SEPIAE SUCCUS. The juice of the cuttle-fish; a blackish fluid contained in the abdomen of the animal, and from which the animal has the power of projecting the juice into the surrounding water.
For medicinal purposes the juice is carefully dried, divested of its membranous envelope, and prepared by trituration according to the rules of the homeopathic pharmacy.
Although Sepia has no place in the pharmacopoeia of the old school, and is, indeed, so little known by them that one of their foremost writers has endeavored to fling ridicule on homeopaths by stating that they ascribe medicinal virtues to the cuttle-fish BONE, which is mere carbonate of lime, it is a singular fact that Hippocrates set a high value on Sepia as a remedy in diseases of women and in dysmenorrhoea, and that Galen ascribes to it tonic and stomachic qualities; while Marcellus recommends it for gravel and for the removal of freckles. A very singular anticipation by the ancients of the exact deductions from the homeopathic law.
Sepia is one of our most important remedies. Its action pervades almost the entire organism and is very enduring, the effects of a single dose often lasting for many weeks.
Upon the vital force and the organic substance it acts with equal energy.
The sphere of action comprises, in particular, the sexual organs of women, the gastro-intestinal tract and its appendages, the skin and glands, and the nervous system of animal life.
The symptoms are most apt to occur or to be aggravated when the patient is at rest, sitting quietly, in the forenoon or evening; and to be relieved by vigorous exercise in the open air. In general, the aggravation occurs about the middle of the forenoon; especially the sense of "sinking at the pit of the stomach," which attends many uterine disorders.
Sepia induces a tendency to free and sudden perspiration from a nervous shock or from exertion, but it is noteworthy that this perspiration comes out after the exertion is over or the shock is past, and when one is sitting quietly. (Calcarea carbonica has sweat during the exertion)
Sepia produces (and cures) what are well known as "hot flashes"— sudden accessions of heat, followed by a momentary sweat and weakness and disposition to syncope. These are frequent and very annoying incidents of the climacteric period in women. Lachesis resembles Sepia in this.
In many respects the symptoms of Sepia closely resemble those of Pulsatilla. As would be naturally inferred, these remedies often act as mutual antidotes; and so it happens that frequently, when they are given in alternation, as the custom is of some physicians, no result is observed. In such cases, it is often sufficient to suspend the administration of one of them in order to get a prompt and satisfactory effect from the other.
The skin affections of Sepia are among its most important symptoms. We find itching of the skin, and itching vesicles and papules on the face, hands and feet; and also a vesiculo-pustular eruption in the hollow of the joints of the knee and elbow. After the Sepia eczema there is abundant desquamation.
While speaking of the skin, it should be mentioned that Sepia produces on the lower lip a swelling with a soreness, burning pain and a pricking as from a splinter of wood. This symptom, together with the constitutional symptoms, has led to the use of Sepia in the treatment of epithelial cancer of the lower lip, two cases of which, cured by Sepia 800, have come within my personal knowledge.
In like manner, the other skin symptoms have induced the successful use of Sepia in cases of Rhus poisoning.
The fever of Sepia is incomplete. Chilliness predominates, but, like the heat, is fugitive and transient. Perspiration is copious, especially at night, and is conjoined with great weakness.
The disposition peculiar to Sepia is a depressed, anxious and fearful state of mind, with a sense of helplessness, and yet great susceptibility to excitement, and still more to terror, frequent attacks of weeping, and despair of life.
HEADACHE. Chiefly pressing and throbbing, with a kind of rush of blood to the face, which becomes red and hot, even to the ears. No general fever, however. General aggravation from motion. Itching of the scalp and falling out of the hair.
EYES. The sense of vision is affected. There is photophobia by day, and a white flickering before the eyes, like a thousand suns or sparks or black specks; around the candle-flame there is a green halo. On attempting to read or write, the vision becomes obscured.
There are supra-orbital pains. The eyelids pain on awaking, as if too heavy, as if paralyzed, corresponding to ptosis—a malady in which Sepia has often been given successfully.
