ANOMALOUS NERVOUS AND MENTAL DISEASES. 2 page

characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium,

and various other phenomena. It is also called aural or auditory

vertigo. The salient symptom is vertigo, and this varies somewhat in

degree according to the portions of the ear affected. If the disease is

in the labyrinth, the patient is supposed to stagger to one side, and

the vertigo is paroxysmal, varying to such a degree as to cause simple

reeling, or falling as if shot. Gray reports the history of a patient

with this sensational record: He had been a peasant in Ireland, and one

day crossing one of the wide moors in a dog-cart, he was suddenly, as

he thought, struck a violent blow from behind, so that he believed that

he lost consciousness for some time. At all events, when he was able to

get up he found his horse and cart some distance off, and, of course,

not a soul in sight. Under the belief that he had been struck by some

enemy he went quietly home and said nothing about it. Some time

afterward, however, in crossing another lonely place he had a similar

experience, and as he came to the conclusion that nobody could have

been near him, he made up his mind that it was some malevolent stroke

of the devil and he consulted a priest who agreed with him in his

belief, and gave him an amulet to wear. A series of similar attacks

occurred and puzzled as to whether there was some diabolical agency at

work, or whether he was the victim of some conspiracy, he emigrated to

America; for several months he had no attacks. A new paroxysm occurring

he consulted Gray, who found indubitable evidence of labyrinthine

disease. The paroxysms of this disease are usually accompanied by

nausea and vomiting, and on account of the paleness of the face, and

the cold, clammy perspiration, attacks have frequently been mistaken

for apoplexy. In disease of the middle ear the attacks are continuous

rather than paroxysmal. If the disease is in the middle or internal

ears, loud noises are generally heard, but if the disease is in the

external ear, the noises are generally absent, and the vertigo of less

degree but continuous. The prognosis varies with the location of the

disease, but is always serious.

Human rumination has been known for many years. Bartholinus, Paullinus,

Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius,

Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others

describe it. Fabricius d'Aquapendente personally knew a victim of

rumination, or, as it is generally called, merycism. The dissection by

Bartholinus of a merycol showed nothing extraordinary in the cadaver.

Winthier knew a Swede of thirty-five, in Germany, apparently healthy,

but who was obliged when leaving the table to retire to some remote

place where he might eject his food into his mouth again, saying that

it gave him the sensation of sweetest honey. The patient related that

from his infancy he had been the subject of acid eructations, and at

the age of thirty he commenced rumination as a means of relief. To

those who are interested in the older records of these cases Percy and

Laurent offer the descriptions of a number of cases.

In a recent discussion before the American Neurological Association

Hammond defined merycism as the functions of remastication and

rumination in the human subject. He referred to several cases, among

them that of the distinguished physiologist, Brown-Sequard, who

acquired the habit as a result of experiments performed upon himself.

Hammond reported a case of a young man who was the subject of merycism,

and whose mental condition was also impaired. No special treatment was

undertaken, but the patient was trephined, with the purpose of

improving his mental condition. There were no unusual features

connected with the operation, but it was noticed that there were no

ruminations with the meals he took until the fifth day, when a slight

rumination occurred. Eight days later a similar button was removed from

the corresponding side of the left skull, and from that time (about six

months) to the time of report, there had been no regurgitation. Whether

the cure of the merycism in this case was directly due to the

operations on the cranium, or the result of the mental improvement, is

a question for discussion. Hammond added that, when acquired, merycism

was almost invariably the result of over-eating and loading the

esophagus, or the result of fast eating.

In remarks upon Hammond's paper Knapp said that two cases had come to

his knowledge, both in physicians, but one of them he knew of only by

hearsay. The other man, now over thirty, had regurgitated his food from

early childhood, and he did not know that he had anything very unusual

the matter with him until he began some investigations upon the

functions and diseases of the stomach. This man was not nervous, and

was certainly not an idiot. He had done active work as a physician, and

called himself in perfect health. He was something of an epicure, and

never suffered from indigestion. After a hearty meal the regurgitation

was more marked. Food had been regurgitated, tasting as good as when

first eaten, several hours after the eating. If he attempted to check

the regurgitation he sometimes had a slight feeling of fulness in the

stomach. Lloyd said that these cases were forms of neuroses, and were

types of hysteric vomiting. There was no gustatory satisfaction

connected with any form of hysteric vomiting that he had seen. In some

of these cases of hysteric vomiting the food does not appear to enter

the stomach, but is rejected by a sort of spasm of the esophagus. This

has been called "esophagismus," and is apparently closely allied to

this neurosis, which some have called "merycism." The President of the

Association said that this would seem to be an affection common among

physicians. A student friend of his who had been affected in this way,

had written an elaborate monograph on the subject. He was disgusted

with the habit, and finally overcame it by the exercise of his

will-power.

