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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..814de3d --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #65927 (https://www.gutenberg.org/ebooks/65927) diff --git a/old/65927-0.txt b/old/65927-0.txt deleted file mode 100644 index 2ac80c8..0000000 --- a/old/65927-0.txt +++ /dev/null @@ -1,3223 +0,0 @@ -The Project Gutenberg eBook of On the Curability of Certain Forms of -Insanity, Epilepsy, Catalepsy, and Hysteria in Females, by Baker Brown - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: On the Curability of Certain Forms of Insanity, Epilepsy, - Catalepsy, and Hysteria in Females - -Author: Baker Brown - -Release Date: July 27, 2021 [eBook #65927] - -Language: English - -Produced by: Richard Tonsing and the Online Distributed Proofreading - Team at https://www.pgdp.net (This file was produced from - images generously made available by The Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK ON THE CURABILITY OF CERTAIN -FORMS OF INSANITY, EPILEPSY, CATALEPSY, AND HYSTERIA IN FEMALES *** - - - - - - ON THE CURABILITY - OF CERTAIN FORMS OF - INSANITY, EPILEPSY, CATALEPSY, - AND - HYSTERIA IN FEMALES. - - - BY - - BAKER BROWN, F.R.C.S. (EXAM.) - - SENIOR SURGEON TO THE LONDON SURGICAL HOME; - LATE SURGEON-ACCOUCHEUR TO, AND LECTURER ON MIDWIFERY AND DISEASES OF - WOMEN AND CHILDREN AT, ST. MARY’S HOSPITAL; - LATE CONSULTING SURGEON TO THE WESTBOURNE DISPENSARY AND PADDINGTON - LYING-IN CHARITY; - PRESIDENT OF THE MEDICAL SOCIETY OF LONDON; - FELLOW OF THE OBSTETRICAL SOCIETY OF LONDON; - MEMBER OF THE HARVEIAN SOCIETY; - CORRESPONDING FELLOW OF THE OBSTETRICAL SOCIETY OF BERLIN; - HON. FELLOW OF THE GENERAL ASSOCIATION OF SURGEONS, NORTHERN GERMANY; - MEMBER OF THE BROOKLYN MEDICAL AND SURGICAL SOCIETY; - CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF PESTH; - CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF BRUSSELS; - CORRESPONDING MEMBER OF THE PHYSIO-MEDICAL AND STATISTICAL SOCIETY OF - MILAN; - HON. CORRESPONDING MEMBER OF THE MEDICAL SOCIETY OF NORWAY, ETC. - -[Illustration] - - LONDON: - ROBERT HARDWICKE, 192, PICCADILLY, W. - 1866. - - - - - COX AND WYMAN, - ORIENTAL, CLASSICAL, AND GENERAL PRINTERS, - GREAT QUEEN STREET, W.C. - - - - - TO DR. E. BROWN-SÉQUARD. F.R.S., &c. - - -DEAR DR. BROWN-SÉQUARD, - - I am deeply indebted for your kind permission to -dedicate this work to you. I feel assured that its introduction to the -Profession under the auspices of the greatest physiologist of the day -will secure for it greater consideration, and lead to a closer -examination of its contents, than would otherwise have been the case. - -With the greatest respect, believe me to be, - - Most faithfully yours, - I. BAKER BROWN. - - 17, CONNAUGHT SQUARE, HYDE PARK, W. - _March, 1866._ - - - - - PREFACE. - - -In offering this little book to my professional brethren, I do not for -one moment wish it to be understood that I claim any originality in the -surgical treatment herein described. - -Having read with great interest the Lectures on the “Physiology and -Pathology of the Central Nervous System,” delivered by Dr. Brown-Séquard -before the Royal College of Surgeons of England, in 1858, and published -in _The Lancet_, I was struck with a fact much insisted upon by the -learned physiologist, namely, the great mischief which might be caused -in the system generally, and in the nervous centres especially, by -peripheral excitement. - -Constantly engaged in the treatment of diseases of the female genitals, -I had been often foiled in dealing successfully with hysterical and -other nervous affections complicating these lesions, without being able -to assign a satisfactory cause for the failure. Dr. Brown-Séquard’s -researches threw a new light on the subject, and by repeated observation -I was led to the conclusion that the cases which had puzzled me, and -defied my most carefully-conceived efforts at relief, depended on -peripheral excitement of the pudic nerve. I at once subjected this -deduction to a surgical test, by removing the cause of excitement. I -have repeated the operation again and again, and it is the object of -this book to show the results. - -Daily experience convinces me that all unprejudiced men must adopt, more -or less, the practice which I have thus carried out; and I have no doubt -that, in properly selected cases, it will prove as successful in their -hands as in mine. - -It will be observed that the majority of the cases I publish have been -taken from the records of the London Surgical Home. I have drawn my -illustrations chiefly from this source, because the practice of the -Institution being freely open to the profession, the cases have been -observed by numerous medical men; and, I may add, that many have become -firm converts to my views. - - - - - ON THE - - CURABILITY OF CERTAIN FORMS OF - - INSANITY, EPILEPSY, CATALEPSY, - - AND - - HYSTERIA IN FEMALES. - - - - - CHAPTER I. - INTRODUCTORY. - - -As the title of this book implies, I do not intend to occupy the -attention of my readers with all the numerous varieties of insanity and -other nervous disorders to which females are liable, but only those -which I believe to be curable by surgical means; nor is it my intention -in this category to include slight cases, but to confine myself to such -as cause more or less severe functional derangement, or which lead to -serious organic lesions. - -The class of diseases on which I shall dwell are those depending on (or -arising from) a loss of nerve tone, caused by continual abnormal -irritation of a nerve centre. - -This is no very new theory; but it has been for Dr. Handheld Jones, by a -large number of cases and experiments, as collated in his admirable work -on “Functional Nervous Disorders,”[1] to make it “abundantly clear that -the great majority of disorders we have to treat at the present time -show more or less marked indications of failure of nervous power.” Dr. -Jones confines himself “to such disorders as are termed functional;” and -I agree with him that “it seems a vain dispute, whether in strict -accuracy there are, or are not, any such disorders; ... for it is -perfectly certain that there are very grave disorders in which the most -careful scrutiny fails to detect any actual change, in which complete -recovery is perfectly possible, and in which the ‘juvantia’ are such as -to operate more in modifying the power of the organs than the texture.” -Dr. Jones then gives two typical cases of functional and organic -disease, between which, as he justly observes, “there intervene numerous -instances of more or less mixed character;” and adds, that “disease -which commences essentially as functional may end as organic.” - -Footnote 1: - - London, Churchill, 1864. - -I am so pleased to be supported by my old friend and colleague in views -that I myself have long entertained, that I intend, without further -preface, to make his researches the whole substratum of my work; and -hope to show how, on the basis of Dr. Jones’s experiments, it is -possible to prove the philosophy of my own practice. - -Whichever of the terms, “inhibitory influence” (Handfield Jones and -Lister), “reflex relaxation” (Brinton), or “reflex paralysis” -(Brown-Séquard), be used, the fact is ceded by all, that “the energetic -operation of an afferent nerve” (Lister), or some impression acting -injuriously on an afferent nerve (Handfield Jones), or, again, “an -actually existing irritation” (Brown-Séquard), exerts an injurious -effect on its nerve centre, this state being, as Dr. Brown-Séquard -thinks, increased or diminished according to the activity of the -irritation, and ceasing with its entire removal, or, more probably, as -Dr. Handfield Jones affirms, persisting after the cessation of the cause -which has morbidly affected it. This latter view appears to me the more -generally correct one, because it can hardly be expected that a gradual -disease will be suddenly removed, there having been no time for recovery -of nerve power. - -In Dr. Handfield Jones’s Lumleian Lectures, delivered last year before -the College of Physicians, he thus sums up his views on this -subject:—“The essential idea of the inhibitory theory is, that an -impression conveyed to a nervous centre by afferent nerves may weaken or -paralyze, instead of exciting, its action, either from the congenital or -acquired debility and sensitiveness of the nerve itself, or because the -impression is unduly intense or absolutely injurious. Both these things -have in every case to be considered—viz., the state of the nerve force, -and the kind and amount of impression, as the resulting phenomena will -vary with the variation of either.” - -Dr. Jones next takes it as a matter of certainty, “that a nervous centre -may be more or less completely paralyzed without having undergone -organic change, in consequence of some enfeebling morbid influence;” and -quotes from Dr. Gull[2] “a most interesting instance of complete -paraplegia induced by sexual excess, in which nothing abnormal could be -detected in the cord, even by careful microscopy. This was paralysis -from simple exhaustion.” - -Footnote 2: - - “Guy’s Hospital Reports,” 1858. Case xvii. - -Still continuing, Dr. Jones draws attention to the anatomical fact of -the remarkably close manner in which “the different nerve centres, or -parts of a nerve centre, are connected by commissural fibres,” and how, -“from a pathological point of view, the same connexion is often very -manifest. The general exhaustion induced by excess of venery,” and other -cases, “are examples which show how excessive consumption of nerve force -in one part weakens it also in others; and this can only be adequately -explained by the intricate commissural connexion between the various -centres.” - -The truth of all these views is well exemplified, as Dr. Kidd has -stated, in cases of epilepsy, which “may originate only in irritation of -bad teeth acting on the brain, or worms irritating the nerves of the -stomach, and so on as to other peripheral irritations; the chief skill -being to find out the spot from which the irritation radiates.” - -A case is also quoted by Dr. Jones, in the Lumleian Lectures, as having -occurred in the practice of Mr. Castle, of New York, where diseased -teeth produced paraplegia, which soon ceased after their removal. - -Long and frequent observation convinced me that a large number of -affections peculiar to females, depended on loss of nerve power, and -that this was produced by peripheral irritation, arising originally in -some branches of the pudic nerve, more particularly the incident nerve -supplying the clitoris, and sometimes the small branches which supply -the vagina, perinæum, and anus. - -Closer observation satisfied me that the greater or less severity of the -functional affections observed, depended on the amount and length of -irritation, and the consequent amount of loss of nerve power. - -Nor are functional disorders the only consequence, but in some cases, -severe organic lesions. - -The progress of the disease may be divided into eight distinct -stages—No. 8 being arrived at, by gradations more or less distinct, -directly from No. 1. - - 1. HYSTERIA (including dyspepsia and menstrual irregularities). - - 2. SPINAL IRRITATION, with reflex action on uterus, ovaries, &c., and - giving rise to uterine displacements, amaurosis, hemiplegia, - paraplegia, &c. - - 3. EPILEPTOID FITS, or HYSTERICAL EPILEPSY. - - 4. CATALEPTIC FITS. - - 5. EPILEPTIC FITS. - - 6. IDIOTCY. - - 7. MANIA. - - 8. DEATH. - -My statement, that death is indeed the direct climax of the series, -might be proved by several cases which have occurred in my own practice, -one only of which I shall relate. Before doing so, I may mention that -Dr. James Russell, of Birmingham, has recorded a case in the _Medical -Times and Gazette_, Oct. 31, 1863, in which a male patient, æt. 32, died -under his care in the Birmingham General Hospital. Complete paralysis -both of sensation and motion in the lower part of the body and lower -extremities attacked him after an unusually excessive venereal -indulgence. There had been gradual exhaustion for the last twelve or -fourteen years, from this cause. There was no attempt at recovery, and -he died in four months from the date of the attack. - -The case that occurred in my own practice was as follows: ——, æt. 19, -has been gradually becoming ill since the age of nine; does not look -older than the latter age, though the sexual organs are as highly -developed as they should be. Has been for many months in a metropolitan -hospital suffering from acute headache, but has received no benefit. For -two years has been perfectly blind. - -She was found dead, and with every evidence of having expired during a -paroxysm of abnormal excitement. - -These cases will illustrate how important it is to arrest the disease -_ab initio_, and the treatment must be the same whether we wish to cure -functional disturbance, arrest organic disease, or, finally, if we have -only a chance, of averting death itself. - -The time required for recovery must depend, not only, as has been -already hinted, on the duration of illness, but also on the peculiar -temperament of the patient, and judicious after-treatment; this latter -requiring long perseverance on the part of both practitioner and the -friends of his patient; and it is as we meet a favourable or -unfavourable case that the opinions of Brown-Séquard, as to instant cure -on removal of irritation, or of Handfield Jones, as to cure after a long -interval, are verified. - -I have pleasure in stating that, with reference to the origin of most -nervous affections of females, I have, in frequent conversation with -Brown-Séquard, found that the views of this distinguished physiologist -entirely coincide with my own, and he often expressed himself as -satisfied that destruction of the nerve causing irritation was the only -effective cure; the best mode of carrying out this destruction was, in -his opinion, yet to be determined. He used actual cautery. - -I hope to be able to show that a far more humane and effectual method is -that which I constantly practise, and for the last six or seven years -have openly and consistently advocated. Of course, from the very novelty -of these views, I have been met with many objections, such as unsexing -the female, preventing the normal excitement consequent on marital -intercourse, or actually, as some most absurdly and unphilosophically -assert, causing sterility: whereas my cases will show fact to be -directly converse to all these theories; and it is curious that a -physician for many years connected with one of our largest metropolitan -hospitals, and recognized as a standard writer on female diseases, has -in writing condemned my practice in not very measured terms, but is -himself constantly in the habit of trying to subdue this peripheral -irritation by continual application of the strongest caustics to the -seat of the irritation; thereby showing that he recognizes the source of -evil, but is not yet able to see that a superficial sore will not -destroy deep-seated nerve irritation. It wants, I imagine, little -argument to prove that so far from this practice being beneficial, it is -likely, by causing increased irritation, to be positively injurious. - -Other practitioners follow Dr. Brown-Séquard’s plan of applying actual -cautery to the irritant nerve; and many more have advanced as far as the -operation—which I was formerly in the habit of practising—subcutaneous -division of the nerve. I have long abandoned this method as being no -more certain in its effect than kindred operations on various branches -of the fifth nerve for tic doloureux. - -Another objection has been made that several of my cases have not been -permanently cured, but have had relapses in a few weeks or months. This -must necessarily be so with all new methods of treatment; but each such -case is of incalculable importance, as teaching me to exclude any but -temporary hope of relief to some, while to others I can speak all the -more positively as to their ultimate permanent recovery. - -Experience seems to teach that in those patients whose brains have been -so weakened by long-continued peripheral excitement, causing frequent -and increasing losses of nerve force, there is not sufficient mental -power to enable them to control any less powerful irritation of smaller -branches of the pudic nerve, than that removed by operation. - -This lesser excitement acts chiefly, I imagine, by preventing -restoration, in the same manner as a drunkard whose brain is weakened by -long indulgence in his baneful habit cannot resist temptation, but is, -however, affected by much smaller quantities of stimuli, than when -strong, he was able to take. - -A striking instance of this kind occurred to me last year. - -One of our most distinguished obstetric physicians requested me to -operate on a lady who had been for some twenty years under very many -eminent practitioners without any but temporary benefit. The result of -the operation was most marked; the irritation subsided, the patient -improved in health, and we confidently expected permanent relief. Yet in -a few weeks after she left our hands and that of the nurse, irritation, -resembling pruritus, gradually returned, and with it the other old -symptoms. - -In all cases of a similar nature which have come under my care, I have -insisted on the importance of the patient being kept for a long time -under careful medical watching and good nursing, and from the results -already obtained from cases in which these precautions have been -exercised, I feel confident of success for the future. - -Lastly, objections have been advanced against the morality of the -operation, and I am here at a loss how to give an answer, for I can -hardly conceive how such a question can be raised against a method of -treatment which has for its object the cure of a disease, that is -rapidly tending to lower the moral tone, and which treatment is dictated -by the loftiest and most moral considerations. I may here observe, that -before commencing treatment, I have always made a point of having my -diagnosis confirmed by the patient or her friends. - -To the philosophical and charitable mind, indeed, the whole subject is -one of the greatest interest, and will lead us to ask the question, may -not this “inhibitory influence,” originating in early life, act so -powerfully on the mind as to unhinge it from that steadiness which is -essential to enable it to keep the passions under control of the will; -to enable, indeed, the moral tone to overcome abnormal excitement? And -if this be true, does not common charity lead us to think that cases -treated by friends and spiritual advisers, as controllable at the will -of the individual, may be in reality simply cases of physical illness -amenable to medical and surgical treatment? Is it not better to look the -matter steadily in the face, and instead of banishing the unhappy -sufferers from their home and from society, endeavour to check their -otherwise hopeless career towards some of the latter stages of this -disease, to restore their mental power, and make them happy and useful -members of the community? - -On this consideration I shall not now dwell further. Every one must feel -it to be a vast and important one, affecting the well-being of the whole -human race. - -All I am now aiming at, is to show that many, if not all, such cases may -be cured. If this is done, I shall indeed be able to say that I am amply -repaid. - -I have the gratification of being able to name the following gentlemen -who have been led to adopt my views and treatment in proper cases:—Sir -James Simpson; Dr. Beattie, of Dublin; Sir John Fife and Dr. Dawson, of -Newcastle-on-Tyne; Dr. Duke, late of Chichester; Dr. Shettle, of -Shaftesbury; John Harrison, Esq., of Chester; Drs. Savage, Routh, and -Rogers, in London; my eldest son, Mr. Boyer Brown, now practising in New -South Wales; with my colleagues in the “London Surgical Home,” Dr. -Barratt, and Messrs. Harper, Chambers, I. B. Brown, junior, and Bantock, -and very many others. - - - - - CHAPTER II. - SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE - TREATED—OPERATION—AFTER-TREATMENT, ETC. - - -Every medical practitioner must have met with a certain class of cases -which has set at defiance every effort at diagnosis, baffled every -treatment, and belied every prognosis. He has experienced great anxiety -and annoyance, and felt how unsatisfactory was his treatment to the -friends of his patient: and this, not so much because he was ignorant of -the cause, as that he was unable to offer any hope of relief. - -The period when such illness attacks the patient is about the age of -puberty, and from that time up to almost every age the following train -of symptoms may be observed, some being more or less marked than others -in the various cases. - -The patient becomes restless and excited, or melancholy and retiring; -listless and indifferent to the social influences of domestic life. She -will be fanciful in her food, sometimes express even a distaste for it, -and apparently (as her friends will say) live upon nothing. She will -always be ailing, and complaining of different affections. At first, -perhaps, dyspepsia and sickness will be observed; then pain in the head -and down the spine; pain, more or less constant, in the lower part of -the back, or on either side in the lumbar region. There will be wasting -of the face and muscles generally; the skin sometimes dry and harsh, at -other times cold and clammy. The pupil will be sometimes firmly -contracted, but generally much dilated. This latter symptom, together -with a hard cord-like pulse, and a constantly moist palm, are, my son -informs me, considered by Mr. Moore, Colonial Surgeon of South -Australia, pathognomonic of this condition. There will be quivering of -the eyelids, and an inability to look one straight in the face. On -inquiring further, there is found to be disturbance or irregularity in -the uterine functions, there being either complete cessation of the -catamenia, or too frequent periods, generally attended with pain; -constant leucorrhœa also frequently existing. Often a great disposition -for novelties is exhibited, the patient desiring to escape from home, -fond of becoming a nurse in hospitals, “sœur de charité,” or other -pursuits of the like nature, according to station and opportunities. - -To these symptoms in the single female will be added, in the married, -distaste for marital intercourse, and very frequently either sterility -or a tendency to abort in the early months of pregnancy. - -These physical evidences of derangement, if left unchecked, gradually -lead to more serious consequences. The patient either becomes a -confirmed invalid, always ailing, and confined to bed or sofa, or, on -the other hand, will become subject to catalepsy, epilepsy, idiotcy, or -insanity. In any case, and more especially when the disease progresses -as far as these latter stages, it will almost universally be found that -there are serious exacerbations at each menstrual period. - -On personal examination, the peculiar straight and coarse hirsute -growth; the depression in the centre of the perinæum; the peculiar -follicular secretion; the alteration of structure of the parts, mucous -membrane taking on the character of skin; and muscle having become -hypertrophied and generally tending towards a fibrous or cartilaginous -degeneration; will all be recognized by the practitioner who has once -had his attention drawn to these subjects. - -Having ascertained the cause and nature of the disease, there are one or -two points to be considered before operative measures are decided on. - -First, as to age. Although there is no doubt that patients may suffer -from peripheral irritation of the pudic nerve from the earliest -childhood, I never operate or sanction an operation on any patient under -ten years of age, which is the earliest date of puberty. In children -younger than this, milder treatment with careful watching, will be found -sufficient if it be thoroughly persevered in. - -There are again, after puberty, cases which give rise to but slight -disturbance, but in which the sufferers are they who love to enlist -sympathy from the charitable, and will be ill, or affect to be ill, in -spite of any and every treatment. - -When I have decided that my patient is a fit subject for surgical -treatment, I at once proceed to operate, after the ordinary preliminary -measures of a warm bath and clearance of the portal circulation. - -The patient having been placed _completely_ under the influence of -chloroform, the clitoris is freely excised either by scissors or knife—I -always prefer the scissors. The wound is then firmly plugged with -graduated compresses of lint, and a pad, well secured by a T bandage. - -A grain of opium is introduced per rectum, the patient placed in bed, -and most carefully watched by a nurse, to prevent hæmorrhage by any -disturbance of the dressing. The neglect of this precaution will be -frequently followed by alarming hæmorrhage, and consequent injurious -results. - -The diet must be unstimulating, and consist of milk, farinaceous food, -fish, and occasionally chicken; all alcoholic or fermented liquors being -strictly prohibited. The strictest quiet must be enjoined, and the -attention of relatives, if possible, avoided, so that the moral -influence of medical attendant and nurse may be uninterruptedly -maintained. - -A month is generally required for perfect healing of the wound, at the -end of which time it is difficult for the uninformed, or non-medical, to -discover any trace of an operation. - -The rapid improvement of the patient immediately after removal of the -source of irritation is most marked; first in the countenance, and soon -afterwards by improved digestion and other evidences of healthy -assimilation. - -It cannot be too often repeated, that this improvement can only be made -permanent, in many cases, by careful watching and moral training, on the -part of both patient and friends. - -In the large majority of cases, I have administered no medicines, -trusting entirely to recovery, after the removal of the source of -irritation. Sometimes, however, we may be materially aided by the use of -such medicines as the bromides of potassium and ammonium, belladonna, -&c. - - - - - CHAPTER III. - HYSTERIA, WITH CASES. - - -It may, perhaps, be necessary before relating cases which I have -treated, suffering from hysteria, to state briefly what I understand by -this term. The word Hysteria was doubtless originally used in the belief -that it depended on excessive reflex action of the nerves of the uterus -and ovaries, when these organs were excited by disease or other causes; -but this view is a very limited one, for, as Dr. Handfield Jones says, -“it does not appear that females suffering with irritable uterus are -more hysterical, often not so much so, as those who have no such -disorder.” There is, however, as I have already mentioned, in almost all -hysterical patients, an exacerbation at the menstrual periods. - -Dr. Copland’s opinion, that “increased reflex excitability of the nerves -of the female generative organs is one principal causative condition of -hysterical affections,” appears to me the correct one. Romberg also -says, “from the time when hysteria has taken root, the reflex action -preponderates throughout the organism, and renders the individual more -dependent upon external stimuli.” - -I have alluded in the last chapter to those patients who have no desire -to get well. Such I am not considering; and although I believe that all -the complaints of an hysterical patient are more or less exaggerated, my -experience differs from that of Dr. Handfield Jones, who believes that -such patients are not “_bonâ fide_ anxious to get well.” In his view he -is supported by Dr. Prout, who considers that “the whole energies of the -patient’s mind are bent on deception;” and by Dr. Watson, who says that -“the deceptive appearances displayed in the bodily functions and -feelings find their counterpart in the mental.” I am confident that I -have met with many instances in which the nerve power has become so -weakened that the patient, without having organic disease, really feels -all the symptoms she describes, and is only too anxious to be cured. The -cases I shall now narrate are a few of a large number that have come -under my care, and I am not without hope that their relation may show -that hysteria, instead of being a term of reproach, does truly represent -a curable disease. - -The following was the first case that came under my notice, after I had -satisfied myself of the correctness of my views on the subject:— - - - CASE I. HYSTERIA—FIVE YEARS’ ILLNESS—OPERATION—CURE IN TWO MONTHS. - - D. E., æt. 26, single; admitted into the London Surgical Home Oct. 12, - 1859. - - _History._—She had been a dressmaker in Yorkshire to all the best - families around, but for the last five years had been so ill as to - render her unable to do any work, and had been entirely supported by - her former customers. When in that neighbourhood, on a professional - visit to a lady, I was requested to see, amongst others, this poor - _ci-devant_ dressmaker. Her physiognomy at once told me the nature of - the case; she was much attenuated, having for a longtime been unable - to retain any food, always being sick, with great pain, immediately - after meals. She had constant acid eructations; was so weak as to be - at times unable to cross the room; complained of a burning, aching - pain, with great weakness at the lower part of the back. Her catamenia - were irregular, with much leucorrhœa; bowels generally costive. She - was very melancholy, and expressed a most earnest desire to be cured. - I advised her admission to the “Home,” and on October 15, I divided - the clitoris subcutaneously. This being my first operation, I did not - know the consequences of performing the operation in this manner. For - two days the hæmorrhage was profuse and uncontrollable. Sleep was - procured by opiates. I ordered ℥ij of olive oil to be rubbed into her - chest every night, with a view to nutrition of her attenuated frame. A - moderately generous diet was given, _but no stimulants_. She was quite - well in two months, and has never since had a day’s illness. She - resumed her occupation as a dressmaker, and recovered nearly all her - former customers. 1865.—I have heard almost yearly of this patient, - and lately had a letter from the lady to whom I previously referred, - saying that my patient is perfectly well and in robust health. - - - CASE II. TWO YEARS’ ILLNESS—OPERATION—CURES. - - P. F., æt. 21, single; admitted into the London Surgical Home Jan. 7, - 1861. - - _History._—Attributes her illness to having strained herself two years - ago, when lifting a heavy saucepan from the fire. Has ever since that - time suffered great pain in the back and side, much worse when she - walks, but tolerably easy in the prone position. Catamenia very - irregular, both as to time and quantity. Great pain in defecation. - Bowels very constipated. Has been eleven weeks in a metropolitan - general hospital, and thirteen weeks in a special hospital for women, - from both of which she was discharged as having nothing the matter, - because she had no evident disease. She had, however, been treated for - uterine disease. - - _On examination_, the uterus was found to be quite healthy; there was, - however, evidence of excitation of the pudic nerve. - - Jan. 10. The clitoris completely excised. - - Jan. 16. Is much better. - - Jan. 31. Discharged from the Home, cured. Is quite well in her health, - having lost all aches and pains, and being able to defecate without - the slightest uneasiness. - - -CASE III. HYSTERIA—THIRTEEN YEARS’ ILLNESS—STERILITY—OPERATION—CURE, AND - SUBSEQUENTLY THREE PREGNANCIES. - - S. S., æt. 33, married; admitted into the London Surgical Home - February 23, 1861. - - _History._—Although married several years, has had no children. About - a year ago suffered from pain in the right side, which, however, being - treated was cured. In April last the pain returned in the back, and at - short intervals has recurred. At times the pain is so severe that she - is unable to walk. Has for thirteen years suffered from leucorrhœa, - globus hystericus, &c.; and has always had distaste for marital - intercourse. - - _Examination_ confirming me in the diagnosis I had formed of this - case, I, on February 28, operated in the usual manner. Her recovery - was retarded by an attack of jaundice, but in May she was discharged - cured. - - In July, 1862, this patient was seen quite well and ruddy, and had - long lost all her old symptoms. She had been once pregnant, but - miscarried at three months. - - In July, 1865, she came to town with her youngest child. She was quite - well, and had never been ill since the operation. - - _Remarks._—This was the first case of this nature under my care, in - which the patient, formerly sterile, became pregnant after removal of - the cause of her illness. - - -CASE IV. HYSTERIA, WITH SLEEPLESSNESS—SIX YEARS’ ILLNESS—OPERATION—CURE. - - H. R., æt. 55, single; admitted into the London Surgical Home Nov. 18, - 1861. - - _History._—For six years has suffered from a feeling of fulness, - weight, and heat at the lower part of abdomen, with pain in the back, - and “bearing down.” At this time her menses had just ceased. Has not - slept well for three or four years. Wakes every hour. Is always - restless and fidgety. Frequent desire to micturate, with pain on doing - so, and often desire without power to void it. Bowels costive; - digestion indifferent. - - She is a nervous, restless woman, with glistening and constantly - wandering eye—pupils dilated. Has suffered from peripheral irritation - for many years. - - Nov. 21, 1861. Usual operation performed. A week later, slept well for - four hours, the first time for many years. - - Dec. 1. Has lost the irritability of the bladder, and passes water - every four hours only; lost also the bearing-down pain; restless - excitement gone. - - Dec. 7. Eats and sleeps well; is cheerful and grateful; leaves the - Home cured, having been in only three weeks. - - In 1863 was perfectly well. - - - CASE V. FISSURE OF THE RECTUM, WITH HYSTERIA—OPERATION FOR THE - FORMER—RELIEF—SUBSEQUENT OPERATION FOR HYSTERIA—CURE. - - Mrs. L., æt. 55; admitted into the London Surgical Home Dec. 9, 1861. - - _History._—Is a widow. Has for many years suffered from all the - inconveniences of a fissure of the rectum, combined with bad - digestion, undue nervous excitability, and sleepless nights. Is very - anxious to be cured. It being thought that all these symptoms might be - due to a painful fissure of the rectum, the ordinary operation for - this affection was performed on December 12. The bowels were opened in - a few days without pain, and the fissure was healing well. Being, - however, still sleepless, excitable, and irritable, questions were - asked which showed that a further operation for removal of another - source of irritation was advisable; therefore, on December 24, I - performed my usual operation. The next night she slept well. She - became quiet and cheerful, and on January 6, 1862, she was discharged - quite well. - - _Remarks._—This case is very interesting, as it shows that there may - exist at the same time more than one irritation exerting inhibitory - influence. - - - CASE VI. HYSTERIA, WITH EPILEPTIFORM ATTACKS IN CHILDHOOD—VARIOUS - AILMENTS FOR THIRTEEN YEARS—OPERATION—NO BENEFIT. - - H. D., æt. 23 single; admitted into the London Surgical Home April, - 1862. - - _History._—When very young, until ten years of age, had frequent fits. - Improved in health till she was fourteen years of age, when she began - to suffer from abdominal enlargement. First menstruated at nineteen. - Is constantly sick after meals. Has been in nearly every hospital in - London. The patient is very hysterical, and is always _talking_ - religion. - - _On examination_ the abdomen was found very tympanitic. Under - chloroform this state quite subsided. Walls of abdomen fat and - muscular. Body generally well nourished. Evidence of continual - irritation of the pudic nerve. - - April 3. Operation as usual. - - For some time after the operation this patient was much better of the - sickness, and great interest was manifested by several visitors in her - case; she never, however, received permanent benefit, being a regular - impostor, and discovered on several occasions tying handkerchiefs, - &c., tightly round her waist to make her abdomen swell. She was - discharged as incurable. - - _Remarks._—This case I have inserted as a warning. It is no fault of - the operation if it fail in such cases. - - - CASE VII. HYSTERIA—SEVERAL YEARS’ ILLNESS—OPERATION—CURE. - - Miss M., æt. 42; admitted into the London Surgical Home April 13, - 1862. - - _History._—Has felt ailing for many years, but for the last two has - suffered pain in the uterine region, and, on pressure, over the - ovaries. This pain is accompanied by bearing down, and a sense of - distension. Suffers from considerable leucorrhœa. Menstruation - regular, and during the period the pain is absent. Bowels regular. - Sleep