Kimball S A
April 9, 1889.-Miss G-, a seamstress, 44 years of age, of medium size, dark hair, came to my office with the following history; She has been having epileptiform attacks for the last eight years, almost every month.
The first attack came on after seeing an old lady fatally injured by falling down an elevator well at a house where she was working. This was in February and the first convulsion occurred the following August, she having been in a very excitable, nervous condition since her accident. Her father was a drunkard, her mother and eldest sister died of phthisis.
Her present condition is as follows, some information being obtained from friends: The attacks usually come before or during the menses; they are apt to be induced from any over excitement or in an overheated room; she can not bear heat; the blood rushes to her head. Two or three days before an attack her head feels badly, as if all the blood were in the vertex; it burns and feels hot.
There is almost always an aura, a sizzling in the fore part of the head; sometimes, however, there will be no warning at all, as is shown by several scars on her forehead where she has struck herself in falling, and at the time of this visit her left eye and temple are black and blue from fulling on the stove. During the attack the convulsive movements are mostly in the lower limbs; she bites her tongue, making it bleed and very sore, but does not forth much at the mouth. She often passes urine during the fit and sometimes has an involuntary stool. .
After the fit she has a long, heavy sleep, and when she awakes her abdomen is very sore.
She began to menstruate when eleven or thirteen years old, and has always been regular but scanty, the flow lasting but three days.
Before menses her head feels badly. During menses the flow relieves her head. She sometimes has a pain in lower back.
Last summer she did not menstruate for three months, and her head felt badly all the time. Since then she has been regular not scanty.
Her appetite is good bowels regular. Face flushed. Tongue trembles on putting it out.
She can not bear anything tight about neck, must have everything loose. Her legs go to occasionally, usually the left.
Memory impaired. Can not remember dates or numbers and she has a rather dull, stupid expression.
Her last menses came March 26; two days before she had a convulsion without any waning and fell against the corner of the stove, striking the left eye and temple and causing the black and blue mark before mentioned. This shows that she fell toward the left side.
She has been taking bromides off and on for four years without any effect, and has lately been to a homoeopathic dispensary without relief.
The symptoms point to but one remedy, the heat and burning of the vertex, the regular but scanty menstruation, the relief by the flow of all head symptoms before menstruating, the inability to bear anything tight about the neck, the trembling of the tongue on putting it out; all these, with the general left-sided tendency of the symptoms, point unmistakably to Lachesis, and she received one dose dry of Lachesis cm.
May 30.-November on May 21, not as much discharge as usual. No convulsion before, no congestion to head before. Tongue does not tremble as much on putting it out.
Face still flushed and she can not bear anything tight about neck. Thanks she remembers better, is much more cheerful and feels very well. Sac. lac.
June 25.-Last menses came all right, no trouble, no convulsion. Is away for the summer at Williamstown, Mass. Sac. lac.
July 22.-Has been quiet well; last menses all right; no convulsions. Writes that she can not remember of being so free from trouble with her head as she is now. Sac. lac.
August 21. -Writes that she has the same story to tell; menses all right, no return of the convulsions. Sac. lac.
Sept. 17-Writes that everything has been all right this month. Sac. lac.
Oct. 21. -Returned last week from Williamstown, where she has been for the summer. She looks very well, and says she has not been as well for years. Menses have been regular; no headache. Once or twice this summer she has had a slight vertigo, and once a little pain in the back of the head. She appears very calm, not at all nervous. Good color, appetite good; legs do not go to sleep. Sac. lac.
January 16, 1890. -Has had no convulsions. In December she had an attack of congestion to the head with vertigo and nausea. She has had “la grippe,” with pains and aching all over. She was very weak after it, but has taken no medicine, and now feels very well. Sac. lac.
February 4.-She had a convulsion, January 24, two days before menstruation. She was sewing in a cold room and her feet were very cold, she became unconscious without warning, and on “coming to” found herself on the floor. She does not know how long she was in that condition; but it was probably a mild convulsion as there was no biting of the tongue, no involuntary stool or urine and no sleepiness after the fit, but she finished her day’s work and went home as usual. Menses came two days after, January 26, without pain.
Her head had been feeling badly before the convulsion, but feels all right now.
