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.
Other important signs found under Ignatia are:
The aerophagy is caused because of the hypersecretion of saliva which is swallowed and with it, air. The patient has a sensation of constriction of the pharynx and feels as if he has a ball in the oesophagus, which gives him a feeling of being strangled. This constriction is brought on by any emotion or opposition and disappears as soon as the patient swallows, even if he swallows only air. In the same way if he has a sore throat the pain is relieved by swallowing, especially if he swallows some solid food.
The patient is often hungry, suddenly hungry, and this is accompanied by a feeling of faintness in the epigastrium. This may happen at any time of the day, but more especially at 11.00 A.M. The patient feel suddenly exhausted and is compelled to take something to eat, but this does not relieve him. This is unlike Sulphur, who feels the sudden need of food in the middle of the morning, but is relieved by taking a snack.
The feeling of faintness of Ignatia may occur when the patient is in bed or sitting down, whereas the same faintness with Sulphur is especially noticed when the patient is standing, for he is a person who cannot stand up for very long.
Another symptom which accompanies the faintness is the continual yawning and involuntary sighing, of which the patient is unaware. The yawns and sighing are more marked before food and in tobacco fumes and then may also cause hiccough.
Nausea is a frequent symptom of Ignatia and it is relieved by taking food. The patient may sit down at table to eat and after a few minutes he wants to be sick. He then gets up and vomits and afterwards sits down and eats a good meal without any ill effects. This is seen with very nervous people who sit down at table with their family and are upset by something.
The patient can eat raw carrots or lobster, but if he has simple meal he has abdominal pain and sickness. In comparison, Bismuth also has a paradoxical symptoms with regard to drink. The patient is ill if the drinks water, whereas wine does not affect him at all. This is the only paradoxical symptom of Bismuth, whereas the paradoxical character of Ignatia is found in all its symptoms.
The patient is often constipated and this is due to spasm of the bowel. If an X-ray is taken for intestinal trouble that has often lasted for a long time, the same picture is always seen. There is ptosis of the colon, which looks like a string of chestnuts. When the patient brings you an X-ray showing this picture and says that he has had all sorts of regimes and treatments you can be certain that he is amenable to Ignatia, or at least that he will need Ignatia among remedies top cure him.
Another interesting symptoms is an acute pain on going to stool, especially if the motion is soft. When he is constipated the patient has no pain. Intestinal atony is marked, especially with people who drink much coffee. The caecum is distended and pain in the appendix area is marked. This is not due to an appendicitis, but to spasm of the caecum. Prolapse of the rectum and haemorrhoids are often present.
The prolapsus is seen not only when the patient goes to stool, but when he stoops. The pain of the haemorrhoids is acute and as if he had a packet of needles in his rectum, and it is noticed when he coughs or stands or sits, and disappears when he gets up and moves about.
Another intestinal symptom is diarrhoea, a sudden from of spasmodic enteritis brought on by emotion such as an examination or before going to the theatre, or even on entering your consulting room. Another remedy, Gelsemium, has a similar diarrhoea. In this case the diarrhoea may by caused by bad news, such as the death of a friend or financial loss.
THE CHEST SYMPTOMS OF IGNATIA.
The cough is dry and persistent. On examination nothing abnormal is found in the trachea or lungs. The cough appears suddenly under the influence of emotion or annoyance. The patient coughs and coughs and the more he coughs the more he wants to cough and more he wants to cough and then sudden for no apparent reason he stops. He is then exhausted.
HEART SYMPTOMS OF IGNATIA.
The chief one is an emotional tachycardia. It appears suddenly and often occurs in the consulting room when the patient is being examined. It will also appear on the receipt of bad news. There are two outstanding sings; the pulse is very variable and may show astonishing variations from 70-120 beats per minute.
The arterial tension is also very variable and at the beginning of your consultation may be 190, but the needle of your sphygmomanometer will after a few seconds drop to 170, and if you take the blood-pressure at the end of your consultation it will be down to 150. Such an unstable arterial tension should make one think at once of Ignatia.
THE HEADACHES OF IGNATIA.
These appear abruptly and are at once very severe. They are often migrainous in type and occur in patients who are fatigued and overworked both physically and intellectually. They are aggravated by noise and light. They are also brought on by odours, especially that of tobacco. The whole head may be affected or only one side. The pain is beating in character, like blows of a hammer.
The patient says it is as a nail were being driven into his head, usually in the temporal or parietal regions. The pain is always relieved by pressure, by lying on the painful side. When the pain disappears the patient immediately passes a large quantity of urine. This reminds us to two other remedies, Gelsemium and Silica. Lac defloratum also passes a large amount of urine, but during the migraine.
THE MENTALITY OF IGNATIA.
Ignatia is said to be a remedy for women and Nux vomica a remedy for men. Strictly speaking this is not true. Nux vomica certainly is more suited to masculine temperaments and Ignatia to feminine temperaments, as the latter are more hypersensitive. In studying Ignatia one must not fall into the error of thinking that the remedy is purely nervous, exasperated and paradoxical. It certainly corresponds to many of the hysterical patients whom you see in the clinics or consulting rooms, but there exist two forms of Ignatia mentality.
