Juniperus sabina : savine. Oil of savine. N.O.Coniferae.
THE older books on therapeutics refer to savine only very briefly: even Ringer dismisses it in a few lines by saying that it is used for both menorrhagia and amenorrhoea, and that ignorant people used it to procure abortion.
The oil of savine is a volatile oil, made from the fresh leaves and green tops of this juniper, and it owes its activity chiefly to the aromatic hydrocarbons, called terpenes, which it contains.
It causes hyperaemia and irritation of the abdominopelvic organs, and indirectly causes uterine contractions and a swollen, tender condition of the uterus, which passes clinically for metritis. In the event of pregnancy the contractions may bring on abortion, and most of the poisonings, some of them fatal, have been caused by doses administered for this purpose, which however is not always accomplished.
Poisonous doses cause abdominal pain, centring in the navel, vomiting, purging, with blood in the stools, tenesmus, albuminuria, haematuria, anuria, collapse, convulsive attacks, coma and death.
Provings add some effects due to minute doses. There are eructations of tasteless gas and vomiting of bile and undigested food. The mouth and the food (milk, coffee, &c.) taste bitter, and heartburn is present, in spite of which there is a desire for sour things, especially lemons. Bleeding from the bowel takes place, the blood being bright red; piles may be induced, with bleeding of a similar character.
The genito-urinary organs suffer as stated: burning pain in the vesical region, urging to urinate, with much dysuria, and even haematuria may be present. There may be burning pain in the urethra (both sexes) during micturition and independently. Besides the umbilical colic referred to above, there is crampy, forcing pain, extending from the same region to the pubes and pelvis, like uterine contractions, and passing down into the thighs. there are also pains deep in the vagina, shooting upwards, with uterine tenderness and intermittent pains, which indicate hyperaemia of the female pelvic organs. Profuse menstruation of bright blood, the flow being more during movement, is a sabina feature, especially when associated with labour-like pains, extending from the sacrum through to the pubes and down the thighs. Clots are mingled with the fluid blood.
The pelvic pains of sabina some what resemble those of actaea but they are more acute, more resemble those inflammation, and the menstrual flow is decidedly in creased by sabina. Another resemblance to actaea is the conjunction of pelvic with joint and muscle pains, like the pains of rheumatism or those from sprains or over exertion, and worse from movement and from pressure. The back, the extensor muscles of the thighs, the heels affected. Exertion causes shooting pains and a weak, paralysed feeling and the painful parts swell up and become red and shiny.
Headache is a natural accompaniment; it is a bursting pain in the forehead, which extends to the right temple and right side of the face. It comes on suddenly and leaves slowly and is relieved in the open air. There is some dysphagia.
The curative virtues of sabina are clearly indicated in the foregoing pathogenesis. The chief spheres are the abdomino- pelvic and the joints and muscles-together or separately. The indication is stronger if both spheres are affected at the same time.
Dysmenorrhoea of intermittent type, “like labour pains,” would indicate sabina, if associated with pains going down the things, and from the sacrum directly through the body to the pubes, and with menorrhagia, the blood being bright red and clotted. If the bladder and rectum were involved, as with a degree of sepsis after abortion or labour, the call for sabina would be louder. Experience seems to show that dysmenia in subjects who begin to menstruate at an early age, often presents some of these features and requires sabina in its treatment.
Miscarriage taking place about the third month is said clinically to present features like sabina poisoning, more frequently than that occurring at other times, and is consequently likely to require that remedy. Before prescribing it, it would, of course, be wise to make sure that the abortion was not due to dosing with this poison. That having been ascertained, when the patient’s condition corresponds with the sabina pathogenesis, it may be given with some confidence as a prophylactic in threatened abortion.
Acrid, thick, offensive leucorrhoea after abortion or labour in uncleanly conditions is included in the sabina picture, with tenderness over the pubes and, when the catamenia become re- established, with menorrhagia.
