SOMNAMBULISM.
A great perturbation in nature! to receive at once the benefit of sleep, and do the effects of watching.
—Macbeth.
We have seen that in certain cases dreams manifest a tendency to pass into action. Thus, the dream with which I was on one occasion occupied became so amusing that I was awakened by a paroxysm of laughter that continued for some time after the termination of the dream. Sometimes the actions which are thus determined become more complicated, but do not suffice to arouse the sleeper. He continues to dream, and to act out his dream. This constitutes the ordinary form of somnambulism. It is a special affection of the nervous system encountered chiefly among persons of a decidedly neurotic constitution—especially among the victims of hysteria, epilepsy, and insanity. Sometimes occurring in cases apparently characterized by perfect health, it will usually be discovered by careful inquiry that the subject is nevertheless connected by near relationship with a neurotic stock. In a third class of patients the neuropathic diathesis is not congenital, but is the acquired result of particular injuries or diseases of the head. It is also observed sometimes as a consequence of transitory functional disturbances of the brain connected with the period of convalescence from diseases that profoundly affect the nutrition of the nervous system. In all cases, however, it is probable that a special nervous temperament exists as a predisposing cause of the phenomena, for the majority of people can sustain injuries of the head, or of the peripheral nervous system, and can pass through all kinds of illness without exhibiting any tendency to somnambulism. As the nervous temperament is the peculiar property of children and of the female sex, it is among them that the affection is usually observed. Before the age of puberty, however, the differential peculiarities of sex are not sufficient to produce any great preponderance in either direction; and small boys are, therefore, perhaps as frequently somnambulistic as their little sisters. Like other neuropathic disorders, this predisposition is frequently met with as an hereditary attribute which may be handed down from generation to generation. Occurring in the experience of young children, it frequently ceases when they arrive at years of maturity. Not always, however, thus ceasing as a consequence of improvement in the general health, but because of the substitution of some more serious disorder.
The phenomena of ordinary somnambulism are manifested, like the dreams out of which they arise, during the period of sleep. But, while dreams most frequently occur during the later portion of the night, after the deepest sleep is past, somnambulism usually occurs in the earlier part of the night, during the deepest sleep. As a consequence of this fact, consciousness is seldom affected by the molecular play of the brain during the somnambulic excursion. The sleepwalker knows nothing, and remembers nothing of the incidents in which he has been an active agent; while the dreamer seems to be more nearly awake. His consciousness is partially aroused by the play of memory and of imagination, and he can remember the spectacle which constituted his dream. The phenomena of somnambulism necessitate the participation of a larger number of faculties than are needed for the production of a dream, but their activities are coÖrdinated upon a plane, so to speak, lower than the platform upon which the elements of dreams are arranged. Consequently, though the elements of the somnambulic process may be far more numerous and various than the elements of a dream, they may be less capable of rising into the realm of consciousness. Such a process may differ from the phenomena of ordinary life only in the fact of unconsciousness; and, when concluded, it leaves no traces in the memory of the waking state. In other instances, on the contrary, so many nervous functions may be suppressed, and so great may be the intensity of the remaining cerebral processes, that the resulting phenomena scarcely differ from an ordinary dream in which consciousness is aroused, and the waking memory is durably impressed. Between these extremes lie opportunities for an indefinite number of combinations; consequently the forms and degrees of somnambulism present a very great variety of manifestation. Maury[74] reduces these to five principal forms: First, simple movement of the limbs in connection with that partial sleep of the intellectual faculties which produces ordinary dreams. Second, somniation, a state in which the patient unconsciously performs such actions as have become so far habitual that, though complicated in their character, they constitute genuine cerebral reflexes. Third, noctambulism, or sleep-walking, in which the action, though complicated in its character, and different from the ordinary waking occupations of the patient, appears to be the result of automatic processes, constituting a dream that is acted out in time and space. Fourth, somnambulism with exaltation of the faculties, producing delirium with conscious movements during the crisis. Fifth, somnambulic life, or double consciousness, in which, with the exception of certain special modifications of intelligence, the conduct of the patient during the paroxysm does not perceptibly differ from that of the waking state, so that the subject seems to experience two successive though disconnected personalities.
The exact relation between these different degrees of somnambulism has been further elucidated by MM. Ball and Chambard.[75] Starting with the proposition that normal healthy existence is a state in which the functions of organic life furnish a basis for nervous sensibility and motion, by means of which the imaginative faculties (imagination and memory), associated with the coÖrdinative faculties (attention, judgment, volition), are sufficiently stimulated to maintain a state of consciousness, they show that the first stage of sleep consists in the suppression of bodily motion and sensibility. The second stage consists in the further suppression of the coÖrdinative faculties. The third stage is marked by the loss of memory and imagination. In the most profound and perfect sleep the functions of organic life alone remain. The process of awaking consists in the revival of the faculties in the inverse order of their extinction. Dreams occur during the period in which motion, sensation, and the coÖrdinative faculties are in abeyance; but somnambulism may accompany each of the stages of sleep. Its simplest form is perhaps the rarest; corresponding to Maury’s fifth variety. In this form the functions of organic life are intact; motion and sensibility seem unchanged; the intellectual faculties display their usual activity; but the ordinary consciousness is never aroused. So far as the normal life of the subject is concerned, he is active, sensible, intelligent, but unconscious; and when the paroxysm is terminated memory contains no account of its events. Such paroxysms may occur but once in the life-time of an individual, or they may be repeated at stated intervals, constituting an alternate succession of mental states without connection in consciousness. This is called the somnambulic life, or double consciousness, several examples of which will be related upon another page.
The second form of somnambulism results from the abolition of consciousness and the more or less complete suppression of the coÖrdinative faculties of the mind. Memory and imagination, released in great measure from the control of the higher intellectual faculties, and excited by such vestiges of sensation as still persist, create a species of delirium in which mutilated sensations, half formed thoughts and disproportioned volitions combine to produce a variety of actions. In this condition the patient dreams, and acts out his dream. He is a somnambulic dreamer.
In the third degree of somnambulism, consciousness and the entire range of intellectual faculties have disappeared. The individual resembles a creature from which the cerebral hemispheres have been removed. He is little better than a living automaton, guided only by impressions received from without. In this condition the movements of the body may become wholly responsive to the will of another—a prominent characteristic of artificial somnambulism or hypnotism.
A fourth degree of somnambulism is marked by the disappearance of consciousness, intellect, sensibility, and the power of motion. Only the lower functions of organic life remain. The patient merely lives, he neither thinks nor acts. This constitutes the state of somnambulic lethargy, a condition which differs from deep sleep only in the fact that under the influence of external impulses or of partial awaking it may easily pass into the second form of the affection, the somnambulic dream.
