Volume 5 — DISEASES OF THE NERVOUS SYSTEM. (continued 11)

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 reported¹⁵ 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.

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.”

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.

Occasionally, cases of unilateral catalepsy associated with rotatory phenomena are met with, especially in hysterical children. In 1882, I studied in the nervous dispensary of the hospital of the University of Pennsylvania an interesting case with rotatory and unilateral cataleptoid symptoms. This case has been reported by James Hendrie Lloyd.¹⁷ The patient was a boy eight years old. His paternal grandfather hanged himself. On the mother's side there was a history of tuberculosis. Two years before coming to the hospital he had had four attacks of spasms. For two weeks he had been having from twelve to twenty similar spasms daily; some of these were observed in the dispensary. “The boy's head was suddenly drawn upward and to the right to its extreme limits by the action chiefly of the sterno-cleido-mastoid muscle. The eyes turned also to the extreme right, with slight convulsive (clonic) action, and became fixed in that position, with very wide dilatation of the pupils. In a second or two he began to rotate his whole body to the right, and turned completely around, perhaps ten or twelve times. On some occasions he had fallen down, his mother said, toward the end of the spell. If taken hold of and steadied—which required but little force by the physician—the rotation could be stopped, though the head and eyes remained drawn, and the boy's arms could be placed in any desired position. If now he was once more let loose, his body again rotated, while his arms were held in true cataleptoid rigidity. The whole duration of the attack was from one half to one minute. The boy was intelligent, and said he knew what was taking place about him while he was in the fit, though he gave no satisfactory evidence of such knowledge at the time. There was no history of headache or any disease. His ears were subsequently examined and found normal. He had taken worm medicine in abundance from the family physician without results. There were no psychical traits of importance to suggest foolish or wilful simulation. The only accident had been a fall from a wagon years previously. As the patient had an adherent prepuce, Wood advised circumcision, and took pains to explain the operation to the mother. This evidently made a great impression on the child's mind, which is worthy of notice in considering the case. The potassium bromide was continued. At the third visit, which had been appointed for the operation of circumcision, the mother reported the patient much better. The boy had been having great fear of the proposed operation, and now said that he thought he could control the spells. A psychical element was thus distinctly indicated, and its likeness to chorea major to some extent increased. It was thought best, however, instead of circumcision, to break up adhesions and retract the foreskin, which was done by J. William White. At the fourth visit, after ten days, a still greater improvement was noted.”

¹⁷ Philada. Med. Times, vol. xii., June 17, 1882.

Lloyd in reporting this case discusses the physiology of the condition, and refers to other cases in medical literature. According to Brown-Séquard, the great cause of rotation phenomena is a convulsive contraction in some of the muscles on one side of the body. Carpenter believes they are due to weakness of the sensori-motor apparatus of one side. Laycock holds that the cerebellum is involved. Lloyd likens the case to chorea major. He refers to cases reported by Radcliffe¹⁸ and J. Andrew Crawford.¹⁹

¹⁸ Reynolds's System of Medicine, art. “Chorea.”

¹⁹ Cycl. of Pract. Medicine, art. “Chorea.”

At the Pennsylvania Training School for Feeble-minded Children at Elwyn is a little patient familiarly spoken of as the Dervish. I have examined this boy several times, and have frequently watched his performances. I. N. Kerlin, superintendent of the institution, has kindly furnished me with some notes of this case. The antecedents of the patient are unknown. He is about fifteen years of age, is of small stature and weight, a demi-microcephalic, epileptic, and mute idiot. His epilepsy, however, supervened only in 1884, and the seizures continue now at the rate of three or four a month. At all times he is subject to certain automatic tricks with his hands, putting and twisting them into various positions. Periodically almost during every day he gives exhibitions of the habit which has led him to be called the Dervish. He commences by tattooing his chin with his left hand; next he delicately and rapidly touches the fingers of his left hand to the wrist of the right, makes two or three salaams, and then impulsively gyrates the body from left to right. The right heel is pivotal, and the force is maintained by touches of the left toe or heel upon the floor. He will usually take from three to seven turns at a time, with a salaam or two between every series. Fifteen minutes or more will be thus consumed before he darts away toward a window, where he remains a few moments in a dazed state, from which he rouses to recommence his hand tricks. Perhaps he will select a broad belt of light in which to display his hand for visual enjoyment. He has a cataract of the right lens, and possibly partial amaurosis of the left eye. A supplemental performance sometimes indulged in is to stand at one fixed point and throw his head and shoulders from side to side, describing with the former two-thirds of a circle, the occiput being flexed backward as far as the neck will permit. These movements, rapidly made, reach three and four hundred under favorable conditions.

Kerlin regards the displays made by this boy to be the pure automatic phenomena of idiocy which have been developed to an artistic finish, and out of which the patient gets enjoyment. This enjoyment probably exists in some anæsthetic or stuporous condition of certain nerve-centres, something like the sensation of common dizziness. He does not look upon the case, therefore, as one of genuine catalepsy, but I have recorded it here in connection with the case just given because it illustrates a phase of automatism and rotation movements closely allied to cataleptoid conditions.

Catalepsy and Cataleptoid Phenomena among the Insane.

