ANOMALOUS NERVOUS AND MENTAL DISEASES. 3 page

reported of a Spanish soldier of twenty-two, confined in the Military

Hospital of San Ambrosio, Cuba, who had been in a cataleptic state for

fourteen months. His body would remain in any position in which it was

placed; defecation and micturition were normal; he occasionally sneezed

or coughed, and is reported to have uttered some words at night. The

strange feature of this case was that the man was regularly nourished

and increased in weight ten pounds. It was noted that, some months

before, this patient was injured and had suffered extreme depression,

which was attributed to nostalgia, after which he began to have

intermittent and temporary attacks, which culminated as related.

Camuset and Planes in January, 1896, mention a man who began to have

grand hallucinations in 1883. In March, 1884, he exhibited the first

signs of sleep, and on March 10th it was necessary to put him to bed,

where he remained, more or less continuously for three months,

awakening gradually, and regaining his normal condition by the middle

of June. He was fed by hand three times daily, was placed on a

night-chair, and with one exception never evacuated in bed. Five months

afterward he showed no signs of relapse. The latest report of a

"sleeping girl" is that of the young Dutch maiden, Maria Cvetskens, of

Stevenswerth, who on December 5, 1895, had been asleep for two hundred

and twenty days. She had been visited by a number of men of good

professional standing who, although differing as to the cause of her

prolonged sleep, universally agreed that there was no deception in the

case. Her parents were of excellent repute, and it had never occurred

to them to make any financial profit out of the unnatural state of

their daughter.

Hypnotism.--The phenomenon of hypnotism was doubtless known to the

Oriental nations, and even to the Greeks, Romans, and Egyptians, as

well as to other nations since the downfall of the Roman Empire. "The

fakirs of India, the musicians of Persia, the oracles of Greece, the

seers of Rome, the priests and priestesses of Egypt, the monastic

recluses of the Middle Ages, the ecstatics of the seventeenth and early

part of the eighteenth century exhibited many symptoms that were, and

are still, attributed by religious enthusiasts to supernatural

agencies, but which are explainable by what we know of hypnotism. The

Hesychasts of Mount Athos who remained motionless for days with their

gaze directed steadily to the navel; the Taskodrugites who remained

statuesque for a long period with the finger applied to the nose; the

Jogins who could hibernate at will; the Dandins of India who became

cataleptoid by 12,000 repetitions of the sacred word Om; St. Simeon

Stylites who, perched on a lofty pillar, preserved an attitude of

saint-like withdrawal from earthly things for days; and even Socrates,

of whom it was said that he would stand for hours motionless and

wordless--all these are probable instances of autohypnotism." (Gray.)

Hypnotism is spoken of as a morbid mental state artificially produced,

and characterized by perversion or suspension of consciousness, and

abeyance of volition; a condition of suggestibility leads the patient

to yield readily to commands of external sense-impressions, and there

is intense concentration of the mental faculties upon some idea or

feeling. There are several methods of inducing hypnosis, one of which

is to give particular direction to the subject's imagination by

concentrating the attention upon an arbitrary point, or by raising an

image of the hypnotic state in the patient's mind. The latter is most

readily induced by speech. Faria formerly strained the attention of the

subject as much as possible, and suddenly called out, "Sleep!" This

method has been used by others. Physical methods consist of certain

stimuli of sight, hearing, and touch. Taste and smell have generally

given negative results. Fixation of the gaze has been the most

successful, but the ticking of a watch has been used. According to

Moll, among uncivilized races particular instruments are used to

produce similar states, for example, the magic drum's sound among the

Lapps, or among other races the monotony of rhythm in song, etc.

Instead of these continuous, monotonous, weak stimulations of the

senses, we find also that sudden and violent ones are made use of--for

example in the Salpetriere, the field of Charcot's work, the loud noise

of a gong, or a sudden ray of light; however, it is more than doubtful

whether these sudden, strong, physical stimuli, without any mental

stimuli, can induce hypnosis. Perhaps we have to do here with states

not far removed from paralysis from fright. The sense of touch is also

brought into play in hypnosis; Richet set great value on the so-called

mesmeric strokes or passes. It is often stated that touches on the

forehead induce a sleepy state in many persons. Hypnotism is practiced

by stimulation of the muscular sense, such as cradle-rocking, used to

send little children to sleep. Similar states are said to be produced

among uncivilized people by violent whirling or dancing movements; the

movements are, however, accompanied by music and other mental

excitations.

