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:
+=======================================================================+
| |Organic|Sensibility:|Imaginative|Coördinative|Consciousness|
| | Life | Motion | Faculties:| Faculties:| |
| | | | Memory, | Judgment, | |
| | | |Imagination| Attention, | |
| | | | | Volition | |
|-----------|-----------------------------------------------------------|
|Normal life|XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX |
|-----------|-----------------------------------------------------------|
|Somnambulic| |
| life |XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX |
|-----------|-----------------------------------------------------------|
|Somnambulic| |
| dream |XXXXXXXXXXXXXXXXXXXXXXXXXX |
|-----------|-----------------------------------------------------------|
|Somnambulic| |
| automatism|XXXXXXXXXXXXXX |
|-----------|-----------------------------------------------------------|
|Somnambulic| |
| lethargy |XX |
+-----------------------------------------------------------------------+
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, assafœtida, 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.