Apis mellifica or Apium virus. The Honey Bee or its Poison. N.O. Insecta.
TINCTURES are made of the whole bee, or of dilutions of the poison with alcohol.
Our knowledge of apis is derived from symptoms occurring in the victims of stings by bees or wasps, the poisons of which seem to be identical, and in the provers of the tincture made from triturations of bees, or of the pure poison extracted from the poison bags. The provers in every case took the poison through the mouth.
The honey-bee poison is a toxalbumin, and its effects are similar to those of other animal poisons, such as the toxalbumins of the snakes, spiders, lizards, &c.
A good general idea of the pathogenetic effects of apis will be gained from reading the following account of poisoning culled from the “Cyclopaedia of Drug Pathogenesy.”
“A farmer, aged 35, of light complexion and robust constitutions, was in August, 1858 stung by a bee on the tip of his nose. It immediately struck though his whole frame like an electric shock, thrilling the ends both of his fingers and toes. He immediately started for the house, distant about three rods, which he reached with difficult, he staggered and was scarcely able to walk; his mind was confused and bewildered; and his head felt big. Upon reaching home his heart palpitated violently, so as to be felt by himself and audible to those in the room; faintness and death-like prostration came on, which continued half an hour and were accompanied by intense anxiety and distress at the stomach, oppression of the chest, dyspnoea, short, rapid breathing and accelerated pulse. Nausea, followed by yellow and bitter vomiting, occurred about three quarters of an hour after the accident. At this time he had a chill, with shivering, accompanied by terrible racking pain all through the head, with increased prostration; no pulse could be felt at the wrist, blood settled under the finger and toe-nails; the ears were purple; jactitation of muscles and complete loss of consciousness came on and lasted for three hours, during which there were flushed of heat mixed with chills. The skin was extremely sensitive to contact, painful to the slightest touch, so that he could not bear the sheet upon him, and red white blotches came out over the body and extremities, like nettle-rash. He gradually recovered, but was left much prostrated, unable to concentrate his mind, and his head felt confused when he attempted to study. This condition lasted some weeks and was attended by frequent attacks of vertigo and blindness.
This case illustrates the great rapidity of the action of apis and the way in which its attack is concentrated on the nervous centres and the skin. This instance of acute poisoning displays most of the main symptoms of apis, but was too rapid to allow all of them to be developed, and we will now supplement it by collating those exhibited in the provers.
In the mental sphere they show that apis causes ill-humour, anxiety with fear of death, a restless desire to be constantly changing occupation, an unfitness fro mental work great tearfulness and, in women, jealousy. There are confusion and vertigo, which is worse from lying down and closing the eyes, and better from walking. The sensorium is depressed to the point of drowsiness and sleep and, as in the case above, even to unconsciousness.
The head feels hot, as if swollen and too full of blood; it throbs; there is headache, varying from a dull feeling to a severe, bursting, expansive pain, which is relieved by compressing the head with the hands, an exception to the general modality, and is worse from any jar such as coughing, and from stooping, from reading and in a warm room. It is felt mostly in the temples and forehead and at times involves the eyes, but it may be general, and is often accompanied with nausea and vomiting. Sometimes a pain is felt which begins in the nape and extends forwards over the side of the head to above and behind the ear, or a sudden pain like a bee-sting, or shootings may occur in the temples.
In the eyes the conjunctivae are injected and may exhibit chemosis. The lids smart, itch and burn, which causes an inclination to press or rub the eyes strongly; they are glued together in the morning, and the tissue under the lower eyelids is oedematous and hangs down like a bag of water; there are photophobia and lachrymation of scalding tears. Thick, greyish, smoky or opaque spots are seen on the cornea, and severe darting, lancinating pains are felt through the eyes. Vision is misty.
In the ears there are burning, itching and pricking, both internally and externally, they are swollen and have a purplish appearance.
Nose.-Violent sneezing takes place and there is a numb, congested feeling in the nose and actual stoppage of it, with discharge of a few drops of mucus from the nostrils.
The face may be much swollen, bloated and livid; or dark red and hot with burning cheeks; or oedematous, waxy and pale. Shooting pains occur in the cheek bones and the chin; shooting, burning pains are felt in the supra-orbital regions and extend to the eyeballs.
