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 difficulty in attending to his work. Next a time of yawning ensues, in which there may be also the _irritability of the overtired_. Then the eyes close, _chiefly from lack of interest_.... (The patient's) pulse, temperature, and respiration may all be of a normal character.... From the depth of this seeming slumber, he may respond immediately when questioned and his _short but coherent answers_ show _no loss either of memory or of orientation_.... His answer given, he straightway resumes his seeming sleep.... _His attitude expresses a desire to be let alone_, a desire which is sometimes articulate in him.... The somnolence may deepen into a stupor from which the patient is not easily aroused to conscious repose.... In the night watches ... a restless delirium of inconstant severity often appears. Spontaneous movements and sounds are made. The movements are purposeful graspings and pointings at unseen things, tossings and turnings...."
The author adds in another part of his article that "The depth of the somnolence and also its duration are unrelated to the severity of the cerebral lesions.... _The extent of the mental disturbance bears no correspondence to the extent of the lesions_, the amount of fever or the blood picture...." [Italics mine.]
We have a perfect picture of a flight from reality into a somnolence into which the unconscious complexes force at times a terrifying presentation of the dreaded reality through nightmares.
The few cases of sleeping sickness reported in recent medical literature show a decided neurotic trend in the subjects affected and reveal circumstances in the patient's life which would make a flight from reality highly desirable.
One typical case reported to me by a Boston physician who personally considers the sleeping sickness as being "unquestionably an acute organic disease of the cerebro-spinal system" has all the earmarks of a neurotic affection: