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Apis Mellifica - The Essential Features

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1. Apis Mellifica - The Essential Features
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Materia Medica Viva

Apis Mellifica


Apium virus. Honey-bee poison.
N.O.Insecta
Tinctures are made of the whole bee or of dilutions of the poison with alcohol.

THE ESSENTIAL FEATURES

Apis is a large remedy that has been but partially understood and little used, mainly because of a lack of appreciation of the inner nature of the remedy. Kent probably felt similarly when he said in his lecture on Apis: "We must be able to see in the general beginning of provings the disease which they resemble, for we do not always see the remedy in the advanced state. We see the disease in a state of progress and must be able to see it in the beginning. As was the disease in the beginning so was the remedy in the beginning. Things that have similar beginnings may have similar endings."

It is the subtle changes in the behavior of people in the beginning of illness that most of the time foretell and determine patho/ogica/ changes in the end. To be able to code these subtle changes is the main objective of this materia medica.

To understand the inner pathology and the idiosyncracies of this most interesting remedy we have to look upon the effect that the bee sting has on the human organism and its side-effects: a sudden edematous swelling which is hot, burning and stinging, and which forces the person to shriek because of its suddeness and intensity. Few people stung by the bee will not give a shout of pain. Sometimes the effect can reach the proportions of a severe generalized allergic reaction in a very short time and can be so serious as to endanger the life of the person who is sensitive to its poison. There is an obvious aggravation from heat and touch. We know all too well how bees do not like to be touched or interfered with, and how they cannot stand the heat well.

The entire pathology of this remedy is built primarily around these external manifestations, as well as some other characteristics of the bee yet to be discussed. If we keep this picture in mind and try to understand its analogous action upon the rest of the human body, then we will be able to recognize the action of the remedy from its beginnings right through to its different advanced pathological states.

The edema of Apis, characterised by burning and stinging, will naturally be aggravated by heat and touch. You cannot aproach the bee, and the Apis person definitely does not like to be touched. The Apis patient does not want to be touched in painful areas, whether physical or psychological. Additionally, the heat of a room, or the radiant heat of a fire, or a warm bath with its hot vapors not only can aggravate pre-existing pathology, but can also provoke it. The aggravation from touch is quite a strong feature of this remedy. For instance, in cases involving an inflammation in the abdominal area, touching the abdomen is likely to provoke stiffening and tightening of the abdominal muscles.

Whether acting upon the skin or the mucous or serous membranes, Apis' tendency is to create edema, effusions, retention of water within the tissues. Water appears to be entrapped in certain parts and cannot be eliminated via natural avenues. This pronounced tendency may lead to general anasarca. "The face is greatly swollen at times, the eyelids look like water bags, the uvula hangs down like a water bag (emphasis mine), the abdominal walls are of great thickness and pit upon pressure, and the mucous membranes in any part look as if they would discharge water if they were punctured," writes Kent.

This being said, it is understandable that this remedy should have no desire to drink water. It is one of the most thirstless remedies of the materia medica because there is retention of water in the tissues; any more water would simply aggravate the situation. However, in cases involving dehydration resulting from the pathology, such as cholera infantum, typhus, diarrhea, ulcerative colitis, even abscesses, etc., we may see the opposite - insatiable thirst. When there is retention of water in the organism, there is a notable thirstlessness, but where we find loss of fluids due to the pathology, we may see excessive thirst.

The edema or the effusions of this remedy are not minor, accidental events, but the main pathognomonic manifestation of its pathology. As mentioned, this remedy has a great preference for collecting and retaining water in certain areas. Acting upon cellular tissues like the eyes, face, throat, uvula, ovaries, etc., it causes edema. Acting upon the membranes covering the heart, the brain, or the lungs, it causes effusion. Kent writes: "The outer part of man is his skin and mucous membranes. When we are dealing with man from centre to circumference, we think of the innermost as the brain and heart and internal organs that are vital, while their coatings and coverings are external. Apis affects the things that are external, it affects the envelopes, the coverings (emphasis mine). You notice how frequently it affects the skin and the tissues near the skin, and it also affects the envelopes, the coverings of organs; for example the pericardium. It establishes serous inflammations with effusion thus we see that the coverings are especially affected by Apis, viz., the skin, the mucous membranes and the coverings of organs."

Such observations are all too important when studying a remedy, but again we should not adhere to such ideas in a superficial way. For example, in a singular action upon the kidneys, Apis forbids the passage of water, causing a generalised anasarca. Can we say that this is something external?

The edemata or swellings usually manifest themselves with great rapidity and intensity. In such cases we see a very rapid effect upon the lower extremities. As an example, you may have a case of severe enterocolitis which is not doing well. On visiting the patient the morning after your first visit you are told that he has passed very little urine. You note the patient's swollen lower legs, which can be twice their usual size, and then you watch in amazement as the swelling moves upward toward the thighs by the hour. This will most probably be a case of Apis.

An analogy may be drawn between the retention of water in these patients and the way strong emotions are retained, creating an "excitable" state. Apis individuals possess intense emotions which are not easily expressed. They are people of passion and intensity, especially in the sexual sphere, but they feel awkward if they express these feelings. For this reason, they keep their emotions hidden, and the pressure of these pent-up emotions can create an extreme sexual fervor which cannot find deep release, thereby resulting in nymphomania in some cases.

 

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It is interesting to note the inclination of the bee to find "nectar" and to impulsively "attach" itself to that sweetness, while at the same time reacting aggressively in case of interference with its activities. It attacks with a blind passion both the nectar and the intruder who tries to approach or touch it. Here there is a very interesting similarity with the personality of Apis - they cannot detach themselves from the "honey" once they have found it.

This is not a question of immorality, but rather of passion. A woman will start an extramarital affair with the idea of stopping it as soon as possible, but she becomes caught and cannot give it up. It is too appealing to her sexually even though she continues to respect her husband and does not want to break up her marriage. She actually can enjoy both her husband and her lover. This story may seem quite common, especially in Mediterranean countries, but it is the result of pathology in Apis individuals.

These people become so involved in sexual play and enjoy it to such an extent that they will become lewd. One must understand that they reach such states because of an inability to express their emotions and erotic needs in a natural and comfortable manner.

Another striking similarity with the honey bee is that the bee is constantly busy, constantly working; it labors in pursuit of the "nectar" as if it were a great pleasure to do so. It is significant perhaps that we prescribe this remedy mainly for two mental conditions: one is a form of "busy insanity", in which the patient is constantly busy doing things, and the other is an erotic insanity! Such analogies may not seem "scientific," but they help to understand and to remember the essential features of the remedy.

