ANOMALOUS NERVOUS AND MENTAL DISEASES. 1 page

Epilepsy has been professionally recognized as a distinct type of

disease since the time of Hippocrates, but in earlier times, and

popularly throughout later times, it was illy defined. The knowledge of

the clinical symptoms has become definite only since the era of

cerebral local anatomy and localization. Examination of the older

records of epilepsy shows curious forms recorded. The Ephemerides

speaks of epilepsy manifested only on the birthday. Testa mentions

epilepsy recurring at the festival of St. John, and Bartholinus reports

a case in which the convulsions corresponded with the moon's phases.

Paullini describes epilepsy which occurred during the blowing of wind

from the south, and also speaks of epilepsy during the paroxysms of

which the individual barked. Fabricius and the Ephemerides record

dancing epilepsy. Bartholinus and Hagendorn mention cases during which

various splendors appeared before the eyes during the paroxysm. Godart

Portius, and Salmuth speak of visions occurring before and after

epileptic paroxysms. The Ephemerides contains records of epilepsy in

which blindness preceded the paroxysm, in which there was singing

during it, and a case in which the paroxysm was attended with

singultus. Various older writers mention cases of epilepsy in which

curious spots appeared on the face; and the kinds of aura mentioned are

too numerous to transcribe.

Baly mentions a case of epilepsy occasioned by irritation in the socket

of a tooth. Webber reports a case of epilepsy due to phimosis and to

irritation from a tooth. Beardsley speaks of an attempt at

strangulation that produced epilepsy. Brown-Sequard records an instance

produced by injury to the sciatic nerve. Doyle gives an account of the

production of epilepsy from protracted bathing in a pond. Duncan cites

an instance of epilepsy connected with vesical calculus that was cured

by lithotomy. Museroft mentions an analogous case. Greenhow speaks of

epilepsy arising from an injury to the thumb. Garmannus, early in the

eighteenth century, describes epilepsy arising from fright and terror.

Bristowe in 1880, and Farre speak of similar instances. In Farre's case

the disease was temporarily cured by an attack of acute rheumatism.

Thorington of Philadelphia has seen a paroxysm of epilepsy induced by

the instillation of atropia in the eye of a child nearly cured of the

malady. It was supposed that the child was terrified on awakening and

finding its vision suddenly diminished, and that the convulsions were

directly due to the emotional disturbance. Orwin describes epilepsy

from prolonged lactation, and instances of ovarian and uterine epilepsy

are quite common.

There is a peculiar case of running epilepsy recorded. The patient was

a workman who would be suddenly seized with a paroxysm, and

unconsciously run some distance at full speed. On one occasion he ran

from Peterborough to Whittlesey, where he was stopped and brought back.

Once he ran into a pit containing six feet of water, from which he was

rescued. Yeo says that sexual intercourse occasionally induces

epilepsy, and relates a case in which a severe epileptic fit terminated

fatally three days after the seizure, which occurred on the nuptial

night.

Drake reports the case of a man who was wounded in the War of 1812,

near Baltimore, the ball passing along the left ear and temple so close

as to graze the skin. Eighteen years after the accident he suffered

with pain in the left ear and temple, accompanied by epileptic fits and

partial amnesia, together with an entire loss of power of remembering

proper names and applying them to the objects to which they belonged.

He would, for instance, invariably write Kentucky for Louisville.

Beirne records the case of a dangerous lunatic, an epileptic, who was

attacked by a fellow-inmate and sustained an extensive fracture of the

right parietal bone, with great hemorrhage, followed by coma. Strange

to say, after the accident he recovered his intellect, and was cured of

his epileptic attacks, but for six years he was a paralytic from the

hips down.

The Dancing Mania.--Chorea has appeared in various epidemic forms under

the names of St. Vitus's dance, St. Guy's dance, St. Anthony's dance,

choromania, tanzplage, orchestromania, dance of St. Modesti or St.

John, the dancing mania, etc.; although these various functional

phenomena of the nervous system have been called chorea, they bear very

little resemblance to what, at the present day, is called by this name.

