Médecine, _Mémoires de l'Académie de Médecine_, Paris, 1856, t. xx. p.
409, A. 526.]
{319} Cullen believed that catalepsy was always a simulated disease;
he preferred, therefore, to place it as a species of apoplexy.
Temporary catalepsy may, according to Rosenthal, be produced in
hysterical patients by covering their eyes with their hands or a
cloth. Malaria has been charged with the production of catalepsy, and
apparently properly. Traumatism is another of its well-authenticated
causes. Blows upon the head have been particularly recorded as having
an etiological relation to this disorder.
Partial catalepsy has been observed after typhoid fever with severe
cerebral symptoms, and also associated with meningitis and
intermittent fever. Mancini[7] relates a case of cerebral rheumatism
complicated or causing catalepsy. A blacksmith, aged thirty-three, had
nearly recovered from a rheumatic attack when he became melancholic,
complaining also of severe headache. When admitted to the hospital he
was found to be imperfectly nourished. He lay on his back, his face
without expression, speechless, motionless, pupils insensible to the
light, smell impaired, sensation of heat and pain and reflexes absent,
galvanic and faradic contractility increased, the rectum and bladder
paralyzed. He presented the phenomena of waxen flexibility, the trunk
and limbs remaining in whatever position was given them. Considering
the previous attack of articular rheumatism and the sudden appearance
of nervous disorder during the convalescence of this disease, Mancini
believed that the case was probably one of cerebral rheumatism. The
man recovered under diaphoretics and counter-irritation.
[Footnote 7: _Lo Sperimentale_, March, 1878.]
Among the important causes of catalepsy bad nutrition may undoubtedly
be placed. In the case of De Schweinitz the cataleptoid phenomena
rapidly improved, and eventually disappeared as the child's general
health was restored by tonics and good diet. Hovey's case was
insufficiently clad and badly fed. One of Laségue's cases, quoted by
Handfield Jones, died of gradual marasmus, another of pulmonary
phthisis. Attacks of catalepsy have sometimes resulted from a
combination of excitement, fatigue, and want of food. They occur also
in diseases or conditions like phthisis, anæmia, and chlorosis,
affections which practically gives us the same cause—namely, bad
nutrition. In these cases the nervous system, like other parts of the
body, takes part in the general exhaustion.
Rosenthal refers to the production of symptoms of temporary catalepsy
by the administration of narcotics and the inhalation of ether and
chloroform. In a somewhat ancient American medical periodical[8]
Charles D. Meigs of Philadelphia gives an interesting account of a
case of catalepsy produced by opium in a man twenty-seven years of
age. The man had taken laudanum. His arms when in a stuporous
condition remained in any posture in which they happened to be left;
his head was lifted off the pillow, and so remained. “If he were made
of wax,” says Meigs, “he could not more steadily preserve any given
attitude.” The patient recovered under purging, emetics, and bleeding.
Darwin, quoted by Meigs, mentions a case of catalepsy which occurred
after the patient had taken mercury. He recovered in a few weeks.
[Footnote 8: _The North American Medical and Surgical Journal_, vol.
i. p. 74, 1826.]
That imitation is an exciting cause of catalepsy has been shown by the
{320} often-told story of epidemic hysteria, but more especially by
accounts given of certain peculiar endemics of catalepsy. Handfield
Jones[9] gives an account of an endemic which prevailed at
Billinghausen near Wurzburg: “The population consists of peasants who
are well off, but who intermarry very much, and are small and
deformed. The affected individuals constitute half of the number,
males as well as females. They are called there the stiff ones
(starren). A chill is commonly said to be the exciting cause of the
attacks. The patients are suddenly seized by a peculiar sensation in
their limbs, upon which all their muscles become tense, their
countenances deadly pale; they retain the posture which they first
assume; their fingers are bent and quiver slightly, and the eyeballs
in the same way, the visual axis converging; their intellects and
senses are normal, but their speech consists only of broken sounds.
