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AHYSTERO-PSYCHOSIS.
EPILEPSY
DEPENDENT UPON
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EROSIONS OF THE CERVIX UTERI.
GEO. J. ENGELMANN. M

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      SAINT LOUIS:
REPRINT FROM ST. LOOTS CLINICAL RECORD.
       ' 1878. 
 
A HYSTERO-PSYCHOSIS.
Epilepsy  Dependent  Upon  Erosions  of  the
                    Cervix Uteri.
                   —t-
              BY GEO. J. ENGELMANN,  M. D.
  I have of late  endeavored  to  call attention  to a class of cases
which  I have described as hystero-neuroses;  cases which may
simulate the most varied diseases, but which are mere reflex phe-
nomena dependent upon uterine derangements and  are  distinctly
proven  to be so dependent by their disappearance upon cure of
the uterine affection by local treatment.
  The  subjoined case  is a reflex insanity following and caused
by disease of the womb,  a hystero-psychosis, or  more definitely,
a hystero-epilepsy ; hystero-epilepsy  proper—epilepsy with a ute-
rine causation—not hystero-epilepsy  as the term is used by alien-
ists, also  by Hammond and others, i. e., epilepsy in hysterical
women  or epilepsy accompanied by erotic manifestations.
  Mrs. O., a medium-sized brunette, aged twenty-eight, was first
menstruated in  her  fifteenth year  and married in her twenty-
fourth ;  period perfectly normal, both before and after marriage,
lasting  three days, never painful; has always been healthy;  no
hereditary taint.   She had one miscarriage, in  about the sixth
week, soon after marriage ; since then has borne two children, the
youngest of which is now eighteen months old.
  A few weeks  after the last confinement she first  complained of
that heaviness of the head, the  dizziness and languor from which
she has  suffered ever since; the epileptic attacks  appeared at the
same time, at first in a ven^ mild form,  once or twice a month, as 
2
St. Louis CLrNicAL Record.
 an oppression of the chest and a shortness of breath which would
 pass away in the course of five or ten minutes.
   These attacks rapidly increased  in frequency  and in severity,
 beginning in the same way with a shortness of breath,  an  oppres-
 sion, a feeling of constriction of the chest, then a twitching in the
 fingers, a spasmodic closing of the hands and she becomes uncon-
 scious ; convulsive movements of  the  arms and  opisthotonus fol-
 low ; this is sometimes so intense that the heels almost touch the
 head and  the  contraction of the  dorsal muscles has  been so
 sudden and so violent that the patient has hurled herself from the
 middle of the bed upon the floor by a single effort.
   During the attack, which lasts from ten to fifteen minutes, the
 patient is totally unconscious, eyes are closed, hands not firmly
 clinched,  thumbs not turned in;  a stage of relaxation follows.
 During the last month she was confined to her bed, the  attacks
 were severe and quite frequent, and her condition grew constantly
 more unbearable, notwithstanding the liberal use  of chloral  and
 bromide of potash  which  was very properly prescribed  by  the
 physician in attendance.
   As the patient did not improve, Dr. H. Greiner was called in ;
 he pursued a similar course  of treatment, adding opium, injec-
 tions ;  by a mistake of the patient's, a teaspoonful of th3 strong
 tincture of  opium was  taken internally,  but even this did  not
 check the attacks which  now  appeared three or four times a day,
 lasting with  great intensity from ten to fifteen minutes at  a time.
   March 18, 1878, I first  saw Mrs. O., in consultation with  Dr.
 Greiner; we had hardly entered the room when her hands began
 to twitch, her eyes closed, her head was plunged into the bedding
 and complete opisthotonus was established ; the spasm yielded for
 a moment to return  with increased severity,  the violent contrac-
 tions of the dorsal  muscles hurling  the patient from one  side of
 the bed to the other so that she was with difficulty  held down by
 our combined efforts.  After the attack, which lasted about twelve
 minutes, a stupor supervened.
   I found the patient in great  suffering, complaining especially of
 dorsal  and hypogastric pain,  heaviness of the head, occasional
 febrile  symptoms, and, at  times, nausea and vomiting more par-
ticularly in the morning ;  the bowels  were constipated, conjunctiva
slightly injected, pupils  normal,  reaction  perfect but slow.  She
had a dull,  stupid look and was not very prompt  in her answers ; 
A Hystero-Pstchosis.
3
in fact Dr. Greiner had told me that I must have patience, as she
was rather slow of understanding.  The  abdomen was tense  and
very sensitive to the touch, especially so in the right side where
we  found  some dullness on percussion,  slight  tumefaction  and
apparently a gurgling sound on  pressure.
  The vaginal walls were swollen; the cervix uteri was enlarged
and  congested  with extensive  erosions  (generally spoken of as
ulcerations)  surrounding the os;  the cervix was very sensitive
but  not  so exquisitely painful  upon the  slightest touch  as  the
enlargement which could be felt  just behind it in the  posterior
cul-de-sac; a harder and less  sensitive tumor was found to the
left, probably faecal masses.
  Although one period had  been missed, patient having last men-
struated on the 18th of Januaiw, I determined to pass the sound,
which entered easily to the depth of 7f c. m., caused  no pain, did
not give a  soft feel when pressed against the fundus, and  did not
bring a drop of blood.   The condition of the pelvic organs  was
such that a careful examination could not be made ; pregnancy was
probable, but as I  deemed  the  epileptic  attack to be due to the
pathological condition of the  womb, I determined to confine the
treatment to this  organ and its adnexa, regardless of the conse-
quences to the ovum, and to stop all medication.