Catalepsy and cataleptoid or cataleptic phenomena are of comparatively frequent occurrence among the insane. Niemeyer says²⁰ that they are especially common among persons suffering from melancholia. Kahlbaum²¹ has described a form of insanity which he names katatonia, from the Greek κατατονος, stretching down. This disease is “characterized by alternate periods, supervening with more or less regularity, of acute mania, melancholia, and epileptoid and cataleptoid states, with delusions of an exalted character and a tendency to dramatism.”²²

²⁰ Textbook of Practical Medicine, Felix von Niemeyer, American trans., 1876, vol. ii. p. 387.

²¹ Klinische Abhandlungen über psychische Krankheiten, 1 Heft, “Die Katatonie,” Berlin, 1874.

²² A Treatise on Insanity in its Medical Relations, by William A. Hammond, M.D., New York, 1883, p. 576.

Kiernan²³ has written a valuable memoir on this affection. He has collected fifty cases, a few of which he gives in detail. Hammond and Spitzka discuss the disorder, giving new cases, in their treatises on insanity.

²³ American Journal of Insanity, July, 1877, and Alienist and Neurologist, October, 1882.

Katatonia may begin in various ways, but it usually pursues a certain cycle. First appears stuporous melancholia, accompanied or followed by cataleptoid manifestations; then a period of mania with illusions, hallucinations, and delusions. Melancholia reappears in some form, with cataleptoid, waxy condition of the muscles, and a disposition to talk in a pompous or dramatic manner; convulsions or choreic movements may be present.²⁴ Sometimes some phase of the cycle is absent.

²⁴ Hammond.

In some cases in which the peculiar cycle and special phenomena which characterize katatonia are not present marked cataleptic or cataleptoid states may be observed among the insane, either as episodes or as long-continuing conditions.

As cases illustrating cataleptoid phenomena among the insane have not yet been published in large number, and are not well understood, I will record here, under the Symptomatology of Catalepsy, some illustrative cases which have either fallen under my own observation or have been supplied to me directly by medical friends.

M. A. Avery, assistant physician to the insane department of the Philadelphia Hospital, has kindly furnished notes of the following interesting case:

T——, aged twenty, single, dressmaker. The patient was somewhat below medium height, slender and emaciated, of nervous temperament, expression melancholy. The attack of insanity for which she was admitted was her first. It began four months before admission. No satisfactory history of the attack could be obtained; she was said to have been depressed in spirits and to have delusions of poisoning. She had attempted suicide by throwing herself from the window.

Upon admission, Sept. 20, 1883, she was quiet and gentle in her manner, but much depressed; she answered questions rationally. No delusions were detected. Sept. 21st she sat quiet and motionless. Her eyes were fixed, with marked double, inward squint. She was apparently insensible to external impressions. This condition lasted about three hours, when she suddenly sprang up, rushed through the ward, and made vigorous efforts to escape. On the 22d she lay in bed in a perfectly passive state, with eyes open and fixed, but the squint had disappeared. There was a constant slight tremor of the lids. The conjunctiva was apparently insensible to touch. She seemed to be unconscious of what was going on around her. Her arms remained raised in any position in which they were placed. About three o'clock in the afternoon this condition passed away, and from that time until she went to bed at eight o'clock she was bright and cheerful and talked in a rational and intelligent manner. For five days she was quiet and melancholy, with one spell of a few hours in which she was in a passive and cataleptic state, as on the 22d.

On the 28th she stood erect with arms extended, whirling rapidly. She continued this for about half an hour, and then, after a short rest, began again. She paid no attention to what was said to her, and seemed unconscious of what took place around her. The next day she remained in a stupid condition most of the time, but occasionally sprang up and danced violently or spun round rapidly with arms extended for a few moments at a time. On the 30th her cataleptic condition was uninterrupted. She lay motionless, with pulse slow and feeble, extremities cold; her limbs were easily placed in any desired position, and remained so for about twenty minutes; then they returned slowly to a more natural and comfortable position. She continued for several days in this condition, then aroused and ate heartily. She seemed brighter and more cheerful, and talked rationally. She said that she knew all that was said and done when she seemed unconscious, and that she wanted to speak, but could not. For several weeks cataleptic symptoms prevailed, with occasional lucid intervals of a few hours. She eventually settled into a childish, demented condition.

In the insane department of the Philadelphia Hospital was a middle-aged man who remained for several years in a stuporous and cataleptoid state. On several occasions he was before the class in the clinic-room. He could not be made to speak, but remained perfectly silent in any condition in which he was placed. His head and trunk could be bowed forward, sideway, or backward; one foot could be elevated while he stood; his arms could be placed in grotesque positions. In whatever attitude he was placed he would remain for a long time. The only history that could be obtained of this man was that he had for several months been in a state of melancholia, after which he was maniacal for three or four months. He escaped from the hospital, and was brought back in the stuporous and cataleptoid condition in which he continued. He had been a masturbator.