Runge discusses three cases of hereditary rumination. These patients

belonged to three generations in the male line. The author subjected

the contents of the stomach of one patient to quite an extensive

analysis, without finding any abnormality of secretion.

Wakefulness.--Generally speaking, the length of time a person can go

without sleep is the same as that during which he can survive without

food. Persons, particularly those of an hysteric nature, are prone to

make statements that they have not slept for many days, or that they

never sleep at all, but a careful examination and watch during the

night over these patients show that they have at least been in a

drowsy, somnolent condition, which is in a measure physiologically

equivalent to sleep. Accounts of long periods of wakefulness arise from

time to time, but a careful examination would doubtless disprove them.

As typical of these accounts, we quote one from Anderson, Indiana,

December 11, 1895:--

"David Jones of this city, who attracted the attention of the entire

medical profession two years ago by a sleepless spell of ninety-three

days, and last year by another spell which extended over one hundred

and thirty-one days, is beginning on another which he fears will be

more serious than the preceding ones. He was put on the circuit jury

three weeks ago, and counting to-day has not slept for twenty days and

nights. He eats and talks as well as usual, and is full of business and

activity. He does not experience any bad effects whatever from the

spell, nor did he during his one hundred and thirty-one days. During

that spell he attended to all of his farm business. He says now that he

feels as though he never will sleep again. He does not seem to bother

himself about the prospects of a long and tedious wake. He cannot

attribute it to any one thing, but thinks that it was probably

superinduced by his use of tobacco while young."

Somnambulism, or, as it has been called, noctambulation, is a curious

phase of nocturnal cerebration analogous to the hypnotic state, or

double consciousness occasionally observed in epileptics. Both

Hippocrates and Aristotle discuss somnambulism, and it is said that the

physician Galen was a victim of this habit. Horstius, ab Heers, and

many others of the older writers recorded interesting examples of this

phenomenon. Schenck remarks on the particular way in which

somnambulists seem to escape injury. Haller, Hoffmann, Gassendi,

Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all

the ancient physiologists and anatomists have written on this subject.

The marvelous manifestations of somnambulism are still among the more

surprising phenomena with which science has to deal. That a person

deeply immersed in thought should walk and talk while apparently

unconscious, excites no surprise, but that anyone should when fast

asleep perform a series of complicated actions which undoubtedly demand

the assistance of the senses is marvelous indeed. Often he will rise in

the night, walk from room to room, go out on porticoes, and in some

cases on steep roofs, where he would not dare to venture while awake.

Frequently he will wander for hours through streets and fields,

returning home and to bed without knowledge of anything having

transpired.

The state of the eyes during somnambulism varies considerably. They

are sometimes closed, sometimes half-closed, and frequently quite open;

the pupil is sometimes widely dilated, sometimes contracted, sometimes

natural, and for the most part insensible to light.

Somnambulism seems to be hereditary. Willis cites an example in which

the father and the children were somnambulists, and in other cases

several individuals in the same family have been afflicted. Horstius

gives a history of three young brothers who became somnambulistic at

the same epoch. A remarkable instance of somnambulism was the case of a

lad of sixteen and a half years who, in an attack of somnambulism, went

to the stable, saddled his horse, asked for his whip, and disputed with

the toll-keeper about his fare, and when he awoke had no recollection

whatever of his acts, having been altogether an hour in his trance.

Marville quotes the case of an Italian of thirty, melancholic, and a

deep thinker, who was observed one evening in his bed. It was seen that

he slept with his eyes open but fixed and immovable. His hands were

cold, and his pulse extremely slow. At midnight he brusquely tore the

curtains of his bed aside, dressed himself, went to his stable, and

mounted a horse. Finding the gate of the court yard closed he opened it

with the aid of a large stone. Soon he dismounted, went to a billiard

room, and simulated all the movements of one playing. In another room

he struck with his empty hands a harpsichord, and finally returned to

his bed. He appeared to be irritated when anybody made a noise, but a

light placed under his nose was apparently unnoticed. He awoke if his

feet were tickled, or if a horn was blown in his ear. Tissot transmits

to us the example of a medical student who arose in the night, pursued

his studies, and returned to bed without awaking; and there is another

record of an ecclesiastic who finished his sermon in his sleep.

