XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES
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, characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium, and various other phenomena. It is also called aural or auditory vertigo. The salient symptom is vertigo, and this varies somewhat in degree according to the portions of the ear affected. If the disease is in the labyrinth, the patient is supposed to stagger to one side, and the vertigo is paroxysmal, varying to such a degree as to cause simple reeling, or falling as if shot. Gray reports the history of a patient with this sensational record: He had been a peasant in Ireland, and one day crossing one of the wide moors in a dog-cart, he was suddenly, as he thought, struck a violent blow from behind, so that he believed that he lost consciousness for some time. At all events, when he was able to get up he found his horse and cart some distance off, and, of course, not a soul in sight. Under the belief that he had been struck by some enemy he went quietly home and said nothing about it. Some time afterward, however, in crossing another lonely place he had a similar experience, and as he came to the conclusion that nobody could have been near him, he made up his mind that it was some malevolent stroke of the devil and he consulted a priest who agreed with him in his belief, and gave him an amulet to wear. A series of similar attacks occurred and puzzled as to whether there was some diabolical agency at work, or whether he was the victim of some conspiracy, he emigrated to America; for several months he had no attacks. A new paroxysm occurring he consulted Gray, who found indubitable evidence of labyrinthine disease. The paroxysms of this disease are usually accompanied by nausea and vomiting, and on account of the paleness of the face, and the cold, clammy perspiration, attacks have frequently been mistaken for apoplexy. In disease of the middle ear the attacks are continuous rather than paroxysmal. If the disease is in the middle or internal ears, loud noises are generally heard, but if the disease is in the external ear, the noises are generally absent, and the vertigo of less degree but continuous. The prognosis varies with the location of the disease, but is always serious.
Human rumination has been known for many years. Bartholinus, Paullinus, Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius, Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others describe it. Fabricius d'Aquapendente personally knew a victim of rumination, or, as it is generally called, merycism. The dissection by Bartholinus of a merycol showed nothing extraordinary in the cadaver. Winthier knew a Swede of thirty-five, in Germany, apparently healthy, but who was obliged when leaving the table to retire to some remote place where he might eject his food into his mouth again, saying that it gave him the sensation of sweetest honey. The patient related that from his infancy he had been the subject of acid eructations, and at the age of thirty he commenced rumination as a means of relief. To those who are interested in the older records of these cases Percy and Laurent offer the descriptions of a number of cases.
In a recent discussion before the American Neurological Association Hammond defined merycism as the functions of remastication and rumination in the human subject. He referred to several cases, among them that of the distinguished physiologist, Brown-Sequard, who acquired the habit as a result of experiments performed upon himself. Hammond reported a case of a young man who was the subject of merycism, and whose mental condition was also impaired. No special treatment was undertaken, but the patient was trephined, with the purpose of improving his mental condition. There were no unusual features connected with the operation, but it was noticed that there were no ruminations with the meals he took until the fifth day, when a slight rumination occurred. Eight days later a similar button was removed from the corresponding side of the left skull, and from that time (about six months) to the time of report, there had been no regurgitation. Whether the cure of the merycism in this case was directly due to the operations on the cranium, or the result of the mental improvement, is a question for discussion. Hammond added that, when acquired, merycism was almost invariably the result of over-eating and loading the esophagus, or the result of fast eating.
In remarks upon Hammond's paper Knapp said that two cases had come to his knowledge, both in physicians, but one of them he knew of only by hearsay. The other man, now over thirty, had regurgitated his food from early childhood, and he did not know that he had anything very unusual the matter with him until he began some investigations upon the functions and diseases of the stomach. This man was not nervous, and was certainly not an idiot. He had done active work as a physician, and called himself in perfect health. He was something of an epicure, and never suffered from indigestion. After a hearty meal the regurgitation was more marked. Food had been regurgitated, tasting as good as when first eaten, several hours after the eating. If he attempted to check the regurgitation he sometimes had a slight feeling of fulness in the stomach. Lloyd said that these cases were forms of neuroses, and were types of hysteric vomiting. There was no gustatory satisfaction connected with any form of hysteric vomiting that he had seen. In some of these cases of hysteric vomiting the food does not appear to enter the stomach, but is rejected by a sort of spasm of the esophagus. This has been called "esophagismus," and is apparently closely allied to this neurosis, which some have called "merycism." The President of the Association said that this would seem to be an affection common among physicians. A student friend of his who had been affected in this way, had written an elaborate monograph on the subject. He was disgusted with the habit, and finally overcame it by the exercise of his will-power.
Runge discusses three cases of hereditary rumination. These patients belonged to three generations in the male line. The author subjected the contents of the stomach of one patient to quite an extensive analysis, without finding any abnormality of secretion.
Wakefulness.--Generally speaking, the length of time a person can go without sleep is the same as that during which he can survive without food. Persons, particularly those of an hysteric nature, are prone to make statements that they have not slept for many days, or that they never sleep at all, but a careful examination and watch during the night over these patients show that they have at least been in a drowsy, somnolent condition, which is in a measure physiologically equivalent to sleep. Accounts of long periods of wakefulness arise from time to time, but a careful examination would doubtless disprove them. As typical of these accounts, we quote one from Anderson, Indiana, December 11, 1895:--
"David Jones of this city, who attracted the attention of the entire medical profession two years ago by a sleepless spell of ninety-three days, and last year by another spell which extended over one hundred and thirty-one days, is beginning on another which he fears will be more serious than the preceding ones. He was put on the circuit jury three weeks ago, and counting to-day has not slept for twenty days and nights. He eats and talks as well as usual, and is full of business and activity. He does not experience any bad effects whatever from the spell, nor did he during his one hundred and thirty-one days. During that spell he attended to all of his farm business. He says now that he feels as though he never will sleep again. He does not seem to bother himself about the prospects of a long and tedious wake. He cannot attribute it to any one thing, but thinks that it was probably superinduced by his use of tobacco while young."
Somnambulism, or, as it has been called, noctambulation, is a curious phase of nocturnal cerebration analogous to the hypnotic state, or double consciousness occasionally observed in epileptics. Both Hippocrates and Aristotle discuss somnambulism, and it is said that the physician Galen was a victim of this habit. Horstius, ab Heers, and many others of the older writers recorded interesting examples of this phenomenon. Schenck remarks on the particular way in which somnambulists seem to escape injury. Haller, Hoffmann, Gassendi, Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all the ancient physiologists and anatomists have written on this subject. The marvelous manifestations of somnambulism are still among the more surprising phenomena with which science has to deal. That a person deeply immersed in thought should walk and talk while apparently unconscious, excites no surprise, but that anyone should when fast asleep perform a series of complicated actions which undoubtedly demand the assistance of the senses is marvelous indeed. Often he will rise in the night, walk from room to room, go out on porticoes, and in some cases on steep roofs, where he would not dare to venture while awake. Frequently he will wander for hours through streets and fields, returning home and to bed without knowledge of anything having transpired.
The state of the eyes during somnambulism varies considerably. They are sometimes closed, sometimes half-closed, and frequently quite open; the pupil is sometimes widely dilated, sometimes contracted, sometimes natural, and for the most part insensible to light.
Somnambulism seems to be hereditary. Willis cites an example in which the father and the children were somnambulists, and in other cases several individuals in the same family have been afflicted. Horstius gives a history of three young brothers who became somnambulistic at the same epoch. A remarkable instance of somnambulism was the case of a lad of sixteen and a half years who, in an attack of somnambulism, went to the stable, saddled his horse, asked for his whip, and disputed with the toll-keeper about his fare, and when he awoke had no recollection whatever of his acts, having been altogether an hour in his trance.
Marville quotes the case of an Italian of thirty, melancholic, and a deep thinker, who was observed one evening in his bed. It was seen that he slept with his eyes open but fixed and immovable. His hands were cold, and his pulse extremely slow. At midnight he brusquely tore the curtains of his bed aside, dressed himself, went to his stable, and mounted a horse. Finding the gate of the court yard closed he opened it with the aid of a large stone. Soon he dismounted, went to a billiard room, and simulated all the movements of one playing. In another room he struck with his empty hands a harpsichord, and finally returned to his bed. He appeared to be irritated when anybody made a noise, but a light placed under his nose was apparently unnoticed. He awoke if his feet were tickled, or if a horn was blown in his ear. Tissot transmits to us the example of a medical student who arose in the night, pursued his studies, and returned to bed without awaking; and there is another record of an ecclesiastic who finished his sermon in his sleep.
The Archbishop of Bordeaux attests the case of a young ecclesiastic who was in the habit of getting up during the night in a state of somnambulism, taking pen, ink, and paper, and composing and writing sermons. When he had finished a page he would read aloud what he had written and correct it. In order to ascertain whether the somnambulist made any use of his eyes the Archbishop held a piece of cardboard under his chin to prevent his seeing the paper upon which he was writing. He continued to write without being in the slightest degree incommoded. In this state he also copied out pieces of music, and when it happened that the words were written in too large characters and did not stand over the corresponding notes he perceived his error, blotted them out, and wrote them over again with great exactness.
Negretti, a sleep-walker, sometimes carried a candle about with him as if to furnish him light in his employment, but when a bottle was substituted he carried it, fancying that he had the candle. Another somnambulist, Castelli, was found by Dr. Sloane translating Italian and French and looking out words in his dictionary. His candle was purposely extinguished, whereupon he immediately began groping about, as if in the dark, and, although other lighted candles were in the room, he did not resume his occupation until he had relighted his candle at the fire. He was insensible to the light of every candle excepting the one upon which his attention was fixed.
Tuke tells of a school-boy who being unable to master a school-problem in geometry retired to bed still thinking of the subject; he was found late at night by his instructor on his knees pointing from spot to spot as though he were at the blackboard. He was so absorbed that he paid no attention to the light of the candle, nor to the speech addressed to him. The next morning the teacher asked him if he had finished his problem, and he replied that he had, having dreamt it and remembered the dream. There are many such stories on record. Quoted by Gray, Mesnet speaks of a suicidal attempt made in his presence by a somnambulistic woman. She made a noose of her apron, fastened one end to a chair and the other to the top of a window. She then kneeled down in prayer, made the sign of the cross, mounted a stool, and tried to hang herself. Mesnet, scientific to the utmost, allowed her to hang as long as he dared, and then stopped the performance. At another time she attempted to kill herself by violently throwing herself on the floor after having failed to fling herself out of the window. At still another time she tried poison, filling a glass with water, putting several coins into it, and hiding it after bidding farewell to her family in writing; the next night, when she was again somnambulistic, she changed her mind once more, writing to her family explaining her change of purpose. Mesnet relates some interesting experiments made upon a French sergeant in a condition of somnambulism, demonstrating the excitation of ideas in the mind through the sense of touch in the extremities. This soldier touched a table, passed his hands over it, and finding nothing on it, opened the drawer, took out a pen, found paper and an inkstand, and taking a chair he sat down and wrote to his commanding officer speaking of his bravery, and asking for a medal. A thick metallic plate was then placed before his eyes so as to completely intercept vision. After a few minutes, during which he wrote a few words with a jumbled stroke, he stopped, but without any petulance. The plate was removed and he went on writing. Somnambulism may assume such a serious phase as to result in the commission of murder. There is a case of a man of twenty-seven, of steady habits, who killed his child when in a state of somnambulism. He was put on trial for murder, and some of the most remarkable facts of his somnambulistic feats were elicited in the evidence. It is said that once when a boy he arose at night while asleep, dressed himself; took a pitcher and went for milk to a neighboring farm, as was his custom. At another time he worked in a lumber-yard in a rain-storm while asleep. Again, when about twenty-one, he was seen in a mill-pond wading about attempting to save his sister who he imagined was drowning. The worst phase of his somnambulism was the impending fears and terrible visions to which he was subjected. Sometimes he would imagine that the house was on fire and the walls about to fall upon him, or that a wild beast was attacking his wife and child; and he would fight, screaming inarticulately all the while. He would chase the imaginary beast about the room, and in fact had grasped one of his companions, apparently believing he was in a struggle with a wild beast. He had often injured himself in these struggles, and had often attacked his father, his wife, sister, fellow-lodgers, and while confined in jail he attacked one of his fellow-prisoners. His eyes would always be wide open and staring; he was always able to avoid pieces of furniture which were in his way, and he occasionally threw them at his visionary enemies. At the time of the murder of his child, in a somnambulistic attack, he imagined that he saw a wild beast rise up from the floor and fly at his child, a babe of eighteen months. He sprang at the beast and dashed it to the ground, and when awakened, to his horror and overwhelming grief he found that he had killed his beloved baby. A similar record has been reported of a student who attempted during the night to stab his teacher; the man was disarmed and locked up in another portion of the building; but he had not the slightest remembrance of the events of the night.