Then, conjunctivitis with biting and burning and itching, but very scanty secretion of mucus or pus.
The face is the seat of eruptions already described. Moreover, on the forehead come irregular non-elevated brown spots, well known as "liver spots." The complexion becomes yellow and earthy. There are often, in connection with the headache or with uterine disorder, tearing pains in the facial bones and in the teeth. Finally, a characteristic symptom of Sepia is a brown discoloration extending across the bridge of the nose like a saddle.
In the mouth often form painful vesicles and ulcers — a form of stomatitis.
The gums swell and bleed easily. The teeth become loose. There is toothache, digging, tearing and gnawing pain, sometimes in a single tooth, sometimes in a whole row, aggravated by warmth. The toothache is generally a sympathetic concomitant of uterine disorder or of pregnancy.
The tongue is often sore, as if scalded. Salivation occurs, the mouth filling with a saltish fluid, while at the same time the throat and fauces are so dry that the patient can hardly utter a sound. (This closely resembles the salivation of pregnancy.)
The taste in the mouth is offensive, slimy, putrid like a bad EGG, with eructations of the same character ; or bitter, often bitter early in the morning, this ceasing after breakfast.
There are abundant eructations ; hiccough after eating; nausea and vomiting of bile, or vomiting of bile early in the morning on rising, with, during the day, attacks of constriction in the hypochondria, and nausea.
There is no thirst. Appetite fails; all food tastes alike. The stomach feels empty and weak with nausea at thought of food. A characteristic symptom is a peculiar faint sinking at the pit of the stomach, which is not necessarily painful to pressure. The faintness of Mercury is accompanied by tenderness; so is that of Calcarea carbonica. (Hydrastis.) Pressure and fullness are also sometimes felt. There are stitches in the region of the liver, which is sometimes sensitive to pressure. Also a fullness in the hepatic region and a pinching pain. It is peculiar to Sepia that the pains in the hypochondria are more tolerable when the patient lies on the painful side, while with Magnesia muriatica the opposite condition obtains. (Bïenninghausen.)
The abdomen is often distended with flatus. There are cutting pains horizontally across the abdomen, sometimes extending up into the chest.
In the rectum and anus a constricting pain which extends into the perineum or the vagina, sometimes up into the abdomen. Sometimes a feeling of soreness and a kind of pressure outward, cutting, burning and itching. Haemorrhoidal tumors occur, which are painful and bleed. After stool, emptiness and weakness in the abdomen.
"The stool is scanty and infrequent.
The evacuation of urine is preceded by pressure and tenesmus; it is frequent, painful, and often ineffectual until after long waiting and effort. At night frequent desire to pass water, which starts tardily, and flows slowly. Again, involuntary micturition at night.
On the sexual organs of women Sepia acts very distinctly. Along with cutting pains in the abdomen, a pressure is felt on the uterus downward, as if everything would fall out.
The menses come too early, but are scanty. They are preceded by violent aching in the abdomen, causing even faintness, and by chilliness and shuddering.
During the menses, restlessness, drawing pains in the limbs and abdomen. Palpitation and dyspnoea, with toothache and headache and epistaxis ; with depression of mind.
At other times than the menstrual period, frequent stitches in the vagina in paroxysms, with or without a watery yet lavish leucorrhoea. The leucorrhoea is rarely acrid, whereas that of Kreosote is very acrid.
Sepia produces (and cures) a dry, fatiguing cough, provoked by a sensation in the region of the stomach, and seeming to come therefrom; or the cough comes, as it seems, from the abdomen. A symptom which I have often verified in practice.
Then again a cough with copious, saltish expectoration, white or grayish yellow : the cough being attended, as all the Sepia symptoms are, by accessory symptoms, such as stitches in the epigastrium or head, faintness, nausea, etc.
From these and other similar symptoms, we draw our indications for Sepia in pulmonary consumption.
