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Reports of Societies

1881 Boston Medical and Surgical Journal  
aspirated the chest in the sixth intercostal space in the line of the axilla. Finding thick pus he made a free opening, evacuating about six ounces. Carbolic spray was used ; a drainage-tube inserted, and Lister dressings applied. The dressings were changed June 23d, 27th, and 31st. On the first occasion 1 estimated that less than one half ounce of odorless pus and serum had escaped. At the subsequent dressings there was still less. On the eleventh day after the operation, finding the discharge
more » ... nding the discharge slight and all symptoms favorable, I removed the tube and dressed the wound with cosmoline, continuing the Lister dressing. The wound healed rapidly, but forty-eight hours after the removal of the tube she contracted a severe cold, coughed violently, and again an effusion could be detected, but not in large amount. She was also troubled with conjunctivitis. In ten days, however, there was decided improvement in regard to the cough, effusion, and conjunctivitis, and on the thirty-third day after the operation the effusion had entirely disappeared and air entered the lung freely. still we believe that a connection exists ; aud, still further, so far as organic cause can be assigned for the production of the neurosis, it must generally be referred to a chronic flexion of the uterus. Hewitt still further asserts he does not remember a single exception, as respects causation of hysteria, among all the cases he has observed. At the same time it is to be borne in mind we may have hysteria without flexion and we may have flexion without hysteria. We are further to consider that uterine disease acts only as an exciting cause of the hysterical disturbance ; back of this must be the irritable condition of the nervous system peculiar to the individual. Hysteria which has lasted for some time, and proceeded to such extent as to get beyond control of the patient, may eventuate iu another stage which has been called catalepsy ; and the so-called hysteria-epilepsy is an exaggerated type. The following illustrative cases were given : -An Irish servant-girl, sixteen years of age, always well up to six months before, when she strained herself by lifting a heavy tub of water and complained that something gave way. Had pain in back and vagina, painful micturition, severe headache, and was unable to stand long at a time. These symptoms, together with painful menstruation, increased until she began to suffer from trembling and vertigo, and finally convulsions attended with a period of unconsciousness. These attacks at last became as frequent as three or four in one day. Examination showed unusual hyperaesthesia of the parts, uterus prolapsed and retroflexed. The uterus was replaced and held in position by a Hodge pessary, which was worn three days, during which time she had no convulsion. Thereafter the instrument became displaced and finally dropped out, two hours after the loss of which a convulsion occurred. Another supporter was introduced and worn some time with complete success. Patient passed out of the care of the doctor for seven months, after which she reported she had worn a supporter all that time and had had no return of the convulsions. Case IL A teacher, twenty-four years of age, of nervous temperament, and who had overworked for the past three years. Presented a group of hysterical symptoms, chiefly marked by a dry, harsh cough, lasting several hours and ending in a kind of convulsion, this condition being especially prominent at the time of menstruation. Examination disclosed uterus markedly retroflexed and somewhat prolapsed. Introduction of a pessary, suitably adjusted, resulted in entire removal of hysterical cough and*allied symptoms. Case III. Dressmaker, thirty-six years of age, suffering from paroxysmal cough, with tendency to convulsion, attended with more or less of coma ; menstruation painful and difficult ; patient thought she had consumption, but examination disclosed heart and lungs healthy ; but vaginal examination revealed fixed retroflexion ; reposition was gradually effected by treatment and finally maintained by a Cutter pessary ; result, slow and steady, and at last complete, recovery from nervous symptoms. The author remarked in conclusion that while three cases could not establish much of themselves, they were still of great interest taken in connection with Hewitt's reports ; in all was present the invariable condition, namely, flexion of the uterus. If we look upon recovery as simply coincidence, it is surely a remarkable one, that it should take place immediately and invariably upon replacement of the uterus. The connection between hysteria and flexion may be difficult to explain ; but there is much evidence both that it is real and that such relation is too often overlooked by the profession. Dr. Warner asked if any other malposition of the uterus might not give rise to hysterical phenomena ; in his own experience had found anteversion more often responsible than any other displacement. Dr. Durell replied that his experience had naturally been limited, but, so far as it went, it emphatically supported the position of Dr. Hewitt, as already declared. Professor Nelson, of Chicago, being present by invitation, was called upon by the chair for an expression of his opinion. The doctor replied he would render his opinion on the subject of discussion rather by a series of questions than by positive assertion. And, first, in respect of physiological conditions, what is it in
doi:10.1056/nejm188109151051107 fatcat:6zvxd5qvabhzdotlqclpiowypq