ANOMALOUS NERVOUS AND MENTAL DISEASES.
Epilepsy has been professionally recognized as a distinct type of
disease since the time of Hippocrates, but in earlier times, and
popularly throughout later times, it was illy defined. The knowledge of
the clinical symptoms has become definite only since the era of
cerebral local anatomy and localization. Examination of the older
records of epilepsy shows curious forms recorded. The Ephemerides
speaks of epilepsy manifested only on the birthday. Testa mentions
epilepsy recurring at the festival of St. John, and Bartholinus reports
a case in which the convulsions corresponded with the moon's phases.
Paullini describes epilepsy which occurred during the blowing of wind
from the south, and also speaks of epilepsy during the paroxysms of
which the individual barked. Fabricius and the Ephemerides record
dancing epilepsy. Bartholinus and Hagendorn mention cases during which
various splendors appeared before the eyes during the paroxysm. Godart
Portius, and Salmuth speak of visions occurring before and after
epileptic paroxysms. The Ephemerides contains records of epilepsy in
which blindness preceded the paroxysm, in which there was singing
during it, and a case in which the paroxysm was attended with
singultus. Various older writers mention cases of epilepsy in which
curious spots appeared on the face; and the kinds of aura mentioned are
too numerous to transcribe.
Baly mentions a case of epilepsy occasioned by irritation in the socket
of a tooth. Webber reports a case of epilepsy due to phimosis and to
irritation from a tooth. Beardsley speaks of an attempt at
strangulation that produced epilepsy. Brown-Sequard records an instance
produced by injury to the sciatic nerve. Doyle gives an account of the
production of epilepsy from protracted bathing in a pond. Duncan cites
an instance of epilepsy connected with vesical calculus that was cured
by lithotomy. Museroft mentions an analogous case. Greenhow speaks of
epilepsy arising from an injury to the thumb. Garmannus, early in the
eighteenth century, describes epilepsy arising from fright and terror.
Bristowe in 1880, and Farre speak of similar instances. In Farre's case
the disease was temporarily cured by an attack of acute rheumatism.
Thorington of Philadelphia has seen a paroxysm of epilepsy induced by
the instillation of atropia in the eye of a child nearly cured of the
malady. It was supposed that the child was terrified on awakening and
finding its vision suddenly diminished, and that the convulsions were
directly due to the emotional disturbance. Orwin describes epilepsy
from prolonged lactation, and instances of ovarian and uterine epilepsy
are quite common.
There is a peculiar case of running epilepsy recorded. The patient was
a workman who would be suddenly seized with a paroxysm, and
unconsciously run some distance at full speed. On one occasion he ran
from Peterborough to Whittlesey, where he was stopped and brought back.
Once he ran into a pit containing six feet of water, from which he was
rescued. Yeo says that sexual intercourse occasionally induces
epilepsy, and relates a case in which a severe epileptic fit terminated
fatally three days after the seizure, which occurred on the nuptial
night.
Drake reports the case of a man who was wounded in the War of 1812,
near Baltimore, the ball passing along the left ear and temple so close
as to graze the skin. Eighteen years after the accident he suffered
with pain in the left ear and temple, accompanied by epileptic fits and
partial amnesia, together with an entire loss of power of remembering
proper names and applying them to the objects to which they belonged.
He would, for instance, invariably write Kentucky for Louisville.
Beirne records the case of a dangerous lunatic, an epileptic, who was
attacked by a fellow-inmate and sustained an extensive fracture of the
right parietal bone, with great hemorrhage, followed by coma. Strange
to say, after the accident he recovered his intellect, and was cured of
his epileptic attacks, but for six years he was a paralytic from the
hips down.
The Dancing Mania.--Chorea has appeared in various epidemic forms under
the names of St. Vitus's dance, St. Guy's dance, St. Anthony's dance,
choromania, tanzplage, orchestromania, dance of St. Modesti or St.
John, the dancing mania, etc.; although these various functional
phenomena of the nervous system have been called chorea, they bear very
little resemblance to what, at the present day, is called by this name.
The epidemic form appeared about 1374, although Hecker claims that, at
that time, it was no new thing. Assemblages of men and women were seen
at Aix-la-Chapelle who, impelled by a common delusion, would form
circles, hand in hand, and dance in wild delirium until they fell to
the ground exhausted, somewhat after the manner of the Ghost-Dance or
Messiah-Dance of our North American Indians. In their Bacchantic leaps
they were apparently haunted by visions and hallucinations, the fancy
conjuring up spirits whose names they shrieked out. Some of them
afterward stated that they appeared to be immersed in a stream of blood
which obliged them to leap so high. Others saw the heavens open and
disclose the Saviour enthroned with the Virgin Mary. The participants
seemed to suffer greatly from tympanites which was generally relieved
by compression or thumping on the abdomen. A few months after this
dancing malady had made its appearance at Aix-la-Chapelle it broke out
at Cologne, and about the same time at Metz, the streets of which were
said to have been filled with 1100 dancers. This rich city became the
scene of the most ruinous disorder. Peasants left their plows,
mechanics their shops, servants their masters, children their homes;
and beggars and idle vagabonds, who understood how to imitate the
convulsions, roved from place to place, inducing all sorts of crime and
vice among the afflicted. Strasburg was visited by the dancing plague
in 1418, and it was here that the plague assumed the name of St.
Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he
was about to undergo martyrdom by order of Diocletian, in the year 303,
is said to have prayed to God that He might protect all those who would
solemnize the day of his commemoration and fast upon its eve. The
people were taught that a voice from heaven was then heard saying,
"Vitus, thy prayer is accepted."
Paracelsus called this malady (Chorus sancti viti) the lascivious
dance, and says that persons stricken with it were helpless until
relieved by either recovery or death. The malady spread rapidly through
France and Holland, and before the close of the century was introduced
into England. In his "Anatomy of Melancholy" Burton refers to it, and
speaks of the idiosyncrasies of the individuals afflicted. It is said
they could not abide one in red clothes, and that they loved music
above all things, and also that the magistrates in Germany hired
musicians to give them music, and provided them with sturdy companions
to dance with. Their endurance was marvelous. Plater speaks of a woman
in Basle whom he saw, that danced for a month. In Strasburg many of
them ate nothing for days and nights until their mania subsided.
Paracelsus, in the beginning of the sixteenth century, was the first to
make a study of this disease. He outlined the severest treatment for
it, and boasted that he cured many of the victims. Hecker conjectures
that probably the wild revels of St. John's day, 1374, gave rise to
this mental plague, which thenceforth visited so many thousands with
incurable aberrations of mind and disgusting distortions of the body.
Almost simultaneous with the dance of "St. With," there appeared in
Italy and Arabia a mania very similar in character which was called
"tarantism," which was supposed to originate in the bite of the
tarantula. The only effective remedy was music in some form. In the
Tigre country, Abyssinia, this disease appeared under the name of
"Tigretier." The disease, fortunately, rapidly declined, and very
little of it seems to have been known in the sixteenth century, but in
the early part of the eighteenth century a peculiar sect called the
"Convulsionnaires" arose in France; and throughout England among the
Methodist sect, insane convulsions of this nature were witnessed; and
even to the present day in some of the primitive religious meetings of
our people, something not unlike this mania of the Middle Ages is
perpetuated.
Paracelsus divided the sufferers of St. Vitus's dance into three
classes .--
(1) Those in which the affliction arose from imagination (chorea
imaginativa).
(2) Those which had their origin in sexual desires depending on the
will.
(3) Those arising from corporeal causes (chorea naturalis). This last
case, according to a strange notion of his own he explained by
maintaining that in certain vessels which are susceptible of an
internal pruriency, and thence produced laughter, the blood is set into
commotion in consequence of an alteration in the vital spirits, whereby
are occasioned involuntary fits of intoxicating joy, and a propensity
to dance. The great physician Sydenham gave the first accurate
description of what is to-day called chorea, and hence the disease has
been named "Sydenham's chorea." So true to life was his portrayal of
the disease that it has never been surpassed by modern observers.
The disease variously named palmus, the jumpers, the twitchers, lata,
miryachit, or, as it is sometimes called, the emeryaki of Siberia, and
the tic-convulsif of La Tourette, has been very well described by Gray
who says that the French authors had their attention directed to the
subject by the descriptions of two American authors--those of Beard
upon "The Jumpers of Maine," published in 1880, and that of Hammond
upon "Miryachit," a similar disease of the far Orient. Beard found that
the jumpers of Maine did unhesitatingly whatever they were told to do.
Thus, one who was sitting in a chair was told to throw a knife that he
had in his hand, and he obeyed so quickly that the weapon stuck in a
house opposite; at the same time he repeated the command given him,
with a cry of alarm not unlike that of hysteria or epilepsy. When he
was suddenly clapped upon the shoulder he threw away his pipe, which he
had been filling with tobacco. The first parts of Virgil's aeneid and
Homer's Iliad were recited to one of these illiterate jumpers, and he
repeated the words as they came to him in a sharp voice, at the same
time jumping or throwing whatever he had in his hand, or raising his
shoulder, or making some other violent motion. It is related by
O'Brien, an Irishman serving on an English naval vessel, that an
elderly and respectable Malay woman, with whom he was conversing in an
entirely unsuspecting manner, suddenly began to undress herself, and
showed a most ominous and determined intention of stripping herself
completely, and all because a by-standing friend had suddenly taken off
his coat; at the same time she manifested the most violent anger at
what she deemed this outrage to her sex, calling the astonished friend
an abandoned hog, and begging O'Brien to kill him. O'Brien,
furthermore, tells of a cook who was carrying his child in his arms
over the bridge of a river, while at the same time a sailor carried a
log of wood in like manner; the sailor threw his log of wood on an
awning, amusing himself by causing it to roll over the cloth, and
finally letting it fall to the bridge; the cook repeated every motion
with his little boy, and killed him on the spot. This miryachit was
observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in
Siberia, whilst Beard has observed it in Michigan as well as in Maine.
Crichton speaks of a leaping ague in Angusshire, Scotland.
Gray has seen only one case of acute palmus, and records it as follows:
"It was in a boy of six, whose heredity, so far as I could ascertain
from the statements of his mother, was not neurotic. He had had trouble
some six months before coming to me. He had been labeled with a number
of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria,
and neurasthenia. His palmodic movements were very curious. When
standing near a table looking at something, the chin would suddenly
come down with a thump that would leave a black-and-blue mark, or his
head would be thrown violently to one side, perhaps coming in contact
with some adjacent hard object with equal force, or, while standing
quietly, his legs would give a sudden twitch, and he would be thrown
violently to the ground, and this even happened several times when he
was seated on the edge of a stool. The child was under my care for two
weeks, and, probably because of an intercurrent attack of diarrhea,
grew steadily worse during that time, in spite of the full doses of
arsenic which were administered to him. He was literally covered with
bruises from the sudden and violent contacts with articles of
furniture, the floor, and the walls. At last, in despair at his
condition, I ordered him to be undressed and put to bed, and steadily
pushed the Fowler's solution of arsenic until he was taking ten drops
three times a day, when, to my great surprise, he began to improve
rapidly, and at the end of six weeks was perfectly well. Keeping him
under observation for two weeks longer I finally sent him to his home
in the West, and am informed that he has since remained perfectly well.
It has seemed to me that many of the cases recorded as paramyoclonus
multiples have been really acute palmus."
Gray mentions two cases of general palmus with pseudomelancholia, and
describes them in the following words:--
"The muscular movements are of the usual sudden, shock-like type, and
of the same extent as in what I have ventured to call the general form.