This was the first convulsion since March 24, an interval of ten months. The reaction of the vital force in a direction toward health which was set in motion by the dose of Lachesis given April 9, 1889, had evidently lost its forward impetus and was beginning to be overcome or go backwards, under the influence of the increasing abnormal condition. This retrograde action began the preceding month in December, as was shown by the attack of vertigo and nausea, and was increasing in force as shown by the convulsion of January 24. No doubt “la grippe” was to some extent responsible for this, as it interfered very seriously with treatment of chronic patients. It now seemed necessary in order to give another impulse to the reactive power of the vital force that either a new remedy should be selected or the last one repeated.
A careful review of the case disclosed the same general condition as at the first examination, although much modified, and many symptoms entirely gone. There being no indications for a new remedy, she received another dose of Lachesis cm.
March 4. Menses came February 25.
No convulsion, but for a week before menstruation she had a sharp pain in the back of the head extending to between the shoulders, and considerable pain in the teeth of the right lower jaw. There was no pain after the flow began, which lasted four or five days and was about normal in quantity; this was an increase in the length of time and amount over her usual condition. Sac. lac.
April 1. -Menses came March 24. No pain or convulsion before. The flow lasted four days; feels very well. Sac. lac.
June 11. Menses, April 22. Head felt badly two days before, with vertigo and rush of blood to the head, but no convulsion, and she was entirely relieved as soon as the flow began. The next period came May 22d. No trouble with head before menses; no convulsion, no pain during. She is now in excellent health and about to go away for the summer. Sac. Lac.
There can not be much doubt that this is a true epilepsy, the only disease of a convulsive nature that would require differentiation is hystero-epilepsy. In this latter affection the patients rarely injure themselves in falling, the attacks seem to have no effect upon their mental or physical condition, the tongue is not bitten, and the convulsions are marked by periods and phases. I can not find that such attacks are attended by involuntary stool or urine.
All of these symptoms were present in a marked degree in my patient, with complete loss of consciousness and deep heavy sleep after the fit, but I do not know whether there was a rise of temperature during the convulsion, which is regarded by some authors as a strong diagnostic point for true epilepsy in doubtful cases.
This case is not given as an instance of a cure of an epilepsy-two or three years immunity from convulsions would be necessary to insure that-but the decreasing of the number of convulsions from one every month to one in fourteen months promises well for a complete cure.
It also seemed worthy of note as well illustrating the effect of the action of a properly selected remedy upon the vital force when compared to the oscillations of a pendulum. We have the long swing toward health of eight months from April to December, 1889, the backward swing of two months to the convulsion of January 24, 1890, then the forward swing of two months to April, then the slight backward swing of one month, as shown in April by the vertigo and rush of blood to the head, then the onward swing toward health to a state of rest which is now continuing, and which, it is hoped, will be lasting.
DR. CARLETON: I have never listened to a paper with more pleasure and I trust with more profit than that one. It covers a great deal of ground and shows deep thought.
DR. KENT: He did not repeat. he let the remedy alone and let the patient get well, and that is always a good lesson.
DR. KIMBALL: Boenninghausen once said that when in epilepsy the memory was impaired, he had always found the case very difficult to cure. Has anybody here verified that?.
DR. KENT: What Boenninghausen said I think was this: If the mind was impaired in the direction of true imbecility, the case was a very grave one. But the memory may be impaired, and very generally is in epilepsy, but that memory may be impaired, and very generally is in epilepsy, but that does not necessarily make a grave case. Weakness of the mind looking towards imbecility does, however, make the case a grave one.
DR. BUTLER: I have case of epilepsy on which I would like some help. A girl, of twenty-four years, who had suffered from epilepsy since she was five years old. She came into my hands about a year ago. For a long time she had been under old school treatment and her organism had been under the influence of bromides for years.
A so called homoeopathic physician, my immediate predecessor, had given her morphine for pains here and there, and she became an habitual morphine eater. She was taking about three grains a day and had to be given a dose before she could be persuaded to let me see her.
I found the girl about twelve years old, mentally. That was her last dose of morphine, and it was a hard fight to get her out of the habit. She made things lively for the neighbors. As her remedy, I was led by a careful comparison of symptoms to select opium, of which she received one dose and has never received another. When she got out from under the influence of the bromides and morphine she commenced having convulsions every other day, and sometimes every day.