The Archbishop of Bordeaux attests the case of a young ecclesiastic who

was in the habit of getting up during the night in a state of

somnambulism, taking pen, ink, and paper, and composing and writing

sermons. When he had finished a page he would read aloud what he had

written and correct it. In order to ascertain whether the somnambulist

made any use of his eyes the Archbishop held a piece of cardboard under

his chin to prevent his seeing the paper upon which he was writing. He

continued to write without being in the slightest degree incommoded. In

this state he also copied out pieces of music, and when it happened

that the words were written in too large characters and did not stand

over the corresponding notes he perceived his error, blotted them out,

and wrote them over again with great exactness.

Negretti, a sleep-walker, sometimes carried a candle about with him as

if to furnish him light in his employment, but when a bottle was

substituted he carried it, fancying that he had the candle. Another

somnambulist, Castelli, was found by Dr. Sloane translating Italian and

French and looking out words in his dictionary. His candle was

purposely extinguished, whereupon he immediately began groping about,

as if in the dark, and, although other lighted candles were in the

room, he did not resume his occupation until he had relighted his

candle at the fire. He was insensible to the light of every candle

excepting the one upon which his attention was fixed.

Tuke tells of a school-boy who being unable to master a school-problem

in geometry retired to bed still thinking of the subject; he was found

late at night by his instructor on his knees pointing from spot to spot

as though he were at the blackboard. He was so absorbed that he paid no

attention to the light of the candle, nor to the speech addressed to

him. The next morning the teacher asked him if he had finished his

problem, and he replied that he had, having dreamt it and remembered

the dream. There are many such stories on record. Quoted by Gray,

Mesnet speaks of a suicidal attempt made in his presence by a

somnambulistic woman. She made a noose of her apron, fastened one end

to a chair and the other to the top of a window. She then kneeled down

in prayer, made the sign of the cross, mounted a stool, and tried to

hang herself. Mesnet, scientific to the utmost, allowed her to hang as

long as he dared, and then stopped the performance. At another time she

attempted to kill herself by violently throwing herself on the floor

after having failed to fling herself out of the window. At still

another time she tried poison, filling a glass with water, putting

several coins into it, and hiding it after bidding farewell to her

family in writing; the next night, when she was again somnambulistic,

she changed her mind once more, writing to her family explaining her

change of purpose. Mesnet relates some interesting experiments made

upon a French sergeant in a condition of somnambulism, demonstrating

the excitation of ideas in the mind through the sense of touch in the

extremities. This soldier touched a table, passed his hands over it,

and finding nothing on it, opened the drawer, took out a pen, found

paper and an inkstand, and taking a chair he sat down and wrote to his

commanding officer speaking of his bravery, and asking for a medal. A

thick metallic plate was then placed before his eyes so as to

completely intercept vision. After a few minutes, during which he

wrote a few words with a jumbled stroke, he stopped, but without any

petulance. The plate was removed and he went on writing. Somnambulism

may assume such a serious phase as to result in the commission of

murder. There is a case of a man of twenty-seven, of steady habits, who

killed his child when in a state of somnambulism. He was put on trial

for murder, and some of the most remarkable facts of his somnambulistic

feats were elicited in the evidence. It is said that once when a boy he

arose at night while asleep, dressed himself; took a pitcher and went

for milk to a neighboring farm, as was his custom. At another time he

worked in a lumber-yard in a rain-storm while asleep. Again, when about

twenty-one, he was seen in a mill-pond wading about attempting to save

his sister who he imagined was drowning. The worst phase of his

somnambulism was the impending fears and terrible visions to which he

was subjected. Sometimes he would imagine that the house was on fire

and the walls about to fall upon him, or that a wild beast was

attacking his wife and child; and he would fight, screaming

inarticulately all the while. He would chase the imaginary beast about

the room, and in fact had grasped one of his companions, apparently

believing he was in a struggle with a wild beast. He had often injured

himself in these struggles, and had often attacked his father, his

wife, sister, fellow-lodgers, and while confined in jail he attacked

one of his fellow-prisoners. His eyes would always be wide open and

staring; he was always able to avoid pieces of furniture which were in

his way, and he occasionally threw them at his visionary enemies. At

the time of the murder of his child, in a somnambulistic attack, he

imagined that he saw a wild beast rise up from the floor and fly at his

child, a babe of eighteen months. He sprang at the beast and dashed it

to the ground, and when awakened, to his horror and overwhelming grief

he found that he had killed his beloved baby. A similar record has

been reported of a student who attempted during the night to stab his

teacher; the man was disarmed and locked up in another portion of the

building; but he had not the slightest remembrance of the events of the

night.

