had gained such considerable strength, that the power of volition has been
partially recovered for some time before the paroxysm ceases. I have
always recovered this power, first in the lower extremities, and last of
all in the head. It begins first to return in one or both feet, and by
moving them about as well as circumstances will allow, I recover by
degrees the command over the muscles of the legs and thighs, and
afterwards of the arms, but partially, and not without great exertion,
which exhausts me much, and does little good towards shaking off the
paroxysm. I have however at sea frequently profited by this power, for I
have been able to communicate a considerable motion to the cot in which I
slept, by pushing against the foot of it with one of my feet, until it
swung so much as to touch against something, and by that means produce a
shock, which being external, has frequently dispelled the fit. It is
really surprizing how slight an impression from without is sufficient
sometimes to recover the patient. Although I have frequently rolled about
the bed, and kicked all the bed-clothes off from me, I have not been able
to succeed for a long time in recovering myself from the paroxysm, when it
has instantly disappeared on receiving a moderate shock from another
person, or even by any one taking hold of my hand.
It is only however in the advanced stage of the disease, that this severe
struggle takes place. In the general way the patient is instantly
liberated from the paroxysm, as soon as he can succeed in moving any of
his limbs. I have seldom met with any one who was able to articulate
during the paroxysm, though I have generally been able myself to call any
person by name, who might be near me, and to beg of them to wake me, but
this is always effected with difficulty, and only after the paroxysm has
already continued some time.
4th. It frequently happens, especially when a person is anxious about
rising at a particular hour, and afraid of over-sleeping it, that he
becomes conscious of that circumstance in his sleep, and feels an ardent
desire to wake himself; to many persons this is by no means a difficult
task, and is soon accomplished; but to those who are subject to
Night-Mare, the reverse of this takes place. They strive with all their
might to awake, and soon become conscious of their precise circumstances,
but cannot recover the power of volition; after contending for this a
short time, the breathing at length becomes laborious, and a complete
paroxysm of Night-Mare succeeds, which always is severe in proportion as
the patient happens to be more perfectly awake.
From these observations it results, that the nature of Incubus is
essentially different to that of either sleeping or waking, and is an
absolute state of disease which may occur during sleep in a slight degree,
without breaking that sleep; that it consists in a suspension of the power
of volition very different to what takes place in natural sleep, because
it is accompanied with a consciousness of that suspension, and a strong
desire of recovering this power. But neither is this sufficient to
constitute Night-Mare, although this disease will, I believe always,
result from such a state of things, yet the paroxysm is by no means
complete, until, in addition to the general paralysis of all the muscles
of voluntary motion, there shall occur likewise a partial paralysis of
some of those concerned in the functions, which are performed
independently of the will, especially of respiration and the circulation
of the blood, the consequence of which will be a difficulty of breathing,
with a sense of oppression about the præcordia, and fluttering of the
heart. I conceive these symptoms to arise principally from a temporary
paralysis of the nerves of the diaphragm; or rather an inaptitude in those
nerves, together with some others of the principal branches of the
intercostals, to perform their functions. Thus then, from this partial
paralysis of the diaphragm and thoracic muscles, the patient is rendered
incapable of dilating the chest so as to allow of the expansion and
consequent inflation of the lungs; the blood consequently meets with some
interruption in its passage through that organ, and this interruption is
speedily communicated to the heart; the re-action which takes place here
is quickly communicated to the whole system, and probably is the
principal cause of the final solution of the paroxysm. How this solution
is at length effected is, I confess, a difficult and obscure question.
