Case CXIII

"I attended," says Abercrombie, "a very intelligent man, who had been sick for some time with a slight fever. Although his reason was unimpaired, he was subject to a frequent hallucination, which consisted in the appearance of an old gray-beaded man, with a countenance of great benevolence. The vision always occurred in the same manner. The phantom entered the room by a door on the left side of the bed, passed round the foot, and came and sat on a chair on the right-hand side. He looked on the sick man with an air of interest and pity, but never spoke. Having remained thus for a few minutes, he vanished."

* Edinburgh Medical and Surgical Journal, vol. vi. p. 291.

Case CXIY. "A lady," continues the same author, "also affected slightly with fever, perceived a large party of men and women in her room, seated as at a soiree, and a servant handing refreshments to them on a waiter. The hallucination lasted during several days, and was varied by the sight of castles and very beautiful churches, which appeared as if out in crystal. From the commencement, the lady was aware that it was an illusion of sight, incident to the fever, and amused her friends by describing the different objects that passed before her."

Conolly, who has very carefully studied the effects of fever on the imagination, has adopted three degrees of impressions which result from it.

In the first, the patient seems to see the bed surrounded with flames, hears voices murmuring in his ear, inhales the odor of a feast; his body feels the sensation of heavy weights moving over it. Fantastic figures incessantly pass before his eyes, which disappear as rapidly as they come.

If patients of this character are questioned, some very calmly acknowledge that they do experience the symptoms stated; others, on the contrary, seem confused, make a thousand excuses before acknowledging what they feel; it is evident that they are endeavoring to get rid of some importunate idea; others, again, believe in the reality of all these sensations. Of these three classes, the last is a prey to delirium, the second approximates to it; the first alone has reason. What is the cause of these slight differences?

The first compare received sensations with surrounding objects, appealing to their senses whose integrity is preserved. They recognize their chamber, their family, their physician. As to the figures which glide about, they are conscious that they do not exist. They recollect that they have been ill for some days, and have had a fever. Comparing present objects and things which they recollect, with the succession of figures that appear before them, or the sounds which they think they have heard, they become convinced that these sensations are only creations of a disturbed mind.

The next class approximates closer to delirium; on awaking, the sight of their curtains in flames, terrifies them; they seize hold of them and look anxiously around, but the sense of touch, and the tranquillity of their attendants, gives them reason to believe that this phenomenon is a symptom of the disease. If they are spoken to at the moment of awaking, the voice addressing them is confounded with the images of the dream; but they open their eyes, look at you, take your hand, and in comparing the sensation that present things awaken with those which they have seen in their troubled dreams, they quickly come to themselves.

This kind of disorder usually lasts some hours or days. If it augments, the objects assume a more decided and constant form, and delirium may supervene.

A poor woman in very feeble health, complained in the dispensary at Stratford, that she constantly saw faces and figures cut in half. Sometimes these apparitions appeared in a crowd, resembling a number of heads eagerly looking in at the door or window.

Patients of the third class are governed by the images that harass them; they cannot give their attention to the sensations which proceed from objects that are present; they continue to talk to persons whom they imagine near to them, and do not recognize the voices of their friends; their eyes are turned towards them, but they have apparently assumed other forms and faces; they look around the room, and think themselves in a strange place. In this state, it is impossible for them to compare the true sensations, which they are incapable of receiving, with the false ones which they alone recognize. They cannot compare what they see with what, in their febrile condition, they have forgotten, and the necessary consequence of this defect is delirium or active insanity.

In the case of fever, says Conolly, I have several times seen these three states vary from one to the other, according as the disease progressed and the integrity of sensation was lost; on the other hand, as the disease diminished, the patient recovered his power over his senses, and it often required but very slight efforts to fix his attention.*

Several times in the course of typhoid fever, we have concluded that the sick had visions. This did not escape the no* tice of Hibbert. Hallucinations have been seen in all stages of this fever and during convalescence. The author of L' Observa-teur Chretien, quoted by Abercrombie, relates that a farmer, returning from market, was much struck by an uncommonly brilliant light, which appeared on the road, in the midst of which stood the Saviour. Seized with fear, he struck spurs into his horse, galloped home, and was much agitated during the whole evening. Symptoms of a typhoid fever that was raging in the neighborhood appeared, and he died in ten days. It was recollected that on the morning of the day on which he saw the vision, he had complained of bad headache and great lassitude; there is no doubt that the hallucination was caused by the fever.

In the same author we read the account of a man, who on recovering from the typhoid fever, imagined himself ten feet in height. His bed appeared to be raised seven or eight feet from the ground, so that he felt afraid to step out of it. The aperture of the chimney, likewise, seemed to him as large as the arch of a bridge. By a singular contradiction, the persons about him appeared to retain their natural size. But the most curious cases are those furnished by illusions of the sight.