  The eroded cervix was  thoroughly cauterized  with nitric acid
and  a glycerine  cotton tampon  introduced; warm poultices were
ordered to the abdomen and three times a day vaginal injections,
first flax-seed tea with  opium,  later  hot  water;  the  bowels were
kept open by mild laxatives.
  With  the  exception of a slight spasm on  the evening of the
18th, the epileptic attacks did not recur from  the  time  of the
application of the nitric  acid until the 22nd, notwithstanding the
discontinuance  of all  sedatives.  The abdominal hardness  and
pain disappeared entirely in the course of two days, the  patient
was  soon  comfortable,  but weak;  and an attack of intermittent
which made its appearance, readily yielded to quinine.
  On the 23d the parts  were soft,  yielding,  no longer sensitive,
and  I was enabled to make a thorough bi-manual examination ; I
found an elastic tumor in the posterior cul-de-sac which I supposed
to be a retroflected gravid uterus;  fearing a return of  the epileptic
attacks,  and the vomiting  being quite annoying, I determined to
satisfy myself as to the condition,  and with sound and fingers I 
4                St. Lours Clinical Record.
replaced the uterus and moved the sound freely about in the cavity
of the womb ;  neither blood nor liquor amnii followed this insult.
Carbolic acid 5i to gi,  (Glycerine and Spirit. Vini aa), was then
applied to the greatly improved cervix.
  On the 24th the patient had a very severe attack for which Dr.
Greiner  was obliged  to  resort to the use of chloroform; on the
following day we again  met at  the bed side; the erosion was im-
proving, the  womb was in its  normal position, hence the previr
ously existing flexion could not have produced the neurosis.  As
merely a slight show oi blood had followed the previous use of the
sound I  became  doubtful  as to  the  diagnosis of pregnane}', but
determined to relieve the uterus of its contents, if there were an}',
I again passed the instrument  freely  around the supposed ovum,
giving but little  pain and causing no flow.
  March 26th,  no hemorrhage  or discharge of any kind,  no epi-
leptic attacks, but vomiting distressing ;  a sponge tent was intro-
duced in order that we might finally determine the  cause of the
uterine enlargement, and if due to a conception, produce miscar-
riage.   The removal of  the tent  on  the next day, the 27th, was
followed by the expulsion of a healthy ovum on the 31st.
  I  did  not  see  the patient until two days  later and  found her
remarkably changed; her  complexion was better, she  had lost
that  dull, stupid look;  vomiting had  ceased with the  expulsion of
the ovum and  the epileptic attacks had not'  returned since the
severe spell on  the 24th, in fact,  had only appeared twice  after
the first cauterization of the cervix.
  The abdomen  was soft,  there was no tenderness,  she had no
complaint to make and expressed  herself as again feeling " like a
well  woman."
  Two weeks after the miscarriage Mrs. O. was attending to the
lighter duties of the household  feeling more  vigorous  and more
cheerful than she  had felt  at any time since the birth of her last
child,  the attacks had not recurred  and she was  free  from that
dizziness and languor which had previously oppiessed her.
  Epilepsy was cured by  an application of nitric acid to an eroded
cervix.
  I have described two equally striking cases in my article on the
hystero-neuroses;  (Transactions of  the  American  Gynecological
Society,  Vol. II, 1877)  in one  the  epileptic attacks  disappeared
on cure  of the erosions, endocervicitis and  amenorrhoea; in the 
A Hystero-Psychosis.
5
other the result was still more remarkable, as an almost idiotic
child, with frequent epileptic attacks of long duration, a burden to
those about her, was restored as a useful  member to the circle of
her friends and developed into a fair-looking girl by establishment
of the menstrual flow and cure of the uterine disorder.
  Dr.  J. M. McWhorter  (Transactions of the Medical Society of
West Virginia, 1877, p. 308) cites a similar case ;  epilepsy of four
years standing,  in a maiden lady twenty-six years of age, cured
after a two  months  treatment of the diseased  womb and  cure of
the  "ulcerations"  about  the  os.   In this case  ten  years have
elapsed without a return of the epileptic attacks,  the lady enjoys
good health,  her mental faculties remain  unimpaired and she has
become the mother of two healthy children.
  I  do not doubt it to have  been a  genuine case  of  hystero-
psychosis,  although  Dr. McWhorter combined  the local treatment
with the internal use of iodide and bromide of potash, to which,
it must be  remembered, I did not resort in my cases.
  These cases of Hystero-Neuroses, of reflex  disease,  whether of
the  nerve  centres, of the  pharynx, the bronchi  or  other organs,
merit greater attention, and it should be accorded them on aecount
of their practical importance to the family physician as well as the
specialist.   Our text-books are silent upon this subject which has
been neglected to  the detriment of many a sufferer ;  many a poor-
woman, with an intractable cough, or perhaps an annoying dys-
pepsia, has been in vain dosed with all  the varied  treasures of the
pharmacopoeia,  when the speculum alone could have pointed the
way to a successful treatment.
  Worse still is the  history of those unfortunates  who  have been
thrust into insane asylums to end, as wretched beings deprived of
reason, a life  which might have been one of utility and of happi-
ness, had the uterine disease, the  primary cause of the mental
derangement, been recognized and treated in time.
   3003 Locust street, April, 1878. 
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