_Too high Pillow_.--There is an abuse in the other direction of too

high a pillow that deserves to be noted. Occasionally the physician

hears complaints of waking up with tired feelings in the large muscles

of the back of the neck near their insertion into the occiput. This is

sometimes complained of {656} as an occipital headache. Not

infrequently it will be found that these people are sleeping on

pillows that are too large, or that they pile up several of them. Most

physicians have found in their experience that having the head quite a

little higher than the rest of the body materially aided sleep,

especially in elderly people. This is true even when there is no

distinct heart lesion, but this favorable position is best secured not

by means of one or more high pillows, but by raising the head of the

bed, or by the insertion of bolsters beneath the mattress, so that

there is a gentle slope upward from the hips to the head. High pillows

should, as a rule, be discouraged, especially in young folks where the

assumption of the strained positions which they cause, may encourage

various deformities in the anatomy of the head and shoulders so that

stoop shoulders or a craned neck result. On the other hand, before

attempting to give drugs to elderly people, the arrangement of the

mattress so as to put the head a foot, or even more, higher than the

body should be tried and will often be found to give relief where

other things fail.

_Discomfort Due to Cold_.--In order to sleep well patients must be

thoroughly comfortable in bed. In recent years as the very hygienic

practice of having a window in the sleeping apartment open has become

a rule among intelligent people, sleeping rooms have been much colder

than they used to be. Care must be taken lest the active factor in

causing wakefulness should be cold. Over and over again I have found

that patients who complain of wakefulness, in the latter part of the

night particularly, that is, in the early morning, were awakened by

the increasing cold because they were insufficiently clothed. Whenever

the sleeping room becomes very cold, then, the patient should not

sleep between cotton or linen sheets which are likely to induce

sensations of chilliness, but in a light woolen nightgown. It is

curious what a difference in the patient's feelings is produced by the

touch of wool to the skin in cold weather as compared with cotton.

Thin, anemic patients are especially likely to suffer from chilliness.

It must not be forgotten, however, that some stout people, in spite of

an accumulation of fat, are really anemic. Their red blood corpuscles

and hemoglobin are distinctly below normal. These constitute some of

that large class of stout women in whom reduction cures fail because

of the anemic tendency. They must be as carefully protected from cold

as thinner persons, yet they need fresh air for their comfort and

health almost as much as tuberculosis patients. The experience of

sanatoria in the Adirondacks and at altitudes generally shows that for

quiet, undisturbed sleep, if the room becomes distinctly cold during

the night because of an open window, a hood or night-cap and gloves,

as well as the wearing of woolen underclothing, even to stockings, is

almost indispensable. In older times, when houses were not well

heated, many persons very sensibly wore night caps. Now that a return

to cold fresh air in the sleeping room has come many will have to

resume the old night-cap habit in spite of cosmetic objections to it.

These may seem little things, but they count very much in relieving

disturbed sleep. The curious thing about them is that patients

themselves seldom realize that certain common-sense regulations are

more important for sleep than formal remedies. They want to be "cured"

of their insomnia, not relieved by suggestion.

_Cold Feet_.--A large number of people have their sleep at the

beginning of the night seriously disturbed by cold feet. Some cannot

get to sleep for {657} an hour or more, because their feet are cold.

If the patients become worried over this loss of sleep, a real

insomnia may develop. It is for these people that the old-fashioned

warming-pan was invented and it should not be forgotten that the

symptom can be relieved very promptly by means of a hot-water bag or a

hot brick wrapped in flannel at the foot of the bed. An excellent

practice for very sensitive persons, is to have the sheets warmed

thoroughly for a couple of hours before bedtime. This is especially

important in damp weather.

The distinguished English surgeon. Sir Henry Thompson, who lived well

beyond eighty years of age (when surely he would seem to have some

right to do so), wrote a little book on how to be well and grow old

and describes a habit which he had acquired and that I have often

recommended to patients and friends as well as used myself with

advantage when there is a tendency to cold feet, either habitually or

occasionally. It is, moreover, useful whenever there is a tendency to

insomnia because some exciting occupation has preceded going to bed.

Before retiring Sir Henry used to sit beside his bath tub and let the

hot water flow into it over his feet, gradually becoming warmer and

warmer, until he could no longer stand the heat. A temperature well

above 120 degrees may be borne with comfort after a while, though at

the beginning it would seem entirely too hot. The feet are kept in the

hot water at least five minutes. When taken out they should be

thoroughly red and show evidence of a good deal of blood having been

attracted to them. If they are now carefully wiped and rubbed

vigorously there will usually be no further tendency to cold feet that

night and sleep will come naturally. Sir Henry said that when he had

been out at meetings where he had to make an address or had to take

part in business of any kind that inclined to make him wakeful, he

found this an excellent method of preparing himself for immediate

sleep.

It must not be forgotten that the worst forms of cold feet are found

among those suffering from flatfoot. The dropping of the arch

interferes with the return circulation and also with lymphatic

circulation. These individuals feel very tired because of their foot

condition, yet their cold feet often disturbs their sleep at the

beginning of the night. The only effective relief for this is afforded

by proper treatment of the feet. (See the chapter on Foot Troubles.)

_Lack of Air_.--On the other hand, occasionally it happens in spite of

all that has been said in recent years about fresh air in sleeping

rooms, windows are hermetically sealed and even then people cover

themselves with many thicknesses of bed clothing and are too warm. I

have found over and over again that where people could not be

persuaded to leave a window open all night (and when they are old and

deeply prejudiced in the matter I do not insist, for the suggestion of

possibly catching cold would almost surely keep them awake), the

thorough airing of rooms before retiring made a great difference in

the sleep of elderly people. When patients are young, I simply insist

on the window being wide open for some time before they go to bed and

slightly during the night, except in extreme cold weather. Many a

patient who complains of waking several times during the night and

being awake for some time on each occasion will begin to have longer

periods of sleep without a break if such a change in the ventilation

of the room is effected. {658} Anyone who has seen fever patients who

had been restless, disturbed and wakeful, sink into a quiet slumber

after the room has been thoroughly aired and the temperature of it

reduced ten or fifteen degrees, will realize how helpful this same

method of treatment will be in nervous, wakeful irritability.

How important air is for the obtaining of the power to sleep for many

hours every day can be best understood and appreciated from the habits

insisted on for patients in tuberculosis sanatoria as a result of

experience. When there is any tendency to a rise in temperature in

these patients they are kept absolutely without exercise. They are

either in bed or on a lounging chair all day, but they are out in the

air or at least close to an open window. As a rule, they sleep some in

the morning and then they sleep again in the afternoon. This would

ordinarily be fatal to sleep at night in even healthy people taking

considerable exercise and therefore presumably tired and more likely

to sleep than these patients who had made no exertion during the

twenty-four hours; but it is not often, after patients have been for

ten days or two weeks at the sanatorium, that there is any complaint

of lack of sleep at night. This is true in spite of the fact that

patients are often wakened by coughing during the night, yet after a

comparatively short interval they go to sleep again and sleep until

morning. This is not true when patients do not pass most of their time

in the open air and when their rooms are not well aired.

Sleep at Sea.--I know nothing that is more effective in doing away

with insomnia than a sea voyage. The passengers sit on their lounging

chairs all the morning in the open air, usually sleeping for some

time, often for several hours. During the afternoon this is repeated.

In spite of this extra sleep they turn in, not long after ten, and

sleep well until morning. There is practically no exercise and the air

usually excites such an appetite that five and even six meals a day

are consumed. There is no disturbance of digestion unless some special

excess is indulged in, and, above all, sleep is rather favored than

impaired by the large amount of food taken. This experience which is

so common, is very valuable as indicating just what is the best

pre-requisite for sleep. It is not exercise and tiredness to such a

degree that one fairly drops from fatigue, but such an oxidation of

all tissues by the breathing of pure air that there are no toxic waste

products left in the system to act as excitants for disturbance of

sleep.

Cold Water.--In summer, when wakefulness is due to heat, a cool bath,

or at least a rub down with cold water and going to bed without drying

is an excellent method of inviting sleep. Under these circumstances

the sheet acts as a soothing cool pack and people who have been

wakeful for hours before, or at least have found considerable

difficulty in getting to sleep, sleep promptly. The mechanism of

sleep-production is easy to understand. There is less blood to go to

the brain when the little capillaries at the surface are pretty well

extended and after the application of cool water the reaction which

follows the closing of the capillaries in response to cold leaves them

of sufficient size to accommodate a large amount of the blood of the

body. Of course, in both cases there is the suggestive value of a

proceeding of this kind so well calculated to predispose the patient's

mind to go to sleep without solicitude.

{659}

Diet.--As has already been outlined in the hints that precede, the

first thing in the treatment of insomnia is to remove any causes that

may be at work in producing wakefulness. Among the most common of

these in our modern life is the taking of coffee or tea, important in

the order mentioned. Every physician has frequent experiences of

people who complain of insomnia, yet who take a cup of coffee late at

night. A large proportion of humanity cannot do this with impunity and

expect to go to sleep promptly. Occasionally one finds that patients

complaining of sleeplessness are taking three to five cups of coffee a

day. This must be stopped. A physician may be told by such patients

that they cannot get along without their coffee. I have only one

answer for this and it is meant to show patients that if they want to

sleep they must take the means to secure it and, above all, must

remove all disturbing factors. I tell them that if they cannot do

without coffee they may continue to do without sleep. If they want to

sleep they must give up coffee or at least must limit the amount. I

have found it comparatively easy to get people to limit coffee-taking

by the suggestion that there should be one tablespoonful of strong

coffee taken to a cup of hot milk. This gives the taste, or rather the

aroma of coffee, for coffee has properly no taste to speak of, and

while, at first, patients crave the stimulation they have been

accustomed to, it takes but a few days to overcome this craving

entirely.

Usually it is easy to get people to confess that they are taking too

much coffee. For some reason not easy to understand it is harder to

get them to acknowledge that they are taking too much tea. Coffee is

taken with a certain amount of deliberation. Tea may be and often is

taken at odd intervals for friendliness' sake and sometimes patients

do not know how much they are taking. Six or seven cups a day may be

their usual quota, yet they do not realize it and at first are

inclined to answer that they take it only two or three times a day,

forgetting the little potations between meals. Tea is not so prone to

cause wakefulness as coffee, yet the toxic irritant principle in both

is the same and when the amount of tea and its strength are

sufficient, the same results follow. The tea habit must always be

given up if there is complaint of lack of sleep, especially early in

the night.

There is a very common persuasion that the eating of food in any

quantity shortly before going to bed, and especially the eating of

certain materials, will keep people awake. It is well known, however,

that there are a great many people who can eat anything and sleep well

after it and young children sleep best when their stomachs are full.

There are undoubtedly idiosyncrasies in this matter that must be

respected, but many patients are deceiving themselves. They are eating

too little and their wakefulness is more due to the mental state than

to anything else. As this contradicts a very prevalent impression, I

may say that it is said deliberately and only after much experience

with people inclined to be over-solicitous about their diet and their

health generally and who were actually producing wakefulness or at

least very light dreamful sleep, by their elimination from their diet,

and especially from their evening meal, of many nutritious substances.

I make it a rule to insist with patients that if it is more than five

hours since their last meal they must take a glass of milk and some

crackers or a cup of cocoa and something to eat before going to bed.

This is particularly important if they have been out in the air much

between their last meal and bedtime.

{660}

The Evening Hours.--The use of the hours after the evening meal is an

extremely important factor with regard to insomnia. If the patient

tries to read the paper or some conventionally interesting magazine or

book, thoughts of the possibility of his not sleeping will surely

obtrude themselves and he will fail to get to sleep when he lies down.

As a matter of fact, he will have so disturbed himself as to

predispose to insomnia. Some quiet occupation, interesting yet not too

interesting, that diverts the mind from the thoughts about itself and

about sleep possibilities, yet does not excite it, is the best

possible auxiliary and preparation for sleep. Prof. Oppenheim has, as

usual, said this very well in his "Letters to Nervous Patients," to

which we have turned so often:

A great deal depends upon the right use of the evening hours. On no

account let yourself occupy them with anxious forebodings about the

night. But, on the other hand. It is not at present wise to take up

your mind with too exciting thoughts, as the strong after-impression

of feeling and fancy may counteract the tendency to sleep. You must

find out for yourself whether a quiet game (cards, halma, chess, or

patience), the reading of a serious or an amusing book, the perusal

of an illustrated paper, or a chat with a friend will be most

certain to give you that tranquillity of mind through the vestibule

of which you will pass into the temple of sleep.

