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.