Case CLIX

Mademoiselle Claire, forty years of age, tall, brown, spare, and sinewy, had always enjoyed good health. This lady, religiously brought up, of sound judgment, very placid disposition, managing her affairs with excellent sense, and beloved by all who knew her, had never evinced any symptoms of insanity until about eight months ago, when it became perceptible that her ideas were less lucid. .Two years previously she had suffered a violent uterine hemorrhage, the result of prolonged fatigue. Her mind, hitherto powerful, had become restless and timid; the slightest thing disturbed her. This condition, which was not much noticed at first, made rapid progress; she lost her sleep, and uttered such violent and piercing shrieks that her neighbors were alarmed. No one could rest near to her. This situation demanded instant attention, and Mademoiselle Claire was transferred to my establishment.

To my interrogations, she replied, that she had committed all imaginable crimes. "I am," said she, "the beast spoken of in the Apocalypse, which was to appear in 1840; God has abandoned me; Satan has entered into me; he is going to chase me through Paris." There was no evil in the world of which she was not the author.

To whatever was said to her, she replied that she was lost. When an attempt was made to persuade her that she could not be so guilty as she pretended, she replied that if she had not already committed these crimes, she would do so. Her appetite was good; all the functions acted well; but her countenance was drawn, haggard, and of a yellowish cast; her breath was offensive, and her tongue white; her sleep was short, and interrupted by sharp cries, which rang through the house. These shrieks were occasioned by the sight of hell and the devil, by the menaces which the bad spirits addressed to her, and by her dread of damnation. At times, also, during the day, she uttered yells. It would seem that there existed some internal crisis whose violence suddenly found vent in this manner.

This irresistible desire to cry out exists frequently with females. Sometimes it consists in barking, howling, groaning, or mewing; at others, in shrieks that succeed each other with the rapidity of lightning. You may be in tranquil conversation with the patients; nothing intimates the approach of a crisis; when, in the midst of the most rational discourse, you are surprised by the violence and suddenness of the maniac howlings. I have known several ladies who were no sooner under the influence of this singular affection, than they commenced running with all speed, to take refuge in some lonely spot, where they would not be noticed. They have afterwards told me that they obeyed an irresistible impulse, and felt no relief until they had uttered their shrieks.* There is evidently, a choraic influence in this symptom.

Madlle. Claire shunned me, because, whilst I evinced much interest in her, I likewise rallied her on her singular ideas: "How is it possible," I would, say, "that a lady of your good sense can imagine she sees the devil, and that in the nineteenth century?" "You are, then, an unbeliever?" "O no! I believe; but not in your idea." I would then leave her, after having endeavored to excite some doubts in her mind.

At other times I would content myself with saying: "All my arguments are useless, I cannot convince you; but doctors who attend the insane have long known, that to try and convince a madman, is to be as mad as he." "But I am not mad." She would then follow me to prove the reality of her sensations. I would laugh, but say nothing more. Sometimes I exclaimed against her pretence of having committed so many crimes. "It is either pride, or madness." She then made attempts to persuade me that she was in her right mind. I listened or took no notice of her, according to the mood in which she might be.

To counteract her physical excitement, I gave her baths and refreshing drinks. The hallucinations tormented her unceasingly, although she forbore to speak to me of them for fear of my ridicule. One evening she was with my little daughter, ten years of age: "Do you not see the flames that come out of my mouth?" she exclaimed; "they surround me, I am lost!" My child having laughingly replied: "What you say is very foolish;" she laughed also; and from that time spoke no more of flames.

Madlle. Claire had some moments of relief, but the hallucinations would seem to return with increased force, particularly in the night, when she would cry out: "I am lost; I am damned."

* A Brierre de Boiamont, De 1'Imitation du Cri des Animaux dans plasieurs affections nerveuses. Gaz. Med. 8 Sept., 1849.

Neither exhortation, advice, nor reprimand had the least effect upon her; only, when most harassed by such attempts, she became less confidential.

As Madlle. Claire was at a critical period of life, and the action was irregular, I proposed a blister on the arm, to which she willingly acceded. Amongst her delirious fancies, was that of confessing to any person with whom she might be in company; and it was then curious to hear this lady, of such Sound judgment, accuse herself of a multitude of childish follies and frivolities which imbittered her life, transformed as they were into crimes, by her perverted intellect. How could such a change have occurred in a mind until now so healthy? Her fortune was sufficient; no passion disturbed her heart; she knew no grief; and moral causes, which I consider so powerful, had no existence in this case; it could but be the influence of that constantly recurring periodical action common to women. I suggested the idea to my patient, who, although she denied that she was insane, acknowledged herself to be suffering, and asserted that she should never be cured. The idea of being at a critical time of life, seemed to impress her, and I frequently recalled it to her notice.*

I showed her much kindness; praised her sense, her judgment, at the same time I expressed my astonishment that one so happily organized could entertain such fancies. Occasionally, I gently rallied her on her devils. "You may laugh," she would say, "but they do exist;" and she would then laugh herself at my ban-terings. The conversations pleased her; I called her self-love as much as possible into play, interested her mind, and appealed to her good sense. This plan, perseveringly carried out, at length produced a useful diversion in her ideas. When her symptoms were decidedly ameliorated, I permitted her to go out and visit her friends. Sometimes these walks were matters of grief to her; she looked on all whom she met as lost; the luxury exhibited in the public gardens, and the brilliant toilets, espe-