Digestive System.-The upper lip is swollen, red and hot; both lips may be oedematous and the lower one chapped; violent pains in the lips extend to the gums, which bleed easily, and jumping pains are experienced in the left upper molars. The tongue is swollen to the extent of making speech difficult, it is raw and burns, the whole of its border feels scalded and is covered with small vesicles. The mouth feels scalded and there is an itching, tingling sensation in the roof of the mouth which extend back to the palate and throat. The saliva is thick and viscid and the taste bitter. Thick phlegm, which causes frequent hawking, collects in the throat, which is swollen inside and outside; the uvula is oedematous. A constrictive sensation is felt with feeling as if something is lodged in the throat which makes swallowing difficult. Ulcers on the tonsils and palate have an erysipelatous or oedematous appearance around them. Nausea is felt in the throat and the sufferer has no desire for food or drink. Sour things are wished for. Eructations taste of eggs. Vomiting, which is often violent, is of food, watery, bitter fluid or bile. The pit of the stomach is sensitive and is the seat of burning pains that are aggravated by pressure.
The abdomen, is swollen, sensitive and sore; burning pains are felt under the short ribs and violent pains occur in the hypogastrium which press down towards the uterus. There is rumbling in the abdomen with an urgent call to stool and a bruised feeling after stool. Throbbing is felt in the rectum, and tenesmus, with a sensation as if the anus is packed full. When there is diarrhoea the stool is watery, greenish-yellow mucus, is painless, and may recur every morning, or it is a “dysentery- like” stool, consisting of a mixture of mucus, food and blood. When there is constipation the stools are large, hard and difficult to expel, and are accompanied by a sensation in the abdomen as if something tight would break if too much effort should be made to evacuate them. The anus protrudes with the stool and remains open. Sometimes from apis the stool is a natural, one but is preceded by emissions of flatus and a small quantity of almost colourless water, containing lumps of blood stained jelly-like mucus.
The urine is scanty, high-coloured and may contain blood, albumin and casts; desire to micturate is very frequent, the patient feels he must pass water every few minutes all day from a forcing-down feeling in the bladder. The act of micturition is accompanied by sore, burning pain in the urethra, and a feeling of stricture in the bulbous portion.
Sexual.-Apis causes frequent and long-lasting erections and a desire for coitus even during the day. Fulness, aching and soreness are felt in the testes, and there is an uneasy sensation in the spermatic cords.
The severe pains across the hypogastrium caused by apis are probably in connection with the uterus. Sharp, lancinating pains in the right ovarian region, which extend down the thigh, are a notable apis symptom. The labia are oedematous. In one prover the drug caused the abortion of a two-months foetus.
Respiration.-In the larynx there is a wearied feeling, dryness and burning, a rough, voice and external sensitiveness; oedema of the glottis has been produced. Breathing is hurried and difficult, and there is a feeling of constriction and suffocation; there may be asthma. Nothing can be borne about the throat (cf. lachesis). Great oppression is felt in the chest accompanied with a desire to draw a deep breath, there is a sense of fulness, tension and pressure, and sharp pains may be experienced, or a bruised soreness in the chest walls. Commencing oedema of the lungs has been observed. The cough is dry, is provoked by irritation in the suprasternal fossa, or by touching the larynx, is croupy with ringing sound, causes painful shocks in the head and is associated with soreness in the upper part of the chest. It is worse when at rest and from warmth and is relieved by detaching a small piece of phlegm. The patient holds his head back when coughing.
Circulation.-The heart’s beats are quickened and may be forcible, and the pulse increased by several beats a minute, except in cases of collapse, when no pulse may be felt at the wrist. Sudden, sharp, stitching pains occur over the cardiac region and may disturb respiration.
Back.-Apis causes stiffness in the back of the neck and painful stitches in the right side of the nape, which are worse from bending the head to the right side. Pains extend from the nape to the left side of the head. Pressive pains are felt under the shoulder blades, especially the left. The back feels tired and bruised, as from over-exertion, burning, stinging pains occur here and there along the spine, There is stiffness in the small of the back and the sacrum, in the latter are felt burning stitches. Sudden flushes of heat occur over the back with a sensation as if sweat is about to break out.
Extremities.-In the extremities there are rheumatic pains about the shoulders, dull pains in the bones of the legs, arms and fingers, pricking and burning in the palms, backs of hands and tips of the fingers, or a feeling of numbness in the finger tips, especially round the roots of the nails, violent pains about the knees, a sensation of weight in the feet and of swelling and numbness in them, the soles and balls of the toes feel cushioned, and there are shooting. burning and redness in the toes, while the feet are cold. the hands and feet tremble. There is great restlessness and a desire to change the position frequently.
