Chapter IV: Spinal Irritation, with Cases

There are perhaps few terms so difficult to define as spinal irritation, for the gradations from hysteria to this state are extremely easy; and, indeed, it will have been seen that in the foregoing chapter most of the patients complained of pain in the spine, and that there was more or less functional disturbance in all of them. The term is also used so freely and vaguely that great caution is necessary in attempting to explain its meaning. Dr. Handfield Jones’s term, “Spinal Paresis,” seems to me an excellent one; by it he means “a state in which, without demonstrable organic change, there is greater or less enfeeblement of the functional power” of the spinal cord. The sensory or motor power may be affected, but rarely both together.

The cause of spinal irritation, or paresis, may be defined in one word—“debility;” this debility always, or almost always, being due to inhibitory irritation.

This state of things may give rise to wide and varied disorders, all the symptoms of which are asthenic in their character, and all of which are marked by extreme nervous prostration.

Without doubt,—for all authors agree on this point, one of the most prominent causes is peripheral irritation of the pudic nerve, producing undue exhaustion.

It is difficult to say how this is produced, but most probably it is that, “owing to the intimate commissural connections between the lumbar enlargement of the cord, where the pudic nerves are implanted (they themselves being small and remote in their origin from the brain); and the superior and nobler nervous centres, the intense excitation of even a small and remote centre is communicated to the others, which, as this subsides, fall as much below, as they have previously been stimulated above par. The depression is proportional to the previous excitement.”

The cases I shall have to relate which may fairly be called cases of spinal irritation are few in number, for the reason I have stated, that they are but a continuation of hysteria,[3] and, indeed, but a state of things of which epileptiform and epileptic fits are the direct sequence.

Footnote 3:

_Vide_ Cases in previous chapter.

It is, however, well to draw attention to the fact that it is in cases of spinal irritation that we observe functional derangements, which are very likely to pass into actual organic diseases; and it is in this class of cases, which are essentially of a chronic character, that very long and persistent perseverance must be pursued. I would, therefore, advise all who meet with them to warn their patients beforehand that they must not be weary and faint-hearted if recovery do not come as soon as hoped for.

CASE XV. SPINAL IRRITATION, AND SUPPOSED UTERINE DISPLACEMENT—SIX YEARS’
ILLNESS—OPERATION—CURE.

In 1860, I was requested to see a young lady, æt. 20, of whom I had
the following history:—For six years she had been confined to a spinal
couch, and had also been supposed to suffer from retroversion of the
uterus. She had worn a spinal apparatus, attached to which was a steel
spring, pressing on sacrum and pubis, and intended “to support the
perinæum, and keep the uterus in position.” Had been treated with
caustics and other therapeutic agents for uterine disease. I found the
uterus normal in position and healthy in appearance; but on further
questioning and examination, I diagnosed peripheral irritation of the
pudic nerve. My opinion was strongly contested, as I was told that the
young lady was very religious; but, as I explained, her illness was to
be attributed solely to a physical condition, and was not at all
necessarily immoral; I was then met with the objection that, in the
event of marriage my operation might interfere with marital happiness
and prevent procreation. I explained how, physiologically, these
objections were untenable, but was then unable to adduce actual cases
in contradiction of them.

Ultimately I performed my operation in the usual manner. For want of
proper attention on the part of the nurse, the dressing was three
times displaced; but, nevertheless, at the end of a month this lady
was well enough to walk three miles.

Up to this date she has remained quite well.

CASE XVI. DYSMENORRHŒA—FIVE YEARS’ ILLNESS—OPERATION—CURE.

D. A., æt. 23; admitted into the London Surgical Home Aug. 4, 1863.

_History._—Has never been very strong; but five years ago had an
attack of gastric fever. Since then has suffered constantly from great
pain during the menstrual period. Occasionally loses a great deal, and
passes large clots of blood. During this time has suffered almost
constantly from leucorrhœa. Suffers severely from pain over region of
left ovary and in the spine. Is hardly ever free from headaches. Is
very restless; never sleeps well; frequently faints; and has little or
no appetite. All her ills are exaggerated at the menstrual epoch.

