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Homeopathic Materia Medica by Farrington



PULSATILLA

(puls)

Today we have to study Pulsatilla. The species which I shall consider is the Pulsatilla of Hahnemann, the PULSATILLA PRATENSIS and not the American plant, the PULSATILLA NUTTALLIANA. There is some little difference in action between the two drugs. The "PRATENSIS" has been better proved. The concordant remedies of this drug are almost without number. The reason for this is that it is a well-proved remedy and one, too, that is often indicated. Its complementary remedies are SULPHURIC ACID and LYCOPODIUM.

Its antidotes are CHAMOMILLA, COFFEA, IGNATIA and NUX VOMICA.

The relation of Pulsatilla to Sulphuric acid calls for particular note. The latter remedy follows the former in gastric troubles. Pulsatilla also has an antidotal effect to Sulphuric acid. When this acid has been used for the cure of the appetite for liquor, Pulsatilla has been proposed as the remedy best suited for the diarrhoea which ensues.

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

So, too, are the mental symptoms of the same fickle nature, the patient now being irritable, then tearful and again, mild and pleasant. These are illustrations of the comparisons that I have stated.

 

 

Pulsatilla seems to be principally adapted to the female organism, although it also affects men as well as women. It is one of those remedies which we are apt to select by the predominance of the mental symptoms. It is especially indicated in patients of a mild, tearful disposition, having a rather slow, phlegmatic temperament. They are never irascible, although at times peevish. Thus in the case of a child with gastric ailment, Pulsatilla may be used when it is peevish, pale, chilly, it is satisfied with nothing. That is not the NUX VOMICA condition, nor is it like CHAMOMILLA, both of which remedies have decidedly more violence with their anger.

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

In these mental symptoms you should compare SEPIA, which, you will recall has a similar mental state; but it differs from Pulsatilla in the presence of irritability and anger. There is also indifference to her household affairs, to which she was formerly attentive.

NATRUM MURIATICUM also has tearful disposition similar to that of Pulsatilla, but with this difference: Consolation under Natrum mur. aggravates, while under Pulsatilla the patient seeks consolation.

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

The IGNATIA patient is sad, but she hides her grief from others.

Especially is Pulsatilla called for in chlorotic or anaemic women, when they complain always of a feeling of chill, and despite this chilliness, they find relief for many of their symptoms in the open air. They cannot tolerate the close room. The pains from which they suffer seem to be accompanied by chilliness. This chilliness is more marked the more decided are the pains. The mental symptoms already mentioned are present. Especially is Pulsatilla the remedy when chlorosis has been complicated by the abuse of iron or quinine. Chlorosis, coming to you from allopathic hands after the failure of iron and quinine, showing you that these remedies are not suitable to the case, will find its first if not its only remedy in Pulsatilla. You will frequently find this hint of service to you in practice, not only in chlorosis, but in other affections as well when they arise not so much from local disease as from a general defective state of nutrition. The whole system is worn out. Every tissue is relaxed. She suffers from changes of position in the uterus. The menses are late and scanty, dark, clotted or changeable in character. Pulsatilla does not always cure after abuse of iron. But it stands in the same relation to this substance that NUX VOMICA does to the abuse of drastic purgatives, and CAMPHOR to CANTHARIDES.

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

You will find many symptoms throughout the entire body calling for Pulsatilla when there is this disturbance in the venous circulation. You will find in the chest a feeling of soreness referred to either sub clavicular region, to the apex of one or the other lung, soreness which is felt when the patient lies on that side or presses against the left chest. This soreness seems to involve the muscular structures about the shoulder and even down the arm of the affected side. This symptom indicates venous congestion, or, at least, sluggish circulation through the upper part of the left lung. It has been a valuable symptom to me and to many physicians in the incipiency of tuberculosis, especially in women of the Pulsatilla temperament. Along with this soreness in the lung there may be some cough with expectoration. Although there may be no symptoms indicating the positive existence of tubercular infiltration we will have other symptoms indicating the onset of the disease. Pulsatilla has several times relieved these cases.

Then, too, we have Pulsatilla indicated in varicose veins, whether occurring on the limbs or about the testicle (varicocele). The affected parts are bluish and annoy the patient by the soreness and stinging pains in them.