It produces various forms of oppression of the chest, burning in the chest and palpitation.
In the sacro-lumbar region Sepia produces pain, which generally is relieved by sitting or lying, worse when standing or walking. The backache of Belladonna is worse when lying down ; better when sitting. Sometimes the reverse.
It is a pressing, dragging pain over the sacrum and at the same time over the hips, and a burning pressure in the spine; also drawing pressure and burning pain across the dorsal region and under the scapula (often like that produced by sewing).
In the extremities, stitches and sticking, drawing pains, with lassitude, coldness of the feet, but sometimes only of the knees; sweat of the feet. The eruptions already described.
Among the general affections for which Sepia has been found a useful remedy may be mentioned, first: Various forms of skin disease, and in particular those of a vesicular character, attended by much itching and followed by desquamation. The vesicular eruption is not attended by the erysipelatous inflammation of the contiguous skin, such as is characteristic of Rhus toxicodendron; and this serves in part to distinguish these drugs.
Sepia is especially successful in the treatment of herpes circinnatus or ringworm, when this occurs in isolated spots. Calcarea carbonica (or acetica) is also useful in this affection. The distinction is to be found in the constitutional symptom. When, however, the herpes circinnatus occurs, not in isolated patches, but over a great portion of the body in intersecting rings, and attended by heat, itching, fever and great constitutional disturbance, Tellurium seems to be indicated, as appears from a proving of that drug in the "American Homeopathic Review."
In connection with skin symptoms, may be mentioned again, the brown discolorations of the forehead and cheeks and of the skin across the bridge of the nose, known as "liver spots," and which are very frequently found conjoined with constitutional symptoms which indicate Sepia as a remedy, these symptoms being particularly those of the hepatic region and of the uterus and its appendages.
In paralysis of the upper eyelid—ptosis—Sepia often effects a cure; also in certain perversions of the function of vision.
The neuralgia, the toothache and the headache of Sepia, are almost always conjoined with some disorder of menstruation, with pregnancy, or with some disease of the sexual organs of women. And it is peculiar to Sepia that, along with its symptoms of disease in the sexual organs, there occurs a considerable number of sympathetic symptoms in distant organs, E.G.: the toothache, headache, salivation, neuralgia.
Attention has been called to the fact that two cases of epithelial cancer of the lower lip have been cured by Sepia. A third case of this disease is so interesting as to be worthy of narration.
An epithelial cancer, far developed, had been excised. The wound healed kindly. After a few months the patient began to emaciate, and to exhibit every sign of cancer cachexy. The decline was alarmingly rapid. Eminent surgeons diagnosticated internal cancer. No hope of recovery was entertained. The complex of symptoms indicated Sepia, which was given, 200, and effected a complete and rapid restoration of health. The health remains good to this day (ten years).
In chronic or sub-acute hepatitis, Sepia does good. Its chief use, however, overshadowing all others, is in displacements and diseases of the uterus. In prolapsus it is the remedy, PAR EXCELLENCE. Yet not to be used to the exclusion of Nux vomica, Pulsatilla, Belladonna and Podophyllum. The simultaneous irritability of the bladder and the presence of leucorrhoea, together with the hot flashes and the sympathetic affections of remote organs, serve especially to indicate it.
Sepia is rarely indicated by these symptoms but that there is present the peculiar "sinking and all-gone sensation" in the pit of the stomach, almost producing faintness, and relieved by lying down and by taking food or wine.
In amenorrhoea or retarded and scanty menstruation, it is often indicated.
Experience has shown its value in cases of ulceration and congestion of the os and cervix uteri. Its use in appropriate cases supersedes all local applications, which in the vast majority of cases are not simply unnecessary, but are very mischievous. The same may be said of mechanical contrivances in uterine displacements, especially pessaries and internal supporters of all kinds.
Sepia is also a remedy in functional derangements of the liver.