A Dane, while on a voyage from Copenhagen, fell and broke his leg, for which he was treated in a hospital. He recovered and became a nurse in the institution. He fell in love with a female nurse, and was to be married, but the lady suddenly fell dead. He became melancholic, and three weeks afterward tried to hang himself. He also had hystero-epileptic seizures, and was for a long time in a condition of extreme stupor with cataleptoid phenomena, from which he passed into a rather excited condition. He had no special delusions, but there was a tendency to dramatism.

Another case came into the nervous wards of the Philadelphia Hospital. No history could be obtained from the patient. Whether or not he had previously suffered from melancholia could not be learned. He would retain for a long time any position in which he was placed. He also had hystero-cataleptic spells, and a peculiarity of enunciation with a tendency to pose. When asked, “How are you to-day?” he would reply, “I pre-sume-that-I-am-a-bout-the-same—that-it-is-likely-that-some-thing-has-dis-ap-peared-in-the-mind.” When asked, “How long have you been sick?” he would begin in the same way: “I-pre-sume-that-I-will-have-to-say-that-at-a-time-re-mote-ly-dis-tant;” and then he would branch off into something else.

Wilks²⁵ speaks of a man whom he saw in the asylum at Morningside who could be moulded into any position. While in bed on his back his arms and legs could be arranged in any position, and there they would remain. He also speaks of a case seen by Savage in Bethlem—a young man who kept his arms stretched out for two hours, and stood on one leg for a very long time or until he fell.

²⁵ Lectures on Diseases of the Nervous System, delivered at Guy's Hospital.

William Barton Hopkins of Philadelphia has given me brief details of a case observed by him at the Pennsylvania Hospital, which would seem to have been either one of katatonia or one of cataleptoid attacks occurring in an inebriate. The patient was an habitual moderate drinker. For three weeks before he was admitted to the hospital he had been drinking heavily. His family history showed a tendency to insanity. He showed great mental anxiety; his face was pale and had a very troubled aspect. He had no hallucinations. Two days after admission a sudden outbreak of mania occurred, in which he showed destructive and dangerous tendencies, and mechanical restraint had to be employed. Under treatment he became quiet, and was removed by his friends, having been altogether five days in the hospital. On the day of his departure, while awaiting some of his friends in the main hall, he suddenly ran up stairs, and was quickly followed by a nurse, who found him raising a window with the apparent intention of jumping out. His face at this time had lost its troubled look, and had rather a pleased but vacant appearance. While in this condition his limbs were placed in various positions, and there remained. On another occasion, while lying on the bed, his limbs and trunk were placed in various grotesque positions, and there remained. The condition of waxen flexibility was well marked; many tests were made.

To Wharton Sinkler I am indebted for the unpublished notes of the case of a woman twenty-seven years of age, who had no family history of insanity, but whose father was a highly nervous man. She had always had good health, and was of good physique. Seven years ago she had an attack of melancholia lasting four or five months; since then she had no trouble until six months since. At this time she began to be low-spirited. Then delusions came on—that she was unworthy to live; that it was wicked for her to eat, because no one else had food; that those about her were in ill-health. She refused to eat, and would not talk, and slept badly. When first seen by Sinkler she was stout and with apparently good nutrition, but was said to have lost flesh. Her face was expressionless, and she was unwilling to converse, but said she was quite well, and that her stepmother was ill and needed treatment. She was undecided in all her movements, and would stand in one spot until led to a chair, where she would remain if seated.

The patient was placed under the care of two nurses, and for a week improved daily—ate food, conversed, read aloud, and sewed. At the end of this time she was left with one nurse, but became obstinate about eating, and had an altercation with the nurse, in which she became violent. After this she gradually got into a cataleptoid state. At first she would stand for a long time in one place, and if seated in a chair would remain in any position in which she was placed. She began to have attacks in which she would lie on the floor motionless for hours. A sharp faradic current was applied to the forearms on one occasion, and she soon became relaxed. In the attacks the eyes were closed or rolled upward and fixed on the ceiling. The muscles were rigid. The arms and legs could be placed in any attitude, and would there remain. There was no analgesia: she had decided objection to pin-pricks. For two or three days she was readily aroused from the cataleptic state by electricity, but it lost its effect, and etherization was resorted to. The first time a few whiffs of ether relaxed the rigid limbs. The next day the rigidity continued until complete etherization was effected. In fact, when the breathing was loudly stertorous and the conjunctiva insensible to touch, the rigidity was complete, and it was not until a large amount of ether had been inhaled that the limbs relaxed. While under the effects of the ether a vaginal examination was made, and the uterus found normal in position and size. No evidences of self-abuse were found, nor had there been any reason for suspecting this. She continued in the condition described for many days. She was filthy in her habits, and would not use the commode, although she was made to sit on it for hours. She would have a stool on the floor or in bed immediately after rising from the commode. She seemed imbecile, and scarcely spoke, or, if she did, would say she was dead or was a baby. She would eat nothing voluntarily: food was put into her mouth, and she would swallow it, but made no effort to close the lips herself. She was fed in this way for four or five weeks. If taken up to be dressed, she would make the procedure as difficult as possible, and when dressed would not let her clothing remain buttoned, so that her clothes had to be sewed on her.

