SPEC. II. give us examples of such order, tetanus very generally, GEN. VIII. . convulsion-fit, epilepsy, and hysteria furnish proofs of Carus Ecthe most capricious alternations of spastic and clonic ac- stasis. tion, or of their existing in different trains of muscles Ecstasy. simultaneously. These remarks pe culiarly ecstasy with catalepsy. How far the These remarks peculiarly apply to ECSTASY, the species immediately before us, compared with CATALEPSY or TRANCE, the species that immediately follows. In both, applicable to the nervous fluids contributory to sensibility and irrita- compared bility are disturbed in their flow or regularity of action, but not equally, nor in the same manner: for while the flow of the former seems to be totally suspended, that of two agree. the latter continues, though with a striking deviation from the uniform tenour of health. Thus far the two diseases agree. They differ in the nature of the disturbance of Wherein they differ, the motific fluid. In ecstasy, this seems to be secreted in excess and irregularly accumulated; in consequence of which the muscles are thrown into a rigid and permanent spasm, not incurvating the body, as in the different modifications of tetanus, but maintaining it erect from an equal excess of supply to the extensor and flexor muscles. In catalepsy, on the contrary, the motific fluid seems to be secreted in deficiency rather than in excess, though it is often irregularly distributed; and hence, while some muscles appear sufficiently supplied, the action of others, even the involuntary ones, is often peculiarly weak. Whence, also, the limbs, instead of resisting external force, yield to it with readiness, and assume any position that may be given to them. mind and In both cases the torpitude of the external senses, ap- In both the pears to extend to those of the mind; for the patient, on returning to himself, has no recollection of any train of ideas that occurred to him during the fit. find presently that in a few instances, the and of judging, and perhaps some other powers, do not seem completely to have failed. Yet, we shall power of sight senses equally tor pid in ge neral: yet not Both dis eases most common to It deserves, however, to be specially remarked, that both these diseases are most common to persons constitutionally disposed to some mental estrangement, as melan- persons predisposed SPEC. II. Carus Ec stasis. Ecstasy. GEN. VIII. choly or revery, hypochondrism, or morbid elevation of mind; thus pointing out to us the outlet at which the sensorial power is often carried off: for we have already seen that, under intense revery, the external senses are, for the most part, inactive or torpid to the impressions of surrounding objects during wakefulness: while the mind is alike dead to every thing but the train of ideas which immediately constitute the subject of the revery. Illustrated. The same tendency to abstraction, though not carried so to mental estrangement: conclusion to be drawn from this. completely into effect, is often to be found in MELANCHOLY, and still more so in that species of ALUSIA which, in the present work, is denominated ELATIO, mental elevation or extravagance, and particularly the variety called ELATIO ECSTATICA, false inspiration, visionary conceits. If the person labouring under any of these be attacked at the same time with a general entasia, or rigid tetanus, erecting instead of incurvating the body, he will be thrown into an ecstasy, constituting the present species. And if, instead of an excessive there be a deficient supply of irritable power, and consequently a flaccidity or flexibility of the muscles instead of a rigidity, his disease will be a catalepsy, constituting the ensuing species, with this difference alone, that in most cases of the two diseases before us, the faculties of the mind unite in the torpitude of the senses, instead of giving rise to it. Isay, in most cases, and have kept to the same limitation in the specific definition: for if it be true that one of the causes of both these affections is profound contemplation or attention of mind, or some overwhelming passion, as we are told by many writers, the mind does not seem, in such cases, to be without ideas, nor without them in a very energetic degree. And it is to ecstasis under this modification that I am inclined to think we Catochus should refer the CATOCHUS of most of the nosologists, which they arrange in the same order as, and next to tetanus, and define a "general spastic rigidity without sensibility." what. Predispo nent cause of ecstasis. Ecstasis is of rare occurrence, its predisponent cause is unquestionably a highly nervous or irritable tempera GEN. VIII. SPEC. II. Carus Ec Ecstasy. ment: the exciting or occasional causes it is not easy, at all times, to determine. For the greater part they seem to be of a mental character, as profound and long con- stasis. tinued meditation upon subjects of great interest and ex- Exciting citement; and terror or other violent emotions of the mind. cause. It seems also to have proceeded, like most of the spasmodic affections already treated of, from various corporeal irritations, and particularly those of the stomach and liver, suppressed menstruation, repelled chronic eruptions, and plethora and perhaps occasionally, as hinted by the younger M. Pinel, from an inflammation of the spinal