TWO VERY INTERESTING CLINICAL CASES

Read before I.H.A., Bureau of Obstetrics, July 27, 1939.

E. GARCIA–TREVINO, M.D.

 

Although the two cases that I am bringing to your attention cannot be considered as obstetrical cases, I submit them in order to arouse your comment, thus gaining from your own personal experiences. One of them really belongs to the field of gynecology, but most obstetricians are also gynecologists. From this case I have learned that fibroma of the uterus can be cured with our homoeopathic remedies.

The condition to which I will refer in the second case developed in the same patient twice, as a complication of two different puerperal periods. It taught me definitely that the homoeopathic physician does not need to resort to the use of narcotics and should therefore never use them.

FIRST CASE.

Mrs. H. G. L., age 38, married 8 years, never having been pregnant. Came to my office for the first time on April 25, 1938, complaining of frequent metrorrhagias for the last two years, sometimes even twice in the same month and just recently she had had one that lasted for 45 consecutive days, but apparently without debilitating the patient. A new haemorrhage and just begun the day before. No vaginal examination was made at this time, following the rule of not examining those cases while they are bleeding to avoid the misleading information that the congested organs may give. Secale 200 was prescribed.

May 3. Patient still flowing with a bright red blood; slightly nauseated; tongue clean. Ipecac. 200.

May 14. Still bleeding although not quite so abundantly. Ipecac. 1M.

May 23. The haemorrhage ceased right after the 1M. potency. A vaginal examination revealed a hard, indurated cervix; uterus retroverted and almost twice the normal size, giving the examining fingers the impression of a hard, solid mass that was easily displaced upwardly by the fingers in the Douglas cul- de-sac.

No sign of tenderness in tubes or ovaries. Diagnosis: A fibromyoma of the uterine wall. A continuation of the remedy was given and the knee-chest position advised, twice daily.

May 30. Patient feeling fine; no sign of haemorrhage since May 14. A continuation of the remedy.

June 20. On June 12 the patient began glowing again, and still is, but rather scarcely, only every other day. Ipecac 1M.

June 28. Haemorrhage stopped two days before, lasted in all fourteen days, but not profuse; the last few days the blood darker in color, no pains or nausea. Sabina 1M.

July 13. Another haemorrhage and only fifteen days had passed since the previous one. Continuation.

July 20. No change; blood at times bright red, others darker; patient feels all right, except for the troublesome flowing and a slight constipation; tongue clean. Ipecac. 10M.

July 27. Six days, today, without haemorrhage. Continuation.

August 16. After twenty-seven days without haemorrhage, it began again today, but moderately. Ipecac. 10M.

August 31. Last flowing lasted only three days as it had not been for the last two years; appetite lost since the death of mother four weeks before. A vaginal examination showed uterus reduced to about two-thirds of previous size. Continuation, and patient advised to keep on with the knee-chest position.

September 28. No sign of haemorrhage or of menstrual flow since August 16. Continuation.

October 17. Two months already without any flow; no other complaints. Continuation.

October 24. On the 21st an apparently normal flowing that lasted only three days. A slight pain at this time at both ovarian regions, a pain that she had experienced when she was menstruating regularly, but that had disappeared since the haemorrhages. Continuation.

November 14. Patient complaining of a mild catarrhal condition, running a slight temperature. A continuation was given, seeing no sufficient reason to disturb the treatment if prescribing for the acute condition.

November 21. The catarrhal condition cleared up soon. On the 18th another normal menstruation at exactly twenty-seven days from previous one, of three days duration; no pains at this time. Continuation.

December 22. Five days ago began flowing again, twenty-nine days since last, but still flowing today. Ipecac. 10M.

Since then patient has been menstruating regularly, every twenty-seven to twenty-nine days, with no complaints, periods lasting only three days, except on last May when it extended over to five days and she received the last dose of Ipecac. 10M.

June 19, 1939. Nine months of regular periods. A new bimanual examination shows that the uterus is now in a normal position and has practically become normal in size. I believe the case cured.

For many years I had been under the impression that these cases could only be treated with surgery; but I now think that if a case of fibroma can be cured homoeopathically many others can, and we must always try our remedies first before sending this type of patients to the operating table.

SECOND CASE.

