GIVEN TO THE WOMEN WHO PROVED LILIUM TIGRINUM.
The object in proving a drug is to ascertain the changes which the drug is capable of producing in the functions and organs of the healthy body.
It is very important that each prover should know and be able to recognize the various sensations and variations of function to which she may, by peculiarity of constitution, be subject when in average health; so that she may not, while proving a drug; mistake such natural variations for effects of a drug.
The prover should have at hand, at all times, a note-book, in which to record the times of taking the drug and the doses, as well as the symptoms as they occur. The record should be made as soon as the symptom is perceived, and the time of its occurrence and the circumstances of the prover at the time should be recorded.
Before beginning the record of a proving, the prover should inscribe in the note-book a statement of her age, temperament, the sicknesses which she has had,
and those to which she has an inherited or acquired tendency; also whatever pains or sensations she may be habitually subject to; also any peculiar susceptibilities she may possess to external influences of any kind, or to mental or moral or emotional excitements, depressions, or perversions. Her constitutional peculiarities respecting the menstrual function should be carefully recorded; regarding frequency, quantity, character, and whatever inconveniences or sufferings precede, accompany, or follow menstruation; such as headache, backache, colic, leucorrhoea, etc., together with peculiar states of mind or emotion.
In describing sensations or pains which may occur during a proving, it is not sufficiently definite to say “pain in the head,” “pain in the back,” etc. The character and locality of the pain must be exactly described in graphic language, stating, for example, that the pain is “cutting,” “burning,” “sticking,” etc., and specifying its location, and, if it move, its course.
The prover should find out by experiment, and should carefully state, what circumstances aggravate or ameliorate the pain (or other symptoms), and note its periodical recurrence, because periodicity is a very important element in the history of the action of drugs. For example: is the pain worse when the prover stands, or sits or lies down, worse during exercise and better during rest, worse on first waking, worse in the cold and relieved by heat, worse or better from touch or pressure, etc., etc. All such conditions of aggravation or amelioration should be carefully recorded.
If the pain move from one part of the body to another, the fact and the course of the pain should be recorded.
The sides of the body on which symptoms occur should always be stated.
The times of occurrence, aggravation, and amelioration are very important elements; as, in the morning or afternoon; at night, before or after midnight, or waking from sleep; just before or after eating, etc., etc.
Changes in the quantity, quality, and appearance of the natural secretions should be carefully described. The urine, for instance, should be measured and the quantity per day recorded; it should be tested for acid and albumen, and whatever sediment it may deposit should be carefully described. Modifications of the menstrual functions should be most carefully recorded; such as its greater or less frequency or quantity; alterations of color and consistency; whether acrid or not; pains and discomforts of body or mind which precede, accompany, or follow it.
Secretions not observed by the prover when in health such as leucorrhoea, unusual perspirations, etc. should be described, as to color, consistency, odor, nature; whether bland or acrid, times of occurrence, and circumstances which increase or diminish them, and symptoms which accompany them.
If organic symptoms occur, such as eruptions or suspected enlargements or displacements of organs, it is well to consult a physician in order to ascertain the exact condition, which should be carefully described.
The records should be full and minute. It is better to be obliged to erase something afterward, than to risk the less of an important symptom by aiming at brevity.
The dose should be taken at a time when the prover can rest, in mind and body, for a half hour after taking it. The early morning is the best time, for then the prover will have a chance to observe the action of the drug for fifteen to eighteen hours without interruption by sleep. It is better to begin with a small dose, gradually increasing it until effects are recognized, and then to cease taking the drug until these effects have ceased. It may then be repeated in a somewhat larger dose. No danger of permanent illness is incurred by this mode of proving drugs.
During a proving, the prover should abstain from the use of medicines, cosmetics and perfumes, but should make no marked deviation from her usual diet and regimen. Habits of so long standing as to have become “second nature” should be continued in moderation, since to break them off suddenly is to institute at once a morbid state.
A SUMMARY OF A FEW PROVINGS UPON WOMEN.
