CHAPTER V.

EPILEPTOID CONVULSIONS, OR HYSTERICAL EPILEPSY, WITH CASES.

In the chapter on hysteria, cases have been recorded of frequent faintings, without spasms, and of spasmodic twitchings of limbs without fainting, _i.e._ without loss of consciousness. We now come to cases more marked and chronic, and having many of the characters of epilepsy. They may be brought to us by the friends of the patient as genuine epileptics. The diagnosis is in some cases difficult, but for the most part easy. Dr. Russell Reynolds[4] has summed up the distinctive features so ably that I cannot do better than quote his final remarks on this subject:—

Footnote 4:

“Epilepsy: its Symptoms, Treatment, and Relation to other Chronic Convulsive Diseases.” By J. Russell Reynolds, M.D. London: Churchill, 1861.

“The paroxysm resembles epilepsy, and sometimes closely, but it differs in essential particulars. The difference is not one only of degree, neither is it to be determined by the relation of hysterical convulsion to pain, nor solely by the nature of the spasm. The diagnosis is to be based upon a combination of features. The paroxysms follow hysteric prodromata. At their onset there is constriction of the throat and epigastrium; there are plaintive cries, sobbings, or laughings, which reappear at the close; _sensibility, perception, and volition are rarely, if ever, completely lost_; the face undergoes little change; there is a twinkling movement of the eyelids; there is no marked dilatation of the pupil; _there is rarely foaming or bitten tongue_; the attacks are of long duration; respiratory movements are disorderly, but there are no evidences of marked asphyxia; the pulse is small; there is no stupor, but only general exhaustion after the attack; and although the paroxysms may recur for many years, and be followed by a peculiar kind of mania, they are rarely followed by dementia.”

I fully agree with Dr. Reynolds that what are called the “diagnostic signs of hysteria,” as frequent micturition of clear pale urine, tympanitis, nausea, &c., have no value in aiding our inquiry as to the nature of these fits: they may be witnessed, and with as great frequency, after epileptic seizures.

One practical point exists; namely, that in hysterical epilepsy the patient seldom, I believe never, in falling hurts herself, whereas true epileptics frequently suffer considerable bodily injuries.

CASE XXII. NINE YEARS’ ILLNESS—EPILEPTIFORM ATTACKS—THREE YEARS’ DURATION—OPERATION—CURE.

G. M., single; admitted into the London Surgical Home December 18, 1860.

_History._—For the last nine years has suffered greatly and regularly during the menstrual periods. Has been much worse for the last three years, during which time has, at each menstrual period, been frequently taken in a fit, dropping down suddenly and fainting right off; this state lasting for two or three hours. Being in service, this has caused her much trouble, as none of her employers would keep 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. In July she was well enough to return to service.

April, 1865. Her mother called at my house to say that this patient had been married some months, and was shortly expecting her confinement. She had remained quite well since the operation.

CASE XXIII. EPILEPTOID FITS—FIFTEEN YEARS—ILLNESS FOR TWENTY-SIX YEARS—OPERATION—CURE.

F. A. C., æt. 41, single; admitted into the London Surgical Home Nov. 6, 1863.

_History._—Says she had congestion of the brain fifteen years ago; since that period cannot remember being well, but from the age of fifteen has been of delicate health. Has suffered from fits for the last fourteen or fifteen years; is never long free from them. During an attack she is not entirely unconscious, but possesses no power to control them nor to speak. Has pain at lower part of spine of a gnawing character. She is a miserable, nervous creature, with pinched features and a wandering restless expression of the eye. There is evidence of injurious peripheral irritation since a very early age.

Nov. 12. Operation as usual under chloroform.

Nov. 19. Is wonderfully better. The expression of her face is much happier, and the face itself has filled out considerably. No pain in the back since the operation.

Dec. 24. Discharged perfectly cured.

CASE XXIV. HYSTERICAL EPILEPSY—LONG DURATION—OPERATION—CURE.

G. C., ÆT. 25; ADMITTED INTO THE LONDON SURGICAL HOME JAN. 28, 1864.

_History._—Has been delicate from childhood. For some months has suffered from a peculiar dragging pain in the lower part of the abdomen. Menstruates regularly. Suffers from “burning” and irritability of bladder. Has constant and severe headache. Has for a long time suffered from “epileptic fits” (on careful observation they were found not to be genuine epileptic), occurring twice or thrice a week. Is a melancholy object, with “woe-begone” expression; listless and indifferent to conversation and surrounding objects; when spoken to, does not answer rationally, and frequently only in monosyllables. Is very reserved and taciturn.

Feb. 4. Patient being under chloroform, the clitoris was excised.

Feb. 13. Progressing favourably; much improved in appearance; more cheerful; converses freely and rationally; expresses herself as grateful for her restoration to health.

March 1. Having had no return of the fits, and lost all her hysterical symptoms, she was discharged cured.

CASE XXV. HYSTERIA AND EPILEPTIFORM ATTACKS—MANY YEARS’ ILLNESS—OPERATION—CURE.

R. D., æt. 31; admitted into the London Surgical Home Feb. 17, 1864.

_History._—Married eight years, with one child. Her husband is in the navy, and often absent from home. 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.

Feb. 18. Clitoris excised.

Feb. 24. Much improved, free from pain or difficulty in micturition. Is quite cheerful, and has had no attack since the operation.

March 26. Still gaining strength, looks much better, and says she now feels well.

March 28. Discharged cured.

CASE XXVI. EPILEPTIFORM FITS AND GENERAL HYSTERIA—FOUR YEARS’ DURATION—OPERATION—CURE.

Mrs. F., æt. 44; admitted into the London Surgical Home April 23, 1864.

_History._—Married sixteen years, but her husband has been abroad for the past seven years. Had inflammation of the womb four years ago, and since that time has continually suffered from bearing-down pains. Frequent desire to micturate. Pain in the loins and spine, sleepless nights, loss of appetite, and other hysterical symptoms. 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.

April 30. Progressing most favourably. Patient expresses great gratitude for the relief she has obtained. She left the Home a month later, looking and feeling quite well; the last note in the case-book being “a very grateful patient.”

CASE XXVII. EPILEPTIFORM FITS—SIX YEARS’ DURATION—OPERATION—CURE.

F. W., æt. 33, single; admitted into the London Surgical Home May 23, 1864.

_History._—Has suffered from fits for more than six years, much more frequently the last six months; having now as many as four or five during the day—always one or two. The fits vary in length from one to three hours’ duration. Is conscious during the attacks, but unable to speak, or in any way to control them. Is invariably worse during the menstrual periods. Suffers from palpitation of the heart.

_Examination_ showed a highly inflamed and sensitive condition of the external generative organs; the patient herself confirmed my opinion of the cause of her attacks.

May 28. Clitoris excised—free hæmorrhage allowed before the dressings were applied.

June 12. Left her bed to-day; has had no fit since the operation, and says she feels well.

June 20. Takes daily exercise, is free from pain, the wound is healed, and her health daily improving. Action of the heart much more moderate.

July 19. Discharged cured, not having had one hysterical attack since the operation.

CASE XXVIII. HYSTERICAL EPILEPSY—THREE YEARS AND A HALF DURATION—OPERATION—CURE.

C. E. S., æt. 24, single; admitted into the London Surgical Home Oct. 17, 1864.

_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.

Oct. 20. The clitoris was excised.

This patient improved very rapidly; passed upwards of a month and a menstrual period in the Home without any return of the fits. All pain over the ovarian regions, and in the loins, &c., left her, and she was discharged Nov. 26, perfectly cured.