Lilium Tigrinum - General symptoms

GENERAL

General

Lilium tigrinum, H. K.

Natural order, Liliaceae.

Common name, Tiger Lily.

Preparation, Tincture of the flowers only (proving Nos. 2 and 3), or tinct. of stalks, leaves, and flowers, gathered in August (subsequent provings).

Symptoms came down on her like a sudden cloud, when she was feeling quite well (thirty-sixth day).

she lost vigor and snap, and could sit down and cry, or be impatient with herself and tear about, but feels hurried.

could walk or run aimlessly for an indefinite time.

with all this depression comes a desire for fine things of all kinds.

she is dissatisfied with what she had and is envious of others (thirty-sixth day),.

Dizziness and faint feeling all over.

blur before the eyes. fear of falling, aggravated in a close hot room, and ameliorated when the fresh air strikes the uncovered head and face, although the cool air produces a feeling of chilliness.

better also when walking in the street.

these symptoms continued very severe for about two hours, then gradually diminished (twenty-fourth day),.

Burning in the forehead, with burning-pressing pains, especially over left eye, in the evening (second day).

the burning-pressing headache returns between 5 and 6 P.M., more in right side of forehead, increasing in strength as the evening passes on, though it does not reach its former severity (third day).

old headache returned, with some lachrymation, in the evening in a warm room (sixth day),.

Prover's eyesight always weak.

she is hypermetropic, uses convex fourteen glasses, now sight is much worse (fourth day).

sight worse, eyes very painful, smarting, must close them often.

light painful, darkness pleasant (fifth day), eyes very sore, sight dim.

must cause the proving (sixth day), eyes no better (eleventh day).

having suffered as above for four weeks, my eyes returned to their former condition, with one exception.

whereas formerly for one year I had a Habit of turning my head towards the left when reading, trying thereby to look with the left eye out of the right glass of the spectacles, and this in order to see the whole of a letter, like b, p, d, etc., of which otherwise I could see only the straight part, but not the curve, now I can see distinctly without turning the head and looking sidewise (after about ten weeks),.

Sweetish nausea, with fulness of the abdomen, particularly after eating, even after eating small quantities, but food does not increase the nausea.

no desire to vomit (after four days).

In the middle of the forenoon, intensely sharp pain in right side, between hip and false ribs, extending forward and upwards to umbilicus.

felt something like an attack of colic, so severe as to render a deep, full breath intolerable.

was almost obliged to stop work (sitting type).

pain lasted till a little past noon, when it stopped suddenly (fifth day),.

Symptoms passed of with a free evacuation of the bowels, which was followed by an acrid smarting at the anus, and at 8 A.M. griping pain in bowels returned, with heat and pain in and across the forehead about 5 P.M. (second day), gradually increasing during the evening and night as before, though less severe, abating as before in the morning at about 8 A.M., with a free and loose discharge from the bowels, followed by the same acrid, smarting sensation at the anus and up the rectum (third day), recurring daily till the eighth day, gradually diminishing in severity. Every morning after rising for five days up to the eighth day, there was diarrhoeic discharge from the bowels, followed by the same acrid, irritating sensation at the anus and up the rectum as at first.

this irritation seemed as if produced by a hot, irritating spray projected upon the parts, and usually continued for about two hours, gradually subsiding,.

A sensation in the pelvis as though everything was coming into the work through the vagina, very distressing, and not relieved by change of position.

the dragging downwards towards 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 upwards, in order to relieve the dragging sensation (twentieth day).

steadily increasing while riding (twenty-first day).

when walking, a sensation as if everything were pressing down in the pelvis, so that she inhales forcibly, in order to draw up the thorax and relieve the pelvis of weight (twenty-second day),.

Bearing down in lower part of abdomen continues, now the twentieth day since it commenced, with severe pressure in the rectum and at the anus, and a constant desire to go to stool, but with every effort to evacuate the bowels, urine only was discharged, sensation as if a hard body were pressing backwards and downwards against the rectum and anus.

standing on the feet aggravated and increased the desire to go to stool.

these symptoms were somewhat relieved by walking in the open air and riding (forty-third day),.