There are two ways in which it takes place; the first and most frequent is
by the patient becoming perfectly awake, by which means he recovers at
once the power of volition, and the partial paralysis of the diaphragm and
thoracic muscles at the same moment ceases, these muscles being then moved
by the power of the will. The other mode by which a solution of the
paroxysm is effected, is by the patient falling into a more perfect sleep,
and losing that consciousness which accompanies Night-Mare. The
involuntary actions then go on as before without interruption, and if the
dreams continue, they are no longer of that harassing and distressing
kind, but are now natural and easy. It is not only in slight cases of
Incubus that the patient recovers from the disease without waking, but
sometimes I have known it to happen even in very severe paroxysms, where
I have become conscious of the place and situation in which I was, and yet
have instantly been asleep on the cessation of the paroxysm. There appears
to me a greater difficulty in explaining this mode of the solution of the
paroxysm than the other, as there seems no evident cause for the cessation
of the paralysis of the Diaphragm, &c. Every thing connected with the
phenomena of sleep, is extremely obscure; and nothing on this subject
appears to me more extraordinary, than the sudden transition from the
sleeping to the waking state. Whatever it is which takes place at that
moment in the brain, and in the whole system, takes place only partially
during Night-Mare. Is it very absurd to suppose that a part of the system
may recover the waking state, while the brain, or some other part, remains
asleep, for want of a sufficient stimulus to rouse them? I cannot help
thinking but something very similar to this takes place in Night-Mare:
hence the power of moving the lower extremities, whilst the superior ones
remain paralyzed: hence the little good resulting to the patient from his
own struggling, whilst a comparatively slight touch from another person is
sufficient to dispel the charm. Hence the appearance of visions, whilst in
every respect the patient appears to himself to be perfectly awake. It
seems that the brain continues to present a succession of images to the
mind as in sleep, whilst at the same time, the body is become susceptible
of external impressions, and conscious of internal ones, such as those
arising from the derangement which has taken place in the functions of the
heart and lungs.
I am aware however of the obscurity and difficulty of this subject itself,
as well as the difficulty of expressing in accurate language, the ideas
which arise in my own mind concerning it. I have used the term paralysis
in speaking of the state of the diaphragm and other muscles during the
paroxysm of Night-Mare; this expression however, must be understood in a
different manner from that in which it is usually applied in medicine; for
in Night-Mare there remains always a consciousness of the inability to
move the muscles, and constant attempt at the same time to move them; this
appears to be as constantly impeded by some external force acting against
the efforts of the will: thus, when my hand and arm are lying uncovered,
and in a position which easily admits of moving it, I am able, by repeated
exertions, at length to raise it and bring it to my head, but the effort
which it requires is equal to what in the waking state, would raise a
covering, which might be laid over it, of twenty pounds weight: should a
part of the sheet, or even a handkerchief be lying over the arm thus
situated, the difficulty would be greatly increased; and the operation,
if effected, would so much exhaust me, that I should be obliged to desist
for some time from any further struggling, and the respiration at the same
time would be greatly accelerated. Nothing of this kind occurs in
paralysis, properly so called; for the patient is not even able to direct
any effort of the will to the paralyzed muscles, and frequently is
scarcely conscious of their existence. These two kinds of paralysis
evidently differ considerably from one another, and ought not to be
expressed by the same term.
In giving my opinion of the causes of Night-Mare, I feel still more
embarrassed for proper terms to express my ideas, than in explaining its
nature. I have already said, that I conceived the ancient physicians to be
well acquainted both with its nature, cause, and mode of cure; it might be
well to take some notice here of their opinions, especially as to the
causes which produce the disease, and the means by which it may be
removed, as these two things depend in a great measure on one another. In
order to render these opinions understood by those who have never read any
of the ancient writers of medicine, from a mistaken idea of their not
being worth the reading, I must premise, that they considered the nerves
to be the conductors of a certain subtile fluid, by means of which the
muscles are made to contract, and all the animal functions are performed;
this they denominated the _animal spirits_, and were of opinion that it
was secreted from the blood by the brain. This secretion they supposed,
like all the other secretions, could only be pure, when the blood from
which it was formed was healthy and proper; and that the goodness and
purity of this latter fluid depended on its being elaborated by healthy
organs out of proper materials. Consequently, that good blood could never
be formed out of an unwholesome diet, nor even out of the most wholesome
food badly digested. This induced them to pay great attention to the
state of the digestive organs, and to the diet of patients, and their
observations led to these conclusions; 1st. That the half digested, or ill
digested food, furnished a smaller proportion of good blood than nature
required, but a large proportion of excrementitious, half digested matter:
2ndly. That some portion of this matter would be taken up by the lacteal
