The skin symptoms are in relation to menses or uterine diseases. Calcarea has leucorrhoea of a copious, milky, sometimes purulent character with sweat on labia. Graphites has perhaps even more copious leucorrhoea, but it is more watery, and sometimes gushes out, especially mornings or during the day.

(From the Pacific Coast Journal of Homoeopathy.).

I CONSIDER these diseases constitutional and treat them as such. Leucorrhoea is often a desirable drainage which must not be suppressed, but assisted. Hence I look upon gynecological conditions not as local affections, but as part of a diseased organism. I use such remedies, which manifest a general constitutional affinity for the female organism or organs. That some remedies should have a more specific action in diseases of women than in men, I can admit only with reservations. I have seen Sepia, which is reputed to be a ladies remedy, act astoundingly in men. Nebel asserts that it is a splendid draining agent.

In gynecological conditions I consider a local examination absolutely necessary in spite of any following constitutional treatment. A physician should not rely only upon subjective symptoms. Many local conditions of the female pelvis are in correlation to, or affected by diseases of the liver, kidneys, lungs, intestines, etc. An important role is also played by gonorrhoeal infections if a suitable soil is found.

On the other hand a large contingency of patients with disturbed functions of the female apparatus comes for treatment, in which the most painstaking local examination finds nothing abnormal. Here the general, subjective and mental symptoms are of the greatest importance in the choice of a remedy, e.g. in sterility.

Leucorrhoea is the condition we are most often called upon to treat. Here we find in the first line remedies Acidum nitricum, Alumina, Calcarea carbonica, Carbo vegetabilis, Graphites, Kreosotum, Lilium tigrinum, Mercurius, Natrum muriaticum, Pulsatilla, Sepia, Sulphur, Thuja.

If there are no specific reasons for other remedies, I start my treatment in young girls affected with mild, catarrhal discharge by giving Pulsatilla, especially if the discharge is thick like cream, and then Sulphur or Sepia, according to symptoms, are given. If these remedies are not sufficient to effect a cure, then Calcarea carbonica or Graphites come in question. In children Mercury or Calcarea carbonica are mostly indicated. In women the symptom complex usually points to Sepia, which is well followed by Natrum muriaticum.

If there is suspicion of gonorrhoea, even if lying far back, my first choice is Thuja 30. In the selection of Sulphur, our greatest remedy which is also a fine drainage agent, the general characteristic are: blood impurities, heat on vertex, burning of soles of feet relieved by sticking them out of bed, weak feeling in stomach around 11 a.m.; drinks much, eats little; aversion against bathing and meat. Redness of mucous membranes at orifices. The leucorrhoea is slimy, yellowish, more acrid than in Pulsatilla, sometimes causing a little burning and intolerable itching of vulva.

The leucorrhoea of Sepia can cause much more itching; above all things it is very acrid, excoriating, purulent, at times purulent-sanguinous, often of offensive odour. The skin symptoms are in relation to menses or uterine diseases. Calcarea has leucorrhoea of a copious, milky, sometimes purulent character with sweat on labia. Graphites has perhaps even more copious leucorrhoea, but it is more watery, and sometimes gushes out, especially mornings or during the day. Natrum muriaticum has mucous discharge and symptoms change frequently; backache with desire for bracing back, worse from needle work.

Lycopodium has a yellowish-shiny discharge; patient is never without flatulency; troubles go from the right side to the left, in the throat as well as in the pelvis. Alumina has protracted acrid leucorrhoea like albumin, running down the legs. In Arsenicum the leucorrhoea is burning and thin, and of foul odour with rapidly sinking strength; great thirst, but drinks only small quantities often. Carbo vegetabilis has very foul-smelling, corroding, sometimes bloody leucorrhoea, and stinking, moist-warm flatulus.

Kreosotum has sanguinous and more brown discharge making underwear stiff; itching; mild or acrid, often following coccygodynia. The brown discoloration is even more characteristic of Lilium, but when it follows menses, it is bright-yellow; severe bearing down forces patient to press hard against vulva. Mercurius has a more greenish or purulent leucorrhoea, often with shreds, worse nights. Acidum nitricum has profuse brownish or flesh coloured discharge with urine of pungent, foul odour.

While going over to other so-called female diseases, I can, of course, touch only superficially upon them. Pruritus vulvae is a crux in which, next to Sulphur, Sepia, has aided splendidly; in old women remember Conium, and in exaggerated sexual irritation Calcarea carb. and Platina, and if haemorrhoids are present, Nux vomica.

