PATHOLOGY—Attempts to explain the nature of catalepsy leave one in a very uncertain and irritable frame of mind. Thus, we are told very lucidly that most authors are inclined to the opinion that the cataleptic rigidity is only an increase of the normal tonus of the voluntary muscles occurring occasionally in the attacks. What appears to be present in all genuine cases of catalepsy is some absence or abeyance of volition or some concentration and circumscription of cerebral activity. The study of the phenomena of catalepsy during hypnosis throws some light upon the nature of catalepsy. Heidenhain's theory of hypnotism is that in the state of hypnosis, whether with or without cataleptic manifestations, we have inhibition of the activity of the ganglion-cells of the cerebral cortex. Herein is the explanation of many cataleptic phenomena even in complicated cases. In hysteria and in catalepsy the patient, dominated by an idea or depressed in the volitional sphere by emotional or exhausting causes, no longer uses to their full value the inhibitory centres. When organic disease complicates catalepsy, it probably acts to inhibit volition by sending out irritative impulses from the seat of lesion.
DURATION.—Usually, attacks of catalepsy recur over a number of years; but even when this is the case the seizures are not as frequent, as a rule, as those of hystero-epileptic paroxysms. Uncomplicated cases of catalepsy, or those cases which occur in the course of hystero-epilepsy, usually preserve good general health.
Of the duration of attacks of catalepsy it need only be said that they may last from a few seconds or minutes to hours, days, weeks, or even months. The liability to the recurrence of cataleptic attacks may last for years, and then disappear.
DIAGNOSIS.—In the first place, the functional nervous disorder described as catalepsy must be separated from catalepsy which occurs as a symptom in certain organic diseases. It is also necessary to be able to determine that a patient is or is not a true katatonic.
It must not be forgotten that genuine catalepsy is very rare. Mitchell at a recent meeting of the Philadelphia Neurological Society said that in his lifetime he had seen but two cases of genuine catalepsy—one for but a few moments before the condition passed off. The other was most extraordinary. Many years ago he saw a young lady from the West, and was told not to mention a particular subject in her presence or very serious results would ensue. He did mention this subject, rather with the desire to see what the result would be. She at once said, “You will see that I am about to die.” The breath began to fail, and grow less and less. The heart beat less rapidly, and finally he could not distinguish the radial pulse, but he could at all times detect the cardiac pulsation with the ear. There was at last no visible breathing, although a little was shown by the mirror. She passed into a condition of true catalepsy, and to his great alarm remained in this state a number of days, something short of a week. Throughout the whole of this time she could not take food by the mouth. Things put in the mouth remained there until she suddenly choked and threw them out. She apparently swallowed very little. She had to be nourished by rectal alimentation. She was so remarkably cataleptic that if the pelvis were raised, so that the head and heels remained in contact with the bed, she would retain this position of opisthotonos for some time. He saw her remain supported on the hands and toes, with feet separated some distance, with the face downward, for upward of half an hour. She remained as rigid as though made of metal. On one occasion while she was lying on her back he raised the arm and disposed of the fingers in various ways. As long as he watched the fingers they remained in the position in which they had been placed. At the close of half an hour the hand began to descend by an excessively slow movement, and finally it suddenly gave way and fell. Not long after this she began to come out of the condition, and quite rapidly passed into hysterical convulsions, out of which she came apparently well. He was not inclined to repeat the experiment.
Catalepsy is to be diagnosticated from epilepsy. It is not likely that a grave epileptic seizure of the ordinary type will be mistaken by an observer of even slight experience for a cataleptic attack. It is some of the aberrant or unusual types of epilepsy that are most closely allied to or simulate catalepsy. Cataleptic or cataleptoid conditions undoubtedly occur regularly or irregularly in the course of a case of epilepsy, but I do believe that it is true, as some observers contend, that between catalepsy and some types of true epilepsy no real distinction can be made. Hazard,27 in commenting on a case reported by Streets,28 holds that no difference can be made between the attacks detailed and those forms of epilepsy described as petit mal.
27 St. Louis Clin. Rec., iii. 1876, p. 125.
28 “Case of Natural Catalepsy,” by Thomas H. Streets. M.D., Passed Assistant Surgeon U. S. N., in the American Journal of Medical Sciences for July, 1876.
The case was that of a sailor aged forty-two years, of previous good health. The attacks to be described followed a boiler explosion, by which he was projected with great force into the water, but from which he received no contusion nor other appreciable injury. There was no history of any nervous trouble in his family. It was the patient's duty to heave the lead. The officer noticed that he was neglecting his business, and spoke to him in consequence, but he paid no attention to what was said to him. “He was in the attitude he had assumed in the act of heaving the lead, the left foot planted in advance, the body leaning slightly forward, the right arm extended, and the line held in the left hand. The fingers were partially flexed, and the sounding-line was paying out through them in this half-closed condition. The eyes were not set and staring, as is the case in epilepsy, but they were moving about in a kind of wandering gaze, as in one lost in thought with the mind away off. The whole duration of the trance was about five minutes.”
Dickson29 reports a very striking case, and in commenting on it holds to the same views. The patient had apparently suffered from some forms of mania with delusions. She was found at times sitting or standing with her body and limbs as rigid as if in rigor mortis, and her face blanched. These spells were preceded by maniacal excitement and followed by violence. On being questioned about the attacks, she said that chloroform had been given her. Numerous experiments were performed with her. Her arms and hands were placed in various positions, in all of which they remained; but it was necessary to hold them for a few moments in order to allow the muscles to become set. She was anæsthetic. After recovering she said that she remembered being on the bed, but did not know how she came there; also, that she had been pricked with a pin, and that her fit had been spoken of as cataleptic. Her mind became more and more affected after each attack, and she finally became more or less imbecile. From the facts observed with reference to this case, Dickson thinks that we may fairly conclude that the mental disturbance in either epilepsy or catalepsy is identical, and results from the same cause—viz. the anæmia and consequent malnutrition of the cerebral lobes; while its termination, dementia, is likely to be the same in either case; also, that catalepsy, instead of being a special and distinct form of nervous disorder, is to be considered as a specific form of epilepsy, and to be regarded as epilepsy, in the same manner as le petit mal is considered epilepsy, and a result of the same proximate cause; the difference in the muscular manifestation bearing comparison with any other specific form of epilepsy, and occurring in consequence of one or other particular cerebral centre becoming more or less affected.