It should be added that the patient was not superstitious, and in her healthy days had never particularly interested herself in the supernatural. During the whole course of treatment, which ended on the 14th November, great indifference was evinced both to the illness and the cure. Next spring the patient returned for out-patient treatment of the headache, which had come back during the very hard work of these months. Apart from this symptom her condition left nothing to be desired. It was demonstrated that she had no remembrance of the attacks of the previous autumn, not even of those of the 19th September and earlier. On the other hand, in hypnosis she could recount the proceedings in the cemetery and during the nightly disturbances.
By the peculiar hallucination and by its appearance our case recalls the conditions which V. Kraft-Ebing has described as "protracted states of hysterical delirium." He says: "Such conditions of delirium occur in the slighter cases of hysteria. Protracted hysterical delirium is built upon a foundation of temporary exhaustion. Excitement seems to determine an outbreak, and it readily recurs. Most frequently there is persecution-delirium with very violent anxiety, sometimes of a religious or erotic character. Hallucinations of all the senses are not rare, but illusions of sight, smell and feeling are the commonest, and most important. The visual hallucinations are especially visions of animals, pictures of corpses, phantastic processions in which dead persons, devils and ghosts swarm. The illusions of hearing are simply sounds (shrieks, howlings, claps of thunder) or local hallucinations, frequently with a sexual content."
This patient's visions of corpses, occurring almost always in attacks, recall the states occasionally seen in hystero-epilepsy. There likewise occur specific visions which, in contrast with protracted delirium, are connected with single attacks.
(1) A lady 30 years of age with grande hystérie had twilight states in which as a rule she was troubled by terrible hallucinations; she saw her children carried away from her, wild beasts eating them up, and so on. She has amnesia for the content of the individual attacks.[3]
(2) A girl of 17, likewise a semi-hysteric, saw in her attacks the corpse of her dead mother approaching her to draw her to her. Patient has amnesia for the attacks.[4]
These are cases of severe hysteria wherein consciousness rests upon a profound stage of dreaming. The nature of the attack and the stability of the hallucination alone show a certain kinship with our case, which in this respect has numerous analogies with the corresponding states of hysteria. For instance, with those cases where a psychical shock (rape, etc.) was the occasion for the outbreak of hysterical attacks, and where at times the original incident is lived over again, stereotyped in the hallucination. But our case gets its specific mould from the identity of the consciousness in the different attacks. It is an "Etat Second" with its own memory and separated from the waking state by complete amnesia. This differentiates it from the above-mentioned twilight states and links it to the so-called somnambulic conditions.
Charcot[5] divides the somnambulic states into two chief classes:—
1. Delirium with well-marked incoordination of representation and action.
2. Delirium with co-ordinated action. This approaches the waking state.
Our case belongs to the latter class.
If by somnambulism be understood a state of systematised partial waking,[6] any critical review of this affection must take account of those exceptional cases of recurrent amnesias which have been observed now and again. These, apart from nocturnal ambulism, are the simplest conditions of systematised partial waking. Naef's case is certainly the most remarkable in the literature. It deals with a gentleman of 32, with a very bad family history presenting numerous signs of degeneration, partly functional, partly organic. In consequence of over-work at the age of 17 he had a peculiar twilight state with delusions, which lasted some days and was cured with a sudden recovery of memory. Later he was subject to frequent attacks of giddiness and palpitation of the heart and vomiting; but these attacks were never attended by loss of consciousness. At the termination of some feverish illness he suddenly travelled from Australia to Zürich, where he lived for some weeks in careless cheerfulness, and only came to himself when he read in the paper of his sudden disappearance from Australia. He had a total and retrograde amnesia for the several months which included the journey to Australia, his sojourn there and the return journey.
Azam[7] has published a case of periodic amnesia. Albert X., 12–½ years old, of hysterical disposition, was several times attacked in the course of a few years by conditions of amnesia in which he forgot reading, writing and arithmetic, even at times his own language, for several weeks at a stretch. The intervals were normal.
Proust[8] has published a case of Automatisme ambulatoire with pronounced hysteria which differs from Naef's in the repeated occurrence of the attacks. An educated man, 30 years old, exhibits all the signs of grande hystérie; he is very suggestible, has from time to time, under the influence of excitement, attacks of amnesia which last from two days to several weeks. During these states he wanders about, visits relatives, destroys various objects, incurs debts, and has even been convicted of "picking pockets."
Boileau describes a similar case[9] of wandering-impulse. A widow of 22, highly hysterical, became terrified at the prospect of a necessary operation for salpingitis; she left the hospital and fell into a state of somnambulism, from which she awoke three days later with total amnesia. During these three days she had travelled a distance of about 60 kilometres to fetch her child.
William James has described a case of an "ambulatory sort."[10]
The Rev. Ansel Bourne, an itinerant preacher, 30 years of age, psychopathic, had on a few occasions attacks of loss of consciousness lasting one hour. One day (January 17, 1887) he suddenly disappeared from Greene, after having taken 551 dollars out of the bank. He remained hidden for two months. During this time he had taken a little shop under the name of H. J. Browne in Norriston, Pa., and had carefully attended to all purchases, although he had never done this sort of work before. On March 14, 1887, he suddenly awoke and went back home, and had complete amnesia for the interval.
Mesnet[11] publishes the following case:—
F., 27 years old, sergeant in the African regiment, was wounded in the parietal bone at Bazeilles. Suffered for a year from hemiplegia, which disappeared when the wound healed. During the course of his illness the patient had attacks of somnambulism, with marked limitation of consciousness; all the senses were paralysed, with the exception of taste and a small portion of the visual sense. The movements were co-ordinated, but obstacles in the way of their performance were overcome with difficulty. During the attacks he had an absurd collecting-mania. By various manipulations one could demonstrate a hallucinatory content in his consciousness; for instance, when a stick was put in his hand he would feel himself transported to a battle scene, would place himself on guard, see the enemy approaching, etc.
Guinon and Sophie Waltke[12] made the following experiments on hysterics:—
A blue glass was held in front of the eyes of a female patient during a hysterical attack; she regularly saw the picture of her mother in the blue sky. A red glass showed her a bleeding wound, a yellow one an orange-seller or a lady with a yellow dress.
Mesnet's case reminds one of the cases of occasional attacks of shrinkage of memory.
MacNish[13] communicates a similar case.
An apparently healthy young lady suddenly fell into an abnormally long and deep sleep—it is said without prodromal symptoms. On awaking she had forgotten the words for and the knowledge of the simplest things. She had again to learn to read, write, and count; her progress was rapid in this re-learning. After a second attack she again woke in her normal state, but without recollection of the period when she had forgotten things. These states alternated for more than four years, during which consciousness showed continuity within the two states, but was separated by an amnesia from the consciousness of the normal state.
These