marrow *. The duration of the fit varies, from a few hours to two or three days. The patient rouses as from a sleep, seems languid, and complains of nausea and vertigo:-evidently showing that the morbid supply of sensorial power is exhausted, and that the spasm has ceased in consequence of such exhaustion. intention. As the disease evidently consists in a disturbance of the Remedial balance of the sensorial power, or in an excessive secretion of irritable, but a deficient or suspended secretion of sensific fluid, the curative intention should lead us to aim at a restoration of this balance: and hence the remedial process will run so nearly parallel with that for tetanus that it is only necessary to refer the reader to the treatment already laid down for that disease. nected with Where catalepsy is connected with a morbid state of the Where conliver, mercury given to ptyalism has often proved highly successful. Dr. Chisholm has given a very interesting case of this kind in a young lady of eighteen of an hys- mercury terical diathesis, and in whom the ecstasy or paroxysm useful. of rigidity was alternated with paroxysms of mania. "At Interesting the end of ten minutes the patient suddenly started up in Chisholm. bed, the muscles became at once relaxed, but maniacal distraction of mind instantly succeeded. During the maniacal state, now, it was particularly singular that, although she could not articulate a single word, and was • Journal de Physiologie Experimentale, par F. Magendie, D.M. &c. Tom. I. Janv. 1821. case from GEN. VIII. SPEC. II. stasis. Ecstasy.. evidently unconscious of what she did, yet she sung some very beautiful airs with a sweetness of tone and correctness of measure extremely interesting and affecting; at the end of ten minutes her head suddenly and unexpectedly dropped, and she fell back into the state of rigidity." She finally recovered by the use of mercury em ployed as above. SPECIES III. CARUS CATALEPSIA. Catalepsy. Trance. SPEC. III. How distinguished from the preceding species. TOTAL SUSPENSION OF SENSIBILITY AND VOLUNTARY GEN. VIII. THIS species is chiefly distinguished from the preceding by the flexibility instead of inflexibility of the muscles. The cause of this difference has been explained under the preceding species, and needs not be repeated in the present place. The specific term common to the Greek writers is derived from xaraλaμlávoμaι, "deprehendor," "to be καταλαμβάνομαι, seized or laid hold of," and alludes to the suddenness of its attack. Origin of the specific name. Predisponent and exciting causes. The predisponent and exciting causes are the same as those of ecstasis: and the state of the habit or idiosyncrasy alone produces the difference of effect. The counDescription. tenance is commonly florid, and the eyes open, and apparently fixed intently upon an object, but in most cases without perception. Yet here, as in ecstasis, we some * Of the Climate and Diseases of Tropical Countries, p. 160. Svo. Lond. 1822. GEN. VIII. SPEC. III. Carus Cata times meet with examples in which one or more of the senses, mental as well as corporeal, do not associate in the general torpitude. So, in paroniria, the sight or hearing lepsia. continues awake, while the other external senses are Catalepsy. plunged into a deep sleep, and, in some cases of paralysis, the sentient fibres retain their activity while those of motion are torpid. Trance. the par The paroxysm commonly attacks without any previous Progress of warning, and closes with sighing or a clonic effort of the oxysm. nervous power to re-establish its regular flow. Its dura- Duration. tion is from a few hours, or minutes, to two or three days; and, according to well established authorities, sometimes for a much longer period. And so completely exhausted Wonderful of irritable power are some of the organs, and even those of irritable of involuntary action, that we have one example in a fo- power. reign journal of forty grains of emetic tartar having been given without any effect *. exhaustion Disease of rare occur ed it as a The disease, like the last, is not common. Dr. Cullen, affirms that he never saw an instance of it, except where rence: it was altogether counterfeited, and asserts the same of and hence other practitioners: which, in fact, he offers as an apology misarranged its place for not knowing exactly where to arrange it. "There- by Cullen; fore," says he, "from the disease being seldom, differently described, and almost always feigned, I can scarcely tell where to place it with certainty: but I am well persuaded that it does not at all differ from the genus apoplexy, and I have hence arranged it as a species of this division." Plethora or pressure of the brain may, perhaps, be an occasional cause of this, as of most other nervous diseases, in some habits; but the greater number of cases that have occurred show very clearly that this disease, in its genuine form, is as distinct from apoplexy as from epilepsy. We have said that both catalepsy and ecstasy are most frequently found in constitutions disposed to mental estrangements. Dr. Gooch has given a very interesting case in illustration of this remark in his paper on puerperal * Behrends, Baldingers, N. Magazine. B. ix. 199. who regardsubdivision of apoplexy. Mostly found like ecstasy in constituposed to tions dis mental estrangement. Striking illustration. |