Such is the classification of MM. Ball and Chambard. It possesses the merit of great precision and clearness. If the warning which its authors themselves utter against its too literal acceptance be respected, it will be found to afford a very convenient explanation of the manner in which the various degrees of somnambulism are reached. But it must be remembered that between these pronounced and definite forms exist a great number of intermediate degrees. Partial revivals and temporary resurrections of the higher faculties of the mind may intrude themselves among the activities which depend upon lower functions; as, for example, when the ordinary unconsciousness of lethargy is briefly interrupted by an event which may remain permanently fixed in memory after waking, even though all other concurrent incidents were unnoticed and left no trace behind. Keeping this caution in mind, the following diagram will be found useful:
The close parallel between this diagram and the one on page 4, which illustrates the course of sleep, will be at once remarked. The difference between the two states cannot be thus diagrammatically expressed. It is the difference between sleep in a healthy, normal subject, and sleep as modified by the somnambulistic temperament. This may be either the result of disease or of congenital defect of cerebral organization. What the particular structural difference may be, it must be impossible to decide, until it shall become possible to state the reason why one brain shall behave only in a normal manner, while another presents all the vagaries of hysteria, somnambulism,—perhaps even of insanity. That the affection is hereditary is a matter of common observation. One of my patients who is somnambulistic—walking in his sleep, climbing over the roof of his house, etc.—is the son of a father who was also a noctambulist, and who once fractured his leg by falling from a step as he was walking down stairs in his sleep. A grand-daughter is both a somniloquist and a somnambulist.
Returning now to the classification adopted by Ball and Chambard, it will be found interesting to consider a few illustrative examples of the different forms and degrees of the affection under consideration.
Somnambulic Lethargy.—This condition represents the form which outwardly resembles profound sleep. It may occur as a paroxysm without relation to other forms of the affection, or, according to my own observation, more frequently associated with other forms of somnambulism. Thus, one of my patients, a lady about thirty-five years of age, having accidentally fallen into the hands of a noted empiric, by whom, for a slight attack of tonsillitis, she was vigorously dosed with atropia, digitalis and calabar bean, finally passed into a somnambulic state corresponding to the somnambulic life of the preceding table. This continued about five weeks, when she became completely lethargic, and was transferred to my care. In this condition she remained unconscious, almost perfectly insensible, with pupils somewhat contracted and sluggish before the light, with a feeble and slightly accelerated pulse, a moderately elevated temperature, bowels and bladder insensible to their contents, mouth and throat filled with an offensive mucous secretion. By great urgency she could be sufficiently roused to open her mouth, so as to permit cleansing the cavity, and to swallow liquid food. Swallowing was effected very slowly, and only after the liquid had remained for some time in the fauces. At the end of about three weeks the patient began to exhibit more vitality. She could be more easily aroused, began to dream and to have hallucinations that were finally prolonged out of sleep into wakefulness. In the course of a few hours she was fully herself again, after eight weeks of unconsciousness.
This form of lethargy is characterized by the complete unconsciousness which persists during its course. Its duration is variable, sometimes continuing for a few minutes only; sometimes lasting through many days and weeks. Dr. W. T. Gairdner, Professor of Medicine in the University of Glasgow,[76] reports the case of a woman who remained for over one hundred and sixty days in a condition of lethargic stupor. “The patient was the mother of a family, and had lived a strictly domestic and (up to a short time before her seizure) healthy and regular life. There were no peculiar moral and religious problems to perplex the situation. There was no history of inveterate hysteria, or of long continued rapt contemplation; nor has there been the slightest evidence of any craving after notoriety, either before the attack or since its termination. The moral atmosphere, in short, surrounding the phenomena, is altogether unfavorable to exaggeration and imposture, for which, indeed, no reasonable motive can be assigned. Nevertheless, under these very commonplace conditions, concurring with some degree of melancholy or mental despondency after delivery, but during a convalescence otherwise normal, Mrs. McI—— presents to our notice a condition of suspended consciousness and disordered innervation in no degree less extreme than the ‘trances’ or cataleptic attacks which have been recorded as the result of the most aggravated hysteria, or as the miracles of religious ecstasy and profound mental emotion. She becomes for the long period of over one hundred and sixty days continuously an almost mindless automaton, connected with the external world only through a few insignificant reflexes and through the organic functions. She is fed, almost without resistance, through the stomach-tube; she defecates and urinates (during much the greater part of the time) unconsciously; she is absolutely passive as regards everything that demands spontaneous movement, and betrays almost no sign of sensation, general or special, when subjected to the severest tests that can be applied short of physical injury. But while her senses were thus shut, and her volitions in suspense to an extent much beyond ordinary sleep, there was, nevertheless, a sleep within the sleep. The periodicity of day and night was maintained by some change in the condition of the innervation, of which snoring was the sole indication. She was not convulsed, nor paralyzed, nor delirious; the singing, laughing, weeping, adoring ecstasies of hysteria and of religious excitement were wholly wanting; nor were there during many months such intervals of normal consciousness as are observed in almost all the recorded cases of hysterical coma and of catalepsy. The statue-like pose, moreover, and the flexibilitas cerea of typical catalepsy, are absent in this case. The return to consciousness was followed or accompanied by a return of all the normal functions of mind and body; there is now no incoherence, nor even distorted perceptions, as of a dream-life occupying the somnolent imagination for months, and therefore all the more hard to reconcile with realities. She is self-possessed, but unobtrusive, easily managed, and betraying only natural emotion; she persists in maintaining that the whole period of the apparent unconsciousness is a complete blank to her recollection. She is grateful for her recovery, but manifests no craving for sympathy, and no tendency, as yet, to revert to any morbid condition of despondency, such as was described at the commencement of the attack. In connection with this last point, although there is no evidence of her having been personally insane, it is not to be denied that her family history contains strong presumptions of a hereditary predisposition bearing in that direction.”
These cases must not be confounded with the examples of lucid lethargy, to which allusion has been made in a previous chapter. Somnambulic lethargy is a condition in which the cerebrum is wholly inert. In lucid lethargy, although there is complete loss of general sensibility and of the power of voluntary motion, the field of consciousness is continually enlightened by perceptions derived from one or more of the special senses, so that the subject is conscious of much that transpires in his immediate neighborhood. These two forms of lethargy sometimes alternate in the experience of the same individual, constituting a portion of the indefinitely varied manifestations of hystero-epilepsy. Grasset relates the case[77] of a little girl, ten years old, who suffered with various forms of hysteria, which were finally replaced by attacks of stupor, lasting several hours. After a time these crises of “nervous sleep” were transformed into more ordinary attacks of somnambulism, in which, “although the child’s eyes are shut, she sees and hears everything during the crises, knows who comes into the room by their step and walk. If anything unpleasant is said to her, or if they threaten to wet her, or make her smell something, she gets angry, and pushes everything violently away that is offered to her. She replies by signs to all questions, and if she wants anything, asks for it by gesture: if she wants to drink, she puts her finger to her lips as if in the act of sucking, and if not understood, becomes irritated, gets up, and leads the father or mother to the sideboard or cupboard, where the things she wants are, and always with the eyes shut. She is able to go through the whole house, I do not say quite alone, because they do not allow her to walk alone, but with help, and she directs the way wherever she wishes to go. During the crises she even sometimes amuses herself with a little dog, which she makes jump over a stick resting on the cross-bars of two chairs opposite each other; and according as she wishes the dog to jump higher or lower, she moves the stick to the lower or higher bars of the chairs, and that with eyes always shut spasmodically. During the whole attack she cannot talk; but towards the end she speaks, although not yet recovered from her state of somnambulism. When the crisis is over, the child remembers nothing of what she has said or done in her sleep, and is much surprised at everything told her.”
