The King in Yellow Robert W Chambers

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 Series Volumes of
Haunted Library of Horror Classics:
The Phantom of the Opera by Gaston Leroux (2020)
The Beetle by Richard Marsh (2020)
Vathek by William Beckford (2020)
The House on the Borderland by William Hope Hodgson (2020)
Of One Blood: or, The Hidden Self by Pauline Hopkins (2021)
The Parasite and Other Tales of Terror by Arthur Conan Doyle (2021)
The King in Yellow by Robert W. Chambers (2021)
Ghost Stories of an Antiquary by M. R. James (2021)
The Castle of Otranto by Horace Walpole (2022)
The Old English Baron by Clara Reeve (2022)
The Mummy! by Jane Webb (2022)
Fantasmagoriana translated into English by Sarah Elizabeth Utterson
(2022)
The Picture of Dorian Gray by Oscar Wilde (2022)
…and more forthcoming
First published in 1895 by F. Tennyson Neely, New York
Introduction © 2021 by Nic Pizzolatto
Additional supplemental material © 2021 by Eric J. Guignard and
Leslie S. Klinger
Copyright © 2021 by Horror Writers Association
Cover and internal design © 2021 by Sourcebooks
Cover design and illustration by Jeffrey Nguyen
Sourcebooks, Poisoned Pen Press, and the colophon are registered
trademarks of Sourcebooks.
All rights reserved. No part of this book may be reproduced in any
form or by any electronic or mechanical means including information
storage and retrieval systems—except in the case of brief quotations
embodied in critical articles or reviews—without permission in writing
from its publisher, Sourcebooks.
The characters and events portrayed in this book are fictitious or are
used fictitiously. Any similarity to real persons, living or dead, is
purely coincidental and not intended by the author.
Published by Poisoned Pen Press, an imprint of Sourcebooks
P.O. Box 4410, Naperville, Illinois 60567-4410
(630) 961-3900
sourcebooks.com
Originally published as The King in Yellow in 1895 in New York City,
New York, United States of America, by F. Tennyson Neely.
Library of Congress Cataloging-in-Publication Data
Names: Chambers, Robert W. (Robert William), author. |
Pizzolatto, Nic, writer of introduction.
Title: The king in yellow / Robert W Chambers ; with an introduction
by Nic
Pizzolatto.
Description: Naperville, Illinois : Poisoned Pen Press, [2021] | Series:
Haunted library of horror classics | “Originally published as The King
in Yellow in 1895 in New York City, New York, United States of
America,
by F. Tennyson Neely.” | Includes bibliographical references.
Identifiers: LCCN 2020048797 | (trade paperback) | (epub)
Subjects: LCSH: Paranormal fiction, American. | GSAFD: Horror
fiction. |
Occult fiction.
Classification: LCC PS1284 .K56 2021 | DDC 813/.52--dc23
LC record available at https://lccn.loc.gov/2020048797
This edition of The King in Yellow is presented by the Horror Writers
Association, a nonprofit organization of writers and publishing
professionals around the world, dedicated to promoting dark
literature and the interests of those who write it.

For more information on HWA, visit: horror.org.

 Contents

Front Cover

Title Page

Copyright

Introduction

The Repairer of Reputations

The Mask

In the Court of the Dragon

The Yellow Sign

The Demoiselle D’ys

The Prophets’ Paradise

The Street of the Four Winds

The Street of the First Shell

The Street of Our Lady of the Fields

Rue Barrée
About the Author, Robert W. Chambers

Suggested Discussion Questions for Classroom Use

Suggested Further Reading of Fiction

About the Series Editors

Back Cover
 Introduction

AS the reader will shortly discern, I am no scholar of The King in

Yellow. I read only two or three of its stories when I ran across the
book as a teenager and never revisited, though a certain few
sentences stayed with me, like a tune that won’t leave your head.
Around two decades later I linked the notional King in Yellow to a
killer and the savage cult that bred him in a Gothic police procedural
I created, at a time when the idea of a story that caused insanity
seemed like a proper metaphor both to a detective’s obsessive
theory and the everyday world I was seeing all around.
The conceit of Chambers’s fictional play appears still more relevant
today, among this landscape of cultural memes, narratives whose
spread can be traced like pathogens, language going viral, fiction
disguised as facts, and a news-entertainment complex whose
defining purpose appears to be waging relentless psychological
warfare on its own audience, almost entirely through stories. The
America seen in “The Repairer of Reputations” looks nearly
prescient, a society falling to chaos in the story’s background while
most of the city is under the power of a grotesque extortionist
whose physical appearance distorts the human as fully as his
enterprise. Like the elusive play, the dwarf’s tools are words—lists,
letters, genealogies, records of transgression.
Stories. Words.
 The idea of “magic words” has always felt misunderstood to me.
The magic is not the words themselves, or any particular word,
because they are, after all, empty vessels. The magic is only ever
using the right words in the exact right way. The secret knowledge
lies in arranging, say, the twenty-six symbols of our English alphabet
into a configuration which reliably produces an intended effect upon
the audience, perhaps and even especially against that audience’s
wishes—configurations most commonly categorized as a story,
poem, lyric, or play. Then there’s no end to the capabilities of
language and its power over human beings, its ability to engender
the most overwhelming emotional states. Put words to music and
the entire world can move.
As we’re all too aware since the world started living on our phones,
stories can without much effort induce apoplectic rage or shattering
fear. More difficult to accomplish, the same vehicle can also make us
feel emptied and purged by a heartbreaking beauty that perhaps
widens the scope of our perceptions, making the experience of
consciousness fundamentally different afterward. Language can also
absolutely drive a person insane. I intend no euphemism; I’m talking
stark raving mad. A configuration of language can demonstrably
trigger mental illness for individuals whose psychologies were stable
prior, but unknowingly receptive to that sort of stimuli. Books of
supposedly secret knowledge and magic have this sort of reputation,
and in my experience it is earned.
Readers may be interested to know there are very real currents of
the occult practiced by lodges in the Typhonian and Voudon
traditions which view Hastur and the King in Yellow as actual
entities, as they do Lovecraft’s Old Ones: nightmares that were
channeled through artists and sensitives who were unaware their
fictions represented the influence of actual para-terrestrial
intelligences. Such occultists have spent the better part of the last
century using ritual and ceremonial magic to ostensibly communicate
with such entities and “hold open the gateways” for same.
Transcriptions of communication from these entities constitute
illuminated manuscripts to members of these lodges, many of whom
believe that the Sign of Protection will shield them as the chthonic
forces from a broken universe exert influence in our dimension.
Speaking of mental illness.
Then again, the above has been taking place throughout the most
brutally transformative, chaotic, and devastating century of our
species. World Wars, mass killings, the advent of serial murderers
and active shooters, to say nothing of technology as fantastical and
horrifying as the atomic bomb or the internet…
I should get back to the topic at hand, which I think had
something to do with stories as viral delivery devices that produce
specific symptoms in an audience…
This book’s original effect on me had been entirely centered
around the peculiar, haunted quality exuded by its omissions, the
idea of the play. The lines Chambers provides from the imaginary
work and the vague wisps of events therein resonate with the
existential gravity of a particular horror—a very personal, human
horror of the mind, where something essential is confirmed, that the
world cannot in any way be apprehended, enlightenment is
indistinguishable from derangement, and the joke is very much on
you.
Reading now, I found these stories also offer a prose style whose
techniques seem significantly ahead of their time, in their meta-
textual conceits, their vision of the world and the dissonance that
vision generates. The legacy of The King in Yellow in the horror
genre is well-known, but Chambers’s careful prose, his willingness to
disorient, and the strangeness of his imagination have surely had an
influence among literary writers outside horror or fantasy. One might
hear his echoes in the compelling dream-logic and almost oppressive
dread in John Hawkes, Fleur Jaeggy, and others.
I’m aware that I’ve been speaking around the work in question,
only grazing it edges, circling, looking to digression.
That feels appropriate, as much in the book suggests it isn’t meant
to be viewed directly, rationally, but rather approached sideways,
seen from the corner of the eye, because that is where its greatest
effects lie, in suggestion and glimpse, in the nuanced madness that
rises to its surfaces like a bubble in the blood.
Probably for those reasons, I’ve never found even the most
imaginative and technically masterful visualizations of the King to
possess any of the dread and dark power the figure attains through
Chambers’s avoidance and implication (and invocation). Likewise,
the few times I’ve sampled the fiction of other writers, which have
grown around the present book, none could reproduce the original’s
stir of almost vertiginous sensation, the fluttering edge of a
transformative perception, always just outside the page’s periphery.
That this book has proven so inspirational while resistant to
emulation might be the strongest evidence of its enduring power.
A very human yearning exists in these stories, too, a longing that
animates its characters and their experience of the world. The desire
at work feels almost too nebulous and primal to be contained by
definition, something like an instinct toward deliverance, however
hazy its conception…
The same longing powers these few, obtuse lines, which may be
among the most uncanny and evocative we have in our literature, an
almost spiritual mystery in the weight they carry:
 “…for I cannot forget Carcosa, where black stars hang in the
heavens; where the shadows of men’s thoughts lengthen in the
afternoon…”
And, oh, what thoughts. And still, what shadows?
Nic Pizzolatto
June 3, 2020
Los Angeles, California
 Author’s Dedication

