many years been known and described under various names. I well
remember when a boy attending a series of exhibitions given by two
travelling apostles of animal magnetism, in which many similar
phenomena were shown by individuals, selected apparently at haphazard
from a promiscuous audience, these persons having first undergone a
process of magnetizing or mesmerizing. In experiments of Heidenhain of
{333} Breslau upon hypnotized individuals many similar phenomena were
investigated, and described and discussed by this physiologist under
the names of automatism at command and imitation automatism. The
hypnotized subjects, for instance, were made to drink ink, supposing
it to be wine, to eat potatoes for pears, to thrust the hand into
burning lights, etc. They also imitated movements possible for them to
see or to gain knowledge of by means of hearing or in any other way.
They behaved like imitating automatons, who repeated movements linked
with unconscious impressions of sight or hearing or with other sensory
impressions. It was noted in the experiments of Heidenhain that the
subjects improved with repetition. The manifestations of my patients,
although not simulated, improved somewhat by practice. Charcot,
Richer, and their confrères have made similar observations on
hysterical and hypnotized patients, which they discuss under the name
of suggestion. Hammond[26] suggested the term suggignoskism, from a
Greek word which means to agree with another person's mind, as a
proper descriptive designation for these phenomena. In referring to
persons said to be in one of the states of hypnosis, he says that he
does not believe that the terms hypnotism and hypnosis are correct,
as, according to his view, the hypnotic state is not a condition of
artificial somnambulism; the subject, he believes, is in a condition
where the mind is capable of being affected by another person through
words or other means of suggesting anything. In the clinical lecture
during which these opinions were expressed he is reported to have
performed on four hypnotized young men experiments similar to those
which were exhibited by my insane patients. His subjects, however,
were not insane. A bottle was transformed by suggestion into a young
lady; sulphur was transmuted into cologne; one of the subjects was
bent into all sorts of shapes by a magnet; another was first turned
into Col. Ingersoll and then into an orthodox clergyman, etc. In
reading such reports, and in witnessing public exhibitions of the kind
here alluded to, one often cannot help believing that collusion and
simulation enter. Without doubt, this is sometimes the case,
particularly in public exhibitions for a price; but what has been
observed in the mentally afflicted, what has been shown again and
again by honest and capable investigators of hypnotism, prove,
however, not only the possibility, but the certainty, of the
genuineness of these phenomena in some cases.
[Footnote 26: _Med. and Surg. Reporter_, vol. xlv., Dec. 10, 1881.]
Catalepsy and this automatism at command are sometimes confused, or
they may both be present in the same case; indeed, they are probably
merely gradations of the same condition, although it is well to be
able to differentiate them for the purposes of more careful and
accurate investigation. In automatism at command the individual does
what he is directed as long as he remains in this peculiar mental
condition. In experimenting upon him, his arms or legs, his trunk or
head, may be put in various positions, and if commanded to retain them
in these positions he will do so, or he will, at command, put them in
various positions, there to stay until a new order is given. Imitation
automatism occurs also in such cases; patients will imitate what they
see or hear. These cases differ only from those of genuine catalepsy
in that they do not seem to present true waxen flexibility. The
phenomena presented are those {334} which result from control over an
easily-moulded will, rather than phenomena due to the fact that the
will is entirely in abeyance.
PATHOLOGY—Attempts to explain the nature of catalepsy leave one in a
very uncertain and irritable frame of mind. Thus, we are told very
lucidly that most authors are inclined to the opinion that the
cataleptic rigidity is only an increase of the normal tonus of the
voluntary muscles occurring occasionally in the attacks. What appears
to be present in all genuine cases of catalepsy is some absence or
abeyance of volition or some concentration and circumscription of
cerebral activity. The study of the phenomena of catalepsy during
hypnosis throws some light upon the nature of catalepsy. Heidenhain's
theory of hypnotism is that in the state of hypnosis, whether with or
without cataleptic manifestations, we have inhibition of the activity
of the ganglion-cells of the cerebral cortex. Herein is the
explanation of many cataleptic phenomena even in complicated cases. In
hysteria and in catalepsy the patient, dominated by an idea or
depressed in the volitional sphere by emotional or exhausting causes,
no longer uses to their full value the inhibitory centres. When
organic disease complicates catalepsy, it probably acts to inhibit
volition by sending out irritative impulses from the seat of lesion.
