ON THE CURABILITY
OF CERTAIN FORMS OF
INSANITY, EPILEPSY, CATALEPSY,
AND
HYSTERIA IN FEMALES.
BY
BAKER BROWN, F.R.C.S. (EXAM.)
SENIOR SURGEON TO THE LONDON SURGICAL HOME;
LATE SURGEON-ACCOUCHEUR TO, AND LECTURER ON MIDWIFERY AND DISEASES OF
WOMEN AND CHILDREN AT, ST. MARY’S HOSPITAL;
LATE CONSULTING SURGEON TO THE WESTBOURNE DISPENSARY AND PADDINGTON
LYING-IN CHARITY;
PRESIDENT OF THE MEDICAL SOCIETY OF LONDON;
FELLOW OF THE OBSTETRICAL SOCIETY OF LONDON;
MEMBER OF THE HARVEIAN SOCIETY;
CORRESPONDING FELLOW OF THE OBSTETRICAL SOCIETY OF BERLIN;
HON. FELLOW OF THE GENERAL ASSOCIATION OF SURGEONS, NORTHERN GERMANY;
MEMBER OF THE BROOKLYN MEDICAL AND SURGICAL SOCIETY;
CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF PESTH;
CORRESPONDING MEMBER OF THE SOCIETY OF MEDICAL SCIENCE OF BRUSSELS;
CORRESPONDING MEMBER OF THE PHYSIO-MEDICAL AND STATISTICAL SOCIETY OF
MILAN;
HON. CORRESPONDING MEMBER OF THE MEDICAL SOCIETY OF NORWAY, ETC.
[Illustration]
LONDON:
ROBERT HARDWICKE, 192, PICCADILLY, W.
1866.
COX AND WYMAN,
ORIENTAL, CLASSICAL, AND GENERAL PRINTERS,
GREAT QUEEN STREET, W.C.
TO DR. E. BROWN-SÉQUARD. F.R.S., &c.
DEAR DR. BROWN-SÉQUARD,
I am deeply indebted for your kind permission to
dedicate this work to you. I feel assured that its introduction to the
Profession under the auspices of the greatest physiologist of the day
will secure for it greater consideration, and lead to a closer
examination of its contents, than would otherwise have been the case.
With the greatest respect, believe me to be,
Most faithfully yours,
I. BAKER BROWN.
17, CONNAUGHT SQUARE, HYDE PARK, W.
_March, 1866._
PREFACE.
In offering this little book to my professional brethren, I do not for
one moment wish it to be understood that I claim any originality in the
surgical treatment herein described.
Having read with great interest the Lectures on the “Physiology and
Pathology of the Central Nervous System,” delivered by Dr. Brown-Séquard
before the Royal College of Surgeons of England, in 1858, and published
in _The Lancet_, I was struck with a fact much insisted upon by the
learned physiologist, namely, the great mischief which might be caused
in the system generally, and in the nervous centres especially, by
peripheral excitement.
Constantly engaged in the treatment of diseases of the female genitals,
I had been often foiled in dealing successfully with hysterical and
other nervous affections complicating these lesions, without being able
to assign a satisfactory cause for the failure. Dr. Brown-Séquard’s
researches threw a new light on the subject, and by repeated observation
I was led to the conclusion that the cases which had puzzled me, and
defied my most carefully-conceived efforts at relief, depended on
peripheral excitement of the pudic nerve. I at once subjected this
deduction to a surgical test, by removing the cause of excitement. I
have repeated the operation again and again, and it is the object of
this book to show the results.
Daily experience convinces me that all unprejudiced men must adopt, more
or less, the practice which I have thus carried out; and I have no doubt
that, in properly selected cases, it will prove as successful in their
hands as in mine.
It will be observed that the majority of the cases I publish have been
taken from the records of the London Surgical Home. I have drawn my
illustrations chiefly from this source, because the practice of the
Institution being freely open to the profession, the cases have been
observed by numerous medical men; and, I may add, that many have become
firm converts to my views.
ON THE
CURABILITY OF CERTAIN FORMS OF
INSANITY, EPILEPSY, CATALEPSY,
AND
HYSTERIA IN FEMALES.
CHAPTER I.
INTRODUCTORY.
As the title of this book implies, I do not intend to occupy the
attention of my readers with all the numerous varieties of insanity and
other nervous disorders to which females are liable, but only those
which I believe to be curable by surgical means; nor is it my intention
in this category to include slight cases, but to confine myself to such
as cause more or less severe functional derangement, or which lead to
serious organic lesions.
The class of diseases on which I shall dwell are those depending on (or
arising from) a loss of nerve tone, caused by continual abnormal
irritation of a nerve centre.
This is no very new theory; but it has been for Dr. Handheld Jones, by a
large number of cases and experiments, as collated in his admirable work
on “Functional Nervous Disorders,”[1] to make it “abundantly clear that
the great majority of disorders we have to treat at the present time
show more or less marked indications of failure of nervous power.” Dr.