Somnambulic Dreams.—The preceding cases illustrate the variable character of the manifestations of somnambulism, and may also serve as an introduction to the more common form of the affection, in which the patient experiences a dream, probably excited by the same causes that produce ordinary dreams, and also acts out his dream. The differences between an ordinary dream and a somnambulic dream lie in the fact that the one produces an often vivid impression upon consciousness and memory, while the other is entirely expended upon the organs of external expression. Starting probably from the same portion of the brain, the physiological dream sets in motion the cortical structures which are in immediate relation with conscious memory; the impulses of the somnambulic dream, on the contrary, are directed towards the lower portions of the nervous system, where they serve to excite the organs of locomotion and expression, which are destitute of every form of mnemonic register. Consequently, the somnambulist retains no recollection of the incidents of his dream.
The simplest form of this affection is presented by the restless child who talks, cries out, and brandishes its fists in sleep. In the majority of instances these manifestations create little more disturbance than the half uttered yelping of a dog that barks in its sleep. But in some cases the outbreak assumes a distressing, if not an alarming character, constituting the affection known by the name of night terrors. The disorder is usually observed in young children of a highly nervous temperament, before the conclusion of their second dentition. The little patients are generally of neurotic lineage. Insanity, hysteria, neurasthenia, epilepsy, chorea, and nervous dyspepsia, are often discovered among their near relatives. Not unfrequently they have been, or will become, choreic. The attack is often preceded by symptoms of indigestion and constipation; but the exciting cause may be usually traced in the commotion of a brain that has been wearied by the exertions of the previous day. The child starts up out of an apparently sound sleep, crying with seeming alarm, calling for his mother, and staring wildly around, with every possible expression of terror. Sometimes he jumps from his couch, and runs headlong into a corner, or seeks concealment under the bed, as if escaping from some frightful object. The eyes are open, tears flow, perspiration covers the skin, there is the greatest excitement, and the little one, clinging convulsively to its parent, will not be quieted. Only after a number of minutes does the child seem to recover the power of recognizing his friends. Presently, however, he lies down, and falls immediately asleep, waking in the morning without the slightest remembrance of the unpleasant event.
Such paroxysms occur during the early part of the night, one or two hours after bedtime, when sleep is passing from its maximum intensity to an inferior degree of depth. This, moreover, is the time when the controlling power of the sensory apparatus over other portions of the nervous system has already reached its minimum. The spinal centres and those intra-cranial ganglia which do not share in the full measure of this repose are therefore in a condition of relative exaltation. Disturbances of internal origin, consequently, produce inordinate excitement of these waking portions of the nervous apparatus. The abnormal quality of this excitement is attested both by the history of the patient, and by the fact that it does not pervade the whole brain. The distribution of motion through the cerebrum is hindered, so that certain portions of the organ remain asleep while other regions are thrown into a state of tumultuous uproar. Such disconnection of the different organs of the nervous system, by withdrawing particular ganglia from the inhibitory influence of the other centres, gives opportunity for violent explosions of nervous force.
Somewhat similar in their origin are those acts of unconscious violence which sometimes occur during the process of sudden awakening out of sound sleep. The patient is usually a deep but uneasy sleeper, who is only aroused imperfectly and with difficulty when the attempt to awaken him is made. Under such circumstances the disturbance to which he is subjected serves as the exciting cause of a dream which, like the ordinary somnambulist, he puts into action before he is fully waked. On recovering complete consciousness, he may retain no recollection of the events of his dream, and may also experience as great a degree of astonishment at the results of his violence as if he had taken no part in its display. A gentleman of my acquaintance, who had suffered considerable uneasiness regarding burglars, was, one night, startled by a noise in his room. Jumping up suddenly, he grasped a pistol and fired it in the direction of a figure dimly perceived near the bed. On waking fully out of sleep, he found that he had inflicted a wound upon the hand of his wife whose movements had disturbed him. Another unfortunate, who was once under my observation for undoubted insanity, was in like manner aroused out of sleep by a supposed noise, probably heard in a dream. With a pistol in each hand, he commenced firing wildly in every direction, fatally wounding his wife who was in bed at his side. When completely awakened he had no recollection of what had occurred, and was overwhelmed by the event.
Wharton and StillÉ[78] have collected a number of similar examples of this disorder, to which the term somnolentia or sleep-drunkenness has been applied. Its connection with morbid disturbance of the brain is usually very evident. Obviously, the moral responsibility of the agent in such cases is identical with that of the ordinary somnambulist, or of the subject of epileptic mania.
Ordinarily, however, the somnambulic dream is less agitated. The patient merely continues the movements with which he was occupied at the moment of falling asleep, as in the case of Galen, who, though long an unbeliever of the tales regarding sleepy soldiers who had unconsciously continued to march with their comrades, at last found himself in a similar manner walking a considerable distance after he had been overtaken by sleep while journeying on foot. In other cases the phenomena though intimately connected with the daily occupations of the subject, present themselves in a form somewhat detached from the waking life. Such are the common experiences of children who get out of bed, and walk around the house, seeking their playthings, or pulling their clothes out of the drawers in which they have been laid. Sometimes the events of the day have evidently suggested the deeds of the night. One of my little acquaintances will leave her bed, walk into another room, seat herself by her mother’s work-basket, thread a needle, and proceed to sew up the imaginary holes in her dress. One of my early playmates, in like manner, after puzzling over a difficult sum in arithmetic, before retiring, arose in his sleep, took paper and a pencil from his mother’s desk, and proceeded before her eyes to work out the correct answer. Another, tempted probably by a vision of ripe grapes upon the trellis, climbed out of his window upon the roof of a shed. Unfortunately, the certainty with which somnambulists usually direct their movements seemed to fail him. He fell heavily to the ground, where he awoke to find himself seriously injured.
An excellent example of a still more complicated series of actions during somnambulism is quoted by P. Max Simon.[79] It illustrates a majority of the facts which have been already brought forward, and will well reward careful consideration. “A young clergyman was in the habit of getting up in his sleep, taking paper, composing and writing sermons. When he had finished a page, he would read it over, if an action performed without the assistance of sight can be called reading. If dissatisfied with anything, he would blot it out, and then write the corrections with great accuracy in their appropriate place above the line. In one of these sermons he made a correction which was quite remarkable. Having in one place written the words ce divin enfant, on revising the page he decided to substitute the word adorable instead of the word divin. He therefore blotted out this last word and placed the other immediately over it; then, perceiving the word ce, which was proper enough before the word divin, lacked the terminal letter t that was needed before a vowel, he very adroitly added the necessary letter, so that the amended sentence correctly read cet adorable enfant. In order to ascertain whether the somnambulist made any use of his eyes, a cardboard was placed under his chin in such a way as to completely obstruct the view of the paper upon the table; but he continued to write without paying any attention to the obstacle. In order to ascertain whether he was aware of the presence of the objects which were before his eyes, the paper upon which he was writing was taken away, and a number of other sheets were successively slipped into its place; but he always noticed the substitution, because they differed in size. When an exactly similar piece was substituted, he accepted it as his own, and wrote down the corrections at the points which corresponded exactly with the writing upon the page which had been removed. It was by means of this ingenious stratagem that some of his nocturnal compositions were preserved.
