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Insomnia; and Other Disorders of Sleep

Chapter 9: CHAPTER VII.
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A clinical and physiological survey of sleep and its disorders that begins with the nature and stages of sleep, bodily and mental changes during the hypnagogic state, and factors that produce natural somnolence. It analyzes causes of wakefulness, including sensory, environmental, metabolic, vascular, and nervous disorders and the effects of stimulants and narcotics. Practical remedies and interventions are reviewed—hygiene, baths, massage, electrical and topical measures, and various sedatives and stimulants—followed by guidance on managing insomnia across specific diseases and life stages. The work closes with an examination of dreaming, hallucinations, and drug- and disease-induced alterations of perception and memory.

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.

 

 


CHAPTER VII.

ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.

There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.
Hamlet.

The phenomena of somnambulism are of apparently spontaneous origin, during ordinary sleep. But from the remotest antiquity it has been known that certain persons may be thrown into an artificial sleep which closely resembles the condition of the somnambulist. Such a degree of susceptibility is not common to all persons. Heidenhain, experimenting upon his class of medical students, found only one in twelve who was thus susceptible. My own experiments lead me to think that American medical students are less easily influenced in this direction. Charcot, whose field of observation covers the inmates of the Salpêtrière Hospital, finds the best examples of the hypnotic state among the hystero-epileptic females in that asylum. To the experiments of Heidenhain, in Germany, of Braid, in England, and of Charcot, in France, we are indebted for the most thoroughly scientific observation and interpretation of the phenomena of hypnotism.

The antecedent physical condition most favorable to the development of the hypnotic state is a highly unstable constitution of the nervous system. For this reason the larger number of qualified subjects is furnished by the female sex—especially by those who possess the hysterical temperament. Frequent repetition of hypnotic exercises renders the subject still more susceptible. Heidenhain was, at first, inclined to the belief that such experiences were not prejudicial to the health of the subject, but the observations of Harting, in the University of Utrecht, and of Milne-Edwards, in Paris,[91] have demonstrated the fact of danger to the health of animals subjected to similar experiments. Hysterical patients have often exhibited considerable exhaustion after hypnotic exhibition in the hospitals of Paris (Charcot and Richer), consequently, it cannot be admitted that the practice is devoid of risk to the health of the individual.

Numerous methods of inducing the hypnotic state have been employed. The greater number consist in artificial modification of the condition of the brain through the agency of sensory impressions originated upon the periphery of the body. The simplest form of such influence is presented by the results of gentle friction of the skin with the palm of the hand or the tips of the fingers. Many an aching head has thus been relieved, many a restless sufferer soothed to sleep. In like manner, a susceptible subject may be hypnotized by any continuous and gentle excitement of the senses of sight, hearing, and touch. Concentration of the attention upon a brilliant object, like a piece of polished metal or a small mirror, especially if it be placed a little above the level of the eyes, and so near that considerable convergence of the eyeballs is necessary for distinct vision, affords a very efficient means of inducing artificial somnambulism. Certain persons may be readily hypnotized by gently pressing the eyelids together, and at the same time making slight pressure upon the eyeballs. Others pass into this condition by merely closing their eyes, and remaining motionless in a quiet room.

The phenomena of artificial somnambulism are frequently developed through the agency of impressions derived directly from the sphere of consciousness. The intellectual effort of trying to sit still and think of nothing is sometimes sufficient to induce the hypnotic state. The ordinary devices by means of which wakeful people are taught to beguile sleep, by counting, or by repeating long lists of names, etc., all belong to this category. Compulsory attention to any continuous intellectual process, like adding up a column of figures, or trying to read a dull book, is sometimes effectual. If, with these, or with similar acts of attention, be associated the expectation that something unusual is about to occur, as when the individual is aware of being the subject of an experiment, the evolution of the somnambulic condition is greatly facilitated. Thus, one of the most recent methods, consists in merely sitting, for half an hour or more, with the back towards the patient. Attention, curiosity, and expectation, are thus excited, and a susceptible person soon begins to manifest some of the numerous and various forms of the hypnotic state. Heidenhain caused one of his students thus to go to sleep in broad daylight, by simply assuring him that he should hypnotize him from a distance at a particular hour of the afternoon. The monks of Mt. Athos were accustomed to hypnotize themselves by fixing their eyes and their thoughts upon the navel; hence the reputation of omphaloscopy as an aid to ecstatic meditation.

