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.