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Books. Change. Lives.

Copyright © 2020 by Katie Golding
Cover and internal design © 2020 by Sourcebooks
Cover art by Craig White
Sourcebooks 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
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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.
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Published by Sourcebooks Casablanca, an imprint of Sourcebooks
P.O. Box 4410, Naperville, Illinois 60567-4410
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 Contents

Front Cover

Title Page

Copyright

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11
Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Epilogue

Acknowledgments

About the Author

Back Cover
 For my father,
who always said I could be anything and never added “except that.”
I may be your princess, but you’ll always be my hero.
 Chapter 1

Billy King—Present Day

Turns out the world’s a lot bigger than Memphis.

“Billy! Billy King!” My name is like cracks of thunder on the Spanish
wind, and as I cruise past the press corps, I can’t quite feel the relief
yet that this is it. It’s over. Flashes from the cameras are too busy
sparkling through my helmet’s face shield, shining off my motorcycle
and nearly blinding me, there are so many of them. Valencia is
already a massive festival, since it’s the last race of the Moto Grand
Prix circuit. But in all my years racing, I’ve never seen the press and
the fans this excited before.
I pull off victory lane and stop in the designated winner’s spot,
already decorated with royal blue Yaalon Moto everything. The fans
are barely held back by the chest-high gate rocking under their
hands and their repeated chants of my name. “Billy! Billy King!”
“All right, y’all, just wait your turn,” I call out to the crowd. My
laugh rings with the pure, sweet adrenaline pumping thick through
my veins, a testament to battling twenty guys on the racetrack for
who’d come out on top. And then beating them all, one by one.
Life doesn’t get much sweeter than this. Especially since tomorrow,
I can finally go home.
 Back to Memphis: the ranch and my saddle, my horse, and my
ropes.
Home to Taryn: her whiskey hair and sapphire eyes.
I pull off my helmet, and after a quick wave to the fans, I start to
find my breath again. I don’t get to keep it long.
My manager’s unmistakable twang cuts cleanly through the roar of
the press corps. “I knew you could make it back, Billy!”
Frank yanks me off my bike and into a suffocating hug, slapping
my back so hard I actually feel it through the armadillo spine of my
leathers. At least he doesn’t notice my wince from the pain in an
ankle that’s supposed to be long healed by now.
Telling him I’m hurt will only risk my future even more after what I
did. Not that anyone seems to care about the reason why I did it.
Frank’s too excited to pay attention to my stumble, setting my
sponsor-coated Stetson on top of my head, then gripping my
shoulders. “Not just first place, Billy! First in the world. Didn’t I
always say about putting bull riders—”
“Did Taryn call? She see it?” I wave toward the press and the fans
again, beaming next to my blue motorcycle. They don’t need to
know there’s sweat pooling in my leathers, and my feet desperately
miss the buttery soles of my Ariat boots.
Mostly, though, I just miss her.
Frank clears his throat as I tip my cowboy hat toward the cameras,
making sure they capture the names of all the people I’m paid to
promote. “She hasn’t called yet,” he mumbles.
My pulse starts racing for a whole bunch of reasons I still can’t
make myself face, and I turn away from the Moto Grand Prix fans,
praying no one caught the look I just felt flash across my face. My
only hope is to keep clinging to Plan A: act like it didn’t happen, and
maybe it didn’t.
 “But she will,” Frank adds in a rush. “You know Taryn. She’s
probably just—”
“Busy.” I shift my helmet to my other hand, wiping sweat off my
face. “Busy being mad at me.”
Suppose she’s right. I never was nothing special.
“Horseshit,” Frank says. “That woman loves you. And need I
remind you, you just won first place at Valencia, Billy. Twenty-five
points, and that makes you a damned MotoPro Grand Prix World
