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diff --git a/43887-0.txt b/43887-0.txt index 0790857..df278ca 100644 --- a/43887-0.txt +++ b/43887-0.txt @@ -1,37 +1,4 @@ -Project Gutenberg's Sleep and Its Derangements, by William A. Hammond - -This eBook is for the use of anyone anywhere at no cost and with -almost no restrictions whatsoever. You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: Sleep and Its Derangements - -Author: William A. Hammond - -Release Date: October 5, 2013 [EBook #43887] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK SLEEP AND ITS DERANGEMENTS *** - - - - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive.) - - - - - - - - +*** START OF THE PROJECT GUTENBERG EBOOK 43887 *** SLEEP AND ITS DERANGEMENTS. @@ -7573,360 +7540,4 @@ Medicine and Medical Jurisprudence, January, 1869, p. 47. End of Project Gutenberg's Sleep and Its Derangements, by William A. 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You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: Sleep and Its Derangements - -Author: William A. Hammond - -Release Date: October 5, 2013 [EBook #43887] - -Language: English - -Character set encoding: ISO-8859-1 - -*** START OF THIS PROJECT GUTENBERG EBOOK SLEEP AND ITS DERANGEMENTS *** - - - - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive.) - - - - - - - - - -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." - - - - -CHAPTER II. - -THE CAUSES OF SLEEP. - - -The exciting cause of natural and periodic sleep is undoubtedly to be -found in the fact that the brain at stated times requires repose, in order -that the cerebral substance which has been decomposed by mental and -nervous action may be replaced by new material. There are other exciting -causes than this, however, for sleep is not always induced by ordinary or -natural influences acting periodically. There are many others, which -within the strict limits of health may cause such a condition of the brain -as to produce sleep. - -Authors, in considering sleep, have not always drawn the proper -distinction between the exciting and the immediate cause. Thus Macario,[5] -in alluding to the alleged causes of sleep, says: - -"Among physiologists some attribute it to a congestion of blood in the -brain; others to a directly opposite cause, that is, to a diminished -afflux of blood to this organ; some ascribe it to a loss of nervous -fluid, others to a flow of this fluid back to its source; others again -find the cause in the cessation of the motion of the cerebral fibers, or -rather in a partial motion in these fibers. Here I stop, for I could not, -even if I wished, mention all the theories which have prevailed relative -to this subject. I will only add that, in my opinion, the most probable -proximate and immediate cause appears to be feebleness. What seems to -prove this view is the fact that exhaustive hot baths, heat, fatigue, too -great mental application are among the means which produce sleep." - -Undoubtedly the influence mentioned by Macario, and many others which he -might have cited, lead to sleep. They do so through the medium of the -nervous system--causing a certain change to take place in the physical -condition of the brain. We constantly see instances of this transmission -of impressions and the production of palpable effects. Under the influence -of fatigue, the countenance becomes pale; through the actions of certain -emotions, blushing takes place. When we are anxious or suffering or -engaged in intense thought, the perspiration comes out in big drops on our -brows; danger makes some men tremble, grief causes tears to flow. Many -other examples will suggest themselves to the reader. It is surely, -therefore, no assumption to say that certain mental or physical influences -are capable of inducing such an alteration in the state of the brain as -necessarily to cause sleep. These influences or exciting causes I propose -to consider in detail, after having given my views relative to the -condition of the brain which immediately produces sleep. - -It is well established as regards other viscera, that during a condition -of activity there is more blood in their tissues than while they are at -rest. It is strange, therefore, that, relative to the brain, the contrary -doctrine should have prevailed so long, and that even now, after the -subject has been so well elucidated by exact observation, it should be the -generally received opinion that during sleep the cerebral tissues are in a -state approaching congestion. Thus Dr. Marshall Hall,[6] while contending -for this view, also advances the theory that there is a special set of -muscles, the duty of which is, by assuming a condition of tonic -contraction, so to compress certain veins as to prevent the return of the -blood from the heart. - -Dr. Carpenter[7] is of the opinion that the first cause of sleep in order -of importance is the pressure exerted by distended blood-vessels upon the -encephalon. - -Sir Henry Holland[8] declares that a "degree of pressure is essential to -perfect and uniform sleep." - -Dr. Dickson[9] regards an increased determination of blood to the -cerebral mass, and its consequent