Pulsatilla patens

Pulsatilla patens is a species of flowering plant in the family Ranunculaceae, native to Europe, Russia, Mongolia, China, Canada and the United States. Common names include Eastern pasqueflower, prairie crocus, and cutleaf anemone

BOTANICAL ANALYSIS.—Root perennial; stem simple, upright, naked except the floral leaf, bearing a large terminal flower. Floral leaf cup-shape, surrounding the stem about an inch below the flower, divided into fifteen to twenty linear spreading divisions. Calyx of six petaloid thin sepals, purplish or white, covered externally with silky hairs. Petals represented by a few gland-like bodies, resembling stamens, but smaller. Stamens numerous. Pistils numerous, in a head. Fruit, consisting of many achenes, borne on an elongated stalk. Achenes bearing slender silky tails, about two inches long.

COMMON NAMES.—In botanical works the plant is called Pasque-flower, derived from the European species, which flowers at Easter.

If it comes into general use as a medicine, the name American Pulsatilla will most probably be that under which it will be known commercially.

BOTANICAL DESCRIPTION.—Anemone patens is a very conspicuous flower in early spring, found in prairie region's of Illinois, thence west to the Rocky Mountains, and northwest. The stem rises about four inches out of the ground, and is terminated by a large, erect, solitary, light bluish purple flower. Below the flower, encircling the stem, is a many-parted floral leaf, covered with silky hairs, as are all parts of the plant. The true leaves are not expanded at flowering time, but are afterwards developed from the root of the plant, and are palmately divided into many linear lobes.

The fruit is a head of achenes, with long silky tails. It is borne on a stalk which is greatly elongated after the plant has flowered.

BOTANICAL HISTORY AND SYNONYMS.—The plant was first described as Clematis hirsutissima, by Pursh (1814), from a specimen collected by Lewis and Clark while on their Western expedition. Nuttall, in 1818, transferred it to the genus Anemone, where it properly belongs, and named it Anemone Ludoviciana, which name was changed by De Candolle, shortly afterwards, to Anemone Nuttalliana. The plant belongs to the section Pulsatilla of the genus Anemone, distinguished by having the achenes prolonged into hairy tails; and by many botanists this is considered a distinct genus. Sprengel adopted this view of the subject, and called the plant Pulsatilla Nuttalliana (1825).

Anemone patens (the typical species) is found in Siberia, and was discovered in British America by Hooker, and included in his Flora Boreali-Americana. For some years the variety (Nuttalliana) was not distinguished from the plant collected by Hooker, and was accordingly called Anemone patens in Torrey and Gray's Flora, and Pulsatilla patens in Gray's Genera. It is only in late years that the plant has been recognized as a distinct variety, and it was named Anemone patens var. Nuttalliana, by Gray, in his Manual, fifth edition (1867).

ALLIED SPECIES.—Anemone alpina Linn. is the only other native species of the section Pulsatilla. It can be readily distinguished by the involucre consisting of three distinct, petioled leaves, in consequence of which it was considered a distinct section (Preonanthus) of the genus, by De Candolle.

It is found in the Rocky Mountains, extending north into British America and is also found in many different varieties in the mountains of Europe.

CHARACTERISTICS.—All parts of fresh Anemone patens are acrid and very irritating. Dr. W. H. Miller informs us that his hands have been badly blistered, in consequence of the juice having spattered over them, while pressing the plant. The vapors evolved from the fresh juice are of such an acrid nature as to have inflamed the eyes, and have closed them temporarily. For this reason, persons refuse to work with the fresh herb, and botanists have been known to severely irritate their hands simply from contact with the recent plant.

COMMERCIAL HISTORY.—To Dr. W. H. Miller, of St. Paul, Minn., and his sons, is due the credit of having introduced American pulsatilla. The only demand for the plant, at present, is from Homoeopathic physicians; and hence we find that pharmacists generally have no acquaintance with such a drug or its preparations. The wholesale druggists of St. Paul, Minn., and of Fon du Lac, Wis., inform us that they have no demand for it. Since the Northwestern prairies must supply the plant, it is reasonable to suppose that the prominent houses of the cities we have named would receive orders for American pulsatilla, if it were in any way a commercial drug.

