CHAPTER IV.

SPINAL IRRITATION, WITH CASES

There are perhaps few terms so difficult to define as spinal irritation, for the gradations from hysteria to this state are extremely easy; and, indeed, it will have been seen that in the foregoing chapter most of the patients complained of pain in the spine, and that there was more or less functional disturbance in all of them. The term is also used so freely and vaguely that great caution is necessary in attempting to explain its meaning. Dr. Handfield Jones’s term, “Spinal Paresis,” seems to me an excellent one; by it he means “a state in which, without demonstrable organic change, there is greater or less enfeeblement of the functional power” of the spinal cord. The sensory or motor power may be affected, but rarely both together.

The cause of spinal irritation, or paresis, may be defined in one word—“debility;” this debility always, or almost always, being due to inhibitory irritation.

This state of things may give rise to wide and varied disorders, all the symptoms of which are asthenic in their character, and all of which are marked by extreme nervous prostration.

Without doubt,—for all authors agree on this point, one of the most prominent causes is peripheral irritation of the pudic nerve, producing undue exhaustion.

It is difficult to say how this is produced, but most probably it is that, “owing to the intimate commissural connections between the lumbar enlargement of the cord, where the pudic nerves are implanted (they themselves being small and remote in their origin from the brain); and the superior and nobler nervous centres, the intense excitation of even a small and remote centre is communicated to the others, which, as this subsides, fall as much below, as they have previously been stimulated above par. The depression is proportional to the previous excitement.”

The cases I shall have to relate which may fairly be called cases of spinal irritation are few in number, for the reason I have stated, that they are but a continuation of hysteria,[3] and, indeed, but a state of things of which epileptiform and epileptic fits are the direct sequence.

Footnote 3:

_Vide_ Cases in previous chapter.

It is, however, well to draw attention to the fact that it is in cases of spinal irritation that we observe functional derangements, which are very likely to pass into actual organic diseases; and it is in this class of cases, which are essentially of a chronic character, that very long and persistent perseverance must be pursued. I would, therefore, advise all who meet with them to warn their patients beforehand that they must not be weary and faint-hearted if recovery do not come as soon as hoped for.

CASE XV. SPINAL IRRITATION, AND SUPPOSED UTERINE DISPLACEMENT—SIX YEARS’ ILLNESS—OPERATION—CURE.

In 1860, I was requested to see a young lady, æt. 20, of whom I had the following history:—For six years she had been confined to a spinal couch, and had also been supposed to suffer from retroversion of the uterus. She had worn a spinal apparatus, attached to which was a steel spring, pressing on sacrum and pubis, and intended “to support the perinæum, and keep the uterus in position.” Had been treated with caustics and other therapeutic agents for uterine disease. I found the uterus normal in position and healthy in appearance; but on further questioning and examination, I diagnosed peripheral irritation of the pudic nerve. My opinion was strongly contested, as I was told that the young lady was very religious; but, as I explained, her illness was to be attributed solely to a physical condition, and was not at all necessarily immoral; I was then met with the objection that, in the event of marriage my operation might interfere with marital happiness and prevent procreation. I explained how, physiologically, these objections were untenable, but was then unable to adduce actual cases in contradiction of them.

Ultimately I performed my operation in the usual manner. For want of proper attention on the part of the nurse, the dressing was three times displaced; but, nevertheless, at the end of a month this lady was well enough to walk three miles.

Up to this date she has remained quite well.

CASE XVI. DYSMENORRHŒA—FIVE YEARS’ ILLNESS—OPERATION—CURE.

D. A., æt. 23; admitted into the London Surgical Home Aug. 4, 1863.

_History._—Has never been very strong; but five years ago had an attack of gastric fever. Since then has suffered constantly from great pain during the menstrual period. Occasionally loses a great deal, and passes large clots of blood. During this time has suffered almost constantly from leucorrhœa. Suffers severely from pain over region of left ovary and in the spine. Is hardly ever free from headaches. Is very restless; never sleeps well; frequently faints; and has little or no appetite. All her ills are exaggerated at the menstrual epoch.

August 7. Usual operation performed.

Sept. 1. Is menstruating without pain.

Sept. 30. Again menstruating without pain, and in normal quantity. Is to be discharged cured.

CASE XVII. SPINAL IRRITATION AND LOSS OF USE OF RIGHT LEG—FIVE YEARS’ ILLNESS—OPERATION—CURE.

M. B., æt. 30, single; admitted into the London Surgical Home Nov. 15, 1861.

_History._—Five years ago first began to suffer pain in the right leg, which was ascribed to sciatica. Fourteen months since this pain became so bad that she could not walk, and she lost all use of her right leg, at the same time felt great weakness and pain in the back, preventing her sitting. For eight months has been confined to a “spinal couch.” Is a spare anæmic woman; dark hair and eyes; dilated pupils; very restless and nervous in her movements, and of a very irritable temper. Has suffered from peripheral irritation since an early age.

Nov. 26, 1861. Usual operation performed.

Dec. 27. She has gradually improved in health and temper since the operation, and is now quite able to walk about her room without help.

She was a long time before her nerve tone was thoroughly restored, but she ultimately got quite strong and continues well.

CASE XVIII. HYSTERIA AND SPINAL IRRITATION TWELVE YEARS—FISSURE OF RECTUM, RECENT DURATION—OPERATION—CURE.

R. C. R., æt. 35 years, single; admitted into the London Surgical Home April 15, 1861.

_History._—Has been suffering for nearly twelve years, at intervals of from six months to six weeks, with pain in the womb and right side, sudden spasms of the limbs, coming on at frequent and irregular intervals. Great pain down the spine and lower part of the back and loins. Has often attacks of severe sickness. Is usually costive. Has lately suffered great pain in defecation. Catamenia regular. Great want of sleep and appetite. Says she is always low-spirited, moping, and listless. Has had much medical treatment.