Bowels naturally regular.

now she has alternately a solid and as loose stool, several during the day, and a constant feeling as though she must have a stool.

this feeling resulted from a sensation as if something were pushing against the anterior wall of the rectum at the anus, and about two to three inches above it (twenty-second day).

for the last thirty-six hours constant desire for stool from pressure on the rectum.

a stool every half hour, lumpy, small, diarrhoeic, with wind.

constant tenesmus. she could sit at stool forever, and burning in the urethra.

continuing several days.

took Helonias Dioica ^Helonias 200, and was greatly relieved (twenty-third day),.

Manifests powerful influence over the pelvic organs, and is adapted to many reflex states dependent on some pathological condition of uterus and ovaries. More often indicated in unmarried women. The action on the heart is very marked. Pain in small spots ( Oxalicum Acidum ^Oxal-ac.) Rheumatic arthritis.

FULL, HEAVY or forced out feeling; uterus; heart; eyelids; ovary [left]

Utero-ovarian sagging Marked nervo-hysterical reflexes (Conium Mac ^Con---- ), especially mental or cardiac

Nervous tremor; in hypogastrium, in spine, knees, etc

Pulsation, ebullition, gurglings and burnings

Backward pains; about eyes; to occiput; from nipples through chest; from heart to l

scapula

Venous congestion

Acrid discharges

Hurried, nervous, snappish and erotic or depressed Fruitless activity

Wild, crazy feeling

Dread; of insanity; being incurable, etc

Desires finery

Burning headache, worse before and after menses; ache over [left], eye; with vertigo and visual effects

Eyes, feel sprained; bite and burn, worse reading Yellowish, patchy tongue

Sweet taste -back of mouth

Craves meat

Hunger, as if from spine

Stiff, tense abdomen

Can't bear weight of covers

Sharp pains, worse doubling up

Early, morning diarrhoea; frequent, small stools; with tenesmus; worse after rising

Heavy dragging or outward urging in pelvis; must hold parts (Sanic---- ); with dysuria Ovarian pain, [left]; into limb; with pain below [left] breast

Menses free, while moving only

Thin, brown, leucorrhoea; acrid

Oppressive load on chest; air hunger; takes long breaths

As of a rivet or ball under [left] mamma

HEART, feels clutched, overful, cold, weak, hangs by a thread, etc

; pains into [left] arm; worse stooping; worse lying on [right] side; nervous

Palpitation Neckache, worse tire

Broken feeling between scapulae

Pain from hip to hip

Can't walk on uneven ground

Chilly, better open air

Burning palms and soles

Uterus Ovaries HEART (R)

Tiger Lily. N. O. Liliaceae. Tincture of fresh stalk, leaves, and flowers. (Some of the provings were made with tincture of the pollen alone.)

Angina pectoris. Asthenopia. Astigmatism. Dementia. Diarrhoea. Dysentery. Eyes, affections of. Fibroma. Heart, affections of; Palpitation of. Hysteria. Ovaries, affections of; dropsy of. Pruritus vulvae. Spinal irritation. Urination, too frequent. Uterus, affections of; displacements of; subinvolution of.

The Tiger Lily, which was introduced into the West from China ^China and Japan, was first suggested as a remedy by W. E. Payne.

Carroll Dunham urged Payne to have it well proved.

Lilium Tigrinum Payne did, and Dunham himself assisted by having it proved on a woman under his own supervision.

The account of this case of Lilium tigrinum disease, with others, is given in Dunham's lucid style in his Science of Therapeutics. Lil. t. was given in the 30th and 3rd attenuations, which were taken during ten days.

The symptoms began early but were somewhat slow in developing, and, after recovery, recurred with other symptoms.

The third series recurred in the ninth week after taking the drug, and this was the most severe of all.

So intense were the sufferings mental and bodily that Dunham felt bound to antidote them with Platinum Metallicum ^Plat. 200, which was speedily effective.

The symptoms developed in this order ($51$) Increased activity; things went more easily. (2) Increased sexual instinct. (3) Sweetish nausea without inclination to vomit.

Abnormal fulness agg. after eating ever so little. (4) Ill-humour.

drowsiness. sleep but with unpleasant dreams. (5) Bloating more pronounced and chiefly across hips in uterine region.

darting pains in head and lower abdomen from ovaries down thighs.

pressure in vagina. pain at top of sacrum extending to hips. (6) Crazy feeling with thoughts of suicide.

head grows wild after being quiet for a short time.

increased depressing weight over parting.

agg. evening.