“The most astonishing thing of all,” continues the author of this article, “was the exact composition of music. A cane served him as a ruler. With it he ruled at equal distances the five necessary lines, putting in their proper place the clef, the flats and the sharps. Finally, he inscribed the notes, at first all in outline, but, when he had finished, he blackened those which should be dark. The words of the song were written below. On one occasion he happened to write them with too large a hand, so that they were not placed directly under their corresponding notes. He soon perceived this defect, and, in order to amend it, he blotted out what he had done by drawing his hand over it, and then rewrote the line of music lower down the page with all the precision imaginable.
“Another singular thing of a different sort, which was not less remarkable. One night, in the middle of winter, he dreamed that he was walking on the bank of a river, and saw a child fall into the water where he was drowning. The severity of the cold did not hinder him from hurrying to the rescue. He threw himself at full length upon his bed, in the position of a man who is swimming, and imitated all his movements. After having fatigued himself for some time with this exercise, he felt a portion of the coverlid gathered in a heap on one corner of the bed. He believed this to be the child; grasped it in one hand, and with the other went through the motions of swimming back to the bank of the supposed river. There he laid down his burden, and came out, shivering and chattering his teeth as if he were really getting out of an icy river. To the bystanders he said that he was freezing, and would die of cold, that his blood was all turned to ice; he must have a glass of brandy to warm him. Not having any, they gave him some water which chanced to be in the room; he tasted it, recognized the deception, and called, with greater emphasis than before, for brandy, insisting upon the magnitude of the danger which threatened his health. A glass of liquor was finally given to him; he drank it with pleasure, and spoke of the great relief which it afforded him. Notwithstanding all these incidents, he did not wake, but went to bed, and slept most profoundly.”
An equally instructive case is related by my distinguished colleague, Prof. J. Adams Allen.[80] The subject of the observation was a medical student who resided in Professor Allen’s house during a portion of the time covered by the narrative.
“About the summer of 1847, a somewhat dilapidated bass-viol, which was a kind of heir-loom in the family, was brought into the house, and he devoted spare moments to learning how to play upon it. Unfortunately, the antiquity of the instrument had told upon its keys, and unless they were wetted at each time of use, it would not remain in tune. He was determined, however, to command its notes, and succeeded. His somnambulic walks, thereafter, led him from his chamber to the parlor, and to the bass-viol, and the family would be awakened in the small hours by the inevitable tuning up prelude, mingled with slipping of the old keys, and quiet objurgations upon his part. Sometimes the bridge would fall down when the keys slipped, and sometimes a string would snap or escape from the keys, nevertheless he would persevere, repair damages, tune up, and then execute all varieties of music of which the machine was capable, not unfrequently accompanying it with his voice. All this would be done in total darkness. When any one entered the room with a light, he took not the least notice, although when spoken to he would reply in monosyllables or with considerable asperity. His face was usually flushed, although sometimes pale—the features immobile and passive, the eye open, pupil dilated, the surface glazed, and the lids apparently motionless. The extremities warm and the pulse full, frequent and soft. Very often the skin would be bathed with free perspiration. Remarkably sensitive to titillations when awake, there seemed total absence of reflex movements from this cause whilst in the somnambulic state.
“As he extended his acquaintance with music and musical instruments, his feats became wonderful. Whilst in attendance upon the Medical College at La Porte, the household looked forward with high anticipations to the hours when his skillful touch of the melodeon would wake them. He had a voice of the purest tone and very considerable compass, in fact of rare sweetness. I am enabled to say from a multitude of observations, that he played with a precision and skill while asleep that he could not approximate while awake. Besides this, he would execute music which he had heard, perhaps, but once, the evening previous or after a long interval—no note of which he could recall in his waking moments. His memory here seemed wonderfully exalted. If interrupted, he was irritable in the extreme, but would go on with his music exactly from the point of interruption.
“Among the numberless exhibitions of his somnambulism, I have time only to notice a few of the most striking.
“Whilst attending lectures at Ann Arbor, where I was then lecturing on Physiology, I requested his assistance in enlarging some of the drawings illustrative of minute anatomy and histology, for use in class demonstrations. He entered into the work with great zeal, and proved very expert and rapid in execution. One evening, previous to the day on which I was about to lecture on the kidney, I wished the cuts in Carpenter’s Physiology, illustrating the tubular arrangement, etc., were ready. He had an engagement for the evening, but said he would try and prepare them in the morning. During the night he rose, dressed himself, played a few tunes on the guitar, part of the time singing (and, by the way, the guitar was about as dilapidated as the bass-viol before noticed, and he had to knot one or two of the strings first), and then arranged the drawing paper, prepared his India ink and brushes, took the parallels and pencils and laid off the space, and worked for half an hour or more rapidly and perfectly, nearly completing the figures on pp. 596 and 597 of Carpenter’s Principles, in the edition of 1853.... These drawings are now in the series used for illustration in Rush Medical College. Although we had a light in the room while watching him, he went on with his work entirely regardless of it. Before completing the work, he went to bed and slept until the usual hour in the morning, when at the breakfast he asked if he had been up in the night, as he had dreamed that he had. This was the only time he ever remembered even dreaming about being up or occupied in anything. He had by this time become so fully aware of his habits, that nothing of the sort astonished him. Shortly after this he went to spend the night with a fellow student, but a little after midnight he rose, dressed himself, and went out, followed by the other gentleman, walked down to the Exchange Hotel, where there were a number of his acquaintances and others waiting for a train of cars due at that time. Some one rallied him on his being out so late, but being cautioned by his companion, they did not attempt to awake him, but watched his movements. On being invited, he took a glass of ale, and then said he would only have time to go home and get his dinner before the afternoon lecture hour. He walked with his friend to our door, and was indignant to find it locked. His room-mate (a cousin) admitted him and awakened myself and wife. He asked if dinner was ready, and seemed astonished that it was not; then said he would get a drink of water and be off, ‘for old D. (one of the faculty) would be mad if he was late.’ I told him he had plenty of time and he need not be in a hurry. He then walked into the kitchen, drank a tumblerful of water, and, looking up to the clock, although it was totally dark, remarked the time, and started for the front door. I then told him that I was not feeling well, was pretty blue, and wished he would sit down and play euchre with us. This seemed to please him, and he took off his overcoat and said he had as lief play until ‘old D.’ was through lecturing, as to go.
“His cousin sat down at the table with us, and we played ‘three-handed (cut-throat) euchre.’ He paid not the slightest attention to us, although we passed the cards backwards and forwards between us, exchanging hands, and everything we could do to attract his attention. He dealt the cards in his turn, correctly, and played ‘according to Hoyle.’ In one hand, spades were trumps, and he held the jack of clubs. Clubs being led, he first threw down this jack, then quickly picked it up, saying, ‘I forgot that was the left bower.’ It is somewhat humiliating to record that, notwithstanding our tricks and devices, he beat us in the game.
“On its conclusion, he got up hastily and insisted upon going to the college. We only prevented him this time, by throwing water in his face—the only method, by the way, in which we could awake him without great violence. Pungent odors, ammonia, camphor, etc., he seemed to disregard, or merely pushed away the object.