Yellowlees speaks of homicide by a somnambulist. According to a prominent New York paper, one of the most singular and at the same time sad cases of somnambulism occurred a few years ago near Bakersville, N.C. A young man there named Garland had been in the habit of walking in his sleep since childhood. Like most other sleep-walkers when unmolested, his ramblings had been without harm to himself or others. Consequently his wife paid little attention to them. But finally he began to stay away from the house longer than usual and always returned soaking wet. His wife followed him one night. Leaving his home he followed the highway until he came to a rough, narrow pig-trail leading to the Tow River. His wife followed with difficulty, as he picked his way through the tangled forest, over stones and fallen trees and along the sides of precipitous cliffs. For more than a mile the sleeper trudged on until he came to a large poplar tree, which had fallen with its topmost branches far out in the river. Walking on the log until he came to a large limb extending over the water, he got down on his hands and knees and began crawling out on it. The frightened wife screamed, calling to him to wake up and come back. He was awakened by the cries, fell into the river, and was drowned. Each night for weeks he had been taking that perilous trip, crawling out on the limb, leaping from it into the river, swimming to the shore, and returning home unconscious of anything having happened.
Dreams, nightmare, and night terrors form too extensive a subject and one too well known to be discussed at length here, but it might be well to mention that sometimes dreams are said to be pathognomonic or prodromal of approaching disease. Cerebral hemorrhage has often been preceded by dreams of frightful calamities, and intermittent fever is often announced by persistent and terrifying dreams. Hammond has collected a large number of these prodromic dreams, seeming to indicate that before the recognizable symptoms of disease present themselves a variety of morbid dreams may occur. According to Dana, Albers says: "Frightful dreams are signs of cerebral congestion. Dreams about fire are, in women, signs of impending hemorrhage. Dreams about blood and red objects are signs of inflammatory conditions. Dreams of distorted forms are frequently a sign of abdominal obstruction and diseases of the liver."
Catalepsy, trance, and lethargy, lasting for days or weeks, are really examples of spontaneously developed mesmeric sleep in hysteric patients or subjects of incipient insanity. If the phenomenon in these cases takes the form of catalepsy there is a waxy-like rigidity of the muscles which will allow the limbs to be placed in various positions, and maintain them so for minutes or even hours. In lethargy or trance-states the patient may be plunged into a deep and prolonged unconsciousness lasting from a few hours to several years. It is in this condition that the lay journals find argument for their stories of premature burial, and from the same source the fabulous "sleeping girls" of the newspapers arise. Dana says that some persons are in the habit of going into a mesmeric sleep spontaneously. In these states there may be a lowering of bodily temperature, a retarding of the respiration and heart-action, and excessive sluggishness of the action of the bowels. The patients can hear and may respond to suggestions, though apparently insensible to painful impressions, and do not appear to smell, taste, or see; the eyes are closed, turned upward, and the pupils contracted as in normal sleep.
This subject has been investigated by such authorities as Weir Mitchell and Hammond, and medical literature is full of interesting cases, many differing in the physiologic phenomena exhibited; some of the most striking of these will be quoted. Van Kasthoven of Leyden reports a strange case of a peasant of Wolkwig who, it is alleged, fell asleep on June 29, 1706, awakening on January 11, 1707, only to fall asleep again until March 15th of the same year. Tuke has resurrected the remarkable case reported by Arnold of Leicester, early in this century. The patient's name was John Engelbrecht. This man passed into a condition of catalepsy in which he heard everything about him distinctly, but in his imagination he seemed to have passed away to another world, this condition coming on with a suddenness which he describes as with "far more swiftness than any arrow can fly when discharged from a cross-bow." He also lost his sensation from the head downward, and recovered it in the opposite direction. At Bologna there was observed the case of a young female who after a profound grief had for forty-two successive days a state of catalepsy lasting from midday to midnight. Muller of Lowenburg records a case of lethargy in a young female, following a sudden fright in her fourteenth year, and abrupt suppression of menstruation. This girl was really in a sleep for four years. In the first year she was awake from one minute to six hours during the day. In the second and third years she averaged four hours wakefulness in ninety-six hours. She took very little nourishment and sometimes had no bowel-movement for sixteen days. Scull reports the history of a man of twenty-seven suffering with incipient phthisis, who remained bedridden and in a state of unconsciousness for fifteen months. One day while being fed he spoke out and asked for a glass of water in his usual manner, and so frightened his sister that she ran from the room. The man had remembered nothing that had occurred during the fifteen months, and asked who was president and seemed eager for news. One curious fact was that he remembered a field of oats which was just sprouting about the time he fell in the trance. The same field was now standing in corn knee-high. After his recovery from the trance he rapidly became worse and died in eighteen months. There is a record of a man near Rochester, N.Y., who slept for five years, never waking for more than sixteen hours at a time, and then only at intervals of six weeks or over. When seized with his trance he weighed 160, but he dwindled down to 90 pounds. He passed urine once or twice a day, and had a stool once in from six to twenty days. Even such severe treatment as counter-irritation proved of no avail. Gunson mentions a man of forty-four, a healthy farmer, who, after being very wet and not changing his clothes, contracted a severe cold and entered into a long and deep sleep lasting for twelve hours at a time, during which it was impossible to waken him. This attack lasted eight or nine months, but in 1848 there was a recurrence accompanied by a slight trismus which lasted over eighteen months, and again in 1860 he was subjected to periods of sleep lasting over twenty-four hours at a time. Blaudet describes a young woman of eighteen who slept forty days, and again after her marriage in her twentieth year she slept for fifty days; it was necessary to draw a tooth to feed her. Four years later, on Easter day, 1862, she became insensible for twelve months, with the exception of the eighth day, when she awoke and ate at the table, but fell asleep in the chair. Her sleep was so deep that nothing seemed to disturb her; her pulse was slow, the respirations scarcely perceptible, and there were apparently no evacuations.
Weir Mitchell collected 18 cases of protracted sleep, the longest continuing uninterruptedly for six months. Chilton's case lasted seventeen weeks. Six of the 18 cases passed a large part of each day in sleep, one case twenty-one hours, and another twenty-three hours. The patients were below middle life; ten were females, seven males, and one was a child whose sex was not given. Eight of the 18 recovered easily and completely, two recovered with loss of intellect, one fell a victim to apoplexy four months after awakening, one recovered with insomnia as a sequel, and four died in sleep. One recovered suddenly after six months' sleep and began to talk, resuming the train of thought where it had been interrupted by slumber. Mitchell reports a case in an unmarried woman of forty-five. She was a seamstress of dark complexion and never had any previous symptoms. On July 20, 1865, she became seasick in a gale of wind on the Hudson, and this was followed by an occasional loss of sight and by giddiness. Finally, in November she slept from Wednesday night to Monday at noon, and died a few days later. Jones of New Orleans relates the case of a girl of twenty-seven who had been asleep for the last eighteen years, only waking at certain intervals, and then remaining awake from seven to ten minutes. The sleep commenced at the age of nine, after repeated large doses of quinin and morphin. Periods of consciousness were regular, waking at 6 A.M. and every hour thereafter until noon, then at 3 P.M., again at sunset, and at 9 P.M., and once or twice before morning. The sleep was deep, and nothing seemed to arouse her. Gairdner mentions the case of a woman who, for one hundred and sixty days, remained in a lethargic stupor, being only a mindless automaton. Her life was maintained by means of the stomach tube. The Revue d'Hypnotisme contains the report of a young woman of twenty-five, who was completing the fourth year of an uninterrupted trance. She began May 30, 1883, after a fright, and on the same day, after several convulsive attacks, she fell into a profound sleep, during which she was kept alive by small quantities of liquid food, which she swallowed automatically. The excretions were greatly diminished, and menstruation was suppressed. There is a case 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 susceptibility and the same fears. Sometimes she could tell the approach of a storm by her nervous symptoms. Caligula, Augustus, Henry III, and other celebrated personages, were overcome with fear during a storm.
Mysophobia is a mild form of insanity characterized by a dread of the contact of dirt. It was named by Hammond, whose patient washed her hands innumerable times a day, so great was the fear of contamination. These patients make the closest inspection of their toilet, their eating and drinking utensils, and all their lives are intensely worried by fear of dirt.
Hematophobia is a horror of blood, which seems to be an instinctive sentiment in civilized man, but which is unknown among savages. When the horror is aggravated to such an extent as to cause distressing symptoms or unconsciousness, it takes the name of hematophobia. There are many cases on record and nearly every physician has seen one or more, possibly among his colleagues.
Necrophobia and thanatophobia are allied maladies, one being the fear of dead bodies and the other the fear of death itself.
Anthropophobia is a symptom of mental disease consisting in fear of society. Beard, Mitchell, Baillarger, and others have made observations on this disease. The antithesis of this disease is called monophobia. Patients are not able to remain by themselves for even the shortest length of time. This morbid dread of being alone is sometimes so great that even the presence of an infant is an alleviation. Gelineau cites an instance in a man of forty-five which was complicated with agoraphobia.
Bacillophobia is the result of abnormal pondering over bacteriology. Huchard's case was in a woman of thirty-eight who, out of curiosity, had secretly read the works of Pasteur, and who seemed to take particular pleasure in conning over the causes of death in the health-reports. Goyard mentions an instance in a Swiss veterinary surgeon.
Kleptophobia, examples of which have been cited by Cullere, is the fear of stealing objects in view, and is often the prelude of kleptomania. The latter disease has gained notoriety in this country, and nearly every large store has agents to watch the apparently growing number of kleptomaniacs. These unfortunate persons, not seldom from the highest classes of society, are unable to combat an intense desire to purloin articles. Legal proceedings have been instituted against many, and specialists have been called into court to speak on this question. Relatives and friends have been known to notify the large stores of the thieving propensities of such patients.