_On examination_ there was found evidence of peripheral excitement of the pudic nerve, and there also existed a fissure of the rectum.

April 18. The usual operation performed, and the fissure of the rectum incised.

After this time defecation was performed without pain. Sleep, appetite, and cheerful spirits returned. She had no more spasmodic twitchings, but she still complained of intense pain in the back on sitting and walking. She was discharged in June much relieved, but not well.

Nov. 9 1861. I received a letter from this lady, stating that she now suffered no pain and was perfectly well. She was stout, and better in every respect than she had been for the last twelve years.

CASE XIX. MENORRHAGIA—MENTAL DELUSION—TWO YEARS’ ILLNESS—OPERATION—CURE—SUBSEQUENT MARRIAGE AND PROGENY.

A young lady, æt. 20, came under my care in 1863, having for two years past suffered from almost constant menorrhagia, during which time she had suffered great irritability of temper, been disobedient to her mother’s wishes, and had sleepless nights, restless desire for society, and was constantly seeking admiration; all these symptoms culminating in a monomania that every gentleman she admired was in love with her, and she insisted on always sending her _carte de visite_ to her favoured one for the time being. In her quieter moments she would spend much time in serious reading. On being consulted, I quickly discovered that all these symptoms arose from peripheral excitement, and that there existed no organic disease to cause the menorrhagia. The usual plan of treatment was followed with the most rapid and marked success. She went the full interval between the ensuing menstrual periods, and the secretion was normal in quantity. All her delusions disappeared, and after three or four months of careful watching, with change of air, she was perfectly well in every respect. A year afterwards she married, and ten months later gave birth to a healthy son. She is now again pregnant.

CASE XX. SPINAL IRRITATION, GIVING RISE TO MENORRHAGIA AND AMAUROSIS—OPERATION—CURE.

A single lady, æt. 35, came under my care in 1863. Had been out of health for some years, suffering from continuous menorrhagia, seldom being free more than ten days or a fortnight in the month. Was thin and spare in appearance; often complaining of headache, especially over the brow and orbits; and, in fact, nearly a confirmed invalid. Latterly she had become almost blind from amaurosis; she could only read the largest type, and not at all by candle-light. Had come to London from the country, and placed herself under the care of one of the most eminent ophthalmic surgeons, who had treated her for three months without the slightest benefit. When I saw her I immediately discovered that long-continued peripheral excitement had caused all her disorders. Quickly after the operation, menstruation became regular; in ten days she was able to read in bed; in a month she was quite well. I frequently hear of her now, as in robust health.

_Remarks._—Beyond a grain of opium after the operation, this patient never had any medicine. I have had other cases exactly similar, with like result.

CASE XXI. SPINAL IRRITATION—LOSS OF POWER IN LOWER EXTREMITIES—OPERATION—RAPID IMPROVEMENT.

Last year I was requested to see a lady, æt. 46, who had been married to a second husband seventeen years without issue, but had two children by her first marriage. Had not menstruated for two years. Has been in ill health for many years, and undergone a variety of medical treatment without benefit. In May, 1863, first began to lose the power of her legs, and to suffer from attacks of pain in the back, shooting up to the spine. She was at this time in Paris, where she consulted several men of eminence, and was treated for uterine disease, but still without benefit. She returned to London in June, 1863, and placed herself under the care of her usual medical attendant. Relief, after some time, not being afforded, she consulted several eminent surgeons in the metropolis. She was told that she had paralysis of the lower extremities, and that nothing could be done with a hope of effecting cure. From January, 1865, she was for six months under the care of an eminent general practitioner, who exhausted the resources of his art, but in vain. She was, in fact, “given up.”

As a last resource, I was applied to. I saw her in August at her own house. Her countenance had a worn and haggard expression; her body was emaciated; skin harsh, dry, and scaly; the lower extremities hung as if paralyzed, but sensibility and voluntary motion—the latter, however, very weak—were not entirely absent. She complained of severe spasmodic attacks of agonizing pain shooting up the spine, like tetanic shocks. Her appetite was very defective, digestion was impaired, the bowels disordered, and sleep was hardly ever procured. There was also partial ptosis of the left upper eyelid. On examination, I found a deep and acutely painful fissure, with large piles and loose skin around the anus, and all the well-marked signs of peripheral irritation of the clitoris.

August, 1865. I operated, Dr. Kidd administering chloroform. I divided the fissure, tied the piles with three ligatures, cut off the loose skin around the anus, and removed the clitoris and elongated labia in my usual manner.

It was gratifying to observe the early relief of her more severe symptoms; by the third day the spasmodic attacks ceased, little or no pain was complained of, and the improvement of the digestive system was most marked, the patient enjoying chops, game, &c., within ten days, and no longer “a martyr to flatulence and dyspepsia.” The digestion was, however, easily deranged, and great care was necessary. At the end of seven weeks, having already on several occasions been driven out in a carriage, she was removed to the country, where she remained for three weeks. It may be here stated that the patient suffered much from the very sultry weather of September, and that improvement was much more rapid when colder weather set in. On her return, she was able to stand for a few minutes with her hands resting on the shoulders of another. 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 hands and feet, and is able to walk across her room, holding the hands of her maid, who retreats before her. She sleeps well every night, and her digestion is in very fair order. She is now able to sit up to all her meals, and to sit in an upright chair for hours together, whereas formerly she was constantly in the recumbent position.