congestion in the larger vessels of the -brain, as necessary to the induction of sleep. - -In his very excellent work on Epilepsy, Dr. Sieveking[10] says: - -"Whether or not there is actually an increase in the amount of blood in -the brain during sleep, and whether, as has been suggested, the choroid -plexuses become turgid or not, we are unable to affirm otherwise than -hypothetically; the evidence is more in favor of cerebral congestion than -of the opposite condition inducing sleep--evidence supplied by physiology -and pathology." Dr. Sieveking does not, however, state what this evidence -is. - -Barthez[11] is of the opinion that during sleep there is a general -plethora of the smaller blood-vessels of the whole body. He does not -appear to have any definite views relative to the condition of the -cerebral circulation. - -Cabanis[12] declares that as soon as the necessity for sleep is -experienced, there is an increased flow of blood to the brain. - -To come to more popular books than those from which we have quoted, we -find Mr. Lewes,[13] when speaking of the causes of sleep, asserting that: -"It is caused by fatigue, because one of the natural consequences of -continued action is a slight congestion; and it is the _congestion_ which -produces sleep. Of this there are many proofs." Mr. Lewes omits to specify -these proofs. - -Macnish[14] holds the view that sleep is due to a determination of blood -to the head. - -That a similar opinion has prevailed from very ancient times, it would be -easy to show. I do not, however, propose to bring forward any further -citations on this point, except the following, from a curious old -black-letter book now before me, in which the views expressed, though -obscure, are perhaps as intelligible as many met with in books of our own -day: - -"And the holy scripture in sundrie places doth call death by the name of -sleepe, which is meant in respect of the resurrection; for, as after -sleepe we hope to wake, so after death we hope to rise againe. But that -definition which Paulus Ægineta maketh of sleepe, in my judgment, is most -perfect where he saith: Sleepe is the rest of the pores animall, -proceeding of some profitable humour moistening the braine. For here is -shewed by what means sleepe is caused; that is, by vapours and fumes -rising from the stomache to the head, where through coldness of the braine -they being congealed, doe stop the conduites and waies of the senses, and -so procure sleepe, which thing may plainly be perceived hereby; for that -immediately after meate we are most prone to sleepe, because then the -vapours ascende most abundantly to the braine, and such things as be most -vaporous do most dispose to sleepe, as wine, milke, and such like."[15] - -The theory that sleep is due directly to pressure of blood-vessels, filled -to repletion, upon the cerebral tissues, doubtless originated in the fact -that a comatose condition may be thus induced. This fact has long been -known. Servetus, among other physiological truths, distinctly announces it -in his _Christianismi Restitutio_, when he says: - -"_Et quando ventriculi ita opplentur pituita, ut arteriæ ipsæ choroidis ea -immergantur, tunc subito generatur appoplexia._" - -Perhaps the theory which prevails at present, of sleep being due to the -pressure of distended blood-vessels upon the choroid plexus, is derived -from these words of Servetus. - -That stupor may be produced by pressure upon the brain admits of no doubt. -It is familiarly known to physicians, surgeons, and physiologists; the two -former meet with instances due to pathological causes every day, and the -latter bring it on at will in their laboratories. But this form of coma -and sleep are by no means identical. On the contrary, the only point of -resemblance between the two consists in the fact that both are accompanied -by a loss of volition. It is true, we may often arrive at a correct idea -of a physiological process from determining the causes and phenomena of -its pathological variations, but such a course is always liable to lead to -great errors, and should be conducted with every possible precaution. In -the matter under consideration it is especially of doubtful propriety, for -the reason stated, that coma is not to be regarded as a modification of -sleep, but as a distinct morbid condition. Sir T. C. Morgan,[16] in -alluding to the fact that sleep has been ascribed to a congested state of -the brain, for the reason that in apoplectic stupor the blood-vessels of -that organ are abnormally distended, objects to the theory, on the ground -that it assimilates a dangerous malady to a natural and beneficial -process. He states (what was true at the time he wrote) that the condition -of the circulation through the brain, during sleep, is wholly unknown. - -It is important to understand clearly the difference between stupor and -sleep, and it is very certain that the distinction is not always made by -physicians; yet the causes of the two conditions have almost nothing in -common, and the phenomena of each are even more distinct. - -1. In the first place, stupor never occurs in the healthy individual, -while