Case LXXV

M. de L. has been distressed, for twenty years, with the notion that he has an acute disease in the stomach and bowels, which, however, does not prevent him from eating of everything with a good appetite. He also feels, in the left hypochondriac region a tumor which experienced physicians cannot discover. About two years ago, he began to think he was surrounded by enemies; that everybody looked askance at him; and that grimaces were made at him. Frequently believing that he heard abuse and menaces, he attacked inoffensive persons, who had not even looked at him.

M. A. De G., the author of several important works, and whose melancholy adventure was published in all the journals, believed at first that his digestive organs were diseased; then he wa3 persuaded that some persons were seeking to poison him.

* Louyer Villermay, Traite des Maladies Nerveuses, et en particulier de l'Hysterie et de l'Hypochondrie, t i. p. 430.

He saw individuals following him everywhere, taking aim at him, seeking to stab him, and endeavoring to enter his chamber.

Case LXXVI

Madame la Gomtesse de M., at a critical period of life, imagined she had an enlargement of the matrix. Probably a few wrinkles, and some gray hairs, were the foundation of this unfortunate conception. I say unfortunate, since she found a surgeon who encouraged her in her belief. From this moment, therefore, the lady, naturally excitable, had no rest. Her imaginary disease imposed on her a thousand privations; and her whole conversation was of remedies. After passing several months in this perpetual panic, she began to complain of a noise in the left side of her head; she at times likened it to the puffing of a cigar; at others to the rushing of a river. This noise became sometimes so excessive as to agitate her extremely.

M. Itard has described several similar cases.* Case LXXVII. M. J., aged thirty years, a German professor, had for several years been much troubled by pains in the intestines. The most striking symptom was a sort of embarrassment, a restraint, which he had vainly endeavored to overcome. This young man, who had received an education superior to his station, was checked by every obstacle that could obstruct the road to fortune. Physical and moral suffering was added to the derangement of his intellectual faculties; he was brought to my establishment. On his arrival, he told me that his abdominal disease was doubtless the cause of the hypochondria by which he was often attacked; that it had increased until it had influenced his brain, given incoherency to his ideas, and made all his actions aimless. His fixed idea was that his friends injured him, placed him under magnetic influence, and that finally they had introduced a magnetizer into his abdomen. He endeavored to explain to me how the magnetizer acted in the inside of his body. It was interesting, in listening to him, to follow out the train of ideas through which he had successively passed to compose what now entirely occupied his mind. Ho held conversations with the magnetizer, whom he could not persuade to depart.

* TraitS des Maladies des Oreilles, 2d edition, revue par M. Boosquet, 1842, 2 vols. 8vo.

Two blisters on the legs, nutritious food, and the judicious occupation of his mind in the analysis of important works, wrought a rapid change, and we soon restored him cured, to his friends.

5. Of Hallucinations in Chorea. - Hallucination is now considered very rare in chorea. Bouteille only mentions one case.* Dr. See, it is said, described several examples in his work, to which a prize was awarded by the Academie de Medecine. But it was not thus in the epidemic chorea of the Middle Ages. "During their dance," says M. Hecker, "the afflicted perceived apparitions; they neither saw nor heard what was passing around them; and their imaginations presented spirits whose names they pronounced, or rather shouted. Several of them afterwards insisted that they were plunged into streams of blood, which made them jump so high. Others, in their ecstasy, perceived the heavens open, with the Virgin and the Saviour enthroned, according to the different views which the belief of the age impressed on their imaginations, "†

M. Nivet has described two cases of false perception of the sight in individuals attacked with the dry colic.‡ M. Tanque-rel's work§ contains several examples.

M. Valleix|| cites facts relative to buzzings, hissings, and cold sensations.

6. Rage. - " The delirium regarded as one of the symptoms of rage," says Trolliet, "and which belongs less to that disease than to frenzy, has occasioned more than one mistake. When it is exhibited, it is in an advanced stage of the affection."

That author, however, cites several examples of hallucinations amongst the patients whom he attended in the hospital at Lyons One of the two expired in giving violent blows to his bed, believing he was fighting an enraged wolf. Another, in struggling with a wild beast, died as he overcame him.¶

* Traite de la Danse de Saint Guy, p. 145, 1816.

† Hecker, Memoire sur la Choree de Moyen age, traduit de 1' Allemand par M. Ferdinand Dubois (Annal. d'Hyg. et de Medecine legal, 1834, t. xii. p. 314). - A. Brierre de Boismont, De l'influence de la civilisation sur le de-veloppement de la Folie (Annal. d'Hygitne, id. t. xxi. p. 183). - Sandras, Maladies Nerveuses, t. i. p. 165.

‡ Mem. sur la colique saturnine, Gaz. Med., No. 2, p. 32, 1837.

$ Le Traits des Maladies de Plomb, by M. Tanquerel Desplanques.

|| Traite des Nevralgies, Paris, 1851, p. 58, 91, 532.

¶ Trolliet, Nouveau Traite de la Rage, p. 201,205, and 206, Paris, 1820.

Felix Plater speaks of a woman who was washing linen under a bridge, and, being left by her companions, was seized with fear. She saw a light gleam from the arch of the bridge; the torrent increase, overflow, and rush impetuously along. On her return home, she showed every symptom of suffocation.*

Recapitulation. - Hallucinations are very rare in catalepsy, on account of the suspension of the intellectual faculties. Some patients, however, have dreams and visions, and can give an account of their state.

The frequent occurrence of epilepsy with insanity, explains why hallucinations are more common in this malady than in the preceding.

Hallucinations in epilepsy being generally of a sad or alarming character, it is possible, to a certain extent, to explain by this influence the nature of the fear, or the indignation usually exhibited by these sufferers during the fit; and probably the reprehensible actions they frequently commit, may be explained in the same way.

Hysteria is often combined with hallucinations. According to Cabanis, catalepsies, ecstasies, and all the paroxysms of excitement which are characterized by ideas, and by eloquence superior to the education and habits of the individual, have their source most frequently in the organs of generation.

The hallucinations of hysterical persons, may occur in a state of sanity, or they may be exhibited in mania, monomania, and dementia.

When hallucinations exist with insane hysteric patients, it is necessary to ascertain to which of these diseases they are related.

Hallucinations in hysteria are generally observed at the commencement of the affection; they may likewise be manifested during the fit when the understanding is not destroyed, or at the close of the crisis.

The fixedness of ideas in hypochondria is favorable to the production of hallucinations. As in other nervous affections, hallucinations of sight and hearing are most common.

Hallucinations may be exhibited in hypochondria, where reason does not seem to be impaired; but, most generally, they are combined with insanity.

* Op. cit., p. 90.

Hallucinations are now rare in chorea; they were frequent in epidemic chorea.

The combinations of catalepsy, epilepsy, hysteria, and hypochondria with monomania and different forms of madness, their transition from one form to the other, and their reunion, by establishing numerous connections between these various affections, give a reason why hallucinations are so often observable.

Chlorosis is combined with hallucinations in a certain number of cases. This state of the system is explained by the excited condition of the nervous system at the time of the affection.

Hallucinations sometimes occur in rage, in dry colic, and in several nervous affections.