SYMPTOMS.
Catalepsy is essentially a paroxysmal or intermittent affection. For its devel opment in its typical form it probably always requires on the part of the sub ject a certain predisposition, an unstable and excitable nervous condition, a tend ency to hysterical manifestations, most prominent among which is hypersensi tiveness of some of the special senses. The paroxysms vary greatly in their severity and duration. The pronounced symptoms usually come on suddenly, but these are often preceded by headache, slight hysterical manifestations, giddi ness, gastric symptoms, or hiccough. The special symptoms are ushered in by all or part of the voluntary muscles sud denly becoming rigid, the limbs remain ing in the positions in which they were arrested by the onset of the attack.
In some cases the arm stops in the act of carrying a cup to the mouth; the latter remains open and the whole body assumes a fixed position, as if petrified. At first the muscles are quite rigid and resist strong passive motion; but soon the rigidity is followed by a soft, wax like state of the muscles. The limbs may then be placed in various positions by moderate passive motion, and in these they will remain for several minutes, or even for hours in some cases. If an arm or a leg is placed at a right angle with the body, with no support except that given by the muscles in a state of in creased tension, it would be main tained in this uncomfortable position for a considerable length of time; but after awhile the limb from force of gravity begins gradually to descend. Two important observations may be made at this stage of the attack that have considerable diagnostic value. One is that the patient's features and respira tion show no evidence of fatigue or vol untary effort, and the other is that if a weight of a few pounds is suspended to the limb, or passive motion is exerted to overcome the tension of the muscles that hold the limb in its position, the mem ber gradually descends, without any ex tra effort being exerted to keep it from falling. Consciousness is always im paired, and sometimes apparently com pletely lost, from the first. The degree of disturbed consciousness varies in dif ferent cases. In some eases it seems to be completely abolished.
[I think Dr. C. K. Mills is right in cautioning against haste in believing that unconsciousness is complete in a given case. J. T. ESKRIDGE.] In a few cases in which the cataleptic condition of the muscles is well marked the patient makes no attempt to answer questions or to move when the skin is irritated, because volition is in abeyance; but the patient may know everything that goes on around her. The pulse, temperature and respiration are slightly changed. The pulse is slow or normal; the temperature is usually a little sub normal; sometimes it is one or several degrees below the normal; respiration is quiet, shallow, and sometimes almost im perceptible. The face is pale, the eyes wide open and looking horizontally for ward. Sometimes the lids are partially or gently closed. The pupils are dilated,
often react to light slowly, but in some cases they show no response. The fundi and optic nerves have been found ane mic, according to W. A. Hammond. The features frequently present a blank or placid appearance, but in some cases they show evidences of mental agitation. The skin is often very cool and pale, especially if the paroxysm is prolonged; this with the almost imperceptible res piration and expressionless features, open eyes, and dilated pupils—give the patient the appearance of death, for which catalepsy is said to have been mis taken.
Cutaneous sensibility is often abol ished; in some cases it is only impaired; rarely a condition of hypermsthesia has been observed. The cornea, conjunctiva, and pharynx may present no evidence of sensation, or they may retain partial sen sibility; so that the eyelids will close when the eyeball is touched, and the re flex of the pharynx may be obtained. In some cases the power of deglutition is said to have been lost, but, more com monly, when the food is placed on the posterior portion of the tongue it will be swallowed_ Thp rlppn reflpyps are usually lessened; they are rarely increased, and in some cases absent. They may be present on one side and absent on the other, although the wax-like condition of the muscles is bilateral. The func tions of the special senses seem to be im paired or abolished, although in some cases it is possible to elicit a response from the patient by stimulating the or gan of hearing, and occasionally that of sight. The electrical reactions of the muscles and nerves have been found: normal, lessened, and in exceptional cases increased.
The paroxysms, even if prolonged, do not remain at their height for a great length of time. They may last only a few minutes, hours, or in rare cases days. In the prolonged attacks there are usually intermissions or remissions. during which the patient completely or partially arouses for a few minutes and then relapses. Hammond says the par oxysm generally disappears as abruptly as it began. "A few deep inspirations are taken. the eyes are opened, or lose their fixedness, the muscles relax, and consciousness is restored. but no knowl edge of what has occurred is retained." It is probable that in the majority of cases there is gradual restoration to con sciousness, the patient remaining be wildered and stupid and the muscles more or less rigid during the emergence from the cataleptic state. Eulenburg states that in some cases the attacks may disappear quite suddenly. "The pa tients recover at once full consciousness and the normal use of their muscles, take up their employment which had been interrupted, continue the sentence previously commenced, and conduct themselves as if not the slightest thing had intervened." [I have seen a few such cases, but 1 have looked upon them as epileptic in character, and of the variety known as petit mat. The subsequent course of two of these has shown that our appre hensions had been NIT] I founded. J. T.