SLEEP AND ITS DERANGEMENTS.
SLEEP AND ITS DERANGEMENTS.
BY WILLIAM A. HAMMOND, M.D.,
PROFESSOR OF DISEASES OF THE MIND AND NERVOUS
SYSTEM, AND OF CLINICAL MEDICINE IN THE BELLEVUE
HOSPITAL MEDICAL COLLEGE, NEW YORK; VICE-PRESIDENT
OF THE ACADEMY OF THE MEDICAL SCIENCES, NATIONAL
INSTITUTE OF LETTERS, ARTS, AND SCIENCES; LATE
SURGEON-GENERAL U. S. ARMY, ETC. ETC.
PHILADELPHIA:
J. B. LIPPINCOTT & CO.
1869.
Entered, according to Act of Congress, in the year 1869, by J. B.
LIPPINCOTT & CO., In the Clerk’s Office of the District Court of the
United States for the Eastern District of Pennsylvania.
PREFACE.
The basis of this little volume is a paper on Insomnia, published in the
New York Medical Journal in May and June, 1865. This was subsequently
enlarged and published in a separate form, under the title “Wakefulness,
with an Introductory Chapter on the Physiology of Sleep.”
The very favorable reception which it met with in this country, in Great
Britain, and on the Continent, from the medical press, the profession, and
the public generally, led to the exhaustion of a large edition in a few
months.
The present issue was announced nearly two years ago, and the printing
begun. Increasing professional duties have, however, prevented me
bestowing that continuous labor upon it which was desirable, and hence the
publication has been long delayed. My apologies therefore are due, first,
to my excellent and dear friend, the senior member of the house of J. B.
Lippincott & Co., whose patience I know has been severely tried, but who
has scarcely reproached me for my neglect; and second, to that portion of
the public which has been kind enough to make repeated inquiries relative
to the appearance of this monograph, and which I trust will not be
disappointed, now that it is really published.
162 WEST 34TH ST., NEW YORK,
_July 10th, 1869_.
CONTENTS.
PAGE
CHAPTER I.
The Necessity for Sleep 9
CHAPTER II.
The Causes of Sleep 18
CHAPTER III.
The Physical Phenomena of Sleep 52
CHAPTER IV.
The State of the Mind during Sleep 62
CHAPTER V.
The Physiology of Dreams 107
CHAPTER VI.
Morbid Dreams 147
CHAPTER VII.
Somnambulism 192
CHAPTER VIII.
The Pathology of Wakefulness 222
CHAPTER IX.
The Exciting Causes of Wakefulness 240
CHAPTER X.
The Treatment of Wakefulness 278
CHAPTER XI.
Somnolence 288
CHAPTER XII.
Somnolentia, or Sleep Drunkenness 304
APPENDIX 317
SLEEP AND ITS DERANGEMENTS.
CHAPTER I.
THE NECESSITY FOR SLEEP.
The state of general repose which accompanies sleep is of especial value
to the organism in allowing the nutrition of the nervous tissue to go on
at a greater rate than its destructive metamorphosis. The same effect is,
of course, produced upon the other structures of the body; but this is not
of so much importance as regards them, for while we are awake they all
obtain a not inconsiderable amount of rest. Even those actions which are
most continuous, such as respiration and the pulsation of the heart, have
distinct periods of suspension. Thus, after the contraction and dilatation
of the auricles and ventricles of the heart, there is an interval during
which the organ is at rest. This amounts to one-fourth of the time
requisite to make one pulsation and begin another. During six hours of the
twenty-four the heart is, therefore, in a state of complete repose. If we
divide the respiratory act into three equal parts, one will be occupied
in inspiration, one in expiration, and the other by a period of
quiescence. During eight hours of the day, therefore, the muscles of
respiration and the lungs are inactive. And so with the several glands.
Each has its time for rest. And of the voluntary muscles, none, even
during our most untiring waking moments, are kept in continued action.
