Sepia officinalis

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 of 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 itself 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 very much used by artists. The history of the introduction of this substance into our materia medica is as follows: Hahnemann had a friend who was an artist, who became so ill that he was scarcely able to attend to his duties. Despite Hahnemann's most careful attention, he grew no better. One day, when in his friend's studio, Hahnemann observed him using the pigment made from the Sepia, and he noticed also that the brush used was frequently moistened in the artist's mouth. Immediately, the possibility of this being the cause of the illness flashed across Hahnemann's mind. He suggested the idea to the artist, who declared positively that the Sepia paint was absolutely innocuous. At the physician's suggestion, however, the moistening of the brush in the mouth was abandoned and the artist's obscure illness shortly passed away. Hahnemann then instituted provings with the Sepia 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 from 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 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 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 weaknesses. The prover becomes languid, prostrated, faint. The joints feel weak as if they would easily become dislocated. The viscera drag, and thus originate the well-known goneness, etc. Venous congestions still continue, and, indeed, from vaso-motor weakness, increase. The prolapsed uterus becomes more and more engorged, the portal stasis augments, and the liver is heavy and sluggish. The bloodvessels are full, and the limbs, hence, feel sore, bruised and tired. The general depressing influence upon the vital powers is further displayed in great weakness, faintness, trembling. 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 prolapses, evacuations of bowels and bladder are tardy and sluggish, etc.; 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 many 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 men, 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 prepared to review the symptoms in detail, and determine if they sustain the assertions thus far made.

To understand the symptomatology of so large a medicine as Sepia, it having in its pathogenesis some two thousand symptoms of more or less importance, we will consider the action of the substance as it affects 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 at 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, epistaxis so-called, either from mechanical causes, as a blow or 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 indicating symptom for Sepia.

Now we look at the symptoms of the skin. Again, we find its action owing to the defective venous circulation. We know that when the vaso motor nerves are inactive the skin is more liable to the effects of irritation, and particularly to herpetic eruptions, and it is particularly herpetic eruptions which Sepia cures. Little vesicles form, particularly 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 that have this symptom, and they are Borax and Mezereum. Sepia has been suggested as a remedy in herpes circinatus.

Sepia also causes yellow-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.

Sepia stands well in the treatment of psoriasis, though inferior to Arsenic and Arsenicum iodatum.

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

Besides Sepia, Calcarea ostr., Baryta carb., and Tellurium, have been recommended for ringworm. Baryta carb. has never been successful in my hands.

Tellurium is useful for ringworms which seem to come in clusters. In scabies Sepia is indicated after Sulphur, when pustules intersperse the itch vesicles.

Sepia has a marked action on the 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, which is not relieved by eating. This effect of Sepia 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 readily. 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, however, is the nearest analogue. Both it and Sepia develop a state of weeping, anxiety with ebullitions, peevish ill-humor, solicitude about health, etc. But only Pulsatilla has the mild, yielding, clinging disposition seeking consolation; but it lacks the angry irritability and the cool indifference of Sepia.

Natrum muriaticum is complementary to Sepia; they agree in causing weeping mood, depression of spirits, persistent recalling of past unpleasantness, irritability, indifference, loss of memory, and alternation of mental states. The former has prominently, " worse from consolation." Clinically, we may say the same for 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 the most vascular erethism; hence it is that under Sepia, disturbed feelings induce congestion to 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 tense headache, animated talking 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 only be 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 the venous, and as reflex from uterine and ovarian irritation, there are, nervous irritability, must 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.

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 but slight, and being associated with lessened venereal passion.

Hepar develops a mood which it may not be inappropriate to consider: Sadness, unpleasant events return to mind; sad evenings, even to 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 (it may be either) of a throbbing character, deep, stitching pains which seem to be in the membranes of the brain, and these pains almost always shoot upwards or from within outwards. The patient can bear neither light, noise or motion. Usually, with women, there are soreness of the face and disturbance of uterine position or of menstruation. We find, too, that the patient may have a jerking of the head backwards and forwards. This has been utilized in nervous women (with hysteria for instance), and also in children with open fontanelles. In this case you should not give Sulphur, Calcarea, or remedies of that type. 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 is of course affected, and the urine is loaded with uric acid.

