Isaac Baker Brown

“ The time required for recovery must depend, not only, as has been already hinted, on the duration of illness, but also on the peculiar temperament of the patient, and judicious after-treatment; this latter requiring long perseverance on the part of both practitioner and the friends of his patient; and it is as we meet a favourable or unfavourable case that the opinions of Brown-Séquard, as to instant cure on removal of irritation, or of Handfield Jones, as to cure after a long interval, are verified. ”

“ Epilepsy is such a chronic disease, and seems to me to produce not only weakening of the mind, but to cause it to be often entirely lost, that, although we may get, as in the following case, a temporary re-kindling of the mental energies, I fear we are not yet able to give much hope of complete recovery. ”

“ Handfield Jones [7] “eccentric causes.” As “centric causes,” he names “poisoning of the blood from retention of excrementitious matter; this, by deranging the nutrition of the nervous tissue, generates the abnormal excitability, which then manifests itself without any special irritant. Various causes of exhaustion, such as hæmorrhage and excessive discharges, venereal excesses, prolonged want of sleep, unremitting pain,” &c., are all “centric” causes of epilepsy. ”

“ Further still, looking on epilepsy as a direct sequel of hysteria, when it is produced by excitation of the pudic nerve, 58the patients are, in an eminent degree, predisposed to the disease.
Women are also more naturally prone to epilepsy from mental emotion than men; “Emotional disturbance being assigned,” says Dr. Reynolds, “as the cause of their attacks in so many as 36 per cent., whereas in the male sex there were only 13 per cent. who referred their diseases to that cause.”
It would be out of place in a work of this nature to detail at length the symptoms of these attacks. ”

“ A period of two years elapsed before she had a second, when, being placed under medical treatment for eighteen months, she had great relief. Since the expiration of that time to the present she has constantly suffered from fits.
Her intellect did not begin to weaken until two years since, but she ceased growing and learning after the first attack. At this time she does not know her right hand from her left; does not know her mother, and shows no signs whatever of ordinary intelligence. From being cleanly as a child, is now most filthy—in fact, is in every sense an idiot. ”

“ Experience seems to teach that in those patients whose brains have been so weakened by long-continued peripheral excitement, causing frequent and increasing losses of nerve force, there is not sufficient mental power to enable them to control any less powerful irritation of smaller branches of the pudic nerve, than that removed by operation. ”

“ Epilepsy is a name signifying a disease, which may be idiopathic, or may arise from a variety of causes; but that eccentric irritation is a powerful and very frequent cause, there is not the slightest doubt. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ Acknowledges great and constant irritation of pudic nerve.
During the day previous to operation, special notice was taken of the nature of the fits. They are epileptic; for although she does not foam at the mouth, she has, on more than one occasion, bitten her tongue, and is perfectly unconscious. There is no rigidity, but a constant struggling, and, unless restrained, the hands always, during an attack, are carried to the seat of irritation. ”

“ 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. ”

“ 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. ”

“ History.—Has been ill for about three years and a half, suffering frequently from an aggravated form of hysterical attacks, with many of the characters of epilepsy, but with only partial insensibility, and without foaming. Is often sick, and suffers from severe pain on the right side, with a feeling of pressure on the lower bowel, with a dragging and bearing-down pain around the loins. Catamenia regular; more subject to the fits at these periods. No difficulty in micturition, but a rather frequent desire to micturate; and urine often loaded. ”

“ Has for many years suffered from all the inconveniences of a fissure of the rectum, combined with bad digestion, undue nervous excitability, and sleepless nights. Is very anxious to be cured. It being thought that all these symptoms might be due to a painful fissure of the rectum, the ordinary operation for this affection was performed on December 12. The bowels were opened in a few days without pain, and the fissure was healing well. ”

“ History.—When very young, until ten years of age, had frequent fits. Improved in health till she was fourteen years of age, when she began to suffer from abdominal enlargement. First menstruated at nineteen. Is constantly sick after meals. Has been in 25nearly every hospital in London. The patient is very hysterical, and is always talking religion.
On examination the abdomen was found very tympanitic. Under chloroform this state quite subsided. Walls of abdomen fat and muscular. Body generally well nourished. Evidence of continual irritation of the pudic nerve. ”

“ The patient having been placed completely under the influence of chloroform, the clitoris is freely excised either by scissors or knife—I always prefer the scissors. The wound is then firmly plugged with graduated compresses of lint, and a pad, well secured by a T bandage.
A grain of opium is introduced per rectum, the patient placed in bed, and most carefully watched by a nurse, to prevent hæmorrhage by any disturbance of the dressing. The neglect of this precaution will be frequently followed by alarming hæmorrhage, and consequent injurious results. ”

“ I am so pleased to be supported by my old friend and colleague in views that I myself have long entertained, that I intend, without further preface, to make his researches the whole substratum of my work ”

