related to the epileptic or hysterical diathesis; but a class of cases
is met with in which no history or evidence of epilepsy or hysteria
can be adduced, and though they may be called epileptoid or hysteroid,
these designations are simply makeshifts; the patients seem to be the
victims of a special morbid hypnosis. Possibly they have a cerebral
hyperæmia or anæmia.
Under the name of morbid somnolence a case has been reported by P. J.
Cremen.[12] The patient was a man fifty-five years old, who was
admitted to the hospital under the care of Cremen. He said he had
recently returned from America, where he had taken a drink which had
affected his head. He went to bed, and the next morning was found in a
deep sleep, from which he could not be aroused. He presented the
appearance of a person in a sound sleep or under the influence of
anæsthetics. All ordinary measures were unavailing to awaken him from
his trance-like condition. He was completely analgesic over the entire
surface of the body. He would not eat or drink when simply directed,
but when the drinking-cup was placed in his hand he drank, and when
bread or meat was given he ate. Subsequently he was seen eating while
in the somnolent state with the eyes closed; but after a time he would
stop, and had to be urged to commence again. Evidently, tactile
sensibility was not lost. The muscular sense appeared to be
diminished. The superficial reflexes were abolished, the knee-jerks
exaggerated; ankle clonus was absent. Smell and taste were obtunded.
Hearing was retained. The state of muscular rigidity during the
somnolence was remarkable. He was placed between two chairs, the tip
of the shoulder resting upon one chair, the heel of the left foot on
the other, and the right leg bent at a right angle to the trunk. A
weight of forty pounds was then supported on the rigid chest without
causing the slightest yielding or movement from the position described
until muscular relaxation took place. He often remained in this state
for four or five days at a time or longer. He could be aroused by a
strong magneto-electric current. In the intervals between the attacks
he was sometimes bright and cheerful, at others gloomy and depressed.
When requested to walk, he would do so in a perfectly straight line,
from which he would not deviate for obstacles. When told to walk
around a table, however, or other obstacle, he would do so. He would
try to do anything that he was told, even to standing on his head. The
somnolent or hypnotic state could be induced at will by closing the
eyelids and pressing the eyeballs for about two minutes. Of the
genuineness of the phenomena Cremen had no doubt; he believed that the
somnolence partook, in some degree, of the nature of that which has
been designated narcolepsy. This case in many respects is similar to
cases of catalepsy and automatism at command. A very similar case has
been reported in the article on Catalepsy.
[Footnote 12: _Brit. Med. Journ._, Dec. 12, 1885.]
Self-concentration in those of robust minds differs rather in degree
than in essence from ecstasy or trance and allied conditions in the
weak and hysterical. “Archimedes,” says Clymer, “engrossed with a
problem in {348} geometry, feels no hunger and is deaf to the tumult
of the soldiers in a captured town; Socrates, occupied with his own
thoughts, stands twenty-four hours immovable in one spot exposed to
the burning rays of the sun.” Goethe, Blake, and others are on record
as having the power to call up images at will. Francis Galton[13] in a
recent work advocates the cultivation of this power of the
reproduction at will of mental imagery. Clarke[14] records many
wonderful instances of pseudopia. In what does the ecstatic differ
from these except in that the mental status of the individual is
different, and that the object of mental concentration is of a special
character, consonant with the person's ideas, training, and
surroundings?
[Footnote 13: _Inquiries into Human Faculty and its Development_,
Francis Galton, F. R. S., New York, 1883.]
[Footnote 14: _Vision, a Study of False Sight_, by Edward H. Clarke,
M.D., Boston, 1878.]
In brown study or reverie, according to Laycock, the eye is fixed by a
muscular action analogous to that of the cataleptic; and not the eye
only, for a limb or the whole body will remain in the same position
for many minutes, the senses themselves being in deep abstraction from
surrounding objects.
Stigmatization.
Stigmatization (from the Greek _στιγμα_, a small puncture) is a
symptom or appearance which usually presents itself in the form of
bloody or blood-like markings on the palms of the hands, the backs of
the feet, and the left side, the positions in which Christ was
lacerated by the nails and the spear at the crucifixion. In some cases
the stigmata are found in scattered points on various parts of the
body, sometimes upon the forehead at the position of the lacerations
produced by the crown of thorns. In various ages it has been claimed
by Catholics that cases of genuine stigmatization have occurred. It is
not, however, a matter of Catholic faith, the claim being simply that
it is a genuine experience which has some supernatural significance.
Hammond[15] has an interesting chapter on the subject of
stigmatization, of which I have made use, and Clymer's[16] article,
already referred to, gives the details of several of the most
interesting historical cases. Space will not permit more than a glance
at this subject. A case of stigmatization is not necessarily one of
hysteria, but the phenomena of simulated, and possibly of genuine,
stigmatization usually occur among the hysterical.