Champion. Now be happy, would ya? ’Cause you’re starting to piss
me off.” He gives me a half grin and takes my helmet from me,
slinging an arm around my shoulders. It does nothing to comfort the
guilt swirling in my stomach. “Come on, cowboy. You about ready to
show ’em what a champion looks like?” He nods toward the wall of
reporters waiting to ask me the same questions they always ask.
“How did it feel to win today?”
“Were you riding for anyone special back home?”
“Is it hard being an American in a European sport?”
I clear my throat and tip up my hat so their lights won’t cast
shadows down my too-long nose. “Yeah. I’m ready.”
Frank claps my back and heads off to organize the interview
lineup, and I glance toward the press spot for third place, my
twenty-five-year-old little brother already hamming it up for the
cameras, probably giving sound clips about his smell-proof
underwear again.
Frank is right. No matter what’s been happening at home, I won
here, and I should be celebrating. My knee surgery from two years
ago has finally stopped causing me problems, and I’ve worked my
ass off to get back to the top of the leaderboard. And like my father
always says: I should try to be more like Mason.
 He never lets love get in the way, and he’s as good on a bike as he
is at riding bulls. Everyone says so. It’s probably why he’s allowed to
keep his hands in both cookie jars, and mine have been firmly tied.
No more wondering if that bull’s gonna spin or blow when that
gate opens. No more wondering if eight seconds are gonna be my
last. Now, it’s two red lights keeping me caged and my wrist on the
throttle setting me free.
Mason finishes his interview, immediately turning to sign a lady’s
chest with a marker as red as her cheeks. Until someone walking by
bumps his shoulder hard enough that he stumbles, nearly knocking
her over.
“Hey!” Protective instincts blaze through me, and I’m three steps
closer than I was a moment ago, my outstretched hand already
steadying Mason by the shoulder. My eyes home in on the back of
Santos Saucedo from Hotaru Racing, strutting away with a chuckle.
Mason looks at me, and neither of us has to glance at the
surrounding press to know they saw that shit go down. And I’m not
about to let our family name get tarnished.
“What was that, friend?” I call out to Santos, cupping my ear. “We
didn’t catch whatcha said.”
Santos turns and rattles off something in Spanish that makes the
press collectively gasp. The nerve of that guy.
“Oh, I’m sorry, man,” I drawl, acting all guilty. Mason crosses his
arms. He’s three inches and a good fifteen pounds littler than me but
with twice the ego and ten times the temper. “We don’t speak fifth
place.” I flash a grin that is sure to ramp Santos’s annoyance through
the damn stratosphere, but he can kiss my ass. Nobody messes with
my brother but me.
A thick hand settles heavy on my far shoulder. “Thanks, y’all,”
Frank says behind us toward the press, “but we gotta get Billy and
Mason upstairs to get their medals. The Kings’ll have more time to
answer questions later, I promise.”
I salute a scowling Santos, letting our manager sweep us out of
the parc fermé and toward the stairs to the podium. The last thing I
need is for Mason to back me into another damn corner. Thanks to
him, racing’s about all I have left.
A familiar throb that has nothing to do with leaning my bike
through pin-tight turns twists through my insides, my ankle hurting
more with every step as I climb the last of the stairs. And three feet
from the door that gives me back to the crowd I’ve spent years
trying to convince to love me, I find myself desperately wishing
they’d just mail me the medal they want to hang around my neck.
“Showtime, boys.” Frank opens the door to a blast of sound that’s
my name on repeat, and since I don’t get a choice, I’m first outside
onto the podium.
The sun is in the wrong spot and the wind doesn’t smell right, but
I wave and smile a little harder at the cameras taking my picture.
Even though the one person who matters probably won’t ever see
them.
She still isn’t answering my calls.
No matter what I do, she hasn’t forgiven me, and it’s why I need
to get my sorry ass back to Memphis. Running home’s the only way
I’m ever gonna get her back.