In hemicrania you may compare Sepia with Belladonna, Sanguinaria, Iris versicolor, Pulsatilla, Nux vomica and Theridion.

Belladonna is to be selected in hemicrania when there is violent hyperaemia, 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 album). They recur every seven days. Sanguinaria also has a menstrual headache which attends a profuse flow. In Sepia the menses are scanty. In Sanguinaria the pains are on the right side; in Sepia they may occur on either.

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 with scanty menses, bursting, throbbing or boring, stitching pains on one side of the head, obscuration of sight, white tongue, nausea and vomiting. Pulsatilla has the most vomiting, 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 may be haemorrhoids, abdominal plethora, or brain fatigue. In general, however, the two drugs are very different.

Arsenicum album 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 Arsenic headache exceptionally derives a temporary relief from the application of cold water to the head.

Theridion has, more accurately speaking, flickering 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.

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 eyes.

The remaining eye-symptoms of Sepia we may summarize as follows: Cataract; trachoma; 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 by 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. (See also, Norton's Ophthalmic Therapeutics.) I have likewise found it efficient in asthenopia, associated with exhaustion dependent upon loss of semen, whether of voluntary or of 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. (Study Jaborandi.)

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, bran-like 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 worse when looking down.

Alumina 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, the action of Sepia on the abdominal organs: We find it indicated in the form of dyspepsia mentioned a few minutes ago, 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 longing for acids, pickles, the gratification of the appetite for which seems to relieve these symptoms. The tongue is coated white, the bowels are usually constipated, the stools being hard, dry and insufficient, or even if not indurated, 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 foetid odor, and is very turbid. When standing, it deposits a lithic acid sediment, which adheres quite tenaciously to the side of the vessel.

Lycopodium is a very worthy rival of Sepia in the condition just described. The distinction between the two remedies may be given you 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 last-named, 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 suited in torpid cases with defective reaction. There are abdominal plethora, congested liver, piles, constipation, hunger about 11 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 the latter disagree. He experiences hunger at 11 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, Staphisagria, Actea vac. 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 Stannum, 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 proceeding 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.

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. Leucorrhoea 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 seems to be 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 upwards, or there may be a sensation as if the uterus was clutched by a hand (Cactus and Lilium have this symptom also). The menses are usually late and scanty, although exceptionally they may be early and profuse.

The most similar remedy to Sepia is Lilium tigrinum, 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 there was some alteration in the functions of the uterus and ovaries noticed. Lilium tigrinum uterine symptoms are those which often follow pregnancy and labor. It is indicated in cases of subinvolution and labor. The uterus does not regain its normal size after confinement. When the patient rises to walk, the uterus falls by its own weight. The patient complains of heavy, dragging sensation, principally in the hypogastric region. She feels the need of some support to hold the abdominal organs up. This is very similar to Sepia. In Sepia the woman sits with her legs crossed, thus giving an artificial support to the uterus. The leucorrhoea, too, is quite similar. Under Sepia it is yellowish-green, somewhat foetid, and often excoriating. Under Lilium I think the most characteristic leucorrhoea is watery, yellowish, or yellowish-brown, and excoriating. This excoriating property of Lilium is quite characteristic. The provers of Lilium had in two cases prolapsus, and in one, retroversion of the uterus. There is urging to urinate under Lilium; the urine when it passes causes burning and smarting, the same kind of feeling at the meatus urinarius as the leucorrhoea 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 have remission at that time of the day.

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 this feeling of oppression 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. Dr. Richard Hughes reports a case with that symptom which he cured with Petroleum.

"Helonias," according to Dunham, "produces profound melancholy, deep, undefined depression, with sensation of soreness and weight in the womb, 'a consciousness of a womb.' Lilium dulls the intellect, produces a sensation of hurry, with inability, 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 there results from its use a diminution of red corpuscles, and a general impoverishment of the blood.