After about ten weeks a slight improvement showed itself, first in her taking food voluntarily, then in speaking. By degrees she became reasonable, and in about four months from the time she was first seen was perfectly well. The medication used was very slight, but she was thoroughly fed, took bromide of sodium and ergot for a time, and occasionally a dose of paraldehyde to produce sleep. She had two efficient nurses, who carefully carried out all directions, and who never yielded a point, but tried to be always as kind as firm. This case is instructive, not only because of its phenomena, but also because of the method of feeding and managing the patient and the result of treatment.

At a meeting of the Philadelphia Neurological Society held February 22, 1886, I exhibited, at the request of Dr. C. P. Henry, of the Insane Department of the Philadelphia Hospital, a case presenting cataleptoid symptoms, the phenomena of automatism at command, and of imitation automatism.

This patient had been recently admitted to the hospital, and no previous history had been obtained. He was a middle-aged man, not unintelligent-looking, and in fair physical condition. His condition and his symptoms had remained practically the same during the short time that had elapsed since admission. He remained constantly speechless, almost continually in one position; would not open his eyes, or at least not widely; would not take food unless forced; and his countenance presented a placid but not stupid or melancholy appearance. He had on several occasions assumed dramatic positions, posing and gesticulating. It had been discovered by Henry that the patient's limbs would remain where they were placed, and that he would obey orders automatically. The case had been regarded as probably one of katatonia, but in the absence of previous history it was not known whether or not he had passed through the cycle of mania, melancholia, etc. which constitutes this fully-developed disease. He had had since admission attacks of some severity, probably, from description, hystero-epileptic in character.

In exhibiting the patient I first placed his arms and legs and body and head in various positions, where they remained until he was commanded to place them in other positions. His mouth was opened, one eye was opened and the other was shut, and he so remained until ordered to close his mouth and eyes. In most of these experiments the acts performed were accompanied by remarks that the patient would do thus and so as he was directed.

Various experiments to show automatism at command were performed. I remarked, for instance, that the gentleman was a good violin-player, when he immediately proceeded to imitate a violin-player. In a similar way he took a lead-pencil which was handed to him and performed upon it as if it were a flute. He danced when it was asserted that he was an excellent dancer; placed his arms in a sparring position and struck out and countered on telling him that he was a prize-fighter; went through many of the movements of drilling as a soldier, such as attention, facing, marking time, and marching. He was told that he was a preacher and must preach, and immediately began to gesticulate very energetically, as if delivering an earnest exhortation. He posed and performed histrionically when told that he was an actor. He was given a glass of water and told that it was good wine, but refused to drink it, motioning it away from him. He was then told that it was very good tea, when he tasted it, evincing signs of pleasure. During all these performances he could not be induced to speak; his eyes remained closed, or at least the eyelids drooped so that they were almost entirely closed. He showed a few phenomena of imitation, as keeping time and marching to the sound of the feet of the operator.

In the nervous wards of the Philadelphia Hospital there is now an interesting case of melancholia with catalepsy and the phenomena of automatism at command—a man aged twenty-five, white, single, who for thirteen years had worked in a type-foundry. Three years before coming to the hospital he had an attack of acute lead-poisoning with wrist-drop. Two years later he had an attack of mental excitement with other evidences of insanity. He had hallucinations of sight and hearing, and thought that he heard voices accusing his sister of immorality. He at times accused this sister of trying to poison him. He believed that his fellow-workmen were trying to have him discharged. This condition lasted for six weeks, when he became gloomy and stuporous, and would make no effort to do anything for himself. His friends had to feed him. When first admitted to the nervous wards he sat in the same position all day long, with his head almost touching his knees, his arms fully extended by his sides. He would not help himself in any way. His eyes were always open, and he never winked. He never slept any during the day, but was perfectly oblivious to all surroundings. He did not speak or move out of any position in which he was placed. He could be placed in all sorts of uncomfortable positions, and would remain in them. After treatment with strong electrical currents and forced exercise he brightened considerably, and would walk, after being started, without urging. When treatment was discontinued, he relapsed into his former state. Frequent experiments have been performed with this man. Placing his limbs in any position, they will remain if a command is given to retain them. He marches, makes movements as if boxing, etc. at command.

The phenomena shown by both of these patients are those which have for 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 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. Hammond²⁶ 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.

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 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 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.

²⁷ St. Louis Clin. Rec., iii. 1876, p. 125.

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.”

Dickson²⁹ 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 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.

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 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 Richer³⁰ 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.”

³⁰ Journal of Nervous and Mental Diseases, vol. x., No. 1, January, 1883.

Chambers³¹ 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.

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. 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.

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.