With them, however, there is associated a curious pseudomelancholia,
consisting of certain fixed melancholy suspicious delusions, without,
however, any of the suicidal tendencies and abnormal sensations up and
down the back of the head, neck, or spine, or the sleeplessness, which
are characteristic of most cases of true melancholia. In both of my
cases the palmus had existed for a long period, the exact limits of
which, however, I could not determine, because the patient scouted the
idea that he had had any trouble of the kind, but which the testimony
of friends and relatives seemed to vouch for. They were both men, one
thirty-six and one thirty-eight years of age. The pseudomelancholia,
however, had only existed in one case for about a year, and in the
other for six months. One case passed away from my observation, and I
know nothing of its further course. The other case recovered in nine
months' treatment, and during the three years that have since elapsed
he has been an active business man, although I have not seen him myself
during that period, as he took a great dislike to me because I was
forced to take strong measures to keep him under treatment, so
persistent were his suspicions."
Athetosis was first described by Hammond in 1871, who gave it the name
because it was mainly characterized by an inability to retain the
fingers and toes in any position in which they might be planed, as well
as by their continuous motion. According to Drewry "athetosis is a
cerebral affection, presenting a combination of symptoms characterized
chiefly by a more or less constant mobility of the extremities and an
inability to retain them in any fixed position. These morbid,
grotesque, involuntary movements are slow and wavy, somewhat regular
and rigid, are not jerky, spasmodic, nor tremulous. The movements of
the digits are quite different from those attending any other disease,
impossible to imitate even by the most skilful malingerer, and, if once
seen, are not likely to be forgotten. In an athetoid hand, says Starr,
the interossei and lumbricales, which flex the metacarpo-phalangeal and
extend the phalangeal joints, are affected; rarely are the long
extensors and the long flexors affected. Therefore the hand is usually
in the so-called interosseal position, with flexion of the proximal and
extension of the middle and distal phalanges. The athetoid movements of
the toes correspond to those of the fingers in point of action. In a
great majority of cases the disease is confined to one side
(hemiathetosis), and is a sequel of hemiplegia. The differential
diagnosis of athetosis is generally easily made. The only nervous
affections with which it could possibly be confounded are chorea and
paralysis agitans. Attention to the twitching, spasmodic, fibrillary
movements, having a quick beginning and a quick ending, which is
characteristic in Sydenham's chorea, would at once exclude that
disease. These jerky movements peculiar to St. Vitus's dance may be
easily detected in a few or many muscles, if moderate care and patience
be exercised on the part of the examiner. This form of chorea is almost
always a disease of childhood. So-called post-hemiplegic chorea is, in
the opinion of both Hammond and Gray, simply athetosis. The silly,
dancing, posturing, wiry movements, and the facial distortion observed
in Huntington's chorea would hardly be mistaken by a careful observer
for athetosis. The two diseases, however, are somewhat alike. Paralysis
agitans (shaking palsy), with its coarse tremor, peculiar facies,
immobility, shuffling gait, the 'bread-crumbling' attitude of the
fingers, and deliberate speech, would be readily eliminated even by a
novice. It is, too, a disease of advanced life, usually. Charcot, Gray,
Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and
others have written on this affection."
The following is the report of a case by Drewry, of double (or, more
strictly speaking, quadruple) athetosis, associated with epilepsy and
insanity: "The patient was a negro woman, twenty-six years old when she
was admitted into this, the Central State (Va.) Hospital, in April,
1886. She had had epilepsy of the grand mal type for a number of years,
was the mother of one child, and earned her living as a domestic. A
careful physical examination revealed nothing of importance as an
etiologic factor. Following in the footsteps of many of those
unfortunates afflicted with epilepsy, she degenerated into a state of
almost absolute imbecility.
"Some degree of mental deficiency seems usually to accompany athetosis,
even when uncomplicated by any other degenerating neurosis. Athetoid
symptoms of an aggravated character, involving both upper and both
lower extremities, had developed previous to her admission into this
hospital, but it was impossible to find out when and how they began.
She had never had, to the knowledge of her friends, an attack of
'apoplexy,' nor of paralysis. The head was symmetric, and without scars
thereon. The pedal extremities involuntarily assumed various distorted
positions and were constantly in motion. The toes were usually in a
state of tonic spasm,--contracted, and drawn downward or extended,
pointing upward, and slightly separated. Irregular alternate extension
and flexion of the toes were marked. The feet were moved upon the
ankles in a stiff and awkward manner. During these 'complex involuntary
movements,' the muscles of the calf became hard and rigid. The act of
walking was accomplished with considerable difficulty, on account of
contractures, and because the feet were not exactly under the control
of the will. The unnatural movements of the hands corresponded to those
of the lower extremities, though they were more constant and active.
The fingers, including the thumbs, were usually widely separated and
extended, though they were sometimes slightly flexed. The hands were
continually in slow, methodic, quasi-rhythmic motion, never remaining
long in the same attitude. In grasping an object the palm of the hand
was used, it being difficult to approximate the digits. The
wrist-joints were also implicated, there being alternate flexion and
extension. In fact these odd contortions affected the entire limb from
the shoulder to the digital extremities. When standing or walking the
arms were held out horizontally, as if to maintain the equilibrium of
the body. The patient's general physical health was fairly good. She
frequently complained of headache, and when she was exceedingly
irritable and violent all the athetoid movements would be intensified.
Speech was jerky and disordered, which gave it a distinctive character.
The special senses seemed to be unimpaired, and the pupils were normal,
except when an epileptic attack came on. Death occurred in January,
1895, after an obstinate attack of status epilepticus." Paramyoclonus
multiplex is a condition of chronic muscular spasm affecting the trunk,
occasionally the muscles of the face, abdomen, or diaphragm. The
muscles affected are usually in the trunk and in the limbs, and not in
the toes and hand; occasionally the movements are tonic as well as
clonic; the degree of spasm varies greatly, and according to Gray may
sometimes be so violent as to throw the patient down or out of the
chair.
Saltatoric spasm is an extremely rare condition, first observed by
Bamberger in 1859. The calf, hip, knee, and back-muscles are affected
by clonic spasm, causing springing or jumping movements when the
patient attempts to stand. The disease is transient, and there are no
mental symptoms.
Progressive muscular atrophy has been observed as far back as
Hippocrates, but it is only in recent times that we have had any
definite knowledge of the subject. It is divided into four types, the
hand type (causing the griffin-or claw-hand, or the ape-hand); the
juvenile type (generally in the muscles of the shoulder and arm); the
facial type; and the peroneal type. Generalized progressive atrophy
leads to a condition that simulates the appearance of a "living
skeleton."
Facial hemiatrophy is an incurable disease, as yet of unknown
pathology. It consists of wasting of the bones, subcutaneous tissues,
and muscles of one-half of the face or head, the muscles suffering but
slightly. The accompanying illustration shows a case in which there was
osseous depression of the cranium and a localized alopecia. The disease
is very rare, only about 100 cases having been reported. Of five cases
seen by Dana, three were in females and two in males; in all the cases
that could be found the origin was between the tenth and twentieth
years. It is a chronic affection, usually beginning in early life,
increasing slowly for years, and then becoming stationary. It is
distinguished from one-sided muscular atrophy by the electric reaction,
which is not lost in the facial muscles in facial hemiatrophy, and
there is no atrophy of other muscles of the body.
Burr contributes an exhaustive paper on hemiatrophy of the tongue with
report of a case as follows: "L. B., female, mulatto, thirty-one years
old, married, came to the Medico-Chirurgical Hospital, Philadelphia,
September 23, 1895, complaining that her 'tongue was crooked.' Save
that she had had syphilis, her personal history is negative. In
February, 1895, she began to suffer from headache, usually behind the
left ear, and often preventing sleep. At times there is quite severe
vertigo. Several weeks after the onset, headache persisting, she awoke
in the night and found the left side of the tongue swollen, black, and
painless. For some hours she could neither speak nor chew, but
breathing was not interfered with. After a few days all symptoms passed
away except headache, and she thought no more of the matter until
recently, as stated above, she noticed by accident that her tongue was
deformed. She is a spare, poorly-fed, muddy-skinned mulatto girl. The
left half of the tongue is only about one-half as large as the right.
The upper surface is irregularly depressed and elevated. There are no
scars. When protruded it turns sharply to the left. Fibrillary
twitching is not present. The mucous membrane is normal. Common
sensation and taste are preserved. The pharyngeal reflex is present.
The palate moves well. There is no palsy or wasting of the face. The
pupils are of normal size and react well to light and with
accommodation. Station and gait are normal. There is no incoordination
of movement in the arms or legs. The knee-jerks are much increased.
There is an attempt at, but no true, clonus; that is, passive flexion
of the foot causes two or three jerky movements. There is no glandular
swelling or tumor about the jaw or in the neck. Touch and pain-sense
are normal in the face and hands, but she complains of numbness in the
hands as if she had on tight gloves. There is no trouble in speaking,
chewing, or swallowing. There is no pain or rigidity in the neck
muscles. Examination of the pharynx reveals no disease of the bones.
Under specific treatment the patient improved."
Astasia-abasia was named by Blocq, who collected 11 cases. According
to Knapp, four cases have been reported in America. The disease
consists in an inability to stand erect or walk normally, although
there is no impairment of sensation, of muscular strength, or of the
coordination of other muscles in walking than the lower extremities. In
attempting to walk the legs become spasmodic; there are rapid flexions
and extensions of the legs on the thighs, and of the thighs on the
pelvis. The steps are short, and the feet drag; the body may make great
oscillations if the patient stands, walks, or sits, and the head and
arms make rhythmical movements; walking may become impossible, the
patient appearing to leap up on one foot and then up on the other, the
body and head oscillating as he advances; he may be able to walk
cross-legged, or by raising the legs high; or to walk on his hands and
feet; he may be able to walk at certain times and not at others; or to
hop with both feet together; he may succeed with great strides and with
the arms extended; or finally he may be able to use his legs perfectly
if suspended (Gray). There are various types which have been called the
paralytic, the choreic, and the saltatory. A tendency to go backward or
retropulsion has been observed, according to Gray, as has also a
tendency to go forward or propulsion. A curious phenomenon in this
disease is that the patient can use the legs perfectly well lying in
bed. The prognosis seems to be favorable.
Meniere's disease is a disease probably of the semicircular canals,
characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium,
and various other phenomena. It is also called aural or auditory
vertigo. The salient symptom is vertigo, and this varies somewhat in
degree according to the portions of the ear affected. If the disease is
in the labyrinth, the patient is supposed to stagger to one side, and
the vertigo is paroxysmal, varying to such a degree as to cause simple
reeling, or falling as if shot. Gray reports the history of a patient
with this sensational record: He had been a peasant in Ireland, and one
day crossing one of the wide moors in a dog-cart, he was suddenly, as
he thought, struck a violent blow from behind, so that he believed that
he lost consciousness for some time. At all events, when he was able to
get up he found his horse and cart some distance off, and, of course,
not a soul in sight. Under the belief that he had been struck by some
enemy he went quietly home and said nothing about it. Some time
afterward, however, in crossing another lonely place he had a similar
experience, and as he came to the conclusion that nobody could have
been near him, he made up his mind that it was some malevolent stroke
of the devil and he consulted a priest who agreed with him in his
belief, and gave him an amulet to wear. A series of similar attacks
occurred and puzzled as to whether there was some diabolical agency at
work, or whether he was the victim of some conspiracy, he emigrated to
America; for several months he had no attacks. A new paroxysm occurring
he consulted Gray, who found indubitable evidence of labyrinthine
disease. The paroxysms of this disease are usually accompanied by
nausea and vomiting, and on account of the paleness of the face, and
the cold, clammy perspiration, attacks have frequently been mistaken
for apoplexy. In disease of the middle ear the attacks are continuous
rather than paroxysmal. If the disease is in the middle or internal
ears, loud noises are generally heard, but if the disease is in the
external ear, the noises are generally absent, and the vertigo of less
degree but continuous. The prognosis varies with the location of the
disease, but is always serious.