sleep is a necessity of life. - -2. It is easy to awaken a person from sleep, while it is often impossible -to arouse him from stupor. - -3. In sleep the mind may be active, in stupor it is as it were dead. - -4. Pressure upon the brain, intense congestion of its vessels, the -circulation of poisoned blood through its substance cause stupor, but do -not induce sleep. For the production of the latter condition a diminished -supply of blood to the brain, as will be fully shown hereafter, is -necessary. - -Perhaps no one agent so distinctly points out the difference between sleep -and stupor as opium and its several preparations. A small dose of this -medicine acting as a stimulant increases the activity of the cerebral -circulation, and excites a corresponding increase in the rapidity and -brilliancy of our thoughts. A larger dose lessens the amount of blood in -the brain, and induces sleep. A very large dose sometimes diminishes the -power of the whole nervous system, lessens the activity of the respiratory -function, and hence allows blood which has not been properly subjected to -the influence of the oxygen of the atmosphere to circulate through the -vessels of the brain. There is nothing in the opium itself which produces -excitement, sleep, or stupor, by any direct action upon the brain. All its -effects are due to its influence on the heart and blood-vessels, through -the medium, however, of the nervous system. This point can be made plainer -by adducing the results of some experiments which I have lately performed. - -_Experiment._--I placed three dogs of about the same size under the -influence of chloroform, and removed from each a portion of the upper -surface of the skull an inch square. The dura mater was also removed, and -the brain exposed. After the effects of the chloroform had passed -off--some three hours subsequent to the operation--I administered to -number one the fourth of a grain of opium, to number two a grain, and to -number three two grains. The brain of each was at the time in a perfectly -natural condition. - -At first the circulation of the blood in the brain was rendered more -active, and the respiration became more hurried. The blood-vessels, as -seen through the openings in the skulls, were fuller and redder than -before the opium was given, and the brain of each animal rose through the -hole in the cranium. Very soon, however, the uniformity which prevailed in -these respects was destroyed. In number one the vessels remained -moderately distended and florid for almost an hour, and then the brain -slowly regained its ordinary appearance. In number two the active -congestion passed off in less than half an hour, and was succeeded by a -condition of very decided shrinking, the surface of the brain having -fallen below the surface of the skull, and become pale. As these changes -supervened, the animal gradually sank into a sound sleep, from which it -could easily be awakened. In number three the surface of the brain became -dark, almost black, from the circulation of blood containing a -superabundance of carbon, and owing to diminished action of the heart and -vessels it sank below the level of the opening, showing, therefore, a -diminished amount of blood in its tissue. At the same time the number of -respirations per minute fell from 26 to 14, and they were much weaker than -before. A condition of complete stupor was also induced from which the -animal could not be aroused. It persisted for two hours. During its -continuance, sensation of all kind was abolished, and the power of motion -was altogether lost. - -It might be supposed that the conditions present in numbers two and three -differed only in degree. That this was not the case is shown by the -following experiment: - -_Experiment._--To the dogs two and three I administered on the following -day, as before, one and two grains of opium respectively. As soon as the -effects began to be manifested upon the condition of the brain, I opened -the trachea of each, and, inserting the nozzle of a bellows, began the -process of artificial respiration. In both dogs the congestion of the -blood-vessels of the brain disappeared. The brain became collapsed, and -the animals fell into a sound sleep, from which they were easily -awakened. If the action of the bellows was stopped and the animals were -left to their own respiratory efforts, no change ensued in number two, but -in number three the surface of the brain became dark, and stupor resulted. - -In order to be perfectly assured upon the subject, I proceeded as follows -with another dog: - -_Experiment._--The animal was trephined as was the others, and five grains -of opium given. At the same time the trachea was opened and the process of -artificial respiration instituted. The brain became slightly congested, -then collapsed, and sleep ensued. The sleep was sound, but the animal was -easily awakened by tickling its ear. After I had continued the process for -an hour and a quarter, I removed the nozzle of the bellows, and allowed -the animal to breathe for itself. Immediately the vessels of the brain -were filled with black blood, and the surface of the brain