In two clinical lectures published in the Philadelphia Medical Times17 I have given the histories of two cases of hystero-epilepsy in which oöphorectomy was resorted to for hystero-epilepsy. In the first of these cases, in which clitoridectomy was also performed, nymphomania, which was a distressing symptom, was benefited, but even this was not completely cured. The following is the patient's own statement: “Since the removal of the ovaries I have been able to control the desire when awake, but at times in my sleep I can feel something like an orgasm taking place. My experience leads me to say that my cure (?) is not due to the absence of the ovaries; there is no diminution of the sexual feeling. There would be as much excitement of the parts if the clitoris were still there. If my will gave way, I would be as bad as ever.” Her general mental and nervous condition is much the same as before the operations. She is still dominated by morbid ideas, still unable to take up any vocation which demands persistence, and still the frequent subject of hystero-epileptic seizures.
17 April 18 and May 30, 1885.
The second of these cases was a young girl about seventeen years old who had never menstruated. She had had epileptic or hystero-epileptic seizures for several years. An operation was performed in which the ovaries and Fallopian tubes were removed. Twelve days after the operation, from which she made a good recovery, she had four convulsive seizures. She had several attacks subsequently, and then for a considerable period was exempt. She had, however, acute inflammatory rheumatism, with endocarditis and valvular trouble. About seven months after the operation she had several severe convulsions with loss of consciousness, and died about a year after the operation, having had many severe seizures during the last few weeks of her life.
There is no warrant either in experience or in a study of the subject for spaying hysterical girls who have never menstruated. In a case diagnosticated as hysterical rhythmical chorea removal of the ovaries was advised by a distinguished specialist. The girl's trouble came on at about the age of thirteen years. She had never menstruated properly, although on one occasion, after several weeks of electric treatment, she had a slight show for a few days. It was proposed to remove the ovaries in this case on some general principle of given hysterical trouble; the ovaries must go. In this case, as in the last, it would have been far better to have put in a good pair of ovaries, or to have developed these rudimentary organs into health and activity.
With reference to oöphorectomy for hystero-epilepsy or any form of grave hysteria it may be concluded—1, It is only rarely justifiable; 2, it is not justifiable in the case of girls who have not menstruated; 3, when disease of the ovaries can be clearly made out by local objective signs, it is sometimes justifiable; 4, it is justifiable in some cases with violent nymphomania; 5, the operation is frequently performed without due consideration, and the statistics of the operation are peculiarly unreliable.
When we come to consider the treatment of the disease hystero-epilepsy, the practical importance of the distinction between this affection and true epilepsy becomes apparent. Cures of hystero-epilepsy are not rare. The original cases here reported have all apparently recovered. Grave hysteria is sometimes cured spontaneously, either by gradual disappearance with the progress of age, or suddenly because of some violent impression or under the influence of unknown causes. One of the worst cases in the service of Charcot has shown a gradual diminution of the hystero-epileptic manifestations with the advance of age. In another case under the influence of strong moral impressions the disease disappeared at a stroke. The affection, however, should not be abandoned to nature, as treatment is often of value.
The hydrotherapeutic method of treatment has been found of the greatest service. Hydrotherapy must be methodically employed by experienced hands. A number of cases cited by Richer were cured at hydrotherapeutic institutions. Limited success has followed the use of metallo-therapy. Besides metallic plates, the same results may be obtained with other physical agents, to which have been given the name of æsthesiogenic agents. Among these are feeble electric currents, vibrations of a tuning-fork, static electricity, etc.
Static electricity has a position of undoubted importance in the treatment of hystero-epilepsy in some of its phases. Those who have walked in the wards and visited the laboratories of Salpêtrière will recall the enormous insulated stools to which are brought troops of hystero-epileptic patients, who, to save time, are given a vigorous simultaneous charge of electricity. Even this wholesale plan of treatment is sometimes markedly efficacious. Vigoroux recommends static electricity as an æsthesiogenic agent, and regards it as the most valuable of all agents of this character.
Those drugs should be resorted to which have a tonic influence on the nervous system. Potassium bromide, as has already been indicated, is not efficacious. More is to be hoped from tonics and antispasmodics, such as valerian, iron, salts of silver, zinc, copper, sodium, and gold chlorides, etc. Good hygienic influences, moral, mental, and physical, are of the utmost importance.