My studies have, for years past, shown me the weakness of the Homoeopathic Materia Medica in respect of the physiological effects of drugs upon the peculiar organism of women. This is due to the fact that but few of the provers to whose observation we owe our Materia Medica were women. I have not been able to imagine any method by which this deficiency in the Materia Medica could be supplied, except by the voluntary acts of women, who should undertake to prove drugs. And it has seemed to me improbable that this work could be performed with the requisite accuracy and intelligence unless the women who should undertake it were educated in the medical sciences. Finally, it appeared to me that women who had become by education and asquirements members of the medical profession, would not be likely t o take a hearty and efficient part with us in the great work of perfecting the vital element of our science, the Materia Medica, unless they were recognized and received by us as fellow-workers on an equal footing in every respect, for a similar reason to that which led Mr. Dickens to decline the Queen’s invitation to give a reading at Windsor Castle, saying, “I will not appear as an artist where I should not be received as a man,” and, conversely, I thought that if so received they would respond cordially and generously to an invitation to engage in the work for the promotion of medical science, and in a department in which they alone could work, and the completeness of which would be forever a monument of their ability and devotion.
When, therefore, at the session of the Institute in 1869 a resolution was pending which declared the eligibility of properly qualified, women to membership, I determined to invite women who had joined the medical profession to engage in the labor of proving drugs, feeling confident that the results of their work would demonstrate how valuable and indispensable it is to the completion and perfection of our Materia Medica. The result even thus far have justified this confidence. More than thirty women, most of them members of the profession, responded cordially to my invitation, and entered upon the work of drug-proving. One-third of the number have already reported results of a satisfactory nature, and of which I here present a summary.
The drug selected for proving was the Lilium tigrinum the tiger-lily which was introduced into the Materia Medica by Dr. W. E. Payne, of Bath, Me., who had communicated to us just enough to show that it had a powerful specific action upon the female organism. The symptoms were known, however, only to members of the Institute. I thought that by engaging a number of provers in different parts of the country, in a simultaneous proving of this drug, utterly unknown to most, if not all of them, I should receive reports which, if they should corroborate each other, would be very conclusive as to the action of the drug.
Inasmuch as this drug belongs by right of discovery t o Dr. W. E. Payne, I have turned over to him the verbatim reports received from my provers, that he might incorporate them with his own, and prepare the whole for publication in the Transactions of the Institute.
The first proving, and which I shall give in greatest detail, was made under my own observation and direction, by a lady of 30 years, unmarried, a practicing physician, and who had always enjoyed good health, although quite susceptible to the action of drugs.
No. 1. She began her proving Oct. 1, 1869, by taking three drugs of the 30 centesimal dilution of Lilium tigrinum thrice daily. She reports as follows:
“I first noticed that I was more active; things went easily. There was no other effect for four days, unless it was increased sexual instinct; then sweetish nausea, with fullness of the abdomen, particularly after eating even after eating small quantities. But food does not increase the nausea; no desire to vomit.
“On the 6th day moral symptoms were developed. I do not want to be pleased; don’t care to talk; desire to sleep. Slept well all night, with unpleasant dreams. Omitted medicine two days, during which the nausea and full feeling subsided. At intervals the skin of the abdomen felt stiff and stretched. On the 7th day took five drops of the 3 degree, and in a few hours the nausea was much increased, with the same bloated sensation in the abdomen, particularly across the hips and in the region of the uterus; darting pains in different parts of the head, some tearing pain in the lower part of the abdomen from the region of the ovary down both sides. I ate as much as usual, but felt no appetite for it; was restless, with a desire to do something, but no ambition. A sensation of pressure in the vagina, and pain at the top of the sacrum extending to the hips.
“8th Day. Worse on going to bed; can’t go to sleep; wild feeling in the head, as though I should go crazy and no one would take care of me; thoughts of suicide; how much opium would put me to sleep forever, and who would find my body, and who would care; nausea constant.
“10th Day. Pain in the right iliac region, better during motion; the head grows wild after I have been quite for a short time. At 2 P.M. of the 10th day (Oct. 10), took five drops of the 3 degree. Increased depressing weight over the pubes; worse in the evening. The knees ache.” No more medicine was taken by this prover.
