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 selected cases of various forms of changes of consciousness all throw a certain light upon our case. Naef's case presents two hysteriform eclipses of memory, one of which is marked by the appearance of delusions, and the other by its long duration, contraction of the field of consciousness, and desire to wander. The peculiar associated impulses are specially clear in the cases of Proust and Mesnet. In our case the impulsive tearing up of the flowers, the digging up of the graves, form a parallel. The continuity of consciousness which the patient presents in the individual attacks recalls the behaviour of the consciousness in MacNish's case; hence our case may be regarded as a transient phenomenon of alternating consciousness. The dreamlike hallucinatory content of the limited consciousness in our case does not, however, justify an unqualified assignment to this group of double consciousness. The hallucinations in the second state show a certain creativeness which seems to be conditioned by the auto-suggestibility of this state. In Mesnet's case we noticed the appearance of hallucinatory processes from simple stimulation of touch. The patient's subconsciousness employs simple perceptions for the automatic construction of complicated scenes which then take possession of the limited consciousness. A somewhat similar view must be taken about our patient's hallucinations; at least, the external conditions which gave rise to the appearance of the hallucinations seem to strengthen our supposition. The walk in the cemetery induces the vision of the skeletons; the meeting with the three boys arouses the hallucination of children buried alive whose voices the patient hears at night-time. She arrived at the cemetery in a somnambulic state, which on this occasion was specially intense in consequence of her having taken alcohol. She performed actions almost instinctively about which her subconsciousness nevertheless did receive certain impressions. (The part played here by alcohol must not be underestimated. We know from experience that it does not only act adversely upon these conditions, but, like every other narcotic, it gives rise to a certain increase of suggestibility.) The impressions received in somnambulism subconsciously form independent growths, and finally reach perception as hallucinations. Thus our case closely corresponds to those somnambulic dream-states which have recently been subjected to a penetrating study in England and France.
These lapses of memory, which at first seem without content, gain a content by means of accidental auto-suggestion, and this content builds itself up automatically to a certain extent. It achieves no further development, probably on account of the improvement now beginning, and finally it disappears altogether as recovery sets in. Binet and Féré have made numerous experiments on the implanting of suggestions in states of partial sleep. They have shown, for example, that when a pencil is put in the anæsthetic hand of a hysteric, letters of great length are written automatically whose contents are unknown to the patient's consciousness. Cutaneous stimuli in anæsthetic regions are sometimes perceived as visual images, or at least as vivid associated visual presentations. These independent transmutations of simple stimuli must be regarded as primary phenomena in the formation of somnambulic dream-pictures. Analogous manifestations occur in exceptional cases within the sphere of waking consciousness. Goethe,[14] for instance, states that when he sat down, lowered his head and vividly conjured up the image of a flower, he saw it undergoing changes of its own accord, as if entering into new combinations.
In half-waking states these manifestations are relatively frequent in the so-called hypnagogic hallucinations. The automatisms which the Goethe example illustrates are differentiated from the truly somnambulic, inasmuch as the primary presentation is a conscious one in this case; the further development of the automatism is maintained within the definite limits of the original presentation, that is, within the purely motor or visual region.
If the primary presentation disappears, or if it is never conscious at all, and if the automatic development overlaps neighbouring regions, we lose every possibility of a demarcation between waking automatisms and those of the somnambulic state; this will occur, for instance, if the presentation of a hand plucking the flower gets joined to the perception of the flower or the presentation of the smell of the flower. We can then only differentiate it by the more or less. In one case we then speak of the "waking hallucinations of the normal," in the other, of the dream-vision of the somnambulists. The interpretation of our patient's attacks as hysterical becomes more certain by the demonstration of a probably psychogenic origin of the hallucination. This is confirmed by her troubles, headache and teno-synovitis, which have shown themselves amenable to suggestive treatment. The ætiological factor alone is not sufficient for the diagnosis of hysteria; it might really be expected a priori that in the course of a disease which is so suitably treated by rest, as in the treatment of an exhaustion-state, features would be