Direct Sleep Suggestions.--Many plans are suggested by which people

are supposed to be able to get to sleep. A favorite and very old

suggestion is that of counting sheep go over a fence or something of

that kind that is merely mechanical, yet takes the mind from other

thoughts. As a rule, any plan involving mental occupation that is

meant to produce sleep is likely to react and do harm rather than

good. Sleep must not be wooed deliberately but must be allowed to come

of its own sweet will. It is extremely important that exciting

thoughts and bothering interests be put aside, not at the moment when

we want to go to sleep, but some considerable time before. This is not

always an easy matter and often requires careful planning. It is worth

while doing it, however, in order to secure sleep promptly and not

allow a prolonged period to pass while one is lying awake, for if

nervous irritability ensues wakefulness is still further prolonged and

the patient may begin to toss and so disarrange the bedclothing and

disturb himself as to prepare for several hours of sleeplessness which

would not have occurred if there had been an appropriate interval

given to preparing the mind for sleep.

Diminishing Solicitude.--Patients must not be too anxious for sleep.

If they worry themselves over the possibility of not sleeping then

they will almost surely disturb their sleep, or at least delay its

coming. The ideal state of mind is not to bother one's head about it,

to lie down habitually at a given hour, compose one's self to sleep

with assurance and then wait its coming without solicitude. Many

people will say this is not easy to do, but habit makes it easy. Most

of our animal life is lived by habit. We are hungry at certain times

by habit. Our bowels move at a particular time by habit. We can sleep

by habit. If we try to use our intellect solicitously with regard to

any of these habitual functions we do much more harm than good. The

more anxiety there is about sleep the more likely it is to be

disturbed. When the habit of sleep at a particular hour has been

broken the best way to regain it is to lie down at that particular

hour and then wait patiently for {661} the advent of sleep. If

impatience gets the better of us sleep is kept off and will not come

for hours. If the patient can lie down feeling "Well, if I do not

sleep now I will to-morrow morning" then there is usually little

difficulty about sleep.

_Dread of Consequences_.--Many people who suffer from insomnia fear

that their loss of sleep will injure their intellectual capacity or

make them prematurely aged, or drain their vitality so that they will

not have health and strength of mind and body when they grow old. This

adds to their solicitude about themselves and inveterates their

condition. There is only one answer to this dread, which has no

foundation in what we know of actualities, and that is, to tell them

the experience of certain persons which absolutely contradicts such a

notion. One distinguished physician who, at the age of seventy-five,

is writing books that are attracting widespread attention and is doing

an amount of work that many a younger man might envy, has told me of

all that he suffered from insomnia between the ages of thirty and

fifty-five. His mental productivity was much hampered at that time by

his wakefulness and anxiety with regard to it. He feared the worst as

regards advancing years, yet he is in the full possession of mental

and bodily strength well beyond the Psalmist's limit. His is not an

exceptional case, for there are many others in my own personal

knowledge. Virchow once told me of years when he suffered from

insomnia, yet he lived to be well past eighty and then died, not from

natural causes, but from an injury. A man who accomplished an immense

amount of work in his day in the organization of a great university

suffered from insomnia in his younger years to such a degree that his

friends and even he himself feared for his mental stability,

eventually overcame this symptom completely and went on to years of

great active work, dying in the end, not from his head, but his heart.

We have records of a number of such cases. Few of the hard students of

the world went through life without having some bother from insomnia.

It is well-known, however, that many of the great thinkers,

investigators and discoverers in philosophy and in science have lived

long lives well beyond the age of the generality of mankind.

Mental Diversion.--The main thing is to banish the thoughts of one's

ordinary occupation as far as that can be accomplished without

laboring so intently at this as to give the mind another bothersome

occupation. Many people find that a game of cards just before going to

bed takes their thoughts off business and worry almost better than

anything else. Something like this is needed in many people. Most

people must not write for some time before retiring, because writing

proves so absorbing an occupation, as a rule, that the mind becomes

thoroughly awake and then remains so for some time afterwards. Reading

is better, but the reading must be chosen with proper care. An

exciting story, for instance, may serve to keep one awake for hours,

as everyone knows who has tried and found himself still reading at

three in the morning after having begun an interesting book. The

reading of works of general information, of travels, of description of

places, where it is comparatively easy to stop at any place, of short

stories which do not hold the interest beyond a brief period, is much

better. Osler's recommendation to have a classic author beside one's

bed to be read for a few minutes every night after retiring as a

preparation for sleep is an excellent remedy for the milder forms of

insomnia, as well as a stepping-stone to scholarship.

{662}

William Black in one of his books has a description of an old man who

had suffered from insomnia very severely until he discovered a plan of

his own to enable him to get to sleep. This consisted in reading the

Encyclopedia Britannica. He began at the beginning and read straight

ahead, article after article, and volume after volume. He never even

by any chance departed from this routine either to look up cross

references, or read anything further about men who were mentioned in

the article he was going through at the moment and whose names

occurred in another volume. He read straight on until his eyes got

heavy and then he went to sleep. At the time he was introduced into

the story he had already read the whole work through twice and was, I

think, at "D" on the third reading. He had had considerable bother

about getting to sleep before he adopted this plan, but it proved an

always efficient somnifacients. There is a story about an old American

farmer who said that he read the dictionary over and over again for

the same purpose. The stories were short and disconnected, but they

never bothered his sleep, while his wife and daughters were sometimes

kept up more than he thought was good for them by their interest in

the story paper.

Treatment of Early Morning Wakefulness.--With regard to the

disturbance of sleep in the early morning hours there are certain

instructions to patients that have always seemed to me extremely

important. Most of the patients who complain of wakefulness in the

early morning hours are really suffering from hunger at that time.

This is especially true with regard to those who stay up rather late

at night. They have their last regular meal about seven or a little

earlier, they get to bed at eleven or even later, and some of them,

following the old maxim that eating before sleep is likely to disturb

it, go to bed on an empty stomach. Whenever more than four hours have

passed since the last meal the stomach is quite empty, and after the

preliminary fatigue has worn off and the sleep has become lighter and

the lack of nourishment more pronounced a vague sense of discomfort in

the abdominal region wakes them, though most of them do not realize

that they are disturbed by a craving for food. In a large number of

these cases I have found that the recommendation of a glass of milk

and some crackers, or some simple cake, just before retiring does more

than anything else to lengthen sleep and prevent what has been

learnedly called matutinal vigilance.

After emptiness of the digestive tract, the most prominent cause of

wakefulness in the early morning is anxiety about the hour of rising

or about some engagement that has to be kept in the early morning. I

have known patients who worked themselves up so much thinking over the

necessity for rising at a particular hour to catch a train, that they

were awake for several hours before they needed to be. Some are much

more inclined to this over-anxiety than others. If they move to the

country where trains have to be caught regularly, their sleep may be

seriously disturbed by this circumstance. If the trouble becomes acute

they must simply change their residence. If it is absolutely necessary

that they stay, then they must have someone to wake them at a definite

time. This must be someone on whom they can absolutely depend,

otherwise the old solicitude will reassert itself. This seems a small

matter, yet I have known serious cases of neurasthenia with annoying

digestive symptoms due to nothing else than this morning wakefulness

consequent upon overanxiety with regard to trains and other morning

engagements.

{663}

Habits.--In the correction of troubles of sleep one of the

difficulties that the physician has to contend with when patients have

grown accustomed to staying up late and finally have so disturbed

their sleep mechanism that symptoms of insomnia develop, is the

declaration that there is no use for them going to bed early since

they cannot sleep. If a man has been accustomed for a long period to

go to bed between midnight and 2 a. m. and his habits are suddenly

changed so that he goes to bed at ten or even eleven, it is very

likely that for some time after retiring he will not sleep. If he

grows over-anxious he may toss and become somewhat feverish and then,

even when the accustomed time for sleep comes, he may not secure it.

Besides, the depression consequent upon failure to sleep when he has

fulfilled his physician's directions and when he knows that this is

considered an important adjuvant in his treatment, acts as a

distinctly discouraging factor. Under these circumstances it is

important to recall to him that one habit can only be removed by the

making of another. It may be necessary to send him to bed for awhile

only an hour earlier than before until he has grown accustomed to

going to sleep somewhat sooner, and then this habit, in turn, be

changed to an earlier hour so as to secure all the sleep that is

necessary.

In a word, insomnia is not a definite affection to be treated by

giving one or the other of one's favorite drugs, or if these should

fail trying still others, but it is a condition of mind very often

predisposed to by certain conditions of body. If this condition of

mind can be adjusted by careful attention to the correction of

whatever may be physically out of order, then there is every reason to

look for definite improvement very soon and complete cure without any

delay. Insomnia is not the awful ailment that it is sometimes

pictured, nor all that it appears to the excited imagination of the

young person who loses a few hours' sleep; but a manifold condition to

be dealt with very differently in different individuals, according to

the indications of the case. If the patient's confidence can be

secured that means more than almost anything else that can be done. If

a little patience is exercised in obtaining such definite details of

the mental state and of certain physical factors as may seem quite

trivial to the patient yet are really predisposing elements for his

affection, the therapeutics become comparatively simple. It is the use

of tact and judgment in this matter that means most, however, and then

very few drugs will be required. Between the habits consequent upon

the opiates and certain of the serious hemolytic conditions due to the

abuse of coal-tar products, this is a consummation that may well be

worked for assiduously.

CHAPTER VIII

SOME TROUBLES OF SLEEP

Certain annoying incidents in connection with sleep annoy those

affected by them so much as to arouse them very completely from sleep

and make them wakeful for a time. Nothing disturbs most people so much

as the thought that some passing incident, a little out of the common,

is quite individual and peculiar to them. If they are at all nervous

they are likely to think that it portends some serious ailment, either

present or about to {664} develop. Nothing reassures them more than to

learn that these incidents are not so uncommon as they imagine, indeed

that many of them are quite frequent, and, above all, that many people

who have had them are still alive and well beyond threescore and ten,

and laughing at the fears of their earlier years.

Starting.--Perhaps one of the most annoying of these incidental

troubles is starting in sleep. It occasionally happens that just about

the time a person is dozing off he suddenly starts and, almost before

he realizes it, is fully awake, his heart beating emphatically and

there may even be a little feeling of oppression on the chest. The

cause is not the same in all cases and individual differences are

worth investigating. In most people this starting means that there is,

for the moment, some mechanical interference with the action of the

heart and that a systole has been delayed and has been pushed through

with more force than usual because of this delay. A full stomach will

occasionally cause this, especially if patients lie on their left

sides. In some people even a drink of water taken just before retiring

will be sufficient weight to cause this interference with heart

action. An accumulation of gas in the stomach will do it by pushing up

against the diaphragm. Where there is a distinct tendency to the

accumulation of gas in the stomach I have sometimes been sure that the

expansion of the gas consequent upon the cozy warmth of the patient in

bed, or its greater effect upon the stomach because the relaxation of

sleep affected even the stomach walls slightly, was the cause of it.

It happens more frequently in the old than it does in the young, but

it is observed at all ages and patients are usually quite disturbed

about it, as, indeed, they are likely to be with regard to anything

that affects their hearts.

The thought that this forcible beat must mean some serious

pathological condition will obtrude itself on many people, and if it

does sleep is sure to be disturbed. Even though there may be no

discoverable lesion of the heart, these patients often, though they

are physicians, will worry lest some underlying condition should be

developing. The first patient who ever described this symptom to me

told me of it while I was a medical student and he is still alive and

in good health, though he is past seventy. At the time I went over him

rather carefully with the idea that there might be an organic heart

lesion, but found none. The prognosis of these cases is always

favorable, for there are many who suffer yet live long. I have found

if to occur particularly in elderly people when they were a little

overtired on going to bed, or in anemic young people when they had had

somewhat more exertion than usual during the day. Unless there is

really some demonstrable heart lesion the start does not mean anything

and patients can be reassured at once. They should be counselled

against lying on the left side, though in some of them it will occur

even while lying on the right side and then the mechanism of its

production seems to be the gaseous over-distention of the stomach.