Eight days afterward (Oct. 20th), she came to me to state her symptoms, her mind being in such a state that she could not herself record them. The following symptoms had come on the 20th (ten days after last dose), and steadily increased; A sensation in the pelvis as though everything was coming into the world through the vagina. Last night it was very distressing, and not relieved by change of position. The dragging downward toward the pelvis is felt as high as the stomach and even the shoulders; not relieved by lying down, though worse when standing; a disposition to place the hand upon the hypogastrium and press upward in order to relieve the dragging sensation. Likewise an aching and pressure across the lumb-sacral region, and some pressure upon the rectum. Likewise pressure and a crazy feeling upon the vertex, so that she cannot write her symptoms. To-day (22d), when walking, a sensation as if everything were pressing down in the pelvis and into the vagina, so that she inhales forcibly in order to draw up the thorax and clear the pelvis.
She wants somebody to talk to her and entertain her. Feels quite nervous; wants to cry from a feeling of irritation and of something wrong in the abdomen and pelvis. Feels hurried and yet incapable, as if she had a great deal to do and cannot do it; much thirst; drinks often, and much at a time.
Bowels generally regular. Now she has alternately a solid and a loose stool, several during the day, and a constant feeling as though she must have a stool; this feeling resulting from a sensation as if something were pressing against the anterior wall of the rectum at the anus and about one to three inches above
She is conscious of feeling nervous and irritable, and yet says she feels jolly. Grumbling pain in right side of head and teeth.
Yesterday, when walking, pain in both ovaries, worse in the left, extending down the anterior and inner aspect of the left thigh, as if it would be impossible to take another step; as soon as she extended the limb she must immediately flex it again, and then, because of a restless discomfort, must again extend it. At length she went to sleep on the back with knees and thighs flexed.
She cannot tell which pelvic pain is the worse, that in the back or that in the pubic region. The whole contents of the pelvis seem to drag downward and forward and quite from the epigastric region.
She cannot record her symptoms. Don’t want to complain, and yet don’t avoid people. Feels bloated, but is not so. Somewhat tender on pressure in the region of the ovaries, especially the right.
Oct. 23. Aching in the pelvis between promontory of sacrum and the pubes. It feels to her as if the aching were not in the uters but around it. She feels constantly the two spots corresponding to the ovaries, and which ache and feel like little coals of fire. In the pelvis, a feeling like a dragging out, as if the whole contents were pushing down into a funnel, the outlet of which coincided with the vagina.
Oct. 25. For the last 36 hours constant desire for stool from pressure on the rectum; a stool every half hour, lumpy, diarrhoeic, with flatus; constant tenesmus, and burning in the urethra. These symptoms continued along with those before described, for several days. The pain in the right ovary increased, until on the 16th she described it as if a knife were inserted into the ovary and ripped down the groin and the anterior part of the thigh; the pain extended over the lumbo-sacral region, and she must cry herself to sleep. Somewhat relieved by pressure on the ovarian region.
Diarrhoea and pressure on bladder continue without relief until the 27th. She remarks that her symptoms are all worse when she gives up active resistance to them and control over herself, as for example, when she sits down to rest or tries to go to sleep.
Oct. 28. Menses occurred at the regular day and normal, but only while she keeps moving. The flow ceases when she becomes quiet. She feels much hurried and driven, but knows not why; walks fast and constantly, but aimlessly; is much confused in mind.
Oct. 29. She noticed some heart symptoms, not very definite. On the 30th, after walking, a sudden fluttering sensation in the heart. This, like all other symptoms, is less felt she can busy herself much. A hurried feeling about the heart with faintness and fluttering as though she could make no exertion but must sit still. The seat of pain is the apex of the heart. Twice she had a sharp pain there. Feels hurried as though she must breathe quickly, yet does not.
The prover feels that her whole system has been profoundly affected by the drug. “She is not the person she once was;” feels hurried but incapable; no heart nor strength for business; discouraged and despondent.
Nov. 1. A dry, single cough; heart symptoms very troublesome; short of breath, especially on going upstairs.
Appetite very much increased, especially for meat, and the more so the more pronounced the symptoms were. The mental symptoms are striking; she is averse to being alone, which formerly she liked (but does not dread it). Her sexual instincts, formerly dormant, are now quite strong; wits and intuitions dull and languid.