My second case was a patient at the time in the hands of another doctor, an American allopathic surgeon who lives in Monterrey, a very good friend of mine whom I respect very much for his surgical skill. He had delivered this lady, Mrs. O. A. T., of her second baby only four days before, on June 21, 1937. The morning of the fourth day she began complaining of pain along the right sciatic and the right anterior crural nerves, pain that was intensifying considerably every minute until it became excruciating and unbearable.

The doctor sent his nurse to the patients home with a 10 gram vial of a 2 percent morphine solution, with instructions to use it in fractional doses pre re nata. The pain was not relieved. That same afternoon, about five oclock, the doctor came personally to see the patient and decided to resort to a rather heroic measure of injecting a 2 percent novocain solution into the sacral canal.

While getting ready for the injection, and knowing that both the patient and her husband were related to me, the doctor asked that I should be called to assist him with the case. I came to the patients home immediately and this is how I came in contact with the case.

At the time of my arrival the patient was being prepared for the injection, lying in bed on her abdomen, and the doctor proceeded to inject 30 c.c. of the novocain solution, followed by 20 c.c. more of normal salt solution. The patient back to the recumbent position, a pulley was attached to the foot of the bed with a five kilogram weight to make traction on the leg. The doctors idea was that by painful nerves the pain could be relieved. Half an hour later the weight had to be cut off, because the patient was suffering tremendously and could not stand it any longer.

When the doctor asked me to help with the case, he also asked me to write a prescription for two ampules of sedol, a morphine preparation by that name to keep the patient from knowing what it really is. He wanted me to use them that night if it was necessary. I told him that I never used narcotics, but since the case was his and not mine, I would do it following his orders. I asked the patients husband to go with me to my office for the prescription, and when there I showed him any narcotic blank book unused.

While filling out the first blank, I made him clearly understand that it was the first prescription for narcotics I had written since practicing in Monterrey and that I was doing it on the condition that the two ampules should be returned to me in case they were not used. He agreed and went directly to the drug store to fill the prescription, in order to have them at hand when needed.

At nine oclock that night the husband called me up to say that his wife was still suffering terribly and begged of me to please go at once and give her one of the injections.

When I got to the door of the house I could hear the agonizing cries of the patient. Saturated as she was with narcotics, the suffering was still worse. It was unbearable to see her suffer. “All right,” I said to the husband, “I am ready to give your wife that injection, but this stuff is practically the same thing she has been getting all day long; in all probability we will not help her much by adding a little more to what she has already been given. Dr. Blank asked me to help with the case and I believe that we can help her more with a homoeopathic remedy, so I will try that first and if it fails, I will give her the sedol injection.”.

I went into the patients room to gather some symptoms and this is what I got: Agonizing pain coming on by spells on right hip extending down the sciatic and anterior crural nerves, < by pressure, she could not lie on the affected side; patient flatulent and constipated, would go several days without a bowel movement and when successful the stool would be hard, difficult and rather small; a slight elevation of temperature during the afternoon; her right foot, that of the affected side, was hot and the left cold. Lycopodium 200 in half a glass of boiled water, a teaspoonful every five minutes, was given, with definite instructions to discontinue it altogether at a sign of marked relief.

The patient took in all three teaspoonfuls, after which she went to sleep. After suffering so miserably all day long, the relief came after the first fifteen minutes under the influence of Lycopodium.

I told the husband that if he would supply me with a place to sleep I would stay over night and be ready for any emergency. We both slept in an adjoining bedroom and woke up the next morning to be surprised with the news that the patient had slept soundly through the night and was still asleep. When she woke up there was no acute pain but still some tenderness in the affected parts, yet she was able to lie on the right side for some time. The condition continued to improve, temperature became normal and remained so and the bowels began to move satisfactorily.

She left her bed five days later with practically no pain n although her entire right lower limb was somewhat stiff.

The attending physician called on her that day and was surprised when the patient herself greeted him at the door. He suggested some x-rays be taken and took them himself on the following day. The bones showed normally. One that same day he gave her an intramuscular injection of solu-salvarsan, thinking that some chronic malarial condition, of which the patient had had manifestations during the puerperium of her first baby, might have been in the background of the present complication.

Two hours later the patient was back in bed with a chill, a slight rise of the temperature, and the pain back again, this time more in the anterior crural nerve of the same right side. I was called in the next morning and informed of the solu- salvarsan injection. By that time the pain was again unbearable, the patient very restless, yet her knee was flexed with a pillow stuck underneath; she said that was the only way she could get some relief; although an electric pad also seemed to help; patient was thirsty, but drinking little at a time.