If there is no sexual desire, then I give Natrum muriaticum or Phosphor.; where labia are inflamed, Mercurius or Sepia are indicated. Vaginitis is usually of gonorrhoeic origin, and aside from external treatment, I use Mercurius 6 and Cannabis, and Cantharis 6 during the acute stage; but if ulcers are present Hepar sulphur is given, and if the secretion is sticky and bloody, Acidum nitricum is indicated. In chronic cases, besides the last named remedies, Thuja 30 is important. Acute metritis, resp. endometritis demands Aconitum and Belladonna in the beginning, later Sepia, Pulsatilla or Mercurius, according to their characteristic symptoms.

In chronic metritis the general symptoms are more important, and the Gold preparations should be consulted, as also Magnesia muriatica, and sometimes Cocculus. In bleeding, my main remedies are Crocus: dark, tenacious, aggravated by the least motion; Belladonna: violent , bright-red with convulsions; Chamomilla; hot, lumpy with great excitement and hyperesthesia; China: has great weakness and convulsions. Malposition of the uterus I treat entirely constitutionally according to the general and local symptoms.

In polypi of the uterus I give Thuja, Calcarea carbonica, Lycopodium, Conium and Aurum, as the main remedies, but, of course, many other medicaments may present themselves. Malignant neoplasm can only be treated successfully by homoeopathic remedies if he diagnosis is made early; advanced cases can be supported with relief of complaints; post operative recurrences are least amenable to treatment.

The best results I have seen from Arsenicum, Carbo animalis and vegetabilis, Aurum, Kreosotum, Hydrastis canadensis in tincture or dec. 2, Lachesis and Conium; Graphites and Thuja have aided well in one case. In acute, ovarian troubles I use Aconitum, Belladonna, Bryonia, and in very painful cases Colocynthis. In subacute cases Apis is the chief remedy, also for cysts, besides Iodum and Thuja. In gonorrhoeal infection the gonorrhoeal remedies must be studied. In ovarian neuralgia Magnesia phosphorica 6 and Colocynthis are most frequently indicated.

In menstrual disturbances I always had the best results, if I treated the patients constitution with the indicated remedy in the 30th centesimal potency. But in severe menorrhagia and dysmenorrhagia, if there were no mechanical causes present, I used remedies of more local action in the 6th centesimal potency during, or shortly before menses.

In amenorrhoea I employ Pulsatilla, Ferrum and Graphites; in epistaxis with congestion to the head Belladonna as also Bryonia as intercurrent remedies. Kali carbonicum has served me well in these conditions, and sometimes Calcarea carbonica. In suppressed menstruation the cause indicates the remedy: fright Aconitum; if condition is sudden with severe congestion to the head with epistaxis Belladonna; following anger Chamomilla or Colocynthis; following suppression of foot sweat Silicea, which has also served me well (when other symptoms indicated this remedy) if scanty menses was too early.

Scanty, insufficient menstrual flow demands next to Pulsatilla also Sulphur or Graphites. If severe abdominal cramps with vertigo and nausea accompany the condition, then Cocculus usually acts promptly. In melancholy, sad patients think of Natrum muriaticum; in nervous patients remember Sepia.

Frequent and copious menses require Chamomilla or Nux vomica or Ipecacuanha, and if pains are very severe Ignatia. If getting wet is the cause: Dulcamara is the remedy, which also often has bladder troubles accompanying; after cold bathing Antimonium crudum, especially if patient has facial acne; following jealousy Ignatia; in suppressed anger of long standing Staphisagria 30th centesimal potency.

In dysmenorrhoea the most reliable remedies are Cocculus and Cuprum if menses are slow in coming; the first has more nausea and vertigo, the last convulsive retching, vomiting and convulsions; Chamomilla and Ignatia if flow is profuse, as also Magnesia phosphorica which has also shooting, lightning-like pains. Belladonna and Nux vomica can be indicated as well as Viburnum opulus tincture, which latter also relieves cramps and pains, and prevents these when given in time.

Now for a few words about difficulty during pregnancy. Here I think first of Pulsatilla 30th centesimal potency, which is valuable in easing the pains. When nausea and vomiting are present, Ipecacuanha or Nux vomica are indicated; if hey are not sufficient give Sulphur or Sepia; if epistaxis is present Bryonia or China, the latter especially in flatulency; palpitation demands Aconitum; patient very fearful and weak Arsenicum; urinary difficulties Pulsatilla, sometimes Nux vomica; pains in mammae Bryonia.