The duration of hypnotic sleep is as variable as that of its prototype in natural somnambulism. The patient usually wakes spontaneously, after a few minutes or hours. Sometimes, however, the period of insensibility is greatly prolonged. If it be desirable to awaken the subject of experiment, a simple reversal of the movements by which sleep was induced may suffice. The paroxysm may be terminated by almost any sudden and energetic appeal to the senses, like an electric shock, a sudden illumination of the eye with vivid light, or a sharp puff of air upon the face.

The simplest phenomena connected with the hypnotic state are those transferences of cerebral perceptions which have been investigated by the Society for Psychical Research.[92] Certain sensitive persons, when blindfolded, are capable of reproducing with considerable accuracy visual images that have been impressed upon the mind of another. The sensitive subject is blindfolded and placed before a table with pencil and paper. Another person then goes out of the room, and gazes at some kind of drawing, geometrical figure, or other object selected without possibility of collusion with the subject of experiment. This person then returns to the room, and places his hand upon the head of the subject, at the same time fixing his attention upon the mental picture of the object. Presently the blindfolded subject takes the pencil and reproduces on paper a rough drawing of the object in question. In some cases it is found possible to effect this transfer of impressions without actual physical contact,—the agent merely standing behind the sensitive subject and concentrating his thought upon the selected object. Closely akin to this is the method of muscle-reading, popularly known as mind-reading. The sensitive is blindfolded, and then presses against his forehead the hand of the person by whom he is to be guided. Almost immediately a tremor pervades his muscles, and he yields all his movements to the guiding influence of the individual with whom he is in contact. If now an object be concealed in any place that is known to the agent, the concentration of that person’s attention upon the hiding place suffices to direct the “mind-reader,” who immediately drags his companion to the given locality.

The explanation of these phenomena consists in a recognition of the fact that certain persons are gifted with nervous organs which are sensitive and responsive to nervous impulses and muscular movements that are too delicate for recognition by the percipient apparatus of ordinary mankind. The more complicated forms of artificial somnambulism result from the complication and exaggeration of the results of this inordinate sensitiveness through the agency of artificial sleep. As in natural somnambulism, so in the hypnotic state, certain organs become totally anæsthetic, while the sensibility of others is wonderfully exalted. Cutaneous sensation may be completely abolished, and the patient may become utterly insensible to every painful impression. The reflex functions may be either suppressed or exaggerated, and the special senses of sight and hearing may be exalted to the highest degree. While in this condition the hyperæsthetic condition of the brain renders the subject peculiarly susceptible to impressions from the will of another, so that all his actions are obedient to the guiding influence of the person under whose control he has passed.

According to Charcot,[93] three principal types of artificial somnambulism may be remarked among the hysterical subjects upon whom he experimented: (1) the cataleptic, (2) the lethargic, and (3) the somnambulic. Of these the first may be developed primarily by any abrupt and powerful impression upon a sensory organ. Gazing upon a brilliant light, fixing the eyes upon a piece of polished metal, or upon the shining eyes of a second person, the sudden clangor of a Chinese gong, may suffice to induce the cataleptic state. Dumontpallier[94] reports the case of a young woman who accidentally hypnotized herself by gazing into the mirror before which she was dressing her hair. This cataleptic state may also be secondarily induced by merely opening the eyes of a patient in whom a condition of hypnotic lethargy has been previously developed. If only one eye be thus opened, the corresponding side of the body alone becomes cataleptic. Closing the eyes causes the disappearance of this symptom, with complete restoration of the purely lethargic state. During the cataleptic condition the several tendinous reflexes disappear, neuro-muscular hyper-excitability ceases, the skin becomes insensible, but the special senses, particularly those of sight and hearing, maintain a partial activity. In this half-awakened state the senses may become avenues of suggestion from without for the production of movements; but, if left to themselves, the limbs remain motionless.