The attack ceases in from one to five minutes, and the body becomes
warm.”
[Footnote 9: _Op. cit._, quoted from _Schmidt's Jahrbuch_.]
SYMPTOMATOLOGY.—The cataleptic seizure, when it is not the result of
some hypnotizing procedure, usually takes place in the following
manner: The patient usually, after some patent exciting cause,
suddenly ceases whatever she may chance to be doing, becoming rigid
and immobile in the last position which she had been in before the
attack ensued. “She remains,” says Rosenthal, “as if petrified by the
head of Medusa.” The features are composed, the eyes usually directed
forward. She is pale; breathing, pulsation, and temperature are
usually somewhat reduced. At first the limbs may be found to offer
some resistance; soon, however, and sometimes from the beginning, they
can be moulded like wax into any possible position, where they will
remain until again changed by external agency.
Attacks of catalepsy, as a rule, come on suddenly, without special
warning; sometimes, however, special phenomena, which may be compared
to epileptic aura, may precede the attack. Thus, Rosenthal speaks of
two cases that were ushered in, and also bowed out, by hiccough. The
attacks may terminate as suddenly as they begin, but sometimes the
patients come out of the state gradually. They are quite likely to
appear dazed and stupid when emerging.
Perverted consciousness is another marked symptom of catalepsy.
According to some authors, the loss of consciousness is absolute, and
upon this symptom they base their diagnosis from two or three other
somewhat similar conditions. As I have already indicated in discussing
the general subject of Hysteria, this question of consciousness or
unconsciousness is not one to be decided in haste. In catalepsy, as in
hystero-epilepsy, the conditions as to consciousness may differ. What
might be termed volitional consciousness is in true catalepsy
certainly in abeyance. Flint[10] divides catalepsy, according to the
condition as to consciousness, into three kinds—namely, complete,
incomplete, and complicated. He, however, regards trance and day-mare
as instances of incomplete catalepsy, in which the intellectual
faculties are not entirely suspended and the senses are not materially
affected, the patient being unable to move or speak, but conscious of
all that is going on around him. He believes that such cases resemble
more closely the cataleptic condition than they do that of ecstasy. In
genuine catalepsy with waxen flexibility, analgesia, etc. there may be
{321} greater or less depths of unconsciousness, but some degree of
unconsciousness or of obtunded consciousness is necessary to the
existence of true catalepsy.
[Footnote 10: _Buffalo Medical Journal_, xiii., 1857-58, p. 141.]
Catalepsy presents well-marked disturbances of sensation, although
these, like the conditions as to consciousness, differ somewhat in
different cases. Anæsthesia in its different forms, and especially
analgesia, are always present in some degree. Experiments without
number have been tried on cataleptic patients, showing their
insensibility to painful impressions: they have been pinched, pricked,
pounded, burned with heated irons, and rubbed down with blocks of ice.
Skoda reports a case in which general sensibility was abolished, but a
lighted paper rotated rapidly before the eyes gave rise to tremors of
the limbs, and strong odors induced slight movement, redness of the
cheeks, lachrymation, acceleration of the pulse, and elevation of the
temperature.
Hyperæsthesia, although rare, has been noted in a few isolated cases
of catalepsy. Puel records a case in which, during the cataleptic
paroxysm, the slightest touch or noise caused the patient to grind the
teeth and cry out. In some cases sensibility to certain special
impressions, as to a strong current of electricity, has been retained,
while all others were abolished. In a case of hystero-catalepsy at the
Philadelphia Hospital, when all other measures had failed an attack
was aborted and evidence of pain produced by the application of a
strong faradic current with metallic electrodes.
A marked change in the state of reflex irritability is another of the
striking symptoms of true catalepsy. Varying conditions as to reflex
irritability have been observed by different authors. So far as I am
aware, few special observations have been made upon the tendon
reflexes in catalepsy. In the case of De Schweinitz the knee-jerk was
apparently absent on one side and present on the other, although the
cataleptic symptoms were not unilateral.
