Case LXI

Mademoiselle 0. had been remarkable for her excellent judgment, so much so as to be constantly consulted by her friends. This fact, which was attested by a number of persons very capable of appreciating her mind, proved to me that, if the absence of judgment be one of the distinctive characteris-. tics of insanity, the rule is not without exception. Who does not remember the case of a man, whose powerful mind assisted in maintaining the peace of the world, and yet, who fell a victim to insanity in the full vigor of manhood.

The first symptoms of her disease were manifested by a kind of presentiment. She begged her friends to place her in a certain establishment, which she named, in case she went mad. The request surprised them much, for at this time she conversed rationally, and had exhibited no singularity of conduct.

Mademoiselle 0. soon thought she heard voices insulting her. They threatened to cut her into four parts, to make mincemeat of her, and to devour her. These voices desired her to swallow everything. Obedient to this order, she successively introduced into her stomach, earrings, pins, mittens, and would have swallowed a set of dominoes, if, suspecting her intention, they had not been taken from her. This lady either laughed when she saw herself the object of our notice, or flew into a rage; she struck, and attempted to scratch us, and said we were all devils. Her incoherent discourse proved the disorder of her faculties. She was being sought for in order to be taken to China; devils maltreated her; we were Messieurs So and So; then we changed into bandits and villains. By a sudden and incomprehensible transition, these wild fancies disappeared as though blown away by the wind, and a sensible, instructive conversation struck every one with astonishment, so incomprehensible was so rapid a change.

This young lady also exhibited a perversion of cutaneous sensitiveness, which made her take pleasure in picking off her skin. This is a symptom we have often noticed with the insane, especially hypochondriacs. This mania was carried to such a length that we often counted as many as twelve large sores on different parts of her body.

Hard work and fatigue, with certain changes in the physical functions which occur in middle life, appear to have caused the mental malady of this lady.

There were times when she was convinced that she grew thin and shrank visibly, although she was enormously stout. Once she entreated a lady to put her into her umbrella or her hat that she might be more easily moved. At other times, she fancied herself metamorphosed into a cat or a dog, and imitated, for hours together, the cries of the different animals.

These illusions were replaced by another that lasted some time. She complained that every one accused her of being a man. Though prior to her derangement she was extremely chaste and correct in every particular, she became most revolt-ingly immodest.

It has been said that the generative instinct has its seat in the brain; but how does it happen that this organ should be aroused at the moment its functions are about to cease? According to a law of physiology, ought not long inaction to induce atrophy? Another reflection also arises: Why is it that females who have been well brought up, use gross words and commit immodest actions; whilst those of loose morals appear reserved? The reply, it appears to us, may be found in the organization. An instinct may be repressed by education and religion; but never destroyed.

She remained for an entire year in this state of mania; a prey to continual hallucinations and illusions. At one time she saw devils and heard voices; then 6he was visited by strangers and by friends; poisoned food was served up for her; her apartment was filled with bad odors, or a dreadful noise was made to prevent her sleeping. Sometimes she pretended that we had beaten her, and showed the sores she had made in tearing off her skin. Sometimes she thought herself the Duchess de Berri, and that she had a little son. At such times, she would seek her child everywhere, and thought she saw him in every object which met her eye.

After this period, we remarked that she became calmer, and had prolonged lucid intervals. She was permitted to descend to the garden. Soon her reason was entirely restored. It has been asserted that, after such prolonged attacks, the intellectual faculties are always somewhat impaired. Mademoiselle 0. was an exception to this rule; for she passed entire days with us, either engaged in conversation, or in giving instruction to my children. The clearness of her explanations, the facility with which she selected examples, and the excellence of her method, daily excited our surprise. Her memory was prodigious; nothing had been forgotten during the long night of her malady. For ten entire days, this miraculous resurrection was sustained; but by degrees her brain was again filled with absurd and singular ideas. She would stop in the midst of the most sensible conversation to tell us that she was not a Chinese, that she had never been to Africa, and that she had not cut any one's throat. Her disorder recurred in all its intensity; and from this relapse until her death, which occurred four months afterwards, she had intermitting periods of calm and madness. In her paroxysms, she would undress to show that her back had been changed; that she was an animal, or that she was Mademoiselle B., one of the boarders, or rather to prove the contrary, in a manner similar to those ancient rhetoricians, who maintained the pro and con of a given proposition. Another peculiarity of this derangement is, that Mademoiselle 0. frequently wrote letters in the midst of the most incoherent discourse, without introducing one word that could betray the state of her mind, a circumstance which, on an inquest, would have been adduced as proof of the soundness of her judgment.