Erotic insanity and sexual mania, especially in women, both form part of the mental pathology of this remedy. Manic-depressive states consisting of eroticism during the manic state and complete apathy during the depressive state could need this remedy. Ailments from sexual excesses is an Apis characteristic. The husband of an Apis patient might be heard to say, "The woman is terrible in bed." By this he means that she is very active and lewd, that there is an almost violent frenzy in her sexual behavior; she needs constant stimulation and never seems to be satisfied. It is a state similar to Cantharis ; indeed, Apis will actually antidote the effect of Cantharis upon the genitourinary organs. These two remedies antidote each other if the seat of trouble is the genitourinary area.

The above description should not give the student the mistaken impression that all Apis women are "nymphomaniacs," but only that they usually have an increased sexual appetite which can sometimes reach such extremes.

In this remedy we may see nymphomania or sexual mania in women coexisting with, alternating with, or stimulated by cystitis. Another interesting characteristic of Apis in women is the easy development of cysts in the ovaries, or enlargement of the ovary, especially on the right side. The cyst can be enormous and can develop in a considerably short time. When you have a case of an ovarian cyst in a sexually frustrated woman which has developed in a short time, is enormous in size, and is soft, as if full of serum, then most probably you have a case of Apis.

You should remember here that the development of the cysts is proportionate to the frustration of the woman's sexual demands. I have seen enormous cysts of this kind disappear in a very short time under a high potency of Apis in women who had been subject to "relationship" stress involving sexual frustration for a long time.

In Apis we see also a strong tendency to jealousy, which is to be expected in such sexually driven women. Ailments originating from jealousy may be seen.

It is interesting to observe that a person suffering emotionally because of some frustration connected with love may often have a weakened heart; such a person could develop a heart complication, pericarditis for instance, as a result of a common cold which has progressed to bronchitis. It seems that once the organism's resistance is lowered, the organ that has been chronically compromised is more liable to break down. Although this theory may seem a gross simplification of the complicated and highly sophisticated biological processes which take place in the human organism, you will nevertheless often perceive such a connection in your cases if you look deeply into the real, dynamic causation of each case. Such perception requires that we evaluate each case on a level far deeper than that of gross pathology.

Just as the heart may be impaired by romantic frustration in Apis, the reproductive organs and the kidneys may suffer as a result of sexual frustration.

The fact that Apis is a jealous remedy could lead to confusion with Lachesis, especially in light of other general characteristics common to both remedies - an aggravation from heat and touch, and an amelioration from cold. Yet the jealousy of Apis is different from that of Lachesis. The jealousy of Lachesis is much more insane and unfounded than that of Apis. Lachesis is tormented due to its suspicion; Apis does not suffer so. The Apis jealousy usually arises for the following reasons: these are sexually passionate people whose intense sexual behavior can approximate, if not parallel, that of the sexually maniacal, yet they are clumsy in expressing their feelings and emotions. This combination of clumsiness and sexual ardor leaves them feeling constantly insecure about their partner. Apis women, for instance, are constantly apprehensive that they may lose their husband to another woman, that he will have sexual experiences with other women of an intensity similar to that which they share within the marriage. They have great difficulty in discussing such concerns however.

They will observe certain signs in their partner, flirtatious behavior for instance, and they will not say anything; however, the poison of jealousy will begin to consume them. Eventually, after many such "signs," their suspicious nature, which had previously remained dormant, will explode in a fit of jealousy. In their rage they will say things which hurt the other person deeply, and regret it later. They sense their own awkwardness, their lack of smoothness and admire how others can express themselves so easily, smoothly and calmly, even in matters like jealousy. After several such explosions, their sexual desire becomes suppressed, and the pathological process which eventuates in an ovarian tumor or cyst begins. It is as if the sexual energy, unable to gain expression, acts destructively.

At this stage they try to laugh and to look happy, even though they feel unhappy and miserable. In our texts it says, "Simulates hilarity while he feels wretched." This is a great keynote for this remedy. They do not want to show their misery, and, even more, they try to give the opposite impression - they pretend to be happy. In our texts we read, "exaggerated joy." It is a peculiar state bordering on hysteria or mental imbalance. Also, "laughing at misfortunes," another characteristic mentioned in the literature, has to be understood as an unbalanced expression of the emotions. They probably feel so awkward at being touched by misfortune that they burst out laughing instead of crying. There is definitely an hysterical element in Apis which makes these patients laugh over serious matters, sometimes with a silly or stupid expression on their face. They do understand that this behavior makes them look ridiculous, but they cannot help themselves.

It is not that they do not complain; indeed, they will often express dissatisfaction and find fault with everything and everybody. But at other times they will try to conceal their misery by maintaining a joyful fagade, especially if they are amorously interested in somebody.

One has to see the clumsiness and awkwardness of Apis to believe it. Regardless of how careful they may try to be, they will knock over two or three glasses when reaching across the table for the salt While walking on a perfectly level street, they will somehow manage to suddenly trip and fall to the ground. If you ask them what happened, why they fell so suddenly and easily, they will not answer; they themselves do not know. They feel awkward; they are awkward. They will knock over both the bedside table and chair before reaching their bed at night, even though that same table and chair have been in that location for a very long time.

They seem to walk in a manner suggesting that they are rushing to get something quickly, without consideration of the surrounding topography.

This clumsiness is the exact opposite of the famous ability of the bee to orientate itself and locate objects spatially. Many Apis patients seem to have lost this faculty, especially when they are in a hurry. They give the impression of being internally busy or preoccupied; it is as if they are absentminded and an awareness of the location of external objects does not register in their minds. Kent goes so far as to say that this disturbance in coordination is the result of a faulty nervous system.

When they try to express their own emotions, they exhibit a similar clumsiness. They are "bumpy" with their expressions, finding it difficult to discuss their emotions in a smooth way. A natural and easy manner of self-expression is denied them, even though they harbor strong emotions. They prefer to contain their emotions, and if they do express them, they do so "jerkily."

Apis individuals are closed, not because it is their nature to be so, but because they do not know how to express themselves. It is this state that makes them often feel irritable, discouraged and weepy. They feel like crying all the time. Kent writes, "The symptoms themselves are great sadness, constant tearfulness without any cause, weeping night and day; cannot sleep from tantalizing thoughts and worrying about everything...; extreme irritability, borrowing troubles about everything. Absolutely joyless. No ability to apply things that would make her happy or joyful.." They try to hide their misery, but at night they will stay awake with depressing thoughts. Eventually, they arrive at a point where they are ready to cry with the least provocation. They may also react aggressively and quarrel for even insignificant reasons.

The state described above can arise after suffering a love disappointment, a grief, or as a result of some other cause for unhappiness. A woman hearing, for instance, that she cannot have a child because her ovaries are full of cysts might go straight into such a state.

These persons try to be kind, to behave in an obliging, even cordial manner. It is only when they are irritated that they will rage, their tongue becoming like the sting of the bee. Then they will suddenly explode and say things that can really hurt another person. They may lose control and want to break things, to strike objects around them or themselves - "knocking his head on the walls or against things."

