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