[Footnote 15: _On Certain Conditions of Nervous Derangement_, New
York, 1881.]
[Footnote 16: _Op. cit._]
According to Garres, the first to exhibit stigmatization was Saint
Francis of Assisium, who was born in 1186 and died in 1236. In 1224 he
was marked, and in memory of the event the 17th of September was set
apart as the Feast of the Holy Stigmata by Pope Benedict XI. The story
of this occurrence is of a highly emotional and sensational character.
Christine de Stumbele, born in 1242, a few miles from Cologne, is
another of the famous hystero-cataleptics and ecstatics who were the
victims of numerous stigmata. These were irregular as to position and
to times of appearance. On one occasion, for instance, she had wounds
on each foot from which the blood flowed freely; a little later, on
the same {349} occasion, she was wounded on the knee, and to the
wondering priest who was ministering to her at this time she showed
hot nails of hideous shapes. She was not only a case of ecstasy and
stigmatization, but a filthy creature withal, who covered herself and
others with excrement, which they had the foolishness to believe came
from the hand of the devil. Veronica Giuliani, another ecstatic, who
conversed with Christ and the Virgin Mary, received the stigmata
during one of her prayers, and was canonized in 1839. Imbert-Gourbeyre
gives a list of 145 persons who have received stigmata, besides 8 now
living known to him. He details one American case, that of a young
French Canadian.
Two of the most extraordinary recent cases are those of Palma d'Oria
and Louise Lateau. These have become stock cases in books and
dissertations on the subject under consideration, and therefore the
briefest accounts of them will be all that is required. Palma in 1871
was sixty-six years old, humpbacked, thin, small, and with light
expressive eyes. It is important to note that she had seen Louisa
Lateau in ecstasy. Wonderful accounts are given of her
performances—eating the Host in the presence of the priest; having
visions of the devil with a little horn on his forehead; on another
occasion Jesus Christ himself bringing to her the communion; seeing
the Host flying through the air before entering her mouth. After the
communion, usually when others were not present, the stigmatization
occurred. Bleedings from the forehead or near it, and hemorrhagic
spots on various parts of the body of various shapes, as of hearts and
of the cross, appeared. Examination of the skin subsequently showed it
to be intact, except that she had a hole in the cranium, which Hammond
suggests was of syphilitic origin. Plates are given in the work of the
credulous Imbert-Gourbeyre representing these figures.
In most respects the most celebrated of all cases of stigmatization is
that of Louise Lateau—celebrated because of the investigations which
have been made of her case; because of the amount of literature,
theological, scientific, and medical, which has been devoted to her;
because of the conflict of opinions even among medical observers in
regard to the true explanation of the phenomena she exhibited. Louise
Lateau was a Belgian peasant-girl, born January 30, 1850. Her parents
were poor. She suffered the hardships of her class, and was as badly
nourished and educated as a poor Belgian peasant-girl is likely to be.
During the cholera epidemic of 1866 she nursed kindly and patiently
many of the victims. In 1867 she became weak, pale, and neuralgic, and
sometimes spat blood. On Friday, April 24, 1868, she for the first
time noticed blood immediately below the left breast; the following
Friday it appeared at the same place, and also on the back of the left
foot; later, it oozed from the left side and both feet, from the palms
and backs of the hands, and from the forehead. Some weeks after this
she began to exhibit the phenomena of ecstasy; and subsequently for
months and years, regularly on every Friday, she had a recurrence of
the stigmata and ecstasy, with accompanying phenomena, sometimes
varying a little in detail. Some of the accounts given by Lefevre and
others of her seizures are beautiful descriptions of attacks of
ecstasy. She stated that during her attacks she had a distinct vision
of the whole scene of the crucifixion.
Numerous experiments, some of them cruel in character, were {350}
performed to test the genuineness of her conditions of unconsciousness
and insensibility. Sight, hearing, and touch were tested. The mucous
membrane of the nose was tickled; strong hartshorn was applied to the
nostrils; she was pricked and stabbed with needles, pins, and even
penknives; painful currents of electricity were used. To none of these
did she respond. During her attacks her pulse was thready, ranging
from 120° to 130° and upward; respiration sometimes could be scarcely
detected, and sometimes fell as low as 10; body-heat was also much
diminished. She recollected everything which passed during the attack.
Different from Palma d'Oria, the examination of her skin revealed
certain appearances. Between Saturday and Thursday oval spots and
patches of rosy hue were to be seen on the backs and palms of the
hands and on the backs and soles of the feet. They were very much in
appearance as if the epidermis were thinned or scraped. The marks on
the forehead were not permanent; the chest was only examined during
the ecstasy. Before the bleedings blebs began to rise at the position
of the spots. The bleeding commonly began in the night between
Thursday and Friday. From the forehead of the girl blood sometimes
oozed from minute points, which looked as if they had been made by
microscopic leeches.