Apis, however, is the only remedy in the materia medica that suffers so much after the rage has passed. After such an explosive release of uncontrolled emotion, they feel ill for quite sometime. Women erupt in red patches around their face or external throat and may suffer headaches, etc.; men might develop a fear of having a heart attack or a brain stroke. The rage seems to induce a surge of blood to the head, hence the subconscious fear.

Another fear of Apis that I have seen once, but very strongly, is a fear of birds; in her case it was so severe that she said, "I would prefer to have a snake near me than a bird."

This remedy, like Natrum muriaticum, has ailments from grief, also ailments from the over-excitement of emotions, such as rage or fury, fright, jealousy; bad news and mental stress are other causations. It is a remedy that is very much affected by the state of the emotions. For example, a characteristic symptom of Apis is: "After severe mental shock paralysed on the whole right side." There is also a possibility that one side of the body will display twitching or intense motor activity while the other side remains motionless, as if paralyzed.

Apis is considered complementary to Natrum muriaticums, and the two remedies will complement each other in either sequence. While Natrum muriaticum may remove many of the results of grief in a patient, certain bodily symptoms may develop which point to Apis and which will be deeply and lastingly cured by this remedy. The two remedies also share similarities, among them: awkwardness, hysteria, a closed personality, and an impassioned self-abandonment in sexual relations; however, Natrum muriaticum is always more romantic and refined, whereas Apis is more coarse and more earthy sexually. Apis is very passionate and deals with others roughly, especially on the emotional and sexual levels. Natrum muriaticum, on the other hand, is a much more refined and sensitive individual, one who cares very much about hurting others and strives not to do so. Both are not overtly sexual in the beginning of a relationship, but once they have established a rapport with their partner, they can behave quite lewdly. Apis women, in particular, do not have the ability to make contact easily with members of the opposite sex and can, therefore, suppress themselves for a long time, but once they have established a relationship, they let themselves go.

From the description of Apis provided so far, the reader will have understood that Apis is an explosive remedy in many respects. We see the same explosiveness, the same suddenness, the same rapidity in the development of the diseases for which it is indicated. There may be a sudden, explosive effusion on the meninges, for instance, and the sudden pressure can make the child shriek with pain. Apis is well known for that symptom, which used to be referred to as a brain cry, a symptom which has been known to appear mostly in inflammation of the meninges or in conditions characterized by increased cerebrospinal fluid pressure on the brain. The pain in Apis comes suddenly and so piercingly that it forces the person to shriek. The shriek or the cry seems to come from the deepest recesses of the organism, causing a chill in the listener. Shrieking in children during sleep, during dentition or after vaccination for polio are symptoms of Apis. Apis is indicated in cases of hydrocephalus manifesting this same kind of shrieking.

In heart conditions such as pericarditis we see the same intensity and the same suddenness, the same intense effusion.

"In those intensely violent and rapid cases of diphtheria in which the whole throat fills right up with edematous swelling, the uvula hanging down like a transparent sac filled with water, and the patient is in imminent danger of death by suffocation from actual closure of throat and larynx, there is no remedy like Apis," writes Nash. But Kent gives another hint - "Apis cures diphtheria, especially when there is a high grade of inflammation and the membrane is scanty or comes slowly or insidiously ... the parts are edematous and the soft palate is puffed like a water bag, and the uvula hangs down with a semi-transparent appearance like a bag of water. All around the throat and mouth there is an edematous condition looking as if it would flow water if pricked." Such vivid descriptions should remain fixed in the memory of the student because it is the impression of a condition that will give the clue to the correct remedy.

We will also observe intense excitement reaching states of delirium in a very short time in cases of congestion or inflammation in the brain; e.g., meningitis or meningoencephalitis; excitement in hydrocephalus. The delirium becomes most prominent at night during sleep and is at its worst after midnight; loquacious delirium; "sexual delirium." There is all this activity at night, but the next morning she is depressed, apathetic, and totally uncommunicative. The midnight aggravation is a characteristic of the remedy.

In similar conditions we observe hallucinations: that he has died or is dying, that someone is in bed with him, that people are beside him, that she is pregnant, that the tongue is made of wood.

And then we see, especially during low types of fevers, a tiredness, weakness, and total apathy that can reach complete unconsciousness. They are not aware of anything going on around them. They seem not to perceive what is being said to them. When pricked with a pin, no sign of feeling is given; when water is put into his mouth, no attempt at swallowing is made. There is no evidence of seeing, hearing or feeling.

There is an interesting keynote in the mental sphere which we see in certain cases: a sense that life is ebbing away with a resignation to dying. They feel they will be dying soon, with the next breath or in a few minutes, and they appear not to resist, as if they do not have the energy to resist. This sensation most probably results from difficult respiration; they seem to have to draw breath to garner enough strength to even pronounce a word. It is not a fear of dying, but rather a presentiment, a foretaste of death - a feeling they are now "going," and they are resigned to this fact. It will sometimes look as if they desire to die, as if their defences have suddenly been completely relinquished.

In chronic mental conditions we see delirium during the menses or delirium with menstrual difficulties. In such cases it is likely that the female hormones are unbalanced due to frustration, again, of the sexual demands.

Allergic conditions that come suddenly, unexpectedly, and with violence and which cover the entire body are seen in Apis. Even anaphylactic shock is possible. In this respect the French dentist, Jean Meuris, writes: "The treatment of anaphylactic shock: the worst kind of shock is the kind that occurs suddenly. The patient suffocates (edema of the glottis), while red spots appear on the throat and face which burn and sting and are worse by warmth. That is the picture of Apis, a remedy which we have always been able to rely on. Placing a few globules of Apis 15 (or 200 Korsakov) on the patient's tongue brings the shock to an immediate halt, and the symptoms usually disappear in the time that it takes for the globules to dissolve."

Apis will also meet cases of allergic conjuctivitis in which the eyes become red and inflamed within a few hours, and the eyelids, as well as the tissues around the eyes, become so edematous that they almost cover the whole eye. The swelling can be such as to obstruct vision.

Apis will be indicated in cases in which the kidneys suddenly fail and from one day to the next an enormous edema develops in the lower limbs. One can almost see the increase in the swelling from one hour to the next. This picture may be seen in severe complications of serious acute diseases or in chronic conditions, such as ulcerative colitis in the advanced stages.

Generalities

What is outstanding in the general features of this remedy is the aggravation from heat of any kind, for instance in a warm room, more so if there is warm air blowing at him or heat from an open fire and even worse in a hot bath, or in a sauna. Typical Apis patients will never enter a sauna, not even a moderately warm bath, as it will make them suffocate and feel dizzy - they may develop headaches, congestion in head, red rash of the skin etc. "In brain troubles", writes Kent, " if you put an Apis patient with congestion of the brain in a warm bath he will go into convulsions ... If a baby needs Apis in congestion of the brain the fits become worse by bathing in hot water."