THE KING IN YELLOW

DEDICATED
TO
MY BROTHER 1

“Along the shore the cloud waves break,

The twin suns sink behind the lake,
The shadows lengthen
In Carcosa.
Strange is the night where black stars rise,
And strange moons circle through the skies,
But stranger still is
Lost Carcosa.
Songs that the Hyades shall sing,
Where flap the tatters of the King,
Must die unheard in
Dim Carcosa.
Song of my soul, my voice is dead,
Die thou, unsung, as tears unshed
Shall dry and die in
Lost Carcosa.”

—Cassilda’s Song in “The King in Yellow.”

Act 1. Scene 2. 2

1 The successful New York City architect Walter Boughton Chambers

(1866–1945).
2 The play is fictional. The name “Carcosa” came from Ambrose
Bierce’s story “An Inhabitant of Carcosa” (1886).
 The Repairer of Reputations

“Ne raillons pas les fous; leur folie dure plus longtemps que la
nôtre… Voila toute la différence.” 3

I.
TOWARD the end of the year 1920 the Government of the United
States had practically completed the programme, adopted during the
last months of President Winthrop’s administration. The country was
apparently tranquil. Everybody knows how the Tariff and Labour
questions were settled. The war with Germany, incident on that
country’s seizure of the Samoan Islands, had left no visible scars
upon the republic, and the temporary occupation of Norfolk by the
invading army had been forgotten in the joy over repeated naval
victories, and the subsequent ridiculous plight of General Von
Gartenlaube’s forces in the State of New Jersey. The Cuban and
Hawaiian investments had paid one hundred per cent and the
territory of Samoa was well worth its cost as a coaling station. The
country was in a superb state of defence. Every coast city had been
well supplied with land fortifications; the army under the parental
eye of the General Staff, organized according to the Prussian system,
had been increased to 300,000 men, with a territorial reserve of a
million; and six magnificent squadrons of cruisers and battle-ships
patrolled the six stations of the navigable seas, leaving a steam
reserve amply fitted to control home waters. The gentlemen from
the West had at last been constrained to acknowledge that a college
for the training of diplomats was as necessary as law schools are for
the training of barristers; consequently we were no longer
represented abroad by incompetent patriots. The nation was
prosperous; Chicago, for a moment paralyzed after a second great
fire, had risen from its ruins, white and imperial, and more beautiful
than the white city which had been built for its plaything in 1893. 4
Everywhere good architecture was replacing bad, and even in New
York, a sudden craving for decency had swept away a great portion
of the existing horrors. Streets had been widened, properly paved
and lighted, trees had been planted, squares laid out, elevated
structures demolished and underground roads built to replace them.
The new government buildings and barracks were fine bits of
architecture, and the long system of stone quays which completely
surrounded the island had been turned into parks which proved a
god-send to the population. The subsidizing of the state theatre and
state opera brought its own reward. The United States National
Academy of Design was much like European institutions of the same
kind. Nobody envied the Secretary of Fine Arts, either his cabinet
position or his portfolio. The Secretary of Forestry and Game
Preservation had a much easier time, thanks to the new system of
National Mounted Police. We had profited well by the latest treaties
with France and England; the exclusion of foreign-born Jews as a
measure of self-preservation, the settlement of the new independent
negro state of Suanee, the checking of immigration, the new laws
concerning naturalization, and the gradual centralization of power in
the executive all contributed to national calm and prosperity. When
the Government solved the Indian problem and squadrons of Indian
cavalry scouts in native costume were substituted for the pitiable
organizations tacked on to the tail of skeletonized regiments by a
former Secretary of War, the nation drew a long sigh of relief. When,
after the colossal Congress of Religions, bigotry and intolerance were
laid in their graves and kindness and charity began to draw warring
sects together, many thought the millennium had arrived, at least in
the new world which after all is a world by itself. 5
But self-preservation is the first law, and the United States had to
look on in helpless sorrow as Germany, Italy, Spain and Belgium
writhed in the throes of Anarchy, while Russia, watching from the
Caucasus, stooped and bound them one by one.
In the city of New York the summer of 1899 was signalized by the
dismantling of the Elevated Railroads. The summer of 1900 will live
in the memories of New York people for many a cycle; the Dodge
Statue was removed in that year. 6 In the following winter began that
agitation for the repeal of the laws prohibiting suicide which bore its
final fruit in the month of April, 1920, when the first Government
Lethal Chamber was opened on Washington Square.
I had walked down that day from Dr. Archer’s house on Madison
Avenue, where I had been as a mere formality. Ever since that fall
from my horse, four years before, I had been troubled at times with
pains in the back of my head and neck, but now for months they
had been absent, and the doctor sent me away that day saying
there was nothing more to be cured in me. It was hardly worth his
fee to be told that; I knew it myself. Still I did not grudge him the
money. What I minded was the mistake which he made at first.
When they picked me up from the pavement where I lay
unconscious, and somebody had mercifully sent a bullet through my
horse’s head, I was carried to Dr. Archer, and he, pronouncing my
brain affected, placed me in his private asylum where I was obliged
to endure treatment for insanity. At last he decided that I was well,
and I, knowing that my mind had always been as sound as his, if not
sounder, “paid my tuition” as he jokingly called it, and left. I told
him, smiling, that I would get even with him for his mistake, and he
laughed heartily, and asked me to call once in a while. I did so,
hoping for a chance to even up accounts, but he gave me none, and