assumed a very -dark appearance. - -The dog could no longer be aroused, and died one hour and a quarter after -the process was stopped. - -I have only stated those points of the experiments cited which bear upon -the subject under consideration, reserving for another occasion others of -great interest. It is, however, shown that a small dose of opium excites -the mind, because it increases the amount of blood in the brain; that a -moderate dose causes sleep, because it lessens the amount of blood; and -that a large dose produces stupor by impeding the respiratory process, -and hence allowing blood loaded with carbon, and therefore poisonous, to -circulate through the brain. - -It is also shown that the condition of the brain during stupor is very -different from that which exists during sleep. In the one case its vessels -are loaded with dark blood; in the other they are comparatively empty, and -the blood remains florid. - -I think it will be sufficiently established, in the course of these -remarks, that sleep is directly caused by the circulation of a less -quantity of blood through the cerebral tissues than traverses them while -we are awake. This is the immediate cause of healthy sleep. Its exciting -cause is, as we have seen, the necessity for repair. The condition of the -brain which is favorable to sleep may also be induced by various other -causes, such as heat, cold, narcotics, anæsthetics, intoxicating liquors, -loss of blood, etc. If these agents are allowed to act excessively, or -others, such as carbonic oxide, and all those which interfere with the -oxygenation of the blood, are permitted to exert their influence, stupor -results. - -The theory above enunciated, although proposed in a modified form by -Blumenbach several years since, and subsequently supported by facts -brought forward by other observers, has not been received with favor by -any considerable number of physiologists. Before, therefore, detailing my -own experience, I propose to adduce a few of the most striking proofs of -its correctness which I have been able to collect, together with the -opinions of some of those inquirers who have recently studied the subject -from this point of view. - -Blumenbach[17] details the case of a young man, eighteen years of age, who -had fallen from an eminence and fractured the frontal bone, on the right -side of the coronal suture. After recovery took place a hiatus remained, -covered only by the integument. While the young man was awake this chasm -was quite superficial, but as soon as sleep ensued it became very deep. -The change was due to the fact that during sleep the brain was in a -collapsed condition. From a careful observation of this case, as well as -from a consideration of the phenomena attendant on the hibernation of -animals, Blumenbach[18] arrives at the conclusion that the proximate cause -of sleep consists in a diminished flow of oxygenated blood to the brain. - -Playfair[19] thinks that sleep is due to "a diminished supply of oxygen to -the brain." - -Dendy[20] states that there was, in 1821, at Montpellier, a woman who had -lost part of her skull, and the brain and its membranes lay bare. When she -was in deep sleep the brain remained motionless beneath the crest of the -cranial bones; when she was dreaming it became somewhat elevated; and -when she was awake it was protruded through the fissure in the skull. - -Among the most striking proofs of the correctness of the view that sleep -is due to diminished flow of blood to the head, are the experiments of Dr. -Alexander Fleming,[21] late Professor of Medicine, Queen's College, Cork. -This observer states, that while preparing a lecture on the mode of -operation of narcotic medicines, he conceived the idea of trying the -effect of compressing the carotid arteries on the functions of the brain. -The first experiment was performed on himself, by a friend, with the -effect of causing immediate and deep sleep. The attempt was frequently -made, both on himself and others, and always with success. "A soft humming -in the ears is heard; a sense of tingling steals over the body, and in a -few seconds complete unconsciousness and insensibility supervene, and -continue so long as the pressure is maintained." - -Dr. Fleming adds, that whatever practical value may be attached to his -observations, they are at least important as physiological facts, and as -throwing light on the causes of sleep. It is remarkable that his -experiments have received so little notice from physiologists. - -Dr. Bedford Brown,[22] of North Carolina, has recorded an interesting -case of extensive compound fracture of the cranium, in which the -opportunity was afforded him of examining the condition of the cerebral -circulation while the patient was under the influence of an anæsthetic, -preparatory to the operation of trephining being performed. A mixture of -ether and chloroform was used. Dr. Brown says: - -"Whenever the anæsthetic influence began to subside, the surface of the -brain presented a florid and injected appearance. The hemorrhage -increased, and the force of the pulsation became much greater. At these -times so great was the