PROGNOSIS.—The prognosis of catalepsy is on the whole favorable. It must be admitted, however, that owing to the presence of neurotic or neuropathic constitution a tendency to relapse is present. Hystero-catalepsy tends to recover with about the same frequency as any of the other forms of grave hysteria. Those cases which can be traced to some special reflex or infectious cause, as worms, adherent prepuce, fecal accumulations, scars, malaria, etc., give relatively a more favorable prognosis. Cases complicated with phthisis, marasmus, cancer, insanity, etc. are of course relatively unfavorable.
TREATMENT.—The treatment of the cataleptic seizure is not always satisfactory, a remedy that will succeed in one case failing in another. Niemeyer says that in case of a cataleptic fit he should not hesitate to resort to affusion of cold water or to apply a strong electrical current, and, unless the respiration and pulse should seem too feeble, to give an emetic. The cold douche to the head or spine will sometimes be efficacious. In conditions of great rigidity and coldness of surface Handfield Jones recommends a warm bath, or, still better, wet packing. Chambers quotes the account of a French patient who without success was thrown naked into cold water to surprise him, after having been puked, purged, blistered, leeched, and bled. This treatment is not to be recommended unless in cases of certain simulation, and even here it is of doubtful propriety and utility. If electricity is used, it should be by one who thoroughly understands the agent. A galvanic current of from fifteen to thirty cells has been applied to the head with instantaneous success in hystero-epileptic and hystero-cataleptic seizures. A strong, rapidly-interrupted faradic current, or a galvanic current to the spine and extremities, sometimes succeeds and sometimes fails. Rosenthal reports that Calvi succeeded in relieving cataleptic stiffness in one case by an injection of tartar emetic into the brachial vein—a procedure, however, not to be recommended for general use. Inhalations of a few drops of nitrate of amyl is a remedy that should not be passed by without a trial; it is of great efficacy in the hysteroidal varieties. Inhalation of ammonia may also be tried. A hypodermic injection of three minims of a 1 per cent. solution of nitroglycerin, as recommended for severe hystero-epileptic seizures, would doubtless be equally efficient in catalepsy.
Music has been used to control hysterical, hystero-epileptic, and cataleptic seizures. The French cases reported have all been of the convulsive types without loss of consciousness and those varieties in which the special sensibility sometimes persists, as in hystero-catalepsy, lethargy, and somnambulism. Music has been used as medicine from the times of Pythagoras to the present, although it can hardly be claimed to have attained a position of much prominence as a therapeutic agent.
In one case a vigorous application of fomentations of turpentine to the abdomen was promptly efficacious in bringing a female patient out of a cataleptic seizure.
Meigs, whose case of catalepsy produced by opium has been reported under Etiology, suggests that purgative medicines, used freely in the treatment of his case, might be advantageously resorted to in any case of catalepsy.
Powerful tonics, such as quinine, iron, salts of zinc and silver, should be used in connection with nutrients, such as cod-liver oil, peptonized beef preparations, milk, and cream, to build up cataleptic cases in the intervals between the attacks.
ECSTASY.
BY CHARLES K. MILLS, M.D.