Case LXXIII

Madame C. has, for several years, been subject to attacks of hysteria; at their approach, she becomes timid, and fearful, until her terrors augment to such a degree that she continually calls for help. This exaggerated alarm is caused by atrocious-looking figures, which she thinks she sees during the paroxysm, and which appear to make grimaces to abuse her, and to threaten to beat her.

Hibbert, in his work on hallucinations, says that when, in hysteric females, the excitement has reached a high pitch, results are produced analogous to those occasioned by deutoxide of azote, to which an extraordinary influence on the blood is attributed.

* Influence des Maladies but les Idees. † M6moires, t i. Paris, 1842.

This author mentions the case of a woman, reported by Por-tius, who was always warned of the approach of her fit, by the apparition of herself in the looking-glass. Sauvage asserts that, during their paroxysms, patients have seen frightful spectres.

M. Michla says, that hallucinations were very frequent in the hysteric epidemic that affected the nuns of Saint Elizabeth at Louviers.*

Hysteria may exist with insanity, and these cases are even common; but we must inquire as to which of the diseases hallucination belongs. Since it is developed at the commencement of the paroxysm, or during its progress, and ceases with it, it may surely be considered as a complication of hysteria.

Case LXXIV

Mademoiselle S., forty-six years of age, believes that she is the author of all the evils in the world. God has deserted her, and abandoned her to Satan. This insanity, which was first exhibited in melancholy, is now characterized by songs, recitations, and soliloquies, which, with her voice raised to a high pitch, she utters with extreme volubility.

Mademoiselle S. feels conscious of this absurdity, and her liability to be taken for a mad woman; but she obeys an irresistible voice; nothing on earth could prevent her giving utterance to her feelings. This state of excitement is succeeded by strong hysterics, and she struggles in long-continued and violent convulsions. The seat of the spasm is in the uterus: when the hand is placed on that region, the movements of the patient become modified, and she tells of all that is passing in her abdomen. During these attacks, the figures of the attendants are transformed. She sees the devil, and hideous phantoms; she strongly believes she is possessed; utters piercing cries, supplicates to be delivered from these apparitions, bursts into shouts of laughter, and melts into tears; then, at the close of some hours, returns to her natural condition.

With many insane hysteric women who have come under our notice, the hallucinations were of an amorous nature; others, when under the influence of religious impressions, are visited by angels or demons, in which case the hallucinations are influenced by the laws which usually govern them.

* Delire, Des Sensations, p. 298, Paris, 1846.

M. Macario* presents us with several interesting examples: -

Hysteria, in mental alienation, is frequently accompanied by erotomania and nymphomania. It is probable that education, in repressing these instincts, had only rendered them more vivid and strong, by reason of their prolonged suppression.

It is usually in the commencement of hysteria that hallucinations are presented; they are also observed during the fit when the faculties are partially retained; and they may be exhibited at the close of the seizure. Hallucinations of sight and hearing are the most common, but all the senses may be affected; and this is also the case with illusions.

4. Of Hallucinations in Hypochondria. - The hypochondriac, by his moral condition, truly represents a lens, where everything converges, and is necessarily predisposed to hallucinations and illusions. Thus incessant study, the fixedness of which nothing can disturb, is favorable to their production. It is common for the patients to complain of detonations, hissings, musical sounds, and extraordinary voices which they hear in the brain. "These persons," says M. Dubois d'Amiens, "think that their brain is effervescing; that it has dried up, or withered; and they say they are about to lose their sight, their hearing, etc."†

Many think that a snake or a fish is moving over different parts of their bodies. One lady, whose case M. Falret has described in his work, said her skin appeared to be covered with scales like those of a carp, but she recognized her mistake on touching it. Some complain of a sensation of heat and cold simultaneously, or successively, in different parts of their bodies.

Hallucinations may accompany hypochondria without any real insanity; but, says Louyer-Villermay, " when we see the frequent union of melancholy and mental alienation with hypochondria, we can readily conceive that a sort of affinity exists between these diverse kinds of madness."

Zimmerman becomes hypochondriac; and this celebrated phy-

* Paralysie hysterique (Annal. Medico-psych., Janv. 1844, pp. 68, 72, sician, author of two highly esteemed treatises, is incessantly complaining of his bad digestion. His work on "Solitude" constantly breathes a melancholy strain. The French Revolution increases his mournful ideas; soon, he experiences wakefulness, optical illusions, and apparitions of phantoms during the night. With these symptoms are combined derangement of the functions of the stomach, tremblings, violent giddiness, especially on the use of coffee; syncope after the least exercise; vacillation, with a want of confidence, and obstinacy; a slight wandering and confusion in his ideas; and pusillanimity, which is quite at variance with his usual character.

77).

† Histoire philosopbique de l'Hypocbondrie et de l'Hysterie, Paris, 1837, 1 vol. in 8vo. See also the work by M. Brachet on Hypochondria, 1 vol. 8vo. 1844; that of M. Michen on the same subject; a Treatise on Hypochondria and Suicide, by M. Falret; and a Practical Treatise on Nervous Diseases, by M. Sandras, 1851, torn. i. p. 514.

Among the many phenomena accompanying hypochondria, we perceive, in its early stage, an extreme desire for solitude, which increases, and, assuming the character of an exclusive delirium, excites a constant fear in the patient that an enemy will enter and devastate his house.*

Georget, whose works may always be advantageously consulted, says that some of these patients finally lose their senses, but that this is a rare termination of the affection. Having had a longer practice than that celebrated physician, we dissent from his opinion; and think that the link between hypochondriasis and insanity is closer than that physician imagined.