Hypnosis is spoken of by Huc and Hellwald of the Buddhist convents in

Thibet; and Sperling, who has had a particularly wide experience in the

field of hypnotism, and whose opinion is of particular value, says that

he has seen dervishes in Constantinople who, from the expression of

their eyes and their whole appearance, as well as from peculiar

postures they maintain for a long time, impressed him as being in a

hypnotic state. The state may have been induced by singing and uniform

whirling motions. Hildebrandt, Jacolliot, Fischer, Hellwald, and other

trustworthy witnesses and authors tell us strange things about the

fakirs of India, which set any attempt at explanation on the basis of

our present scientific knowledge at defiance--that is, if we decline to

accept them as mere juggler's tricks. Hypnotism seems to be the only

explanation. It is a well known fact that both wild and domestic beasts

can be hypnotized and the success of some of the animal-tamers is due

to this fact. In hypnotism we see a probable explanation for the

faith-cures which have extended over many centuries, and have their

analogy in the supposed therapeutic powers of the Saints.

The medicolegal aspect of hypnotism may be called in to answer whether

crime may be committed at suggestion. Such examples have already been

before the public in the recent trial of the Parisian strangler,

Eyraud. It was claimed that his accomplice in the crime, Gabrielle

Bompard, had been hypnotized. Bernheim narrates a case of outrage

effected in the hypnotic condition, which was brought to light by a

trial in the South of France.

As to the therapeutic value of hypnotism, with the exception of some

minor benefits in hysteric cases and in insomnia, the authors must

confess that its use in Medicine seems very limited.

African sleep-sickness is a peculiar disorder, apparently infectious in

character, which occurs among the negroes of the western coast of

Africa. It has been transported to other regions but is endemic in

Africa. According to Dana it begins gradually with malaise and

headache. Soon there is drowsiness after meals which increases until

the patient is nearly all the time in a stupor. When awake he is dull

and apathetic. There is no fever; the temperature may be subnormal. The

pulse, too, is not rapid, the skin is dry, the tongue moist but coated,

the bowels regular. The eyes become congested and prominent. The

cervical glands enlarge. The disease ends in coma and death. Recovery

rarely occurs. Sometimes the disease is more violent, and toward the

end there are epileptic convulsions and muscular tremors. Autopsies

have revealed no pathologic changes.

Recently Forbes contributes an interesting paper on the sleeping

sickness of Africa. The disease may occur in either sex and at any age,

though it is most frequent from the twelfth to the twentieth years, and

in the male sex. It begins with enlargement of the cervical glands, and

drowsiness and sleep at unusual hours. At first the patient may be

aroused, but later sinks into a heavy stupor or coma. Death occurs in

from three to twelve months, and is due to starvation. Forbes reports

11 fatal cases, and two that passed from observation. At the autopsy

are found hyperemia of the arachnoid, and slight chronic

leptomeningitis and pachymeningitis. There is also anemia of the

brain-substance. In one of his cases the spleen was enlarged. He was

inclined to regard the disease as a neurosis.

Aphasia is a disease of the faculty of language, that is, a disturbance

of the processes by which we see, hear, and at the same time appreciate

the meaning of symbols. It includes also the faculty of expressing our

ideas to others by means of the voice, gesture, writing, etc. The

trouble may be central or in the conducting media. The varieties of

aphasia are:--

(1) Amnesia of speech.

(2) Amnesia of speech and written language.

(3) Amnesia of speech, written language, and gesture.

In most cases there is no paralysis of the tongue or speech-forming

organs. As a rule the intellect is unaffected, the patient has the

ideas, but lacks the power to give them proper expression through

words, written language, or gesture. If the patient is enable to write,

the condition is known as agraphia. Word-blindness, word-deafness,

etc., are terms of different forms of aphasia.

What was probably a case of incomplete aphasia is mentioned by Pliny,

that of Messala Corvinus who was unable to tell his own name; and many

instances of persons forgetting their names are really nothing but

cases of temporary or incomplete aphasia. In some cases of incomplete

and in nearly all cases of complete aphasia, involuntary sentences are

ejaculated. According to Seguin a reverend old gentleman affected with

amnesia of words was forced to utter after the sentence, "Our Father

who art in heaven," the words "let Him stay there." A lady seen by

Trousseau would rise on the coming of a visitor to receive him with a

pleased and amiable expression of countenance, and show him to a chair,

at the same time addressing to him the words, "cochon, animal, fichue

bete," French words hardly allowable in drawing-room usage. She was

totally aphasic but not paralyzed. Women often use semi-religious

expressions like "Oh dear," or "Oh Lord." Men of the lower classes

retain their favorite oaths remarkably. Sometimes the phrases

ejaculated are meaningless, as in Broca's celebrated case.

