skeletons. She was not at all frightened, but was rather surprised that the attendant did not see them too. Once she ran to the window, but was otherwise quiet. The next morning, while still in bed, she saw skeletons, but not in the afternoon. The following night at four o'clock she awoke and heard the dead children in the neighbouring cemetery cry out that they had been buried alive. She wanted to go out to dig them up, but allowed herself to be restrained. Next morning at seven o'clock she was still delirious, but recalled accurately the events in the cemetery at C. and those on approaching the Asylum. She stated that at C. she wanted to dig up the dead children who were calling her. She had only torn up the flowers to free the graves and to be able to get at them. In this state Professor Bleuler explained to her that later on, when in a normal state again, she would remember everything. The patient slept in the morning, afterwards was quite clear, and felt herself relatively well. She did indeed remember the attacks, but maintained a remarkable indifference towards them. The following nights, with the exception of those of the 22nd and the 25th September, she again had slight attacks of delirium, when once more she had to deal with the dead. The details of the attacks differed, however. Twice she saw the dead in her bed, but she did not appear to be afraid of them, she got out of bed frequently, however, because she did not want "to inconvenience the dead"; several times she wanted to leave the room.
After a few nights free from attacks there was a slight one on the 30th Sept., when she called the dead from the window. During the day her mind was clear. On the 3rd of October she saw a whole crowd of skeletons in the drawingroom, as she afterwards related, during full consciousness. Although she doubted the reality of the skeletons, she could not convince herself that it was a hallucination. The following night, between twelve and one o'clock—the earlier attacks were usually about this time—she was obsessed with the idea of dead people for about ten minutes. She sat up in bed, stared at a corner and said: "Well, come!—but they're not all there. Come along! Why don't you come? The room is big enough, there's room for all; when all are there, I'll come too." Then she lay down with the words: "Now they're all there," and fell asleep again. In the morning she had not the slightest recollection of any of these attacks. Very short attacks occurred in the nights of the 4th, 6th, 9th, 13th and 15th of October, between twelve and one o'clock. The last three occurred during the menstrual period. The attendant spoke to her several times, showed her the lighted street-lamps, and trees; but she did not react to this conversation. Since then the attacks have altogether ceased. The patient has complained about a number of troubles which she had had all along. She suffered much from headache the morning after the attacks. She said it was unbearable. Five grains of Sacch. lactis promptly alleviated this; then she complained of pains in both fore-arms, which she described as if it were a teno-synovitis. She regarded the bulging of the muscles in flexion as a swelling, and asked to be massaged. Nothing could be seen objectively, and no attention being paid to it, the trouble disappeared. She complained exceedingly and for a long time about the thickening of a toenail, even after the thickened part had been removed. Sleep was often disturbed. She would not give her consent to be hypnotised for the night-attacks. Finally on account of headache and disturbed sleep she agreed to hypnotic treatment. She proved a good subject, and at the first sitting fell into deep sleep with analgesia and amnesia.
In November she was again asked whether she could now remember the attack on the 19th September which it had been suggested that she would recall. It gave her great trouble to recollect it, and in the end she could only state the chief facts, she had forgotten the details.
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,