The epidemic form appeared about 1374, although Hecker claims that, at

that time, it was no new thing. Assemblages of men and women were seen

at Aix-la-Chapelle who, impelled by a common delusion, would form

circles, hand in hand, and dance in wild delirium until they fell to

the ground exhausted, somewhat after the manner of the Ghost-Dance or

Messiah-Dance of our North American Indians. In their Bacchantic leaps

they were apparently haunted by visions and hallucinations, the fancy

conjuring up spirits whose names they shrieked out. Some of them

afterward stated that they appeared to be immersed in a stream of blood

which obliged them to leap so high. Others saw the heavens open and

disclose the Saviour enthroned with the Virgin Mary. The participants

seemed to suffer greatly from tympanites which was generally relieved

by compression or thumping on the abdomen. A few months after this

dancing malady had made its appearance at Aix-la-Chapelle it broke out

at Cologne, and about the same time at Metz, the streets of which were

said to have been filled with 1100 dancers. This rich city became the

scene of the most ruinous disorder. Peasants left their plows,

mechanics their shops, servants their masters, children their homes;

and beggars and idle vagabonds, who understood how to imitate the

convulsions, roved from place to place, inducing all sorts of crime and

vice among the afflicted. Strasburg was visited by the dancing plague

in 1418, and it was here that the plague assumed the name of St.

Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he

was about to undergo martyrdom by order of Diocletian, in the year 303,

is said to have prayed to God that He might protect all those who would

solemnize the day of his commemoration and fast upon its eve. The

people were taught that a voice from heaven was then heard saying,

"Vitus, thy prayer is accepted."

Paracelsus called this malady (Chorus sancti viti) the lascivious

dance, and says that persons stricken with it were helpless until

relieved by either recovery or death. The malady spread rapidly through

France and Holland, and before the close of the century was introduced

into England. In his "Anatomy of Melancholy" Burton refers to it, and

speaks of the idiosyncrasies of the individuals afflicted. It is said

they could not abide one in red clothes, and that they loved music

above all things, and also that the magistrates in Germany hired

musicians to give them music, and provided them with sturdy companions

to dance with. Their endurance was marvelous. Plater speaks of a woman

in Basle whom he saw, that danced for a month. In Strasburg many of

them ate nothing for days and nights until their mania subsided.

Paracelsus, in the beginning of the sixteenth century, was the first to

make a study of this disease. He outlined the severest treatment for

it, and boasted that he cured many of the victims. Hecker conjectures

that probably the wild revels of St. John's day, 1374, gave rise to

this mental plague, which thenceforth visited so many thousands with

incurable aberrations of mind and disgusting distortions of the body.

Almost simultaneous with the dance of "St. With," there appeared in

Italy and Arabia a mania very similar in character which was called

"tarantism," which was supposed to originate in the bite of the

tarantula. The only effective remedy was music in some form. In the

Tigre country, Abyssinia, this disease appeared under the name of

"Tigretier." The disease, fortunately, rapidly declined, and very

little of it seems to have been known in the sixteenth century, but in

the early part of the eighteenth century a peculiar sect called the

"Convulsionnaires" arose in France; and throughout England among the

Methodist sect, insane convulsions of this nature were witnessed; and

even to the present day in some of the primitive religious meetings of

our people, something not unlike this mania of the Middle Ages is

perpetuated.

Paracelsus divided the sufferers of St. Vitus's dance into three

classes .--

(1) Those in which the affliction arose from imagination (chorea

imaginativa).

(2) Those which had their origin in sexual desires depending on the

will.

(3) Those arising from corporeal causes (chorea naturalis). This last

case, according to a strange notion of his own he explained by

maintaining that in certain vessels which are susceptible of an

internal pruriency, and thence produced laughter, the blood is set into

commotion in consequence of an alteration in the vital spirits, whereby

are occasioned involuntary fits of intoxicating joy, and a propensity

to dance. The great physician Sydenham gave the first accurate

description of what is to-day called chorea, and hence the disease has

been named "Sydenham's chorea." So true to life was his portrayal of

the disease that it has never been surpassed by modern observers.

The disease variously named palmus, the jumpers, the twitchers, lata,

miryachit, or, as it is sometimes called, the emeryaki of Siberia, and

the tic-convulsif of La Tourette, has been very well described by Gray

who says that the French authors had their attention directed to the

subject by the descriptions of two American authors--those of Beard

upon "The Jumpers of Maine," published in 1880, and that of Hammond

upon "Miryachit," a similar disease of the far Orient. Beard found that

the jumpers of Maine did unhesitatingly whatever they were told to do.