disturbed. Feels depressed, and is inclined to melancholia. - - _On examination_ there was no congestion of uterus or enlargement of - ovaries, but there was evidence of peripheral irritation of the pudic - nerve. - - April 17. Usual operation performed. - - She rapidly improved; sleep and cheerfulness returned, and all pain - left her. She expressed herself as not having been so well for many - years. - - May 13. Left the Home, having gained flesh and strength, and being - quite cured of all her bad symptoms. - - _Remarks._—Interest attaches to this case, as instead of exacerbation, - there was diminution of the symptoms during menstruation. - - - CASE VIII. HYSTERIA—MANY YEARS’ ILLNESS—PHANTOM TUMOUR—OPERATION—CURE. - - A. B., æt. 24; admitted into the London Surgical Home 16th July, 1862. - - _History._—Is a single woman, and procures a living by dressmaking. - When younger, was a nurse-maid. Catamenia commenced before she was - thirteen, but she was not regular until she was nineteen, since which - the function has proceeded normally both in time and quantity. Has for - many years been ailing, and always had something the matter. Has - suffered from intense irritation in the genital region, especially in - the bladder, and she has constant pain in the back. For two years has - been treated at a dispensary for an abdominal tumour; during this - period she has taken much medicine, but without benefit. - - _On examination_ the abdomen was found increased in size and - universally tympanitic. Under the influence of chloroform the swelling - entirely subsided. - - July 17. Usual operation performed under the influence of chloroform. - - Sept. 2. She was discharged quite cured, all her hysterical symptoms - having left her, and the tumour never having been seen since the day - of operation. - - - CASE IX. HYSTERIA—FIVE YEARS’ - ILLNESS—STERILITY—OPERATION—CURE—PREGNANCY—TWO CHILDREN. - - Mrs. O. came under my care in 1862. She had been ill ever since - marriage, five years previously; having distaste for the society of - her husband, always laid upon the sofa, and under medical treatment. - Evidence of peripheral excitement being manifest, I performed my usual - operation. She rapidly lost all the hysterical symptoms which had - previously existed; and in about a year came up to town to consult me - concerning a tumour, which greatly frightened her, as she feared it - was ovarian. I discovered that she was six months pregnant. She was - delivered at full time of a healthy child. In 1865 she again called on - me to show herself, not only in robust health, but pregnant for the - second time. - - - CASE X. HYSTERIA—IRRITATION OF RIGHT OVARY—MENORRHAGIA—NINE YEARS’ - ILLNESS—OPERATION—CURE. - - C. M. A., æt. 28, single; admitted into the London Surgical Home June - 22, 1863. - - _History._—Since the age of 19 has been more or less subject to - uterine flooding; for the first three years lost blood every day. Has - been five times in a metropolitan hospital; always better while there, - but as bad as ever as soon as she left. The bleeding is much worse at - each menstrual period. She passes large coagula; has constant pain in - the back, headache, and palpitation of the heart, and cannot sleep; is - dreadfully pale and anæmic. - - _Examination_ showed great irritation over right ovary, and there was - evidence of long-continued peripheral irritation. - - July 2. Usual operation. - - July 7. Menstruation came on in a moderate flow. - - July 10. Menstruation ceased; is much better, and there is sign of - returning colour in the face. - - July 31. Has improved considerably, and had no return of the bleeding. - To be discharged cured. - - - CASE XI. HYSTERIA—MANY YEARS’ ILLNESS—OPERATION—CURE—MARRIAGE AND - PROGENY. - - Emma K., æt. 22, single; admitted September 16, 1863, into the London - Surgical Home. - - _History._—Commenced menstruating at 15 years of age, but owing to the - use of cold water during a period, the secretion was arrested for six - months; the function was then restored, and has ever since continued - normal. At 16 she suffered from piles, which occasioned very much - irritation and pain after each evacuation, aggravated by constipation - and by walking. Though regular as to time, there is always excessive - catamenial flow, and it lasts for eight days. Has been under long and - varied medical treatment, without benefit. - - _Examination_ showed peripheral irritation, as evinced by the abnormal - condition of the external genitals. - - Sept. 17, 1863. The usual operation performed. - - Oct. 1. Progressing most favourably. - - Oct. 22. Leaves quite cured. - - 1866. This lady married, and was delivered August, 1865, of a living - child. She is still quite well. - -It will have been observed that one very prominent symptom in many of -the foregoing cases is sleeplessness, or perhaps more properly, frequent -wakefulness at nights, and constant restless movements in the day. These -are the cases which, if left to go on, are very liable to terminate in -insanity. The three following are instances in which the hysteria was -verging on this state, and as they can hardly be classed under the head -of insanity, I prefer narrating them here. - - -CASE XII. HYSTERIA—MENTAL ABERRATION, AND TENDENCY TO MELANCHOLIA—EIGHT - YEARS’ ILLNESS—OPERATION—CURE. - - In December, 1861, a single lady consulted me, giving the following - history of her illness:— - - Has not been well for seven or eight years; has felt languid, and not - so lively as formerly. For the last two years has menstruated every - three weeks, and the flow has lasted four or five days. There is - considerable white discharge from the vagina after each period, - lasting for a week. Great irritation about vulva, perinæum, and anus - before and during each menstrual period. For the last five or six - years had had occasional irresistible and unaccountable fits of - depression; thinks that it is her mind—if her mind were as strong as - her body she would be pretty well: her memory is good, but mind weak. - Has suffered from great pain at lower part of the back; says she - cannot rise from a chair without great difficulty, on account of a - feeling of stiffness in hips and trembling of the legs (this is - probably owing to a swelling of the hip-joint, as all the joints of - her fingers and ankles are swollen). Says she can sit quietly to - crochet or needlework, but cannot sit quietly to think, or compose her - mind to write a letter: has not written a letter properly for three - years. Has been subject to attacks of melancholy and weeping, without - any tangible cause, but which she cannot resist. Suffers from want of - sleep, and at night frequently lies awake four or five hours together. - Appetite good; bowels costive. - - In appearance is fresh-coloured and plump, but she says she is thinner - than formerly; dark eyes; large dilated pupils. - - _On examination_ there was evidence of great irritation about the - vulva, and constriction of the anus, with a very small fissure. - - Dec. 21. I divided the fissure, and performed my usual operation. - - Dec. 31. Very much improved; swelling of the joints much less. - - Jan. 1. She sat up, and feels much better. Her spirits are improved; - has no pain in the joints; sleeps well. In another month she returned - home quite well, and has continued so to the present time. - - - CASE XIII. EXTREME HYSTERIA, VERGING ON INSANITY—FIVE YEARS’ - ILLNESS—OPERATION—CURE. - - Mrs. ——, æt. 32, married; admitted into the London Surgical Home - August 5, 1862. - - _History._—Has been married twelve years, but has had no children nor - miscarriages. Has always enjoyed pretty good health until about five - years ago, when she began to suffer from leucorrhœa and great pain - during menstruation. Catamenia regular in time and quantity. Her - bladder is so irritable that sometimes she has to pass her water every - half-hour; the urine sometimes very much loaded. Suffers from headache - and giddiness in the morning. Says that for the last three years the - act of coition has been accomplished without the least pleasure, but - with pain. Bowels are opened regularly and without pain. - - August 7. Having diagnosed the cause of the disease, the usual - operation was performed. - - August 9. A severe attack of erysipelas came on, and she was very ill - for some days, but she made a good recovery. - - A few days after the operation this patient was observed to be - occasionally very violent and unmanageable, and to have at these times - a wild maniacal look. On questioning her husband, it appeared that for - several years she had been subject to fits of violent excitement, - especially during the menstrual period, and that at such times “she - would fly at him and rend his skin, like a tigress.” - - This patient made a good recovery; she remained quite well, and became - in every respect a good wife. - - - CASE XIV. EXTREME HYSTERIA—INCIPIENT INSANITY—OPERATION—CURE. - - Mrs. R., æt. 42; admitted into the London Surgical Home Aug. 5, 1862. - - _History._—Has been married, but has been a widow for twelve years. Is - companion to a lady. Never had any family. Has been ailing for some - years, but has not suffered severely until the last six months. - Suffers most from pain in the lower part of the abdomen, and from - constant burning and irritation about the vulva. During the last few - months has become very nervous and fidgety; never can remain quiet, - and says that lately she “has had a sort of lost feeling, particularly - when writing; being unable to compose her thoughts, or concentrate her - mental energies.” Has suffered from considerable irritability of the - bladder; and her urine is often full of thick deposit. Catamenia - regular in time and quantity. Cannot sleep. - - _On examination_, is a very nervous woman, her eyes restless and never - quiet; constant twitchings of the limbs, and occasionally an - appearance almost of insanity about her expression. There is every - evidence of a long-continued inhibitory influence. - - August 7. The usual operation performed. - - August 8. Feels very comfortable. Slept better last night than for - some years. - - August 9. Is improving wonderfully: the expression of countenance - completely changed. - - Sept. 9. Left quite well. Has got fat, and has now a cheerful face and - manner. Says she feels a different being, and is quite astonished at - her own improvement. Has lost all her nervous twitchings and other - uncomfortable symptoms, and has now a comfortable night’s rest. - - - - - CHAPTER IV. - SPINAL IRRITATION, WITH CASES - - -There are perhaps few terms so difficult to define as spinal irritation, -for the gradations from hysteria to this state are extremely easy; and, -indeed, it will have been seen that in the foregoing chapter most of the -patients complained of pain in the spine, and that there was more or -less functional disturbance in all of them. The term is also used so -freely and vaguely that great caution is necessary in attempting to -explain its meaning. Dr. Handfield Jones’s term, “Spinal Paresis,” seems -to me an excellent one; by it he means “a state in which, without -demonstrable organic change, there is greater or less enfeeblement of -the functional power” of the spinal cord. The sensory or motor power may -be affected, but rarely both together. - -The cause of spinal irritation, or paresis, may be defined in one -word—“debility;” this debility always, or almost always, being due to -inhibitory irritation. - -This state of things may give rise to wide and varied disorders, all the -symptoms of which are asthenic in their character, and all of which are -marked by extreme nervous prostration. - -Without doubt,—for all authors agree on this point, one of the most -prominent causes is peripheral irritation of the pudic nerve, producing -undue exhaustion. - -It is difficult to say how this is produced, but most probably it is -that, “owing to the intimate commissural connections between the lumbar -enlargement of the cord, where the pudic nerves are implanted (they -themselves being small and remote in their origin from the brain); and -the superior and nobler nervous centres, the intense excitation of even -a small and remote centre is communicated to the others, which, as this -subsides, fall as much below, as they have previously been stimulated -above par. The depression is proportional to the previous excitement.” - -The cases I shall have to relate which may fairly be called cases of -spinal irritation are few in number, for the reason I have stated, that -they are but a continuation of hysteria,[3] and, indeed, but a state of -things of which epileptiform and epileptic fits are the direct sequence. - -Footnote 3: - - _Vide_ Cases in previous chapter. - -It is, however, well to draw attention to the fact that it is in cases -of spinal irritation that we observe functional derangements, which are -very likely to pass into actual organic diseases; and it is in this -class of cases, which are essentially of a chronic character, that very -long and persistent perseverance must be pursued. I would, therefore, -advise all who meet with them to warn their patients beforehand that -they must not be weary and faint-hearted if recovery do not come as soon -as hoped for. - - -CASE XV. SPINAL IRRITATION, AND SUPPOSED UTERINE DISPLACEMENT—SIX YEARS’ - ILLNESS—OPERATION—CURE. - - In 1860, I was requested to see a young lady, æt. 20, of whom I had - the following history:—For six years she had been confined to a spinal - couch, and had also been supposed to suffer from retroversion of the - uterus. She had worn a spinal apparatus, attached to which was a steel - spring, pressing on sacrum and pubis, and intended “to support the - perinæum, and keep the uterus in position.” Had been treated with - caustics and other therapeutic agents for uterine disease. I found the - uterus normal in position and healthy in appearance; but on further - questioning and examination, I diagnosed peripheral irritation of the - pudic nerve. My opinion was strongly contested, as I was told that the - young lady was very religious; but, as I explained, her illness was to - be attributed solely to a physical condition, and was not at all - necessarily immoral; I was then met with the objection that, in the - event of marriage my operation might interfere with marital happiness - and prevent procreation. I explained how, physiologically, these - objections were untenable, but was then unable to adduce actual cases - in contradiction of them. - - Ultimately I performed my operation in the usual manner. For want of - proper attention on the part of the nurse, the dressing was three - times displaced; but, nevertheless, at the end of a month this lady - was well enough to walk three miles. - - Up to this date she has remained quite well. - - - CASE XVI. DYSMENORRHŒA—FIVE YEARS’ ILLNESS—OPERATION—CURE. - - D. A., æt. 23; admitted into the London Surgical Home Aug. 4, 1863. - - _History._—Has never been very strong; but five years ago had an - attack of gastric fever. Since then has suffered constantly from great - pain during the menstrual period. Occasionally loses a great deal, and - passes large clots of blood. During this time has suffered almost - constantly from leucorrhœa. Suffers severely from pain over region of - left ovary and in the spine. Is hardly ever free from headaches. Is - very restless; never sleeps well; frequently faints; and has little or - no appetite. All her ills are exaggerated at the menstrual epoch. - - August 7. Usual operation performed. - - Sept. 1. Is menstruating without pain. - - Sept. 30. Again menstruating without pain, and in normal quantity. Is - to be discharged cured. - - - CASE XVII. SPINAL IRRITATION AND LOSS OF USE OF RIGHT LEG—FIVE YEARS’ - ILLNESS—OPERATION—CURE. - - M. B., æt. 30, single; admitted into the London Surgical Home Nov. 15, - 1861. - - _History._—Five years ago first began to suffer pain in the right leg, - which was ascribed to sciatica. Fourteen months since this pain became - so bad that she could not walk, and she lost all use of her right leg, - at the same time felt great weakness and pain in the back, preventing - her sitting. For eight months has been confined to a “spinal couch.” - Is a spare anæmic woman; dark hair and eyes; dilated pupils; very - restless and nervous in her movements, and of a very irritable temper. - Has suffered from peripheral irritation since an early age. - - Nov. 26, 1861. Usual operation performed. - - Dec. 27. She has gradually improved in health and temper since the - operation, and is now quite able to walk about her room without help. - - She was a long time before her nerve tone was thoroughly restored, but - she ultimately got quite strong and continues well. - - - CASE XVIII. HYSTERIA AND SPINAL IRRITATION TWELVE YEARS—FISSURE OF - RECTUM, RECENT DURATION—OPERATION—CURE. - - R. C. R., æt. 35 years, single; admitted into the London Surgical Home - April 15, 1861. - - _History._—Has been suffering for nearly twelve years, at intervals of - from six months to six weeks, with pain in the womb and right side, - sudden spasms of the limbs, coming on at frequent and irregular - intervals. Great pain down the spine and lower part of the back and - loins. Has often attacks of severe sickness. Is usually costive. Has - lately suffered great pain in defecation. Catamenia regular. Great - want of sleep and appetite. Says she is always low-spirited, moping, - and listless. Has had much medical treatment. - - _On examination_ there was found evidence of peripheral excitement of - the pudic nerve, and there also existed a fissure of the rectum. - - April 18. The usual operation performed, and the fissure of the rectum - incised. - - After this time defecation was performed without pain. Sleep, - appetite, and cheerful spirits returned. She had no more spasmodic - twitchings, but she still complained of intense pain in the back on - sitting and walking. She was discharged in June much relieved, but not - well. - - Nov. 9 1861. I received a letter from this lady, stating that she now - suffered no pain and was perfectly well. She was stout, and better in - every respect than she had been for the last twelve years. - - - CASE XIX. MENORRHAGIA—MENTAL DELUSION—TWO YEARS’ - ILLNESS—OPERATION—CURE—SUBSEQUENT MARRIAGE AND PROGENY. - - A young lady, æt. 20, came under my care in 1863, having for two years - past suffered from almost constant menorrhagia, during which time she - had suffered great irritability of temper, been disobedient to her - mother’s wishes, and had sleepless nights, restless desire for - society, and was constantly seeking admiration; all these symptoms - culminating in a monomania that every gentleman she admired was in - love with her, and she insisted on always sending her _carte de - visite_ to her favoured one for the time being. In her quieter moments - she would spend much time in serious reading. On being consulted, I - quickly discovered that all these symptoms arose from peripheral - excitement, and that there existed no organic disease to cause the - menorrhagia. The usual plan of treatment was followed with the most - rapid and marked success. She went the full interval between the - ensuing menstrual periods, and the secretion was normal in quantity. - All her delusions disappeared, and after three or four months of - careful watching, with change of air, she was perfectly well in every - respect. A year afterwards she married, and ten months later gave - birth to a healthy son. She is now again pregnant. - - - CASE XX. SPINAL IRRITATION, GIVING RISE TO MENORRHAGIA AND - AMAUROSIS—OPERATION—CURE. - - A single lady, æt. 35, came under my care in 1863. Had been out of - health for some years, suffering from continuous menorrhagia, seldom - being free more than ten days or a fortnight in the month. Was thin - and spare in appearance; often complaining of headache, especially - over the brow and orbits; and, in fact, nearly a confirmed invalid. - Latterly she had become almost blind from amaurosis; she could only - read the largest type, and not at all by candle-light. Had come to - London from the country, and placed herself under the care of one of - the most eminent ophthalmic surgeons, who had treated her for three - months without the slightest benefit. When I saw her I immediately - discovered that long-continued peripheral excitement had caused all - her disorders. Quickly after the operation, menstruation became - regular; in ten days she was able to read in bed; in a month she was - quite well. I frequently hear of her now, as in robust health. - - _Remarks._—Beyond a grain of opium after the operation, this patient - never had any medicine. I have had other cases exactly similar, with - like result. - - - CASE XXI. SPINAL IRRITATION—LOSS OF POWER IN LOWER - EXTREMITIES—OPERATION—RAPID IMPROVEMENT. - - Last year I was requested to see a lady, æt. 46, who had been married - to a second husband seventeen years without issue, but had two - children by her first marriage. Had not menstruated for two years. Has - been in ill health for many years, and undergone a variety of medical - treatment without benefit. In May, 1863, first began to lose the power - of her legs, and to suffer from attacks of pain in the back, shooting - up to the spine. She was at this time in Paris, where she consulted - several men of eminence, and was treated for uterine disease, but - still without benefit. She returned to London in June, 1863, and - placed herself under the care of her usual medical attendant. Relief, - after some time, not being afforded, she consulted several eminent - surgeons in the metropolis. She was told that she had paralysis of the - lower extremities, and that nothing could be done with a hope of - effecting cure. From January, 1865, she was for six months under the - care of an eminent general practitioner, who exhausted the resources - of his art, but in vain. She was, in fact, “given up.” - - As a last resource, I was applied to. I saw her in August at her own - house. Her countenance had a worn and haggard expression; her body was - emaciated; skin harsh, dry, and scaly; the lower extremities hung as - if paralyzed, but sensibility and voluntary motion—the latter, - however, very weak—were not entirely absent. She complained of severe - spasmodic attacks of agonizing pain shooting up the spine, like - tetanic shocks. Her appetite was very defective, digestion was - impaired, the bowels disordered, and sleep was hardly ever procured. - There was also partial ptosis of the left upper eyelid. On - examination, I found a deep and acutely painful fissure, with large - piles and loose skin around the anus, and all the well-marked signs of - peripheral irritation of the clitoris. - - August, 1865. I operated, Dr. Kidd administering chloroform. I divided - the fissure, tied the piles with three ligatures, cut off the loose - skin around the anus, and removed the clitoris and elongated labia in - my usual manner. - - It was gratifying to observe the early relief of her more severe - symptoms; by the third day the spasmodic attacks ceased, little or no - pain was complained of, and the improvement of the digestive system - was most marked, the patient enjoying chops, game, &c., within ten - days, and no longer “a martyr to flatulence and dyspepsia.” The - digestion was, however, easily deranged, and great care was necessary. - At the end of seven weeks, having already on several occasions been - driven out in a carriage, she was removed to the country, where she - remained for three weeks. It may be here stated that the patient - suffered much from the very sultry weather of September, and that - improvement was much more rapid when colder weather set in. On her - return, she was able to stand for a few minutes with her hands resting - on the shoulders of another. Remaining in town for some weeks, she - again left for the sea-side, where she stayed about three weeks, and - returned to town in the beginning of this year. Her condition is now - as follows:— - - She looks remarkably well in the face, which has entirely lost its - expression of suffering. She is free from pain. Sensibility in the - lower extremities is perfect; their muscular power is greatly - improved. She can raise herself from a chair so as to rest on her - hands and feet, and is able to walk across her room, holding the hands - of her maid, who retreats before her. She sleeps well every night, and - her digestion is in very fair order. She is now able to sit up to all - her meals, and to sit in an upright chair for hours together, whereas - formerly she was constantly in the recumbent position. - - - - - CHAPTER V. - EPILEPTOID CONVULSIONS, OR HYSTERICAL EPILEPSY, WITH CASES. - - -In the chapter on hysteria, cases have been recorded of frequent -faintings, without spasms, and of spasmodic twitchings of limbs without -fainting, _i.e._ without loss of consciousness. We now come to cases -more marked and chronic, and having many of the characters of epilepsy. -They may be brought to us by the friends of the patient as genuine -epileptics. The diagnosis is in some cases difficult, but for the most -part easy. Dr. Russell Reynolds[4] has summed up the distinctive -features so ably that I cannot do better than quote his final remarks on -this subject:— - -Footnote 4: - - “Epilepsy: its Symptoms, Treatment, and Relation to other Chronic - Convulsive Diseases.” By J. Russell Reynolds, M.D. London: Churchill, - 1861. - -“The paroxysm resembles epilepsy, and sometimes closely, but it differs -in essential particulars. The difference is not one only of degree, -neither is it to be determined by the relation of hysterical convulsion -to pain, nor solely by the nature of the spasm. The diagnosis is to be -based upon a combination of features. The paroxysms follow hysteric -prodromata. At their onset there is constriction of the throat and -epigastrium; there are plaintive cries, sobbings, or laughings, which -reappear at the close; _sensibility, perception, and volition are -rarely, if ever, completely lost_; the face undergoes little change; -there is a twinkling movement of the eyelids; there is no marked -dilatation of the pupil; _there is rarely foaming or bitten tongue_; the -attacks are of long duration; respiratory movements are disorderly, but -there are no evidences of marked asphyxia; the pulse is small; there is -no stupor, but only general exhaustion after the attack; and although -the paroxysms may recur for many years, and be followed by a peculiar -kind of mania, they are rarely followed by dementia.” - -I fully agree with Dr. Reynolds that what are called the “diagnostic -signs of hysteria,” as frequent micturition of clear pale urine, -tympanitis, nausea, &c., have no value in aiding our inquiry as to the -nature of these fits: they may be witnessed, and with as great -frequency, after epileptic seizures. - -One practical point exists; namely, that in hysterical epilepsy the -patient seldom, I believe never, in falling hurts herself, whereas true -epileptics frequently suffer considerable bodily injuries. - - - CASE XXII. NINE YEARS’ ILLNESS—EPILEPTIFORM ATTACKS—THREE YEARS’ - DURATION—OPERATION—CURE. - - G. M., single; admitted into the London Surgical Home December 18, - 1860. - - _History._—For the last nine years has suffered greatly and regularly - during the menstrual periods. Has been much worse for the last three - years, during which time has, at each menstrual period, been - frequently taken in a fit, dropping down suddenly and fainting right - off; this state lasting for two or three hours. Being in service, this - has caused her much trouble, as none of her employers would keep her. - For the last six months has suffered severe pain over right ovary, - increased by exercise or pressure, and at the menstrual period. - Believing that the dysmenorrhœa and fits both arose from the same - cause, on January 3, clitoris was cut down to the base. After this - operation she never had a fit, and all untoward symptoms left her - except the dysmenorrhœa; she was therefore re-admitted May 27, 1861, - and there being some narrowing of the cervix, it was incised with the - hysterotome. June 21, catamenia came on without pain, and continued to - do so regularly. In July she was well enough to return to service. - - April, 1865. Her mother called at my house to say that this patient - had been married some months, and was shortly expecting her - confinement. She had remained quite well since the operation. - - - CASE XXIII. EPILEPTOID FITS—FIFTEEN YEARS—ILLNESS FOR TWENTY-SIX - YEARS—OPERATION—CURE. - - F. A. C., æt. 41, single; admitted into the London Surgical Home Nov. - 6, 1863. - - _History._—Says she had congestion of the brain fifteen years ago; - since that period cannot remember being well, but from the age of - fifteen has been of delicate health. Has suffered from fits for the - last fourteen or fifteen years; is never long free from them. During - an attack she is not entirely unconscious, but possesses no power to - control them nor to speak. Has pain at lower part of spine of a - gnawing character. She is a miserable, nervous creature, with pinched - features and a wandering restless expression of the eye. There is - evidence of injurious peripheral irritation since a very early age. - - Nov. 12. Operation as usual under chloroform. - - Nov. 19. Is wonderfully better. The expression of her face is much - happier, and the face itself has filled out considerably. No pain in - the back since the operation. - - Dec. 24. Discharged perfectly cured. - - - CASE XXIV. HYSTERICAL EPILEPSY—LONG DURATION—OPERATION—CURE. - - G. C., ÆT. 25; ADMITTED INTO THE LONDON SURGICAL HOME JAN. 28, 1864. - - _History._—Has been delicate from childhood. For some months has - suffered from a peculiar dragging pain in the lower part of the - abdomen. Menstruates regularly. Suffers from “burning” and - irritability of bladder. Has constant and severe headache. Has for a - long time suffered from “epileptic fits” (on careful observation they - were found not to be genuine epileptic), occurring twice or thrice a - week. Is a melancholy object, with “woe-begone” expression; listless - and indifferent to conversation and surrounding objects; when spoken - to, does not answer rationally, and frequently only in monosyllables. - Is very reserved and taciturn. - - Feb. 4. Patient being under chloroform, the clitoris was excised. - - Feb. 13. Progressing favourably; much improved in appearance; more - cheerful; converses freely and rationally; expresses herself as - grateful for her restoration to health. - - March 1. Having had no return of the fits, and lost all her hysterical - symptoms, she was discharged cured. - - - CASE XXV. HYSTERIA AND EPILEPTIFORM ATTACKS—MANY YEARS’ - ILLNESS—OPERATION—CURE. - - R. D., æt. 31; admitted into the London Surgical Home Feb. 17, 1864. - - _History._—Married eight years, with one child. Her husband is in the - navy, and often absent from home. Previous to her marriage had a - severe illness, in which she was delirious, and again in 1860, when - she lost her reason for six weeks. “Was very feverish and could retain - no food on the stomach.” The menstrual periods are most irregular, six - or eight months sometimes elapsing between each appearance. Has not - menstruated since June last. Has great difficulty in passing her - urine. For many years has suffered from fits of an epileptiform - character, having, in an attack, convulsions and rigidity, but never - hurting herself in falling, foaming at the mouth, nor biting her - tongue. - - Feb. 18. Clitoris excised. - - Feb. 24. Much improved, free from pain or difficulty in micturition. - Is quite cheerful, and has had no attack since the operation. - - March 26. Still gaining strength, looks much better, and says she now - feels well. - - March 28. Discharged cured. - - - CASE XXVI. EPILEPTIFORM FITS AND GENERAL HYSTERIA—FOUR YEARS’ - DURATION—OPERATION—CURE. - - Mrs. F., æt. 44; admitted into the London Surgical Home April 23, - 1864. - - _History._—Married sixteen years, but her husband has been abroad for - the past seven years. Had inflammation of the womb four years ago, and - since that time has continually suffered from bearing-down pains. - Frequent desire to micturate. Pain in the loins and spine, sleepless - nights, loss of appetite, and other hysterical symptoms. Has slight - “epileptic fits” two or three times a week, more frequently at - catamenial periods, which are regular in appearance and not profuse. - Has no premonition of fits; is but partially conscious; at first - struggles, then becomes rather rigid, and on recovery is always - exhausted. Patient is most anxious to be cured of her attacks, of the - cause of which she is fully conscious. - - April 25. Clitoris excised, under chloroform. - - April 26. Had a good night, better than for years. - - April 30. Progressing most favourably. Patient expresses great - gratitude for the relief she has obtained. She left the Home a month - later, looking and feeling quite well; the last note in the case-book - being “a very grateful patient.” - - - CASE XXVII. EPILEPTIFORM FITS—SIX YEARS’ DURATION—OPERATION—CURE. - - F. W., æt. 33, single; admitted into the London Surgical Home May 23, - 1864. - - _History._—Has suffered from fits for more than six years, much more - frequently the last six months; having now as many as four or five - during the day—always one or two. The fits vary in length from one to - three hours’ duration. Is conscious during the attacks, but unable to - speak, or in any way to control them. Is invariably worse during the - menstrual periods. Suffers from palpitation of the heart. - - _Examination_ showed a highly inflamed and sensitive condition of the - external generative organs; the patient herself confirmed my opinion - of the cause of her attacks. - - May 28. Clitoris excised—free hæmorrhage allowed before the dressings - were applied. - - June 12. Left her bed to-day; has had no fit since the operation, and - says she feels well. - - June 20. Takes daily exercise, is free from pain, the wound is healed, - and her health daily improving. Action of the heart much more - moderate. - - July 19. Discharged cured, not having had one hysterical attack since - the operation. - - - CASE XXVIII. HYSTERICAL EPILEPSY—THREE YEARS AND A HALF - DURATION—OPERATION—CURE. - - C. E. S., æt. 24, single; admitted into the London Surgical Home Oct. - 17, 1864. - - _History._—Has been ill for about three years and a half, suffering - frequently from an aggravated form of hysterical attacks, with many of - the characters of epilepsy, but with only partial insensibility, and - without foaming. Is often sick, and suffers from severe pain on the - right side, with a feeling of pressure on the lower bowel, with a - dragging and bearing-down pain around the loins. Catamenia regular; - more subject to the fits at these periods. No difficulty in - micturition, but a rather frequent desire to micturate; and urine - often loaded. - - Oct. 20. The clitoris was excised. - - This patient improved very rapidly; passed upwards of a month and a - menstrual period in the Home without any return of the fits. All pain - over the ovarian regions, and in the loins, &c., left her, and she was - discharged Nov. 26, perfectly cured. - - - - - CHAPTER VI. - CATALEPSY, WITH CASES. - - -This affection is extremely rare, and I consider myself favoured in -Having witnessed three well-marked cases. “It occurs chiefly,” says Dr. -Jones, “in those who have weakly and excitable nervous systems, feeble -health, and ill-governed minds, and who may be said to possess neither a -‘mens sana,’ nor a ‘corpus sanum.’” That this is true there is not the -least doubt, and the first case—one of semi-catalepsy, or hysterical -catalepsy—shows how completely it is a nervous affection, and depending, -at any rate at the commencement of the disease, very much on mental -control. - -There are also, it is true, one or two rare cases on record which were -caused by growths on the brain; and it is sometimes “encountered in -tubercular meningitis, or chronic softening of the brain.”