August 7. Usual operation performed.

Sept. 1. Is menstruating without pain.

Sept. 30. Again menstruating without pain, and in normal quantity. Is
to be discharged cured.

CASE XVII. SPINAL IRRITATION AND LOSS OF USE OF RIGHT LEG—FIVE YEARS’
ILLNESS—OPERATION—CURE.

M. B., æt. 30, single; admitted into the London Surgical Home Nov. 15,
1861.

_History._—Five years ago first began to suffer pain in the right leg,
which was ascribed to sciatica. Fourteen months since this pain became
so bad that she could not walk, and she lost all use of her right leg,
at the same time felt great weakness and pain in the back, preventing
her sitting. For eight months has been confined to a “spinal couch.”
Is a spare anæmic woman; dark hair and eyes; dilated pupils; very
restless and nervous in her movements, and of a very irritable temper.
Has suffered from peripheral irritation since an early age.

Nov. 26, 1861. Usual operation performed.

Dec. 27. She has gradually improved in health and temper since the
operation, and is now quite able to walk about her room without help.

She was a long time before her nerve tone was thoroughly restored, but
she ultimately got quite strong and continues well.

CASE XVIII. HYSTERIA AND SPINAL IRRITATION TWELVE YEARS—FISSURE OF
RECTUM, RECENT DURATION—OPERATION—CURE.

R. C. R., æt. 35 years, single; admitted into the London Surgical Home
April 15, 1861.

_History._—Has been suffering for nearly twelve years, at intervals of
from six months to six weeks, with pain in the womb and right side,
sudden spasms of the limbs, coming on at frequent and irregular
intervals. Great pain down the spine and lower part of the back and
loins. Has often attacks of severe sickness. Is usually costive. Has
lately suffered great pain in defecation. Catamenia regular. Great
want of sleep and appetite. Says she is always low-spirited, moping,
and listless. Has had much medical treatment.

_On examination_ there was found evidence of peripheral excitement of
the pudic nerve, and there also existed a fissure of the rectum.

April 18. The usual operation performed, and the fissure of the rectum
incised.

After this time defecation was performed without pain. Sleep,
appetite, and cheerful spirits returned. She had no more spasmodic
twitchings, but she still complained of intense pain in the back on
sitting and walking. She was discharged in June much relieved, but not
well.

Nov. 9 1861. I received a letter from this lady, stating that she now
suffered no pain and was perfectly well. She was stout, and better in
every respect than she had been for the last twelve years.

CASE XIX. MENORRHAGIA—MENTAL DELUSION—TWO YEARS’
ILLNESS—OPERATION—CURE—SUBSEQUENT MARRIAGE AND PROGENY.

A young lady, æt. 20, came under my care in 1863, having for two years
past suffered from almost constant menorrhagia, during which time she
had suffered great irritability of temper, been disobedient to her
mother’s wishes, and had sleepless nights, restless desire for
society, and was constantly seeking admiration; all these symptoms
culminating in a monomania that every gentleman she admired was in
love with her, and she insisted on always sending her _carte de
visite_ to her favoured one for the time being. In her quieter moments
she would spend much time in serious reading. On being consulted, I
quickly discovered that all these symptoms arose from peripheral
excitement, and that there existed no organic disease to cause the
menorrhagia. The usual plan of treatment was followed with the most
rapid and marked success. She went the full interval between the
ensuing menstrual periods, and the secretion was normal in quantity.
All her delusions disappeared, and after three or four months of
careful watching, with change of air, she was perfectly well in every
respect. A year afterwards she married, and ten months later gave
birth to a healthy son. She is now again pregnant.

CASE XX. SPINAL IRRITATION, GIVING RISE TO MENORRHAGIA AND
AMAUROSIS—OPERATION—CURE.