The patient wants the windows open to cool the room even if he has chills. It is one of the characteristics of this remedy that they feel that they cannot breathe, that they will suffocate in a warm room. He will uncover himself even when suffering from chills as heat makes him feel uncomfortable. Cold bathing ameliorates allergic conditions of the skin. Here we may point to the sophisticated system of uentilation operated by bees to survive in the heat of the summer.

Another general symptom is the aggravation from touch. Apis is extremely sensitive to touch, similarly to Lachesis, and indeed Lachesis will often be given first in such cases. This aggravation is apparent not only in the skin conditions where we may have allergic exanthemata, nodular swellings, erysipelas etc, but also in cases of inflammation of the intestines, enteritis, cholera infantum, ulcerative colitis or common diarrhea where the patient cannot stand any touching on the abdomen. In ovarian cysts where there is inflammation or in uterine problems we see the same sensitivity. Even the hair is sensitive to touch.

The complaints of Apis appear with violence and rapidity and can become quite serious in a short time.

The right side is primarily affected; ailments start on the right side spreading from there to the left. But one should never be discouraged from prescribing Apis for a cyst on the left side, once the other characteristics of the remedy are there. In the beginning of my practice, I missed several such cases because I thought I should adhere with absolute faith to the books. Later on I prescribed Apis with success for cysts or enlarged ovary on the left side.

Lying down aggravates many of the complaints of Apis while there is an amelioration from sitting. General prostration, lassitude with trembling.

Apis can be an important remedy for the bad effects and consequences of acute eruptions and exanthema that have been suppressed or never properly developed. Thereby many different ailments and diseases may occur; restlessness, delirium, convulsions, meningitis, hydrocephalus, inflammation of the throat, dyspnoea, asthmatic respiration, diarrhea, nephritis, edema with scant urine, cysts of all kinds etc.

Special attention should be paid to the ability of Apis to develop all kinds of cysts, which are usually enormous in size and develop with extreme rapidity. Apis should also be thought of in cystic tumors.

Head/Vertigo

In the head, as may be expected, we have a lot of congestions, fullness, confusion felt as vertigo. Headache with vertigo. Head confused and dizzy with constant pressive pain above and around the eyes. Confused vertigo, very violent at times, worse when sitting, extreme when lying with eyes closed. The whole brain feels tired, as if asleep and crawling.

Congestion of head much worse in a warm room and better in open air. Most of the head ailments are worse from warm room, warm bathing etc. and better in open air and from cold applications. Congestion of head before menses, the congestion grows in inverse proportion to the flow of menses. Head feels as if too full, as if there is too much blood in it. Great rush of blood to the head. Head feels too large, swollen, causing her to look into the glass involuntarily.

Head feels big and confused, bewildered. The headaches are mostly of a pressive character, as if pressure is exercised from within. Sometimes this becomes much stronger and then we have bursting headaches. Many kinds of headaches, the dull, pressive pain and the throbbing in the head for instance, are ameliorated by pressure with the hands. A known time aggravation for the headaches is 10 a.m. lasting until the evening or around 6 P.M.

Headache worse reading, increased in a warm room. Forgetful during headache.

Bores head into pillows, rolling the head from side to side or the head is drawn back rigidly in serious forms of brain affections. During diarrhea, while the weakness increases the headache diminishes.

Eye

Conjunctivitis, trachoma and in general most of the severe inflammations of the eye and its deeper tissues will be covered by this remedy. Enormous swellings around the eyes in allergic conditions or conjunctivitis or kidney problems will call this remedy to mind initially. The eyelids could be red and edematous and enormously swollen. The swellings are always impressive and sometimes can entirely close the eyes. Burning and stinging pains. Sensitive to bright light. Kent gives a vivid description. - "Inflammations that are erysipelatous in character, that leave thickening of the mucous membrane and lids and white spots over the eyes, opacities. Inflammation with opacities very extensive or in patches. When the inflammatory condition is active it is attended with edema of the lids, such as you would expect to see after a bee sting. The swelling of the mucous membranes of the lids is so enormous that they roll out, looking like pieces of raw beef. The fluid will run out on cheeks in great abundance."

On close examination of the eyes and immediate surrounding, you will seldom fail to recognise a case of Apis, whatever the pathology from which they are suffering may be. Most of the time there will be the characteristic swelling around the eyes and more prominently the affection of the right eye.

The inflammations will be relieved by cold applications, and aggravated by radiating heat and bright light. Inflammations with severe shooting pains.

Keratitis with pains shooting through eyes, with swollen lids and conjuctiva. Keratitis with hot burning lachrymation gushing out on opening the eyes. Severe inflammations with dreadful shooting pains. t gives you the impression that it is ;yes. Either the whole face may be eruptions or lupus) or around the soft palate is puffed like a water bag, and the uvula hangs down with a semi-transparent appearence like a bag of water. All around the throat and mouth there is an edematous condition looking as if it will flow water if pricked."

Sometimes during a severe cold with sore throat, a pharyngitis, the uvula will be so inflamed and elongated that on empty swallowing it will be caught by the contraction of the esophagus and pulled down. In such cases the uvula is very long, hanging from a thin stem and at the end there is a kind of an edematus swelling while the whole pharynx is inflamed and painfully burning.

In such severe inflammations there is an aggravation from warmth, especially warm air blowing from a radiator and at the same time there is some relief from drinking something cold. The relief is not tremendous - because the inflammation is usually severe - but it is definitely there.

Aversion to warm drinks. Mouth, throat and pharynx bright red, glossy as if varnished. Tenacious mucus in throat, very troublesome. Constricting feeling in throat with the sensation, as if a foreign body was lodged in it, worse from tight clothes. Splinter-like pain on swallowing or stinging pain. Tonsils are so swollen they impede swallowing. Deep ulcers. Dryness without thirst; burning in the throat extending to stomach. Vascular goitre, cysts of the thyroid gland especially in combination with ovarian diseases.

Stomach

Thirstless when there is retention of water in the body, thirsty when there is loss of fluids. Thirstless in ascites, in kidney insufficiency, in cerebrospinal meningitis, in hydrothorax etc. Violent thirst, would like to drink all the time (during typhus, or in severe diarrhea).

When thirsty would like some vinegar in the water otherwise the water seems tasteless. Gastritis or duodenal ulcer with burning heat in the stomach rising up to esophagus. Pain in epigastrium, cannot bear to be touched, even the bed sheet is intolerable. Desire for salads, especially celery and sometimes a strong desire for fat of meat. Desires to drink milk which ameliorates the pains and the burning.