alternate heaving and bulging of the brain, that we -were compelled to suspend operations until they were quieted by a -repetition of the remedy. Then the pulsations would diminish, the cerebral -surface recede within the opening of the skull, as if by collapse; the -appearance of the organ becoming pale and shrunken with a cessation of the -bleeding. In fact, we were convinced that diminished vascularity of the -brain was an invariable result of the impression of chloroform or ether. -The changes above alluded to recurred sufficiently often, during the -progress of the operation, in connection with the anæsthetic treatment, to -satisfy us that there could be no mistake as to the cause and effect." - -It will be shown, in the course of the present memoir, that Dr. Brown's -conclusions, though in the main correct, are erroneous so far as they -relate to the effect of chloroform upon the cerebral circulation; nor -does it appear that he employed this agent unmixed with ether, in the case -which he has recorded so well. He has, probably, based his remarks on this -point upon the phenomena observed when the compound of ether and -chloroform was used--the action of pure chloroform, as regards its effect -upon the quantity of blood circulating through the brain, being the -reverse of that which he claims for it. - -But the most philosophical and most carefully digested memoir upon the -proximate cause of sleep, which has yet been published, is that of Mr. -Durham.[23] Although my own experiments in the same direction, and which -will be hereafter detailed, were of prior date, I cheerfully yield all the -honor which may attach to the determination of the question under -consideration to this gentleman, who has not only worked it out -independently, but has anticipated me several years in the publication, -besides carrying his researches to a much further point than my own -extended. - -With the view of ascertaining by ocular examination the vascular condition -of the brain during sleep, Durham placed a dog under the influence of -chloroform, and removed with a trephine a portion of bone as large as a -shilling from the parietal region; the dura mater was also cut away. -During the continuance of the anæsthetic influence, the large veins of -the surface of the pia mater were distended, and the smaller vessels were -full of dark-colored blood. The longer the administration of the -chloroform was continued, the greater was the congestion. As the effects -of this agent passed off, the animal sank into a natural sleep, and then -the condition of the brain was very materially changed. Its surface became -pale and sank down below the level of the bone; the veins ceased to be -distended, and many which had been full of dark blood could no longer be -distinguished. When the animal was roused, the surface of the brain became -suffused with a red blush, and it ascended into the opening through the -skull. As the mental excitement increased, the brain became more and more -turgid with blood, and innumerable vessels sprang into sight. The -circulation was also increased in rapidity. After being fed, the animal -fell asleep, and the brain again became contracted and pale. In all these -observations the contrast between the two conditions was exceedingly well -marked. - -To obviate any possible effects due to atmospheric pressure, watch-glasses -were applied to the opening in the skull, and securely cemented to the -edges with Canada balsam. The phenomena observed did not differ from those -previously noticed; and, in fact, many repetitions of the experiment gave -like results. - -Durham, in the next place, applied ligatures to the jugular and vertebral -veins, with the effect--as was to be expected--of producing intense -congestion of the brain, attended with coma. This last condition he very -properly separates from sleep, which is never caused by pressure from the -veins. He likens sleep to the state induced by preventing the access of -blood to the brain through the carotids, but does not allude to Fleming's -researches on this point. - -From his observations, Durham deduces the following conclusions: - -"1. Pressure of distended veins upon the brain is not the cause of sleep, -for during sleep the veins are not distended; and when they are, symptoms -and appearances arise which differ from those which characterize sleep. - -"2. During sleep the brain is in a comparatively bloodless condition, and -the blood in the encephalic vessels is not only diminished in quantity, -but moves with diminished rapidity. - -"3. The condition of the cerebral circulation during sleep is, from -physical causes, that which is most favorable to the nutrition of the -brain tissue; and, on the other hand, the condition which prevails during -waking is associated with mental activity, because it is that which is -most favorable to oxydation of the brain substance, and to various changes -in its chemical constitution. - -"4. The blood which is derived from the brain during sleep is distributed -to the alimentary and excretory organs. - -"5. Whatever increases the activity of the cerebral circulation tends to -preserve