CHAPTER XVII.

ANOMALOUS NERVOUS AND MENTAL DISEASES. Epilepsy has been professionally recognized as a distinct type of disease since the time of Hippocrates, but in earlier times, and popularly throughout later times, it was illy defined. The knowledge of the clinical symptoms has become definite only since the era of cerebral local anatomy and localization. Examination of the older records of epilepsy shows curious forms recorded. The Ephemerides speaks of epilepsy manifested only on the birthday. Testa mentions epilepsy recurring at the festival of St. John, and Bartholinus reports a case in which the convulsions corresponded with the moon's phases. Paullini describes epilepsy which occurred during the blowing of wind from the south, and also speaks of epilepsy during the paroxysms of which the individual barked. Fabricius and the Ephemerides record dancing epilepsy. Bartholinus and Hagendorn mention cases during which various splendors appeared before the eyes during the paroxysm. Godart Portius, and Salmuth speak of visions occurring before and after epileptic paroxysms. The Ephemerides contains records of epilepsy in which blindness preceded the paroxysm, in which there was singing during it, and a case in which the paroxysm was attended with singultus. Various older writers mention cases of epilepsy in which curious spots appeared on the face; and the kinds of aura mentioned are too numerous to transcribe. Baly mentions a case of epilepsy occasioned by irritation in the socket of a tooth. Webber reports a case of epilepsy due to phimosis and to irritation from a tooth. Beardsley speaks of an attempt at strangulation that produced epilepsy. Brown-Sequard records an instance produced by injury to the sciatic nerve. Doyle gives an account of the production of epilepsy from protracted bathing in a pond. Duncan cites an instance of epilepsy connected with vesical calculus that was cured by lithotomy. Museroft mentions an analogous case. Greenhow speaks of epilepsy arising from an injury to the thumb. Garmannus, early in the eighteenth century, describes epilepsy arising from fright and terror. Bristowe in 1880, and Farre speak of similar instances. In Farre's case the disease was temporarily cured by an attack of acute rheumatism. Thorington of Philadelphia has seen a paroxysm of epilepsy induced by the instillation of atropia in the eye of a child nearly cured of the malady. It was supposed that the child was terrified on awakening and finding its vision suddenly diminished, and that the convulsions were directly due to the emotional disturbance. Orwin describes epilepsy from prolonged lactation, and instances of ovarian and uterine epilepsy are quite common. There is a peculiar case of running epilepsy recorded. The patient was a workman who would be suddenly seized with a paroxysm, and unconsciously run some distance at full speed. On one occasion he ran from Peterborough to Whittlesey, where he was stopped and brought back. Once he ran into a pit containing six feet of water, from which he was rescued. Yeo says that sexual intercourse occasionally induces epilepsy, and relates a case in which a severe epileptic fit terminated fatally three days after the seizure, which occurred on the nuptial night. Drake reports the case of a man who was wounded in the War of 1812, near Baltimore, the ball passing along the left ear and temple so close as to graze the skin. Eighteen years after the accident he suffered with pain in the left ear and temple, accompanied by epileptic fits and partial amnesia, together with an entire loss of power of remembering proper names and applying them to the objects to which they belonged. He would, for instance, invariably write Kentucky for Louisville. Beirne records the case of a dangerous lunatic, an epileptic, who was attacked by a fellow-inmate and sustained an extensive fracture of the right parietal bone, with great hemorrhage, followed by coma. Strange to say, after the accident he recovered his intellect, and was cured of his epileptic attacks, but for six years he was a paralytic from the hips down. The Dancing Mania.--Chorea has appeared in various epidemic forms under the names of St. Vitus's dance, St. Guy's dance, St. Anthony's dance, choromania, tanzplage, orchestromania, dance of St. Modesti or St. John, the dancing mania, etc.; although these various functional phenomena of the nervous system have been called chorea, they bear very little resemblance to what, at the present day, is called by this name. The epidemic form appeared about 1374, although Hecker claims that, at that time, it was no new thing. Assemblages of men and women were seen at Aix-la-Chapelle who, impelled by a common delusion, would form circles, hand in hand, and dance in wild delirium until they fell to the ground exhausted, somewhat after the manner of the Ghost-Dance or Messiah-Dance of our North American Indians. In their Bacchantic leaps they were apparently haunted by visions and hallucinations, the fancy conjuring up spirits whose names they shrieked out. Some of them afterward stated that they appeared to be immersed in a stream of blood which obliged them to leap so high. Others saw the heavens open and disclose the Saviour enthroned with the Virgin Mary. The participants seemed to suffer greatly from tympanites which was generally relieved by compression or thumping on the abdomen. A few months after this dancing malady had made its appearance at Aix-la-Chapelle it broke out at Cologne, and about the same time at Metz, the streets of which were said to have been filled with 1100 dancers. This rich city became the scene of the most ruinous disorder. Peasants left their plows, mechanics their shops, servants their masters, children their homes; and beggars and idle vagabonds, who understood how to imitate the convulsions, roved from place to place, inducing all sorts of crime and vice among the afflicted. Strasburg was visited by the dancing plague in 1418, and it was here that the plague assumed the name of St. Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he was about to undergo martyrdom by order of Diocletian, in the year 303, is said to have prayed to God that He might protect all those who would solemnize the day of his commemoration and fast upon its eve. The people were taught that a voice from heaven was then heard saying, "Vitus, thy prayer is accepted." Paracelsus called this malady (Chorus sancti viti) the lascivious dance, and says that persons stricken with it were helpless until relieved by either recovery or death. The malady spread rapidly through France and Holland, and before the close of the century was introduced into England. In his "Anatomy of Melancholy" Burton refers to it, and speaks of the idiosyncrasies of the individuals afflicted. It is said they could not abide one in red clothes, and that they loved music above all things, and also that the magistrates in Germany hired musicians to give them music, and provided them with sturdy companions to dance with. Their endurance was marvelous. Plater speaks of a woman in Basle whom he saw, that danced for a month. In Strasburg many of them ate nothing for days and nights until their mania subsided. Paracelsus, in the beginning of the sixteenth century, was the first to make a study of this disease. He outlined the severest treatment for it, and boasted that he cured many of the victims. Hecker conjectures that probably the wild revels of St. John's day, 1374, gave rise to this mental plague, which thenceforth visited so many thousands with incurable aberrations of mind and disgusting distortions of the body. Almost simultaneous with the dance of "St. With," there appeared in Italy and Arabia a mania very similar in character which was called "tarantism," which was supposed to originate in the bite of the tarantula. The only effective remedy was music in some form. In the Tigre country, Abyssinia, this disease appeared under the name of "Tigretier." The disease, fortunately, rapidly declined, and very little of it seems to have been known in the sixteenth century, but in the early part of the eighteenth century a peculiar sect called the "Convulsionnaires" arose in France; and throughout England among the Methodist sect, insane convulsions of this nature were witnessed; and even to the present day in some of the primitive religious meetings of our people, something not unlike this mania of the Middle Ages is perpetuated. Paracelsus divided the sufferers of St. Vitus's dance into three classes .-- (1) Those in which the affliction arose from imagination (chorea imaginativa). (2) Those which had their origin in sexual desires depending on the will. (3) Those arising from corporeal causes (chorea naturalis). This last case, according to a strange notion of his own he explained by maintaining that in certain vessels which are susceptible of an internal pruriency, and thence produced laughter, the blood is set into commotion in consequence of an alteration in the vital spirits, whereby are occasioned involuntary fits of intoxicating joy, and a propensity to dance. The great physician Sydenham gave the first accurate description of what is to-day called chorea, and hence the disease has been named "Sydenham's chorea." So true to life was his portrayal of the disease that it has never been surpassed by modern observers. The disease variously named palmus, the jumpers, the twitchers, lata, miryachit, or, as it is sometimes called, the emeryaki of Siberia, and the tic-convulsif of La Tourette, has been very well described by Gray who says that the French authors had their attention directed to the subject by the descriptions of two American authors--those of Beard upon "The Jumpers of Maine," published in 1880, and that of Hammond upon "Miryachit," a similar disease of the far Orient. Beard found that the jumpers of Maine did unhesitatingly whatever they were told to do. Thus, one who was sitting in a chair was told to throw a knife that he had in his hand, and he obeyed so quickly that the weapon stuck in a house opposite; at the same time he repeated the command given him, with a cry of alarm not unlike that of hysteria or epilepsy. When he was suddenly clapped upon the shoulder he threw away his pipe, which he had been filling with tobacco. The first parts of Virgil's aeneid and Homer's Iliad were recited to one of these illiterate jumpers, and he repeated the words as they came to him in a sharp voice, at the same time jumping or throwing whatever he had in his hand, or raising his shoulder, or making some other violent motion. It is related by O'Brien, an Irishman serving on an English naval vessel, that an elderly and respectable Malay woman, with whom he was conversing in an entirely unsuspecting manner, suddenly began to undress herself, and showed a most ominous and determined intention of stripping herself completely, and all because a by-standing friend had suddenly taken off his coat; at the same time she manifested the most violent anger at what she deemed this outrage to her sex, calling the astonished friend an abandoned hog, and begging O'Brien to kill him. O'Brien, furthermore, tells of a cook who was carrying his child in his arms over the bridge of a river, while at the same time a sailor carried a log of wood in like manner; the sailor threw his log of wood on an awning, amusing himself by causing it to roll over the cloth, and finally letting it fall to the bridge; the cook repeated every motion with his little boy, and killed him on the spot. This miryachit was observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in Siberia, whilst Beard has observed it in Michigan as well as in Maine. Crichton speaks of a leaping ague in Angusshire, Scotland. Gray has seen only one case of acute palmus, and records it as follows: "It was in a boy of six, whose heredity, so far as I could ascertain from the statements