SOW-BREAD. The student of materia medica should, at the very outset of his career, begin to guard against a danger which often besets the physician and leads him astray in practice—the danger of regarding certain remedies as favorite remedies and looking at them with a partial eye; of allowing the high estimate in which he has been led by his accidental experience to hold them, to incline him to see indications for these favorites where such indications do not exist.
You will sometimes hear an experienced practitioner speak of such or such a remedy as "a favorite" of his. To say the least, this is a dangerous way of regarding any drug. If it lead him to give it where a strictly impartial judgment would not pronounce it more exactly homeopathic to the case than any other known drug, it prevents his curing his patient in the quickest and surest way. Science has no partialities, and knows no preferences. Among the servants whom she puts at our disposal there is no possible position of honor for one above another. The drug which cures but a single case a year for us, because but one case in the year has demanded its administration, is as much entitled to our scientific regard as that which serves us every day.
Again, you should remember that your duty is, as scientific men, to judge impartially between the remedies which seem to be indicated in the case before you, and to choose, without fear or favor, that which is most homeopathic to it: without fear that because it is a remedy you have seldom used it may not act so well as the symptoms promise; without favor from an inclination to a drug that has often done good in many cases, and from which therefore you incline to hope for good, although it is not so homeopathic to the case in hand. This impartial judgment is very difficult but all-important. You will often find yourselves tempted to twist the patient's symptoms, ignoring some and perverting others, so as to bring the complex into a better resemblance to those of some drug from which you have often seen rapid beneficial action. It would relieve your mind so greatly if it would only turn out that the simile of the case is really to be found in Belladonna, or Bryonia, or Cimicifuga ! And so you try to construe the symptoms in the direction of these drugs. Gentlemen, this is a delusion and a snare. If you thus deceive yourselves, and then give a drug which is not really indicated, you will get a little deceitful ease of mind for a few hours but no good to your patient. In these, as in all cases in life, look the truth right in the face, meet it squarely, and "do your level best!" You will find, perhaps, that not Belladonna nor Bryonia nor Cimicifuga is indicated, but Silicea clearly, and nothing else. Now you get uneasy. What! Silicea a remedy for chronic diseases, for ulcers and abscesses—a drug of slow action ! Can I dare to give it in this rapid-running and, if not arrested, speedily fatal phlegmasia, even though it be well indicated? Yes, give it, nothing doubting; and it will henceforth rank high in your esteem. It is my opinion that drugs which cure in chronic diseases appear to be slow of action because the morbid processes in such diseases are slow, and VICE VERSA. In other words, I believe that the duration of action of a drug depends not so much on some inherent positive quality of the drug as upon the rapidity with which the physiological (and hence the pathological) processes are accomplished in the tissues involved and acted upon, which are slow in chronic, and rapid in acute, diseases. We shall have occasion to recur to this subject.
The value of Pulsatilla in measles having been mentioned, this is a suitable time to speak of another drug which, in its applicability to this same form of disease, is closely related to Pulsatilla; I mean the Euphrasia officinalis.
Moreover, the eminent value of Pulsatilla in certain forms of anaemia and amenorrhoea, makes this a proper place to treat of the Cyclamen Europaeum, which is near akin to Pulsatilla in its physiological effects.
An immediate comparison of these drugs with their cognate, Pulsatilla, may bring sharply and clearly before your minds the resemblances and differences which constitute the elements of our decision in selecting or rejecting the remedy for a patient.
I shall proceed to treat of three drugs which, one in one point and others in other points, are related to Pulsatilla (but none of which is so well proved or so frequently called for in practice as that polychrest),— Cyclamen, Euphrasia and Allium cepa.
The Cyclamen Europaeum, or Sow-bread, although no longer contained in the pharmacopoeia of the allopaths, was extensively used in medicine by the ancients. Their descriptions of its properties are vague enough, but it is remarkable that they ascribe to it a power to affect the uterus and its appendages—which ascription was not physiologically verified until the most recent provings, which were made by members of the Austrian society of homeopathic physicians at Vienna. (Vol. ii.)