DURATION.—Usually, attacks of catalepsy recur over a number of years;
but even when this is the case the seizures are not as frequent, as a
rule, as those of hystero-epileptic paroxysms. Uncomplicated cases of
catalepsy, or those cases which occur in the course of
hystero-epilepsy, usually preserve good general health.
Of the duration of attacks of catalepsy it need only be said that they
may last from a few seconds or minutes to hours, days, weeks, or even
months. The liability to the recurrence of cataleptic attacks may last
for years, and then disappear.
DIAGNOSIS.—In the first place, the functional nervous disorder
described as catalepsy must be separated from catalepsy which occurs
as a symptom in certain organic diseases. It is also necessary to be
able to determine that a patient is or is not a true katatonic.
It must not be forgotten that genuine catalepsy is very rare. Mitchell
at a recent meeting of the Philadelphia Neurological Society said that
in his lifetime he had seen but two cases of genuine catalepsy—one for
but a few moments before the condition passed off. The other was most
extraordinary. Many years ago he saw a young lady from the West, and
was told not to mention a particular subject in her presence or very
serious results would ensue. He did mention this subject, rather with
the desire to see what the result would be. She at once said, “You
will see that I am about to die.” The breath began to fail, and grow
less and less. The heart beat less rapidly, and finally he could not
distinguish the radial pulse, but he could at all times detect the
cardiac pulsation with the ear. There was at last no visible
breathing, although a little was shown by the mirror. She passed into
a condition of true catalepsy, and to his great alarm remained in this
state a number of days, something short of a week. Throughout the
whole of this time she could not take food by the mouth. Things put in
the mouth remained there until she suddenly choked and threw them out.
She apparently swallowed very little. She had to be nourished by
rectal alimentation. She was so remarkably cataleptic that if the
pelvis were raised, so that {335} the head and heels remained in
contact with the bed, she would retain this position of opisthotonos
for some time. He saw her remain supported on the hands and toes, with
feet separated some distance, with the face downward, for upward of
half an hour. She remained as rigid as though made of metal. On one
occasion while she was lying on her back he raised the arm and
disposed of the fingers in various ways. As long as he watched the
fingers they remained in the position in which they had been placed.
At the close of half an hour the hand began to descend by an
excessively slow movement, and finally it suddenly gave way and fell.
Not long after this she began to come out of the condition, and quite
rapidly passed into hysterical convulsions, out of which she came
apparently well. He was not inclined to repeat the experiment.
Catalepsy is to be diagnosticated from epilepsy. It is not likely that
a grave epileptic seizure of the ordinary type will be mistaken by an
observer of even slight experience for a cataleptic attack. It is some
of the aberrant or unusual types of epilepsy that are most closely
allied to or simulate catalepsy. Cataleptic or cataleptoid conditions
undoubtedly occur regularly or irregularly in the course of a case of
epilepsy, but I do believe that it is true, as some observers contend,
that between catalepsy and some types of true epilepsy no real
distinction can be made. Hazard,[27] in commenting on a case reported
by Streets,[28] holds that no difference can be made between the
attacks detailed and those forms of epilepsy described as petit mal.
[Footnote 27: _St. Louis Clin. Rec._, iii. 1876, p. 125.]
[Footnote 28: “Case of Natural Catalepsy,” by Thomas H. Streets. M.D.,
Passed Assistant Surgeon U. S. N., in the _American Journal of Medical
Sciences_ for July, 1876.]