As regards the phenomena presented by Louise Lateau, various
hypotheses have been advanced; the chief, however, are the three
following: (1) The theological view—namely, that the stigmata were
genuine miraculous performances, the blood flowing by supernatural
command. (2) The view that the stigmata were genuine pathological
phenomena, vaso-motor in character—that the bleedings were in some way
similar to attacks of purpura hemorrhagica or to hæmidrosis or bloody
sweat. (3) The view that the stigmata were produced by deceit—that in
all probability, in order to excite the sympathy and astonishment
which are so dear to the hysterical mind, the girl in some way caused
the bleedings. The carefully detailed accounts of the phenomena seem
to lend the strongest support to the last view.
A good test was employed for the detection of simulated stigmatization
in the following case,[17] which came under the care of Mr. Henry Lee
at St. George's Hospital, London. An unmarried seamstress aged sixteen
had on the outside of her right leg above the ankle a discolored
patch, from which she said that every month for two years there had
been a discharge of about a tablespoonful of blood. The patch was
covered with minute red spots resembling flea-bites. Fresh red spots
and effusion of blood were seen at succeeding visits. Lee ordered a
sheet of lead to be applied over the bleeding surface, to be secured
by a starched bandage. On the next visit, when the dressings were
removed, a few spots and a little blood were found, but the sheet of
lead was pierced with holes large enough to admit a needle. When asked
how this had happened the girl was silent, and was discharged as a
convicted impostor. In Lefevre's experiment with Louise Lateau he
placed a leather glove upon one hand, tying and sealing it at the
wrists; but it is easily to be seen why this test was not as thorough
as that with the lead.
[Footnote 17: _British Medical Journal_, vol. i., 1871, p. 479.]
Another case of ecstasy with stigmatization is cited by Bourneville
and Hammond from Magnus Huss of Stockholm—a servant-girl twenty-three
years old who was subject to convulsions, and also to {351}
hemorrhages, which usually came on as the result of great emotional
disturbance. In her case examination showed no cicatrices. The
hemorrhages occurred from the scalp, the eyes, the face around the
eyes, the left ear, and the stomach. Her menstruation went on
regularly during the attacks: sometimes she had ecchymoses and
apparent bruises on the left half of the body, the limbs of which were
semi-paralyzed for short periods. The attacks occurred with
convulsions and unconsciousness, which usually lasted about half an
hour, and from which she awakened as if from a long sleep.
Autographic Women.
Certain peculiar phenomena have been described under the head of
femmes autographiques, or the autographic women, and are worthy of
note. Dujardin-Beaumetz[18] in a case of well-marked hysteria with
loss of general sensibility reports that he was able to write or trace
with a needle or pointed instrument on the skin. Within a space thus
traced the skin was elevated in a white patch or plate. After some
five minutes the line would show itself more and more in relief, until
it attained from one and a half to two millimeters in thickness. It
would remain from three to six, and sometimes twelve, hours. He varied
the experiments in many ways, executing upon the skin designs, tables,
and names of from ten to fifteen letters. He detected in the centre of
some of the spaces traced a marked elevation of temperature, sometimes
appreciable to the hand. This woman was known by the name of femme
diche, or the autographic woman.
[Footnote 18: _Bull. et Mém. Société médicale de Hôpital de Paris_,
1880, 12, xvi. 197-202.]
Dujardin-Beaumetz held that the phenomena were vaso-motor. The red
lines traced readily admit of this explanation. The white space in
relief, however, was not so easily explained. He had observed among
hysterical women, under the influence of pressure, irritation, or the
application of magnets, the appearance of patches of urticaria. One of
the common tricks of the Spiritualists is to have the name of a spirit
that has been called up appear upon the bared arm of the medium. Among
friends and private patients, and among the hysterical patients in the
wards of the Philadelphia Hospital, I have successfully performed
experiments similar to those reported by Dujardin-Beaumetz. Such
phenomena are by no means confined to cases of hysteria. One of my
most striking successes in an attempt at skin-writing was in the case
of a male physician of a peculiarly clear and pale complexion. Certain
peculiar conditions of the skin will allow this to be done with
facility. The similarity of this class of phenomena to that of the
stigmata will at once appear evident. Such phenomena occur among the
hysterical with a tendency to vaso-motor deficiency of control.
Fasting Saints and Fasting Girls.
The wonderful saints who starved themselves or lived on sacramental
bread are almost a multitude. Saint Joseph, Saint Catherine of Sienna,
{352} Saint Rose of Lima, Saint Collete, Saint Peter of Alcantara are
of the number. In modern and even in recent times not a few of these
cases have become widely known. Margaret Weiss, about whom a book was
written in 1542, is said to have done without food and drink for three
years. She suffered from pains and contractures. She passed neither
urine nor feces; at least, such are the accounts which have come down
to us.