The symptom known as flexibilitas cerea, or wax-like flexibility, to
which I have referred under Synonyms, is, as has been stated, by some
considered pathognomonic of this affection. While I do not hold to
this view, I regard the symptom as the most important phenomenon of
the disease. It is a symptom which from its very nature can be, up to
a certain point, readily shammed, and when considering Diagnosis some
methods of determining its genuineness will be given.
Careful observation as to the pulse, respiration, and temperature are
lacking in the reported cases of catalepsy. According to
Eulenburg,[11] “the respiration is generally of normal frequency,
sometimes rather slow, more frequently of diminished or irregular
intensity, so that lighter and deeper inspirations alternate. The
pulse may also be slower, with slight excursion and diminished tension
of the arteries. The temperature generally remains normal, but in
certain cases is decidedly lowered.” The lowering of temperature, and
particularly the presence of extreme coldness of the surface, with
exceedingly weak pulse and respiration, have doubtless always been
present in the cases—a few, at least, authentic—in which catalepsy has
been supposed to be death.
[Footnote 11: _Op. cit._]
{322} Hypnotic Catalepsy.
The investigations into the subject of hypnotism made in recent years
have given to the profession a series of interesting phenomena which
should be considered, at least briefly, under the symptomatology of
catalepsy. In a general review of the subject of hypnotism[12] by me
many of the facts observed and theories advanced by Braid, Heidenhain,
Charcot, Richer, and others were examined. I will here recall those
observations of Heidenhain[13] and of Charcot and Richer[14] which
relate to the production of a cataleptic or cataleptoid state, and to
the phenomena which take place in this state.
[Footnote 12: _Am. Journ. Med. Science_, Jan., 1882.]
[Footnote 13: _Animal Magnetism: Physiological Observations_, by
Rudolph Heidenhain, Prof. Physiology in the University of Breslau,
London, 1880.]
[Footnote 14: _Etudes cliniques sur l'Hystero-epilepsie, ou Grande
Hystérie_.]
The method of Heidenhain was similar to that employed by Braid. The
latter, however, did not make use of passes. In the first place, the
individual was made to gaze fixedly at a shining faceted glass button
for some six or eight minutes, the visual axes being made to converge
as much as possible. Heidenhain, like Braid, found the most
advantageous direction of the visual axes to be that of upward
convergence. According to Carpenter, in the fixation this upward
convergence is very important; it suffices of itself in blind people
or in the night to produce hypnosis. After the fixation of gaze had
been continued for some six or eight minutes, the operator stroked
over the face, without immediately touching the surface, from the
forehead to the chest, after each pass bringing the hands, which were
warm, around in an arc to the forehead again. He either allowed the
eyelids to be closed or gently closed them. After ten or twelve passes
he asked the person to open his eyes. When this occurred without
hesitation or with only slight difficulty, he again made the person
stare at the glass for some six minutes, and then repeated the passes,
which often brought about the hypnotic state when the simple fixation
did not succeed.
The symptoms of the hypnotic state were in the main those which have
just been described as the symptoms of catalepsy—namely, diminution of
consciousness, insensibility, increased reflex irritability, and
fixity of the body or limbs in any position given.
In the slighter forms of hypnotism the subjects were able to remember
what had occurred during their apparent sleep. In more fully-developed
forms they had no remembrance of what had taken place, but by giving
hints and leading questions of their various actions they were able to
call them to mind. In the most complete forms of hypnotism no
remembrance whatever was retained. It can nevertheless be proved that
even during the most completely developed hypnosis sensory perceptions
take place, but they are no longer converted into conscious ideas, and
consequently are not retained by the memory; and this is undoubtedly
because the hypnotized individuals have lost the power of directing
their attention to their sensations.
A symptom of the hypnotic state in its most complete development was
highly marked insensibility to pain. A pin could be run right into the
hand, and only an indistinct feeling of contact was brought about.