—_Reynolds._ - -That the cause in the three cases in my own practice was excitation of -the pudic nerve, may, I think, most fairly be concluded, from the fact -that after the operation neither patient had a single fit. - -To those who have not seen a patient suffering from this disease, a few -words from Dr. Reynolds may be necessary:— - -“The pathognomonic symptom is the persistence of the limbs in a state of -balanced muscular contraction, so that they retain the position in which -they were placed at the commencement of the attack. The limbs may be -readily moved by the observer, but they retain the attitudes in which -they are left, and these sometimes for hours, sometimes for days. - -“Perception and volition are lost; the condition resembles that of -‘brown study;’ the circulation and respiration are uninterrupted.” - -Catalepsy seems to rank between tetanus and epilepsy, and, according to -Dr. Jones, depends on the simultaneous morbid affection of various nerve -centres which, when separately affected, produce but one -disorder,—hysteria, tetanus, or epilepsy. - - - CASE XXIX. HYSTERICAL CATALEPSY—MANY YEARS’ - DURATION—OPERATION—RELIEF—REMARKS. - - MRS. ——, æt. 33, widow; admitted into the London Surgical Home May 5, - 1865. - - _History._—Never had any children, and but one miscarriage. - Menstruation began when she was fourteen, and she was then first - attacked with fits. From the patient’s description, they would seem to - have then been of a cataleptic character; there was no loss of - consciousness. From the age of 21 up to the present time, besides - slight convulsive attacks in the daytime, she has been subject to fits - at night, occurring irregularly, but averaging one a week, and always - after each menstrual period. They commence with a strong convulsion, - which lasts for a few minutes, and is succeeded by perfect rigidity of - the body and unconsciousness for half an hour or more. Are preceded by - headache during the day. Catamenia appear regularly, but are scanty. - Acknowledges constant peripheral excitation, and says that, during - marriage, she never had pleasure _in coitu_. The dilated pupil, hot - skin, moist palm, and other unmistakable symptoms, plainly pointed to - the cause of her disorder. - - May 6. Excision of clitoris and the very elongated nymphæ. Free - hæmorrhage was allowed before the wound was dressed. - - The operation was, in this instance, only successful in diminishing - the frequency and intensity of the fits. The following is the - description given by the house-surgeon of an attack some days after - the operation:— - - “While conversing with the house-surgeon this morning, she had a - slight convulsive attack, not lasting more than thirty seconds, and - characterized by the following phenomena:—No loss of consciousness, - rigidity of limbs, with tonic contraction of the flexor muscles, and - strong contraction of the orbicularis palpebrarum.” - - Whenever visited, and frequently when the wound was dressed, these - fits recurred; but towards the end of the month the number - considerably diminished. - - She was discharged on June 15th, very much improved in health, and - decidedly relieved by the operation. - - - CASE XXX. HYSTERICAL CATALEPTIC FITS OF LONG DURATION—OPERATION—CURE. - - H. L., æt. 25, single; admitted into the London Surgical Home January - 27, 1864. - - _History._—This patient was sent to me by Dr. Pennefather, of - Tottenham, with the following letter:— - - “Dear Sir,—The girl —— was some time since suffering from religious - monomania; she is of hysterical habit and weak constitution, ever - complaining of abdominal pain or uneasiness.” - - She also gave the following additional account of herself:— - - “Began to feel unwell about twelve months since. Had a very bad fever - about five months ago, which left her perfectly prostrated. Always - felt weak, and more or less subject to fits. Menstruation regular and - never profuse. Great pain in the back and bearing-down feeling in the - lower part of the body. Complains of great pain in defecation. - Sea-bathing has benefitted her temporarily. Is incessantly crying - without cause or power to prevent herself.” - - The day following admission she had a fit of a cataleptic nature, and - lasting twenty-five minutes. After the fit the patient was left very - prostrated. - - In addition to symptoms of pudic irritation, there was a small fissure - of the rectum. - - January 24. Clitoris excised, and fissure divided. There was - considerable secondary hæmorrhage in the excising, which, however, - seemed to have a beneficial effect, as after it the patient expressed - herself as more comfortable, and slept quietly. - - Feb. 14. Much more cheerful; has had no cataleptic attack or symptom - of hysteria since the operation. - - Feb. 28. Has improved daily, and leaves the Home this day cured. - - - CASE XXXI. CATALEPTIC FITS—TWO YEARS’ ILLNESS—OPERATION—CURE. - - M. N., æt. 17; admitted into the London Surgical Home September 4, - 1861. - - _History._—Was perfectly well up to the age of fifteen, when she went - to a boarding-school in the West of England. In the course of three or - four months she became subject to all symptoms of hysteria, and from - that time gradually got worse, having fits, at first mild in character - and of rare occurrence, but gradually mere severe and frequent, till - she became a confirmed cataleptic. For several months before - admission, she had been attacked with as many as four or five fits a - day, and during the whole journey from the North of England to London - she was unconscious and rigidly cataleptic. She was seen immediately - on arrival, and there was no doubt that it was a genuine case of this - disease. So sensitive was she, that if any one merely touched her bed, - or walked across the room, she would immediately be thrown into the - cataleptic state. - - Before making any personal examination, Mr. Brown ascertained both - from her mother and herself, that she had long indulged in - self-excitation of the clitoris, having first been taught by a - schoolfellow. The commencement of her illness corresponded exactly - with the origin of its cause; in fact, cause and effect were here so - perfectly manifested, that it hardly wanted anything more than the - history to enable one to form a correct diagnosis. All the other - symptoms attending these cases were, however, well marked. - - The next day after admission she was operated upon, and from that date - she never had a fit. She remained in the Home for several weeks. Five - weeks after operation, she walked all over Westminster Abbey, whereas - for quite a year and a half before treatment, she had been incapable - of the slightest exertion. - - - CASE XXXII. CATALEPTIC FITS—MANY YEARS’ DURATION—OPERATION—CURE. - - In 1861 I saw a lady, æt. 50, single—a patient of Dr. Dawson, of - Newcastle-on-Tyne. - - She had been suffering from cataleptic attacks for several years, - gradually increasing in severity. As in the previous case, the mere - touching or shaking of her bed would induce an attack—indeed, the - simple brushing of her dress by any one passing her when she walked - out of doors, would immediately be followed by a fit. History and - examination plainly confirming me in my opinion as to the cause of her - attacks, the usual treatment was adopted, and from that time to this - she has never had an attack. - - - CASE XXXIII. CATALEPTIC FITS—SIX YEARS’ DURATION—OPERATION—CURE. - - MISS ——, æt. 38, single; admitted into the London Surgical Home August - 10, 1865. - - _History._—Was tolerably well until two years and a half ago, but - since that time has suffered more or less from menorrhagia, with - severe pain in back. Has also severe smarting pain in the bowels, and - has frequently lost a considerable quantity of blood _per anum_. Has - always been subject to hysterical attacks, but for the last six years - has had fits of a much more serious character. They have increased in - severity, duration, and frequency, and it is on account of them that - she seeks relief. Almost immediately after admission, this patient had - a fit, and she was kept a fortnight under observation, that the nature - of the attacks might be thoroughly investigated. - - She would have a fit sometimes twice a day; but on an average about - every other day—either early in the morning or late in the evening. - She was most generally attacked when walking about the room—sometimes - when sitting—but she was never observed to have one when asleep. She - would at the commencement of an attack cease walking, or doing - whatever she was employed in; her face would become very pale and set; - the eyelids, at first quivering, would be fixed; the eyes wide open - and looking upwards, the pupils very dilated. Her mouth would be - rigidly shut, and during the attack it was impossible by any means to - open it. Her arms would fall straight by her side, and be immovable; - the hands unclenched, and fingers extended. If standing, she would be - quite upright, and require no support. If sitting, she would always - stand up when a fit was coming on. If lying, she would be extended - straight on her back. The fit would last for two or three hours, and - on a few occasions for as many as six hours. The experiment was - frequently made of moving her arms when in the cataleptic state, and - on such occasions the limb would remain in the position in which it - was placed, till the end of the attack. She was always perfectly - unconscious, and no kind of stimulant was of the slightest use in - restoring her during the paroxysm—time alone was of avail. The attack - was sudden, but the recovery to consciousness was but gradual; she - would appear as if awoke from a deep sleep, and would be very - exhausted, but express no desire for food, wine, or other stimulants. - As soon as she recovered, she would sleep for many hours, and awake - quite well, but still weak. - - Aug. 24. The clitoris was excised, and a painful fissure of the rectum - divided. She never had a fit after the operation. Menstruation came on - on the 28th, in moderate flow. - - Oct. 5. This patient has improved wonderfully since operation, and now - looks extremely well. The wound is quite healed. She takes walks - daily, and has had no fits, and is to be discharged as cured. - - In November she called at the Home, to say that she was quite well, - and had never had the slightest return of her former illness; she - menstruates regularly and normally. - - Feb., 1866. She remains well. - - - - - CHAPTER VII. - EPILEPSY, WITH CASES. - - -Referring my readers for full information on the pathology and history -of epilepsy to Dr. Russell Reynolds’s exhaustive treatise on the subject -already referred to, I would mention, as shortly as possible, a few -facts which are necessary to be borne in mind, with especial reference -to the class of cases which I am now considering. - -Dr. J. C. Prichard, in writing of diseases of the nervous system, has -well said that “few diseases are better characterized by them symptoms -than epilepsy; yet in this instance there is such a variety in the -phenomena as renders it difficult to contrive a definition in a few -words which may comprehend every form of the complaint.” - -I have said that when convulsions become chronic they are considered to -take on an epileptiform character. Now, although we know that in a few -cases involuntary spasm may take place in sleep, _i.e._ with loss of -consciousness, I think we may, for all general purposes, take as a -definition of epilepsy a chronic convulsive disease, each convulsive -attack being accompanied with “sudden and complete loss of -consciousness,” this latter symptom being considered by the late Dr. -Todd[5] as “the pathognomonic symptom of the disease,” but only, as Dr. -Reynolds[6] has shown, “when it occurs as a paroxysmal or occasional -event.” - -Footnote 5: - - _Medical Times and Gazette_, August 5, 1854, p. 129. - -Footnote 6: - - _Op. cit._, p. 31. - -The causes of epilepsy are various—“partly physical, partly immaterial.” -Of the former are injuries and tumours of the brain or meninges, -intestinal worms, renal and biliary calculi, &c. &c. These are termed by -Dr. Handfield Jones[7] “eccentric causes.” As “centric causes,” he names -“poisoning of the blood from retention of excrementitious matter; this, -by deranging the nutrition of the nervous tissue, generates the abnormal -excitability, which then manifests itself without any special irritant. -Various causes of exhaustion, such as hæmorrhage and excessive -discharges, venereal excesses, prolonged want of sleep, unremitting -pain,” &c., are all “centric” causes of epilepsy. - -Footnote 7: - - _Op. cit._, p. 209. - -Dr. Reynolds is right in considering epilepsy an idiopathic disease, -inasmuch as it occurs, without discoverable organic lesion with which it -can be associated, and because there is no structural lesion of the -brain, or spinal cord, to be found constantly associated with it; but -when he says that it is idiopathic because, “in many cases, eccentric -irritation cannot be shown to be the cause of the attacks,” I cannot go -with him. Epilepsy is a name signifying a disease, which may be -idiopathic, or may arise from a variety of causes; but that eccentric -irritation is a powerful and very frequent cause, there is not the -slightest doubt. Dr. Reynolds classes it as second of six in a table -given in his book, physical conditions being mentioned as first; and -finding, in a hundred cases, that 24·63 have no assignable cause, and -18·84 are doubtful, he gives 13·04 as due to eccentric irritation. - -In considering peripheral irritation of the pudic nerve as a cause of -this disease, we must, I think, consider mental emotion, which occupies -the highest rank in causes of epilepsy, in conjunction with that second -in the list,—eccentric irritation. I would, therefore, classify the -cause of epilepsy depending on such irritation as both eccentric and -centric. The former, inasmuch as it produces exhaustion, and, by -deranging the nutrition of the nervous tissue, generates abnormal -excitability; the latter, for that it is a physical excitant which is -not only “a mere provocative of the paroxysms, the convulsions being -supposed to ensue as the reflex results of irritation, but that it -actually _sets up_ in the nervous centres that state of excitability -which is the essence of the disorder.” Further still, looking on -epilepsy as a direct sequel of hysteria, when it is produced by -excitation of the pudic nerve, the patients are, in an eminent degree, -predisposed to the disease. - -Women are also more naturally prone to epilepsy from mental emotion than -men; “Emotional disturbance being assigned,” says Dr. Reynolds, “as the -cause of their attacks in so many as 36 per cent., whereas in the male -sex there were only 13 per cent. who referred their diseases to that -cause.” - -It would be out of place in a work of this nature to detail at length -the symptoms of these attacks. Whether they are truly epileptic will be -seen as the cases are related. I have been very careful to separate -those which seemed to be of an hysterical or epileptoid nature; and have -had the advantage of being able to show the greater number of them to -many eminent members of the medical profession, who have witnessed my -practice in the London Surgical Home. - - - CASE XXXIV. EPILEPTIC FITS—TWELVE YEARS’ DURATION—OPERATION—CURE. - - S. F., æt. 41, single; admitted into the London Surgical Home Dec. 16, - 1861. - - _History._—Was always ailing, and hysterical for many years. Catamenia - appeared early, and always rather profuse. For the last twelve years - has suffered from epileptic fits; recurring frequently every week or - fortnight, and lately as often as every day. Has constant headaches; - is losing memory and all power of concentrating her ideas. Has no - premonition of seizure; falls down; is unconscious; has frequently - bitten her tongue; and “froths” at the mouth. Says she has had several - attacks of hæmatemesis. She was a dressmaker, and had so frequently, - on her way to or from business, fallen in the streets, that she had - been carried into almost every hospital in London, and a large number - of open surgeries. - - _On examination_ there was found every indication of irritation about - the vulva, and also a small polypus of the os uteri, which latter was - large and patulous. - - Dec. 19. Usual operation of excision; polypus uteri also removed. - - The recovery of this patient was rapid and uninterrupted. After the - operation, she never had a fit, and hardly a headache. She was - discharged Jan. 20, 1862, perfectly well, and with greatly increased - mental power. When heard of at commencement of 1864, she remained - well, and had had no recurrence of any of her old symptoms. - - - CASE XXXV. EPILEPTIC FITS—FIVE YEARS’ DURATION—PRECEDED BY CATALEPTIC - FITS, DURING THE TEN PREVIOUS YEARS—OPERATION—CURE. - - In the beginning of April, 1862, a single lady, æt. 28, came under my - notice, giving the following account of herself.—When about ten years - old had a fit, whilst she was sitting at needlework; she fell down - suddenly as if dead, and remained insensible for two hours; was very - ill for three weeks after the attack. Was quite well until the age of - fourteen, when she began to have them every three months. When about - twenty-two had an interval of eleven months without a fit, but - frequently fainted during that period. During the time she was in the - fits she would be perfectly unconscious. She was told that her limbs - were quite rigid, and always remained in the exact position in which - they were when the fit commenced. In 1857 the fits changed in their - nature—the patient at first falling down quietly, but subsequently - becoming very convulsed, and trying to hurt herself. The first of this - nature lasted two hours and three-quarters. Has lately had them much - oftener, but not always of the severe form. Has had eight severe fits - in the last two years and a half, besides the milder, which come - sometimes a dozen in a fortnight. Is unconscious, but always knows - when she has had one. Foams at the mouth, but makes no noise. Has - frequently fallen down suddenly in church and other public places. Has - been under many physicians, all of whom have been of opinion that she - is suffering from genuine epilepsy. - - April 2. Clitoris excised. - - April 6. Has had no attack, but complains of occasional pain in the - top of her head. - - She never had an attack after the operation. Returned home in a month, - and shortly afterwards she was thrown out of a pony chaise; she had no - fit, but wrote that, prior to treatment, a very much slighter accident - would have immediately produced one. - - I heard of this lady later in the year; she was still quite well. Not - having heard since from her, as was agreed when she left me, I am - satisfied that she has had no relapse. - - - CASE XXXVI. EPILEPTIC FITS—MANY YEARS’ DURATION—OPERATION—CURE. - - N. L. M., æt. 21; admitted into the London Surgical Home May 9, 1863. - - _History._—Married four years and had two children; the labours have - been bad, and followed by severe hæmorrhage. Had aborted at six weeks, - a fortnight previous to admission, and had lost a large quantity of - blood. First suffered from epileptic fits at puberty; had several - before marriage, and has had four or five since marriage; but has - never had a fit when pregnant. Not very regular in menstruation, which - is accompanied with severe pain. Has constant pain on right side of - head, in back, loins, &c. Great pain in micturating and on defecation. - She is always totally unconscious during the fits, and they are - followed by extreme prostration. Is of melancholy aspect, excessively - anæmic, and somewhat chlorotic; even the mucous membranes (of mouth - especially) are blanched. The cause of her fits being diagnosed, the - usual _operation_ was performed May 14. - - May 18. Progressing excellently. - - May 20. There was great irritability of the bladder, which, however, - was immediately relieved by an alkaline and henbane mixture. - - May 31. Has not had any return of her bad symptoms until to-day, when, - on being removed to a strange ward, she had a fit, not of violent - character, and followed by a heavy drowsiness. - - June 2. Is quite herself again. - - July 4. Has left quite well in every respect, and when heard of many - months later remained well. - - _Remarks._—The fit following on change of this patient from one ward - to another where there were strangers, shows how important it is for a - permanent cure, that visitors and relatives should not be allowed to - excite and agitate a patient suffering from these attacks after an - operation is performed, and when the mind is hardly restored to its - natural balance. - - - CASE XXXVII. EPILEPTIC FITS—TWO YEARS’ DURATION—OPERATION—CURE. - - H. C., æt. 20, single; admitted into the London Surgical Home Feb. 24, - 1864. - - _History._—About three years since, first commenced ailing. - Menstruation ceased for four months, when it appeared for two days. - Fifteen months then elapsed before the function was restored. - Epileptic fits have been developed for about two years. The patient at - the commencement of an attack is strongly convulsed, has no - premonition, and is perfectly unconscious. Frequently falls when - walking in the streets. Has often hurt herself in her falls, and also - bitten her tongue. Has the usual symptoms of bearing-down of the womb, - and pain in the loins. No pain in defecation. Bowels costive. Pain in - micturition, and sometimes retention of urine, occasionally not - passing any for two days. - - March 3. Clitoris excised in the usual manner under chloroform. Was - restless and hysterical for the first six days, when she improved - daily, became cheerful, and much more intelligent. She never had - another fit, and on April 13, being quite cured, was, at her own - request, retained in the Home as a servant. She remained there under - observation for six months, during which time she had not only no - return of her former attacks, but progressively improved in health, - and her menstruation became quite regular. - - Since that time she has been living as cook in a family which I - frequently visit, and it is therefore certain that she remains - perfectly well. - - - CASE XXXVIII. SEVERE AND FREQUENT EPILEPTIC FITS FOR THREE YEARS AND A - HALF—OPERATION—CURE. - - C. T., æt. 21; admitted into the London Surgical Home June 23, 1864. - - _History._—Health always good till three years ago, when, after a - severe fright, she became very excited and had a fit. Since that time - has been continually subject to them. She never passes a day without - two or three, and frequently has as many as six, or even eight, in the - twenty-four hours. Is most subject to them at night when sleeping. Is - always suffering from headache. Her mental powers are somewhat - impaired, as she has very slight recollection of persons, or of - events, from day to day. Catamenia very irregular. Has not menstruated - since March last. Bowels costive; pulse regular and firm. Is of a - sallow complexion, with vacant and weak expression of countenance. - Acknowledges great and constant irritation of pudic nerve. - - During the day previous to operation, special notice was taken of the - nature of the fits. They are epileptic; for although she does not foam - at the mouth, she has, on more than one occasion, _bitten her tongue_, - and is _perfectly unconscious_. There is no rigidity, but a constant - struggling, and, unless restrained, the hands always, during an - attack, are carried to the seat of irritation. - - June 23. The usual operation of excision was performed under - chloroform. As soon as she recovered, she managed to remove the - dressings. Hæmorrhage for two hours was the result. When arrested, two - grains of opium were administered, which produced sleep. On awaking, - she again endeavoured to remove the dressings; but, her hands being - confined, she was unable to do so. She had no more fits, and but a few - hysterical attacks. On July 17th she was discharged, as her parents - were anxious for her return. She had not then had a fit of any kind - for sixteen days. - - August 15. I received the following letter from her father:— - - - “Dear Sir,—It would be very unkind in me, and much out of place, to - hide from you and the world at large what have been my feelings during - the past three weeks. My daughter, C. T., came to your Home, Stanley - Terrace, Notting Hill, on the 23rd of June last, to be treated by you - for epilepsy, or epileptic fits, having been afflicted for three years - and a half. The class of fit you may better judge of than myself; - sufficient to say, they were very bad and very frequent. I am happy to - say, and acquaint you, that since her return she has not had a single - symptom of fit or hysteria of any kind. Her general health is also - very good, and fast improving, and I do hope, by the blessing of God, - she may continue so. If you have any desire to see her, I shall feel - in duty bound to let her wait upon you, with her mother, at any time - you may think fit to appoint, as your opinion just at this time might - have a still more happy effect for the future. You are quite at - liberty to use this for the benefit of the Institution in whatever way - you may like or seem good.” - - - A twelvemonth later, this patient was still free from any return of - the fits. - - -CASE XXXIX. EPILEPSY, WITH DEMENTIA—ONE YEAR’S DURATION—OPERATION—CURE. - - A. H., æt. 17; admitted into the London Surgical Home June 28, 1864. - - _History._—Catamenia first appeared three years ago. They have - continued regular to the present time. About twelve months since was - observed, whenever sent on an errand from home, that she would wander - about in an absent manner, and return home having forgotten all about - any message which had been given her. About this time fits were first - developed; they increased in frequency and intensity, and she now has - them daily, and one or more of less violent character nearly every - night in her sleep. When seized, she falls, struggles violently, foams - at the mouth, often bites her tongue, and is totally unconscious to - all around her. After a fit, she sinks into a deep sleep, which lasts - for two hours. Has no recollection on awaking of what has taken place. - Acknowledges to frequent injurious habits, but is unconscious of their - being the cause of her illness. Is vague in all her ideas and - conversation, and has almost entirely lost her memory. - - Both history and personal examination plainly showed what was the - cause of her attacks. - - On July 7 the clitoris was completely excised. She had no return of - the fits; and on the 23rd the following report appears in the - case-book:—“Left her bed to-day. Is greatly changed; quite rational in - all her movements; converses freely and quietly, remembers passing - events from day to day, and it is indeed almost impossible to - recognize in her the half-idiotic, almost demented girl who entered - the Home less than a month ago.” - - She remained in the Home some time longer for observation. Fits never - returned; her mind improved daily, and she was discharged as perfectly - cured. - - -CASE XL. EPILEPTIC FITS—TWO YEARS AND A HALF DURATION—OPERATION—RELIEF. - - S. Z., æt. 16, single; admitted into the London Surgical Home October - 20, 1865. - - _History._—Was strong and well until two and a half years ago, when - she had an epileptic fit in the middle of the night. Can assign no - cause for the attack. For a long time had a fit once a month, but - latterly once a week. The catamenia appeared six months before the - first fit, and have always been regular. There is no exacerbation at - menstrual epoch. Complains of great irritation of pudendals for three - years. - - Nov. 2. Since admission this patient has been watched: she has had two - fits, both of a genuine epileptic character. - - Mr. Brown this day performed his usual operation. She went on well - till the 10th, when she had a slight fit; there being irresistible - irritation, the hands were restrained. A lotion of bromide of ammonium - was ordered to be applied to the wound, and 20 grains of the bromide - to be given in water three times daily. - - She convalesced well, and had no more attacks till the 29th, when, her - hands having been released only a few minutes previously, she had a - fit, and the nurse found one hand on the wound. She was conscious - during the attack, which was not so violent as before treatment. - - Dec. 2. Discharged relieved. If this patient could be under control - for a few months, she would probably be cured. - - - CASE XLI. EPILEPTIC FITS, WITH DEMENTIA—THIRTY YEARS’ - DURATION—OPERATION—CURE. - - M. F., æt. 44, single; admitted into the London Surgical Home December - 8, 1865. - - _History._—Epileptic fits first attacked her when she was about 14, at - which age she menstruated. For the first few years there was a long - interval between each, but they gradually became more frequent and - violent. Latterly she has had several during the week of each - menstrual period, and as a rule none in the interval. Catamenia have - been tolerably regular in appearance, but rather profuse. Is tall, - pale, and thin; has a dull and somewhat vacant expression; is very - eccentric in her manners and conversation; is frequently observed, - both day and night, by the nurses to practise injurious habits, to - which she acknowledges for the last thirty years. The fits are genuine - epileptic. - - _On examination_, there is evidence of very long-continued peripheral - irritation, and also a fissure of rectum. - - Dec. 12. The usual operation on clitoris and rectum. - - Dec. 13. In the absence of nurse, removed the dressing, and - immediately had a fit. To have opium 1 grain, with ¼ grain of extract - of belladonna, every six hours. - - Under this treatment the patient improved daily, became cheerful, - rational, tractable, and much more sensible in her conversation. - - She passed two menstrual epochs, but without a fit, and she was - discharged perfectly cured. - -I have a much larger number of cases occurring in private practice, but, -for that reason, am obliged to omit them. I shall, however, when a -longer time has elapsed, publish them. - - - - - CHAPTER VIII. - IDIOTCY AND INSANITY, WITH CASES. - - -As epilepsy is a much graver disease than hysteria, so is the sequel of -the former—dementia or idiotcy—much more permanent and difficult to be -removed by treatment than insanity, which is the ordinary sequel of -hysteria. - -I shall give but one case of idiotcy, because I regret to say that I -have never yet been able to thoroughly restore the mental powers in any -patients suffering from this dreadful affliction. Epilepsy is such a -chronic disease, and seems to me to produce not only weakening of the -mind, but to cause it to be often entirely lost, that, although we may -get, as in the following case, a temporary re-kindling of the mental -energies, I fear we are not yet able to give much hope of complete -recovery. Even here, however, I have such faith in the efficacy of -perseverance in constant watching, that I am almost inclined to believe -that, had this patient been in a condition of life to ensure vigilant -medical supervision for a lengthened period after operation, we might at -last have succeeded in, if not complete, at least, much creator -restoration than in a public institution, or to those in humble -circumstances, the surgeon is in a condition to promise. - - - CASE XLII. EPILEPTIC FITS, WITH COMPLETE IDIOTCY—OPERATION—GREAT - TEMPORARY RELIEF, BUT NOT PERMANENT BENEFIT. - - Mary J., æt. 19, single; admitted into the London Surgical Home Feb. - 15, 1864. - - This patient was brought to me by Dr. Marley, with the following - account:— - - “Has the appearance of a child of 10 or 12 years old; mammæ not - developed; has had epileptic fits ever since 12 years of age. Is now - almost idiotic; stares vacantly; slobbers at the mouth; passes her - motions anywhere, without regard to common decency, and cannot retain - her urine. I find from her mother that she is incessantly irritating - her genitals. Her fits vary in frequency, from two or three a day to - four or five a week. Being satisfied of the cause of her fits, I sent - her to you.” - - _History_, taken at the Home from her mother.—Had perfect health until - she reached her eleventh year; was forward in her lessons, and well - educated for her age and position. At this time she was suddenly - seized with a severe fit, for which no cause could be assigned. A - period of two years elapsed before she had a second, when, being - placed under medical treatment for eighteen months, she had great - relief. Since the expiration of that time to the present she has - constantly suffered from fits. - - Her intellect did not begin to weaken until two years since, but she - ceased growing and learning after the first attack. At this time she - does not know her right hand from her left; does not know her mother, - and shows no signs whatever of ordinary intelligence. From being - cleanly as a child, is now most filthy—in fact, is in every sense an - idiot. - - Has never menstruated. - - _On examination_—although, as stated by Dr. Marley, the mammæ were - very rudimentary—there was full development, and indeed abnormal - hypertrophy, of the external genitals. - - Feb. 18. The usual operation performed, under chloroform. The hands to - be restrained, and the patient most carefully watched. - - Feb. 19. Has passed a good night, and is quiet. - - Feb. 23. Has been very drowsy since the operation. To-day asked for - food for the first time, and showed some signs of intelligence. - - Feb. 26. Gave rational answers to several questions which were asked - her. Also remembers from day to day any promises of delicacies of diet - or money. - - March 1. Passed a good night; feels free from pain. Was given some - printed cards, which she read—_the first time for nine years_. - - March 2. Improving much. Is much more modest in her behaviour, but - still passes her excretions without regard to time or place. Notices - passing events, and remembers names and faces. - - March 3. Has given sensible and somewhat witty replies to various - questions asked her in the presence of about twenty medical gentlemen, - who to-day came to see the operation. When moneys were given her, she - at once told their different relative value. - - March 4. Morning: Seems no worse for the excitement of - yesterday.—Evening: Had a slight fit. - - March 5. A little heavy and stupid to-day. Somewhat irritable and - obstinate. - - March 6. Much better. Has a daily clearer notion of right and wrong. - Likes books with pictures and large print. When she comes to hard - words, she asks the meaning, like a child, but cannot always grasp the - meaning of an explanation. - - March 8. Not quite so well to-day. Had a slight epileptic fit this - evening, followed by a very severe one in two hours. - - March 9. Again much better, but irritable. - - March 12. Two fits. - - March 16. Not so well: another fit to-day. - - She from this time seemed to retrograde; and on the 4th of April was - discharged as incurable. - -It will be recollected how, at the end of the chapter on Hysteria, I -gave three cases of extreme nervous irritability, with sleeplessness, -and tendency to an unhinging of the mental equilibrium. We now come to -insanity itself. It would be vain to talk of the varieties of forms in -which this state may be seen, when produced by abnormal peripheral -irritation of the pudic nerve. It is, however, worthy of notice how each -history seems to tell its own explanation of the cause; and after the -first few days of treatment, when excitement, caused by irritation from -the wound and a natural repugnance to restraint, has passed off, how -rapid is the improvement, and how permanent is the result. I have no -hesitation in saying that in no case am I so certain of a permanent cure -as in acute nympho-mania; for I have never after my treatment seen a -recurrence of the disease, whereas, under medical treatment, of how -short duration is but too frequently the benefit. - - - CASE XLIII. INCIPIENT SUICIDAL MANIA—MANY YEARS’ GRADUAL - ILLNESS—OPERATION—CURE. - - R. T., æt. 39, single; admitted into the London Surgical Home Oct. 22, - 1861. - - _History._—Has been ailing for many years, and given great trouble and - anxiety to her friends. For some time past she has been very strange - in her manner, very restless, never quiet, constantly wakeful, - threatening suicide, talking to people, even perfect strangers, of her - ailments and their causes, of which she is fully conscious. Was - formerly modest and quiet. - - _On examination_, she is a fine woman, of restless appearance and - manner; eye wandering and unsteady; pupil dilated. The cause of her - mental derangement being obvious, on - - Oct. 24 the usual operation was performed. - - The improvement in her mental and bodily health was wonderful: she - gained flesh, and became cheerful and modest. She was discharged six - weeks after admission. - - When heard of in February, 1863, this patient continued quite well. - -The first case of actual insanity that came under my care was a patient -of Dr. Warren Diamond, then resident in his private asylum. I cannot do -better than transcribe the account which he sent me with the following -note:— - - “Effra Hall, Brixton, S. - - “DEAR SIR,—A month having elapsed since you gave up your patient, I - forward some particulars of the case, and shall be glad to answer more - fully any special time or state you would like to know more about. You - will, perhaps, be able to pick something out of this rambling account - that may be interesting to you. Hoping you will excuse omissions, &c. - - “Believe me, yours faithfully, - - “WARREN H. DIAMOND.” - - “I. Baker Brown, Esq.” - - - CASE XLIV. SEVERAL YEARS’ ILLNESS—TWO MONTHS’ INSANITY—OPERATION—CURE. - - “Miss E. R., æt. 34, single; no occupation, living with her friends; - hair light reddish-brown; face set and vacant, with an occasional - pained expression; eyes fixed and dull; extremities damp and cold; - stature moderate and well formed. Has for several years past been - looked on by her friends as different from others—strange and - eccentric. Would go out and walk away into the country alone for - miles, and come back exhausted. When friends called, would start up - and run round the garden, or to the top of the house and back again, - giving no reason for it but that she must do it. Always exceedingly - irritable and passionate. Unless some excitement was going on, was - listless and unable to rouse herself. When at parties, was so forward - and open in her manners, that she was generally avoided by gentlemen. - _Never had an offer of marriage._ Her mother died about a year and a - half ago, but she took no notice of the occurrence, and was - consequently remarked on by her friends. Since then she has been - getting more strange and peculiar. About February last, a sister told - her, in joke, that if she did not take care she would soon become a - fit subject for Dr. Diamond, little thinking how soon it would happen. - She recently made enemies of old friends, so that her brothers could - not make out why they fell off. Would sit or stand without noticing - them when they called; and asked them what they wanted that they came - to her house (she was the eldest of the family). - - “I was consulted about her in the end of March, but had then none of - her previous history. She was vacant and dreamy; talked of flowers - which she called her friends; said ‘people’s faces were masks; that - she was quite unable to rouse or employ herself, as she was changed;’ - very uncertain in appetite, going a day without her food; not sleeping - at night, and for the last few nights showing such great excitement - and passion, that her sisters were required to sit up with her. - - “I recommended change along the south coast, with sea-bathing, &c. She - did not improve; and the attendant informing me of a constant - irritation of the vulva, lotions were used, but without benefit. Her - general health and appetite improved; but not the mind. She could not - sleep, and would not bear narcotics; _stimulants acted as narcotics_, - but soon lost their effect. - - “Bowels regular; pulse small and slow; action of heart being - irritable, and not corresponding at all times to the power or quantity - of the pulse. She sits up in bed, nursing the pillow, and talking to - it as if it were a baby; says ‘that she died last Sunday’—‘is - lost’—‘is buried.’ - - “When out of doors, great difficulty is experienced in getting her in - again; she wishes to wander away, without aim or purpose. Having given - my opinion to her friends, I was authorized to admit her April 18, - 1861. Before she left home, she continued calling out, ‘Take me to a - mad-house! take me quick, or I shall never get well!’ She persisted in - saying ‘she was dead,’ and ‘she felt buried.’ Answers in - monosyllables. Her pupil is contracted and fixed. At night she does - not sleep, and is in such a continual state of excitement that the - attendant cannot sleep with her. Has lost all natural modesty in - manner and speech. Is not blasphemous. Before me is perfectly reserved - and correct in her manner. When I ask questions, she will, after a - pause, answer in monosyllables, or repeat the question over and over - again, as if trying to grasp the meaning and ally her thoughts. Unless - walked about, will stand for hours in one place, gaping, yawning, and - throwing her arms about listlessly. She was in this state when you saw - her, and from what you told me of your experience of the operation and - its results, I was led to infer relief from it in this case, as the - delusion of having died on a certain day was movable and could be - reasoned away; but the heavy oppressed feeling still made her say, - ‘But if I am not dead, I am lost, or changed,’ and naturally led back - to the idea. I ascribed the state of her mind to weakening of the - body, and general nervous irritation caused by long-continued reflex - excitation; and I believed that if the source of irritation could be - removed, her mental health would follow as her blood became healthy, - and fit to make reparation. - - “I was led to think more of her uterine state from her expression of - pain when she was walked about, and she was reported by the nurse as - always complaining of her back, at the lower part, and of great - tenderness on pressure over the ovaries. - - “May 27, 1861. You operated on her, she being under the influence of - chloroform. She was naturally restless afterwards, not understanding - why she was kept in bed. Profuse menstruation came on in the evening, - which had not happened for four months previously, and then always - very scanty and with much pain. Half an ounce of laudanum, with oil, - was rubbed into her chest during four hours; she did not, however, - sleep, but continued moaning all night. - - “May 28. Easier, and more herself—takes her food. - - “May 29. Slept well last night, without opiates; says she shall now - get well and be able to go home; answers questions more readily, and - makes longer replies. _Pupil dilated and acts slowly._ Her nurse says - she is quite altered in every way, and compares the change in her mind - since the operation to ‘dividing the tightened strings of a fiddle, - and letting them all loose.’ - - “June 2. Left her bed; is still menstruating; appears cheerful; asks - questions now, and converses for short periods; has done a few - stitches of needlework; says nothing about ‘being lost or dead’ since - the operation. Surface of body and extremities warm. Freaky, anxious - look about her eyes and nose gone. Laughs and jokes. Says ‘she has - been in a dream,’ ‘that things now seem light,’ and ‘that she means to - get well.’ - - “July 3. She has gradually improved and become more natural in her - habits and ideas; sleeps soundly every night; takes her meals well; - walks about without compulsion; takes a pride in making herself neat, - and has washed and dressed herself ever since she left her bed; is - perfectly modest in manner and conversation. Her friends remark on the - great improvement in her mind, she having had no delusions. Her mental - state is, however, weak—what might better be called foolish, with some - amount of wilful obstinacy. The family medical attendant, and, in - fact, every one who has been in her company, notice the extraordinary - change that has taken place in her since your operation. I think the - present state of her mind results from the long-continued exhaustion, - and to restore it will be a matter of time. Her pupils act naturally.” - - I have often since heard of this lady as perfectly well, and as never - having had recurrence of illness. In 1865 I was consulted on the - propriety of marriage, to which I gave my full consent. - - - CASE XLV. ACUTE INSANITY—TWO MONTHS—OPERATION—CURE. - - Miss ——, æt. 17, moderate height, and well formed, hair light golden, - grey eyes and fair complexion, came under my care June 19, 1861. - - _History_ (taken from her mother).—When ten years old, had - inflammation of the womb, and after she recovered began to menstruate. - The function continued regularly until about eight months ago, since - when the catamenia have appeared every ten days, and, in fact, have - been hardly ever absent. In the latter part of last April she left - home for change of air, and returned May 15th, when her mother noticed - that she was thinner than before her departure, and, on inquiry, it - appeared that during the latter part of her stay she had been very - excited, at other times very low, sometimes laughing and singing, and - requiring port wine and brandy at all times of the day, though - generally abstemious, and never taking wine or other stimuli. The - first night after her return home she went to one of her sisters’ - rooms and began to talk of being married; did not sleep all that - night. May 17th. Was found to be rather wild in the morning; was taken - out for a drive during the day; did not sleep that night, from - constant excitement of the genitals. Had been seen by her ordinary - medical attendant, who ordered opiates, but without the effect of - giving her sleep. On the 28th, another physician saw her, and ordered - opiates, but without effect, as she did not have an hour’s sleep night - or day. May 22nd. An eminent authority in female diseases was called - in, and also, among other remedies, ordered opiates at night-time, but - with no effect. She continued raving and rambling till June 8th, when - a physician, who devotes himself to mental diseases, saw her; he said - that her mind was not affected, but that her behaviour was caused - simply by debility, and ordered wine, eggs, &c., and a _strong - opiate_, but without the desired effect. - - June 17. Was much worse. The last physician again saw her; said that - she was quite mad, must be taken from home, and could never recover. - She called her mother “Monsieur le Diable,” and her father “God.” She - was constantly irritating her clitoris, and indulged in most immodest - behaviour. Was ordered ext. cannabis indicæ, and slept three hours. - 19th. No better, and on this day I first saw her; she was then wild in - expression of countenance, and on entering the room she addressed me - as “Your Majesty,” and said “I was the Queen.” She also asked, “Why - has your Majesty condescended to visit me?” - - June 21. Before operating, the patient being under chloroform, I made - an examination, and found my diagnosis verified by the existence of - all the ordinary local symptoms. The hymen was quite absent. (In one - of her paroxysms she had stuffed a pocket handkerchief into the - vagina.) I performed my usual operation, and immediately administered - two grains of opium. She passed a tolerable night, not being noisy, - but not sleeping. - - June 22. Tolerably quiet. Not aware of what is passing around her, but - apparently comfortable. To have broth and milk diet—_no stimulants_. - - June 23. Passed a quiet night; but did not sleep much, though she had - a grain of opium. Dressing removed. Wound looking well. - - June 24. Has not passed quite such a good night—rather noisy. - - June 25. Menses came on. Has had a very bad night, and been very - troublesome. Chloroform administered to insensibility several times in - the course of the day. A liniment, containing seven drachms of soap - liniment and one drachm of laudanum, to be rubbed in to the chest - constantly. This seemed to quiet her. - - June 27. Has passed a rather better night, sleeping a little; but - towards morning she became very noisy, and chloroform was again - administered. To have the liniment rubbed in at night. - - June 28. A much better night. - - June 29. Has had a very fair night; and from this time she gradually - improved, sleeping well and being generally quite rational; her - appetite also improved. - - July 7. Menstruation occurred, and she was not so well for a day or - two, as she attempted to irritate the wound; but, being carefully - watched, was prevented. - - July 10. Catamenia ceased. Is quiet again. - - July 11. Went out in a bath chair, and said she enjoyed the airing. - From this time she gradually got better, and on the 28th she went into - the country for change. Her menses came on five weeks from the last - appearance; she was quite quiet all the time. Since then she has - menstruated regularly every three weeks, and in normal quantity. - - A year after operation she had a slight relapse of melancholy, and - fears were entertained that she was again going to be ill; but a brisk - purgation of calomel completely dispersed all symptoms. - - 1866. I have frequently heard of this young lady. She is now in good - health, moving in high society, and universally admired. - - - CASE XLVI. HYSTERICAL HOMICIDAL MANIA—ONE YEAR’S - DURATION—OPERATION—CURE. - - In December, 1861, Mrs. —— came under my care, by the recommendation - of Dr. Forbes Winslow. She gave me the following history of herself:— - - _History._—She was 57, and had had four children and two premature - labours. The last child was born twenty-three years ago. Twenty months - since had an attack of erysipelas in the face, with eruptions on - different parts of the body. Has never been well since, and last - August had another attack of erysipelas. Is constantly suffering with - shiverings, followed by burning heat and sweating, with prickling heat - of the skin. For the last year has never slept for more than an hour; - always waking with a _start_; feeling frantic, and very hot and - flushed. Has a constant feeling that she will be lost eternally, and - of this she is constantly speaking. - - From her husband I learnt the following:— - - After her last confinement, twenty-three years ago, she had puerperal - mania, from which she did not completely recover for six months. About - a year ago she began to show symptoms of mental derangement, first - exhibited in religious subjects, she constantly declaring that her - soul was irrevocably lost. About eight months ago she first tried to - destroy herself, by endeavouring to jump out of the window, &c., and - it was at this time thought advisable to place her in an asylum, where - she was kept four months, and when she left she was for a time much - better. While an inmate of the asylum, was made to take much exercise, - for which her husband says she is always better. - - She gradually got worse, and came under the care of Dr. Forbes - Winslow, to whom I am indebted for the case. Her husband says that for - the last two or three months she has slept pretty well from 10 p.m. - till 2 a.m., when she would suddenly wake, and warn him that a - “frenzy” was coming on. This frenzy consisted in her rising up, - fighting out with her arms, and scratching or tearing any one near - her; in the paroxysm the desire was always to destroy her husband. - After a few minutes the mania would subside, and be succeeded, first - by a kind of stupor, and then very profuse perspirations. One - peculiarity about her is, that when in this state she does or says - anything foolish, she knows it, and is afterwards very annoyed and - ashamed of her conduct. She has a great fear that she will be - permanently mad. - - The appetite has always been good, though she has said lately that she - cannot bear food, and that it always causes a horrid taste in her - mouth. She has, in a desultory manner, read many medical works, and - fancies that every one of her organs is in some way or other diseased. - - _On examination_, she had the appearance of a woman about 60. Her - eyes, of a dark grey, were never quiet, and could not look you - straight in the face; the pupil was much and constantly dilated. The - tongue quite clean, and pulse good. Heart, lungs, and other organs - seemed to be healthy. She owned with great shame to long-continued - pernicious habits. - - Dec. 14. I performed my usual operation. - - Dec. 21. Has very much improved, and had no “frenzies” since the - operation; sleeps well, and for many hours, but will not own to being - better. Complains of her skin being dry, and “burning hot.” It is, - however, moist and cool; at times she perspires freely. - - Dec. 26. Both husband and nurse consider her much improved. She has - been up both yesterday and to-day; sleeps and eats well. She is, - however, sulky; says she is very bad, and shall soon die. - - A fortnight later she was quite well, being entirely free since the - operation from maniacal attacks; but she complained to my son, Mr. - Boyer Brown, that I had unsexed her. He answered that nothing of the - sort had been done, but that the operation had prevented her from - making herself ill. From this time she steadily improved, and walked - out with her husband every day, who called on me many weeks later to - express his gratitude for the complete restoration of his wife to - health; for whereas before his nights were passed in constant fear, - rendering his life most wretched, his home was now one of comfort and - happiness both night and day. - - -CASE XLVII. ACUTE HYSTERICAL MANIA—FOUR MONTHS’ DURATION—OPERATION—CURE. - - Miss ——, æt. 23, was sent to me by Mr. Radcliffe, stating that she had - been brought over from Ireland as an insane patient, and that - everything had been settled for her admission to some asylum, when he - was induced to consult me on the last day before her entering one. He - stated that the paroxysms always came on at half-past five or six - every evening: I replied, if the attacks depended on peripheral - irritation, that an operation would at once prevent recurrence of the - attacks. She was accordingly admitted into the London Surgical Home - Feb. 6, 1864. - - When admitted, said she had taken no food for three days, and asked - for a cup of tea, which was given her. Enema was also administered. - - 3.45 p.m. Was seized with a fit, throwing her arms up over her head, - and then appearing as if comatose. In about twenty minutes revived: - the lips began to quiver, and she gradually became conscious, saying, - “I want a knife—I want blood!” She asked for the matron’s hand, that - she might bite it off. - - [The fit coming on earlier on this day was doubtless due to excitement - consequent on her removal.] - - 5 p.m. Mr. Baker Brown saw her; as soon as he came near her, she - seized his shoulder with great violence; was wild, and would not - answer questions; but gradually became soothed, and allowed an - examination. - - _Externally_, the abdomen showed signs of a child having been born, - and the mammæ had certainly contained milk. The _clitoris_ was - enlarged and hard; the _nymphæ_ long and flabby; the mucous membrane - roughened and discoloured. - - _Per vaginam_, the _uterus_ was found to be retroverted; there was - also a fissure of the _rectum_. - - _Operation_, 5.30 p.m. Was very violent under the first attempts to - administer chloroform. She was long in being brought under its - influence, but when once thoroughly anæsthetized, bore it exceedingly - well. - - The clitoris was excised, the elongated nymphæ removed, and the - fissure of the rectum divided. The wounds were dressed in the usual - manner, and the patient having had two grains of opium administered, - was ordered to be constantly watched. - - In twenty minutes awoke from the chloroform. Was calm, and slept at - intervals during the night. - - Feb. 7, 10 a.m. Visited by Mr. B. Brown. Present—Mr. I. B. Brown, - junior, House-Surgeon, and Matron. Pulse quick but steady; tongue - brown and furred; breath offensive; gums spongy; pupil natural; - countenance rather flushed; skin moist and warm. - - The following answers were given to questions asked of her by Mr. - Brown, seventeen hours after operation, and are in her own words; - much, however, of the information was volunteered without questions:— - - “Last March, instead of sliding down a slope, I jumped. This caused - displacement of my womb. I suffered great agonies. I was fomented with - hot water. I thought it was my back that was hurt. Since then I have - been subject to fainting and weakness. I suffer great irritation about - my private parts—cannot keep my hands away. The irritation is worse at - night. I am obliged to relieve the irritation by rubbing—sometimes for - two or three minutes at a time. There is always a discharge. I feel - very depressed afterwards. At times I have lost my brain, and felt as - if I did not care for living. I would like to have my hands untied; I - will be very quiet. Have been separated from my relatives for three - years. I shan’t tell you how long I have been married—(a pause). I am - very rude—I beg your pardon. I have been married three years. I had a - baby two years ago: it was not born at the full time—I think five - months. I don’t know whether it was alive. I left home with my friend - when I was sixteen (?). It is two years since I left him. I am now - twenty-three. - - “After the accident, suffered great pain.” Mr. Brown here looked at - her gums, and she immediately said, “Oh, yes; I had mercury given me - by Surgeon ——, in Dublin: he said it was my spine. He did not examine - my womb. Dr. —— examined it, and said there was great displacement. I - have been better for treatment at times. My brain has been affected. I - have fought very much. I have wanted a child’s blood. I have had it - sometimes by sucking the wounds of a child. When in a fit, I don’t - know what is going on around, or what is being said, but I recognize - people’s voices. I am not regular. Was kept in bed last September for - six weeks for flooding; was so for ten days after I was put in bed. - Was the same in Paris last year. I was studying in Paris to fit myself - for a governess.” - - The following are extracts from a letter voluntarily sent to Mr. Brown - by a lady with whom the patient lived for many months, and left only - three weeks previous to admission. Having stated that for some time - she was hysterical, and becoming daily more excitable, the letter - says— - - “On the 13th of September last, she for the first time seemed - delirious when going to bed. This was mentioned next morning to - Surgeon ——, who declared it to be nervous irritability of the - spine.... On the 27th, Dr. —— was called in, and at once gave his - opinion that there was ailment of the womb. He then ordered small - blisters on the lower part of the stomach, which in less than ten - hours relieved her, and removed the mania. She had not any reason for - _many_ days previous, and was sinking.... On the 3rd of October, Dr. - —— fixed an instrument to support the womb; and, except during the - time when the intensity of pain caused it, there was no delirium; for - a few days she got claret, which seemed to excite her greatly, so it - was discontinued; but on the 13th of October I was desired to give her - port wine in abundance. She was excessively weak, and mania so - dreadful, that she made several attempts to injure herself and me. She - got as many as eight large glasses of best port on some days; strong - beef-tea, chicken soup, and all the nourishment possible. It was not - only suggested, but it was advised to remove her to a lunatic asylum; - however, feeling that certainly nine-tenths of her time she was - perfectly sane, and could know well where she was and with whom, I did - not like the idea of placing so young a creature in an asylum. I kept - her here, and watched her day and night; she never was left alone for - one moment for three months.... I ought to mention that the order for - abundance of wine, &c., was from the opinion that ‘want of blood to - the brain’ caused the mania; and that the intense inflammation of all - internal organs was relieved by blisters on the lower part of the - stomach and by mercury.” - - Feb. 8. Lint removed from rectum, and wounds dressed. Is calm and - rational; passed a quiet day. - - Feb. 10. Very restless; obliged to restrain hands and legs. - - Feb. 11. Better; says her head feels heavy; countenance cheerful; - manner quiet and rational. - - Feb. 12. Very excited and irritable; constantly managing to free her - hands; will allow no one near her.—2 p.m.: Is quite maniacal; has - managed to irritate the wounds, and also the mammæ. To have one grain - of opium in pill, and ten grains of bromide of ammonium three times a - day. - - Feb. 13, 6 a.m. Hands again free; repeat opium. Slept afterwards till - 4 p.m., when she awoke calm and rational.—9 p.m. Slept again. - - Feb. 14. Very restless, and at times violent. Bandages removed and - jacket substituted. - - Feb. 15. Much better; rational, and conversing cheerfully. - - Feb. 16. Improving. - - Feb. 17. At her urgent request, hands were freed, but shortly after - she became excited. - - Feb. 19. More sensible; had to-day symptoms of a severe bilious - attack, which upset her for some days. - - Feb. 24. Much better; allowed to see her sister—the first time since - the operation. - - March 1. Much improved; has written to her sister, and amused herself - knitting and reading during the day. - - March 2. Allowed to dress; seemed to enjoy the change, and is very - cheerful. - - March 4. Visited by her sister; has been quietly cheerful all day. Is - certainly improving wonderfully. - - March 20. Took a walk, and enjoyed it. - - March 25. Spent the day away from the Home with her sister; returned - looking quite well, and all the better for the change. - - April 2. Discharged quite cured. - - This patient remained perfectly well, and I hear has since been - legally married. - - - CASE XLVIII. INCIPIENT MANIA—ONE YEAR’S - DURATION—OPERATION—CURE—SUBSEQUENT PREGNANCY. - - In 1863, Mrs. S. M., married, mother of three children, æt. 30, came - under my care, because she had been suffering for more than a year - from menorrhagia, which had gradually affected her mind, causing her - to have a great distaste for her husband; so much so, that he and his - friends were induced seriously to contemplate a separation. On the - first examination, her face indicated mental disturbance, eyes - restless, pupils dilated, and manner generally excitable. She told me - that she could not sleep at night, complained of constant weary - uneasiness in her womb, pain in her back, great pain on defecation, - constant desire to micturate. She said she was glad to be away from - home, as she made every one around her unhappy. Believed that she - would be a permanently insane patient, and never expected to return to - her family again. - - On more minute examination, I found irritable clitoris and labia, a - painful fissure of the rectum, with great relaxation of the sphincter - ani, which, on inquiry, was found to be caused by the frequent - introduction of her finger, with a view to peripheral irritation. At - her own request, she had long been separated _à mensâ_ from her - husband, on account of her great distaste for him and cohabitation - with him. - - I pursued the usual surgical treatment, which was followed by - uninterrupted success; and after two months’ treatment, she returned - to her husband, resumed cohabitation, and stated that all her distaste - had disappeared; soon became pregnant, resumed her place at the head - of her table, and became a happy and healthy wife and mother. She was - in due time safely delivered, and has ever since remained in perfect - health. - - _Remarks._—From observations of this case, one feels compelled to say, - may not it be typical of many others where there is a judicial - separation of husband and wife, with all the attendant domestic - miseries, and where, if medical and surgical treatment were brought to - bear, all such unhappy measures would be obviated? - -A careful perusal of the cases related in the foregoing pages will show -that all the theoretical objections mentioned in the introductory -chapter, as having been raised against my treatment, have been fully -contradicted by facts. Of the permanency of the result, I myself am -fully satisfied; and I hope at a future time, by a much larger number of -cases, to confirm others in the same opinion. - - - COX AND WYMAN, PRINTERS, GREAT QUEEN STREET, W.C. - ------------------------------------------------------------------------- - - - - - TRANSCRIBER’S NOTES - - - 1. P. 42, changed “prodomata” to “prodromata”. - 2. Silently corrected typographical errors and variations in spelling. - 3. Archaic, non-standard, and uncertain spellings retained as printed. - 4. Footnotes were re-indexed using numbers. - 5. Enclosed italics font in _underscores_. - -*** END OF THE PROJECT GUTENBERG EBOOK ON THE CURABILITY OF CERTAIN -FORMS OF INSANITY, EPILEPSY, CATALEPSY, AND HYSTERIA IN FEMALES *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm -concept and trademark. 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page-break-before: always; } - .ol_1 li {font-size: .9em; } - .x-ebookmaker .ol_1 li {padding-left: 1em; text-indent: 0em; } - body {font-family: Georgia, serif; text-align: justify; } - table {font-size: .9em; padding: 1.5em .5em 1em; page-break-inside: avoid; - clear: both; } - div.titlepage {text-align: center; page-break-before: always; - page-break-after: always; } - div.titlepage p {text-align: center; text-indent: 0em; font-weight: bold; - line-height: 1.5; margin-top: 3em; } - .ph1 { text-indent: 0em; font-weight: bold; font-size: xx-large; - margin: .67em auto; page-break-before: always; } - .ph2 { text-indent: 0em; font-weight: bold; font-size: x-large; margin: .75em auto; - page-break-before: always; } - .x-ebookmaker p.dropcap:first-letter { float: left; } - </style> - </head> - <body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females, by Baker Brown</p> -<div style='display:block; margin:1em 0'> -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Baker Brown</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: July 27, 2021 [eBook #65927]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Richard Tonsing and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK ON THE CURABILITY OF CERTAIN FORMS OF INSANITY, EPILEPSY, CATALEPSY, AND HYSTERIA IN FEMALES ***</div> - -<div class='tnotes covernote'> - -<p class='c000'><strong>Transcriber’s Note:</strong></p> - -<p class='c000'>The cover image was created by the transcriber and is placed in the public domain.</p> - -</div> - -<div class='titlepage'> - -<div> - <h1 class='c001'><span class='xlarge'>ON THE CURABILITY</span><br /> <span class='small'>OF CERTAIN FORMS OF</span><br /> INSANITY, EPILEPSY, CATALEPSY,<br /> <span class='small'>AND</span><br /> HYSTERIA IN FEMALES.</h1> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c002'> - <div><span class='small'>BY</span></div> - <div class='c003'><span class='large'>BAKER BROWN, F.R.C.S. (<span class='sc'>Exam.</span>)</span></div> - <div class='c003'><span class='xsmall'>SENIOR SURGEON TO THE LONDON SURGICAL HOME;</span></div> - <div><span class='xsmall'>LATE SURGEON-ACCOUCHEUR TO, AND LECTURER ON MIDWIFERY AND DISEASES OF WOMEN AND CHILDREN AT, ST. MARY’S HOSPITAL;</span></div> - <div><span class='xsmall'>LATE CONSULTING SURGEON TO THE WESTBOURNE DISPENSARY AND PADDINGTON LYING-IN CHARITY;</span></div> - <div><span class='xsmall'>PRESIDENT OF THE MEDICAL SOCIETY OF LONDON;</span></div> - <div><span class='xsmall'>FELLOW OF THE OBSTETRICAL SOCIETY OF LONDON;</span></div> - <div><span class='xsmall'>MEMBER OF THE HARVEIAN SOCIETY;</span></div> - <div><span class='xsmall'>CORRESPONDING FELLOW OF THE OBSTETRICAL SOCIETY OF BERLIN;</span></div> - <div><span class='xsmall'>HON. FELLOW OF THE GENERAL ASSOCIATION OF SURGEONS, NORTHERN GERMANY;</span></div> - <div><span class='xsmall'>MEMBER OF THE BROOKLYN MEDICAL AND SURGICAL SOCIETY;</span></div> - <div><span class='xsmall'>CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF PESTH;</span></div> - <div><span class='xsmall'>CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF BRUSSELS;</span></div> - <div><span class='xsmall'>CORRESPONDING MEMBER OF THE PHYSIO-MEDICAL AND STATISTICAL SOCIETY OF MILAN;</span></div> - <div><span class='xsmall'>HON. CORRESPONDING MEMBER OF THE MEDICAL SOCIETY OF NORWAY, ETC.</span></div> - </div> -</div> - -<div class='figcenter id001'> -<img src='images/title.jpg' alt='' class='ig001' /> -</div> - -<div class='nf-center-c0'> - <div class='nf-center'> - <div>LONDON:</div> - <div>ROBERT HARDWICKE, 192, PICCADILLY, W.</div> - <div>1866.</div> - </div> -</div> - -</div> - -<div class='nf-center-c0'> -<div class='nf-center c004'> - <div><span class='small'>COX AND WYMAN,</span></div> - <div><span class='small'>ORIENTAL, CLASSICAL, AND GENERAL PRINTERS,</span></div> - <div><span class='small'>GREAT QUEEN STREET, W.C.</span></div> - </div> -</div> - -<div class='chapter'> - <h2 class='c005'>TO DR. E. BROWN-SÉQUARD. F.R.S., &c.</h2> -</div> - -<p class='c006'><span class='sc'>Dear Dr. Brown-Séquard</span>,</p> - -<p class='c007'>I am deeply indebted for your kind permission -to dedicate this work to you. I feel assured that its -introduction to the Profession under the auspices of the greatest -physiologist of the day will secure for it greater consideration, -and lead to a closer examination of its contents, than would -otherwise have been the case.</p> - -<p class='c008'>With the greatest respect, believe me to be,</p> - -<div class='lg-container-r'> - <div class='linegroup'> - <div class='group'> - <div class='line'>Most faithfully yours,</div> - <div class='line in6'>I. BAKER BROWN.</div> - </div> - </div> -</div> - -<div class='lg-container-l'> - <div class='linegroup'> - <div class='group'> - <div class='line'><span class='sc'>17, Connaught Square, Hyde Park, W.</span></div> - <div class='line in12'><em>March, 1866.</em></div> - </div> - </div> -</div> - -<div class='chapter'> - <span class='pageno' id='Page_v'>v</span> - <h2 class='c005'>PREFACE.</h2> -</div> - -<p class='drop-capa0_0_6 c009'>In offering this little book to my professional -brethren, I do not for one moment -wish it to be understood that I claim any -originality in the surgical treatment herein -described.</p> - -<p class='c008'>Having read with great interest the Lectures -on the “Physiology and Pathology of the -Central Nervous System,” delivered by Dr. -Brown-Séquard before the Royal College of -Surgeons of England, in 1858, and published -in <cite>The Lancet</cite>, I was struck with a fact much -insisted upon by the learned physiologist, -namely, the great mischief which might be -caused in the system generally, and in the -nervous centres especially, by peripheral excitement.</p> - -<p class='c008'><span class='pageno' id='Page_vi'>vi</span>Constantly engaged in the treatment of -diseases of the female genitals, I had been often -foiled in dealing successfully with hysterical -and other nervous affections complicating -these lesions, without being able to assign a -satisfactory cause for the failure. Dr. Brown-Séquard’s -researches threw a new light on -the subject, and by repeated observation I -was led to the conclusion that the cases -which had puzzled me, and defied my most -carefully-conceived efforts at relief, depended -on peripheral excitement of the pudic nerve. -I at once subjected this deduction to a -surgical test, by removing the cause of excitement. -I have repeated the operation again -and again, and it is the object of this book -to show the results.</p> - -<p class='c008'>Daily experience convinces me that all -unprejudiced men must adopt, more or less, -the practice which I have thus carried out; -and I have no doubt that, in properly -selected cases, it will prove as successful -in their hands as in mine.</p> - -<p class='c008'><span class='pageno' id='Page_vii'>vii</span>It will be observed that the majority of -the cases I publish have been taken from -the records of the London Surgical Home. -I have drawn my illustrations chiefly from -this source, because the practice of the -Institution being freely open to the profession, -the cases have been observed by numerous -medical men; and, I may add, that -many have become firm converts to my -views.</p> - -<div class='chapter ph1'> - -<div class='nf-center-c0'> -<div class='nf-center c004'> - <div><span class='large'>ON THE</span></div> - <div class='c003'><span class='large'>CURABILITY OF CERTAIN FORMS OF</span></div> - <div class='c003'>INSANITY, EPILEPSY, CATALEPSY,</div> - <div class='c003'><span class='large'>AND</span></div> - <div class='c003'>HYSTERIA IN FEMALES.</div> - </div> -</div> - -</div> - -<div class='chapter'> - <span class='pageno' id='Page_3'>3</span> - <h2 class='c005'>CHAPTER I.<br /> <span class='large'>INTRODUCTORY.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>As the title of this book implies, I do not intend -to occupy the attention of my readers with all -the numerous varieties of insanity and other nervous -disorders to which females are liable, but only those -which I believe to be curable by surgical means; -nor is it my intention in this category to include -slight cases, but to confine myself to such as cause -more or less severe functional derangement, or which -lead to serious organic lesions.</p> - -<p class='c008'>The class of diseases on which I shall dwell are -those depending on (or arising from) a loss of -nerve tone, caused by continual abnormal irritation -of a nerve centre.</p> - -<p class='c008'>This is no very new theory; but it has been for -Dr. Handheld Jones, by a large number of cases and -experiments, as collated in his admirable work on -“Functional Nervous Disorders,”<a id='r1' /><a href='#f1' class='c010'><sup>[1]</sup></a> to make it “abundantly -clear that the great majority of disorders we -have to treat at the present time show more or less -<span class='pageno' id='Page_4'>4</span>marked indications of failure of nervous power.” -Dr. Jones confines himself “to such disorders as are -termed functional;” and I agree with him that “it -seems a vain dispute, whether in strict accuracy -there are, or are not, any such disorders; ... for -it is perfectly certain that there are very grave disorders -in which the most careful scrutiny fails to -detect any actual change, in which complete recovery -is perfectly possible, and in which the ‘<span lang="la" xml:lang="la">juvantia</span>’ are -such as to operate more in modifying the power of -the organs than the texture.” Dr. Jones then gives -two typical cases of functional and organic disease, -between which, as he justly observes, “there intervene -numerous instances of more or less mixed -character;” and adds, that “disease which commences -essentially as functional may end as organic.”