Patients may be told at once that it occurs in a large number of

people and then, instead of lying awake and worrying about it as they

often do, they learn simply to place themselves in a more comfortable

position and go to sleep again without solicitude. They would learn

this for themselves in the course of time, but the physician's

reassurance will enable them to anticipate the lessons of experience

and they will thus be saved worrying.

At times this starting from sleep seems due to some unusual noise. In

{665} certain nervous states even slight noises produce an exaggerated

reaction and there seems to be a surprising, almost hypnotic, acuity

of hearing just at the moment when all the other senses are going to

sleep. Any of the small noises that sound so loud in the stillness of

the night may serve to wake the patient so thoroughly after a

preliminary doze that sleep is disturbed for some time. As a rule,

however, such noises would not disturb people if they were in normal

healthy condition, or at least the disturbance would be only

momentary. The solicitous effort that some people make to get away

from every possible noise is an attempt in the wrong direction. We

have heard of people building special houses, or noise-proof rooms in

the center of houses where they hoped it would be impossible to be

disturbed. What is needed is not so much an effort to secure

absolutely noiseless surroundings, which is almost impossible in any

circumstances, be it city or country, but to change the patient's

physical condition so that slight noises are not reacted to so

explosively. There are many general directions for this and certain

drugs, as the bromides, are of distinct service. On the other hand,

the taking of cinchona products seems often to emphasize it.

I have found that two classes of nervous patients particularly were

likely to be disturbed by these starts in their sleep. The first class

is perhaps the larger. They are the patients who do not eat enough.

They will usually be found to be underweight and to be nursing some

thought with regard to their digestion, or some supposed idiosyncrasy

towards food that is keeping them below the normal weight for their

height. Nothing makes sleep lighter than a certain amount of hunger.

This hunger may be disguised so completely, or so covered up by the

patient's persuasion that more food cannot be taken without serious

gastric disturbance, that it may pass utterly unnoticed. When such

patients are disturbed early in the night, it usually means that

besides taking a not quite sufficient amount of food they are taking

more tea or coffee or some stimulant than is good for them. I say some

stimulant because in several cases that I investigated rather

carefully the cause seemed to be the alcohol taken with one of the

largely advertised patent medicines, a supposed digestive tonic,

consisting mainly of dilute alcohol, and really about as strong as

whiskey. When the tendency to be startled occurs in the early

mornings, then people need to eat something simple just before they go

to bed.

The other class of cases who are likely to start at night in their

sleep are those who do not get out into the air enough during the day

or who sleep in rooms insufficiently ventilated. At the beginning of

the night the lack of ventilation makes the sleep light and easily

disturbed. After a certain number of hours have been spent in a badly

ventilated room the patient sinks into a rather deep sleep, which is

likely to be dreamy, however, and then he is rather hard to waken, but

wakes not feeling rested, but on the contrary often heavier and more

tired than on retiring. In these cases an investigation of the amount

of air the patient is allowing to enter his sleeping room or that his

circumstances provide him with is extremely important. As for those

who do not get out enough during the day, it is easy to understand

that their sleep may be light. To them, as a rule, it will be a

surprise to find how much depth is added to their sleep by an

additional hour or two in the air. Commonly, people who do not get out

much during the day are shivery and {666} suffer from cold, especially

in the winter time, and so they are likely to keep their rooms rather

tightly closed. In this case they have two reasons for a tendency to

be wakeful, which is emphasized if there are noises near them or if

there is anything that disturbs their sleep.

In young children, of course, it must not be forgotten that starting

in sleep may be due to the twitching pains of a beginning tuberculous

joint disease. At times the children are so young, or the symptoms so

vague and the tenderness, if there is any, so deep, that the real

significance of this may not be recognized. The most successful

treatment for these starting pains in children that has thus far been

found, forms a striking commentary on what we have just been saying

with regard to fitful sleep when ventilation is insufficient or when

the patient has not been out of doors enough during the day. The

children from the New York hospitals who in recent years were taken

down to Sea Breeze during the autumn and winter and made to live in

wards, the windows of which were constantly open so that the

temperature was often below fifty, so that doctors and nurses had to

wrap themselves up warmly and sometimes cover their heads and their

hands, had all been sufferers from these starting pains before this

experience, but gradually they lessened in frequency until after a few

months the crying of a child at night because of these pains was

extremely rare. The lesson is evident, and abundance of air not only

cures tuberculous conditions, but also makes the nervous system so

much less irritable that starting pains do not so easily affect it.

Noise.--Slight noises often make it impossible for nervous people to

sleep. This is much more a question of personal sensitiveness and

anxious expectancy and over-irritability than anything else. One

distinguished physician whom I knew was extremely sensitive to noise

and would be awake for hours if wakened up early in the night by the

slamming of a door or a call in the street or anything of the kind. He

suffered from insomnia to a noteworthy degree and found to his

surprise that he could sleep better on a train than anywhere else.

After he had lost two or three nights of sleep he actually used to

make arrangements to take a berth on an express train going out of his

city, ride until the morning and then come back. He usually slept well

amidst all the noise and jar of the train, though he would be quite

sleepless at home as the result of even slight noises. I have known

people suffering from insomnia who took a long ocean trip on a slow

vessel and who slept well amidst all the noises of shipboard, but were

light sleepers after landing, and felt that they missed the noise and

bustle. Of course, in these cases the rocking movements sometimes

predispose to sleep. It is not the custom now to rock infants to sleep

and a very definite agreement seems to have been come to among

pediatrists to forbid the practice as harmful. It is probable,

however, that the instinct of the race in the matter was not at fault.

Rocking seems to relax a certain tension of muscles that of itself

prevents the brain anemia which is the physiological basis of sleep.

It is extremely difficult for nervous people to relax themselves

completely, and the rocking movements, by tending to help them in this

matter, are excellent predisposing factors. A rocking chair or a

hammock furnish abundant proof of this.

Noise in general, as regards its relation to sleep, is an extremely

individual matter. Habit plays the largest role in the matter. We all

know the {667} stories of men who have gone to great expense in order

to build noise-proof rooms and yet have found afterwards that they did

not sleep well. The rustle of the bedclothes as their thoraxes rose

and fell in respiration was enough to disturb them when they allowed

themselves to become over-sensitive about noise. We all know how

impossible sleep becomes with a rustle of a mouse in the wastepaper

basket, or the scratching of one on the wainscoting. On the other

hand, anyone who has lived in a large city where past hundreds of

thousands of homes the elevated trains thunder every few minutes all

during the night, or the trolley goes rolling by within a few feet of

the bed, knows, too, that a great many people become accustomed to

noises so as to be utterly undisturbed by them, though at the

beginning any such insensitiveness to noise seemed out of the

question.

I remember having a patient who insisted that he could not sleep so

near the elevated. At the end of a week he had lost so many nights of

sleep that he was almost in despair. If he did get sound asleep he

said he used to hear the thunder of the elevated train coming toward

him in his dreams and he would begin to pull his feet up so as to get

them out of the way of the train, yet always with the feeling that he

could not get them quite far enough, until his knees were almost to

his chin. Under the influence of a little bromides, two hours more of

outdoor air than he had been accustomed to before, and some

reassurance that noise need not disturb sleep at all if taken

philosophically, he learned in the course of two weeks to sleep quite

peacefully and now has lived for ten years where the elevated passes

within ten feet of his window, which is wide open for seven months in

the year and always at least slightly open, except in the most stormy

weather. It is a question, then, of the individual much more than his

surroundings. The problem is to predispose the mind to sleep and then

the senses will not disturb it except under special circumstances.

As a matter of fact, noises usually disturb people very little at

night. The most surprising things can happen between 12 and 3 o'clock

and attract no attention. Burglars calmly blow up a safe in a hotel

confident that if there is no one awake when the explosion occurs

there will be no investigation, because even though people wake up at

the noise, they will wait for its repetition in order to see what it

means, will not get up to investigate, especially in cold weather, and

usually promptly go to sleep again.

Lying Awake.--There are many people to whom lying awake carries with

it a sense of discouragement and dread. They seem to forget that lying

awake and occupation with pleasant thoughts may be made a very

agreeable pastime by those who are not over-anxious to sleep and who

let the pleasant thoughts that may be suggested by the environment or

the noises that are heard flow through consciousness. Everyone knows

how pleasant it is or may be to listen to the rain patter on the roof

of a country house, or to hear the murmur of the ocean or of the wind

through the trees when there is not too much anxiety about to-morrow

and to-morrow's occupations and the necessity for sleep to be ready

for them. Stewart Edward White, in his series of essays on "The

Forest," has a chapter on Lying Awake at Night that can well be

recommended to the attention of those who complain bitterly of an hour

of sleeplessness. Of course, in his case the lying awake is in the

midst of the forest with all the witchery of wind in the trees and the

{668} unusual sounds of forest life, while ordinary lying awake is in

the rather monotonous environment at home, but still there is much

that can be said for his insistence that in peaceful brooding,

faculties revive while soft velvet fingers are laid on the drowsy

imagination and you feel that in their caressing vaster spaces of

thought are opened up. The impatience that comes to so many almost at

once if they fail to go to sleep promptly only serves to keep them

awake just that much more surely.

Very often, as suggested by Mr. White, this wakefulness occurs just

when a good night's rest is surely expected. There is sometimes even a

preliminary period of drowsiness. Then some little noise that

ordinarily would not be noticed at all floats into the consciousness

with a vigor that indicates that one sense is thoroughly awake. The

very surprise of it wakes up the other senses with a start and then

comes the thought that there is to be no sleep for some time. If this

is resented, the period of wakefulness will be all the longer. If,

when it has proved to be inevitable, one sits up quietly, reads a book

for a time, plays a quiet game of solitaire, it may be on a board kept

beside the bed for such purposes, or in some quiet way succeeds in

bothering away the thought of insomnia, then almost surely sleep will

come after a time, quietly and restfully, and the lost period will not

prove harmful. If nature does not want to sleep she must not be forced

into it, but gently led and after a time the wakefulness will

disappear.

Night Terrors.--One of the troubles of sleep that is more often called

to the attention of the physician than almost any other, is the

so-called "night terrors" of children. Little ones wake with a scream,

sit up in bed, evidently terrified, usually trembling, and ready to

seek refuge from something that has seriously disturbed them. Under

Dreams we have called attention to the fact that usually these terrors

are due to a dream. Sometimes the dreams are the ordinary experience

of supposed falling in sleep, from which the patients wake very much

startled, or they are repetitions of exciting scenes through which

they have passed, or of stories that they have heard, or, above all,

plays that they have seen. Ghost stories, for instance, told shortly

before they go to bed will often disturb children. Fairy stories and

the ordinary myths of childhood, usually with a happy ending and

without any serious terrors in them, are not so likely to disturb

them. Melodramatic theatrical performances to which children lend

themselves and their attention with great concentration of mind, have

nearly as much effect on them as if they passed through the actual

scenes. Every physician knows how much a fright is likely to disturb a

child and cause it to wake many a night afterwards in a state of

terror.

Respiratory Interference.--It is particularly important to remember

that any interference with breathing will almost surely wake the child

in a seriously startled condition. Adults are often affected by this

same sort of dream, due very often to some pathological condition in

the throat around which a series of dream ideas collect with somewhat

poignant results. I have known a man suffering from elongated uvula

wake up thinking that he was suffocating because, as he thought, he

had nearly swallowed his tongue, or at least had been trying to do so.

The sensation was so startling that it brought him to his feet at

once. I have known a patient traveling a long five-days' railroad

journey and suffering severely from train catarrh, come to the {669}

persuasion that he might suffocate during sleep because his nose was

completely stopped up and he had not the habit of sleeping with his

mouth open. As a result his sleep was as much disturbed by his mind as

his breathing. If these affect adults so strongly, it is easy to

understand why children should be so frightened by them. Children who

are mouth-breathers from adenoids or nasal obstruction, and still more

those whose nasal breathing apparatus is not completely stopped up,

but who are frequent intermittent mouth-breathers, are especially

likely to be troubled in this way. The neurosis known as nervous

croup, due to a spasm of the vocal cords, occurs oftenest in this

class of children and is an associated phenomenon to that of night

terrors.

