Miss ——, æt. 38, single; admitted into the London Surgical Home August 10, 1865.
History.—Was tolerably well until two years and a half ago, but since that time has suffered more or less from menorrhagia, with severe pain in back. Has also severe smarting pain in the bowels, and has frequently lost a considerable quantity of blood per anum. Has always been subject to hysterical attacks, but for the last six years has had fits of a much more serious character. They have increased in severity, duration, and frequency, and it is on account of them that she seeks relief. Almost immediately after admission, this patient had a fit, and she was kept a fortnight under observation, that the nature of the attacks might be thoroughly investigated.
She would have a fit sometimes twice a day; but on an average about every other day—either early in the morning or late in the evening. She was most generally attacked when walking about the room—sometimes when sitting—but she was never observed to have one when asleep. She would at the commencement of an attack cease walking, or doing whatever she was employed in; her face would become very pale and set; the eyelids, at first quivering, would be fixed; the eyes wide open and looking upwards, the pupils very dilated. Her mouth would be rigidly shut, and during the attack it was impossible by any means to open it. Her arms would fall straight by her side, and be immovable; the hands unclenched, and fingers extended. If standing, she would be quite upright, and require no support. If sitting, she would always stand up when a fit was coming on. If lying, she would be extended straight on her back. The fit would last for two or three hours, and on a few occasions for as many as six hours. The experiment was frequently made of moving her arms when in the cataleptic state, and on such occasions the limb would remain in the position in which it was placed, till the end of the attack. She was always perfectly unconscious, and no kind of stimulant was of the slightest use in restoring her during the paroxysm—time alone was of avail. The attack was sudden, but the recovery to consciousness was but gradual; she would appear as if awoke from a deep sleep, and would be very exhausted, but express no desire for food, wine, or other stimulants. As soon as she recovered, she would sleep for many hours, and awake quite well, but still weak.
Aug. 24. The clitoris was excised, and a painful fissure of the rectum divided. She never had a fit after the operation. Menstruation came on on the 28th, in moderate flow.
Oct. 5. This patient has improved wonderfully since operation, and now looks extremely well. The wound is quite healed. She takes walks daily, and has had no fits, and is to be discharged as cured.
In November she called at the Home, to say that she was quite well, and had never had the slightest return of her former illness; she menstruates regularly and normally.
Feb., 1866. She remains well.
CHAPTER VII.
EPILEPSY, WITH CASES.
Referring my readers for full information on the pathology and history of epilepsy to Dr. Russell Reynolds’s exhaustive treatise on the subject already referred to, I would mention, as shortly as possible, a few facts which are necessary to be borne in mind, with especial reference to the class of cases which I am now considering.
Dr. J. C. Prichard, in writing of diseases of the nervous system, has well said that “few diseases are better characterized by them symptoms than epilepsy; yet in this instance there is such a variety in the phenomena as renders it difficult to contrive a definition in a few words which may comprehend every form of the complaint.”