A CASE OF HYSTERO-EPILEPSY SUCCESSFULLY TREATED BY REMOVAL OF DAMAGED UTERINE APPENDAGES

Lawson Tait
1887 The Lancet  
THE husband of this patient, a well-known physician in Rome, applied to me early in August concerning the sufferings of his wife, and he has given me the following history of the case. She was thirty-three years of age last July; she was married at eighteen; the first child was born ten months afterwards, the labour being natural and the convalescence perfect. In 1874 she aborted at the third month, the pregnancy being twins. The came of the abortion was accredited to an accident, by which she
more » ... dent, by which she fell downstairs. This abortion was followed by pelvic peritonitis on the right side, which seemed to centre in the Fallopian tube, and she was unable to leave her bed for three months. One year afterwards she aborted again, and on this occasion a similar inflammatory attack occurred on the left side; but she was not so severely ill as on the previous occasion. Her second convalescence, however, was very protracted; she never regained her ordinary strength; was unable to walk without suffering from pain in the pelvic fossa, which was greatly intensified at each menstrual period; and ever after the first abortion she was altered in temperament, and became exalt6 and irritable. For four years after the second abortion marital intercourse had to be avoided on account of the intense suffering it occasioned. In the spring of 1885 she was attacked for the first time with a convulsion, which lasted for about an hour, and similar attacks were repeated for two months, twice in twenty-four hours, which were very violent, sometimes requiring five or six persons to hold her. During the following two months they diminished somewhat in violence, in length, and in frequency, and quite disappeared in May, 1885. During that time she made frequent attempts at suicide, and her husband did not consider it safe to leave her without the constant presence of a nurse day and night, until December of the same year. During 1886 she had no attack, but was very feeble, very highly excited at times, and alternately in a condition of despondency. On Jan. 2nd, 1887, she was suddenly seized with violent trembling, which passed into convulsions, and these lasted for four hours. Similar attacks occurred daily, sometimes twice a day, until the middle of March. On May 15th she was removed from Rome to Lugano, it being her husband's intention, as soon as she was able to travel, to bring her to England for the purpose of having an operation performed for the removal of the uterine appendages. At Lugano she had a period, during which she was worse than ever ; for most of the time she was in a condition of convulsion, and for the greater part she was unconscious. I Her husband communicated with me by letter on August 5th, to tell me of her condition. His letter is as follows: The day before she was to start she was again seized worse than ever, the convulsions lasting from three to four hours, followed by wild delirium; for days she had no sleep. This continued for eight days, then she began to improve, and I was hopeful of getting her to England by easy stages. But ten days since she became worse, and the mania that followed was of a suicidal character. I am satisfied nothing will be of service except removal of the uterine appendages, as those on the right side have been diseased for the last eleven years. During the present attack there has been great tumefaction over the right ovary and tube, with fever and intense pain. Four days since a considerable quantity of fetid, greenish-yellow pus escaped from the uterus; in my opinion it came from the tube. Since then she has been better, and there has been less tumefaction. I cannot operate on my own wife, and I propose that you should do the operation. Please write and tell me when I had better bring her." I replied by telegram that it seemed to me impossible to move the patient under such circumstances, and that I would run over to Lugano for the purpose of placing my services at his disposal. He replied by telegram to the effect that she was too ill to permit ot such delay, and Professor Porro of Milan was called to see her. On Aug. 17th I received from the husband the following letter: " Professor Porro commenced his operation yesterday at 11 o'clock, and finished by abandoning it at a quarter-past 12. He made an incision three inches and a quarter long. He says both tubes and ovaries were so densely adherent that it was impossible to separate them from the mass of organised tissue in which they were embedded. The slighter adhesions he broke up, and then crushed the base of the ovaries with strong forceps, with the hope, he says, of partly destroying their function. He wished me to feel the attachments, but I declined, as I preferred to leave all responsibility with him. She suffers dreadfully. I give her as much morphia as I dare, but there seems no possibility of controlling it entirely. There is constant nausea and vomiting; the pulse is very weak and compressible (80); temperature 99°. If my poor wife recovers sufficiently, and you think there is a possibility of help in the future, I shall bring her to you." She recovered from the operation, and on Aug. 30th I received a letter from the husband to the effect that he was coming over to England to confer with me on the subject of future interference. But on his road he received in London a telegraphic despatch that all the symptoms, including the violent convulsions, had returned with, if possible, greater severity. To continue the history from that day in his own words: " I told Dr. Solaro of Lugano, in whose care I left her, that I expected a return of the convulsions, and in the event of that happening he was to notify to me immediately, when I would return with Mr. Lawson Tait, as the appendages must then be got out at any risk. On Sept. 18th I received a letter from my daughter stating, '-Your worst fears have been realised, the convulsions have returned as bad as ever, and she remains unconscious.' Next morning came a telegram which informed me that four violent convulsions had occurred in thirty hours, and this was followed by another that she was insane. I replied, 'Send to the asylum for help; I leave here to-night with Tait.' I saw him in Birmingham next morning, and he left with me by the ne.t continental express, reaching Lugano on the 22nd. He operated on the 23rd with an incision not over two inches, and removed the appendages from both sides without any apparent difficulty. The operation from commencement to finish occupied exactly nine minutes and a quarter. The patient has had no trouble since; is bright and cheerful; has a better appetite than at any time during the last three years; the expression of the face has entirely changed ; the old, haggard, anxious, irritable look has gone, and in the place is a contented, peaceful expression. I can only conclude by saying your skill has saved the reason and life of my wife.' At the operation I found the uterine appendages, as Professor Porro had, densely adherent, both tubes occluded, and contained certainly not more than a teaspoonful each of limpid serum. The patient has had up to the present time no return of her previous symptoms. I can, with such a narrative, only say that it is idle to talk of hydrosalpinx being a harmless condition which may be always left alone. Birmingham. As this subject is now being discussed, 1 venture to summarise briefly the operations in the Kashmir Mission Hospital since 1881. In that year Dr. Downes (now of Eastbourne) performed Spanton's operation in eight cases, of which one recurred at the time, and I have since seen another with recurrence. In the following year he performed three Spanton's, and three by ligature and excision of the sac (Annandale's operation). Of the latter, one died; of the former, one recurred. In the same year (1882), I performed two Spanton's operations, in 1883 I performed six Spanton's operations, of which one recurred, and two by ligature and excision;
doi:10.1016/s0140-6736(00)30742-5 fatcat:crjlkuwkcjcipf3326m3kfzbde