except in what is called uterine epilepsy. Nor is it useful in puerperal convulsions, nor in any form of periodic convulsions nonchoreic in nature.

The spasms of hysteria, when not caused by actual displacement of the womb, are easily controlled by this remedy. In fact, in many of the conditions of delicate, hysterical women, there is more or less sleeplessness, nervous mobility, incessant talking; she feels grieved and wronged. Under these circumstances cimicifuga is remedial.

It is not indicated in neuralgia confined to any particular nerve or region, as is true of so many drugs, though it seems to affect the left side the most.

Enfeebled dermal enervation, frequent in those whose nervous system has been weakened by long illness, evincing itself in cold night sweats, coming on about three o'clock in the morning, and lasting sometimes through the forenoon, is greatly benefited by small, persistent doses of cimicifuga.

III. We are now to consider its relation to muscle fibre; and we will find it curative in several of its diseases; these, however, manifest themselves in almost kaleidoscopic variety of form and symptoms. Cimicifuga is pre-eminently a muscle remedy.

In both rheumatic fever and chronic rheumatism it is a remedy of prime importance. In the first, there are several conditions, which, if present, point to cimicifuga as the remedy. These are suddenness in the onset of the disease, extreme severity of all the symptoms, and its location in the large muscles. When these conditions are present, cimicifuga acts with great certainty. Like arnica, it acts best when the disease is in the muscle-fibre; but arnica is indicated when the inflammation is traumatic, rather than rheumatic, in origin. Bryonia is more serviceable in inflammations of the synovial capsules; rhus toxicodendron, when the disease is in the tendons; colchicum, when it affects the small joints; asclepias, when it invades the large joints, with great swelling and heat; chelidonium, when the least touch on any part of the body gives intense pain; caulophyllum, when in the wrists and hands, especially of women; rhododendron, when in the cervical and thoracic muscles; spigelia, when occurring on the left side, in anæmic persons; and ruta graveolens, when occurring in the knee and ankle joints.

In chronic rheumatism it is somewhat different, although here, I think, you will always find that the inception of the disease originally was sudden and severe, in those cases that are rapidly cured by cimicifuga. It seems to possess a strong affinity for lactic acid, and greatly increases the excretion of solids in the urine when administered to a rheumatic patient. Dr. Ringer gives the following as a case in which it will prove signally beneficial:

The disease, after affecting various locations, finally seats itself in one part, as the wrist and hand; the tissues here become much thickened, the bones of the wrist enlarged, till after a time all movement is lost, and the member becomes useless. Warmth allays the pain, which almost ceases at night. The attack presents many of the characters of gonorrhoeal rheumatism, but there is no history of gonorrhoea. I have several times observed the almost instant relief given by this drug in cases like that just described, after iodide of potassium and other remedies had been fairly tried in vain, the pain giving way at once, and the joints becoming again supple and useful. -Therapeutics, page 416.

But it is mainly when the pain, stiffness and lameness settle in the long muscles, as of the thigh* and arm, that cimicifuga is preeminent; though you will see good effects from it in chronic intercostal rheumatism, diaphragmatic rheumatism, pleurodynia, cervical rheumatism, and especially lumbago. The lumbago is worse when the patient is standing or sitting; relieved by lying down; aggravated by cold and stormy weather.

Non-rheumatic myositis, when the suddenness and severity of the inflammation are characteristic, will be greatly benefited by cimicifuga. This condition more frequently shows itself as psoitis.

In atony of the muscles, identified by Dr. Inman as a pathological entity, and named by him myalgia, cimicifuga divides the field with arnica and gelsemium. This last remedy is indicated when the pains are general, with feverishness; arnica, when traumatic, or the result of fatigue; and cimicifuga, when the fault lies in the trophic nerves. Myalgia is a very common affection, and in its various forms includes headache from atony of the muscle of the head and neck, stiff neck, wry neck, crick in the back, spinal myalgia, diaphragmalgia, pleurodynia,† myalgic colic, spasm of the

* Dr. Hale reports a case of many years' standing where the sufferings were at times intolerable, permanently cured in a few weeks by ten drops of tincture cimicifuga three times a day.

Pleurodynia may be rheumatic, myalgic, or neuralgic.

broad ligaments, and many others. Myalgic troubles often follow scarlet fever, and cimicifuga will generally put them to flight. (A great deal more readily than it does bed bugs. Cimex and fuga !)

IV. In diseases of the heart, cimicifuga will often do you good service. I use it quite as frequently as digitalis, and it is often difficult to select between them. If the condition is one of atony, or where the trophic nerves fail in their duty, cimicifuga is indicated. Cardiac debility is characterized by a weak pulse, which is irregular and intermitting, and is benefited by this drug. Angina pectoris is often myalgic, and when this is the case, cimicifuga will allay the tendency to spasm. The heart is sometimes choreic, even where there are no general symptoms. This condition may be diagnosed by the unexpectedness of the motions, and that they subside entirely during sleep. When this condition can be distinctly made out, especially in women, it may be met with cimicifuga.