Appetite and sleep totally lost in manic depressive states, especially during the state of mania (for four weeks). Eructations taste like food, increased after drinking water. Desire to vomit. Vomiting of everything he has eaten and mucus. Vomiting of bile after the stomach has been emptied. Vomiting and retching with great anxiety. Distress felt in stomach region. Extreme pain and tenderness in region of stomach with vomiting. Nausea followed by yellow and bitter vomiting. 2 a word of caution here concerning the expression "especially when" which I often use myself: this is not the only condition under which the remedy is indicated, but it is the most unique, the most characteristic for that remedy.

Abdomen

The abdominal walls are very tender and sore, they feel almost bruised not only in all kinds of inflammations of the intestines, or the peritoneum but also in ascites, very tensed or tight and sensitive to even light pressure or touch.

Soreness of the bowels when sneezing or pressing upon them. Burning and stinging pains are characteristic of this remedy. The abdomen feels full, bloated and is evidently enlarged. Ascites; peritonitis. Abdomen full, swollen and tender, with swollen feet and scanty secretion of urine is a typical picture for this remedy.

Violent burning pain under the short ribs, worse on left side. Violent pains in the abdomen aggravated in a horizontal position and relieved when sitting up. Violent pains across the lower abdomen with bitter vomiting and diarrhea.

In severe acute diarrhea an uneasy feeling like restlessness or distress is felt deep in the abdomen; it gives them great anxiety, they cannot tell whether this restlessness is purely psychological or whether the intestines are really moving. I have seen a similar symptom in Calcarea carbonica. Internal trembling with anxiety. Restlessness of intestines; pain in abdomen with a feverish trembling feeling.

Rectum

This remedy has diarrheas with vomiting making it a good remedy for cholera infantum or for severe cases of gastroenteritis. Sensation of an electric shock in the rectum followed by urging to stool. Sensation of rawness in the anus with diarrhea. The stool is acrid excoriating the anus. Watery diarrhea. Stool yellowish, greenish, watery. Diarrhea before menses. During climacteric women have chronic diarrhea with passage of blood and mucus. Painless diarrhea which ameliorates chest complaints. Every day six to eight diarrheic stool which smell like carrion (a decomposing animal). Diarrheic stool in children that is mixed with mucus and blood making it look like "tomato sauce". Anus protrudes and seems to remain open, "stools occur with every motion of the body as if the anus were constantly open" (in ascites). Colourless water oozes from rectum. Loose stool in the morning. Many affections like inflammation of ovaries, meningitis, prostatic affections etc are often accompanied not by diarrhea but by: difficult stool; constipation; hard stool, retention of stool, prolonged periods of constipation alternating with diarrheas.

Chronic constipation. Constipation or hard, regular stools, during menses.

Urinary organs

Apis has a profound effect upon the genito-urinary organs. Its main action is the retention or suppression of urine. The urine is scanty, coming in drops. Much straining but only a few drops are passed. Must press a long time before urine starts (prostatitis); dribbling a little hot urine. Urine scanty in heart diseases. The whole urinary tract is irritated; burning, smarting, soreness, constriction of urethra; agony in voiding urine; uneasy feeling in cords. Urine suppressed. Kent writes: -"Infants go a long time without passing urine, screeching and carrying the hand to the head, crying out in sleep, kicking off the covers. Very often a dose of Apis will be found useful". Frequent urination in cases of cystitis. Constant urge to pass water but only a little urine is voided every time (in inflammation of the ovaries.) The urination is sometimes profuse (prolapse of uterus). Excessive proteinuria, "half of the bulk of the urine is albumin." With proteinuria the urine is scanty and fetid.

Proteinuria during pregnancy. Frequent but scanty emission of milky urine (hydrocephalus, meningitis). Urine dark, like coffee; urine of a greenish hue (pleurisy). Urine contains uriniferous tubes and epithelium (in acute or chronic nephritis). Nephritis that develops as a sequel of acute disease. Involuntary urination in old people. Stinging stitching pains in kidneys extending to ureters.

Tenderness and soreness in region of kidneys worse on pressure or when stooping.

Male – genitalia

The sexual desire is increased with frequent and long-lasting erections. Sexual passion increased to the level of mania. There is violent sexual excitement without any cause, when studying, when driving, when sitting alone in the room.

Swelling of testicles, fullness felt mostly on right testicle. Dropsy of scrotum and prepuce. Hydrocele. Erysipelatous inflammation and swelling of scrotum, of penis.

Affections of prostate gland, hypertrophy of prostate with agonising pains during urination. Walks up and down the room with the pains. Condylomata of penis, burning.

Female – genitalia

The female organs seem to be affected by an excess hormonal functioning, so the desire for sexual intercourse is tremendously increased. The ovaries become engorged, hardened, particularly the right one. Great heaviness in the ovarian area, cases of cysts or tumors in that region or a feeling of drawing downwards in the area of the ovary with burning pain that extends down the thigh. Worse stooping. Cystic tumors that appear first on the right ovary and then on the left.

Patients dislike touching this area, and will avoid doing so. Pains in ovaries from continence or after coitus. Tightness in ovarian region, worse on raising the arms.

The uterus swells up. There is hypertrophy of uterus, a sensation of fullness, weight with downward pressing and stinging pains in uterus. Cysts, tumors, indurations, enlargement of ovaries more on the right side. Prolapse of uterus with tenderness in the area. Menses suppressed at puberty. Menses too scanty, lasting but one or two days. During menses great sleepiness with dullness of mind and cold feet. Leucorrhea profuse; acrid; green. Habitual abortion during the early months 2-4th. Apis should be prescribed with caution for pregnant woman with acute complaints such as fever or the common cold, and the low potencies should not be repeated too often or for several days. However, Apis can, and should, be given during the abortion process if the symptoms agree. Sharp stinging pains in the ovarian region during abortion. Metrorrhagia with profuse flow of blood with heaviness in abdomen, faintness, great uneasiness and restlessness. The Apis woman is likely to encounter many problems in bearing children, because due to these constitutional complaints she will either have great difficulty in conceiving, or may lose the child (abort) in the early months of pregnancy.

Chest

Respiration - Apis has difficulties with respiration in general but these difficulties vary in the diverse pathological conditions.

For instance the breathing will be difficult when we have dropsy or ascites: here we see shortness of breath, oppressed breathing which is worse in a heated room, worse lying, worse at night in bed, must sit up, cannot bend forward or backwards as the respiration becomes laboured, lying flat in bed is impossible, has fear of suffocation and will stay sitting up for days. Here the difficulty in breathing is part of the whole picture of dropsy, or hydrothorax, as if the lungs were pressurised and have no room to function, but the lungs per se do not show pathology.

The difficulty in respiration is only part of a much greater picture that looks grave but not because of lung disease.

