Providence Morning Star

THE MYSTERY OF LIFE, MADE SIMPLE - A CASE OF ALIENATION AT BELLEVUE HOSPITAL.

There is in a corner of No. 12 ward in Bellevue Hospital, screened off from the rest of the patients, a very interesting case, in the person of an Irish coachman, named Lavelle, twenty-six years of age, who lies stretched out in bed, with closed eyes, and arms folded across his chest, so that a casual observer at a little distance, looking at his placid face, and white bed-clothes, might think him dead. On closer inspection, however, his quick breathing, frequent spasmodic twitching of some of the muscles of the neck, rolling of the eyeballs under the closed lids, weak but quick pulse, slight warmth, a pinkish tinge in the cheeks, and occasional perspiration, show that life is still there. He never speaks, seldom moves, but now and then turns over and lies on his side when asleep. He gives no very distinct sign of consciousness, but he has not the insensible look of a person laboring under coma, concussion, or syncope. You may shout his name in his ear, but he does not seem to hear you. From day to day he lies on his back in this manner. He is fed twice in the twenty-four hours on a mixture of beef tea, milk, eggs, and whiskey, which is conveyed into his stomach by a long tube through his mouth, kept open for the purpose, as his teeth are constantly clenched. For some time after admission he could be fed only by his wife, as he refused to take sustenance from others. Galvanism, a good application in suitable cases is occasionally applied to the spine and other parts, as a remedial agent, and to assist the ordinary processes of nature. His nurse and some others who have seen him think that he is really conscious; that he hears all that is said and knows what is going on, but either cannot or will not speak; that he rolls his eyes voluntarily, and turns them away from visitors because fearing detection, he does not wish to see them, and that he dislikes the galvanism, because he cries out when it is administered. When his case is discussed at the bedside, and he is unpleasantly spoken about, he can be seen to swallow his saliva, so to speak, involuntarily, as most persons do under similar circumstances. He lies on a clean and comfortable water bed, wisely ordered to prevent the formation of bed sores on his attenuated body. He was admitted about the middle of February, and has been nearly three months under medical supervision. There has not been any material change in his condition since, except that he has become thinner, doubtless under the combined effect of his scanty diet and want of exercise. His relatives are somewhat reticent regarding his previous history. But they hint that it is connected with some love affair, about which he and his wife had "words," after which he went off into his present state. This throws an air of romance over the story, which it might not otherwise possess for many.

When the patient was first admitted his malady was believed to be catalepsy. This is a singular malady; so rare that superstitious people have believed it due to supernatural agencies; while others altogether deny its occurrence, or laugh at its victims as imposters. Nevertheless catalepsy unquestionably does happen, usually in hysterical females. The patient, with open, staring eyes and outstretched limbs, looks like a wax figure, statue, or corpse. The extremities are not tied down by spasms as in tetanus; nor agitated by occasional contraction and relaxation of the muscles, as in epilepsy; nor yet left passively obedient to the laws of gravity, as in paralysis; but assume, and retain any position in which we choose to place them. Raise the arm and it remains so. Or put the body in a sitting or standing posture, and it will continue thus until relieved from it. A slight push, however, will make it fall. No marked respiratory rising and falling of the chest can be seen, or movement of the nostrils, as in ordinary breathing. Some degree of warmth and a feeble pulse are the only signs of life. Catalepsy occurs most frequently in winter.

Lavelle shows only some of the symptoms of catalepsy. At a distance he may seem dead. The pulse is weak and quick; and apparently there is total deafness, at least he gives no evidence of hearing. But sensation is not altogether lost. Tickling his soles does not make him wince, but the stronger shocks of galvanism do. It is thought that consciousness and the mental faculties are not in abeyance; and voluntary motion certainly is not, for he occasionally turns in bed and shifts his arms. And there are many reasons for believing that, whatever the case may have been originally, it is not one of pure catalepsy now. For instance, the latter disease occurs usually in women. Again, this case is too prolonged for catalepsy, which occurs in paroxysms or fits, whose length may be reckoned by hours. Here are frequent spasmodic twitchings of certain muscles, that is of the fingers and wrists, neck, eyelids, eyeballs and jaw, which are absent in catalepsy. His arms are perfectly passive and do not retain the position in which they may be placed, but fall when unsupported, and sooner or later return either voluntarily or instinctively to their usual position across the chest, and the jaw immediately shuts again when forcibly opened. The eyes are not open and staring, but firmly shut; the balls roll about, and the pupils are not contractile. The respiratory movements can be readily seen. But if it is not catalepsy what is it? Is it a case of real disease or of shamming? Or is it one of the many peculiar forms of insanity caused originally and since kept up by the continuance of some strong mental emotion, and characterized by certain fixed ideas and especially determined obstinacy. That it is a cerebro-spinal affection of some kind, cannot be doubted. But the symptoms generally, their history and protraction, seem to show that other organs and parts of the nervous centres are diseased than those in the catalepsy; and that this is a more serious affection, perhaps, originating in a more lasting and deeper-seated cause.

In Lavelle's case it would be difficult to predict the issue. But while there is life there is hope. There is no very evident reason why he should not recover, and that completely physically and mentally as well as in body. But at the same time it is also possible that his restoration may find him wholly or partially deprived of some of our usual endowments, whether those depending on the soundness of the brain and its functions, or those contingent on the healthiness of its outposts, the nerves.

Lavelle was dismissed by his employer for having got married, just before he had the attack.