Aphasia may be the result of sudden strong emotions, in such cases

being usually temporary; it may be traumatic; it may be the result of

either primary or secondary malnutrition or degeneration.

There are some cases on record in which the sudden loss and the sudden

return of the voice are quite marvelous.

Habershon reports the case of a woman who on seeing one of her children

scalded fell unconscious and motionless, and remained without food for

three days. It was then found that she suffered from complete aphasia.

Five weeks after the incident she could articulate only in a very

limited vocabulary.

In the Philosophical Transactions Archdeacon Squire tells of the case

of Henry Axford, who lost the power of articulation for four years;

after a horrible dream following a debauch he immediately regained his

voice, and thereafter he was able to articulate without difficulty.

Ball records a curious case of what he calls hysteric aphonia. The

patient was a young lady who for several months could neither sing nor

speak, but on hearing her sister sing a favorite song, she began to

sing herself; but, although she could sing, speech did not return for

several weeks. Ball remarks that during sleep such patients may cry out

loudly in the natural voice.

Wadham reports the case of a boy of eighteen who was admitted to his

ward suffering with hemiplegia of the left side. Aphasia developed

several days after admission and continued complete for three months.

The boy gradually but imperfectly recovered his speech. Over six months

after the original admission he was readmitted with necrosis of the

jaw, for which he underwent operation, and was discharged a month

later. From this time on he became progressively emaciated until his

death, twelve months after Wadham first saw him. A postmortem

examination showed nearly total destruction of the Island of Reil,

popularly called the speech-center. Jackson mentions a hemiplegic

patient with aphasia who could only utter the words "come on to me,"

"come on," and "yes" and "no." Bristowe cites the history of a sailor

of thirty-six, a patient of St. Thomas Hospital, London, who suffered

from aphasia for nine months. His case was carefully explained to him

and he nodded assent to all the explanations of the process of speech

as though he understood all thoroughly. He was gradually educated to

speak again by practicing the various sounds. It may be worth while to

state that after restoration of speech he spoke with his original

American accent.

Ogle quotes six cases of loss of speech after bites of venomous snakes.

Two of the patients recovered. According to Russ this strange symptom

is sometimes instantaneous and in other instances it only appears after

an interval of several hours. In those who survive the effects of the

venom it lasts for an indefinite period. One man seen by Russ had not

only lost his speech in consequence of the bite of a fer-de-lance

snake, but had become, and still remained, hemiplegic. In the rest of

Russ's cases speech alone was abolished. Russ remarks that the

intelligence was altogether intact, and sensibility and power of motion

were unaffected. One woman who had been thus condemned to silence,

suddenly under the influence of a strong excitement recovered her

speech, but when the emotion passed away speech again left her. Ogle

accounts for this peculiar manifestation of aphasia by supposing that

the poison produces spasm of the middle cerebral arteries, and when the

symptom remains a permanent defect the continuance of the aphasia is

probably due to thrombosis of arteries above the temporary constriction.

Anosmia, or loss of smell, is the most common disorder of olfaction; it

may be caused by cortical lesions, olfactory nerve-changes, congenital

absence, or over-stimulation of the nerves, or it may be a symptom of

hysteria.

Ogle, after mentioning several cases of traumatic anosmia, suggests

that a blow on the occiput is generally the cause. Legg reports a

confirmatory case, but of six cases mentioned by Notta two were caused

by a blow on the crown of the head, and two on the right ear. The

prognosis in traumatic anosmia is generally bad, although there is a

record of a man who fell while working on a wharf, striking his head

and producing anosmia with partial loss of hearing and sight, and who

for several weeks neither smelt nor tasted, but gradually recovered.

Mitchell reports a case of a woman of forty who, after an injury to her

nose from a fall, suffered persistent headache and loss of smell. Two

years later, at bedtime, or on going to sleep, she had a sense of

horrible odors, which were fecal or animal, and most intense in nature.

The case terminated in melancholia, with delirium of persecution,

during which the disturbance of smell passed away.

Anosmia has been noticed in leukoderma and allied disturbances of

pigmentation. Ogle mentions a negro boy in Kentucky whose sense of

smell decreased as the leukoderma extended. Influenza, causing

adhesions of the posterior pillars of the fauces, has given rise to

anosmia.

