Chapter M: A. Avery, assistant physician to the insane department of the (2)

TREATMENT.—With reference to the treatment of ecstasy little need be said. It must, in part at least, be directed to rousing and changing {344} 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. Flint[6] 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!”

[Footnote 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 {345} 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.

[Footnote 7: _Op. cit._]

[Footnote 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 {346} 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's[9] 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.”

[Footnote 9: Quoted by Crothers in _Quarterly Journal of Inebriety_, January, 1880.]

T. D. Crothers[10] 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.

[Footnote 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.]

Dana[11] 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.

[Footnote 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 {347} 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.

[Footnote 12: _Brit. Med. Journ._, Dec. 12, 1885.]

Self-concentration in those of robust minds differs rather in degree than in essence from ecstasy or trance and allied conditions in the weak and hysterical. “Archimedes,” says Clymer, “engrossed with a problem in {348} geometry, feels no hunger and is deaf to the tumult of the soldiers in a captured town; Socrates, occupied with his own thoughts, stands twenty-four hours immovable in one spot exposed to the burning rays of the sun.” Goethe, Blake, and others are on record as having the power to call up images at will. Francis Galton[13] in a recent work advocates the cultivation of this power of the reproduction at will of mental imagery. Clarke[14] records many wonderful instances of pseudopia. In what does the ecstatic differ from these except in that the mental status of the individual is different, and that the object of mental concentration is of a special character, consonant with the person's ideas, training, and surroundings?

[Footnote 13: _Inquiries into Human Faculty and its Development_, Francis Galton, F. R. S., New York, 1883.]

[Footnote 14: _Vision, a Study of False Sight_, by Edward H. Clarke, M.D., Boston, 1878.]

In brown study or reverie, according to Laycock, the eye is fixed by a muscular action analogous to that of the cataleptic; and not the eye only, for a limb or the whole body will remain in the same position for many minutes, the senses themselves being in deep abstraction from surrounding objects.

Stigmatization.

Stigmatization (from the Greek _στιγμα_, a small puncture) is a symptom or appearance which usually presents itself in the form of bloody or blood-like markings on the palms of the hands, the backs of the feet, and the left side, the positions in which Christ was lacerated by the nails and the spear at the crucifixion. In some cases the stigmata are found in scattered points on various parts of the body, sometimes upon the forehead at the position of the lacerations produced by the crown of thorns. In various ages it has been claimed by Catholics that cases of genuine stigmatization have occurred. It is not, however, a matter of Catholic faith, the claim being simply that it is a genuine experience which has some supernatural significance. Hammond[15] has an interesting chapter on the subject of stigmatization, of which I have made use, and Clymer's[16] article, already referred to, gives the details of several of the most interesting historical cases. Space will not permit more than a glance at this subject. A case of stigmatization is not necessarily one of hysteria, but the phenomena of simulated, and possibly of genuine, stigmatization usually occur among the hysterical.

[Footnote 15: _On Certain Conditions of Nervous Derangement_, New York, 1881.]

[Footnote 16: _Op. cit._]

According to Garres, the first to exhibit stigmatization was Saint Francis of Assisium, who was born in 1186 and died in 1236. In 1224 he was marked, and in memory of the event the 17th of September was set apart as the Feast of the Holy Stigmata by Pope Benedict XI. The story of this occurrence is of a highly emotional and sensational character. Christine de Stumbele, born in 1242, a few miles from Cologne, is another of the famous hystero-cataleptics and ecstatics who were the victims of numerous stigmata. These were irregular as to position and to times of appearance. On one occasion, for instance, she had wounds on each foot from which the blood flowed freely; a little later, on the same {349} occasion, she was wounded on the knee, and to the wondering priest who was ministering to her at this time she showed hot nails of hideous shapes. She was not only a case of ecstasy and stigmatization, but a filthy creature withal, who covered herself and others with excrement, which they had the foolishness to believe came from the hand of the devil. Veronica Giuliani, another ecstatic, who conversed with Christ and the Virgin Mary, received the stigmata during one of her prayers, and was canonized in 1839. Imbert-Gourbeyre gives a list of 145 persons who have received stigmata, besides 8 now living known to him. He details one American case, that of a young French Canadian.

