HISTORY.—The word catalepsy was used by Greek writers in its etymological signification of a seizure or surprise. Hippocrates described catalepsy; Galen, Aëtius, Rondeletius, and Fernelius have all related cases; Aëtius has left an accurate description of both catochus and catalepsy. In 1683, Laurence Bellini published a quarto volume on various subjects, one of which was catalepsy. From time to time interesting cases of catalepsy have been reported by medical writers. One of the best is that recorded by John Jebb in 1782, and quoted by Chambers in Reynolds's System of Medicine. The researches in hypnotism during the present century, and particularly those of Heidenhain and of Charcot and Richer, have thrown new light on many cataleptic phenomena.
ETIOLOGY.—In catalepsy, as in hysteria, insanity, and many neuroses, inheritance frequently plays a predisposing part. Eulenburg places it in the large group of diseased conditions designated by Griesinger constitutional neuropathies. The cataleptic of one generation may be the descendant of the insane, the epileptic, the syphilitic, or the alcoholized of a former. Catalepsy is particularly likely to occur in families which have a history of insanity or drunkenness. Of the cases detailed or alluded to in this paper, more than a majority had a clear neurotic history. Catalepsy, like hysteria, occurs with some frequency among the tuberculous.
Age plays some part in the development of catalepsy. It is of most frequent occurrence between the ages of fifteen and thirty, but has been observed at all ages. It is of unusual occurrence in very early childhood, but A. Jacoby,3 Clinical Professor of the Diseases of Children in the College of Physicians and Surgeons in New York, reports a case of well-marked catalepsy in a child three years old. This patient, a girl, was admitted to the Mt. Sinai Hospital, New York, in September, 1879. She had whooping cough and some symptoms of typhoid fever. After she had been in the hospital three weeks choreic twitchings of the eyes and eyelids, with divergent strabismus, were observed. Examining her, it was found that she was cataleptic; her arms and legs would remain in any position in which they were placed; she would drop the uplifted arms slowly when commanded; sensibility to contact, pain, and temperature were entirely lost, and the skin and patellar reflexes were diminished. Her appetite was ravenous, and urine was passed in large quantities. Other phenomena and details of cataleptic symptoms, which continued for about a month, are recorded by Jacoby. The child recovered, but remained weak and anæmic for a long time.
3 American Journal of Medical Science, N. S. lxxxix., 1885, p. 450.
Monti4 records eleven cases of catalepsy met with in children, male and female in about equal numbers, of from five to fifteen years, the average age being nine years. Eulenburg speaks of catalepsy at five years of age, and quotes Schwartz, who noticed in a boy seven years old, in consequence of rough treatment, first a choreic condition, which later passed into catalepsy. Lloyd's case, to be detailed later, also studied by myself at the University Hospital, was in a boy eight years old. B. L. Hovey5 of Rochester, New York, reports an interesting case of catalepsy in a boy eight years old.
4 Gerhardt's Handb. d. Kinderk., vol. v., L. P., 186 et seq., quoted by Jacobi.
5 The Hospital Gazette, 1879, vi. p. 19.
C. E. de Schweinitz of Philadelphia, Ophthalmic Surgeon to the Children's Hospital and Prosector of Anatomy at the University of Pennsylvania, has kindly put into my hands the unpublished notes of a highly interesting case of catalepsy or automatism at command, or of both, in a child two and a half years old. I will give this case in full, chiefly in the language of De Schweinitz, because it is, so far as I know, the youngest case on record. Some of the tests which were applied in this case are among the most useful which can be resorted to in determining how far the phenomena presented are genuine or induced, simulated, or imitated:
The patient was a girl aged two and a half years, who had recently recovered from an attack of diphtheritic conjunctivitis. During the period of her convalescence the attending nurse called attention to the unusual position assumed by the child while sleeping—viz. a lateral decubitus, the head raised a short distance from the pillow, and the forearm slightly elevated and stretched out from the body, the muscles at the same time exhibiting marked tremulousness. A series of trials readily demonstrated that the child when awake could be placed in any position compatible with her muscular power, and that she could thus remain until released. She was placed, for instance, in the sitting posture, the arm brought at right angles to the body, the forearm at right angles to the arm, and the hand at right angles to the forearm, both legs raised from the bed, and the head bent backward. This position, a most uncomfortable and difficult one to preserve, would be maintained until the little subject dropped from sheer exhaustion. Flexion and extension of each separate finger were easily produced, and the fingers remained until replaced in the positions in which they had been fixed. At the beginning the child's mind was sluggish, although she asked for food and made known her various wants. How far she appreciated surrounding objects could not be accurately ascertained, inasmuch as the previous disease of her eyes had left her with a central corneal macula on each side, rendering her almost sightless in one eye and with but indifferent object-perception in the other. Voluntary motion was preserved, and she sat up, turned, and moved whenever she pleased, but most often when at rest at this stage maintained somewhat of the position before described which during sleep first attracted attention to this condition.
In conjunction with Morris Lewis an examination of the cutaneous sensibility and reflexes was made, which showed diminished sensibility in the legs and thighs, but not higher up, where the pricks of the instrument were quickly appreciated. Her knee-jerk was apparently absent on the right side and present on the left; but this test, always most unsatisfactory in children, yielded no certain evidence and constantly gave contradictory results. Scratching the skin of the soles of the feet, legs, thighs, and abdomen with a pointed instrument was followed by marked reflex movements. Electro-muscular contractility was everywhere preserved. The child at this time was feeble and anæmic, but her appetite was good—not depraved nor voracious; the tongue was clean, the bowels regular. The urine was of a light amber color, specific gravity 1020, free from albumen and sugar.