</p> - -<div class='footnote' id='f1'> -<p class='c008'><a href='#r1'>1</a>. London, Churchill, 1864.</p> -</div> - -<p class='c008'>I am so pleased to be supported by my old friend -and colleague in views that I myself have long entertained, -that I intend, without further preface, to make -his researches the whole substratum of my work; -and hope to show how, on the basis of Dr. Jones’s -experiments, it is possible to prove the philosophy -of my own practice.</p> - -<p class='c008'>Whichever of the terms, “inhibitory influence” -(Handfield Jones and Lister), “reflex relaxation” -(Brinton), or “reflex paralysis” (Brown-Séquard), -be used, the fact is ceded by all, that “the energetic -operation of an afferent nerve” (Lister), or some -impression acting injuriously on an afferent nerve -<span class='pageno' id='Page_5'>5</span>(Handfield Jones), or, again, “an actually existing -irritation” (Brown-Séquard), exerts an injurious -effect on its nerve centre, this state being, as Dr. -Brown-Séquard thinks, increased or diminished according -to the activity of the irritation, and ceasing -with its entire removal, or, more probably, as Dr. -Handfield Jones affirms, persisting after the cessation -of the cause which has morbidly affected it. This -latter view appears to me the more generally correct -one, because it can hardly be expected that a gradual -disease will be suddenly removed, there having been -no time for recovery of nerve power.</p> - -<p class='c008'>In Dr. Handfield Jones’s Lumleian Lectures, delivered -last year before the College of Physicians, he thus -sums up his views on this subject:—“The essential -idea of the inhibitory theory is, that an impression -conveyed to a nervous centre by afferent nerves may -weaken or paralyze, instead of exciting, its action, -either from the congenital or acquired debility and -sensitiveness of the nerve itself, or because the impression -is unduly intense or absolutely injurious. -Both these things have in every case to be considered—viz., -the state of the nerve force, and the kind -and amount of impression, as the resulting phenomena -will vary with the variation of either.”</p> - -<p class='c008'>Dr. Jones next takes it as a matter of certainty, -“that a nervous centre may be more or less completely -paralyzed without having undergone organic -change, in consequence of some enfeebling morbid -<span class='pageno' id='Page_6'>6</span>influence;” and quotes from Dr. Gull<a id='r2' /><a href='#f2' class='c010'><sup>[2]</sup></a> “a most -interesting instance of complete paraplegia induced -by sexual excess, in which nothing abnormal could -be detected in the cord, even by careful microscopy. -This was paralysis from simple exhaustion.”</p> - -<div class='footnote' id='f2'> -<p class='c008'><a href='#r2'>2</a>. “Guy’s Hospital Reports,” 1858. Case xvii.</p> -</div> - -<p class='c008'>Still continuing, Dr. Jones draws attention to the -anatomical fact of the remarkably close manner in -which “the different nerve centres, or parts of a nerve -centre, are connected by commissural fibres,” and -how, “from a pathological point of view, the same -connexion is often very manifest. The general exhaustion -induced by excess of venery,” and other -cases, “are examples which show how excessive -consumption of nerve force in one part weakens it -also in others; and this can only be adequately -explained by the intricate commissural connexion -between the various centres.”</p> - -<p class='c008'>The truth of all these views is well exemplified, as -Dr. Kidd has stated, in cases of epilepsy, which “may -originate only in irritation of bad teeth acting on -the brain, or worms irritating the nerves of the -stomach, and so on as to other peripheral irritations; -the chief skill being to find out the spot from which -the irritation radiates.”</p> - -<p class='c008'>A case is also quoted by Dr. Jones, in the Lumleian -Lectures, as having occurred in the practice of -Mr. Castle, of New York, where diseased teeth produced -paraplegia, which soon ceased after their removal.</p> - -<p class='c008'><span class='pageno' id='Page_7'>7</span>Long and frequent observation convinced me that -a large number of affections peculiar to females, depended -on loss of nerve power, and that this was -produced by peripheral irritation, arising originally -in some branches of the pudic nerve, more particularly -the incident nerve supplying the clitoris, and -sometimes the small branches which supply the -vagina, perinæum, and anus.</p> - -<p class='c008'>Closer observation satisfied me that the greater or -less severity of the functional affections observed, depended -on the amount and length of irritation, and the -consequent amount of loss of nerve power.</p> - -<p class='c008'>Nor are functional disorders the only consequence, -but in some cases, severe organic lesions.</p> - -<p class='c008'>The progress of the disease may be divided into -eight distinct stages—No. 8 being arrived at, by -gradations more or less distinct, directly from No. 1.</p> - -<p class='c011'>1. <span class='sc'>Hysteria</span> (including dyspepsia and menstrual -irregularities).</p> - -<p class='c011'>2. <span class='sc'>Spinal Irritation</span>, with reflex action on uterus, -ovaries, &c., and giving rise to uterine displacements, -amaurosis, hemiplegia, paraplegia, &c.</p> - -<p class='c011'>3. <span class='sc'>Epileptoid Fits</span>, or <span class='sc'>Hysterical Epilepsy</span>.</p> - -<p class='c011'>4. <span class='sc'>Cataleptic Fits.</span></p> - -<p class='c011'>5. <span class='sc'>Epileptic Fits.</span></p> - -<p class='c011'>6. <span class='sc'>Idiotcy.</span></p> - -<p class='c011'>7. <span class='sc'>Mania.</span></p> - -<p class='c011'>8. <span class='sc'>Death.</span></p> - -<p class='c008'><span class='pageno' id='Page_8'>8</span>My statement, that death is indeed the direct -climax of the series, might be proved by several cases -which have occurred in my own practice, one only of -which I shall relate. Before doing so, I may mention -that Dr. James Russell, of Birmingham, has recorded -a case in the <cite>Medical Times and Gazette</cite>, Oct. 31, 1863, -in which a male patient, æt. 32, died under his care -in the Birmingham General Hospital. Complete -paralysis both of sensation and motion in the lower -part of the body and lower extremities attacked him -after an unusually excessive venereal indulgence. -There had been gradual exhaustion for the last twelve -or fourteen years, from this cause. There was no -attempt at recovery, and he died in four months -from the date of the attack.</p> - -<p class='c008'>The case that occurred in my own practice -was as follows: ——, æt. 19, has been gradually -becoming ill since the age of nine; does not look -older than the latter age, though the sexual organs -are as highly developed as they should be. Has -been for many months in a metropolitan hospital -suffering from acute headache, but has received no -benefit. For two years has been perfectly blind.</p> - -<p class='c008'>She was found dead, and with every evidence of -having expired during a paroxysm of abnormal excitement.</p> - -<p class='c008'>These cases will illustrate how important it is to -arrest the disease <i><span lang="la" xml:lang="la">ab initio</span></i>, and the treatment must -be the same whether we wish to cure functional -<span class='pageno' id='Page_9'>9</span>disturbance, arrest organic disease, or, finally, if we -have only a chance, of averting death itself.</p> - -<p class='c008'>The time required for recovery must depend, not only, -as has been already hinted, on the duration of illness, -but also on the peculiar temperament of the patient, -and judicious after-treatment; this latter requiring -long perseverance on the part of both practitioner -and the friends of his patient; and it is as we -meet a favourable or unfavourable case that the -opinions of Brown-Séquard, as to instant cure on -removal of irritation, or of Handfield Jones, as to -cure after a long interval, are verified.</p> - -<p class='c008'>I have pleasure in stating that, with reference to -the origin of most nervous affections of females, I -have, in frequent conversation with Brown-Séquard, -found that the views of this distinguished physiologist -entirely coincide with my own, and he often expressed -himself as satisfied that destruction of the nerve -causing irritation was the only effective cure; the -best mode of carrying out this destruction was, in -his opinion, yet to be determined. He used actual -cautery.</p> - -<p class='c008'>I hope to be able to show that a far more -humane and effectual method is that which I constantly -practise, and for the last six or seven years -have openly and consistently advocated. Of course, -from the very novelty of these views, I have been -met with many objections, such as unsexing the -female, preventing the normal excitement consequent -<span class='pageno' id='Page_10'>10</span>on marital intercourse, or actually, as some most -absurdly and unphilosophically assert, causing sterility: -whereas my cases will show fact to be directly -converse to all these theories; and it is curious that -a physician for many years connected with one of -our largest metropolitan hospitals, and recognized as -a standard writer on female diseases, has in writing -condemned my practice in not very measured terms, -but is himself constantly in the habit of trying to -subdue this peripheral irritation by continual application -of the strongest caustics to the seat of the -irritation; thereby showing that he recognizes the -source of evil, but is not yet able to see that a -superficial sore will not destroy deep-seated nerve -irritation. It wants, I imagine, little argument to -prove that so far from this practice being beneficial, -it is likely, by causing increased irritation, to be positively -injurious.</p> - -<p class='c008'>Other practitioners follow Dr. Brown-Séquard’s plan -of applying actual cautery to the irritant nerve; and -many more have advanced as far as the operation—which -I was formerly in the habit of practising—subcutaneous -division of the nerve. I have long abandoned -this method as being no more certain in its effect than -kindred operations on various branches of the fifth -nerve for <span lang="fr" xml:lang="fr">tic doloureux</span>.</p> - -<p class='c008'>Another objection has been made that several of -my cases have not been permanently cured, but have -had relapses in a few weeks or months. This must -<span class='pageno' id='Page_11'>11</span>necessarily be so with all new methods of treatment; -but each such case is of incalculable importance, as -teaching me to exclude any but temporary hope of -relief to some, while to others I can speak all the -more positively as to their ultimate permanent recovery.</p> - -<p class='c008'>Experience seems to teach that in those patients -whose brains have been so weakened by long-continued -peripheral excitement, causing frequent and increasing -losses of nerve force, there is not sufficient -mental power to enable them to control any less powerful -irritation of smaller branches of the pudic nerve, -than that removed by operation.</p> - -<p class='c008'>This lesser excitement acts chiefly, I imagine, by -preventing restoration, in the same manner as a -drunkard whose brain is weakened by long indulgence -in his baneful habit cannot resist temptation, but is, -however, affected by much smaller quantities of -stimuli, than when strong, he was able to take.</p> - -<p class='c008'>A striking instance of this kind occurred to me last -year.</p> - -<p class='c008'>One of our most distinguished obstetric physicians -requested me to operate on a lady who had been for -some twenty years under very many eminent practitioners -without any but temporary benefit. The -result of the operation was most marked; the irritation -subsided, the patient improved in health, and we -confidently expected permanent relief. Yet in a few -weeks after she left our hands and that of the nurse, -<span class='pageno' id='Page_12'>12</span>irritation, resembling pruritus, gradually returned, and -with it the other old symptoms.</p> - -<p class='c008'>In all cases of a similar nature which have come -under my care, I have insisted on the importance of -the patient being kept for a long time under careful -medical watching and good nursing, and from the -results already obtained from cases in which these -precautions have been exercised, I feel confident of -success for the future.</p> - -<p class='c008'>Lastly, objections have been advanced against the -morality of the operation, and I am here at a loss how -to give an answer, for I can hardly conceive how such a -question can be raised against a method of treatment -which has for its object the cure of a disease, that is -rapidly tending to lower the moral tone, and which -treatment is dictated by the loftiest and most moral -considerations. I may here observe, that before commencing -treatment, I have always made a point of -having my diagnosis confirmed by the patient or her -friends.</p> - -<p class='c008'>To the philosophical and charitable mind, indeed, -the whole subject is one of the greatest interest, and -will lead us to ask the question, may not this “inhibitory -influence,” originating in early life, act so powerfully -on the mind as to unhinge it from that steadiness -which is essential to enable it to keep the passions -under control of the will; to enable, indeed, the moral -tone to overcome abnormal excitement? And if this -be true, does not common charity lead us to think that -<span class='pageno' id='Page_13'>13</span>cases treated by friends and spiritual advisers, as controllable -at the will of the individual, may be in reality -simply cases of physical illness amenable to medical -and surgical treatment? Is it not better to look the -matter steadily in the face, and instead of banishing -the unhappy sufferers from their home and from society, -endeavour to check their otherwise hopeless career -towards some of the latter stages of this disease, to restore -their mental power, and make them happy and -useful members of the community?</p> - -<p class='c008'>On this consideration I shall not now dwell further. -Every one must feel it to be a vast and important one, -affecting the well-being of the whole human race.</p> - -<p class='c008'>All I am now aiming at, is to show that many, if not -all, such cases may be cured. If this is done, I shall -indeed be able to say that I am amply repaid.</p> - -<p class='c008'>I have the gratification of being able to name the -following gentlemen who have been led to adopt my -views and treatment in proper cases:—Sir James -Simpson; Dr. Beattie, of Dublin; Sir John Fife and -Dr. Dawson, of Newcastle-on-Tyne; Dr. Duke, late -of Chichester; Dr. Shettle, of Shaftesbury; John -Harrison, Esq., of Chester; Drs. Savage, Routh, and -Rogers, in London; my eldest son, Mr. Boyer Brown, -now practising in New South Wales; with my colleagues -in the “London Surgical Home,” Dr. Barratt, -and Messrs. Harper, Chambers, I. B. Brown, junior, -and Bantock, and very many others.</p> - -<div class='chapter'> - <span class='pageno' id='Page_14'>14</span> - <h2 class='c005'>CHAPTER II.<br /> <span class='large'>SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>Every medical practitioner must have met with -a certain class of cases which has set at -defiance every effort at diagnosis, baffled every treatment, -and belied every prognosis. He has experienced -great anxiety and annoyance, and felt how -unsatisfactory was his treatment to the friends of -his patient: and this, not so much because he was -ignorant of the cause, as that he was unable to -offer any hope of relief.</p> - -<p class='c008'>The period when such illness attacks the patient -is about the age of puberty, and from that time up -to almost every age the following train of symptoms -may be observed, some being more or less marked -than others in the various cases.</p> - -<p class='c008'>The patient becomes restless and excited, or -melancholy and retiring; listless and indifferent to -the social influences of domestic life. She will be -<span class='pageno' id='Page_15'>15</span>fanciful in her food, sometimes express even a distaste -for it, and apparently (as her friends will say) -live upon nothing. She will always be ailing, and -complaining of different affections. At first, perhaps, -dyspepsia and sickness will be observed; then pain -in the head and down the spine; pain, more or less -constant, in the lower part of the back, or on either side -in the lumbar region. There will be wasting of the face -and muscles generally; the skin sometimes dry and -harsh, at other times cold and clammy. The pupil will -be sometimes firmly contracted, but generally much -dilated. This latter symptom, together with a hard -cord-like pulse, and a constantly moist palm, are, -my son informs me, considered by Mr. Moore, Colonial -Surgeon of South Australia, pathognomonic -of this condition. There will be quivering of the -eyelids, and an inability to look one straight in the -face. On inquiring further, there is found to be -disturbance or irregularity in the uterine functions, -there being either complete cessation of the catamenia, -or too frequent periods, generally attended with -pain; constant leucorrhœa also frequently existing. -Often a great disposition for novelties is exhibited, -the patient desiring to escape from home, fond of becoming -a nurse in hospitals, “<span lang="fr" xml:lang="fr">sœur de charité</span>,” or -other pursuits of the like nature, according to station -and opportunities.</p> - -<p class='c008'>To these symptoms in the single female will be -<span class='pageno' id='Page_16'>16</span>added, in the married, distaste for marital intercourse, -and very frequently either sterility or a tendency to -abort in the early months of pregnancy.</p> - -<p class='c008'>These physical evidences of derangement, if left unchecked, -gradually lead to more serious consequences. -The patient either becomes a confirmed invalid, always -ailing, and confined to bed or sofa, or, on the other -hand, will become subject to catalepsy, epilepsy, -idiotcy, or insanity. In any case, and more especially -when the disease progresses as far as these latter -stages, it will almost universally be found that there -are serious exacerbations at each menstrual period.</p> - -<p class='c008'>On personal examination, the peculiar straight and -coarse hirsute growth; the depression in the centre of -the perinæum; the peculiar follicular secretion; the -alteration of structure of the parts, mucous membrane -taking on the character of skin; and muscle having -become hypertrophied and generally tending towards -a fibrous or cartilaginous degeneration; will all be -recognized by the practitioner who has once had his -attention drawn to these subjects.</p> - -<p class='c008'>Having ascertained the cause and nature of the -disease, there are one or two points to be considered -before operative measures are decided on.</p> - -<p class='c008'>First, as to age. Although there is no doubt that -patients may suffer from peripheral irritation of the -pudic nerve from the earliest childhood, I never operate -or sanction an operation on any patient under ten -years of age, which is the earliest date of puberty. -<span class='pageno' id='Page_17'>17</span>In children younger than this, milder treatment with -careful watching, will be found sufficient if it be -thoroughly persevered in.</p> - -<p class='c008'>There are again, after puberty, cases which give -rise to but slight disturbance, but in which the sufferers -are they who love to enlist sympathy from the charitable, -and will be ill, or affect to be ill, in spite of any -and every treatment.</p> - -<p class='c008'>When I have decided that my patient is a fit subject -for surgical treatment, I at once proceed to operate, -after the ordinary preliminary measures of a warm -bath and clearance of the portal circulation.</p> - -<p class='c008'>The patient having been placed <em>completely</em> under the -influence of chloroform, the clitoris is freely excised -either by scissors or knife—I always prefer the scissors. -The wound is then firmly plugged with graduated -compresses of lint, and a pad, well secured by a T -bandage.</p> - -<p class='c008'>A grain of opium is introduced per rectum, the -patient placed in bed, and most carefully watched by -a nurse, to prevent hæmorrhage by any disturbance -of the dressing. The neglect of this precaution will -be frequently followed by alarming hæmorrhage, and -consequent injurious results.</p> - -<p class='c008'>The diet must be unstimulating, and consist of milk, -farinaceous food, fish, and occasionally chicken; all -alcoholic or fermented liquors being strictly prohibited. -The strictest quiet must be enjoined, and the attention -of relatives, if possible, avoided, so that the moral -<span class='pageno' id='Page_18'>18</span>influence of medical attendant and nurse may be uninterruptedly -maintained.</p> - -<p class='c008'>A month is generally required for perfect healing of -the wound, at the end of which time it is difficult for -the uninformed, or non-medical, to discover any trace -of an operation.</p> - -<p class='c008'>The rapid improvement of the patient immediately -after removal of the source of irritation is most -marked; first in the countenance, and soon afterwards -by improved digestion and other evidences of -healthy assimilation.</p> - -<p class='c008'>It cannot be too often repeated, that this improvement -can only be made permanent, in many cases, -by careful watching and moral training, on the part of -both patient and friends.</p> - -<p class='c008'>In the large majority of cases, I have administered -no medicines, trusting entirely to recovery, after the -removal of the source of irritation. Sometimes, however, -we may be materially aided by the use of such -medicines as the bromides of potassium and ammonium, -belladonna, &c.</p> - -<div class='chapter'> - <span class='pageno' id='Page_19'>19</span> - <h2 class='c005'>CHAPTER III.<br /> <span class='large'>HYSTERIA, WITH CASES.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>It may, perhaps, be necessary before relating -cases which I have treated, suffering from -hysteria, to state briefly what I understand by this -term. The word Hysteria was doubtless originally -used in the belief that it depended on excessive -reflex action of the nerves of the uterus and ovaries, -when these organs were excited by disease or other -causes; but this view is a very limited one, for, as -Dr. Handfield Jones says, “it does not appear that -females suffering with irritable uterus are more -hysterical, often not so much so, as those who have -no such disorder.” There is, however, as I have -already mentioned, in almost all hysterical patients, -an exacerbation at the menstrual periods.</p> - -<p class='c008'>Dr. Copland’s opinion, that “increased reflex -excitability of the nerves of the female generative -organs is one principal causative condition of hysterical -affections,” appears to me the correct one. Romberg -also says, “from the time when hysteria has taken -root, the reflex action preponderates throughout the -<span class='pageno' id='Page_20'>20</span>organism, and renders the individual more dependent -upon external stimuli.”</p> - -<p class='c008'>I have alluded in the last chapter to those patients -who have no desire to get well. Such I am not considering; -and although I believe that all the complaints -of an hysterical patient are more or less exaggerated, -my experience differs from that of Dr. Handfield -Jones, who believes that such patients are not “<i><span lang="la" xml:lang="la">bonâ -fide</span></i> anxious to get well.” In his view he is supported -by Dr. Prout, who considers that “the whole energies -of the patient’s mind are bent on deception;” -and by Dr. Watson, who says that “the deceptive -appearances displayed in the bodily functions and -feelings find their counterpart in the mental.” I am -confident that I have met with many instances in -which the nerve power has become so weakened that -the patient, without having organic disease, really -feels all the symptoms she describes, and is only too -anxious to be cured. The cases I shall now narrate -are a few of a large number that have come under -my care, and I am not without hope that their relation -may show that hysteria, instead of being a term -of reproach, does truly represent a curable disease.</p> - -<p class='c008'>The following was the first case that came under -my notice, after I had satisfied myself of the correctness -of my views on the subject:—</p> - -<div> - <span class='pageno' id='Page_21'>21</span> - <h3 class='c012'><span class='sc'>Case I. Hysteria—Five Years’ Illness—Operation—Cure in Two Months.</span></h3> -</div> - -<p class='c013'>D. E., æt. 26, single; admitted into the London Surgical Home -Oct. 12, 1859.</p> - -<p class='c011'><em>History.</em>—She had been a dressmaker in Yorkshire to all the -best families around, but for the last five years had been so ill as -to render her unable to do any work, and had been entirely supported -by her former customers. When in that neighbourhood, on -a professional visit to a lady, I was requested to see, amongst -others, this poor <i><span lang="fr" xml:lang="fr">ci-devant</span></i> dressmaker. Her physiognomy at once -told me the nature of the case; she was much attenuated, having for a -longtime been unable to retain any food, always being sick, with great -pain, immediately after meals. She had constant acid eructations; -was so weak as to be at times unable to cross the room; complained -of a burning, aching pain, with great weakness at the lower part of -the back. Her catamenia were irregular, with much leucorrhœa; -bowels generally costive. She was very melancholy, and expressed -a most earnest desire to be cured. I advised her admission to the -“Home,” and on October 15, I divided the clitoris subcutaneously. -This being my first operation, I did not know the consequences of -performing the operation in this manner. For two days the -hæmorrhage was profuse and uncontrollable. Sleep was procured -by opiates. I ordered ℥ij of olive oil to be rubbed into her chest -every night, with a view to nutrition of her attenuated frame. A -moderately generous diet was given, <em>but no stimulants</em>. She was -quite well in two months, and has never since had a day’s illness. -She resumed her occupation as a dressmaker, and recovered nearly -all her former customers. 1865.—I have heard almost yearly of -this patient, and lately had a letter from the lady to whom I previously -referred, saying that my patient is perfectly well and in -robust health.</p> - -<div> - <span class='pageno' id='Page_22'>22</span> - <h3 class='c012'><span class='sc'>Case II. Two Years’ Illness—Operation—Cures.</span></h3> -</div> - -<p class='c013'>P. F., æt. 21, single; admitted into the London Surgical Home -Jan. 7, 1861.</p> - -<p class='c011'><em>History.</em>—Attributes her illness to having strained herself two -years ago, when lifting a heavy saucepan from the fire. Has ever -since that time suffered great pain in the back and side, much worse -when she walks, but tolerably easy in the prone position. Catamenia -very irregular, both as to time and quantity. Great pain in -defecation. Bowels very constipated. Has been eleven weeks in -a metropolitan general hospital, and thirteen weeks in a special -hospital for women, from both of which she was discharged as -having nothing the matter, because she had no evident disease. -She had, however, been treated for uterine disease.</p> - -<p class='c011'><em>On examination</em>, the uterus was found to be quite healthy; there -was, however, evidence of excitation of the pudic nerve.</p> - -<p class='c011'>Jan. 10. The clitoris completely excised.</p> - -<p class='c011'>Jan. 16. Is much better.</p> - -<p class='c011'>Jan. 31. Discharged from the Home, cured. Is quite well -in her health, having lost all aches and pains, and being able to -defecate without the slightest uneasiness.</p> - -<h3 class='c012'><span class='sc'>Case III. Hysteria—Thirteen Years’ Illness—Sterility—Operation—Cure, and subsequently Three Pregnancies.</span></h3> - -<p class='c013'>S. S., æt. 33, married; admitted into the London Surgical Home -February 23, 1861.</p> - -<p class='c011'><em>History.</em>—Although married several years, has had no children. -About a year ago suffered from pain in the right side, which, however, -being treated was cured. In April last the pain returned in the -back, and at short intervals has recurred. At times the pain is so -severe that she is unable to walk. Has for thirteen years suffered -from leucorrhœa, <span lang="la" xml:lang="la">globus hystericus</span>, &c.; and has always had distaste -for marital intercourse.</p> - -<p class='c011'><span class='pageno' id='Page_23'>23</span><em>Examination</em> confirming me in the diagnosis I had formed of -this case, I, on February 28, operated in the usual manner. Her -recovery was retarded by an attack of jaundice, but in May she -was discharged cured.</p> - -<p class='c011'>In July, 1862, this patient was seen quite well and ruddy, and -had long lost all her old symptoms. She had been once pregnant, -but miscarried at three months.</p> - -<p class='c011'>In July, 1865, she came to town with her youngest child. She -was quite well, and had never been ill since the operation.</p> - -<p class='c011'><em>Remarks.</em>—This was the first case of this nature under my care, -in which the patient, formerly sterile, became pregnant after removal -of the cause of her illness.</p> - -<h3 class='c012'><span class='sc'>Case IV. Hysteria, with Sleeplessness—Six Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>H. R., æt. 55, single; admitted into the London Surgical Home -Nov. 18, 1861.</p> - -<p class='c011'><em>History.</em>—For six years has suffered from a feeling of fulness, -weight, and heat at the lower part of abdomen, with pain in the back, -and “bearing down.” At this time her menses had just ceased. -Has not slept well for three or four years. Wakes every hour. Is -always restless and fidgety. Frequent desire to micturate, with -pain on doing so, and often desire without power to void it. Bowels -costive; digestion indifferent.</p> - -<p class='c011'>She is a nervous, restless woman, with glistening and constantly -wandering eye—pupils dilated. Has suffered from peripheral irritation -for many years.</p> - -<p class='c011'>Nov. 21, 1861. Usual operation performed. A week later, slept -well for four hours, the first time for many years.</p> - -<p class='c011'>Dec. 1. Has lost the irritability of the bladder, and passes water -every four hours only; lost also the bearing-down pain; restless -excitement gone.</p> - -<p class='c011'>Dec. 7. Eats and sleeps well; is cheerful and grateful; leaves -the Home cured, having been in only three weeks.</p> - -<p class='c011'>In 1863 was perfectly well.</p> - -<div> - <span class='pageno' id='Page_24'>24</span> - <h3 class='c012'><span class='sc'>Case V. Fissure of the Rectum, with Hysteria—Operation for the former—Relief—Subsequent Operation for Hysteria—Cure.</span></h3> -</div> - -<p class='c013'>Mrs. L., æt. 55; admitted into the London Surgical Home Dec. 9, -1861.</p> - -<p class='c011'><em>History.</em>—Is a widow. Has for many years suffered from all the -inconveniences of a fissure of the rectum, combined with bad -digestion, undue nervous excitability, and sleepless nights. Is -very anxious to be cured. It being thought that all these symptoms -might be due to a painful fissure of the rectum, the ordinary -operation for this affection was performed on December 12. The -bowels were opened in a few days without pain, and the fissure was -healing well. Being, however, still sleepless, excitable, and irritable, -questions were asked which showed that a further operation for -removal of another source of irritation was advisable; therefore, on -December 24, I performed my usual operation. The next night she -slept well. She became quiet and cheerful, and on January 6, -1862, she was discharged quite well.</p> - -<p class='c011'><em>Remarks.</em>—This case is very interesting, as it shows that there -may exist at the same time more than one irritation exerting inhibitory -influence.</p> - -<h3 class='c012'><span class='sc'>Case VI. Hysteria, with Epileptiform Attacks in Childhood—Various Ailments for Thirteen Years—Operation—No Benefit.</span></h3> - -<p class='c013'>H. D., æt. 23 single; admitted into the London Surgical Home -April, 1862.</p> - -<p class='c011'><em>History.</em>—When very young, until ten years of age, had frequent -fits. Improved in health till she was fourteen years of age, when -she began to suffer from abdominal enlargement. First menstruated -at nineteen. Is constantly sick after meals. Has been in -<span class='pageno' id='Page_25'>25</span>nearly every hospital in London. The patient is very hysterical, -and is always <em>talking</em> religion.</p> - -<p class='c011'><em>On examination</em> the abdomen was found very tympanitic. Under -chloroform this state quite subsided. Walls of abdomen fat and -muscular. Body generally well nourished. Evidence of continual -irritation of the pudic nerve.</p> - -<p class='c011'>April 3. Operation as usual.</p> - -<p class='c011'>For some time after the operation this patient was much better -of the sickness, and great interest was manifested by several -visitors in her case; she never, however, received permanent -benefit, being a regular impostor, and discovered on several occasions -tying handkerchiefs, &c., tightly round her waist to make her -abdomen swell. She was discharged as incurable.</p> - -<p class='c011'><em>Remarks.</em>—This case I have inserted as a warning. It is no fault -of the operation if it fail in such cases.</p> - -<h3 class='c012'><span class='sc'>Case VII. Hysteria—Several Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>Miss M., æt. 42; admitted into the London Surgical Home April -13, 1862.</p> - -<p class='c011'><em>History.</em>—Has felt ailing for many years, but for the last two -has suffered pain in the uterine region, and, on pressure, over the -ovaries. This pain is accompanied by bearing down, and a sense -of distension. Suffers from considerable leucorrhœa. Menstruation -regular, and during the period the pain is absent. Bowels -regular. Sleep disturbed. Feels depressed, and is inclined to -melancholia.</p> - -<p class='c011'><em>On examination</em> there was no congestion of uterus or enlargement -of ovaries, but there was evidence of peripheral irritation of -the pudic nerve.</p> - -<p class='c011'>April 17. Usual operation performed.</p> - -<p class='c011'>She rapidly improved; sleep and cheerfulness returned, and all -pain left her. She expressed herself as not having been so well -for many years.</p> - -<p class='c011'><span class='pageno' id='Page_26'>26</span>May 13. Left the Home, having gained flesh and strength, -and being quite cured of all her bad symptoms.</p> - -<p class='c011'><em>Remarks.</em>—Interest attaches to this case, as instead of exacerbation, -there was diminution of the symptoms during menstruation.</p> - -<h3 class='c012'><span class='sc'>Case VIII. Hysteria—Many Years’ Illness—Phantom Tumour—Operation—Cure.</span></h3> - -<p class='c013'>A. B., æt. 24; admitted into the London Surgical Home 16th -July, 1862.</p> - -<p class='c011'><em>History.</em>—Is a single woman, and procures a living by dressmaking. -When younger, was a nurse-maid. Catamenia commenced -before she was thirteen, but she was not regular until she was -nineteen, since which the function has proceeded normally both in -time and quantity. Has for many years been ailing, and always -had something the matter. Has suffered from intense irritation in -the genital region, especially in the bladder, and she has constant -pain in the back. For two years has been treated at a dispensary -for an abdominal tumour; during this period she has taken much -medicine, but without benefit.</p> - -<p class='c011'><em>On examination</em> the abdomen was found increased in size and -universally tympanitic. Under the influence of chloroform the -swelling entirely subsided.</p> - -<p class='c011'>July 17. Usual operation performed under the influence of -chloroform.</p> - -<p class='c011'>Sept. 2. She was discharged quite cured, all her hysterical -symptoms having left her, and the tumour never having been seen -since the day of operation.</p> - -<h3 class='c012'><span class='sc'>Case IX. Hysteria—Five Years’ Illness—Sterility—Operation—Cure—Pregnancy—Two Children.</span></h3> - -<p class='c013'>Mrs. O. came under my care in 1862. She had been ill ever -since marriage, five years previously; having distaste for the -society of her husband, always laid upon the sofa, and under -<span class='pageno' id='Page_27'>27</span>medical treatment. Evidence of peripheral excitement being -manifest, I performed my usual operation. She rapidly lost all -the hysterical symptoms which had previously existed; and in -about a year came up to town to consult me concerning a tumour, -which greatly frightened her, as she feared it was ovarian. I discovered -that she was six months pregnant. She was delivered at -full time of a healthy child. In 1865 she again called on me to -show herself, not only in robust health, but pregnant for the -second time.