When the acute stage, after abortion or labour, is passed, joint pains, due to mildly toxic absorption, may come on and supply additional evidence in favour of sabina.
This remedy has been used with advantages as a palliative in menorrhagia and metrorrhagia associated with uterine fibroids (myomata).
The indications are bright, intermittent flow with forcing pains. The impression give is that blood coagulates in the enlarged uterine cavity, temporarily arresting the flow, until the increasing accumulation of blood stimulates the uterus to contract, and mixed clot and fluid are expelled with pain. the bleeding may sometimes last, with intermissions, until another period is due. Uterine haemorrhages are common in mental patients and sabina may occasionally be required.
Retained placentas may be a cause or a complication of the menorrhagia requiring sabina. Metritis and ovaritis with such causes and symptoms require consideration for the claims of sabina.
Intermenstrual pains and bleedings associated with sexual excitement may require the remedy.
The candidate for sabina is likely to be a sensitive women, nervous, highly strung and very susceptible to the influence of music, which “goes through” her, causing palpitation or tremors.
The sabina “rheumatism ” is worse from movement and in warm rooms and warm air. It may be of gonorrhoeal origin with transitory redness and shining of the inflamed joints, toes, wrists, &c., and stiffness and weakness. Mental depression is often prominent in these patients.
Gouty joint pains may require sabina, especially the pains in the heels of old men, rendering walking difficult, and causing tenderness on pressure and making it difficult to find a comfortable position for any length of time. The feet become hot and burning in bed, causing restlessness, and making the patient want to put them out of bed to cool them (as in sulphur cases). In such subjects piles, which bleed, burn and itch, are often associated with the joint pains, and unless the modalities of some other deeper-acting drug give it a prior claim, they confirm the choice of sabina.
The wrist is another favourite site for gout or rheumatism requiring this remedy. A feature of these arthritic cases is that joint pains and haemorrhages-rectal or uterine-may alternate.
Success has been obtained with sabina in cases of varicosis, either in the limbs or at the anus for piles which bleed freely. In some cases of kind pulsation or throbbing is felt all over the body, and seems to be located in the veins, a feeling of fulness or puffiness in the parts is described. Where the piles are chronic, constipation in a sabina case is commonly present. In cases where genito-urinary symptoms of an acute type co-exist, the bowel symptoms would be looseness or diarrhoea, with blood in the motions, and tenesmus. In the drug this complex is found in poisoning cases, and in disease in septic cases following miscarriage or labour.
Urinary System.-The acute symptoms in this sphere have led to the use of sabina for gonorrhoea and acute urethritis and vaginitis, not of gonococcal origin, such as coli infections.
Old, copious, blood-stained leucorrhoea is said to be amenable to sabina. It is hardly necessary to raise the warning that with such a discharge the cause should be exactingly sought for. Warty excrescences or condylomata around the anus and vulva have responded to this remedy when it was well chosen.
(1) Pains (head) come suddenly and leave gradually.
(2) Pelvic pains shoot: (a) from sacrum to pubes; (b) from pubes down front of thighs; (c) from deep in vagina towards navel.
(3) Pelvic pains intermit like uterine contractions.
(4) Sensitiveness to sounds, especially music.
(5) Craving for sour things, in spite of presence of heartburn.
(6) Bleeding from urinary tract and lower bowel; the blood is bright, strangury and tenesmus accompany.
(7) Blood bright and partly clotted.
(8) Named Disorders.-Menorrhagia, metrorrhagia, dysmenorrhoea, “after pains, retained placenta or moles (promotes expulsion); threatened abortion or effects of abortion; acrid, offensive leucorrhoea; mild, septic, gonorrhoeal or coli infections, warts and condylomata; nephritis, cystitis.
Piles, with bright haemorrhage and straining, proctitis; conjunction of uterine, bowel and bladder symptoms.
Rheumatic, gouty or gonorrhoea joint affections.
From warm rooms and warm air; and from movement.
pressure, open air, warmth (dysmenorrhoea).