The case was that of a sailor aged forty-two years, of previous good
health. The attacks to be described followed a boiler explosion, by
which he was projected with great force into the water, but from which
he received no contusion nor other appreciable injury. There was no
history of any nervous trouble in his family. It was the patient's
duty to heave the lead. The officer noticed that he was neglecting his
business, and spoke to him in consequence, but he paid no attention to
what was said to him. “He was in the attitude he had assumed in the
act of heaving the lead, the left foot planted in advance, the body
leaning slightly forward, the right arm extended, and the line held in
the left hand. The fingers were partially flexed, and the
sounding-line was paying out through them in this half-closed
condition. The eyes were not set and staring, as is the case in
epilepsy, but they were moving about in a kind of wandering gaze, as
in one lost in thought with the mind away off. The whole duration of
the trance was about five minutes.”
Dickson[29] reports a very striking case, and in commenting on it
holds to the same views. The patient had apparently suffered from some
forms of mania with delusions. She was found at times sitting or
standing with her body and limbs as rigid as if in rigor mortis, and
her face blanched. These spells were preceded by maniacal excitement
and followed by violence. On being questioned about the attacks, she
said that chloroform had been given her. Numerous experiments were
performed {336} with her. Her arms and hands were placed in various
positions, in all of which they remained; but it was necessary to hold
them for a few moments in order to allow the muscles to become set.
She was anæsthetic. After recovering she said that she remembered
being on the bed, but did not know how she came there; also, that she
had been pricked with a pin, and that her fit had been spoken of as
cataleptic. Her mind became more and more affected after each attack,
and she finally became more or less imbecile. From the facts observed
with reference to this case, Dickson thinks that we may fairly
conclude that the mental disturbance in either epilepsy or catalepsy
is identical, and results from the same cause—viz. the anæmia and
consequent malnutrition of the cerebral lobes; while its termination,
dementia, is likely to be the same in either case; also, that
catalepsy, instead of being a special and distinct form of nervous
disorder, is to be considered as a specific form of epilepsy, and to
be regarded as epilepsy, in the same manner as le petit mal is
considered epilepsy, and a result of the same proximate cause; the
difference in the muscular manifestation bearing comparison with any
other specific form of epilepsy, and occurring in consequence of one
or other particular cerebral centre becoming more or less affected.
[Footnote 29: “On the Nature of the Condition known as Catalepsy.” by
J. Thompson Dickson, M.A., M.B. (Cantab., etc.), _British Med.
Journ._, vol. ii., Dec. 25, 1869.]
I do not believe that this ground is well taken. The conditions
present in petit mal are sometimes somewhat similar to, but not
identical with, those of genuine catalepsy. In the first place, the
loss of consciousness, although more complete and more absolute—or
rather, strictly speaking, more profound—than in genuine catalepsy, is
of much briefer duration. The vertigo or vertiginous phenomena which
always accompany genuine petit mal are rarely if ever present in
catalepsy. To say that the mental disturbance in catalepsy and in
epilepsy is identical is to admit an imperfect acquaintanceship with
both disorders. The mental state during the attack of either disorder
it is only possible to study by general inspection or by certain
test-experiments.
Tetanus is not likely, of course, to be mistaken for catalepsy, but
there is a possibility of such an occurrence. The differential
diagnosis already given between hystero-epilepsy and tetanus will,
however, furnish sufficient points of separation between catalepsy and
tetanus.
Catalepsy has been supposed to be apoplexy, or apoplexy catalepsy. The
former mistake is, of course, more likely to be made than the latter.
A careful study of a few points should, however, be sufficient for the
purposes of clear differentiation. The points of distinction given
when discussing the diagnosis of hysterical and organic palsies of
cerebral origin will here apply. In true apoplexy certain peculiar
changes in pulse, respiration, and temperature can always be expected,
and these differ from those noted in catalepsy. The stertorous
breathing, the one-sided helplessness, the usually flushed face, the
conjugate deviation of the eyes and head, the loss of control over
bowels and bladder, are among the phenomena which can be looked for in
most cases of apoplexy, and are not present in catalepsy.