Sleeping in the Light.--The habit of accustoming children to sleep

with a light in the room nearly always lessens the depth of their

sleep. They are more easily wakened and their sleep is not so

refreshing. Besides, if they do not grow accustomed to the dark when

they are young, they may always retain a dread of the dark and will

require some light in the room where they sleep. Nature intended that

the eyes and the optic nerve should have as complete a rest as

possible and even with the lids lowered some light stimulus, if it is

present, finds its way to the nerve fibers. Hence the desirability of

having as far as possible an absolutely dark room. For some very

timorous children, this may seem impossible. Many mothers will recall

how awful the dark seemed to them and what shadowy shapes loomed up in

it. It will usually be found on inquiry, however, that in these cases

the children, after having been accustomed to sleep with some light

and after having had all sorts of exciting pictures shown them and

stories told them, were asked to sleep in the dark. From the very

beginning they should be accustomed to sleeping in the dark and then

it has none of the terrors thus pictured.

CHAPTER IX

DREAMS

Dreams, that is, thoughts and illusions and mental phenomena of

various kinds that occur during sleep, have always been interesting to

the psychologist, and have usually been related to physicians by

patients either because they were thought to have a significance

related to disease, or because something in them disturbed the

patient's mind. This is almost as true in the modern time as it was

long ago. It is curiously interesting to note that the very latest

development of psychotherapy includes the use of hints obtained from

dreams in order to determine the origin of psycho-neurotic conditions

and certain of the minor psychic disturbances, and also as a

foundation for treatment. The oldest stories of therapeutics that we

have are those of patients waited on by the priest physicians of the

olden times in the temples, who were supposed to be greatly helped by

information obtained from the patient's dreams. It is interesting to

read such recent studies as that of "Incubation in the Old Temples,"

by Miss Ingersoll, with the thought in mind that we are once more

analyzing dreams in order to accomplish a similar purpose.

{670}

Dreams are so often a source of disturbance of mind for patients, lead

to such disturbed sleep, or even so affect the bodily health that it

is important for anyone who wants to influence patients through their

minds to know the significance attributed to dreams by the most recent

studies of them. This is all the more important because dreams are

such a universal phenomenon. From our earliest years we dream. The

night terrors of children are probably due to dreams and show that

even as early as the age of three we dream vividly. Doubtless some of

the terrifying dreams of childhood are similar to those that we

experience later. Dreams of falling, dreams of being cold, of being

out of breath, with vivid repetitions of exciting scenes through which

they have gone during the day, or which they have seen in picture or

been told in story, form the substance of these dreams. Children are

likely to be much disturbed by them. They wake in a terror of anxiety,

in cold sweat, and crying bitterly because of their dream visions.

Older people are not so much disturbed at the moment, but often brood

over dreams and may be seriously affected by them.

It is difficult, however, to persuade many people that their dreams

have no special significance, either of present or of future evil, and

to many the fact that they dream much becomes a suggestion of

wakefulness that disturbs sleep and makes them quite unequal to the

next day's work, because they have the feeling that, as they have been

dreaming all night, they must be quite tired. Tiredness in nervous

people is often a matter of the mental state rather than of physical

exhaustion or genuine mental weariness. The actual place of dreams in

psychology, then, becomes an important consideration in

psychotherapeutics.

Our real advances in the knowledge of the significance of dreams have

come from the study of the dreams that are common to most people.

These show us exactly how and why dreams occur and just what their

meaning is. Probably the most familiar dream common to all the human

race is that of falling from a height. Everyone has been wakened with

a startled sense of intense relief that the sensation of falling was

illusory. The waking came just before the bottom was reached. There is

a tradition that if one ever did strike the bottom in one's dream it

would be the end and that death would result as surely as if the fall

were real. So far we have had no one come back to tell us of that, and

the tradition is reasonably safe from direct contradiction. It serves

without any reason, however, to disturb timorous people and make them

dread to fall asleep again. Often this dream-falling so seriously

affects sensitive individuals that they do not get to sleep for an

hour or more and occasionally those with an inclination to insomnia

may even suffer for the rest of the night from the effect of it. It is

important to explain, then, what we know about the causation of the

dream. In nearly all cases the subject on waking finds himself on his

back, and then the inclination is at once to turn over to the side

with a sigh of relief. Commonly the dream occurs rather early in the

night, when a rather heavy meal has been taken shortly before

retiring. The weight in the stomach, particularly if considerable

liquid has been taken, seems to press upon the abdominal aorta and

interferes, to some extent at least, with the circulation to the legs.

This deprives little nerves at the periphery of the body of some of

their nutrition and causes a tingling feeling in them. This is quite

different from pressure {671} on nerves, which gives the sensation

termed "being asleep" to a limb. This tingling feeling resembles that

which we experience when going down rapidly in an elevator. It is the

falling sensation. This sensation tries to force its way into the

consciousness and in this process does not completely wake

consciousness up, but brings about an association of ideas connected

with falling--hence the dream of being on a height and of falling

therefrom out of which we wake so startled. The whole process instead

of being injurious is really conservative. It is important that the

aorta should not be pressed upon and this is the mode by which

awakening is brought about and the position shifted so that further

interference is stopped, though we ourselves are quite unconscious of

the real purpose that has been accomplished. An explanation of this

kind usually makes people who suffer from such dreams and have been

disturbed by them much more tolerant of the phenomenon and more ready

to go to sleep again, since evidently nature can be trusted to care

for them even during sleep.

After the sensation of falling probably the commonest dream that

humanity has, at least in the civilized state, is that of being out in

some public place without sufficient clothing. Usually we wake just to

find that some portion of our anatomy has been exposed to the air and

that it is cold. It is this sensation gradually forcing its way into

consciousness that has gathered around it a group of ideas that form

our dream.

Among men, a familiar dream is that of running for a car, or away from

something, or to catch someone, and finding that it is almost

impossible to move. We are so out of breath that we are scarcely able

to drag one foot after another and, indeed, sometimes we seem to be

actually rooted to the spot. We cannot move at all. When we wake after

this dream we find that, because of a cold in the head, our nose is

stopped up by the secretion and that our mouths are shut and

consequently we were getting no air. When that sensation tries to

break into the consciousness there gather around it certain familiar

ideas usually associated with being out of breath and hence we have

the dream of trying to run without being able to move.

Frequency of Dreams.--Nervous people often complain that they dream

all night or else very frequently, and that as a consequence their

sleep is not restful. It is probable that there are always ideas in

the mind and that literally we dream without ceasing. These ideas,

however, do not get into our consciousness except just during the

process of waking. All those who have investigated the subject of

dreams are practically agreed on this. In subsequent paragraphs we

quote a number of good observers on this subject. Certainly this is

what we should expect from what we all know about day-dreaming. We can

never catch ourselves during the day without finding some thought

wandering through our minds. If we want to understand dreaming during

sleep this day dreaming is instructive. We jump from one idea to

another, apparently without a connection; yet there is always some

connecting link. We have just read in the paper of someone in Cairo,

and we think of old Egypt, and then of old Babylonia, and the Code of

Hammurrabi, and the laws of the Medes and the Persians, and Xenophon

and our school days, and of an old schoolmaster now a missionary in

Japan, and of Japanese art and of an American artist much influenced

by it, and of one of his great windows in a church in New York and of

social work in connection with that church, {672} and of settlement

houses and then Hull House, Chicago, and then of the Adamses in

Massachusetts, and so on.

Thus, also, do our minds go flitting round apparently during the

night. We remember only such things as are brought into our

consciousness directly and emphatically during the process of

wakening. During our day dreaming we recall only those things which

for some reason led us to think consciously about them and then follow

out our thoughts to definite conclusions. It is an interesting study

to follow back our day dreams through their wanderings to the origin.

As a rule, however, we lose track of the connections and after a time

remember only some of the wonderful transformations and

transmigrations of thought; and so it is in our dreams.

With regard to the frequency of dreaming. Sir Arthur Mitchell in his

book "Dreaming, Laughing, and Blushing" (London, 1905), insists on the

great probability of the constancy of our dreaming during sleep. He

says:

It seems to me that there is no such thing as dreamless sleep.

During the whole continuance of sleep, the mind, I believe, is

occupied with a certain kind of thinking which works round what I

have called hallucinations. I do not expect to be able to prove the

correctness of this opinion as to the persistence of dreams all

through sleep, but I think that it can easily be shown to be

possibly correct. I go further, and say that many things show that

it is probably correct. I may not be able to prove absolutely its

correctness, but it is proper to bear in mind that it is quite as

difficult to prove absolutely that it is not correct. My difficulty

is frankly avowed. Many things, however, are taught in biology as

being certainly true. In regard to which a like avowal could be made

but is not made. There is what has been called a "conjectural

biology."

We do not and we cannot remember much of what we have been thinking

about while we are awake. This is unquestionably true in a large

sense. But, nevertheless, we do not doubt that we have been thinking

continuously. We do not suppose that at any time all thinking had

ceased, though we may be completely unable to recall what it was

about.

He shows further that many writers on dreams and careful students of

the subject in the past have come to the same conclusion. Robert Dale

Owen, for instance, deliberately endeavored to find out whether he had

always been dreaming just before he awoke. After months of observation

he records that in every instance he was conscious of having dreamed.

Hazlitt, a century ago, tried the same thing for a prolonged period

and notes that whenever he was waked, and immediately recollected

himself as to possible dreaming, he was always aware that he had been

dreaming. Sir Arthur Mitchell himself has tried this same experiment

on himself and for a considerable time has scarcely ever failed to put

to himself this question about dreaming when he awoke and always got a

satisfying affirmative answer. Personally, for several years, I have

been interested enough in this subject to recur frequently to it

immediately on awaking and I cannot say that I have ever, under those

circumstances, failed to find that there had been some vague dream

fancies at least running through my mind before I was fully awake.

This opinion as to the constancy of dreaming during sleep has many

authorities in its support. Sir Arthur Mitchell has quoted a number,

some of them distinguished physicians, who add the weight of their

testimony to this view:

It is not a new thing to hold that there is no sleep without

dreaming--in other words, that dreaming goes on unceasingly all

through sleep. I have stated my own {673} opinion strongly, but the

same opinion has been nearly as strongly expressed by others. Sir

Benjamin Brodie, for instance, may be said to express it when he

writes, "I believe that I seldom if ever sleep without dreaming."

Sir Henry Holland expresses it still more plainly when he says: "No

moment of sleep is without some condition of dreaming." Goodwin says

much the same thing when he asserts that "sleep is not a suspension

of thought"--in other words, that dreaming is sleep-thinking. Dr.

John Reid still more clearly holds the opinion, though he does not

furnish me with a short apt quotation. Hazlitt, too, may be taken as

holding that there is no such thing as dreamless sleep.

Descartes and his followers may, perhaps, be regarded as holding that

the mind is unceasingly at work in sleep--even in the "profoundest

sleep," though "the memory retains it not," and Isaac Watts says that

"the soul never intermits its activity," and that we may "know of

sleeping thoughts at the moment they arise, and not retain them the

next moment."

Hippocrates, Leibnitz, and Abercrombie have also been quoted as

holding that there is no dreamless sleep, and so far as they express

themselves on the subject they appear to do so.

A strong weight of opinion in all ages favors the view that during

sleep dream-thoughts are constantly running through our mind, though

we recollect only those which are impressed upon us at the moment of

awaking. We do not even recall those unless, for some reason, we have

paid special attention to them. That is just exactly what is true of

day dreaming. After it is over we have no idea at all of the thoughts

that occupied our minds for hours, though we are all aware that at any

given moment, if we turned our consciousness inwards we found that

there was something that we were thinking about.

Short Duration of Dreams.--This view of the constant occurrence of

dreams during sleep is confirmed by other things that we have come to

know as to dreams and dream states. Probably the most interesting of

these is with regard to the length of dreams. As our memory of dreams

is only such as we have from the thoughts of sleep getting into our

consciousness just at the moment of awaking, dreams are never as long

as they sometimes seem to be. As a matter of fact, they occupy but a

few moments, though in that time a long story may seem to unroll

itself. Probably nothing gives more assurance to people who are

persuaded that they are losing much rest because of their dreams than

this explanation of the brevity of the phenomena. Nervous people wake

frequently. Whenever they wake they find themselves dreaming. As a

consequence, they acquire the persuasion that they have been dreaming

"all the night long," and it is not hard for them to suggest to

themselves in the early morning that they are not rested. Nervous

people seldom feel rested in the early morning, it is their worst

time, and with the occurrence of dreams as a suggested reason for

this, they exaggerate the feeling of tiredness with which they get up.

