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A CASE PRESENTING ANOMALOUS SYMPTOMS OF APPARENTLY HYSTERICAL CHARACTER.
64 nitric acid lotion during the day, or one of this form, which is much used at the Skin Hospital: a drachm of borax, half an ounce of rectified spirit, one grain of the bichloride of mercury, and eight ounces of water. George-street, Hanover-square, 1864.
considerable effort to
displace
or
bend her extremities.
Her
eyes were widely opened; the ball of the eye immovably fixed; the conjunctiva injected from continued exposure to the air. She never blinked, but could be made to do so by rapidly wafting the hand at the distance of an inch or two from the eye, and which was no doubt a reflex action caused by the impression of the air on the highly sensitive conjunctiva. The pupils of the eyes were greatly dilated, but the iris being in a state of
A CASE PRESENTING ANOMALOUS SYMP- perpetual motion, their dimensions were ever altering. On approaching a light to the eye the pupil contracted, but instantly TOMS OF APPARENTLY HYSTERICAL regained its former dimensions when taken away. There was CHARACTER.* a slight degree of ptosis of the right eyelid, and I also noticed an equally slight deviation of the left angle of the mouth. The BY RICHARD HOLT, ESQ., pulse was frequent (90) and full; the temperature of the skin HOUSE-SURGEON TO THE GENERAL LYING IN HOSPITAL, YORK-ROAD, increased; the face slightly flushed; and the pulsation of the LAMBETH. carotids could be distinctly perceived. I titillated the soles of the feet., but it had not the slightest effect. I pinched up a TERESINA B-,better known under the name of " L’Incle- fold of the skin of the dorsum of the hand with a pair of forceps, and twisted it round and round with considermoniata," aged fourteen; of a bilio sanguineous temperament; dressing able force, without obtaining the slightest manifestation of non-menstruated; of an apparently sound constitution; bearing feeling, although, if sensation had not been abolished, such an no outward marks of a scrofulous, rachitic, or herpetic diathesis, experiment must have caused intolerable pain. I next raised and declaring that up to the age of twelve, the time at which her up, and placed the trunk in an oblique position at an of 45° to the bed. She only retained this position, which she became affected with her present malady, she had never angle considerable muscular effort, for about the space of required suffered from any previous disease, with the exception of an one minute, during which the recti muscles were thrown into intermittent fever of a few days’ duration, was admitted into violent contraction; she became very flushed in the face, and the wards of Signor Gamberini, in the Ospedale Maggiore, of gradually sank back on her pillow. Dr. Gamberini, who on the same evening two hours later, asserted that Milan, at the commencement of 1862, for a nervous disease for visited her tried the same experiment she retained this position having which she had undergone at home during two years every ima- for a considerable time, and that he had to use some degree of ginable, yet unavailing, method of treatment, and which was force to make her resume the horizontal position. These so extraordinary a nature that the physicians were quite embarrassed what name to apply to it, never before having witnessed its counterpart. J shall, therefore, imitate their wise reserve, and limit myself to describing the various phenomena by which it was attended, without attempting to assign a name ’ to a disease of which I know of no analogous example. The causes which might have originated the malady are obscure. She declared that she never suffered from any contusion of the head or other local lesion, gastro-enteric irritation, repercussed exanthemata, worms, &c. Moreover, the teeth were all sound. The only thing I could ascertain which might have acted as a determinating cause was a fright occasioned by some men with masks, which she experienced shortly before the manifestation of the present symptoms, which I shall now proceed to describe. Every day, precisely as the clock strikes one, she begins to shake her head from right to left, gently at first, but with everincreasing rapidity ; and so great is the velocity these movements attain towards three o’clock, that it is almost impossible
of
,
distinguish her features. Her long hair is wafted in all directions ; her mouth is firmly compressed, and her fists are clenched. From time to time she bursts out into a violent fit of laughter. During this period the pupil of the eye is contracted, but there are no muscular twitchings of the face or extremities; no strabismus or other signs of irritation of the cerebrospinal nerves. She is perfectly conscious, understanding everything that is said to
to her. I held out my hand, and told her to come away from the place where she was sitting. She instantly grasped it, and walked for about ten yards to another seat. A few minutes before three o’clock she utters, in quick succession, some incomprehensible words. This, as the nun told me, is an infallible sign that the paroxysm is about to terminate, and exactly at three o’clock the gyration of the head suddenly stops. She falls back in a state of complete exhaustion, panting for breath, and covered with profuse perspiration. Water being given to her she soon recovers, and remains perfectly calm, snpporting her head on her hands till about half-past four o’clock, when she eagerly asks for her dinner. As soon as this is finished she is put to bed, for precisely at five o’clock she falls back into a state of complete insensibility, and remains so till five o’clock next morning ; and from that time till the recurrence of the access at one she is perfectly calm and sensible. I shall now briefly describe what t myself witnessed on the two occasions I visited her whilst in this condition. I found her lying on her back at full length in the bed. All the muscles of the body seemed unnaturally rigid, requiring some