There is a variety of mania to which circumstances have given the name of puerperal mania, or the madness of women during childbed confinement. The strangest hallucinations of sight and hearing throw the patient into inexpressible agitation, and by turns they endure all the tortures of the fear of death, and of poisoning, and all the agonies of despair.*

M. Esquirol, who has published an excellent treatise on this subject, estimates the number of women who are attacked with this mania to be seven per cent. of all cases of derangement - an estimate which appears to us to require reconsideration. He has not directed attention to the phenomenon of hallucinations and illusions, which Mr. Morel, on the contrary, considers frequent. He, however, relates four cases in which there was a combination of these two symptoms.

In an article published by us on the Insanity of Women in Childbed,t we have noticed hallucinations, and have shown those of hearing to be very common. The women hear voices ringing in their ears. In some unhappy cases, these voices impel them to commit suicide. Out of 111 cases of puerperal madness, collected in Bedlam, 32 had a tendency to suicide.

* Morel, M6moire sur la Manie des Femmes en couches, Paris, 1842. † Bibliotheque des Medecins Praticiens, t. ix. p. 472.

Hallucinations and illusions in maniacs occasion resolutions and actions, which are incomprehensible at first sight, but to which a deeper knowledge of these two states almost always furnish a natural explanation. A madman looks fiercely at you; he is about to spring upon you and to beat you. He acts thus because an illusion has changed your appearance into that of an enemy; or he thinks that you are making grimaces at him, or insulting him. Here is one who springs out of the window, because he thinks that the street is on a level with his room, or that he is stepping into a garden filled with fruits and flowers. Another throws his bread into the stream, or crushes it beneath his feet, to make it more tender, and to give it another flavor.

Many maniacs refuse food on their entrance into a hospital, believing it to be poisoned. Some look extatically on the sky, because they conceive the clouds to be of gold, or to represent knights and palaces. One of our patients turned continually on his heel; we learned that he was an old engineer for many years in the establishment of Dr. Blanche, who, by means of rotary machinery, raised water to an immense height.

There are others who see animals, insects, or brilliant colors, on their clothes, or in their straw. The slightest noises occasion a variety of impressions; voices threaten, cannon are fired, or concerts are performed. These false sensations often occasion reprehensible or dangerous actions. Some maniacs kill, because they see the devil before them; others die of hunger, burn or mutilate themselves, in obedience to a command. Facts of this kind are numerous. It is very difficult to trace them to their real causes, from the agitation and irascibility of the patient, and from the impossibility of obtaining an answer to any question. These eccentricities arise from hallucinations and illusions.

Recapitulation. - Mania is a form of madness which is often combined with hallucinations and illusions. The union of these two symptoms has struck us as more common in mania than in other forms of insanity.

False impressions may be exhibited at the commencement of mania, during its progress, and at its close, or they may replace it.

Hallucination and illusion may be the causes of mania, which takes their place, and of which it is then but the transformation.

Of all hallucinations and illusions, those of hearing and sight are the most common; they are very frequently combined, may exist singly, or may replace each other.

Illusions are sometimes transformed into hallucinations, and vice versa.

Hallucinations, most usually primitive in mania, are sometimes symptomatic.

Puerperal mania is frequently combined with hallucinations and illusions, which considerably augment the sickness.

The hallucinations and illusions of maniacs occasion a multitude of singular resolutions, and lead to actions of an injurious and dangerous character.

It is often difficult to prove the hallucinations and illusions of maniacs, especially in a large establishment, in consequence of their perturbation and the versatility of their ideas; but prolonged and attentive observation leaves no doubt on the mind that both of these morbid states are developed among the greater number of these afflicted beings.