A prominent Homoeopathic firm of New York write us that, in consequence of the readiness with which it decomposes, they have the plant carefully tinctured in their branch house of the Northwest. In Chicago, it can easily be obtained fresh from the adjacent prairies. The indications are that before long our American pulsatilla will be in demand, and doubtless replace the imported.

CONSTITUENTS.—All portions of fresh Anemone patens are very acrid, but the dried plant is scarely more than astringent, imparting, after being preserved a year, simply a tingling sensation, when chewed. Mr. A. W. Miller analyzed it (1862), and found that a hot infusion of the fresh plant gave off highly irritating vapors, thus supporting the theory of a volatile acrid principle. The aqueous distillate reacted upon blue litmus paper, showing the presence of some volatile acid principle. Upon agitating the aqueous distillate with chloroform, separating the chloroform and evaporating it spontaneously, a white substance remained. This possessed the acrid nature of the fresh plant, and was supposed to be anemonin, both in consequence of its characteristics, and from the close relationship of Anemone patens to other plants yielding anemonin. The amount obtained, however, was so small that it could not be positively identified. In 1873, Mr. F. B. Miller, brother of A. W. Miller, reëxamined Anemone patens, working with a mixture of five pounds each of the fresh and the dried plant. This mixture was placed in a still, covered with water, and one quart of distillate obtained. The distillate was agitated with chloroform, and the chloroformic solution evaporated, whereby a mass of feathery white crystals was obtained. These crystals were neutral at first, but assumed an acid reaction after a few days, and became colored. Some of the expressed juice of the plant, to which an amount of alcohol sufficient to preserve it had been added, was also distilled, and the distillate extracted in like manner with chloroform. The result was a colorless liquid, which became dark red as the chloroform evaporated, a mass of brown crystals, of an acid nature, remaining. Eight pounds of dried Anemone patens were then submitted to the foregoing manipulation, but none of the acrid substance was obtained, thus supporting the conclusion that the anemonin was destroyed by drying the plant.

In addition to anemonin, the Messrs. Miller found only the ordinary constituents of plants, identifying glucose, a tannin, two resins, pectin, calcium compounds, magnesium compounds, and sulphates. Albumen was not found by either experimenter.

RESUME.—Our native species of Pulsatilla possesses the characteristics of the foreign Pulsatillas. Anemonin is the active principle, and it disappears when the plant is dried. Only preparations made without heat, and of the fresh plant, should be used in medicine. The United States Pharmacopoeia states that the plant should not be kept longer than one year; but all of the testimony at our command, and our experience, is to the extent that even drying the plant renders it unreliable, and that preparations of the dried plant are almost, if not entirely, inert.

MEDICAL HISTORY.—Anemone patens was the chief medicinal plant of the Minnesota tribes of Indians. They considered it a "cure-all," and valued it highly, and it was by their recommendation that the plant was brought to the notice of Dr. W. H. Miller.

The first recorded recognition that we can find of American pulsatilla, is a note in Griffith's Medical Botany (1847), which was followed by a recommendation from Dr. Clapp, in his account of the medical plants of the United States (1850), and by Dr. John King, in his Dispensatory of 1852. These seem to have been only suppositions, drawn both from the relationships which exist between this plant and the European Pulsatillas, and their similar acrid properties. At any rate, these authors bring no evidence to indicate a personal experience with the plant, and produce no reference to show that others had employed it.