Yellowlees speaks of homicide by a somnambulist. According to a

prominent New York paper, one of the most singular and at the same time

sad cases of somnambulism occurred a few years ago near Bakersville,

N.C. A young man there named Garland had been in the habit of walking

in his sleep since childhood. Like most other sleep-walkers when

unmolested, his ramblings had been without harm to himself or others.

Consequently his wife paid little attention to them. But finally he

began to stay away from the house longer than usual and always returned

soaking wet. His wife followed him one night. Leaving his home he

followed the highway until he came to a rough, narrow pig-trail leading

to the Tow River. His wife followed with difficulty, as he picked his

way through the tangled forest, over stones and fallen trees and along

the sides of precipitous cliffs. For more than a mile the sleeper

trudged on until he came to a large poplar tree, which had fallen with

its topmost branches far out in the river. Walking on the log until he

came to a large limb extending over the water, he got down on his hands

and knees and began crawling out on it. The frightened wife screamed,

calling to him to wake up and come back. He was awakened by the cries,

fell into the river, and was drowned. Each night for weeks he had been

taking that perilous trip, crawling out on the limb, leaping from it

into the river, swimming to the shore, and returning home unconscious

of anything having happened.

Dreams, nightmare, and night terrors form too extensive a subject and

one too well known to be discussed at length here, but it might be well

to mention that sometimes dreams are said to be pathognomonic or

prodromal of approaching disease. Cerebral hemorrhage has often been

preceded by dreams of frightful calamities, and intermittent fever is

often announced by persistent and terrifying dreams. Hammond has

collected a large number of these prodromic dreams, seeming to indicate

that before the recognizable symptoms of disease present themselves a

variety of morbid dreams may occur. According to Dana, Albers says:

"Frightful dreams are signs of cerebral congestion. Dreams about fire

are, in women, signs of impending hemorrhage. Dreams about blood and

red objects are signs of inflammatory conditions. Dreams of distorted

forms are frequently a sign of abdominal obstruction and diseases of

the liver."

Catalepsy, trance, and lethargy, lasting for days or weeks, are really

examples of spontaneously developed mesmeric sleep in hysteric patients

or subjects of incipient insanity. If the phenomenon in these cases

takes the form of catalepsy there is a waxy-like rigidity of the

muscles which will allow the limbs to be placed in various positions,

and maintain them so for minutes or even hours. In lethargy or

trance-states the patient may be plunged into a deep and prolonged

unconsciousness lasting from a few hours to several years. It is in

this condition that the lay journals find argument for their stories of

premature burial, and from the same source the fabulous "sleeping

girls" of the newspapers arise. Dana says that some persons are in the

habit of going into a mesmeric sleep spontaneously. In these states

there may be a lowering of bodily temperature, a retarding of the

respiration and heart-action, and excessive sluggishness of the action

of the bowels. The patients can hear and may respond to suggestions,

though apparently insensible to painful impressions, and do not appear

to smell, taste, or see; the eyes are closed, turned upward, and the

pupils contracted as in normal sleep.

This subject has been investigated by such authorities as Weir Mitchell

and Hammond, and medical literature is full of interesting cases, many

differing in the physiologic phenomena exhibited; some of the most

striking of these will be quoted. Van Kasthoven of Leyden reports a

strange case of a peasant of Wolkwig who, it is alleged, fell asleep on

June 29, 1706, awakening on January 11, 1707, only to fall asleep again

until March 15th of the same year. Tuke has resurrected the remarkable

case reported by Arnold of Leicester, early in this century. The

patient's name was John Engelbrecht. This man passed into a condition

of catalepsy in which he heard everything about him distinctly, but in

his imagination he seemed to have passed away to another world, this

condition coming on with a suddenness which he describes as with "far

more swiftness than any arrow can fly when discharged from a

cross-bow." He also lost his sensation from the head downward, and

recovered it in the opposite direction. At Bologna there was observed

the case of a young female who after a profound grief had for forty-two

successive days a state of catalepsy lasting from midday to midnight.