{323} Immediately on awaking the full sense of pain was again present.
The fact that the tactile sense and the sense of pain are distinct was
corroborated.
Increased reflex irritability and tonic spasm of the voluntary muscles
accompanied the hypnotic condition. Stroking the flexible right arm of
a subject, it at once became stiff, since all the muscles were thrown
into a state of reflex spasm. Reflex muscular contraction spread over
the body when certain definite cutaneous surfaces were irritated. With
slight increase of reflex irritability those muscles alone contracted
which lay immediately under the area of the skin which had been
stroked. Stroking the ball of the thumb caused adduction of the thumb.
Stimulating the skin over the sterno-mastoid caused the head to assume
the stiff-neck position. When the irritability was somewhat more
increased, by a continuous irritation of a definite spot of skin
neighboring and even distant groups of muscles could be set into
activity. Heidenhain stroked continuously the ball of the left thumb
of his brother, when the following muscle-groups were successively
affected with spasm: left thumb, left hand, left forearm, left upper
arm and shoulder, right shoulder and arm, right forearm, right hand,
left leg, left thigh, right thigh, right leg, muscles of mastication,
muscles of the neck.
From a study of such phenomena Heidenhain was inclined to consider
that the hypnotic state was nothing more than artificially produced
catalepsy.
The possibility of fixing any part of the body in any given position
constituted an essential factor in the exhibition of Hansen. He made
one of his subjects, for instance, sit before him in a chair, and
adapted the hands to the seat so that his fingers grasped the edges.
After hypnotizing him he stroked along his arms, and his fingers took
convulsive hold of the edges of the seat. Placing himself in front of
the subject, he bent forward; the subject did the same. He then walked
noisily backward, and thereupon the subject followed him through the
hall, carrying his chair with him like a snail its shell.
One of the observations of Richer was on the influence of light on
catalepsy and hysterical lethargy. The patient was placed before a
bright focus of light, as a Drummond or electric light, on which she
was requested to fix her sight. In a short time, usually a few seconds
or several minutes, sometimes instantaneously, she passed into the
cataleptic state. She was as one fascinated—immobile, the wide-open
eye fixed on the light, the conjunctiva injected and humid. Anæsthesia
was complete. If the patient was hemianæsthetic, she became totally
anæsthetic. She did not present contractures. Her limbs preserved the
suppleness of the normal state or nearly this—sometimes being the seat
of a certain stiffness; but they acquired the singular property of
preserving the attitude which one gave them. One interesting
peculiarity was the influence of gesture on physiognomy. The features
reflected the expression of the gesture. A tragic attitude imprinted a
severe air on the physiognomy; the brows contracted. If one brought
the two hands to the mouth, as in the act of sending a kiss, a smile
immediately appeared on the lips. It was an example of what Braid
calls the phenomena of suggestion—of Heidenhain's imitation. The state
of catalepsy endured as long as the agent which produced it—that is,
as long as the light continued to impress the retina.
{324} The characteristics of the two abnormal states—catalepsy and
lethargy—into which hystero-epileptics may be thrown were summarized
by Richer as follows: (1) Cataleptic state: The eyes wide open; total
and absolute anæsthesia; aptitude of the limbs and different parts of
the body to preserve the situation in which they are placed; little or
no muscular rigidity; impossibility of causing muscular contraction by
mechanical excitation. (2) Lethargic state: The eyes wide open or half
closed; persistent trembling of the upper eyelids; convulsion of the
eyeballs; total and absolute anæsthesia; muscular hyperexcitability;
the limbs, in a condition of resolution, do not preserve the situation
given to them, except the provoked contracture impressed upon them.
In the experiments at Salpêtrière the hystero-epileptics were
sometimes plunged into the states of catalepsy and lethargy under the
influence of sonorous vibrations instead of frights.