Thus, one who was sitting in a chair was told to throw a knife that he

had in his hand, and he obeyed so quickly that the weapon stuck in a

house opposite; at the same time he repeated the command given him,

with a cry of alarm not unlike that of hysteria or epilepsy. When he

was suddenly clapped upon the shoulder he threw away his pipe, which he

had been filling with tobacco. The first parts of Virgil's aeneid and

Homer's Iliad were recited to one of these illiterate jumpers, and he

repeated the words as they came to him in a sharp voice, at the same

time jumping or throwing whatever he had in his hand, or raising his

shoulder, or making some other violent motion. It is related by

O'Brien, an Irishman serving on an English naval vessel, that an

elderly and respectable Malay woman, with whom he was conversing in an

entirely unsuspecting manner, suddenly began to undress herself, and

showed a most ominous and determined intention of stripping herself

completely, and all because a by-standing friend had suddenly taken off

his coat; at the same time she manifested the most violent anger at

what she deemed this outrage to her sex, calling the astonished friend

an abandoned hog, and begging O'Brien to kill him. O'Brien,

furthermore, tells of a cook who was carrying his child in his arms

over the bridge of a river, while at the same time a sailor carried a

log of wood in like manner; the sailor threw his log of wood on an

awning, amusing himself by causing it to roll over the cloth, and

finally letting it fall to the bridge; the cook repeated every motion

with his little boy, and killed him on the spot. This miryachit was

observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in

Siberia, whilst Beard has observed it in Michigan as well as in Maine.

Crichton speaks of a leaping ague in Angusshire, Scotland.

Gray has seen only one case of acute palmus, and records it as follows:

"It was in a boy of six, whose heredity, so far as I could ascertain

from the statements of his mother, was not neurotic. He had had trouble

some six months before coming to me. He had been labeled with a number

of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria,

and neurasthenia. His palmodic movements were very curious. When

standing near a table looking at something, the chin would suddenly

come down with a thump that would leave a black-and-blue mark, or his

head would be thrown violently to one side, perhaps coming in contact

with some adjacent hard object with equal force, or, while standing

quietly, his legs would give a sudden twitch, and he would be thrown

violently to the ground, and this even happened several times when he

was seated on the edge of a stool. The child was under my care for two

weeks, and, probably because of an intercurrent attack of diarrhea,

grew steadily worse during that time, in spite of the full doses of

arsenic which were administered to him. He was literally covered with

bruises from the sudden and violent contacts with articles of

furniture, the floor, and the walls. At last, in despair at his

condition, I ordered him to be undressed and put to bed, and steadily

pushed the Fowler's solution of arsenic until he was taking ten drops

three times a day, when, to my great surprise, he began to improve

rapidly, and at the end of six weeks was perfectly well. Keeping him

under observation for two weeks longer I finally sent him to his home

in the West, and am informed that he has since remained perfectly well.

It has seemed to me that many of the cases recorded as paramyoclonus

multiples have been really acute palmus."

Gray mentions two cases of general palmus with pseudomelancholia, and

describes them in the following words:--

"The muscular movements are of the usual sudden, shock-like type, and

of the same extent as in what I have ventured to call the general form.

With them, however, there is associated a curious pseudomelancholia,

consisting of certain fixed melancholy suspicious delusions, without,

however, any of the suicidal tendencies and abnormal sensations up and

down the back of the head, neck, or spine, or the sleeplessness, which

are characteristic of most cases of true melancholia. In both of my

cases the palmus had existed for a long period, the exact limits of

which, however, I could not determine, because the patient scouted the

idea that he had had any trouble of the kind, but which the testimony

of friends and relatives seemed to vouch for. They were both men, one

thirty-six and one thirty-eight years of age. The pseudomelancholia,

however, had only existed in one case for about a year, and in the

other for six months. One case passed away from my observation, and I

know nothing of its further course. The other case recovered in nine

months' treatment, and during the three years that have since elapsed

he has been an active business man, although I have not seen him myself

during that period, as he took a great dislike to me because I was

forced to take strong measures to keep him under treatment, so

persistent were his suspicions."