Le Grande du Saulle has given to the disease in which there is a morbid doubt about everything done, the name folie de doute. Gray mentions a case in a patient who would go out of a door, close it, and then come back, uncertain as to whether he had closed it, close it again, go off a little way, again feel uncertain as to whether he had closed it properly, go back again, and so on for many times. Hammond relates the history of a case in an intelligent man who in undressing for bed would spend an hour or two determining whether he should first take off his coat or his shoes. In the morning he would sit for an hour with his stockings in his hands, unable to determine which he should put on first.
Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of hydrophobia which sometimes assumes all the symptoms of the major disease, and even produces death. Gelineau, Colin, Berillon, and others have studied cases. In Berillon's case the patient was an artist, a woman of brunet complexion, who for six years had been tormented with the fear of becoming mad, and in whom the symptoms became so intense as to constitute pseudobydrophobia. At their subsidence she was the victim of numerous hallucinations which almost drove her to the point of suicide.
Spermatophobia has been noticed among the ignorant, caused or increased by inspection of sensational literature, treatises on the subject of spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense religious scruples, who was married at eighteen, and lost her husband six years afterward. She had a proposition of marriage which she refused, and was prostrated by the humid touch of the proposer who had kissed her hand, imagining that the humidity was due to semen. She was several times overcome by contact with men in public conveyances, her fear of contamination being so great. Zoophobia, or dread of certain animals, has been mentioned under another chapter under the head of idiosyncrasies. Pantophobia is a general state of fear of everything and everybody. Phobophobia, the fear of being afraid, is another coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or fear of fire; stasophobia, or inability to arise and walk, the victims spending all their time in bed; toxicophobia or fear of poison, etc., will be left to the reader's inspection in special works on this subject.
Demonomania is a form of madness in which a person imagines himself possessed of the devil. Ancient records of this disease are frequent, and in this century Lapointe reports the history of demonomania in father, mother, three sons, and two daughters, the whole family, with the exception of one son, who was a soldier, being attacked. They imagined themselves poisoned by a sorceress, saw devils, and had all sorts of hallucinations, which necessitated the confinement of the whole family in an asylum for over a month. They continued free from the hallucinations for two years, when first the mother, and then gradually all the other members of the family, again became afflicted with demonomania and were again sent to the asylum, when, after a residence therein of five months, they were all sufficiently cured to return home.
Particular aversions may be temporary only, that is, due to an existing condition of the organism, which, though morbid, is of a transitory character. Such, for instance, are those due to dentition, the commencement or cessation of the menstrual function, pregnancy, etc. These cases are frequently of a serious character, and may lead to derangement of the mind. Millington relates the history of a lady who, at the beginning of her first pregnancy, acquired an overpowering aversion to a half-breed Indian woman who was employed in the house as a servant. Whenever this woman came near her she was at once seized with violent trembling; this ended in a few minutes with vomiting and great mental and physical prostration lasting several hours. Her husband would have sent the woman away, but Mrs. X insisted on her remaining, as she was a good servant, in order that she might overcome what she regarded as an unreasonable prejudice. The effort was, however, too great, for upon one occasion when the woman entered Mrs. X's apartment rather unexpectedly, the latter became greatly excited, and, jumping from an open window in her fright, broke her arm, and otherwise injured herself so severely that she was confined to her bed for several weeks. During this period, and for some time afterward, she was almost constantly subject to hallucinations, in which the Indian woman played a prominent part. Even after her recovery the mere thought of the woman would sometimes bring on a paroxysm of trembling, and it was not till after her confinement that the antipathy disappeared.
Circular or periodic insanity is a rare psychosis. According to Drewry reports of very few cases have appeared in the medical journals. "Some systematic writers," says Drewry, "regard it as a mere subdivision of periodic insanity (Spitzka). A distinguished alienist and author of Scotland however has given us an admirable lecture on the subject. He says: 'I have had under my care altogether about 40 cases of typical folie circulaire.' In the asylum at Morningside there were, says Dr. Clouston, in 800 patients 16 cases of this peculiar form of mental disease. Dr. Spitzka, who was the first American to describe it, found in 2300 cases of pauper insane four per cent to be periodic, and its sub-group, circular, insanity. Dr. Stearns states that less than one-fourth of one per cent of cases in the Hartford (Conn.) Retreat classed as mania and melancholia have proved to be folie circulaire. Upon examination of the annual reports of the superintendents of hospitals for the insane in this country, in only a few are references made to this as a distinct form of insanity. In the New York State hospitals there is a regular uniform classification of mental diseases in which 'circular (alternating) insanity' occupies a place. In the report of the Buffalo Hospital for 1892, in statistical table No. 4, 'showing forms of insanity in those admitted, etc., since 1888,' out of 1428 cases, only one was 'alternating (circular) insanity.' In the St. Lawrence Hospital only one case in 992 was credited to this special class. In the institution in Philadelphia, of which Dr. Chapin is the superintendent, 10,379 patients have been treated, only three of whom were diagnosed cases of manie circulaire. Of the 900 cases of insanity in the State Hospital at Danville, Pa., less than four per cent were put in this special class. There are in the Central (Va.) State Hospital (which is exclusively for the colored insane) 775 patients, three of whom are genuine cases of circular insanity, but they are included in 'periodic insanity.' This same custom evidently prevails in many of the other hospitals for the insane."
Drewry reports three cases of circular insanity, one of which was as follows:--
"William F., a negro, thirty-six years old, of fair education, steady, sober habits, was seized with gloomy depression a few weeks prior to his admission to this hospital, in September, 1886. This condition came on after a period of fever. He was a stranger in the vicinity and scarcely any information could be obtained regarding his antecedents. When admitted he was in a state of melancholic hypochondriasis; he was the very picture of abject misery. Many imaginary ills troubled his peace of mind. He spoke of committing suicide, but evidently for the purpose of attracting attention and sympathy. On one occasion he said he intended to kill himself, but when the means to do so were placed at his command, he said he would do the deed at another time. The most trivial physical disturbances were exaggerated into very serious diseases. From this state of morbid depression he slowly emerged, grew brighter, more energetic, neater in personal appearance, etc. During this period of slow transition or partial sanity he was taken out on the farm where he proved to be a careful and industrious laborer. He escaped, and when brought back to the hospital a few weeks subsequently he was in a condition of great excitement and hilarity. His expression was animated, and he was, as it were, overflowing with superabundance of spirit, very loquacious, and incessantly moving. He bore an air of great importance and self-satisfaction; said he felt perfectly well and happy, but abused the officers for keeping him 'confined unjustly in a lunatic asylum.' It was his habit almost daily, if not interfered with, to deliver a long harangue to his fellow-patients, during which he would become very excited and noisy. He showed evidences of having a remarkable memory, particularly regarding names and dates. (Unusual memory is frequently observed in this type of insanity, says Stearns.) He was sometimes disposed to be somewhat destructive to furniture, etc., was neat in person, but would frequently dress rather 'gorgeously,' wearing feathers and the like in his hat, etc. He was not often noisy and sleepless at night, and then only for a short time. His physical health was good. This 'mental intoxication,' as it were, lasted nearly a year. After this long exacerbation of excitement there was a short remission and then depression again set in, which lasted about fifteen months. At this time this patient is in the depressed stage or period of the third circle. So, thus the cycles have continuously repeated their weary rounds, and in all probability they will keep this up 'until the final capitation in the battle of life has taken place.'"
Katatonia, according to Gray, is a cerebral disease of cyclic symptoms, ranging in succession from primary melancholia to mania, confusion, and dementia, one or more of these stages being occasionally absent, while convulsive and epileptoid symptoms accompany the mental changes.
It is manifestly impossible to enter into the manifold forms and instances of insanity in this volume, but there is one case, seldom quoted, which may be of interest. It appeared under the title, "A Modern Pygmalion." It recorded a history of a man named Justin, who died in the Bicetre Insane Asylum. He had been an exhibitor of wax works at Montrouge, and became deeply impressed with the beautiful proportions of the statue of a girl in his collection, and ultimately became intensely enamored with her. He would spend hours in contemplation of the inanimate object of his affections, and finally had the illusion that the figure, by movements of features, actually responded to his devotions. Nemesis as usual at last arrived, and the wife of Justin, irritated by his long neglect, in a fit of jealousy destroyed the wax figure, and this resulted in a murderous attack on his wife by Justin who resented the demolition of his love. He was finally secured and lodged in Bicetre, where he lived for five years under the influence of his lost love.
An interesting condition, which has been studied more in France than elsewhere, is double consciousness, dual personality, or, as it is called by the Germans, Doppelwahrnehmungen. In these peculiar cases an individual at different times seems to lead absolutely different existences. The idea from a moralist's view is inculcated in Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject Weir Mitchell illustrated his paper by examples, two of which will be quoted. The first was the case of Mary Reynolds who, when eighteen years of age, became subject to hysteric attacks, and on one occasion she continued blind and deaf for a period of five or six weeks. Her hearing returned suddenly, and her sight gradually. About three months afterward she was discovered in a profound sleep. Her memory had fled, and she was apparently a new-born individual. When she awoke it became apparent that she had totally forgotten her previous existence, her parents, her country, and the house where she lived. She might be compared to an immature child. It was necessary to recommence her education. She was taught to write, and wrote from right to left, as in the Semitic languages. She had only five or six words at her command--mere reflexes of articulation which were to her devoid of meaning. The labor of re-education, conducted methodically, lasted from seven to eight weeks. Her character had experienced as great a change as her memory; timid to excess in the first state, she became gay, unreserved, boisterous, daring, even to rashness. She strolled through the woods and the mountains, attracted by the dangers of the wild country in which she lived. Then she had a fresh attack of sleep, and returned to her first condition; she recalled all the memories and again assumed a melancholy character, which seemed to be aggravated. No conscious memory of the second state existed. A new attack brought back the second state, with the phenomenon of consciousness which accompanied it the first time. The patient passed successively a great many times from one of these states to the other. These repeated changes stretched over a period of sixteen years. At the end of that time the variations ceased. The patient was then thirty-six years of age; she lived in a mixed state, but more closely resembling the second than the first; her character was neither sad nor boisterous, but more reasonable. She died at the age of sixty-five years.
The second case was that of an itinerant Methodist minister named Bourne, living in Rhode Island, who one day left his home and found himself, or rather his second self, in Norristown, Pennsylvania. Having a little money, he bought a small stock in trade, and instead of being a minister of the gospel under the Methodist persuasion, he kept a candy shop under the name of A. J. Brown, paid his rent regularly, and acted like other people. At last, in the middle of the night, he awoke to his former consciousness, and finding himself in a strange place, supposed he had made a mistake and might be taken for a burglar. He was found in a state of great alarm by his neighbors, to whom he stated that he was a minister, and that his home was in Rhode Island. His friends were sent for and recognized him, and he returned to his home after an absence of two years of absolutely foreign existence. A most careful investigation of the case was made on behalf of the London Society for Psychical Research.
An exhaustive paper on this subject, written by Richard Hodgson in the proceedings of the Society for Psychical Research, states that Mr. Bourne had in early life shown a tendency to abnormal psychic conditions; but he had never before engaged in trade, and nothing could be remembered which would explain why he had assumed the name A. J. Brown, under which he did business. He had, however, been hypnotized when young and made to assume various characters on the stage, and it is possible that the name A. J. Brown was then suggested to him, the name resting in his memory, to be revived and resumed when he again went into a hypnotic trance.