Human rumination has been known for many years. Bartholinus, Paullinus,
Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius,
Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others
describe it. Fabricius d'Aquapendente personally knew a victim of
rumination, or, as it is generally called, merycism. The dissection by
Bartholinus of a merycol showed nothing extraordinary in the cadaver.
Winthier knew a Swede of thirty-five, in Germany, apparently healthy,
but who was obliged when leaving the table to retire to some remote
place where he might eject his food into his mouth again, saying that
it gave him the sensation of sweetest honey. The patient related that
from his infancy he had been the subject of acid eructations, and at
the age of thirty he commenced rumination as a means of relief. To
those who are interested in the older records of these cases Percy and
Laurent offer the descriptions of a number of cases.
In a recent discussion before the American Neurological Association
Hammond defined merycism as the functions of remastication and
rumination in the human subject. He referred to several cases, among
them that of the distinguished physiologist, Brown-Sequard, who
acquired the habit as a result of experiments performed upon himself.
Hammond reported a case of a young man who was the subject of merycism,
and whose mental condition was also impaired. No special treatment was
undertaken, but the patient was trephined, with the purpose of
improving his mental condition. There were no unusual features
connected with the operation, but it was noticed that there were no
ruminations with the meals he took until the fifth day, when a slight
rumination occurred. Eight days later a similar button was removed from
the corresponding side of the left skull, and from that time (about six
months) to the time of report, there had been no regurgitation. Whether
the cure of the merycism in this case was directly due to the
operations on the cranium, or the result of the mental improvement, is
a question for discussion. Hammond added that, when acquired, merycism
was almost invariably the result of over-eating and loading the
esophagus, or the result of fast eating.
In remarks upon Hammond's paper Knapp said that two cases had come to
his knowledge, both in physicians, but one of them he knew of only by
hearsay. The other man, now over thirty, had regurgitated his food from
early childhood, and he did not know that he had anything very unusual
the matter with him until he began some investigations upon the
functions and diseases of the stomach. This man was not nervous, and
was certainly not an idiot. He had done active work as a physician, and
called himself in perfect health. He was something of an epicure, and
never suffered from indigestion. After a hearty meal the regurgitation
was more marked. Food had been regurgitated, tasting as good as when
first eaten, several hours after the eating. If he attempted to check
the regurgitation he sometimes had a slight feeling of fulness in the
stomach. Lloyd said that these cases were forms of neuroses, and were
types of hysteric vomiting. There was no gustatory satisfaction
connected with any form of hysteric vomiting that he had seen. In some
of these cases of hysteric vomiting the food does not appear to enter
the stomach, but is rejected by a sort of spasm of the esophagus. This
has been called "esophagismus," and is apparently closely allied to
this neurosis, which some have called "merycism." The President of the
Association said that this would seem to be an affection common among
physicians. A student friend of his who had been affected in this way,
had written an elaborate monograph on the subject. He was disgusted
with the habit, and finally overcame it by the exercise of his
will-power.
Runge discusses three cases of hereditary rumination. These patients
belonged to three generations in the male line. The author subjected
the contents of the stomach of one patient to quite an extensive
analysis, without finding any abnormality of secretion.
Wakefulness.--Generally speaking, the length of time a person can go
without sleep is the same as that during which he can survive without
food. Persons, particularly those of an hysteric nature, are prone to
make statements that they have not slept for many days, or that they
never sleep at all, but a careful examination and watch during the
night over these patients show that they have at least been in a
drowsy, somnolent condition, which is in a measure physiologically
equivalent to sleep. Accounts of long periods of wakefulness arise from
time to time, but a careful examination would doubtless disprove them.
As typical of these accounts, we quote one from Anderson, Indiana,
December 11, 1895:--
"David Jones of this city, who attracted the attention of the entire
medical profession two years ago by a sleepless spell of ninety-three
days, and last year by another spell which extended over one hundred
and thirty-one days, is beginning on another which he fears will be
more serious than the preceding ones. He was put on the circuit jury
three weeks ago, and counting to-day has not slept for twenty days and
nights. He eats and talks as well as usual, and is full of business and
activity. He does not experience any bad effects whatever from the
spell, nor did he during his one hundred and thirty-one days. During
that spell he attended to all of his farm business. He says now that he
feels as though he never will sleep again. He does not seem to bother
himself about the prospects of a long and tedious wake. He cannot
attribute it to any one thing, but thinks that it was probably
superinduced by his use of tobacco while young."
Somnambulism, or, as it has been called, noctambulation, is a curious
phase of nocturnal cerebration analogous to the hypnotic state, or
double consciousness occasionally observed in epileptics. Both
Hippocrates and Aristotle discuss somnambulism, and it is said that the
physician Galen was a victim of this habit. Horstius, ab Heers, and
many others of the older writers recorded interesting examples of this
phenomenon. Schenck remarks on the particular way in which
somnambulists seem to escape injury. Haller, Hoffmann, Gassendi,
Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all
the ancient physiologists and anatomists have written on this subject.
The marvelous manifestations of somnambulism are still among the more
surprising phenomena with which science has to deal. That a person
deeply immersed in thought should walk and talk while apparently
unconscious, excites no surprise, but that anyone should when fast
asleep perform a series of complicated actions which undoubtedly demand
the assistance of the senses is marvelous indeed. Often he will rise in
the night, walk from room to room, go out on porticoes, and in some
cases on steep roofs, where he would not dare to venture while awake.
Frequently he will wander for hours through streets and fields,
returning home and to bed without knowledge of anything having
transpired.
The state of the eyes during somnambulism varies considerably. They
are sometimes closed, sometimes half-closed, and frequently quite open;
the pupil is sometimes widely dilated, sometimes contracted, sometimes
natural, and for the most part insensible to light.
Somnambulism seems to be hereditary. Willis cites an example in which
the father and the children were somnambulists, and in other cases
several individuals in the same family have been afflicted. Horstius
gives a history of three young brothers who became somnambulistic at
the same epoch. A remarkable instance of somnambulism was the case of a
lad of sixteen and a half years who, in an attack of somnambulism, went
to the stable, saddled his horse, asked for his whip, and disputed with
the toll-keeper about his fare, and when he awoke had no recollection
whatever of his acts, having been altogether an hour in his trance.
Marville quotes the case of an Italian of thirty, melancholic, and a
deep thinker, who was observed one evening in his bed. It was seen that
he slept with his eyes open but fixed and immovable. His hands were
cold, and his pulse extremely slow. At midnight he brusquely tore the
curtains of his bed aside, dressed himself, went to his stable, and
mounted a horse. Finding the gate of the court yard closed he opened it
with the aid of a large stone. Soon he dismounted, went to a billiard
room, and simulated all the movements of one playing. In another room
he struck with his empty hands a harpsichord, and finally returned to
his bed. He appeared to be irritated when anybody made a noise, but a
light placed under his nose was apparently unnoticed. He awoke if his
feet were tickled, or if a horn was blown in his ear. Tissot transmits
to us the example of a medical student who arose in the night, pursued
his studies, and returned to bed without awaking; and there is another
record of an ecclesiastic who finished his sermon in his sleep.
The Archbishop of Bordeaux attests the case of a young ecclesiastic who
was in the habit of getting up during the night in a state of
somnambulism, taking pen, ink, and paper, and composing and writing
sermons. When he had finished a page he would read aloud what he had
written and correct it. In order to ascertain whether the somnambulist
made any use of his eyes the Archbishop held a piece of cardboard under
his chin to prevent his seeing the paper upon which he was writing. He
continued to write without being in the slightest degree incommoded. In
this state he also copied out pieces of music, and when it happened
that the words were written in too large characters and did not stand
over the corresponding notes he perceived his error, blotted them out,
and wrote them over again with great exactness.
Negretti, a sleep-walker, sometimes carried a candle about with him as
if to furnish him light in his employment, but when a bottle was
substituted he carried it, fancying that he had the candle. Another
somnambulist, Castelli, was found by Dr. Sloane translating Italian and
French and looking out words in his dictionary. His candle was
purposely extinguished, whereupon he immediately began groping about,
as if in the dark, and, although other lighted candles were in the
room, he did not resume his occupation until he had relighted his
candle at the fire. He was insensible to the light of every candle
excepting the one upon which his attention was fixed.
Tuke tells of a school-boy who being unable to master a school-problem
in geometry retired to bed still thinking of the subject; he was found
late at night by his instructor on his knees pointing from spot to spot
as though he were at the blackboard. He was so absorbed that he paid no
attention to the light of the candle, nor to the speech addressed to
him. The next morning the teacher asked him if he had finished his
problem, and he replied that he had, having dreamt it and remembered
the dream. There are many such stories on record. Quoted by Gray,
Mesnet speaks of a suicidal attempt made in his presence by a
somnambulistic woman. She made a noose of her apron, fastened one end
to a chair and the other to the top of a window. She then kneeled down
in prayer, made the sign of the cross, mounted a stool, and tried to
hang herself. Mesnet, scientific to the utmost, allowed her to hang as
long as he dared, and then stopped the performance. At another time she
attempted to kill herself by violently throwing herself on the floor
after having failed to fling herself out of the window. At still
another time she tried poison, filling a glass with water, putting
several coins into it, and hiding it after bidding farewell to her
family in writing; the next night, when she was again somnambulistic,
she changed her mind once more, writing to her family explaining her
change of purpose. Mesnet relates some interesting experiments made
upon a French sergeant in a condition of somnambulism, demonstrating
the excitation of ideas in the mind through the sense of touch in the
extremities. This soldier touched a table, passed his hands over it,
and finding nothing on it, opened the drawer, took out a pen, found
paper and an inkstand, and taking a chair he sat down and wrote to his
commanding officer speaking of his bravery, and asking for a medal. A
thick metallic plate was then placed before his eyes so as to
completely intercept vision. After a few minutes, during which he
wrote a few words with a jumbled stroke, he stopped, but without any
petulance. The plate was removed and he went on writing. Somnambulism
may assume such a serious phase as to result in the commission of
murder. There is a case of a man of twenty-seven, of steady habits, who
killed his child when in a state of somnambulism. He was put on trial
for murder, and some of the most remarkable facts of his somnambulistic
feats were elicited in the evidence. It is said that once when a boy he
arose at night while asleep, dressed himself; took a pitcher and went
for milk to a neighboring farm, as was his custom. At another time he
worked in a lumber-yard in a rain-storm while asleep. Again, when about
twenty-one, he was seen in a mill-pond wading about attempting to save
his sister who he imagined was drowning. The worst phase of his
somnambulism was the impending fears and terrible visions to which he
was subjected. Sometimes he would imagine that the house was on fire
and the walls about to fall upon him, or that a wild beast was
attacking his wife and child; and he would fight, screaming
inarticulately all the while. He would chase the imaginary beast about
the room, and in fact had grasped one of his companions, apparently
believing he was in a struggle with a wild beast. He had often injured
himself in these struggles, and had often attacked his father, his
wife, sister, fellow-lodgers, and while confined in jail he attacked
one of his fellow-prisoners. His eyes would always be wide open and
staring; he was always able to avoid pieces of furniture which were in
his way, and he occasionally threw them at his visionary enemies. At
the time of the murder of his child, in a somnambulistic attack, he
imagined that he saw a wild beast rise up from the floor and fly at his
child, a babe of eighteen months. He sprang at the beast and dashed it
to the ground, and when awakened, to his horror and overwhelming grief
he found that he had killed his beloved baby. A similar record has
been reported of a student who attempted during the night to stab his
teacher; the man was disarmed and locked up in another portion of the
building; but he had not the slightest remembrance of the events of the
night.
