If the primary presentation disappears, or if it is never conscious at all, and if the automatic development overlaps neighbouring regions, we lose every possibility of a demarcation between waking automatisms and those of the somnambulic state; this will occur, for instance, if the presentation of a hand plucking the flower gets joined to the perception of the flower or the presentation of the smell of the flower. We can then only differentiate it by the more or less. In one case we then speak of the "waking hallucinations of the normal," in the other, of the dream-vision of the somnambulists. The interpretation of our patient's attacks as hysterical becomes more certain by the demonstration of a probably psychogenic origin of the hallucination. This is confirmed by her troubles, headache and teno-synovitis, which have shown themselves amenable to suggestive treatment. The ætiological factor alone is not sufficient for the diagnosis of hysteria; it might really be expected _a priori_ that in the course of a disease which is so suitably treated by rest, as in the treatment of an exhaustion-state, features would be observed here and there which could be interpreted as manifestations of exhaustion. The question arises whether the early lapses and later somnambulic attacks could not be conceived as states of exhaustion, so-called "neurasthenic crises." We know that in the realm of psychopathic mental deficiency there can arise the most diverse epileptoid accidents, whose classification under epilepsy or hysteria is at least doubtful. To quote C. Westphal: "On the basis of numerous observations, I maintain that the so-called epileptoid attacks form one of the most universal and commonest symptoms in the group of diseases which we reckon among the mental diseases and neuropathies; the mere appearance of one or more epileptic or epileptoid attacks is not decisive for its course and prognosis. As mentioned, I have used the concept of epileptoid in the widest sense for the attack itself."[15] The epileptoid moments of our case are not far to seek; the objection can, however, be raised that the colouring of the whole picture is hysterical in the extreme. Against this, however, it must be stated that every somnambulism is not _eo ipso_ hysterical. Occasionally states occur in typical epilepsy which to experts seem parallel with somnambulic states,[16] or which can only be distinguished by the existence of genuine convulsions.[17] As Diehl shows,[18] in neurasthenic mental deficiency crises also occur which often confuse the diagnosis. A definite presentation-content can even create a stereotyped repetition in the individual crisis. Lately Mörchen has published a case of epileptoid neurasthenic twilight state.[19] I am indebted to Professor Bleuler for the report of the following case:--