A single lady, æt. 35, came under my care in 1863. Had been out of
health for some years, suffering from continuous menorrhagia, seldom
being free more than ten days or a fortnight in the month. Was thin
and spare in appearance; often complaining of headache, especially
over the brow and orbits; and, in fact, nearly a confirmed invalid.
Latterly she had become almost blind from amaurosis; she could only
read the largest type, and not at all by candle-light. Had come to
London from the country, and placed herself under the care of one of
the most eminent ophthalmic surgeons, who had treated her for three
months without the slightest benefit. When I saw her I immediately
discovered that long-continued peripheral excitement had caused all
her disorders. Quickly after the operation, menstruation became
regular; in ten days she was able to read in bed; in a month she was
quite well. I frequently hear of her now, as in robust health.

_Remarks._—Beyond a grain of opium after the operation, this patient
never had any medicine. I have had other cases exactly similar, with
like result.

CASE XXI. SPINAL IRRITATION—LOSS OF POWER IN LOWER
EXTREMITIES—OPERATION—RAPID IMPROVEMENT.

Last year I was requested to see a lady, æt. 46, who had been married
to a second husband seventeen years without issue, but had two
children by her first marriage. Had not menstruated for two years. Has
been in ill health for many years, and undergone a variety of medical
treatment without benefit. In May, 1863, first began to lose the power
of her legs, and to suffer from attacks of pain in the back, shooting
up to the spine. She was at this time in Paris, where she consulted
several men of eminence, and was treated for uterine disease, but
still without benefit. She returned to London in June, 1863, and
placed herself under the care of her usual medical attendant. Relief,
after some time, not being afforded, she consulted several eminent
surgeons in the metropolis. She was told that she had paralysis of the
lower extremities, and that nothing could be done with a hope of
effecting cure. From January, 1865, she was for six months under the
care of an eminent general practitioner, who exhausted the resources
of his art, but in vain. She was, in fact, “given up.”

As a last resource, I was applied to. I saw her in August at her own
house. Her countenance had a worn and haggard expression; her body was
emaciated; skin harsh, dry, and scaly; the lower extremities hung as
if paralyzed, but sensibility and voluntary motion—the latter,
however, very weak—were not entirely absent. She complained of severe
spasmodic attacks of agonizing pain shooting up the spine, like
tetanic shocks. Her appetite was very defective, digestion was
impaired, the bowels disordered, and sleep was hardly ever procured.
There was also partial ptosis of the left upper eyelid. On
examination, I found a deep and acutely painful fissure, with large
piles and loose skin around the anus, and all the well-marked signs of
peripheral irritation of the clitoris.

August, 1865. I operated, Dr. Kidd administering chloroform. I divided
the fissure, tied the piles with three ligatures, cut off the loose
skin around the anus, and removed the clitoris and elongated labia in
my usual manner.

It was gratifying to observe the early relief of her more severe
symptoms; by the third day the spasmodic attacks ceased, little or no
pain was complained of, and the improvement of the digestive system
was most marked, the patient enjoying chops, game, &c., within ten
days, and no longer “a martyr to flatulence and dyspepsia.” The
digestion was, however, easily deranged, and great care was necessary.
At the end of seven weeks, having already on several occasions been
driven out in a carriage, she was removed to the country, where she
remained for three weeks. It may be here stated that the patient
suffered much from the very sultry weather of September, and that
improvement was much more rapid when colder weather set in. On her
return, she was able to stand for a few minutes with her hands resting
on the shoulders of another. Remaining in town for some weeks, she
again left for the sea-side, where she stayed about three weeks, and
returned to town in the beginning of this year. Her condition is now
as follows:—

She looks remarkably well in the face, which has entirely lost its
expression of suffering. She is free from pain. Sensibility in the
lower extremities is perfect; their muscular power is greatly
improved. She can raise herself from a chair so as to rest on her
hands and feet, and is able to walk across her room, holding the hands
of her maid, who retreats before her. She sleeps well every night, and
her digestion is in very fair order. She is now able to sit up to all
her meals, and to sit in an upright chair for hours together, whereas
formerly she was constantly in the recumbent position.