T——, aged twenty, single, dressmaker. The patient was somewhat below medium height, slender and emaciated, of nervous temperament, expression melancholy. The attack of insanity for which she was admitted was her first. It began four months before admission. No satisfactory history of the attack could be obtained; she was said to have been depressed in spirits and to have delusions of poisoning. She had attempted suicide by throwing herself from the window.
Upon admission, Sept. 20, 1883, she was quiet and gentle in her manner, but much depressed; she answered questions rationally. No delusions were detected. Sept. 21st she sat quiet and motionless. Her eyes were fixed, with marked double, inward squint. She was apparently insensible to external impressions. This condition lasted about three hours, when she suddenly sprang up, rushed through the ward, and made vigorous efforts to escape. On the 22d she lay in bed in a perfectly passive state, with eyes open and fixed, but the squint had disappeared. There was a constant slight tremor of the lids. The conjunctiva was apparently insensible to touch. She seemed to be unconscious of what was going on around her. Her arms remained raised in any position in which they were placed. About three o'clock in the afternoon this condition passed away, and from that time until she went to bed at eight o'clock she was bright and cheerful and talked in a rational and intelligent manner. For five days she was quiet and melancholy, with one spell of a few hours in which she was in a passive and cataleptic state, as on the 22d.
On the 28th she stood erect with arms extended, whirling rapidly. She continued this for about half an hour, and then, after a short rest, began again. She paid no attention to what was said to her, and seemed unconscious of what took place around her. The next day she remained in a stupid condition most of the time, but occasionally sprang up and danced violently or spun round rapidly with arms extended for a few moments at a time. On the 30th her cataleptic condition was uninterrupted. She lay motionless, with pulse slow and feeble, extremities cold; her limbs were easily placed in any desired position, and remained so for about twenty minutes; then they returned slowly to a more natural and comfortable position. She continued for several days in this condition, then aroused and ate heartily. She seemed brighter and more cheerful, and talked rationally. She said that she knew all that was said and done when she seemed unconscious, and that she wanted to speak, but could not. For several weeks cataleptic symptoms prevailed, with occasional lucid intervals of a few hours. She eventually settled into a childish, demented condition.
In the insane department of the Philadelphia Hospital was a middle-aged man who remained for several years in a stuporous and cataleptoid state. On several occasions he was before the class in the clinic-room. He could not be made to speak, but remained perfectly silent in any condition in which he was placed. His head and trunk could be bowed forward, sideway, or backward; one foot could be elevated while he stood; his arms could be placed in grotesque positions. In whatever attitude he was placed he would remain for a long time. The only history that could be obtained of this man was that he had for several months been in a state of melancholia, after which he was maniacal for three or four months. He escaped from the hospital, and was brought back in the stuporous and cataleptoid condition in which he continued. He had been a masturbator.
A Dane, while on a voyage from Copenhagen, fell and broke his leg, for which he was treated in a hospital. He recovered and became a nurse in the institution. He fell in love with a female nurse, and was to be married, but the lady suddenly fell dead. He became melancholic, and three weeks afterward tried to hang himself. He also had hystero-epileptic seizures, and was for a long time in a condition of extreme stupor with cataleptoid phenomena, from which he passed into a rather excited condition. He had no special delusions, but there was a tendency to dramatism.
Another case came into the nervous wards of the Philadelphia Hospital. No history could be obtained from the patient. Whether or not he had previously suffered from melancholia could not be learned. He would retain for a long time any position in which he was placed. He also had hystero-cataleptic spells, and a peculiarity of enunciation with a tendency to pose. When asked, “How are you to-day?” he would reply, “I pre-sume-that-I-am-a-bout-the-same—that-it-is-likely-that-some-thing-has-dis-ap-peared-in-the-mind.” When asked, “How long have you been sick?” he would begin in the same way: “I-pre-sume-that-I-will-have-to-say-that-at-a-time-re-mote-ly-dis-tant;” and then he would branch off into something else.
Wilks25 speaks of a man whom he saw in the asylum at Morningside who could be moulded into any position. While in bed on his back his arms and legs could be arranged in any position, and there they would remain. He also speaks of a case seen by Savage in Bethlem—a young man who kept his arms stretched out for two hours, and stood on one leg for a very long time or until he fell.
25 Lectures on Diseases of the Nervous System, delivered at Guy's Hospital.
William Barton Hopkins of Philadelphia has given me brief details of a case observed by him at the Pennsylvania Hospital, which would seem to have been either one of katatonia or one of cataleptoid attacks occurring in an inebriate. The patient was an habitual moderate drinker. For three weeks before he was admitted to the hospital he had been drinking heavily. His family history showed a tendency to insanity. He showed great mental anxiety; his face was pale and had a very troubled aspect. He had no hallucinations. Two days after admission a sudden outbreak of mania occurred, in which he showed destructive and dangerous tendencies, and mechanical restraint had to be employed. Under treatment he became quiet, and was removed by his friends, having been altogether five days in the hospital. On the day of his departure, while awaiting some of his friends in the main hall, he suddenly ran up stairs, and was quickly followed by a nurse, who found him raising a window with the apparent intention of jumping out. His face at this time had lost its troubled look, and had rather a pleased but vacant appearance. While in this condition his limbs were placed in various positions, and there remained. On another occasion, while lying on the bed, his limbs and trunk were placed in various grotesque positions, and there remained. The condition of waxen flexibility was well marked; many tests were made.
To Wharton Sinkler I am indebted for the unpublished notes of the case of a woman twenty-seven years of age, who had no family history of insanity, but whose father was a highly nervous man. She had always had good health, and was of good physique. Seven years ago she had an attack of melancholia lasting four or five months; since then she had no trouble until six months since. At this time she began to be low-spirited. Then delusions came on—that she was unworthy to live; that it was wicked for her to eat, because no one else had food; that those about her were in ill-health. She refused to eat, and would not talk, and slept badly. When first seen by Sinkler she was stout and with apparently good nutrition, but was said to have lost flesh. Her face was expressionless, and she was unwilling to converse, but said she was quite well, and that her stepmother was ill and needed treatment. She was undecided in all her movements, and would stand in one spot until led to a chair, where she would remain if seated.