Yellowlees speaks of homicide by a somnambulist. According to a
prominent New York paper, one of the most singular and at the same time
sad cases of somnambulism occurred a few years ago near Bakersville,
N.C. A young man there named Garland had been in the habit of walking
in his sleep since childhood. Like most other sleep-walkers when
unmolested, his ramblings had been without harm to himself or others.
Consequently his wife paid little attention to them. But finally he
began to stay away from the house longer than usual and always returned
soaking wet. His wife followed him one night. Leaving his home he
followed the highway until he came to a rough, narrow pig-trail leading
to the Tow River. His wife followed with difficulty, as he picked his
way through the tangled forest, over stones and fallen trees and along
the sides of precipitous cliffs. For more than a mile the sleeper
trudged on until he came to a large poplar tree, which had fallen with
its topmost branches far out in the river. Walking on the log until he
came to a large limb extending over the water, he got down on his hands
and knees and began crawling out on it. The frightened wife screamed,
calling to him to wake up and come back. He was awakened by the cries,
fell into the river, and was drowned. Each night for weeks he had been
taking that perilous trip, crawling out on the limb, leaping from it
into the river, swimming to the shore, and returning home unconscious
of anything having happened.
Dreams, nightmare, and night terrors form too extensive a subject and
one too well known to be discussed at length here, but it might be well
to mention that sometimes dreams are said to be pathognomonic or
prodromal of approaching disease. Cerebral hemorrhage has often been
preceded by dreams of frightful calamities, and intermittent fever is
often announced by persistent and terrifying dreams. Hammond has
collected a large number of these prodromic dreams, seeming to indicate
that before the recognizable symptoms of disease present themselves a
variety of morbid dreams may occur. According to Dana, Albers says:
"Frightful dreams are signs of cerebral congestion. Dreams about fire
are, in women, signs of impending hemorrhage. Dreams about blood and
red objects are signs of inflammatory conditions. Dreams of distorted
forms are frequently a sign of abdominal obstruction and diseases of
the liver."
Catalepsy, trance, and lethargy, lasting for days or weeks, are really
examples of spontaneously developed mesmeric sleep in hysteric patients
or subjects of incipient insanity. If the phenomenon in these cases
takes the form of catalepsy there is a waxy-like rigidity of the
muscles which will allow the limbs to be placed in various positions,
and maintain them so for minutes or even hours. In lethargy or
trance-states the patient may be plunged into a deep and prolonged
unconsciousness lasting from a few hours to several years. It is in
this condition that the lay journals find argument for their stories of
premature burial, and from the same source the fabulous "sleeping
girls" of the newspapers arise. Dana says that some persons are in the
habit of going into a mesmeric sleep spontaneously. In these states
there may be a lowering of bodily temperature, a retarding of the
respiration and heart-action, and excessive sluggishness of the action
of the bowels. The patients can hear and may respond to suggestions,
though apparently insensible to painful impressions, and do not appear
to smell, taste, or see; the eyes are closed, turned upward, and the
pupils contracted as in normal sleep.
This subject has been investigated by such authorities as Weir Mitchell
and Hammond, and medical literature is full of interesting cases, many
differing in the physiologic phenomena exhibited; some of the most
striking of these will be quoted. Van Kasthoven of Leyden reports a
strange case of a peasant of Wolkwig who, it is alleged, fell asleep on
June 29, 1706, awakening on January 11, 1707, only to fall asleep again
until March 15th of the same year. Tuke has resurrected the remarkable
case reported by Arnold of Leicester, early in this century. The
patient's name was John Engelbrecht. This man passed into a condition
of catalepsy in which he heard everything about him distinctly, but in
his imagination he seemed to have passed away to another world, this
condition coming on with a suddenness which he describes as with "far
more swiftness than any arrow can fly when discharged from a
cross-bow." He also lost his sensation from the head downward, and
recovered it in the opposite direction. At Bologna there was observed
the case of a young female who after a profound grief had for forty-two
successive days a state of catalepsy lasting from midday to midnight.
Muller of Lowenburg records a case of lethargy in a young female,
following a sudden fright in her fourteenth year, and abrupt
suppression of menstruation. This girl was really in a sleep for four
years. In the first year she was awake from one minute to six hours
during the day. In the second and third years she averaged four hours
wakefulness in ninety-six hours. She took very little nourishment and
sometimes had no bowel-movement for sixteen days. Scull reports the
history of a man of twenty-seven suffering with incipient phthisis, who
remained bedridden and in a state of unconsciousness for fifteen
months. One day while being fed he spoke out and asked for a glass of
water in his usual manner, and so frightened his sister that she ran
from the room. The man had remembered nothing that had occurred during
the fifteen months, and asked who was president and seemed eager for
news. One curious fact was that he remembered a field of oats which was
just sprouting about the time he fell in the trance. The same field
was now standing in corn knee-high. After his recovery from the trance
he rapidly became worse and died in eighteen months. There is a record
of a man near Rochester, N.Y., who slept for five years, never waking
for more than sixteen hours at a time, and then only at intervals of
six weeks or over. When seized with his trance he weighed 160, but he
dwindled down to 90 pounds. He passed urine once or twice a day, and
had a stool once in from six to twenty days. Even such severe treatment
as counter-irritation proved of no avail. Gunson mentions a man of
forty-four, a healthy farmer, who, after being very wet and not
changing his clothes, contracted a severe cold and entered into a long
and deep sleep lasting for twelve hours at a time, during which it was
impossible to waken him. This attack lasted eight or nine months, but
in 1848 there was a recurrence accompanied by a slight trismus which
lasted over eighteen months, and again in 1860 he was subjected to
periods of sleep lasting over twenty-four hours at a time. Blaudet
describes a young woman of eighteen who slept forty days, and again
after her marriage in her twentieth year she slept for fifty days; it
was necessary to draw a tooth to feed her. Four years later, on Easter
day, 1862, she became insensible for twelve months, with the exception
of the eighth day, when she awoke and ate at the table, but fell asleep
in the chair. Her sleep was so deep that nothing seemed to disturb her;
her pulse was slow, the respirations scarcely perceptible, and there
were apparently no evacuations.
Weir Mitchell collected 18 cases of protracted sleep, the longest
continuing uninterruptedly for six months. Chilton's case lasted
seventeen weeks. Six of the 18 cases passed a large part of each day in
sleep, one case twenty-one hours, and another twenty-three hours. The
patients were below middle life; ten were females, seven males, and one
was a child whose sex was not given. Eight of the 18 recovered easily
and completely, two recovered with loss of intellect, one fell a victim
to apoplexy four months after awakening, one recovered with insomnia as
a sequel, and four died in sleep. One recovered suddenly after six
months' sleep and began to talk, resuming the train of thought where it
had been interrupted by slumber. Mitchell reports a case in an
unmarried woman of forty-five. She was a seamstress of dark complexion
and never had any previous symptoms. On July 20, 1865, she became
seasick in a gale of wind on the Hudson, and this was followed by an
occasional loss of sight and by giddiness. Finally, in November she
slept from Wednesday night to Monday at noon, and died a few days
later. Jones of New Orleans relates the case of a girl of twenty-seven
who had been asleep for the last eighteen years, only waking at certain
intervals, and then remaining awake from seven to ten minutes. The
sleep commenced at the age of nine, after repeated large doses of
quinin and morphin. Periods of consciousness were regular, waking at 6
A.M. and every hour thereafter until noon, then at 3 P.M., again at
sunset, and at 9 P.M., and once or twice before morning. The sleep was
deep, and nothing seemed to arouse her. Gairdner mentions the case of a
woman who, for one hundred and sixty days, remained in a lethargic
stupor, being only a mindless automaton. Her life was maintained by
means of the stomach tube. The Revue d'Hypnotisme contains the report
of a young woman of twenty-five, who was completing the fourth year of
an uninterrupted trance. She began May 30, 1883, after a fright, and
on the same day, after several convulsive attacks, she fell into a
profound sleep, during which she was kept alive by small quantities of
liquid food, which she swallowed automatically. The excretions were
greatly diminished, and menstruation was suppressed. There is a case
reported of a Spanish soldier of twenty-two, confined in the Military
Hospital of San Ambrosio, Cuba, who had been in a cataleptic state for
fourteen months. His body would remain in any position in which it was
placed; defecation and micturition were normal; he occasionally sneezed
or coughed, and is reported to have uttered some words at night. The
strange feature of this case was that the man was regularly nourished
and increased in weight ten pounds. It was noted that, some months
before, this patient was injured and had suffered extreme depression,
which was attributed to nostalgia, after which he began to have
intermittent and temporary attacks, which culminated as related.
Camuset and Planes in January, 1896, mention a man who began to have
grand hallucinations in 1883. In March, 1884, he exhibited the first
signs of sleep, and on March 10th it was necessary to put him to bed,
where he remained, more or less continuously for three months,
awakening gradually, and regaining his normal condition by the middle
of June. He was fed by hand three times daily, was placed on a
night-chair, and with one exception never evacuated in bed. Five months
afterward he showed no signs of relapse. The latest report of a
"sleeping girl" is that of the young Dutch maiden, Maria Cvetskens, of
Stevenswerth, who on December 5, 1895, had been asleep for two hundred
and twenty days. She had been visited by a number of men of good
professional standing who, although differing as to the cause of her
prolonged sleep, universally agreed that there was no deception in the
case. Her parents were of excellent repute, and it had never occurred
to them to make any financial profit out of the unnatural state of
their daughter.
Hypnotism.--The phenomenon of hypnotism was doubtless known to the
Oriental nations, and even to the Greeks, Romans, and Egyptians, as
well as to other nations since the downfall of the Roman Empire. "The
fakirs of India, the musicians of Persia, the oracles of Greece, the
seers of Rome, the priests and priestesses of Egypt, the monastic
recluses of the Middle Ages, the ecstatics of the seventeenth and early
part of the eighteenth century exhibited many symptoms that were, and
are still, attributed by religious enthusiasts to supernatural
agencies, but which are explainable by what we know of hypnotism. The
Hesychasts of Mount Athos who remained motionless for days with their
gaze directed steadily to the navel; the Taskodrugites who remained
statuesque for a long period with the finger applied to the nose; the
Jogins who could hibernate at will; the Dandins of India who became
cataleptoid by 12,000 repetitions of the sacred word Om; St. Simeon
Stylites who, perched on a lofty pillar, preserved an attitude of
saint-like withdrawal from earthly things for days; and even Socrates,
of whom it was said that he would stand for hours motionless and
wordless--all these are probable instances of autohypnotism." (Gray.)
Hypnotism is spoken of as a morbid mental state artificially produced,
and characterized by perversion or suspension of consciousness, and
abeyance of volition; a condition of suggestibility leads the patient
to yield readily to commands of external sense-impressions, and there
is intense concentration of the mental faculties upon some idea or
feeling. There are several methods of inducing hypnosis, one of which
is to give particular direction to the subject's imagination by
concentrating the attention upon an arbitrary point, or by raising an
image of the hypnotic state in the patient's mind. The latter is most
readily induced by speech. Faria formerly strained the attention of the
subject as much as possible, and suddenly called out, "Sleep!" This
method has been used by others. Physical methods consist of certain
stimuli of sight, hearing, and touch. Taste and smell have generally
given negative results. Fixation of the gaze has been the most
successful, but the ticking of a watch has been used. According to
Moll, among uncivilized races particular instruments are used to
produce similar states, for example, the magic drum's sound among the
Lapps, or among other races the monotony of rhythm in song, etc.