vessels into the circulation, and deprave the blood, and consequently all
the secretions, more or less: 3dly. That different kinds of humors
resulted from this condition of the digestive organs; the principal of
which, and the only one we have here to deal with, is the _pituitous_
humor, of which they enumerated several kinds, and to the presence of
which they attributed most of the diseases of the human body. That kind of
_Pituita_, to which most of the ancient physicians attributed the
production of Night-Mare and deranged sleep, was called the _Pituita
Acida_, which was found to be generated in great abundance in the stomachs
and intestines of all patients subject to Night-Mare: this was supposed to
enter into the circulation, and to cause some derangement in the functions
of the nerves and animal spirits, by obstructing the free motion of the
latter, and rendering the former bad conductors. They had various opinions
respecting the manner in which this obstruction was effected, and also as
to the part where it took place; some making the brain the seat of this
affection, others the lungs and diaphragm. But without entering into the
merits of their respective theories, we shall pass on to their ideas of
the indication of cure. I cannot however pass over this part of the
subject without noticing Willis’s opinion of it, and the ingenious
hypothesis by which he attempts to explain this difficult subject. There
are few physicians who have left so splendid a monument of talents,
learning, and industry, for the admiration of posterity, as Willis has
done; and although an English physician, and flourishing in the British
court, there is no country in Europe in which his works are less known and
admired than in that in which they were published. In his work DE ANIMA
BRUTORUM, of which no man will ever repent the reading, he treats of this
disease in a distinct chapter, cap. vi. and places the seat of it in the
_cerebellum_. The following short extract will give some idea of his
hypothesis:
“_Quamobrem Ephialtis paroxysmum induci putamus, quatenus inter
dormiendum, una cum_ succo nerveo, _materies quædam incongrua_ cerebello
_instillata, quæ spiritus in prima scaturigine torporem, sive_ narcosin
_quandam inducens, eos mox a functionum suarum muniis paululum cessare
cogit, proinde ut ab altero velut lethargo intra cerebellum excitato_,
actiones vitales _eclipsin brevem patiantur; qua durante, partim a_
præcordiorum _obstrictorum lucta, partimque a_ sanguine _in iis plurimum
aggesto, et stagnante_, gravamen _istud, ac velut_ molis incumbentis,
_sensus infertur; deinde quoniam cæteræ omnes totius corporis facultates
a_ cordis _motu dependent, idcirco hoc impedito, et suppresso, illæ statim
deliquia, aut inordinationes subeunt, præsertim vero quià_ sanguinis in
cerebrum, _pro spirituum animalium fomite_, effluxus _interrumpitur,
propterea mox horum_ effluxus _in_ systema nervosum _supprimitur, adeo ut
laborantes, dum pectoris molem imaginariam excutere satagunt, nec corpus
nec membrum aliquod movere possint; nimirum quia_ spirituum (_donec
sanguinis affluxu destituuntur_) irradiatio _in partes motrices inhibetur:
interim qui in cerebro resident, huc, illuc, lati, phantasmata confusa, et
ex molestia a præcordiis impressa, horrenda spectorum insomnia
concipiunt._”
It appears evident, from the mode of treatment to which this disease gives
way, that the primary cause, in whatever manner it may act, has its seat
in the digestive organs; nor can any difference, or even error, in
explaining its _modus agendi_, in any manner invalidate this doctrine. The
ancient physicians seem tolerably well to agree on this point, and
consider Night-Mare as a species of epilepsy, arising from a
superabundance of _acid humor_ in the _primæ viæ_, and their treatment was
entirely directed to the evacuation and correction of that humor. If they
were mistaken in their pathological ideas of this affection, they were at
all events successful in their treatment; and it was usually their
practice to reason from the cure to the cause of a disease, a safe mode of
reasoning in medicine. Experience had taught them that a long train of
diseases originated from this cause, and a little observation will suffice
to convince any man, unprejudiced by medical theories, that Night-Mare
originates from no other cause than a defect in the digestive process,
whereby the food, which should be converted into good chyle, is
transformed into a half-digested mass of acid matter, which is productive
of heart-burn, acid eructations, flatulence, and intolerable gripings,
with the whole train of dyspeptic and hypochondriacal symptoms. There are
many stomachs which convert every thing they receive instantly into an
acid, and such will be generally found to be the case with persons subject
to habitual Night-Mare, or frightful dreams, and disturbed sleep. Such
stomachs too are frequently distended with some acid gas, and I have often
found the paroxysm of Night-Mare to be the consequence of this distension
alone, and to be immediately removed by any thing which would dispel the
gas, such as a glass of peppermint cordial, or gin, or any carminative
medicine. A medical gentleman in Norfolk, who laboured under an inveterate
disease of the digestive organs for several years, which in the end proved
fatal, was dreadfully tormented by the most pertinacious paroxysms of
Night-Mare, which threatened suffocation, had recourse to a solution of
Ammonia in warm water, which he always drank when the paroxysms of
Night-Mare began to disturb him; for whenever they did begin, they always
continued to torment him, every time he fell asleep. The success of this
plan very far exceeded his expectations. The immediate effect of the
medicine was to send up a great quantity of wind from the stomach, which
was succeeded by a profuse perspiration, and tranquil, undisturbed sleep.