Knees ache. From this point, ten days after the first dose, no more medicine was taken, but the Lil. tig. disease continued to develop and increase in intensity for eight weeks longer, when it was so bad that it had to be put an end to by an antidote.

Of these symptoms the most prominent were a "downward dragging" from shoulders, from thorax, from left breast, from epigastrium down to pelvis, and out at the vagina as if everything would be forced through. (In some other provers who were examined actual displacement was found, especially anteversion.) Late in the proving a thin brown leucorrhoea appeared, leaving a brown stain.

Lilium Tigrinum was intermittent.

The downward pressure involved the rectum and bladder, and loins.

There was consciousness of the ovaries as distinct painful and burning spots with pains radiating from them down the thighs.

Menses came at regular times but flowed only as long as she kept moving.

Much hurried and driven, she knows not why.

Heart symptoms came on at this time, about a month after commencing the proving Sudden fluttering sensation, less felt if she can busy herself very much.

Faintness accompanied the fluttering, as though she could make no exertion but must sit still.

Sharp pain in apex of heart.

After a cessation of symptoms for about a week there was a recurrence of the same, including leucorrhoea, burning pain from groin to groin, with new mental symptoms, including obscene thoughts and disposition to strike and swear.

Menses recurred after only two weeks' interval, leucorrhoea having ceased two days before.

After another brief interval the second recurrence occurred, which was put an end to by Platinum.

In male provers there was a good deal of pelvic distress, affecting bladder, rectum, and back, and a very decided increase in sexual instinct, but nothing approaching the intensity of the action on the female organs.

The heart, in the males, appears to have borne the chief impact of the drug's action.

The outward forcing in which the down-dragging symptoms of the female provers culminated was manifested in other symptoms.

One man had this The heart's action was intermittent, every intermission followed by a violent throb, causing an involuntary catching of the breath; at the same time the blood rushed up through the carotids to the head, producing great heat and a crowded feeling of head and face.

Another prover, woman, 53, who had ceased to menstruate, took a drop of 30th.

She had A feeling of exhaustion as if the blood were pushed outward.

and later a blinding headache "as if all the blood were pressing outward through every aperture." S Lilienthal had among his symptoms "A sensation as if a rubber band were stretched tightly from temple to temple".

"as if a Scutellaria Lateriflora ^skullcap were crushing the head".

"as if the brain was being pushed through eyes and ears." "Outward forcing" is plainly a keynote of Lilium Tigrinum.

and the contractive pains at the heart as if grasped with a hand are all of a piece with this.

The characteristic feature in the heart-grip is an intermittent pressure.

there is alternate spasm and relaxation as if a hand squeezed the heart and then let go and squeezed again. Another leading indication is when there is pain and numbness in the right arm along with the heart pain.

and again when there is alternation between heart pains and uterine or ovarian pains. The pains of Lil. tig. are wandering, flying, shooting, squeezing and relaxing, opening and shutting, burning and radiating. They radiate from ovary to heart to left breast, down legs (especially left), across to opposite ovary.

through left breast to back.

from ilium to ilium. across sacrum. In contradistinction to the down-dragging is a "pulling-up" sensation from the tip of the coccyx. A patient to whom I gave Lil. tig. 30 said it caused a sensation in the abdomen as if the contents were "tied up in knots." C. Sigmund Rage has observed (H. R., xi. 482) excellent results from Lil. t. 3x and 30 in cases of uterine fibroid presenting the characteristic symptoms of the remedy. The 2x and 3x caused severe aggravations.

backache. fever and sweat during the night.

fear of dying. Among other peculiar sensations are With nausea, a lump in centre of chest which could be moved down by empty swallowing. As if an electric current in fingers and hands. As if cool wind blowing on lower extremities. The eyes were the seat of many marked symptoms, and one prover who was astigmatic, after much suffering in the eyes during the proving, found her astigmatism gone when the proving was over.