Gibbon¹ has well described the occurrence of ecstasy in the monks of the Oriental Church in the following passage: “The fakirs of India and the monks of the Oriental Church were alike persuaded that in total abstraction of the faculties of the mind and body the purer spirit may ascend to the enjoyment and vision of the Deity. The opinions and practices of the monasteries of Mount Athos will be best represented in the words of an abbot who flourished in the eleventh century. ‘When thou art alone in thy cell,’ says the ascetic teacher, ‘shut thy door and seat thyself in a corner; raise thy mind above all things vain and transitory; recline thy beard and thy chin on thy breast; turn thine eyes and thy thoughts toward the middle of thy belly, the region of the navel; and search the place of the heart, the seat of the soul. At first all will be dark and comfortless; but if you persevere day and night you will feel an ineffable joy; and no sooner has the soul discovered the place of the heart than it is involved in a mystic and ethereal light.’ This light, the production of a distempered fancy, the creature of an empty stomach and an empty brain, was adored by the Quietists as the pure and perfect essence of God himself; and as long as the folly was confined to Mount Athos the simple solitaries were not inquisitive how the divine essence could be a material substance, or how an immaterial substance could be perceived by the eyes of the body. But in the reign of the younger Andronicus the monasteries were visited by Barlaam, a Calabrian monk, who was equally skilled in philosophy and theology, who possessed the languages of the Greeks and Latins, and whose versatile genius could maintain their opposite creeds according to the interest of the moment. The indiscretion of an ascetic revealed to the curious traveller the secrets of mental prayer, and Barlaam embraced the opportunity of ridiculing the Quietists, who placed the soul in the navel—of accusing the monks of Mount Athos of heresy and blasphemy.”

¹ Decline and Fall of the Roman Empire, by Edward Gibbon, Esq., in 8 vols., vol. viii. p. 64, London, 1838.

Some of Swedenborg's supernatural visions were, so far as can be judged, simply accounts of attacks of ecstasy; and of like character were the visions of John Engelbrecht as related by Arnold.²

² Observations, etc., London, 1806.

In a very curious American book³ published in 1815 a history is given of the wonderful performances of a woman named Rachel Baker, who was undoubtedly in the habit of passing into conditions of religious ecstasy, during which were present many of the phenomena which occur in ecstatics, Catholic or Protestant, religious or otherwise. When seventeen years old she witnessed the baptism of a young lady, which impressed her strongly and caused her to become much dejected and affected about her religious state. She began to have evening reveries or night talks which soon attracted attention. She united with the Presbyterian Church. These reveries after a while expanded into evening exercises which began with prayer, after which she exhorted and made a closing prayer. She removed from Marcellus to Scipio, New York, in 1813, and shortly afterward, in the same year, she went to New York City for medical advice. While there she gave many opportunities to witness her powers when in what her editors quaintly call her somnial paroxysms. Her discourses were good illustrations of what is sometimes termed trance-preaching.

³ Devotional Somnium; or, A Collection of Prayers and Exhortations Uttered by Miss Rachel Baker, by Several Medical Gentlemen, New York, 1815.

One of the most interesting parts of this curious book is a dissertation by Samuel L. Mitchill, M.D., on the function of somnium. He says there are three states of animal existence—wakefulness, sleep, and vision or dream. The definition of somnium, which he quotes from Cicero, is a very fair one to be applied to some of the conditions which we now speak of under such heads as lethargy, trance, ecstasy, etc. “By somnium,” he says, “may be understood the performance of certain mental and bodily actions, which are usually voluntary, without the direction or government of the will or without the recollection afterward that such volition existed.” He divides somnium into symptomatic and idiopathic. The symptomatic somnium occurs from indigestion, the nightmare, from affusions of water into the chest, from a feverish state of the body, from debility with fasting, from fresh and vivid occurrences, etc. The idiopathic somnium is divided into somnium from abstraction, somnium with partial or universal lunacy, with walking, with talking, with invention, with mistaken impressions of sight and of hearing, with singing, with ability to pray and preach or to address the Supreme Being and human auditors in an instructive and eloquent manner, without any recollection of having been so employed, and with utter incompetency to perform such exercises of devotion and instruction when awake. To the last of these affections he refers the case of Rachel Baker, whose devotional somnium he describes.

A number of other curious cases are recorded in this book: that of Job Cooper, a weaver who flourished in Pennsylvania about the year 1774; that of the Rev. Dr. Tennent, who came near having a funeral in one of his states of trance, who has related his own views, apprehensions, and observations while in a state of suspended animation. He saw hosts of happy beings; he heard songs and hallelujahs; he felt joy unutterable and full of glory: he was, in short, in a state of ecstatic trance. Goldsmith's history of Cyrillo Padovando, a noted sleep-walker, who was a very moral man while awake, but when sleep-walking a first-class thief, robber, and plunderer of the dead, is also given.

One of the most remarkable instances of ecstasy is that of the girl Bernadette Soubirons, whose wonderful visions led to the establishment of the now famous shrine of Our Lady of Lourdes in the south of France. It is related of this young girl by her historian Lasserre⁴ that when about to cross the Gave, a mountain-stream of the Pyrenees, she suddenly saw in a niche of a rock a female figure of incomparable splendor, which she described as a real woman with an aureola about her head and her whole body of surprising brightness. The child afterward described in detail the vision she had seen. Later, on a number of occasions at the same spot, she saw the same vision, described as appearing transfigured. The child believed that she saw the Immaculate Virgin. The Virgin told her that she wished a church to be built on the spot. The place has since become a shrine for Catholics of all nations.

⁴ Our Lady of Lourdes, by Henri Lasserre, translated from the French, 7th ed., New York, 1875.