I have always found, in my own case, that Night-Mare was accompanied with
distension of the stomach and bowels by flatus, constipation, and acid
eructations.
In this state of things every thing which is eaten or drank becomes
instantly acid; and even the saliva in the mouth, I have often observed to
have an acid taste. I have made repeated inquiries of others who were
habitually subject to Night-Mare, and have always found them to be
complaining of the same symptoms, although they had no idea that these
were any way connected with the disease in question. A closer examination
into the state of my own health, soon convinced me that my Night-Mare,
which was become so alarming as to induce the greatest fear of epilepsy,
was altogether depending on the state of dyspepsia under which I was
labouring, and which was always greatly increased by remaining at sea,
until at length it incapacitated me for my duty; attacking me in the
daytime, affecting my memory, and threatening the most serious
consequences. Under these circumstances I was twice invalided, and on
retiring into the country, in a few months recovered my health, so that
the Night-Mare, which was before habitual, and made its attacks whenever I
went to sleep, was now become in a measure accidental, and depending upon
causes more within my command. It was still however very severe, and
returned on the slightest degree of irregularity of living, and on going
to sea again, became worse than ever, accompanied with severe palpitations
of the heart, and great irregularity in the pulse. It was under these
circumstances that I began first to pay attention to that acidifying
principle which I found to exist in the organs of digestion, and to try
upon myself the effects of those remedies which have proved so successful
in combating this monster, that has so long proved the enemy of my repose.
Observing the success of the Ammonia in the case which I have mentioned
above, I had recourse to it myself in the same manner, but found it so
disagreeable to the stomach, that it frequently produced vomiting. This
indeed removed the tendency to Night-Mare, but it equally prevented my
rest. I tried some of the other alkaline salts, but with no better
success; the reason of which was, I believe, that I drank them dissolved
in some cold liquor, upon an empty stomach, at the time that the disease
was most troublesome to me, that is, early in the morning. Finding the
stomach reject the alkalies in this simple form, I made a variety of
attempts to render them palatable, and at length hit on the method of
dissolving them in ale, or porter, and fixed on the Carbonate of Soda as
the most agreeable of them. This experiment proved of more service to me
than I expected; for I soon found it to be, not a nauseous draught, like
the aqueous solution, but a delicious beverage, which I could drink with
great pleasure; for the porter or ale, which is generally greatly
inclining to acidity, was much benefited and improved by it. The carbonate
of soda becomes partially decomposed by the acid of the liquor, and parts
with a great portion of its carbonic acid gas, which causes the liquor to
foam up, and imparts to it the appearance and flavour of bottled porter
or ale. Having thus ameliorated the malt liquor itself, I grew fond of it,
and drank as much every day as would receive about a drachm of the
carbonate of soda, only at my meals; but whenever I found that sense of
oppression about the præcordia which indicated the predisposition to
Night-Mare, I had immediate recourse to a large dose of the soda, and
always obtained relief. This salt not only corrects the acidity in the
_primæ viæ_, but likewise brings away by stool a quantity of viscid slimy
matter, so acrid, as to burn and excoriate the parts as it passes out. As
I constantly persisted in the use of this alkaline salt, and got rid of
this trash from the body, my appetite, which had long been lost and
depraved, returned, and the digestive organs performed their functions
again with ease and success. But still the propensity to acidifying
remains, and a cautious attention to diet, and to the evacuations is
always necessary. By perseverance in a plan founded on these principles, I
found my enemy at length subdued, and brought under a degree of control
which I had never hoped to obtain, and this circumstance has induced me to
give to the world, (and more particularly to those labouring under the
same disease,) my opinions and advice. By a close attention to the latter,
I do not doubt but they will succeed in driving from their couch this
fiend of night, this enemy of repose.