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e is in the external ear； the noises are generally absent； and the vertigo of less degree but continuous。 The prognosis varies with the location of the disease； but is always serious。
Human rumination has been known for many years。 Bartholinus； Paullinus； Blanchard； Bonet； the Ephemerides； Fabricius Hildanus； Horstius； Morgagni； Peyer； Rhodius； Vogel； Salmuth； Percy； Laurent； and others describe it。 Fabricius d'Aquapendente personally knew a victim of rumination； or； as it is generally called； merycism。 The dissection by Bartholinus of a merycol showed nothing extraordinary in the cadaver。 Winthier knew a Swede of thirty…five； in Germany； apparently healthy； but who was obliged when leaving the table to retire to some remote place where he might eject his food into his mouth again； saying that it gave him the sensation of sweetest honey。 The patient related that from his infancy he had been the subject of acid eructations； and at the age of thirty he commenced rumination as a means of relief。 To those who are interested in the older records of these cases Percy and Laurent offer the descriptions of a number of cases。
In a recent discussion before the American Neurological Association Hammond defined merycism as the functions of remastication and rumination in the human subject。 He referred to several cases； among them that of the distinguished physiologist； Brown…Sequard； who acquired the habit as a result of experiments performed upon himself。 Hammond reported a case of a young man who was the subject of merycism； and whose mental condition was also impaired。 No special treatment was undertaken； but the patient was trephined； with the purpose of improving his mental condition。 There were no unusual features connected with the operation； but it was noticed that there were no ruminations with the meals he took until the fifth day； when a slight rumination occurred。 Eight days later a similar button was removed from the corresponding side of the left skull； and from that time （about six months） to the time of report； there had been no regurgitation。 Whether the cure of the merycism in this case was directly due to the operations on the cranium； or the result of the mental improvement； is a question for discussion。 Hammond added that； when acquired； merycism was almost invariably the result of over…eating and loading the esophagus； or the result of fast eating。
In remarks upon Hammond's paper Knapp said that two cases had come to his knowledge； both in physicians； but one of them he knew of only by hearsay。 The other man； now over thirty； had regurgitated his food from early childhood； and he did not know that he had anything very unusual the matter with him until he began some investigations upon the functions and diseases of the stomach。 This man was not nervous； and was certainly not an idiot。 He had done active work as a physician； and called himself in perfect health。 He was something of an epicure； and never suffered from indigestion。 After a hearty meal the regurgitation was more marked。 Food had been regurgitated； tasting as good as when first eaten； several hours after the eating。 If he attempted to check the regurgitation he sometimes had a slight feeling of fulness in the stomach。 Lloyd said that these cases were forms of neuroses； and were types of hysteric vomiting。 There was no gustatory satisfaction connected with any form of hysteric vomiting that he had seen。 In some of these cases of hysteric vomiting the food does not appear to enter the stomach； but is rejected by a sort of spasm of the esophagus。 This has been called 〃esophagismus；〃 and is apparently closely allied to this neurosis； which some have called 〃merycism。〃 The President of the Association said that this would seem to be an affection common among physicians。 A student friend of his who had been affected in this way； had written an elaborate monograph on the subject。 He was disgusted with the habit； and finally overcame it by the exercise of his will…power。
Runge discusses three cases of hereditary rumination。 These patients belonged to three generations in the male line。 The author subjected the contents of the stomach of one patient to quite an extensive analysis； without finding any abnormality of secretion。
Wakefulness。Generally speaking； the length of time a person can go without sleep is the same as that during which he can survive without food。 Persons； particularly those of an hysteric nature； are prone to make statements that they have not slept for many days； or that they never sleep at all； but a careful examination and watch during the night over these patients show that they have at least been in a drowsy； somnolent condition； which is in a measure physiologically equivalent to sleep。 Accounts of long periods of wakefulness arise from time to time； but a careful examination would doubtless disprove them。 As typical of these accounts； we quote one from Anderson； Indiana； December 11； 1895：
〃David Jones of this city； who attracted the attention of the entire medical profession two years ago by a sleepless spell of ninety…three days； and last year by another spell which extended over one hundred and thirty…one days； is beginning on another which he fears will be more serious than the preceding ones。 He was put on the circuit jury three weeks ago； and counting to…day has not slept for twenty days and nights。 He eats and talks as well as usual； and is full of business and activity。 He does not experience any bad effects whatever from the spell； nor did he during his one hundred and thirty…one days。 During that spell he attended to all of his farm business。 He says now that he feels as though he never will sleep again。 He does not seem to bother himself about the prospects of a long and tedious wake。 He cannot attribute it to any one thing； but thinks that it was probably superinduced by his use of tobacco while young。〃
Somnambulism； or； as it has been called； noctambulation； is a curious phase of nocturnal cerebration analogous to the hypnotic state； or double consciousness occasionally observed in epileptics。 Both Hippocrates and Aristotle discuss somnambulism； and it is said that the physician Galen was a victim of this habit。 Horstius； ab Heers； and many others of the older writers recorded interesting examples of this phenomenon。 Schenck remarks on the particular way in which somnambulists seem to escape injury。 Haller； Hoffmann； Gassendi； Caelius Rhodiginus； Pinel； Hechler； Bohn； Richter；in fact nearly all the ancient physiologists and anatomists have written on this subject。 The marvelous manifestations of somnambulism are still among the more surprising phenomena with which science has to deal。 That a person deeply immersed in thought should walk and talk while apparently unconscious； excites no surprise； but that anyone should when fast asleep perform a series of complicated actions which undoubtedly demand the assistance of the senses is marvelous indeed。 Often he will rise in the night； walk from room to room； go out on porticoes； and in some cases on steep roofs； where he would not dare to venture while awake。 Frequently he will wander for hours through streets and fields； returning home and to bed without knowledg