CHAPTER VI.CATALEPSY, WITH CASES.
This affection is extremely rare, and I consider myself favoured in Having witnessed three well-marked cases. “It occurs chiefly,” says Dr. Jones, “in those who have weakly and excitable nervous systems, feeble health, and ill-governed minds, and who may be said to possess neither a ‘mens sana,’ nor a ‘corpus sanum.’” That this is true there is not the least doubt, and the first case—one of semi-catalepsy, or hysterical catalepsy—shows how completely it is a nervous affection, and depending, at any rate at the commencement of the disease, very much on mental control.
There are also, it is true, one or two rare cases on record which were caused by growths on the brain; and it is sometimes “encountered in tubercular meningitis, or chronic softening of the brain.”—Reynolds.
That the cause in the three cases in my own practice was excitation of the pudic nerve, may, Ithink, most fairly be concluded, from the fact that after the operation neither patient had a single fit.
To those who have not seen a patient suffering from this disease, a few words from Dr. Reynolds may be necessary:—
“The pathognomonic symptom is the persistence of the limbs in a state of balanced muscular contraction, so that they retain the position in which they were placed at the commencement of the attack. The limbs may be readily moved by the observer, but they retain the attitudes in which they are left, and these sometimes for hours, sometimes for days.
“Perception and volition are lost; the condition resembles that of ‘brown study;’ the circulation and respiration are uninterrupted.”
Catalepsy seems to rank between tetanus and epilepsy, and, according to Dr. Jones, depends on the simultaneous morbid affection of various nerve centres which, when separately affected, produce but one disorder,—hysteria, tetanus, or epilepsy.
Mrs.——, æt. 33, widow; admitted into the London Surgical Home May 5, 1865.
History.—Never had any children, and but one miscarriage. Menstruation began when she was fourteen, and she was then first attacked with fits. From the patient’s description, they would seem to have then been of a cataleptic character; there was noloss of consciousness. From the age of 21 up to the present time, besides slight convulsive attacks in the daytime, she has been subject to fits at night, occurring irregularly, but averaging one a week, and always after each menstrual period. They commence with a strong convulsion, which lasts for a few minutes, and is succeeded by perfect rigidity of the body and unconsciousness for half an hour or more. Are preceded by headache during the day. Catamenia appear regularly, but are scanty. Acknowledges constant peripheral excitation, and says that, during marriage, she never had pleasurein coitu. The dilated pupil, hot skin, moist palm, and other unmistakable symptoms, plainly pointed to the cause of her disorder.
May 6. Excision of clitoris and the very elongated nymphæ. Free hæmorrhage was allowed before the wound was dressed.
The operation was, in this instance, only successful in diminishing the frequency and intensity of the fits. The following is the description given by the house-surgeon of an attack some days after the operation:—
“While conversing with the house-surgeon this morning, she had a slight convulsive attack, not lasting more than thirty seconds, and characterized by the following phenomena:—No loss of consciousness, rigidity of limbs, with tonic contraction of the flexor muscles, and strong contraction of theorbicularis palpebrarum.”
Whenever visited, and frequently when the wound was dressed, these fits recurred; but towards the end of the month the number considerably diminished.
She was discharged on June 15th, very much improved in health, and decidedly relieved by the operation.
H. L., æt. 25, single; admitted into the London Surgical Home January 27, 1864.
History.—This patient was sent to me by Dr. Pennefather, of Tottenham, with the following letter:—
“Dear Sir,—The girl —— was some time since suffering from religious monomania; she is of hysterical habit and weak constitution, ever complaining of abdominal pain or uneasiness.”
She also gave the following additional account of herself:—
“Began to feel unwell about twelve months since. Had a very bad fever about five months ago, which left her perfectly prostrated. Always felt weak, and more or less subject to fits. Menstruation regular and never profuse. Great pain in the back and bearing-down feeling in the lower part of the body. Complains of great pain in defecation. Sea-bathing has benefitted her temporarily. Is incessantly crying without cause or power to prevent herself.”
The day following admission she had a fit of a cataleptic nature, and lasting twenty-five minutes. After the fit the patient was left very prostrated.
In addition to symptoms of pudic irritation, there was a small fissure of the rectum.
January 24. Clitoris excised, and fissure divided. There was considerable secondary hæmorrhage in the excising, which, however, seemed to have a beneficial effect, as after it the patient expressed herself as more comfortable, and slept quietly.
