Case LVIII

- Mademoiselle R., aged thirty, a religious novice, entered the Salpetrifere on the 12th of July, 1842, under the care of M. Mitivie. On his visit, he found the patient in the following state: She was standing, immovable; her countenance was sad and heavy; her eyes wide open and fixed: " I vainly endeavored," says the author, "to obtain a few words from her. It might be supposed that she either did not hear, or did not comprehend what I said. She refused food. Her eyes were often slowly and mechanically turned towards the door; on placing her in bed, she recommenced the same action. She appeared to pay no attention to what was passing around her.

"Towards the close of the month, a remarkable change took place; she spoke long, and with facility; her countenance became animated, and her ideas sparkling. There was no longer occasion to interrogate her; she took the lead in questioning. Yesterday she was visited by the Sisters of St. Antoine's Hospital, who, she said, had been very useful in giving clearness to her ideas. From that time her cure was completed.

"The treatment was baths, a douche, and occupation. The following is the account Mademoiselle R. gave me of her intellectual state during her malady: -

"She had no idea of being in a hospital; the women who surrounded her she imagined to be disguised soldiers (a very common illusion with women, and which is only a symptom of uterine excitability). When she was taken to the bath, in which were several other patients, she attempted to drown herself to escape the violence of the imaginary soldiers. All the faces she saw were hideous and menacing; it seemed as if everybody was intoxicated. She thought that Paris was given up to fire and slaughter, and that all the nuns were strangled. Every instant she expected a similar fate. She thought the floor concealed a vast trap, into which she feared to fall. The noise which was made in scrubbing the boards became to her that of a saw which they were using to raze the house; she dreaded to see a vast fire burst out. Of all that she heard, she could only remember these words, 'We must kill her, we must burn her,' etc. She had a constant buzzing in her ears, which prevented her hearing what was said. A low voice asked her the particulars of her life, and she replied to it; she refused to eat, fearing she would be poisoned.

"Mademoiselle R. had short lucid intervals; but she soon fell back into stupor;' she seemed to have a bandage over her eyes. She believed that her care was effected by a cold water douche, which acted so powerfully as to make her cry out.

"She subsequently described the state from which she had recovered with considerable force of expression. 'She could not compare it,' she said, ' to anything but a bad dream.' "

Case LIX

- M. B., twenty-five years of age, principal in a government office, was brought to Charenton on the 12th of August, 1833.

On two different occasions he had been attacked with paroxysms of mental alienation. The first symptoms of the last attack appeared to be those of violent frenzy. On entering, M. B. was pale; his eyes fixed; his countenance had lost all expression, and denoted profound stupor. He remained the entire day in one place perfectly dumb, and appeared indifferent to all that surrounded him. Memory seemed entirely gone. His stupor was such that we were obliged to force him to eat; and he was so unclean that we were forced to substitute a long linen blouse for his clothes.

A blister on the nape of the neck produced favorable results; and towards the end of December he was completely cured.

The state in which M. B. remained, during three months, can be best described by comparing it to a long dream. He said that everything around him was transformed. He believed in a universal annihilation. The ground trembled and opened under his feet; every moment he felt on the point of being engulfed in its fathomless abysses. When he held on to persons near to him, it was in order to prevent their falling down the precipices, that resembled the craters of volcanoes. M. B. took the bath-room for hell (for which reason he resisted entering it), and the baths for boats. He thought that all who were with him were drowning. It seemed to him that his blood had never ceased to flow on the ground since he was bled. The blister which was placed on his neck was the brand of a convict, and he thought himself disgraced forever by this mark of infamy. He could not understand who all the strange people were by whom he was surrounded, but finally concluded that they were resuscitated corpses. He saw his brother in the midst of torments; and heard incessantly the cries of his parents who were being strangled, and who implored his aid. Above all was heard the voice of his uncle, who was his benefactor. Every shriek was a dagger to him. Fire-arms were discharged all around him; halls pierced him through without harming him, but killed other persons. In his mind all was chaos, confusion, destruction. He no longer distinguished day and night; months seemed years; he accused himself of all the evil that was done, and therefore attempted several times to destroy himself.

The memoir of M. Baillarger contains a number of instances of stupor; but we fear that this physician has confounded the state of immobility, very frequent in hypochondriacs, with real stupor; and that, with him, the appearance has, in some cases, been taken for the reality. In this case, he has only followed the example of many estimable men, who, in their works on typhoid fever, rank with that grievous complaint certain morbid states that have only a delusive appearance of analogy to it. With this exception, M. Baillarger's work has thrown a new light on this form of mental disease, and shown that this malady is principally characterized by numerous hallucinations and illusions, which form an imaginary world for the patient.

Dr. Delasiauve* opposes the opinion of M. Baillarger, and considers stupor as a peculiar state. According to him, hallucinations are a consequence of stupor, the result of obtuseness of the intellect, and not the result of melancholic preoccupation.

In the article "Stupor," contained in the Supplement au Dic-tionnaire des Dictionnaires de Medecine, we have observed that the malady, like sleep, can have two different states, the one characterized by a complete suspension of the mind, and the other by the existence of dreams.

Recapitulation. - Stupor, successively considered as a new state, a variety of madness, and the highest degree of a variety of hypochondria, is almost always accompanied by hallucinations and illusions.

In the cases cited, hallucinations and illusions were constantly observed; most generally they were combined. In three cases, one alone existed.

The most usual form was that which occurred with derangement of the organs of sight and hearing.

In almost all the examples furnished, the conduct, actions, and whimsicalities of the afflicted were explained by hallucinations or illusions.

* Du diagnostic differentielle de la Lypemanie, published in the Annates Medico-Ptychologiquts, Juillet, 1851.

The errors of the senses, so numerous and of such varied character, to which these insane persons are subject, create for them a special and imaginary world.