Case XLIX

Madame L., whose misfortunes and heroic devotion have made her name forever celebrated, became insane in consequence of very severe moral emotions. The commencement of her malady was characterized by extreme agitation, occasioned by fear of persecution that possessed her, and by the painful hallucinations of hearing, sight, and touch. This lady not only heard voices that held conversations painful to her, but also saw the most hideous and threatening figures come out of the wall. Whenever she placed her feet on the ground, she thought that she received electric shocks, which made her throw off both shoes and stockings, and constantly change her place.†

Case L

On the 30th December, 1839, M. D. was received into my establishment. He came from Bicetre, where he had been conveyed two months previously for an act of madness. Son to a rich merchant, and having tasted all the delights of luxury, he saw, by a continuous train of catastrophes, the whole of his fortune perish. Obliged to give lessons, and frequently reduced to endure the greatest privations, his mind became deeply saddened; irresolution, dejection, and despair were the unhappy consequences. From this stage to madness was but a step, which was soon taken.

When he came to me, I found him agitated, fearful, and trembling at the slightest question. He complained of general chilliness, a common symptom with lypemaniacs; but what tormented him more than anything else was, to hear the voices of his enemies, who spoke to him through the walls, and to be harassed by individuals who had pat objects of value into his pillow and his mattress, in order to dishonor him, and make him pass for a thief. This idea never left him a moment's peace. He passed his days in sighing, and complaining that he was about to suffer the most cruel torments. It was in vain to say to him: "For ten days you have repeated the same thing, and yet nothing has happened to you." It was in vain to surround him with cares and kindnesses; he was insensible to everything. I know of no sight more painful than that of melancholy which has reached this stage, and, having several times witnessed it, I can comprehend the contagiousness of example and suicide.

* Alex. Morison, Gases of Mental Disease, with Practical Observations on their Medical Treatment. † Marc, op. cit.

In order to lessen his anguish, I had his pillow unsewn, which he imagined was filled by his malicious enemies with diamonds, although he could never tell us why they desired his ruin. After looking most attentively at its contents, he was tranquil for the rest of the day; but on the next day his notions returned, and, although we proposed to repeat the experiment, he told me, with a despairing tone, that the unseen persons took care to remove the diamonds. This poor creature was worse at night than during the day. He would then see a man who took his clothes, to fill them with precious stones. At other times, his persecutors, assembling in greater numbers, would put him in the bath, maltreat and beat him. In the morning, he declared his body broken down by the evil done to him. At other times, he was transported to different parts of France, to Africa, or to America. His descriptions of these places were confused; often he was satisfied with merely naming them.

His plate, the wall, his curtains appeared filled with people and ships, come to carry him off. When bis food was brought, he would never take his own plate, but that of another, as he had conceived the idea that we wished to poison him. The drinks we provided were a terrible punishment, in consequence of the poisonous effluvia he found in them; and he never emptied his glass, supposing that some of the poison would remain at the bottom. One of his great fears was to be left in a room where there was any silver plate, so much did he dread being accused of stealing it.

This very man, whose false perceptions nothing could conquer, joined in conversation with remarkable appositeness whenever his attention could be unexpectedly fixed.

The despair which his constant dread of being accused of robbery occasioned, made us fear that he would commit suicide, so that he was constantly watched. It often happens with those patients, who believe that we wish to poison them, that they diminish the quantity of their food daily. This progressive abstinence has the effect of determining dyspeptic symptoms, which increase so much as to make it very difficult to oblige them to take the quantity of food absolutely necessary. Many complain of violent pains in the pharynx, in the oesophagus, and in the stomach; and deglutition becomes very painful.

M. D., who had for some time eaten but little, began to insist on it that copper and sponge were put into his throat and stomach. He did not conceal his impression that myself, my wife, and my children were plotting to poison him. He begged our pardon for the idea; understood that it must appear very strange; and that any one else who should hold such language might be looked on as a madman, but said, nevertheless, that what he asserted was the truth.