Nov. 10. The prover reports: She had been quite well since the 4th, and supposed the action of the drug exhausted, but on the 7th the bearing down sensation in the pelvis returned; everything seemed to be pressing out of the vagina. This continued on the 8th like light labor pains. Leucorrhoea also occurred (a thin acrid discharge, leaving a brown stain). She had never before had it. All these symptoms worse afternoon and evening till midnight. On the 9th leucorrhoea had ceased, but in the afternoon it returned worse than ever, and she could not sleep for the pelvic distress.
Nov. 11. She feels depression; has pressure on bladder and rectum; is inert, yet restless and peevish; leucorrhoea continues. With these symptoms comes the desire again for meat. Burning pain across the hypogastrium from groin to groin. In short, the symptoms first experienced repeat themselves. She had not taken any more of the Lilium tigrinum. In addition she notices a peculiar mental condition; a desire for fine things of every kind. She is dissatisfied with what she has, and envious of others.
Nov. 12. While attending a lecture, much irritation in the womb and a singular state of mind desire to strike the lecturer, and in the evening a disposition to swear at everybody and everything, and to think and speak and of obscene things; as these feelings came, the uterine pains passed away. To day the leucorrhoea ceased.
Nov. 13. She has been languid, dull,and forgetful since the last report. Menses recurred (14th) after an interval of only two weeks; a slight, dark, thick, and offensive discharge.
Dec. 1. It is eight weeks since she took Lilium tigrinum. Yesterday, great hunger, and she ate largely, yet felt as if she should starve. Felt the old hurry and incapacity; the old pains in head and teeth relieved by motion and occupation, followed by the diarrhoea and the pressure on the bladder.
Dec. 4. She is now passing this, the third series of symptoms produced by the Lilium tigrinum; the passionate excitement, the aching and burning pain in the ovaries (in the right), which organs are distinctly defined to her sensation; then despondency with aggravation at night and diarrhoea in the morning; then pressing down in the pelvis and burning all around the pubes and genitals, worse from 3 to 5 p.m., and passing away from 8 p.m., accompanied by pressure on the bladder.
The symptoms on this occasion were so severe and distressing physical no less than mental that I could not allow the prover to continue to endure them, and gave Platina200 repeatedly, under which she gained speedy relief.
No. 2. To compare with the above, I will give an abstract of a proving made under the supervision of Dr. W. E. Payne, at about the same time, the provers having no communication:
Mrs. P., aged 55 has ceased to menstruate.
Jan. 26, 1870, took a drop of the 30 centesimal. In the evening, after griping pain, had free, faecal stool, followed by acrid feeling in anus and rectum, a very rare thing for this prover. During the night, a feeling in all the extremities as if the blood were pushed outward; restlessness; heat and pain in forehead and brow.
Next day a free stool, followed by acrid sensation at the anus. Frequent desire to urinate during the day, with scanty discharge and followed by an acrid sensation in the urethra. These symptoms recurred daily with marked aggravation about 5 p.m. till February 2. Diarrhoeic stool every morning, followed by acrid irritation at anus, continuing about an hour. Same symptoms with urine.
Feb. 2. Repeated medicine. Increase of the above symptoms; burning in palms and soles all night, with constant desire to find a cool place for them; some cutting pain in the left mammary gland, with aching, beginning below the nipple, deep in the breast, as though between the gland and the ribs and extending around that side to the spine, seeming to pass under the lower end of scapula,
coming on after retiring and worse when lying on the affected side.
These symptoms continued and recurred daily; she repeated the medicine, which was followed by a severe blinding headache in the anterior part of the head, the peculiarity of which was a sensation as if all the blood were pressing outward through every aperture. The medicine was repeated every third or fourth day. About the 9th and 10th, in the left side of the abdomen (ovarian region) soreness to pressure; darting pains at times in this region, extending to the groin and pubes in front; frequent desire to urinate.
On the 12th, the head being clearer and better, great heaviness and pressure in the region of the womb, with stinging and darting pain in the ovarian region.
14th. The ovarian pains becomes more decided and extend down the left thigh.
This series of symptoms continued until the 21st, when the ovarian pain continuing, there was also a bearing down in the uterine region, with a desire to sustain the parts by pressing upward with the hand against the vulva; symptoms which continued and are described on the 25th as a pressing and bearing down sensation” in the whole of the sexual organs, with a feeling as if the internal parts were being pulled outward and downward from the mammary and umbilical region through the vagina; irresistible desire to press the hands against the vulva to prevent the internal organs from escaping.