During the state of provoked hysterical catalepsy it was found that
sight and hearing could be affected by various procedures. The eyes
were fixed, and seemed not to see anything. If, however, an object was
slightly oscillated in the axis of the visual rays at a little
distance from the eyes, soon the gaze of the patient followed these
movements. The eyes, and sometimes even the head, seemed to turn at
the will of the operator. Hallucinations were produced. When the look
was directed upward the expression became laughing; when downward,
sombre. The cataleptic state might now cease completely. The patient
walked, followed the object on which her gaze was fixed, and took
attitudes in relation with the hallucination suggested. Music also
caused her to assume positions related with the various sentiments
suggested to her by the music. Sudden withdrawal of the object from
before the eyes or of the sound from the range of hearing caused a
return of the catalepsy. The cataleptic patient in whom the eye was in
such a state as to perceive the movements of an experimenter placed in
front of her reproduced these movements exactly. At the Philadelphia
Hospital I have repeated most of the experiments of Heidenhain and of
Charcot and Richer.
Unilateral Catalepsy.
Hemi-catalepsy or unilateral catalepsy is sometimes observed, and has
been studied both in hypnotic investigations and as a special nervous
affection. Charcot and Richer found that hemi-catalepsy or lethargy
may be produced on a patient, and that they may both exist
simultaneously in the same subject. When, for instance, a patient was
plunged into the cataleptic state under the influence of a bright
light, shutting with the hand one of the eyes, the patient at once
became lethargic on the same side only; the other side remained
cataleptic. Heidenhain and Gruetzner studied some remarkable
phenomena, which they have recorded under the name of unilateral
hypnosis, in which some surprising sensory disturbances occur. They
also found, among other things, a striking disturbance in the process
of accommodation and in the perception of colors in the eye of the
cataleptic side. In a case of hystero-epilepsy upon which I performed
numerous hypnotic experiments which have been reported[15] {325} the
patient nearly always presented unilateral cataleptic phenomena. These
were present on the left side, the patient being subject to
convulsions which were more marked on the right side, this being also
much wasted.
[Footnote 15: _Philadelphia Med. Times_, Nov. 19, 1881.]
I witnessed some curious unilateral cataleptoid phenomena in the case
of a medical friend, who has made a note of his experience.[16] He
says: “In the course of some experiments on table-tipping, which were
conducted mainly to satisfy the curiosity of persons who had never
seen anything of the kind, I became the subject of a very peculiar and
marked hypnotic influence. The ordinary tricks of tipping, answering
questions, guessing numbers, etc. had been performed with the table,
during the greater part of which I had been one of the circle, when my
right hand began to contract so as to form an arch, and was then
lifted from the table. These movements were not volitional; I was
unable to control them. While my hand was in this position one of the
persons sitting at the table suddenly put his hand on my forehead, and
I sank back in the chair, passing into a conscious but apparently
powerless state, but only for a few moments. Later in the evening the
hypnotic influence in the right hand was still more distinctly
manifested. If allowed to remain a short time on the table, the
fingers began to vibrate vertically and horizontally, the motion
finally extending to the forearm and becoming so violent as to throw
the hand about in a rapid and forcible manner. While thus affected I
found it utterly impossible to sign my name. I would be able to form
the first letter or so, and then most extraordinary gyrations would be
made. In one instance I wrote very slowly, using all the muscular
control at my command, and succeeded in writing the full name, but in
a form wholly different from my ordinary signature.”
[Footnote 16: _Polyclinic_, Sept. 15, 1883.]
My attention was called to these phenomena, and the experiments were
repeated the next week in my presence, with like results. In addition,
I succeeded in forcibly placing the affected arm in various
positions—bent at right angles, the hand resting on the top of the
head, etc.—from which positions he was unable to move it. He seemed to
have lost the connection between volition and the motor impulse. The
experiments were continued for several hours at each sitting, but
owing to the depressed mental state which was produced for a short
time, apparently by them, they have not been repeated.