CATALEPSY.
BY CHARLES K. MILLS, M.D.
DEFINITION.—Catalepsy is a functional nervous disease characterized by conditions of perverted consciousness, diminished sensibility, and especially by muscular rigidity or immobility, which is independent of the will, and in consequence of which the whole body, the limbs, or the parts affected remain in any position or attitude in which they may be placed.
Catalepsy sometimes, but not frequently, occurs as an independent disease; that is, the cataleptic seizure is the only abnormal phenomena exhibited by the patient. It is sometimes present, although also rarely, in organic disease of the nervous system. It has been noted, for instance, as occurring in the course of cases of cerebral hemorrhage, softening of the brain, abscess, tumor, and tubercular meningitis. One case is referred to by C. Handfield Jones in which it seemed to be due to intracranial epithelioma. As commonly seen, it is a complication, or perhaps, more properly speaking, a form of hysteria—hystero-catalepsy.
SYNONYMS.—Some of the many synonyms which have been used for catalepsy are Catochus, Morbus attonitus, Stupor vigilans, Synochus, Eclipsis, and Hysteria cataleptica. Trance and ecstasy are discussed sometimes as synonymous with catalepsy, but they will be considered as separate affections, as they have certain distinctive features. Catalepsy, trance, ecstasy, hystero-epilepsy, and other severe nervous disturbances may, however, all appear in the same patient at different times or at different stages of the same seizure.
With reference to the term catochus (κατοχη, from κατεχω, I take possession of), which has been used as synonymous with catalepsy, Laycock1 points out what he considers to be the proper use of this word, differentiating two cataleptic conditions, which he designates as the tetanic and the paralytic states. Catochus is the tetanic form, in which the trunk and limbs are rigidly extended and consciousness is abolished. Catalepsy proper is Laycock's paralytic form, although the term paralytic, as here applied, is by no means happy. It is the form characterized by the peculiar and striking symptom known as waxen flexibility (flexibilitas cerea)—a condition in which the limbs or parts are passive and are capable of being moulded like wax or lead pipe. Rosenthal would not consider any case as one of genuine catalepsy if this waxen flexibility was absent. I do not think that this rigorous criterion should always be imposed, although it might perhaps be better to apply the term cataleptoid to all cases which do not present true wax-like flexibility. The distinction sometimes made between catalepsia vera, or true catalepsy, and catalepsia spuria, or false catalepsy, is practically that indicated between Laycock's two forms. According to Charcot and Richer,2 the flexibilitas cerea is not present in the cataleptic state of hypnotism.
1 A Treatise on the Nervous Diseases of Women, by Thomas Laycock, M.D., London, 1840.
2 Journal of Mental and Nervous Diseases, Jan., 1883.