Athetosis was first described by Hammond in 1871, who gave it the name

because it was mainly characterized by an inability to retain the

fingers and toes in any position in which they might be planed, as well

as by their continuous motion. According to Drewry "athetosis is a

cerebral affection, presenting a combination of symptoms characterized

chiefly by a more or less constant mobility of the extremities and an

inability to retain them in any fixed position. These morbid,

grotesque, involuntary movements are slow and wavy, somewhat regular

and rigid, are not jerky, spasmodic, nor tremulous. The movements of

the digits are quite different from those attending any other disease,

impossible to imitate even by the most skilful malingerer, and, if once

seen, are not likely to be forgotten. In an athetoid hand, says Starr,

the interossei and lumbricales, which flex the metacarpo-phalangeal and

extend the phalangeal joints, are affected; rarely are the long

extensors and the long flexors affected. Therefore the hand is usually

in the so-called interosseal position, with flexion of the proximal and

extension of the middle and distal phalanges. The athetoid movements of

the toes correspond to those of the fingers in point of action. In a

great majority of cases the disease is confined to one side

(hemiathetosis), and is a sequel of hemiplegia. The differential

diagnosis of athetosis is generally easily made. The only nervous

affections with which it could possibly be confounded are chorea and

paralysis agitans. Attention to the twitching, spasmodic, fibrillary

movements, having a quick beginning and a quick ending, which is

characteristic in Sydenham's chorea, would at once exclude that

disease. These jerky movements peculiar to St. Vitus's dance may be

easily detected in a few or many muscles, if moderate care and patience

be exercised on the part of the examiner. This form of chorea is almost

always a disease of childhood. So-called post-hemiplegic chorea is, in

the opinion of both Hammond and Gray, simply athetosis. The silly,

dancing, posturing, wiry movements, and the facial distortion observed

in Huntington's chorea would hardly be mistaken by a careful observer

for athetosis. The two diseases, however, are somewhat alike. Paralysis

agitans (shaking palsy), with its coarse tremor, peculiar facies,

immobility, shuffling gait, the 'bread-crumbling' attitude of the

fingers, and deliberate speech, would be readily eliminated even by a

novice. It is, too, a disease of advanced life, usually. Charcot, Gray,

Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and

others have written on this affection."

The following is the report of a case by Drewry, of double (or, more

strictly speaking, quadruple) athetosis, associated with epilepsy and

insanity: "The patient was a negro woman, twenty-six years old when she

was admitted into this, the Central State (Va.) Hospital, in April,

1886. She had had epilepsy of the grand mal type for a number of years,

was the mother of one child, and earned her living as a domestic. A

careful physical examination revealed nothing of importance as an

etiologic factor. Following in the footsteps of many of those

unfortunates afflicted with epilepsy, she degenerated into a state of

almost absolute imbecility.

"Some degree of mental deficiency seems usually to accompany athetosis,

even when uncomplicated by any other degenerating neurosis. Athetoid

symptoms of an aggravated character, involving both upper and both

lower extremities, had developed previous to her admission into this

hospital, but it was impossible to find out when and how they began.

She had never had, to the knowledge of her friends, an attack of

'apoplexy,' nor of paralysis. The head was symmetric, and without scars

thereon. The pedal extremities involuntarily assumed various distorted

positions and were constantly in motion. The toes were usually in a

state of tonic spasm,--contracted, and drawn downward or extended,

pointing upward, and slightly separated. Irregular alternate extension

and flexion of the toes were marked. The feet were moved upon the

ankles in a stiff and awkward manner. During these 'complex involuntary

movements,' the muscles of the calf became hard and rigid. The act of

walking was accomplished with considerable difficulty, on account of

contractures, and because the feet were not exactly under the control

of the will. The unnatural movements of the hands corresponded to those

of the lower extremities, though they were more constant and active.

The fingers, including the thumbs, were usually widely separated and

extended, though they were sometimes slightly flexed. The hands were

continually in slow, methodic, quasi-rhythmic motion, never remaining

long in the same attitude. In grasping an object the palm of the hand

was used, it being difficult to approximate the digits. The

wrist-joints were also implicated, there being alternate flexion and

extension. In fact these odd contortions affected the entire limb from

the shoulder to the digital extremities. When standing or walking the

arms were held out horizontally, as if to maintain the equilibrium of

the body. The patient's general physical health was fairly good. She

frequently complained of headache, and when she was exceedingly

irritable and violent all the athetoid movements would be intensified.

Speech was jerky and disordered, which gave it a distinctive character.

The special senses seemed to be unimpaired, and the pupils were normal,

except when an epileptic attack came on. Death occurred in January,

1895, after an obstinate attack of status epilepticus." Paramyoclonus

multiplex is a condition of chronic muscular spasm affecting the trunk,

occasionally the muscles of the face, abdomen, or diaphragm. The

muscles affected are usually in the trunk and in the limbs, and not in

the toes and hand; occasionally the movements are tonic as well as

clonic; the degree of spasm varies greatly, and according to Gray may

sometimes be so violent as to throw the patient down or out of the

chair.