different results
position nervous
are to a certain degree explicable by the supthat at the early hour at which I visited her the phenomena had not yet attained their maximum of in-
tensity ; but Dr. Gamberini himself acknowledged that
on sube obtain such marked results. Thus far most of the symptoms would seem to coincide with those of an ordinary case of catalepsy, but the following considerations will show that there exists a marked difference between the two diseases. In catalepsy, as soon as the access is over, the patient seems as if he had been aroused from a profound sleep, not retaining the slightest recollection of anything that occurred during the paroxysm. Here, on the contrary, the patient, though unable to speak or move, is perfectly conscious of everything that takes place around her, and is able next morning to repeat word for word whatever has been said in her hearing. A few evenings previous to my visit the assistant-physician stuck some pins into her arms. She gave no signs of feeling at the time, but next morning, as soon as he made his appearance, she assailed him with bitter reproaches for his inhumanity towards her. Another remarkable circumstance in connexion with this disease is, that during the intervals of the part xysms (i, e., from five A.lI1. to one P.M., and from three r.M. to five P.M.), although according to her own assertion she feels perfectly well, yet she is unable to walk even a single step unsupported. This, however, seems to depend more on the will than the power, for I put one end of a quill into her hand whilst I held the other lightly between my tinger and thumb, and thus conducted her across the room, though it is evident that this could not have afforded her any effectual support. The patient, who has been upwards of a year an inmate of the hospital, during which time antiphlogistics, antispasmodics, tonics, &c., have all been tried in succession, and all found equally inefficient, is now on the point ofbeing discharged incurable. January, 1864.
sequent evenings he did
not
THE CINCHONA PLANT IN JAMAICA.—In the autumn of 1860 a quantitv of the seeds of several species of the Cinchona were received at Jamaica. By the month of October following abont 400 healthy plants were raised, but owing to the low level at which they were planted, more than half perished. They were then removed to an elevation of about 4000 feet above sea level, with the best results. In twelve months a plant of the red bark (Cinchona succirubra) had attained theheight of 44 inches, with leaves measuring lpz inches in length by 8 3/4inches in breadth. The culture of the Cinchona micrantha (grey bark) has not been so successful ; the leaves are, however, much larger. As there is abundance of land in the island possessing all the conditions requisite for the growth of this case; but a large supply may shortly be to a condition the plant, it is anticipated that
* Mr. Holt abstains from giving ary name to the disease in there does not seem to be any reason for giving a special name which would appear to be only one of anomalous hysteria.-ED. L.
produced.
considerable effort to
displace
or
bend her extremities.
Her
eyes were widely opened; the ball of the eye immovably fixed; the conjunctiva injected from continued exposure to the air. She never blinked, but could be made to do so by rapidly wafting the hand at the distance of an inch or two from the eye, and which was no doubt a reflex action caused by the impression of the air on the highly sensitive conjunctiva. The pupils of the eyes were greatly dilated, but the iris being in a state of
A CASE PRESENTING ANOMALOUS SYMP- perpetual motion, their dimensions were ever altering. On approaching a light to the eye the pupil contracted, but instantly TOMS OF APPARENTLY HYSTERICAL regained its former dimensions when taken away. There was CHARACTER.* a slight degree of ptosis of the right eyelid, and I also noticed an equally slight deviation of the left angle of the mouth. The BY RICHARD HOLT, ESQ., pulse was frequent (90) and full; the temperature of the skin HOUSE-SURGEON TO THE GENERAL LYING IN HOSPITAL, YORK-ROAD, increased; the face slightly flushed; and the pulsation of the LAMBETH. carotids could be distinctly perceived. I titillated the soles of the feet., but it had not the slightest effect. I pinched up a TERESINA B-,better known under the name of " L’Incle- fold of the skin of the dorsum of the hand with a pair of forceps, and twisted it round and round with considermoniata," aged fourteen; of a bilio sanguineous temperament; dressing able force, without obtaining the slightest manifestation of non-menstruated; of an apparently sound constitution; bearing feeling, although, if sensation had not been abolished, such an no outward marks of a scrofulous, rachitic, or herpetic diathesis, experiment must have caused intolerable pain. I next raised and declaring that up to the age of twelve, the time at which her up, and placed the trunk in an oblique position at an of 45° to the bed. She only retained this position, which she became affected with her present malady, she had never angle considerable muscular effort, for about the space of required suffered from any previous disease, with the exception of an one minute, during which the recti muscles were thrown into intermittent fever of a few days’ duration, was admitted into violent contraction; she became very flushed in the face, and the wards of Signor Gamberini, in the Ospedale Maggiore, of gradually sank back on her pillow. Dr. Gamberini, who on the same evening two hours later, asserted that Milan, at the commencement of 1862, for a nervous disease for visited her tried the same experiment she retained this position having which she had undergone at home during two years every ima- for a considerable time, and that he had to use some degree of ginable, yet unavailing, method of treatment, and