“On regaining consciousness, he always appeared like one stunned, or suffering from a severe shock. The influence upon the pulse and nervous system was always so severe, that we never awaked him at these times if we could avoid it.
“Whenever a little out of health, as from trifling attacks of indigestion, or after watching with the sick, or fatigue, he would be sure to be up and doing something notable in the somnambulic state.
“One of the most remarkable of his exploits occurred several years after the incident just given. I think it was in 1860 or 1861.... In the rounds of his practice he had a patient, about whom he was very anxious. It was in the coldest winter weather, and the residence of the patient was about two miles distant. Visiting him early in the evening, he found him in a state so unsatisfactory, that he informed the family that if he did not find him better the next visit, he should change the medicine entirely. On rising the next morning, he went to the barn to put his horse to the cutter for an early start. He was a little puzzled at finding things somewhat misplaced, but supposed some person had been at the stable in search of a missing article. On visiting the patient, he was gratified to find a marked improvement. He inquired when the improvement commenced, and was answered, ‘Immediately after taking the powders which he had given in the night.’ The truth flashed upon him at once, but concealing his emotion, he inquired, with as careless an air as he could assume, ‘About what time was it when I was here?’ They replied, ‘Between two and three o’clock.’ This proved to have been the case, as he was afterwards told by the family where he boarded. He had been giving the patient some fluid medicine, which he ordered discontinued, and then put up several powders, such as he had concluded upon the night previous, combining them as usual, and administering the first one himself.”
The foregoing examples illustrate the fact that ordinary vision is not necessary to guide the movements of the somnambulist. Sometimes the patient walks about with open eyes; on other occasions they are firmly closed. It is generally admitted that the tactile and muscular senses are greatly exalted, so that they furnish guiding sensations which are sufficient to direct the most complicated movements. The history of the medical student observed by Dr. Allen shows how preternaturally sensitive the organs of vision may become—actually seeing the clock in the dark during the somnambulic paroxysm. When one considers the remarkably hyperÆsthetic condition of the senses in certain other forms of nervous disorder, it is not surprising that sensory impressions which would be wholly neglected in a healthy waking state, may become sufficient to excite perceptions and to guide the movements which they have aroused. It is undoubtedly true that in certain cases the somnambulist does derive some information through the medium of the eyes—does really see; but it is also a fact that he only sees, hears, tastes and feels the objects which are immediately related with the action of his dream. It appears also that an impression derived from any organ of sense may suffice to arouse any other or all of the internal organs of perception, so that the patient seems to see, to hear, and even to taste objects which he knows only through the sense of touch. Sometimes the image thus externalized coincides with the actual reality; but often this is not the case, as, in the experience of the young clergyman, the somnambulist seemed to see the paper which he only perceived through contact with his fingers. The image thus created corresponded exactly with the external fact; but when a similar contact with a pile of bed-clothes excited the illusion of a drowning child in his grasp, the internal image did not in the least correspond with the external object, and he probably derived no information through the sense of sight in either case. In another instance, however, as we shall learn upon another page, the subject is so far dependent upon the sense of sight that its obstruction is sufficient to arrest his movements, as certainly as if he were awake.
Ordinarily the memory is not impressed by the events of the somnambulic dream, but we have already learned that it is sometimes affected precisely as in common dreaming. One of my little acquaintances could not find her night-dress when she went to bed one night. She was therefore obliged to wear a gown that was old and ragged. Later in the evening her sister discovered the missing garment, and laid it over a chair in the bed-room. In the morning the night-dresses had changed place, and the ragged one occupied the chair. This occasioned considerable surprise, until the child remembered that during the night she had dreamed that two of her playmates had come to sleep with her, and that she felt so mortified at being seen in a ragged dress that she got out of bed and changed her night-gown. Sometimes the events of a somnambulic paroxysm are remembered during a subsequent attack, though they are forgotten during the interval, as in a case, reported by Macario, of a young girl who had been violated during somnambulic sleep. On awaking she had no idea of anything that had occurred, but during a subsequent paroxysm she told her mother all that had happened.[81] In certain cases a dim recollection of some particular incident may be retained, as in the case of my patient who was for eight weeks in the somnambulic state. On recovery, the only thing that she could remember was a momentary glimpse of some one who was holding up his fingers before her eyes. Meeting the physician, subsequently to her recovery, who had thus attempted to arouse her attention, she recognized in his countenance the features which had momentarily impressed her consciousness during the period of somnambulic life.
It is seldom observed that somnambulism is attended with dangerous tendencies, yet they are sometimes present. One of my patients once took by mistake ninety grains of chloral at a single dose. While under its effects she got out of bed, walked into her sister’s room, shook her fist in her face, and swore furiously at her. On awaking, next morning, she was greatly shocked by the account of this dreadful behavior, so utterly at variance with her usual temper and character. Another somnambulic patient one night rushed into her mother’s room, violently accusing her of stealing her pocket-book, and threatening vengeance if it were not returned. Such patients sometimes mislay the articles with which they occupy themselves during a paroxysm, and on waking they erroneously infer that they have been robbed. Sometimes, as in the celebrated case related by Mesnet, the natural propensities of the individual seem to be released from all restraint, and brutal instincts guide the actions of the somnambulist, who then steals, or eats and drinks with the voracity of a savage. Ball and Chambard (loc. cit.) have collected a number of examples in which impulses to suicide or other forms of violence were manifested under such circumstances. Obviously, where the moral sense is asleep, and where the affection is the result of causes beyond the control of the patient, he cannot be held morally responsible for the consequences of such actions. His condition closely resembles that of the victim of epileptic mania who delivers himself during a paroxysm to all degrees of furious and homicidal violence, without retaining the slightest recollection of the fact after its conclusion. The closeness of the parallel between these two disorders is rendered further apparent by the circumstance that although all memory of the events of epileptic mania is usually abolished, it does sometimes persist after the termination of the attack. Thus, one of my epileptic patients for a time manifested symptoms of insanity after every fit. During one of these paroxysms he imagined that the sparrows on the housetop were all singing a particular tune which had attracted his attention shortly before the convulsion. Then it seemed to him that the breathing of his sleeping child whispered the same tune. Placing his hand upon the bosom of his wife, her breathing assumed the same musical character. Calling upon his family to listen to the wonderful music, they all asserted that they too could hear it. It was a considerable time after his recovery before he could be convinced that this vividly remembered experience was a pure illusion. The members of his family had been cautioned against contradicting their father during his paroxysms; consequently, when he asked if they could hear the melody which delighted him, they answered affirmatively, and thus confirmed him in his delusion. To the ordinary form of epileptic mania such paroxysms sustain a relation similar to that subsisting between ordinary dreams and the somnambulic experience.