About the year 1854, Dr. W. H. Miller, of St. Paul, Minn., was induced to experiment with the plant by an Indian who informed Dr. Miller that it was the "great medicine" of the Northwestern tribes of Indians. At that time the plant grew in abundance over where is now the city of St. Paul, and Dr. Miller has used it in his practice from that date. In 1862, Dr. A. W. Miller, the son of Dr. W. H. Miller, presented a thesis to the Philadelphia College of Pharmacy , which was afterward published in the American journal of Pharmacy. This paper introduced the plant to the authors of the United States Dispensatory, and in the twelfth edition (1865) it was briefly considered in that work under Nuttall's name, Anemone Ludoviciana, which was the term by which the plant was known to and recognized by the Messrs. Miller. Although Dr. Miller valued the plant highly, and was a member of the Regular school of medicine, we cannot find that others of that section have taken hold of it. However, these statements brought the plant before Prof. E. M. Hale, of Chicago, who experimented with it, and by means of a paper in the Medical Investigator brought it to the attention of Homoeopathic physicians. Dr. Burt, of Lincoln, Ill., then "proved" the drug, and published the result of his observations in the United States Medical and Surgical journal. Hale's New Remedies (1875), and Allen's Encyclopedia of Pure Materia Medica (1878), gave our American pulsatilla extended and favorable notices, thus bringing the plant creditably before the Homoeopathic section of the medical profession. Until 1882, the United States Pharmacopoeia neglected all varieties of pulsatilla, but in the last revision introduced them, and recognized our American plant Anemone patens var. Nuttalliana, as one of the officinal species. There is no doubt that while this plant has been used successfully by one member of the Regular school of medicine, and by some Eclectic physicians, its recognition by our Pharmacopoeia is due to the Homoeopathic branch of the profession.

In reviewing this subject, we must admit that out Anemone patens var. Nuttalliana is so nearly like the foreign allied species that there is no reason that the future supply of "pulsatilla" should not be derived from our native plant. The European species that are collected for medicinal use, differ from each other as widely as from the variety of the species indigenous to America. Experience has shown that a tincture prepared from our fresh herb is perfectly reliable, and we would prefer such a preparation to the tincture of European commerce, made by persons over whom we have no control, and whose reputations are not at stake.

MEDICAL PROPERTIES.—The European pulsatillas have been used in medicine from very early times. Galen, Dioscorides, and others, have written about the different species of Anemone, but it seems to have been reserved for Baron Störck to have revived the application of pulsatilla. It is not our intention to review the entire history of the foreign plant, and we therefore refer the reader, if interested, to works which treat directly of those subjects. Griffith announced (1847) that the properties of our native variety of Anemone patens would prove to be similar to those of Anemone Pulsatilla; and this statement was supported (or accepted) by Clapp, (1850). Prof. John King, in his Dispensatory (1852), states that it has been recommended in "amaurosis and other diseases of the eye, secondary syphilis, cutaneous diseases, and whooping cough. When applied to the head, it is said to be a speedy cure for tinea capitis. In the recent state, the leaves bruised and applied to the skin are rubefacient. In large doses, this article produces nausea, vomiting, looseness of the bowels, and bloody urine." Dr. W. H. Miller found it beneficial in certain eye diseases, and in ear-ache; but these names are indefinite expressions, and diseases such as "incipient blindness," may arise from different causes, so that, using the words of a prominent specialist, "to resort to any remedy for the relief of so important a symptom, without thoroughly investigating its cause, appears to me irrational." However, as the testimony is that under certain conditions it is a good remedy, the plant is worthy of a more detailed investigation in this direction, Dr. Miller also considers it a good pile remedy, writing us, "I have cured very bad cases in a comparatively short time;" and in this connection it might be well to note that the only ascribed value of the nearly related Thalictrum anemonoides , is that of a pile remedy. In the Regular section of medicine, however, there have been no investigations other than by Dr. Miller. In the Eclectic branch of the medical profession, Prof. J. M. Scudder has long been an active worker in favor of Pulsatilla. He has stated, in his work "Specific Medication," the conditions in which he values this drug, and defined them more clearly than we have found elsewhere; and with his consent we reproduce, in part, as follows: "The principal use of pulsatilla is to relieve certain cerebral symptoms with difficulty relieved by other remedies. In some diseases of women, in spermatorrhoea and prostatorrhoea, in heart disease, and some chronic affections, we find certain head symptoms playing an important part, and giving a good deal of trouble. The patient is nervous, restless, has an active imagination for disease, a fear of impending danger, etc. These symptoms are very unpleasant, and not unfrequently prevent the curative action of remedies. Pulsatilla reaches them, and gives prompt and certain relief."

