226 Dr. Sonden on an Epidemic Religiofis Ecstasy. If these means fail, and they well if the tumour be large, it will be necessary to make an opening into it. For this purpose Moscati and Paletta passed a seton through the turnout to pro- voke suppuration, on the supposition that the bone was diseased. G61is of Vienna establishes a slight issue on the top by means of caustic potash, in hopes of promoting absorption; and he cites thirty-two cases of cure by this means, in from eighteen to fourteen days; but Zeller throws great doubt upon some of these ; Krukenberg and Schmitt, however, adopt GSlis's plan. LSwenhardt recommends puncture with a trocar, and strapping. By far the simplest mode, however, is to make an incision with a bistoury, sufficiently ample, according to the size of the tu- rnout, and by most writers this plan is preferred. The wmmd may be dressed with charpie, according to Chelius, or with spermaceti cerate; or, when the blood is evacuated, a strap of plaster may be passed across it. The simpler the dressing the better. I may remark, in conclusion, that we should take care not to make tile incision near any of the principal arteries of the scalp.

ART. IX.--Memoir on an Epidemic Religious Ecstasy which prevailed in Sweden in 1841 and 1842. By Dr. C. V. SONDEN, Physician to the Lunatic Hospital at Stockholm. Translated from the Gazette Medicale. THE singular malady which manifested itself at the end of the year 1841, and which, especially at the beginning of 1842, spread itself among the inhabitants of the country of the central part of the kingdom, assuredly deserves to be transmitted to posterity, considering that it was not an accidental and isolated phenomenon, but provoked by an assemblage of many causes, known or unknown, and acting slowly and simultaneously; it ought to be considered as one of the partial eruptions of the Dr. Sonden on an Epidemic Religious Ecstasy. 227 epidemic, which, under the name of St. John's dance, Chorea St. Viti, made such terrible ravages during the middle ages. A complete history, however, of the aforesaid malady, must not be expected, since it is not yet over, nor even a detailed descrip- tion of all its peculiarities, considering that I was not myself an eye-witness, and that I have had no other source of infor- mation than the official reports ; but I dare hope, that the sketch which I am going to present, will not be in any essential point, either erroneous or incomplete. " It seems well to de- serve the trouble," says the celebrated Hecker, in the preface to his historical work on the malady in question, " to describe diseases which propagate themselves on the rays of light, on the wings of thought, and which move the soul by the irritation of the senses, and spread themselves miraculously in the nerves, those paths through which penetrate the will and sentiments of man." Ishould have wished to have extracted from his remarkable work the most essential part of the history of this disease during the middle ages, quote the frightful descriptions which it con- tains of the dancers of St. Gui and of St. John, in Holland and the Rhenish Provinces, in 1374, the analogous horrors of the " Tarentisme" in Italy, the " Tigretier" among the Abyssi- nians, the similar malady become indigenous in the Shetland Isles ; as also like phenomena in like periods, such as tile ex- cesses of the " Convulsionnaires" in France, of the English and American religious fanatics ; but to avoid too great prolixity, I feel myself forced to refer the reader to this work% as to a pro- found history, and an interesting reading, supposing the reader yet unacquainted with it ; I pass at once then to tile description of the malady. In general this form of singular and epidemic malady, was distinguished by two prominent and remarkable symptoms; one physical, and consisting in a spasmodic attack of involuntary contractions, of contortions, &c. ; the other men- tal, consisting of an ecstasy more or less involuntary, during

~' Die Tanzwuth, Eine Volks.Krankheit Im Mittetalter; Berlin, 1832. 228 Dr. Sonden on an Epidemic Religious Ecstasy.

