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BY E. O. ADAMS, M. D., PROFESSOR OF DISEASES OF THE DIGESTIVE OR-
GANS, CLEVELAND HOMEOPATHIC MEDICAL COLLEGE.

Mrs. H.

History. Age, 33. Has been in poor
health for 12 years. Has had to be
careful of what she ate, and had more
or less digestive distress every day,
such as gas, distention and some pain.
These symptoms were worse from eat-
ing, and there would be periods of
nausea and vomiting. Had most se-
vere attack four years ago, and then
vomited some blood. At that time she
was in bed three months, and since
then has been worse than previously.
She is always worse at the menstrual
period, during which time she also has
severe pelvic pain, flows too profusely,
and generally has to go to bed for a
few days. Has been treated by num-
erous doctors, who have medicated, di-
eted, dilated cervix, curetted, massaged,
used electricity, etc., etc. Has had no
pregnancies.

Present Condition.-Somewhat emac-
iated, but does not appear especially
anemic. Mentally, feels very badly as
a result of suffering. Does not know
what is the matter with her, but what-
ever it is, longs for relief, and is will-
ing to submit to anything that offers
hope. And if relief is not secured soon,
longs that death may end her suffer-
ings.

Mrs. M.

History.-Age, 35. Has been in poor
health for 16 years. Been on some
kind of diet or other most of the time.
Had indigestion, with gaseous disten-
tion, constipation, pain and cardiac
palpitation. Frequent attacks of vom-
iting. These attacks more apt to come
at menstrual period, when there is con-
siderable pelvic pain, and a profuse
and long lasting flow, so much so that
at various times it has been diagnosed
as abortion, but this has never been
proven by finding the products of con-
ception. Probably also largely because
of these symptoms, a uterine fibroid
has been diagnosed. Has vomited
blood two or three times at these per-
iods. Has doctored a great deal, in-
cluding various operative pelvic meas-
ures, of which one was cauterization of
internal hemorrhoids, with resulting
rectal stricture. Had one baby several
years ago, accompanied she says by
laceration, which was immediately re-
paired, and followed by puerperal

fever.

Present Condition. - Fairly well nour-
ished, but has lost considerable weight
in last month as result of frequent
vomiting, low diet and profuse menor-
rhagia. Is in condition of constant
fear. Thinks she has serious heart dis-
ease, cancer of the stomach, a fibroid
of the uterus, besides several other
lesser ailments. Yet, although she
greatly fears each of these, she is still

* Written expressly for the REPORTER.

198422

Physically there is considerable tenderness all over the abdomen, but a certain point three or four inches above the umbilicus, pressure causes greatest distress, and causes pain through to the back. Stomach dilated. No, growths cr thickenings can be found. Uterus enlarged, hard, fixed and tender. Laboratory Findings. In gastric juice the Hel is increased, ranging about 40. Total acidity, 72. Organic acids, absent. Products of digestion about normal. If she goes long enough without vomiting, lavage discloses that food is retained in the stomach considerably longer than normal.

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Above, briefly told by means of parallel comparisons, are the reports of two cases, which, as regards many important particulars, are quite similar, yet, they are totally different as regards the diagnosis, and the treatment required for their relief. The two points which were of chief importance in differentiation, were as follows:

1. The difference in the mentality. In Mrs. M., there was about her entire personality a sort of indefinable, yet easily recognized suggestion that she was a neurotic; her intense and variable. fears; her conversation which lacked continuity of thought; her imperious manner, which might be followed by sudden change to tears and despondency. Of course, such cases may develop severe organic disease, therefore it is necessary to look carefully for it, but here no evidence of such condition could be found. In Mrs. H. these features were entirely lacking, and there were only the indications of a long continued suffering.

2. The other point which had a bearing on the diagnosis, was the finding upon careful search in Mrs. H. of a small, circumscribed spot in the epigastrium, that seemed much more sore upon pressure, than any of the rest of the abdomen. With Mrs. M. no such spot could be found.

Mrs. M. came under my care first, and upon arriving at the conclusion that her troubles were hysterical, I told her repeatedly, and with a manner of certainty, that in the past she might, or might not have had organic disease of the stomach. Possibly there had been an ulcer at the time she had vomited blood, or that might have been only a form of vicarious menstruation. But that if she had had such trouble then, it had entirely disappeared now, and that her present discomfort was entirely due to the alarm which arose in her mind when she did have such trouble as had not disappeared when the cause of it had been removed. That when such trouble existed, of course she felt worse at the menstrual period, and therefore she had gotten into the habit of expecting trouble at that time; had eaten with fear of resulting trouble; and of course it had come. I explained how nerves pass down to the stomach from the brain, and through them how it is possible for the mental influences of fear, or the expectation of any given phenomena, to powerfully affect the stomach and the process of digestion. I found on questioning that the vomiting always preceded the menorrhagia, and so told her what I believe was true, that the latter was entirely due to the effort of straining when she vomited; and that this also caused the soreness which she had in the abdomen and pelvis.

By means of such statements, and by positively affirming that she had no organic heart disease, or stomach disease, or uterine disease, except those due to the straining of vomiting, and by various other statements and arguments, which I attempted to make appear reasonable to her, the treatment was instituted. As she was in bed, I allowed her to remain there for a few days, and hot fomentations were placed over the abdomen to help relieve the tenderness present. This all happened about two years ago, and she has not vomited more than half a dozen times since then. Occasionally she has a slight back-sliding, and needs a few repetitions of the psycho-therapeutic prescriptions. But as compared with her health of the preceding sixteen years, she has during the past two years been well. Menstruation is normal in amount, and practically painless. Appetite good and she has eaten freely. With but a very few, short exceptions, digestion has caused no distress. Cases such as this one. are the kind that Christian Scientists are apt to benefit, and gain honor thereby, but in my opinion we as physicians can do better

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