The case is much more dramatic when Apis is indicated in real severe cases of laryngitis with edema or in asthmatic cases. During the crisis they lose their color, face becomes dark, blue, the lips become blue, the situation looks desperate, they cannot breathe at all, they are unable to speak, can speak only in a whisper, they have to loosen the collar around the throat, it appears as if the larynx is constricted and cannot stand even the slightest pressure, around the throat, they have to force the air in and out. They need to have somebody constantly fanning them otherwise they feel they will die. Much like Carbo vegetabilis they need to go and stand at the open window (if they can walk), they need fresh cool air which seems to ameliorate the situation a little.

Heat of the room is entirely intolerable, the temperature has to be quite low and the windows open. They cannot lie down with the head low, they always sleep with the head high or sitting up but if the crisis comes during sleep, which happens especially after midnight, they will have to sit up in bed in order to be able to draw a breath. There is restlessness and agony.

There is another pathological situation which can be called a nervous or functional dyspnea. You can see it in meningitis, or in acute high fever diseases that are not necessarily focussed on the lungs. When the fever is high even in the stage of chills, the breathing is very difficult, feeble, interrupted panting, they feel that they are going to die soon, that they cannot survive because they cannot breathe, but the physician cannot find any underlying pathology to explain the situation, only the high fever. A woman has an inflammation of the ovaries with fever and the respiration is affected in the way we described.

This is exactly what we call "strange, rare and peculiar" in the remedies. What we call the "keynotes".

Apis cannot stand the external heat or the rising of the inner temperature of the body, as in fever; he cannot breathe in the heat.

Is it then a coincidence that bees have to ventilate themselves constantly even in quite moderate temperatures? How is it that the tongue of Lachesis when protruded fay the patient acts exactly like the tongue of the snake? How coincidental are these phenomena or how much do they point to another hidden reality ?

Many times we have been asked to explain the action of the remedies, to understand the why's and wherefore's, the underlying causes, the correspondences, and when we see these phenomena and point them out as a matter of interest and research we are accused of being "meta-physicians," even by so-called homeopathic-physicians, as if the logical mind could perceive and explain everything, and pretend in the name of science to be able to understand the totality where we only know a small part of a whole. Actually we still know very little on matters of health and disease, because for many decades we have been following the wrong path in investigation and research. Today tremendous amounts of money are spent on a heart transplanted in an old man, but with the same money homeopathy could have saved thousands of heart patients from arriving at a stage where they need a transplant. But in these matters I would like to refer the reader to my book "A New Model for Health and Disease."

Cough

Whooping cough, croupy cough, dry with gagging. Cough that starts at night and continues until the early hours of the morning, worse at midnight. Violent cough with dyspnea and blue face. Farrington writes :"In pleuritis with exudation Apis is one of the best remedies we have to bring about absorption of the fluid. Apis and Sulphurwill cure the majority of these cases." Expectoration of profuse, frothy mucus. Expectoration sweetish. Sensation of soreness of the chest as if bruised. Stitches in chest, sticking pain in right side of chest. Shooting pains from front to back. Erysipelas on the mammae.

Heart

The heart has its share of symptoms in this remedy as well. There is effusion into the pericardium. Hydropericardium. The pulse is accelerated. The heart is audible, with every contraction of the heart the whole body shakes.

Cardiac distress, great anguish, restlessness, feels as if each breath will be the last. Palpitation of heart from scanty secretion of urine.

Insufficiency of mitral valves. Organic heart disease. When the case is gone to exhaustion the pulse is feeble, imperceptible, indistinct.

Back

Stiffness of the back and neck. Stiches on right side of neck worse moving the head towards this direction. Swelling in the back of the neck in gouty patients.

Pulsating pain in cervical region extending to left shoulder. Burning pressing pain in coccygeal region worse from any attempt to sit down.

Back feels bruised. Bearing down in small of back as if menses would come on.

Coldness, chilliness of back but does not want warmth locally. Great weakness of whole back.

Extremities

There is definitely a tendency to paralysis in the extremities not only with affections of the spinal cord, after apoplexy or thrombosis, but also with diseases like arthritis, rheumatism, and especially with strong emotions or mental shock. "Whole nervous system under a paralysing influence in scarlatina." "After excessive grief the whole right side paralysed". The extremities become heavy, stiff, powerless.

One side paralysed the other twitching, or convulsing. Partial paralysis of right side with numbness. Left arm almost paralysed due to severe cervical syndrome with burning pains from cervical region extending to the arm worse in the morning on waking. Upper extremities perfectly powerless, cannot take hold of anything, has to be fed (in spinal disease). Edema of feet and legs in a man affected with chronic rheumatism and partial paralysis. Sticking pains in right forearm with a paralysed feeling. Rheumatic pains in shoulder joints extending to back of neck. Electric-like pains go through the extremities. Lower extremities swell, become edematous mostly from disfunction of the kidneys or heart. Edema of hands. Drawing pain in arms extending to ends of fingers. Sensation of numbness in fingers especially tips, about root of nails. Swelling of ankles. Sensation in feet and toes as if too large, heavy, swollen and stiff; especially in the evening or at night when taking off the shoes. The swelling makes the leg look transparent, waxy. Panaritium with burning, stinging and throbbing.

Sleep

It is very interesting to look at the dreams of Apis and compare them both with the symptomatology and with the action of bees: dreams of travelling long distances; dreams of flying far in the air; dreams that he made journeys in great leaps through the air; plagues himself in dreams all night, with a flying apparatus, tries to arrange the wings which, however, will not work. (!)

The suppressed anger is also of interest: dreams of many people who are quarrelling; one of them, who becomes nearly beside himself, he leads from the room by the arm, whereby he is calmed. Dreams with vexatious care about about various kinds of business. Dreams of a tormenting, active kind, full of care and toil (remember the "busy insanity"). And finally the aggravation from heat which terrifies her: dreams of a great, hot stove; was obliged to walk over a hot floor. Great desire to sleep amounting to the most extreme sleepiness. Great inclination to sleep but inability to do so from great nervous restlessness. Sleepiness during menses. Very sleepy early in the evening.

Fever

Fever or chills are more prominent in the aftemoon from 3 p.m. to 4 or 5p.m. Even during chill the patient feels worse if the room is overheated especially by radiated heat and better uncovered.

Excitement during fever. Motion brings on shiverings; shiverings followed by heat.

During fever or when the fever drops patient goes to deep sleep. Dry skin with high fever. Thirstless during fever; thirsty during chills. During the time fever is high it is usually accompanied by a strong headache. Heat of one part with coldness of the other. Sweat is absent or breaks out only in spells, but soon dries off again.

Skin

Skin dry, hot, better bathing in cold water, cold applications. Has a transparent waxy appearance. Erysipelas, carbuncles, ulcers, bites from insects, edematous swellings, all with stinging, burning pains. The patient will not let you touch these areas, she will scream, so sensitive and raw does it feel. Urticaria and nettle rash, with edematous swelling of the skin, burning, stinging, intolerable itching at night, which is ameliorated by cold water. Urticaria caused by warmth, physical exertion, fever, perspiration or allergy; can occur with many diseases. Body covered with large, elevated, white areas.