"I would not treat some cases of spermatorrhoea without I could employ this remedy; for with the unnatural excitement of the mind, no remedy would exert a curative influence. So in some cases of heart disease, the head symptoms are the most prominent and unpleasant features. Relieve the unpleasant mental sensations and dread of danger, and we have removed a permanent cause of excitement."

"Though pulsatilla is the remedy for nervousness, it must not be given with any expectation of benefit where the excitement depends upon irritation and determination of blood. In this case it will either exert no influence, or it will be unfavorable. The pulsatilla exerts a marked influence upon the reproductive organs of both male and female. I regard it as decidedly the best emmenagogue, When the suppression is not the result of, or attended by, irritation and determination of blood; where there is simple suppression from atony or nervous shock, it may be used with confidence. In male or female it lessens sexual excitement. It does not diminish sexual power, but rather strengthens it, by lessening morbid excitement."

HOMOEOPATHIC USES.—(Written for this publication by Prof. E. M. Hale.) The uses of this plant in our school coincide nearly with the uses of the European variety introduced by Hahnemann. My provings and experiments show that the symptoms elicited are very similar. Those who have used it to any extent, declare it to be of great value in nervous erethism, especially when reflex, and due to disordered states of the sexual organs or the digestive tract. It is useful in chlorosis, with great nervousness, in neuralgia, characterized by its wandering, erratic character. We find it specific in catarrhal affections, especially in mucous diarrhoea and leucorrhoea. It causes venous congestion, and is useful in varicosis. It has cured urticaria, and itching papulae. It is as useful in nervous or gastric sick headache, as is the pulsatilla of Europe. The pain commences in the nape of the neck, ascends to one side of the head and eye, and is attended by chilliness and vomiting. It has proved specific in conjunctivitis catarrhalis, ophthalmia tarsi, hordeolum, opacity of the cornea, pustules and granulations in the eyes. It is useful in otitis and otalgia from catarrh; in catarrhal angina, when the mucous surfaces are of a livid, purple hue, and covered with mucus. This light purple, or dark violet hue, attends all the local disorders indicating pulsatilla. The indications for its use in gastric troubles are the same as for Pulsatilla nig. It has great curative power over disorders of menstruation, regulating irregular menses, restoring suppressed menses, and modifying painful or profuse menses. I have used it successfully in gonorrhoea and orchitis; as well as ovaritis due to suppression of the menses. It is well known that when a catarrhal flux from any organ is suddenly checked, a rheumatic affection of some muscle or joint may result. Here both species of pulsatilla act promptly curative, restoring the discharge and arresting the inflammation. I would advise its use for all the symptoms of Pulsatilla nig. It has the advantage of being indigenous, and obtainable pure, and in inexhaustible quantities.

PHARMACEUTICAL PREPARATIONS.—The fresh juice is mixed with one-half its bulk of alcohol (Dr. Miller). A tincture is made by using one part of fresh crushed pulsatilla and two parts of alcohol, according to our method of making tincture of Clematis virginiana. The German Pharmacopoeia recognizes a preparation (solid extract) made by heating the expressed juice of the flowering plant, filtering, evaporating the filtrate to a small bulk, adding alcohol, filtering again, and evaporating to the proper consistence.

DOSE.—King recommended from one to two grains of the fresh plant daily.

Dr. Miller writes us that he administers "ten drops of the juice of the fresh plant once a day, but for extreme cases, such as incipient blindness or syphilis, I give from ten to twenty drops two or three times per day, until narcotic (sic) symptoms come, which consist of headache, watery eyes, and especially a sensation as if the patient was smelling strong mustard. Then I discontinue the medication for a few days, and afterwards resume with the same dose."

Prof. Scudder uses a mixture of from ten to thirty drops of fresh, strong tincture of pulsatilla, to four ounces of water, and administers of this a teaspoonful every four hours.

Clinical.
      Amenorrhoea.
      Clavus.
      Cold, liability to.
      Deafness.
      Diarrhoea.
      Dyspepsia.
      Feet, fidgety.
      Home-sickness.
      Knees, rheumatism of.
      Liver, pains in.
      Measles, prophylaxis of.
      Menses, retarded.
      Ptosis.
      Rheumatism, wandering.
      Sciatica.
      Shoulder, r., pain in.
      Tinnitus.
      Uterus, pains in.

