May the 13th, Anno 1694, one Samuel Chilton, of Tinsburg near Bath, a Labourer, about 25 years of age, of a robust habit of Body, not fat, but fleshy, and a dark brown Hair, happen’d, without any visible cause, or evident sign, to fall into a very profound Sleep, out of which no Art used by those that were near him, cou’d rouze him, till after a month time; then rose of himself, put on his Cloaths, and went about his business of Husbandry as usual; slept, cou’d eat and drink as before, but spoke not one word till about a month after. All the time he slept Victuals stood by him; his Mother fearing he would be starv’d, in that sullen humour, as she thought it, put Bread and Cheese and Small Beer before him, which was spent every day, and supposed by him, tho no one ever saw him eat or drink all that time.

From this time he remained free of any drowsiness or sleepiness till about the 9th of April 1696, and then fell into his Sleeping sit again just as he did before. After some days they were prevail’d with to try what effect Medicines might have on him and accordingly one Mr Gibs, a very able Apothecary of Bath, went to him, Bled, Blister’d, Capp’d and Scarrified him, and used all the external irritating Medicines he could think on, but all to no purpose, nothing of all these making any manner of impression on him; and after the first fortnight he was never observed to open his Eyes. Victuals stood by him.

The second one is by a French physician who studied and graduated in Montpellier, France, Edmé Pierre Chauvot de Beauchêne (1786) [10].

„A girl, in her fourteenth year, was overcome with a lethargic sleep which lasted several days. From that point forward, the affection of sleep recurred at irregular intervals; it usually lasted eight to ten days, continuing at times for fifteen; and upon one sole occasion, it persisted into the seventeenth day.“

There was no typical overeating but “during the first four years of her disease this poor girl had appetite as bizarre as they were dangerous, causing her to eat lime, plaster, soil and vinegar. Thereafter, these appetites subsided, and she nourished herself indiscriminate with all sorts of aliment. This food always occasioned vomiting” (Fig. 28.3).

During the nineteenth century more cases were published. In a report read at the Royal College of Physicians of London in April 1815, and published later the same year in Medical Transitions,

“Richard Patrick Satterly described the case of a 16 year old boy who on his return from school was observed to be pale and unwell. He felt cold and complained of a frontal headache. During the following three days, his symptoms appeared to be abating; then the headache worsened, he became flushed, restless and agitated, and his pulse rate was raised. About the seventh day, the patient developed a voracious appetite…he would eat a pound-and-a-half of beef steaks, a large fowl, or a couple of rabbits, at one meal without apparently satisfying his appetite”….“The craving for food came on regularly with the paroxysms of fever, and continued unabated until that subsided, when he usually fell into a sound sleep. The period of the recurrence of the paroxysm was very uncertain, but it was marked by a distinct circumscribed redness of one or both cheeks; the moment this spot became visible, the boy would rouse himself (for he was at other times either sleeping, or dull and torpid)” [11].

Later on, in 1862, Brière de Boismont reported the case of

a child who, in a recurrent manner, slept a lot, was difficult to arouse, and as soon as he was awakened extemporaneously sang, recited, and acted with great ardor and aplomb. When he was not asleep, he ate ravenously. As soon as he got out of his bed, he would go close to another patient’s bed, and overtly seize without any scruple all the food he could find. Apart from this intriguing disease, he was intelligent and skilful [12].

From 1862 onwards, reports became more frequent. Mendel described the case of a soldier, aged 25, who had attacks of 3–5 days’ duration at a frequency of 1–2 years. There was no mention whether the patient showed excessive appetite [13]. The same applies to an adolescent girl who had her first attack while sitting in church, went home, and did not wake up for 3 days [14]. Anfimoff, a Russian physician, reported a youth of 19 years who slept deeply during the first 2 or 3 days of his attacks and then woke up frequently and went to sleep again [15]. His appetite was excellent. In dream, he saw a horse and was scared and afraid of everything. These attacks reappeared every few months.

Later on, case reports concentrated in Germany. Stöcker reported on a 21-year-old man who had experienced headache and frequent epistaxis since childhood, and who, from the ages 19 to 22 years, had recurrent attacks of sleepiness and indifference [16]. Schröder commented on a 17-year-old adolescent who periodically, at intervals of 3 months’ duration, had prolonged sleep episodes associated with transient psychological changes and indecent behavior [17]. Such episodes stopped after 3 years. Krüger reported two cases [18]. The first one was in a 44-year-old single woman with recurrent episodes of abnormal sleep at the ages 16, 19, 34, 43, and 44. She did not take any food during the second one and ate normally during the following ones. The second case was a 20-year-old man who had his first attack of sleep during his military service after a grueling day followed by three more attacks lasting for 2–5 days each time at 6–18-month intervals.

Finally, a last case report was by a Russian physician, J.W. Kanabich [19]. The patient was a 19-year-old man who had two attacks of sleepiness accompanied by restlessness, nervousness, and apathy at the age of 14 and 14.5 years.

Thus, from 1786 to 1924, 12 cases of recurrent hypersomnia were published, with an acceleration of the publications in the second half of the nineteenth century. There were nine male and three female cases. The median age of onset was 17 with a range of 12–25. Circumstances at onset included overwork in three cases [16, 18], struggle with a comrade [13], strong emotion [15], sitting in church [14], cold and fever [11], and seasickness [16] in one case each. The duration of the episodes was from 2 days to 12 weeks and the interval between episodes varied from 1 to 2 months to 15 years in one case [18]. Hypersomnia was present in all cases, overeating in four [10–12,15], disinhibited sexuality in one [17], odd behavior, childish, singing, and incoherent utterance in one [10], singing, recitation, and acting with great ardor and aplomb in one [12], agitation in one [11], psychological changes (dull, indifferent, inertia of thought, visual and auditory hallucinations, apathy) in five [15–19], mental symptom (anxiety) in one [15], dysautonomic signs in two [11, 18], and poor sleep for several nights on recovery in three [16–18]. In total, almost all the symptoms and signs later described in KLS were present in a dissociated way.