I told him I would wait.
The fall from my horse had fortunately left no evil results; on the
contrary it had changed my whole character for the better. From a
lazy young man about town, I had become active, energetic,
temperate, and above all—oh, above all else—ambitious. There was
only one thing which troubled me, I laughed at my own uneasiness,
and yet it troubled me.
During my convalescence I had bought and read for the first time,
The King in Yellow. I remember after finishing the first act that it
occurred to me that I had better stop. I started up and flung the
book into the fireplace; the volume struck the barred grate and fell
open on the hearth in the firelight. If I had not caught a glimpse of
the opening words in the second act I should never have finished it,
but as I stooped to pick it up, my eyes became riveted to the open
page, and with a cry of terror, or perhaps it was of joy so poignant
that I suffered in every nerve, I snatched the thing out of the coals
and crept shaking to my bedroom, where I read it and reread it, and
wept and laughed and trembled with a horror which at times assails
me yet. This is the thing that troubles me, for I cannot forget
Carcosa where black stars hang in the heavens; where the shadows
of men’s thoughts lengthen in the afternoon, when the twin suns
sink into the lake of Hali; 7 and my mind will bear for ever the
memory of the Pallid Mask. I pray God will curse the writer, as the
writer has cursed the world with this beautiful, stupendous creation,
terrible in its simplicity, irresistible in its truth—a world which now
trembles before the King in Yellow. When the French Government
seized the translated copies which had just arrived in Paris, London,
of course, became eager to read it. It is well known how the book
spread like an infectious disease, from city to city, from continent to
continent, barred out here, confiscated there, denounced by Press
and pulpit, censured even by the most advanced of literary
anarchists. No definite principles had been violated in those wicked
pages, no doctrine promulgated, no convictions outraged. It could
not be judged by any known standard, yet, although it was
acknowledged that the supreme note of art had been struck in The
King in Yellow, all felt that human nature could not bear the strain,
nor thrive on words in which the essence of purest poison lurked.
The very banality and innocence of the first act only allowed the
blow to fall afterward with more awful effect.
It was, I remember, the 13th day of April, 1920, that the first
Government Lethal Chamber was established on the south side of
Washington Square, between Wooster Street and South Fifth
Avenue. The block which had formerly consisted of a lot of shabby
old buildings, used as cafés and restaurants for foreigners, had been
acquired by the Government in the winter of 1898. The French and
Italian cafés and restaurants were torn down; the whole block was
enclosed by a gilded iron railing, and converted into a lovely garden
with lawns, flowers and fountains. In the centre of the garden stood
a small, white building, severely classical in architecture, and
surrounded by thickets of flowers. Six Ionic columns supported the
roof, and the single door was of bronze. A splendid marble group of
the Fates 8 stood before the door, the work of a young American
sculptor, Boris Yvain, who had died in Paris when only twenty-three
years old.
 The inauguration ceremonies were in progress as I crossed
University Place and entered the square. I threaded my way through
the silent throng of spectators, but was stopped at Fourth Street by
a cordon of police. A regiment of United States lancers were drawn
up in a hollow square round the Lethal Chamber. On a raised tribune
facing Washington Park stood the Governor of New York, and behind
him were grouped the Mayor of New York and Brooklyn, the
Inspector-General of Police, the Commandant of the state troops,
Colonel Livingston, military aid to the President of the United States,
General Blount, commanding at Governor’s Island, Major-General
Hamilton, commanding the garrison of New York and Brooklyn,
Admiral Buffby of the fleet in the North River, Surgeon-General
Lanceford, the staff of the National Free Hospital, Senators Wyse
and Franklin of New York, and the Commissioner of Public Works.
The tribune was surrounded by a squadron of hussars of the
National Guard.
The Governor was finishing his reply to the short speech of the
Surgeon-General. I heard him say: “The laws prohibiting suicide and
providing punishment for any attempt at self-destruction have been
repealed. The Government has seen fit to acknowledge the right of
man to end an existence which may have become intolerable to him,
through physical suffering or mental despair. It is believed that the
community will be benefited by the removal of such people from
their midst. Since the passage of this law, the number of suicides in
the United States has not increased. Now the Government has
determined to establish a Lethal Chamber in every city, town and
village in the country, it remains to be seen whether or not that class
of human creatures from whose desponding ranks new victims of
self-destruction fall daily will accept the relief thus provided.” He
paused, and turned to the white Lethal Chamber. The silence in the
street was absolute. “There a painless death awaits him who can no
longer bear the sorrows of this life. If death is welcome let him seek
it there.” Then quickly turning to the military aid of the President’s
household, he said, “I declare the Lethal Chamber open,” and again
facing the vast crowd he cried in a clear voice: “Citizens of New York
and of the United States of America, through me the Government
declares the Lethal Chamber to be open.”
The solemn hush was broken by a sharp cry of command, the
squadron of hussars filed after the Governor’s carriage, the lancers
wheeled and formed along Fifth Avenue to wait for the commandant
of the garrison, and the mounted police followed them. I left the
crowd to gape and stare at the white marble Death Chamber, and,
crossing South Fifth Avenue, walked along the western side of that
thoroughfare to Bleecker Street. Then I turned to the right and
stopped before a dingy shop which bore the sign,

HAWBERK, ARMOURER.