Characteristics.
      The American Pulsatilla approaches more nearly to P. vulgaris than to P-nig. in its botanical characters.
      It flourishes especially in the dry and sandy bluffs which form the bed of the Mississippi. The flower is pale purplish.
      "The odor of the dried plant is rather faint, being slightly camphoraceous, the taste of the dried flowers simply sweetish and herbaceous, that of the leaves more astringent with very slight acrimony.
      The taste and to some extent the odor of the fresh plant are both acrid and irritating" (Hale).
      A. W. Miller, a pharmaceutist (referred to by Hale), analyzed P. nutt.
      The extracted substances had an acrid, almost caustic taste, and well-marked camphoraceous odor.
      When volatilized they produced an irritating, pungent vapor, affecting the eyes and causing sneezing.
      The analysis revealed the following constituents: (1) organic Grape-sugar, gum, resin, an alkaloid and anemonic acid.
      (2) Inorganic Sulphate of potash, carbonate of potash, chlorate of potassium, carbonate of lime, magnesia, and "a proto-salt of iron." Dr. W. H. Miller (brother of A.W. M.), an allopathists, claimed to have used P. nutt.
      With success in many chronic eye affections, particularly catarrh, amaurosis, and corneal opacities, cutaneous eruptions, and secondary syphilis.
      Hale instituted the first homeopathic research, and Burt was the first prover.
      The symptoms have a strong resemblance to those of P. nig., and cases cured with P. nutt.
      are mostly such as would be amenable to P. nig.
      A patient of mine was incidentally cured of a tendency to catch colds by taking P. nutt.
      for some weeks as a prophylactic against measles.
      Burnett cured with it a case of deafness and oedema of left upper eyelid.
      The proving showed a powerful effect on the menstrual function, and Hale reports many cures of retentio mensium: (1) A young lady, formerly subject to retardation of menses, had: Constant chilliness, cold hands and feet, loss of appetite, sour eructations, nausea after meals, hemicrania, toothache, melancholy, general malaria.
      Menses two weeks late, took a chill at the time they were due, when she had precursory symptoms, no symptoms of menses now.
      P. nutt. 1 in water every two hours.
      After the first dose the menses came on and the constitutional symptoms cleared off.
      (2) Plethoric, usually healthy young woman, had menses delay two weeks.
      Continual severe headache, a heaviness and fullness, worse moving or stooping, sight dim, complete blindness on stooping or rising suddenly, weight in uterine region severe aching extending to back, worse evening.
      Hands and feet cold, weakness in lower limbs.
      Act. failed to relieve.
      P. nutt.
      Ix, 5 drops every three hours, brought speedy improvement.
      Next day menses came on profusely but without pain, two days before the expiration of the eighth week.
      The Puls. flying pains were very noticeable in the proving.
      Hale reports this case: strong, healthy looking man had wandering rheumatic pains chiefly in dorsum of right foot, loins, thighs, chest, arms, head.
      The head pain was a dull, heavy pressure in vertex, nearly constant, with occasional sharp pains.
      Some fever but no local inflammation of joints or muscles.
      Urine scanty, depositing lithates.
      Acidity of stomach.
      Appetite good.
      Bowels normal.
      P. nutt.
      Ix cured in three days.
      Some Peculiar Symptoms are: Home-sick feeling.
      Trembling weakness, weariness, heaviness, Snapping noise in ears.
      Fidgety feet.
      Colic before and after stool.
      Colic after eating a pear.
      Stiffness of fingers.
      Hands hot and dry (a constant symptom).
      The symptoms are worse coming in from open air, after eating, eating a pear, at night, by warmth, by reading, on urinating, on walking.
      better Walking in open air, rubbing with flesh-brush, scratching.

Relations.
      See Puls. 
      Antidoted by: Ant. c. 
      Compare: In fidgety feet, Zn., Caust.

Mind.
      Sad, gloomy, with frequent eructations.
      Home-sick, despondent.
      Anxiety, at night.
      Irritable, quick, nervous motions.
      Dull, disinclined for work.