which was force to make her resume the horizontal position. These so extraordinary a nature that the physicians were quite embarrassed what name to apply to it, never before having witnessed its counterpart. J shall, therefore, imitate their wise reserve, and limit myself to describing the various phenomena by which it was attended, without attempting to assign a name ’ to a disease of which I know of no analogous example. The causes which might have originated the malady are obscure. She declared that she never suffered from any contusion of the head or other local lesion, gastro-enteric irritation, repercussed exanthemata, worms, &c. Moreover, the teeth were all sound. The only thing I could ascertain which might have acted as a determinating cause was a fright occasioned by some men with masks, which she experienced shortly before the manifestation of the present symptoms, which I shall now proceed to describe. Every day, precisely as the clock strikes one, she begins to shake her head from right to left, gently at first, but with everincreasing rapidity ; and so great is the velocity these movements attain towards three o’clock, that it is almost impossible
of
,
distinguish her features. Her long hair is wafted in all directions ; her mouth is firmly compressed, and her fists are clenched. From time to time she bursts out into a violent fit of laughter. During this period the pupil of the eye is contracted, but there are no muscular twitchings of the face or extremities; no strabismus or other signs of irritation of the cerebrospinal nerves. She is perfectly conscious, understanding everything that is said to
to her. I held out my hand, and told her to come away from the place where she was sitting. She instantly grasped it, and walked for about ten yards to another seat. A few minutes before three o’clock she utters, in quick succession, some incomprehensible words. This, as the nun told me, is an infallible sign that the paroxysm is about to terminate, and exactly at three o’clock the gyration of the head suddenly stops. She falls back in a state of complete exhaustion, panting for breath, and covered with profuse perspiration. Water being given to her she soon recovers, and remains perfectly calm, snpporting her head on her hands till about half-past four o’clock, when she eagerly asks for her dinner. As soon as this is finished she is put to bed, for precisely at five o’clock she falls back into a state of complete insensibility, and remains so till five o’clock next morning ; and from that time till the recurrence of the access at one she is perfectly calm and sensible. I shall now briefly describe what t myself witnessed on the two occasions I visited her whilst in this condition. I found her lying on her back at full length in the bed. All the muscles of the body seemed unnaturally rigid, requiring some
different results
position nervous
are to a certain degree explicable by the supthat at the early hour at which I visited her the phenomena had not yet attained their maximum of in-
tensity ; but Dr. Gamberini himself acknowledged that
on sube obtain such marked results. Thus far most of the symptoms would seem to coincide with those of an ordinary case of catalepsy, but the following considerations will show that there exists a marked difference between the two diseases. In catalepsy, as soon as the access is over, the patient seems as if he had been aroused from a profound sleep, not retaining the slightest recollection of anything that occurred during the paroxysm. Here, on the contrary, the patient, though unable to speak or move, is perfectly conscious of everything that takes place around her, and is able next morning to repeat word for word whatever has been said in her hearing. A few evenings previous to my visit the assistant-physician stuck some pins into her arms. She gave no signs of feeling at the time, but next morning, as soon as he made his appearance, she assailed him with bitter reproaches for his inhumanity towards her. Another remarkable circumstance in connexion with this disease is, that during the intervals of the part xysms (i, e., from five A.lI1. to one P.M., and from three r.M. to five P.M.), although according to her own assertion she feels perfectly well, yet she is unable to walk even a single step unsupported. This, however, seems to depend more on the will than the power, for I put one end of a quill into her hand whilst I held the other lightly between my tinger and thumb, and thus conducted her across the room, though it is evident that this could not have afforded her any effectual support. The patient, who has been upwards of a year an inmate of the hospital, during which time antiphlogistics, antispasmodics, tonics, &c., have all been tried in succession, and all found equally inefficient, is now on the point ofbeing discharged incurable. January, 1864.
sequent evenings he did
not
THE CINCHONA PLANT IN JAMAICA.—In the autumn of 1860 a quantitv of the seeds of several species of the Cinchona were received at Jamaica. By the month of October following abont 400 healthy plants were raised, but owing to the low level at which they were planted, more than half perished. They were then removed to an elevation of about 4000 feet above sea level, with the best results. In twelve months a plant of the red bark (Cinchona succirubra) had attained theheight of 44 inches, with leaves measuring lpz inches in length by 8 3/4inches in breadth. The culture of the Cinchona micrantha (grey bark) has not been so successful ; the leaves are, however, much larger. As there is abundance of land in the island possessing all the conditions requisite for the growth of this case; but a large supply may shortly be to a condition the plant, it is anticipated that
* Mr. Holt abstains from giving ary name to the disease in there does not seem to be any reason for giving a special name which would appear to be only one of anomalous hysteria.-ED. L.
produced.