Hallucinations in catalepsy, epilepsy, hysteria, hypochondria, chorea, rage, etc. -

Recapitulation.

We have now considered hallucinations in the grand divisions of insanity.

This section is the most important of all, and it might furnish materials for volumes; but our examination of it is necessarily restricted to the limits appropriated to our subject, and to the size of our book.

Hallucinations are not only exhibited in mental diseases, but appear from time to time, and sometimes very frequently, in another series of nervous affections, which have some points of affinity with insanity. These diseases are catalepsy, epilepsy, hysteria, hypochondria, chorea, chlorosis, rage, etc.

The febrile delirium, observable in lunatic asylums, will serve as a natural transition to acute or chronic, inflammatory or other diseases, which are combined with hallucinations. This last group will only comprise those affections that most frequently present this phenomenon, or in which they offer some remarkable peculiarities; otherwise, we should enlarge our list immoderately, and without benefit to science.

1. Of Catalepsy in connection with Hallucinations. - The early authors, who have studied catalepsy, have described cases that would seem to prove it to be combined with hallucinations. We find the following sentence in Frederick Hoffman: "Narrant mira gaudia, aut phantasma tragica, visiones divinas consortium angelorum, quin et futura prsenuntiari videntur ae vatidicos se simulant." But, on reading the two cases stated by this author, we immediately perceive that they belong to ecstatic catalepsy.

The difficulty of detecting the existence of hallucinations in catalepsy, rests on the alteration of the intellectual faculties in this singular state. They are, however, almost always more or less entirely suspended; or, as M. Bourdin expresses it, veiled.* In my article on Catalepsy,† I have likewise stated that, during the paroxysm, the senses are almost entirely suspended, and the mental faculties numbed. Nevertheless, we perceive, by the observations of some patients and the perusal of cases published by some authors, that there are cataleptics who have dreams or visions, which bear relation to the objects which have so powerfully affected them. In a case recorded in the Memoirs of the Academie Royale des Sciences, catalepsy was caused by suspense consequent on an important lawsuit, and, during the fit, the patient gave an exact account of the business. Dr. Hamilton, in his fragmentary memoirs,‡ has given the history of a young person who heard all that was said around her.

Experience proves that this malady may precede or succeed a fit of hysteria, of monomania, or somnambulism, and unite so completely with these affections, as to make it almost impossible, in some cases, to distinguish the primary affection from the accessory phenomena. Thus, although we admit that hallucinations are very rare in catalepsy, since the exercise of thought is destroyed, suspended, or singularly diminished, we yet think that they exist in some cases.

2. Of Epilepsy in connection with Hallucinations. - The frequent union of epilepsy and insanity leads to the belief that some epileptics are subject to hallucination. Aretee was the first who noticed this fact.§ In the examinations made at Salpetrifere, Esquirol found that, out of three hundred epileptic patients, more than one-half were insane. The greater number, indeed, had dementia; but some were maniacs and monomaniacs. Now, we know that dementia is far from being an obstacle to the production of hallucinations. The same facts have been reported at Bicetre and Charenton.

Many of these patients, before the suspension of all sensibility, have had the most varied hallucinations; they think they see luminous bodies, which they fear will consume them. They see black figures that expand, become enormous, and threaten to envelop them in darkness; they hear noises resembling claps of thunder, the rolling of drums, the clang of arms, the tumult of combat; they smell the most offensive odors, and they feel blows. All these hallucinations inspire them with the greatest terror. Perhaps it is this, adds Esquirol, that imprints on the countenance of most epileptics that character of fear or indignation common to them under the paroxysm. These facts had not escaped Hibbert and Paterson, who called special attention to the hallucinations observable in epilepsy.

* Bourdin, Traite de Catalepsie, Paris, 1843.

† Encyclopedic Catholique. ‡ Revue Britannique.

§ De Caus. et Sign, de Morb. Diut., lib. i. c. 5.

Dr. Gregory speaks, in his lectures, of an individual subject to attacks of epilepsy, in whom the seizure was always preceded by the apparition of an old woman in a red cloak, with an ill-natured countenance and a hideous figure, who advanced and struck him on the head with her cane. He had scarcely received the blow, when he fell to the ground in convulsions.*

Amongst my patients were several in whom the attack was preceded by an apparition, and others in whom the hallucination followed the fit.