The lethargic state may be induced by simply pressing together the eyelids of the subject, or by causing him to fix his gaze upon some definite object. The paroxysm begins with a deep inspiration, causing a peculiar laryngeal sound, followed sometimes by the appearance of a little foam on the lips. The eyelids are either wholly or partially closed, and are in a state of continual tremulous motion. The eyeballs are generally turned upwards and inwards. The muscles are completely relaxed. The tendinous reflexes are exaggerated; pressure over a muscle, or upon a nerve, arouses a peculiar contracture of synergic muscles and groups of muscles that are supplied by the excited nerve trunk. The facial muscles, however, do not thus become contractured; they merely contract during the application of the stimulus. If the lethargic subject be rendered cataleptic by opening the eyes, these contractures persist even after waking; and they can only be dispelled by renewing the lethargic state before resorting to pressure upon the antagonistic muscles—the process by which contractures peculiar to this species of lethargy may always be annulled. By the approach of a magnet to a contractured limb, the rigidity may be completely transferred to the corresponding muscles upon the opposite side of the body. If upon a limb of a lethargic subject who has been rendered cataleptic by opening the eyes, an Esmarch’s band be applied, pressure over the bloodless muscles excites no contracture until the band is removed. A contracture is then developed, and it may be transferred to the opposite limb by the approach of a magnet. To this phenomenon has been applied the term latent contracture.

The extraordinary muscular excitability manifested by these subjects is further illustrated by an observation recorded by Dumontpallier.[95] If one end of an India rubber tube, half an inch in diameter, and five or six yards in length, be applied over a muscle in the leg, and if the other end be in like manner connected with a watch, every movement of the second hand will be followed by a slight contraction in the muscle. The same result follows connection with the wire of a telephone; and, if a microphone be introduced into the circuit, the incidence of a ray of light upon the instrument, or even its reflection from the conjunctival surface of the eye of a spectator, will arouse a responsive muscular contraction. Charcot has also seen muscular motion upon the opposite side of the body when a mild galvanic current was applied to the parietal surface of the skull, presumably over the motor centres of the corresponding half of the brain.

During these manifestations of muscular hyper-excitability, there is complete insensibility to pain, but the senses of sight and hearing seem to preserve some degree of activity. The subject, however, does not often exhibit any susceptibility to influence by suggestion.

The somnambulic state may be directly induced by fixed attention with the eyes, by feeble and monotonous excitement of the senses, by passing the hands over the face and arms of the subject, and by many other processes of analogous character. This variety constitutes the ordinary form of hypnotic sleep. It may be very easily developed during either the lethargic or the cataleptic state as a consequence of pressure or of gentle friction upon the top of the head. Thus Heidenhain, in the course of his experiments, caused muscular paralysis by rubbing the scalp. Friction of one side of the head occasioned paralysis of the opposite side of the body without notable affection of the consciousness of the subject. The eyes and the eyelids behave as in the lethargic state. The subject seems to be asleep, but there is less muscular relaxation than in the lethargic variety. There is no exaggeration of the tendinous reflexes, and muscular hyper-excitability is absent. But by lightly touching or breathing upon the surface of a limb, its muscles may be thrown into a condition of rigidity which differs from the contracture of the lethargic state, in the fact that it does not yield to excitement of the antagonistic muscles, though yielding readily to a sudden repetition of the same form of excitement by which it was originally produced. Thus a subject under my own observation who, by pressure upon the eyeballs, was rendered insensible to every form of painful stimulation, would immediately pass into a state of perfect rigidity, if his limbs and body were rubbed for a few seconds with the palm of the hand. While in this condition, if the heels were placed upon a chair and the back of the head upon another, not only could the entire weight of the body be thus supported, but also the additional weight of another full-grown man, sitting upon his body, without causing any more yielding than if it had been a log of wood that was lying across the chairs. From the immobility of the cataleptic state this rigidity differs by its greater degree of resistance to passive motion. Though insensibility to pain may be perfectly developed in this state, there is generally an exalted condition of certain forms of cutaneous sensibility, and of the muscular sense. Strange perversions of other special senses are sometimes remarked. Thus, Cohn[96] discovered that a patient who was naturally color-blind, was able, when unilaterally hypnotized, “to distinguish colors which were otherwise undistinguishable.” Conversely, when the cataleptic state is induced, the healthy eye becomes incapable of discerning colors. Spasm of accommodation is also present, and is one of the earliest demonstrable symptoms of the hypnotic condition.

These remarkable exaggerations and perversions of sensibility have been the cause on the one hand, of much skepticism regarding the verity of the phenomena of hypnotism, and, on the other, of much credulity, extending even to a belief in the existence of supernatural and miraculous powers. The extraordinary character of these experiences is well illustrated by the following letter from Lieut. J. M. Brooke, of the United States Navy, to President Wayland, of Brown University. It may be found in “Wayland’s Intellectual Philosophy.”

Washington, Oct. 27th, 1851.

