By the term trance I would define all those conditions in which there is protracted derangement of volition or the will; sensibility and voluntary action being suspended, while the vital functions are performed, yet with diminished energy; the “deep sleep” of Paracelsus, Hieronymus Fabricius, Celsus, and other writers of antiquity.
In some the rosy colour of the lips and cheeks will not fade; in others, they are pale and bloodless; the body becomes cold as marble, the pulse often imperceptible, and the vapour of breathing on a polished surface alone distinguishes the still living being from the perfect work of the sculptor. I have, however, had patients who were rosy when they fell asleep, but became pale about the end of the second day.
Girls often smile sweetly in full catalepsy, but the countenance will become anxious as waking approaches; and this must ever excite suspicion. The body indeed is, to the external world, dead; for although the cataleptic will often swallow food, while all the other muscles are in spasm, this may, I believe does, depend on mere irritability, by which, as I before told you, the brain is first excited, and then directs a movement without the mind’s feeling. Catalepsy is so peculiar to young females of extreme sensibility, that it may be considered an intense hysteria, depending on certain sympathies, or resulting from sudden or powerful influences on the passions. The form of catalepsy marked by hysteria is least dangerous; but it is very stubborn. Probably this is the form so common in Germany.
Previous to the cataleptic acme girls are often maniacally violent, and will then suddenly regain their temper and their reason. They will sit and play with their fingers in a sullen mood, and the power of motion and speech and other acts of volition may be alternately impaired or lost. In some, the sleep has been preceded by fits of lethargy, by lassitude, and inaptitude to exertion, and perhaps a propensity to sleep-walking. The decided state of catalepsy has begun in an epileptic convulsion. In all, I think, I have seen combined with this disorder, irregular determination of blood; in one case, where the taste and smell were gone for four or five months, the climax was suicide by arsenic.
The countenance is almost always placid in cataleptic sleep; the eyes being turned up, the pupils dilated, but the eyelids closed. If the fit be the result of sudden fright, the features will remain as they were at that moment—the eyelid fixed, but the pupil usually sensible. The joints and muscles are pliable, and may be moulded to any form, but they remain in that position as rigidly fixed as the limbs of a clay figure, or the anchylosed joints of the self-torturing fakir; insensible to all stimuli, beating, tickling, or pricking.
I have seen patients lapse into a state of catalepsy, in a moment, without a struggle. I remember, during one of my visits to the asylum in Hoxton, a maniac, who often in the midst of his occupation became instantaneously a statue; leaning a little forward, one arm lifted up, and the index finger pointed as at some interesting object; the eye staring and ghastly, and the whole expression as of one rapt in an ecstacy of thought or vision.
The waking from a trance, like the recovery from the asphyxia of drowning, is painful. It is attended with a struggle, and the hand is almost invariably placed firmly over the heart, as if its actions were a painful effort to overcome congestion.
In some cases, indeed, a purple hue will suddenly suffuse the cataleptic body; the limbs are then extremely rigid, but become pliant when the healthy tint is restored.
The sensation in the brain of the cataleptic, as of those recovering from drowning, resembles the pricking of needles, the circulation soon becoming accelerated. Hunger is usually intense when the patient awakes. The usual duration of catalepsy is from twenty to forty hours. The return of volition is commonly marked by perspiration; this premonitory sign is often followed by a piercing shriek, as in the case of night-mare, and, indeed, in a slight degree, of an infant’s cry as soon as it is born.
It has appeared to me that the cataleptic is marked by extremes of feeling and disposition. The sensibility either being too dull for the feeling of joy, or so intensely excited by pleasure, as to approach the confine of delirium. One of my patients, in particular, who was an eighty-hour sleeper, endured a metamorphosis from religious enthusiasm to theatrical mania. Her Bible was discarded for romances and play-books, and even the most licentious volumes.