Medical practitioners, like other men, are apt to "run in grooves," and the grooves grow deeper by use. With regard to the materia medica, they are apt to remember of each remedy some one or two applications in which it is eminently useful, and to forget or ignore many others in which, though, perhaps, less frequently indicated, it is equally valuable.
Thus, everyone has in mind the virtues of Silicea in suppurative inflammation of connective tissue, while comparatively few might think of it as a remedy in cerebro-meningitis, or in neuralgia, or in epilepsy.
Sepia, in like manner, suggests itself to every practitioner in cases of chronic uterine disease, and its value in such cases has caused it to be classed, in the medical mind, with remedies specially adapted to chronic cases. The remarks I purpose to make will show, I think, that it may also be a remedy for acute conditions. They will serve, likewise, to call attention to the re-proving of Sepia, made under the direction of the Bureau of Materia Medica of the American Institute of Homeopathy, and published in the Transactions of that body for 1875. While this proving confirms in a remarkable manner, the Hahnemannian proving of Sepia, and may be said to have added little absolutely new to our knowledge of this drug, it certainly presents, in a definite form, symptoms that are somewhat shadowy in the original proving, and thereby furnishes evident indications, where formerly these were perceptible only to acute observers.
I propose to consider only the relations of Sepia to " functional derangements of the liver," taking from Murchison's recent work,# the symptoms of these derangements and placing under each of these symptoms the corresponding group of Sepia symptoms.
Before describing the symptoms of functional derangement of the liver, Dr. Murchison states that the functions of the healthy liver are—not simply nor. chiefly the secretion of bile—but
"1. The formation of glycogen, which contributes to the maintenance of animal heat and to the nutrition of the blood and tissues, and the development of white blood corpuscles.
"2. The destructive metamorphosis of albuminoid matter, and the formation of urea and other nitrogenous products, which are subsequently eliminated by the kidneys, these chemical changes also contributing to the development of animal heat.
"3. The secretion of bile, the greater part of which is re-absorbed, assisting in the assimilation of fat and peptones, and probably in those chemical changes which go on in the liver and portal circulation, while part is excrementitious, and in passing along the bowels stimulates peristalsis and arrests decomposition."
A "functional derangement" may be a modification or an arrest of any one or several of these healthy functions.
1. If the power to convert glucose into glycogen be impaired by functional derangement of the liver, glucose passes into the general circulation, is eliminated by the kidneys, and we have one of the several forms of glycosuria,—forms which agree in this one symptom (sugar in the urine), but differ profoundly in the pathological conditions on which this symptom depends, and in the indications for, and their amenability to, treatment. The form we have described is often transient, and always a mild and curable form of diabetes; or, this glyco-genetic function may be modified in another way, and we may have a more serious form of glycosuria by an increased conversion of glycogen into sugar, from hyperaemia of the liver depending on paralysis of the vaso-motor nerves, resulting from irritation of the roots of the pneumo-gastric nerves, injuries of the spinal cord, poisoning by curare, etc.
2. When the function by which the liver disintegrates and eliminates albuminoid matter is imperfectly performed, the disintegration stops short of the formation of urea which is soluble; and products more sparingly soluble, and which are less completely oxidized, than urea, are formed, viz., uric acid, etc.; or products still less oxidized, such as leucin and tyrosin, which we find in acute atrophy of the liver when this function of that viscus is almost abolished. Where, under this functional derangement, uric acid is formed instead of urea, we find in the urine deposits of uric acid, of urates, and abnormal pigment.
Such is a brief statement of Murchison's views of the functions of healthy liver, and the results of some of their derangements. I shall restrict my remarks upon Sepia to the second form of derangement above described, viz., that of the function by which albuminoid matter is disintegrated and eliminated, and the derangement of which is manifested, among other symptoms, by excess of uric acid and urates in the urine.