It is hardly probable that a cataleptic will often be supposed to be
drunk, or a man intoxicated to be a cataleptic; but cases are on
record in which doubts have arisen as to whether an individual was
dead drunk or in a cataleptic stupor. The labored breathing, the fumes
of alcohol, the absence of waxen flexibility, the possibility of being
half aroused by {337} strong stimuli, will serve to make the diagnosis
from catalepsy. The stupor, the anæsthesia, the partial loss of
consciousness, the want of resistance shown by the individual deeply
intoxicated, are the reasons why occasionally this mistake may be
made.
Catalepsy is simulated not infrequently by hysterical patients.
Charcot and Richer[30] give certain tests to which they put their
cataleptic subjects with the view of determining as to the reality or
simulation of the cataleptic state. They say that it is not exactly
true that if in a cataleptic subject the arm is extended horizontally
it will maintain its position during a time sufficiently long to
preclude all supposition of simulation. “At the end of from ten to
fifteen minutes the member begins to descend, and at the end of from
twenty to twenty-five minutes at the most it resumes the vertical
position.” These also are the limits of endurance to which a vigorous
man endeavoring to preserve the same position will attain. They have
therefore resorted to certain experimental tests. The extremity of the
extended limb is attached to a tambour which registers the smallest
oscillations of the member, while at the same time a pneumograph
applied to the chest gives the curve of respiratory movements. In the
case of the cataleptic the lever traces a straight and perfectly
regular line. In the case of the simulator the tracings at first
resemble those of the cataleptic, but in a few minutes the straight
line changes into a line sharply broken, characterized by instants of
large oscillations arranged in series. The pneumograph in the case of
the cataleptic shows that the respirations are frequent and
superficial, the end of the tracings resembling the beginning. In the
case of the simulator, in the beginning the respiration is regular and
normal, but later there may be observed irregularity in the rhythm and
amplitude of the respiratory movements—deep and rapid depressions,
indicative of the disturbance of respiration that accompanies the
phenomena of effort. “In short, the cataleptic gives no evidence of
fatigue; the muscles yield, but without effort, and without the
concurrence of the volition. The simulator, on the contrary, committed
to this double test, finds himself captured from two sides at the same
moment.”
[Footnote 30: _Journal of Nervous and Mental Diseases_, vol. x., No.
1, January, 1883.]
Chambers[31] says that no malingerer could successfully feign the
peculiar wax-like yielding resistance of a cataleptic muscle. He
speaks of using an expedient like that of Mark's. Observing that
really cataleptic limbs finally, though slowly, yield to the force of
gravity and fall by their own weight, he attached a heavy body to the
extended hand of a suspected impostor, who by an effort of will bore
it up without moving. The intention of the experiment was explained,
and she confessed her fraud. This rough test, although apparently
different, is in reality similar to that of Charcot and Richer. In
both proof of willed effort is shown.
[Footnote 31: _Reynolds's System of Medicine_, vol. ii., No. 108.]
It must not be forgotten that in catalepsy, as has been already noted
in hysteria, real and simulated phenomena may commingle in the same
case; also, that upon a slight foundation of genuine conditions a
large superstructure of simulated or half-simulated phenomena may be
reared.
PROGNOSIS.—The prognosis of catalepsy is on the whole favorable. It
must be admitted, however, that owing to the presence of neurotic or
neuropathic constitution a tendency to relapse is present. {338}
Hystero-catalepsy tends to recover with about the same frequency as
any of the other forms of grave hysteria. Those cases which can be
traced to some special reflex or infectious cause, as worms, adherent
prepuce, fecal accumulations, scars, malaria, etc., give relatively a
more favorable prognosis. Cases complicated with phthisis, marasmus,
cancer, insanity, etc. are of course relatively unfavorable.