Alfred Binet describes a case somewhat similar to that of Mary Reynolds: "Felida, a seamstress, from 1858 up to the present time (she is still living) has been under the care of a physician named Azam in Bordeaux. Her normal, or at least her usual, disposition when he first met her was one of melancholy and disinclination to talk, conjoined with eagerness for work. Nevertheless her actions and her answers to all questions were found to be perfectly rational. Almost every day she passed into a second state. Suddenly and without the slightest premonition save a violent pain in the temples she would fall into a profound slumber-like languor, from which she would awake in a few moments a totally different being. She was now as gay and cheery as she had formerly been morose. Her imagination was over-excited. Instead of being indifferent to everything, she had become alive to excess. In this state she remembered everything that had happened in the other similar states that had preceded it, and also during her normal life. But when at the end of an hour or two the languor reappeared, and she returned to her normal melancholy state, she could not recall anything that had happened in her second, or joyous, stage. One day, just after passing into the second stage, she attended the funeral of an acquaintance. Returning in a cab she felt the period coming on which she calls her crisis (normal state). She dozed several seconds, without attracting the attention of the ladies who were in the cab, and awoke in the other state, absolutely at a loss to know why she was in a mourning carriage with people who, according to custom, were praising the qualities of a deceased person whose name she did not even know. Accustomed to such positions, she waited; by adroit questions she managed to understand the situation, and no one suspected what had happened. Once when in her abnormal condition she discovered that her husband had a mistress, and was so overcome that she sought to commit suicide. Yet in her normal mind she meets the woman with perfect equilibrium and forgetfulness of any cause for quarrel. It is only in her abnormal state that the jealousy recurs. As the years went on the second state became her usual condition. That which was at first accidental and abnormal now constitutes the regular center of her psychic life. It is rather satisfactory to chronicle that as between the two egos which alternately possess her, the more cheerful has finally reached the ascendant."
Jackson reports the history of the case of a young dry-goods clerk who was seized with convulsions of a violent nature during which he became unconscious. In the course of twenty-four hours his convulsions abated, and about the third day he imagined himself in New York paying court to a lady, and having a rival for her favors; an imaginary quarrel and duel ensued. For a half-hour on each of three days he would start exactly where he had left off on the previous day. His eyes were open and to all appearances he was awake during this peculiar delirium. When asked what he had been doing he would assert that he had been asleep. His language assumed a refinement above his ordinary discourse. In proportion as his nervous system became composed, and his strength improved, this unnatural manifestation of consciousness disappeared, and he ultimately regained his health.
A further example of this psychologic phenomenon was furnished quite meetly at a meeting of the Clinical Society of London, where a well known physician exhibited a girl of twelve, belonging to a family of good standing, who displayed in the most complete and indubitable form this condition of dual existence. A description of the case is as follows:--
"Last year, after a severe illness which was diagnosed to be meningitis, she became subject to temporary attacks of unconsciousness, on awakening from which she appeared in an entirely different character. In her normal condition she could read and write and speak fluently, and with comparative correctness. In the altered mental condition following the attack she loses all memory for ordinary events, though she can recall things that have taken place during previous attacks. So complete is this alteration of memory, that at first she was unable to remember her own name or to identify herself or her parents. By patient training in the abnormal condition she has been enabled to give things their names, though she still preserves a baby-fashion of pronouncing. She sometimes remains in the abnormal condition for days together and the change to her real self takes place suddenly, without exciting surprise or dismay, and she forthwith resumes possession of her memory for events of her ordinary life. During the last month or two she appears to have entered on a new phase, for after a mental blank of a fortnight's duration she awakened completely oblivious of all that had happened since June, 1895, and she alludes to events that took place just anterior to that date as though they were of recent occurrence; in fact she is living mentally in July, 1895. These cases, though rare, are of course not infrequently met with, and they have been carefully studied, especially in France, where women appear more prone to neurotic manifestations. The hypothesis that finds most favor is that the two halves of the brain do not work in unison; in other words, that there has been some interference with the connections which in the ordinary normal being make of a wonderful composite organ like the brain one organic whole."
Proust tells a story of a Parisian barrister of thirty-three. His father was a heavy drinker, his mother subject to nervous attacks, his younger brother mentally deficient, and the patient himself was very impressionable. It was said that a judge in a court, by fixing his gaze on him, could send him into an abnormal state. On one occasion, while looking into a mirror in a cafe, he suddenly fell into a sleep, and was taken to the Charite where he was awakened. He suffered occasional loss of memory for considerable lengths of time, and underwent a change of personality during these times. Though wide awake in such conditions he could remember nothing of his past life, and when returned to his original state he could remember nothing that occurred during his secondary state, having virtually two distinct memories. On September 23, 1888, he quarreled with his stepfather in Paris and became his second self for three weeks. He found himself in a village 100 miles from Paris, remembering nothing about his journey thereto; but on inquiry he found that he had paid a visit to the priest of the village who thought his conduct odd, and he had previously stayed with an uncle, a bishop, in whose house he had broken furniture, torn up letters, and had even had sentence passed upon him by a police court for misdemeanor. During these three weeks he had spent the equivalent of $100, but he could not recall a single item of expenditure. Davies cites a remarkable case of sudden loss of memory in a man who, while on his way to Australia, was found by the police in an exhausted condition and who was confined in the Kent County Insane Asylum. He suffered absolute loss of all memory with the exception of the names of two men not close acquaintances, both of whom failed to recognize him in his changed condition in confinement. Four months later his memory returned and his identity was established.
In the Revue Philosophique for 1885 there are the details of a case of a young man who seemed able to assume six states of what might be fairly called different personalities. The memories attached to each of these states were very different, though only one was completely exclusive of the others. The handwriting varied from complete competence to complete incompetence. His character varied between childish timidity, courteous reserve, and reckless arrogance; and to four of his conditions there was a form of hysteric paralysis attached. Mere suggestion would not only induce any one of these varied forms of paralysis, but also the memories, capacities, and characters habitually accompanying it.
A young man named Spencer, an inmate of the Philadelphia Hospital, was exhibited before the American Neurological Society in June, 1896, as an example of dual personality. At the time of writing he is and has been in apparently perfect health, with no evidence of having been in any other condition. His faculties seem perfect, his education manifests itself in his intelligent performance of the cleric duties assigned to him at the hospital, yet the thread of continuous recollection which connects the present moment with its predecessors--consciousness and memory--has evidently been snapped at some point of time prior to March 3d and after January 19th, the last date at which he wrote to his parents, and as if in a dream, he is now living another life. The hospital staff generally believe that the man is not "shamming," as many circumstances seem to preclude that theory. His memory is perfect as to everything back to March 3d. The theory of hypnotism was advanced in explanation of this case.
The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican Brothers," has been discussed by Sedgwick, Elliotson, Trousseau, Laycock, Cagentre, and others. Marshall Hall relates what would seem to verify the Corsican myth, the history of twin brothers nine months of age, who always became simultaneously affected with restlessness, whooping and crowing in breathing three weeks previous to simultaneous convulsions, etc. Rush describes a case of twin brothers dwelling in entirely different places, who had the same impulse at the same time, and who eventually committed suicide synchronously. Baunir describes a similar development of suicidal tendency in twin brothers. A peculiar case of this kind was that of the twin brothers Laustand who were nurses in a hospital at Bordeaux; they invariably became ill at the same time, and suffered cataract of the lens together.
Automatism has been noticed as a sequel to cranial injuries, and Huxley quotes a remarkable case reported by Mesnet. The patient was a young man whose parietal bone was partially destroyed by a ball. He exhibited signs of hemiplegia on the right side, but these soon disappeared and he became subject to periodic attacks lasting from twenty-four to forty-eight hours, during which he was a mere automaton. In these attacks he walked continually, incessantly moving his jaw, but not uttering a word. He was insensible to pain, electric shock, or pin-prick. If a pen was placed in his hand he would write a good letter, speaking sensibly about current topics. When a cigarette-paper was placed in his hand he sought his tobacco box, and adroitly rolled a cigarette and lighted it. If the light went out he procured another, but would not allow another to substitute a match. He allowed his mustache to be burned without resistance, but would not allow a light to be presented to him. If chopped charpie was put in his pocket instead of tobacco he knew no difference. While in his periods of automatism he was in the habit of stealing everything within his grasp. He had been a concert singer, and a peculiar fact was that if given white gloves he would carefully put them on and commence a pantomime of the actions of a singer, looking over his music, bowing, assuming his position, and then singing.
It is particularly in hypnotic subjects that manifestations of automatism are most marked. At the suggestion of battle an imaginary struggle at once begins, or if some person present is suggested as an enemy the fight is continued, the hypnotic taking care not to strike the person in question. Moll conceded that this looked like simulation, but repetition of such experiments forced him to conclude that these were real, typical hypnoses, in which, in spite of the sense-delusions, there was a dim, dreamy consciousness existing, which influenced the actions of the subject, and which prevented him from striking at a human being, although hitting at an imaginary object. Many may regard this behavior of hypnotics as pure automatism; and Moll adds that, as when walking in the street while reading we automatically avoid knocking passers-by, so the hypnotic avoids hitting another person, although he is dimly or not at all aware of his existence.
Gibbs reports a curious case of lack of integrity of the will in a man of fifty-five. When he had once started on a certain labor he seemed to have no power to stop the muscular exercise that the task called forth. If he went to the barn to throw down a forkful of hay, he would never stop until the hay was exhausted or someone came to his rescue. If sent to the wood-pile for a handful of wood, he would continue to bring in wood until the pile was exhausted or the room was full. On all occasions his automatic movements could only be stopped by force.
At a meeting in Breslau Meschede rendered an account of a man who suffered from simple misdirection of movement without any mental derangement. If from his own desire, or by direction of others, he wanted to attempt any muscular movement, his muscles performed the exact opposite to his inclinations. If he desired to look to the right, his eyes involuntarily moved to the left. In this case the movement was not involuntary, as the muscles were quiet except when called to action by the will, and then they moved to the opposite.