Murchison gives the following names of diseased conditions resulting from this derangement:
1. Atonic dyspepsia, of which the symptoms will presently be given in detail.
2. Gout—anomalous or regular; urates in the blood, and deposited in or near the joints.
3. Urinary or biliary calculi.
4. Granular degeneration of the kidneys, from their constant work in eliminating urates. (Dr. Geo. Johnson.)
The symptoms of the atonic dyspepsia are given more particularly by Murchison, as follows:
After each group I cite, from the new or from Hahnemann's proving, the corresponding Sepia symptom :
1. Tongue : that of atonic dyspepsia, large, pale, flabby, indented. Sepia: tongue coated brown or yellow (148, 149); tongue feels too large. (155.)
2. Appetite good, but suddenly satisfied ; loathing of fat. Sepia: sudden craving, sudden satiety (185, 184) ; good appetite, but loathing of meat. (Hahn., 510, 522.)
3. Bitter or coppery taste ; worse in the morning. Sepia: putrid, insipid taste (177, 178); bitter, repulsive taste in the morning. (Hahn., 499.)
4. Flatulence (from lack of bile?). Sepia: abdomen very much distended after the least bit of food. (207, 215.)
5. Constipation, from lack of normal stimulus to the excretion, and with great depression of spirits; or there may be pale or dark offensive diarrhoea. Sepia : constipation ; seems to have lost power (243, 241) ; constipation, with bleeding and weight and pain in the rectum (236) ; only small, hard lumps passed (241); hard stools; faeces covered with mucus, followed by slimy, bilious or catarrhal stools. (255, 256.)
6. Intestinal haemorrhage ; haemorrhoids. Sepia: considerable bleeding from the rectum and intense bearing down at the anus. (261, 262.)
7. Hepatic pains; weight, fullness, tightness; worse when lying on the left side. Sepia: as if the abdomen were full and bloated across the epigastric region (214, 215) ; as if a load rested on the epigastrium (217); soreness around the umbilical region on pressure, especially on the right side (221) ; Boenninghausen names Sepia under the rubric "worse from lying on the left side."
8. Jaundice (?). Sepia: yellow face and whites of eyes. (Hahn., 325.)
9. Aching of the limbs and lassitude. Sepia: weakness and aching of the thighs and legs (419-421); general weariness and prostration in the joints. (422.)
10. Pain in the right shoulder and about the scapula. Sepia : long-continued pain under the right shoulder. (410, 413.)
11. Hepatic neuralgia, with great depression of spirits. Sepia : stitches in the hypochondria, across the abdomen, making her cry out (Hahn., 626) ; frequent stitches under the right ribs. (Hahn., 627, 629, and 624, 625.)
12. Cramps in the legs. Sepia: cramps in the calves at night. (Hahn., 1310-1314.)
13. Dull headache in the forehead and occiput in the morning on waking, lasting part of a day, or several days, with constipation and pain in the right hypochondrium. Sepia: dull, stupid headache, with great mental depression (40-43) ; dull pain over both eyes (55) ; dull headache through the temples and forehead (59) ; waked with dull headache in the back of the head (74).
14. Vertigo and dim vision. Sepia: dizziness (35 Hahn., 87-100); obscured vision. (Hahn., 258, 259.) 15. Noises in the ears. Sepia: both ears feel stopped (in); ringing, singing, roaring, etc. (Hahn., 293-304.)
16. Sleeplessness. Sepia: restless nights; tired mornings (504); disturbed sleep. (508, 509, 511, 5I2-)
17. Depression of spirits ; irritability of temper. Sepia: mental depression ; very low spirited, with headache (2-5) ; very irritable; very cross. (5, 6, 10, 12.)
18. Palpitations and fluttering of the heart. Sepia: palpitation, very nervous (360, 365); seemed as if the heart occupied all the cavities of the body (359); pulsation with soreness in the stomach (199.)
19. Irregularities of pulse; intermission (which is always due rather to hepatic indigestion than to cardiac disease ; intermission of pulse. (Hahn., 1098, 1099.)