CLINICAL

Inflammation, enlargement and cysts of the ovaries. Abortion in early months. Proteinuria during pregnancy. Kidney diseases, dropsy, hematuria, anasarca. Hydrocele. Retention or suppression of urine. Angina, laryngitis, pleuritis with exudation, diphtheria. All kinds of ophthalmia, (severe conjunctivitis, trachoma, allergic conditions etc.) Hay fever. Asthma. Anaphylactic shock. Hydrothorax. Headaches, congestion of head. Heart diseases, pericarditis. Hydrocephalus, meningitis, meningo-encephalitis. Dysentry, gastro-enteritis, cholera infantum. Allergic conditions, urticaria, lupus erythematodus. Delay in the appearence of skin eruption resulting in internal troubles. Suppressed eruptions.

RELATIONSHIP

Complementary: Natrium muriaticum. The "chronic," Apis.; also Baryta carbonica, if lymphatics are involved. Inimical: Rhus.

Compare: Apium w'rus (auto-toxaemia, with pus products); Zincum; Cantharis; Vespa; Lachesis.

DOSAGE

From the lowest to the highest.

CASES


"A lad aged about twelve years has been afflicted for several months with ascites and hydrothorax. He has been treated for some three months by allopathic physicians first for dysentery, followed by ascites, and afterwards for several months by a homeopathic physician. No permanent benefit resulted from either mode of medication, and the symptoms finally became so urgent that I was called in consultation, and tapping was at once resorted to in order to save the patient from imminent danger.

Appropriate homeopathic remedies were again prescribed, but without arresting the onward course of the malady. The patient commenced to ill up again with great rapidity. The secretion of the urine was nearly suspended, the skin was dry and hot, pulse rapid and weak, respiration short and difficult, great tenderness of the abdomen, dryness of the mouth and throat, thirst, excessive restlessness and anxiety, short irritating cough and an almost entire inability to sleep.

At this stage of the case, a strolling Indian woman -one of the few survivors of the Narragansett tribe, suggested to the family the use of a honey bee every night and morning. She enclosed the bees in a covered tin pail, and placed them in a heated oven until they were killed, and then after powdering them, administered one in syrup every night and morning. After the lapse of about 24 hours the skin became less hot and softer, the respiration less difficult and more free, the pulse slower and more developed, and there was a decided increase in the quantity of urine. From this time the symptoms continued steadily to improve, the dropsical effusion diminished day by day, until at the expiration of a few weeks the patient was entirely cured. " Dr.E.E MARCY and others : Elements of a new materia medica p.4422.

Observation: no comments

2. A number of years ago I was called in Watkins Glen N.Y. in consultation in a very bad case of diphtheria. One had already died in the family and four laid dead in the place that day. Over forty cases had died in the place and there was an exodus going on for fear. Her attending physician, a noble, white haired old man, and withal a good and able man, said when I looked up to him and remarked I was rather young to counsel him; "Doctor, I am on my knees to anybody, for every case has died that has been attacked". The patient was two rooms away from us, but I could hear her difficult breathing even then. Apis was comparatively a new remedy then for that disease, but as I looked in to her throat I saw Apis in a moment, and a few questions confirmed it. I told the doctor what I thought and asked him if he had tried it. He said "No, he had not thought of it, but it was a powerful blood poison; try it." It cured the case, and not one case that took this remedy from the beginning and persistently, died. It was the remedy for the genus epidemicus." Dr. Nash. Both the above cases are quoted in Tyler's "Homeopathic drug pictures" under Apis.

Observation: The case is interesting because it stresses the effect of Apis in diphtheria, but it does not give us enough information, or new information, on Apis. The comment that "no one died that took this remedy from the beginning and persistantly" has to be taken with caution and not to be tried in this spirit. The catch words here are "from the beginning and persistently" implying that they have seen some deaths but attributed them to the fact they were not taking the remedy from the beginnng. And what does the doctor mean by "the beginning"?

3. This is a most instructive case that every student should read.

B.H. aged nine years, very scrofulous by inheritance from both parents. (Patient had a fair skin and was always pale; blue eyes; red hair.)

Had lost in his sixth year the use of his legs, but, after a tedious course of treatment, had regained their use, so that he could walk with considerable ease. We found the child with a high fever, sore throat and scarlet rash. Aconite was indicated and was given. He was very ill but did passably well until the fourth day, when the eruption commenced to disappear, and at the same time, alarming changes took place. The fever became continuous; the countenance bore an expression of stupor, increased by the drooping of the lower jaw; the nose looked pinched; the teeth were covered with dirty, sticky, slimy discharge of foul matter from the secretion. It seemed as if the vital forces had completely surrendered themselves to the poison, which evidently penetrated the whole system. At first Cupr-met. was given with the view of bringing out the disappearing eruption. The patient growing worse Apis 2 was prescribed without producing any change; the symptoms remained the same; the tongue became sore, cracked and bleeding; the discharge from the nose became very irritating; the bowels became hard and were tender to touch; diarrhea set in. Remedies were changed as seemed best, the patient apparently sinking, edema of the feet and limbs then set in with painful and scanty emissions of urine. At that time Arsenic 30 was given, but without producing any effect, when we concluded to give Apis 30 until the patient got better or died. This was strictly followed out during the six weeks of sickness following. He was on the verge of death for weeks. General dropsy developed itself; suffocation threatened one day to end his life, from effusion in the thorax; hydrocephalus had all but declared itself on the next; the glands of his neck swelled; his ears discharged ; his face was bloated so he could not see ; at last the abdominal dropsy became so threatening that 1 proposed tapping as a last resort to save his life, the parents objecting. At this time we changed to the second attenuation of Apis; the change was followed by excellent effects upon the kidneys. Within forty eight hours enormous quantities of urine were passed, relieving the patient very much. Under the action of Apis, for it alone was given, alternating weekly the lower triturations with the higher dilutions of the drug the one symptom after the other disappeared. Occasional aggravations showed themselves but on the whole the little fellow gained ground inch by inch. All during the succeeding summer, he was more or less of an invalid, but by the first of Oct., his father brought him to the office having walked the entire distance from his home, and looking fresher and healthier than he had for many years. The cure was permanent; and he seemed ever after in perfect health. Dr.C.J.Hampel and H.R.Arndt.