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

In these venous symptoms Pulsatilla has an important analogue, namely, HAMAMELIS, which vies with it here. Before Hamamelis was proved, Pulsatilla was the only remedy we could depend upon in the class of symptoms enumerated. Hamamelis is the preferable drug in varicose veins unless constitutional symptoms call for Pulsatilla, especially in the case of varicocele. Varicocele has been cured by Hamamelis applied externally and taken internally. The great characteristic of this drug, and that which makes its choice certain, is soreness of the affected part. It is a soreness which is not exactly the bruised feeling of ARNICA; it is not the sensitive soreness of LACHESIS; nor the stinging soreness of APIS; but IT IS THAT SORE FEELING WHICH BELONGS TO VENOUS CONGESTION. You may apply Hamamelis successfully in any condition in which that is present. I have often made use of the drug in pregnancy, when varicose veins appeared over the abdomen, and when the patient could not make any motion without experiencing a bruised sore feeling. Hamamelis is not the panacea which druggists would have us believe. It does not cure everything, sprains, scalds, etc., but it DOES cure the class of symptoms I have mentioned. Another concordant remedy of Pulsatilla is LILIUM TIGRINUM, which, like the former, affects the right heart, producing engorgement of the veins, relief in the open air, scanty menses, and taste of blood in the mouth. But it differs from Pulsatilla in the decided tendency to prolapsus uteri, with bearing down, relieved by supporting the abdomen, or by crossing the limbs. Also when Lilium is indicated, there is present a sharp pain, extending from the left nipple through the chest to the back.

Another analogue is SEPIA, which has many of the Pulsatilla symptoms. It, too, is indicated in anaemia and chlorosis, and it also has this mild tearful temperament, but there is a difference in the mental symptoms. With Sepia there may be irritability or vehemence at times. The Sepia patient has complete aversion to her usual household duties.

Let us now consider the action of Pulsatilla on mucous membranes.

 

This is easily remembered. It produces a catarrhal inflammation of the mucous membranes, and this ends in the production of bland yellow or yellowish-green mucus. Now you have an indication which you may apply to any mucous membrane.

Conjunctivitis calls for Pulsatilla when the discharge is thick, yellow or yellowish-green, and bland; hence, it is not indicated in the beginning, but during the course of the matured disease. It is an invaluable remedy in the ophthalmia after measles and in purulent ophthalmia, and in ophthalmia neonatorum or the ophthalmia of the new born, whether these troubles are of gonorrhoeal origin or not, when the discharge is of the character just described. Its analogue here is ARGENTUM NITRICUM, which has the same symptoms precisely, only more marked. It is to be used after the failure of Pulsatilla.

MERCURIUS CORROSIVUS is suggested in cases which, despite Argentum nitricum, threaten to ulcerate and perforate the cornea.

These are not by any means the only eye symptoms of Pulsatilla. Dr. George S. Norton, of New York, published in the HAHNEMANNIAN MONTHLY, some years ago, a paper on the uses of this remedy in diseases of the eye. This paper covered some six or eight pages. In addition to the conjunctival inflammation just noticed, Pulsatilla causes: Obscuration of vision, with vertigo and nausea, diplopia, starry apparitions, circles of fire, etc. (these generally being reflex symptoms); pustules on the cornea, with very little dread of light, but with lachrymation, worse in the open air; pressing-stinging pains in the eye ; lids swollen; styes, relieved when in the open air; margin of lids inflamed and swollen, but not excoriated.

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

Pulsatilla also affects the nasal mucous membrane, and develops symptoms which indicate it in the advanced stages of a cold. It should not be given in the beginning of a cold unless the temperament and other symptoms decide, because the sneezing and the serous excoriating discharge are not characteristic Pulsatilla symptoms. But when you find a nasal catarrh "ripened," that is, when the nasal discharge is thick, muco-purulent, yellowish or yellowish-green, and not excoriating in the least, you have a perfect picture of Pulsatilla.

In chronic nasal catarrh you may give Pulsatilla if the discharge is of this character. You must give the drug frequently and persistently, in order to cure. In addition to the symptoms already enumerated, there is still another, namely, loss of taste and smell. There is a remedy known as CYCLAMEN, which is very similar to Pulsatilla in its symptomatology. It seems to be suited to nasal catarrh when there are loss of taste and smell, and this thick discharge just like that of Pulsatilla; but it has, in addition, spasmodic sneezing.

PENTHORUM SEDOIDES is useful in the incipiency of coryza when there is rawness in the nose and throat. The patient complains of a constant wet feeling in the nose, but without coryza. Later, there is a formation of thick purulent discharge, just as in Pulsatilla.'

