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. He has experienced great anxiety
and annoyance, and felt how unsatisfactory was his treatment to the
friends of his patient: and this, not so much because he was ignorant of
the cause, as that he was unable to offer any hope of relief.
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 fanciful 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. At first,
perhaps, dyspepsia and sickness will be observed; then pain in the head
and down the spine; pain, more or less constant, in the lower part of
the back, or on either side in the lumbar region. There will be wasting
of the face and muscles generally; the skin sometimes dry and harsh, at
other times cold and clammy. The pupil will be sometimes firmly
contracted, but generally much dilated. This latter symptom, together
with a hard cord-like pulse, and a constantly moist palm, are, my son
informs me, considered by Mr. Moore, Colonial Surgeon of South
Australia, pathognomonic of this condition. There will be quivering of
the eyelids, and an inability to look one straight in the face. On
inquiring further, there is found to be disturbance or irregularity in
the uterine functions, there being either complete cessation of the
catamenia, or too frequent periods, generally attended with pain;
constant leucorrhœa also frequently existing. 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 added, in the married,
distaste for marital intercourse, and very frequently either sterility
or a tendency to abort in the early months of pregnancy.
These physical evidences of derangement, if left unchecked, gradually
lead to more serious consequences. The patient either becomes a
confirmed invalid, always ailing, and confined to bed or sofa, or, on
the other hand, will become subject to catalepsy, epilepsy, idiotcy, or
insanity. In any case, and more especially when the disease progresses
as far as these latter stages, it will almost universally be found that
there are serious exacerbations at each menstrual period.
On personal examination, the peculiar straight and coarse hirsute
growth; the depression in the centre of the perinæum; the peculiar
follicular secretion; the alteration of structure of the parts, mucous
membrane taking on the character of skin; and muscle having become
hypertrophied and generally tending towards a fibrous or cartilaginous
degeneration; will all be recognized by the practitioner who has once
had his attention drawn to these subjects.
Having ascertained the cause and nature of the disease, there are one or
two points to be considered before operative measures are decided on.
First, as to age. 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. In children
younger than this, milder treatment with careful watching, will be found
sufficient if it be thoroughly persevered in.
There are again, after puberty, cases which give rise to but slight
disturbance, but in which the sufferers are they who love to enlist
sympathy from the charitable, and will be ill, or affect to be ill, in
spite of any and every treatment.
When I have decided that my patient is a fit subject for surgical
treatment, I at once proceed to operate, after the ordinary preliminary
measures of a warm bath and clearance of the portal circulation.
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.
The diet must be unstimulating, and consist of milk, farinaceous food,
fish, and occasionally chicken; all alcoholic or fermented liquors being
strictly prohibited. The strictest quiet must be enjoined, and the
attention of relatives, if possible, avoided, so that the moral
influence of medical attendant and nurse may be uninterruptedly
maintained.
A month is generally required for perfect healing of the wound, at the
end of which time it is difficult for the uninformed, or non-medical, to
discover any trace of an operation.
The rapid improvement of the patient immediately after removal of the
source of irritation is most marked; first in the countenance, and soon
afterwards by improved digestion and other evidences of healthy
assimilation.
It cannot be too often repeated, that this improvement can only be made
permanent, in many cases, by careful watching and moral training, on the
part of both patient and friends.
In the large majority of cases, I have administered no medicines,
trusting entirely to recovery, after the removal of the source of
irritation. Sometimes, however, we may be materially aided by the use of
such medicines as the bromides of potassium and ammonium, belladonna,
&c.