Part 22 (1/2)

Subsequently to his retirement from active business pursuits, the patient, a man fifty-nine years old, became depressed, morose, and irritable, till insomnia at length drove him in desperation to attempt suicide. By the merest chance he failed of his purpose. The development of involuntary sounds a few weeks later was followed at the end of a month by the equally involuntary e.j.a.c.u.l.a.t.i.o.n of his wife's and children's names--”Numa! Helen! Camille! Maria!” This habit persisted for as long as fourteen months, after which during three years he enjoyed excellent health. Owing to financial worries, however, a relapse occurred. Every few minutes he uttered various articulate cries in a loud, clear, and well-modulated voice, sometimes repeating the four names with great rapidity, at others calling out the same name with increasing violence. Severe convulsive twitches of arm and trunk musculature synchronised with his exclamations. The patient was incapable of either restraining or even modifying the cries; he was equally unable to replace one by another, to say Henry instead of Numa, or Jean instead of Helen.

For hours at a stretch he would repeat the names of friends who had come to visit him; on the day before a consultation on his case his one cry was the name of the new physician who was going to examine him.

A gradual improvement took place, and eighteen months after the onset of the condition the cure was complete.

In the same connection Pitres refers to a case reported by Calvert Holland.

A miner who had gone through the experience of incipient suffocation found himself two months later irresistibly impelled to exuberant speech. The rapidity and indistinctness of his enunciation of words were very much in evidence, as well as a tendency to stammering and to tautology. A further symptom consisted in rotatory spasms of the head; but after five months a satisfactory cure resulted.

We may cite a last instance from Ball:

A young girl was in the habit of kneeling down, making the sign of the cross, and repeating ”Jesus, Mary, Joseph.” The performance was limited to this order of events, but its practice in drawing-rooms and still more in thoroughfares led to her being certified as insane.

ECHOLALIA

In his description of the disease which bears his name, Gilles de la Tourette used the expression echolalia to denote a certain phenomenon of occasional occurrence among those who tic.

The patient (says Guinon) repeats echo-like the sounds he hears around him, and like the echo his reproduction of them is more or less lengthy. In its mildest form the symptom may consist in the repet.i.tion of a simple involuntary ”ah!” which some one near by has e.j.a.c.u.l.a.t.ed, or the last word or two of some one's talk is mimicked, or in a more advanced stage the whole of a phrase is reproduced.

As a general rule the ”echo” is rather obtrusive, but its commencement at least may be very different, the patient being astonished to find himself repeating in a subdued tone of voice what he hears others saying; and, struggling in fear to rid himself of the habit, he ends by sinking into a state of actual anguish. It is at this moment that he fails to inhibit his impulses and gives vent to the word he has been endeavouring to check, which he may repeat loudly and violently in a sort of fury. The fidelity and clearness with which the utterances of others are imitated are remarkable.

Sometimes by an effort of the will the patient is able to suppress, it may be imperfectly, the impulse to echo, so that while his tongue is under his control, his will gives rein to his other tics, and a regular muscular debauch takes place. In the mildest cases he can replace a word by a movement, by a little cough or an insignificant ”ahem!” but not beyond a certain point, for he will thus restrain himself only when he is forewarned; a sudden and unexpected e.j.a.c.u.l.a.t.i.o.n in his neighbourhood will catch him off his guard.

In spite of their frequency among those who are addicted to tic, echolalia and echokinesis cannot be enumerated with the tics, seeing that their exhibition is dependent on the actions of others, whereas once a tic is established it requires no stimulus from without for its manifestation. Of course their affinity to the tics is very close: they spring from the same soil; they represent in the adult the persistence and amplification of the child's propensity for imitation, and therefore in their own way postulate a degree of mental infantilism.

Echolalia in the blind has been made the subject of an interesting study by Noir.

The echolalic repeats abruptly and rapidly what is said by others in his presence. That he does not stop to reflect is attested by his mimicry of bizarre words, technical terms, even of idioms in a foreign language.

It is an interesting fact that of twelve cases of echolalia that have come under our observation, fifty per cent. occurred among the blind. The coincidence is a rational one; blindness and echolalia are united as cause and effect. In the case of the person born blind the auditory memory is in such an advanced state of development that, if he be not very intelligent, he will seek to fix the sound of an auditory impression in his defectively organised mind as soon as he hears it, and being unable to whisper it mentally, he stimulates his auditory centres by a less delicate process, and forthwith repeats aloud the word he has just heard.

This is why we meet with instances of the echolalic blind repeating a sentence before replying to it. It is instructive to note in this connection that the choicest example of echokinesis we have seen was in a deaf mute, in whom no doubt the visual phenomena were a.n.a.logous to the auditory phenomena of the echolalic.

Noir is inclined to apply this mechanism to the case of echolalics who are not actually blind. He quotes instances which go to show that their visual memory is awanting, that as far as it is concerned they are ”blind.”

The hypothesis is attractive. It may be further remarked that the echolalia is a ”motor,” in the same way as the patient afflicted with hallucinations of sight or hearing is an ”auditory” or a ”visual.”

Echolalia is amenable to treatment, and is even capable of cure. Noir gives an interesting example of the evolution of the process.

If I say to an echolalic, ”Are you hungry?” he will instantly answer, ”Are you hungry?” Under the influence of re-education the reply will eventually change to ”Are you hungry? are you ...? Yes, sir, I'm hungry,” then to ”Yes, sir, I'm hungry,” and finally to ”Yes, sir.”

Echolalia, however, is not an exclusive appurtenance of those who tic.

We can remember a case of general paralysis in the clinique of Brissaud at the Hotel Dieu, who had the regular habit of repeating the question that was addressed to him; if it were a little long, only the last ten or fifteen words were echoed. A case is quoted by Cantilena of a woman with right hemiplegia and partial epilepsy who invariably reiterated the closing phrase of anything said to her. Several cerebral tumours were discovered at the autopsy.

It is conceivable of course that an actual lesion, as well as a congenital developmental defect, may interfere with the will's inhibitory powers, in which case auditory or visual stimuli are transmitted to motor centres unmodified, the result being the production of sounds or of other movements.

COPROLALIA