Case no. 10
24. 2. 1918.
|Insanity – habitual, at every pregnancy|
Mrs.-; age 30 or 31. Intelligent; mild; yielding; fair complexion; thin built (but medium built before her illnesses); active and of a religious temper It was at the fourth pregnancy that I came to know that at the previous three conceptions she had developed regular symptoms of insanity. I was prevailed upon to take up the case. Insanity-habitual, at every pregnancy! Looked quite an interesting case, and I made out the record with great care. There was no miasmatic history on any side. The only important things were the death, or more correctly, suicide by drowning, of an uncle of the patient due to insanity, and the death of her father due to chronic dyspepsia after a long suffering of 3 years or so. The husband’s father had asthma and had died of it.
She was married at 13. She had leucorrhœa before her marriage, and it was cured by a Kaviraj. After 3 or 4 months of her marriage, she menstruated for the first time. The discharge was scanty, lasting for 1 or 2 days, and it was attended with pain. This continued for 3 or 4 years. Ayurvedic treatment relieved it to some extent only, and Allopathic treatment after that increased the discharge. It was at this time that she became pregnant for the first time. And symptoms of insanity developed fully at the fourth month. The detailed symptoms of this insanity were not however available, as the husband was absent from home at that time, and he could only say that the fit lasted for about seven months. It was only after a month of the delivery that the patient realised that a child was born to her.
The second pregnancy took place after a period of 4 years, and during these 4 years the menstrual course had almost stopped, that is to say, she used only to stain the linen, and there was no flow. She was constipated from her childhood, but it assumed a more aggravated form about this time. She began to have motions only at intervals of 4 or 5 days. A new symptom appeared about this time. It was cold in the nose, and she used to have it at least once or twice every month. She used to have headache if she had an exposure in the sun, and could not look downwards during the headache. She would lie down still during the headache, and would keep the doors and windows open. She had Allopathic and Ayurvedic treatment off and on during this time, but there was no improvement.
However, when she became pregnant for the second time at the age of 21 or 22, and when she developed symptoms of insanity at the fourth month as before, the husband was at home and was able to watch out the symptoms in details. The main symptom was a mania of washing things with water and of having repeated baths. Was awfully morose, and attended to her household duties in a hasty mood If any body said a disparaging word, she would become angry at first, and this used to be followed by a long fit of weeping. If any body were scolded for giving her any troubles, she would heave a heavy sigh and then re-assume her original mood. The fit of weeping was so lengthy, and such a flood of tears would stream down her eyes, that one would wonder, how she could weep out so much tears on such a slight cause. The memory was badly impaired.
The third pregnancy (at the age of 25 or 26), was also attended with similar symptoms of insanity. The fourth pregnancy was watched by myself. There was a strong desire for bath; temper irritable and morose; severe constipation and sweating on the head and forehead.
28. 1. 18. Natrum Mur-200. One dose every morning, for 5 days. Report wanted after a month. She was delivered of a child after 10 or 12 days of the above doses, and the treatment was stopped for about 2 months.
14. 4. 18. Natrum Mur-200. One dose weekly, and placebo. The constipation seemed to have been relieved to some extent after a month, and the medicine was consequently stopped. But the above improvement did not continue.
17. 6. 18. Natrum Mur-1000, one dose, and report after a month. Slight improvement of constipation only.
18. 7. 18. Natrum Mur-10 m. Four times daily in graduated doses, and placebo.
27. 7. 18. Severe hammering headache and obstinate constipation. There was no motion for the last 6 days. Profuse running of the nose. No medicine, but placebo only.
13. 8. 18. Much better. Constipation almost gone, and she was having motions almost daily. The condition of the mind seemed better. No medicine.
14. 9. 18. Slight headache only a few days ago.
21. 9. 18. A lot of urticaria had come out. There was severe itching. No medicine.
12. 10. 18. The mental improvement was gone. Morose again and averse to talking with others. Also constipation. Natrum Mur-c.m. one dose only.
24. 11. 18. Menstruation appeared for the first time after delivery. There was no pain this time, and the discharge was pretty profuse. Placebo.
22. 12. 18. Menstruation still more profuse; and the patient better in all respects. But there were some itching eruptions like ringworm on the waist, back and armpits.
No more medicines were given, and it was proposed to take up the treatment after watching at the next pregnancy if insanity developed again. The next pregnancy took place after 2 or 3 years, but there was no insanity, and the husband did not consider further treatment necessary. The patient was, however, all right now except that there was a tendency for catching cold. And it seems to me that without further treatment, she was not cured completely as a patient, and this tendency for running of the nose might result in complications.
(1) In case of further treatment, it seems to me that Tuberculinum-200 and higher would have been necessary.
(2) I could not say what connection insanity had with pregnancy; I think, I might have found it out, if I could have watched the patient more closely during the period of pregnancy.
(3) I had to keep a special eye on-Apis, Sepia, Tuberculinum and Kali Carb during the course of the treatment. Such patients require these medicines according as the symptoms call for them by their totality.
(4) The same patient may require more than one medicine at times; and the subsequently selected medicine has to be used only when the previously selected one has acted off fully and brought on a stage for indicating the next one. It is the indication by symptoms that must decide the selection each time, and there is no rule that Natrum Mur. will have to be followed invariably by Apis or Sepia, though it is a complementary remedy that is generally indicated after the one used.
(5) The patient in this case had Psora and Sycosis. Running of the nose is a Sycotic symptom, but the tendency for frequent running of the nose is tubercular, and this is why I was thinking of a remedy like Tuberculinum, at last.