I glanced in at the doorway and saw Hawberk busy in his little

shop at the end of the hall. He looked up, and catching sight of me
cried in his deep, hearty voice, “Come in, Mr. Castaigne!” Constance,
his daughter, rose to meet me as I crossed the threshold, and held
out her pretty hand, but I saw the blush of disappointment on her
cheeks, and knew that it was another Castaigne she had expected,
my cousin Louis. I smiled at her confusion and complimented her on
the banner she was embroidering from a coloured plate. Old
Hawberk sat riveting the worn greaves of some ancient suit of
armour, and the ting! ting! ting! of his little hammer sounded
pleasantly in the quaint shop. Presently he dropped his hammer, and
fussed about for a moment with a tiny wrench. The soft clash of the
mail sent a thrill of pleasure through me. I loved to hear the music
of steel brushing against steel, the mellow shock of the mallet on
thigh pieces, and the jingle of chain armour. That was the only
reason I went to see Hawberk. He had never interested me
personally, nor did Constance, except for the fact of her being in love
with Louis. This did occupy my attention, and sometimes even kept
me awake at night. But I knew in my heart that all would come
right, and that I should arrange their future as I expected to arrange
that of my kind doctor, John Archer. However, I should never have
troubled myself about visiting them just then, had it not been, as I
say, that the music of the tinkling hammer had for me this strong
fascination. I would sit for hours, listening and listening, and when a
stray sunbeam struck the inlaid steel, the sensation it gave me was
almost too keen to endure. My eyes would become fixed, dilating
with a pleasure that stretched every nerve almost to breaking, until
some movement of the old armourer cut off the ray of sunlight,
then, still thrilling secretly, I leaned back and listened again to the
sound of the polishing rag, swish! swish! rubbing rust from the
rivets.
Constance worked with the embroidery over her knees, now and
then pausing to examine more closely the pattern in the coloured
plate from the Metropolitan Museum.
“Who is this for?” I asked.
Hawberk explained, that in addition to the treasures of armour in
the Metropolitan Museum of which he had been appointed armourer,
he also had charge of several collections belonging to rich amateurs.
This was the missing greave of a famous suit which a client of his
had traced to a little shop in Paris on the Quai d’Orsay. He, Hawberk,
had negotiated for and secured the greave, and now the suit was
complete. He laid down his hammer and read me the history of the
suit, traced since 1450 from owner to owner until it was acquired by
Thomas Stainbridge. When his superb collection was sold, this client
of Hawberk’s bought the suit, and since then the search for the
missing greave had been pushed until it was, almost by accident,
located in Paris.
“Did you continue the search so persistently without any certainty
of the greave being still in existence?” I demanded.
“Of course,” he replied coolly.
Then for the first time I took a personal interest in Hawberk.
“It was worth something to you,” I ventured.
“No,” he replied, laughing, “my pleasure in finding it was my
reward.”
“Have you no ambition to be rich?” I asked, smiling.
“My one ambition is to be the best armourer in the world,” he
answered gravely.
Constance asked me if I had seen the ceremonies at the Lethal
Chamber. She herself had noticed cavalry passing up Broadway that
morning, and had wished to see the inauguration, but her father
wanted the banner finished, and she had stayed at his request.
“Did you see your cousin, Mr. Castaigne, there?” she asked, with
the slightest tremor of her soft eyelashes.
“No,” I replied carelessly. “Louis’ regiment is manoeuvring out in
Westchester County.” I rose and picked up my hat and cane.
“Are you going upstairs to see the lunatic again?” laughed old
Hawberk. If Hawberk knew how I loathe that word “lunatic,” he
would never use it in my presence. It rouses certain feelings within
me which I do not care to explain. However, I answered him quietly:
“I think I shall drop in and see Mr. Wilde for a moment or two.”
“Poor fellow,” said Constance, with a shake of the head, “it must be
hard to live alone year after year poor, crippled and almost
demented. It is very good of you, Mr. Castaigne, to visit him as often
as you do.”
“I think he is vicious,” observed Hawberk, beginning again with his
hammer. I listened to the golden tinkle on the greave plates; when
he had finished I replied:
“No, he is not vicious, nor is he in the least demented. His mind is
a wonder chamber, from which he can extract treasures that you and
I would give years of our life to acquire.”
Hawberk laughed.
I continued a little impatiently: “He knows history as no one else
could know it. Nothing, however trivial, escapes his search, and his
memory is so absolute, so precise in details, that were it known in
New York that such a man existed, the people could not honour him
enough.”
“Nonsense,” muttered Hawberk, searching on the floor for a fallen
rivet.
“Is it nonsense,” I asked, managing to suppress what I felt, “is it
nonsense when he says that the tassets and cuissards 9 of the
enamelled suit of armour commonly known as the ‘Prince’s
Emblazoned’ can be found among a mass of rusty theatrical
properties, broken stoves and ragpicker’s refuse in a garret in Pell
Street?”
Hawberk’s hammer fell to the ground, but he picked it up and
asked, with a great deal of calm, how I knew that the tassets and
left cuissard were missing from the “Prince’s Emblazoned.”
“I did not know until Mr. Wilde mentioned it to me the other day.
He said they were in the garret of 998 Pell Street.”
“Nonsense,” he cried, but I noticed his hand trembling under his
leathern apron.
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The periods of puberty and early menstruation and of pregnancy
furnish the most favorable opportunities for the development of
cataleptoid seizures in predisposed individuals. In 3 of 10 cases
observed by Landouzy catalepsy appeared to be developed in
consequence of the sudden suppression of menstruation; in a fourth
it occurred in a young girl after a dysmenorrhœa with chronic
phlegmasia of the genitals. Masturbation is sometimes mentioned as
a cause, particularly in boys.

Reflex irritation undoubtedly often acts as an exciting cause of

catalepsy. Preputial irritation, relieved in part by circumcision, was
present in the case of Lloyd, and has been noted by others.
Handfield Jones mentions a case, recorded by Austen in his work on
General Paralysis, in which the cataleptic seizure was, to all
appearances, due to fecal accumulations. The attack disappeared
promptly after an enema had thoroughly operated.

Briquet believed that catalepsy, when it did not follow upon organic
disease, was ordinarily the result of moral causes, such as vivid and
strong emotions—fear, chagrin, indigestion, anger, or profound and
prolonged meditation. He refers to the able and curious thesis of
Favrot,6 who states that in twenty cases in which the causes of the
malady were indicated it had been always the result of a moral
affection. A magistrate insulted at his tribunal, seized with
indignation, is suddenly taken with catalepsy, etc. According to Puel,
its causes are always depressing moral affections, as chagrin,
hatred, jealousy, and terror at bad treatment. Unrequited love is set
down as a cause, but what has not unrequited love produced? Jones
mentions a case which occurred in a man sixty years old on the
sudden death of his wife.
6 “De la Catalepsie”—Mémoire couronné par l'Académie de Médecine, Mémoires de
l'Académie de Médecine, Paris, 1856, t. xx. p. 409, A. 526.

Cullen believed that catalepsy was always a simulated disease; he

preferred, therefore, to place it as a species of apoplexy. Temporary
catalepsy may, according to Rosenthal, be produced in hysterical
patients by covering their eyes with their hands or a cloth. Malaria
has been charged with the production of catalepsy, and apparently
properly. Traumatism is another of its well-authenticated causes.
Blows upon the head have been particularly recorded as having an
etiological relation to this disorder.

Partial catalepsy has been observed after typhoid fever with severe
cerebral symptoms, and also associated with meningitis and
intermittent fever. Mancini7 relates a case of cerebral rheumatism
complicated or causing catalepsy. A blacksmith, aged thirty-three,
had nearly recovered from a rheumatic attack when he became
melancholic, complaining also of severe headache. When admitted
to the hospital he was found to be imperfectly nourished. He lay on
his back, his face without expression, speechless, motionless, pupils
insensible to the light, smell impaired, sensation of heat and pain
and reflexes absent, galvanic and faradic contractility increased, the
rectum and bladder paralyzed. He presented the phenomena of
waxen flexibility, the trunk and limbs remaining in whatever position
was given them. Considering the previous attack of articular
rheumatism and the sudden appearance of nervous disorder during
the convalescence of this disease, Mancini believed that the case
was probably one of cerebral rheumatism. The man recovered under
diaphoretics and counter-irritation.
7 Lo Sperimentale, March, 1878.

Among the important causes of catalepsy bad nutrition may

undoubtedly be placed. In the case of De Schweinitz the cataleptoid
phenomena rapidly improved, and eventually disappeared as the
child's general health was restored by tonics and good diet. Hovey's
case was insufficiently clad and badly fed. One of Laségue's cases,
quoted by Handfield Jones, died of gradual marasmus, another of
pulmonary phthisis. Attacks of catalepsy have sometimes resulted
from a combination of excitement, fatigue, and want of food. They
occur also in diseases or conditions like phthisis, anæmia, and
chlorosis, affections which practically gives us the same cause—
namely, bad nutrition. In these cases the nervous system, like other
parts of the body, takes part in the general exhaustion.
Rosenthal refers to the production of symptoms of temporary
catalepsy by the administration of narcotics and the inhalation of
ether and chloroform. In a somewhat ancient American medical
periodical8 Charles D. Meigs of Philadelphia gives an interesting
account of a case of catalepsy produced by opium in a man twenty-
seven years of age. The man had taken laudanum. His arms when in
a stuporous condition remained in any posture in which they
happened to be left; his head was lifted off the pillow, and so
remained. “If he were made of wax,” says Meigs, “he could not more
steadily preserve any given attitude.” The patient recovered under
purging, emetics, and bleeding. Darwin, quoted by Meigs, mentions
a case of catalepsy which occurred after the patient had taken
mercury. He recovered in a few weeks.
8 The North American Medical and Surgical Journal, vol. i. p. 74, 1826.