Sleep is restless and dreams many and various, but most commonly of business, journeyings and flying; the patient may scream out in sleep, the brain seems too active and to have no rest day or night. On the other hand there may be extreme sleepiness and continuous deep sleep, sometimes followed by aggravation (arg. met., lach.).
The kind of fever that apis produces is one characterized by thirst during the cold stage but absence of it during the hot stage. There is but little sweat. The chill commences about 3 p.m.; during its continuance the hands feel dead. The hot stage is the predominating one and is accompanied with a racking headache, which merges into a continuous deep sleep.
In the skin apis causes burning, itching and pricking; the skin is excessively sensitive to contact; red and white blotches or wheals, like urticaria, which itch, sting and burn, occur all over the body. The rash may be rough, or smooth like erysipelas. A hot, dry skin alternates with moisture; it may appear pale, waxy, almost transparent, from oedema or blue-black or livid.
Some general effects of the drug may be noted that have not been considered under the special localities; they are the great prostration, weakness and lassitude that it causes, and the tired, bruised feeling in the back and limbs, as after great exertion the day before; awkwardness; the tendency to fainting fits; the swollen sensation as if the whole body is too large, as well as the feeling of swelling in particular parts; the actual oedema which is partial or general; internal trembling sensations, with shuddering over the back, especially the upper part; the twitching of muscles and loss of muscular power and the convulsions that sometimes occur. It has occasionally been observed that while one side is convulsed the other side is paralysed.
Acute inflammations with oedema are the complaints for which apis is especially suitable. These comprise a large number of disorders. Thus it is a remedy for glossitis when the tongue, especially the right half, is much swollen and has a raw surface covered with little burning, stinging vesicles; for tonsillitis when the tonsils are swollen and bright red and there is stinging pain on swallowing, and also for deep ulcers on the tonsils and palate with an oedematous appearance round them and an oedematous uvula. When oedema is extreme there is no pain. The scarlatina sore throat is often of this description and then apis is the indicated remedy; similarly it may be the suitable medicine in diphtheria.
Apis is of great value in oedema of the glottis, such as may occur from extension of the inflammation in tonsillitis or from a scald caused by inhaling steam from the spout of a kettle. The inflammatory swelling of the larynx and tracheal mucous membrane is the cause of the cough for which this drug is useful it is excited by a tickling low down and in the suprasternal fossa, is short and dry and constantly repeated, it causes, from concussion, pain in the head and soreness in the upper chest, is worse in a lying position and in warm air. If the swelling is great, breathing becomes asthmatic, there is violent dyspnoea and a sensation of suffocation as if every breath will be the last.
Apis is useful for hydrothorax coming on after pleurisy and associated with the same sense of oppression and impending suffocation. Similarly it is of service in another serous effusion, viz., in ascites from peritonitis. An inflammatory oedema of synovial membranes for which it is useful is that of the joints in acute rheumatism.
Apis is indicated in acute nephritis not only by the scanty urine, albumin and casts caused by the drug, but also by the general or partial oedema which is present, especially in the lower extremities, the labia pudendi, and the loose tissue under the eyelids. It is often employed in nephritis occurring in scarlet fever or the exanthemata, when the patient is drowsy; or in stupor, with puffed face and absence of thirst.
Brain.-Apis has gained a great reputation in meningitis and congestion of the brain, when probably there is effusion into the arachnoid. Tuberculous and cerebro-spinal meningitis, and the cerebral affections of children, associated with dentition and worms, all come under its influence,. In these cases there is sopor interrupted buy sudden piercing cries, the cri cerebral the head is retracted, rolls from side to side boring into the pillow, and there is strabismus. The little patient frequently carries its hand to its head. Convulsions may occur and are made worse by putting the patient into a hot bath; they are usually accompanied with opisthotonos.
The nervous and mental symptoms of the provings suggest that apis might be useful for oedema of the brain in general paralysis of the insane, tumours and encephalitis, also in the following conditions-Melancholia; anxiety neurosis; suspicion in (a) confusional cases; (b) paranoia; (c) alcoholic toxaemia; also loquaciousness in confusional cases stupor. The modality worse from heat should be present if apis is the correct drug.
