he same time there existed a more or less distinct
clouding of consciousness, with the simultaneous presence of hysterical
stigmata, especially total analgesia. After a short time recovery took
place, the patients suddenly awoke as if from a dream and evidenced a
more or less complete amnesia of the events which had transpired.

Numerous discussions concerning this disease-picture have appeared of
late years in literature. The Ganser syndrome, or twilight state, has
been enlarged upon, and several variations of this condition have been
isolated. The chief contention, however, of the various authors on this
subject seems to be whether this symptom-complex should be considered as
hysterical or whether it should be placed among the large group of
degenerative states. Both views are ably defended by prominent
psychiatrists. I have recently observed the Ganser syndrome in an
undoubted case of toxic-exhaustion psychosis.

Raecke[6] designated this disease-picture described by Moeli and Ganser
as an hysterical twilight state in psychopathic individuals. These
conditions were developed in them as the result of emotional excitement
in imprisonment. The constant hearings, the confusing cross-questioning,
the fear of punishment, finally the injurious effect of solitary
confinement, shock and weaken the slight mental tension of the prisoner
to a marked extent. As a result of this, we have on the one hand a
condition of apathy, of inability to concentrate the mind, of incapacity
to think and of a sort of feeling of being wholly at sea, accompanied by
vertigo and other nervous manifestations, while on the other hand the
physical despair, the obstinacy of the prisoner, now increase to
pathological maniacal attacks, now again are changed to stubbornness,
mutism, with refusal of food. At the same time the more or less constant
wish to be considered sick, and in consequence to be freed from
imprisonment (and in this we see perhaps the hysterical component), may
influence deleteriously and in a peculiarly modifying way the
disease-picture. The various questions put to the patient by the
examiner may act as so many suggestions. Raecke further calls attention
to the manifold similarities which these conditions may show with
catatonic processes. In these hysterical twilight states, quite aside
from mutism, negativism, and catalepsy, peculiar mannerisms were noted,
a sort of affected, childish way of speaking, motor stereotypies,
swaying of