SPIGELIA is one of our best remedies for catarrh of the posterior nares. The symptoms indicating it are profuse discharge of mucus through the posterior nares; nasal mucus passes off only through the posterior nares. This drug has accomplished some good cures in the hands of Dr. Aug. Korndoerfer.

HYDRASTIS is also suited to post-nasal catarrh. The discharge is of a thin watery character, and is attended with a great deal of burning and rawness, together with a sensation as of a hair in the nostrils.

Pulsatilla is an invaluable remedy in affection of the ears. In otitis externa you may use it when the external ear is hot, red, and swollen, and there are darting, tearing, pulsating pains, which are worse at night.

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

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

BELLADONNA and MERCURIUS have a deeper action than Pulsatilla, acting on the cellular tissues.

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

PLANTAGO MAJOR is to be thought of when earache is associated with toothache.

TELLURIUM causes catarrh of the middle ear, which may even involve the internal ear or the brain, or even penetrate into the cells of the mastoid process and establish an abscess there. Pus forms in the middle ear, and finally, perforating the membrana tympani, escapes externally.

 

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

Leaving the pharynx we next come to the stomach, of which organ Pulsatilla produces a catarrh. It is indicated in this disease when the tongue is coated with a thick rough white fur. The mouth is dry, and yet there is not much thirst, thirstlessness being a characteristic of the remedy. There are also nausea, and sometimes vomiting, the vomited matters consisting either of food or mucus, and also of bile. The food vomited may have been that eaten a long time before, thus showing the weak digestion of the remedy. A feeling of fulness and heaviness in the stomach after eating, sometimes associated with a feeling of rawness in the stomach as from ulceration. This last is merely a subjective symptom and is a common sensation in Pulsatilla. Usually there is diarrhoea, with slimy or watery stools, and worse after midnight. Attending these gastric symptoms is heartburn, and not very often water-brash. When water-brash calls for Pulsatilla there is a putrid taste in the mouth in the morning, better after drinking. The patient craves lemonade. He may complain that his mouth is dry, yet it seems to contain plenty of mucus. Other symptoms experienced are feeling of weight in the epigastrium an hour after eating, relieved by eating again ; feeling in the oesophagus as if food was lying there (also CHINA, ABIES); throbbing in the epigastrium; much flatulence, which moves about, causing pinching pains and rumbling, worse on awaking or just after supper. Now these are the symptoms calling for this remedy in gastric catarrh. What are the exciting causes ? First of all and most important, it is called for when the trouble has arisen after partaking of fatty food or of pastry. It is also indicated in gastric catarrh arising from a mixed diet, as turkey, vegetables, coffee, etc.; also after chilling the stomach with ice-cream or ice-water, especially if the stomach is warm. In still other cases it may be indicated after getting wet, especially after getting the feet wet when suppression of the menses ensues.

It will be well for you if now I differentiate this remedy from others commonly used in these dyspeptic symptoms. But let me say first that other remedies besides Pulsatilla, having aggravation from eating fatty foods are IPECAC, THUJA and CARBO VEG. ARSENICUM and CARBO VEG. have aggravation from eating ice-cream, and NUX VOMICA and IPECAC, from partaking of a mixed diet, or aggravation from eating at night; you may think also of CINCHONA ; for desire for lemonade, of CYCLAMEN, SABINA and BELLADONNA; for nausea at the thought or smell of food, particularly if rich or fat, of SEPIA and COLCHICUM ; for vomiting of food long after eating, KREOSOTE.

BRYONIA we know produces a catarrh of the stomach with white coated tongue, putrid taste in the mouth and a feeling as of a heavy load in the stomach. It may also be indicated in gastric catarrh brought on by chilling the stomach, although it is more suitable when the trouble has been brought on by the heat of summer weather. Bryonia usually, however, has constipation as an accompanying symptom, or if it has diarrhoea, it has not this yellowish-green or watery stool. Instead of this, the stools are papescent and have a putrid or old cheese odor.

NUX VOMICA resembles Pulsatilla. Both are serviceable in catarrh of the stomach arising from over-eating or from a mixed diet. Especially is Nux indicated after indulgence in alcoholic drink. Dryness of the mouth with little or no thirst and uncomfortable feeling about the stomach, are also found under Nux vomica. The bowels are constipated. While heartburn is characteristic of Pulsatilla, water-brash is characteristic of Nux vomica; of course this last statement is only comparatively speaking.

