MY FIRST CASE. Knowing how often cases of this kind relapse, I was not surprised when three weeks later the family called, saying Sandela had started weeping and crying again. This is much the same way she had started the month before. When I arrived at the home I could see the severe mania of jealously and suicide were again very strong.

You can all remember one case which you had during your first year of medical practice that distinctly stands out in your mind for one reason or another. During that first year you probably had more time thoroughly to repertorize each case and to watch the results more closely.

Remembering the pitfalls of that early period you can be more lenient when I describe my first case!.

This is the story of Sandela, who could have been playing the leading role in the movie called “The Snake Pit” when I first saw her. In fact two other doctors had already recommended confinement to a mental hospital before she killed her self.

I must have had the faith in Homoeopathy that is supposed to move mountains,as I look back on this case, or I might have agreed with the other doctors.

Sandela lives in a working, middle-class home with her husband and two children. She is a heavily built, light haired Polish girl, about 30 years old and weighing about 190 lbs.

When I first saw her the light hair was flying in all directions. Her face held an expression of fear, and her eyes were dilated and staring. She was partially disoriented, and talked almost constantly, changing from one subject to another without any sequence. Much of this talk centered around her fears for her children and her own religious salvation.

She reluctantly allowed me to examine her as though I were a necessary intrusion on her constant talking. The examination of the eye, ear, nose, throat, chest, heart, and abdomen were all negative. The reflexes were hyperactive. A urinanalysis was normal except for the large amount of bilirubin present. Microscopically there were no abnormal findings. The blood pressure was 130/56, pulse 84, respiration 20.

According to her husband and nurse, who was a close friend, her prior history was quite normal until one week previous. She then suddenly began doing strange things and attempting to commit suicide. The nurse stated that Sandela would be very quiet at times and then at other times she would be very loquacious and difficult to manage. It was necessary to watch her closely or she would run away, or try to use a razor or knife on herself. Several times she had locked herself in the bathroom searching for a razor, and it was necessary to remove the bathroom door. At this time my first prescription was Lachesis 30.

The next day the suicidal tendencies were still very strong, and I could see no visible improvement. I asked the nurse to keep a record of Sandelas actions and conversation for me. I hoped it might furnish a better clue to the psychological problem behind the attempted suicides.

Fortunately, the nurse was a conscientious soul, and she had made a very complete written account of the patient both day and night. It was evident that some terrific conflict was driving Sandela to this escapist behaviour. After studying the nurses report, and the family situation, it would seem that Sandelas present condition had been in the making many months before this outward breaking point was reached. No one factor seemed in itself to cause this conflict. Rather it was the steady accumulation of things over a period of time until some last straw tipped the scales beyond her physical and mental endurance.

It was evident that Sandelas husband was the dictator of the household. He held almost fanatical religious beliefs which he insisted must be observed to the letter of the law in his home. During the previous winter there had been several relatives living with them in quite crowded arrangements. This had greatly increased Sandelas work. Her husband did not care for these relatives and in consequence he stayed away from home as much as possible. In turn this created suspicion and jealousy in a tried, overworked mind which finally vented itself in the present crisis.

I feel that many of her fears for her children were fears as to what happen to them after she had gone. My home visit the following evening found Sandela much weaker both mentally and physically. She had had no appetite all day. Her mind which had been so hyperactive before was now dull and stupid. She repeated words over and over again, especially those words which she had just heard or which had been brought to her attention as I was trying to question her. She stated she left on edge all the time, and that she had a feeling as though there was electricity in her forehead. Basing my prescription on her symptoms and constitutional build I gave Calcarea carb. 30.

At this time I took her husband aside and had a very down to earth discussion with him. It was one of the most difficult talks I had encountered, but it seemed very much needed.

A C Neiswander