Instead of these continuous, monotonous, weak stimulations of the
senses, we find also that sudden and violent ones are made use of--for
example in the Salpetriere, the field of Charcot's work, the loud noise
of a gong, or a sudden ray of light; however, it is more than doubtful
whether these sudden, strong, physical stimuli, without any mental
stimuli, can induce hypnosis. Perhaps we have to do here with states
not far removed from paralysis from fright. The sense of touch is also
brought into play in hypnosis; Richet set great value on the so-called
mesmeric strokes or passes. It is often stated that touches on the
forehead induce a sleepy state in many persons. Hypnotism is practiced
by stimulation of the muscular sense, such as cradle-rocking, used to
send little children to sleep. Similar states are said to be produced
among uncivilized people by violent whirling or dancing movements; the
movements are, however, accompanied by music and other mental
excitations.
Hypnosis is spoken of by Huc and Hellwald of the Buddhist convents in
Thibet; and Sperling, who has had a particularly wide experience in the
field of hypnotism, and whose opinion is of particular value, says that
he has seen dervishes in Constantinople who, from the expression of
their eyes and their whole appearance, as well as from peculiar
postures they maintain for a long time, impressed him as being in a
hypnotic state. The state may have been induced by singing and uniform
whirling motions. Hildebrandt, Jacolliot, Fischer, Hellwald, and other
trustworthy witnesses and authors tell us strange things about the
fakirs of India, which set any attempt at explanation on the basis of
our present scientific knowledge at defiance--that is, if we decline to
accept them as mere juggler's tricks. Hypnotism seems to be the only
explanation. It is a well known fact that both wild and domestic beasts
can be hypnotized and the success of some of the animal-tamers is due
to this fact. In hypnotism we see a probable explanation for the
faith-cures which have extended over many centuries, and have their
analogy in the supposed therapeutic powers of the Saints.
The medicolegal aspect of hypnotism may be called in to answer whether
crime may be committed at suggestion. Such examples have already been
before the public in the recent trial of the Parisian strangler,
Eyraud. It was claimed that his accomplice in the crime, Gabrielle
Bompard, had been hypnotized. Bernheim narrates a case of outrage
effected in the hypnotic condition, which was brought to light by a
trial in the South of France.
As to the therapeutic value of hypnotism, with the exception of some
minor benefits in hysteric cases and in insomnia, the authors must
confess that its use in Medicine seems very limited.
African sleep-sickness is a peculiar disorder, apparently infectious in
character, which occurs among the negroes of the western coast of
Africa. It has been transported to other regions but is endemic in
Africa. According to Dana it begins gradually with malaise and
headache. Soon there is drowsiness after meals which increases until
the patient is nearly all the time in a stupor. When awake he is dull
and apathetic. There is no fever; the temperature may be subnormal. The
pulse, too, is not rapid, the skin is dry, the tongue moist but coated,
the bowels regular. The eyes become congested and prominent. The
cervical glands enlarge. The disease ends in coma and death. Recovery
rarely occurs. Sometimes the disease is more violent, and toward the
end there are epileptic convulsions and muscular tremors. Autopsies
have revealed no pathologic changes.
Recently Forbes contributes an interesting paper on the sleeping
sickness of Africa. The disease may occur in either sex and at any age,
though it is most frequent from the twelfth to the twentieth years, and
in the male sex. It begins with enlargement of the cervical glands, and
drowsiness and sleep at unusual hours. At first the patient may be
aroused, but later sinks into a heavy stupor or coma. Death occurs in
from three to twelve months, and is due to starvation. Forbes reports
11 fatal cases, and two that passed from observation. At the autopsy
are found hyperemia of the arachnoid, and slight chronic
leptomeningitis and pachymeningitis. There is also anemia of the
brain-substance. In one of his cases the spleen was enlarged. He was
inclined to regard the disease as a neurosis.
Aphasia is a disease of the faculty of language, that is, a disturbance
of the processes by which we see, hear, and at the same time appreciate
the meaning of symbols. It includes also the faculty of expressing our
ideas to others by means of the voice, gesture, writing, etc. The
trouble may be central or in the conducting media. The varieties of
aphasia are:--
(1) Amnesia of speech.
(2) Amnesia of speech and written language.
(3) Amnesia of speech, written language, and gesture.
In most cases there is no paralysis of the tongue or speech-forming
organs. As a rule the intellect is unaffected, the patient has the
ideas, but lacks the power to give them proper expression through
words, written language, or gesture. If the patient is enable to write,
the condition is known as agraphia. Word-blindness, word-deafness,
etc., are terms of different forms of aphasia.
What was probably a case of incomplete aphasia is mentioned by Pliny,
that of Messala Corvinus who was unable to tell his own name; and many
instances of persons forgetting their names are really nothing but
cases of temporary or incomplete aphasia. In some cases of incomplete
and in nearly all cases of complete aphasia, involuntary sentences are
ejaculated. According to Seguin a reverend old gentleman affected with
amnesia of words was forced to utter after the sentence, "Our Father
who art in heaven," the words "let Him stay there." A lady seen by
Trousseau would rise on the coming of a visitor to receive him with a
pleased and amiable expression of countenance, and show him to a chair,
at the same time addressing to him the words, "cochon, animal, fichue
bete," French words hardly allowable in drawing-room usage. She was
totally aphasic but not paralyzed. Women often use semi-religious
expressions like "Oh dear," or "Oh Lord." Men of the lower classes
retain their favorite oaths remarkably. Sometimes the phrases
ejaculated are meaningless, as in Broca's celebrated case.
Aphasia may be the result of sudden strong emotions, in such cases
being usually temporary; it may be traumatic; it may be the result of
either primary or secondary malnutrition or degeneration.
There are some cases on record in which the sudden loss and the sudden
return of the voice are quite marvelous.
Habershon reports the case of a woman who on seeing one of her children
scalded fell unconscious and motionless, and remained without food for
three days. It was then found that she suffered from complete aphasia.
Five weeks after the incident she could articulate only in a very
limited vocabulary.
In the Philosophical Transactions Archdeacon Squire tells of the case
of Henry Axford, who lost the power of articulation for four years;
after a horrible dream following a debauch he immediately regained his
voice, and thereafter he was able to articulate without difficulty.
Ball records a curious case of what he calls hysteric aphonia. The
patient was a young lady who for several months could neither sing nor
speak, but on hearing her sister sing a favorite song, she began to
sing herself; but, although she could sing, speech did not return for
several weeks. Ball remarks that during sleep such patients may cry out
loudly in the natural voice.
Wadham reports the case of a boy of eighteen who was admitted to his
ward suffering with hemiplegia of the left side. Aphasia developed
several days after admission and continued complete for three months.
The boy gradually but imperfectly recovered his speech. Over six months
after the original admission he was readmitted with necrosis of the
jaw, for which he underwent operation, and was discharged a month
later. From this time on he became progressively emaciated until his
death, twelve months after Wadham first saw him. A postmortem
examination showed nearly total destruction of the Island of Reil,
popularly called the speech-center. Jackson mentions a hemiplegic
patient with aphasia who could only utter the words "come on to me,"
"come on," and "yes" and "no." Bristowe cites the history of a sailor
of thirty-six, a patient of St. Thomas Hospital, London, who suffered
from aphasia for nine months. His case was carefully explained to him
and he nodded assent to all the explanations of the process of speech
as though he understood all thoroughly. He was gradually educated to
speak again by practicing the various sounds. It may be worth while to
state that after restoration of speech he spoke with his original
American accent.
Ogle quotes six cases of loss of speech after bites of venomous snakes.
Two of the patients recovered. According to Russ this strange symptom
is sometimes instantaneous and in other instances it only appears after
an interval of several hours. In those who survive the effects of the
venom it lasts for an indefinite period. One man seen by Russ had not
only lost his speech in consequence of the bite of a fer-de-lance
snake, but had become, and still remained, hemiplegic. In the rest of
Russ's cases speech alone was abolished. Russ remarks that the
intelligence was altogether intact, and sensibility and power of motion
were unaffected. One woman who had been thus condemned to silence,
suddenly under the influence of a strong excitement recovered her
speech, but when the emotion passed away speech again left her. Ogle
accounts for this peculiar manifestation of aphasia by supposing that
the poison produces spasm of the middle cerebral arteries, and when the
symptom remains a permanent defect the continuance of the aphasia is
probably due to thrombosis of arteries above the temporary constriction.
Anosmia, or loss of smell, is the most common disorder of olfaction; it
may be caused by cortical lesions, olfactory nerve-changes, congenital
absence, or over-stimulation of the nerves, or it may be a symptom of
hysteria.
Ogle, after mentioning several cases of traumatic anosmia, suggests
that a blow on the occiput is generally the cause. Legg reports a
confirmatory case, but of six cases mentioned by Notta two were caused
by a blow on the crown of the head, and two on the right ear. The
prognosis in traumatic anosmia is generally bad, although there is a
record of a man who fell while working on a wharf, striking his head
and producing anosmia with partial loss of hearing and sight, and who
for several weeks neither smelt nor tasted, but gradually recovered.
Mitchell reports a case of a woman of forty who, after an injury to her
nose from a fall, suffered persistent headache and loss of smell. Two
years later, at bedtime, or on going to sleep, she had a sense of
horrible odors, which were fecal or animal, and most intense in nature.
The case terminated in melancholia, with delirium of persecution,
during which the disturbance of smell passed away.
Anosmia has been noticed in leukoderma and allied disturbances of
pigmentation. Ogle mentions a negro boy in Kentucky whose sense of
smell decreased as the leukoderma extended. Influenza, causing
adhesions of the posterior pillars of the fauces, has given rise to
anosmia.
Occasionally overstimulation of the olfactory system may lead to
anosmia. Graves mentions a captain of the yeomanry corps who while
investigating the report that 500 pikes were concealed at the bottom of
a cesspool in one of the city markets superintended the emptying of the
cesspool, at the bottom of which the arms were found. He suffered
greatly from the abominable effluvia, and for thirty-six years
afterward he remained completely deprived of the sense of smell.
In a discussion upon anosmia before the Medico-Chirurgical Association
of London, January 25, 1870, there was an anosmic patient mentioned who
was very fond of the bouquet of moselle, and Carter mentioned that he
knew a man who had lost both the senses of taste and smell, but who
claimed that he enjoyed putrescent meat. Leared spoke of a case in an
epileptic affected with loss of taste and smell, and whose paroxysms
were always preceded by an odor of peach-blossoms.
Hyperosmia is an increase in the perception of smell, which rarely
occurs in persons other than the hysteric and insane. It may be
cultivated as a compensatory process, as in the blind, or those engaged
in particular pursuits, such as tea-tasting. Parosmia is a rare
condition, most often a symptom of hysteria or neurasthenia, in which
everything smells of a similar, peculiar, offensive odor.
Hallucinations of odor are sometimes noticed in the insane. They form
most obstinate cases, when the hallucination gives rise to imaginary
disagreeable, personal odors.