A frank discussion of this question of the duration of dreams is often

the best possible therapeutic auxiliary for such cases. It gives them

a new series of suggestions and, above all, relieves them of

unfavorable suggestions.

Prof. Maury of the University of Paris tells a striking story of a

very brief dream of his own which shows how short may be the time

occupied by what seems surely a long dream. He had been reading before

going to bed a very striking book on the Reign of Terror. He dreamt

that he himself was arrested during the Terror, taken to prison, that

his name was called on the list of the condemned, that he was carried

to the guillotine, fastened to the {674} board, pushed beneath the

knife and that he woke just as the knife struck his neck. Of course he

awoke with the usual sense of thankfulness and relief that comes at

such times. When he awoke he found that a light curtain rod had fallen

from the bed above him and had struck just across his neck. His dream

evidently had all come to him during the extremely short time

necessary for him to become fully awake after the rod had hit him. His

mind was occupying itself with the history that he had read before

going to bed. When the rod struck him the long story of his arrest and

imprisonment, the journey to the place of the guillotine and the

preparations for execution, all came to him as a series of rapid ideas

during his coming to consciousness.

It is probable that most of our dreams are not much longer than this.

One of my earliest recollections is of an old gentleman coming into

the country school during my first year as a pupil and telling us the

story of a dream of his of the night before quite as brief as that of

Professor Maury. He had fallen asleep after dinner in his chair and,

having a cold that stopped up his nose and his mouth being shut, he

had the usual dream of being out of breath from running. It took him

back to the story of the massacre of Wyoming, near the scene of which

the school was situated. He dreamt that for hours he had been running

away from the Indians and seemed at last utterly unable to escape them

because he was out of breath. He made such efforts in his chair that

his wife awakened him and then he found that he had been asleep

altogether only a very few minutes.

Significance of Dreams.--Many people are quite sure that their dreams

have a definite significance quite apart from any mere wandering of

the mind or the suggestion of half-waking and the ideas that gather

round sensations not fully in the consciousness. A number of people,

for instance, have dreams of events that are happening at a distance

at the moment that they dream. The Psychic Research Society of England

has gathered a number of these and it is indeed difficult to

understand many of them. There seems no doubt, however, that in many

cases there is an illusion of memory, by which, after an event, dreams

that might be taken to refer in some vague way to the happening, are

clothed with a wealth of detail which appears to make them wonderful

premonitory representations of future events or repetitions of

simultaneous events. One of the most familiar of this form of dreams

is what has been called a phantasm of the dying. People dying at a

distance seem to have some wonderful power of making themselves appear

to very near friends, especially brothers and sisters, and, above all,

twins, and to friends with whom they have been very intimately

associated. Occasionally such phantasms are seen during waking hours,

or what are supposed to be waking hours, though it must not be

forgotten that dreams may come very easily and almost unconsciously in

short naps, but much more frequently in what are known to be dreams.

Nearly always these partake of the nature of the ordinary dream, as

can be seen by a careful analysis of their conditions, and are mere

coincidences occupying a very brief space of time. A typical example

of this is to be found in one of the stories told by Camille

Flammarion, the French astronomer, in his book "The Unknown." A young

man who had fallen in love with a young woman was deeply grieved to be

parted from her by the injunction of parents. Separated by a long

distance, they kept up a clandestine {675} correspondence for more

than a year. For a considerable period, however, he had not heard from

her, and he was beginning to be anxious lest anything had happened to

her. One night she appeared to him in a dream in his room in white

garments with a pale face and, placing her cold hand in his, she bade

him good-bye. He awoke with a start. He found it difficult to sleep

and was very anxious about her. The next day he learned that she had

died the night before and concluded that his dream was a last message

from her. The end of the story, however, as it is told, spoils this

nice sentimental conclusion. When he awoke he found he had in his hand

a glass of ice water which had been standing on the table beside him.

The grasping of this had awakened him. During the awakening process

the thoughts of her in his mind gathered round the cold sensation in

his hand and gave him the dream of her and the last farewell.

There are many instances in which dreams of future events seem to come

true. Indeed, so many of these stories have been told that it is hard

to persuade some people that dreams have no meaning and can have no

meaning. By this we mean that they can by no possibility represent

prophetic foresight. What patients need to be made to understand is

that dreams represent only straggling sensations trying to get into

our consciousness, just barely succeeding, and then arousing trains of

ideas unconnected in themselves, but which we connect afterwards when

we recollect our dreams. This whole subject has been studied so

thoroughly in Maury's work on _"Le Sommeil et les Reves"_ about the

middle of the last century and Freud _"Ueber den Traum"_ and Sante de

Sanctis' _"I Sogni"_ Turin, 1899, at the end of the century, that

there can be no further doubts about the matter for those who are open

to conviction. Most people, however, want to believe that their dreams

mean something. They like to think that they are in some way picked

out from the multitude and that their dreaming has a significance more

than is accorded to other people. It is, indeed, this

self-centeredness that makes for the belief in premonitions and

prophetic dreams and, as in all cases, these feelings work out their

own revenge.

If they will listen to reason, however, most people may be rather

readily convinced that their dreams cannot have any serious

significance. In the chapter on Premonitions we have already called

attention to the situation that exists with regard to the possibility

of future events giving information of themselves in advance of their

happening. Simultaneous events may perhaps in some way give warnings.

The possibility of action on the mind at a distance, especially where

minds are involved, has been discussed and admitted. The cases in

which it is supposed to have happened are, to my mind, all dubious and

are mere coincidences. For future events, however, there is no

possible physical explanation. When we turn to explanations in the

borderland between spirit and matter we find nothing satisfactory. The

future event exists nowhere. No spirit even knows it; it is dependent

on human free will. To the Creator it is known only as a contingent

possibility dependent on free will. The information does not come from

Him, for then there would be more design in these incidents. Such

dreams would effect some serious purpose, while usually they have but

minor significance in the stories as told and they often concern only

the most trivial things.

What is thus true of premonitions can readily be applied to dreams.

{676} There is no reasonable source of information with regard to

future events. What, then, are we to say of the dreams that come true?

There is no doubt that dreaming is extremely common. Probably, as was

said, we never sleep without dreams. There are a billion dreams at

least, probably many billions of dreams every night, then, in this

little world of ours. When these are startling they cling to us. It

would be surprising if some of them did not come true. Indeed, it is

inevitable, according to the theory of probabilities, that some of

them will connect themselves directly with future events. We have a

few thousands of such startling coincidences in the history of the

race. Out of these have been made all the data supposed to underlie

the teaching that dreams have a prophetic significance. It is much

easier to understand with regard to dreams than even with regard to

telepathy coincidence explains all the supposedly wonderful warnings

of events that actually happen after we have had apparently

premonitory dreams.

An interesting example of a premonition that did not come true, the

subject of which was sure that it was a waking premonition and not a

dream, though it seems more likely that it was as suggested by the

narrator a sleep vision, is told by Sir Arthur Mitchell in his

"Dreaming, Laughing, Blushing" (London, 1905). A number of scientists

who discussed the story declared that if it had only come true it

would have been one of the most startling manifestations of

premonition and of the clairvoyant power of dreams, or at least of

their telepathic significance, that we have ever had. It involved so

many distinguished scientists that there could have been no doubt

about it. It was so detailed and those details were known to so many

authorities in science, that it would have carried great weight and it

would have been extremely difficult to have people accept it as a

mere coincidence. It is easy to see now after the event that, if it

had been fulfilled, it would have been, in spite of its startlingness,

a mere coincidence. Since it was not fulfilled, however, it represents

one of the best evidences that we have for the insignificance of

premonitory or telepathic dreams.

Sir William T. Gairdner, K. C. B., whose interesting typhus delirium

experience appears in the paper by Professor Coates on "Sleep,

Dreams and Delirium" (_Glas. Med. Jour.,_ Vol. xxxviii, 1892, pp.

241-261), has written to me about his dreams generally, and he

concludes his letter with the narrative of a dream, which, as he

correctly says, "if it had only fulfilled itself, might have become

famous." He prefaces the narrative by this statement: "In all my

individual experience, now extending over more than the usual term

of life, I have never met with anything suggestive in the remotest

degree of telepathy or second sight, or of dream prophecies or any

other fact bearing on the marvellous." He then goes on to tell the

dream to which I have referred. "In crossing the Atlantic In 1891,"

he says, "in delightful weather and perfect bodily health, and

without a shade of anxiety on my mind so far as I was aware (in

waking consciousness), I was suddenly aroused in the very early

morning, say, three or four a. m., out of a perfectly sound, and, as

I should call it, dreamless sleep, by the apparition of a telegram

written on the usual paper, and presumably from home, in these

words: 'Miss Dorothea died at ----,' all the rest being blurred and

indistinct, but these words having a startling distinctness and a

vivid sense of reality. I was not, I think, in the least degree

alarmed at first, and certainly had no superstition about it on

discovering that it was only a dream; but, failing to get any more

sleep, I rose early, took my bath as usual, and went on deck, where

I had to repeat the story of my dream to each one of some three or

four companions who were on board, of whom I will only mention Sir.

John Batty Tuke, Professor Young of Owens College, and Professor

{677} Cunningham, then of Trinity College, Dublin. Any of these

gentlemen will confirm my saying that I attached no special

importance to this dream in the way of a scare or a superstition,

but in this way it got abroad to a certain extent within a small

circle on board in such a way as would have ensured it a widespread

fame had it only come true. In discussing the matter at breakfast I

remarked (alluding to telepathy) that the telegram was clearly,

judging from its terms, not from my wife or any member of my

immediate family, and could only have been despatched by a servant

or some one with whom I could not be supposed to be in telepathic

rapport. From this point of view it clearly refuted itself, and yet

the effect upon my mind was such that, upon arriving at New York, I

at once despatched a telegram announcing my arrival and making

inquiry, the reply to which showed that the family were pursuing a

quite undisturbed course at St. Andrews."

Sir William describes himself as aroused out of sound sleep by the

apparition of a telegram, but I think this only means that he became

suddenly awake on seeing the telegram during sleep. He does not say

whether he knew in his dream that he was a passenger on a great ship

on the mid-ocean, but he says that the telegram was written on the

usual paper by which I take it that he means the paper used here on

shore.

If it happened that the death of Miss Dorothea took place about the

time of the appearance of the telegram to so distinguished a man as

Sir William in his sleep, I scarcely think there would be any more

startling record of a so-called telepathic message. But most happily

the death did not take place, so that the story of the dream will be

forgotten. Tens of thousands of similar dream stories have that

fate.

Children's Dreams.--There is an old tradition that to tell our dreams

causes them to come back, or at least to recur in some other form.

This tradition is so old and so universal that probably there is more

in it than might at first be thought. This emphasizing of certain

forms of unconscious cerebration probably encourages their repetition,

or, at least, the repetition of further processes of the same kind.

There seems to be no doubt, too, that the reading of certain kinds of

imaginative writing and the looking at exciting pictures sometimes

leads to dreams about them. Certainly children should not be told

terrifying stories and the more nervous they are and the more affected

they are by such stories, which to some people make renewed

temptations to tell them, the more should they be avoided.

Any physician who has had much experience with city children,

especially in New York City, is likely to know how exciting, tragic

and, above all, melodramatic scenes serve as the basis for disturbing

dreams and night terrors. They will not, of course, in vigorous,

healthy and strong-minded children, but these are the ones who are

most prone to play out of doors and so are likely to be less bothered.

Just the nervous, old-fashioned, delicate children who prefer the

theater to sports of other kinds, are likely to be most affected in

this unfortunate way. The scenes become so real to children that they

impress them very deeply and are readily rehearsed in the unconscious

cerebration of sleep. Many a child sees in its dreams someone, often a

near relative, fastened on the carriage of a sawmill and inevitably

approaching a buzz-saw, or fastened inextricably to the rails while an

express train thunders down on them. That they should wake up with a

start and a scream of terror and lose most of their night's sleep and

disturb that of others, is not surprising. It is well known how

witnessing actual danger, as of an automobile accident, or a railroad

wreck, disturbs a child's imagination for long after; and its theater

experiences are almost as actual as the reality.

