TREATMENT.—With reference to the treatment of ecstasy little need be said. It must, in part at least, be directed to rousing and changing the dormant or dreamy condition of the individual. As it is the mind or the volitional nature which is chiefly affected, the use of agents which either directly or reflexly exert a powerful impression on the cerebral centres is indicated. Thus, in all ages harsh measures have received more or less applause in the treatment of ecstasy. The cold douche or shower-bath, the plunge-bath, the hot iron, painful electric currents, scourging, and beating have all had their advocates. Flint6 gives details of a case in which burning with a heated hammer was employed for three weeks, the patient eventually recovering, either because of, or in spite of, the treatment. Chambers believes in the forcible repression of ecstatic and emotional exhibitions. “In Unst, the most northerly of the Shetland Islands,” he says, “an epidemic of convulsive fits occurring in sermon-time began to prevail in several parish churches. At one of these, Northmaven, the disease was cut short by a rough fellow of a Turk who carried out a troublesome patient and tossed her into a wet ditch. Nobody else caught it. From what scandalous scenes Europe might have been saved had the first dancer on St. John's Eve been tossed into a wet ditch!”
6 Loc. cit.
Trance, Lethargy, and Morbid Somnolence.
Trance may be defined as a derangement of the nervous system characterized by general muscular immobility, complete mental inertia, and insensibility to surroundings. The condition of a patient in a state of trance has been frequently, and not inaptly, compared to that of a hibernating animal. Trance may last for minutes, hours, days, weeks, or even months. Astonishing stories, some true, others—and these the greater number—false, frequently find their way into newspapers. A recent story is that of a hystero-cataleptic young woman of Nebraska who is reported to have been for seventy days in a state of trance, during which she was to all appearance lifeless with the exception of respiration and pulsation. She said that she was unconscious during the whole time of her protracted trance, but, although she exerted her utmost power to evince her consciousness, she could not move a muscle. Such cases like the Welsh fasting girl either live or seem to live for a long time on little or no food; doubtless food is often taken secretly.
In an interesting case which, so far as I know, has never been put upon record in any medical publication, attacks of catalepsy or of trance, or of both, occurred three times at long intervals during the life of this individual. The first time was while held in the arms of his mother preparatory to receiving the baptismal rite: the clergyman and others observed that the infant changed appearance and suddenly became rigid. It was feared that he was dying; the ceremonies were stopped, but in response to efforts after a time he came back to a normal state. When about sixteen years of age, while at school, he was accidentally wounded; it was necessary to probe for the ball, and while this was being done he again passed into a trance-like condition. Many years later, while in good health, a prosperous and well-known citizen, he suddenly again fell into an unconscious condition, and was believed to be dead. So marked were the appearances of death that after numerous efforts to resuscitate him preparations were made for his funeral. The knowledge of his previous attacks, however, induced his friends and relatives to defer his interment and continue their efforts. He finally revived just as they were about to give up in despair.
Aëtius, according to Laycock,7 mentions hysteric death as being very common in his day, and asserts that real death may supervene without any of the ordinary symptoms. The eyes preserve their brightness and the color of the skin remains vivid. Good cites the case of a woman whose funeral was postponed to ascertain the cause of her death, and whom the first touch of the scalpel brought to her senses. Authors and travellers have described wonderful cases of trance which have been observed in Persia and in India. A Persian youth is recorded to have possessed the power to restrain his breath for two days; and fakirs in India are said sometimes to have allowed themselves to be buried alive for weeks. Doubtless, a little Caucasian light let in upon some of these stories might dissolve them, as the esoteric Buddhism of Madame Blavatzsky has been dissipated into thin air by a hard-headed English investigator. According to Diogenes,8 Empedocles, a celebrated disciple of Pythagoras, obtained great fame by curing a female supposed to be dead, but whom he discovered to be suffering from hysteria. He termed the affection under which she labored apnoë, and maintained that a female might live in an apparently lifeless state for thirty days.
7 Op. cit.
8 Quoted by Laycock.
Landouzy has reported an interesting instance of lethargy produced by the application of a magnet to a patient suffering from hysteria major. The attacks of hysterical sleep are often preceded by convulsive phenomena, and, according to Briquet, are often ushered in by epileptoid signs, such as whistling inspiration, movements of deglutition, frothing, and transient rigidity of the limbs. Richer reports a remarkable case of Plendlers of Vienna, in which a young girl, after a series of violent hysterical attacks, fell apparently dead. Preparations were made to bury her, when she was found to be living, having been in a state of lethargy. Among cases observed in Salpêtrière the duration of lethargy has been from two to eight days. Sometimes, in cases of grave hysteria, attacks of lethargy complicated with general or partial contractures and epileptoid phenomena have been observed. The presence of neuro-muscular hyperexcitability is of diagnostic value in determining the nature of such cases; if present, we have probably to deal with phenomena of hysterical lethargy. This symptom may, of course, pass unperceived. A woman came under observation a short time since, being then far gone in pregnancy. About a month before delivery she had a very marked hysterical outbreak, in which she so simulated apoplexy as to make it almost impossible to decide what was the matter with her. She had apparently lost sensation, her breathing was stertorous, her pulse labored, and she had divergent strabismus. In the course of half an hour the symptoms passed off.
In trance, as in ecstasy, the patient may remain motionless and apparently unconscious of all surroundings; but in the former the visionary state, the radiant expression, and the statuesque positions are not necessarily present. In trance, as stated by Wilks, the patients may lie like an animal hibernating for days together, without eating or drinking, and apparently insensible to all objects around them. In ecstasy the mind, under certain limitations, is active; it is concentrated upon some object of interest, admiration, or adoration. Conditions of trance, as a rule, last longer than those of ecstasy.