ANTIMONIUM CRUDUM resembles Pulsatilla, but the tongue under this remedy is coated white as though it had been whitewashed. Vomiting predominates over the other symptoms. A slight quantity of food excites nausea and vomiting. It is an excellent remedy in children.

IPECACUANHA is a first-class remedy in these gastric catarrhs caused by chilling the stomach with ice-water or by eating pastry, confectionery or other indigestible substances. Usually the tongue is clean. It seldom has the thick coating belonging to Pulsatilla or Antimonium crudum. Nausea predominates over every other symptom.

ARSENICUM is complementary to Pulsatilla when gastric catarrh arises from chilling the stomach with ice-cream or ice-water.

I mentioned for Pulsatilla, the sensation as of a stone in the epigastrium. You will find a similar symptom under ABIES NIGRA, which has been successfully used in gastric troubles when the patient experiences after eating, a sensation as of a hard-boiled egg in the stomach. In symptoms of the bowels you may use Pulsatilla, in constipation occurring in pregnant women or following the abuse of Cinchona and its preparations. The stools are large.

You may also use it for diarrhoea when the stools are of a greenish-yellow or of a changeable color. It is usually caused by partaking of a mixed diet late the night before. The patient is worse after midnight.

Here you should compare IRIS VERSICOLOR, which is one of the best remedies we have for cholera morbus, coming preferably at two or three o'clock in the morning with vomiting of food and sour and bilious matters and purging at the same time. It differs from VERATRUM ALBUM in the absence of coldness and symptoms of collapse.

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

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

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

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

 

 

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

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

In induration of the testicle you may compare at your leisure CONIUM, ARNICA, STAPHISAGRIA, SPONGIA, AURUM, besides the remedies already mentioned. You may give OXALIC ACID when there are terrible neuralgic pains in the spermatic cords, worse from the slightest motion.

MERCURIUS is called for when the glands are swollen and when what little discharge remains, is greenish and when there is phimosis.

Pulsatilla is of use in enlargement of the prostate. It is indicated by the mechanical symptom, "faeces when they escape, are large and flat."

Hydrocele, especially the congenital form, may yield to Pulsatilla.

Next let us study Pulsatilla in its relation to the synovial membranes. Pulsatilla has not an affinity for the true serous membranes, as we found under ACONITE and BRYONIA, but it acts on the synovial sacs which are slightly different from the pure serous membranes. Pulsatilla you find indicated in rheumatism of the joints, and in gouty, gonorrhoeal, and traumatic synovitis. The joint is, of course, swollen, and the pains are of a sharp stinging character and are accompanied by a feeling of soreness or of subcutaneous ulceration about the affected joint. The pains in these joint inflammations are usually erratic, now here and now there. The tearing pains in the joint, force the patient to move the affected part. Pressure relieves. These tearing pains often extend down the limb and are accompanied by jerking, probably through irritation of the muscular nerves, and are relieved by slowly moving about. I dwell upon these pains because they so frequently call for Pulsatilla. They are usually worse from warmth and are relieved by cold. They are worse in the evening.

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

In rheumatism with erratic pains you may compare KALI BICHROMICUM, SULPHUR, and BRYONIA.

KALI BICHROMICUM is called for in gonorrhoeal rheumatism. The pains are better in a warm room.

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

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

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

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

RANUNCULUS BULBOSUS, headache on the vertex as if pressed asunder, worse in the evening and on going from cold to warm air and VICE VERSA.

RANUNCULUS SEDERATUS, gnawing in the vertex in a small spot. COCCULUS INDICUS, pain in the occiput as if it was opening and shutting.

SPIGELIA, sensation as if the head was open along the vertex. CARBO ANIMALIS, feeling in the vertex as if pressed asunder; must hold it together.

VERATRUM ALBUM, pressure on the vertex, with pain in stomach, head relieved by pressing the vertex, and aggravated by motion.

MENYANTHES, compressive headache in vertex and sensation when ascending steps as if a weight pressed on the brain, with cold hands and feet.

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

The eye symptoms and some of those of the ears, have already been considered. We will now proceed with those of the latter organ that still remain. Pulsatilla has long been known as a remedy for otitis externa or inflammation of the external auditory meatus. The pains are very severe, as indeed they must be from the confined nature of the canal, surrounded as it is by bone. The external ear is swollen and red. The pains are usually worse at night. The trouble may end with otorrhcea, which has the character already described.