Feb. 14. Much more cheerful; has had no cataleptic attack or symptom of hysteria since the operation.
Feb. 28. Has improved daily, and leaves the Home this day cured.
M. N., æt. 17; admitted into the London Surgical Home September 4, 1861.
History.—Was perfectly well up to the age of fifteen, when she went to a boarding-school in the West of England. In the course of three or four months she became subject to all symptoms of hysteria, and from that time gradually got worse, having fits, at first mild in character and of rare occurrence, but gradually mere severe and frequent, till she became a confirmed cataleptic. Forseveral months before admission, she had been attacked with as many as four or five fits a day, and during the whole journey from the North of England to London she was unconscious and rigidly cataleptic. She was seen immediately on arrival, and there was no doubt that it was a genuine case of this disease. So sensitive was she, that if any one merely touched her bed, or walked across the room, she would immediately be thrown into the cataleptic state.
Before making any personal examination, Mr. Brown ascertained both from her mother and herself, that she had long indulged in self-excitation of the clitoris, having first been taught by a schoolfellow. The commencement of her illness corresponded exactly with the origin of its cause; in fact, cause and effect were here so perfectly manifested, that it hardly wanted anything more than the history to enable one to form a correct diagnosis. All the other symptoms attending these cases were, however, well marked.
The next day after admission she was operated upon, and from that date she never had a fit. She remained in the Home for several weeks. Five weeks after operation, she walked all over Westminster Abbey, whereas for quite a year and a half before treatment, she had been incapable of the slightest exertion.
In 1861 I saw a lady, æt. 50, single—a patient of Dr. Dawson, of Newcastle-on-Tyne.
She had been suffering from cataleptic attacks for several years, gradually increasing in severity. As in the previous case, the mere touching or shaking of her bed would induce an attack—indeed, the simple brushing of her dress by any one passing her when she walked out of doors, would immediately be followed by a fit. History and examination plainly confirming me in my opinion as to the cause of her attacks, the usual treatment was adopted, and from that time to this she has never had an attack.
Case XXXIII. Cataleptic Fits—Six Years’ Duration—Operation—Cure.
Miss——, æt. 38, single; admitted into the London Surgical Home August 10, 1865.
History.—Was tolerably well until two years and a half ago, but since that time has suffered more or less from menorrhagia, with severe pain in back. Has also severe smarting pain in the bowels, and has frequently lost a considerable quantity of bloodper anum. Has always been subject to hysterical attacks, but for the last six years has had fits of a much more serious character. They have increased in severity, duration, and frequency, and it is on account of them that she seeks relief. Almost immediately after admission, this patient had a fit, and she was kept a fortnight under observation, that the nature of the attacks might be thoroughly investigated.
She would have a fit sometimes twice a day; but on an average about every other day—either early in the morning or late in the evening. She was most generally attacked when walking about the room—sometimes when sitting—but she was never observed to have one when asleep. She would at the commencement of an attack cease walking, or doing whatever she was employed in; her face would become very pale and set; the eyelids, at first quivering, would be fixed; the eyes wide open and looking upwards, the pupils very dilated. Her mouth would be rigidly shut, and during the attack it was impossible by any means to open it. Her arms would fall straight by her side, and be immovable; the hands unclenched, and fingers extended. If standing, she would be quite upright, and require no support. If sitting, she would always stand up when a fit was coming on. If lying, she would be extended straight on her back. The fit would last for two or three hours, and on a few occasions for as many as six hours. The experiment was frequently made of moving her arms when in the cataleptic state, and on such occasions the limb would remain in the positionin which it was placed, till the end of the attack. She was always perfectly unconscious, and no kind of stimulant was of the slightest use in restoring her during the paroxysm—time alone was of avail. The attack was sudden, but the recovery to consciousness was but gradual; she would appear as if awoke from a deep sleep, and would be very exhausted, but express no desire for food, wine, or other stimulants. As soon as she recovered, she would sleep for many hours, and awake quite well, but still weak.
Aug. 24. The clitoris was excised, and a painful fissure of the rectum divided. She never had a fit after the operation. Menstruation came on on the 28th, in moderate flow.
Oct. 5. This patient has improved wonderfully since operation, and now looks extremely well. The wound is quite healed. She takes walks daily, and has had no fits, and is to be discharged as cured.
In November she called at the Home, to say that she was quite well, and had never had the slightest return of her former illness; she menstruates regularly and normally.
Feb., 1866. She remains well.