***

I’m already sweating in my best pearl-snap shirt despite the cool

November air, hinting at the icy December we’re gonna have. I pluck
once more at my starched collar, pointing my battered old boots
toward the barn, trying to gain some kind of confidence from being
in Memphis, even if my body still thinks I’m in Spain.
 My ears haven’t stopped ringing from the end-of-season awards
ceremony, my tux a wrinkled mess since I went straight from the
televised stage to the Valencia airport. But I’m back under the same
Osage orange trees I grew up climbing while my horse munched on
the bumpy hedge apples. And when I head inside, the chatter from
farmhands is gonna be in English and not the liquid Italian of my pit
crew.
None of it’s making me feel better when I’m about to see her, and
I know damn well all she’s gonna do is yell at me, and all I want to
do is kiss her and get back to how we used to be. I’ve only been
gone a week this last time. But it was a week too long after the way
she sent me off.
I touch my hat in Hargrove tradition as I cross under the
homemade “Bless Your Boots” sign hanging above the barn
entrance, instantly welcomed by a chorus of sniffs and snorts from
the horse stalls I pass. It eases something in my chest that’s been
wrong since I last left home for the circuit.
Since I could kind of use it, I go ahead and stop by Gidget’s stall,
hooking my arms over the latched gate. “Hey, buddy.” He stops
fluffing his bed of straw, his ears already turned my direction before
he lifts his head and stares me dead in the eye. A broad grin
stretches across my face when he huffs and starts walking over, his
pace extra slow and stompy, clearly irritated with how long I’ve been
gone. At least he’s willing to forgive me for it. “I know, bud. I missed
you, too.”
I reach out and stroke the side of his neck, wishing everything was
as simple as blazing-fast blue motorcycles and golden horses who
only ask that you bring treats before you ride. But like everything
else I wasn’t supposed to fall in love with, Gidget isn’t really mine.
He’s Lorelai Hargrove’s, the future heiress to the Hargrove Horse
Ranch.
No one except a rancher’s daughter could afford an Akhal-Teke of
their own. But no one really cares that I ride Gidget all the time,
either. Lorelai is usually too busy training for our next race. She’s
Frank’s original rodeo-racing experiment, and she’s fast, feisty, and
stubborn. Once the sponsors let her move up from MotoA and into
MotoPro with me and Mason, we’re all gonna be screwed.
“No, I didn’t bring any apples,” I tell Gidget when he starts nipping
at my shirt and sniffing toward my jeans. “I’ll bring you some later,
though. Promise.”
“Hey, Gidget. I didn’t know your cowboy was back.” James smiles
on his way behind me, leading a silky chestnut mare out the other
entrance to the barn. “Glad to have you home, Billy.”
I return his smile on instinct, tipping my hat in the direction of his
silver mustache. “Thank you, sir. Good to be back.”
“Girls are working Bopper, if you’re wondering. Though you might
wanna take a bodyguard with you,” he adds with a rumbly chuckle.
“They’re out for blood, those two.”
I chew on my tongue, knowing better than to bite the hand that
feeds my horse. James is married to Lynn, who owns Hargrove
Ranch. And I’ve spent the last year very unsuccessfully trying to
convince Lynn to sell me Gidget. She won’t budge, though. Because
I don’t have the land to keep him on. “Yes, sir.”
James is still happily making his way out of the barn and looking
like he’s whispering to the mare about me. I doubt it has anything to
do with my record-breaking win, because whatever it is he says to
the horse, he cracks himself up.
I make a face at Gidget, who’s still sniffing for food in my shirt
pocket before I press a kiss to his nose. “Well, buddy, wish me luck.”
 Gidget snorts because we both know I’m fresh out of it. Any last
bit of luck I had, I just used up in Valencia salvaging my career. But
taking a risk has never stopped me before. Hell, the first time I rode
a bull, I was convinced I was gonna die.
One second was all I got. It was enough, though. I woke up on a
stretcher begging my father to let me have another go despite my
mama’s tears still running down her cheeks. That next time, I lasted
for three seconds before Nova Bomb spun and sent me flying,
cracking two ribs and fracturing my collarbone.
I’m always better on my second attempt—always. Still, Taryn says
that’s the worst thing about bull riders: we don’t expect to stay on.
It’s just a game of how long we can last until the bull beats us, and
it always beats us. But no bull bucking me ever hurt as much as
when Taryn did it.
It’s a long walk toward the training pen, set far enough in the
pasture that the colts don’t get distracted by the noise of the barn
and the commands of the trainers. But with the wide-open sky and
no trees between us, Taryn sees me coming every step of the way.
I know it, though she pretends she doesn’t—she refuses to look
my direction. But she’s sitting a little stiffer in the saddle, the
clenched muscles in her long legs stretching her jeans, and accusing
me of the crimes she screamed at me from across her kitchen table.
I cast them out of my mind. I don’t want to be mad, and seeing
her sit a horse like that has always sent a freight train barreling