Head.
      Dizziness on entering house from open air, sudden, in afternoon with fullness of head.
      Dull heavy headache, mornings, better by active exercise before breakfast.
      Flying pains in head and feet.
      Dull, oppressive, frontal headache, on waking.
      Hard pains in upper forehead pass in wave to occiput, involving whole brain.
      With headache cutting pains in epigastrium.
      Hard pain over left eye, as if a nail being pressed into forehead.
      Pain over right eye, afternoon, better walking in open air, worse in warm room, with sense of heat, fullness in head, and dryness of eyes.
      Sharp, shooting pains through both temples, in right temple.
      Dull pain in right temple, in vertex.
      Severe throbbing on vertex.
      Full, hot feeling at cerebellum.
      Headache arising from nape of neck and upwards.

Eyes.
      Profuse secretion of mucus from eyes.
      Dull pain deep in eyes, with smarting.
      Dryness, smarting, profuse flow of tears.
      Twitching: of left brow and upper lid for half an hour after going to bed, right lids worse reading.
      Paralysis of lids.
      Edema of left upper lid.
      Tarsal edges red, dry, irritable.
      Lids agglutinated, profuse secretion of soft, yellow, or white matter.
      Profuse lachrymation with dull pains in eyeball extending to malar bone.
      Neuralgic pains in eyeballs, while walking, worse r.

Ears.
      Hard, drawing pains along right Eustachian tube. With the pains in head and eyes, frequent drawing pains in ears from within out.
      Sharp pains in right ear and temples.
      L. ear feels closed, later both.
      Snapping noises in ears, fluttering in r. Deafness, with oedema of left upper eyelid (cured).

Nose.
      Dryness and heat in nose.

Face.
      Face red, hot, flushed.
      Complexion at first rough, later very clear after disappearance of rash.
      After eating, flushed, pressure of blood in face.
      Painful drawing in left cheek-bone and jaw.
      Lips dry.

Mouth.
      Tongue: coated white, with flat, pappy taste on rising, covered with tough slime, red, rather dry and swollen, teeth indented, yellowish coat along center, unusually red after eating.
      Breath offensive, to self and others, after eating.
      Mouth and lips dry.
      Smarting of velum palati.
      Mouth filling with saliva.
      On awaking, dry, pappy taste in mouth, as if tongue thickly coated (which it was not).
      Taste: flat, flat bitter, flat rough, sweetish, bad.
      Awoke after afternoon sleep with vinegar-like acidity in mouth and dull, pressing pain in stomach.

Throat.
      Frequent inclination to clear throat.
      After eating slight irritation in throat, with easy expectoration of white, tough mucus.
      Throat dry, smarts on waking, contains much tough mucus hard to dislodge.
      Scratchy, husky feeling in throat.
      Sensation of plug in lower throat.

Stomach.
      Great hunger, rapidly returned after eating.
      Loss of appetite.
      More thirst than usual, cold water extremely grateful.
      Eructations: tasting of Puls., while riding belches up food hot and tasteless, of hot, tasteless wind, of sour air.
      Thick gulping.
      Heartburn.
      Nausea, and dull headache, then faintness at stomach, on entering house.
      Fullness in stomach preventing eating in spite of appetite (cured in the proving).
      Painful emptiness, pressure, then rising towards oesophagus like heartburn.
      Emptiness: after action of bowels, after eating.
      Gnawing, empty sensation.
      Weight and pressure in stomach, after eating, with faintness.
      Distress: with severe cutting pains in epigastrium.
      Feeling as if needles being pressed through stomach.
      Heat in stomach gradually increasing to pain, worse in spots under sternum, burning, pricking burning.

Abdomen.
      Dull pains in right hypochondrium, in l. Severe pain in umbilicus six AM, with desire for stool, stool dark, covered with mucus, severe pains for half an hour after.
      Rumbling, after dinner of wind in distended abdomen moving from epigastrium to hypogastrium.
      Aching in one spot worse by moving.
      Colicky pains after eating a ripe pear.
      Aching in left groin, above left iliac crest on moving or bending.
      Dull pains: in whole abdomen, by spells in hypogastrium.

