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:—
[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.”