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 Sulphur is substituted, and improvement is at once noticed. After a while, 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, a mollusc, bears a family resemblance to Sepia. 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."

Secretions are more copious than is usual with Sepia. Thus menses are profuse instead of scanty. Copious urination at night; urine pale; 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 the affections of the 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 upwards to abdomen or thorax; thick, green or bloody leucorrhoea. Murex agrees rather with Lilium and Platina in sexual erethism, and with Kreosote in urinary symptoms.

Clinically it has been used for polyuria, with frequent urging at night. Kreosote has: Sudden urging, cannot get out of bed quick enough; urinates with great haste, and passes a large amount; urine offensive.

Kreosote, moreover, bears some relation to Sepia. Both have intermittent menstrual flow, dragging downwards in the back, and pressure outward in the genitals; painful coitus; vomiting of pregnancy; urine deposits a red sediment, and is turbid and offensive.

But the menses are usually copious. They are accompanied with 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 leucorrhoea is more irritating, acrid; it excoriates the parts over which it flows. Sometimes it is yellow, when it has the odor of fresh green corn.

This acridity of leucorrhoea 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, 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 quite 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; awakes at 3 a.m. But Nux produces a peculiar irritability of tissues, rendering the patient over-susceptible, 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. Menses are too early, though not very profuse, and are accompanied with more spasmodic pains and spasmodic movements in the abdomen than is Sepia, but with less steady bearing down and dragging. Nux has one symptom, common after lacerated perineum, viz.: internal swelling and burning of the vagina like a prolapsus.

Aloes acts on the liver, increases the bile, causes griping in the bowels, and diarrhoea. Its action on the bowels and uterus reminds us of Sepia, for it induces a determination of blood to these parts, with 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 under Aloes declared 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 quite universal, even characterizing the headache; dull headache across above the forehead, with heaviness in the eyes and nausea — 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, is a weakness of the sphincters. The patient feels a lack of confidence in them; fears lest stools will escape with flatus — faeces and urine will pass together — every time she passes urine, a feeling as if some thin stool would escape — sudden urging in the morning.

Aloes, then, is needed when with uterine congestion and prolapsus, there are heaviness in the abdomen and back, uncertain control of the rectum. The woman frequently suffers from loose bowels. Without any warning, she feels faint, with a sensation as if she was 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 just 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 hypogastrium and sacral region, with retarded menses.

Its prolapsus uteri is, however, near akin to that of Stannum, bearing down as if the genitals would come out during stool. In Stannum, however, it is recorded as occurring during hard stool; so Podophyllum causes the most relaxation in the pelvic region.

Podophyllum, it would seem, affects first the stomach and liver, and then uterine and rectal symptoms develop. We find it, therefore, most effective when its gastric symptoms concur with its uterine. While it resembles Sepia in causing bearing down in the hypogastric and sacral regions, relieved by lying down, aching in the ovaries, 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 faecal, but are too frequent. Watery, gushing diarrhoea, from 3 a.m. into the forenoon. Prolapsus ani before stool. After stool weak, faint feeling in the abdomen, weak rectum and prolapsus of the same. This weakness resembles Aloes. 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, late menses, bearing down, uterine cramps; backache; fainting; hemicrania, clavus. Suitable for women who are irresolute, yielding, lachrymose; or silent, peevish; nothing pleases. 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. Faint, must have air. Chilly, yet generally better in the open air; chilly with the pains; anaemia; chlorosis.

The uterine pains of Pulsatilla are cutting, pressing with weighty feeling, 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 so 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 stop with complete inertia. Thus there is want of power from the very beginning, shown in the fitful character of the contractions, and finally in their utter failure. Sepia causes more bearing down with the cramp. If indicated in labor, it is when an indurated and unyielding cervix retards the progress. And then there may be spasmodic contractions of the os and upward-shooting pains. Here it favors Gelsemium and Calcarea; while Pulsatilla favors Caulophyllum and Secale.

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, Aurum mur., Aurum mur. natronat. are similar. But though gold causes hyperaemia, it acts quite 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 hyperaemia.