It used to be considered that the root of Cyclamen, applied externally, hastened difficult labors, and assuaged the pains. Also, that to touch Cyclamen, or take it internally, would produce abortion, or bring on premature labor. In less ancient times it was used as a remedy for amenorrhoea, and likewise to promote the expulsion of the placenta.
Our knowledge of the physiological action of Cyclamen is probably quite incomplete. I can offer no complete analysis of its effects. It was proved by Hahnemann and his pupils (Materia Medica Pura, vol. v.), and again by the Vienna society (Zeitschrift des Vereins, etc., vol. ii.).
SENSORIUM. The sensorium is benumbed, the mind becomes inactive; lassitude and drowsiness oppress the prover, and yet he does not sleep inordinately. The memory is somewhat impaired; there is no disposition to mental labor. Cyclamen produces dizziness, which is perceived when one is standing still, and even when leaning the head against a support. It seems as if the brain were moving within the cranium, or as it does when one is riding in a wagon with the eyes closed. Objects move in a circle, or oscillate before the eyes. It is worse toward evening, and even is troublesome in bed, feeling as if the head were revolving. It is worse when one walks in the open air, is better in the room and when sitting.
Note the resemblances to Pulsatilla and the differences. The vertigo is worse in the afternoon and evening, as are Pulsatilla symptoms generally. But it is worse in the air and when in motion, and better in the room and when sitting quietly; just the reverse of Pulsatilla in both of these conditions— air and motion. Confusion of the head and depressed feeling. Despondency, with irritation.
HEAD. The pains in the head are chiefly of a drawing, sticking or pressing character. Sometimes they pass from one side to the other, sometimes from the front to the back part of the head, but this is rare. They are located chiefly in the front part of the head, a stitching headache in the left temple being a strongly marked symptom. The semi-lateral character of the headache is marked, it occupies one side of the head or the other, the left temple being the seat of the pain almost always. In this Cyclamen resembles Spigelia, but the Spigelia pains involve the globe of the eye. Ignatia, Thuja and Silicea, among others, have semi-lateral headaches.
The pain is worse in the afternoon and evening. It is accompanied, when severe, by dimness of vision, or almost complete obscuration of sight; it is also accompanied by a sense of heat in the head, and this and the pain are relieved by the application of cold water.
The obscuration of vision accompanying the headache, when considered in connection with the pale complexion, rings about the eyes, depraved appetite and enfeebled digestion, and menstrual irregularities of Cyclamen, appears to be only a functional disturbance ; but it is one which points to its use in certain forms of anaemia in women.
EYES. The eyes look dull, lie deep, and have blue rings around them. The pupils contract and dilate alternately every few seconds. Dilatation is the more permanent condition. Glittering, as of a multitude of needles before the eyes. Obscured vision in all degrees, from the semblance of a cloud before the eyes to absolute (though transient) blindness. "It grows black before the eyes." Where there appears no obscuration, the strength of vision seems to be impaired.
It remains for clinical experience to show us the full significance of these symptoms and what relation they bear to diseases of the eyes attended by histological changes (note: The sense of vision seems to be markedly modified, the pupils being greatly dilated, and the sight obscured even to absolute blindness; but it is to be noticed that these symptoms always accompany the symptoms of gastric disturbance and the headache, and they are unquestionably sympathetic with these affections, and are not idiopathic eye symptoms. Taken from another paper on Cyclamen.— H. E. K. D.)
EARS. Roaring and noises especially at night. Earache with the headache.
NOSE. The sense of smell is blunted. Sneezing and profuse coryza. Frequent and forcible sneezing, with itching in the ear. Frequent but not copious epistaxis.
FACE. The face is pale, but the cheeks are the seat of circumscribed redness and heat. Eruption on the face; many papules which often become filled with yellowish-white serum and then dry up; they are more abundant on the forehead.
MOUTH. Much tenacious mucus in the mouth. Fauces red. Increased salivation. The diminution of the sense of taste in Cyclamen probably is closely related to the alteration of the mucous secretions of the buccal surface. Natrum muriaticum has complete loss of taste without such alteration, but coinciding with coryza. This coincidence is characteristic of it.
Tongue covered with a white coat, red at the tip, with several small vesicles which burn when she speaks or chews; salivation being abundant.