wakefulness; and whatever decreases the activity of the cerebral -circulation, and, at the same time, is not inconsistent with the general -health of the body, tends to induce and favor sleep. Such circumstances -may act primarily through the nervous or through the vascular system. -Among those which act through the nervous system, may be instanced the -presence or absence of impressions upon the senses, and the presence or -absence of exciting ideas. Among those which act through the vascular -system, may be mentioned unnaturally or naturally increased or decreased -force or frequency of the heart's action. - -"6. A probable explanation of the reason why quiescence of the brain -normally follows its activity, is suggested by the recognized analogical -fact that the products of chemical action interfere with the continuance -of the action by which they are produced." - -Luys,[24] after stating the two opposite views relative to the state of -the cerebral circulation during sleep, gives his adhesion on principles of -analogy to that which holds to a diminished afflux of blood. Taking the -condition of the salivary glands during their periods of inaction as the -basis of his argument, he says: - -"We are then naturally led, in making the application of known facts to -those which are yet unknown, to say that the nervous tissue and the -glandular tissue present, between themselves, the closest analogy, so far -as circulatory phenomena and the double alternation of their periods of -activity and repose are concerned. And that if the period during which the -gland reconstitutes its immediate principles corresponds to a period of -reduced activity of circulatory phenomena--to a state of relative -anæmia--and that when it functionates it is awakened to a state in which -its capillaries are turgid with blood, it is very admissible that the same -circulatory conditions should be present in the nervous tissue, and that -the period of inactivity, or of sleep, should be characterized by an -anemic state. Inversely, the period of activity or wakefulness should be -marked by an acceleration of the flow of blood, and by a kind of erethism -of the vascular element." - -Having thus, in as succinct a manner as possible, brought forward the -principal observations relative to the immediate cause of sleep, which up -to the present time have been published, I come, in the next place, to -detail the result of my own researches. - -In 1854 a man came under my observation who had, through a frightful -railroad accident, lost about eighteen square inches of his skull. There -was thus a fissure of his cranium three inches wide and six inches long. -The lost portion consisted of a great part of the left parietal, and part -of the frontal, occipital, and right parietal bones. The man, who was -employed as a wood chopper, was subject to severe and frequent epileptic -fits, during which I often attended him. In the course of my treatment, I -soon became acquainted with the fact that, at the beginning of the -comatose condition which succeeded the fits, there was invariably an -elevation of that portion of the scalp covering the deficiency in the -cranium. As the stupor passed away, and sleep from which he could easily -be aroused ensued, the scalp gradually became depressed. When the man was -awake, the region of scalp in question was always nearly on a level with -the upper surface of the cranial bones. I also noticed on several -occasions that during natural sleep the fissure was deeper, and that in -the instant of awaking, the scalp covering it rose to a much higher level. - -After my attention was thus drawn to this subject, I observed that in -young infants the portion of scalp covering the anterior fontanelle was -always depressed during sleep, and elevated during wakefulness. - -During the summer of 1860 I undertook a series of experiments, with the -view of ascertaining the condition of the cerebral circulation during -sleep, of which the following is a brief abstract: - -A medium-sized dog was trephined over the left parietal bone, close to the -sagittal suture, having previously been placed under the full anæsthetic -influence of ether. The opening made by the trephine was enlarged with a -pair of strong bone-forceps, so as to expose the dura mater to the extent -of a full square inch. This membrane was then cut away and the brain -brought into view. It was sunk below the inner surface of the skull, and -but few vessels were visible. Those which could be perceived, however, -evidently conveyed dark blood, and the whole exposed surface of the brain -was of a purple color. As the anæsthetic influence passed off, the -circulation of the blood in the brain became more active. The purple hue -faded away, and numerous small vessels filled with red blood became -visible; at the same time the volume of the brain increased, and when the -animal became fully aroused, the organ protruded through the opening in -the skull to such an extent that, at the most prominent part, its surface -was more than a quarter of an inch above the external surface of the -cranium. While the dog continued awake, the condition and position of