Muller of Lowenburg records a case of lethargy in a young female,

following a sudden fright in her fourteenth year, and abrupt

suppression of menstruation. This girl was really in a sleep for four

years. In the first year she was awake from one minute to six hours

during the day. In the second and third years she averaged four hours

wakefulness in ninety-six hours. She took very little nourishment and

sometimes had no bowel-movement for sixteen days. Scull reports the

history of a man of twenty-seven suffering with incipient phthisis, who

remained bedridden and in a state of unconsciousness for fifteen

months. One day while being fed he spoke out and asked for a glass of

water in his usual manner, and so frightened his sister that she ran

from the room. The man had remembered nothing that had occurred during

the fifteen months, and asked who was president and seemed eager for

news. One curious fact was that he remembered a field of oats which was

just sprouting about the time he fell in the trance. The same field

was now standing in corn knee-high. After his recovery from the trance

he rapidly became worse and died in eighteen months. There is a record

of a man near Rochester, N.Y., who slept for five years, never waking

for more than sixteen hours at a time, and then only at intervals of

six weeks or over. When seized with his trance he weighed 160, but he

dwindled down to 90 pounds. He passed urine once or twice a day, and

had a stool once in from six to twenty days. Even such severe treatment

as counter-irritation proved of no avail. Gunson mentions a man of

forty-four, a healthy farmer, who, after being very wet and not

changing his clothes, contracted a severe cold and entered into a long

and deep sleep lasting for twelve hours at a time, during which it was

impossible to waken him. This attack lasted eight or nine months, but

in 1848 there was a recurrence accompanied by a slight trismus which

lasted over eighteen months, and again in 1860 he was subjected to

periods of sleep lasting over twenty-four hours at a time. Blaudet

describes a young woman of eighteen who slept forty days, and again

after her marriage in her twentieth year she slept for fifty days; it

was necessary to draw a tooth to feed her. Four years later, on Easter

day, 1862, she became insensible for twelve months, with the exception

of the eighth day, when she awoke and ate at the table, but fell asleep

in the chair. Her sleep was so deep that nothing seemed to disturb her;

her pulse was slow, the respirations scarcely perceptible, and there

were apparently no evacuations.

Weir Mitchell collected 18 cases of protracted sleep, the longest

continuing uninterruptedly for six months. Chilton's case lasted

seventeen weeks. Six of the 18 cases passed a large part of each day in

sleep, one case twenty-one hours, and another twenty-three hours. The

patients were below middle life; ten were females, seven males, and one

was a child whose sex was not given. Eight of the 18 recovered easily

and completely, two recovered with loss of intellect, one fell a victim

to apoplexy four months after awakening, one recovered with insomnia as

a sequel, and four died in sleep. One recovered suddenly after six

months' sleep and began to talk, resuming the train of thought where it

had been interrupted by slumber. Mitchell reports a case in an

unmarried woman of forty-five. She was a seamstress of dark complexion

and never had any previous symptoms. On July 20, 1865, she became

seasick in a gale of wind on the Hudson, and this was followed by an

occasional loss of sight and by giddiness. Finally, in November she

slept from Wednesday night to Monday at noon, and died a few days

later. Jones of New Orleans relates the case of a girl of twenty-seven

who had been asleep for the last eighteen years, only waking at certain

intervals, and then remaining awake from seven to ten minutes. The

sleep commenced at the age of nine, after repeated large doses of

quinin and morphin. Periods of consciousness were regular, waking at 6

A.M. and every hour thereafter until noon, then at 3 P.M., again at

sunset, and at 9 P.M., and once or twice before morning. The sleep was

deep, and nothing seemed to arouse her. Gairdner mentions the case of a

woman who, for one hundred and sixty days, remained in a lethargic

stupor, being only a mindless automaton. Her life was maintained by

means of the stomach tube. The Revue d'Hypnotisme contains the report

of a young woman of twenty-five, who was completing the fourth year of

an uninterrupted trance. She began May 30, 1883, after a fright, and

on the same day, after several convulsive attacks, she fell into a

profound sleep, during which she was kept alive by small quantities of

liquid food, which she swallowed automatically. The excretions were

greatly diminished, and menstruation was suppressed. There is a case

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