I could clearly see the toxic effects of the arsenicum she had received with the salvarsan injection, yet the symptoms were definitely pointing to the indication of that remedy, so I gave her Arsenicum album 200 in half a glass of boiled water, a teaspoonful every five minutes. The pain was again relieved after the fourth dose and the remedy discontinued. The improvement went on until the patient was on her feet again.

On June 6, 1938, the patient, in the seventh month of her third pregnancy, began again to have pain in the right anterior crural nerve extending down to the leg, < lying down. The first two months of pregnancy patient suffered from nausea, the rest of the time, until this day, normal, except for a slight swelling of her feet. Rhus tox. 200, single dose, was given with excellent results.

August 28, 1938. Patient almost at term, complained today of pain all over the body, after having taken a bath, but worse along anterior right crural nerve, > on the slightest movement. Bryonia 200 took care of this spell.

November 13, 1938. Her third baby was born September 14, normally delivered by the same doctor who had taken care of her before; but at this time she had been running a slight fever, of about half a degree Centigrade, every day since the birth of her baby. Yesterday she began feeling her right leg heavy and stiff, today the pain is again excruciating along the region of the anterior crural nerve, but this time extending to both ovarian regions; there has been an offensive yellowish uterine discharge for the two months, also constipation. Lycopodium 200 in half a glass of boiled water, a teaspoonful every ten to fifteen minutes, failed to relieve.

November 14. Pain still worse, temperature 38 C. (101.2 F.); patient feels as though the hip joint were being dislocated, and does not permit anyone to move her limb or even the bed, for the slightest movement aggravates. Bryonia 200, single dose.

November 15. Relieved for a few hours, but now pain worse than ever; temperature still half a degree above normal. Bryonia 200 in half a glass of boiled water, a teaspoonful pre re nata.

November 17. Pain greatly relieved since day before yesterday; temperature normal; bowels moving easier. Patient being improved, a continuation of the remedy was given.

During this last painful attack one of the two ampules of sedol prescribed for the patient the year before, under the doctors orders, was injected the first night. The patient still kept them. When the pain was at its height and she was begging for it, I consented to use one, to show her how the pain would be still worse after the effect of the narcotic was gone. She soon confirmed the fact, for the effect of the drug was very brief and she never again asked for the second ampule that I still keep. I was after this experience, that Bryonia was used with the gratifying results already mentioned.

The object of bringing this case for your discussion is to assure you of my earnest conviction that we homoeopaths do not need to prescribe narcotics in any painful condition if we take the necessary pains to find the similimum. My narcotic blank book is still unused, except for that single prescription which was never intended to be used. MONTERREY, N. L., MEXICO.

DISCUSSION.

DR. HAYES: Dr. Trevino certainly selected the right title for his paper, Two Very Instructive Clinical Cases.

The most significant thing to me in these reports is not that Ipecac cured a fibroid or some other remedy cured something else, but what we can read between the lines. Between all those lines we read about the importance of theory. In other words, he used principles, and managed his cases clear through with those principles, similarity, a single dose, or with the principle of dosage as it may appear in the individual case, the proper interval, and so on. That all goes back to the importance of theory, and that is the first step, it seems to me, in gaining mastery of homoeopathy.

DR. MOORE: Of course, this paper was interesting all the way through, but the one item of arsphenamin with the Arsenic in its high potency antidoting it was very interesting to me.

DR. MARQUEZ: I was very much interested in the case of fibroid the doctor mentioned. I was just wondering, for the sake of the statistical data, if a compilation could be made of the cases of fibroid cured exclusively by homoeopathic medication, which would give us further proof of homoeopathy against surgery in cases of uncomplicated proof of homoeopathy against surgery in cases of uncomplicated fibroids where there is no tendency to malignant formation.

I have no comment on the second case, unless it is to say that the patient was very foolish in continuing with the first doctor.

DR. SHERWOOD: I, too, noticed the ingratitude on the part of this patient who, in spite of all the doctor had done during her second pregnancy, when she comes along to her third calls on the allopath.

With regard to the comments of the last speaker, I want to say if the fibroid case were mine, even if there were indications of malignancy, I certainly would rather trust to my homoeopathic remedy and would be far more hopeful of a permanent result than I would be in resorting to surgery.

DR. DIXON: I want to compliment the essayist in the fight he put up to do away with narcotics. That, I think, is good homoeopathy, and it takes real fortitude to go through a case of that sort and not resort to narcotics. Few of the men do it. That just shows how the well selected homoeopathic remedy will combat pain.