20. Feeble circulation ; anaemia. Sepia: pale, sickly aspect. (Hahn., 324.)
21. Angina pectoris, Sepia (?)
22. Pulsations in various parts of the body, especially in the epigastrium. Sepia: pulsations felt in the body, in the head and extremities, day and night, especially in the night. (Hahn., 1409, 1410.)
23. Urine heavier than normal; it deposits uric acid and urates. Sepia : every prover noticed marked diminution in the quantity and increase in the specific gravity of the urine, which deposited uric acid and urates. This was reported by provers of both sexes, and from various potencies of Sepia.
24. Chronic catarrh of the fauces. Sepia : feeling of rawness in the posterior fauces, etc. (165, 167.)
25. Chronic bronchitis. Sepia: coughing spells in the morning, with either difficult expectoration, or copious sputa, easily raised ; harsh, dry cough. (342, 344.)
26. Spasmodic asthma. Sepia: tightness and constrictive sensation in the chest. (346.)
27. Eczema, lepra, psoriasis, lichen, urticaria, boils, pigment spots, pruritus. Sepia: vesicular, papular and pustular eruptions (484 -495) ; itching (484) ; yellow spots on the face and a yellow patch over the dorsum of the nose. (Hahn., 326.)
In an excellent physiological study of Hahnemann's proving of Sepia, Dr. V. Meyer of Leipzig, in 1853, used the following language: "This remedy operates especially on the portal system, by retarding the circulation, and causing an overloading of the vascular system with venous blood, or with blood more or less resembling venous. A plethora venosa, as it is called, gives rise to most of the various symptoms. The pathological process is also marked by a state of depression. # # All further morbid conditions are but secondary." # # "All disorders of the portal system must first affect the neighboring organ, the liver." ("Homeopathische Vierteljahrschrift," iv., 2. Translation in "British Journal of Homeopathy," xiii., pp. 635, 636.)
CASES ILLUSTRATING THE USE OF SEPIA IN ACUTE DISEASE, CONNECTED WITH FUNCTIONAL DERANGEMENT OF THE LIVER.
CASE 1. August, 1875. A lad, seven years old, was brought home from the country, said to be suffering from remittent fever; he had been ill three weeks, and presented the following symptoms : febrile condition persistent, very weak, keeping his bed, extreme depression of spirits and irritability of temper, occipital headache, sudden, excessive desire for food, but eats only a small quantity. Two or three stools daily and one or two at night, of normal consistency; but clay-colored and offensive. Successive outbreaks of furuncles on the nates; on the right side of the abdomen, just below the arch of the ribs, a very tender spot which is the seat of constant pain; the whole right hypochondrium is tender and heavy; aching in the right shoulder, restless sleep; the urine has a pink deposit, stains everything it touches red and stains the vessel; heavy sweats at night. He is reported to have had Podophyllum, China, Bryonia, etc., etc., without perceptible effect.
I gave Sepia 30 trituration, in solution, a dose every four hours during the day. In two days a vast improvement was manifest; and in a week he was perfectly well, and has so continued to the present. Improvement was noticed first in his fever, spirits and temper, then in his appetite and digestion; then the pain and soreness vanished; then the stools and sleep became normal; last of all, the urine became normal.
CASE 2. A lady, aged thirty, has been ill nine or ten days; is in a remittent febrile condition with evening exacerbations, no chills, pulse at eleven A.M., ninety-six. Aching weight and soreness in the right hypochondrium, and distress and aching in right shoulder and scapula; cheeks flushed, the forehead and conjunctivae yellow; irregular yellow patches on the forehead, lassitude; the limbs and back ache, obstinate constipation and occipital headache; anorexia, she loathes fat and milk; thirst, tongue flabby and indented, great flatulence after food, restless sleep, dry hot skin, urine scanty and loaded with urates. Her disease is said to have been pronounced remittent fever and prescribed for as such. She has taken Podophyllum and she knows not what else.
I gave Sepia 30 trituration, in solution, a dose every four hours. In twelve hours the fever had gone and did not return, the side was better, the bowels had moved; in a week she was entirely well.