Meredith Clymer⁵ has written an elaborate communication on ecstasy. Ambrose Paré, quoted by Clymer, defines ecstasy as a reverie with rapture of the mind, as if the soul was parted from the body. Briquet describes it as a state of cerebral exaltation carried to such a degree that the attention, concentrated on a single object, produces the temporary abolishment of the other senses and of voluntary movements.

⁵ “Notes on Ecstasy and other Dramatic Disorders of the Nervous System,” Journal of Psychological Medicine, vol. iv., No. 4, October 1870.

ETIOLOGY.—Under the predisposing causes of ecstasy may be comprised almost all of those described under hysteria. The predisposition to the development of ecstasy will be governed in great measure by peculiarities of religious education and of domestic and social environment.

Extreme religious feeling is undoubtedly among the most frequent of the exciting causes of ecstasy. The accidents and incidents of love have also had a place. Sexual excitement is sometimes associated with the production of ecstasy. “In pre-Christian times,” says Chambers, “when, in default of revelation, men worshipped their incarnate passions, we have from the pen of Sappho a description of a purely erotic ecstasy which can never be produced again.” Fear or fright has been known to throw a predisposed individual into an attack of ecstasy. Severe threats have occasionally had the same influence.

SYMPTOMATOLOGY.—In considering the symptomatology of ecstasy it will only be necessary to call attention to the ecstatic attack. The accompanying phenomena are those of hysteria, hystero-epilepsy, etc., already fully described. I cannot do better than quote from Lasserre the account of one of the ecstatic seizures of Bernadette Soubirons. Although given in turgid language and from the religious point of view, the description is a good one of the objective phenomena of ecstasy:

“A few moments afterward you might have seen her brow light up and become radiant. The blood, however, did not mantle her visage; on the contrary, she grew slightly pale, as if Nature somewhat succumbed in the presence of the apparition which manifested itself to her. All her features assumed a lofty and still more lofty expression, and entered, as it were, a superior region, a country of glory, significant of sentiments and things which are not found below. Her mouth, half open, was gasping with admiration and seemed to aspire to heaven. Her eyes, fixed and blissful, contemplated an invisible beauty, which no one else perceived, but whose presence was felt by all, seen by all, so to say, by reverberation on the countenance of the child. This poor little peasant-girl, so ordinary in her habitual state, seemed to have ceased to belong to this earth.

“It was the Angel of Innocence, leaving the world for a moment behind and falling in adoration at the moment the eternal gates are opened and the first view of paradise flashes on the sight.

“All those who have seen Bernadette in this state of ecstasy speak of the sight as of something entirely unparalleled on earth. The impression made upon them is as strong now, after the lapse of ten years, as on the first day.

“What is also remarkable, although her attention was entirely absorbed by the contemplation of the Virgin full of grace, she was, to a certain degree, conscious of what was passing around her.

“At a certain moment her taper went out; she stretched out her hand that the person nearest to her might relight it.

“Some one having wished to touch the wild rose with a stick, she eagerly made him a sign to desist, and an expression of fear passed over her countenance. ‘I was afraid,’ she said afterward with simplicity, ‘that he might have touched the Lady and done her harm.’”

Side by side with this description by the devout Lasserre of the appearance presented by Bernadette when in a state of ecstasy, I will quote the often-recorded account which Saint Theresa has given in her Memoirs of her subjective condition while in a similar state:

“There is a sort of sleep of the faculties of the soul, understanding, memory, and will, during which one is, as it were, unconscious of their working. A sort of voluptuousness is experienced, akin to what might be felt by a dying person happy to expire on the bosom of God. The mind takes no heed of what is doing; it knows not whether one is speaking or is silent or weeping; it is a sweet delusion, a celestial frenzy, in which one is taught true wisdom in a way which fills us with inconceivable joy. We feel as about to faint or as just fallen into a swoon; we can hardly breathe; and bodily strength is so feeble that it requires a great effort to raise even the hands. The eyes are shut, or if they remain open they see nothing; we could not read if we would, for, though we know that they are letters, we can neither tell them apart nor put them together, for the mind does not act. If any one in this state is spoken to, he does not hear; he tries in vain to speak, but he is unable to form or utter a single word. Though all external forces abandon you, those of the soul increase, so as to enable you the better to possess the glory you are enjoying.”

Occasionally striking illustrations of ecstasy are to be found among hysterical and hystero-epileptic patients in whom religious faith has no place. In these cases usually other special phases of grave hysteria are present. In some of the descriptions given by Charcot and Richer of hystero-epileptics in the stage of emotional attitudes or statuesque positions the patients are, for a time at least, in an ecstatic condition in which the hallucinations may be connected with sentiments of religion, love, fear, or other emotions. One shows an attitude of menace or an expression of fear; in another the expression is of beatitude or saintly happiness: to this expression perhaps succeeds one of intense joy; to this, one of passion and lubricity. Throughout all the changing phases of attitude and expression the patient has the other concomitants of the true ecstatic state, such as want of volition and insensibility.