We come next to the action of Pulsatilla on the female organism. It is here that Pulsatilla has won its laurels. We find it indicated in young girls at the age of puberty when the menstrual flow has either not established itself normally or even not at all. It is especially at this time that you may find this sorenesss of the apices of the lungs calling for Pulsatilla, and you know well that unless you remove this symptom and establish the menstrual flow, your patient will have some form of phthisis. When the menses are established they are apt to be too late and too scanty. The flow is fitful in its character, now coming on and now stopping, now appearing as dark clotted blood, and again as an almost colorless watery flow. It is preceded by menstrual colic. The pains are of a crampy griping character, and so severe that the patient can hardly bear them. She almost smothers if the room is closed. She has the Pulsatilla temperament well-marked. Amenorrhoea may call for Pulsatilla when occurring during the ordinary period of menstruation, when it occurs as a result of wet feet, and when nose-bleed acts vicariously for the menses. In some of these cases, a single dose will bring on the menstrual flow, while in others you are obliged to give the drug repeatedly.

During pregnancy, you may find use for Pulsatilla. Soreness of the uterus and of the abdominal walls, may call for it as well as for HAMAMELIS.

Then again it may correct malpositions of the foetus in utero.

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

During labor, Pulsatilla is called for when the pains are slow, weak and ineffectual. Then again we may find the pains spasmodic and irregular, and they may even excite fainting, as in NUX VOMICA. The patient feels as if smothering and calls on you to open the windows.

Again you may have it called for after labor when the placenta remains adherent. In these cases, it will not only bring about release of the placenta, but it will so tone up the uterus as to avoid post-partum haemorrhage. CANTHARIS is also useful in this condition.

Pulsatilla may also be used for after-pains, the temperament agreeing.

These pains, however, call more frequently for CHAMOMILLA and XANTHOXYLLUM. This last remedy in particular is a good one.

CUPRUM is a good remedy for severe crampy after-pains in women who have born many children.

Pulsatilla may also be useful for scanty or suppressed lochia.

It may also be indicated as frequently as HAMAMELIS in phlegmasia alba dolens, or milk leg.

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

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

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

Still another remedy is AGNUS CASTUS Avhich is useful when the mind is greatly depressed.

CAUSTICUM is called for in women of a rheumatic diathesis. The face is usually sallow and the patient gloomy and depressed.

Now Pulsatilla in its relation to diseases of women has a great many allies. First of all we may mention ACTEA RACEMOSA or CIMICIFUGA.

This remedy resembles Pulsatilla because it acts on the uterus. Both remedies favor normal labor. Here Actea is probably the superior of the two. It also resembles Pulsatilla in its action during labor, being indicated for labor pains which are very distressing. The symptoms, however, are not intermittent, but rather continuous. As to temperament, we find Actea racemosa differing'from Pulsatilla. For instance, it is indicated in a high degree of nervousness, both during labor, and out of labor, during which the woman has a horribly apprehensive mood. She has a dread or fear of something about to happen, and this haunts her from day to day. At other times she has a dread of undertaking anything, even ordinary work. Actea racemosa is also indicated in any deviation from normal in the position of the uterus when there are sharp cutting pains across the hypogastrium from side to side. It is also to be used for neuralgias reflex from uterine irritation and that, too, whether it be the nerves of the head, chest or limbs that are involved.

Another remedy to be compared with Pulsatilla is CAULOPHYLLUM. This is a remedy that we have not had many years, and yet it so useful that we would not now be able to get along without it. Its main characteristic is intermittency of pains. If they are neuralgic and reflex from uterine disorder, they are intermittent in character. They are usually sharp and crampy, and appear in bladder, groins and lower extremities. During labor Caulophyllum is indicated when there is extreme uterine atony. The pains may be as severe as ever, yet there is apparently no expulsive effort. It is often indicated in nervous women in whom pain seems to be intolerable. The pains are spasmodic and fly about from place to place, now in the groins, then in the abdomen, and next in' the chest, but not going in the direction of the normal pains. The patient seems to be exhausted. There is great exhaustion of the whole system. She can scarcely speak at times, so weak is the voice. These are symptoms which call for CAULOPHYLLUM. It has been used here by most physicians in the low potencies, although all potencies may be used. It may also be indicated during the last weeks of pregnancy when the patient suffers from false labor pains, these consisting of painful bearing-down sensations in the hypogastrium. I have known a single dose to stop them after they had lasted for hours.