SirIt affords me pleasure to comply with your request, made through my brother William, relative to some experiments performed on board the United States steamer ‘Princeton,’ in the latter part of the year 1847, she being then on a cruise in the Mediterranean. Nathaniel Bishop, the subject of the experiments, was a mulatto, about twenty-six years of age, in good health, but of an excitable disposition. The first experiment was of the magnetic or mesmeric sleep, which overpowered him in thirty minutes from the commencement of the passes made in the ordinary way, accompanied with a steadfast gaze and effort of the will that he should sleep.

“In this state he was insensible to all voices but mine, unless I directed or willed him to hear others; he was also insensible to such amount of pain as one might inflict without injury, that is, what would have been pain to another. He would obey my directions to whistle, dance or sing. When aroused from this sleep he had no recollection of what occurred while in it. That such an influence could be exerted, I was already aware, having previously witnessed satisfactory experiments. Of clairvoyance I had never been convinced; indeed, considered it nothing but a sort of dreaming produced by the will of the operator. I became aware of its truth rather through accident than design.

“It happened, one day, that some of my brother officers asked a question which the others could not answer. Bishop, who had been a few moments before in a mesmeric sleep, gave the desired information, speaking with confidence and apparent accuracy. As the information related to something which it seemed almost impossible to know without seeing, we were very much surprised. It struck me that he might be clairvoyant; and I at once asked him to tell me the time by a watch kept in the binnacle, on the spar or upper deck, we being on the berth or lower deck. He answered correctly, as I found upon looking at the watch, allowing eight or nine seconds for time occupied in getting on deck. I then asked him many questions with regard to objects at a distance, which he answered, and, as far as I could ascertain, correctly.

“For example, one evening, while at anchor in the port of Genoa, the captain was on shore. I asked Bishop, in the presence of several officers, where the captain then was. He replied, ‘At the opera with Mr. Lester, the consul.’ ‘What does he say?’ I inquired. Bishop appeared to listen, and in a moment replied: ‘The captain tells Mr. Lester that he was much pleased with the port of Xavia; that the authorities treated him with much consideration.’ Upon this, one of the officers laughed, and said that when the captain returned he would ask him. He did so, saying, ‘Captain, we have been listening to your conversation while on shore.’ ‘Very well,’ remarked the captain, ‘what did I say?’ expecting some jest. Then the officer repeated what the captain had said of Xavia and its authorities. ‘Ah,’ said the captain, ‘who was at the opera? I did not see any of the officers there.’ The lieutenant then explained the matter. The captain confirmed its truth, and seemed much surprised, as there had been no other communication with the shore during the evening. I may remark that we touched at several ports between Xavia and Genoa.

“On another occasion, an officer being on shore, I directed Bishop to examine his pockets; he made several motions with his hands, as if actually drawing something from the officer’s pockets, saying, ‘Here is a handkerchief and a box; what a curious thing! full of little white sticks with blue ends. What are they, Mr. Brooke?’ I replied, ‘Perhaps they are matches.’ ‘So they are,’ he exclaimed. My companion, expecting the officer mentioned, went on deck, and meeting him at the gangway, asked, ‘What have you in your pockets?’ ‘Nothing,’ he replied. ‘But have you not a box of matches?’ ‘Oh, yes!’ said he. ‘How did you know it? I bought them just before I came on board. The matches are peculiar, made of white wax with blue ends.’

“The surgeons of the ‘Princeton’ ridiculed these experiments, upon which I requested one of them (Farquharson) to test for himself, which he consented to do. With some care he placed Bishop and myself in one corner of the apartment, and then took a position some ten feet distant, concealing between his hands a watch, the long hand of which traversed the dial. He first asked for a description of the watch. To which Bishop replied, ‘’Tis a funny watch, the second hand jumps.’

“The doctor then asked him to tell the minute and second, which he did; directly afterwards exclaiming, ‘The second hand has stopped!’ which was the case, Dr. Farquharson having stopped it. ‘Well,’ said the doctor, ‘to what second does it point, and to what hour, and what minute is it now?’ Bishop answered correctly, adding, ‘’Tis going again.’ He then told twice in succession the minute and second.

“The doctor was convinced, saying that it was contrary to reason, but he must believe. I then proposed that the doctor should mark; and directed Bishop to look in his mother’s house, in Lancaster, Pa., (where he had never been) for a clock; he said there was one, and told the time by it; one of the officers calculated the difference in time for the longitudes of Lancaster and Genoa, and the clock was found to agree within five minutes of the watch time.”