DIAGNOSIS.—A cataleptic may also be an ecstatic or the reverse; but not a few cases are on record in the history of which, on the one hand, an individual has been subject over a long period to cataleptic seizures without the recurrence of ecstasy, or, on the other hand, to fits of ecstasy without a single attack of true catalepsy. Cataleptic attacks usually occur with more suddenness than ecstasy; the cataleptic may suddenly become rigid and statuesque—the ecstatic gradually, although it may be somewhat rapidly, passes step by step into a visionary state. In catalepsy and ecstasy the expression of the patient differs. One of the striking features of ecstasy is not simply the absorbed and abstracted, but also the radiant, expression of countenance. In catalepsy the expression is more likely to be vacant or at least negative. In ecstasy waxen flexibility is not present. The muscles can act in obedience to the will, and the trunk and limbs do not maintain the positions in which they are placed for any unusual time. In genuine catalepsy the consciousness is so suspended or altered that the period of the seizure afterward remains a blank in the memory of the patient. In ecstasy, however, the visions and fancies present during the fit can afterward be recalled, and are frequently recounted by the individual.

DURATION, COURSE, PROGNOSIS.—Nothing need be said as to duration, course, prognosis, etc. of ecstasy. The remarks made in considering hysteria, hystero-epilepsy, etc. fully cover these matters.

TREATMENT.—With reference to the treatment of ecstasy little need be said. It must, in part at least, be directed to rousing and changing the dormant or dreamy condition of the individual. As it is the mind or the volitional nature which is chiefly affected, the use of agents which either directly or reflexly exert a powerful impression on the cerebral centres is indicated. Thus, in all ages harsh measures have received more or less applause in the treatment of ecstasy. The cold douche or shower-bath, the plunge-bath, the hot iron, painful electric currents, scourging, and beating have all had their advocates. Flint⁶ gives details of a case in which burning with a heated hammer was employed for three weeks, the patient eventually recovering, either because of, or in spite of, the treatment. Chambers believes in the forcible repression of ecstatic and emotional exhibitions. “In Unst, the most northerly of the Shetland Islands,” he says, “an epidemic of convulsive fits occurring in sermon-time began to prevail in several parish churches. At one of these, Northmaven, the disease was cut short by a rough fellow of a Turk who carried out a troublesome patient and tossed her into a wet ditch. Nobody else caught it. From what scandalous scenes Europe might have been saved had the first dancer on St. John's Eve been tossed into a wet ditch!”

⁶ Loc. cit.

Trance, Lethargy, and Morbid Somnolence.

Trance may be defined as a derangement of the nervous system characterized by general muscular immobility, complete mental inertia, and insensibility to surroundings. The condition of a patient in a state of trance has been frequently, and not inaptly, compared to that of a hibernating animal. Trance may last for minutes, hours, days, weeks, or even months. Astonishing stories, some true, others—and these the greater number—false, frequently find their way into newspapers. A recent story is that of a hystero-cataleptic young woman of Nebraska who is reported to have been for seventy days in a state of trance, during which she was to all appearance lifeless with the exception of respiration and pulsation. She said that she was unconscious during the whole time of her protracted trance, but, although she exerted her utmost power to evince her consciousness, she could not move a muscle. Such cases like the Welsh fasting girl either live or seem to live for a long time on little or no food; doubtless food is often taken secretly.

In an interesting case which, so far as I know, has never been put upon record in any medical publication, attacks of catalepsy or of trance, or of both, occurred three times at long intervals during the life of this individual. The first time was while held in the arms of his mother preparatory to receiving the baptismal rite: the clergyman and others observed that the infant changed appearance and suddenly became rigid. It was feared that he was dying; the ceremonies were stopped, but in response to efforts after a time he came back to a normal state. When about sixteen years of age, while at school, he was accidentally wounded; it was necessary to probe for the ball, and while this was being done he again passed into a trance-like condition. Many years later, while in good health, a prosperous and well-known citizen, he suddenly again fell into an unconscious condition, and was believed to be dead. So marked were the appearances of death that after numerous efforts to resuscitate him preparations were made for his funeral. The knowledge of his previous attacks, however, induced his friends and relatives to defer his interment and continue their efforts. He finally revived just as they were about to give up in despair.

Aëtius, according to Laycock,⁷ mentions hysteric death as being very common in his day, and asserts that real death may supervene without any of the ordinary symptoms. The eyes preserve their brightness and the color of the skin remains vivid. Good cites the case of a woman whose funeral was postponed to ascertain the cause of her death, and whom the first touch of the scalpel brought to her senses. Authors and travellers have described wonderful cases of trance which have been observed in Persia and in India. A Persian youth is recorded to have possessed the power to restrain his breath for two days; and fakirs in India are said sometimes to have allowed themselves to be buried alive for weeks. Doubtless, a little Caucasian light let in upon some of these stories might dissolve them, as the esoteric Buddhism of Madame Blavatzsky has been dissipated into thin air by a hard-headed English investigator. According to Diogenes,⁸ Empedocles, a celebrated disciple of Pythagoras, obtained great fame by curing a female supposed to be dead, but whom he discovered to be suffering from hysteria. He termed the affection under which she labored apnoë, and maintained that a female might live in an apparently lifeless state for thirty days.

⁷ Op. cit.

⁸ Quoted by Laycock.