straight into my chest. It’s almost as good as when she wakes up
slowly next to me, her silky spine long and bare as she reaches for
the coffee I’ve already made and set on her nightstand. When I’m
lucky enough to be home.
“Afternoon, ladies,” I drawl to Taryn and Lorelai, taking the last few
feet up to the fence of the training pen. My heart’s beating straight
out of my chest, a fresh brew of sweat tickling my hairline, and I
can’t stop thinking I should’ve shaved. But I couldn’t get my truck
here fast enough.
Lorelai tosses her wildly curly brown hair. “Taryn, I’m heading to
the house. Call me later.” She throws me a murderous look before
leaving the way I came.
Taryn still hasn’t said anything, except small corrections to the colt
she’s working. Round and round she goes, her hands light on the
reins and the sun on her hat but not on her face. Pride laps at my
heart from the dirt smeared on her shirt and mud caked up her
jeans, everything about her more beautiful than I remember, and so
damn hard. A woman who works, every day of her life. A woman
who rides.
I can’t keep the adoration out of my voice. “Hi, honey.”
She gives two clicks to her colt and turns him the other way,
bumping his trot to a canter and testing his different gears. It prods
my smile even more, because she knows them all—on a horse, on a
motorcycle. She’s even taught me a few tricks that have helped me
keep an edge on the racetrack, because she doesn’t only train colts.
She also races Superbike eight months a year, and then she comes
home to Memphis and barrel races in rodeos.
I never stood a chance over whether I was gonna fall in love with
her. It was always just a matter of how long she was gonna let me
hang around.
“I brought you something.” I pull my medal out of my back pocket
and hang it on the fence post. If anyone knows what it takes to earn
this, it’s Taryn. And she should have this, more than me. “Hope you
like it.”
On her next pass, she reaches out and knocks my medal off the
post, letting it fall in the dirt. “Fuck off, Billy.”
 Frustration simmers in my chest, and I keep watching her,
remembering how sweet she was before I ruined it. When once
upon a time, she loved me back.
At least she cussed at me.
She never yells at her horse when Aston Magic starts being moody,
and she lives her life by the motto “Kill ’em with kindness.” I’ve seen
her bite her tongue so many times, she shouldn’t have one left. But
none of that restraint ever seems to apply to me, and the moment I
get downgraded to the sweet-pea public persona, I’m calling in the
big guns.
Two more circles, and her colt’s hooves have firmly buried my
medal beyond sight.
Stick to Plan A, I tell myself. Act like it didn’t happen, and maybe it
didn’t.
“He’s looking good,” I muse mostly to myself. “He from Buddy
Holly’s line?”
“Goddamn it,” she mutters, pulling her horse to a stop and
dismounting. “You just can’t leave me alone, can you?”
I risk a smile; it’s been a hell of a long time since I’ve had the
pleasure of her riding my ass about something, and I missed it more
than she’ll ever know. “No, ma’am. Apparently not.”
She feeds her colt a treat before leading him toward the gate. I
hurry to open it for her and wait while she leads him through, my
eyes stealing a quick peek at her curves in her jeans and her long
blond braid swishing from under her cowgirl hat. Damn, I missed
her.
I remember to latch the gate once I get my blood flowing back
above my belt line, turning to find her already walking away. “Aw,
come on, Taryn. I know you’re mad, but—”
this lady. You can wait.” He turned to me, calm as anything. “Sorry.
He may look like a horse, but he’s really a heifer when he’s hungry.”
Aston shifted beneath me like she wasn’t impressed, though I was
having a harder time than ever keeping a straight face. “It’s all
right.”
But it apparently wasn’t, because Gidget’s nose was right back in
Billy’s face, blowing raspberries. I couldn’t help it anymore, clasping
my hand over my mouth.
Billy took a deep breath, holding up a single finger. “If you’ll excuse
us.”
I nodded, pulling my hand away and chewing the hell out of the
inside of my cheek to keep from laughing. Which was so weird:
cocky guys in my experience were typically grabby and pushy but
hardly ever funny. At least, not as funny as they thought they were.
“By all means.”
He took Gidget’s lead and walked them a few feet away. He kept
his head close to his horse’s, talking and gesturing and looking like
he was cutting a deal to get him to behave. It ended with Billy
pulling a treat from his back pocket and pressing a kiss to Gidget’s
nose while he ate it. Aww.
Aston huffed and shifted again as Billy led Gidget toward us, my
quarter horse clearly over the advances of the Akhal-Teke and ready
to be pampered after working her ass off in the arena. And as much
as Billy was…intriguing, to say the least, Aston Magic came first.
“Sorry about that.” Billy made a supposed-to-be-stern face at his
horse. “Gonna have a long talk about our manners when we get
home.”
Oh, damn it, that was cute.
“It’s fine.” I kept my spine straight and chin high, voice kind but
firm. “But I can’t stay, so you may as well get to telling me what
Another random document with
no related content on Scribd:
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