Observation: there are several points of great interest in this case.

a. The expression "Aconite was indicated" is rather unfortunate, as Aconite was not indicated at that moment. The prescription helped in a negative way to speed up the evolution of the disease.

b. The correct prescription was not apparent from the beginning due to the fact that there were not enough symptoms or the case was not taken in a complete manner.

c. After Aconite, instead of looking for the totality, Cuprum was given on etiological reasons, for they thought that the Aconite suppressed the eruption.

d. One of the main points of interest is that as the case evolved it pointed clearly now to Apis, but the remedy was tried in very low potency.

e. As various other wrong remedies were tried, instead of becoming confused the case tended more and more to point to the picture of Apis. That was the reason why the doctors decided correctly not only to retry Apis but to stick to it. - Once you have a clear picture the remedy must act.

f. Here we have a peculiar observation: While the doctors do not report any significant change with the higher potency yet they stick to it for several weeks. I think that in this point the report is not true. They must have observed certain slight changes in the general state of the patient that gave them hope. A change of remedy at this stage would have meant death for the child.

g. Now comes the most interesting observation: While the low potency showed no result at all in the beginning, and in spite of the fact that it was definitely indicated, after the repetition it showed an apparent effect. The question is: was it the effect of the lower potency that brought the change, or was it time for the high potency to show its effect? I believe in the first supposition. The organism having been sensitised and strengthened by the high potency, it reacts now to the stimulation of the lower.

Can we infer from this that the organism sometimes is "saturated" with a repetition of a high potency and stops reacting to it, while an even higher or lower potency may further stimulate it? The case shows that the answer here is in the affirmative. The lower potency is preferable in this case due to the heavy pathology. It is also most interesting to note the fact that in order to start a reaction we need a certain vibrational frequency which is provided here by the 30th potency. Perhaps the range which could have provided an initial reaction was between 12c and 200c. Higher than 200 would have been inactive.

h. Another interesting point is that after an acute has been treated with a remedy that seems to be the constitutional remedy of the patient the whole organism is rejuvenated and finds itself in a better state than before the acute.

i. This case due to its severity shows clearly what happens if we lose courage and, under the pressure of the gravity of the case, start prescribing one remedy after the other instead of sitting back, watching and studying the case well before going ahead and prescribing.

This case exemplifies also the thorough knowledge and expertise that is required in our science and tells of the many difficulties and the different angles that we have to deal with in treating patients with homeopathy.

4. A boy, four years old, a son of German parents, was given up by the attending allopathic physician as a hopeless hydrocephalus. When first seen, the child was lying on its back, with eyes wide open, extreme squinting, dilated pupils, rolling eyeballs without winking. He gave no evidence of seeing when the finger was thrust toward the eye; when pricked with a pin, no sign of feeling; when water was put in to his mouth no effect at swallowing was made... The left side was entirely motionless for two days, but he moved the right arm and leg occasionally. He had passed no water in forty-eight hours and the region of the bladder showed very slight distention. Drugs had produced no stool for several days. At the commencement of his illness he complained of pain in the occiput with occasional sharp shrieks. He had been blistered with cantharides from the nape of the neck to the lumbar region two days previously, since which time he had passed no water, and given no evidence of seeing, hearing or feeling. Apis 30. After five days he had so far recovered, that he sat up in bed, he moved both sides of the body equally well, and all his senses were restored. Dr.W.P.Wesselhoeft.

Observations: This is a typical case of Apis as we see the retention of urine, the occasional sharp shrieks due to the pressure from the cerebrospinal fluid, the unconsciousness of Apis and its tendency to produce paralysis on one side and twitchings or convulsions of the other side.

This case exemplifies very well the state of "unconsciousness" of Apis without being in a coma. In the books it says "paralysis of the left side, twitchings on right". Students should not take the symptom literally and look for twitchings. In this case for instance it must be understood as some nervous action on one side while the other is motionless or semi-paralysed.

5. I was called in consultation to see Miss M. who was thought to be near dying. I found the patient in great distress, panting respiration, unable to speak, only in a whisper, and each word uttered separately from the next by several respirations. She had great pain shooting all through her chest from front to back. She had informed me she could not long survive, as each breath seemed as if it would be her last one. She had no thirst, scanty urine, and had not slept for two days. Percussion over her chest gave a clear and healthy sound. Auscultation revealed permeability of air through her lungs but a very loud bronchial rale.
No other remedy has this combination of symptoms excepting Apis. My choice fell on the 40m potency for the reason that she was too ill to bear a lower potency of a large dose of the material. Directions were given to repeat the Apis 40m in water every hour till she seemed a little better, then to cease giving entirely till we saw her in the morning.

After the third dose she became quiet, fell asleep for two hours and remained quiet the whole night, sleeping at intervals till morning. Contrary to instructions, the remedy was repeated every time she awoke, till 9 in the morning, when she received the last dose remaining, soon after which she became as bad as on the previous evening. We saw her at 10.30 a.m. and found her about the same as on my first visit. Now what was to be done. The same remedy was still indicated, and it was very evident that she had been overdosed, therefore sac-lac. was given during the day and when we saw her at 6.30 p.m. she was again more comfortable. Sac-lac. was given till 10.30 the next morning, when we found her still more comfotable. Next day still better, and still Sac lac. So day after day showed that, on the whole, she was improving and she made a perfect recovery without a further dose of medicine. Dr.H.N.Guersney.

Observation:

a. In this case the attending physician himself designates the symptoms on which he prescribed the remedy. The most interesting point is the description of the "presentiment of death" in this lady where she feels that "every breath will be the last" and the expression: " she informed me that she could not long survive". This is a unique feature with this remedy as it is neither "fear of death" nor "predicting the time of death," it is rather a feeling that the "soul will come out with the breath."

b. Overdosing the patient can bring about a relapse. In this case what Dr.Guersney did was correct, ie waiting to see the evolution. But not all cases will do better spontaneously. Had the following 24 hours brought about an aggravation instead of an amelioration, a higher potency would have accomplished the cure. The fact that the case reacts to an already high potency without much aggravation shows that we are allowed to go higher without danger.

c. Another interesting observation is that the doctor says that the case was too ill to bear a large dose of medicine. Yet the B.H. case was much more severe and Apis 2 acted well. Where is the truth?
Guersney must probably have had some bad experiences with very low potencies, where the patient was too sensitive to the medicine. It is also true that we must be careful with low potencies especially with minerals and animal poisons as they can stimulate unnecessary aggravations, though I believe for instance that a dose of 30 given in repeated doses would have accomplished the same result with less danger of overdosing the patient.

d. I would like to draw attention to the expression of Dr. Guersney to stop the medicine if "she seemed a little better". The stress is in the expression " little better" as this would indicate that an improvement had started and the medicine should be discontinued.

A remark that applies to all these cases is the dramatic turn that Apis cases can take and reach quite soon in a dangerous state.

Anyhow as a general observation on the potencies and their repetition I would like to state that we still have a lot to learn in order to establish final rules. Such matters need a lot of testing and research to arrive at the right conclusion.

The last three cases are quoted in N.M.Chowdhuri's Materia Medico under Apis.

Index
1. Apis Mellifica - The Essential Features