience is wanting. Like Sepia, they cause uterine pains and bearing down; the first, dragging in the genitals and spine; urging to stool and to micturition; the second, bearing down with great weakness in the legs. Sepia, in a few instances, has relieved choreic symptoms; sudden jerking of the head backward and forward; twisting pain in the stomach rising to the throat.

Among similar remedies we should not forget to include Zizia. It causes an increase of blood in the uterus, with backache, smarting, burning in the back, spasmodic movements of the face and limbs. The mind is at first exhilarated, then depressed, and finally a state of indifference obtains. The most marked characteristic, however, is restless, choreic movements, worse during sleep.

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

In threatened abortion, Sepia is indicated not so much by the pains as by the evidence of disturbed circulation. This, together with irritable nerves and laxness of tissue, makes up the cause of the impending catastrophe. It will be noticed that there are, or there have been, fulness and pressure of blood to the head and chest, feeling of heaviness in the abdomen, flushes of heat, with faintness and momentary attacks of blindness—observed especially when the patient is in a warm or close room, kneeling in church, when using the eyes steadily, etc. A common attendant, clearly expressive of the nature of the Sepia case, is the excellent keynote of Dr. H. N. Guernsey: sense of weight in the anus like a heavy ball.

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