That imitation is an exciting cause of catalepsy has been shown by

the often-told story of epidemic hysteria, but more especially by
accounts given of certain peculiar endemics of catalepsy. Handfield
Jones9 gives an account of an endemic which prevailed at
Billinghausen near Wurzburg: “The population consists of peasants
who are well off, but who intermarry very much, and are small and
deformed. The affected individuals constitute half of the number,
males as well as females. They are called there the stiff ones
(starren). A chill is commonly said to be the exciting cause of the
attacks. The patients are suddenly seized by a peculiar sensation in
their limbs, upon which all their muscles become tense, their
countenances deadly pale; they retain the posture which they first
assume; their fingers are bent and quiver slightly, and the eyeballs in
the same way, the visual axis converging; their intellects and senses
are normal, but their speech consists only of broken sounds. The
attack ceases in from one to five minutes, and the body becomes
warm.”
9 Op. cit., quoted from Schmidt's Jahrbuch.

SYMPTOMATOLOGY.—The cataleptic seizure, when it is not the result of

some hypnotizing procedure, usually takes place in the following
manner: The patient usually, after some patent exciting cause,
suddenly ceases whatever she may chance to be doing, becoming
rigid and immobile in the last position which she had been in before
the attack ensued. “She remains,” says Rosenthal, “as if petrified by
the head of Medusa.” The features are composed, the eyes usually
directed forward. She is pale; breathing, pulsation, and temperature
are usually somewhat reduced. At first the limbs may be found to
offer some resistance; soon, however, and sometimes from the
beginning, they can be moulded like wax into any possible position,
where they will remain until again changed by external agency.

Attacks of catalepsy, as a rule, come on suddenly, without special

warning; sometimes, however, special phenomena, which may be
compared to epileptic aura, may precede the attack. Thus,
Rosenthal speaks of two cases that were ushered in, and also
bowed out, by hiccough. The attacks may terminate as suddenly as
they begin, but sometimes the patients come out of the state
gradually. They are quite likely to appear dazed and stupid when
emerging.

Perverted consciousness is another marked symptom of catalepsy.

According to some authors, the loss of consciousness is absolute,
and upon this symptom they base their diagnosis from two or three
other somewhat similar conditions. As I have already indicated in
discussing the general subject of Hysteria, this question of
consciousness or unconsciousness is not one to be decided in
haste. In catalepsy, as in hystero-epilepsy, the conditions as to
consciousness may differ. What might be termed volitional
consciousness is in true catalepsy certainly in abeyance. Flint10
divides catalepsy, according to the condition as to consciousness,
into three kinds—namely, complete, incomplete, and complicated.
He, however, regards trance and day-mare as instances of
incomplete catalepsy, in which the intellectual faculties are not
entirely suspended and the senses are not materially affected, the
patient being unable to move or speak, but conscious of all that is
going on around him. He believes that such cases resemble more
closely the cataleptic condition than they do that of ecstasy. In
genuine catalepsy with waxen flexibility, analgesia, etc. there may be
greater or less depths of unconsciousness, but some degree of
unconsciousness or of obtunded consciousness is necessary to the
existence of true catalepsy.
10 Buffalo Medical Journal, xiii., 1857-58, p. 141.

Catalepsy presents well-marked disturbances of sensation, although

these, like the conditions as to consciousness, differ somewhat in
different cases. Anæsthesia in its different forms, and especially
analgesia, are always present in some degree. Experiments without
number have been tried on cataleptic patients, showing their
insensibility to painful impressions: they have been pinched, pricked,
pounded, burned with heated irons, and rubbed down with blocks of
ice. Skoda reports a case in which general sensibility was abolished,
but a lighted paper rotated rapidly before the eyes gave rise to
tremors of the limbs, and strong odors induced slight movement,
redness of the cheeks, lachrymation, acceleration of the pulse, and
elevation of the temperature.

Hyperæsthesia, although rare, has been noted in a few isolated

cases of catalepsy. Puel records a case in which, during the
cataleptic paroxysm, the slightest touch or noise caused the patient
to grind the teeth and cry out. In some cases sensibility to certain
special impressions, as to a strong current of electricity, has been
retained, while all others were abolished. In a case of hystero-
catalepsy at the Philadelphia Hospital, when all other measures had
failed an attack was aborted and evidence of pain produced by the
application of a strong faradic current with metallic electrodes.

A marked change in the state of reflex irritability is another of the

striking symptoms of true catalepsy. Varying conditions as to reflex
irritability have been observed by different authors. So far as I am
aware, few special observations have been made upon the tendon
reflexes in catalepsy. In the case of De Schweinitz the knee-jerk was
apparently absent on one side and present on the other, although
the cataleptic symptoms were not unilateral.
The symptom known as flexibilitas cerea, or wax-like flexibility, to
which I have referred under Synonyms, is, as has been stated, by
some considered pathognomonic of this affection. While I do not
hold to this view, I regard the symptom as the most important
phenomenon of the disease. It is a symptom which from its very
nature can be, up to a certain point, readily shammed, and when
considering Diagnosis some methods of determining its genuineness
will be given.

Careful observation as to the pulse, respiration, and temperature are

lacking in the reported cases of catalepsy. According to Eulenburg,11
“the respiration is generally of normal frequency, sometimes rather
slow, more frequently of diminished or irregular intensity, so that
lighter and deeper inspirations alternate. The pulse may also be
slower, with slight excursion and diminished tension of the arteries.
The temperature generally remains normal, but in certain cases is
decidedly lowered.” The lowering of temperature, and particularly the
presence of extreme coldness of the surface, with exceedingly weak
pulse and respiration, have doubtless always been present in the
cases—a few, at least, authentic—in which catalepsy has been
supposed to be death.
11 Op. cit.

Hypnotic Catalepsy.

The investigations into the subject of hypnotism made in recent

years have given to the profession a series of interesting
phenomena which should be considered, at least briefly, under the
symptomatology of catalepsy. In a general review of the subject of
hypnotism12 by me many of the facts observed and theories
advanced by Braid, Heidenhain, Charcot, Richer, and others were
examined. I will here recall those observations of Heidenhain13 and
of Charcot and Richer14 which relate to the production of a cataleptic
or cataleptoid state, and to the phenomena which take place in this
state.
12 Am. Journ. Med. Science, Jan., 1882.

13 Animal Magnetism: Physiological Observations, by Rudolph Heidenhain, Prof.

Physiology in the University of Breslau, London, 1880.

14 Etudes cliniques sur l'Hystero-epilepsie, ou Grande Hystérie.

The method of Heidenhain was similar to that employed by Braid.

The latter, however, did not make use of passes. In the first place,
the individual was made to gaze fixedly at a shining faceted glass
button for some six or eight minutes, the visual axes being made to
converge as much as possible. Heidenhain, like Braid, found the
most advantageous direction of the visual axes to be that of upward
convergence. According to Carpenter, in the fixation this upward
convergence is very important; it suffices of itself in blind people or in
the night to produce hypnosis. After the fixation of gaze had been
continued for some six or eight minutes, the operator stroked over
the face, without immediately touching the surface, from the
forehead to the chest, after each pass bringing the hands, which
were warm, around in an arc to the forehead again. He either
allowed the eyelids to be closed or gently closed them. After ten or
twelve passes he asked the person to open his eyes. When this
occurred without hesitation or with only slight difficulty, he again
made the person stare at the glass for some six minutes, and then
repeated the passes, which often brought about the hypnotic state
when the simple fixation did not succeed.

The symptoms of the hypnotic state were in the main those which
have just been described as the symptoms of catalepsy—namely,
diminution of consciousness, insensibility, increased reflex irritability,
and fixity of the body or limbs in any position given.

