as the average, normal man.

After Aspern and after Waterloo, reality had become such, that an escape from it, via the unconsciousness of sleep, must have been welcome. That the reaction of defeat must have been more keenly felt by the young man who lost Aspern and who presented strong neurotic traits, than by the more settled man who lost Waterloo, can be easily understood.

Nansen in his Polar exile slept twenty hours a day. He certainly was not in need of rest or recuperation, for his idleness was complete, but the reality of ice and snow which kept him a prisoner, was one from which he was glad to withdraw his attention.

I personally observed two cases in which sudden fits of sleepiness could be interpreted as an escape from reality.

A gambler could go for several days and nights without sleep, provided he was winning. After a heavy loss or a period during which his earnings were offset by his losses, he would go to bed and sleep as much as four days and four nights at a time, arising once or twice a day to partake of some food and returning at once to his slumbers.

A neurotic with a strong inferiority complex was overwhelmed by sleepiness every time he encountered a defeat of a sexual or egotistic nature. After a quarrel, or whenever a discussion in which he took part turned to his disadvantage, he had to lie down and “sleep it off.”

This is probably the key to the enigma of Casper Hauser’s case. He was born in Germany at the beginning of the last century and brought up in complete solitude, in a small dark room. At the age of seventeen, he had never seen men, animals or plants, the sun, moon or stars. He then was taken out of his cell, and abandoned on the streets of Nuremberg, dazed and helpless.

All the efforts made by kind Samaritans to develop his mentality proved futile. They had only one result: to make him fall asleep. Accustomed for years to the peace, quiet and safety of his cell, he reacted to a new, troublesome and complicated environment as newly born infants do, who in incredibly long periods of sleep, in no wise explainable through fatigue, escape reality and return to the perfect happiness of the fetal state.

In certain forms of the disturbance known as sleeping sickness, people merge into a sleep which continues for weeks, months or even years, and which sometimes culminates in death. (In many cases, however, the sleepiness may be totally lacking.)

The sleeping sickness was first observed some hundred years ago on the West Coast of Africa and, since then, in an area of the African continent extending from Senegal to the Congo. Negroes are almost the only sufferers, although a few whites have been affected by this disease which, at times, extends to large numbers of the population.

According to various medical observers, the sleeping sickness usually appears among slaves doing arduous, exhausting work.

It is the individuals who stand lowest in intelligence who are most severely affected. In communities where the mental development has been retarded, imitation easily spreads the contagion and this is probably the reason why entire villages are decimated by that curious malady.

Whether the sleeping sickness is in certain cases induced by the bite of a fly or appears without obvious physical cause is immaterial.[1] Paranoia induced by syphilis is in no way different from ordinary paranoia.

Hence we are justified in linking together certain aspects of the African sleeping sickness and the lethargic ailment which affects the white races in Europe and America.

Both have the appearance of normal sleep, the only striking difference, barring certain physical syndromes, being the unusual length of the sleeping period or its onset at unusual and unexpected times.

In white subjects, narcolepsy is seldom fatal but has been known to last for years.

The most famous case on record is probably that of Karoline Ollson reported in a Salpétrière publication for 1912.

Karoline Ollson was born in 1861 in a small town of Sweden. At the age of 14, at the onset of her menstruation, she once came home complaining of toothache, went to bed and remained bedridden till 1908. For thirty-two years she slept all day and all night, waking up now and then for a few minutes, taking dim notice of happenings in her environment and speaking a few words. Two glasses of milk a day seemed to be sufficient to sustain her. She was kept for a fortnight in a hospital from which she was discharged when her ailment was diagnosed as “hysteria.”

When her mother died in 1905 she woke up and wept as long as the corpse remained in the house. Then she became quiet again and resumed her slumbers. In April, 1908, when her menstruation stopped, she woke up, left her bed and has led a normal life since.

Dr. Toedenström who describes the case states that she looked incredibly young. Two weeks after she left her bed she had become strong enough to take charge of the household.

Stekel, discussing this strange case in one of his lectures, said: “This woman spent the entire time of her womanhood in sleep, for she fell asleep at the time of her first menstruation period and her awakening coincided with her climacteric. She was a child and wished to remain a child. The first question she asked on arising, ‘Where is mama?’ shows that she was suffering from psychic infantilism. It is probable that dreams of childhood filled her thirty-year sleep and she may even have dreamt that she was still an unborn child for whom life had not yet begun.”

Medical literature contains many reports of freakish cases in which the subject falls asleep suddenly, while attending to duties of an uninteresting character; a young waiter, for instance, falling asleep while waiting on a table, remaining absolutely motionless for a whole minute and then waking up and resuming his work. Manacéine mentions two similar cases she observed personally. Both patients were illiterate and of slow intellect. One of them, a housemaid of nineteen, was a sound sleeper at night and yet, in the day time, one could never be sure of her remaining awake. She fell asleep once in the act of announcing a visitor and while bringing in a tray loaded with cups of coffee. The other was a woman of fifty, who was employed as a nurse until one day, falling asleep suddenly, she dropped an infant on the floor and almost killed him. In both the pulse was remarkably slow (a vagotonic symptom): in the girl it varied from 50 to 70 when awake, in the older woman from 40 to 60.

An epidemic of sleeping fits, lasting only a few minutes at a time, raged for several years in a small German town near Würzburg. The attacks took place at any moment and were liable to leave the patient immobilized in some curious position. It was the weaker part of the population, physically and mentally, which was affected by that curious trouble, apparently transmitted from parents to children, probably, as all neurotic complaints are, through imitation.

Stekel considers hysterical and epileptic fits as forms of morbid sleep during which hysterics gratify sexual cravings and epileptics sadistic cravings.

This is how Dr. Isador Abrahamson describes, from recent cases observed at Mount Sinai Hospital, the course of lethargic encephalitis which is one of the scientific names coined to designate the sleeping sickness:

“At the onset of the disease, there is a period of variable duration in which the patient experiences increasing