Presentiment, or divination of approaching death, appearing to be a hypothetic allegation, has been established as a strong factor in the production of a fatal issue in many cases in which there was every hope for a recovery. In fact several physicians have mentioned with dread the peculiar obstinacy of such presentiment. Hippocrates, Romanus, Moller, Richter, Jordani, and other older writers speak of it. Montgomery reports a remarkable case of a woman suffering from carcinoma of the uterus. He saw her on October 6, 1847, when she told him she had a strong presentiment of death on October 28th. She stated that she had been born on that day, her first husband had died on October 28th, and she had married her second husband on that day. On October 27th her pulse began to fail, she fell into a state of extreme prostration, and at noon on the 28th she died. In substantiation of the possibility of the influence of presentiment Montgomery cites another case in which he was called at an early hour to visit a lady, the mother of several children. He found her apparently much agitated and distressed, and in great nervous excitement over a dream she had had, in which she saw a handsome monument erected by some children to their mother. She had awakened and became dreadfully apprehensive, she could not tell as to what. The uneasiness and depression continued, her pulse continued to grow weak, and she died at twelve that night without a struggle. Andrews has made several observations on this subject, and concludes that presentiment of death is a dangerous symptom, and one which should never be overlooked. One of his cases was in a man with a fractured leg in the Mercy Hospital at Pittsburg. The patient was in good health, but one day he became possessed of a cool, quiet, and perfectly clear impression that he was about to die. Struck with his conviction, Andrews examined his pulse and general condition minutely, and assured the patient there was not the slightest ground for apprehension. But he persisted, and was attacked by pneumonia three days later which brought him to the verge of the grave, although he ultimately recovered. In another instance a young man of ruddy complexion and apparent good health, after an operation for varicocele, had a very clear impression that he would die. Careful examination showed no reason for apprehension. After five or six days of encouragement and assurance, he appeared to be convinced that his reasoning was foolish, and he gave up the idea of death. About the ninth day the wound presented a healthy, rosy appearance, and as the patient was cheerful he was allowed to leave his bed. After a few hours the nurse heard the noise of labored breathing, and on investigation found the patient apparently in a dying condition. He was given stimulants and regained consciousness, but again relapsed, and died in a few moments. At the necropsy the heart was found healthy, but there were two or three spots of extravasated blood in the brain, and evidences of cerebral congestion. Vos remarks that he remembers a case he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A man who had been intemperate was rolling a sod of grass, and got some grit into his left palm. It inflamed; he put on hot cow-dung poultices by the advice of some country friends. He was admitted with a dreadfully swollen hand. It was opened, but the phlegmonous process spread up to the shoulder, and it was opened in many places, and at last, under chloroform, the limb was amputated below the joint. The stump sloughed, and pus pointing at the back of the neck, an opening was again made. He became in such a weak state that chloroform could not be administered, and one morning he had such a dread of more incisions that, saying to us all standing round his bed, 'I can bear it no more, I must now die,' he actually did die in a few minutes in our presence. His was the last arm that Mr. Holden ever amputated at St. Bartholomew's."
XVIII. HISTORIC EPIDEMICS
A short history of the principal epidemics, including as it does the description of anomalous diseases, many of which are now extinct, and the valuable knowledge which finally led to their extinction, the extraordinary mortalities which these epidemics caused, and many other associate points of interest would seem fitting to close the observations gathered in this volume. As the illustrious Hecker says, in the history of every epidemic, from the earliest times, the spirit of inquiry was always aroused to learn the machinery of such stupendous engines of destruction; and even in the earliest times there was neither deficiency in courage nor in zeal for investigation. "When the glandular plague first made its appearance as a universal epidemic, whilst the more pusillanimous, haunted by visionary fears, shut themselves up in their closets, some physicians at Constantinople, astonished at the phenomena opened the boils of the deceased. The like has occurred both in ancient and modern times, not without favorable results for Science; nay, more mature views excited an eager desire to become acquainted with similar or still greater visitations among the ancients, but, as later ages have always been fond of referring to Grecian antiquity, the learned of those times, from a partial and meagre predilection, were contented with the descriptions of Thucydides, even where nature had revealed, in infinite diversity, the workings of her powers."
There cannot but be a natural interest in every medical mind to-day in the few descriptions given of the awful ravages of the epidemics which, fortunately, in our enlightened sanitary era, have entirely disappeared. In the history of such epidemics the name of Hecker stands out so prominently that any remarks on this subject must necessarily, in some measure, find their origin in his writings, which include exhaustive histories of the black death, the dancing mania, and the sweating sickness. Few historians have considered worthy of more than a passing note an event of such magnitude as the black death, which destroyed millions of the human race in the fourteenth century and was particularly dreadful in England. Hume has given but a single paragraph to it and others have been equally brief. Defoe has given us a journal of the plague, but it is not written in a true scientific spirit; and Caius, in 1562, gave us a primitive treatise on the sweating sickness. It is due to the translation of Hecker's "Epidemics of the Middle Ages" by Babbington, made possible through the good offices of the Sydenham Society, that a major part of the knowledge on this subject of the English-reading populace has been derived.
The Black Death, or, as it has been known, the Oriental plague, the bubonic plague, or in England, simply the plague, and in Italy, "la Mortalega" (the great mortality) derived its name from the Orient; its inflammatory boils, tumors of the glands, and black spots, indicative of putrid decomposition, were such as have been seen in no other febrile disease. All the symptoms were not found in every case, and in many cases one symptom alone preceded death. Although afflicted with all the manifestations of the plague, some patients recovered. According to Hecker the symptoms of cephalic affliction were seen; many patients were stupefied and fell into a deep sleep, or became speechless from palsy of the tongue, while others remained sleepless and without rest. The fauces and tongue were black and as if suffused with blood; no beverage could assuage the burning thirst, so that suffering continued without alleviation until death, which many in their despair accelerated with their own hands. Contagion was evident, for attendants caught the disease from their parents and friends, and many houses were emptied of their inhabitants. In the fourteenth century this affection caused still deeper sufferings, such as had not been hitherto experienced. The organs of respiration became the seats of a putrid inflammation, blood was expectorated, and the breath possessed a pestiferous odor. In the West an ardent fever, accompanied by an evacuation of blood, proved fatal in the first three days. It appears that buboes and inflammatory boils did not at first appear, but the disease in the form of carbuncular affection of the lungs (anthrax artigen) caused the fatal issue before the other symptoms developed. Later on in the history of the plague the inflammatory boils and buboes in the groins and axillae were recognized at once as prognosticating a fatal issue.
The history of this plague extends almost to prehistoric times. There was a pest in Athens in the fifth century before Christ. There was another in the second century, A.D., under the reign of Marcus Aurelius, and again in the third century, under the reign of the Gauls; following this was the terrible epidemic of the sixth century, which, after having ravaged the territory of the Gauls, extended westward. In 542 a Greek historian, Procopius, born about the year 500, gives a good description of this plague in a work, "Pestilentia Gravissima," so called in the Latin translation. Dupouy in "Le Moyen Age Medical," says that it commenced in the village of Peleuse, in Egypt, and followed a double course, one branch going to Alexandria and the other to Palestine. It reached Constantinople in the Spring of 543, and produced the greatest devastation wherever it appeared. In the course of the succeeding half century this epidemic became pandemic and spread over all the inhabited earth. The epidemic lasted four months in Constantinople, from 5000 to 10,000 people dying each day. In his "History of France," from 417 to 591, Gregorius speaks of a malady under the name inguinale which depopulated the Province of Arles. In another passage this illustrious historian of Tours says that the town of Narbonne was devastated by a maladie des aines. We have records of epidemics in France from 567 to 590, in which bubonic symptoms were a prominent feature. About the middle of the fourteenth century the bubonic plague made another incursion from the East. In 1333, fifteen years before the plague appeared in Europe, there were terrible droughts in China followed by enormous floods in which thousands of people perished. There are traditions of a plague in Tche in 1334, following a drought, which is said to have carried off about 5,000,000 people. During the fifteen years before the appearance of the plague in Europe there were peculiar atmospheric phenomena all over the world, besides numerous earthquakes. From the description of the stinking atmosphere of Europe itself at this time it is quite possible that part of the disease came, not from China, but originated in Southern Europe itself. From China the route of caravans ran to the north of the Caspian Sea, through Asia, to Tauris. Here ships were ready to take the produce of the East to Constantinople, the capital of commerce, and the medium of communication between Europe, Asia, and Africa. Other caravans went from Europe to Asia Minor and touched at the cities south of the Caspian Sea, and lastly there were others from Bagdad through Arabia to Egypt; the maritime communication on the Red Sea to Arabia and Egypt was also not inconsiderable. In all these directions contagion found its way, though doubtless Constantinople and the harbors of Asia Minor were the chief foci of infection, whence it radiated to the most distant seaports and islands. As early as 1347 the Mediterranean shores were visited by the plague, and in January, 1348, it appeared in the south of France, the north of Italy, and also in Spain. Place after place was attacked throughout the year, and after ravishing the whole of France and Germany, the plague appeared in England, a period of three months elapsing before it reached London. The northern kingdoms were attacked in 1349, but in Russia it did not make its appearance before 1351.
As to the mortality of this fearful epidemic Dupony considers that in the space of four years more than 75,000,000 fell victims, that is, about half of the population of the countries visited. Hecker estimates that from 1347 to 1351, 25,000,000 people died, or one-quarter of the total population of Europe. It was reported to Pope Clement that throughout the East, probably with the exception of China, nearly 24,000,000 people had fallen victims to the plague. Thirteen millions are said to have died in China alone. Constantinople lost two-thirds of its population. When the plague was at its greatest violence Cairo lost daily from 10,000 to 15,000, as many as modern plagues have carried off during their whole course. India was depopulated. Tartary, Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies. In this latter country Arabian historians mention that Maara el nooman, Schisur, and Harem in some unaccountable manner remained free. The shores of the Mediterranean were ravaged and ships were seen on the high seas without sailors. In "The Decameron" Boccaccio gives a most graphic description of the plague and states that in Florence, in four months, 100,000 perished; before the calamity it was hardly supposed to contain so many inhabitants. According to Hecker, Venice lost 100,000; London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000; Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there were 56,000 victims in Marseilles, and at Montpellier three-quarters of the population and all the physicians were stricken with the epidemic.
Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II, Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of Castile, and other notable persons perished. All the cities of England suffered incredible losses. Germany seems to have been particularly spared; according to a probable calculation, only about 1,250,000 dying. Italy was most severely visited, and was said to have lost most of its inhabitants. In the north of Europe two of the brothers of Magnus, King of Sweden, died; and in Westgothland alone 466 priests died. The plague showed no decrease in the northern climates of Iceland and Greenland, and caused great havoc in those countries.
The moral effect of such a great pandemic plague can be readily surmised. The mental shock sustained by all nations during the prevalence of the black plague is beyond parallel and description. An awful sense of contrition and repentance seized Christians of every community. They resolved to forsake their vices, and to make restitution for past offenses; hence extreme religious fanaticism held full sway throughout Europe. The zeal of the penitents stopped at nothing. The so-called Brotherhood of the Cross, otherwise known as the Order of Flagellants, which had arisen in the thirteenth century, but was suppressed by the mandates and strenuous efforts of the Church, was revived during the plague, and numbers of these advocates of self-chastisement roamed through the various countries on their great pilgrimages. Their power increased to such an extent that the Church was in considerable danger, for these religious enthusiasts gained more credit among the people, and operated more strongly on their minds than the priests from whom they so entirely withdrew that they even absolved each other. Their strength grew with such rapidity, and their numbers increased to such an extent daily, that the State and the Church were forced to combine for their suppression. Degeneracy, however, soon crept in, crimes were committed, and they went beyond their strength in attempting the performance of miracles. One of the most fearful consequences of this frenzy was the persecution of the Jews. This alien race was given up to the merciless fury and cruelty of the populace. The persecution of the Jews commenced in September and October, 1348, at Chillon on Lake Geneva, where criminal proceedings were instituted against them on the mythic charge of poisoning the public wells. These persecuted people were summoned before sanguinary tribunals, beheaded and burned in the most fearful manner. At Strasburg 2000 Jews were burned alive in their own burial-ground, where a large scaffold had been erected, their wealth being divided among the people. In Mayence 12,000 Jews were said to have been put to a cruel death. At Eslingen the whole Jewish community burned themselves in their synagogue, and mothers were often seen throwing their children on the pile, to prevent them from being baptized, and then precipitating themselves into the flames. The cruel and avaricious desires of the monarchs against these thrifty and industrious people added fuel to the flames of the popular passion, and even a fanatic zeal arose among the Jews to perish as martyrs to their ancient religion. When we sum up the actual effects as well as the after effects of the black death, we are appalled at the magnitude of such a calamity, the like of which the world had never seen before.