In the slighter forms of hypnotism the subjects were able to

remember what had occurred during their apparent sleep. In more
fully-developed forms they had no remembrance of what had taken
place, but by giving hints and leading questions of their various
actions they were able to call them to mind. In the most complete
forms of hypnotism no remembrance whatever was retained. It can
nevertheless be proved that even during the most completely
developed hypnosis sensory perceptions take place, but they are no
longer converted into conscious ideas, and consequently are not
retained by the memory; and this is undoubtedly because the
hypnotized individuals have lost the power of directing their attention
to their sensations.

A symptom of the hypnotic state in its most complete development

was highly marked insensibility to pain. A pin could be run right into
the hand, and only an indistinct feeling of contact was brought about.
Immediately on awaking the full sense of pain was again present.
The fact that the tactile sense and the sense of pain are distinct was
corroborated.

Increased reflex irritability and tonic spasm of the voluntary muscles

accompanied the hypnotic condition. Stroking the flexible right arm of
a subject, it at once became stiff, since all the muscles were thrown
into a state of reflex spasm. Reflex muscular contraction spread over
the body when certain definite cutaneous surfaces were irritated.
With slight increase of reflex irritability those muscles alone
contracted which lay immediately under the area of the skin which
had been stroked. Stroking the ball of the thumb caused adduction of
the thumb. Stimulating the skin over the sterno-mastoid caused the
head to assume the stiff-neck position. When the irritability was
somewhat more increased, by a continuous irritation of a definite
spot of skin neighboring and even distant groups of muscles could
be set into activity. Heidenhain stroked continuously the ball of the
left thumb of his brother, when the following muscle-groups were
successively affected with spasm: left thumb, left hand, left forearm,
left upper arm and shoulder, right shoulder and arm, right forearm,
right hand, left leg, left thigh, right thigh, right leg, muscles of
mastication, muscles of the neck.
From a study of such phenomena Heidenhain was inclined to
consider that the hypnotic state was nothing more than artificially
produced catalepsy.

The possibility of fixing any part of the body in any given position
constituted an essential factor in the exhibition of Hansen. He made
one of his subjects, for instance, sit before him in a chair, and
adapted the hands to the seat so that his fingers grasped the edges.
After hypnotizing him he stroked along his arms, and his fingers took
convulsive hold of the edges of the seat. Placing himself in front of
the subject, he bent forward; the subject did the same. He then
walked noisily backward, and thereupon the subject followed him
through the hall, carrying his chair with him like a snail its shell.

One of the observations of Richer was on the influence of light on

catalepsy and hysterical lethargy. The patient was placed before a
bright focus of light, as a Drummond or electric light, on which she
was requested to fix her sight. In a short time, usually a few seconds
or several minutes, sometimes instantaneously, she passed into the
cataleptic state. She was as one fascinated—immobile, the wide-
open eye fixed on the light, the conjunctiva injected and humid.
Anæsthesia was complete. If the patient was hemianæsthetic, she
became totally anæsthetic. She did not present contractures. Her
limbs preserved the suppleness of the normal state or nearly this—
sometimes being the seat of a certain stiffness; but they acquired the
singular property of preserving the attitude which one gave them.
One interesting peculiarity was the influence of gesture on
physiognomy. The features reflected the expression of the gesture. A
tragic attitude imprinted a severe air on the physiognomy; the brows
contracted. If one brought the two hands to the mouth, as in the act
of sending a kiss, a smile immediately appeared on the lips. It was
an example of what Braid calls the phenomena of suggestion—of
Heidenhain's imitation. The state of catalepsy endured as long as
the agent which produced it—that is, as long as the light continued to
impress the retina.
The characteristics of the two abnormal states—catalepsy and
lethargy—into which hystero-epileptics may be thrown were
summarized by Richer as follows: (1) Cataleptic state: The eyes
wide open; total and absolute anæsthesia; aptitude of the limbs and
different parts of the body to preserve the situation in which they are
placed; little or no muscular rigidity; impossibility of causing muscular
contraction by mechanical excitation. (2) Lethargic state: The eyes
wide open or half closed; persistent trembling of the upper eyelids;
convulsion of the eyeballs; total and absolute anæsthesia; muscular
hyperexcitability; the limbs, in a condition of resolution, do not
preserve the situation given to them, except the provoked
contracture impressed upon them.

In the experiments at Salpêtrière the hystero-epileptics were

sometimes plunged into the states of catalepsy and lethargy under
the influence of sonorous vibrations instead of frights.

During the state of provoked hysterical catalepsy it was found that

sight and hearing could be affected by various procedures. The eyes
were fixed, and seemed not to see anything. If, however, an object
was slightly oscillated in the axis of the visual rays at a little distance
from the eyes, soon the gaze of the patient followed these
movements. The eyes, and sometimes even the head, seemed to
turn at the will of the operator. Hallucinations were produced. When
the look was directed upward the expression became laughing;
when downward, sombre. The cataleptic state might now cease
completely. The patient walked, followed the object on which her
gaze was fixed, and took attitudes in relation with the hallucination
suggested. Music also caused her to assume positions related with
the various sentiments suggested to her by the music. Sudden
withdrawal of the object from before the eyes or of the sound from
the range of hearing caused a return of the catalepsy. The cataleptic
patient in whom the eye was in such a state as to perceive the
movements of an experimenter placed in front of her reproduced
these movements exactly. At the Philadelphia Hospital I have
repeated most of the experiments of Heidenhain and of Charcot and
Richer.
 Unilateral Catalepsy.

Hemi-catalepsy or unilateral catalepsy is sometimes observed, and

has been studied both in hypnotic investigations and as a special
nervous affection. Charcot and Richer found that hemi-catalepsy or
lethargy may be produced on a patient, and that they may both exist
simultaneously in the same subject. When, for instance, a patient
was plunged into the cataleptic state under the influence of a bright
light, shutting with the hand one of the eyes, the patient at once
became lethargic on the same side only; the other side remained
cataleptic. Heidenhain and Gruetzner studied some remarkable
phenomena, which they have recorded under the name of unilateral
hypnosis, in which some surprising sensory disturbances occur.
They also found, among other things, a striking disturbance in the
process of accommodation and in the perception of colors in the eye
of the cataleptic side. In a case of hystero-epilepsy upon which I
performed numerous hypnotic experiments which have been
reported15 the patient nearly always presented unilateral cataleptic
phenomena. These were present on the left side, the patient being
subject to convulsions which were more marked on the right side,
this being also much wasted.
15 Philadelphia Med. Times, Nov. 19, 1881.

I witnessed some curious unilateral cataleptoid phenomena in the

case of a medical friend, who has made a note of his experience.16
He says: “In the course of some experiments on table-tipping, which
were conducted mainly to satisfy the curiosity of persons who had
never seen anything of the kind, I became the subject of a very
peculiar and marked hypnotic influence. The ordinary tricks of
tipping, answering questions, guessing numbers, etc. had been
performed with the table, during the greater part of which I had been
one of the circle, when my right hand began to contract so as to form
an arch, and was then lifted from the table. These movements were
not volitional; I was unable to control them. While my hand was in
this position one of the persons sitting at the table suddenly put his
hand on my forehead, and I sank back in the chair, passing into a
conscious but apparently powerless state, but only for a few
moments. Later in the evening the hypnotic influence in the right
hand was still more distinctly manifested. If allowed to remain a short
time on the table, the fingers began to vibrate vertically and
horizontally, the motion finally extending to the forearm and
becoming so violent as to throw the hand about in a rapid and
forcible manner. While thus affected I found it utterly impossible to
sign my name. I would be able to form the first letter or so, and then
most extraordinary gyrations would be made. In one instance I wrote
very slowly, using all the muscular control at my command, and
succeeded in writing the full name, but in a form wholly different from
my ordinary signature.”
16 Polyclinic, Sept. 15, 1883.