which the patient believed he heard or saw divine, superna- tural things, and felt forced to speak about them, or, as the people said, to preach; occasionally, one or other of these symptoms varied a little in particular cases. The variations were, however, so insignificant, that one always understood that the symptoms were, at the bottom, the same. The spasm consisted essentially in convulsive starts, contortions, hideous or ridiculous, disfiguring the muscles of the face, of tlle body, especially of the extremities, oftenest of the shoulders, sometimes bounds and leaps, often so impetuous that the pa- tient could not keep himself seated on a chair, nor remain in his bed. But the disease was not observed to be accompanied by any mania to dance, nor any semi-paralytic symptoms such as we observe in ordinary chorae. Every thing which affected the mind or the fancy of the patient in a disagreeable manner singularly provoked or augmented these contortions. A single word that the patient regarded as impious, even when it had been pronounced in an innocent manner, and only en passant, instantly occasioned these contortions. Besides this, they occurred at irregular intervals, generally when astonished strangers found themselves present, without that not so often, rarely when the patient was alone, and scarcely ever at night. I do not know that any patient complained of having felt pain, except a woman who was attacked with this disease the first, a case the details of which are perfectly well known. Some experienced certainly a little indisposition during the precursor signs; but the greater part did not feel any illness during the access, they appeared to be~ on the contrary, as well as they ever were. The people looked on the spasm as an in- fallible sign of the presence of the Holy Ghost in the body of the sick man, and as a proof of the deformity of the sin. The mental symptom was characterized by a more or less complete alteration of the habituat use of the senses, with which the patient was attacked suddenly in the state of wakefulness, by tile want of a clear idea of his existence and of his personal free- Dr. Sonden on an Epidemic Religious Ecstasy. 229

will so that the natural chain of the fimctions of the mind is in- terrupted, whilst the activity of the imagination is exalted to an extraordinary degree, or at least is exercised exclusively, which causes tile patient to believe that he lives in another sphere than that which surrounds him. This activity is manifested by an irresistible loquacity, and by a constant mania of' wishing to preach the word of God, by visions and by prophecies. This access also followed at irregular intervals, and was most frequently preceded, accompanied, and succeeded, by symptoms of spasm. Most physicians who have witnessed these paroxysms have likened them to somnambulism, or magnetic sleep, without any of them being able to declare positively that the aforesaid paroxysms belonged to that state. The discourses or sermons always turned upon religious topics, as the popular denomina- tion of "preaching disease" shows, they were exhortations to sinners to be converted, condemnations levelled against every kind of immorality, drunkenness, oaths, &c. ; but the rage of the preachers was oftener directed against perfectly innocent pleasures, such as dancing, simple games, or against objects of dress, as brilliant combs, buttons, ear-rings, red cloth, and other trifles; the sick often spoke of visions which they had had of heaven, hell, angels, &c. ; they also predicted the end of the world and tile last judgment, or the day of their own death, always with the pretence of making their predictions pass for holy prophecies, which, however, had all the common defect of not being fulfilled ; and generally, every thing they said in this state of ecstacy, they gave as immediate inspirations of the Holy Ghost. However complicated the exposition we have just given may appear, it is incontestable, and constituted a single disease, whether called ecstacy, vision, magnetic state, or whatever you will. During the paroxysms, the eyes of the patient shone with extraordinary lustre with frequent side glances. The most extraordinary gesticulations accompanied the declamation; the imagination was not, however~ always exalted ; every time it VOL. XXIV. NO. 71. 