In the fifteenth and sixteenth centuries the plague was generally diffused throughout Europe, and in the latter half of the seventeenth century a final Occidental incursion of the plague took place. From 1603 to 1604 over 30,000 people perished in London from the plague, and in 1625 the mortality in that city amounted to 35,417 persons. But the great plague of London did not begin until 1664. In this plague the patient at first became sensible of great weariness and fatigue, had slight chills, nausea, vomiting, vertigo, and pains in the loins. The mental disturbance rapidly increased, and stupor and delirium ensued. The face was alternately flushed and pallid, and a sense of constriction was experienced in the region of the heart. Darting pains were felt all over the body, soon followed by the enlargement of the lymphatic glands, or by the formation of carbuncles in various parts of the body. About the third day the tongue became dry and brown, and the gums, tongue, and teeth were covered with a dark fur, and the excretions became offensive; paralysis intervened; ecchymosed patches or stripes due to extravasation appeared on the skin; finally the pulse sank, the body grew cold and clammy, delirium or coma seized the victim, and in five or six days, sometimes in two or three, the painful struggle was at an end.
It was supposed that the disease originated in the Orient and was brought to London from Holland. In his "Journal of the Plague in London" Defoe describes its horrors, and tells of the dead-cart which went through the streets gathering the victims. A few extracts from Pepys's "Diary," the evidence of an eye-witness and a contemporary, show the ghastly aspects of this terrible visitation. On August 31st he writes: "In the City, this week, died 7496, and of them 6102 died of the plague. But it is found that the true number of the dead this week is nearer 10,000; partly from the poor who cannot be taken care of through the greatness of the number, and partly from the Quakers and others that will not have any bell rung for them." According to Adams, John Evelyn noted in his "Kalendarium":--"Sept. 7th.--Near 10,000 now died weekly; however, I went all along the City and suburbs from Kent street to St. James's, a dismal passage, and dangerous to see so many coffins exposed in the streets; the streets thin of people, the shops shut up, and all in silence, no one knowing whose turn might be next."
As the cold weather came on the plague diminished in intensity and the people regained their confidence and returned to the city. According to Adams, in the first week of March, 1666, deaths by the plague had decreased to 42; and by the end of the month it was nearly extinct after carrying off about 100,000 victims. In our days we can hardly comprehend the filthy hygienic conditions under which the people in the cities lived, and it was probably to this fact that the growth and perpetuation of this plague was due.
As to the bubonic plague recently raging in Camptown, China, Mary Niles says that it was the same disease as the great London plague, and was characterized mainly by glandular enlargement. It had not appeared in the Canton district for forty years or more, though it was endemic in Yunnan. In some places it began in the winter; and as early as January she herself found the first case in Canton in an infected house. In no case was direct contagiousness found to exist. The glands enlarged twelve hours after the fever began, and sometimes suppurated in nonfatal cases in a short time. Kitasato has recently announced the discovery of the specific cause of the bubonic plague.
Sweating Sickness.--According to Hecker, very shortly after Henry's triumphant march from Bosworth Field, and his entry into the capital on August 8, 1485, the sweating sickness began its ravages among the people of the densely populated city. According to Lord Bacon the disease began about September 21st, and lasted to the end of October, 1485. The physicians could do little or nothing for the people, and seemed to take no account of the clinical history of the disease,--in this respect not unlike the Greek physicians who for four hundred years paid no attention to small-pox because they could find no description of it in the immortal works of Galen. The causes seemed to be uncleanliness, gluttony, immoderate drinking, and also severe inundations leaving decaying vegetation. Richmond's army has been considered a factor in the germination of the seeds of pestilent disorder which broke out soon after in the camps of Litchfield, and on the banks of the Severn.
Sweating sickness was an inflammatory rheumatic fever, with great disorder of the nervous system, and was characterized by a profuse and injurious perspiration. In the English epidemic the brain, meninges, and the nerves were affected in a peculiar manner. The functions of the pneumogastric nerves were violently disordered in this disease, as was shown by the oppressed respiration and extreme anxiety, with nausea and vomiting,--symptoms to which modern physicians attach much importance. The stupor and profound lethargy show that there was an injury to the brain, to which, in all probability, was added a stagnation of black blood in the torpid veins. Probably decomposing blood gave rise to the offensive odor of the person. The function of the lungs was considerably impaired. The petechial fever in Italy in 1505 was a form of the sweating sickness. There were visitations in 1506 and in 1515 in England. In 1517 the disease lasted full six months and reached its greatest height about six weeks after its appearance, but was apparently limited to England. Meningeal symptoms were characteristic of the third visitation of the disease. In 1528 and 1529 there was a fourth visitation which resulted in the destruction of the French Army before Naples. It is said that in 1524 a petechial fever carried off 50,000 people in Milan, and possibly this was the same disease. In 1529 the disease had spread all over Europe, attended with great mortality.
Germany, France, and Italy were visited equally. The famine in Germany, at this time, is described by authorities in a tone of deep sympathy. Swabia, Lorraine, Alsace, and provinces on the border of the lower Rhine, were frightfully affected, so that the disease reached the same heights there as in France. In England Henry VIII endeavored to avoid the epidemic by continual traveling, until at last he grew tired of so unsettled a life and determined to await his destiny at Tytynhangar. It was not the inhabitants of the land alone who were affected, but even fish and the fowls of the air sickened. According to Schiller, in the neighborhood of Freiburg in Breisgau, dead birds were found scattered under the trees with boils as large as peas under their wings,--indicating among them a disease, and this extended far beyond the southern districts of the Rhine. The disease was undoubtedly of a miasmatic infectious nature, as was proved by its rapid spread and the occasional absence of a history of contagion. It was particularly favored in its development by high temperature and humidity.
The moral effect of the sweating sickness, similar to that of the black plague, was again to increase religious fanaticism and recreate the zeal of persecution.
On the 15th of April, 1551, there was an outbreak of the fifth and last epidemic of sweating fever in Shrewsbury, on the Severn. With stinking mists it gradually spread all over England, and on the 9th of July it reached London. The mortality was very considerable. The English residents were particularly susceptible, foreigners being comparatively exempt. The epidemic terminated about the 30th of September. Since that time the sweating sickness has never reappeared in England; but in the beginning of the eighteenth century a disease very similar in symptoms and course broke out in Picardy, in Northern France. Toward the end of the century it spread to the South of France, and since that time has appeared epidemically, 195 distinct outbreaks having been observed in the course of one hundred and sixty-nine years, from 1618 to 1787. The disease has frequently appeared in Italy since 1755, and in various parts of Germany since 1801. In Belgium it has been observed in a few places within the present century (Rohe).
Chronologic Table of the Principal Plagues.--In December, 1880, H. P. Potter, F.R.C.S., published a chronologic table of some of the principal plagues on record. In comments on his table, Potter says that he has doubtless included mention of many plagues which, although described under that name, are probably a dissimilar disease, writers having applied the terms pestilential and pestilent in a generic sense to diseases specifically different. It must also be remembered that, in some cases, death must have been due to famine, want, and privation, which are so frequently coexistent with pestilence. Following the idea of Hecker, the dancing manias have been included in this table.
{table omitted}
Small-pox.--From certain Chinese records it appears that small-pox, or a disease with similar symptoms, was known in China before the Christian era, and it was supposed to have been known at a very early period in India. Most likely it was introduced into Europe in the second century by a Roman army returning from Asia. Before the sixth century, the terrible century of the great plague, there seem to be no records of small-pox or other eruptive fevers. Neither Hippocrates, Galen, nor the Greek physicians who practiced at Rome, mention small-pox, although it is now believed that the Emperor Marcus Aurelius died of this disease. According to Dupony, the first document mentioning variola was in 570 A.D., by Marius, a scholar of Avenches, in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et variola, Italiam Galliamque valde affecit.") Ten years later Gregory of Tours describes an epidemic with all the symptoms of small-pox in the fifth reign of King Childebert (580); it started in the region of Auvergne, which was inundated by a great flood; he also describes a similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him, Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth century wrote a most celebrated work on small-pox and measles, which is the earliest accurate description of these diseases, although Rhazes himself mentions several writers who had previously described them, and who had formulated rules for their cure. He explained these diseases by the theory of fermentation, and recommended the cooling treatment. Adams remarks that although it is probable that small-pox existed for ages in Hindoostan and China, being completely isolated in those countries from the European world, it was not introduced into the West until the close of the seventh century. Imported into Egypt by the Arabians, it followed in the tracks of their conquests, and was in this way propagated over Europe. The foregoing statement disagrees with Dupony and others. It is well known that small-pox was prevalent in Europe before Rhazes's description of it, and after the Crusades it spread over Central and Western Europe, but did not extend to the northern countries until some years later. In 1507 the Spaniards introduced it into San Domingo, and in 1510 into Mexico, where it proved a more fatal scourge than the swords of Cortez and his followers, for according to Robertson it swept away in Mexico three millions and a half of people. In 1707 it appeared in Iceland, and carried off more than one-fourth of its inhabitants; in 1733, according to Collinson, it almost depopulated Greenland. The Samoyeds, Ostiaks, and other natives of Eastern Siberia, have frequently suffered from devastating epidemics. In Kamchatka the disease was introduced in 1767, and many villages were completely depopulated. According to Moore, at the beginning of the eighteenth century nearly one-fourteenth of the population died from small-pox in England, and at the end of the century the number of the victims had increased to one-tenth. In the last century the statement was made in England that one person in every three was badly pock-marked. The mortality of the disease at the latter half of the eighteenth century was about three to every thousand inhabitants annually. India has always been a fertile ground for the development of small-pox, and according to Rohe the mortality from small-pox has been exceedingly great for the past twenty years. From 1866 to 1869, 140,000 persons died in the Presidencies of Bombay and Calcutta, and several years later, from 1873 to 1876, 700,000 died from this disease. China, Japan, and the neighboring countries are frequently visited with small-pox, and nearly all the inhabitants of Corea are said to bear evidences of the disease. In the Marquesas Islands one-fourth of the inhabitants had fallen victims to the disease since 1863. It was first introduced into the Sandwich Islands in 1853, and it then carried off eight per cent of the natives. Australia, Tasmania, New Zealand, and the Fiji Archipelago have to the present day remained exempt from small-pox; although it has been carried to Australia in vessels, rigorous quarantine methods have promptly checked it. On the American continent it was believed that small-pox was unknown until the conquest of Mexico. It has been spread through various channels to nearly all the Indian tribes of both North and South America, and among these primitive people, unprotected by inoculation or vaccination, its ravages have been frightful.
That small-pox a disease so general and so fatal at one time--has, through the ingenuity of man, in civilized communities at least, become almost extinct, is one of the greatest triumphs of medicine.
Inoculation was known in Europe about 1700, and in 1717 the famous letter of Lady Montagu from Adrianople was issued, containing in part the following statements:--
"The small-pox, so fatal and so general amongst us, is here entirely harmless, by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met, the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer her with a large needle, and puts into the vein as much matter as can lie upon the head of her needle, and after that binds up the little wound with a hollow shell, and in this manner opens four or five veins."