My attention was called to these phenomena, and the experiments

were repeated the next week in my presence, with like results. In
addition, I succeeded in forcibly placing the affected arm in various
positions—bent at right angles, the hand resting on the top of the
head, etc.—from which positions he was unable to move it. He
seemed to have lost the connection between volition and the motor
impulse. The experiments were continued for several hours at each
sitting, but owing to the depressed mental state which was produced
for a short time, apparently by them, they have not been repeated.

Occasionally, cases of unilateral catalepsy associated with rotatory

phenomena are met with, especially in hysterical children. In 1882, I
studied in the nervous dispensary of the hospital of the University of
Pennsylvania an interesting case with rotatory and unilateral
cataleptoid symptoms. This case has been reported by James
Hendrie Lloyd.17 The patient was a boy eight years old. His paternal
grandfather hanged himself. On the mother's side there was a
history of tuberculosis. Two years before coming to the hospital he
had had four attacks of spasms. For two weeks he had been having
from twelve to twenty similar spasms daily; some of these were
observed in the dispensary. “The boy's head was suddenly drawn
upward and to the right to its extreme limits by the action chiefly of
the sterno-cleido-mastoid muscle. The eyes turned also to the
extreme right, with slight convulsive (clonic) action, and became
fixed in that position, with very wide dilatation of the pupils. In a
second or two he began to rotate his whole body to the right, and
turned completely around, perhaps ten or twelve times. On some
occasions he had fallen down, his mother said, toward the end of the
spell. If taken hold of and steadied—which required but little force by
the physician—the rotation could be stopped, though the head and
eyes remained drawn, and the boy's arms could be placed in any
desired position. If now he was once more let loose, his body again
rotated, while his arms were held in true cataleptoid rigidity. The
whole duration of the attack was from one half to one minute. The
boy was intelligent, and said he knew what was taking place about
him while he was in the fit, though he gave no satisfactory evidence
of such knowledge at the time. There was no history of headache or
any disease. His ears were subsequently examined and found
normal. He had taken worm medicine in abundance from the family
physician without results. There were no psychical traits of
importance to suggest foolish or wilful simulation. The only accident
had been a fall from a wagon years previously. As the patient had an
adherent prepuce, Wood advised circumcision, and took pains to
explain the operation to the mother. This evidently made a great
impression on the child's mind, which is worthy of notice in
considering the case. The potassium bromide was continued. At the
third visit, which had been appointed for the operation of
circumcision, the mother reported the patient much better. The boy
had been having great fear of the proposed operation, and now said
that he thought he could control the spells. A psychical element was
thus distinctly indicated, and its likeness to chorea major to some
extent increased. It was thought best, however, instead of
circumcision, to break up adhesions and retract the foreskin, which
was done by J. William White. At the fourth visit, after ten days, a still
greater improvement was noted.”
17 Philada. Med. Times, vol. xii., June 17, 1882.
Lloyd in reporting this case discusses the physiology of the
condition, and refers to other cases in medical literature. According
to Brown-Séquard, the great cause of rotation phenomena is a
convulsive contraction in some of the muscles on one side of the
body. Carpenter believes they are due to weakness of the sensori-
motor apparatus of one side. Laycock holds that the cerebellum is
involved. Lloyd likens the case to chorea major. He refers to cases
reported by Radcliffe18 and J. Andrew Crawford.19
18 Reynolds's System of Medicine, art. “Chorea.”

19 Cycl. of Pract. Medicine, art. “Chorea.”

At the Pennsylvania Training School for Feeble-minded Children at

Elwyn is a little patient familiarly spoken of as the Dervish. I have
examined this boy several times, and have frequently watched his
performances. I. N. Kerlin, superintendent of the institution, has
kindly furnished me with some notes of this case. The antecedents
of the patient are unknown. He is about fifteen years of age, is of
small stature and weight, a demi-microcephalic, epileptic, and mute
idiot. His epilepsy, however, supervened only in 1884, and the
seizures continue now at the rate of three or four a month. At all
times he is subject to certain automatic tricks with his hands, putting
and twisting them into various positions. Periodically almost during
every day he gives exhibitions of the habit which has led him to be
called the Dervish. He commences by tattooing his chin with his left
hand; next he delicately and rapidly touches the fingers of his left
hand to the wrist of the right, makes two or three salaams, and then
impulsively gyrates the body from left to right. The right heel is
pivotal, and the force is maintained by touches of the left toe or heel
upon the floor. He will usually take from three to seven turns at a
time, with a salaam or two between every series. Fifteen minutes or
more will be thus consumed before he darts away toward a window,
where he remains a few moments in a dazed state, from which he
rouses to recommence his hand tricks. Perhaps he will select a
broad belt of light in which to display his hand for visual enjoyment.
He has a cataract of the right lens, and possibly partial amaurosis of
the left eye. A supplemental performance sometimes indulged in is
to stand at one fixed point and throw his head and shoulders from
side to side, describing with the former two-thirds of a circle, the
occiput being flexed backward as far as the neck will permit. These
movements, rapidly made, reach three and four hundred under
favorable conditions.

Kerlin regards the displays made by this boy to be the pure

automatic phenomena of idiocy which have been developed to an
artistic finish, and out of which the patient gets enjoyment. This
enjoyment probably exists in some anæsthetic or stuporous
condition of certain nerve-centres, something like the sensation of
common dizziness. He does not look upon the case, therefore, as
one of genuine catalepsy, but I have recorded it here in connection
with the case just given because it illustrates a phase of automatism
and rotation movements closely allied to cataleptoid conditions.

Catalepsy and Cataleptoid Phenomena among the Insane.

Catalepsy and cataleptoid or cataleptic phenomena are of

comparatively frequent occurrence among the insane. Niemeyer
says20 that they are especially common among persons suffering
from melancholia. Kahlbaum21 has described a form of insanity
which he names katatonia, from the Greek κατατονος, stretching
down. This disease is “characterized by alternate periods,
supervening with more or less regularity, of acute mania,
melancholia, and epileptoid and cataleptoid states, with delusions of
an exalted character and a tendency to dramatism.”22
20 Textbook of Practical Medicine, Felix von Niemeyer, American trans., 1876, vol. ii.
p. 387.

21 Klinische Abhandlungen über psychische Krankheiten, 1 Heft, “Die Katatonie,”

Berlin, 1874.
 22 A Treatise on Insanity in its Medical Relations, by William A. Hammond, M.D., New
York, 1883, p. 576.

Kiernan23 has written a valuable memoir on this affection. He has

collected fifty cases, a few of which he gives in detail. Hammond and
Spitzka discuss the disorder, giving new cases, in their treatises on
insanity.
23 American Journal of Insanity, July, 1877, and Alienist and Neurologist, October,
1882.

Katatonia may begin in various ways, but it usually pursues a certain

cycle. First appears stuporous melancholia, accompanied or
followed by cataleptoid manifestations; then a period of mania with
illusions, hallucinations, and delusions. Melancholia reappears in
some form, with cataleptoid, waxy condition of the muscles, and a
disposition to talk in a pompous or dramatic manner; convulsions or
choreic movements may be present.24 Sometimes some phase of
the cycle is absent.
24 Hammond.

In some cases in which the peculiar cycle and special phenomena

which characterize katatonia are not present marked cataleptic or
cataleptoid states may be observed among the insane, either as
episodes or as long-continuing conditions.