Perversion of the tactile sense, or wrong reference to the sensation of
pain, has occasionally been noticed. The Ephemerides records a case in
which there was the sense of two objects from a single touch on the
hypochondrium. Weir Mitchell remarks that soldiers often misplace the
location of pain after injuries in battle. He also mentions several
cases of wrong reference of the sensation of pain. These instances
cannot be called reflex disturbances, and are most interesting. In one
case the patient felt the pain from a urethral injection in gonorrhea,
on the top of the head. In another an individual let an omnibus-window
fall on his finger, causing but brief pain in the finger, but violent
pains in the face and neck of that side. Mitchell also mentions a
naturalist of distinction who had a small mole on one leg which, if
roughly rubbed or pinched, invariably seemed to cause a sharp pain in
the chin.
Nostalgia is the name generally given to that variety of melancholia in
which there is an intense longing for home or country. This subject has
apparently been overlooked in recent years, but in the olden times it
was extensively discussed. Swinger, Harderus, Tackius, Guerbois,
Hueber, Therrin, Castellanau, Pauquet, and others have written
extensively upon this theme. It is said that the inhabitants of cold
countries, such as the Laplanders and the Danes, are the most
susceptible to this malady. For a long time many writers spoke of the
frequency and intensity of nostalgia among the Swiss. Numerous cases of
suicide from this affliction have been noticed among these hardy
mountaineers, particularly on hearing the mountain-song of their homes,
"Ranz des vaches." This statement, which is an established fact, is
possibly due to the social constitution of the Swiss mountaineers, who
are brought up to a solitary home life, and who universally exhibit
great attachment to and dependence upon their parents and immediate
family. In the European armies nostalgia has always been a factor in
mortality. In the Army of the Moselle, and in Napoleon's Alpine Army,
the terrible ravages of suicide among the young Bretons affected with
nostalgia have been recorded; it is among the French people that most
of the investigation on this subject has been done. Moreau speaks of a
young soldier in a foreign country and army who fell into a most
profound melancholy when, by accident, he heard his native tongue.
According to Swinger and Sauvages women are less subject to nostalgia
than men. Nostalgia has been frequently recorded in hospital wards.
Percy and Laurent have discussed this subject very thoroughly, and cite
several interesting cases among emigrants, soldiers, marines, etc.
Hamilton speaks of a recruit who became prostrated by longing for his
home in Wales. He continually raved, but recovered from his delirium
when assured by the hospital authorities of his forthcoming furlough.
Taylor records two cases of fatal nostalgia. One of the victims was a
Union refugee who went to Kentucky from his home in Tennessee. He died
talking about and pining for his home. The second patient was a member
of a regiment of colored infantry; he died after repeatedly pining for
his old home.
Animals are sometimes subject to nostalgia, and instances are on record
in which purchasers have been compelled to return them to the old home
on account of their literal home-sickness. Oswald tells of a bear who,
in the presence of food, committed suicide by starvation.
Hypochondria consists of a mild form of insanity in which there is a
tendency to exaggerate the various sensations of the body and their
importance, their exaggeration being at times so great as to amount to
actual delusion. All sorts of symptoms are dwelt upon, and the doctor
is pestered to the extreme by the morbid fears of the patient.
Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or
Zwangshandlungen, and by the French, peurs maladies, have only been
quite recently studied, and form most interesting cases of minor
insanity. Gelineau has made extensive investigations in this subject,
and free reference has been made to his work in the preparation of the
following material.
Aichmophobia is a name given by the French to the fear of the sight of
any sharp-pointed instrument, such as a pin, needle, fish-spine, or
naked sword. An illustrious sufferer of this 'phobia was James I of
England, who could never tolerate the appearance of a drawn sword.
Gelineau reports an interesting case of a female who contracted this
malady after the fatigue of lactation of two children. She could not
tolerate knives, forks, or any pointed instruments on the table, and
was apparently rendered helpless in needle-work on account of her
inability to look at the pointed needle.
Agoraphobia is dread of an open space, and is sometimes called
Kenophobia. The celebrated philosopher Pascal was supposed to have been
affected with this fear. In agoraphobia the patient dreads to go across
a street or into a field, is seized with an intense feeling of fright,
and has to run to a wall or fall down, being quite unable to proceed.
There is violent palpitation, and a feeling of constriction is
experienced. According to Suckling, pallor and profuse perspiration are
usually present, but there is no vertigo, confusion of mind, or loss of
consciousness. The patient is quite conscious of the foolishness of the
fears, but is unable to overcome them. The will is in abeyance and is
quite subservient to the violent emotional disturbances. Gray mentions
a patient who could not go over the Brooklyn Bridge or indeed over any
bridge without terror. Roussel speaks of a married woman who had never
had any children, and who was apparently healthy, but who for the past
six months had not been able to put her head out of the window or go
upon a balcony. When she descended into the street she was unable to
traverse the open spaces. Chazarin mentions a case in a woman of fifty,
without any other apparent symptom of diathesis. Gelineau quotes a case
of agoraphobia, secondary to rheumatism, in a woman of thirty-nine.
There is a corresponding fear of high places often noticed, called
acrophobia; so that many people dare not trust themselves on high
buildings or other eminences.
Thalassophobia is the fear of the view of immense spaces or
uninterrupted expanses. The Emperor Heraclius, at the age of
fifty-nine, had an insurmountable fear of the view of the sea; and it
is said that when he crossed the Bosphorus a bridge of boats was
formed, garnished on both sides with plants and trees, obscuring all
view of the water over which the Emperor peacefully traversed on
horseback. The moralist Nicole, was equally a thalassophobe, and always
had to close his eyes at the sight of a large sheet of water, when he
was seized with trembling in all his limbs. Occasionally some accident
in youth has led to an aversion to traversing large sheets of water,
and there have been instances in which persons who have fallen into the
water in childhood have all their lives had a terror of crossing
bridges.
Claustrophobia is the antithesis of agoraphobia. Raggi describes a case
of such a mental condition in a patient who could not endure being
within an enclosure or small space. Suckling mentions a patient of
fifty-six who suffered from palpitation when shut in a railway carriage
or in a small room. She could only travel by rail or go into a small
room so long as the doors were not locked, and on the railroad she had
to bribe the guard to leave the doors unlocked. The attacks were purely
mental, for the woman could be deceived into believing that the door to
a railroad carriage was unlocked, and then the attack would immediately
subside. Suckling also mentions a young woman brought to him at Queen's
Hospital who had a great fear of death on getting into a tram car, and
was seized with palpitation and trembling on merely seeing the car.
This patient had been in an asylum. The case was possibly due more to
fear of an accident than to true claustrophobia. Gorodoichze mentions a
case of claustrophobia in a woman of thirty-eight, in whose family
there was a history of hereditary insanity. Ball speaks of a case in a
woman who was overcome with terror half way in the ascension of the
Tour Saint-Jacques, when she believed the door below was closed.
Gelineau quotes the case of a brave young soldier who was believed to
be afraid of nothing, but who was unable to sleep in a room of which
the door was closed.
Astrophobia or astropaphobia is a morbid fear of being struck by
lightning. It was first recognized by Bruck of Westphalia, who knew a
priest who was always in terror when on a country road with an
unobstructed view of the sky, but who was reassured when he was under
the shelter of trees. He was advised by an old physician always to use
an umbrella to obstruct his view of the heavens, and in this way his
journeys were made tranquil. Beard knew an old woman who had suffered
all her life from astrophobia. Her grandmother had presented the same
susceptibility and the same fears. Sometimes she could tell the
approach of a storm by her nervous symptoms. Caligula, Augustus, Henry
III, and other celebrated personages, were overcome with fear during a
storm.
Mysophobia is a mild form of insanity characterized by a dread of the
contact of dirt. It was named by Hammond, whose patient washed her
hands innumerable times a day, so great was the fear of contamination.
These patients make the closest inspection of their toilet, their
eating and drinking utensils, and all their lives are intensely worried
by fear of dirt.
Hematophobia is a horror of blood, which seems to be an instinctive
sentiment in civilized man, but which is unknown among savages. When
the horror is aggravated to such an extent as to cause distressing
symptoms or unconsciousness, it takes the name of hematophobia. There
are many cases on record and nearly every physician has seen one or
more, possibly among his colleagues.
Necrophobia and thanatophobia are allied maladies, one being the fear
of dead bodies and the other the fear of death itself.
Anthropophobia is a symptom of mental disease consisting in fear of
society. Beard, Mitchell, Baillarger, and others have made observations
on this disease. The antithesis of this disease is called monophobia.
Patients are not able to remain by themselves for even the shortest
length of time. This morbid dread of being alone is sometimes so great
that even the presence of an infant is an alleviation. Gelineau cites
an instance in a man of forty-five which was complicated with
agoraphobia.
Bacillophobia is the result of abnormal pondering over bacteriology.
Huchard's case was in a woman of thirty-eight who, out of curiosity,
had secretly read the works of Pasteur, and who seemed to take
particular pleasure in conning over the causes of death in the
health-reports. Goyard mentions an instance in a Swiss veterinary
surgeon.
Kleptophobia, examples of which have been cited by Cullere, is the fear
of stealing objects in view, and is often the prelude of kleptomania.
The latter disease has gained notoriety in this country, and nearly
every large store has agents to watch the apparently growing number of
kleptomaniacs. These unfortunate persons, not seldom from the highest
classes of society, are unable to combat an intense desire to purloin
articles. Legal proceedings have been instituted against many, and
specialists have been called into court to speak on this question.
Relatives and friends have been known to notify the large stores of the
thieving propensities of such patients.
Le Grande du Saulle has given to the disease in which there is a morbid
doubt about everything done, the name folie de doute. Gray mentions a
case in a patient who would go out of a door, close it, and then come
back, uncertain as to whether he had closed it, close it again, go off
a little way, again feel uncertain as to whether he had closed it
properly, go back again, and so on for many times. Hammond relates the
history of a case in an intelligent man who in undressing for bed would
spend an hour or two determining whether he should first take off his
coat or his shoes. In the morning he would sit for an hour with his
stockings in his hands, unable to determine which he should put on
first.
Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of
hydrophobia which sometimes assumes all the symptoms of the major
disease, and even produces death. Gelineau, Colin, Berillon, and others
have studied cases. In Berillon's case the patient was an artist, a
woman of brunet complexion, who for six years had been tormented with
the fear of becoming mad, and in whom the symptoms became so intense as
to constitute pseudobydrophobia. At their subsidence she was the victim
of numerous hallucinations which almost drove her to the point of
suicide.
Spermatophobia has been noticed among the ignorant, caused or increased
by inspection of sensational literature, treatises on the subject of
spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense
religious scruples, who was married at eighteen, and lost her husband
six years afterward. She had a proposition of marriage which she
refused, and was prostrated by the humid touch of the proposer who had
kissed her hand, imagining that the humidity was due to semen. She was
several times overcome by contact with men in public conveyances, her
fear of contamination being so great. Zoophobia, or dread of certain
animals, has been mentioned under another chapter under the head of
idiosyncrasies. Pantophobia is a general state of fear of everything
and everybody. Phobophobia, the fear of being afraid, is another
coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or
fear of fire; stasophobia, or inability to arise and walk, the victims
spending all their time in bed; toxicophobia or fear of poison, etc.,
will be left to the reader's inspection in special works on this
subject.
Demonomania is a form of madness in which a person imagines himself
possessed of the devil. Ancient records of this disease are frequent,
and in this century Lapointe reports the history of demonomania in
father, mother, three sons, and two daughters, the whole family, with
the exception of one son, who was a soldier, being attacked. They
imagined themselves poisoned by a sorceress, saw devils, and had all
sorts of hallucinations, which necessitated the confinement of the
whole family in an asylum for over a month. They continued free from
the hallucinations for two years, when first the mother, and then
gradually all the other members of the family, again became afflicted
with demonomania and were again sent to the asylum, when, after a
residence therein of five months, they were all sufficiently cured to
return home.