But for the brain there is no rest, except during sleep, and even this
condition is, as we all know, only one of comparative quietude in many
instances. So long as an individual is awake, there is not a single second
of his life during which the brain is altogether inactive; and even while
he is deprived by sleep of the power of volition, nearly every other
faculty of the mind is capable of being exercised; and several of them, as
the imagination and memory, for instance, are sometimes carried to a pitch
of exaltation not ordinarily reached by direct and voluntary efforts. If
it were not for the fact that all parts of the brain are not in action at
the same time, and that thus some slight measure of repose is afforded, it
would probably be impossible for the organ to maintain itself in a state
of integrity.
During wakefulness therefore the brain is constantly in action, though
this action may be of such a character as not always to make us conscious
of its performance. A great deal of the power of the brain is expended in
the continuance of functional operations necessary to our well-being.
During sleep these are altogether arrested or else very materially
retarded in force and frequency.
Many instances of what Dr. Carpenter very happily calls “unconscious
cerebration” will suggest themselves to the reader. We frequently find
suggestions occurring to us suddenly--suggestions which could only have
arisen as the result of a train of ideas passing through our minds, but of
which we have been unconscious. This function of the brain continues in
sleep, but not with so much force as during wakefulness. The movements of
the heart, of the inspiratory muscles, and of other organs which perform
either dynamic or secretory functions are all rendered less active by
sleep; and during this condition the nervous system generally obtains the
repose which its ceaseless activity during our periods of wakefulness so
imperatively demands. Sleep is thus necessary in order that the body, and
especially the brain and nervous system, may be renovated by the formation
of new tissue to take the place of that which by use has lost its normal
characteristics.
From what has been said it will be seen that the brain is no exception to
the law which prevails throughout the whole domain of organic nature--that
use causes decay. The following extract from another work[1] bears upon
this point, and I think tends to its elucidation.
“During life the fluids and tissues of the body are constantly undergoing
change. New matter is deposited, and the old is removed with ceaseless
activity. The body may be regarded as a complex machine, in which the law,
that force is only generated by decomposition, is fully carried out. Every
motion of the body, every pulsation of the heart, every thought which
emanates from the encephalon is accompanied by the destruction of a
certain amount of tissue. As long as food is supplied in abundance, and
the assimilative functions are not disordered, reparation proceeds as
rapidly as decay, and life is the result; but should nutrition be
arrested, by any cause, for any considerable period, new matter ceases to
be formed, and the organs, worn out, act no longer, and death ensues.
“The animal body differs from any inorganic machine in the fact that it
possesses the power of self-repair. In the steam-engine, for instance, the
fuel which serves for the production of steam, and subsequently for the
creation of force, can do nothing toward the repair of the parts which
have been worn out by use. Day by day, by constant attrition and other
causes, the engine becomes less perfect, and eventually must be put in
order by the workman. In the animal body, however, the material which
serves for the production of force is the body itself, and the substances
which are taken as food are assimilated according to their character by
those organs and parts which require them.
“The body is therefore undergoing continued change. The hair of yesterday
is not the hair of today; the muscle which extends the arm is not
identically the same muscle after as before its action; old material has
been removed and new has been deposited to an equal extent; and though the
weight and form, the chemical constitution and histological character have
been preserved, the identity has been lost.”
All this is especially true of the brain. Its substance is consumed by
every thought, by every action of the will, by every sound that is heard,
by every object that is seen, by every substance that is touched, by every
odor that is smelled, by every painful or pleasurable sensation, and so
each instant of our lives witnesses the decay of some portion of its mass
and the formation of new material to take its place. The necessity for
sleep is due to the fact that during our waking moments the formation of
the new substance does not go on as rapidly as the decay of the old. The
state of comparative repose which attends upon this condition allows the
balance to be restored, and hence the feeling of freshness and
rejuvenation we experience after a sound and healthy sleep. The more
active the mind the greater the necessity for sleep, just as with a
steamer, the greater the number of revolutions its engine makes, the more
imperative is the demand for fuel.
The power with which this necessity can act is oftentimes very great, and
not even the strongest exertion of the will is able to neutralize it. I
have frequently seen soldiers sleep on horseback during night marches,
and have often slept thus myself. Galen on one occasion walked over two
hundred yards while in a sound sleep. He would probably have gone farther
but for the fact of his striking his foot against a stone and thus
awaking.