of his mother, was not neurotic. He had had trouble some six months before coming to me. He had been labeled with a number of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria, and neurasthenia. His palmodic movements were very curious. When standing near a table looking at something, the chin would suddenly come down with a thump that would leave a black-and-blue mark, or his head would be thrown violently to one side, perhaps coming in contact with some adjacent hard object with equal force, or, while standing quietly, his legs would give a sudden twitch, and he would be thrown violently to the ground, and this even happened several times when he was seated on the edge of a stool. The child was under my care for two weeks, and, probably because of an intercurrent attack of diarrhea, grew steadily worse during that time, in spite of the full doses of arsenic which were administered to him. He was literally covered with bruises from the sudden and violent contacts with articles of furniture, the floor, and the walls. At last, in despair at his condition, I ordered him to be undressed and put to bed, and steadily pushed the Fowler's solution of arsenic until he was taking ten drops three times a day, when, to my great surprise, he began to improve rapidly, and at the end of six weeks was perfectly well. Keeping him under observation for two weeks longer I finally sent him to his home in the West, and am informed that he has since remained perfectly well. It has seemed to me that many of the cases recorded as paramyoclonus multiples have been really acute palmus." Gray mentions two cases of general palmus with pseudomelancholia, and describes them in the following words:-- "The muscular movements are of the usual sudden, shock-like type, and of the same extent as in what I have ventured to call the general form. With them, however, there is associated a curious pseudomelancholia, consisting of certain fixed melancholy suspicious delusions, without, however, any of the suicidal tendencies and abnormal sensations up and down the back of the head, neck, or spine, or the sleeplessness, which are characteristic of most cases of true melancholia. In both of my cases the palmus had existed for a long period, the exact limits of which, however, I could not determine, because the patient scouted the idea that he had had any trouble of the kind, but which the testimony of friends and relatives seemed to vouch for. They were both men, one thirty-six and one thirty-eight years of age. The pseudomelancholia, however, had only existed in one case for about a year, and in the other for six months. One case passed away from my observation, and I know nothing of its further course. The other case recovered in nine months' treatment, and during the three years that have since elapsed he has been an active business man, although I have not seen him myself during that period, as he took a great dislike to me because I was forced to take strong measures to keep him under treatment, so persistent were his suspicions." Athetosis was first described by Hammond in 1871, who gave it the name because it was mainly characterized by an inability to retain the fingers and toes in any position in which they might be planed, as well as by their continuous motion. According to Drewry "athetosis is a cerebral affection, presenting a combination of symptoms characterized chiefly by a more or less constant mobility of the extremities and an inability to retain them in any fixed position. These morbid, grotesque, involuntary movements are slow and wavy, somewhat regular and rigid, are not jerky, spasmodic, nor tremulous. The movements of the digits are quite different from those attending any other disease, impossible to imitate even by the most skilful malingerer, and, if once seen, are not likely to be forgotten. In an athetoid hand, says Starr, the interossei and lumbricales, which flex the metacarpo-phalangeal and extend the phalangeal joints, are affected; rarely are the long extensors and the long flexors affected. Therefore the hand is usually in the so-called interosseal position, with flexion of the proximal and extension of the middle and distal phalanges. The athetoid movements of the toes correspond to those of the fingers in point of action. In a great majority of cases the disease is confined to one side (hemiathetosis), and is a sequel of hemiplegia. The differential diagnosis of athetosis is generally easily made. The only nervous affections with which it could possibly be confounded are chorea and paralysis agitans. Attention to the twitching, spasmodic, fibrillary movements, having a quick beginning and a quick ending, which is characteristic in Sydenham's chorea, would at once exclude that disease. These jerky movements peculiar to St. Vitus's dance may be easily detected in a few or many muscles, if moderate care and patience be exercised on the part of the examiner. This form of chorea is almost always a disease of childhood. So-called post-hemiplegic chorea is, in the opinion of both Hammond and Gray, simply athetosis. The silly, dancing, posturing, wiry movements, and the facial distortion observed in Huntington's chorea would hardly be mistaken by a careful observer for athetosis. The two diseases, however, are somewhat alike. Paralysis agitans (shaking palsy), with its coarse tremor, peculiar facies, immobility, shuffling gait, the 'bread-crumbling' attitude of the fingers, and deliberate speech, would be readily eliminated even by a novice. It is, too, a disease of advanced life, usually. Charcot, Gray, Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and others have written on this affection." The following is the report of a case by Drewry, of double (or, more strictly speaking, quadruple) athetosis, associated with epilepsy and insanity: "The patient was a negro woman, twenty-six years old when she was admitted into this, the Central State (Va.) Hospital, in April,