Pericarditis and endocarditis are most frequently rheumatic in origin, and where this diathesis exists, you will have frequent use for cimicifuga.

It is often useful in fevers as an intercurrent remedy. It will reinforce bryonia in the treatment of pleuritis. It is highly recommended in variola and varioloid. Dr. Coe says, when administered during the febrile stage, it reduces the force and frequency of the pulse, allays cerebral excitement, equalizes the circulation, and induces a gentle diaphoresis. The aching pains of the first stage of this disease certainly do seem to indicate it.

It is asserted that its use will prevent the pitting of small pox. When eruptive diseases show a tendency to retrocess, and invade the mucous membrane, cimicifuga will translate the disease to the surface.

Its influence in febrile conditions is rather erethestic than febrile, and it is not, properly speaking, a fever remedy. It is, therefore, more frequently called for in children, where there exists a strong tendency to cerebral complication.

V. Were I to rest here, you would have reason to treasure cimicifuga as a precious gift from the divine hand to suffering humanity. But the half has not been told. In the ovario-uterine region it finds its great field of usefulness, so much so, as to have

won, from the aborigines, the name squaw root, and to be one of our most important remedies in many of the diseases of women.

First, in ovarian disorders, you will find it helpful, when these are erethestic, or from passive congestion, but not where there is actual inflammation or organic lesion. In this neuralgic condition of the ovaries, and the infra-mammary and other pains that so frequently arise from it, cimicifuga is one of our best remedies, especially when attended with depressed state of mind.

Dystocia may be prevented by giving drop doses of the fluid extract, several times a day, for two or three weeks previous to delivery, increasing the dose to three or four drops as the date approaches.

As a partus exceberator it was in common use among the aborigi nes centuries ago. It is an active ecbolic, and is so used by many women. For its parturifacient virtues, it is deservedly held in high repute. It will replace ergot of rye with manifest advantage to both mother and child. It is, perhaps, not equal to either ustilago or caulophyllum, but neither are specifics, one may answer where the other fails.

When you use cimicifuga for this purpose, give twenty drops at once, and follow it up with five drop doses every ten minutes until it begins to act.

It does not, like ergot of rye, produce continuous contraction of the uterus, but merely strengthens and prolongs the contractile movements, and therefore endangers less the soft structures of the mother, and does not asphyxiate the child.

After delivery, it may be used to expel the placenta, remove clots, or check post-partum hemorrhage, and is so used by many of our best practitioners, but I prefer either corn ergot or ergot of rye. If you have not had occasion to use cimicifuga to promote labor, it is often useful subsequently, in drop doses. It soothes the irritated nerves, the woman drops off to sleep, and awakes fresh and hopeful. It is also likely to prevent suppression of the lochia from nervous chill, or myalgic cramp of the uterus.

Dr. King recommends it in habitual abortion, sterility, and prolapsus uteri, when caused by deficiency of nervous energy; I have not used it for these purposes, but Dr. Morrow frequently boasted of the number of women he had restored to fecundity by its use.

In leucorrhoea, however, I have found it highly efficacious, where there is absence of ulceration. An ounce of the fluid extract in a pint of boiling water, used topically, at blood heat. Teaspoonful doses of the same solution three times a day.

The analogous disease, gleet, is greatly ameliorated, and often quickly cured by the same treatment.

In congestive or rheumatic dysmenorrhoea, with pains in the back, hips and thighs, tenderness in the hypogastrium, and the discharge of dark, coagulated blood; in metorrhagia from atony of the uterus, with dark, coagulated discharge; in delayed menstruation, with rheumatic headache, lowness of spirits, and aching in the limbs; and in amenorrhoea, from deficient local nervous energy, or associated with hysteria or chorea, cimicifuga will prove rapidly

curative.

Nervous cough, and a sense as of a dry spot in the throat, when symptomatic of uterine disorder, or occurring during pregnancy, with hoarseness and a feeling of suffocation, is a further indication for this remedy. Urticaria and other irritations of the skin are sometimes due to reflex uterine disorder, and when this is the case cimicifuga will cure the cause and remove the consequences.

In alternation with dyalized iron it will often be found valuable in chlorosis. Five drops of each two or three times a day.

Nervous exhaustion from sexual diseases in men is often benefited by cimicifuga, with or without phosphorus.

VI. I have now only to speak of its influence upon the respiratory tract.

In phthisis, in alternation with iodine, sanguinaria or phosphorus, it will ameliorate the cough and hectic conditions, lower the pulse nearly to the normal standard, cure the pains in the chest walls, and improve digestion and blood making.

It is well adapted to chronic cases of tracheitis and bronchitis, acting as a mild expectorant, in doses of five to ten drops of the tincture.

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I have already referred to the kind of cough in which it is likely prove serviceable. It has been given with much success in the influenzas and catarrhs, associated with the rheumatic diathesis, and I should rarely rely upon it when a general feeling of soreness did not accompany the local trouble. Compared with its great usefulness in muscular, uterine and neurotic diseases, its influence here is but slight.