Sarah Jacob, the Welsh fasting girl, has shared with Louise Lateau
popular and medical notoriety. When about ten years old she suffered
from various hysterical and hystero-epileptic symptoms. The quantity
of food she took gradually dwindled; on October 10, 1867, it was said
that she ceased to take any food whatever, and so continued till the
day of her death, more than two years later. She had many visitors,
pilgrims from far and near, who often left money or gifts. The vicar
of her neighborhood came to believe in her, and an investigation was
suggested. At one investigation, not very rigidly conducted, nothing
was discovered. After a time she was visited by Fowler of London, who
decided that the case was one of hysteria with simulation, probably
associated with the power or habit of long fasting. Trained nurses
were sent from Guy's Hospital to conduct the second watching. Under
the watching the girl died, starved to death. The father was afterward
condemned to imprisonment and hard labor for twelve months, the mother
for six months. In Brooklyn a few years since one Molly Fancher, a
similar case, attracted much attention, and was written about and
commented upon by the press.
{353}
NEURASTHENIA.
BY H. C. WOOD, M.D.
INTRODUCTION.—The term neurasthenia, signifying nervous weakness, and
not rarely paraphrased by nervous exhaustion, indicates by its very
derivation that it denotes not a distinct disease, but a condition of
the body. The relations of the nervous system to the functions of
organic and animal life are so intimate that almost all forms of
exhaustion might well be discussed under the present heading. A
further difficulty in attempting to decide the exact limitations of
this article is to be found in the fact that hysteria, insanity,
chorea, and various other nervous diseases are very closely connected
with nervous exhaustion. Indeed, many of the cases which are
considered by authorities as instances of neurasthenia would be more
appropriately classed with one or other of the especial diseases.
Thus, the nervous fears discussed in such detail by George M. Beard in
his work upon neurasthenia plainly belong with the monomaniacal
insanities, and, although they usually are associated with nervous
depression, may coexist with great physical and mental power.
Further, very many chronic diseases produce neurasthenia. It has not
been many years since general debility was a common inscription upon
records of diagnosis. In very many cases the general debility
afflicted the diagnostic powers or zeal of the physician rather than
the body of the patient, and it is to be feared that neurasthenia not
rarely at present replaces it. Malarial poisoning, chronic Bright's
disease, chronic diarrhœa, lithæmia, and various other affections may
be readily overlooked, and patient and physician satisfied with the
diagnosis of neurasthenia; indeed, in my own experience in a very
considerable proportion of the cases which had been diagnosed as
nervous exhaustion the patient was really suffering from definite
disease.
The folly of attempting to make neurasthenia a distinct affection is
strongly brought out whenever it is attempted to give sharp diagnostic
differences between it and other diseases. As examples may be noted
the flat contradictions which exist in the different diagnostic tables
given in the elaborate work of the late George M. Beard.
It is necessary, therefore, in the outset, to recognize that
neurasthenia is a bodily condition which is very frequently associated
with various chronic disorders, or not rarely coexists with perverted
functional activity of the nervous centres, which perverted
nerve-functions may, however, exist independently of any perceptible
neurasthenia, and are not simply the outcomes of the neurasthenia.
Under these circumstances an apology {354} for devoting an article in
this work to the consideration of neurasthenia may seem necessary to
readers. The justification of the present discussion is to be found in
the facts that neurasthenia often exists without the presence of
definite disease, and that still more frequently it is a bodily
condition which dominates in its therapeutic importance the
manifestations of perverted functions, so that the patient is to be
treated for it rather than for the disease with which it is
associated.
ETIOLOGY.—There are various chronic diseases which may lead directly
to nervous exhaustion. Neurasthenia may, moreover, be the result of
disease which is long past; neglected diarrhœas, bleeding piles, and
other affections with exhausting discharges, when they have been
cured, may leave behind them conditions whose source and nature it is
most important to recognize.
Overwork, excessive mental emotion, need only to be alluded to as
capable of producing a pure neurasthenia. As Samuel Jackson was
accustomed to say, in his lectures at the University of Pennsylvania
thirty years ago, “Whenever the expenditure of nerve-force is greater
than the daily income, physical bankruptcy sooner or later results.”
It is to be remembered that the nerve-capital of persons differs
almost as widely as does their moneyed capital. There are numerous
families many of whose members are neurasthenics from birth—_i.e._ who
are born with less power of creating nervous energy than is necessary
to meet the requirements of the ordinary duties of life. There is
every grade of natural endowment between the most feeble person,
scarcely able to produce more nervous energy than is necessary for
breathing, eating, and drinking, and the organism that is capable of
enduring incessant toil. The development of neurasthenia is therefore
not so much the result of a strain which is absolutely great as of a
strain which is excessive in its relations to the organism which has
to bear it.