the -brain remained unchanged. After the lapse of half an hour, sleep ensued. -While this state was coming on I watched the brain very attentively. Its -volume slowly decreased; many of its smaller blood-vessels became -invisible, and finally it was so much contracted that its surface, pale -and apparently deprived of blood, was far below the level of the cranial -wall. - -Two hours subsequently the animal was again etherized, in order that the -influence of the ether upon the cerebral circulation might be observed -from the commencement. At the time the dog was awake, and had a few -minutes previously eaten a little meat and drank a small quantity of -water. The brain protruded through the opening in the skull, and its -surface was of a pink hue, with numerous red vessels ramifying over it. -The ether was administered by applying to the muzzle of the animal a towel -folded into the shape of a funnel, and containing a small sponge saturated -with the agent. - -As soon as the dog commenced to inspire the ether, the appearance of the -brain underwent a change of color, and its volume became less. As the -process of etherization was continued, the color of the surface darkened -to a deep purple, and it ceased to protrude through the opening. Finally, -when a state of complete anæsthesia was reached, it was perceived that the -surface of the brain was far below the level of the cranial fissure, and -that its vessels conveyed black blood alone. - -Gradually the animal regained its consciousness; the vessels resumed their -red color, and the brain was again elevated to its former position. In -this last experiment there did not appear to be any congestion of the -brain. Had this condition existed, it would have been difficult to account -for the diminution in bulk, which certainly took place. There was -evidently less blood in the cerebral tissue than there had been previously -at the etherization; but this blood, instead of being oxygenated, was -loaded with excrementitial matters, and consequently was not fitted to -maintain the brain in a condition of activity. - -The following morning, the dog being quite lively, I removed the sutures -which had been placed in the skin, covering the hole in the cranium, with -the view of ascertaining the effects of chloroform upon the brain, when -introduced into the system by inhalation. Suppuration had not yet taken -place, and the parts were in good condition. The opening in the skull was -completely filled by the brain, and the surface of the latter was -traversed by a great many small vessels carrying red blood. The chloroform -was administered in the same way in which the ether had been given the -previous day. - -In a few seconds the change in color of the blood circulating in the -vessels began to take place, but there was no sinking of the brain below -the level of the chasm in the skull. On the contrary, its protrusion was -greater than before the commencement of the experiment. There was thus not -only unoxygenated blood circulating to too great an extent through the -brain, but there was very decided congestion. - -The foregoing experiments were frequently repeated on other dogs, and also -on rabbits, with like results. Within a short period I have in part gone -over the ground again, without observing any essential point of difference -in the effects produced. - -I have never repeated Fleming's experiment on the human subject, except in -one instance, and then sleep, or a condition resembling it, was -instantaneously produced. As soon as the pressure was removed from the -carotids, the individual gained his consciousness. On dogs and rabbits, -however, I have performed it frequently, and though if the pressure be -continued for longer than one minute, convulsions generally ensue, a state -of insensibility resembling natural sleep is always the first result. -Lately, I have had, through the kindness of my friend, Dr. Van Buren, the -opportunity of examining a case which affords strong confirmation of the -correctness of the preceding views. It was that of a lady in whom both -common carotids were tied for a cirsoid aneurism, involving a great -portion of the right side of the scalp. One carotid was tied by the late -Dr. J. Kearney Rogers, and the other by Dr. Van Buren, seven years ago, -with the effect of arresting the progress of the disease. No peculiar -symptoms were observed in consequence of these operations, except the -supervention of persistent drowsiness, which was especially well marked -after the last operation, and which, even now, is at times quite -troublesome. - -We thus see that the _immediate_ cause of sleep is a diminution of the -quantity of blood circulating in the vessels of the brain, and that the -_exciting_ cause of periodical and natural sleep is the necessity which -exists that the loss of substance which the brain has undergone, during -its state of greatest activity, should be restored. To use the simile of -the steam-engine again, the fires are lowered and the operatives go to -work to repair damages and put the machine in order for next day's work. - -Whatever other cause is capable of lessening the quantity of