While there is nothing remarkable about arriving at the remedy in this case, it is reported merely as warning against something of which probably most of are guilty, namely, routine prescribing., Often we like to think we are prescribing intuitively when we are merely prescribing routinely.
There is another point, too, of which this paper may serve as a reminder, to wit, the easy path of classifying remedies into acute and chronic. It comes unconsciously, I admit, and the only reason I bring it up is that I am as guilty as any one else and perhaps more guilty than most.
When we think of Ipecac in haemorrhage we think almost at once of the dramatic scene of post-partum bleeding where the mother had only seconds to live, she is in a state of shock, the blood is gushing, the pulse is thready and she is pale and, oh, so sick to her stomach.
In contrast, where the patient is in early middle life, able to be up and around and at work, one is not likely to think at once of Ipecac in metrorrhagia. This happened to a man who is usually a very careful prescriber, my father. He is somewhat of a snap-shot prescriber and usually hits the target very well but he overlooked Ipecac in this case and the only reason I got in my two cents worth was the fact that she arrived on the day he is not in the office.
Mrs. B. S., a woman in her early forties, twice married, twice divorced, and the mother of two boys. She, at the time I first saw her, was again contemplating marriage. There were the bright red blood, the clots, the gushing, the almost continuous flow and some cramps. Looking back over the remedies he had given her there was not much choice but to ask if she ever felt nauseated with all of them. The reply was an emphatic “yes,” and so she was given a dose of Ipecac 1M and plenty of Sac.lac. A steady decrease in the flow was noted accompanied by a great sense of general improvement. About 3 weeks later the dose was repeated and the next thing I knew she was married again.
Alas, as sequel to the above little story. Her new husband was the victim of active hormones which plied him with ambition, and as she is not one who would avert the glances of the ale, he pursued her night and day, giving her no chance even to keep up with world events. She bore up well under all this activity for several weeks and then there was more metrorrhagia.
I prescribed once more but have not seen her since, so that I do not know whether she completely recovered or not. I advised a vacation from such strenuous work and would like to know how it all worked out. The psychoanalysts might say that the flow returned due to a subconscious defense mechanism against continuous assault; the materialists would say it was due purely to mechanical causes. I prefer the midline and would prefer to think it was the result of both.
It is remarkable how a simple remedy in a small dose will enable an individual to stand up under great strains and stresses.
The human mind must follow the law of least effort in Nature that we so easily revert to routine behavior, to which classification may be one of the narcotics which helps us to that end. It sort of eases our consciences and, because classification is one of the methods of science, it seems so scientific; but everything has its time and place and the trick of success is putting the right thing in the right place at the right time. TOLEDO,OHIO.