The left side was most markedly affected. Intense restlessness, nervous system irritable, weak, trembling.

aimless hurry. walks to and fro. Convulsive contractions of almost all muscles of body, and feeling as if she would be crazy if she did not hold tightly upon herself. Feeling as if she must scream. "Cannot walk on uneven ground" (H. C. Allen). Burning palms and soles accompany other complaints. The symptoms are amel. lying on left side, when lying down at all is tolerated. Rest in general agg. (Berridge cured a lady, 50, of heart pain, as if grasped with hand, with cold feeling from apex of heart to under left scapula; excited by worry; agg. lying on right side; amel. lying on left side and when busy at work.) Hasty, busy movement amel. Pressure and support amel. Must cross legs to relieve bearing down.

must put hands to vulva to prevent contents escaping. Movement agg. uterine symptoms unable to move for fear her womb would drop from her. Stooping agg. heart pain. Standing agg. downward dragging. agg. Afternoon and night from 5 p.m. to 8 a.m. Diarrhoea agg. early morning. amel. In open air. agg. In warm room.

is faint. Touch agg. (on epigastrium = desire to vomit).

agg. haemorrhoids. Pressure of bedclothes is intolerable on abdomen and uterine region. Rubbing and pressure amel. heart spasm. Jarring agg.

Tiger Lily. W. Payne. Liliaceae.

So far as proved Lilium Tigrinum has shown itself adapted to the complaints of women.

It is especially suited to hysterical women, who suffer from uterine troubles, cardiac troubles and various nervous manifestations; suitable to a woman who is extremely irritable, full of fanciful notions, insanity, religious melancholy and imaginations, with cardiac affections and prolapsus.

These conditions often alternate; when the mental symptoms are most marked the physical symptoms are relieved. The "dragging down" that is associated with prolapsus seems to be a dragging down from the region of the stomach, and even sometimes from the throat.

A bearing down, as if all the interior organs were dragging down. With this state of extreme relaxation there is great fidgetiness and most marked of all, palpitation. She can lie only on the back, and is aggravated from lying on either side. From every emotion the heart flutters, and is irregular and excitable. These mental symptoms and heart symptoms and uterine symptoms often rotate or alternate, and constitute the principal features.

Has wrong ideas concerning everything. Receives wrong impressions and everything is inverted. It is impossible to please her. Now these states are present with a state of irritability of the sexual organs, nymphomania.

violent sexual excitement associated with spasms, with palpitation, with sweats, with periods of exhaustion. She sits alone and broods over imaginary troubles, and when spoken to is crabbed.

"Ideas not clear; they become more so if she exercises her will."

"Makes mistakes in writing, in speaking, cannot apply the mind steadily; tormented about her salvation."

The patient tries to describe an indescribable feeling by saying she has a "crazy feeling" in the head, as if the ideas scattered, and the more she attempts to think rationally the more irrational she becomes. The more she attempts to think of something the less likely she is to recall it. When putting the mind upon something else it comes back again. Lilium Tigrinum has all kinds of symptoms from sexual excesses in overwrought and nervous women, from sexual excitement, causing confusion of mind with palpitation.

It says in the text

"Listless, inert, yet does not want to sit still."

Lilium Tigrinum patient will sit still and brood and think over the past, and when spoken to will jump up and run hastily and excitedly and slam the door without any cause; when spoken to kindly by members of the family, or a friend, it seems that she will go wild. A patient once under an aggravation from Lilium Tigrinum said to me

"I was spoken to to-day in a street car, and I was so mad I wanted to fling something at his head."

She was thinking over something about herself, and did not want to be disturbed. It is a violent state of temper, a violent state of irritability, a loss of balance. She says

"It seems as if I must fly when spoken to or disturbed."

When coming in contact with her friends she has these feelings. The contact seems to arouse her out of a state of lassitude and quietness. Strange things occur in Lilium Tigrinum. The sensations described in the text are so vague and so varied that you can see that it is an effort on the part of the provers to describe what they feel. The sensations are numerous and indescribable.

Lilium Tigrinum patient very commonly is a warm-blooded patient.

She is like the Pulsatilla ^Pulsatilla patient.

warm-blooded, wants a cool room, likes to walk in the open air, except at times when the prolapsus is aggravated by walking. The head is generally relieved by moving about in the open air, better when walking in the open air. The headache and most of the complaints are relieved from cold, or from a cool room, and aggravated from a warm room. The dyspnoea comes on in a warm room. The patient suffocates in a crowded room, in the theatre, in church, like Apis Mel ^Apis, Iodium ^Iodine,Kali Iodatum ^{Kali i}., Lycopodium ^Lyc. and Pulsatilla ^Puls.