Stool and Anus.
      Evening and afternoon, feeling as if must go to stool immediately, with constant distress in lower epigastrium and umbilicus.
      Sudden attack of diarrhoea while riding on horseback.
      Stools: dark, thin, pap-like, watery, light yellow, painless, mushy, dark, slightly covered with mucus, dry, hard, lumpy.
      Constipation.

Urinary Organs.
      Pain on urinating, at end of urethra.
      Frequent micturition.
      Tenesmus, extending up ureters, uneasiness in kidneys.
      Urine: pale, albuminous, excess of water, skunk-like odor.

Male Sexual Organs.
      Distressing erection, soon subsiding.
      Pain in penis on waking, worse on micturating.
      Hard, sticking pains in (left) spermatic cord and testes.
      Dull pains in testes, worse r. Emission.

Female Sexual Organs.
      Stinging, darting pains passing through uterus from side to side.
      Leucorrhoea, bland but so profuse, and with so great depression that the prover refused to take more of the drug although it removed a pleuritic pain.
      Leucorrhoea, painless, four AM
      Feeling as if menses coming on.
      (Menses became more regular.)
      Menses weak, too soon (never before, but discharge, which had been formerly too dark and with pain, was this time natural in color and painless).
      Menses, always copious, became increased to flooding and lasted three days.
      In morning on awaking found menses had returned first time since weaning babe (two months).

Respiratory Organs.
      Coughed much.
      Constant inclination to cough.
      Small sore spot in upper trachea.

Chest.
      Sharp, stabbing pain in pectoralis major muscle, followed by burning distress therein.
      During evening sever pain under left arm nearer back.
      Aching pain in chest all forenoon.
      Itching blotches on right breast, right side chest.

Heart.
      Audible pulsation of heart.
      Pulse accelerated.

Neck and Back.
      Stiffness right side neck, morning.
      Backache.
      Lameness in back, especially loins.
      Woke frequently with backache.
      Weakness of loins, feeling as if menses coming on.

Limbs.
      Aching in limbs and loins wakes him frequently.
      Frequent flying pains in hands, feet, toes.

Upper Limbs.
      Rheumatism of right shoulder.
      Lameness in muscles of right upper arm.
      Muscles stiff.
      Frequent momentary pains in wrists and fingers.
      Fingers stiff.
      Hands dry and hot all day.

Lower Limbs.
      Sharp neuralgic pains along sciatic nerve from hip-joint to middle of thigh.
      Drawing in (left) sartorius muscle, when walking.
      Pain in both knees, worse l., severe, dull in right for two hours in bed, rheumatic.
      Legs heavy while walking, trembling weakness, nervous pains, worse l. Cramp.
      Dull pain in ankles, flying pains.
      With desire to urinate, afternoon, and at night, nervous sensation is felt, irresistible fidgets, worse night.
      Elevated eruption on ankles and half-way up leg, several large blotches on back, dark red, itches all the time, worse night.
      Very cold feet, evening.

Generalities.
      Great debility, on rising, in evening.
      Languid, feverish, depressed.

Skin.
      Elevated blotchy eruption on legs and back.
      Slight rash on back and shoulders.
      Itching scattered pimples right side of chest, light red, rash-like blotches on right breast, itching severely at night, worse when heated.
      Red rash on body, face, neck, back, chest, abdomen, limbs, worse chest and abdomen, later erythema, later nodules, turn white after scratching (better Ant. c. 200).
      Itching: intense all over, worse night before bedtime, better rubbing, worse riding in cold air, returned repeatedly throughout the winter.

Sleep.
      Sleepy, sleep not refreshing.
      Sleepless: for an hour four AM, for several hours, from over-eating.
      Restless, with frontal headache.
      Many dreams, confused.

Fever.
      Chilly, with full, uncomfortable feeling in stomach, with inclination to yawn, with papescent stool, shaking.
      Heat, feverish, with debility, skin hot, flaccid, better cool, blustering wind.
      Hot face, cold feet, hands hot and feverish.