In like manner as it is often remarked that certain dreams betray a condition of unusual cerebral excitement, so do certain cases of somnambulism manifest a delirious exaltation of the faculties in action. This characteristic often belongs to the night-terrors of children. It is a condition in which the brain is occupied by the scenery of a vivid and highly dramatic vision which dominates the actions of the subject. This was most conspicuously shown in the following case, from J. P. Frank,[82] and in certain periods of the paroxysms observed by Mesnet (p. 198). Frank’s patient was a healthy and well nurtured young German girl, who during the wars of 1812 had been terribly alarmed by a party of French soldiers who had broken into the house and threatened to kill her father. The next day at the same hour she passed into a somnambulic state, which lasted till sunset. After a brief introductory period of agitation, she uttered a deep sigh, which was rather a sob than a sigh, and fell into a profound sleep. Presently she smiled, her countenance seemed lighted with inspiration, her right arm was raised in the air, and the left was directed towards the earth. In this cataleptic attitude she remained for about a minute. She then seemed to have decided what to do; from an imaginary cartridge-box behind her back she pulled out a cartridge, bit off the end, poured out the powder upon her fist as if she were priming a musket. She then went through the motions of loading a gun, ramming down the wad with an imaginary ramrod, and cried out in French, a language which she had never heard before: “Marche! Ou est le baron? SacrÉ nom de Dieu!” Repeating the violent ejaculations and threats addressed by the soldiers to her father, she exhibited the utmost terror; her body was covered with a cold sweat, and she seemed ready to faint away. At this moment she woke up, called impatiently for her handkerchief, with which she wiped the perspiration from her face, and resumed her ordinary avocations as if nothing had happened.
Still more remarkable was the case reported by Dr. Mesnet.[83] From the excellent translation prepared by T. J. Huse, M. D.,[84] the following sketch has been outlined:
The patient, aet. 27 years, received in one of the battles near Sedan, during the Franco-Prussian war, a bullet wound which fractured the left parietal bone. His right arm was almost immediately paralyzed; after a few minutes the paralysis involved the right leg, and he lost consciousness. It was only after the lapse of three weeks that he recovered his senses. He was finally taken to Paris, where the paralysis gradually disappeared. From a period some three or four months after the reception of the injury, he began to manifest periodical attacks of somnambulism, at intervals of fifteen to thirty days with an average duration of fifteen to thirty hours. During the whole of this time his life presented two essentially distinct phases—the one normal, the other pathological. In the normal condition he was able to gain a livelihood. He had been a clerk in several houses, a singer in a cafÉ, and while in the hospital had made himself useful and agreeable. The somnambulic attacks which he experienced were characterized by an instantaneous onset, resulting in the abolition of all his senses except the tactile sense. Sight was perhaps partially persistent, for on many occasions he seemed to be impressed by brilliant objects, but he was obliged to employ the sense of touch in order to understand their form, volume, etc. During all these crises his gait was easy, his attitude calm, his countenance peaceful; his eyes were widely open, with dilated pupils; the forehead and brows were contracted; there was an incessant nystagmus, indicating a disordered state in the brain; he was continually mumbling or muttering. When walking in a familiar locality he moved with perfect freedom; but if in a strange place, or if obstacles were placed in his way, he examined the obstructions by feeling of them with his hands, and turned easily aside. If any attempt was made to change his direction, or to quicken or retard his pace, he allowed himself to be directed like a mere automaton, continuing to walk in any way thus chosen for him. He would also eat, drink, smoke, dress himself, walk out, and retire to bed as usual. These processes seemed to be effected as a result of previous habit, without any actual consciousness or feeling. He ate voraciously without discernment, and drank in the same manner ordinary wine, wine of quinine, water, assafoetida, without exhibiting any evidence of sensation whatever.
While under treatment in the Saint Antoine Hospital, this patient was carefully studied by Dr. Mesnet and by Alfred Maury, the celebrated author. They found that by means of impressions upon his tactile sensibility it was possible during any one of his paroxysms to suggest certain modes of action which were reproduced whenever he was again placed in the same conditions. Thus, “he was promenading in the garden, under a grove of trees, when some one put back into his hand the cane which he had let fall a few moments previously. He felt of it, turned his hand several times around the curved handle of the cane, became attentive, seemed to listen, and suddenly cried out, ‘hurry!’ then, ‘there they are! there are at least twenty of them, to the two of us! we shall get the better of them!’ and then, carrying his hand behind his back, as if to get a cartridge, he went through the movements of loading his musket, crouched at full length in the grass, concealing his head behind a tree, in the posture of a sharp-shooter, and following with his gun at his shoulder all the movements of the enemy whom he seemed to see close at hand. This scene often repeated in detail during the course of the observations, has seemed to each of us the most complete expression of an hallucination called up by an illusion of touch, which, giving to a cane the properties of a gun, awakened in this person remembrances of his last campaign, and reproduced the struggle in which he was so grievously wounded.”
On another occasion the patient was at the end of a corridor, near a door that was locked; he “passed his hands over this door, found the knob, grasped it, and attempted to open it; failing to accomplish this, he sought for the keyhole, then for the key, which, however, was not there; then, passing his fingers over the screws which secured the lock, he endeavored to seize them and turn them for the purpose of detaching the lock. This entire series of actions bears witness to an effort of his mind connected with the object before him. He was on the point of leaving the door and turning towards another room, when I held up before his eyes a bunch of seven or eight keys; he did not see them; I jingled them loudly at his ear; he did not notice them; placing them in his hand, he immediately took hold of them, and tried them one by one in the keyhole, without finding the single one which could fit; he then left the place, and went into one of the wards, taking in his passage various articles with which he filled his pockets; at length he came to a little table used for the records of the wards. He then passed his hands over the table, but it was empty; in feeling of it, however, he came across the handle of a drawer; opening it, he took up a pen, and all at once this pen suggested to him the idea of writing; for at that moment he began to ransack the drawer, taking out and placing on the table several sheets of paper, and also an inkstand. He then sat down and commenced a letter, in which he recommended himself to his commanding officer for his good conduct and bravery, and made application for the military medal. This letter was written with many mistakes in it, but these were identical as regards expression and orthography with all that we have seen him make in his healthy state. While the patient was writing, he aided us in an experiment that encouraged to immediately examine in what degree the sense of sight assisted in the performance of this action. The facility with which he traced his letters, and followed the lines upon the paper, left no doubt concerning the exercise of vision upon the writing; but, in order to make the proof satisfactory, we have several times interposed a thick plate of sheet-iron between his hands and his eyes when he was writing; and, although all the visual rays were intercepted, he did not immediately break off the line he had begun; he still continued to trace a few words written in an almost illegible manner with the letters entangled in each other; then finally he stopped without manifesting either discontent or impatience. The obstacle removed, he finished the uncompleted line, and began another. The sense of sight was therefore in full activity, and essential to the written expression of the patient.” Other observations showed that the sense of sight was only roused at the instance of touch, and that its exercise remained limited to those objects alone with which it was actually connected by the touch.
On another occasion he passed through a long ward of patients, “taking indiscriminately every article that came within his reach, and concealing them afterwards under the quilt, under a mattress, under a chair-cover, and under a pile of sheets. Arrived in the garden, he took from his pocket a book of cigarette papers, opened it, and detached a leaf from it; then took out his tobacco and rolled a cigarette with the dexterity of one who is accustomed to this proceeding. He searched for his match-box, lighted his cigarette with a match, which falling still burning on the ground, he extinguished by placing his foot upon it; then smoked his cigarette while strolling back and forth to the entire extent of the garden, without any of these actions presenting the slightest deviation in their manner from the ordinary method. Everything that he did was the faithful reproduction of his ordinary round of life.