What that is only one that feels it can describe. It is described sometimes as a tingling, or an electric sensation. A slight tingling comes up the back of the head and goes to the top, and is associated with vertigo. When you come to sift that thought it really brings nothing to mind. Very often you have to get those things clinically, and think about them to get at the idea.

The pains in the forehead are very marked, and they are associated with great disturbance of vision, a loss of vision, the room looks dark, or the eyes are unable to focus. Nervous disturbance of vision, photophobia, twitching of the lids, jerking about the eyeballs, and inflammation of the mucous membrane of the eyes, of the lids and balls, conjunctivitis. Very often with the complaints of the head the eyes are turned in, a convergent strabismus, or there is threatened syncope, with the pain in the forehead.

By all these things mentioned it may be known what an over-sensitive, extremely nervous, hysterical person the Lilium tig patient must be. These things are commonly associated with patients who are extremely nervous, who have fluttering of the heart, who have pain down the spine, and more or less prolapsus, with a great sense of dragging down. When one condition is present, the other is commonly absent.

they alternate, or they may exist all together.

"Wild feeling in the head, as tho' she would go crazy, with pain in the right iliac region."

These provers seemed to like the expression, "crazy feeling in the head, as if she would go crazy".

That crazy feeling is a confusion of mind, as if the mind were quite unable to concentrate itself. That is what is interpreted by this crazy feeling the patients have. It is sometimes like a vertigo, as if things were going round, or as if she would lose her mind. Then it comes again as a terrible, tearing headache, described as a crazy headache in the forehead. Headache in which there is confusion of the mind, or as if the mind would go crazy.

The whole abdominal viscera seem to be dragging down from the stomach. The patient wants to hold up the abdomen, pendulous abdomen. It seems as if the pelvic organs would protrude. The patient must lie down, wants to wear a T bandage. Wants to grasp the abdomen from the sides and lift up for support. It is a sensation of weakness or bearing down in the pelvis as if everything were coming into the world through the vagina.

Lilium Tigrinum has a very urgent diarrhoea, driving out of bed in the morning.

he must make great baste. You may get this confused with Sulphur ^Sulphur, because Lilium tig has great heat in the head, emptiness in the stomach, and great burning of the palms and soles. It has also a dysentery that you will hardly be able to distinguish from Mercurius Corrosivus ^{Merc. cor}., so marked is the tenesmus, mucus and blood.

The stool is merely mucus mingled with blood, and the tenesmus is as great and the burning in the anus as marked as in Mercurius Corrosivus ^{Merc. cor} It is especially suited for those attacks of dysentery that come on as an occasional chronic manifestation in nervous patients such as I have described. Now, do not think that because this patient is nervous that she is weak, or liliputian, or lean.

for it is especially suitable for those with full veins.

apparently plethoric, full blooded, fleshy, rotund women who are very nervous, and especially at the change of life.

Recurrent dysenteric attacks with every cold in those who suffer from pelvic and abdominal relaxation, mental irritability as described, palpitation and fluttering of the heart, with nervous constitutions. You do not see Mercurius Corrosivus ^{Merc. cor} in such a picture. If it were a dysentery alone I would not be able to tell which it was.

All of these dysenteric manifestations have been left out of the Guiding Symptoms, yet I have seen them verified over and over. Again, it has a most inveterate and troublesome constipation.

It has also a tenesmus of the bladder and rectum. Teasing to urinate, as well as urging to stool. Sit a long time with much urging, and after long straining no stool.

Frequent urging, with a sensation as if a ball were in the rectum. When the fundus of the uterus is turned back to the rectum it gives a sensation as if the rectum were full of faeces.

it brings on urging to stool and the patient will sit and strain, and the tenesmus of the bladder and rectum is unbearable. Constant urging to stool, and no stool in the rectum. You will be astonished to know that the remedy that is indicated with such symptoms will relieve the patient of all distress in a short time.

But you ask, will Lilium Tigrinum put the uterus right again? Well, the patient will get relief of her sufferings and will not feel this uncomfortable state after the administration of the remedy. The bowels become regular, the disturbance of micturition is relieved and the patient gradually returns to health and later the uterus will be found in place.

"Pressure in the rectum, with almost constant desire to go to stool."

Lilium tigrinum has cured the most inveterate protruding hemorrhoids with burning.