The Abbé Richard states that once when coming from the country alone and
on foot, sleep overtook him when he was more than half a league from town.
He continued to walk, however, though soundly asleep, over an uneven and
crooked road.[2]
Even when the most stirring events are transpiring, some of the
participants may fall asleep. Sentinels on posts of great danger cannot
always resist the influence. To punish a man with death, therefore, for
yielding to an inexorable law of his being, is not the least of the
barbarous customs which are still in force in civilized armies. During the
battle of the Nile many of the boys engaged in handing ammunition fell
asleep, notwithstanding the noise and confusion of the action and the fear
of punishment. And it is said that on the retreat to Corunna whole
battalions of infantry slept while in rapid march. Even the most acute
bodily sufferings are not always sufficient to prevent sleep. I have seen
individuals who had been exposed to great fatigue, and who had while
enduring it met with accidents requiring surgical interference, sleep
through the pain caused by the knife. Damiens, who attempted the
assassination of Louis XV. of France, and who was sentenced to be torn to
pieces by four horses, was for an hour and a half before his execution
subjected to the most infamous tortures, with red-hot pincers, melted
lead, burning sulphur, boiling oil, and other diabolical contrivances, yet
he slept on the rack, and it was only by continually changing the mode of
torture, so as to give a new sensation, that he was kept awake. He
complained, just before his death, that the deprivation of sleep was the
greatest of all his torments.
Dr. Forbes Winslow[3] quotes from the _Louisville Semi-Monthly Medical
News_ the following case:
“A Chinese merchant had been convicted of murdering his wife, and was
sentenced to die by being deprived of sleep. This painful mode of death
was carried into effect under the following circumstances: The condemned
was placed in prison under the care of three of the police guard, who
relieved each other every alternate hour, and who prevented the prisoner
falling asleep night or day. He thus lived nineteen days without enjoying
any sleep. At the commencement of the eighth day his sufferings were so
intense that he implored the authorities to grant him the blessed
opportunity of being strangled, guillotined, burned to death, drowned,
garroted, shot, quartered, blown up with gunpowder, or put to death in
any conceivable way their humanity or ferocity could invent. This will
give a slight idea of the horrors of death from want of sleep.”
In infants the necessity for sleep is much greater than in adults, and
still more so than in old persons. In the former the formative processes
are much more active than those concerned in disintegration. Hence the
greater necessity for frequent periods of repose. In old persons, on the
contrary, decay predominates over construction, there is a decreased
activity of the brain, the nervous system, and of all other organs, and
thus the demand for rest and recuperation is lessened.
The necessity for sleep is not felt by all organic beings alike. The
differences observed are more due to variations in habits, modes of life,
and inherent organic dispositions, than to any inequality in the size of
the brain, although the latter has been thought by some authors to be the
cause. It has been assumed that the larger the brain the more sleep was
required. Perhaps this is true as regards the individuals of any one
species of animals, but it is not the case when species are compared with
each other. In man, for instance, persons with large heads, as a rule,
have large, well-developed brains, and consequently more cerebral action
than individuals with small brains. There is accordingly a greater waste
of cerebral substance and an increased necessity for repair.
This is not, however, always the case, as some individuals with small
brains have been remarkable for great mental activity.
All animals sleep, and even plants have their periods of comparative
repose. As Lelut says:[4]
“No one is ignorant of the nocturnal repose of plants. I say repose and
nothing else. I do not say diminution or suspension of their sensibility,
for plants have no sensibility. I say diminution of their organic
actions--a diminution which is evident and characteristic in all, more
evident and more characteristic in some. * * *
“Their interior or vital movements are lessened, the flow of the sap and
of other fluids which penetrate and rise in them is retarded. Their more
mobile parts--the leaves, the flowers--show by their falling, their
occlusion, their inclination that their organic actions are diminished,
and that a kind of repose has been initiated, which takes the place of the
lying down, which, with animals, is the condition and the result of
sleep.”