2 n 230 Dr. Sonden on an Epidemic Religious Ecstasy. was so the delivery was of an original kind, whatever the ser- mon was, or it more generally happened, that it was full of maledictions and menaces of hell. Otherwise, the natural functions of the patients were discharged with normal regu- larity, as the appetite, the evacuations, sleep, &c. But the ac- cesses left after them much weakness and exhaustion. In the generality of cases, it was not possible to state the distinct pe- riods, for the paroxysm more generally manifested itself sud- denly and nearly in all its intensity, as if by enchantment. Preludes, however, sometimes shewed themselves of lorrger or shorter duration, which consisted in a strong sensation of in- quietude or of repentance, an oppression or slight pain in the head and the limbs, difficult respiration, loss of appetite, suffer- ingand burning feel in the chest, and a disposition to fainting or slight swoons, general uneasiness, a commencing incapacity of voluntary motion of the head, the arms, and legs, a capri- cious temper, &c. The face alternately reddened and grew pale, the expression of the eyes changed and became gene- rally more lively. The eruption of the disease manifested itself by spasms and the mental ecstasy above mentioned, with an irresistible inclination to preach ; during these accesses, the patient declared that he was quite well, even better than ever. Several degrees of intensity of the paroxysms have been ob- served. I think two sufficiently distinct, one moderate and file other stronger. They resemble each other, however, in essen- tial points~ that is to say, that in both cases the patient felt the same spasms, the same irresistible inclination to preaching, the same belief in the immediate influence of a supreme power. The more severe state was that in which the patients found themselves after an attack of convulsions, when they suddenly fell down senseless, or, according to an eye-witness, almost as if they had the failing sickness, and remained for a longer or shorter time in a state of exhaustion, or deprived of sense ; during the attack, they were sometimes perfectly tranquil, Dr. Sonden on an Epidemic Religious Ecstasy. 231 and as if in a profound sleep; sometimes they had continued contortions, struck their hands, sighed, smiled, and so forth ; then they regained tile use of their senses, as if they awoke from a dream, and related that they had had supernatural visions and uttered prophecies. So far the discourses of the ecstatic preachers always bore on tile same subject, to wit-- religious topics, visions, and prophecies,--they saw the place of punishment of the condemned, and the repast of the elect at the table of God, they predicted the end of the world, and so forth,--one sees that this state is essentially the same as the lesser degree of the disease. On the other hand it would be wrong to regard mental diseases of other kinds, as mania, melancholy, and madness, into which these patients sometimes fell, as higher degrees of" tile same malady. This, there- fore, had degenerated from its true origin, and had become another disease of the mind, of a particular character, generally chronic. It was believed possible to recognize two distinct forms of this epidemic, viz., a physical and mental chorea. Without wishing in any way to contest the justice of this ob- servation, inasmuch as there have been cases where the spas- modic symptoms have manifested themselves to a predomi- nating or exclusive degree; and others, where the mental symptom has declared itself alone, or has had tile preponder- ance, it appears more reasonable, and more conformable to experience, to consider these different symptoms as variations of the same morbid state (since they depend on the same epi- demic influence), as diseases specifically, or even generically different. The disease commonly attacked young people from 16 to 30 years old; often also children from 6 to 16 years. The greater number were women, but men also were attacked, al- though they rarely succeeded in attractir~g attention as preachers, which is as much as to say, that they were less exalted, or less foolish. The greater number of the sick appertained to the poorer class of people ; however, it was not without example to 232 Dr. Sonden on an Epidemic Religious Ecstasy. find eases of the disease among persons of the educated classes. Among some the spasmodic symptoms prevailed, in others the mental symptoms had the preponderance; some completely wanted one of these symptoms. In moderate cases, the patients had the strength to resist the attack and to repress it, their will being yet sufficiently strong for that, and the accesses then reappeared quicker; in cases, on the other hand, where the disease had a more developed form, the will was weak or governed by the pretended spirit, and where the symptoms were visibly aggravated by repressive measures, they continued weeks or months entire. All caught the disease by what may be called a mental contagion, that is to say, in hearing or look- ing at some woman attacked with the disease of preaching; (some even pretended that it was only necessary to hear a similar scene of preaching spoken of, to be attacked with the same ma- lady, which some physicians, ocular witnesses, loudly declared that they doubt ;) but it has not been shown, that the disease had broke forth otherwise in the whole number of patients, with the exception of the first who was attacked with it, and of whom it may be said, not without reason,that she had got it in consequence of over-reading religious books. During a long state of lan- guor which had kept her in bed many weeks, she had done nothing else but read the Bible, the Psalter, and