{678}

Many of the colored supplements of Sunday newspapers seem to be

particularly undesirable literature for children in this respect,

though, of course, there are many other reasons why children should

not be encouraged to look at them. It is not unusual for the

newspapers to give lurid pictures of wonderful dreams or things that

happen in dreams. This is undoubtedly a suggestion that acts in

causing nearly all children, but especially those of nervous

organization, to dream much more than would ordinarily be the case. It

recalls the old warning about telling dreams. These sets of pictures

certainly serve to develop the imagination of the child along

undesirable lines. Possibly some of them which emphasize the fact that

after eating certain very undesirable foods, dreams are much more

likely to come than at other times may not be without their

prophylactic sanitary value, but this is a doubtful advantage compared

to the psychic harm that they bring. I am not of those who would limit

the fairy stories and other pleasant essays in imagination which

delight children so much and form a desirable part of their education,

but artistic effort that is terrifying or deterrent, whether with pen

or brush, should be kept away from them until after their mental

control is well established. Children will probably dream anyhow, and,

therefore, should have a pleasant fund of imaginative material as a

basis for their dreams.

CHAPTER X

DISORDERS OF MEMORY

Many patients suffering from various nervous symptoms insist that they

are losing their memory or that it is becoming notably deficient in

some ways. If they are a little on in years they are sure that their

memory is not as good as it used to be and that they now forget many

things that were formerly remembered without difficulty. Especially

are they likely to assert that the names of people and certain words

will not come to them when they want them, that they often have to

seek for facts and dates that should be quite familiar, that they fail

to remember acquaintances and the like. These symptoms of which they

complain are often sources of considerable worry and serve to

emphasize in them the idea that there is something serious the matter

with their general health, or some pathological condition developing

in their brain. They have heard much of loss of memory as a sign of

degenerative nervous diseases and they are prone to think that their

own special loss of memory, be it real or imaginary, must be a

forerunner, or perhaps even an early symptom, of some important

organic lesion.

This idea of progressive memory disturbance as a preliminary of

nervous breakdown often becomes so firmly fixed as to be of itself a

profound source of anxiety to patients, and an almost unspeakable

dread. So it is important to make them understand what the real nature

of their condition is and what their loss of memory, supposed or real,

is due to. As a matter of fact, what many of these patients need is

not treatment for a diseased memory, but reassurance from what we know

about the psychology of memory, that their troubles are only quite

natural incidents in the life history of their particular memory {679}

faculty. Many a man who is worrying about his supposed loss of memory

or, at least, impairment of it in some way, is not suffering from a

true pathological condition, but is usually the victim only of some

functional disturbance of the nervous system with the neurotic anxiety

and heightened introspection that accompanies such a condition.

Reasons for Memory Difficulties.--Nervous patients particularly

complain that they do not remember what they wish to as easily as they

used to a few years before. They say that it is much more difficult

for them to impress things upon their memories and, in addition, that

it is much easier for them to forget. There are three quite natural

reasons for these phenomena as far as they actually exist, which

should be pointed out to these patients. The first and most important

is that they are incapable of that concentration of mind which they

had in earlier years and which enabled them to give themselves up so

completely to the consideration of a particular subject that it could

not help but be impressed on their minds. They are now so much

occupied with many other things, and, above all, most of these

patients are so preoccupied with themselves that they cannot hope to

have the concentration of mind that was comparatively easy when they

were younger and is now impaired, but which is so necessary for the

enduring remembrance of things. Secondly, their over-anxiety to

remember things sometimes acts as an inhibitory motive in securing

that deep, impression that will enable them to remember details very

well. Thirdly, their supposed impairment of memory is due to a false

judgment with regard to themselves. They are not comparing their power

of memory now with what they used to have, but owing to anxiety about

themselves they have taken to comparing themselves with others and,

after all, the faculty of memory acts very differently for different

people and it is well known that what one man remembers with ease

another recalls with difficulty, or only because of special attention.

_Attention and Memory_.--The first of these causes for supposed

impairment deserves to be discussed further. It is often said that as

we grow older our memory is not so retentive as it used to be, and

that while we remember the events of boyhood and the things we learned

in the early years of school life, our recollection of recent events

and things learned in later years is much less vivid. This is all very

true, but the reason usually given, that in the meantime our memories

have failed in power is inconclusive. What we learned in early

childhood came to us with the surprise of novelty and for this reason

we paid close attention, it was new and impressed us with its

importance, it was dwelt upon for long periods and often, because

there was little else to think about, has been frequently recalled

since and, of course, is indelibly impressed upon our memories. The

same thing is true with regard to early acquaintances. We got to know

them so well that, of course, we cannot forget them. What we have

learned in later life, however, has come in the midst of many other

things, has not been dwelt on very long, has not been often recalled

and, of course, occupies much less place in the memory than the things

of earlier life. That is not, however, because of any defect in

memory, but because of lack of attention and repetition that means so

much for memory.

_Age and Memory_.--It is often said that people do not learn so

readily when they get older. This is, of course, a truth of common

experience, but {680} it is not because of dullness of the faculty of

memory, but failure to concentrate the attention sufficiently for

memorizing. I have known old men who could learn things just as well

as any young man and indeed better than most of them. They were men

who had been accustomed all their lives to concentrate attention on

the subject they had in hand and who did not allow the cares and

worries of life to intrude on their studies. Cato learning Greek at

eighty is often quoted as an exceptional example, but I have had some

dear old friends who could learn things quite as readily as younger

men and whose minds were just as bright and clear. Whenever they

devoted as much attention to anything that they wanted to remember as

they did when they were younger men, I am sure that they remembered

quite as well. It is a question of attention and not of any loss of

faculty that makes the difference between the memory of the young and

the old until, of course, senile impairment actually comes.

_Solicitude and Memory_.--Everyone who has had to depend much on his

memory knows that over-anxiety with regard to the recollection of

anything may seriously inhibit the power to recall it. Public speakers

know that to hesitate is to be lost. If they want a particular name or

word which they know often escapes them, they must with confidence

begin the sentence in which it is to occur, though perhaps wondering

all the time whether the word will be on hand or not for them to use

it. Occasionally it will not come, but as a rule it turns up just in

time. If they allow themselves to be disturbed by the thought that the

word or expression may not come, then they know the hopeless vacant

blank that stares them in the face when they want it. They have to

make a circumlocution in the hope that it may turn up. Some let it go

at that, but many start another sentence in the hope to tempt it to

come and often it will eventually come, but sometimes it persistently

refuses to come. That is not a loss of memory but a failure of neuron

connections. There are some of us who know that certain words will

always do that with us. Archimedes has bothered me for years and his

name will often not come when I want it. Then there are certain words

with regard to which transposition is likely to take place. We

involuntarily and unconsciously substitute one word for another. We

call one man by another's name. We have done it before and we know

that we are likely to do it again. Somehow the connections in memory

exist along these wrong lines and are constantly mismade. The name of

something a man has written comes up instead of his name. This

heterophemia is often noted in men of excellent memory.

Peculiarities of Memory.--Memory is an illusive and elusive function

at best. All of us have had the sensation of having a word, and

particularly a name, on the tip of our tongues. We often know the

first letter and sometimes the first syllable of it. What memory

brings to us, however, may not always be the first syllable of a word

or name, though we are prone to think it must be, and we may go

looking for it in the dictionary of names only to discover after a

time that we are many letters away from its beginning. Very often we

have to give up seeking in sheer inability to get a hint of it and

then of itself it will come a little later. Sometimes it will come

when we no longer want it. As a rule, words that have escaped us once

in this way are prone to do so again. Over and over again the

experience will be that {681} a particular word or group of words

escapes our memory, or at least fails to be at our command, as most

other things are. Those of us who are not much given to introspection

take no notice of these difficulties which are common-place

experiences enough, but the man or the woman who is looking for

symptoms, who is prone to believe for some reason or other that his or

her memory is failing, will take these hints of the more or less

natural fallacy of memory as confirmations, strong as direct proof of

the fact that memory is seriously deteriorating.

Such pauses and lapses of memory are much more likely to occur if we

are nervous and over-anxious about possible loss of memory. I was once

asked to attend for a few hours before the time fixed for his oration

one of the greatest orators of this country, who was about to talk at

a university commencement. What surprised me was that this practiced

speaker, who had often appeared before very large audiences, took a

very light meal in considerable trepidation, immediately after asked

to have certain books brought to him and certain facts looked up for

him, took notes in a hurried, feverish way and generally displayed all

the over-excitement of the schoolboy about to make his first oration.

He was a magnificent occasional speaker, often called upon, yet he

assured me that it was always thus with him and that the reason for it

was that in spite of previous preparation--and the finish of his

orations made it clear that he had devoted much thought to them

beforehand--certain of his facts and names and dates had the habit of

slipping from him in the midst of the development of his theme, unless

he had refreshed his memory with regard to them immediately before,

and that he feared that sometime he would find himself in the midst of

an address with an absolute blank before him and that he would be

compelled to sit down in disgrace. He had never done so and never did

in the many years that he, lived afterwards, though always with this

dread, never trusting his memory as most people do.

_Name Memory_.--There are certain circumstances in which memory may

fail and yet no significance of a pathological nature can be

attributed to the fact. All of us probably have had the disturbing

experience of undertaking to introduce two friends whom we had known

for many years and yet having to ask at least one of them for his name

before we could make the introduction. It is not that we did not know

the name, but at the moment we were utterly unable to recall it. After

this has happened once or twice it is prone to happen again, because

when we set about introducing people the thought of the previous

unfortunate occurrences of this kind comes to our mind and acts as an

inhibition of memory, making it impossible for us to recall names. Not

infrequently if we are brought to the pass of having to ask one of the

parties for his name we have to ask the other, though it was on the

tip of our tongue a moment before, because in the meantime the

disturbance of mind incident to having to ask has interfered with the

train of recollection. Men have been known to forget their own names

under circumstances of great excitement and such a forgetting is not

pathological, but only a physiological disturbance of function because

of secondary trains of association set to work in the brain which

disturb ordinary recollection. Of course, some people have an

excellent memory for names and never have such experiences, but they

are very rare, though practice in recalling names does much to keep

{682} people from such embarrassing situations. On the other hand,

there are some people especially gifted with name memories. Napoleon

could recall all his soldiers' names.

Fatigue and Memory.--Occasionally it happens quite normally that when

we are very tired certain portions of our memory at least become vague

and indefinite and may even fail to respond to any excitation on our

part. Under these circumstances we seem to be able only with

considerable effort to exert the effort necessary to bring about such

connections of brain cells as will facilitate recollection and

reproduction and we may fail entirely. In a foreign country it is, as

a rule, much more easy to talk the language in the morning when we are

fresh than in the evening when we are tired. Especially is this true

if we are asked to pass from one foreign language to another, which

always requires a special effort. Everyone who has traveled must have

had the experience that on crossing the frontier suddenly to be

addressed in German after he has been talking French for weeks, may

quite nonplus the traveler, even though he knows German as well or

even better than French. This is especially true if much depends on

the answers, if he has been addressed by a railway official or customs

inspector. Apparently there must be a momentary wait until some

shifting operation takes place in the brain before the German memory

can get to work to establish the connections necessary to enable him

to talk German. After a man has been talking to a number of people in

one foreign tongue he is likely to be quite lost for words for a

moment if he has to use another. The effects of fatigue and excitement

and unusualness upon memory then must be remembered in order to be

able to reassure patients who pervert the significance of the

phenomena.

Ribot gives an excellent personal illustration of this peculiarity of

memory in his "Diseases of Memory," which is worth recalling here. He

says:

I descended on the same day two very deep mines In the Hartz

Mountains, remaining some hours underground in each. While in the

second mine, and exhausted both from fatigue and inanition, I felt

the utter impossibility of talking longer with the German inspector

who accompanied me. Every German word and phrase deserted my

recollection; and it was not until I had taken food and wine, and

been some time at rest, that I regained them again.

Sensations and Memory.--Just as soon as people compare their memories

with others, as they do when they worry and begin to grow

introspectively self-conscious, they find noteworthy differences and

because of differences they will be prone to think that their memory

is pathologically defective when it is only different, or, still more,

that because they are not able to remember some things, as others do,

their memory must be failing. It is well known that some people have a

good memory for things seen, others for things heard, and still others

only for things in which they have taken actual part. These are spoken

of as visual, auditory and action memories. Memories for things seen

are divided into special classes. Some people remember forms very

well, while others remember colors. It is evident that our memories

are somehow dependent on the special mode in which sensation affects

us and that our acutest sensations are the sources of our longest and

best memories. Color vision defectives are not affected much by colors

and easily forget them. The tone-deaf have no memory for tunes. Every

sense defect affects the memory. Sense defects are often unconscious.

