Beard's9 theory of trance is that it is “a functional disease of the nervous system in which the cerebral activity is concentrated in some limited region of the brain, with suspension of the activity of the rest of the brain, and consequent loss of volition. Like other functional nervous diseases, it may be induced either physically or psychically—that is, by all the influences that act on the nervous system or on the mind; more frequently the latter, sometimes both combined.”
9 Quoted by Crothers in Quarterly Journal of Inebriety, January, 1880.
T. D. Crothers10 has contributed some papers upon the subject of the trance state in inebriety. He gives the clinical history of some cases of inebriety which presented the phenomena of cerebral automatism or trance. He concludes that loss of memory and consciousness may come on in inebriety and the patient give little or no evidence of his actual condition. His conclusions are, that when the trance state is established beyond doubt the individual is irresponsible for his acts during this period. The study of the trance state in affections of such definite origin and positive pathology as inebriety helps to throw light upon its occurrence and explanation in cases of hysteria.
10 “Cerebral Trance; or, Loss of Consciousness and Memory in Inebriety,” Quarterly Journal of Inebriety, January, 1880; and The Trance State in Inebriety: its Medico-Legal Relations; with an Introduction on the Nature and Character of the Trance State, by George M. Beard, M.D., a paper read before the New York Medico-Legal Society, November 2, 1881, Hartford, Conn., 1882.
Dana11 reports about fifty cases of prolonged morbid somnolence. Nearly all those reported previous to 1878 are cases of what has been termed trance-like sleep or lethargy. In 1878, Gelineau called attention to a disease which he termed narcolepsy. Dana has seen five cases, and reports two others from notes furnished by Putzel of New York. Some of the cases collected are both interesting and remarkable. Dana calls attention to the distinction made by Briquet between prolonged hysteria and lethargy. In lethargy the condition of unconsciousness is generally more profound, the reflexes are abolished, and the patient cannot be aroused. A patient may even have periods of sleep within the lethargy.
11 “Morbid Drowsiness and Somnolence,” Journ. of Nervous and Mental Disease, vol. xi., No. 2, April 18, 1884.
Dana excludes from his cases of prolonged somnolence those cases of drowsiness due to ordinary causes, as old age, diseased blood-vessels, cerebral malnutrition, or inflammation; various toxæmiæ, as malaria, uræmia, colæmia, and syphilis; dyspepsia, diabetes, obesity, insolation, cerebral anæmia and hyperæmia, cerebral tumors and cranial injuries, exhausting diseases, and the sleeping sickness of Africa.
He found that the prolonged somnolence shows itself in very different ways. Sometimes the patient suffers from simply a great prolongation of natural sleep; sometimes from a constant, persistent drowsiness, which he is often obliged to yield to; sometimes from frequent brief attacks of somnolence, not being drowsy in the intermission; sometimes from single or repeated prolonged lethargic attacks; finally, sometimes from periodical attacks of profound somnolence or lethargy which last for days, weeks, or months.
He says that most cases of functional morbid somnolence are closely related to the epileptic or hysterical diathesis; but a class of cases is met with in which no history or evidence of epilepsy or hysteria can be adduced, and though they may be called epileptoid or hysteroid, these designations are simply makeshifts; the patients seem to be the victims of a special morbid hypnosis. Possibly they have a cerebral hyperæmia or anæmia.
Under the name of morbid somnolence a case has been reported by P. J. Cremen.12 The patient was a man fifty-five years old, who was admitted to the hospital under the care of Cremen. He said he had recently returned from America, where he had taken a drink which had affected his head. He went to bed, and the next morning was found in a deep sleep, from which he could not be aroused. He presented the appearance of a person in a sound sleep or under the influence of anæsthetics. All ordinary measures were unavailing to awaken him from his trance-like condition. He was completely analgesic over the entire surface of the body. He would not eat or drink when simply directed, but when the drinking-cup was placed in his hand he drank, and when bread or meat was given he ate. Subsequently he was seen eating while in the somnolent state with the eyes closed; but after a time he would stop, and had to be urged to commence again. Evidently, tactile sensibility was not lost. The muscular sense appeared to be diminished. The superficial reflexes were abolished, the knee-jerks exaggerated; ankle clonus was absent. Smell and taste were obtunded. Hearing was retained. The state of muscular rigidity during the somnolence was remarkable. He was placed between two chairs, the tip of the shoulder resting upon one chair, the heel of the left foot on the other, and the right leg bent at a right angle to the trunk. A weight of forty pounds was then supported on the rigid chest without causing the slightest yielding or movement from the position described until muscular relaxation took place. He often remained in this state for four or five days at a time or longer. He could be aroused by a strong magneto-electric current. In the intervals between the attacks he was sometimes bright and cheerful, at others gloomy and depressed. When requested to walk, he would do so in a perfectly straight line, from which he would not deviate for obstacles. When told to walk around a table, however, or other obstacle, he would do so. He would try to do anything that he was told, even to standing on his head. The somnolent or hypnotic state could be induced at will by closing the eyelids and pressing the eyeballs for about two minutes. Of the genuineness of the phenomena Cremen had no doubt; he believed that the somnolence partook, in some degree, of the nature of that which has been designated narcolepsy. This case in many respects is similar to cases of catalepsy and automatism at command. A very similar case has been reported in the article on Catalepsy.