other reli- gious books, till at length the disease declared itself. During a year that this mental epidemic reigned, several thousand persons were attacked by it, and, it may be presumed, that many others will be so again. Now that the disease still con- tinues to be propagated, although less strongly, and visibly diminishing in intensity, it is yet too soon to try to work out the history of its development~ or even make statistical tables of the number of sick; and I am afraid it will al- ways be impossible to furnish the exact number ; for, as well as l know, there do not exist on this head official reports by which one may be guided. The reports sent to the Royal College of Medicine, and which they were kind enough to Dr. Sonden on an Epidemic Religious Ecstasy. 233 communicate to me, only exhibited 300 cases, which scarcely amounts to the sixteenth or twentieth part of their total number. It is generally acknowledged, and has been often stated, that interested views, the desire of making a noise, and of passing tbra saint, have in this instancc, as well as in similar cases, caused impostors to spring up, who simulated or feigned the disease. The intelligent reader will easily comprehend, even if the re- mark were not made, that the contents of the sermons gave no support to their pretensions to a divine origin ; but that they were, on the contrary, foolish, meagre in ideas, often filled with pure nonsense, yet oftener with exclamations repeated to satiety, and constant recapitulation of the same absurdities, delivered with a sententious tone. It was only the most ignorant and superstitious of the people who allowed themselves to be led by a stupid admiration which the slightest efforts of reason, the first appeal to true religious feelings, must have dissipated. However, the concourse of hearers of the rank of peasants was so great, the blind exalta- tion and fanaticism among those who ought to have been re- garded as reasonable, had increased so much, especially at the beginning, that the crowd was seen passing in thousands to the cabin of the individual who was preaching, and it was not with- out example, that ecclesiastics, officers of justice, and physicians, have been driven away by the fanatics with blows of cudgels and stones, so that with reason,violent proceedings capable of compro- mising public safety and order were apprehended,. It was only after the united efforts and active vigilance of an enlightened clergy, of the government of the province, and of the physicians, that they succeeded in convincing the inhabitants of the true nature of' this phenomenon, that is to say, that it was a disease, and to bring them back to reflection and tranquiUity, and to the shame of having shown so much credulity and stupidity, as well as to make them take remedies proper to cure the disease. However, it is to be feared, that so many cares and efforts united would have produced very little effect, without the lucky 234 Dr. Sonden on an Epidemic Religious Ecstasy.

circumstance, that the prophecies so often repeated and an- nounced, as about to be accomplished in a few days, were not fulfilled, which brought about, that the most reasonable among the inhabitants were soon gained in favour of the good Cause. We admit, as appears to us, on sound physiological principles, that the vegetative and sensitive, or, in other words, the corpo- real and spiritual lives, compose together in man an inseparable whole, although in their external manifestations they appear often to diverge to such a point, that to the eyes of the observer, they present themselves almost as independent one from the other. It is sufficient to observe, that man is affected, and that his con- dition is modified in turns by mental and physical influences; that on one hand, extraordinary or violent mental impressions may provoke morbid alterations in the vegetative life, and, on the other, that irregular vegetative fnnctions are capable of causing derangements and diseases in the sensitive life in pro- portion to their greater or less relation with the organs of this life. We are then led to consider separately the mental and physical causes, which may be regarded as the origin of the disease in question, for in fact it seems that it may be estab- lished in this case, as in many others, that it is not exclusively a single circumstance, for instance, the ergot of rye, the perusal of religious books, or reveries on matters of religion, or any other particular cause, which can have provoked so singular a phe- nomenon, but that many circumstances together have concurred to produce it. To avoid too great prolixity, I will not quote here all the causes looked upon as generally predisposing to mental diseases, but I will confine myself to the causes which have par- ticularly excited among us the above named religious ecstasy. We must consider, first, as a remote c~use, the education of the people, which embraces no object of higher interest than religious instruction. Even in places where education is found in a satisfactory state, and where there are no fanatics to mislead the mind, it is always confined within sufficiently Dr. Sonden on an Epidemic Religious Ecstasy. 