Two of the most extraordinary recent cases are those of Palma d'Oria and Louise Lateau. These have become stock cases in books and dissertations on the subject under consideration, and therefore the briefest accounts of them will be all that is required. Palma in 1871 was sixty-six years old, humpbacked, thin, small, and with light expressive eyes. It is important to note that she had seen Louisa Lateau in ecstasy. Wonderful accounts are given of her performances—eating the Host in the presence of the priest; having visions of the devil with a little horn on his forehead; on another occasion Jesus Christ himself bringing to her the communion; seeing the Host flying through the air before entering her mouth. After the communion, usually when others were not present, the stigmatization occurred. Bleedings from the forehead or near it, and hemorrhagic spots on various parts of the body of various shapes, as of hearts and of the cross, appeared. Examination of the skin subsequently showed it to be intact, except that she had a hole in the cranium, which Hammond suggests was of syphilitic origin. Plates are given in the work of the credulous Imbert-Gourbeyre representing these figures.

In most respects the most celebrated of all cases of stigmatization is that of Louise Lateau—celebrated because of the investigations which have been made of her case; because of the amount of literature, theological, scientific, and medical, which has been devoted to her; because of the conflict of opinions even among medical observers in regard to the true explanation of the phenomena she exhibited. Louise Lateau was a Belgian peasant-girl, born January 30, 1850. Her parents were poor. She suffered the hardships of her class, and was as badly nourished and educated as a poor Belgian peasant-girl is likely to be. During the cholera epidemic of 1866 she nursed kindly and patiently many of the victims. In 1867 she became weak, pale, and neuralgic, and sometimes spat blood. On Friday, April 24, 1868, she for the first time noticed blood immediately below the left breast; the following Friday it appeared at the same place, and also on the back of the left foot; later, it oozed from the left side and both feet, from the palms and backs of the hands, and from the forehead. Some weeks after this she began to exhibit the phenomena of ecstasy; and subsequently for months and years, regularly on every Friday, she had a recurrence of the stigmata and ecstasy, with accompanying phenomena, sometimes varying a little in detail. Some of the accounts given by Lefevre and others of her seizures are beautiful descriptions of attacks of ecstasy. She stated that during her attacks she had a distinct vision of the whole scene of the crucifixion.

Numerous experiments, some of them cruel in character, were {350} performed to test the genuineness of her conditions of unconsciousness and insensibility. Sight, hearing, and touch were tested. The mucous membrane of the nose was tickled; strong hartshorn was applied to the nostrils; she was pricked and stabbed with needles, pins, and even penknives; painful currents of electricity were used. To none of these did she respond. During her attacks her pulse was thready, ranging from 120° to 130° and upward; respiration sometimes could be scarcely detected, and sometimes fell as low as 10; body-heat was also much diminished. She recollected everything which passed during the attack. Different from Palma d'Oria, the examination of her skin revealed certain appearances. Between Saturday and Thursday oval spots and patches of rosy hue were to be seen on the backs and palms of the hands and on the backs and soles of the feet. They were very much in appearance as if the epidermis were thinned or scraped. The marks on the forehead were not permanent; the chest was only examined during the ecstasy. Before the bleedings blebs began to rise at the position of the spots. The bleeding commonly began in the night between Thursday and Friday. From the forehead of the girl blood sometimes oozed from minute points, which looked as if they had been made by microscopic leeches.

As regards the phenomena presented by Louise Lateau, various hypotheses have been advanced; the chief, however, are the three following: (1) The theological view—namely, that the stigmata were genuine miraculous performances, the blood flowing by supernatural command. (2) The view that the stigmata were genuine pathological phenomena, vaso-motor in character—that the bleedings were in some way similar to attacks of purpura hemorrhagica or to hæmidrosis or bloody sweat. (3) The view that the stigmata were produced by deceit—that in all probability, in order to excite the sympathy and astonishment which are so dear to the hysterical mind, the girl in some way caused the bleedings. The carefully detailed accounts of the phenomena seem to lend the strongest support to the last view.

A good test was employed for the detection of simulated stigmatization in the following case,[17] which came under the care of Mr. Henry Lee at St. George's Hospital, London. An unmarried seamstress aged sixteen had on the outside of her right leg above the ankle a discolored patch, from which she said that every month for two years there had been a discharge of about a tablespoonful of blood. The patch was covered with minute red spots resembling flea-bites. Fresh red spots and effusion of blood were seen at succeeding visits. Lee ordered a sheet of lead to be applied over the bleeding surface, to be secured by a starched bandage. On the next visit, when the dressings were removed, a few spots and a little blood were found, but the sheet of lead was pierced with holes large enough to admit a needle. When asked how this had happened the girl was silent, and was discharged as a convicted impostor. In Lefevre's experiment with Louise Lateau he placed a leather glove upon one hand, tying and sealing it at the wrists; but it is easily to be seen why this test was not as thorough as that with the lead.