Particular aversions may be temporary only, that is, due to an existing
condition of the organism, which, though morbid, is of a transitory
character. Such, for instance, are those due to dentition, the
commencement or cessation of the menstrual function, pregnancy, etc.
These cases are frequently of a serious character, and may lead to
derangement of the mind. Millington relates the history of a lady who,
at the beginning of her first pregnancy, acquired an overpowering
aversion to a half-breed Indian woman who was employed in the house as
a servant. Whenever this woman came near her she was at once seized
with violent trembling; this ended in a few minutes with vomiting and
great mental and physical prostration lasting several hours. Her
husband would have sent the woman away, but Mrs. X insisted on her
remaining, as she was a good servant, in order that she might overcome
what she regarded as an unreasonable prejudice. The effort was,
however, too great, for upon one occasion when the woman entered Mrs.
X's apartment rather unexpectedly, the latter became greatly excited,
and, jumping from an open window in her fright, broke her arm, and
otherwise injured herself so severely that she was confined to her bed
for several weeks. During this period, and for some time afterward, she
was almost constantly subject to hallucinations, in which the Indian
woman played a prominent part. Even after her recovery the mere thought
of the woman would sometimes bring on a paroxysm of trembling, and it
was not till after her confinement that the antipathy disappeared.
Circular or periodic insanity is a rare psychosis. According to Drewry
reports of very few cases have appeared in the medical journals. "Some
systematic writers," says Drewry, "regard it as a mere subdivision of
periodic insanity (Spitzka). A distinguished alienist and author of
Scotland however has given us an admirable lecture on the subject. He
says: 'I have had under my care altogether about 40 cases of typical
folie circulaire.' In the asylum at Morningside there were, says Dr.
Clouston, in 800 patients 16 cases of this peculiar form of mental
disease. Dr. Spitzka, who was the first American to describe it, found
in 2300 cases of pauper insane four per cent to be periodic, and its
sub-group, circular, insanity. Dr. Stearns states that less than
one-fourth of one per cent of cases in the Hartford (Conn.) Retreat
classed as mania and melancholia have proved to be folie circulaire.
Upon examination of the annual reports of the superintendents of
hospitals for the insane in this country, in only a few are references
made to this as a distinct form of insanity. In the New York State
hospitals there is a regular uniform classification of mental diseases
in which 'circular (alternating) insanity' occupies a place. In the
report of the Buffalo Hospital for 1892, in statistical table No. 4,
'showing forms of insanity in those admitted, etc., since 1888,' out of
1428 cases, only one was 'alternating (circular) insanity.' In the St.
Lawrence Hospital only one case in 992 was credited to this special
class. In the institution in Philadelphia, of which Dr. Chapin is the
superintendent, 10,379 patients have been treated, only three of whom
were diagnosed cases of manie circulaire. Of the 900 cases of insanity
in the State Hospital at Danville, Pa., less than four per cent were
put in this special class. There are in the Central (Va.) State
Hospital (which is exclusively for the colored insane) 775 patients,
three of whom are genuine cases of circular insanity, but they are
included in 'periodic insanity.' This same custom evidently prevails in
many of the other hospitals for the insane."
Drewry reports three cases of circular insanity, one of which was as
follows:--
"William F., a negro, thirty-six years old, of fair education, steady,
sober habits, was seized with gloomy depression a few weeks prior to
his admission to this hospital, in September, 1886. This condition came
on after a period of fever. He was a stranger in the vicinity and
scarcely any information could be obtained regarding his antecedents.
When admitted he was in a state of melancholic hypochondriasis; he was
the very picture of abject misery. Many imaginary ills troubled his
peace of mind. He spoke of committing suicide, but evidently for the
purpose of attracting attention and sympathy. On one occasion he said
he intended to kill himself, but when the means to do so were placed at
his command, he said he would do the deed at another time. The most
trivial physical disturbances were exaggerated into very serious
diseases. From this state of morbid depression he slowly emerged, grew
brighter, more energetic, neater in personal appearance, etc. During
this period of slow transition or partial sanity he was taken out on
the farm where he proved to be a careful and industrious laborer. He
escaped, and when brought back to the hospital a few weeks subsequently
he was in a condition of great excitement and hilarity. His expression
was animated, and he was, as it were, overflowing with superabundance
of spirit, very loquacious, and incessantly moving. He bore an air of
great importance and self-satisfaction; said he felt perfectly well and
happy, but abused the officers for keeping him 'confined unjustly in a
lunatic asylum.' It was his habit almost daily, if not interfered with,
to deliver a long harangue to his fellow-patients, during which he
would become very excited and noisy. He showed evidences of having a
remarkable memory, particularly regarding names and dates. (Unusual
memory is frequently observed in this type of insanity, says Stearns.)
He was sometimes disposed to be somewhat destructive to furniture,
etc., was neat in person, but would frequently dress rather
'gorgeously,' wearing feathers and the like in his hat, etc. He was not
often noisy and sleepless at night, and then only for a short time. His
physical health was good. This 'mental intoxication,' as it were,
lasted nearly a year. After this long exacerbation of excitement there
was a short remission and then depression again set in, which lasted
about fifteen months. At this time this patient is in the depressed
stage or period of the third circle. So, thus the cycles have
continuously repeated their weary rounds, and in all probability they
will keep this up 'until the final capitation in the battle of life has
taken place.'"
Katatonia, according to Gray, is a cerebral disease of cyclic symptoms,
ranging in succession from primary melancholia to mania, confusion, and
dementia, one or more of these stages being occasionally absent, while
convulsive and epileptoid symptoms accompany the mental changes.
It is manifestly impossible to enter into the manifold forms and
instances of insanity in this volume, but there is one case, seldom
quoted, which may be of interest. It appeared under the title, "A
Modern Pygmalion." It recorded a history of a man named Justin, who
died in the Bicetre Insane Asylum. He had been an exhibitor of wax
works at Montrouge, and became deeply impressed with the beautiful
proportions of the statue of a girl in his collection, and ultimately
became intensely enamored with her. He would spend hours in
contemplation of the inanimate object of his affections, and finally
had the illusion that the figure, by movements of features, actually
responded to his devotions. Nemesis as usual at last arrived, and the
wife of Justin, irritated by his long neglect, in a fit of jealousy
destroyed the wax figure, and this resulted in a murderous attack on
his wife by Justin who resented the demolition of his love. He was
finally secured and lodged in Bicetre, where he lived for five years
under the influence of his lost love.
An interesting condition, which has been studied more in France than
elsewhere, is double consciousness, dual personality, or, as it is
called by the Germans, Doppelwahrnehmungen. In these peculiar cases an
individual at different times seems to lead absolutely different
existences. The idea from a moralist's view is inculcated in
Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject
Weir Mitchell illustrated his paper by examples, two of which will be
quoted. The first was the case of Mary Reynolds who, when eighteen
years of age, became subject to hysteric attacks, and on one occasion
she continued blind and deaf for a period of five or six weeks. Her
hearing returned suddenly, and her sight gradually. About three months
afterward she was discovered in a profound sleep. Her memory had fled,
and she was apparently a new-born individual. When she awoke it became
apparent that she had totally forgotten her previous existence, her
parents, her country, and the house where she lived. She might be
compared to an immature child. It was necessary to recommence her
education. She was taught to write, and wrote from right to left, as in
the Semitic languages. She had only five or six words at her
command--mere reflexes of articulation which were to her devoid of
meaning. The labor of re-education, conducted methodically, lasted from
seven to eight weeks. Her character had experienced as great a change
as her memory; timid to excess in the first state, she became gay,
unreserved, boisterous, daring, even to rashness. She strolled through
the woods and the mountains, attracted by the dangers of the wild
country in which she lived. Then she had a fresh attack of sleep, and
returned to her first condition; she recalled all the memories and
again assumed a melancholy character, which seemed to be aggravated. No
conscious memory of the second state existed. A new attack brought back
the second state, with the phenomenon of consciousness which
accompanied it the first time. The patient passed successively a great
many times from one of these states to the other. These repeated
changes stretched over a period of sixteen years. At the end of that
time the variations ceased. The patient was then thirty-six years of
age; she lived in a mixed state, but more closely resembling the second
than the first; her character was neither sad nor boisterous, but more
reasonable. She died at the age of sixty-five years.
The second case was that of an itinerant Methodist minister named
Bourne, living in Rhode Island, who one day left his home and found
himself, or rather his second self, in Norristown, Pennsylvania. Having
a little money, he bought a small stock in trade, and instead of being
a minister of the gospel under the Methodist persuasion, he kept a
candy shop under the name of A. J. Brown, paid his rent regularly, and
acted like other people. At last, in the middle of the night, he awoke
to his former consciousness, and finding himself in a strange place,
supposed he had made a mistake and might be taken for a burglar. He was
found in a state of great alarm by his neighbors, to whom he stated
that he was a minister, and that his home was in Rhode Island. His
friends were sent for and recognized him, and he returned to his home
after an absence of two years of absolutely foreign existence. A most
careful investigation of the case was made on behalf of the London
Society for Psychical Research.
An exhaustive paper on this subject, written by Richard Hodgson in the
proceedings of the Society for Psychical Research, states that Mr.
Bourne had in early life shown a tendency to abnormal psychic
conditions; but he had never before engaged in trade, and nothing could
be remembered which would explain why he had assumed the name A. J.
Brown, under which he did business. He had, however, been hypnotized
when young and made to assume various characters on the stage, and it
is possible that the name A. J. Brown was then suggested to him, the
name resting in his memory, to be revived and resumed when he again
went into a hypnotic trance.
Alfred Binet describes a case somewhat similar to that of Mary
Reynolds: "Felida, a seamstress, from 1858 up to the present time (she
is still living) has been under the care of a physician named Azam in
Bordeaux. Her normal, or at least her usual, disposition when he first
met her was one of melancholy and disinclination to talk, conjoined
with eagerness for work. Nevertheless her actions and her answers to
all questions were found to be perfectly rational. Almost every day she
passed into a second state. Suddenly and without the slightest
premonition save a violent pain in the temples she would fall into a
profound slumber-like languor, from which she would awake in a few
moments a totally different being. She was now as gay and cheery as she
had formerly been morose. Her imagination was over-excited. Instead of
being indifferent to everything, she had become alive to excess. In
this state she remembered everything that had happened in the other
similar states that had preceded it, and also during her normal life.
But when at the end of an hour or two the languor reappeared, and she
returned to her normal melancholy state, she could not recall anything
that had happened in her second, or joyous, stage. One day, just after
passing into the second stage, she attended the funeral of an
acquaintance. Returning in a cab she felt the period coming on which
she calls her crisis (normal state). She dozed several seconds, without
attracting the attention of the ladies who were in the cab, and awoke
in the other state, absolutely at a loss to know why she was in a
mourning carriage with people who, according to custom, were praising
the qualities of a deceased person whose name she did not even know.
Accustomed to such positions, she waited; by adroit questions she
managed to understand the situation, and no one suspected what had
happened. Once when in her abnormal condition she discovered that her
husband had a mistress, and was so overcome that she sought to commit
suicide. Yet in her normal mind she meets the woman with perfect
equilibrium and forgetfulness of any cause for quarrel. It is only in
her abnormal state that the jealousy recurs. As the years went on the
second state became her usual condition. That which was at first
accidental and abnormal now constitutes the regular center of her
psychic life. It is rather satisfactory to chronicle that as between
the two egos which alternately possess her, the more cheerful has
finally reached the ascendant."