TASTE. Pappy taste. The sense of taste is blunted; almost all food tastes alike (or is alike tasteless); nausea and bitter taste. The white-coated tongue, flat, pappy taste, aversion to fat and to bread and butter, remind us strongly of Pulsatilla. But the aversion to food after eating but little (although the first mouthful were enjoyed) and the great thirst, are different from the Pulsatilla symptoms.
APPETITE. Diminished. Or good appetite, but one becomes satisfied after eating but little. Sudden satiety. Aversion to various articles of food, to bread and butter, to fat, and to meat. Great thirst ; increased, even excessive thirst. Little or no thirst.
STOMACH. The digestion is weakened ; yet there is little or no change in the organic substance, although we might infer that a tendency to a change in the blood composition, similar to that in chlorosis, might result from a more thorough proving. Eructations of a fatty taste and smell; nausea, and accumulation of water in the mouth ; eructations tasting of the food last eaten. Nausea, with headache, vertigo, seeing of colors and double vision. The nausea is relieved by lemonade, as is also that of Pulsatilla, from fat food, especially pork. Oppression, as from too copious a meal. All of these symptoms are worse in the evening. Pressure and distention in the region of the stomach. Vomiting of mucus, after which sleep. There is much qualmishness and semi-nausea, as after eating fat food, with chilliness and depression of spirits.
HYPOCHONDRIA. Stitches in the liver, and stitching pain in the intestines below the liver.
ABDOMEN. Fullness in the abdomen, distention by much flatus. Rumbling, with pain and nausea. The hypogastrium is very tender to pressure.
STOOL. Much disposition to stool, renewed even after evacuation. While the rectum symptoms, tenesmus, etc., resemble those of Pulsatilla, the stool differs.
Stool first normal, then liquid, light yellow. Evacuation forcible, as if shot out. Diarrhoea yellow, pappy or watery, preceded by pinching pain in the abdomen. Pressure upon the rectum and anus, with itching, burning, and discharge of blood. Diarrhoea renewed by coffee.
URINARY ORGANS. Frequent copious discharge of whitish urine, stitching in the urethra, and dark-red urine. Scanty urine.
SEXUAL ORGANS. MEN. Glans and prepuce sore.
WOMEN. Menses too profuse and too frequent, with severe labor-like pains. Discharge clotted, and black, and membranous. Cyclamen differs entirely from Pulsatilla. Instead of being scanty and retarded, the menses are too profuse and anticipate, while at the same time many constitutional symptoms are the same as those of Pulsatilla.
In the mammae, a watery secretion, resembling milk, which leaves on the linen spots like a weak solution of starch. It flows spontaneously and can be pressed from the breast. This discharge followed and relieved a sense of fullness and tension and stitching in the mammae, which were larger than natural, and felt as if a stream of air from the stomach and abdomen had been passing out through the nipples.
THORAX. Dyspnoea, oppression. Great lassitude; feeling as if she had not strength enough to draw a full breath. Pressure on the sternum. Stitches here and there in the chest. Palpitation of the heart. Irritated heart action. Pulse at first accelerated and double, then quiet and very weak.
BACK. Drawing down the spine.
In the right side, in the region of the kidney, a deep pinching dull stitch, recurring every few seconds, worse on inspiration, which indeed is almost prevented by the violence of the pain.
In the gluteus maximus (left) rheumatic drawing extending to the sacrum. Drawing in the sacrum. Stiff neck. Tearing over the scapula, with paralyzed feeling in the arm.
UPPER EXTREMITIES. Paralytic hard pressure, feeling as if it were in the periosteum and deep in the muscles, extending into the fingers and preventing writing. Painful drawing in the inner surfaces of the elbow and the wrist. Spasmodic, slow contraction of the thumb and index ; it needs force to extend them again. Pricking itching as from needles between the fingers, relieved by scratching. Numbness in the right hand.
LOWER EXTREMITIES. Cramp-like pain in the thighs. Numbness. Soreness of the heels and toes.