Occasionally overstimulation of the olfactory system may lead to

anosmia. Graves mentions a captain of the yeomanry corps who while

investigating the report that 500 pikes were concealed at the bottom of

a cesspool in one of the city markets superintended the emptying of the

cesspool, at the bottom of which the arms were found. He suffered

greatly from the abominable effluvia, and for thirty-six years

afterward he remained completely deprived of the sense of smell.

In a discussion upon anosmia before the Medico-Chirurgical Association

of London, January 25, 1870, there was an anosmic patient mentioned who

was very fond of the bouquet of moselle, and Carter mentioned that he

knew a man who had lost both the senses of taste and smell, but who

claimed that he enjoyed putrescent meat. Leared spoke of a case in an

epileptic affected with loss of taste and smell, and whose paroxysms

were always preceded by an odor of peach-blossoms.

Hyperosmia is an increase in the perception of smell, which rarely

occurs in persons other than the hysteric and insane. It may be

cultivated as a compensatory process, as in the blind, or those engaged

in particular pursuits, such as tea-tasting. Parosmia is a rare

condition, most often a symptom of hysteria or neurasthenia, in which

everything smells of a similar, peculiar, offensive odor.

Hallucinations of odor are sometimes noticed in the insane. They form

most obstinate cases, when the hallucination gives rise to imaginary

disagreeable, personal odors.

Perversion of the tactile sense, or wrong reference to the sensation of

pain, has occasionally been noticed. The Ephemerides records a case in

which there was the sense of two objects from a single touch on the

hypochondrium. Weir Mitchell remarks that soldiers often misplace the

location of pain after injuries in battle. He also mentions several

cases of wrong reference of the sensation of pain. These instances

cannot be called reflex disturbances, and are most interesting. In one

case the patient felt the pain from a urethral injection in gonorrhea,

on the top of the head. In another an individual let an omnibus-window

fall on his finger, causing but brief pain in the finger, but violent

pains in the face and neck of that side. Mitchell also mentions a

naturalist of distinction who had a small mole on one leg which, if

roughly rubbed or pinched, invariably seemed to cause a sharp pain in

the chin.

Nostalgia is the name generally given to that variety of melancholia in

which there is an intense longing for home or country. This subject has

apparently been overlooked in recent years, but in the olden times it

was extensively discussed. Swinger, Harderus, Tackius, Guerbois,

Hueber, Therrin, Castellanau, Pauquet, and others have written

extensively upon this theme. It is said that the inhabitants of cold

countries, such as the Laplanders and the Danes, are the most

susceptible to this malady. For a long time many writers spoke of the

frequency and intensity of nostalgia among the Swiss. Numerous cases of

suicide from this affliction have been noticed among these hardy

mountaineers, particularly on hearing the mountain-song of their homes,

"Ranz des vaches." This statement, which is an established fact, is

possibly due to the social constitution of the Swiss mountaineers, who

are brought up to a solitary home life, and who universally exhibit

great attachment to and dependence upon their parents and immediate

family. In the European armies nostalgia has always been a factor in

mortality. In the Army of the Moselle, and in Napoleon's Alpine Army,

the terrible ravages of suicide among the young Bretons affected with

nostalgia have been recorded; it is among the French people that most

of the investigation on this subject has been done. Moreau speaks of a

young soldier in a foreign country and army who fell into a most

profound melancholy when, by accident, he heard his native tongue.

According to Swinger and Sauvages women are less subject to nostalgia

than men. Nostalgia has been frequently recorded in hospital wards.

Percy and Laurent have discussed this subject very thoroughly, and cite

several interesting cases among emigrants, soldiers, marines, etc.

Hamilton speaks of a recruit who became prostrated by longing for his

home in Wales. He continually raved, but recovered from his delirium

when assured by the hospital authorities of his forthcoming furlough.

Taylor records two cases of fatal nostalgia. One of the victims was a

Union refugee who went to Kentucky from his home in Tennessee. He died

talking about and pining for his home. The second patient was a member

of a regiment of colored infantry; he died after repeatedly pining for

his old home.

Animals are sometimes subject to nostalgia, and instances are on record

in which purchasers have been compelled to return them to the old home

on account of their literal home-sickness. Oswald tells of a bear who,

in the presence of food, committed suicide by starvation.

Hypochondria consists of a mild form of insanity in which there is a

tendency to exaggerate the various sensations of the body and their

importance, their exaggeration being at times so great as to amount to

actual delusion. All sorts of symptoms are dwelt upon, and the doctor

is pestered to the extreme by the morbid fears of the patient.

Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or

Zwangshandlungen, and by the French, peurs maladies, have only been

quite recently studied, and form most interesting cases of minor

insanity. Gelineau has made extensive investigations in this subject,

and free reference has been made to his work in the preparation of the

following material.

Aichmophobia is a name given by the French to the fear of the sight of

any sharp-pointed instrument, such as a pin, needle, fish-spine, or

naked sword. An illustrious sufferer of this 'phobia was James I of

England, who could never tolerate the appearance of a drawn sword.

Gelineau reports an interesting case of a female who contracted this

malady after the fatigue of lactation of two children. She could not

tolerate knives, forks, or any pointed instruments on the table, and

was apparently rendered helpless in needle-work on account of her

inability to look at the pointed needle.

Agoraphobia is dread of an open space, and is sometimes called

Kenophobia. The celebrated philosopher Pascal was supposed to have been

affected with this fear. In agoraphobia the patient dreads to go across

a street or into a field, is seized with an intense feeling of fright,

and has to run to a wall or fall down, being quite unable to proceed.

There is violent palpitation, and a feeling of constriction is

experienced. According to Suckling, pallor and profuse perspiration are

usually present, but there is no vertigo, confusion of mind, or loss of

consciousness. The patient is quite conscious of the foolishness of the

fears, but is unable to overcome them. The will is in abeyance and is

quite subservient to the violent emotional disturbances. Gray mentions

a patient who could not go over the Brooklyn Bridge or indeed over any

bridge without terror. Roussel speaks of a married woman who had never

had any children, and who was apparently healthy, but who for the past

six months had not been able to put her head out of the window or go

upon a balcony. When she descended into the street she was unable to

traverse the open spaces. Chazarin mentions a case in a woman of fifty,

without any other apparent symptom of diathesis. Gelineau quotes a case

of agoraphobia, secondary to rheumatism, in a woman of thirty-nine.

There is a corresponding fear of high places often noticed, called

acrophobia; so that many people dare not trust themselves on high

buildings or other eminences.

Thalassophobia is the fear of the view of immense spaces or

uninterrupted expanses. The Emperor Heraclius, at the age of

fifty-nine, had an insurmountable fear of the view of the sea; and it

is said that when he crossed the Bosphorus a bridge of boats was

formed, garnished on both sides with plants and trees, obscuring all

view of the water over which the Emperor peacefully traversed on

horseback. The moralist Nicole, was equally a thalassophobe, and always

had to close his eyes at the sight of a large sheet of water, when he

was seized with trembling in all his limbs. Occasionally some accident

in youth has led to an aversion to traversing large sheets of water,

and there have been instances in which persons who have fallen into the

water in childhood have all their lives had a terror of crossing

bridges.

Claustrophobia is the antithesis of agoraphobia. Raggi describes a case

of such a mental condition in a patient who could not endure being

within an enclosure or small space. Suckling mentions a patient of

fifty-six who suffered from palpitation when shut in a railway carriage

or in a small room. She could only travel by rail or go into a small

room so long as the doors were not locked, and on the railroad she had

to bribe the guard to leave the doors unlocked. The attacks were purely

mental, for the woman could be deceived into believing that the door to

a railroad carriage was unlocked, and then the attack would immediately

subside. Suckling also mentions a young woman brought to him at Queen's

Hospital who had a great fear of death on getting into a tram car, and

was seized with palpitation and trembling on merely seeing the car.

This patient had been in an asylum. The case was possibly due more to

fear of an accident than to true claustrophobia. Gorodoichze mentions a

case of claustrophobia in a woman of thirty-eight, in whose family

there was a history of hereditary insanity. Ball speaks of a case in a

woman who was overcome with terror half way in the ascension of the

Tour Saint-Jacques, when she believed the door below was closed.

Gelineau quotes the case of a brave young soldier who was believed to

be afraid of nothing, but who was unable to sleep in a room of which

the door was closed.

Astrophobia or astropaphobia is a morbid fear of being struck by

lightning. It was first recognized by Bruck of Westphalia, who knew a

priest who was always in terror when on a country road with an

unobstructed view of the sky, but who was reassured when he was under

the shelter of trees. He was advised by an old physician always to use

an umbrella to obstruct his view of the heavens, and in this way his

journeys were made tranquil. Beard knew an old woman who had suffered

all her life from astrophobia. Her grandmother had presented the same

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