The prolonged action of gold develops a fever not unlike that of mercury, with profuse sweat, salivation and copious urine. There is, too, 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; easily enraged by trifling contradiction; cheerfulness; but the most persistent state is one of melancholy and disgust for life, with 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 fearfulness. Rush of blood to the chest when walking fast or for a long time, with bursting fulness. Bruised pain in the uterine region. Over-sensitive to pain, nervous, tremulous, agitated. Uterus congested and prolapsed by its very weight. Sexual desire increased.

While, then, there are congestions, prolapsus and melancholy, as in Sepia and Murex, the course of the symptoms is different, and especially are the mental symptoms different. 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; must move from place to place (as in Arsenic); 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 with flushes of heat. Both produce weariness of life, with desire to die, even with suicidal tendency; Aurum, because she has lost the affections of her friends (Talcott); Sepia, from sheer loathing of life.

Platina favors on the one side gold, and on the other Sepia. All three have weariness of life. Platina, however, has with this a great dread of death, which the patient believes near at hand. As with Aurum the Platina patient feels as if she was alone, but she has a peculiar state of the 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 look to be smaller 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 relaxed; in the former it is a decided cramping followed by numbness — a symptom which is universal in this remedy.

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; leucorrhoea stains yellow; menses are followed by great weakness, she can hardly speak; "goneness," not better from eating. Desire to be alone; she avoids all conversation; anxiety and orgasm. The carbons act on the veins, favor offensive flatus, offensive discharges and excoriations, which latter are superficial and irregular in outline. Inflammations are sluggish, but tend to suppuration or death of the parts, with burning pains, great weakness, collapse.

Carbo veg. has caused bearing down in the rectum and vagina; the os is unusually open; weight in the uterus and right ovary; menses have a strong odor; leucorrhoea excoriates; genitals are sore in places, smart, itch, burn, 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.

The carbons, then, would come into use when induration or ulceration is present, with " venosity," offensive excoriating discharges, and with gastric disturbances, characterized by an accumulation and passage of offensive flatus.

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

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.

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 with a variety of accessory symptoms, as with Sepia.

The remedy is not often quoted for prolapsus uteri, but it certainly is needed when there is a feeling as if the womb would press out the vagina; heavy load in the abdomen; lancinating-like electric shocks down the thighs (Leadam).

The leucorrhoea is profuse, coming in gushes, and is excoriating. The remedy affects the ovaries more decidedly than does Sepia; left ovary indurated, swollen, pains 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. Eruptions are moist, and sweat is offensive as in Sepia, but only Graphites has the glueyness of the secretions well-marked. 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 in 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; melancholy, apprehensive; over-sensitive to music. Backache very like Sepia; heaviness, worse sitting, better moving, bruised pain over the back at night, tension, boring from tip of left scapula through. Skin dry, rough.

Clinically, it has served when the cervix is enlarged, with ill-shaped os. Dr. Betts has succeeded 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 melancholic, 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, seeks consolation); headaches congestive, pseudo-plethoric, with bursting pains, worse from the least motion, even of the eyeballs; mucous membranes smart as with Sepia, but there is an abnormal dryness; thus, tongue feels dry, eyelids are dry, rectum dry, smarts, etc. With this there is a tendency to erosions, with smarting burning; thus the tongue is sore and ulcerated; gums sore and bleed. Skin unnaturally dry. The prolapsus uteri is worse in the morning, must sit down to prevent it, with backache, which is relieved by lying on the back. Tension in the hypogastric and inguinal regions as if the skin was tight (Apis). Leucorrhoea greenish, with smarting and 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 varies the case. According to the prover, Dr. R. T. Cooper, it is useful in debilitated persons, of lax fibre and rather sluggish, mentally and bodily. This debility is accompanied with * emaciation, nervous exhaustion and other evidences of deep-seated changes in the organism. There are vertigo to falling, 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 vertex, with uterine symptoms. Brain feels paralyzed, also the limbs; fingers numb; fainting spells. Tongue large, takes print of teeth; flatulency, costive, bloated after meals, flatulent asthma — all indicating abdominal plethora.