Saltatoric spasm is an extremely rare condition, first observed by

Bamberger in 1859. The calf, hip, knee, and back-muscles are affected

by clonic spasm, causing springing or jumping movements when the

patient attempts to stand. The disease is transient, and there are no

mental symptoms.

Progressive muscular atrophy has been observed as far back as

Hippocrates, but it is only in recent times that we have had any

definite knowledge of the subject. It is divided into four types, the

hand type (causing the griffin-or claw-hand, or the ape-hand); the

juvenile type (generally in the muscles of the shoulder and arm); the

facial type; and the peroneal type. Generalized progressive atrophy

leads to a condition that simulates the appearance of a "living

skeleton."

Facial hemiatrophy is an incurable disease, as yet of unknown

pathology. It consists of wasting of the bones, subcutaneous tissues,

and muscles of one-half of the face or head, the muscles suffering but

slightly. The accompanying illustration shows a case in which there was

osseous depression of the cranium and a localized alopecia. The disease

is very rare, only about 100 cases having been reported. Of five cases

seen by Dana, three were in females and two in males; in all the cases

that could be found the origin was between the tenth and twentieth

years. It is a chronic affection, usually beginning in early life,

increasing slowly for years, and then becoming stationary. It is

distinguished from one-sided muscular atrophy by the electric reaction,

which is not lost in the facial muscles in facial hemiatrophy, and

there is no atrophy of other muscles of the body.

Burr contributes an exhaustive paper on hemiatrophy of the tongue with

report of a case as follows: "L. B., female, mulatto, thirty-one years

old, married, came to the Medico-Chirurgical Hospital, Philadelphia,

September 23, 1895, complaining that her 'tongue was crooked.' Save

that she had had syphilis, her personal history is negative. In

February, 1895, she began to suffer from headache, usually behind the

left ear, and often preventing sleep. At times there is quite severe

vertigo. Several weeks after the onset, headache persisting, she awoke

in the night and found the left side of the tongue swollen, black, and

painless. For some hours she could neither speak nor chew, but

breathing was not interfered with. After a few days all symptoms passed

away except headache, and she thought no more of the matter until

recently, as stated above, she noticed by accident that her tongue was

deformed. She is a spare, poorly-fed, muddy-skinned mulatto girl. The

left half of the tongue is only about one-half as large as the right.

The upper surface is irregularly depressed and elevated. There are no

scars. When protruded it turns sharply to the left. Fibrillary

twitching is not present. The mucous membrane is normal. Common

sensation and taste are preserved. The pharyngeal reflex is present.

The palate moves well. There is no palsy or wasting of the face. The

pupils are of normal size and react well to light and with

accommodation. Station and gait are normal. There is no incoordination

of movement in the arms or legs. The knee-jerks are much increased.

There is an attempt at, but no true, clonus; that is, passive flexion

of the foot causes two or three jerky movements. There is no glandular

swelling or tumor about the jaw or in the neck. Touch and pain-sense

are normal in the face and hands, but she complains of numbness in the

hands as if she had on tight gloves. There is no trouble in speaking,

chewing, or swallowing. There is no pain or rigidity in the neck

muscles. Examination of the pharynx reveals no disease of the bones.

Under specific treatment the patient improved."

Astasia-abasia was named by Blocq, who collected 11 cases. According

to Knapp, four cases have been reported in America. The disease

consists in an inability to stand erect or walk normally, although

there is no impairment of sensation, of muscular strength, or of the

coordination of other muscles in walking than the lower extremities. In

attempting to walk the legs become spasmodic; there are rapid flexions

and extensions of the legs on the thighs, and of the thighs on the

pelvis. The steps are short, and the feet drag; the body may make great

oscillations if the patient stands, walks, or sits, and the head and

arms make rhythmical movements; walking may become impossible, the

patient appearing to leap up on one foot and then up on the other, the

body and head oscillating as he advances; he may be able to walk

cross-legged, or by raising the legs high; or to walk on his hands and

feet; he may be able to walk at certain times and not at others; or to

hop with both feet together; he may succeed with great strides and with

the arms extended; or finally he may be able to use his legs perfectly

if suspended (Gray). There are various types which have been called the

paralytic, the choreic, and the saltatory. A tendency to go backward or

retropulsion has been observed, according to Gray, as has also a

tendency to go forward or propulsion. A curious phenomenon in this

disease is that the patient can use the legs perfectly well lying in

bed. The prognosis seems to be favorable.

Meniere's disease is a disease probably of the semicircular canals,

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