Their effect on memory may {683} only be noted when introspection

begins to bring out the special sensation and memory qualities of the

individual. Nature, not disease, may be the basis of some memory

troubles thus brought to recognition. All these curious phenomena with

regard to memory need to be recalled whenever there is question of a

supposed deterioration of it, for it is not easy to decide such a

question.

Limits of Normal Forgetfulness.--Curious instances of forgetfulness

may occur in the experience of men with excellent memories, which,

when they happen to persons morbidly inclined to test their every act,

are interpreted to signify something much more serious than they

really mean. Nearly everyone has had more than once the experience of

telling a story to a particular group of people and then forgetting

all about having told it and coming back a few days later to tell it

over again. Occasionally a teacher hears the same lesson a week apart

and yet does not remember that he went over it before, though the

class is almost sure to do so. A man may repeat a lecture that he has

given before to the same audience without realizing it. The story has

been told more than once of a clergyman delivering the same sermon on

two Sundays in succession and, though such lapses are very rare, they

do not necessarily indicate a failing memory, but may only mean a lack

of concentration of attention on the part of the human mind. Prof.

Ribot in his "Diseases of Memory" tells the story of one such case in

which the subject was quite alarmed lest it should indicate that he

was beginning to suffer from some serious memory disturbance due to

brain disease, though there was no ground for his fears:

A dissenting minister, apparently in good health, went through the

entire pulpit service one Sunday morning with perfect

consistency--his choice of hymns and lessons and extempore prayer

being all related to the subject of the sermon. On the Sunday

following he went through the service in precisely the same manner,

selecting the same hymns and lessons, offering the same prayer,

giving out the same text, and preaching the same sermon. On

descending from the pulpit he had not the slightest remembrance of

having gone through precisely the same service on the preceding

Sunday. He was much alarmed and feared an attack of brain disease,

but nothing of the kind supervened.

Attention not Memory.--When patients come with complaints of the loss

of memory, the most important thing is to analyze their symptoms

carefully. This will usually enable us to give patients ample

reassurance. I have known men who were convinced that they were losing

their memories because of their failure to recall important details in

their business affairs in the midst of much hurry and bustle in the

winter time, find that when they were living a simpler life in the

course of travel or life in the country during the summer time under

conditions different from the ordinary, their memory could be

absolutely depended on for trains and travel details and all important

matters to which they were now devoting attention.

Cultivating Looseness of Memory.--Many people complain of loss of

memory in the sense that they do not now remember when things took

place as well as they used to. For instance, I have had men of fifty

tell me that they were sure that their memories were growing weaker

than they used to be because a number of times within a year they had

found that events which they thought had taken place only a year or

two ago really dated four or {684} five or even more years in the

past. Some are considerably disturbed by this. As a matter of fact it

is only another instance of lack of attention. Most of what we read in

newspapers attracts so little of our serious attention that it is no

wonder that we do not recall with exactness when events took place.

Events crowd each other out of memory. Newspaper reading is, indeed,

the best possible cultivation of looseness of memory that we could

have. We do not expect to remember what we read. We would probably

grow distracted if we did. At the end of the day if you ask a man what

he read in the morning paper he will have no idea at all, unless

something especially startling or particularly interesting to him has

turned up. After a week we could no more separate Monday's from

Tuesday's news of the week before than we could recall a random list

of events, having heard it but once. We cultivate looseness of memory

with great assiduity. Let us not be surprised if, to some extent, we

succeed.

Memories Individual.--People are often much worried over children's

memories and may communicate this worry and anxiety to the children

themselves, making them solicitous. It is probable that our memories

are like our stature. They are what they are. By thinking we cannot

add a cubit to the one nor facility to the other. The training of the

memory is a very small element compared to the natural faculty. It

must not be forgotten, however, that many distinguished men have been

noted for rather bad memories when they were young and yet these

faculties have developed quite enough to enable them to accomplish

good work afterwards. The memory is, after all, a comparatively

unimportant faculty in itself and other intellectual faculties surpass

it in significance. It is the faculty that first develops, however,

and so a child is often thought to be intellectually slow when it has

not so bright a memory as its companions, though a little later its

other faculties may develop so as to put it on a plane above its

fellows. Memories, too, are very individual and may not retain any of

the ordinary subjects, while they may be very attentive for certain

special lines of thought. This form of the faculty is better, for the

encyclopedic memory is usually of little use and, except in high

degrees, encourages superficiality rather than real knowledge.

As a matter of fact, few of our greatest thinkers have had what would

be called brilliant memories and it would almost seem as though the

diversion of mental energy to this faculty rather disturbed the

development of the others. Many a distinguished man has been rather

notorious as a child for bad memory, so that in the early days when

memory was the only faculty called upon at school he was set down as a

dunce. Perhaps the most striking example of this was Sir Isaac Newton,

who was actually called a dunce, and yet the world would welcome a few

other such dunces. Thomas of Aquin, the great medieval writer on

philosophy and theology, who still influences philosophy so much, was

so slow as a young man that he was called by his fellow pupils "the

dumb ox." His great teacher, Albertus Magnus, recognized the depth of

mind that his fellow students could not see and declared that the

bellowings of that "ox" would be heard throughout the world. Sir

Walter Scott was spoken of as a very backward child. This is all the

more surprising to those who know and appreciate the wealth of

information that he put into his Waverley Novels. Goldsmith, than whom

we have no more brilliant writer in English, seemed not only a dunce

as a child, but all his {685} life, so far as outward appearance went,

was a numbsknll. This was due to a lack of readiness rather than any

lack of wit.

Tricks of Memory.--Some tricks of memory may be very disturbing to

those who are over-occupied with themselves and with the possibility

of losing their memory. For their consolation it is well for the

physician who hears their complaints to have at hand some stories that

illustrate certain of these curious tricks of memory. I had been

trying to persuade a literary woman for some time that it was not her

memory that was playing her false, but merely her habit of attention

and lack of concentration of mind on things because she is occupied

with a great many interests, when one day she came to me with what she

thought was absolutely convincing proof that her memory was going. She

had read a passage in a newspaper the day before which she liked very

much, but after reflection it sounded strangely like some of the

things that she had thought along these lines herself. It was a

quotation, but there was no indication to tell whence it came. A

little inquiry, however, showed that the quotation was from an article

of her own written only two years before. Here was definite proof of a

failure of memory. Strange as it may seem, however, this experience is

quite common. I feel sure that there is not a single writer for

periodical literature who has not had similar experiences. Anyone who

writes much editorially, where the articles are unsigned, finds it

rather difficult two or three years later, as a rule, to be absolutely

sure which editorials are his. Occasionally it happens that even by

the time the proof comes back for monthly periodicals, say six weeks

or two months, some at least of what was written may seem quite

unfamiliar. This will be particularly true if phases of the same

subjects have been treated in successive articles and thus repetitions

are caused.

There is plenty of good warrant for such occurrences in the lives of

distinguished writers. Scott once heard a song in a drawing-room that

he did not care for very much and he said rather contemptuously, "Oh!

that's some of Byron's stuff." His attention was called to the fact

that he was the author of the stuff himself. Carlyle confessed to

Froude when Froude went over some of the passages of Carlyle's own

autobiography with him, that he had quite forgotten some of the things

written down there. Manzoni, the distinguished Italian writer, whose

"I Promessi Sposi" has probably been more read throughout Europe than

any novel written during the nineteenth century, except possibly some

of Scott's, tells some stories of his own lapses of memory and, above

all, of having once quoted a sentence of his own to confirm something

that he was saying, though he confessed that he did not know by whom

the quotation had been written.

Memory and Low Grade Intelligence.--There are many people who complain

of their memory and of their inability to recall many things which

others recall without difficulty. They are prone to think that this is

some defect in them and not infrequently, as a consequence of

comparisons, they persuade themselves that their memory was better and

that it has lost some of its qualities. Until they became familiar

with some of the feats of memory possible of performance by others,

they were quite satisfied, but now they find in every instance of

forgetting a new symptom of an increasingly deficient memory. I have

found in these cases, that setting before such people some of the

curiosities of memory, and especially the fact that memory is by no

{686} means necessarily connected with profound intelligence, so that,

indeed, its presence is quite compatible with a low grade of

intelligence or even with what is practically idiocy, will do much to

rob these gloomy forebodings of their terrors with regard to their own

supposed deterioration of intellect. Ribot, in his "Diseases of

Memory" [Footnote 52] has an excellent passage in which he sums up a

number of these peculiarities of memory that are likely to be

especially consolatory to people of ordinary memory who are worrying

about themselves.

[Footnote 52: International Scientific Series,

D. Appleton & Co., New York.]

It has long been observed that in many idiots and imbeciles the

senses are very unequally developed; thus, the hearing may be of

extreme delicacy and precision, while the other senses are blunted.

The arrest of development is not uniform in all respects. It is not

surprising, then, that general weakness of memory should co-exist in

the same subject with evolution and even hypertrophy of a particular

memory. Thus certain idiots, insensible to all other impressions,

have an extraordinary taste for music, and are able to retain an air

which they have once heard. In rare instances there is a memory for

forms and colors, and an aptitude for drawing. Cases of memory of

figures, dates, proper names, and words in general, are more common.

An idiot "could remember the day when every person in the parish had

been buried for thirty-five years, and could repeat with unvarying

accuracy the name and age of the deceased, and the mourners at the

funeral. Out of the line of burials he had not one idea, could not

give an intelligible reply to a single question, nor be trusted even

to feed himself." Certain idiots, unable to make the most elementary

arithmetical calculations, repeat the whole of the multiplication

table without an error. Others recite, word for word, passages that

have been read to them, and cannot learn the letters of the

alphabet. Drobisch reports the following case of which he was an

observer: A boy of fourteen, almost an idiot, experienced great

trouble in learning to read. He had, nevertheless, a marvelous

facility for remembering the order in which words and letters

succeeded one another. When allowed two or three minutes in which to

glance over the page of a book printed in a language which he did

not know, or treating of subjects of which he was ignorant, he

could, in the brief time mentioned, repeat every word from memory

exactly as if the book remained open before him. The existence of

this partial memory is so common that it has been utilized in the

education of idiots and imbeciles. It is worth noting that idiots

attacked by mania or some other acute disease frequently display a

temporary memory. Thus, an idiot in a fit of anger told of a

complicated incident of which he had been a witness long before, and

which at the time seemed to have made no impression upon him.

Training Memory.--In recent years in many departments of therapeutics

training has been found to be of value. This is especially true with

regard to nervous defects. Probably one of the greatest surprises that

nervous specialists have had in the last twenty-five years in the

domain of therapeutics came from the introduction of Frenkel's methods

of retraining the muscles in locomotor ataxia. This idea of retraining

has been found useful in such distinct departments as the use of the

eye muscles, the co-ordination of the muscles of speech, so as to get

rid of stuttering and stammering, and the muscles of the hand for

writing. We are only just beginning to realize that retraining can be

of great value in psychic affections also. Patients may be disciplined

against their dreads and tremulousness due to over-apprehension and

against even certain defective uses of their intellect. Urbantschitsch

of Vienna showed that by training defective hearing it might in many

cases be very much improved. What he accomplished, however, was not

{687} any better use of the external auditory apparatus, but a more

intense attention of mind which enabled the patient to catch and

understand sounds which had hitherto been so vague that their

significance was lost.

In a number of cases of complaint of loss of memory I have

deliberately set patients to retrain their memories and have at least

relieved their apprehensions if I have not always succeeded in

increasing their actual memory power. It has even seemed, however,

that in old people some actual improvement of the memory faculties was

thus brought about. Under the head of Occupation of Mind I have

referred to the exercise of memory in younger people as representing

an excellent form of mental diversion. When the idea first suggested

itself it seemed as though patients would not take to it at all, and

yet I have found that with a little persuasion they become much

interested and find a great deal of pleasure in their gradually

increasing power to recall the great thoughts of great authors in the

literal original words. A reference to that chapter will tell more of

my experience. This made me more confident of the possibilities there

were of making people understand that if they were losing their

memories they could bring them back by proper exercise. In this way

many of the modern evils of lack of attention and of failure of

concentration of mind can be corrected.