TREATMENT.—The treatment of the cataleptic seizure is not always
satisfactory, a remedy that will succeed in one case failing in
another. Niemeyer says that in case of a cataleptic fit he should not
hesitate to resort to affusion of cold water or to apply a strong
electrical current, and, unless the respiration and pulse should seem
too feeble, to give an emetic. The cold douche to the head or spine
will sometimes be efficacious. In conditions of great rigidity and
coldness of surface Handfield Jones recommends a warm bath, or, still
better, wet packing. Chambers quotes the account of a French patient
who without success was thrown naked into cold water to surprise him,
after having been puked, purged, blistered, leeched, and bled. This
treatment is not to be recommended unless in cases of certain
simulation, and even here it is of doubtful propriety and utility. If
electricity is used, it should be by one who thoroughly understands
the agent. A galvanic current of from fifteen to thirty cells has been
applied to the head with instantaneous success in hystero-epileptic
and hystero-cataleptic seizures. A strong, rapidly-interrupted faradic
current, or a galvanic current to the spine and extremities, sometimes
succeeds and sometimes fails. Rosenthal reports that Calvi succeeded
in relieving cataleptic stiffness in one case by an injection of
tartar emetic into the brachial vein—a procedure, however, not to be
recommended for general use. Inhalations of a few drops of nitrate of
amyl is a remedy that should not be passed by without a trial; it is
of great efficacy in the hysteroidal varieties. Inhalation of ammonia
may also be tried. A hypodermic injection of three minims of a 1 per
cent. solution of nitroglycerin, as recommended for severe
hystero-epileptic seizures, would doubtless be equally efficient in
catalepsy.
Music has been used to control hysterical, hystero-epileptic, and
cataleptic seizures. The French cases reported have all been of the
convulsive types without loss of consciousness and those varieties in
which the special sensibility sometimes persists, as in
hystero-catalepsy, lethargy, and somnambulism. Music has been used as
medicine from the times of Pythagoras to the present, although it can
hardly be claimed to have attained a position of much prominence as a
therapeutic agent.
In one case a vigorous application of fomentations of turpentine to
the abdomen was promptly efficacious in bringing a female patient out
of a cataleptic seizure.
Meigs, whose case of catalepsy produced by opium has been reported
under Etiology, suggests that purgative medicines, used freely in the
treatment of his case, might be advantageously resorted to in any case
of catalepsy.
Powerful tonics, such as quinine, iron, salts of zinc and silver,
should be used in connection with nutrients, such as cod-liver oil,
peptonized beef preparations, milk, and cream, to build up cataleptic
cases in the intervals between the attacks.
{339}
ECSTASY.
BY CHARLES K. MILLS, M.D.
DEFINITION.—Ecstasy is a derangement of the nervous system
characterized by an exalted visionary state, absence of volition,
insensibility to surroundings, a radiant expression, and immobility in
statuesque positions. The term ecstasy is derived from two Greek
words, _ἐκ_ and _στάσις_, which means to be out of one's senses or to
be beside one's self. Commonly, ecstasy and catalepsy, or ecstasy and
hystero-epilepsy, or all three of these disorders, alternate, coexist,
or occur at intervals in the same individual. Occasionally, however,
the ecstatic seizure is the only disorder which attracts attention.
Usually, in ecstasy the concentration of mind and the visionary
appearance have reference to religious or spiritual objects.
SYNONYMS.—Trance is sometimes used as synonymous with ecstasy. While,
however, ecstasy is a trance-like condition, conditions of trance
occur which are not forms of ecstasy. Other synonyms are
Carus-extasis, Catochus, Catalepsia spuria.
HISTORY AND LITERATURE.—Accounts of cases of ecstasy abound in both
ancient and modern medical and religious literature. The epidemics of
the Middle Ages, the days of the New England witchcraft, the revivals
in England and America, have afforded many striking illustrations. Not
a few special cases of ecstasy have become historical. Elizabeth of
Hungary and Joan of Arc were both cataleptics and ecstatics. Saint
Gertrude, Saint Bridget, Saint Theresa, Saint Catharine, and many
other saintly individuals of minor importance have owed their
canonization and their fame to the facility with which they could pass
into states of ecstasy, catalepsy, or hystero-epilepsy.