[Footnote 17: _British Medical Journal_, vol. i., 1871, p. 479.]

Another case of ecstasy with stigmatization is cited by Bourneville and Hammond from Magnus Huss of Stockholm—a servant-girl twenty-three years old who was subject to convulsions, and also to {351} hemorrhages, which usually came on as the result of great emotional disturbance. In her case examination showed no cicatrices. The hemorrhages occurred from the scalp, the eyes, the face around the eyes, the left ear, and the stomach. Her menstruation went on regularly during the attacks: sometimes she had ecchymoses and apparent bruises on the left half of the body, the limbs of which were semi-paralyzed for short periods. The attacks occurred with convulsions and unconsciousness, which usually lasted about half an hour, and from which she awakened as if from a long sleep.

Autographic Women.

Certain peculiar phenomena have been described under the head of femmes autographiques, or the autographic women, and are worthy of note. Dujardin-Beaumetz[18] in a case of well-marked hysteria with loss of general sensibility reports that he was able to write or trace with a needle or pointed instrument on the skin. Within a space thus traced the skin was elevated in a white patch or plate. After some five minutes the line would show itself more and more in relief, until it attained from one and a half to two millimeters in thickness. It would remain from three to six, and sometimes twelve, hours. He varied the experiments in many ways, executing upon the skin designs, tables, and names of from ten to fifteen letters. He detected in the centre of some of the spaces traced a marked elevation of temperature, sometimes appreciable to the hand. This woman was known by the name of femme diche, or the autographic woman.

[Footnote 18: _Bull. et Mém. Société médicale de Hôpital de Paris_, 1880, 12, xvi. 197-202.]

Dujardin-Beaumetz held that the phenomena were vaso-motor. The red lines traced readily admit of this explanation. The white space in relief, however, was not so easily explained. He had observed among hysterical women, under the influence of pressure, irritation, or the application of magnets, the appearance of patches of urticaria. One of the common tricks of the Spiritualists is to have the name of a spirit that has been called up appear upon the bared arm of the medium. Among friends and private patients, and among the hysterical patients in the wards of the Philadelphia Hospital, I have successfully performed experiments similar to those reported by Dujardin-Beaumetz. Such phenomena are by no means confined to cases of hysteria. One of my most striking successes in an attempt at skin-writing was in the case of a male physician of a peculiarly clear and pale complexion. Certain peculiar conditions of the skin will allow this to be done with facility. The similarity of this class of phenomena to that of the stigmata will at once appear evident. Such phenomena occur among the hysterical with a tendency to vaso-motor deficiency of control.

Fasting Saints and Fasting Girls.

The wonderful saints who starved themselves or lived on sacramental bread are almost a multitude. Saint Joseph, Saint Catherine of Sienna, {352} Saint Rose of Lima, Saint Collete, Saint Peter of Alcantara are of the number. In modern and even in recent times not a few of these cases have become widely known. Margaret Weiss, about whom a book was written in 1542, is said to have done without food and drink for three years. She suffered from pains and contractures. She passed neither urine nor feces; at least, such are the accounts which have come down to us.

Sarah Jacob, the Welsh fasting girl, has shared with Louise Lateau popular and medical notoriety. When about ten years old she suffered from various hysterical and hystero-epileptic symptoms. The quantity of food she took gradually dwindled; on October 10, 1867, it was said that she ceased to take any food whatever, and so continued till the day of her death, more than two years later. She had many visitors, pilgrims from far and near, who often left money or gifts. The vicar of her neighborhood came to believe in her, and an investigation was suggested. At one investigation, not very rigidly conducted, nothing was discovered. After a time she was visited by Fowler of London, who decided that the case was one of hysteria with simulation, probably associated with the power or habit of long fasting. Trained nurses were sent from Guy's Hospital to conduct the second watching. Under the watching the girl died, starved to death. The father was afterward condemned to imprisonment and hard labor for twelve months, the mother for six months. In Brooklyn a few years since one Molly Fancher, a similar case, attracted much attention, and was written about and commented upon by the press.

{353}

NEURASTHENIA.

BY H. C. WOOD, M.D.