DR. GRIMMER: I want to add my commendations on the doctors paper. I take a great deal of pride in hearing of anything. Dr. Trevino does, because I think I had some little influence in helping to bring him to a better vision of real homoeopathic principles and philosophy. The doctor showed his knowledge of the philosophy when those symptoms came back. The old haemorrhage of the philosophy when those symptoms came back. The old haemorrhage returning, he continued his remedy. He knew his remedy was working. Some who are not so well grounded, some fairly good prescribers, spoil their cases by putting in a new remedy when it is only the reactions of a former remedy that is working. They break into that rhythm and sometimes spoil the case or make it very difficult to get back to the curative channel.

Dr. Trevino surely managed both of these cases as a true homoeopath.

DR. BOND: I want to report one experience I had with reference to morphine. The case was a man about fifty years old who had a very severe sciatica which seemed to affect the nerve high up just as it came off the very low segments. This man had been given morphine, he had been given the usual saturation of salicylates, but it wasnt until I gave him the remedy based on the modality, aggravation when lying on the right side, that he was cured. The remedy was Mercurius 1M. Morphine and all the others distinctly failed.

DR. TROUP: I would like to offer a suggestion based on Dr. Trevinos knee-chest position. If it is consistent with fracture work, why should it not also, in manner of splinting, be consistent in uterine displacements. The knee-chest position is certainly fatiguing, and in order to get correction in retro displacements must be maintained for quite a series of days or weeks. Why would it not be definitely in line to support that uterus, even though fibrous heavy, by the use of a Smith or Smith-Hodges pessary worn through the day and night alike?.

We have had one or two experiences in that line where little was derived from consistent knee-chest position in two postpartum patients, but with the fitting of a definitely supportive and comfortable pessary of the hard rubber type there was so much relief from the mechanical dragging effects that it seemed only well within reason to sense that, this relief would enable any medication, to round out the results in full measure and in a much shorter time.

DR. GARCIA-TREVINO: I feel very grateful to you all for the discussion of this paper. I knew I was going to learn something from this discussion.

In closing, I must say it is a fact that whatever my attitude toward my patients is, and whatever we are doing down in Monterrey, I owe to the six years I was associated with Dr. Grimmer. The least I can do is to pay him this public tribute. Dr. Cookinham told me yesterday that he was a schoolmate of Dr. Grimmer, and when I told him that I had associated with Dr. Grimmer for six years, his comment was, “You were lucky.”

I must say that whatever I do with my patients, and whatever we are doing down at home–this small group of homoeopaths I mentioned–is under the influence of Dr. Grimmers teachings.

I also want to say, in regard to the last doctor who spoke, I never recommended pessaries. I must confess I have had no experience in using them. I dont use them on general principles. I used a pessary only once, and it was not satisfactory. I always consider that we should avoid the use of any foreign body. A pessary will act as a foreign body and cause irritation. If the doctor will recall my paper, I did not advise the knee-chest position in the postpartum case. I advised that position in the fibroid case.

The retroversion of the uterus is a mechanical condition that has to be helped mechanically. Our remedies will not lift the retroverted uterus. We have to help the patient mechanically, and I have found that the least injurious treatment is the knee-chest position. I always advise patients to begin with five minutes in that position, and to increase that until they are able to stay in that position ten minutes twice a day and, if possible, introduce one or two fingers into the vagina, which is a pouch, to let the air in. By doing that, the air fills the vaginal pouch and throws the uterus forward. That really helps, with the aid of your homoeopathic remedies.

What is the etiology, the cause of the retroversion of the uterus? The ligaments have lost their elasticity, and exercising the limbs will help to restore the elasticity. You do exercise them by having the patient in that position for five or ten minutes, even if the uterus goes back to the abnormal position after the exercise. By repeating that and helping with the indicated remedy, those fibers and muscles regain their elasticity and the uterus will remain in that position. It will probably take a year or two, as effects from exercise do take a long time.

In regard to the narcotics, I just want to say that I practiced in San Antonio, Texas, for a year and a half, and when I left and sent the blanks back to the proper officers they were surprised to get them unused, both the narcotic and whisky prescription blanks. I practiced in Chicago for six years, and when I left there I sent the blanks back and they were surprised to get them unused. Down at home, I filled in only one prescription, and that was the one I mentioned.

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