"Haemorrhoids after delivery, sore to touch, bearing down after stool as if all would protrude from the vagina."

It does not mean that we shall apply that simply to hemorrhoids that come after delivery, but it has cured hemorrhoids in such a constitution, and not only hemorrhoids, but relaxed uterus and vagina.

A paralytic relaxation is present in all the abdominal tissues. I have mentioned the uterine symptoms incidentally in connection with other parts.

"Menses scanty, flow only when moving about."

Lilium Tigrinum will make you think of Pulsatilla ^Puls, the menses being so scanty, and because the Pulsatilla ^Puls patient is of similar nervous temperament. Pulsatilla ^Puls has scanty menstruation and relief in the open air. It has also much dragging down in the pelvis, though not so extreme as a rule as in this medicine. But there is much in this medicine quite different from Pulsatilla ^Puls

The come the heart symptoms.

"Seems as if the heart were grasped or squeezed in a vise, hard, as if violently grasped."

"Constrictive pain in the heart." "In fresh air, chilly, but vertigo is better."

Pain in the back and down the spine; irritable and sensitive spine with trembling. It competes very closely with Platinum Metallicum ^Platina

Great bearing down, as if pelvic contents would press out through the vagina; better by pressing up with the hand or sitting down (Sepia ^Sepia crosses the legs.)

Sensation of constriction in heart with uterine troubles.

Frequent desire for stool and urine with uterine displacements, tenesmus.

Tormented about her salvation.

Listless, yet does not want to sit still; restless, yet does not want to walk; hurried manner, desire to do something, yet no ambition; imperative duties, inability to perform them.

Depression of spirits disposition to weep; aversion to food; indifferent about anything being done for her.

Lilium tigrinum is one of the remedies that closely resembles Sepia ^Sepia in its action on the uterine organs. This symptom, for instance, "weight, with feeling as if the pelvic contents would pass out through the vagina if not prevented by pressure with the hand (pressing up against the vulva, Lilium tig.), or by sitting down." There is no remedy that is more efficacious for uterine displacement than Lilium. The persistent bearing-down feeling in the uterine region of Lilium is attended with a feeling as if the pelvic viscera, indeed the whole abdominal contents, were being dragged downward, even from the chest and shoulders, towards the vagina.

The choice between Lilium and Sepia ^Sepia might not always be easy. The Sepia ^Sepia case is more likely to be a chronic one. On the other hand, the Lilium case is more intense, painful and distressing. The Sepia ^Sepia cachexia, of course, would decide easily in its favour, if it is markedly present. There is more urinary irritation, or frequent desire to urinate, with Lilium; indeed this is sometimes so severe as to make one think of Cantharis ^Cantharis. Again, rectal irritation and distress in often found in conjunction with the urinary, in this respect reminding one of Mercurius Corrosivus ^{Merc. cor}., Capsicum Annuum ^Capsicum or Nux Vomica ^{Nux vomica}.

With the uterine we often have quite an array of very severe heart symptoms. There are sharp quick pains, and much fluttering of the heart. Lilium Tigrinum also has in a marked degree the great characteristic symptom of Cactus Grandiflorus ^Cactus grandiflorus, "sensation as if the heart were constricted or held by an iron band." This symptom, associated with the many other heart symptoms, has sometimes led to a prescription of Cactus Grandiflorus ^Cactus, when Lilium was the remedy and vice versa. The uterine symptoms are sometimes masked so as to be over-looked for the time by the violence of the heart symptoms. All these heart, urinary, and rectal symptoms seem to be mainly reflex, while the real trouble is centered in the uterus and its appendages.

The mind is also very markedly affected under Lilium. Here it may resemble Pulsatilla ^Pulsatilla for tearfulness; doubts her salvation, like Veratrum Album ^{Veratrum album}, Sulphur ^Sulphur and Lycopodium ^Lycopodium and a constant hurried feeling, as of imperative duties with utter inability to perform them. (See Argentum Nitricum ^{Argentum nitricum}.).

Region

VENOUS CIRCULATION FEMALE ORGANS

Rectum Bladder

Left side

Nerves

Characteristics

I never obtained good results from Lil. tig. until I gave it in the 30th attenuation. I have tried higher, but the aggravations from these were so severe that I have kept to the 30th.