As cases illustrating cataleptoid phenomena among the insane have

not yet been published in large number, and are not well understood,
I will record here, under the Symptomatology of Catalepsy, some
illustrative cases which have either fallen under my own observation
or have been supplied to me directly by medical friends.

M. A. Avery, assistant physician to the insane department of the

Philadelphia Hospital, has kindly furnished notes of the following
interesting case:
T——, aged twenty, single, dressmaker. The patient was somewhat
below medium height, slender and emaciated, of nervous
temperament, expression melancholy. The attack of insanity for
which she was admitted was her first. It began four months before
admission. No satisfactory history of the attack could be obtained;
she was said to have been depressed in spirits and to have
delusions of poisoning. She had attempted suicide by throwing
herself from the window.

Upon admission, Sept. 20, 1883, she was quiet and gentle in her
manner, but much depressed; she answered questions rationally. No
delusions were detected. Sept. 21st she sat quiet and motionless.
Her eyes were fixed, with marked double, inward squint. She was
apparently insensible to external impressions. This condition lasted
about three hours, when she suddenly sprang up, rushed through
the ward, and made vigorous efforts to escape. On the 22d she lay
in bed in a perfectly passive state, with eyes open and fixed, but the
squint had disappeared. There was a constant slight tremor of the
lids. The conjunctiva was apparently insensible to touch. She
seemed to be unconscious of what was going on around her. Her
arms remained raised in any position in which they were placed.
About three o'clock in the afternoon this condition passed away, and
from that time until she went to bed at eight o'clock she was bright
and cheerful and talked in a rational and intelligent manner. For five
days she was quiet and melancholy, with one spell of a few hours in
which she was in a passive and cataleptic state, as on the 22d.

On the 28th she stood erect with arms extended, whirling rapidly.
She continued this for about half an hour, and then, after a short rest,
began again. She paid no attention to what was said to her, and
seemed unconscious of what took place around her. The next day
she remained in a stupid condition most of the time, but occasionally
sprang up and danced violently or spun round rapidly with arms
extended for a few moments at a time. On the 30th her cataleptic
condition was uninterrupted. She lay motionless, with pulse slow and
feeble, extremities cold; her limbs were easily placed in any desired
position, and remained so for about twenty minutes; then they
returned slowly to a more natural and comfortable position. She
continued for several days in this condition, then aroused and ate
heartily. She seemed brighter and more cheerful, and talked
rationally. She said that she knew all that was said and done when
she seemed unconscious, and that she wanted to speak, but could
not. For several weeks cataleptic symptoms prevailed, with
occasional lucid intervals of a few hours. She eventually settled into
a childish, demented condition.

In the insane department of the Philadelphia Hospital was a middle-

aged man who remained for several years in a stuporous and
cataleptoid state. On several occasions he was before the class in
the clinic-room. He could not be made to speak, but remained
perfectly silent in any condition in which he was placed. His head
and trunk could be bowed forward, sideway, or backward; one foot
could be elevated while he stood; his arms could be placed in
grotesque positions. In whatever attitude he was placed he would
remain for a long time. The only history that could be obtained of this
man was that he had for several months been in a state of
melancholia, after which he was maniacal for three or four months.
He escaped from the hospital, and was brought back in the
stuporous and cataleptoid condition in which he continued. He had
been a masturbator.

A Dane, while on a voyage from Copenhagen, fell and broke his leg,
for which he was treated in a hospital. He recovered and became a
nurse in the institution. He fell in love with a female nurse, and was
to be married, but the lady suddenly fell dead. He became
melancholic, and three weeks afterward tried to hang himself. He
also had hystero-epileptic seizures, and was for a long time in a
condition of extreme stupor with cataleptoid phenomena, from which
he passed into a rather excited condition. He had no special
delusions, but there was a tendency to dramatism.

Another case came into the nervous wards of the Philadelphia

Hospital. No history could be obtained from the patient. Whether or
not he had previously suffered from melancholia could not be
learned. He would retain for a long time any position in which he was
placed. He also had hystero-cataleptic spells, and a peculiarity of
enunciation with a tendency to pose. When asked, “How are you to-
day?” he would reply, “I pre-sume-that-I-am-a-bout-the-same—that-
it-is-likely-that-some-thing-has-dis-ap-peared-in-the-mind.” When
asked, “How long have you been sick?” he would begin in the same
way: “I-pre-sume-that-I-will-have-to-say-that-at-a-time-re-mote-ly-dis-
tant;” and then he would branch off into something else.

Wilks25 speaks of a man whom he saw in the asylum at Morningside

who could be moulded into any position. While in bed on his back his
arms and legs could be arranged in any position, and there they
would remain. He also speaks of a case seen by Savage in Bethlem
—a young man who kept his arms stretched out for two hours, and
stood on one leg for a very long time or until he fell.
25 Lectures on Diseases of the Nervous System, delivered at Guy's Hospital.

William Barton Hopkins of Philadelphia has given me brief details of

a case observed by him at the Pennsylvania Hospital, which would
seem to have been either one of katatonia or one of cataleptoid
attacks occurring in an inebriate. The patient was an habitual
moderate drinker. For three weeks before he was admitted to the
hospital he had been drinking heavily. His family history showed a
tendency to insanity. He showed great mental anxiety; his face was
pale and had a very troubled aspect. He had no hallucinations. Two
days after admission a sudden outbreak of mania occurred, in which
he showed destructive and dangerous tendencies, and mechanical
restraint had to be employed. Under treatment he became quiet, and
was removed by his friends, having been altogether five days in the
hospital. On the day of his departure, while awaiting some of his
friends in the main hall, he suddenly ran up stairs, and was quickly
followed by a nurse, who found him raising a window with the
apparent intention of jumping out. His face at this time had lost its
troubled look, and had rather a pleased but vacant appearance.
While in this condition his limbs were placed in various positions, and
there remained. On another occasion, while lying on the bed, his
limbs and trunk were placed in various grotesque positions, and
there remained. The condition of waxen flexibility was well marked;
many tests were made.

To Wharton Sinkler I am indebted for the unpublished notes of the

case of a woman twenty-seven years of age, who had no family
history of insanity, but whose father was a highly nervous man. She
had always had good health, and was of good physique. Seven
years ago she had an attack of melancholia lasting four or five
months; since then she had no trouble until six months since. At this
time she began to be low-spirited. Then delusions came on—that
she was unworthy to live; that it was wicked for her to eat, because
no one else had food; that those about her were in ill-health. She
refused to eat, and would not talk, and slept badly. When first seen
by Sinkler she was stout and with apparently good nutrition, but was
said to have lost flesh. Her face was expressionless, and she was
unwilling to converse, but said she was quite well, and that her
stepmother was ill and needed treatment. She was undecided in all
her movements, and would stand in one spot until led to a chair,
where she would remain if seated.

The patient was placed under the care of two nurses, and for a week
improved daily—ate food, conversed, read aloud, and sewed. At the
end of this time she was left with one nurse, but became obstinate
about eating, and had an altercation with the nurse, in which she
became violent. After this she gradually got into a cataleptoid state.
At first she would stand for a long time in one place, and if seated in
a chair would remain in any position in which she was placed. She
began to have attacks in which she would lie on the floor motionless
for hours. A sharp faradic current was applied to the forearms on one
occasion, and she soon became relaxed. In the attacks the eyes
were closed or rolled upward and fixed on the ceiling. The muscles
were rigid. The arms and legs could be placed in any attitude, and
would there remain. There was no analgesia: she had decided
objection to pin-pricks. For two or three days she was readily
aroused from the cataleptic state by electricity, but it lost its effect,
and etherization was resorted to. The first time a few whiffs of ether