“This first cigarette terminated, he prepared to make another, when we stepped up and began to interpose obstacles.... He searched vainly in his pocket for his tobacco, as we had filched it. He searched for it in another pocket, going through all his clothes until he came back to look for it in the first pocket, when his face expressed surprise. I offered him his tobacco-pouch, but he did not perceive it; I held it near his eyes, yet he still did not perceive it; even when I shook it just in front of his nose, he did not notice it. But when I placed it in contact with his hand, he seized it and completed his cigarette directly. Just as he was about to light his cigarette with one of his matches, I blew it out and offered him instead a lighted match which I held in my own hand; he did not perceive it; I brought it so close to his eyes as to singe a few lashes, yet he still did not perceive it, neither did he make the slightest motion of blinking.... The patient sees certain objects and does not perceive others; his sense of sight receives impressions from all objects in personal relation with himself through the touch, and does not receive impressions, on the contrary, from things external to him; he perceives his own match, but does not perceive mine.”
During the course of this observation the patient gave evidence that the memory of his former occupation as a professional singer had been revived. He began to hum some of the familiar airs, and then proceeded to his room in the hospital, where he carefully dressed himself as if for a public performance. “On his bed he chanced to meet with several numbers of a periodical romance, which he turned rapidly over without finding that for which he was searching.... I took one of those numbers, rolled it up, and putting it into his hand in that condition, satisfied his want by this semblance of a roll of music, for he then took his cane, and traversed the ward with a slow step, well contented. When stopped on his way, for the purpose of taking off the coat he was wearing (which had been foisted on him by one of the observers), he permitted it without offering any resistance.... At this moment the sun lit up with a bright ray a glass window that closed the lodge on the side towards the court.... This ray must have given him the impression of a footlight, for he at once placed himself before it, readjusted his toilet, opened the roll of paper which he carried in his hand, and softly hummed an air, running his eyes over the pages as he slowly turned them, and marking with his hand a measure that was perfectly rhythmical. Then he sang aloud, in a highly agreeable manner, giving his song the correct expression, a patriotic ballad to which we all listened with pleasure. This first selection terminated, he sang a second, and afterwards a third. We then saw him take out his handkerchief to wipe his face. I offered him a wine-glass of a strong mixture of vinegar and water, which he did not notice; I placed the glass under his nose without his perceiving the smell of the vinegar; I put it into his hand, and he drank it without complaining of any unpleasant sensation.”
The conclusions which may be drawn from this remarkable history have been sufficiently expressed by Dr. Mesnet[85] in the following words:
“The disturbance which these functional perversions of the nervous system bring into the course of life, extends not only to the organs of sense, and to intellectual actions properly so called, but it also sometimes awakens some instinctive excitation which surrenders the individual without any defence, and destitute of rational discernment, to the most deplorable impulses. He acts with the semblance of a freedom which he does not possess; he seems to prepare and to combine certain actions in the light of conscious volition, when he is in reality only a blind instrument, obedient to the irresistible mandates of an unconscious impulse.”
The bearing of these conclusions upon the question of the moral responsibility of the somnambulist needs no further advertisement.
The likeness of certain features of such cases to the phenomena of hypnotism is worthy of note. In this particular there is an evident likeness between the cerebral susceptibility of the ordinary dreamer, the somnambulist, and the hypnotised subject. All are alike in a condition which renders their imagination and their volition subservient to guiding sensations from without, so that their movements may be directed by the will of another. We have seen how the course of an ordinary dream may be modified by such suggestions. The history of the patient just related, illustrates the manner in which the actions of a somnambulic dreamer may be controlled by the will of a spectator. The ordinary phenomena of hypnotism exhibit the same subjection to the will of another. It is probable that a considerable part of the superior notoriety which belongs to this feature of hypnotism, is due merely to the fact that natural somnambulism is rarely made the object of such experiments and observations as are daily applied to the subjects of artificial somnambulism.
Somnambulic Life.—We come now to the last term of the series, the simplest, yet perhaps the rarest form of the affection. In this form, the patient seems perfectly awake; he is in possession of all his senses; he is capable of sustained and rational volition; he lives and behaves, in short, like any other person. But his life is divided into periods which are, so far as consciousness is concerned, completely distinct from each other. This double-consciousness may be exhibited but once in a lifetime, or it may be frequently repeated, so that the patient oscillates between the two states until it becomes doubtful which is the natural condition and which is the acquired. These states of double-consciousness are divided from each other by a more or less complete break in the chain of memory. The residual strata which, so to speak, have been deposited from the sea of events upon the floor of memory, have become broken and “faulted.” The line of rupture marks the division between the two fields of consciousness; they no longer lie in the same plane, consequently there can be little or no continuity of memory between them. The events which transpire in one state affect the mind so long as, and whenever it is in connection with the cerebral register which is fitted to that state; as soon as the connection is shifted, the mind takes cognizance of the events that are recorded upon the other portion of the register, but, for want of physical continuity between the different portions of the record, the mind cannot at once receive a continuously connected report from the entire organ of recollection. From this results a mode of life essentially similar to the life of certain epileptics who are ushered by each seizure into a state of apparently conscious activity of which they have no recollection after recovery. Thus, one of my epileptic patients, who was subject to seizures, both of the convulsive and the non-convulsive form of the disease, on one occasion left home, after a fit, and traveled a considerable distance into the country, putting up for the night at taverns and farm houses, and apparently behaving like any other respectable citizen. It was three weeks before he came to himself. On recovering his normal consciousness, the period of his wanderings was a perfect blank in his memory. Such attacks are usually of shorter duration, and are more frequently associated with hysteria; bearing to the hysterical paroxysm the same relation which they share with the epileptic fit. When the predisposing temperament exists, a great variety of excitations may serve to produce the phenomena, so that unless careful observation is employed, the truly somnambulic character of the paroxysm may easily be overlooked. Thus, the true nature of the affection was not suspected by the early attendants of the patient who became the subject of lethargic stupor, as related on page 173. Under the influence of powerful drugs acting upon a highly sensitive nervous organization, she became, at first, “hystericky.” She manifested great distress, complained bitterly of her sufferings, passed through the ordeal of several consultations, was subjected to a considerable surgical operation, and only ceased to appear conscious at the expiration of five weeks, when she passed into the lethargic state previously described. At the time of my first visit, just before the commencement of stupor, she walked into the room where I was waiting, greeted me with her usual affability, gave me some account of her sensations, and neither did nor said anything that could lead me to suspect that she was not in her normal frame of mind. But, with the exception of the single incident mentioned on page 193, the entire period from the commencement of her medication to the close of the lethargic stupor was utterly blotted out of her recollection.