These symptoms are met with in connection with uterine diseases Menses clotted, black; 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. Womb feels as if it opened and shut; thus not precisely the clutching and relaxing of Sepia. Feels as if the womb was pushed up when she sits down (a symptom of Ferrum iod. also). Swelling low down in the abdomen, going up to the chest, causing dyspnoea, worse after eating. A weight seems to fall from across the pit of the chest to the abdomen, with aching on the top of the head. Swelling in the left ovarian region at time of menses. It seemed 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 overpowered with heat. This latter is also in Sepia as well as 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 hyperaemia of the brain and cord, and even inflammation in the cervical and dorsal spine. Hence comes its occipital pains, lightning-like pains, delirium, etc. (see below). It here resembles Absinthe, Abrotanum, Gelsemium; the last of which remedies, however, has more drowsiness and muscular paresis with less excitement.

Sepia, too, causes fulness of the spinal vessels, but less marked than Actea, more passive, more torpid. Sensory nerves in Actea are excited, while, at the same time, like the motor nerves and the muscles, they are weak. The heart acts feebly and nervously, the pulse is either very quick and feeble or too slow and intermitting. With this there is scanty urine, depositing a red or yellow sediment. There is a general feeling of uneasiness, restlessness and fidgets; or tremors, nervous chills. The muscles feel sore, bruised, stiff; severe myalgic pains, with numb feeling. Pains violent, 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, with no apparent cause, but which cannot be overcome, reducing the patient to despair. In her excited state she feels as if the top of her head was flying 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. And the disturbed state of the uterus seems to be based on a rheumatic diathesis. She suffers more from neuralgia than the Sepia patient; dull aching from occiput to 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; uterus sensitive to touch, pains shoot across from side to side; bearing down, with tightness around the hips, menses scanty, pain continues after flow begins. The epigastric faintness is not quite the "goneness" of Sepia. It is accompanied with nervousness, tremors, waves spreading thence all over, 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.

Kali ferrocyanidum has relieved bearing down; pus-like leucorrhoea, profuse but not irritating; sadness even to tears. Sinking sensation at the epigastrium. Passive uterine hemorrhage 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 gastric sinking is connected with weakened heart, the beats of which becomes diminished in number and force, with consequent coldness, sinking, vertigo, numbness, and tremors. The remedy, then, suits the debilitated when the heart fails. It is closely allied to Kali Carb, 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, worse holding oneself erect or bending backwards. 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. Prolapsus is worse during stool or micturition, with sense of weakness and distress. Aching in the uterus. Cutting through to 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, consumptive; suffers from partial profuse sweats; but they are not offensive as in Sepia. Every exposure increases her rheumatic pains and, with these, her distress at the uterus.

Among the remaining remedies I may briefly refer to the following:

Mitchella, cervix engorged, dark red, swollen. 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, vesical irritability in women (Hughes) — Hydrocotyle, irritation of the neck of the bladder; cervix uteri red, with heat and itching of the vagina (confirmed by Dr. Mitchell) — Vespa, ulcer around the os; Apis, dysuria.

Sepia ought not to be confounded with Secale. and 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 involuntary muscular fibres in general. Secondarily, from undue relaxation, they favor tumefactions, passive haemorrhages. Their " bearing down " is prolonged, 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, coming as in Sepia, around the pelvis to the 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, backache, urging to stool and to micturition; the second, bearing down with great weakness in the legs.

Sepia, in a few instances, has relieved choreic-like symptoms; sudden jerking of the head backwards and forwards; twisting in the stomach and then rising to the throat. Among similar remedies we should not forget to include Zizia. It causes an increase of blood in the uterus, 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, Natr. 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 abodomen, piles; flushes of heat, with faintness and momentary attacks of blindness — observed especially when the patient was in a warm or close room, kneeling as in church, when steadily using the eyes, 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 Aloes. The latter has also sensation of a plug wedged in between the symphysis pubis and os coccygis.