As regards functional activities, Cyclamen depresses the sensorium, as we have seen, producing confusion, vertigo, lassitude. Vision is enfeebled, and, for the time, under certain circumstances, suspended. Digestion is retarded and enfeebled, the taste blunted, appetite soon and suddenly satiated, desires for food unnatural and restricted, thirst increased. The activity of the large intestine and of the female sexual system seems to be increased, diarrhoea and menorrhagia resulting. The organic substance is modified in so far as that diarrhoea is produced, the menstrual flow is increased, hastened, and changed to a dark, lumpy mass. The skin, too, is the seat of a vesicular or pustular eruption, itching, but relieved by scratching—this chiefly in the face. The scalp itches, the itching ceases on scratching, but immediately recurs in another place; the itching is a fine stitching or biting sensation.
The fever, in so far as fever is produced by Cyclamen, is partial in all its stages. Chill predominates. The heat occurs at evening, and is without thirst.
Sleep is restless. It is hard to fall asleep in the evening. One goes to sleep late, has vivid dreams, wakens early, before day-break, but is very tired; lies awake, cannot sleep again, yet even at the usual hour for rising cannot get up because of lassitude and weakness. The pains, which ceased during sleep, re-appear soon after waking. This is different from the sleep of Pulsatilla, which begins late but is sound, and the patient sleeps till late in the morning. It is different from Nux vomica, which has early evening sleep. Sulphur has no sound sleep.
The peculiarities of Cyclamen are found in the fact that so many of the symptoms of various parts of the body, as for example the digestive and the female sexual organs, are accompanied by the semi-lateral headache (in the left temple) with nausea, vertigo and obscuration of sight, the face being pale and the eyes sunken.
The aggravations are at night and when at rest; from eating fat food, and while reposing. Ameliorations when moving.
If, now, we compare this record, scanty as it is, with the symptomatology of Pulsatilla, we are struck with the resemblance. The gastric symptoms are almost identical.
We have the same white-coated tongue, the same qualmishness and disgust for food, especially fat food, the same absence of thirst and of febrile excitement, the same sympathy of the sensorium, eyes and head with these gastric symptoms. The peculiarities of the affections of the head and eyes are different, to be sure, from those of Pulsatilla; for Cyclamen produces semi-lateral headaches and absolute blindness, while the blindness of Pulsatilla is incomplete and only momentary, and the headache equilateral. But this very difference is a matter of congratulation, for there is a prospect that one or the other will cover most of the cases of sick headache and megrim that come before us for treatment.
But a large majority of such cases are the concomitants, if not the consequences, of menstrual irregularities, chiefly amenorrhoea, for they generally occur in women.
Now, you will have taken notice that in giving a summary of the action of Cyclamen just now, I said nothing whatever of its effects on the sexual organs of women.
What a pity, one cannot help exclaiming, that it does not act on these organs and affect their functions, for if it did, there could hardly be imagined a more admirably homeopathic remedy for the megrim that attends irregular menstruation. Failing such action, we might hardly be warranted in giving it. But does it not act on these organs and modify these functions ? Hahnemann did not know that it did nor did his pupils. How could any one know ? Only by the drug being proved by women on themselves !
No other form of proving, no other mode of investigation could give us this desired knowledge.
Not, therefore, until under the auspices of the Vienna Society, very imperfect provings were made by women, had we a knowledge of the fact that Cyclamen does indeed cause scanty menstruation, indeed cause absolute amenorrhoea, with megrim and loss of vision.
The only clinical indications for Cyclamen that I shall draw your attention to just now, follow directly from what has been said.
It promises to be, and has approved itself, a remedy of great value in those forms of menstrual irregularity which are attended by megrim and blindness.
In gastric disorders, the symptoms of which resemble those already described, and for which Pulsatilla seems to be the suitable remedy, but where the headache is semi-lateral rather than general, Cyclamen is likely to be of service.
The remarks which have been made on the subject of our knowledge of the action of Cyclamen on the organism of women, lead directly to a subject of exceeding importance to all women who, in studying the profession of medicine, aim to be not merely apprentices to an art by the exercise of which they can make a living, but also, and more than this, students of a science fraught with blessings to the race, a portion of eternal truth, a science which it is the mission of the human race to elaborate and make perfect,— each student doing his • or her appropriate work, and having a place to fill and a function to perform, indispensable to the perfection of the task.