235 narrow limits, and in consequence, this instruction may be easily corrupted by incredulity, imposition, or fanaticism. It is an un- doubted fact, that phenomena such as those in question were only manifested previously among the least enlightened class of the people; it is also equally true that in the places where the disease began, the minds had been a long time previously disturbed and exalted by particular sermons and exercises of devotion of self- called preachers and other sectaries, rendered fanatical by millions of fanatic pamphlets, composed by the Murbecks, the Nymans, and many others. Finally, that much mental mischief had resulted by a neglected or erroneous religious instruc- tion, the fault of the proper servants of the Church. It ap- pears therefore evident that we must look for the essential cause of the disease and the most powerful one in this predominating disposition of the mind. M. Ponten, an enlightened ecclesiastic, who has himself, during forty years, treated lunatics in his own house, and precisely in the locality where the disease broke out, attributes to the great activity of these preachers, not only that private individuals have fallen into religious melancholy, but also mentions emphatically the circumstance, " that the number of patients attacked with mental alienation has visibly increased during late years." The same testimony has been given by other enlightened persons and by public journals. If we also take into account the efforts latterly made by apostles of new doctrines to shake the ancient faith, to agitate the minds, to sow doubts and spread intolerance between indi- viduals, it must be agreed that at this period there really ex- isted more materials than enough to excite fanaticism, and even ecstasy. No very strong or extraordinary impulse was neces- sary to push the prevailing extravagance to a true state of mad- ness. Such an impulse, however, did arrive, when a young girl, irritable and sensitive to a degree, became devotedly exalted by frequent perusals of the Bible and other religious works, and finished by falling into a state of ecstasy at tile end of a long 236 Dr. Sonden on an Epidemic Religious Ecstasy.

nervous illness. Then the epidemic with the rapidity of light- ning fired the mass already long heated, and spread itself with an astonishing rapidity. Many individuals became completely alt~cted ; a great number experienced more or less well-marked symptoms of the disease; and all the inhabitants were imbued with a spirit of fanaticism if not infected with this mental epide- mic. It is certainly very rare that the cause of a mental malady is exhibited to the eye in a more distinct manner. Tile fanatic disposition of mind may then be admitted as alone sufficient to explain the origin and the rapid propagation of the disease. Besides this, it would not be right to omit that both drunken- hess and the use of bad food, rye affected with the ergot (secale cornutum), were also assigned as causes of this disease, and not without some reason. With respect to the first, the very general use of alcoholic liquors, with its usual inevitable consequences, the activity of the soul paralysed, the corporeal strength and the faculty of labour destroyed, morality sullied, order disturbed, the well-being and the happiness of families dissipated~ and every sentiment of honour and virtue lost, and, finally, its slave dragged down below the level of the brute. Then, on the other hand, the violent revulsion produced by the exhortations of austere ministers inducing a sudden disuse of the habitual stimu- lant, became too much for the weakened mind torn by the stings of conscience and remorse, and not only despair, but mental alienation was induced. As to the second cause, viz. the use of bad food, there is more room for doubt. During the last few years the harvests had been very bad, and the nourishment of the peasantry in consequence scanty and unwholesome, and it is possible, that the feeble state of the body thus engendered, may have rendered the mind less able to sustain the shocks of sudden excitement ; but that the ergot of rye contributed in an essential manner to this is most unlikely. One fact is certain, that, as has been already said, it was chiefly persons in youth, for instance, from the age of 16 to 30, Dr. Sonden on an Epidemic Religious Ecstasy. 237 that were attacked with the disease, then children, and that the smallest number belonged to manhood or old age. It is equally certain that the greatest number of patients was corf/posed of young girls and young women. As to the corporeal constitution, tile temperament, and to the disposition of the individuals, no rule can be established, for every qualification of this kind was swallowed up in the stormy and devastating whirlwind of the epidemic when it had once broken out.

VOL. XXW. NO. 71. 2