These symptoms continued to recur for a full month after the last dose of Lilium, and the morning diarrhoea for more than six weeks.
No. 3. This prover took Lilium 3 in one dose a quarter ounce. No symptoms were observed for two weeks. Then of which the most striking were those last in order, pain in the lumbar region as though the back would break; bearing down pain in the pelvis, especially when walking; pressure and weight low down in the vagina.
She reports, also, a headache, as if the head were too full of blood as if the blood would issue from nose and ears.
No. 4. This prover, who had suffered from astigmatism, and was hypermetrophic, experienced from Lilium3, heart symptoms, pain through the heart to the back, and a feeling as if the heart were squeezed in a vice. She cannot walk straight by going into a warm room, the symptoms having occurred while walking in cold air.
Also, her eyesight very dim. She took no more medicine, and in about a month her eyesight was restored, She then found that the astigmatism no longer existed.
No.5. This prover describes the same headache as the previous prover – pressure from within outward; the same nervous prostration, and a morning diarrhoea with much tenesmus. She states the symptoms persisted for a month after the last dose.
No.6. This prover reports nervous tremulousness and inability to apply the mind; aggravation in the afternoon, and a headache similar to the preceding. Also, menses diminished in quantity, but occurring too soon. Likewise severe pains in the uterus; could not bear the weight of clothing on the pelvis; profuse acrid leucorrhoea. While the pain in the pelvis was so severe, a vaginal examination disclosed the fact that the uterus was anteverted, a state of things that had never before existed. During the pains hysterical paroxysms.
Nos. 7 and 8. The same series of symptoms as above.
From this resume we may gather some of the chief characteristics of Lilium. When taken in moderate doses the effects are not immediate. Days elapse before unmistakable symptoms of the drug-action appear. But the effects are very persistent, as the record of every prover shows. They tend, moreover, to recur at longer or shorter intervals, and in groups which preserve a definite order. Thus prover No.1, whose record I have given at greater length, reports a third recurrence of a group of symptoms nearly two months after the dose of Lilium. In male provers the same recurrence of symptoms in definite groups has been observed, with an interval of comparative freedom from symptoms. The simultaneous observation of these peculiarities in provers residing far from each other, and known to each other, precludes any doubt of its genuineness.
Of the symptoms observed by women, as well as men, the effects on the mind are noteworthy, and are of two varieties. First, as noticed by Dr. Payne, anxiety and apprehension that an incurable disease exists or is impending, and this produces despondency. Second, as exhibited most decidedly in prover No. 1 and clearly, though less pronounced, in several others, a consciousness of an unnatural state of mind and feeling, which at last develops into an exalted condition in which the prover is disposed to find fault with persons and things, to exaggerate her own importance and excellence and look down upon others. Conjoined with this state of things has resulted in hysterical paroxysms. In prover No.1 It assumed such marked proportions I was constrained to put an end to it by administering Platina, the indications for which are evident from the mental symptoms. Intellectual activity is impaired in both men and women. Both have complained of the feeling of hurry and restlessness, which is so well described by prover No.1.
Menstruation is accelerated, in some cases recurring in two weeks. The flow is very scanty.
An acrid, thin brownish leucorrhoea was, to several provers, a troublesome symptom.
But the most striking symptoms, and those most widely observed, relate to the pelvic organs. They did not generally present themselves until a number of days after the proving was begun. They consist of a dragging or pulling or forcing down sensation in the pelvis, as though the entire contents of the pelvis were pulled down though the vagina, or would issue from the vulva. This sensation is not confined to the back or hips nor again to the hypogastric region – but is described as pervading the entire pelvis. And the two provers in whom this symptom was most marked describe the dragging as coming even from the thorax, the mammary region, and the shoulders. So marked is the sensation of downward and outward pressure that the provers place the hand on the hypogastrium or the vulva as though to prevent protrusion. In three provers, physical inspection revealed the existence of anteversion uteri, a trouble which none of them had ever before experienced.
In this train of symptoms belong also the tenesmus of bladder and rectum, and the diarrhoea and frequent micturition.
There is agreement of the provers respecting pains, burning or cutting, and tenderness in the region of the ovaries, especially of the right ovary.