Is it the ambition of any one of you to study science in this spirit ? Will you work for a living, then die, and leave no sign ? Or do you aim so to order your professional career that, while you gain an honorable livelihood by honorable toil, you may yet, when you pass away, leave science the richer for some facts or some generalization; adorned by some memorial of a life honorable to your art, which is eternal, as well as to your own ephemeral personality ?
At the same time that you, in common with all students, may cherish this honorable ambition, do you more particularly, as women, desire to vindicate your enterprise in exploring the paths of medical science hitherto untrodden by your sex ? Are you willing to enter upon a path of scientific investigation and research which the feet of man can never tread, the results of which, while they splendidly justify you in entering on the study of medicine, shall confer blessings unspeakable on that half of the race which is of your own sex, and thus on the whole race ?
To those who are thus minded, to those women who can do for women what men have done for men, and would have done for women had it been within their power, I will indicate the way of self-sacrifice which ends in honor.
All the facts stated in these lectures concerning the action of drugs on the human organism have been derived from provings of drugs on the healthy subject. Although those provings have been extensively and accurately made only by homeopathicians, yet their necessity is urged and admitted by the leading authorities of every school of medicine.
The principle is this: We learn how a drug affects the healthy organism, and from this action we judge, according to a law of cure, what effect it would have upon a sick person.
Now, we have seen that drugs act differently upon different living organisms. We may not infer from the action of drugs upon animals their action upon man, because the organs of animals differ from those of man. Neither, then, may we infer from the action of drugs upon men their action upon women ; more particularly as regards the action upon those organs which distinguish women from men.
Here, then, I find a worthy and an indispensable work for women who are educated physicians, as worthy and no less indispensable than that of men.
Claim, if you please, for women an equal right with men to practice medicine and make money, I admit their right and would give them fair play, but I do not see any necessity, except it reside in their own desires and impulses. But as regards the work of perfecting the sciences of physiology and pathology and materia medica, I see so great a necessity for women to devote themselves to the labors of investigation and experiment, that I should never cease to urge on them such a devotion of their gifts and of themselves, for the sake of science and of their own fellow-women whom this devotion would make science so much more potent to relieve !
I care not so much to shield women from what is called the rude attendance of rough men in the sick-room; but I do desire that women should prove drugs and ascertain their effects on the healthy, and what sicknesses they will cure, so that the medical attendant on sick women, whether he be man-doctor or woman-doctor, may know what drug to give and how to cure !
This is a mission which none but medically educated women can fulfill.
The students of our colleges and hospitals are all engaged, and are wont to engage, in drug provings. Will you do as much for your sex as men do for theirs ? Will you engage in proving drugs ? The mouths of those who rail against women's medical colleges would be effectually closed could we place in their hands an exhaustive proving by women of such a drug as Murex, or Cyclamen, or Caulophyllum !
The problem in drug proving is simply to ascertain the specific individual effects of the drug upon the healthy organism of the prover.
In order to get only the specific effects, uncomplicated with the generic effects, the prover must begin with very small doses, until the measure of his or her susceptibility has been gauged.
In order to be sure that the symptoms noted are in reality the effects of the drug experimented on, the prover must be always on the watch to discriminate between such effects and sensations to which he or she may be constitutionally subject; or the effects of unusual exertions, of changes in diet, of exposure to physical, mental or moral excitement or depression.
The symptoms of mind and disposition should be carefully noted.
The conditions of symptoms, viz.: the times and circumstances when and under which symptoms are aggravated or ameliorated should be most carefully noted.
Also the relations of symptoms to each other.
Inasmuch as changes in different organs in the body occur with very different degrees of rapidity, the prover should not hastily repeat doses, nor change the drug he is proving, nor relax the vigilance of his self scrutiny. For, though symptoms of the mind, or stomach, or lungs, may occur very soon after taking a dose of the drug, on the other hand, symptoms of the skin, bones and glands, may not occur for weeks or months.
I should recommend the proving of Murex purpurea as a drug that promises to be very useful, and would advise the provers to begin with the sixth dilution, taking a three-drop dose every night for four nights, and then awaiting results for a week. The class of provers may report progress every week.