</p> - -<h3 class='c012'><span class='sc'>Case X. Hysteria—Irritation of Right Ovary—Menorrhagia—Nine Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>C. M. A., æt. 28, single; admitted into the London Surgical -Home June 22, 1863.</p> - -<p class='c011'><em>History.</em>—Since the age of 19 has been more or less subject to -uterine flooding; for the first three years lost blood every day. -Has been five times in a metropolitan hospital; always better -while there, but as bad as ever as soon as she left. The bleeding -is much worse at each menstrual period. She passes large coagula; -has constant pain in the back, headache, and palpitation of the -heart, and cannot sleep; is dreadfully pale and anæmic.</p> - -<p class='c011'><em>Examination</em> showed great irritation over right ovary, and there -was evidence of long-continued peripheral irritation.</p> - -<p class='c011'>July 2. Usual operation.</p> - -<p class='c011'>July 7. Menstruation came on in a moderate flow.</p> - -<p class='c011'>July 10. Menstruation ceased; is much better, and there is -sign of returning colour in the face.</p> - -<p class='c011'>July 31. Has improved considerably, and had no return of -the bleeding. To be discharged cured.</p> - -<div> - <span class='pageno' id='Page_28'>28</span> - <h3 class='c012'><span class='sc'>Case XI. Hysteria—Many Years’ Illness—Operation—Cure—Marriage and Progeny.</span></h3> -</div> - -<p class='c013'>Emma K., æt. 22, single; admitted September 16, 1863, into -the London Surgical Home.</p> - -<p class='c011'><em>History.</em>—Commenced menstruating at 15 years of age, but -owing to the use of cold water during a period, the secretion was -arrested for six months; the function was then restored, and has -ever since continued normal. At 16 she suffered from piles, which -occasioned very much irritation and pain after each evacuation, -aggravated by constipation and by walking. Though regular as -to time, there is always excessive catamenial flow, and it lasts for -eight days. Has been under long and varied medical treatment, -without benefit.</p> - -<p class='c011'><em>Examination</em> showed peripheral irritation, as evinced by the -abnormal condition of the external genitals.</p> - -<p class='c011'>Sept. 17, 1863. The usual operation performed.</p> - -<p class='c011'>Oct. 1. Progressing most favourably.</p> - -<p class='c011'>Oct. 22. Leaves quite cured.</p> - -<p class='c011'>1866. This lady married, and was delivered August, 1865, of -a living child. She is still quite well.</p> - -<p class='c008'>It will have been observed that one very prominent -symptom in many of the foregoing cases is sleeplessness, -or perhaps more properly, frequent wakefulness -at nights, and constant restless movements in the -day. These are the cases which, if left to go on, -are very liable to terminate in insanity. The three -following are instances in which the hysteria was -verging on this state, and as they can hardly be -classed under the head of insanity, I prefer narrating -them here.</p> - -<div> - <span class='pageno' id='Page_29'>29</span> - <h3 class='c012'><span class='sc'>Case XII. Hysteria—Mental Aberration, and Tendency to Melancholia—Eight Years’ Illness—Operation—Cure.</span></h3> -</div> - -<p class='c013'>In December, 1861, a single lady consulted me, giving the following -history of her illness:—</p> - -<p class='c011'>Has not been well for seven or eight years; has felt languid, and -not so lively as formerly. For the last two years has menstruated -every three weeks, and the flow has lasted four or five days. There -is considerable white discharge from the vagina after each period, -lasting for a week. Great irritation about vulva, perinæum, and -anus before and during each menstrual period. For the last five -or six years had had occasional irresistible and unaccountable fits -of depression; thinks that it is her mind—if her mind were as -strong as her body she would be pretty well: her memory is good, -but mind weak. Has suffered from great pain at lower part of the -back; says she cannot rise from a chair without great difficulty, -on account of a feeling of stiffness in hips and trembling of the -legs (this is probably owing to a swelling of the hip-joint, as all -the joints of her fingers and ankles are swollen). Says she can sit -quietly to crochet or needlework, but cannot sit quietly to think, -or compose her mind to write a letter: has not written a letter -properly for three years. Has been subject to attacks of melancholy -and weeping, without any tangible cause, but which she -cannot resist. Suffers from want of sleep, and at night frequently -lies awake four or five hours together. Appetite good; bowels -costive.</p> - -<p class='c011'>In appearance is fresh-coloured and plump, but she says she is -thinner than formerly; dark eyes; large dilated pupils.</p> - -<p class='c011'><em>On examination</em> there was evidence of great irritation about the -vulva, and constriction of the anus, with a very small fissure.</p> - -<p class='c011'>Dec. 21. I divided the fissure, and performed my usual -operation.</p> - -<p class='c011'>Dec. 31. Very much improved; swelling of the joints much -less.</p> - -<p class='c011'><span class='pageno' id='Page_30'>30</span>Jan. 1. She sat up, and feels much better. Her spirits are -improved; has no pain in the joints; sleeps well. In another -month she returned home quite well, and has continued so to the -present time.</p> - -<h3 class='c012'><span class='sc'>Case XIII. Extreme Hysteria, verging on Insanity—Five Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>Mrs. ——, æt. 32, married; admitted into the London Surgical -Home August 5, 1862.</p> - -<p class='c011'><em>History.</em>—Has been married twelve years, but has had no children -nor miscarriages. Has always enjoyed pretty good health until -about five years ago, when she began to suffer from leucorrhœa -and great pain during menstruation. Catamenia regular in time -and quantity. Her bladder is so irritable that sometimes she has -to pass her water every half-hour; the urine sometimes very much -loaded. Suffers from headache and giddiness in the morning. Says -that for the last three years the act of coition has been accomplished -without the least pleasure, but with pain. Bowels are -opened regularly and without pain.</p> - -<p class='c011'>August 7. Having diagnosed the cause of the disease, the -usual operation was performed.</p> - -<p class='c011'>August 9. A severe attack of erysipelas came on, and she -was very ill for some days, but she made a good recovery.</p> - -<p class='c011'>A few days after the operation this patient was observed to be -occasionally very violent and unmanageable, and to have at these -times a wild maniacal look. On questioning her husband, it -appeared that for several years she had been subject to fits of violent -excitement, especially during the menstrual period, and that at such -times “she would fly at him and rend his skin, like a tigress.”</p> - -<p class='c011'>This patient made a good recovery; she remained quite well, and -became in every respect a good wife.</p> - -<div> - <span class='pageno' id='Page_31'>31</span> - <h3 class='c012'><span class='sc'>Case XIV. Extreme Hysteria—Incipient Insanity—Operation—Cure.</span></h3> -</div> - -<p class='c013'>Mrs. R., æt. 42; admitted into the London Surgical Home Aug. 5, -1862.</p> - -<p class='c011'><em>History.</em>—Has been married, but has been a widow for twelve -years. Is companion to a lady. Never had any family. Has been -ailing for some years, but has not suffered severely until the last -six months. Suffers most from pain in the lower part of the abdomen, -and from constant burning and irritation about the vulva. -During the last few months has become very nervous and fidgety; -never can remain quiet, and says that lately she “has had a sort of -lost feeling, particularly when writing; being unable to compose her -thoughts, or concentrate her mental energies.” Has suffered from -considerable irritability of the bladder; and her urine is often -full of thick deposit. Catamenia regular in time and quantity. -Cannot sleep.</p> - -<p class='c011'><em>On examination</em>, is a very nervous woman, her eyes restless and -never quiet; constant twitchings of the limbs, and occasionally an -appearance almost of insanity about her expression. There is every -evidence of a long-continued inhibitory influence.</p> - -<p class='c011'>August 7. The usual operation performed.</p> - -<p class='c011'>August 8. Feels very comfortable. Slept better last night -than for some years.</p> - -<p class='c011'>August 9. Is improving wonderfully: the expression of countenance -completely changed.</p> - -<p class='c011'>Sept. 9. Left quite well. Has got fat, and has now a cheerful -face and manner. Says she feels a different being, and is quite -astonished at her own improvement. Has lost all her nervous -twitchings and other uncomfortable symptoms, and has now a comfortable -night’s rest.</p> - -<div class='chapter'> - <span class='pageno' id='Page_32'>32</span> - <h2 class='c005'>CHAPTER IV.<br /> <span class='large'>SPINAL IRRITATION, WITH CASES</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>There are perhaps few terms so difficult to define -as spinal irritation, for the gradations from -hysteria to this state are extremely easy; and, indeed, -it will have been seen that in the foregoing chapter -most of the patients complained of pain in the spine, -and that there was more or less functional disturbance -in all of them. The term is also used so freely and -vaguely that great caution is necessary in attempting -to explain its meaning. Dr. Handfield Jones’s term, -“Spinal Paresis,” seems to me an excellent one; by it -he means “a state in which, without demonstrable -organic change, there is greater or less enfeeblement -of the functional power” of the spinal cord. The -sensory or motor power may be affected, but rarely -both together.</p> - -<p class='c008'>The cause of spinal irritation, or paresis, may be -defined in one word—“debility;” this debility always, -or almost always, being due to inhibitory irritation.</p> - -<p class='c008'>This state of things may give rise to wide and varied -disorders, all the symptoms of which are asthenic in -<span class='pageno' id='Page_33'>33</span>their character, and all of which are marked by -extreme nervous prostration.</p> - -<p class='c008'>Without doubt,—for all authors agree on this point, -one of the most prominent causes is peripheral irritation -of the pudic nerve, producing undue exhaustion.</p> - -<p class='c008'>It is difficult to say how this is produced, but most -probably it is that, “owing to the intimate commissural -connections between the lumbar enlargement of the -cord, where the pudic nerves are implanted (they themselves -being small and remote in their origin from the -brain); and the superior and nobler nervous centres, -the intense excitation of even a small and remote -centre is communicated to the others, which, as this -subsides, fall as much below, as they have previously -been stimulated above par. The depression is proportional -to the previous excitement.”</p> - -<p class='c008'>The cases I shall have to relate which may fairly be -called cases of spinal irritation are few in number, for -the reason I have stated, that they are but a continuation -of hysteria,<a id='r3' /><a href='#f3' class='c010'><sup>[3]</sup></a> and, indeed, but a state of things of -which epileptiform and epileptic fits are the direct -sequence.</p> - -<div class='footnote' id='f3'> -<p class='c008'><a href='#r3'>3</a>. <em>Vide</em> Cases in previous chapter.</p> -</div> - -<p class='c008'>It is, however, well to draw attention to the fact -that it is in cases of spinal irritation that we observe -functional derangements, which are very likely to pass -into actual organic diseases; and it is in this class of -cases, which are essentially of a chronic character, -<span class='pageno' id='Page_34'>34</span>that very long and persistent perseverance must be -pursued. I would, therefore, advise all who meet with -them to warn their patients beforehand that they must -not be weary and faint-hearted if recovery do not come -as soon as hoped for.</p> - -<h3 class='c012'><span class='sc'>Case XV. Spinal Irritation, and supposed Uterine Displacement—Six Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>In 1860, I was requested to see a young lady, æt. 20, of whom I -had the following history:—For six years she had been confined to a -spinal couch, and had also been supposed to suffer from retroversion -of the uterus. She had worn a spinal apparatus, attached to which -was a steel spring, pressing on sacrum and pubis, and intended “to -support the perinæum, and keep the uterus in position.” Had been -treated with caustics and other therapeutic agents for uterine -disease. I found the uterus normal in position and healthy in -appearance; but on further questioning and examination, I diagnosed -peripheral irritation of the pudic nerve. My opinion was -strongly contested, as I was told that the young lady was very religious; -but, as I explained, her illness was to be attributed solely to -a physical condition, and was not at all necessarily immoral; I was -then met with the objection that, in the event of marriage my -operation might interfere with marital happiness and prevent procreation. -I explained how, physiologically, these objections were -untenable, but was then unable to adduce actual cases in contradiction -of them.</p> - -<p class='c011'>Ultimately I performed my operation in the usual manner. For -want of proper attention on the part of the nurse, the dressing was -three times displaced; but, nevertheless, at the end of a month this -lady was well enough to walk three miles.</p> - -<p class='c011'>Up to this date she has remained quite well.</p> - -<div> - <span class='pageno' id='Page_35'>35</span> - <h3 class='c012'><span class='sc'>Case XVI. Dysmenorrhœa—Five Years’ Illness—Operation—Cure.</span></h3> -</div> - -<p class='c013'>D. A., æt. 23; admitted into the London Surgical Home Aug. 4, -1863.</p> - -<p class='c011'><em>History.</em>—Has never been very strong; but five years ago had -an attack of gastric fever. Since then has suffered constantly from -great pain during the menstrual period. Occasionally loses a great -deal, and passes large clots of blood. During this time has suffered -almost constantly from leucorrhœa. Suffers severely from pain over -region of left ovary and in the spine. Is hardly ever free from -headaches. Is very restless; never sleeps well; frequently faints; -and has little or no appetite. All her ills are exaggerated at the -menstrual epoch.</p> - -<p class='c011'>August 7. Usual operation performed.</p> - -<p class='c011'>Sept. 1. Is menstruating without pain.</p> - -<p class='c011'>Sept. 30. Again menstruating without pain, and in normal -quantity. Is to be discharged cured.</p> - -<h3 class='c012'><span class='sc'>Case XVII. Spinal Irritation and Loss of Use of Right Leg—Five Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>M. B., æt. 30, single; admitted into the London Surgical Home -Nov. 15, 1861.</p> - -<p class='c011'><em>History.</em>—Five years ago first began to suffer pain in the right -leg, which was ascribed to sciatica. Fourteen months since this -pain became so bad that she could not walk, and she lost all use of -her right leg, at the same time felt great weakness and pain in the -back, preventing her sitting. For eight months has been confined -to a “spinal couch.” Is a spare anæmic woman; dark hair and -eyes; dilated pupils; very restless and nervous in her movements, -and of a very irritable temper. Has suffered from peripheral irritation -since an early age.</p> - -<p class='c011'><span class='pageno' id='Page_36'>36</span>Nov. 26, 1861. Usual operation performed.</p> - -<p class='c011'>Dec. 27. She has gradually improved in health and temper -since the operation, and is now quite able to walk about her room -without help.</p> - -<p class='c011'>She was a long time before her nerve tone was thoroughly restored, -but she ultimately got quite strong and continues well.</p> - -<h3 class='c012'><span class='sc'>Case XVIII. Hysteria and Spinal Irritation Twelve Years—Fissure of Rectum, recent Duration—Operation—Cure.</span></h3> - -<p class='c013'>R. C. R., æt. 35 years, single; admitted into the London Surgical -Home April 15, 1861.</p> - -<p class='c011'><em>History.</em>—Has been suffering for nearly twelve years, at intervals -of from six months to six weeks, with pain in the womb and right -side, sudden spasms of the limbs, coming on at frequent and irregular -intervals. Great pain down the spine and lower part of the back and -loins. Has often attacks of severe sickness. Is usually costive. -Has lately suffered great pain in defecation. Catamenia regular. -Great want of sleep and appetite. Says she is always low-spirited, -moping, and listless. Has had much medical treatment.</p> - -<p class='c011'><em>On examination</em> there was found evidence of peripheral excitement -of the pudic nerve, and there also existed a fissure of the -rectum.</p> - -<p class='c011'>April 18. The usual operation performed, and the fissure of -the rectum incised.</p> - -<p class='c011'>After this time defecation was performed without pain. Sleep, -appetite, and cheerful spirits returned. She had no more spasmodic -twitchings, but she still complained of intense pain in the back on -sitting and walking. She was discharged in June much relieved, -but not well.</p> - -<p class='c011'>Nov. 9 1861. I received a letter from this lady, stating that -she now suffered no pain and was perfectly well. She was stout, -and better in every respect than she had been for the last twelve -years.</p> - -<div> - <span class='pageno' id='Page_37'>37</span> - <h3 class='c012'><span class='sc'>Case XIX. Menorrhagia—Mental Delusion—Two Years’ Illness—Operation—Cure—Subsequent Marriage and Progeny.</span></h3> -</div> - -<p class='c013'>A young lady, æt. 20, came under my care in 1863, having for -two years past suffered from almost constant menorrhagia, during -which time she had suffered great irritability of temper, been disobedient -to her mother’s wishes, and had sleepless nights, restless -desire for society, and was constantly seeking admiration; all these -symptoms culminating in a monomania that every gentleman she -admired was in love with her, and she insisted on always sending -her <i><span lang="fr" xml:lang="fr">carte de visite</span></i> to her favoured one for the time being. In her -quieter moments she would spend much time in serious reading. -On being consulted, I quickly discovered that all these symptoms -arose from peripheral excitement, and that there existed no organic -disease to cause the menorrhagia. The usual plan of treatment -was followed with the most rapid and marked success. She went -the full interval between the ensuing menstrual periods, and the -secretion was normal in quantity. All her delusions disappeared, -and after three or four months of careful watching, with change of -air, she was perfectly well in every respect. A year afterwards she -married, and ten months later gave birth to a healthy son. She is -now again pregnant.</p> - -<h3 class='c012'><span class='sc'>Case XX. Spinal Irritation, giving rise to Menorrhagia and Amaurosis—Operation—Cure.</span></h3> - -<p class='c013'>A single lady, æt. 35, came under my care in 1863. Had been out -of health for some years, suffering from continuous menorrhagia, -seldom being free more than ten days or a fortnight in the month. -Was thin and spare in appearance; often complaining of headache, -especially over the brow and orbits; and, in fact, nearly a confirmed -invalid. Latterly she had become almost blind from -amaurosis; she could only read the largest type, and not at all by -<span class='pageno' id='Page_38'>38</span>candle-light. Had come to London from the country, and placed -herself under the care of one of the most eminent ophthalmic -surgeons, who had treated her for three months without the slightest -benefit. When I saw her I immediately discovered that long-continued -peripheral excitement had caused all her disorders. Quickly -after the operation, menstruation became regular; in ten days she -was able to read in bed; in a month she was quite well. I frequently -hear of her now, as in robust health.</p> - -<p class='c011'><em>Remarks.</em>—Beyond a grain of opium after the operation, this -patient never had any medicine. I have had other cases exactly -similar, with like result.</p> - -<h3 class='c012'><span class='sc'>Case XXI. Spinal Irritation—Loss of Power in Lower Extremities—Operation—Rapid Improvement.</span></h3> - -<p class='c013'>Last year I was requested to see a lady, æt. 46, who had been -married to a second husband seventeen years without issue, but -had two children by her first marriage. Had not menstruated for -two years. Has been in ill health for many years, and undergone -a variety of medical treatment without benefit. In May, 1863, -first began to lose the power of her legs, and to suffer from attacks -of pain in the back, shooting up to the spine. She was at this -time in Paris, where she consulted several men of eminence, and -was treated for uterine disease, but still without benefit. She -returned to London in June, 1863, and placed herself under the -care of her usual medical attendant. Relief, after some time, not -being afforded, she consulted several eminent surgeons in the metropolis. -She was told that she had paralysis of the lower extremities, -and that nothing could be done with a hope of effecting -cure. From January, 1865, she was for six months under the care -of an eminent general practitioner, who exhausted the resources -of his art, but in vain. She was, in fact, “given up.”</p> - -<p class='c011'>As a last resource, I was applied to. I saw her in August at -<span class='pageno' id='Page_39'>39</span>her own house. Her countenance had a worn and haggard expression; -her body was emaciated; skin harsh, dry, and scaly; the -lower extremities hung as if paralyzed, but sensibility and voluntary -motion—the latter, however, very weak—were not entirely absent. -She complained of severe spasmodic attacks of agonizing pain -shooting up the spine, like tetanic shocks. Her appetite was very -defective, digestion was impaired, the bowels disordered, and sleep -was hardly ever procured. There was also partial ptosis of the left -upper eyelid. On examination, I found a deep and acutely painful -fissure, with large piles and loose skin around the anus, and all -the well-marked signs of peripheral irritation of the clitoris.</p> - -<p class='c011'>August, 1865. I operated, Dr. Kidd administering chloroform. -I divided the fissure, tied the piles with three ligatures, cut -off the loose skin around the anus, and removed the clitoris and -elongated labia in my usual manner.</p> - -<p class='c011'>It was gratifying to observe the early relief of her more severe -symptoms; by the third day the spasmodic attacks ceased, little -or no pain was complained of, and the improvement of the digestive -system was most marked, the patient enjoying chops, game, &c., -within ten days, and no longer “a martyr to flatulence and -dyspepsia.” The digestion was, however, easily deranged, and -great care was necessary. At the end of seven weeks, having -already on several occasions been driven out in a carriage, she was -removed to the country, where she remained for three weeks. It -may be here stated that the patient suffered much from the very -sultry weather of September, and that improvement was much -more rapid when colder weather set in. On her return, she was -able to stand for a few minutes with her hands resting on the -shoulders of another. Remaining in town for some weeks, she -again left for the sea-side, where she stayed about three weeks, -and returned to town in the beginning of this year. Her condition -is now as follows:—</p> - -<p class='c011'>She looks remarkably well in the face, which has entirely lost its -expression of suffering. She is free from pain. Sensibility in the -lower extremities is perfect; their muscular power is greatly improved. -She can raise herself from a chair so as to rest on her -<span class='pageno' id='Page_40'>40</span>hands and feet, and is able to walk across her room, holding the -hands of her maid, who retreats before her. She sleeps well every -night, and her digestion is in very fair order. She is now able to -sit up to all her meals, and to sit in an upright chair for hours -together, whereas formerly she was constantly in the recumbent -position.</p> - -<div class='chapter'> - <span class='pageno' id='Page_41'>41</span> - <h2 class='c005'>CHAPTER V.<br /> <span class='large'>EPILEPTOID CONVULSIONS, OR HYSTERICAL EPILEPSY, WITH CASES.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>In the chapter on hysteria, cases have been recorded -of frequent faintings, without spasms, and of spasmodic -twitchings of limbs without fainting, <em>i.e.</em> without -loss of consciousness. We now come to cases more -marked and chronic, and having many of the characters -of epilepsy. They may be brought to us by the friends -of the patient as genuine epileptics. The diagnosis is -in some cases difficult, but for the most part easy. -Dr. Russell Reynolds<a id='r4' /><a href='#f4' class='c010'><sup>[4]</sup></a> has summed up the distinctive -features so ably that I cannot do better than quote his -final remarks on this subject:—</p> - -<div class='footnote' id='f4'> -<p class='c008'><a href='#r4'>4</a>. “Epilepsy: its Symptoms, Treatment, and Relation to other -Chronic Convulsive Diseases.” By J. Russell Reynolds, M.D. -London: Churchill, 1861.</p> -</div> - -<p class='c008'>“The paroxysm resembles epilepsy, and sometimes -closely, but it differs in essential particulars. The -difference is not one only of degree, neither is it to -be determined by the relation of hysterical convulsion -to pain, nor solely by the nature of the spasm. The -<span class='pageno' id='Page_42'>42</span>diagnosis is to be based upon a combination of features. -The paroxysms follow hysteric prodromata.<a id='t42'></a> At their -onset there is constriction of the throat and epigastrium; -there are plaintive cries, sobbings, or -laughings, which reappear at the close; <em>sensibility, perception, -and volition are rarely, if ever, completely lost</em>; -the face undergoes little change; there is a twinkling -movement of the eyelids; there is no marked dilatation -of the pupil; <em>there is rarely foaming or bitten -tongue</em>; the attacks are of long duration; respiratory -movements are disorderly, but there are no evidences -of marked asphyxia; the pulse is small; there is no -stupor, but only general exhaustion after the attack; -and although the paroxysms may recur for many years, -and be followed by a peculiar kind of mania, they are -rarely followed by dementia.”</p> - -<p class='c008'>I fully agree with Dr. Reynolds that what are called -the “diagnostic signs of hysteria,” as frequent micturition -of clear pale urine, tympanitis, nausea, &c., -have no value in aiding our inquiry as to the nature of -these fits: they may be witnessed, and with as great -frequency, after epileptic seizures.</p> - -<p class='c008'>One practical point exists; namely, that in hysterical -epilepsy the patient seldom, I believe never, in falling -hurts herself, whereas true epileptics frequently suffer -considerable bodily injuries.</p> - -<div> - <span class='pageno' id='Page_43'>43</span> - <h3 class='c012'><span class='sc'>Case XXII. Nine Years’ Illness—Epileptiform Attacks—Three Years’ Duration—Operation—Cure.</span></h3> -</div> - -<p class='c013'>G. M., single; admitted into the London Surgical Home December -18, 1860.</p> - -<p class='c011'><em>History.</em>—For the last nine years has suffered greatly and regularly -during the menstrual periods. Has been much worse for the -last three years, during which time has, at each menstrual period, -been frequently taken in a fit, dropping down suddenly and fainting -right off; this state lasting for two or three hours. Being in service, -this has caused her much trouble, as none of her employers would -keep her. For the last six months has suffered severe pain over -right ovary, increased by exercise or pressure, and at the menstrual -period. Believing that the dysmenorrhœa and fits both arose from -the same cause, on January 3, clitoris was cut down to the base. -After this operation she never had a fit, and all untoward symptoms -left her except the dysmenorrhœa; she was therefore re-admitted -May 27, 1861, and there being some narrowing of the cervix, it was -incised with the hysterotome. June 21, catamenia came on without -pain, and continued to do so regularly. In July she was well -enough to return to service.</p> - -<p class='c011'>April, 1865. Her mother called at my house to say that this -patient had been married some months, and was shortly expecting -her confinement. She had remained quite well since the operation.</p> - -<h3 class='c012'><span class='sc'>Case XXIII. Epileptoid Fits—Fifteen Years—Illness for Twenty-six Years—Operation—Cure.</span></h3> - -<p class='c013'>F. A. C., æt. 41, single; admitted into the London Surgical -Home Nov. 6, 1863.</p> - -<p class='c011'><em>History.</em>—Says she had congestion of the brain fifteen years ago; -since that period cannot remember being well, but from the age of -<span class='pageno' id='Page_44'>44</span>fifteen has been of delicate health. Has suffered from fits for the -last fourteen or fifteen years; is never long free from them. During -an attack she is not entirely unconscious, but possesses no power to -control them nor to speak. Has pain at lower part of spine of a -gnawing character. She is a miserable, nervous creature, with -pinched features and a wandering restless expression of the eye. -There is evidence of injurious peripheral irritation since a very -early age.</p> - -<p class='c011'>Nov. 12. Operation as usual under chloroform.</p> - -<p class='c011'>Nov. 19. Is wonderfully better. The expression of her face is -much happier, and the face itself has filled out considerably. No -pain in the back since the operation.</p> - -<p class='c011'>Dec. 24. Discharged perfectly cured.</p> - -<h3 class='c012'><span class='sc'>Case XXIV. Hysterical Epilepsy—Long Duration—Operation—Cure.</span></h3> - -<p class='c013'><span class='sc'>G. C., æt. 25; admitted into the London Surgical Home Jan. 28, -1864.</span></p> - -<p class='c011'><em>History.</em>—Has been delicate from childhood. For some months -has suffered from a peculiar dragging pain in the lower part of the -abdomen. Menstruates regularly. Suffers from “burning” and -irritability of bladder. Has constant and severe headache. Has -for a long time suffered from “epileptic fits” (on careful observation -they were found not to be genuine epileptic), occurring twice -or thrice a week. Is a melancholy object, with “woe-begone” expression; -listless and indifferent to conversation and surrounding -objects; when spoken to, does not answer rationally, and frequently -only in monosyllables. Is very reserved and taciturn.</p> - -<p class='c011'>Feb. 4. Patient being under chloroform, the clitoris was excised.</p> - -<p class='c011'>Feb. 13. Progressing favourably; much improved in appearance; -more cheerful; converses freely and rationally; expresses -herself as grateful for her restoration to health.</p> - -<p class='c011'>March 1. Having had no return of the fits, and lost all her -hysterical symptoms, she was discharged cured.</p> - -<div> - <span class='pageno' id='Page_45'>45</span> - <h3 class='c012'><span class='sc'>Case XXV. Hysteria and Epileptiform Attacks—Many Years’ Illness—Operation—Cure.</span></h3> -</div> - -<p class='c013'>R. D., æt. 31; admitted into the London Surgical Home Feb. 17, -1864.</p> - -<p class='c011'><em>History.</em>—Married eight years, with one child. Her husband is -in the navy, and often absent from home. Previous to her marriage -had a severe illness, in which she was delirious, and again in 1860, -when she lost her reason for six weeks. “Was very feverish and -could retain no food on the stomach.” The menstrual periods are -most irregular, six or eight months sometimes elapsing between -each appearance. Has not menstruated since June last. Has great -difficulty in passing her urine. For many years has suffered from -fits of an epileptiform character, having, in an attack, convulsions -and rigidity, but never hurting herself in falling, foaming at the -mouth, nor biting her tongue.</p> - -<p class='c011'>Feb. 18. Clitoris excised.</p> - -<p class='c011'>Feb. 24. Much improved, free from pain or difficulty in micturition. -Is quite cheerful, and has had no attack since the operation.</p> - -<p class='c011'>March 26. Still gaining strength, looks much better, and says -she now feels well.</p> - -<p class='c011'>March 28. Discharged cured.</p> - -<h3 class='c012'><span class='sc'>Case XXVI. Epileptiform Fits and General Hysteria—Four Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>Mrs. F., æt. 44; admitted into the London Surgical Home April -23, 1864.</p> - -<p class='c011'><em>History.</em>—Married sixteen years, but her husband has been -abroad for the past seven years. Had inflammation of the womb -four years ago, and since that time has continually suffered from -bearing-down pains. Frequent desire to micturate. Pain in the -loins and spine, sleepless nights, loss of appetite, and other hysterical -<span class='pageno' id='Page_46'>46</span>symptoms. Has slight “epileptic fits” two or three times a week, -more frequently at catamenial periods, which are regular in appearance -and not profuse. Has no premonition of fits; is but partially -conscious; at first struggles, then becomes rather rigid, and on recovery -is always exhausted. Patient is most anxious to be cured -of her attacks, of the cause of which she is fully conscious.</p> - -<p class='c011'>April 25. Clitoris excised, under chloroform.</p> - -<p class='c011'>April 26. Had a good night, better than for years.</p> - -<p class='c011'>April 30. Progressing most favourably. Patient expresses great -gratitude for the relief she has obtained. She left the Home a -month later, looking and feeling quite well; the last note in the -case-book being “a very grateful patient.”</p> - -<h3 class='c012'><span class='sc'>Case XXVII. Epileptiform Fits—Six Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>F. W., æt. 33, single; admitted into the London Surgical Home -May 23, 1864.</p> - -<p class='c011'><em>History.</em>—Has suffered from fits for more than six years, much -more frequently the last six months; having now as many -as four or five during the day—always one or two. The fits vary in -length from one to three hours’ duration. Is conscious during the -attacks, but unable to speak, or in any way to control them. Is -invariably worse during the menstrual periods. Suffers from palpitation -of the heart.</p> - -<p class='c011'><em>Examination</em> showed a highly inflamed and sensitive condition of -the external generative organs; the patient herself confirmed my -opinion of the cause of her attacks.</p> - -<p class='c011'>May 28. Clitoris excised—free hæmorrhage allowed before the -dressings were applied.</p> - -<p class='c011'>June 12. Left her bed to-day; has had no fit since the operation, -and says she feels well.</p> - -<p class='c011'>June 20. Takes daily exercise, is free from pain, the wound is -healed, and her health daily improving. Action of the heart much -more moderate.</p> - -<p class='c011'><span class='pageno' id='Page_47'>47</span>July 19. Discharged cured, not having had one hysterical attack -since the operation.</p> - -<h3 class='c012'><span class='sc'>Case XXVIII. Hysterical Epilepsy—Three Years and a Half Duration—Operation—Cure.</span></h3> - -<p class='c013'>C. E. S., æt. 24, single; admitted into the London Surgical -Home Oct. 17, 1864.</p> - -<p class='c011'><em>History.</em>—Has been ill for about three years and a half, suffering -frequently from an aggravated form of hysterical attacks, with -many of the characters of epilepsy, but with only partial insensibility, -and without foaming. Is often sick, and suffers from severe -pain on the right side, with a feeling of pressure on the lower -bowel, with a dragging and bearing-down pain around the loins. -Catamenia regular; more subject to the fits at these periods. No -difficulty in micturition, but a rather frequent desire to micturate; -and urine often loaded.</p> - -<p class='c011'>Oct. 20. The clitoris was excised.</p> - -<p class='c011'>This patient improved very rapidly; passed upwards of a month -and a menstrual period in the Home without any return of the fits. -All pain over the ovarian regions, and in the loins, &c., left her, and -she was discharged Nov. 26, perfectly cured.</p> - -<div class='chapter'> - <span class='pageno' id='Page_48'>48</span> - <h2 class='c005'>CHAPTER VI.<br /> <span class='large'>CATALEPSY, WITH CASES.