The pioneer woman's view of migraine: Elizabeth Garrett Anderson's thesis "Sur la migraine".
This is a presentation of a doctoral thesis of 1870. The author was English but the thesis and the examinations were in French. Elizabeth Garrett Anderson, usually referred to as E.G.A., was the first woman in Britain to obtain the title of M.D., but not the first in Europe. Nadeshda Prokofevna Suslova, a Russian, received her M.D. in 1867 in Zurich, the most liberal university at that time, soon to be flooded by female students from Russia. E.G.A. had been applying to the few possible European universities but she settled for Paris after the Empress Eugenie had decided that she should be accepted there. This meant that she could succeed without having to be a Paris resident, just by writing a thesis and passing a series of examinations presided over by Paul Broca. This was important as she was already conducting private and dispensary practice, and could not find a locum (she insisted on a woman). E.G.A. had suffered many setbacks, for being a woman, as such being unacceptable in dissection rooms and operating theatres, and generally in a professional career where women were unheard of. She was finally permitted to receive her medical diploma from the Worshipful Society of Apothecaries of London. She wrote about her thesis: "I have chosen Headache as its subject. I had to find a subject which could be well studied without post-mortem observations, of which I can have but very few in either private or dispensary practice; and I wished also to take a large subject, one that demanded some insight into the harmony that exists between the main physiological functions." Marcia Wilkinson (M.W.), who worked in the Elizabeth Garrett Anderson Hospital in London for 35 years, heard there of E.G.A.'s thesis on migraine and sent for it from Paris. In 1966 she translated it into English from the original French, being interested both in the subject and in the person of this resolute and lucid woman. When H. Isler found the French thesis in the British Library he intended to translate it but, after discussion, we decided on a joint effort (95% of the translation is by M.W.; very few details were changed, and some footnotes added for better understanding). We think that E.G.A.'s text is a classic, showing profound understanding, sound practical advice, and also, in its theoretical part, the limits of neurophysiological knowledge in Paris when Brown-Sequard was "charge des cours" there. We may add that in her various examinations she had to answer questions, in French, on the use of footprints by the police, the general nature of fishes, toxic fishes, electric fishes, cod liver oil, and the secretion of tears. She earned much applause from the public, which consisted of male French students, and the overt appreciation of Paul Broca, head examiner, and Dr Wurtz, the Dean of the Faculte de Médecine. The impact of her thesis in the 19th century was modest. It appears to be rather marginal in the German literature of the early 20th century, but it has imprinted the management of migraine at the City of London Migraine Clinic in the last thirty years. The importance of nutrition, regular meals, regular habits, the need to supplement analgesics with antiemetics, and the treatment of the attack with rest, and great quantities of hot tea, were certainly related to E.G.A.'s doctrine. The internationally prevailing recommendation to give antiemetics, and then only analgesics, as well as the combination of both in one tablet, may thus be traced back to E.G.A. via the teachings of M.W. and Nat Blau.
Wilkinson
M
M
City of London Migraine Clinic, London, UK.
Isler
H
H
D004212:Academic Dissertations as Topic / Q000266:history; D004739:England; D005602:France; D049672:History, 19th Century; D008881:Migraine Disorders / Q000266:history*