Such clairvoyance is very rare; in fact, it is difficult, at first thought, to believe in its existence. Nor should its alleged possession be credited in any instance until all possibility of deception has been excluded. The example just related seems to be, in this respect, one of the best, for the reason of its occurrence in a little group of men whose isolation and thorough acquaintance with each other must have reduced the chances of simulation to the lowest degree. When carefully considered, moreover, it is apparent that the exaltation of the functions of sight and of hearing in this case was not different in kind or in degree from that that has already been recorded in connection with certain cases of natural somnambulism and of dreaming. The condition of the brain is probably identical in all such instances; it is the mode of its induction that is subject to variation. The remarkable feature of the hypnotic state consists in its production at the pleasure of either the subject or of the agent under whose control he has passed; whereas the phenomena of natural somnambulism and of the clairvoyant dream occur only during sleep, and independently of the will of the patient.

Another singular fact in this connection is the receptivity of the hypnotized brain for suggestions from the minds of other persons. Usually, the patient is insensible to all communications which do not emanate from the agent by whom he is held in control; but in certain cases it is probable that the brain is more or less open to impressions of a particular sort from any source. Numerous examples illustrate the manner in which the course of an ordinary dream may be thus directed. The hypnotic dream is far more easily modified by suggestions from without. The simplest examples of this are exhibited by the hypnotized subject who walks, jumps, lies down, executes every variety of pantomime, in obedience to the commands of his director. Somewhat more complicated are the actions that are developed through excitement of the imitative faculties. Every movement of the director that can be perceived by the subject will be at once reproduced. Dr. Fischer relates[97] the case of a patient who, although exceedingly ignorant of the art of music, was able, during the hypnotic paroxysm, to sing with Jenny Lind all kinds of songs, so accurately that it was impossible to distinguish their separate voices. Expression of the various emotions and passions may also be provoked by merely placing the subject in the several attitudes characteristic of such feelings.

In the lower grades of the hypnotic state, consciousness is not abolished, and the subsequent recollection of events during the experience may be quite perfect. In such cases illusions and hallucinations, that were excited by suggestions from the controlling mind of another, survive in memory, and become the causes of serious delusion. Witness, for example, the manner in which excitable people, partially hypnotized in a so-called “spiritual circle,” believe in the reality of the illusions which have occupied their powers of perception during a “seance.” To this inferior grade of self-induced hypnotism belong all those conditions of sensory hyperæsthesia by means of which certain persons are enabled to read the hidden thoughts of others. This capacity is, essentially, a mere exaltation of that power which all mankind shares in a greater or less degree. In every instance it has been remarked that the ordinary “medium” can only respond correctly to questions for which the true answer is present in the mind of the questioner. To all other interrogatories the replies are delivered purely under the influence of random suggestion. In some cases the pathway of communication lies through actual bodily contact, as in ordinary “mind-reading,” where the invisible molecular oscillations of the muscular elements of one person serve to guide the perceptions and movements of another. But, more frequently, the transmission of ideas is effected through the action of the facial and ocular muscles. From these organs of expression the “table-rapper,” or the “planchette-writer,” reads the unspoken thoughts of the questioner, in a manner very like, yet vastly more delicate than that by which deaf mutes are taught to interpret the movements of the lips of persons with whom they converse. This fact is clearly illustrated by the experience of Maury,[98] in an interview with a celebrated table-rapper who, without the slightest hesitation, made known to him the age, name, and date of death of a brother whom he had lost. She also gave the same information regarding his father, and pronounced the names of other persons upon whom he had fixed his attention. But, if he turned away his face, or if he concealed his eyes so that the woman could no longer scrutinize their expression, her responses became entirely uncertain and destitute of conformity with fact.

The induction of the hypnotic state, if not too often repeated, is sometimes of considerable service in the relief of various functional disorders of a painful character. This fact, enthusiastically announced, many years ago, by Dr. Braid, has recently been freshly brought forward through the experiments of Fischer,[99] Wiehe,[100] Rieger,[101] and others. In our own country this method of treatment has not yet been adopted by many in the medical profession, though its efficacy in a particular class of cases is not denied. Outside of professional circles, however, it is exploited to a considerable extent under the strange misnomer of Metaphysical Healing. But, as De Watteville has truly remarked,[102] “the time is near when the curative influence of hypnotism will be submitted to the same scrutiny as its physiological and psychological import has undergone.”

 

THE END.

 

 


INDEX.