She had a very peculiar aura; it was an impulse to run. She would suddenly run into another room and fall into a convulsion: She has convulsions about once a week, without biting her tongue, as she formerly did. For the last three months all her symptoms are lighter, but not less frequent. General health improved most wonderfully. She has become a rather plump girl; jolly, good-natured, never cross; and she has not grown a particle, mentally, but still remains as to her mind about twelve years old. She has still the same aura, but lighter.
DR. CAMPBELL: I would suggest Belladonna.
DR. KIMBALL: I think Sepia has that symptom.
DR. SAWYER: I have treated a number of cases of epilepsy successfully and I have never cured one without producing an eruption. An old eruption reproduced and the cure becomes simple and easy. Dr. Kimball’s case is a magnificent one.
DR. KENT: Some two years ago an epileptic patient came to me with an eruption over the palms of the hands. The case bothered me for some time. The convulsions came both day and night, most violent in the night; they were very prolonged. I carefully selected Silica as his remedy. They gradually became has frequent and less violent until a condition that might be called petit-mal ensued; this improved finally into a vertigo. At the present time he occasionally has a feeling come over him, as if would become unconscious; it amounts to an absentmindedness.
It may last two or three seconds and then pass away. It has been ten or twelve months since the last convulsion. His mental condition is also greatly improved. He has had a continuous succession of boils ever since. His age is about forty-six or seven, and he has had epilepsy thirty years. He had two doses of Silica.
DR. CUSTIS: I have been particularly interested in epilepsy and particularly unsuccessful in treating it. I never have cured a case, although I have thought several times that I had.
One man, with inherited epilepsy, came to me, whose case I studied very carefully. I soon found that sweet things aggravated his trouble; in fact, if I could keep him from touching anything sweet he would have no attacks. But he had an uncontrollable craving for sweet things; it was as strong as come men have for liquor. He would actually steal preserves and sweetmeats from his own wife. For two years we managed to control his appetite, but the first time he ate of sweetmeats, which was in Paris, he had a severe attack and died.
One reason of my poor success is, I think, that all my patients had been saturated with the bromides. I have two children to whom epilepsy has clung from birth up to the present time; one is sixteen and the other twenty-five. Neither has ever taken any bromides, but both Dr. Hering and Dr. Lippe failed on these cases. I have found the avoidance of sugar a help in epilepsy.
DR. REED: I have only had one case of epilepsy-a Swede girl; The trouble started at her fourteenth year from a fright while playing with her sisters. She touched a goose egg with a stick; it exploded with a loud noise and threw her into a fit. She would have two or three attacks in the night and terrible ones the next day. One dose of Calcarea cm. was what I gave her. Six months of freedom from them followed; they then came back and I have never been able to control them since.
DR. KENT: It is perfectly proper to ask why we fail to cure epilepsy; -sometimes because the symptoms of the disease are marked by the previous drugging, and sometimes it is difficult to find symptoms peculiar to the patient, because there are so many symptoms peculiar to epilepsy which would be worthless on which to prescribe. There is nothing peculiar and distinctive about epilepsy to prescribe for; but there is in every patient, if we can find them, peculiar symptoms not distinctive of epilepsy, which are important as guide posts to the similimum.
Violent screaming, sinking in the pit of the stomach, as aura in the knees of in some particular part of the body, or an awful fear; these are peculiar and worthy of study, because they are peculiar to the patient and not peculiar to epilepsy. On the other hand, the biting of the tongue, the fall, the frothing at the mouth, the rigidity of the muscles, are common to all cases of epilepsy, and are poor things to prescribe on.
DR. SAWYER: I do not believe there ever was an epileptic who did not have either sycosis, psora or syphilis. Too much eating, too much work, and so forth may be the exciting cause, but there must be a predisposing cause at the bottom.
DR. KIMBALL: The symptoms for Lachesis were very evident in my patient. Dr. Lippe quotes Boenninghausen as saying that cases with night attacks followed by headache are almost helpless; hot, says Lippe, he did not have at that time the proving of Bufo which is often indicated in such cases.