Read Ebook: On the Curability of Certain Forms of Insanity Epilepsy Catalepsy and Hysteria in Females by Brown Isaac Baker

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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.

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 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 leucorrhoea 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, "soeur de charit?," 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 perinaeum; 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.

A grain of opium is introduced per rectum, the patient placed in bed, and most carefully watched by a nurse, to prevent haemorrhage by any disturbance of the dressing. The neglect of this precaution will be frequently followed by alarming haemorrhage, 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.

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."

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:--

D. E., aet. 26, single; admitted into the London Surgical Home Oct. 12, 1859.

P. F., aet. 21, single; admitted into the London Surgical Home Jan. 7, 1861.

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.

S. S., aet. 33, married; admitted into the London Surgical Home February 23, 1861.

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.

H. R., aet. 55, single; admitted into the London Surgical Home Nov. 18, 1861.

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.

Mrs. L., aet. 55; admitted into the London Surgical Home Dec. 9, 1861.

H. D., aet. 23 single; admitted into the London Surgical Home April, 1862.

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.

Miss M., aet. 42; admitted into the London Surgical Home April 13, 1862.

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.

A. B., aet. 24; admitted into the London Surgical Home 16th July, 1862.

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.

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.

C. M. A., aet. 28, single; admitted into the London Surgical Home June 22, 1863.

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.

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