Landouzy has reported an interesting instance of lethargy produced by the application of a magnet to a patient suffering from hysteria major. The attacks of hysterical sleep are often preceded by convulsive phenomena, and, according to Briquet, are often ushered in by epileptoid signs, such as whistling inspiration, movements of deglutition, frothing, and transient rigidity of the limbs. Richer reports a remarkable case of Plendlers of Vienna, in which a young girl, after a series of violent hysterical attacks, fell apparently dead. Preparations were made to bury her, when she was found to be living, having been in a state of lethargy. Among cases observed in Salpêtrière the duration of lethargy has been from two to eight days. Sometimes, in cases of grave hysteria, attacks of lethargy complicated with general or partial contractures and epileptoid phenomena have been observed. The presence of neuro-muscular hyperexcitability is of diagnostic value in determining the nature of such cases; if present, we have probably to deal with phenomena of hysterical lethargy. This symptom may, of course, pass unperceived. A woman came under observation a short time since, being then far gone in pregnancy. About a month before delivery she had a very marked hysterical outbreak, in which she so simulated apoplexy as to make it almost impossible to decide what was the matter with her. She had apparently lost sensation, her breathing was stertorous, her pulse labored, and she had divergent strabismus. In the course of half an hour the symptoms passed off.

In trance, as in ecstasy, the patient may remain motionless and apparently unconscious of all surroundings; but in the former the visionary state, the radiant expression, and the statuesque positions are not necessarily present. In trance, as stated by Wilks, the patients may lie like an animal hibernating for days together, without eating or drinking, and apparently insensible to all objects around them. In ecstasy the mind, under certain limitations, is active; it is concentrated upon some object of interest, admiration, or adoration. Conditions of trance, as a rule, last longer than those of ecstasy.

Beard's⁹ theory of trance is that it is “a functional disease of the nervous system in which the cerebral activity is concentrated in some limited region of the brain, with suspension of the activity of the rest of the brain, and consequent loss of volition. Like other functional nervous diseases, it may be induced either physically or psychically—that is, by all the influences that act on the nervous system or on the mind; more frequently the latter, sometimes both combined.”

⁹ Quoted by Crothers in Quarterly Journal of Inebriety, January, 1880.

T. D. Crothers¹⁰ has contributed some papers upon the subject of the trance state in inebriety. He gives the clinical history of some cases of inebriety which presented the phenomena of cerebral automatism or trance. He concludes that loss of memory and consciousness may come on in inebriety and the patient give little or no evidence of his actual condition. His conclusions are, that when the trance state is established beyond doubt the individual is irresponsible for his acts during this period. The study of the trance state in affections of such definite origin and positive pathology as inebriety helps to throw light upon its occurrence and explanation in cases of hysteria.

¹⁰ “Cerebral Trance; or, Loss of Consciousness and Memory in Inebriety,” Quarterly Journal of Inebriety, January, 1880; and The Trance State in Inebriety: its Medico-Legal Relations; with an Introduction on the Nature and Character of the Trance State, by George M. Beard, M.D., a paper read before the New York Medico-Legal Society, November 2, 1881, Hartford, Conn., 1882.

Dana¹¹ reports about fifty cases of prolonged morbid somnolence. Nearly all those reported previous to 1878 are cases of what has been termed trance-like sleep or lethargy. In 1878, Gelineau called attention to a disease which he termed narcolepsy. Dana has seen five cases, and reports two others from notes furnished by Putzel of New York. Some of the cases collected are both interesting and remarkable. Dana calls attention to the distinction made by Briquet between prolonged hysteria and lethargy. In lethargy the condition of unconsciousness is generally more profound, the reflexes are abolished, and the patient cannot be aroused. A patient may even have periods of sleep within the lethargy.

¹¹ “Morbid Drowsiness and Somnolence,” Journ. of Nervous and Mental Disease, vol. xi., No. 2, April 18, 1884.

Dana excludes from his cases of prolonged somnolence those cases of drowsiness due to ordinary causes, as old age, diseased blood-vessels, cerebral malnutrition, or inflammation; various toxæmiæ, as malaria, uræmia, colæmia, and syphilis; dyspepsia, diabetes, obesity, insolation, cerebral anæmia and hyperæmia, cerebral tumors and cranial injuries, exhausting diseases, and the sleeping sickness of Africa.

He found that the prolonged somnolence shows itself in very different ways. Sometimes the patient suffers from simply a great prolongation of natural sleep; sometimes from a constant, persistent drowsiness, which he is often obliged to yield to; sometimes from frequent brief attacks of somnolence, not being drowsy in the intermission; sometimes from single or repeated prolonged lethargic attacks; finally, sometimes from periodical attacks of profound somnolence or lethargy which last for days, weeks, or months.

He says that most cases of functional morbid somnolence are closely 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.

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 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 Galton¹³ in a recent work advocates the cultivation of this power of the reproduction at will of mental imagery. Clarke¹⁴ 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?

¹³ Inquiries into Human Faculty and its Development, Francis Galton, F. R. S., New York, 1883.

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. Hammond¹⁵ has an interesting chapter on the subject of stigmatization, of which I have made use, and Clymer's¹⁶ 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.

¹⁵ On Certain Conditions of Nervous Derangement, New York, 1881.

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 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 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.

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 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-Beaumetz¹⁸ 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.

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, 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.

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.