In the last year and a half has had very great nervous strain owing to several cases of illness and one death in the family.
General physical condition good. Blood pressure 120/70.
Taking into consideration especially the injury from the fall, I gave on January 14, 1939, Hyper. perf. 1M. which was followed by some relief.
Two weeks later, January 28, I was called to see the patient, who was menstruating and suffering much pain in abdomen and back > firm pressure. There was also hard headache, extending down the neck > pressure.
For this I prescribed Nat. mur. 1M., but it did not relieve and twenty-four hours later I gave Nux vomica 1M. which relieved the condition.
Two weeks later there was another headache which began on waking, was worse in the occiput and extended to neck and back. There was the sensation of a tight band around the head, the eyes felt pulled back and there was aggravation from stooping. Sepia improved conditions promptly.
This remedy proved helpful for some time. A beginning headache was stopped by a dose of Sepia, and the menstrual condition was much relieved. For about three months the patient did not have a real headache.
In the autumn, after a busy summer, the headaches returned with menstruation and did not yield to Sepia. Besides the severe pain there were peculiar sensory phenomena. The hearing was abnormally acute, there were imaginary odors, and every thing tasted salt. Coffea 200 helped temporarily.
Then the pain returned with much chilliness and Silica 200 relieved. However, there was no sense of security and the patient was persuaded by a relative to see another physician, who ordered injections of theelin, an estrogenic hormone. I believe there has been an improvement in the condition of the head.
Case II. Mrs. E.M., dressmaker, English. Age 45. Three daughters, twenty-one, nineteen and sixteen. Divorced. In December, 1939, the gall-bladder was removed on account of severe headaches, vomiting and gastric pain. She made a good recovery from the operation, but the headaches persisted.
As a little girl she had “bilious” attacks and headaches, was a sickly child and had to be sent to the country to get stronger. There was some tuberculosis in the family.
At present the headache come every week or two. They begin at four or five a.m. and in the occiput, with a feeling that it is being crushed > turning on the abdomen. The pain then extends to the face, temples, zygomae and teeth; it begins on one side and goes to the other, > wet heat. The eye-sight is affected- everything looks angular. The pain causes nausea and vomiting, first of food, later of bile.
Four months ago during a headache she had a severe pain in the cardiac region with sweating and lost consciousness. Six weeks later she had an attack of clutching pain in chest with difficult breathing and much sweat. Since then occasional clutching pain in the epigastrium. Hospital examinations have failed to find evidence of coronary thrombosis, the diagnosis made at the time of attack, and an oculist who examined the eyes declared them “disgustingly healthy.” On Oct. 3, 1940, Mrs. M. came to me with the history given.
I found nothing organically wrong with the heart. Her blood pressure was 130/78. She complained of present dull pain in her left chest, a dull, heavy ache across the dorsal region > sitting straight, not > lying. Cact. gr. 1M.
The prescription was followed by improvement for six days. Then there was a slight pain in the chest with a sense of pressure as if she had swallowed something too large. Desires much air, cant have anything around the throat. Pulse rapid and irregular. She feels too large, and her hands feel swollen. Lach. 1M.
The next day she felt miserable. Her chest was sore, with pain in the cardiac region extending to the arms. On looking over the record I feel sure this was an aggravation after the Lachesis, but at the time I gave Cact, gr. 45M. which relieved, and the patient was comfortable for ten days.
Then at the half-way point between menstrual periods she developed a severe right-sided facial neuralgia which yielded to Spigelia 1M.
This remedy has been repeated a number of times for the excruciating neuralgic pain which came with, or in place of, the headaches.
On Feb. 15, 1941, the symptoms of aggravation at 4 p.m., oppression in the abdomen > for undressing, longing for open air, led to Lyc. 1M. and two months later the 10M. was given for aversion to descending stairs or a hill, depression and weeping, and troublesome dreams of the husband from whom she was divorced.
Later these dreams returned and were relieved by Sepia 200 and 1M.
On June 24, 1941, she declared herself better in many ways, especially mentally.
The summer was fairly good. The fall brought some return of symptoms and Sulphur seemed indicated and was given but without very marked benefit.
Later Psorinum seemed the remedy and apparently helped for a time. In February the menstrual flow, which had been more comfortable and normal, was very copious and lasted three weeks painless, bright liquid with large dark clots. It finally was > after Calcarea carb. 1M.
After the flow ceased I made a pelvic examination and found the uterus low and freely movable, but rather hard.
On March 4, I made a new study of the case, especially from the mental symptoms, as follows:.
1. Suicidal disposition. Keeps away from the river for fear of impulse to drown herself.
2. Discontented with her work, her home, etc. Not constant.
3. Desires light.
4. Aggravation from darkness.
5. Changing symptoms.
6. Changing pains.
7. Stitching pains in heels.
Pulsatilla has all the symptoms except the desire for light and ranked much higher than any other remedy. Its administration was marked by a short time of almost exaltation, so that the patient over-exerted herself sadly. However, the mental symptoms were relieved and when next she came to the office on April 6 a remedy stood out clearly. Sense of exhaustion in spring, < on waking, < heat; feels hot at night. Pain in chest < ascending. Heart feels big.
Lachesis 1M. brought a marked improvement, and at her last visit May 25 the patient declared herself very markedly better than a year ago.
The prescribing in this case has been far from perfect, and there will undoubtedly still be some headaches; but there has been a gain both mental and physical and against heavy odds. Her life has been and still is exceedingly difficult, and she carries a heavy load of bad inheritance. NORTHAMPTON, MASS.
DISCUSSION.
DR. GREEN: Migraine is one of the hardest things to treat that we have to deal with, and perhaps nothing else needs such a thorough study of family background and chronic tendencies from way back.
I am inclined to think that the number of remedies indicated is not so large, and that the basic remedy which may be very discouraging at first, may yield the best results in the end. By a basic remedy I mean one that might have an acute complementary remedy that could be used as a palliative, without disturbing the action of the deeper one.
Dr. PULFORD: I want to call your attention to one remedy and the one condition in migraine, and that is skimmed milk. Lac defloratum has cured a number of cases of migraine for me by eliminating skimmed milk. The average milk of the city is skimmed milk, there is no doubt of it, and it is filled with artificial stuff, and then artificial cream that makes it look very rich. But I am positive that it is the base of a lot of these migraines.
DR. SUTHERLAND: The last case Dr. Stevens cited, I wonder whether a prescription of Cactus following Lachesis perhaps wasnt suppression and gave the difficulty encountered toward the latter end of the case. After she gave Pulsatilla, that unlocked that, and then Lachesis came back, which is now helping, I have lost the detail somewhat, but I recall there was Lachesis prescribed, with some amelioration, and then what appeared to be an aggravation from it. I think that was just the action of the Lachesis. Had the doctor waited a little while, that would have subsided and there would not be any occasion for the Cactus. Cactus is a suppressant.
DR. BRYANT: I just want to report one case which I think was cured under Niccolum, and to verify what Dr. Pulford had to say about Lac defloratum.
DR. STEVENS: I am sure Dr. Sutherland is right about my giving Cactus after Lachesis. It was practically at the beginning of the case, and I was scared, because the poor thing was suffering so much. But every time she has had some aggravation after the Lachesis. I am very sure this aggravation came the very next day after the first dose of Lachesis. If I had had my courage with me, and had given her plenty of Sac. lac., perhaps I would have gotten much more speedy results. She is still on Lachesis and improved, but she is really wretchedly tired, has had a very hard life. I think that rest is going to help very much, along with the remedy.
