Address to the Medico-Psychological Association in Moscow by the President, Professor Mierzejewsky, on the “Mental and Nervous Diseases in Russia.”

Resuming our notice in our last number of this pamphlet we proceed to give a sketch of the interesting case which Dr. Garnier reports (vide “Journal of Mental Science,” January, 1888, page 627). Prolonged and minute examination showed that a criminal act was committed in a state of somnambulistic automatism. The patient was twenty, a dentist's pupil, and one evening entered a curiosity shop opposite his own residence, and proceeded quietly to remove a number of articles in a leisurely manner, as if he was quite at home. He carried to his own house various articles of furniture, and was only prevented by the arrival of the shopkeeper, who easily apprehended him. Stupid and dumfoundered, he at once stoutly denied the charge, and acted in a very eccentric manner. At the police-station it was observed that he had momentary fits of absence. When spoken to he no longer replied. When his name was called he did not move, and the strongest appeals did not arouse him from his torpor. He had a succession of attacks of somnambulism, and when before the magistrate was in one of them. He had been subject to similar attacks. He was the only son of a neurotic mother, who was extremely impressionable and subject to hysteria. Healthy till eleven, he then manifested grave cerebral symptoms, which were attributed, rightly or wrongly, to sunstroke. For some weeks his life was in danger; he had several convulsive attacks, and for a long after this period he was subject to attacks of somnambulism. After a time, however, he appeared to have recovered, but he retained an unhealthy condition of the nervous system, especially mental instability. At last he aspired to a great fortune, and was full of confidence in his powers. He was placed with a dentist, but he never properly applied himself to his work. In 1884 he had typhoid fever, and although it was a mild attack, its effect upon his organization was marked. His moral feelings underwent an evident change. He entirely neglected his work, became fantastic in his appearance, and was by turns exalted and apathetic. In the middle of 1885 there was much nocturnal agitation. He started up in his bed, groaned, and sometimes shouted with terror, and spoke incoherently. After a while he was seen to rise from his bed in the middle of the night, and wander about mechanically in his room. He displaced articles of furniture, or he occupied himself as if engaged in his customary occupations. He generally returned to his bed without anything happening, but at other times he had convulsive seizures. One night his parents observed him walking in his sleep, but they were afraid to interfere. Suddenly he went towards the window, opened it, and attempted to jump out. He was, however, prevented. A hystero-epileptic attack followed, and after a few minutes he awoke, without the slightest remembrance of what had occurred. After a while these attacks appeared in the day time, being characterized by strange absences or dreamy attacks in which consciousness was suspended. He would fall asleep at table, or in the middle of his work; his immobility being readily mistaken for mere apathy and idleness. He was spoken loudly to, he was shaken, etc., but all to no purpose. One day during an excursion into the country, he was found in a strange attitude, and when spoken to made no answer. They were obliged to bring him back to Paris in this state, and it was only on the morning afterwards that he became himself, when he was astonished to hear what he had done. About this time the mode of life, conversation, and conduct of X— showed that he had true mental disorder. Seized with feverish excitement, exuberant, versatile, and ambitious, he no longer attended to his duties. His excited brain became the seat of impracticable projects. He announced that he would become a great musician, at another time a doctor of eminence. For some weeks he occupied himself in attempting to carry out these projects. He suddenly quitted his family without any other motive than to escape their oversight. His extravagances increased, and criminal acts followed. At last judicial proceedings were taken against him. Such was the state of affairs when he was arrested under the circumstances already mentioned. It should be stated that he was a youth of middle stature, and fairly robust, with well-developed muscles. His step was firm, and there was nothing in his appearance to suggest a feminine temperament. He, however, was markedly emotional; he blushed easily, and there was a mixture of astonishment and vague apprehension in his expression. His conversation was inconsecutive, his explanations very confused. He complained of having been jeered at when examined at the depot, and he demanded that an end should be put to the annoyances from which he suffered. The attendants reported that he did not sleep during the night, but got up and walked about, and when requested to lie down he did not reply, but continued to walk about. “He seems like a man,” said one of the attendants, “who seeks something that he cannot find.” M. Garnier then found complete cutaneous analgesia, except two hyperæsthesic spots, about the size of a franc piece, situated symmetrically upon the back of each wrist. There was narrowing of the visual field, gustatory and olfactory anæsthesia. Circular pressure exerted upon the forearm easily caused contraction of the hand. On many occasions M. Garnier observed X— at the time of his attacks of somnambulism. The transition to morbid sleep came on instantly without warning. The return to his normal condition was different, there being frequently a violent convulsive attack with opisthotonos, contortions, frightful hallucinations, and sobbings, which terminated the attack. Sleep sometimes came on quite spontaneously, without any sensorial excitement. Sometimes it was the brilliancy of a lamp, or other brilliant object, which the patient could not look at without going to sleep. As is common with persons during somnambulism, he then becomes the prey of the automatic action of his brain, induced by the remains of impressions or ideas which had occupied him when awake. He goes, comes, and acts in a co-ordinate manner, but he is only en rapport with the external world on one side. A question without direct relation to the idea which is for the moment dominating his mind will not be heard. But if the interrogation strikes this precise point it becomes possible to enter into communication with him upon this very limited subject. X— walks in that slow and measured way peculiar to noctambules. The eyelids are half-closed; he is agitated by a continual shudder; the head is rather inclined as if watching his movements. It was to be expected that a person offering such functional troubles of the nervous system would be easily hypnotized. And, moreover, it was not without interest in the present case to institute a comparison between the symptoms of spontaneous somnambulism, and those developed under somnambulism artificially induced. As was expected, he was thrown very easily and rapidly into the condition of hypnotism by means of the usual methods. If in the attack of spontaneous somnambulism X— was master of himself (as much so as a man can be who is impelled by a blind force), and obeyed an impulse which was his own, he was artificially sent to sleep, he was at once at the mercy of the hypnotizer. From numerous experiments, conducted with every necessary precaution, he was shown to be in a state of passive obedience to suggestions of the most varied kind.

Dr. G. Rabbas (“Zeitschrift für Psychiatrie” xli. Band, 3 Heft), following out the observations of Dr. Rieger, has, in a course of careful experiments, tested the capacity of the insane for reading in progressive dementia. He found that in general paralysis the power of reading was diminished, and in the end totally destroyed, and that this incapacity commenced at an early period of the disease. The words were given wrong or altered in a senseless manner, with a faint connection with the text read, whereas in functional insanity as well as senile dementia the power of reading was long retained even in cases where the mental fatuity seemed greater than in given cases of general paralysis. When maniacs could be induced to read they read on quickly without any regard to stops or beginnings of sentences, but they generally read correctly, without alteration of the words. This early loss of reading power in general paralysis, like the alteration in writing, is of great use for a differential diagnosis.

Aberdeen,—Considerable pressure on the accommodation for pauper patients continues, but it has been diminished as far as possible by boarding out suitable cases and transferring the fatuous to workhouses. It is satisfactory to learn that the Directors have had under consideration the best method of providing the necessary buildings. including a general dining-hall, a general bath-room, and a separate chapel.