My rule now is to tell patients who come complaining of loss of memory

that if there is any real loss of memory it is due to their improper

use of the faculty, or perhaps to their failure to exercise it

sufficiently, for the proper performance of function depends on

adequate exercise. They are then instructed to take certain simple

classical bits of literature and commit them to memory. At the

beginning such short poems with frequently repeated rhymes of the

modern poets as are comparatively easy to learn are set as memory

exercises. Later Goldsmith's "Traveler" and "Deserted Village" are

suggested. Then passages from Shakeaspeare are given. Just as soon as

the patient finds that he can commit to memory as he used to, if he

only gives himself to the task, a change comes over his ideas with

regard to the loss of memory. For many of these people the occupation

of mind is an excellent therapeutic measure. Besides selections can be

made in such a way as to keep before their minds the thoughts they

most need in the shape of memory lessons. It is a discipline of memory

that revives it and also a constant exercise in favorable suggestion.

Gregor in the _Monattschrift fuer Psychiatrie und Neurologie_, Band

XXI, has detailed some of his experiences with the retraining of the

memory of patients suffering from Korsakoff's Psychosis--alcoholic

neuritis with psychic disturbances, especially of memory. The patient

was required to learn words and then after a certain length of time

was tested to see if he could learn a similar series with fewer

repetitions than at first. The memory increased in capacity with the

exercises and there was evidently a definite gain in the faculty. In

this disease patients have also lost the power to some degree at least

of recognizing objects. After exercises in recognition they are much

more capable in this matter, however, and it is evident that in every

way the memory can be improved. This experience, with a serious form

of disease that gravely impairs the memory, shows how much can be

accomplished in circumstances far more unfavorable than are those

which usually bring patients to the physician complaining of

deficiencies of memory.

{688}

CHAPTER XI

PSYCHIC CONTAGION

The term psychic contagion is often thought of as merely figurative.

It is, however, quite literal. Many minds are influenced by what they

see happening round them and induced to imitate the activities of

others. The term psychic contagion is so thoroughly descriptive of

what happens that it deserves the place that it has secured.

Everywhere and at all times we find historical traces of psychic

contagion compelling people to perform in crowds or groups the most

curious and inexplicable and sometimes the most horrible things. Even

in the old myths before the times of the Trojan War, we have the story

of hysteria spreading among the daughters of King Proteus, so that the

famous old physician, Pelampus, had to administer white hellebore in

goat's milk in order to relieve them. It is probable that this rather

heroic remedy with its definite effect upon the bowels produced such a

revulsion of feeling as to cure the hysteria. Anyone who has read the

awful tragedy that Euripides has written in the _Bacchae_ will have

had brought home to him a typical example of psychic contagion. The

queen mother in the midst of one of the Bacchic orgies kills her own

son in the frenzy that has come from the religious excitement

exaggerated by the association of a number of women in the religious

rites of the god Bacchus. It is well understood that this was not a

case of drunkenness, but of psychic intoxication.

Phrygian Bacchantes are described as overcome from time to time by

paroxysms of curious uncontrollable automatic movements with or

without disturbance of consciousness. This represents the earliest

form of what came to be known afterwards as St. Vitus Dance when it

spread among a number of people. Such manifestations were not at all

uncommon in the East in the earlier days and they have continued

during all history. In Hindustan epidemics of automatic movements,

evidently choreic in character, have been known for many centuries

under the name of _lapax_. Outbreaks of this kind were common in the

Middle Ages and Paracelsus has described them as happening early in

the sixteenth century. At any time the occurrence of an hysterical

seizure in a crowded hall, and especially in a schoolroom, will lead

to other hysterical manifestations. A case of chorea will induce

imitative movements in susceptible bystanders that may be quite

uncontrollable. Tics of various kinds are readily picked up by

children and special care must be exercised to prevent their spread.

In general the state of mind is extremely important in all these

conditions and they can be influenced favorably only through the mind.

Contagions Trifles.--Perhaps the extent to which psychic contagion

influences us can be seen better in little things than anywhere else.

Everyone knows how contagious yawning is. Again and again observations

have been made while actors were yawning upon the stage. Nearly

everyone in the theater begins to yawn in a few minutes and, in spite

of the most determined {689} efforts, every now and then even the most

serious-minded elderly gentleman in the audience finds himself

unconsciously joining in. It seems foolish and to an onlooker appears

almost prearranged. It is only necessary, however, to yawn a few times

in a street car, especially at night, to have many imitators. Nearly

the same thing is true of all respiratory phenomena. Sighing, for

instance, is quite contagious. Coughing is often as much the result of

imitation as anything else. At certain pauses in church services a

preliminary cough is heard and then some scattering coughs here and

there, like the musketry of scouts, and then a whole battery of coughs

is let off, especially if it is in the winter time, because nearly

everybody within hearing is tempted to cough. To talk about yawning or

coughing or sighing before some people is almost sure to produce a

tendency to these manifestations. These apparently trivial happenings

help to explain many phenomena of human imitation in more serious

things.

Most of the phenomena associated with expression are liable to be

initiated as the result of imitation. Laughing, for instance, is

particularly contagious among young folks and is especially likely to

be insuppressible when they wish to be particularly solemn. At

religious services it takes but little to make people laugh and

giggle, no matter how much they may wish to be dignified and

reverential. A few giggling girls will sometimes disturb a serious

service. Extremes are particularly prone to meet in this matter and

the sublime easily becomes the ridiculous. A titter will set off even

the best intentioned of young folks in spite of resolutions to the

contrary. Crying has something of the same contagious nature, though

it is not quite so strong, but among women tears are particularly

likely to evoke tears. The epidemic of curious manifestations of

expression, usually of an hysterical nature, that we know by tradition

to have spread in communities in the Middle Ages and much later, are

only typical examples of this tendency for modes of expression to be

contagious to an exaggerated degree.

Expectoration is largely dependent on imitation, sometimes conscious,

of course, but often quite unconscious. In the recent crusade

organized to prevent the spread of tuberculosis the question of

expectoration as a diffusing agent of the bacilli has given a new

importance to observations on this subject. It is recognized that we

have "a spitting sex" and that men spit from force of habit, boys

imitate them, while women and girls almost never spit. There is no

reason in the world why when men and women are engaged in the same

occupations there should be any difference in this regard between

them, yet employers know how hard it is to keep corners and by-places

in the rooms where men work free from expectoration, while no such

difficulty is found where women work. We have a spitting sex because

of psychic contagion, and in spite of the fact that there are serious

dangers connected with the habit. What is true of spitting may also be

true of other habits relating to the respiratory passages. Hawking and

blowing the nose more frequently than is needed are spread by psychic

contagion and certain habits in these matters that are injurious to

the respiratory apparatus often require considerable effort to break.

Fads and Health.--Enlightened as we think ourselves, we have many more

examples of psychic contagion in the present than we would perhaps

care to admit, unless the facts were called to our special attention.

{690} At a particular period in the modern time it becomes the fad to

do things in a special way. We write alike, we build our houses after

a common type. We take our recreation in a particular fashion.

Bicycling comes in and goes out; roller skating attacks nearly every

one of the young folks and then is abandoned. There are fashions in

everything and fashions, after all, are recurring instances of psychic

contagion. The mental influence spreads from one to another. It may be

that a particular fashion, as in houses or in clothes, is especially

ugly. That makes no difference. After a time taste revolts against it,

but in the meantime the psychic contagion is enough to overturn the

canons of taste. There are fashions in literature, or at least what is

called literature. The nature novel comes and goes, then the novel of

adventure has its place, then the detective novel, after a time the

little-country prince or princess and their romance comes into

fashion. After a time we realize that these are passing fancies, but

in the meantime they have influenced many people.

Some of these fashions bring conditions that are deleterious to

health. The moving-picture show in places that almost never have a

stime of sunlight in them and are, in their way, quite as bad,

especially for respiratory troubles, as the dust-laden atmosphere of

the roller-skating rink, become the fad of the moment in spite of

knowledge or ignorance of hygiene. Just now we are in the midst of a

fad for fresh air, that, unfortunately, goes and comes with the

centuries and we have no guarantee that people will not learn again to

live in closely sealed houses. High heels come and go, as do corsets

of various kinds, more or less injurious, in spite of the admonition

of the physician. In fact, one of the most interesting studies in

psychic contagion is the history of the fashions. A particular

fashion, especially in its exaggerated forms, will probably look well

on about one-fifth of the women at a given time. About four-fifths of

them, however, adopt it in spite of the fact that on three-fifths it

emphasizes certain qualities that it would be well to keep in the

background. It is woman's principal desire to please, yet this is

completely perverted by the psychic epidemic of fashion which causes

people to follow after others quite as much as did the medieval people

in various fads that attracted attention and have come down to us.

Our enlightenment, at least in as far as that word means general

diffusion of the ability to read, has rather added to the power of

psychic contagion. People accept ideas from others almost as

unconsciously as they catch disease from those suffering from it. The

psychology of advertising shows how easy it is to make people accept

things just by insisting on them and by frequent repetitions of

statements. The psychology of the proprietary medicine business in

modern times is about as typical an example of psychic contagion

induced deliberately as one could well imagine. Those who stop to

reason do not fall victims. Most people, however, do not stop to

reason. They have not the mental resistive vitality to render them

immune to the influence of certain irrationalities and so literally

hundreds of millions of dollars have been spent on perfectly useless,

oftentimes harmful drugs, which people had become persuaded through

the psychic contagium of printer's ink were sure to do them good. The

psychology of the mob has been studied somewhat in recent years and it

shows how clear it is that men follow after one another in doing

foolish things even more than in doing wise ones. Psychic contagion is

a prominent factor in life, it always has been, is now, and evidently

always {691} will be, and must be reckoned with by anyone who wishes

to recognize the principles that underlie psychotherapy.

Suicide Contagions.--It is with regard to much more serious things

than fashions, however, that psychic contagion is most manifest. For

instance, there is no doubt that suicide is frequently the result of

such psychic influence. Seldom does it happen that a very queer

suicide is reported without there being certain imitations of it more

or less complete in various parts of the country afterwards. There is

no doubt that the reporting of suicides has a serious effect in this

matter. Perhaps the most striking example of this that we have ever

had in America was the well-known suicidal epidemic at Emporia,

Kansas, which reached its height just about the middle of June, 1901.

Two or three well-known people in town committed suicide at the end of

May and the beginning of June. A veritable epidemic of suicide broke

out as a consequence. Nothing seemed to stop it and the authorities

were much disturbed. Finally it was agreed that the most potent

influence in bringing about the imitation of the epidemic was the

publication of the details of the suicides in the papers. The Mayor of

the city, after consulting with the Board of Health, decided to issue

the following proclamation:

I have consulted the Board of Health, and if the Emporia papers do

not comply with my request I shall have a right to stop, and I will

stop summarily, the publication of these suicide details, under the

law providing for the suppression of epidemics. There is clearly an

epidemic in this city, and although it is mental, it is none the

less deadly. Its contagion may be clearly shown to come from what is

known in medicine as the psychic suggestion found in the publication

of the details of suicides. If the paper on which the local Journals

are printed had been kept in a place infected with smallpox, I could

demand that the Journals stop using that paper, or stop publication.

If they spread another contagion--the contagious suggestion of

suicide--I believe the liberty of the press is not to be considered

before the public welfare, and that the courts would sustain me in

using force to prevent the publication of newspapers containing

matter clearly deleterious to the public health.

Murder.--In almost the same way murders prove contagious. Especially

is this true of murder and suicide together. These occur notably in

groups. A man who is downhearted and for whom the future looks blank,

will, out of a sense of pity for those who are dependent on him,

murder them and himself; then the brutal story is reported and another

tottering intellect gives way and a similar story has to be told

within a few days. A mother who is melancholic about her health and

includes her children in her gloomy outlook makes away with them and

herself. Within a few days a similar story is reported because of the

influence of psychic contagion. Very often there are distinct

imitations of the methods employed in the first case. Often, however,

it is only the idea itself that has proved contagious. There is no

doubt that this suggestion brings about subsequent cases when

otherwise such an awful thought might not occur. The connection is too

clear for us to doubt the reality of it or to think that it is mere

coincidence. As in Emporia, doubtless the suppression of the

description of such events would have a beneficial effect. There are

many disequilibrated minds, apparently just tottering on the verge of

an insane act of this kind, that are pushed over by the suggestion

furnished by the details of another story.

{692}