Soon after this letter Lady Montagu had her son inoculated in Turkey, and four years later her daughter was to be the first subject inoculated in England. She made rapid progress notwithstanding the opposition of the medical profession, and the ignorance and credulity of the public. The clergy vituperated her for the impiety of seeking to control the designs of Providence. Preaching in 1722, the Rev. Edward Massey, for example, affirmed that Job's distemper was confluent small-pox, and that he had been inoculated by the Devil. Lady Montagu, however, gained many supporters among the higher classes. In 1721 Mead was requested by the Prince of Wales to superintend the inoculation of some condemned criminals, the Prince intending afterward to continue the practice in his own family; the experiment was entirely successful, and the individuals on whom it was made afterward received their liberty (Adams).
According to Rohe, inoculation was introduced into this country in 1721 by Dr. Zabdiel Boylston of Boston, who had his attention directed to the practice by Cotton Mather, the eminent divine. During 1721 and 1722 286 persons were inoculated by Boylston and others in Massachusetts, and six died. These fatal results rendered the practice unpopular, and at one time the inoculation hospital in Boston was closed by order of the Legislature. Toward the end of the century an inoculating hospital was again opened in that city.
Early in the eighteenth century inoculation was extensively practiced by Dr. Adam Thomson of Maryland, who was instrumental in spreading a knowledge of the practice throughout the Middle States.
Despite inoculation, as we have already seen, during the eighteenth century the mortality from small-pox increased. The disadvantage of inoculation was that the person inoculated was affected with a mild form of small-pox, which however, was contagious, and led to a virulent form in uninoculated persons. As universal inoculation was manifestly impracticable, any half-way measure was decidedly disadvantageous, and it was not until vaccination from cow-pox was instituted that the first decided check on the ravages of small-pox was made.
Vaccination was almost solely due to the persistent efforts of Dr. Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.
In his comments on the life of Edward Jenner, Adams, in "The Healing Art," has graphically described his first efforts to institute vaccination, as follows: "To the ravages of small-pox, and the possibility of finding some preventive Jenner had long given his attention. It is likely enough that his thoughts were inclined in this direction by the remembrance of the sufferings inflicted upon himself by the process of inoculation. Through six weeks that process lingered. He was bled, purged, and put on a low diet, until 'this barbarism of human veterinary practice' had reduced him to a skeleton. He was then exposed to the contagion of the small-pox. Happily, he had but a mild attack; yet the disease itself and the inoculating operations, were probably the causes of the excessive sensitiveness which afflicted him through life.
"When Jenner was acting as a surgeon's articled pupil at Sudbury, a young countrywoman applied to him for advice. In her presence some chance allusion was made to the universal disease, on which she remarked: 'I shall never take it, for I have had the cow-pox.' The remark induced him to make inquiries; and he found that a pustular eruption, derived from infection, appeared on the hands of milkers, communicated from the teats of cows similarly disordered; this eruption was regarded as a safeguard against small-pox. The subject occupied his mind so much that he frequently mentioned it to John Hunter and the great surgeon occasionally alluded to it in his lectures, but never seems to have adopted Jenner's idea that it might suggest some efficacious substitute for inoculation. Jenner, however, continued his inquiries, and in 1780 he confided to his friend, Edward Gardner, his hope and prayer that it might be his work in life to extirpate smallpox by the mode of treatment now so familiar under the name of vaccination.
"At the meetings of the Alveston and Radborough Medical Clubs, of both of which Jenner was a member, he so frequently enlarged upon his favorite theme, and so repeatedly insisted upon the value of cow-pox as a prophylactic, that he was denounced as a nuisance, and in a jest it was even proposed that if the orator further sinned, he should then and there be expelled. Nowhere could the prophet find a disciple and enforce the lesson upon the ignorant; like most benefactors of mankind he had to do his work unaided. Patiently and perseveringly he pushed forward his investigations. The aim he had in view was too great for ridicule to daunt, or indifference to discourage him. When he surveyed the mental and physical agony inflicted by the disease, and the thought occurred to him that he was on the point of finding a sure and certain remedy, his benevolent heart overflowed with unselfish gladness. No feeling of personal ambition, no hope or desire of fame, sullied the purity of his noble philanthropy. 'While the vaccine discovery was progressive,' he writes, 'the joy at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities, blended with the fond hope of enjoying independence, and domestic peace and happiness, were often so excessive, that, in pursuing my favorite subject among the meadows, I have sometimes found myself in a kind of reverie. It is pleasant to recollect that those reflections always ended in devout acknowledgments to that Being from whom this and all other blessings flow.' At last an opportunity occurred of putting his theory to the test. On the 14th day of May, 1796,--the day marks an epoch in the Healing Art, and is not less worthy of being kept as a national thanksgiving than the day of Waterloo--the cow-pox matter or pus was taken from the hand of one Sarah Holmes, who had been infected from her master's cows, and was inserted by two superficial incisions into the arms of James Phipps, a healthy boy of about eight years of age. The cow-pox ran its ordinary course without any injurious effect, and the boy was afterward inoculated for the small-pox,--happily in vain. The protection was complete; and Jenner thenceforward pursued his experiments with redoubled ardor. His first summary of them, after having been examined and approved by several friends, appeared under the title of 'An Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June, 1798. In this important work he announced the security against the small-pox afforded by the true cow-pox, and proceeded to trace the origin of that disease in the cow to a similar affection of the horse's heel."
This publication produced a great sensation in the medical world, and vaccination spread so rapidly that in the following summer Jenner had the indorsement of the majority of the leading surgeons of London. Vaccination was soon introduced into France, where Napoleon gave another proof of his far-reaching sagacity by his immediate recognition of the importance of vaccination. It was then spread all over the continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it into America; in 1801, with his sons-in-law, President Jefferson vaccinated in their own families and those of their friends nearly 200 persons. Quinan has shown that vaccination was introduced into Maryland at least simultaneously with its introduction into Massachusetts. De Curco introduced vaccination into Vienna, where its beneficial results were displayed on a striking scale; previously the average annual mortality had been about 835; the number now fell to 164 in 1801, 61 in 1802, and 27 in 1803. After the introduction of vaccination in England the mortality was reduced from nearly 3000 per million inhabitants annually to 310 per million annually. During the small-pox epidemic in London in 1863, Seaton and Buchanan examined over 50,000 school children, and among every thousand without evidences of vaccination they found 360 with the scars of small-pox, while of every thousand presenting some evidence of vaccination, only 1.78 had any such traces of small-pox to exhibit. Where vaccination has been rendered compulsory, the results are surprising. In 1874 a law was established in Prussia that every child that had not already had small-pox must be vaccinated in the first year of its life, and every pupil in a private or public institution must be revaccinated during the year in which his or her twelfth birthday occurs. This law virtually stamped small-pox out of existence; and according to Frolich not a single death from small-pox occurred in the German army between 1874 and 1882. Notwithstanding the arguments advanced in this latter day against vaccination, the remembrance of a few important statistic facts is all that is necessary to fully appreciate the blessing which Jenner conferred upon humanity. In the last century, besides the enormous mortality of small-pox (it was computed that, in the middle of the last century, 2,000,000 victims perished in Russia from small-pox), the marks of affliction, blindness, deafness, etc., were plain in at least one member of every family.
Asiatic cholera probably originated centuries ago in India, where it is now endemic and rages to such an extent as to destroy 750,000 inhabitants in the space of five years. There is questionable evidence of the existence of cholera to be found in the writings of some of the classic Grecian and Indian authors, almost as far back as the beginning of the Christian era. In the sixteenth and seventeenth centuries travelers in the East gave accounts of this disease. Sonnerat, a French traveler, describes a pestilence having all the characteristics of Asiatic cholera which prevailed in the neighborhood of Pondicherry and the Coromandel coast from 1768 to 1769, and which, within a year, carried off 60,000 of those attacked. According to Rohe, Jasper Correa, an officer in Vasco da Gama's expedition to Calicut, states that Zamorin, the chief of Calicut, lost 20,000 troops by the disease. Although cholera has frequently extended to Europe and America, its ravages have never been nearly as extensive as in the Oriental outbreaks. An excellent short historic sketch of the epidemics of the cholera observed beyond the borders of India has been given by Rohe. In 1817 cholera crossed the boundaries of India, advancing southeasterly to Ceylon, and westerly to Mauritius, reaching the African coast in 1820. In the following two years it devastated the Chinese Empire and invaded Japan, appearing at the port of Nagasaki in 1822. It advanced into Asiatic Russia, and appeared as far east as St. Petersburg in 1830, from whence it spread north to Finland. In 1831 it passed through Germany, invading France and the western borders of Europe, entering the British Isles in 1832, and crossing the Atlantic Ocean for the first time, appeared in Canada, having been carried thence by some Irish emigrants.
From Canada it directly made its way to the United States by way of Detroit. In the same year (1832) it appeared in New York and rapidly spread along the Atlantic coast.
"During the winter of 1832 it appeared at New Orleans, and passed thence up the Mississippi Valley. Extending into the Indian country, causing sad havoc among the aborigines, it advanced westward until its further progress was stayed by the shores of the Pacific Ocean. In 1834 it reappeared on the east coast of the United States, but did not gain much headway, and in the following year New Orleans was again invaded by way of Cuba. It was again imported into Mexico in 1833. In 1835 it appeared for the first time in South America, being restricted, however, to a mild epidemic on the Guiana coast.
"In 1846 the disease again advanced beyond its natural confines, reaching Europe by way of Turkey, in 1848. In the autumn of this year it also appeared in Great Britain, Belgium, the Netherlands, Sweden, and the United States, entering by way of New York and New Orleans. In the succeeding two years the entire extent of country east of the Rocky Mountains was invaded. During 1851 and 1852 the disease was frequently imported by emigrants, who were annually arriving in great numbers from the various infected countries of Europe. In 1853 and 1854 cholera again prevailed extensively in this country, being, however, traceable to renewed importation of infected material from abroad. In the following two years it also broke out in numerous South American States, where it prevailed at intervals until 1863. Hardly had this third great pandemic come to an end before the disease again advanced from the Ganges, spreading throughout India, and extending to China, Japan, and the East Indian Archipelago, during the years 1863 to 1865. In the latter year it reached Europe by way of Malta and Marseilles. It rapidly spread over the Continent, and in 1866 was imported into this country by way of Halifax, New York, and New Orleans. This epidemic prevailed extensively in the Western States, but produced only slight ravages on the Atlantic Coast, being kept in check by appropriate sanitary measures. In the same year (1866) the disease was also carried to South America, and invaded for the first time the states bordering on the Rio de la Plata and the Pacific coast of the Continent.
"Cholera never entirely disappeared in Russia during the latter half of the sixth decade, and in 1870 it again broke out with violence, carrying off a quarter of a million of the inhabitants before dying out in 1873. It spread from Russia into Germany and France and was imported, in 1873, into this country, entering by way of New Orleans and extending up the Mississippi Valley. None of the Atlantic coast cities suffered from this epidemic in 1873, and since that year the United States has been entirely free from the disease, with the exception of a few imported cases in New York harbor in 1887" (and in 1893). In 1883 an epidemic of cholera raged in Egypt and spread to many of the Mediterranean ports, and reappeared in 1885 with renewed violence. In Spain alone during this latter epidemic the total number of cases was over one-third of a million, with nearly 120,000 deaths. In 1886 cholera caused at least 100,000 deaths in Japan. In the latter part of 1886 cholera was carried from Genoa to Buenos Ayres, and crossing the Andean range invaded the Pacific coast for a second time. In Chili alone there were over 10,000 deaths from cholera in the first six months of 1887. Since then the entire Western hemisphere has been virtually free from the disease.
