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.