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>This affection is extremely rare, and I consider -myself favoured in Having witnessed three well-marked -cases. “It occurs chiefly,” says Dr. Jones, -“in those who have weakly and excitable nervous -systems, feeble health, and ill-governed minds, and -who may be said to possess neither a ‘<span lang="la" xml:lang="la">mens sana</span>,’ -nor a ‘<span lang="la" xml:lang="la">corpus sanum</span>.’” That this is true there is -not the least doubt, and the first case—one of semi-catalepsy, -or hysterical catalepsy—shows how completely -it is a nervous affection, and depending, at -any rate at the commencement of the disease, very -much on mental control.</p> - -<p class='c008'>There are also, it is true, one or two rare cases on -record which were caused by growths on the brain; -and it is sometimes “encountered in tubercular -meningitis, or chronic softening of the brain.”—<em>Reynolds.</em></p> - -<p class='c008'>That the cause in the three cases in my own -practice was excitation of the pudic nerve, may, I -<span class='pageno' id='Page_49'>49</span>think, most fairly be concluded, from the fact that -after the operation neither patient had a single fit.</p> - -<p class='c008'>To those who have not seen a patient suffering from -this disease, a few words from Dr. Reynolds may be -necessary:—</p> - -<p class='c008'>“The pathognomonic symptom is the persistence -of the limbs in a state of balanced muscular contraction, -so that they retain the position in which they -were placed at the commencement of the attack. The -limbs may be readily moved by the observer, but -they retain the attitudes in which they are left, and -these sometimes for hours, sometimes for days.</p> - -<p class='c008'>“Perception and volition are lost; the condition -resembles that of ‘brown study;’ the circulation and -respiration are uninterrupted.”</p> - -<p class='c008'>Catalepsy seems to rank between tetanus and -epilepsy, and, according to Dr. Jones, depends on the -simultaneous morbid affection of various nerve centres -which, when separately affected, produce but one disorder,—hysteria, -tetanus, or epilepsy.</p> - -<h3 class='c012'><span class='sc'>Case XXIX. Hysterical Catalepsy—Many Years’ Duration—Operation—Relief—Remarks.</span></h3> - -<p class='c013'><span class='sc'>Mrs.</span> ——, æt. 33, widow; admitted into the London Surgical -Home May 5, 1865.</p> - -<p class='c011'><em>History.</em>—Never had any children, and but one miscarriage. -Menstruation began when she was fourteen, and she was then first -attacked with fits. From the patient’s description, they would -seem to have then been of a cataleptic character; there was no -<span class='pageno' id='Page_50'>50</span>loss of consciousness. From the age of 21 up to the present time, -besides slight convulsive attacks in the daytime, she has been -subject to fits at night, occurring irregularly, but averaging one -a week, and always after each menstrual period. They commence -with a strong convulsion, which lasts for a few minutes, and is -succeeded by perfect rigidity of the body and unconsciousness for -half an hour or more. Are preceded by headache during the day. -Catamenia appear regularly, but are scanty. Acknowledges -constant peripheral excitation, and says that, during marriage, she -never had pleasure <i><span lang="la" xml:lang="la">in coitu</span></i>. The dilated pupil, hot skin, moist -palm, and other unmistakable symptoms, plainly pointed to the -cause of her disorder.</p> - -<p class='c011'>May 6. Excision of clitoris and the very elongated nymphæ. -Free hæmorrhage was allowed before the wound was dressed.</p> - -<p class='c011'>The operation was, in this instance, only successful in diminishing -the frequency and intensity of the fits. The following is the -description given by the house-surgeon of an attack some days -after the operation:—</p> - -<p class='c011'>“While conversing with the house-surgeon this morning, she had -a slight convulsive attack, not lasting more than thirty seconds, -and characterized by the following phenomena:—No loss of consciousness, -rigidity of limbs, with tonic contraction of the flexor -muscles, and strong contraction of the <span lang="la" xml:lang="la">orbicularis palpebrarum</span>.”</p> - -<p class='c011'>Whenever visited, and frequently when the wound was dressed, -these fits recurred; but towards the end of the month the number -considerably diminished.</p> - -<p class='c011'>She was discharged on June 15th, very much improved in health, -and decidedly relieved by the operation.</p> - -<h3 class='c012'><span class='sc'>Case XXX. Hysterical Cataleptic Fits of Long Duration—Operation—Cure.</span></h3> - -<p class='c013'>H. L., æt. 25, single; admitted into the London Surgical Home -January 27, 1864.</p> - -<p class='c011'><em>History.</em>—This patient was sent to me by Dr. Pennefather, of -Tottenham, with the following letter:—</p> - -<p class='c011'><span class='pageno' id='Page_51'>51</span>“Dear Sir,—The girl —— was some time since suffering from -religious monomania; she is of hysterical habit and weak constitution, -ever complaining of abdominal pain or uneasiness.”</p> - -<p class='c011'>She also gave the following additional account of herself:—</p> - -<p class='c011'>“Began to feel unwell about twelve months since. Had a very -bad fever about five months ago, which left her perfectly prostrated. -Always felt weak, and more or less subject to fits. Menstruation -regular and never profuse. Great pain in the back and bearing-down -feeling in the lower part of the body. Complains of great -pain in defecation. Sea-bathing has benefitted her temporarily. Is -incessantly crying without cause or power to prevent herself.”</p> - -<p class='c011'>The day following admission she had a fit of a cataleptic nature, -and lasting twenty-five minutes. After the fit the patient was left -very prostrated.</p> - -<p class='c011'>In addition to symptoms of pudic irritation, there was a small -fissure of the rectum.</p> - -<p class='c011'>January 24. Clitoris excised, and fissure divided. There was -considerable secondary hæmorrhage in the excising, which, however, -seemed to have a beneficial effect, as after it the patient expressed -herself as more comfortable, and slept quietly.</p> - -<p class='c011'>Feb. 14. Much more cheerful; has had no cataleptic attack or -symptom of hysteria since the operation.</p> - -<p class='c011'>Feb. 28. Has improved daily, and leaves the Home this day -cured.</p> - -<h3 class='c012'><span class='sc'>Case XXXI. Cataleptic Fits—Two Years’ Illness—Operation—Cure.</span></h3> - -<p class='c013'>M. N., æt. 17; admitted into the London Surgical Home September -4, 1861.</p> - -<p class='c011'><em>History.</em>—Was perfectly well up to the age of fifteen, when -she went to a boarding-school in the West of England. In the -course of three or four months she became subject to all symptoms -of hysteria, and from that time gradually got worse, having fits, at -first mild in character and of rare occurrence, but gradually mere -severe and frequent, till she became a confirmed cataleptic. For -<span class='pageno' id='Page_52'>52</span>several months before admission, she had been attacked with as -many as four or five fits a day, and during the whole journey from -the North of England to London she was unconscious and rigidly -cataleptic. She was seen immediately on arrival, and there was -no doubt that it was a genuine case of this disease. So sensitive -was she, that if any one merely touched her bed, or walked across -the room, she would immediately be thrown into the cataleptic -state.</p> - -<p class='c011'>Before making any personal examination, Mr. Brown ascertained -both from her mother and herself, that she had long indulged in -self-excitation of the clitoris, having first been taught by a schoolfellow. -The commencement of her illness corresponded exactly -with the origin of its cause; in fact, cause and effect were here -so perfectly manifested, that it hardly wanted anything more than -the history to enable one to form a correct diagnosis. All the other -symptoms attending these cases were, however, well marked.</p> - -<p class='c011'>The next day after admission she was operated upon, and from -that date she never had a fit. She remained in the Home for -several weeks. Five weeks after operation, she walked all over -Westminster Abbey, whereas for quite a year and a half before -treatment, she had been incapable of the slightest exertion.</p> - -<h3 class='c012'><span class='sc'>Case XXXII. Cataleptic Fits—Many Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>In 1861 I saw a lady, æt. 50, single—a patient of Dr. Dawson, -of Newcastle-on-Tyne.</p> - -<p class='c011'>She had been suffering from cataleptic attacks for several years, -gradually increasing in severity. As in the previous case, the mere -touching or shaking of her bed would induce an attack—indeed, -the simple brushing of her dress by any one passing her when -she walked out of doors, would immediately be followed by a fit. -History and examination plainly confirming me in my opinion as -to the cause of her attacks, the usual treatment was adopted, -and from that time to this she has never had an attack.</p> - -<div> - <span class='pageno' id='Page_53'>53</span> - <h3 class='c012'><span class='sc'>Case XXXIII. Cataleptic Fits—Six Years’ Duration—Operation—Cure.</span></h3> -</div> - -<p class='c013'><span class='sc'>Miss</span> ——, æt. 38, single; admitted into the London Surgical -Home August 10, 1865.</p> - -<p class='c011'><em>History.</em>—Was tolerably well until two years and a half ago, -but since that time has suffered more or less from menorrhagia, -with severe pain in back. Has also severe smarting pain in the -bowels, and has frequently lost a considerable quantity of blood -<i><span lang="la" xml:lang="la">per anum</span></i>. Has always been subject to hysterical attacks, but -for the last six years has had fits of a much more serious character. -They have increased in severity, duration, and frequency, -and it is on account of them that she seeks relief. Almost immediately -after admission, this patient had a fit, and she was kept a -fortnight under observation, that the nature of the attacks might -be thoroughly investigated.</p> - -<p class='c011'>She would have a fit sometimes twice a day; but on an average -about every other day—either early in the morning or late in the -evening. She was most generally attacked when walking about -the room—sometimes when sitting—but she was never observed -to have one when asleep. She would at the commencement of an -attack cease walking, or doing whatever she was employed in; her -face would become very pale and set; the eyelids, at first quivering, -would be fixed; the eyes wide open and looking upwards, the -pupils very dilated. Her mouth would be rigidly shut, and during -the attack it was impossible by any means to open it. Her arms -would fall straight by her side, and be immovable; the hands -unclenched, and fingers extended. If standing, she would be quite -upright, and require no support. If sitting, she would always -stand up when a fit was coming on. If lying, she would be extended -straight on her back. The fit would last for two or three -hours, and on a few occasions for as many as six hours. The experiment -was frequently made of moving her arms when in the cataleptic -state, and on such occasions the limb would remain in the position -<span class='pageno' id='Page_54'>54</span>in which it was placed, till the end of the attack. She was always -perfectly unconscious, and no kind of stimulant was of the slightest -use in restoring her during the paroxysm—time alone was of avail. -The attack was sudden, but the recovery to consciousness was but -gradual; she would appear as if awoke from a deep sleep, and -would be very exhausted, but express no desire for food, wine, or -other stimulants. As soon as she recovered, she would sleep for -many hours, and awake quite well, but still weak.</p> - -<p class='c011'>Aug. 24. The clitoris was excised, and a painful fissure of -the rectum divided. She never had a fit after the operation. -Menstruation came on on the 28th, in moderate flow.</p> - -<p class='c011'>Oct. 5. This patient has improved wonderfully since operation, -and now looks extremely well. The wound is quite healed. She -takes walks daily, and has had no fits, and is to be discharged -as cured.</p> - -<p class='c011'>In November she called at the Home, to say that she was quite -well, and had never had the slightest return of her former illness; -she menstruates regularly and normally.</p> - -<p class='c011'>Feb., 1866. She remains well.</p> - -<div class='chapter'> - <span class='pageno' id='Page_55'>55</span> - <h2 class='c005'>CHAPTER VII.<br /> <span class='large'>EPILEPSY, WITH CASES.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>Referring my readers for full information on the -pathology and history of epilepsy to Dr. Russell -Reynolds’s exhaustive treatise on the subject already -referred to, I would mention, as shortly as possible, a -few facts which are necessary to be borne in mind, with -especial reference to the class of cases which I am now -considering.</p> - -<p class='c008'>Dr. J. C. Prichard, in writing of diseases of the -nervous system, has well said that “few diseases are -better characterized by them symptoms than epilepsy; -yet in this instance there is such a variety in the phenomena -as renders it difficult to contrive a definition in -a few words which may comprehend every form of the -complaint.”</p> - -<p class='c008'>I have said that when convulsions become chronic -they are considered to take on an epileptiform character. -Now, although we know that in a few cases -involuntary spasm may take place in sleep, <em>i.e.</em> with -loss of consciousness, I think we may, for all general -purposes, take as a definition of epilepsy a chronic -<span class='pageno' id='Page_56'>56</span>convulsive disease, each convulsive attack being -accompanied with “sudden and complete loss of -consciousness,” this latter symptom being considered -by the late Dr. Todd<a id='r5' /><a href='#f5' class='c010'><sup>[5]</sup></a> as “the pathognomonic symptom -of the disease,” but only, as Dr. Reynolds<a id='r6' /><a href='#f6' class='c010'><sup>[6]</sup></a> has -shown, “when it occurs as a paroxysmal or occasional -event.”</p> - -<div class='footnote' id='f5'> -<p class='c008'><a href='#r5'>5</a>. <cite>Medical Times and Gazette</cite>, August 5, 1854, p. 129.</p> -</div> - -<div class='footnote' id='f6'> -<p class='c008'><a href='#r6'>6</a>. <em>Op. cit.</em>, p. 31.</p> -</div> - -<p class='c008'>The causes of epilepsy are various—“partly physical, -partly immaterial.” Of the former are injuries and -tumours of the brain or meninges, intestinal worms, -renal and biliary calculi, &c. &c. These are termed -by Dr. Handfield Jones<a id='r7' /><a href='#f7' class='c010'><sup>[7]</sup></a> “eccentric causes.” As -“centric causes,” he names “poisoning of the blood -from retention of excrementitious matter; this, by -deranging the nutrition of the nervous tissue, generates -the abnormal excitability, which then manifests -itself without any special irritant. Various causes of -exhaustion, such as hæmorrhage and excessive discharges, -venereal excesses, prolonged want of sleep, -unremitting pain,” &c., are all “centric” causes of -epilepsy.</p> - -<div class='footnote' id='f7'> -<p class='c008'><a href='#r7'>7</a>. <em>Op. cit.</em>, p. 209.</p> -</div> - -<p class='c008'>Dr. Reynolds is right in considering epilepsy an -idiopathic disease, inasmuch as it occurs, without discoverable -organic lesion with which it can be associated, -and because there is no structural lesion of the brain, or -spinal cord, to be found constantly associated with it; -<span class='pageno' id='Page_57'>57</span>but when he says that it is idiopathic because, “in many -cases, eccentric irritation cannot be shown to be the -cause of the attacks,” I cannot go with him. Epilepsy is -a name signifying a disease, which may be idiopathic, or -may arise from a variety of causes; but that eccentric -irritation is a powerful and very frequent cause, there -is not the slightest doubt. Dr. Reynolds classes it as -second of six in a table given in his book, physical -conditions being mentioned as first; and finding, in a -hundred cases, that 24·63 have no assignable cause, -and 18·84 are doubtful, he gives 13·04 as due to -eccentric irritation.</p> - -<p class='c008'>In considering peripheral irritation of the pudic -nerve as a cause of this disease, we must, I think, consider -mental emotion, which occupies the highest rank -in causes of epilepsy, in conjunction with that second -in the list,—eccentric irritation. I would, therefore, -classify the cause of epilepsy depending on such irritation -as both eccentric and centric. The former, -inasmuch as it produces exhaustion, and, by deranging -the nutrition of the nervous tissue, generates abnormal -excitability; the latter, for that it is a physical excitant -which is not only “a mere provocative of the -paroxysms, the convulsions being supposed to ensue -as the reflex results of irritation, but that it actually -<em>sets up</em> in the nervous centres that state of excitability -which is the essence of the disorder.” Further still, -looking on epilepsy as a direct sequel of hysteria, -when it is produced by excitation of the pudic nerve, -<span class='pageno' id='Page_58'>58</span>the patients are, in an eminent degree, predisposed to -the disease.</p> - -<p class='c008'>Women are also more naturally prone to epilepsy -from mental emotion than men; “Emotional disturbance -being assigned,” says Dr. Reynolds, “as the -cause of their attacks in so many as 36 per cent., -whereas in the male sex there were only 13 per cent. -who referred their diseases to that cause.”</p> - -<p class='c008'>It would be out of place in a work of this nature to -detail at length the symptoms of these attacks. -Whether they are truly epileptic will be seen as the -cases are related. I have been very careful to separate -those which seemed to be of an hysterical or epileptoid -nature; and have had the advantage of being able to -show the greater number of them to many eminent -members of the medical profession, who have witnessed -my practice in the London Surgical Home.</p> - -<h3 class='c012'><span class='sc'>Case XXXIV. Epileptic Fits—Twelve Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>S. F., æt. 41, single; admitted into the London Surgical Home -Dec. 16, 1861.</p> - -<p class='c011'><em>History.</em>—Was always ailing, and hysterical for many years. -Catamenia appeared early, and always rather profuse. For the last -twelve years has suffered from epileptic fits; recurring frequently -every week or fortnight, and lately as often as every day. Has -constant headaches; is losing memory and all power of concentrating -her ideas. Has no premonition of seizure; falls down; is -unconscious; has frequently bitten her tongue; and “froths” at -<span class='pageno' id='Page_59'>59</span>the mouth. Says she has had several attacks of hæmatemesis. She -was a dressmaker, and had so frequently, on her way to or from -business, fallen in the streets, that she had been carried into almost -every hospital in London, and a large number of open surgeries.</p> - -<p class='c011'><em>On examination</em> there was found every indication of irritation -about the vulva, and also a small polypus of the <span lang="la" xml:lang="la">os uteri</span>, which -latter was large and patulous.</p> - -<p class='c011'>Dec. 19. Usual operation of excision; polypus uteri also removed.</p> - -<p class='c011'>The recovery of this patient was rapid and uninterrupted. After -the operation, she never had a fit, and hardly a headache. She was -discharged Jan. 20, 1862, perfectly well, and with greatly increased -mental power. When heard of at commencement of 1864, she -remained well, and had had no recurrence of any of her old -symptoms.</p> - -<h3 class='c012'><span class='sc'>Case XXXV. Epileptic Fits—Five Years’ Duration—Preceded by Cataleptic Fits, during the Ten previous Years—Operation—Cure.</span></h3> - -<p class='c013'>In the beginning of April, 1862, a single lady, æt. 28, came -under my notice, giving the following account of herself.—When -about ten years old had a fit, whilst she was sitting at needlework; -she fell down suddenly as if dead, and remained insensible for two -hours; was very ill for three weeks after the attack. Was quite -well until the age of fourteen, when she began to have them -every three months. When about twenty-two had an interval of -eleven months without a fit, but frequently fainted during that -period. During the time she was in the fits she would be perfectly -unconscious. She was told that her limbs were quite rigid, and -always remained in the exact position in which they were when the -fit commenced. In 1857 the fits changed in their nature—the patient -at first falling down quietly, but subsequently becoming very convulsed, -and trying to hurt herself. The first of this nature lasted two -hours and three-quarters. Has lately had them much oftener, but -not always of the severe form. Has had eight severe fits in the -<span class='pageno' id='Page_60'>60</span>last two years and a half, besides the milder, which come -sometimes a dozen in a fortnight. Is unconscious, but always -knows when she has had one. Foams at the mouth, but makes no -noise. Has frequently fallen down suddenly in church and other -public places. Has been under many physicians, all of whom have -been of opinion that she is suffering from genuine epilepsy.</p> - -<p class='c011'>April 2. Clitoris excised.</p> - -<p class='c011'>April 6. Has had no attack, but complains of occasional pain in -the top of her head.</p> - -<p class='c011'>She never had an attack after the operation. Returned home in a -month, and shortly afterwards she was thrown out of a pony chaise; -she had no fit, but wrote that, prior to treatment, a very much -slighter accident would have immediately produced one.</p> - -<p class='c011'>I heard of this lady later in the year; she was still quite well. -Not having heard since from her, as was agreed when she left me, -I am satisfied that she has had no relapse.</p> - -<h3 class='c012'><span class='sc'>Case XXXVI. Epileptic Fits—Many Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>N. L. M., æt. 21; admitted into the London Surgical Home -May 9, 1863.</p> - -<p class='c011'><em>History.</em>—Married four years and had two children; the labours -have been bad, and followed by severe hæmorrhage. Had aborted -at six weeks, a fortnight previous to admission, and had lost a large -quantity of blood. First suffered from epileptic fits at puberty; -had several before marriage, and has had four or five since marriage; -but has never had a fit when pregnant. Not very regular in menstruation, -which is accompanied with severe pain. Has constant -pain on right side of head, in back, loins, &c. Great pain in micturating -and on defecation. She is always totally unconscious during -the fits, and they are followed by extreme prostration. Is of melancholy -aspect, excessively anæmic, and somewhat chlorotic; even -the mucous membranes (of mouth especially) are blanched. The -<span class='pageno' id='Page_61'>61</span>cause of her fits being diagnosed, the usual <em>operation</em> was performed -May 14.</p> - -<p class='c011'>May 18. Progressing excellently.</p> - -<p class='c011'>May 20. There was great irritability of the bladder, which, -however, was immediately relieved by an alkaline and henbane -mixture.</p> - -<p class='c011'>May 31. Has not had any return of her bad symptoms until -to-day, when, on being removed to a strange ward, she had a fit, -not of violent character, and followed by a heavy drowsiness.</p> - -<p class='c011'>June 2. Is quite herself again.</p> - -<p class='c011'>July 4. Has left quite well in every respect, and when heard -of many months later remained well.</p> - -<p class='c011'><em>Remarks.</em>—The fit following on change of this patient from one -ward to another where there were strangers, shows how important -it is for a permanent cure, that visitors and relatives should not be -allowed to excite and agitate a patient suffering from these attacks -after an operation is performed, and when the mind is hardly -restored to its natural balance.</p> - -<h3 class='c012'><span class='sc'>Case XXXVII. Epileptic Fits—Two Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>H. C., æt. 20, single; admitted into the London Surgical Home -Feb. 24, 1864.</p> - -<p class='c011'><em>History.</em>—About three years since, first commenced ailing. -Menstruation ceased for four months, when it appeared for two -days. Fifteen months then elapsed before the function was restored. -Epileptic fits have been developed for about two years. The patient -at the commencement of an attack is strongly convulsed, has no -premonition, and is perfectly unconscious. Frequently falls when -walking in the streets. Has often hurt herself in her falls, and also -bitten her tongue. Has the usual symptoms of bearing-down of -the womb, and pain in the loins. No pain in defecation. Bowels -costive. Pain in micturition, and sometimes retention of urine, -occasionally not passing any for two days.</p> - -<p class='c011'><span class='pageno' id='Page_62'>62</span>March 3. Clitoris excised in the usual manner under chloroform. -Was restless and hysterical for the first six days, when she -improved daily, became cheerful, and much more intelligent. She -never had another fit, and on April 13, being quite cured, was, at her -own request, retained in the Home as a servant. She remained -there under observation for six months, during which time she had -not only no return of her former attacks, but progressively improved -in health, and her menstruation became quite regular.</p> - -<p class='c011'>Since that time she has been living as cook in a family which -I frequently visit, and it is therefore certain that she remains -perfectly well.</p> - -<h3 class='c012'><span class='sc'>Case XXXVIII. Severe and Frequent Epileptic Fits for Three Years and a Half—Operation—Cure.</span></h3> - -<p class='c013'>C. T., æt. 21; admitted into the London Surgical Home June -23, 1864.</p> - -<p class='c011'><em>History.</em>—Health always good till three years ago, when, after a -severe fright, she became very excited and had a fit. Since that -time has been continually subject to them. She never passes a day -without two or three, and frequently has as many as six, or even -eight, in the twenty-four hours. Is most subject to them at night -when sleeping. Is always suffering from headache. Her mental -powers are somewhat impaired, as she has very slight recollection -of persons, or of events, from day to day. Catamenia very irregular. -Has not menstruated since March last. Bowels costive; pulse -regular and firm. Is of a sallow complexion, with vacant and weak -expression of countenance. Acknowledges great and constant irritation -of pudic nerve.</p> - -<p class='c011'>During the day previous to operation, special notice was taken -of the nature of the fits. They are epileptic; for although she does -not foam at the mouth, she has, on more than one occasion, <em>bitten -her tongue</em>, and is <em>perfectly unconscious</em>. There is no rigidity, but -a constant struggling, and, unless restrained, the hands always, -during an attack, are carried to the seat of irritation.</p> - -<p class='c011'><span class='pageno' id='Page_63'>63</span>June 23. The usual operation of excision was performed under -chloroform. As soon as she recovered, she managed to remove the -dressings. Hæmorrhage for two hours was the result. When -arrested, two grains of opium were administered, which produced -sleep. On awaking, she again endeavoured to remove the dressings; -but, her hands being confined, she was unable to do so. She had -no more fits, and but a few hysterical attacks. On July 17th she -was discharged, as her parents were anxious for her return. She -had not then had a fit of any kind for sixteen days.</p> - -<p class='c011'>August 15. I received the following letter from her father:—</p> - -<p class='c014'>“Dear Sir,—It would be very unkind in me, and much out of -place, to hide from you and the world at large what have been my -feelings during the past three weeks. My daughter, C. T., came to -your Home, Stanley Terrace, Notting Hill, on the 23rd of June -last, to be treated by you for epilepsy, or epileptic fits, having been -afflicted for three years and a half. The class of fit you may better -judge of than myself; sufficient to say, they were very bad -and very frequent. I am happy to say, and acquaint you, that -since her return she has not had a single symptom of fit or hysteria -of any kind. Her general health is also very good, and fast improving, -and I do hope, by the blessing of God, she may continue -so. If you have any desire to see her, I shall feel in duty bound -to let her wait upon you, with her mother, at any time you may -think fit to appoint, as your opinion just at this time might have a -still more happy effect for the future. You are quite at liberty to -use this for the benefit of the Institution in whatever way you may -like or seem good.”</p> - -<p class='c014'>A twelvemonth later, this patient was still free from any return -of the fits.</p> - -<div> - <span class='pageno' id='Page_64'>64</span> - <h3 class='c012'><span class='sc'>Case XXXIX. Epilepsy, with Dementia—One Year’s Duration—Operation—Cure.</span></h3> -</div> - -<p class='c013'>A. H., æt. 17; admitted into the London Surgical Home June -28, 1864.</p> - -<p class='c011'><em>History.</em>—Catamenia first appeared three years ago. They have -continued regular to the present time. About twelve months since -was observed, whenever sent on an errand from home, that she -would wander about in an absent manner, and return home having -forgotten all about any message which had been given her. About -this time fits were first developed; they increased in frequency -and intensity, and she now has them daily, and one or more of less -violent character nearly every night in her sleep. When seized, -she falls, struggles violently, foams at the mouth, often bites her -tongue, and is totally unconscious to all around her. After a fit, -she sinks into a deep sleep, which lasts for two hours. Has no -recollection on awaking of what has taken place. Acknowledges -to frequent injurious habits, but is unconscious of their being the -cause of her illness. Is vague in all her ideas and conversation, -and has almost entirely lost her memory.</p> - -<p class='c011'>Both history and personal examination plainly showed what was -the cause of her attacks.</p> - -<p class='c011'>On July 7 the clitoris was completely excised. She had no -return of the fits; and on the 23rd the following report appears in -the case-book:—“Left her bed to-day. Is greatly changed; quite -rational in all her movements; converses freely and quietly, remembers -passing events from day to day, and it is indeed almost -impossible to recognize in her the half-idiotic, almost demented -girl who entered the Home less than a month ago.”</p> - -<p class='c011'>She remained in the Home some time longer for observation. -Fits never returned; her mind improved daily, and she was discharged -as perfectly cured.</p> - -<div> - <span class='pageno' id='Page_65'>65</span> - <h3 class='c012'><span class='sc'>Case XL. Epileptic Fits—Two Years and a Half Duration—Operation—Relief.</span></h3> -</div> - -<p class='c013'>S. Z., æt. 16, single; admitted into the London Surgical Home -October 20, 1865.</p> - -<p class='c011'><em>History.</em>—Was strong and well until two and a half years ago, -when she had an epileptic fit in the middle of the night. Can -assign no cause for the attack. For a long time had a fit once a -month, but latterly once a week. The catamenia appeared six -months before the first fit, and have always been regular. There -is no exacerbation at menstrual epoch. Complains of great irritation -of pudendals for three years.</p> - -<p class='c011'>Nov. 2. Since admission this patient has been watched: she -has had two fits, both of a genuine epileptic character.</p> - -<p class='c011'>Mr. Brown this day performed his usual operation. She went -on well till the 10th, when she had a slight fit; there being irresistible -irritation, the hands were restrained. A lotion of bromide -of ammonium was ordered to be applied to the wound, and 20 -grains of the bromide to be given in water three times daily.</p> - -<p class='c011'>She convalesced well, and had no more attacks till the 29th, when, -her hands having been released only a few minutes previously, she -had a fit, and the nurse found one hand on the wound. She was -conscious during the attack, which was not so violent as before -treatment.</p> - -<p class='c011'>Dec. 2. Discharged relieved. If this patient could be under -control for a few months, she would probably be cured.</p> - -<h3 class='c012'><span class='sc'>Case XLI. Epileptic Fits, with Dementia—Thirty Years’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>M. F., æt. 44, single; admitted into the London Surgical Home -December 8, 1865.</p> - -<p class='c011'><em>History.</em>—Epileptic fits first attacked her when she was about -<span class='pageno' id='Page_66'>66</span>14, at which age she menstruated. For the first few years there -was a long interval between each, but they gradually became more -frequent and violent. Latterly she has had several during the -week of each menstrual period, and as a rule none in the interval. -Catamenia have been tolerably regular in appearance, but rather -profuse. Is tall, pale, and thin; has a dull and somewhat vacant -expression; is very eccentric in her manners and conversation; is -frequently observed, both day and night, by the nurses to practise -injurious habits, to which she acknowledges for the last thirty -years. The fits are genuine epileptic.</p> - -<p class='c011'><em>On examination</em>, there is evidence of very long-continued peripheral -irritation, and also a fissure of rectum.</p> - -<p class='c011'>Dec. 12. The usual operation on clitoris and rectum.</p> - -<p class='c011'>Dec. 13. In the absence of nurse, removed the dressing, and -immediately had a fit. To have opium 1 grain, with ¼ grain of -extract of belladonna, every six hours.</p> - -<p class='c011'>Under this treatment the patient improved daily, became cheerful, -rational, tractable, and much more sensible in her conversation.</p> - -<p class='c011'>She passed two menstrual epochs, but without a fit, and she was -discharged perfectly cured.</p> - -<p class='c008'>I have a much larger number of cases occurring -in private practice, but, for that reason, am obliged -to omit them. I shall, however, when a longer time -has elapsed, publish them.</p> - -<div class='chapter'> - <span class='pageno' id='Page_67'>67</span> - <h2 class='c005'>CHAPTER VIII.<br /> <span class='large'>IDIOTCY AND INSANITY, WITH CASES.</span></h2> -</div> - -<p class='drop-capa0_0_6 c009'>As epilepsy is a much graver disease than -hysteria, so is the sequel of the former—dementia -or idiotcy—much more permanent and difficult -to be removed by treatment than insanity, which -is the ordinary sequel of hysteria.</p> - -<p class='c008'>I shall give but one case of idiotcy, because I -regret to say that I have never yet been able to -thoroughly restore the mental powers in any patients -suffering from this dreadful affliction. Epilepsy is -such a chronic disease, and seems to me to produce -not only weakening of the mind, but to cause it to be -often entirely lost, that, although we may get, as in -the following case, a temporary re-kindling of the -mental energies, I fear we are not yet able to give -much hope of complete recovery. Even here, however, -I have such faith in the efficacy of perseverance -in constant watching, that I am almost inclined to -believe that, had this patient been in a condition of -life to ensure vigilant medical supervision for a -lengthened period after operation, we might at last -<span class='pageno' id='Page_68'>68</span>have succeeded in, if not complete, at least, much -creator restoration than in a public institution, or to -those in humble circumstances, the surgeon is in a -condition to promise.</p> - -<h3 class='c012'><span class='sc'>Case XLII. Epileptic Fits, with Complete Idiotcy—Operation—Great Temporary Relief, but not Permanent Benefit.</span></h3> - -<p class='c013'>Mary J., æt. 19, single; admitted into the London Surgical -Home Feb. 15, 1864.</p> - -<p class='c011'>This patient was brought to me by Dr. Marley, with the following -account:—</p> - -<p class='c011'>“Has the appearance of a child of 10 or 12 years old; mammæ -not developed; has had epileptic fits ever since 12 years of age. -Is now almost idiotic; stares vacantly; slobbers at the mouth; -passes her motions anywhere, without regard to common decency, -and cannot retain her urine. I find from her mother that she -is incessantly irritating her genitals. Her fits vary in frequency, -from two or three a day to four or five a week. Being satisfied of -the cause of her fits, I sent her to you.”</p> - -<p class='c011'><em>History</em>, taken at the Home from her mother.