Thèse pour le Doctorat en Médecine; Par Mdlle. Elizabeth Garrett, Docteur en Médecine. Sur la Migraine. Paris:1870.

IT WOULD BE IMPOSSIBLE, in any case, to pass without notice so striking an event as the appearance of the inaugural treatise of the first lady - an English lady, moreover - who has ever passed through the formidable ordeal of the examination for the Paris doctorate of medicine.

But in fact the treatise before us needs no recommendation from the unusual circumstances under which it appears. It is a piece of scientific work which will be able to hold its own with the critics, and deserves the impartial study of the profession as any monograph on nervous disease which has appeared of late years.

It is not the province of this journal to discuss medical politics, and we shall not pronounce any opinion as to the probability of lady doctors, in any considerable numbers, acquiring such a genuine knowledge of medical science as is displayed in Dr Garrett’s inaugural treatise; but we may at least say that we should personally be delighted to welcome as colleagues any number of ladies who should prove themselves to have mastered their profession as she has done.

Between the two views, which respectively represent migraine as essentially an affection of the stomach and of the brain, we have declared unhesitatingly in favour of the latter1; regarding the disease as (primarily) a trigeminal neuralgia, and the stomach affection as a mere secondary complication due to reflex nervous irritation. We are glad to find that Miss Garrett, who has made a very careful clinical study of the disease, so far shares our opinions that she rejects unhesitatingly the view of Tissot and his school, which regards the stomach as the original source of the disease.

She came to the following conclusions:

“1 Migraine is essentially a neurosis, having its origin in the abnormal condition of a portion of the brain. 2 In all probability migraine, in a natural classification of diseases, should be placed between asthma and epilepsy. 3 The central nervous debility is almost invariably accompanied by an analogous depression of some portion of the visceral nervous system, most frequently of the gastric or the duodenal nerves. 4 There is reason to suppose that in migraine, as happens in other cases of severe and recurrent pain, the central lesion consists in imperfect nutrition of the nervous  tissues. The immediate result of this is a too rapid discharge of the inherent electricity of the nervous molecules. 

5 The cerebral lesion, though usually congenital or inherent, may be induced by certain poisons, as those of gout and malaria, or by some external interference with nervous nutrition.”

With these general propositions we quite agree.

The treatment of migraine which our authoress recommends is grounded thoroughly on the idea that migraine is essentially a neuralgia: thus the prime remedies which she recommends are the bracing influences of fresh air and vigorous exercise, and next to these the purely nervine tonics, especially nux vomica. But she makes a special feature of the subsidiary diet and medication by which the stomach and intestines are guarded from becoming the source of irritation (e.g. from alcoholic stimulants), which might act as an exciting cause of the access of migraine. Miss Garrett’s theory being that the predisposition to the latter is usually inherent and congenital.  We are glad to see that she adds her testimony to one most important, but as yet little employed remedy, the constant electric current.

Not only is she perfectly justified in asserting that a few very short séances during which the current from no more than ten cells is applied, will act as a more powerful tonic and prophylactic against the attacks than any drugs, but she might have spoken far more strongly than she has done of the power of this remedy to arrest the actual paroxysm, especially if taken in time. The current need only be applied for about two minutes in the case of the actual attack, and for about half this time when used as a prophylactic.

 In finishing our brief notice of this very interesting  and practical treatise, we cannot omit a word of praise for the clear and fluent style in which it is written, and the excellence of its French diction; these are remarkable, and add much to the pleasure of the reader.

1 vide Practitioner, vol. ii 1869.