The first is a state of profound depression, which may suddenly overwhelm the patient after great sorrow, such as the loss of a dear friend. The patient wishes to be left alone in her sorrow. She does not weep, but is in a state of profound shock. The second form very frequently is seen: i.e. with a certain type of woman who in the morning or afternoon is annoyed or upset by some member of her family, often, of course, her husband. She then has headache, nausea, abdominal pain and goes to bed with raised temperature and sulks.
Then in the evening a friend unexpectedly arrives with a bunch of flowers and proposed to take her to the theatre. Immediately all her symptoms disappear and she is happy and pleasant to every-body. There is, therefore, with Ignatia, on the one hand profound depression and on the other a marked instability of temper. When the patient is depressed, she always begins to suffer in silence and becomes melancholic. But when she is exasperated, she tends to quarrel with everybody around her. She may also even have convulsions and tremblings, and then becomes much more likely to need Gelsemium.
In chronic disease when the patients nervous hypersensitivity makes her amenable to Ignatia, it is best to give a dose of the 200 or 1m to desensitize the nervous system, for this will bring out the underlying symptoms and permit the deeper acting remedy, that may be indicated, to have a better chance of acting.
In acute conditions when instability of the nervous system is most in evidence, Ignatia is then the remedy that will restore the patients equilibrium.
Finally, what are the remedies complementary to Ignatia? Instability of the nervous system is, as we have seen, the general characteristic of Ignatia. It is this factor that enables Ignatia to restore the patient to his normal equilibrium. But it must not be thought that all patients showing mental instability are amenable to Ignatia. Each patient reacts according to his temperament and type.
In the troubled times through which we have lived during the past few years, people have been affected by their circumstances of peril and danger. Some are little affected, others are much affected. Some are depressed and others irritated. Homoeopathy does not offer them sedatives in the ordinary sense, but it can give them remedies which are efficacious so long as they are prescribed on the indications given in our Materia Medica.
In comparison with the nervous instability of Ignatia, we can described two states which cannot be confounded with it and the study of which is of great interest, since these two states correspond to two other remedies, Gelsemium and Sepia. The Gelsemium patient is extremely sensitive and irritable. The slightest trouble upsets him completely. Not only does bad news depress and dishearten him, but it causes tremblings, diarrhoea and insomnia. Being unable to bear any contradiction or opposition, he is afraid of conversing or discussing affairs with others.
He avoids the society of his fellow creatures. He desires above all peace and quietness and seeks to be alone. He cannot control his actions or his muscles and flies into a temper for the least thing or trembles on any exertion or emotion.
This weakness is marked and may even lead to incoordination of his limbs. His pulse is slow at rest and accelerated on movement. He passes gradually into a state of apathy and difference and does not want to speak or drink. He suffers also from severe migraine, preceded by ocular disturbances.
The Sepia patient is characterized by sadness and indifference. His depression is profound and he looks only on the black side of things. He is apathetic and cares not for his family or his family duties or pleasures. Nothing interests him and he desires to be alone. Any attention from his friends irritates him. He does not exhibit the nervous irritability of Ignatia with its alternations of exaltation and depression. With Sepia, the depression is constant and it does not vary. The liver is often affected, leading to portal congestion, constipation, haemorrhoid and symptoms of pelvic congestion.
Ignatia, Gelsemium and Sepia correspond to three different nervous conditions, between which a certain relation can be established. An Ignatia patient may become Sepia. A Sepia subject may become one of Gelsemium, owing to the action of various toxins which are operating on the system, toxins of autogenous or tuberculous nature. But with the Ignatia patient we must think of the possible origin of his troubles and also of the possible consequences of their long duration if an efficacious treatment cannot be found to deal with them.
Undoubtedly, the signs of Ignatia do not often correspond to those of organic lesions. More often they are due to functional conditions whose paradoxical nature shows their nervous origin. The prolongation of these symptoms leads progressively to a deep fatigue of the patient. The nervous system wears itself out. Profound depression gradually overcomes the patient.
He cannot put his thoughts together, cannot find words to express his thoughts. Physical weakness: he cannot walk far, suffers from headaches, grows thin, sweats heavily and shows signs of decalcification, such as Phosphaturia and dental caries. Then we find all the signs of Phosphoric acid, the indication of which is obvious.
The demineralization is in fact one of the most important causes of the nervous depression. It is often accompanied by the usual symptoms of the Tuberculinique state and it is necessary to prescribe one of the diluted Tuberculins and the indication of Natrum muriaticum becomes apparent.
Compare this latter remedy with Ignatia. The last named cannot bear to be left alone, whereas Natrum muriaticum prefers to be alone. Ignatia wants to be made a fuss of and desires to be commisurated with, whereas Natrum muriaticum dislikes consolation and weeps if one tries to console him. Ignatia shows no objective sings other than the imprint of the teeth on a clean tongue.