[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIII., No. 8, 1890.] 
THE IMPORTANCE OF A CORREQT CLINICAL HISTORY IN 
OPERATIVE GYNECOLOGICAL CASES. 
BY 
I. 8. STONE, M.D., 
Lincoln, Va. 
Some months since the writer prepared a paper for the 
Nashville Session of the American Medical Association, enti- 
tled " Psychical Results of Abdominal Operations." The re- 
sult of the investigation clearly proved that in most cases 
where insanity followed such surgery there was a history of 
mental aberration pre-existing, and that heredity figured as an 
etiological factor. 
The following case is noted, to show how easily one may 
overlook the history of such symptoms: 
Miss , age 35, single, was sent to me in May for Bat- 
tey's operation. She had been an invalid for ten years, hav- 
ing hysteria from uterine and ovarian causes. She was treated 
for retro-displacement and fixation of the uterus and menor- 
rhagia in 1889, and had her uterus dilated and curetted. 
The treatment instituted not having been found beneficial, 
but, in fact, rather harmful, it was decided, after careful ex- 
amination and consultation, to open the abdomen and ascer- 
tain the cause of the trouble. 
The left ovary was found very small (cirrhotic ?); the right, 
cystic to such an extent that it looked like a small cluster of 
grapes; firm adhesions on the right side, the separation of 
which permitted easy motion of the uterus, as was confirmed by 2 
STONE : CORRECT CLINICAL 'IISTORY IN OPERATIVE CASES. 
vaginal examination at the time ; appendages on both sides re- 
moved. The patient had no sign of peritonitis, so far as pain, 
distention, or other interference with the bowels was concerned. 
But there were other interesting phenomena to mention. On 
the third day temperature 102°, pulse 130 to 140 ; the heart 
plainly to be heard across the room ; the face not anxious ; no 
sign of peritonitis, but certain peculiar mental symptoms be- 
gan to show themselves. She was deluded in regard to many 
things, but not violent. Her nurse could do nothing for her 
without giving offence, and anew one was selected. This con- 
dition continued for three days, when she was given chloral- 
amid and sulfonal, with good results. She also took bromide 
of potassium and tincture of digitalis, which had a beneficial 
effect in controlling the violent action of the heart. The 
patient was hungry all the time, and had a natural movement 
of the bowels each day during the two weeks in bed. She 
sat up on the tenth day, looked well, and had full diet. The 
history given by the patient herself afforded no suggestion of 
insanity, nor did her physician, a man of more than average 
ability, allude to a history of mental disease; yet upon close 
inquiry it appears that her mind has been on more than one 
occasion far below the standard of health. I attribute her 
rapid pulse and increased temperature to her mental condition 
entirely. 
It is quite possible that this case would be considered one of 
psychosis due to operation, by those who have reported cases. 
There can be no reasonable doubt of the operation having 
been the exciting cause of this attack, but it is equally true 
that any shock might temporarily unbalance a nervous and 
mental equipoise which, by reason of previous attacks, had 
been greatly disturbed. 
The patient has entirely recovered, and appears well in 
every way, save the slightest tendency to insomnia. 
In conclusion I would urge upon the profession the great 
importance of careful inquiry upon this point; and to those 
who are influenced by the statistics of Dr. Keith, I would say 
that Mr. Tait (with all his immense experience) has had 
only two cases of insanity as a result of operative work. One 
of these was shown to have had former symptoms, and the 
other was apparently the result of the anesthesia.