I have next to speak of HELONIAS DIOICA, or the false unicorn, one of the order of Liliaceae. This is one of the new remedies and it is one which has proven itself worthy of a place by the side of the well-tried Pulsatilla. It is serviceable in females who are run down as to their nervous system ; who are easily fatigued by any work and who complain of a fired backache, this tired feeling extending into the limbs. They seem to feel better when they are working than they did when they commenced to work. Now this is not the RHUS TOX. condition. It is not due to a limbering up of stiff joints as under the latter remedy. The reason for the symptom is, that some of the languor passes off as the patient continues her labors. The backache is usually situated in the lumbar region just over the site of kidneys, or it may appear lower down and affect the sacral region. Pain in either of these situations may accompany uterine disturbances. You will find also that Helonias is useful for suppression of the menses (here it is quite akin to Pulsatilla), when the kidneys are congested. It seems as if the monthly congestion, instead of venting itself as it should through the uterine vessels, has extended to the kidneys, giving rise to albuminuria. The urine is scanty and turbid. Then, again, you find Helonias called for after confinement, when there is a tendency to prolapsus and other malpositions of the uterus. The patient complains of heaviness and dragging in the pelvic region. There is a sensitiveness which has been expressed as "consciousness of the existence of a womb." You know that we are not conscious of our internal organs. They move and perform their respective functions without any sensation. The minute your sensations tell you that you have a stomach or liver, that minute you begin to have disease there. Accompanying these symptoms of prolapsus and of uterine over-sensitiveness, you will notice too long-lasting lochia, if I may use that term. To be more exact, I should say that there is a sanguineous discharge, which continues for weeks after confinement. I can recall a case which I treated last winter. It was that of a lady who gave birth to a very large child, and suffered afterwards from prolapsus uteri. I gave her several remedies without relieving her, so that at the end of three months, she was still uncured. About this time she began to complain of tightness across the chest, with cough and some little bloody sputum. Her mother before her had died of phthisis after giving birth to twins, so I feared serious lung affection. Phosphorus did no good ; Nux did no good. I studied up the case more thoroughly. She told me that she felt as though there were a heavy weight over the chest on the sternum and a feeling as though the chest had been gripped in a vice with that sore feeling which follows. This annoyed her when she awakened at night. These chest symptoms were symptoms that had been noticed in the male provers of Helonias. However, I gave that drug, which entirely removed that symptom and the prolapsus. Then, again, with the Helonias you frequently find a tendency to inflammation of the vulva and vagina with formation of pus. You may also use it in ulceration of the cervix uteri. With this, there is a leucorrhoea which has a bad odor, and every little exertion tends to produce a flow of blood. With these symptoms there is almost always persistent itching about the genitals with or without the formation of blisters or sores. During labor itself we know little or nothing concerning the value of Helonias.

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

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

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

 

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

Lastly, LILIUM TIGRINUM, which helps in uterine complaints when there are sharp pains across the abdomen from one ilium to the other, but in addition there are marked bearing-down pains, making the patient cross her limbs. She places her hand over the vulva to support the viscera.

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

Pulsatilla is indicated in measles. I think that it is often given in the wrong place. It is indicated when the catarrhal symptoms are prominent and we have coryza and profuse lachrymation. The cough is usually dry at night and loose in the day time. The child sits up in bed to cough. It may also be used when there is earache. Do not give Pulsatilla in the beginning when the fever is high. You should begin the case with ACONITE or GELSEMIUM. The eruption may come out to its full extent or it may have a dark appearance.

KALI BICHROMICUM is to be used when instead of simple catarrh of the eyes you have pustules developed on the cornea. The throat is swollen and pains go from the throat into the ears, the salivary glands 'are swollen, and there is catarrhal deafness.

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

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

In backache, worse from sitting, you may think of ZINCUM, KOBALT, SEPIA and CANNABIS INDICA.

The sleep symptoms of Pulsatilla are very characteristic. The sleep is restless with frequent waking and troubled dreams; on waking the patient is dull and listless.

In sleep symptoms Pulsatilla and NUX VOMICA differ ver.y much. While the former is wide awake and full of ideas in the evening, Nux is sleepy in the evening. The Nux patient awakes at three or four o'clock in the morning feeling rested. He then goes to sleep again and awakes at the usual time feeling a great deal worse.

COCCULUS has sleeplessness from pure mental activity. Sickness follows very slight deprivation of sleep.

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