Jackson reports the history of the case of a young dry-goods clerk who
was seized with convulsions of a violent nature during which he became
unconscious. In the course of twenty-four hours his convulsions abated,
and about the third day he imagined himself in New York paying court to
a lady, and having a rival for her favors; an imaginary quarrel and
duel ensued. For a half-hour on each of three days he would start
exactly where he had left off on the previous day. His eyes were open
and to all appearances he was awake during this peculiar delirium. When
asked what he had been doing he would assert that he had been asleep.
His language assumed a refinement above his ordinary discourse. In
proportion as his nervous system became composed, and his strength
improved, this unnatural manifestation of consciousness disappeared,
and he ultimately regained his health.
A further example of this psychologic phenomenon was furnished quite
meetly at a meeting of the Clinical Society of London, where a well
known physician exhibited a girl of twelve, belonging to a family of
good standing, who displayed in the most complete and indubitable form
this condition of dual existence. A description of the case is as
follows:--
"Last year, after a severe illness which was diagnosed to be
meningitis, she became subject to temporary attacks of unconsciousness,
on awakening from which she appeared in an entirely different
character. In her normal condition she could read and write and speak
fluently, and with comparative correctness. In the altered mental
condition following the attack she loses all memory for ordinary
events, though she can recall things that have taken place during
previous attacks. So complete is this alteration of memory, that at
first she was unable to remember her own name or to identify herself or
her parents. By patient training in the abnormal condition she has been
enabled to give things their names, though she still preserves a
baby-fashion of pronouncing. She sometimes remains in the abnormal
condition for days together and the change to her real self takes place
suddenly, without exciting surprise or dismay, and she forthwith
resumes possession of her memory for events of her ordinary life.
During the last month or two she appears to have entered on a new
phase, for after a mental blank of a fortnight's duration she awakened
completely oblivious of all that had happened since June, 1895, and she
alludes to events that took place just anterior to that date as though
they were of recent occurrence; in fact she is living mentally in July,
1895. These cases, though rare, are of course not infrequently met
with, and they have been carefully studied, especially in France, where
women appear more prone to neurotic manifestations. The hypothesis that
finds most favor is that the two halves of the brain do not work in
unison; in other words, that there has been some interference with the
connections which in the ordinary normal being make of a wonderful
composite organ like the brain one organic whole."
Proust tells a story of a Parisian barrister of thirty-three. His
father was a heavy drinker, his mother subject to nervous attacks, his
younger brother mentally deficient, and the patient himself was very
impressionable. It was said that a judge in a court, by fixing his gaze
on him, could send him into an abnormal state. On one occasion, while
looking into a mirror in a cafe, he suddenly fell into a sleep, and was
taken to the Charite where he was awakened. He suffered occasional loss
of memory for considerable lengths of time, and underwent a change of
personality during these times. Though wide awake in such conditions he
could remember nothing of his past life, and when returned to his
original state he could remember nothing that occurred during his
secondary state, having virtually two distinct memories. On September
23, 1888, he quarreled with his stepfather in Paris and became his
second self for three weeks. He found himself in a village 100 miles
from Paris, remembering nothing about his journey thereto; but on
inquiry he found that he had paid a visit to the priest of the village
who thought his conduct odd, and he had previously stayed with an
uncle, a bishop, in whose house he had broken furniture, torn up
letters, and had even had sentence passed upon him by a police court
for misdemeanor. During these three weeks he had spent the equivalent
of $100, but he could not recall a single item of expenditure. Davies
cites a remarkable case of sudden loss of memory in a man who, while on
his way to Australia, was found by the police in an exhausted condition
and who was confined in the Kent County Insane Asylum. He suffered
absolute loss of all memory with the exception of the names of two men
not close acquaintances, both of whom failed to recognize him in his
changed condition in confinement. Four months later his memory returned
and his identity was established.
In the Revue Philosophique for 1885 there are the details of a case of
a young man who seemed able to assume six states of what might be
fairly called different personalities. The memories attached to each of
these states were very different, though only one was completely
exclusive of the others. The handwriting varied from complete
competence to complete incompetence. His character varied between
childish timidity, courteous reserve, and reckless arrogance; and to
four of his conditions there was a form of hysteric paralysis attached.
Mere suggestion would not only induce any one of these varied forms of
paralysis, but also the memories, capacities, and characters habitually
accompanying it.
A young man named Spencer, an inmate of the Philadelphia Hospital, was
exhibited before the American Neurological Society in June, 1896, as an
example of dual personality. At the time of writing he is and has been
in apparently perfect health, with no evidence of having been in any
other condition. His faculties seem perfect, his education manifests
itself in his intelligent performance of the cleric duties assigned to
him at the hospital, yet the thread of continuous recollection which
connects the present moment with its predecessors--consciousness and
memory--has evidently been snapped at some point of time prior to March
3d and after January 19th, the last date at which he wrote to his
parents, and as if in a dream, he is now living another life. The
hospital staff generally believe that the man is not "shamming," as
many circumstances seem to preclude that theory. His memory is perfect
as to everything back to March 3d. The theory of hypnotism was advanced
in explanation of this case.
The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican
Brothers," has been discussed by Sedgwick, Elliotson, Trousseau,
Laycock, Cagentre, and others. Marshall Hall relates what would seem to
verify the Corsican myth, the history of twin brothers nine months of
age, who always became simultaneously affected with restlessness,
whooping and crowing in breathing three weeks previous to simultaneous
convulsions, etc. Rush describes a case of twin brothers dwelling in
entirely different places, who had the same impulse at the same time,
and who eventually committed suicide synchronously. Baunir describes a
similar development of suicidal tendency in twin brothers. A peculiar
case of this kind was that of the twin brothers Laustand who were
nurses in a hospital at Bordeaux; they invariably became ill at the
same time, and suffered cataract of the lens together.
Automatism has been noticed as a sequel to cranial injuries, and Huxley
quotes a remarkable case reported by Mesnet. The patient was a young
man whose parietal bone was partially destroyed by a ball. He exhibited
signs of hemiplegia on the right side, but these soon disappeared and
he became subject to periodic attacks lasting from twenty-four to
forty-eight hours, during which he was a mere automaton. In these
attacks he walked continually, incessantly moving his jaw, but not
uttering a word. He was insensible to pain, electric shock, or
pin-prick. If a pen was placed in his hand he would write a good
letter, speaking sensibly about current topics. When a cigarette-paper
was placed in his hand he sought his tobacco box, and adroitly rolled a
cigarette and lighted it. If the light went out he procured another,
but would not allow another to substitute a match. He allowed his
mustache to be burned without resistance, but would not allow a light
to be presented to him. If chopped charpie was put in his pocket
instead of tobacco he knew no difference. While in his periods of
automatism he was in the habit of stealing everything within his grasp.
He had been a concert singer, and a peculiar fact was that if given
white gloves he would carefully put them on and commence a pantomime of
the actions of a singer, looking over his music, bowing, assuming his
position, and then singing.
It is particularly in hypnotic subjects that manifestations of
automatism are most marked. At the suggestion of battle an imaginary
struggle at once begins, or if some person present is suggested as an
enemy the fight is continued, the hypnotic taking care not to strike
the person in question. Moll conceded that this looked like simulation,
but repetition of such experiments forced him to conclude that these
were real, typical hypnoses, in which, in spite of the sense-delusions,
there was a dim, dreamy consciousness existing, which influenced the
actions of the subject, and which prevented him from striking at a
human being, although hitting at an imaginary object. Many may regard
this behavior of hypnotics as pure automatism; and Moll adds that, as
when walking in the street while reading we automatically avoid
knocking passers-by, so the hypnotic avoids hitting another person,
although he is dimly or not at all aware of his existence.
Gibbs reports a curious case of lack of integrity of the will in a man
of fifty-five. When he had once started on a certain labor he seemed to
have no power to stop the muscular exercise that the task called forth.
If he went to the barn to throw down a forkful of hay, he would never
stop until the hay was exhausted or someone came to his rescue. If sent
to the wood-pile for a handful of wood, he would continue to bring in
wood until the pile was exhausted or the room was full. On all
occasions his automatic movements could only be stopped by force.
At a meeting in Breslau Meschede rendered an account of a man who
suffered from simple misdirection of movement without any mental
derangement. If from his own desire, or by direction of others, he
wanted to attempt any muscular movement, his muscles performed the
exact opposite to his inclinations. If he desired to look to the right,
his eyes involuntarily moved to the left. In this case the movement was
not involuntary, as the muscles were quiet except when called to action
by the will, and then they moved to the opposite.
Presentiment, or divination of approaching death, appearing to be a
hypothetic allegation, has been established as a strong factor in the
production of a fatal issue in many cases in which there was every hope
for a recovery. In fact several physicians have mentioned with dread
the peculiar obstinacy of such presentiment. Hippocrates, Romanus,
Moller, Richter, Jordani, and other older writers speak of it.
Montgomery reports a remarkable case of a woman suffering from
carcinoma of the uterus. He saw her on October 6, 1847, when she told
him she had a strong presentiment of death on October 28th. She stated
that she had been born on that day, her first husband had died on
October 28th, and she had married her second husband on that day. On
October 27th her pulse began to fail, she fell into a state of extreme
prostration, and at noon on the 28th she died. In substantiation of the
possibility of the influence of presentiment Montgomery cites another
case in which he was called at an early hour to visit a lady, the
mother of several children. He found her apparently much agitated and
distressed, and in great nervous excitement over a dream she had had,
in which she saw a handsome monument erected by some children to their
mother. She had awakened and became dreadfully apprehensive, she could
not tell as to what. The uneasiness and depression continued, her
pulse continued to grow weak, and she died at twelve that night without
a struggle. Andrews has made several observations on this subject, and
concludes that presentiment of death is a dangerous symptom, and one
which should never be overlooked. One of his cases was in a man with a
fractured leg in the Mercy Hospital at Pittsburg. The patient was in
good health, but one day he became possessed of a cool, quiet, and
perfectly clear impression that he was about to die. Struck with his
conviction, Andrews examined his pulse and general condition minutely,
and assured the patient there was not the slightest ground for
apprehension. But he persisted, and was attacked by pneumonia three
days later which brought him to the verge of the grave, although he
ultimately recovered. In another instance a young man of ruddy
complexion and apparent good health, after an operation for varicocele,
had a very clear impression that he would die. Careful examination
showed no reason for apprehension. After five or six days of
encouragement and assurance, he appeared to be convinced that his
reasoning was foolish, and he gave up the idea of death. About the
ninth day the wound presented a healthy, rosy appearance, and as the
patient was cheerful he was allowed to leave his bed. After a few hours
the nurse heard the noise of labored breathing, and on investigation
found the patient apparently in a dying condition. He was given
stimulants and regained consciousness, but again relapsed, and died in
a few moments. At the necropsy the heart was found healthy, but there
were two or three spots of extravasated blood in the brain, and
evidences of cerebral congestion. Vos remarks that he remembers a case
he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A
man who had been intemperate was rolling a sod of grass, and got some
grit into his left palm. It inflamed; he put on hot cow-dung poultices
by the advice of some country friends. He was admitted with a
dreadfully swollen hand. It was opened, but the phlegmonous process
spread up to the shoulder, and it was opened in many places, and at
last, under chloroform, the limb was amputated below the joint. The
stump sloughed, and pus pointing at the back of the neck, an opening
was again made. He became in such a weak state that chloroform could
not be administered, and one morning he had such a dread of more
incisions that, saying to us all standing round his bed, 'I can bear it
no more, I must now die,' he actually did die in a few minutes in our
presence. His was the last arm that Mr. Holden ever amputated at St.
Bartholomew's."