Macnish[86] relates a similar case of a young lady who “unexpectedly, and without any forewarning, fell into a profound sleep which continued several hours beyond the ordinary term. On waking, she was discovered to have lost every trace of acquired knowledge. Her memory was tabula rasa—all vestiges, both of words and things, were obliterated and gone. It was found necessary for her to learn everything again. She even acquired, by new efforts, the art of spelling, reading, writing, and calculating; and gradually became acquainted with the persons and objects around, like a being for the first time brought into the world. In these exercises she made considerable proficiency. But, after a few months, another fit of somnolency supervened. On rousing from it, she found herself restored to the state she was in before the first paroxysm; but was wholly ignorant of every event and occurrence that had befallen her afterward. During four years and upwards she has passed periodically from one state to the other, always after a long and sound sleep.... The former condition of her existence she now calls the Old State, and the latter the New State; and she is as unconscious of her double character as two distinct persons are of their respective natures. For example, in her old state she possesses all the original knowledge; in her new state only what she acquired since. If a lady or gentleman be introduced to her in the old state, or vice versa (and so of all other matters), to know them satisfactorily she must learn them in both states. In the old state, she possesses fine powers of penmanship, while in the new, she writes a poor, awkward hand, not having had time or means to become expert. Both the lady and her family are now capable of conducting the affair without embarrassment. By simply knowing whether she is in the old or new state, they regulate the intercourse, and govern themselves accordingly.”
Another remarkable case was reported at length by Dr. Azam, of Bordeaux.[87] The principal facts are given in a translation by Dr. J. I. Tucker in the Chicago Journal of Nervous and Mental Disease.[88] The patient was a young woman who began to exhibit the symptoms of hysteria at the age of puberty, and from that time till the present, a period of nearly thirty years, she has lived a double life, passing alternately from normal life into somnambulic life. These transitions were ushered in by a sharp pain in both temples, followed by a species of stupor, lasting about ten minutes. She would then open her eyes, apparently awake, and would remain in the condition of somnambulic life for an hour or two, when the languor and sleepiness would reappear for a few minutes, after which she would awaken in her normal state. At first these paroxysms were renewed every five or six hours; but, as she grew older, they occurred less frequently, and were greatly prolonged, until, finally, the periods of somnambulic life considerably exceeded the duration of normal life. During normal life she was hypochondriacal, hysterical, and a sufferer with neuralgia. During somnambulic life she was free from pain, lively, imaginative, and coquettish. While in this state of existence she remembered the events of her entire life—normal or otherwise; but on returning to her natural mode of life, she retained no recollection of her somnambulic periods. Memory, during normal life, was limited to anterior normal periods. As time advanced, this peculiar mode of existence became an increasing source of inconvenience and mental distress, often leading the superficial observer to suppose that she was insane.
This case differs from the others in the circumstance that the period of somnambulic life was more vigorous and healthy than the ordinary condition. This seems to suggest an explanation of the forgetfulness which marked the period of normal life. During that period the functions of the brain were depressed, so that its molecular movements could not reach the level of the field of consciousness occupied during the second period. Other observations, such as that of Sir Henry Holland,[89] who, while exhausted by fatigue, lost all recollection of the German language until he was restored by rest and food, indicate that such defects of memory depend upon a deficient nutrition of the brain substance—a condition which is undoubtedly associated with an enfeebled cerebral circulation. We may, therefore, suppose that in Dr. Azam’s case the paroxysms of somnambulic life were induced by periodical discharges of force within the brain, causing an improvement in the circulation of blood, and a corresponding gain in health and general vivacity. Such exaltation of the faculties would be perfectly consistent with an exercise of memory covering all the events of life. But, when, as in cases like that reported by Macnish, and by myself, somnambulic life is the result either of disease or simple somnambulic sleep, it is a condition in which, as in physiological sleep, the cerebral functions, taken as a whole, are depressed rather than exalted. The resulting train of ideas is developed upon a plane below the level of ordinary consciousness, and is, consequently, as easily forgotten as the dreams which are developed during sleep.
Such, then, are the principal characteristics of somnambulism—a state in which dreams are supplemented by more or less complete and appropriate action; ordinarily without subsequent recollection of either dream or action. The somnambulic dream usually occurs during or soon after the period of deepest sleep, when the influences of the external world are most completely suppressed. Released from the control of its sensory portion, the remainder of the brain awakens, and becomes aroused to a condition of relative exaltation. No longer distracted by the solicitations of external sense, the attention is concentrated upon the hallucinations which constitute the dream. In the simpler forms of noctambulism only the automatic locomotive apparatus is awakened, and the sleeper moves in accordance with the impressions derived from habit, aided by actual exaltation of the muscular and tactile senses. But, in some of the more complicated cases, a certain amount of special sensibility seems to exist. The patient is capable of exercising just that amount of perception which is necessary to accomplish his purpose, though blind and deaf and insensible to every other impression. The more complete the waking of the sense-organs, the closer the resemblance to the condition of ordinary life, or even to the condition of ecstasy, in which cerebral exaltation is the prominent feature, and in which the power of recollection generally persists. Accordingly, it sometimes happens that the somnambulist can recall the events of his paroxysm. In such cases the power of recollection is due to the same conditions that control the recollection of our ordinary dreams. But the phenomena of ordinary somnambulism are as completely as possible removed from all connection with the mental actions which arise directly from the operation of the senses. By reason of such isolation the ordinary association of ideas affords no help to the memory, and the dream remains in oblivion. Alfred Maury expresses the opinion[90] that the principal cause of forgetfulness of the events of somnambulism consists in the exhaustion of the cerebral elements through the intensity of the excitement to which they have been subjected during the paroxysm. Doubtless this, in certain cases, may contribute to the loss of memory, but it should be remembered that the excitement may be relative rather than absolute. Certain elements wake while others are asleep; and these waking cells may be aroused to a degree far in excess of what is usual during the sleep of the brain without attaining to the level of their diurnal activity. The mind, undisturbed by external impressions, gives its attention to the operation of these waking organs, and a dream with all its consequences, somnambulic or otherwise, is the result. In other words, the plane of consciousness, so to speak, is lowered in sleep to the level of these molecular vibrations. But when the entire brain has been completely reawakened, the residual vibrations of those elements which yielded the physical basis of the dream, and which, had they originally occurred during the waking state, might have persisted with energy sufficient to furnish a groundwork for recollection of the ideas which they had first suggested, are no longer sufficiently forcible to be felt in consciousness. Recollection of mental states thus generated must necessarily be impossible under such conditions. Sometimes, however, the somnambulist who, while awake, had forgotten all the incidents of his somnambulic experience, can remember, in a subsequent paroxysm, all that occurred during the preceding attack. Facts of this kind have been observed in the waking life of certain hysterical persons, but the apparent doubling of their personality is connected with the waking state, or with its semblance, while in ordinary somnambulism it is only during sleep that the alternations of memory and forgetfulness occur. A similar recollection of previous visions is sometimes experienced in dreams, showing a close relationship between the dreams of sleep and of somnambulism. The bond of association between events thus isolated in time must be sought in a renewal of like conditions of the brain during the successive periods of somnambulic exaltation. We must suppose that the molecules which were in a state of excitement during the first paroxysm are again aroused in a similar manner after a period of waking quiescence. If, during sleep, their movements, though of an exalted character, have only just sufficed to arouse consciousness in the form of a dream, it is scarcely probable that during the phase of comparative inactivity which supervenes when the whole brain is awake, their residual motion could disturb the sphere of consciousness. Hence the time occupied by their somnambulic vigor must remain a blank in memory during the waking state. But, when the original state of relative exaltation has been reproduced by a second paroxysm of disorder, if the same molecular movements be in any way renewed, the conditions of memory are fulfilled; consciousness is once more aroused as before, and the patient remembers the dream or the events of the previous attack.