“ Although there is no doubt that patients may suffer from peripheral irritation of the pudic nerve from the earliest childhood, I never operate or sanction an operation on any patient under ten years of age, which is the earliest date of puberty. 17In children younger than this, milder treatment with careful watching, will be found sufficient if it be thoroughly persevered in. ”

“ Had a very bad fever about five months ago, which left her perfectly prostrated. Always felt weak, and more or less subject to fits. Menstruation regular and never profuse. Great pain in the back and bearing-down feeling in the lower part of the body. Complains of great pain in defecation. Sea-bathing has benefitted her temporarily. Is incessantly crying without cause or power to prevent herself.”
The day following admission she had a fit of a cataleptic nature, and lasting twenty-five minutes. After the fit the patient was left very prostrated. ”

“ On the 28th, another physician saw her, and ordered opiates, but without effect, as she did not have an hour’s sleep night or day. May 22nd. An eminent authority in female diseases was called in, and also, 76among other remedies, ordered opiates at night-time, but with no effect. She continued raving and rambling till June 8th, when a physician, who devotes himself to mental diseases, saw her; he said that her mind was not affected, but that her behaviour was caused simply by debility, and ordered wine, eggs, &c., and a strong opiate, but without the desired effect. ”

“ 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 40hands and feet, and is able to walk across her room, holding the hands of her maid, who retreats before her. ”

“ The period when such illness attacks the patient is about the age of puberty, and from that time up to almost every age the following train of symptoms may be observed, some being more or less marked than others in the various cases.
The patient becomes restless and excited, or melancholy and retiring; listless and indifferent to the social influences of domestic life. She will be 15fanciful in her food, sometimes express even a distaste for it, and apparently (as her friends will say) live upon nothing. She will always be ailing, and complaining of different affections. ”

“ One of our most distinguished obstetric physicians requested me to operate on a lady who had been for some twenty years under very many eminent practitioners without any but temporary benefit. The result of the operation was most marked; the irritation subsided, the patient improved in health, and we confidently expected permanent relief. Yet in a few weeks after she left our hands and that of the nurse, 12irritation, resembling pruritus, gradually returned, and with it the other old symptoms. ”

“ 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 ”

“ Often a great disposition for novelties is exhibited, the patient desiring to escape from home, fond of becoming a nurse in hospitals, “sœur de charité,” or other pursuits of the like nature, according to station and opportunities.
To these symptoms in the single female will be 16added, in the married, distaste for marital intercourse, and very frequently either sterility or a tendency to abort in the early months of pregnancy. ”

“ The appetite has always been good, though she has said lately that she cannot bear food, and that it always causes a horrid taste in her mouth. She has, in a desultory manner, read many medical works, and fancies that every one of her organs is in some way or other diseased. ”

“ Previous to her marriage had a severe illness, in which she was delirious, and again in 1860, when she lost her reason for six weeks. “Was very feverish and could retain no food on the stomach.” The menstrual periods are most irregular, six or eight months sometimes elapsing between each appearance. Has not menstruated since June last. Has great difficulty in passing her urine. For many years has suffered from fits of an epileptiform character, having, in an attack, convulsions and rigidity, but never hurting herself in falling, foaming at the mouth, nor biting her tongue. ”

“ One peculiarity about her is, that when in this state she does or says anything foolish, she knows it, and is afterwards very annoyed and ashamed of her conduct. She has a great fear that she will be permanently mad. ”

“ Would go out and walk away into the country alone for miles, and come back exhausted. When friends called, would start up and run round the garden, or to the top of the house and back again, giving no reason for it but that she must do it. ”

“ Pain in the loins and spine, sleepless nights, loss of appetite, and other hysterical 46symptoms. Has slight “epileptic fits” two or three times a week, more frequently at catamenial periods, which are regular in appearance and not profuse. Has no premonition of fits; is but partially conscious; at first struggles, then becomes rather rigid, and on recovery is always exhausted. Patient is most anxious to be cured of her attacks, of the cause of which she is fully conscious.
April 25. Clitoris excised, under chloroform.
April 26. Had a good night, better than for years. ”

“ This lesser excitement acts chiefly, I imagine, by preventing restoration, in the same manner as a drunkard whose brain is weakened by long indulgence in his baneful habit cannot resist temptation, but is, however, affected by much smaller quantities of stimuli, than when strong, he was able to take. ”

“ From the age of 21 up to the present time, besides slight convulsive attacks in the daytime, she has been subject to fits at night, occurring irregularly, but averaging one a week, and always after each menstrual period. ”

“ She was discharged quite cured, all her hysterical symptoms having left her, and the tumour never having been seen since the day of operation.
Case IX. Hysteria—Five Years’ Illness—Sterility—Operation—Cure—Pregnancy—Two Children. Mrs. O. came under my care in 1862. She had been ill ever since marriage, five years previously; having distaste for the society of her husband, always laid upon the sofa, and under 27medical treatment. Evidence of peripheral excitement being manifest, I performed my usual operation. She rapidly lost all the hysterical symptoms which had previously existed ”