The life of man is a long train of contradictions and falsehoods; with one turn of the dice, he moves from black to white, and does and says just the contrary to what he did and said just before. The acts of the insane are only an exaggeration of this singular contrariety. Here is an unhappy being, who, full of fear at being poisoned, condemns himself to all the horrors of famine, substitutes a real punishment to escape imaginary torments, and who dreads death, but brings it on himself. It is in vain that he sees those with whom he dines eat of the same dishes and drink of the same wine; nothing tranquillizes him; he persists in believing that the head of the establishment, who has the greatest interest in preserving his patients, is making every effort to kill them by poison, without being able to give any motive for the act. Is it true, as moralists assert, that anticipated ills are more terrible than those that are present?

Four months after his entrance, his extreme emaciation proved the effect of this regimen on his organization; the pulse was weak and slow; the skin was sensibly cold, especially the extremities, and the complexion was cadaverous. For some days he had a short, dry cough, and his breath was inexpressibly offensive. As the disorder progressed, his voice became hoarse, and finally inaudible; it was necessary to lean close to him to catch any of his words.

Notwithstanding this wasting, and the certain signs of approaching death, the poor man no less persisted in his chimerical ideas; he was still convinced that they were putting sponges, keys, and other strange substances into his stomach. In order to prevent his food touching the plates, he endeavored to hold it suspended in the air. His distress, when it fell, was fearful. Even just before his death-agony, he repeated that he had been poisoned, and that his pillows were full of diamonds which he was accused of stealing. He expired with the assertion that the morsel he ate was poisoned.

The hallucinations of lypemaniacs bear relation to the cause and nature of their malady, to the character of their general ideas, and to the germ of their passions; and they will, therefore, be a more or less faithful reproduction of all these qualities. Those who have studied chemistry and physics, or who have heard these sciences made the subject of conversation, believe themselves to be pursued by philosophers, by electricity, and magnetism. Those who have been rich, who have been industrious, and have lost their money, imagine that they are being robbed, or that the gendarmes are coming for them. In a word, in the greater number of cases, hallucination is only an echo that supplies to us useful information. Some hypochondriacs, victims of hallucinations, are in a state of anxiety which it is impossible to describe; they conceive that whilst, apparently, every precaution is taken to prevent their killing themselves, the means are surreptitiously pointed out. These hypochondriacs look mournful and repel-lant; despair is painted on all their features; their countenances are fixed, earthy, and yellowish; their eyes, deep sunk and downcast, are of the same tint, or very much bloodshot. They have more or less of cephalalgia across the forehead, and particularly at the root of the nose. These patients feel much throbbing in the interior of the head; they are tormented with sleeplessness, or, if they sleep, they are troubled by dreams and fantastic apparitions.

Ascetic delirium has fatal results. When the miserable beings who are attacked by it are haunted by hallucinations, they yield entirely to the impulses of the devil, who is the spring of all their actions. * The fear of the devil, and the dread of future punishments, had formerly an extraordinary influence on the human mind. Demonology, which has greatly diminished since the 18th century, reappears with the reaction of religious feeling, as if evil must be the inevitable shadow of good. In the space of six years, we have noticed fifteen cases in our establishment.

Dr. Macario has an idea that this form of madness is frequent in the provincial insane asylums, which he attributes to the fact that materialism has not become so strongly rooted in the French soil as might be supposed.† He thinks that these insane persons have a crowd of hallucinations and illusions. The devil presents himself to them under the form of an animal - sometimes as a man-dog, a hunchback, or a lightning flash. He enters into them; speaks by their mouths; engrosses all their faculties; bites and burns them; tears out their hearts, their brains, their intestines, and torments them in a thousand ways; spreads an infectious odor of sulphur, of a goat, etc.; at other times, and this is particularly remarked in females, the evil spirit makes unhallowed proposals.

Some demonomaniacs are taken up into the air or transported to hell, where, full of terror, they watch the torments of the damned. Others believe themselves transformed into animals, trees, fruits, or reduced to cinders, and then, like the phoenix, believe themselves resuscitated and regenerated; some are surrounded with hideous reptiles and corpses; some again say they have sold their souls to the devil, and signed the compact with blood; they believe themselves eternally damned. There are those who say that they will never die; but, at the end of the world, be alone on the earth. Some are happier; they are protected by the devil, who teaches them the secret of making gold, predicts to them the future, unveils the mysteries of hell, and gives them the power of performing miracles; at their voice, the lightnings flash, the thunder roars, rain falls, the earth opens, and the dead come to life.