“When out of doors, great difficulty is experienced in getting her in again; she wishes to wander away, without aim or purpose. Having given my opinion to her friends, I was authorized to admit her April 18, 1861. Before she left home, she continued calling out, ‘Take me to a mad-house! take me quick, or I shall never get well!’ She persisted in saying ‘she was dead,’ and ‘she felt buried.’ Answers in monosyllables. Her pupil is contracted and fixed. At night she does not sleep, and is in such a continual state of excitement that the attendant cannot sleep with her. Has lost all natural modesty in manner and speech. Is not blasphemous. Before me is perfectly reserved and correct in her manner. When I ask questions, she will, after a pause, answer in monosyllables, or repeat the question over and over again, as if trying to grasp the meaning and ally her thoughts. Unless walked about, will stand for hours in one place, gaping, yawning, and throwing her arms about listlessly. She was in this state when you saw her, and from what you told me of your experience of the operation and its results, I was led to infer relief from it in this case, as the delusion of having died on a certain day was movable and could be reasoned away; but the heavy oppressed feeling still made her say, ‘But if I am not dead, I am lost, or changed,’ and naturally led back to the idea. I ascribed the state of her mind to weakening of the body, and general nervous irritation caused by long-continued reflex excitation; and I believed that if the source of irritation could be removed, her mental health would follow as her blood became healthy, and fit to make reparation.
“I was led to think more of her uterine state from her expression of pain when she was walked about, and she was reported by the nurse as always complaining of her back, at the lower part, and of great tenderness on pressure over the ovaries.
“May 27, 1861. You operated on her, she being under the influence of chloroform. She was naturally restless afterwards, not understanding why she was kept in bed. Profuse menstruation came on in the evening, which had not happened for four months previously, and then always very scanty and with much pain. Half an ounce of laudanum, with oil, was rubbed into her chest during four hours; she did not, however, sleep, but continued moaning all night.
“May 28. Easier, and more herself—takes her food.
“May 29. Slept well last night, without opiates; says she shall now get well and be able to go home; answers questions more readily, and makes longer replies. Pupil dilated and acts slowly. Her nurse says she is quite altered in every way, and compares the change in her mind since the operation to ‘dividing the tightened strings of a fiddle, and letting them all loose.’
“June 2. Left her bed; is still menstruating; appears cheerful; asks questions now, and converses for short periods; has done a few stitches of needlework; says nothing about ‘being lost or dead’ since the operation. Surface of body and extremities warm. Freaky, anxious look about her eyes and nose gone. Laughs and jokes. Says ‘she has been in a dream,’ ‘that things now seem light,’ and ‘that she means to get well.’
“July 3. She has gradually improved and become more natural in her habits and ideas; sleeps soundly every night; takes her meals well; walks about without compulsion; takes a pride in making herself neat, and has washed and dressed herself ever since she left her bed; is perfectly modest in manner and conversation. Her friends remark on the great improvement in her mind, she having had no delusions. Her mental state is, however, weak—what might better be called foolish, with some amount of wilful obstinacy. The family medical attendant, and, in fact, every one who has been in her company, notice the extraordinary change that has taken place in her since your operation. I think the present state of her mind results from the long-continued exhaustion, and to restore it will be a matter of time. Her pupils act naturally.”
I have often since heard of this lady as perfectly well, and as never having had recurrence of illness. In 1865 I was consulted on the propriety of marriage, to which I gave my full consent.
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.