The practical joke

In 1873 a physician from St Louis, Dr Walter Coles, recorded a particularly unusual home visit he had recently been asked to make. His report was published in the St Louis Medical and Surgical Journal:

Effects of a fright

On the evening of the 1st of May, we were summoned in haste to the residence of a gentleman nearby, to see a boy about fourteen years of age, who was laboring under the effects of a sudden and severe fright.

This cannot have been a regular occurrence, particularly for a patient of this age.

It seems that the gentleman of the house and his wife had gone out to spend the evening, leaving the patient, a hired white boy, with another servant boy a little older, and several of his own young sons in the house. These boys plotted a practical joke against the patient, by dressing up the effigy of a man in coat, hat, etc., and leaning it against the back kitchen door leading into the yard, in the meanwhile, one of the other boys ran around the house and rapped at the back door, which the patient was sent to open.

To be fair, this does sound rather a good practical joke.

Immediately prior to this, we should remark that the boy seemed apparently well, and in good spirits, having been romping with his playmates. He went with alacrity to the door expecting perhaps to admit one of the servants, when suddenly on opening it, the figure of a man fell in on him. The poor little fellow gave a sudden scream, and staggering back, fell on the floor insensible.

I am a terrible sucker for sudden frights and no doubt would have screamed too. But I probably wouldn’t have passed out. The boy’s friends soon became worried, since the victim of their prank was unconscious and apparently not getting better.

When we saw him he was rolling on the floor, trembling in the most violent manner. The pupils were slightly dilated, face somewhat flushed, or perhaps natural, the pulse weak but frequent. The heart palpitated most tumultuously, but not apparently influencing the pulse.

As a basic point of physiology, it is rather difficult to see how the behaviour of the heart would not influence the pulse.

There was total loss of consciousness, while every few seconds the face would partake of an expression of the utmost terror, and the arms and hands become extended as in an effort to avoid some frightful object; at these times his screams were sometimes loud and piercing.

This was a condition of severe terror: the boy remained unconscious for well over an hour.

There were intervals of repose, lasting from ten to sixty seconds, but no return to consciousness, though the eyes were open and natural in expression. Suddenly however, the dreadful phantom would again appear, and throw him into a tremor whilst with outstretched arms, terrified face, and sometimes a flood of tears, he attempted to shun his fancied danger.

The doctor decided that a sedative was required, so administered bromide – a drug which had been discovered only 15 years earlier. It was also the first effective treatment for epilepsy, a condition the doctor suspected in this case.

Under the influence of liberal doses of bromide of potassium, the patient gradually became more composed, and finally relapsed into an uneasy slumber, lasting six hours, from which he awoke fully conscious, though with a confused recollection of the cause of his troubles the night previous. He was also nervous, and inclined to hesitate and stammer in replying to questions. The bromide being continued, all these symptoms rapidly subsided.

The doctor enquired about the boy’s medical history, and came to the conclusion that he was not epileptic.

There was neither convulsion, stertor and frothing at the mouth, nor the characteristic drowsiness and stupor, that usually follow epilepsy. It was certainly not hysteria, and the only explanation we can give of his condition, is, that he was the subject of temporary functional mental palsy, the result of the sudden and profound impression produced by the fright.

Dr Coles’s diagnosis is not terribly useful, since ‘functional mental palsy’ means little more than ‘mind paralysis’. His suggestion was that the ‘apparition’ the boy had seen at the door made such an impression on his mind that it entirely obscured any other conscious thought.

Lacking any psychiatric expertise, I will not venture to comment on what might have been going on, except to say that the boy undoubtedly experienced a classic stress response which flooded his body with adrenaline, increasing the heart rate and respiration. It is possible, I imagine, that his collapse was partly physiological, partly psychological. If you can shed any further light on this intriguing case, do leave a comment below.

2 thoughts on “The practical joke”

  1. An interesting case –

    As a (retired) cardiologist I immediately thought of Long QT Syndrome – often an inherited/genetic abnormality of the ECG, generally with totally normal cardiac anatomy – this means that in fatal cases, the autopsy is often normal. There are many different types now recognised & with LQT Type 1, the collapse is often triggered by a sudden adrenaline surge, due to ‘extreme emotion’ like a fright. The mechanism is a ventricular tachyarrhythmia called Torsade de pointes, which may then self terminate terminate. It would be interesting to know if there was any history of previous collapse or a family history of sudden death (unlikely to get that information now).

    Obviously there are other possible causes but I think cardiac arrhythmias, due to conditions like LQT Syndrome always need to be considered in (young) patients with unexplained loss of consciousness.

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