MR. PRESIDENT, LADIES AND GENTLEMEN,.
In presenting to you this study of one of our most interesting remedies I shall not be telling you anything about it that you do not already know. But I shall be presenting it to you in a form with which you are perhaps not familiar. We have all studied the remedy from Kents Materia Medica and Clarkes Dictionary, as well as from other sources, and their various presentations are masterpieces of their kind. But they are perhaps not altogether in line with modern medical teaching.
The present day newly qualified medical man and woman, whom we hope to attract to our ranks and whom we need urgently to carry on our work in the future, is apt to be unattracted by the form in which they are written; a mass of symptoms with not direct reference to the various system of the body involved.
In my opinion we do need a book written on new lines which will give a living picture of our remedies combining the brilliant mental sketches of Kent with an account of the underlying clinical condition of the patient. The account of Ignatia that I am about to read will, I hope, give you an idea of what I mean.
CHARACTERISTICS: All the symptoms, nervous and functional, are characterized by their variability and inconstancy; their paradoxical and contradictory character.
MODALITIES: Aggravation by emotion and sorrow, by cold, by strong odours, by tobacco, coffee and alcohol.
Amelioration by warmth, by strong pressure, by walking about.
Its predominant characteristics are:.
2. The pains, which paradoxical and contradictory like all symptoms of the remedy.
3. The anguish that the patient suffers.
Let us take first the instability or variability of the manifestations of Ignatia. This is the outstanding characteristic of the remedy. Nothing is stable and one can never be certain of the next day or even of the following hour. The patient, who appears at one moment to be desperately ill, will shortly after appear well and cheerful.
A changeable disposition is an outstanding feature. The patient passes abruptly from severe depression and sadness to extreme cheerfulness. But what characterizes the remedy is that in each of these alternating conditions the patient is sincere, whether he be sad or happy.
All the painful sensations of Ignatia appear abruptly and sometimes disappear gradually, but more often they disappear abruptly also.
This instability of Ignatia must not be confused with the variability of the symptoms of Pulsatilla. In the Materia Medica we read that with Pulsatilla everything is variable. It is the same with Ignatia, but in this case the picture is dominated by the constant instability, whereas Pulsatilla presents a more limited variability. Although the pains of Pulsatilla are erratic like those of Ignatia and although they appear abruptly, they never, on the contrary, disappear in like manner, but always gradually.
The cause of the symptoms of Pulsatilla is much less the nervous system as in Ignatia, but the state of the circulation which is affected, i.e. venous congestion, cyanosis of the extremities, delay and scantiness of the periods. These are the invariable signs of Pulsatilla, whereas with Ignatia all the symptoms may vary from one moment to another. The instability of all symptoms is the outstanding characteristic of Ignatia.
On the other hand the origin of the variability of the Pulsatilla patient arises always from a Tuberculinique intoxication, but with Ignatia there is usually found a condition of auto-intoxication. The instability of Ignatia always shows itself by its acuteness. The patient will be not merely tired out, but he will be low-spirited and depressed; he will not be sad, but very sad. Then suddenly the next hour he will be on the contrary in good spirits. All the variations are governed by hypersensitivity of the nervous system, the hypersensitivity which is another characteristic of the remedy.
THE PAINS AND HYPERSENSITIVITY OF THE NERVOUS SYSTEM.
The pains of Ignatia are always acute, always violent. The patient reacts in an extreme fashion. This hypersensitivity is well known to the dentist and when a patient has teeth which are extremely sensitive to the drill, the remedy that will allow the dentist to work comfortably and the patient to bear the pain easily will be Ignatia.
Hypersensitivity to pain is also found in other remedies such as Aconite, Chamomilla and Coffea. With Aconite is found great anguish and fear of death. The patient feels his symptoms more acutely than most people and this hypersensitiveness is accompanied by great anguish and anxiety.
Chamomilla also has hypersensitiveness to pain, but at the same time exhibits vaso- motor troubles: the patient has one cheek red and the other pale, perspiration of the head and marked agitation. Coffea also exhibits hypersensitivity to pain and this is accompanied by insomnia. The patient thinks without ceasing of all sorts of things, and ideas pass through his brain with surprising rapidity.
The pains of Ignatia, in addition to being, sharp and acute, cover small circumscribed areas. The Materia Medica does not actually say that the areas can be covered by a finger as in Kali bichromicum, but this description applies to both remedies, only whereas with Kali bichromicum the pain is caused by a lesion, i.e. an ulcer or a neuritis, with Ignatia it is due to a sensory disturbance such as a neuralgia which is fleeting and comes and goes and always has the same characteristic, i.e. instability. The pains, however, have a certain regularity and they come at the same time. This regularity reminds us of Cedron, the pains of which have a daily fixed time of appearance.
If the pains of Ignatia are regular in the time of their appearance, they are not regular in their position, but are erratic and movable. For this reason they can be compared to those of Pulsatilla and Kali bichromicum. Their abrupt appearance and disappearance recall the pains of Magnesium phosphate.
Another outstanding characteristic of Ignatia is that all the manifestations of the remedy, painful or otherwise, functional as well as mental, have a paradoxical and contradictory character. All the symptoms are ameliorated by things that would aggravate any other patient: in other words, the modalities of Ignatia are the reverse of those which are usually found with other remedies.
For example, if the patient has buzzing in the ears, this will be better in a noisy place or on listening to music. If he has a sore throat the will be better on swallowing solid food. If he is nauseated this will be relieved by taking food.
The hypersensitivity and instability of the patient have certain habitual causes. The first is grief, often caused by some severe shock, such as the loss of a dear relation or friend or a disappointment in love. Another cause is nervous overstrain, such as is seen in intellectual people who do not have enough physical exercise and who are very sensitive to tobacco smoke and to coffee.
Other causes of this emotional condition are strong odours, such as those of perfumes and especially the odour of tobacco which will often bring on an attack of migraine. In the Materia Medica there is only one remedy which is, on the contrary, ameliorated by tobacco smoke and that is Tarentula cubensis. The patient needing this remedy may have an abscess or gangrenous condition characterized by severe burning pain with rise of temperature and rapid pulse and symptoms of septicaemia.
Strangely enough this patient is quickly relieved by tobacco fumes, not cured, but the pains is eased. The aggravation of the Ignatia patients symptoms from tea and coffee, particularly from coffee, is well known and often the patient has abused these drinks and also alcohol.
But here we must add that symptoms eased by abuse of tea are more marked with Thuja than with Ignatia. The Ignatia patient drinks three or four cups of coffee in order to be able to continue to overwork. It is quite evident that in order to get a result from Ignatia, the patient must be made to give up coffee.
The patient is always relieved by warmth, by warm drinks and warm applications to painful parts. He is also better when he walks about and particularly from recreation. If a patient comes to you very upset by some occurrence and you can distract his attention from the matter and make him think of other things, he feels better at once.
Let us now study the Ignatia patient from a clinical point of view.
THE DIGESTIVE SYSTEM.
This is the most frequently affected system. It must not be imagined that the Ignatia patient is only of the nervous order. He can and often does present digestive symptoms. His lips are dry and parched, his month dry, and he suffers from thirst. The inner surface of the lower lip is excoriated and fiery in appearance. The tongue is large, swollen and shows the imprint of the teeth.
This is not a characteristic sign of Ignatia alone, as it is also seen with Mercurius. But with Mercurius the mouth has a foul odour and the tongue is covered with a white or yellow fur, especially on its posterior part and there is increased salivation. Ignatia also shows increased salivation.