29 “On the Nature of the Condition known as Catalepsy.” by J. Thompson Dickson, M.A., M.B. (Cantab., etc.), British Med. Journ., vol. ii., Dec. 25, 1869.
I do not believe that this ground is well taken. The conditions present in petit mal are sometimes somewhat similar to, but not identical with, those of genuine catalepsy. In the first place, the loss of consciousness, although more complete and more absolute—or rather, strictly speaking, more profound—than in genuine catalepsy, is of much briefer duration. The vertigo or vertiginous phenomena which always accompany genuine petit mal are rarely if ever present in catalepsy. To say that the mental disturbance in catalepsy and in epilepsy is identical is to admit an imperfect acquaintanceship with both disorders. The mental state during the attack of either disorder it is only possible to study by general inspection or by certain test-experiments.
Tetanus is not likely, of course, to be mistaken for catalepsy, but there is a possibility of such an occurrence. The differential diagnosis already given between hystero-epilepsy and tetanus will, however, furnish sufficient points of separation between catalepsy and tetanus.
Catalepsy has been supposed to be apoplexy, or apoplexy catalepsy. The former mistake is, of course, more likely to be made than the latter. A careful study of a few points should, however, be sufficient for the purposes of clear differentiation. The points of distinction given when discussing the diagnosis of hysterical and organic palsies of cerebral origin will here apply. In true apoplexy certain peculiar changes in pulse, respiration, and temperature can always be expected, and these differ from those noted in catalepsy. The stertorous breathing, the one-sided helplessness, the usually flushed face, the conjugate deviation of the eyes and head, the loss of control over bowels and bladder, are among the phenomena which can be looked for in most cases of apoplexy, and are not present in catalepsy.
It is hardly probable that a cataleptic will often be supposed to be drunk, or a man intoxicated to be a cataleptic; but cases are on record in which doubts have arisen as to whether an individual was dead drunk or in a cataleptic stupor. The labored breathing, the fumes of alcohol, the absence of waxen flexibility, the possibility of being half aroused by strong stimuli, will serve to make the diagnosis from catalepsy. The stupor, the anæsthesia, the partial loss of consciousness, the want of resistance shown by the individual deeply intoxicated, are the reasons why occasionally this mistake may be made.
Catalepsy is simulated not infrequently by hysterical patients. Charcot and Richer30 give certain tests to which they put their cataleptic subjects with the view of determining as to the reality or simulation of the cataleptic state. They say that it is not exactly true that if in a cataleptic subject the arm is extended horizontally it will maintain its position during a time sufficiently long to preclude all supposition of simulation. “At the end of from ten to fifteen minutes the member begins to descend, and at the end of from twenty to twenty-five minutes at the most it resumes the vertical position.” These also are the limits of endurance to which a vigorous man endeavoring to preserve the same position will attain. They have therefore resorted to certain experimental tests. The extremity of the extended limb is attached to a tambour which registers the smallest oscillations of the member, while at the same time a pneumograph applied to the chest gives the curve of respiratory movements. In the case of the cataleptic the lever traces a straight and perfectly regular line. In the case of the simulator the tracings at first resemble those of the cataleptic, but in a few minutes the straight line changes into a line sharply broken, characterized by instants of large oscillations arranged in series. The pneumograph in the case of the cataleptic shows that the respirations are frequent and superficial, the end of the tracings resembling the beginning. In the case of the simulator, in the beginning the respiration is regular and normal, but later there may be observed irregularity in the rhythm and amplitude of the respiratory movements—deep and rapid depressions, indicative of the disturbance of respiration that accompanies the phenomena of effort. “In short, the cataleptic gives no evidence of fatigue; the muscles yield, but without effort, and without the concurrence of the volition. The simulator, on the contrary, committed to this double test, finds himself captured from two sides at the same moment.”
30 Journal of Nervous and Mental Diseases, vol. x., No. 1, January, 1883.
Chambers31 says that no malingerer could successfully feign the peculiar wax-like yielding resistance of a cataleptic muscle. He speaks of using an expedient like that of Mark's. Observing that really cataleptic limbs finally, though slowly, yield to the force of gravity and fall by their own weight, he attached a heavy body to the extended hand of a suspected impostor, who by an effort of will bore it up without moving. The intention of the experiment was explained, and she confessed her fraud. This rough test, although apparently different, is in reality similar to that of Charcot and Richer. In both proof of willed effort is shown.
31 Reynolds's System of Medicine, vol. ii., No. 108.
It must not be forgotten that in catalepsy, as has been already noted in hysteria, real and simulated phenomena may commingle in the same case; also, that upon a slight foundation of genuine conditions a large superstructure of simulated or half-simulated phenomena may be reared.