229 A. The following case is taken from the paper by Dr. Elliotson referred to in 223 A and 224 A (Zoist, vol. iv. p. 185), being quoted by him from the Northern Journal of Medicine for June 1845. The case was there reported by Dr. David Skae.

The patient was an unmarried man, in the prime of life, connected with the legal profession, regular and temperate in his habits. His complaint began with the usual symptoms of dyspepsia, passing into hypochondria and ultimately into a state between hypochondria and mental alienation. The dyspeptic symptoms had become a subject of complaint and solicitude to the patient about ten or twelve years earlier. There generally succeeded a train of morbid feelings and finally of illusions founded upon them, the sensations felt being imagined to be sufferings of a mysterious and unparalleled kind. Feelings of gloom and despondency were at the same time developed; the most trifling errors were magnified into unpardonable crimes. He began a system of reading the Bible with great zeal and rapidity; by quickly scanning the pages and turning over the leaves, he grew to believe that he read through the whole Bible once and all the metrical psalms once or twice daily. He sat up most of the night and lay in bed all day, surrounded with Bibles and Psalm-books. He also developed suicidal tendencies, but these were restrained by his natural timidity and conscientiousness.

Dr. Skae writes: -

From an early period in the history of this case it was observed that the symptoms displayed an aggravation every alternate day. This gradually became more and more marked; and for the last eighteen months the symptoms described have become distinctly periodic. On each alternate day the patient is affected in the manner just described and will neither eat, sleep, nor walk, but continues incessantly turning over the leaves of a Bible, and complaining piteously of his misery. On the intermediate days he is, comparatively speaking, quite well, enters into the domestic duties of his family, eats heartily, walks out, transacts business, assures every one he is quite well, and appears to entertain no apprehension of a return of his complaints. What is chiefly remarkable... is the sort of double existence which the individual appears to have. On those days on which he is affected with his malady, he appears to have no remembrance whatever of the previous or of any former day on which he was comparatively well, nor of any of the engagements of those days; he cannot tell whether he was out, nor what he did, nor whom he saw, nor any transaction in which he was occupied.

Neither does he anticipate any amendment on the succeeding day.... On the intermediate days... he distinctly remembers the transactions of previous days on which he was well, but appears to have little or no recollection of the occurrences of the days on which he was ill. He appears in short to have a... sort of two-fold existence, one half of which he spends in the rational enjoyment of life and discharge of its duties, and the other in a state of hopeless hypochondriacism, amounting almost to complete mental aberration.