I fully agree with Dr. Reynolds that what are called the “diagnostic signs of hysteria,” as frequent micturition of clear pale urine, tympanitis, nausea, &c., have no value in aiding our inquiry as to the nature of these fits: they may be witnessed, and with as great frequency, after epileptic seizures.
One practical point exists; namely, that in hysterical epilepsy the patient seldom, I believe never, in falling hurts herself, whereas true epileptics frequently suffer considerable bodily injuries.
Case XXII. Nine Years’ Illness—Epileptiform Attacks—Three Years’ Duration—Operation—Cure.
G. M., single; admitted into the London Surgical Home December 18, 1860.
History.—For the last nine years has suffered greatly and regularly during the menstrual periods. Has been much worse for the last three years, during which time has, at each menstrual period, been frequently taken in a fit, dropping down suddenly and fainting right off; this state lasting for two or three hours. Being in service, this has caused her much trouble, as none of her employers would keep her. For the last six months has suffered severe pain over right ovary, increased by exercise or pressure, and at the menstrual period. Believing that the dysmenorrhœa and fits both arose from the same cause, on January 3, clitoris was cut down to the base. After this operation she never had a fit, and all untoward symptoms left her except the dysmenorrhœa; she was therefore re-admitted May 27, 1861, and there being some narrowing of the cervix, it was incised with the hysterotome. June 21, catamenia came on without pain, and continued to do so regularly. In July she was well enough to return to service.
April, 1865. Her mother called at my house to say that this patient had been married some months, and was shortly expecting her confinement. She had remained quite well since the operation.
Case XXIII. Epileptoid Fits—Fifteen Years—Illness for Twenty-six Years—Operation—Cure.
F. A. C., æt. 41, single; admitted into the London Surgical Home Nov. 6, 1863.
History.—Says she had congestion of the brain fifteen years ago; since that period cannot remember being well, but from the age of fifteen has been of delicate health. Has suffered from fits for the last fourteen or fifteen years; is never long free from them. During an attack she is not entirely unconscious, but possesses no power to control them nor to speak. Has pain at lower part of spine of a gnawing character. She is a miserable, nervous creature, with pinched features and a wandering restless expression of the eye. There is evidence of injurious peripheral irritation since a very early age.
Nov. 12. Operation as usual under chloroform.