Fear and premonition of death may be present.
Many eye complaints are influenced by apis, notably conjunctivitis when there is chemosis and the lids are so swollen that the eyes can hardly be opened; hot tears gush out from between the lids and there is photophobia. In keratitis and ulceration of the cornea the drug is useful and also in rheumatic ophthalmia. a characteristic indication for the use of apis in eye diseases is that they are aggravated from exposure of the eyes to radiant heat; the patient cannot bear to look into the fire.
All the above complaints are distinguished by the presence of oedema, and the same holds true for the affections of the skin for which apis is indicated, viz., urticarias, where the skin is covered with large white or pink wheals which itch burn and sting. Erythema nodosum also presents the conjunction of inflammation and oedema and is beneficially treated with apis. Some cases of lichen are suitable for it. The erysipelas cases that require it are those where there is much oedema, perhaps vesication, with red shiny skin and which progress rapidly. They commonly commence in the neighbourhood of the right ear, spread to the eyes and nose and across to the other side of the face. Erysipelas starting in the umbilical wound in newly-born children is frequently of the kind indicating apis. It has been used for panaritium and felons about the nails, as it seems to have a special affinity for that region. Its characteristic stinging burning pains render it suitable for the allayment of similar pains when occurring in cancers and carbuncles.
Apis is one of the remedies for morning diarrhoea and is indicated in that affection when the stools are thin, yellow watery with some mucus, and passed without pain but with some tenesmus; flatus is often passed before the stool.
Sexual.- Apis is useful in disorders of the female sexual organs; it both causes and prevents abortion, most commonly at the second or third month. It is a remedy for metritis and cellulitis after delivery, for menorrhagia and dysmenorrhoea. It has been used for pains occurring in the right ovarian region and thought to be due to disease of the ovary. Its value in ovarian cysts, for which it has been recommended, is more than doubtful.
Beside its value in nephritis, it is a remedy frequently required for inflammation of the neck of the bladder with strangury, there is frequent desire with passage of only a very few drops of urine associated with burning pain along the urethra. Apis antidotes a similar condition caused by the abuse of cantharides.
Fever.- In the intermittent fevers for which apis is indicated the chill commences usually about 3 p.m. and is accompanied by thirst and a dead feeling in the hands; the heat which is the most prolonged stage and in which there is not thirst, is accompanied with a violent headache or continuous deep sleep; the sweating stage is very short or absent and here also there is no thirst External heat aggravates all the stages, even the chill. In the apyrexia there are pains in the splenic region, the feet are swollen the urine scanty, the limbs and joints sore the patient is restless and there is urticaria.
Some apis symptoms e.g., vertigo, muscular soreness (legs) are relieved by walking or movement, while others are aggravated, such as headache, sickly feeling subscapular pain.
Apis is useful in other kinds of fever, such as enteric, continued low fevers and the exanthematic fevers, provided the general characteristics are present; the patient is alternately perspiring or hot and dry.
The same indications are necessary for this drug to the suitable for the ailments from fright rage, vexation, jealousy or hearing bad news, for which it is sometimes prescribed.
Carbolic acid is an antidote to bee stings.
(1) Aggravation from heat in any form.
(2) Over-sensitiveness; of skin, of mind, of organs.
(3) Sadness indifference, suspicion, jealousy.
(4) Foolish or childish behaviors.
(5) Stinging, burning pains, with rapid change of site.
(6) Violence and rapidity of complaints.
(7) Right sided symptoms go from right to left.
(8) Absence of thirst where it is expected, i.e., during heat, and also generally.
(9) Tight constrictive sensation in throat larynx, chest, abdomen.
(11) Inflammation and oedema: of skin, mucous membranes, serous membranes, synovial membranes, subcutaneous tissues.
(12) Urticaria and erysipelas.
(13) Cerebral affections, especially in children; meningitis, cri cerebral.
(14) Morning diarrhoea.
(15) Prostration faintness.
From heat close rooms, especially if warm (puls., iod., kali., iod., camph., secale., sulph.); from touch and pressure (except headache); in the morning (restlessness, diarrhoea); 3.p.m (chills) evening (erysipelas, vertigo, headache, fever); night; lying down (most symptoms), radiant heat (eyes,&c.), getting wet.
From cold, cold washing, expectoration (cough and dyspnoea), sitting, changing position.