—Had perfect -health until she reached her eleventh year; was forward in her -lessons, and well educated for her age and position. At this time -she was suddenly seized with a severe fit, for which no cause could -be assigned. A period of two years elapsed before she had a -second, when, being placed under medical treatment for eighteen -months, she had great relief. Since the expiration of that time to -the present she has constantly suffered from fits.</p> - -<p class='c011'>Her intellect did not begin to weaken until two years since, but -she ceased growing and learning after the first attack. At this -time she does not know her right hand from her left; does not -know her mother, and shows no signs whatever of ordinary intelligence. -From being cleanly as a child, is now most filthy—in fact, -is in every sense an idiot.</p> - -<p class='c011'><span class='pageno' id='Page_69'>69</span>Has never menstruated.</p> - -<p class='c011'><em>On examination</em>—although, as stated by Dr. Marley, the mammæ -were very rudimentary—there was full development, and indeed -abnormal hypertrophy, of the external genitals.</p> - -<p class='c011'>Feb. 18. The usual operation performed, under chloroform. The -hands to be restrained, and the patient most carefully watched.</p> - -<p class='c011'>Feb. 19. Has passed a good night, and is quiet.</p> - -<p class='c011'>Feb. 23. Has been very drowsy since the operation. To-day -asked for food for the first time, and showed some signs of intelligence.</p> - -<p class='c011'>Feb. 26. Gave rational answers to several questions which were -asked her. Also remembers from day to day any promises of -delicacies of diet or money.</p> - -<p class='c011'>March 1. Passed a good night; feels free from pain. Was -given some printed cards, which she read—<em>the first time for nine -years</em>.</p> - -<p class='c011'>March 2. Improving much. Is much more modest in her behaviour, -but still passes her excretions without regard to time or -place. Notices passing events, and remembers names and faces.</p> - -<p class='c011'>March 3. Has given sensible and somewhat witty replies to -various questions asked her in the presence of about twenty medical -gentlemen, who to-day came to see the operation. When moneys -were given her, she at once told their different relative value.</p> - -<p class='c011'>March 4. Morning: Seems no worse for the excitement of -yesterday.—Evening: Had a slight fit.</p> - -<p class='c011'>March 5. A little heavy and stupid to-day. Somewhat irritable -and obstinate.</p> - -<p class='c011'>March 6. Much better. Has a daily clearer notion of right -and wrong. Likes books with pictures and large print. When -she comes to hard words, she asks the meaning, like a child, but -cannot always grasp the meaning of an explanation.</p> - -<p class='c011'>March 8. Not quite so well to-day. Had a slight epileptic fit -this evening, followed by a very severe one in two hours.</p> - -<p class='c011'>March 9. Again much better, but irritable.</p> - -<p class='c011'>March 12. Two fits.</p> - -<p class='c011'>March 16. Not so well: another fit to-day.</p> - -<p class='c011'><span class='pageno' id='Page_70'>70</span>She from this time seemed to retrograde; and on the 4th of -April was discharged as incurable.</p> - -<p class='c008'>It will be recollected how, at the end of the chapter -on Hysteria, I gave three cases of extreme nervous -irritability, with sleeplessness, and tendency to an -unhinging of the mental equilibrium. We now come -to insanity itself. It would be vain to talk of the -varieties of forms in which this state may be seen, -when produced by abnormal peripheral irritation of -the pudic nerve. It is, however, worthy of notice -how each history seems to tell its own explanation of -the cause; and after the first few days of treatment, -when excitement, caused by irritation from the wound -and a natural repugnance to restraint, has passed off, -how rapid is the improvement, and how permanent is -the result. I have no hesitation in saying that in no -case am I so certain of a permanent cure as in acute -nympho-mania; for I have never after my treatment -seen a recurrence of the disease, whereas, under -medical treatment, of how short duration is but too -frequently the benefit.</p> - -<h3 class='c012'><span class='sc'>Case XLIII. Incipient Suicidal Mania—Many Years’ Gradual Illness—Operation—Cure.</span></h3> - -<p class='c013'>R. T., æt. 39, single; admitted into the London Surgical Home -Oct. 22, 1861.</p> - -<p class='c011'><em>History.</em>—Has been ailing for many years, and given great -trouble and anxiety to her friends. For some time past she has -<span class='pageno' id='Page_71'>71</span>been very strange in her manner, very restless, never quiet, constantly -wakeful, threatening suicide, talking to people, even perfect -strangers, of her ailments and their causes, of which she is fully -conscious. Was formerly modest and quiet.</p> - -<p class='c011'><em>On examination</em>, she is a fine woman, of restless appearance and -manner; eye wandering and unsteady; pupil dilated. The cause -of her mental derangement being obvious, on</p> - -<p class='c011'>Oct. 24 the usual operation was performed.</p> - -<p class='c011'>The improvement in her mental and bodily health was wonderful: -she gained flesh, and became cheerful and modest. She was discharged -six weeks after admission.</p> - -<p class='c011'>When heard of in February, 1863, this patient continued quite -well.</p> - -<p class='c008'>The first case of actual insanity that came under -my care was a patient of Dr. Warren Diamond, then -resident in his private asylum. I cannot do better -than transcribe the account which he sent me with -the following note:—</p> - -<div class='lg-container-r c015'> - <div class='linegroup'> - <div class='group'> - <div class='line'>“Effra Hall, Brixton, S.</div> - </div> - </div> -</div> - -<p class='c011'>“<span class='sc'>Dear Sir</span>,—A month having elapsed since you gave up your -patient, I forward some particulars of the case, and shall be glad to -answer more fully any special time or state you would like to know -more about. You will, perhaps, be able to pick something out of -this rambling account that may be interesting to you. Hoping you -will excuse omissions, &c.</p> - -<div class='lg-container-r c015'> - <div class='linegroup'> - <div class='group'> - <div class='line'>“Believe me, yours faithfully,</div> - </div> - <div class='group'> - <div class='line in8'>“<span class='sc'>Warren H. Diamond</span>.”</div> - </div> - </div> -</div> - -<div class='lg-container-l c015'> - <div class='linegroup'> - <div class='group'> - <div class='line'>“I. Baker Brown, Esq.”</div> - </div> - </div> -</div> - -<div> - <span class='pageno' id='Page_72'>72</span> - <h3 class='c012'><span class='sc'>Case XLIV. Several Years’ Illness—Two Months’ Insanity—Operation—Cure.</span></h3> -</div> - -<p class='c013'>“Miss E. R., æt. 34, single; no occupation, living with her friends; -hair light reddish-brown; face set and vacant, with an occasional -pained expression; eyes fixed and dull; extremities damp and cold; -stature moderate and well formed. Has for several years past been -looked on by her friends as different from others—strange and -eccentric. Would go out and walk away into the country alone -for miles, and come back exhausted. When friends called, would -start up and run round the garden, or to the top of the house and -back again, giving no reason for it but that she must do it. Always -exceedingly irritable and passionate. Unless some excitement was -going on, was listless and unable to rouse herself. When at parties, -was so forward and open in her manners, that she was generally -avoided by gentlemen. <em>Never had an offer of marriage.</em> Her -mother died about a year and a half ago, but she took no notice of -the occurrence, and was consequently remarked on by her friends. -Since then she has been getting more strange and peculiar. About -February last, a sister told her, in joke, that if she did not take -care she would soon become a fit subject for Dr. Diamond, little -thinking how soon it would happen. She recently made enemies -of old friends, so that her brothers could not make out why they -fell off. Would sit or stand without noticing them when they -called; and asked them what they wanted that they came to her -house (she was the eldest of the family).</p> - -<p class='c011'>“I was consulted about her in the end of March, but had then -none of her previous history. She was vacant and dreamy; talked -of flowers which she called her friends; said ‘people’s faces were -masks; that she was quite unable to rouse or employ herself, as -she was changed;’ very uncertain in appetite, going a day without -her food; not sleeping at night, and for the last few nights showing -such great excitement and passion, that her sisters were required -to sit up with her.</p> - -<p class='c011'><span class='pageno' id='Page_73'>73</span>“I recommended change along the south coast, with sea-bathing, -&c. She did not improve; and the attendant informing me of a -constant irritation of the vulva, lotions were used, but without -benefit. Her general health and appetite improved; but not the -mind. She could not sleep, and would not bear narcotics; <em>stimulants -acted as narcotics</em>, but soon lost their effect.</p> - -<p class='c011'>“Bowels regular; pulse small and slow; action of heart being -irritable, and not corresponding at all times to the power or quantity -of the pulse. She sits up in bed, nursing the pillow, and -talking to it as if it were a baby; says ‘that she died last Sunday’—‘is -lost’—‘is buried.’</p> - -<p class='c011'>“When out of doors, great difficulty is experienced in getting her -in again; she wishes to wander away, without aim or purpose. -Having given my opinion to her friends, I was authorized to admit -her April 18, 1861. Before she left home, she continued calling -out, ‘Take me to a mad-house! take me quick, or I shall never get -well!’ She persisted in saying ‘she was dead,’ and ‘she felt -buried.’ Answers in monosyllables. Her pupil is contracted and -fixed. At night she does not sleep, and is in such a continual state -of excitement that the attendant cannot sleep with her. Has lost -all natural modesty in manner and speech. Is not blasphemous. -Before me is perfectly reserved and correct in her manner. When -I ask questions, she will, after a pause, answer in monosyllables, or -repeat the question over and over again, as if trying to grasp the -meaning and ally her thoughts. Unless walked about, will stand -for hours in one place, gaping, yawning, and throwing her arms -about listlessly. She was in this state when you saw her, and from -what you told me of your experience of the operation and its -results, I was led to infer relief from it in this case, as the delusion -of having died on a certain day was movable and could be -reasoned away; but the heavy oppressed feeling still made her say, -‘But if I am not dead, I am lost, or changed,’ and naturally led -back to the idea. I ascribed the state of her mind to weakening of -the body, and general nervous irritation caused by long-continued -reflex excitation; and I believed that if the source of irritation could -be removed, her mental health would follow as her blood became -healthy, and fit to make reparation.</p> - -<p class='c011'><span class='pageno' id='Page_74'>74</span>“I was led to think more of her uterine state from her expression -of pain when she was walked about, and she was reported by the -nurse as always complaining of her back, at the lower part, and of -great tenderness on pressure over the ovaries.</p> - -<p class='c011'>“May 27, 1861. You operated on her, she being under the influence -of chloroform. She was naturally restless afterwards, not -understanding why she was kept in bed. Profuse menstruation -came on in the evening, which had not happened for four months -previously, and then always very scanty and with much pain. Half -an ounce of laudanum, with oil, was rubbed into her chest during -four hours; she did not, however, sleep, but continued moaning all -night.</p> - -<p class='c011'>“May 28. Easier, and more herself—takes her food.</p> - -<p class='c011'>“May 29. Slept well last night, without opiates; says she shall -now get well and be able to go home; answers questions more -readily, and makes longer replies. <em>Pupil dilated and acts slowly.</em> -Her nurse says she is quite altered in every way, and compares the -change in her mind since the operation to ‘dividing the tightened -strings of a fiddle, and letting them all loose.’</p> - -<p class='c011'>“June 2. Left her bed; is still menstruating; appears cheerful; -asks questions now, and converses for short periods; has done a -few stitches of needlework; says nothing about ‘being lost or -dead’ since the operation. Surface of body and extremities warm. -Freaky, anxious look about her eyes and nose gone. Laughs and -jokes. Says ‘she has been in a dream,’ ‘that things now seem -light,’ and ‘that she means to get well.’</p> - -<p class='c011'>“July 3. She has gradually improved and become more natural -in her habits and ideas; sleeps soundly every night; takes her -meals well; walks about without compulsion; takes a pride in -making herself neat, and has washed and dressed herself ever since -she left her bed; is perfectly modest in manner and conversation. -Her friends remark on the great improvement in her mind, she -having had no delusions. Her mental state is, however, weak—what -might better be called foolish, with some amount of wilful -obstinacy. The family medical attendant, and, in fact, every one -who has been in her company, notice the extraordinary change -<span class='pageno' id='Page_75'>75</span>that has taken place in her since your operation. I think the -present state of her mind results from the long-continued exhaustion, -and to restore it will be a matter of time. Her pupils act -naturally.”</p> - -<p class='c011'>I have often since heard of this lady as perfectly well, and as -never having had recurrence of illness. In 1865 I was consulted -on the propriety of marriage, to which I gave my full consent.</p> - -<h3 class='c012'><span class='sc'>Case XLV. Acute Insanity—Two Months—Operation—Cure.</span></h3> - -<p class='c013'>Miss ——, æt. 17, moderate height, and well formed, hair light -golden, grey eyes and fair complexion, came under my care June -19, 1861.</p> - -<p class='c011'><em>History</em> (taken from her mother).—When ten years old, had inflammation -of the womb, and after she recovered began to menstruate. -The function continued regularly until about eight months -ago, since when the catamenia have appeared every ten days, and, -in fact, have been hardly ever absent. In the latter part of last -April she left home for change of air, and returned May 15th, -when her mother noticed that she was thinner than before her -departure, and, on inquiry, it appeared that during the latter part -of her stay she had been very excited, at other times very low, -sometimes laughing and singing, and requiring port wine and -brandy at all times of the day, though generally abstemious, and -never taking wine or other stimuli. The first night after her return -home she went to one of her sisters’ rooms and began to talk of being -married; did not sleep all that night. May 17th. Was found to -be rather wild in the morning; was taken out for a drive during -the day; did not sleep that night, from constant excitement of the -genitals. Had been seen by her ordinary medical attendant, who -ordered opiates, but without the effect of giving her sleep. On the -28th, another physician saw her, and ordered opiates, but without -effect, as she did not have an hour’s sleep night or day. May 22nd. -An eminent authority in female diseases was called in, and also, -<span class='pageno' id='Page_76'>76</span>among other remedies, ordered opiates at night-time, but with no -effect. She continued raving and rambling till June 8th, when a -physician, who devotes himself to mental diseases, saw her; he -said that her mind was not affected, but that her behaviour was -caused simply by debility, and ordered wine, eggs, &c., and a <em>strong -opiate</em>, but without the desired effect.</p> - -<p class='c011'>June 17. Was much worse. The last physician again saw her; -said that she was quite mad, must be taken from home, and could -never recover. She called her mother “<span lang="fr" xml:lang="fr">Monsieur le Diable</span>,” and -her father “God.” She was constantly irritating her clitoris, and -indulged in most immodest behaviour. Was ordered ext. <span lang="la" xml:lang="la">cannabis -indicæ</span>, and slept three hours. 19th. No better, and on this day I -first saw her; she was then wild in expression of countenance, and -on entering the room she addressed me as “Your Majesty,” and said -“I was the Queen.” She also asked, “Why has your Majesty condescended -to visit me?”</p> - -<p class='c011'>June 21. Before operating, the patient being under chloroform, -I made an examination, and found my diagnosis verified by the -existence of all the ordinary local symptoms. The hymen was quite -absent. (In one of her paroxysms she had stuffed a pocket handkerchief -into the vagina.) I performed my usual operation, and immediately -administered two grains of opium. She passed a tolerable -night, not being noisy, but not sleeping.</p> - -<p class='c011'>June 22. Tolerably quiet. Not aware of what is passing around -her, but apparently comfortable. To have broth and milk diet—<em>no -stimulants</em>.</p> - -<p class='c011'>June 23. Passed a quiet night; but did not sleep much, though -she had a grain of opium. Dressing removed. Wound looking -well.</p> - -<p class='c011'>June 24. Has not passed quite such a good night—rather noisy.</p> - -<p class='c011'>June 25. Menses came on. Has had a very bad night, and -been very troublesome. Chloroform administered to insensibility -several times in the course of the day. A liniment, containing -seven drachms of soap liniment and one drachm of laudanum, to -be rubbed in to the chest constantly. This seemed to quiet her.</p> - -<p class='c011'>June 27. Has passed a rather better night, sleeping a little; but -<span class='pageno' id='Page_77'>77</span>towards morning she became very noisy, and chloroform was again -administered. To have the liniment rubbed in at night.</p> - -<p class='c011'>June 28. A much better night.</p> - -<p class='c011'>June 29. Has had a very fair night; and from this time she -gradually improved, sleeping well and being generally quite rational; -her appetite also improved.</p> - -<p class='c011'>July 7. Menstruation occurred, and she was not so well for a -day or two, as she attempted to irritate the wound; but, being -carefully watched, was prevented.</p> - -<p class='c011'>July 10. Catamenia ceased. Is quiet again.</p> - -<p class='c011'>July 11. Went out in a bath chair, and said she enjoyed the -airing. From this time she gradually got better, and on the 28th -she went into the country for change. Her menses came on five -weeks from the last appearance; she was quite quiet all the time. -Since then she has menstruated regularly every three weeks, and -in normal quantity.</p> - -<p class='c011'>A year after operation she had a slight relapse of melancholy, -and fears were entertained that she was again going to be ill; but a -brisk purgation of calomel completely dispersed all symptoms.</p> - -<p class='c011'>1866. I have frequently heard of this young lady. She is now -in good health, moving in high society, and universally admired.</p> - -<h3 class='c012'><span class='sc'>Case XLVI. Hysterical Homicidal Mania—One Year’s Duration—Operation—Cure.</span></h3> - -<p class='c013'>In December, 1861, Mrs. —— came under my care, by the recommendation -of Dr. Forbes Winslow. She gave me the following -history of herself:—</p> - -<p class='c011'><em>History.</em>—She was 57, and had had four children and two premature -labours. The last child was born twenty-three years ago. -Twenty months since had an attack of erysipelas in the face, with -eruptions on different parts of the body. Has never been well -since, and last August had another attack of erysipelas. Is constantly -suffering with shiverings, followed by burning heat and -sweating, with prickling heat of the skin. For the last year has -<span class='pageno' id='Page_78'>78</span>never slept for more than an hour; always waking with a <em>start</em>; -feeling frantic, and very hot and flushed. Has a constant feeling -that she will be lost eternally, and of this she is constantly -speaking.</p> - -<p class='c011'>From her husband I learnt the following:—</p> - -<p class='c011'>After her last confinement, twenty-three years ago, she had -puerperal mania, from which she did not completely recover for -six months. About a year ago she began to show symptoms of -mental derangement, first exhibited in religious subjects, she constantly -declaring that her soul was irrevocably lost. About eight -months ago she first tried to destroy herself, by endeavouring to -jump out of the window, &c., and it was at this time thought advisable -to place her in an asylum, where she was kept four months, -and when she left she was for a time much better. While an -inmate of the asylum, was made to take much exercise, for which -her husband says she is always better.</p> - -<p class='c011'>She gradually got worse, and came under the care of Dr. Forbes -Winslow, to whom I am indebted for the case. Her husband -says that for the last two or three months she has slept pretty well -from 10 p.m. till 2 a.m., when she would suddenly wake, and warn -him that a “frenzy” was coming on. This frenzy consisted in her -rising up, fighting out with her arms, and scratching or tearing any -one near her; in the paroxysm the desire was always to destroy -her husband. After a few minutes the mania would subside, and -be succeeded, first by a kind of stupor, and then very profuse -perspirations. One peculiarity about her is, that when in this -state she does or says anything foolish, she knows it, and is afterwards -very annoyed and ashamed of her conduct. She has a great -fear that she will be permanently mad.</p> - -<p class='c011'>The appetite has always been good, though she has said lately -that she cannot bear food, and that it always causes a horrid taste -in her mouth. She has, in a desultory manner, read many medical -works, and fancies that every one of her organs is in some way or -other diseased.</p> - -<p class='c011'><em>On examination</em>, she had the appearance of a woman about 60. -Her eyes, of a dark grey, were never quiet, and could not look you -<span class='pageno' id='Page_79'>79</span>straight in the face; the pupil was much and constantly dilated. -The tongue quite clean, and pulse good. Heart, lungs, and other -organs seemed to be healthy. She owned with great shame to -long-continued pernicious habits.</p> - -<p class='c011'>Dec. 14. I performed my usual operation.</p> - -<p class='c011'>Dec. 21. Has very much improved, and had no “frenzies” -since the operation; sleeps well, and for many hours, but will not -own to being better. Complains of her skin being dry, and -“burning hot.” It is, however, moist and cool; at times she -perspires freely.</p> - -<p class='c011'>Dec. 26. Both husband and nurse consider her much improved. -She has been up both yesterday and to-day; sleeps and eats well. -She is, however, sulky; says she is very bad, and shall soon die.</p> - -<p class='c011'>A fortnight later she was quite well, being entirely free since the -operation from maniacal attacks; but she complained to my son, -Mr. Boyer Brown, that I had unsexed her. He answered that -nothing of the sort had been done, but that the operation had -prevented her from making herself ill. From this time she steadily -improved, and walked out with her husband every day, who called -on me many weeks later to express his gratitude for the complete -restoration of his wife to health; for whereas before his nights -were passed in constant fear, rendering his life most wretched, his -home was now one of comfort and happiness both night and day.</p> - -<h3 class='c012'><span class='sc'>Case XLVII. Acute Hysterical Mania—Four Months’ Duration—Operation—Cure.</span></h3> - -<p class='c013'>Miss ——, æt. 23, was sent to me by Mr. Radcliffe, stating -that she had been brought over from Ireland as an insane patient, -and that everything had been settled for her admission to some -asylum, when he was induced to consult me on the last day before -her entering one. He stated that the paroxysms always came on -at half-past five or six every evening: I replied, if the attacks -depended on peripheral irritation, that an operation would at once -<span class='pageno' id='Page_80'>80</span>prevent recurrence of the attacks. She was accordingly admitted -into the London Surgical Home Feb. 6, 1864.</p> - -<p class='c011'>When admitted, said she had taken no food for three days, and -asked for a cup of tea, which was given her. Enema was also -administered.</p> - -<p class='c011'>3.45 p.m. Was seized with a fit, throwing her arms up over -her head, and then appearing as if comatose. In about twenty -minutes revived: the lips began to quiver, and she gradually -became conscious, saying, “I want a knife—I want blood!” She -asked for the matron’s hand, that she might bite it off.</p> - -<p class='c011'>[The fit coming on earlier on this day was doubtless due to -excitement consequent on her removal.]</p> - -<p class='c011'>5 p.m. Mr. Baker Brown saw her; as soon as he came near -her, she seized his shoulder with great violence; was wild, and -would not answer questions; but gradually became soothed, and -allowed an examination.</p> - -<p class='c011'><em>Externally</em>, the abdomen showed signs of a child having been -born, and the mammæ had certainly contained milk. The <i><span lang="la" xml:lang="la">clitoris</span></i> -was enlarged and hard; the <i><span lang="la" xml:lang="la">nymphæ</span></i> long and flabby; the mucous -membrane roughened and discoloured.</p> - -<p class='c011'><i><span lang="la" xml:lang="la">Per vaginam</span></i>, the <i><span lang="la" xml:lang="la">uterus</span></i> was found to be retroverted; there was -also a fissure of the <i><span lang="la" xml:lang="la">rectum</span></i>.</p> - -<p class='c011'><em>Operation</em>, 5.30 p.m. Was very violent under the first attempts -to administer chloroform. She was long in being brought under -its influence, but when once thoroughly anæsthetized, bore it -exceedingly well.</p> - -<p class='c011'>The clitoris was excised, the elongated nymphæ removed, and -the fissure of the rectum divided. The wounds were dressed in -the usual manner, and the patient having had two grains of opium -administered, was ordered to be constantly watched.</p> - -<p class='c011'>In twenty minutes awoke from the chloroform. Was calm, and -slept at intervals during the night.</p> - -<p class='c011'>Feb. 7, 10 a.m. Visited by Mr. B. Brown. Present—Mr. I. B. -Brown, junior, House-Surgeon, and Matron. Pulse quick but -steady; tongue brown and furred; breath offensive; gums spongy; -pupil natural; countenance rather flushed; skin moist and warm.</p> - -<p class='c011'><span class='pageno' id='Page_81'>81</span>The following answers were given to questions asked of her by -Mr. Brown, seventeen hours after operation, and are in her own -words; much, however, of the information was volunteered without -questions:—</p> - -<p class='c011'>“Last March, instead of sliding down a slope, I jumped. This -caused displacement of my womb. I suffered great agonies. I -was fomented with hot water. I thought it was my back that -was hurt. Since then I have been subject to fainting and weakness. -I suffer great irritation about my private parts—cannot -keep my hands away. The irritation is worse at night. I am -obliged to relieve the irritation by rubbing—sometimes for two or -three minutes at a time. There is always a discharge. I feel -very depressed afterwards. At times I have lost my brain, and -felt as if I did not care for living. I would like to have my hands -untied; I will be very quiet. Have been separated from my -relatives for three years. I shan’t tell you how long I have been -married—(a pause). I am very rude—I beg your pardon. I have -been married three years. I had a baby two years ago: it was -not born at the full time—I think five months. I don’t know -whether it was alive. I left home with my friend when I was -sixteen (?). It is two years since I left him. I am now twenty-three.</p> - -<p class='c011'>“After the accident, suffered great pain.” Mr. Brown here -looked at her gums, and she immediately said, “Oh, yes; I had -mercury given me by Surgeon ——, in Dublin: he said it was -my spine. He did not examine my womb. Dr. —— examined -it, and said there was great displacement. I have been better for -treatment at times. My brain has been affected. I have fought -very much. I have wanted a child’s blood. I have had it sometimes -by sucking the wounds of a child. When in a fit, I don’t -know what is going on around, or what is being said, but I recognize -people’s voices. I am not regular. Was kept in bed last -September for six weeks for flooding; was so for ten days after I -was put in bed. Was the same in Paris last year. I was studying -in Paris to fit myself for a governess.”</p> - -<p class='c011'>The following are extracts from a letter voluntarily sent to -<span class='pageno' id='Page_82'>82</span>Mr. Brown by a lady with whom the patient lived for many months, -and left only three weeks previous to admission. Having stated -that for some time she was hysterical, and becoming daily more -excitable, the letter says—</p> - -<p class='c011'>“On the 13th of September last, she for the first time seemed -delirious when going to bed. This was mentioned next morning -to Surgeon ——, who declared it to be nervous irritability of the -spine.... On the 27th, Dr. —— was called in, and at once gave -his opinion that there was ailment of the womb. He then ordered -small blisters on the lower part of the stomach, which in less than -ten hours relieved her, and removed the mania. She had not any -reason for <em>many</em> days previous, and was sinking.... On the 3rd -of October, Dr. —— fixed an instrument to support the womb; -and, except during the time when the intensity of pain caused it, -there was no delirium; for a few days she got claret, which seemed -to excite her greatly, so it was discontinued; but on the 13th of -October I was desired to give her port wine in abundance. She -was excessively weak, and mania so dreadful, that she made several -attempts to injure herself and me. She got as many as eight large -glasses of best port on some days; strong beef-tea, chicken soup, -and all the nourishment possible. It was not only suggested, but -it was advised to remove her to a lunatic asylum; however, feeling -that certainly nine-tenths of her time she was perfectly sane, and -could know well where she was and with whom, I did not like the -idea of placing so young a creature in an asylum. I kept her here, -and watched her day and night; she never was left alone for one -moment for three months.... I ought to mention that the order -for abundance of wine, &c., was from the opinion that ‘want of -blood to the brain’ caused the mania; and that the intense inflammation -of all internal organs was relieved by blisters on the -lower part of the stomach and by mercury.”</p> - -<p class='c011'>Feb. 8. Lint removed from rectum, and wounds dressed. Is -calm and rational; passed a quiet day.</p> - -<p class='c011'>Feb. 10. Very restless; obliged to restrain hands and legs.</p> - -<p class='c011'>Feb. 11. Better; says her head feels heavy; countenance -cheerful; manner quiet and rational.</p> - -<p class='c011'><span class='pageno' id='Page_83'>83</span>Feb. 12. Very excited and irritable; constantly managing to -free her hands; will allow no one near her.—2 p.m.: Is quite -maniacal; has managed to irritate the wounds, and also the -mammæ. To have one grain of opium in pill, and ten grains of -bromide of ammonium three times a day.</p> - -<p class='c011'>Feb. 13, 6 a.m. Hands again free; repeat opium. Slept afterwards -till 4 p.m., when she awoke calm and rational.—9 p.m. Slept -again.</p> - -<p class='c011'>Feb. 14. Very restless, and at times violent. Bandages removed -and jacket substituted.</p> - -<p class='c011'>Feb. 15. Much better; rational, and conversing cheerfully.</p> - -<p class='c011'>Feb. 16. Improving.</p> - -<p class='c011'>Feb. 17. At her urgent request, hands were freed, but shortly -after she became excited.</p> - -<p class='c011'>Feb. 19. More sensible; had to-day symptoms of a severe -bilious attack, which upset her for some days.</p> - -<p class='c011'>Feb. 24. Much better; allowed to see her sister—the first time -since the operation.</p> - -<p class='c011'>March 1. Much improved; has written to her sister, and amused -herself knitting and reading during the day.</p> - -<p class='c011'>March 2. Allowed to dress; seemed to enjoy the change, and -is very cheerful.</p> - -<p class='c011'>March 4. Visited by her sister; has been quietly cheerful all -day. Is certainly improving wonderfully.</p> - -<p class='c011'>March 20. Took a walk, and enjoyed it.</p> - -<p class='c011'>March 25. Spent the day away from the Home with her sister; -returned looking quite well, and all the better for the change.</p> - -<p class='c011'>April 2. Discharged quite cured.</p> - -<p class='c011'>This patient remained perfectly well, and I hear has since been -legally married.</p> - -<div> - <span class='pageno' id='Page_84'>84</span> - <h3 class='c012'><span class='sc'>Case XLVIII. Incipient Mania—One Year’s Duration—Operation—Cure—Subsequent Pregnancy.</span></h3> -</div> - -<p class='c013'>In 1863, Mrs. S. M., married, mother of three children, æt. 30, -came under my care, because she had been suffering for more than -a year from menorrhagia, which had gradually affected her mind, -causing her to have a great distaste for her husband; so much so, -that he and his friends were induced seriously to contemplate a -separation. On the first examination, her face indicated mental -disturbance, eyes restless, pupils dilated, and manner generally -excitable. She told me that she could not sleep at night, complained -of constant weary uneasiness in her womb, pain in her -back, great pain on defecation, constant desire to micturate. She -said she was glad to be away from home, as she made every one -around her unhappy. Believed that she would be a permanently -insane patient, and never expected to return to her family again.</p> - -<p class='c011'>On more minute examination, I found irritable clitoris and labia, -a painful fissure of the rectum, with great relaxation of the sphincter -ani, which, on inquiry, was found to be caused by the frequent -introduction of her finger, with a view to peripheral irritation. At -her own request, she had long been separated <i><span lang="co" xml:lang="co">à mensâ</span></i> from her -husband, on account of her great distaste for him and cohabitation -with him.</p> - -<p class='c011'>I pursued the usual surgical treatment, which was followed by -uninterrupted success; and after two months’ treatment, she returned -to her husband, resumed cohabitation, and stated that all -her distaste had disappeared; soon became pregnant, resumed her -place at the head of her table, and became a happy and healthy -wife and mother. She was in due time safely delivered, and has -ever since remained in perfect health.</p> - -<p class='c011'><em>Remarks.</em>—From observations of this case, one feels compelled -to say, may not it be typical of many others where there is a judicial -separation of husband and wife, with all the attendant domestic -miseries, and where, if medical and surgical treatment were brought -to bear, all such unhappy measures would be obviated?</p> - -<p class='c008'><span class='pageno' id='Page_85'>85</span>A careful perusal of the cases related in the -foregoing pages will show that all the theoretical -objections mentioned in the introductory chapter, as -having been raised against my treatment, have been -fully contradicted by facts. Of the permanency of -the result, I myself am fully satisfied; and I hope at -a future time, by a much larger number of cases, to -confirm others in the same opinion.</p> - -<div class='nf-center-c0'> -<div class='nf-center c002'> - <div><span class='small'>COX AND WYMAN, PRINTERS, GREAT QUEEN STREET, W.C.</span></div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='tnotes x-ebookmaker'> - -<div class='chapter ph2'> - -<div class='nf-center-c0'> -<div class='nf-center c004'> - <div>TRANSCRIBER’S NOTES</div> - </div> -</div> - -</div> - - <ol class='ol_1 c002'> - <li>P. <a href='#t42'>42</a>, changed “prodomata” to “prodromata”. - - </li> - <li>Silently corrected typographical errors and variations in spelling. - - </li> - <li>Archaic, non-standard, and uncertain spellings retained as printed. - </li> - <li>Footnotes were re-indexed using numbers. - </li> - </ol> - -</div> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK ON THE CURABILITY OF CERTAIN FORMS OF INSANITY, EPILEPSY, CATALEPSY, AND HYSTERIA IN FEMALES ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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