Definition. Tetanic and paralytic forms. Balance of flexors and
extensors Cataleptoid. No constant lesion. Hysterical. Hypnotic.
Subjects: horse, ox, wolf, cat, chicken, Guineapig, snake, frog,
crayfish. Causes: strong mental impression, indigestion, etc., in
susceptible system. Lesion: inconstant, muscular degeneration, etc.
Symptoms: wax-like retention of position given, voluntary movement in
abeyance, mental functions impaired, secretions altered. Duration and
frequency variable. Treatment: shock; cold; ammonia, pepper, snuff,
electricity, amyle nitrite, nitro-glycerine, apomorphine, bromides,
purgatives, bitters, iron, zinc, silver, open air exercise.
_Definition._ This is a functional nervous disorder, characterized by
paroxysms of impaired or perverted consciousness, diminished
sensibility, and above all a condition of muscular rigidity, by means of
which the whole body, or it may be but one or more limbs retain any
position in which they may be placed.
Laycock describes two forms in man—the catochus or tetanic form, and the
paralytic form. Mills would restrict the name catalepsy to cases in
which the muscular tone is such that the affected part may be bent or
moulded like wax or a leaden pipe, and will not vary from this when left
alone. Other forms in which this waxen flexibility (flexibilitas cerea)
is absent or imperfect he would designate as cataleptoid.
The disease is not associated with any constant cerebral lesion, though
it may supervene in the course of other nervous disorders, and therefore
may own an exciting cause in existing lesions of the brain. The
immediate cause must however be held to be functional, and this is in
keeping with its most common form in man (hysterical), and with the
hypnotic form which is observed both in man and animals. This latter may
be looked on as a form of induced or hypnotic sleep, in which the
retention of the position given to a limb or part is the most prominent
symptom. In all cases there is an impaired condition of the sensory
functions of the cerebral convolutions, and an insusceptibility of the
motor centres to the control of the will, or the reflex stimulus.
Hering has recorded the disease in the horse, Landel in the ox, and
Leisering in the prairie wolf. The hypnotic form has been shown in cats,
chickens, and Guinea pigs. The serpent charming of the Indian dervishes
and similar effects on frogs and crayfish have been attributed to
hypnotic catalepsy.
_Causes._ Strong mental emotions and diseases which profoundly affect
the nervous system have been adduced as causes (fear, excitement,
chills). Indigestible food has even been charged with causing it. There
is undoubtedly, to begin with, a specially susceptible nervous system,
and hence it is liable to prove hereditary, and in man to appear as a
form of hysteria, or to alternate in the same family with epilepsy,
chorea, alcoholism, opium addiction and other neurosis.
Hypnotism as a cause is claimed by various writers. Azam says that in
the fairs in the South of France, jugglers hypnotize cocks by placing
the bill on a board, on which they trace a black line passing between
the two feet of the bird. Cadeac adds that Father Kircher, in the 17th
century, employed a similar method to put fowls to sleep. Alix put cats
to sleep by securing them firmly, and then looking steadily into their
eyes. The condition attained varies according to the degree of the
sleep, the will being dominated first, and later, consciousness of
external objects is lost. Hypnotism, however, appears to be difficult
and uncertain in the lower animals, in keeping with the limited
development of intelligence and will, as compared with the human being.
Cadeac states that the very old and the very young are completely
refractory to hypnotizing influences.
_Lesions._ No constant pathological changes are found, though different
nervous lesions may serve to rouse the disease in a predisposed subject.
Fröhner found in the affected muscles granular swelling, fatty
degeneration, hæmorrhages, and waxy (amyloid) degeneration of the
cardiac muscles, corresponding to what has been found in tetanus; also
hæmorrhages on the stomach and intestines.
_Symptoms._ The leading objective symptom is the tonic condition of the
muscles by which a perfect balance is established and maintained between
the flexors and extensors so that the affected part maintains the same
position which it had when the attack began, or any other position which
may be given to it during the progress of the paroxysm. The position is
only changed when the muscles involved have become completely exhausted.
During the attack the affected muscles are swollen and firm, so that
their outline may often be traced through the skin, later as the attack
subsides they become soft and flaccid. Voluntary movement of the
affected muscles is impossible until after the paroxysm. The attack
usually comes on suddenly and in this respect resembles epilepsy; at
other times there are premonitory symptoms of nervous anxiety,
excitement or irritability. There is usually considerable impairment of
consciousness, intelligence, common sensation, and even of the special
senses. In a cataleptic dog Fröhner noted mental and motor troubles,
considerable anæsthesia, and loss of sight, smell, and hearing. The eyes
are fixed, the pupils either contracted or dilated, and the urine passed
may be albuminous or even icteric.
_Course, Duration._ Like other functional nervous disorders this is
extremely uncertain in its progress. There may be but one attack or a
succession; they may last from a few minutes, to 7 days (Fröhner), or
even several weeks (Hertwig); they may end in recovery or less
frequently they may prove fatal usually by inanition.
_Treatment._ During a seizure a sudden shock will sometimes cut short
the attack, douching with cold water, an inhalation of ammonia, of
capsicum or of snuff, or the application of electricity in an
interrupted current through the spine and affected muscles. Ether
anæsthesia will not always relax (Sinkler). Inhalation of a few drops of
nitrite of amyle has proved effective in man, as has also the injection
subcutem of three drops of a 1 per cent solution of nitro-glycerine,
apomorphine hypodermically is usually effective (Sinkler). Bromide of
potassium has also been advised, and in case of coldness of the surface,
a warm bath.
When there is overloaded stomach and gastric indigestion an emetic is
indicated, and in constipation a purgative (for speedy action chloride
of barium or physostigma subcutem).
In the intervals between attacks tonics and general hygiene should be
invoked to build up the weakened nervous system. Quinine, and salts of
iron, zinc or silver with a nourishing diet and out door exercise are
especially indicated.