Catalepsy Consequent Upon an Attack of Acute Mania? Recovery
106 Art. VIII.?
In tlie last number of Lunier and Baillarger’s excellent Annates Medico-psychologiques, Dr Lagardelle, the chief of the Marseilles Lunatic Asylum, gives some very interesting details of a case of catalepsy consequent upon an attack of acute mania. I)r. Lagardelle points out in his introductory remarks, “that catalepsy, although of rare occurrence, has been known ever since the most remote times. Ccelius Aurelianus gave a very early and detailed description of it, and even at the present time this description is correct in the main; in other words, the clinical history of this disease is even now very incomplete. Most authors consider it to be essentially a neurotic affection. Considering at present the immense progress which has recently been made in the study and knowledge of nervous diseases, we are almost justified in predicting that in a very short time both the nature and the immediate cause of the cataleptic state will be known.
In 1856 Dr Puel, who in a remarkable memoir quoted no less than 150 cases of catalepsy which he had collected in very different localities, defined this disease as ” an intermittent neurose, without any notable modification in the functions of respiration and of circulation, with a special perturbation of all the functions of relation, essentially characterised by the inability of the patient to extend or to contract voluntarily the muscles of animal life, while another person may easily cause these same muscles to pass through all the stages intermediate between the limits of contraction and extension.” This definition is contest- able, but we think that those which have been given since that time are not much better. The definition of Coelius Aurelianus might be opposed to them, and the pathognomonic symptom might be characterised thus : neque extenta recolligunt membra, neque conducta distendunt. The muscles of animal life pre- serve during a variable period the attitudes which have been given to them.
It has been said that catalepsy was generally a complication of hysteria, but then how could it be explained that out of 148 cases Dr Puel found 68 to refer to male patients and only 80 to women.
According to Dr Lagardelle’s views catalepsy is a special disturbance of central innervation, and he points out that this view explains in a most natural manner why this malady is often combined with certain forms of mental disease. He then gives the following description of a case in point, and remarks that it adds a new form of mania to those which have hitherto been considered susceptible of being complicated with catalepsy. Gr. A., a young man of 19 years of age, of nervous- sanguinic temperament, good constitution, without hereditary antecedents, was an employe in a branch of Government administration; his apparent conduct was very regular and irreproachable, but there existed secret habits of masturbation. On April 15, after a restless night, he declared to his family in an arrogant tone of voice and a strange expression in his face, that he was not going to work ; he locked himself up in his room, and covered the walls and the floor with drawings repre- senting balloons with large wings. He then became imperious and excited, spoke with volubility of fortunes, of balloons which he was going to conduct, of birds flying in the air, &c. The following night he was extremely restless, had auricular and visual hallucinations, became more and more excited and at last dangerous. On the 16th the delirium had got worse and general; he assaulted his mother, who wanted to calm him and reason with him, and struck her violently. His father then entered the room, and the patient, upon seeing him, suddenly rushed to the window and threw himself out. The room was on the third floor, and he fell into a yard. It may be asked whether this young man obeyed a sentiment of fear upon seeing his father ; whether he mistook the window for the door ; whether he had an idea of committing suicide ; or whether he was merely following some irresistible instinctive impulse. Dr Lagardelle inclines to the latter view, and remarks that he had occasion to observe that in this case there was a special alteration of volition. Strange to say, the patient, who might have been killed by the fall, fell upon his back and slightly upon the arm, and received only an insignificant contusion upon the latter. He got up without much difficulty, and his agita- tion in consequence became only more violent. He was imme- diately removed to the Marseilles Lunatic Asylum. The mania of the patient was characterised by insomnia, excessive mobility, irrational and eccentric actions (which necessitated his being closely and uninterruptedly watched), personal illusions, auri- cular and visual hallucinations, an animated facial expression, excessive volubility, and greatly dilated pupils; he spoke in- cessantly of birds, of flying balloons, gave no reply to questions addressed to him, and behaved in a most insolent manner. On April 20th, upon seeing another patient come into the apartment where he was kept, he rushed upon him and tried to strangle him; the attendant, however, succeeded soon in parting them. This act was incontestably an impulsive one. On the 24th, during the day, the patient ceased to speak; he shut his eyes, let his head fall forward, and, reclining upon a bench, remained motionless, letting the saliva run out of his mouth. In the evening the patient awoke, and proceeded like an automaton to sit at the table.
During the night he remained calm, made no noise, and in the morning, when the attendant tried to make him get up, he remained motionless, with a haggard look in the eyes. At eight o’clock Dr Lagardelle visited him, and found him extended upon his back, with an expression of stupidity in his face, pupils very dilated, and almost normal pulse. He was then pricked with a pin upon various parts of his body, but he remained perfectly insensible, motionless, and his facial expres- sion was unchanged. The four extremities were then succes- sively placed into different positions, and they remained so for nearly a quarter of an hour.
The patient was then carried into the hydro-therapeutical hall, and a powerful douche was applied for two minutes to the whole posterior part of his body. The skin was not sensitive, and showed no redness, but the patient seemed to wake a little. He was then rubbed energetically, and, after having been dressed, was made to walk up and down quickly for the space of half an hour.
The cataleptic state had ceased, but it returned the same evening and then lasted for about an hour. The next morning a short attack of but slight intensity occurred; the patient was again placed under the douche, and the skin reddened a little. On the third day of this treatment the skin became red after half a minute ; the patient was no longer delirious, but related what happened during the second attack of catalepsy. He saw that he was being pricked with pins, but he felt nothing; he was perfectly conscious of the various positions into which his limbs were placed, but he could neither move them nor speak.
During the following eight or ten days the patient was per- fectly conscious of all that happened, and stated that he felt a strange sensation in all his nerves, and under the influence of the continued douches these sensations disappeared gradually. On May 10 they had quite left him, and he left the hospital perfectly cured.
Dr Lagardelle then continues: “This case should give rise to considerations which it seems to us premature to develop; however, we will recapitulate the questions it calls forth, without wishing to discuss them, nor to decide them finally. The cataleptic state just described differs considerably from the descriptions of catalepsy hitherto given by authors on the subject, and quite upsets certain definitions. Con- sciousness and memory are retained, while volition is destroyed after having first been perverted. Must the cause of these attacks be ascribed to the acute mania or to the fall from the window ? Masturbation produced a functional disturbance in the cerebro-spinal nervous system. If during the acute mania the brain was affected, we may be allowed to suppose that the medulla was not in its normal state, and that the fall from the window could produce upon these predisposed organs either a general disturbance or at least a shock sufficient to bring about these cataleptic attacks.
A sane person falling from a third floor window would at least be seriously injured, if not killed. How could this young maniac fall from that height and then get up as if nothing had happened? Were the cataleptic fits beneficial to the maniacal delirium in the same way as certain intermittent and acute diseases cure mental disease ? The disturbance in his general sensibility was accompanied by a relative cessation of the functions of the skin.
The recovery proceeded gradually, and in the same measure as the skin became more sensitive and impressible.
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