Jones confines himself “to such disorders as are termed functional;” and
I agree with him that “it seems a vain dispute, whether in strict
accuracy there are, or are not, any such disorders; ... for it is
perfectly certain that there are very grave disorders in which the most
careful scrutiny fails to detect any actual change, in which complete
recovery is perfectly possible, and in which the ‘juvantia’ are such as
to operate more in modifying the power of the organs than the texture.”
Dr. Jones then gives two typical cases of functional and organic
disease, between which, as he justly observes, “there intervene numerous
instances of more or less mixed character;” and adds, that “disease
which commences essentially as functional may end as organic.”
Footnote 1:
London, Churchill, 1864.
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; and
hope to show how, on the basis of Dr. Jones’s experiments, it is
possible to prove the philosophy of my own practice.
Whichever of the terms, “inhibitory influence” (Handfield Jones and
Lister), “reflex relaxation” (Brinton), or “reflex paralysis”
(Brown-Séquard), be used, the fact is ceded by all, that “the energetic
operation of an afferent nerve” (Lister), or some impression acting
injuriously on an afferent nerve (Handfield Jones), or, again, “an
actually existing irritation” (Brown-Séquard), exerts an injurious
effect on its nerve centre, this state being, as Dr. Brown-Séquard
thinks, increased or diminished according to the activity of the
irritation, and ceasing with its entire removal, or, more probably, as
Dr. Handfield Jones affirms, persisting after the cessation of the cause
which has morbidly affected it. This latter view appears to me the more
generally correct one, because it can hardly be expected that a gradual
disease will be suddenly removed, there having been no time for recovery
of nerve power.
In Dr. Handfield Jones’s Lumleian Lectures, delivered last year before
the College of Physicians, he thus sums up his views on this
subject:—“The essential idea of the inhibitory theory is, that an
impression conveyed to a nervous centre by afferent nerves may weaken or
paralyze, instead of exciting, its action, either from the congenital or
acquired debility and sensitiveness of the nerve itself, or because the
impression is unduly intense or absolutely injurious. Both these things
have in every case to be considered—viz., the state of the nerve force,
and the kind and amount of impression, as the resulting phenomena will
vary with the variation of either.”
Dr. Jones next takes it as a matter of certainty, “that a nervous centre
may be more or less completely paralyzed without having undergone
organic change, in consequence of some enfeebling morbid influence;” and
quotes from Dr. Gull[2] “a most interesting instance of complete
paraplegia induced by sexual excess, in which nothing abnormal could be
detected in the cord, even by careful microscopy. This was paralysis
from simple exhaustion.”
Footnote 2:
“Guy’s Hospital Reports,” 1858. Case xvii.
Still continuing, Dr. Jones draws attention to the anatomical fact of
the remarkably close manner in which “the different nerve centres, or
parts of a nerve centre, are connected by commissural fibres,” and how,
“from a pathological point of view, the same connexion is often very
manifest. The general exhaustion induced by excess of venery,” and other
cases, “are examples which show how excessive consumption of nerve force
in one part weakens it also in others; and this can only be adequately
explained by the intricate commissural connexion between the various
centres.”
The truth of all these views is well exemplified, as Dr. Kidd has
stated, in cases of epilepsy, which “may originate only in irritation of
bad teeth acting on the brain, or worms irritating the nerves of the
stomach, and so on as to other peripheral irritations; the chief skill
being to find out the spot from which the irritation radiates.”
A case is also quoted by Dr. Jones, in the Lumleian Lectures, as having
occurred in the practice of Mr. Castle, of New York, where diseased
teeth produced paraplegia, which soon ceased after their removal.
Long and frequent observation convinced me that a large number of
affections peculiar to females, depended on loss of nerve power, and
that this was produced by peripheral irritation, arising originally in
some branches of the pudic nerve, more particularly the incident nerve
supplying the clitoris, and sometimes the small branches which supply
the vagina, perinæum, and anus.
Closer observation satisfied me that the greater or less severity of the
functional affections observed, depended on the amount and length of
irritation, and the consequent amount of loss of nerve power.
Nor are functional disorders the only consequence, but in some cases,
severe organic lesions.
The progress of the disease may be divided into eight distinct
stages—No. 8 being arrived at, by gradations more or less distinct,
directly from No. 1.
1. HYSTERIA (including dyspepsia and menstrual irregularities).
2. SPINAL IRRITATION, with reflex action on uterus, ovaries, &c., and
giving rise to uterine displacements, amaurosis, hemiplegia,
paraplegia, &c.
3. EPILEPTOID FITS, or HYSTERICAL EPILEPSY.
4. CATALEPTIC FITS.
5. EPILEPTIC FITS.
6. IDIOTCY.
7. MANIA.
8. DEATH.
My statement, that death is indeed the direct climax of the series,
might be proved by several cases which have occurred in my own practice,
one only of which I shall relate. Before doing so, I may mention that
Dr. James Russell, of Birmingham, has recorded a case in the _Medical
Times and Gazette_, Oct. 31, 1863, in which a male patient, æt. 32, died
under his care in the Birmingham General Hospital. Complete paralysis
both of sensation and motion in the lower part of the body and lower
extremities attacked him after an unusually excessive venereal
indulgence. There had been gradual exhaustion for the last twelve or
fourteen years, from this cause. There was no attempt at recovery, and
he died in four months from the date of the attack.