In 1889 there was an epidemic of cholera in the Orient; and in 1892 and 1893 it broke out along the shores of the Mediterranean, invading all the lines of commerce of Europe, Hamburg in the North and Marseilles in the South being especially affected. In the summer of 1893 a few cases appeared in New York Bay and several in New York city, but rigorous quarantine methods prevented any further spread.
Typhus fever is now a rare disease, and epidemics are quite infrequent. It has long been known under the names of hospital-fever, spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the regular associate of such social disturbances as overcrowding, excesses, famine, and war. For the past eight centuries epidemics of typhus have from time to time been noticed, but invariably can be traced to some social derangement.
Yellow Fever is a disease prevailing endemically in the West Indies and certain sections of what was formerly known as the Spanish Main. Guiteras recognizes three areas of infection:--
(1) The focal zone from which the disease is never absent, including Havana, Vera Cruz, Rio, and the other various Spanish-American points.
(2) The perifocal zone, or regions of periodic epidemics, including the ports of the tropical Atlantic and Africa.
(3) The zone of accidental epidemics, between the parallels of 45 degrees north and 35 degrees south latitude.
In the seventeenth century Guadaloupe, Dominica, Martinique, and Barbadoes suffered from epidemics of yellow fever. After the first half of the seventeenth century the disease was prevalent all through the West Indies. It first appeared in the United States at the principal ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it reappeared in Philadelphia and Charleston, and since that time many invasions have occurred, chiefly in the Southern States.
The epidemic of 1793 in Philadelphia, so graphically described by Matthew Carey, was, according to Osler, the most serious that has ever prevailed in any city of the Middle States. Although the population of the city was only 40,000, during the months of August, September, October, and November the mortality, as given by Carey, was 4041, of whom 3435 died in the months of September and October. During the following ten years epidemics of a lesser degree occurred along the coast of the United States, and in 1853 the disease raged throughout the Southern States, there being a mortality in New Orleans alone of nearly 8000. In the epidemic of 1878 in the Southern States the mortality was nearly 16,000. South America was invaded for the first time in 1740, and since 1849 the disease has been endemic in Brazil. Peru and the Argentine Republic have also received severe visitations of yellow fever since 1854. In Cuba the disease is epidemic during June, July, and August, and it appears with such certainty that the Revolutionists at the present time count more on the agency of yellow fever in the destruction of the unacclimated Spanish soldiers than on their own efforts.
Leprosy is distinctly a malady of Oriental origin, and existed in prehistoric times in Egypt and Judea. It was supposed to have been brought into Europe by a Roman army commanded by Pompey, after an expedition into Palestine. Leprosy was mentioned by several authors in the Christian era. France was invaded about the second century, and from that time on to the Crusades the disease gradually increased. At this epoch, the number of lepers or ladres becoming so large, they were obliged to confine themselves to certain portions of the country, and they took for their patron St. Lazare, and small hospitals were built and dedicated to this saint. Under Louis VIII 2000 of these hospitals were counted, and later, according to Dupony, there were 19,000 in the French kingdom. Various laws and regulations were made to prevent the spread of the contagion. In 1540 it was said that there were as many as 660 lepers in one hospital in Paris.
No mention is made in the Hippocratic writings of elephantiasis graecorum, which was really a type of leprosy, and is now considered synonymous with it. According to Rayer, some writers insist that the affection then existed under the name of the Phoenician disease. Before the time of Celsus, the poet Lucretius first speaks of elephantiasis graecorum, and assigns Egypt as the country where it occurs. Celsus gives the principal characteristics, and adds that the disease is scarcely known in Italy, but is very common in certain other countries. Galen supplies us with several particular but imperfect cases--histories of elephantiasis graecorum, with a view to demonstrate the value of the flesh of the viper, and in another review he adds that the disease is common in Alexandria. Aretaeus has left a very accurate picture of the symptoms of elephantiasis graecorum; and Pliny recapitulates the principal features and tells us that the disease is indigenous in Egypt. The opinion of the contagiousness of elephantiasis graecorum which we find announced in Herodotus and Galen is more strongly insisted upon by Caelius Aurelianus who recommends isolation of those affected. Paulus aegenita discusses the disease. The Arabian writers have described elephantiasis graecorum under the name of juzam, which their translators have rendered by the word lepra. Later, Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have discussed it.
The statistics of leprosy in Europe pale before the numbers affected in the East. The extent of its former ravages is unknown, but it is estimated that at the present day there are over 250,000 lepers in India, and the number in China is possibly beyond computation. According to Morrow, in 1889 in the Sandwich Islands there were 1100 lepers in the settlement at Molokai. Berger states that there were 100 cases at Key West; and Blanc found 40 cases at New Orleans. Cases of leprosy are not infrequently found among the Chinese on the Pacific coast, and an occasional case is seen in the large cities of this country. At the present day in Europe, where leprosy was once so well known, it is never found except in Norway and the far East.
Possibly few diseases have caused so much misery and suffering as leprosy. The banishment from all friends and relatives, the confiscation of property and seclusion from the world, coupled with poverty and brutality of treatment,--all emphasize its physical horror a thousandfold. As to the leper himself, no more graphic description can be given than that printed in The Ninteenth Century, August, 1884: "But leprosy! Were I to describe it no one would follow me. More cruel than the clumsy torturing weapons of old, it distorts, and scars, and hacks, and maims, and destroys its victim inch by inch, feature by feature, member by member, joint by joint, sense by sense, leaving him to cumber the earth and tell the horrid tale of a living death, till there is nothing left of him. Eyes, voice, nose, toes, fingers, feet, hands, one after the other are slowly deformed and rot away, until at the end of ten, fifteen, twenty years, it may be, the wretched leper, afflicted in every sense himself, and hateful to the sight, smell, hearing, and touch of others, dies, despised and the most abject of men."
Syphilis.--Heretofore the best evidence has seemed to prove that syphilis had its origin in 1494, during the siege of Naples by Charles VIII of France; but in later days many investigators, prominent among them Buret, have stated that there is distinct evidence of the existence of syphilis in prehistoric times. Buret finds evidence of traces of syphilis among the Chinese five thousand years ago, among the Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in biblic times, and among the Greeks and Romans after Christ. Some American writers claim to have found evidences of syphilitic disease in the skulls and other bones of the prehistoric Indian mounds, thus giving further evidence to the advocates of the American origin of syphilis. The Spaniards claimed that, returning from America in 1493, Columbus brought with him syphilis. Friend says: "One thing is remarkable; the Spaniards, upon their first expedition to America, brought home from thence this contagious disorder, and soon after carried another affection thither, the small-pox, of which the Indian Prince Montezuma died." The first descriptions of syphilis are given under the name of morbus gallicus, while the French in return called it morbus neapolitanus or mal d'Italie. The name of syphilis was said to have been first given to it by a physician of Verona, in a poem describing the disease. Inspired by heroic epics Fracastor places before us the divinities of paganism, and supposes that a shepherd, whom he called Syphilus, had addressed words offensive to Apollo, and had deserted his altars. To punish him the God sent him a disease of the genitals, which the inhabitants of the country called the disease of Syphilus.
"Syphilidemque ab eo labem dixere coloni."
Buret traces the origin of the word syphilis from sun, with, and filia, love, the companion of love; which means in plain language that the pox is a disease transmitted more especially by venereal relations. The first great epidemic of syphilis occurred between 1493 and 1496, and attacked all ranks, neither the Church nor the Crown being spared. The ravages of this disease were increased by the treatment with mercury which soon afterward was found in proper doses to be a specific in this disease. It is possible that the terrible manifestations of syphilis of which we read in the older writers were in a great measure due to the enormous doses of mercury. At the present day syphilis is universally prevalent. In his excellent monograph Sturgis estimated in New York, in 1873, that one out of 18 suffered from it; and White of Philadelphia pronounces the opinion that "not less than 50,000 people in that city are affected with syphilis." According to Rohe, on this basis Gihon estimates the number of syphilitics in the United States at one time as 2,000,000.
To-day no disease, except possibly tuberculosis, is a greater agency in augmenting the general mortality and furthering sickness than syphilis. Its hereditary features, the numerous ways in which it may be communicated outside of the performance of the sexual act, and the careful way in which it is kept from the sanitary authorities render it a scourge which, at the present day, we seem to have no method of successfully repressing.
Modern Mortality from Infectious Diseases.--As to the direct influence on the mortality of the most common infectious diseases of the present day, tuberculosis, universally prevalent, is invariably in the lead. No race or geographic situation is exempt from it. Osler mentions that in the Blood Indian Reserve of the Canadian Northwest Territories, during six years, among a population of about 2000 there were 127 deaths from pulmonary consumption. This enormous death-rate, it is to be remembered, occurred in a tribe occupying one of the finest climates of the world, among the foothills of the Rocky Mountains, a region in which consumption is extremely rare among the white population, and in which cases of tuberculosis from the Eastern provinces do remarkably well. Mayo-Smith quotes a table illustrating the annual deaths (based on the returns from 1887 to 1891) from certain infectious diseases per 10,000 European inhabitants. The figures for each disease give a rough measure of its prevalence in different countries. The large figures as to small-pox show the absence in Italy and "Hieronymi Fracastorii," Veronae, 1530. Statistics and Sociology, New York, 1885.
Austria of vaccination; diphtheria seems to be very fatal in Germany and Austria; Italy has a large rate for typhoid fever, and the same is true of the other fevers; France, Germany, and Austria show a very large rate for tuberculosis, while Italy has a small rate.
DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS.
Small- Scarlet Diphtheria Typhoid Tuber- COUNTRY. pox. Measles. fever fever. culosis
Italy, . . . . . 3.86 6.17 2.99 6.08 7.49 13.61 France (cities). 2.3 5.18 3.1 6.66 5.32 33. England, . . . . 0.11 4.68 2.31 1.74 1.9 16.09 Ireland, . . . . 0.01 2.01 1.22 0.76 2.33 21.15 Germany (cities). 0.04 2.8 2.15 10.21 2.11 31.29 Prussia, . . . . 0.03 3.2 2.46 14.17 2.26 28.06 Austria, . . . . 4.43 5.36 5.57 13.2 5.42 37.2 Switzerland, . . 0.06 1.53 1.22 3.53 1.47 21.07 Belgium, . . . . 1.52 6.2 1.62 5.77 3.83 19.87 Holland, . . . . 0.02 3.93 0.38 1.45 2.5 19.21 Sweden, . . . . . 0.01 2.3 3.69 3.89 2.22 0.
Based upon the Tenth Census Reports, we figure that of every 10,000 inhabitants of the United States the number of deaths for the census year from similar diseases was as follows:--
Rural. Cities.
Measles, . . . . . . . 1.62 1.54 Scarlet Fever, . . . . 2.84 5.54 Diphtheria, . . . . . 7.53 8. Croup, . . . . . . . . 3.51 4.08 Typhoid Fever, . . . . 4.75 3.46 Tuberculosis, . . . . 16.29 28.55
The general average of deaths from small-pox was about 0.14.
The end
You’ve reached the end of Anomalies and Curiosities of Medicine.
Read and listen together
FrankensteinRead along