The case that occurred in my own practice was as follows: ——, æt. 19,
has been gradually becoming ill since the age of nine; does not look
older than the latter age, though the sexual organs are as highly
developed as they should be. Has been for many months in a metropolitan
hospital suffering from acute headache, but has received no benefit. For
two years has been perfectly blind.
She was found dead, and with every evidence of having expired during a
paroxysm of abnormal excitement.
These cases will illustrate how important it is to arrest the disease
_ab initio_, and the treatment must be the same whether we wish to cure
functional disturbance, arrest organic disease, or, finally, if we have
only a chance, of averting death itself.
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.
I have pleasure in stating that, with reference to the origin of most
nervous affections of females, I have, in frequent conversation with
Brown-Séquard, found that the views of this distinguished physiologist
entirely coincide with my own, and he often expressed himself as
satisfied that destruction of the nerve causing irritation was the only
effective cure; the best mode of carrying out this destruction was, in
his opinion, yet to be determined. He used actual cautery.
I hope to be able to show that a far more humane and effectual method is
that which I constantly practise, and for the last six or seven years
have openly and consistently advocated. Of course, from the very novelty
of these views, I have been met with many objections, such as unsexing
the female, preventing the normal excitement consequent on marital
intercourse, or actually, as some most absurdly and unphilosophically
assert, causing sterility: whereas my cases will show fact to be
directly converse to all these theories; and it is curious that a
physician for many years connected with one of our largest metropolitan
hospitals, and recognized as a standard writer on female diseases, has
in writing condemned my practice in not very measured terms, but is
himself constantly in the habit of trying to subdue this peripheral
irritation by continual application of the strongest caustics to the
seat of the irritation; thereby showing that he recognizes the source of
evil, but is not yet able to see that a superficial sore will not
destroy deep-seated nerve irritation. It wants, I imagine, little
argument to prove that so far from this practice being beneficial, it is
likely, by causing increased irritation, to be positively injurious.
Other practitioners follow Dr. Brown-Séquard’s plan of applying actual
cautery to the irritant nerve; and many more have advanced as far as the
operation—which I was formerly in the habit of practising—subcutaneous
division of the nerve. I have long abandoned this method as being no
more certain in its effect than kindred operations on various branches
of the fifth nerve for tic doloureux.
Another objection has been made that several of my cases have not been
permanently cured, but have had relapses in a few weeks or months. This
must necessarily be so with all new methods of treatment; but each such
case is of incalculable importance, as teaching me to exclude any but
temporary hope of relief to some, while to others I can speak all the
more positively as to their ultimate permanent recovery.
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.
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.
A striking instance of this kind occurred to me last year.
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, irritation,
resembling pruritus, gradually returned, and with it the other old
symptoms.
In all cases of a similar nature which have come under my care, I have
insisted on the importance of the patient being kept for a long time
under careful medical watching and good nursing, and from the results
already obtained from cases in which these precautions have been
exercised, I feel confident of success for the future.
Lastly, objections have been advanced against the morality of the
operation, and I am here at a loss how to give an answer, for I can
hardly conceive how such a question can be raised against a method of
treatment which has for its object the cure of a disease, that is
rapidly tending to lower the moral tone, and which treatment is dictated
by the loftiest and most moral considerations. I may here observe, that
before commencing treatment, I have always made a point of having my
diagnosis confirmed by the patient or her friends.
To the philosophical and charitable mind, indeed, the whole subject is
one of the greatest interest, and will lead us to ask the question, may
not this “inhibitory influence,” originating in early life, act so
powerfully on the mind as to unhinge it from that steadiness which is
essential to enable it to keep the passions under control of the will;
to enable, indeed, the moral tone to overcome abnormal excitement? And
if this be true, does not common charity lead us to think that cases
treated by friends and spiritual advisers, as controllable at the will
of the individual, may be in reality simply cases of physical illness
amenable to medical and surgical treatment? Is it not better to look the
matter steadily in the face, and instead of banishing the unhappy
sufferers from their home and from society, endeavour to check their
otherwise hopeless career towards some of the latter stages of this
disease, to restore their mental power, and make them happy and useful
members of the community?
On this consideration I shall not now dwell further. Every one must feel
it to be a vast and important one, affecting the well-being of the whole
human race.
All I am now aiming at, is to show that many, if not all, such cases may
be cured. If this is done, I shall indeed be able to say that I am amply
repaid.
I have the gratification of being able to name the following gentlemen
who have been led to adopt my views and treatment in proper cases:—Sir
James Simpson; Dr. Beattie, of Dublin; Sir John Fife and Dr. Dawson, of
Newcastle-on-Tyne; Dr. Duke, late of Chichester; Dr. Shettle, of
Shaftesbury; John Harrison, Esq., of Chester; Drs. Savage, Routh, and
Rogers, in London; my eldest son, Mr. Boyer Brown, now practising in New
South Wales; with my colleagues in the “London Surgical Home,” Dr.
Barratt, and Messrs. Harper, Chambers, I. B. Brown, junior, and Bantock,
and very many others.