blood in the -brain is also capable of inducing sleep. There is no exception to this -law, and hence we are frequently able to produce this condition at will. -Several of these factors have been already referred to, but it will be -interesting to consider them all somewhat more at length. - -_Heat._--Most persons in our climate, and in those of higher temperatures, -have felt the influence of heat in causing drowsiness, and eventually -sleep, if the action is powerful enough and sufficiently prolonged. It is -not difficult to understand the mode by which heat acts in giving rise to -sleep. During the prevalence of high temperatures the blood flows in -increased proportion to the surface of the body and to the extremities, -and consequently the quantity in the brain is diminished. Sleep -accordingly results unless the irritation induced by the heat is so great -as to excite the nervous system. Heat applied directly to the head exerts, -of course, a directly contrary effect upon the cerebral circulation, as we -see in sun-stroke. Here there is internal cerebral congestion, loss of -consciousness, stupor, etc. - -That the effect of heat is to dilate the vessels of the part subjected to -its influence, can be ascertained by putting the arm or leg into hot -water. The swelling of the blood-vessels is then very distinctly seen. It -will be shown hereafter that one of the best means of causing sleep in -morbid wakefulness is the warm-bath. - -_Cold._--A slight degree of cold excites wakefulness at first, but if the -constitution be strong the effect is to predispose to sleep. This it does -by reason of the determination of blood to the surface of the body which -moderate cold induces in vigorous persons. The ruddy complexion and warmth -of the hands and feet produced in such individuals under the action of -this influence are well known. - -But if the cold be very intense, or the reduction of temperature sudden, -the system, even of the strongest persons, cannot maintain a resistance, -and then a very different series of phenomena result. Stupor, not sleep, -is the consequence. The blood-vessels of the surface of the body contract -and the blood accumulates in the internal organs, the brain among them. -Many instances are on record showing the effect of extreme cold in -producing stupor and even death. One of the most remarkable of these is -that related by Captain Cook, in regard to an excursion of Sir Joseph -Banks, Dr. Solander, and nine others, over the hills of Terra del Fuego. -Dr. Solander, knowing from his experience in Northern Europe that the -stupor produced by severe cold would terminate in death unless resisted, -urged his companions to keep in motion when they began to feel drowsy. -"Whoever sits down will sleep," said he, "and whoever sleeps will rise no -more." Yet he was the first to feel this irresistible desire for repose, -and entreated his companions to allow him to lie down. He was roused from -his stupor with great difficulty and carried to a fire, when he revived. -Two black men of the party, whose organizations were not so robust as -those of the whites, perished. Dr. Whiting[25] relates the case of Dr. -Edward Daniel Clark, the celebrated traveler, who on one occasion came -very near losing his life by cold. He had performed divine service at a -church near Cambridge, and was returning home on horseback, when he felt -himself becoming very cold and sleepy. Knowing the danger of yielding to -the influence which was creeping over him, he put his horse into a fast -trot, hoping thereby to arouse himself from the alarming torpor. This -means proving unavailing, he got down and led his horse, walking as fast -as he could. This, however, did not long succeed. The bridle dropped from -his arm, his legs became weaker and weaker, and he was just sinking to the -ground when a gentleman who knew him came up in a carriage and rescued -him. - -I have often myself noticed this effect of cold in producing numbness and -drowsiness, and on one occasion was nearly overcome by it. I was crossing -the mountain ridge between Cebolleta and Covero, in New Mexico, when the -thermometer fell in about two hours from 52° to 22° Fahrenheit. So great -was the effect upon me that if I had had much farther to go I should -probably have succumbed. As it was, I reached a rancho in time to be -relieved, though several minutes elapsed before I was able to speak. The -sensations experienced were rather agreeable than otherwise. There was a -great desire to rest and to yield to the languor which was present, and -there was a feeling of recklessness which rendered me perfectly -indifferent to the consequences. I should have dismounted from my horse -and given way to the longing for repose if I had been able to do so. I -have several times experienced very similar effects from change of air. A -few years since I was so drowsy at the sea-coast, whither I had gone from -a hot city, that it was with difficulty I could keep awake, even when -engaged in active physical exercise. - -Another potent cause of sleep, and one of which we generally avail -ourselves, is the _diminution of the power of the attention_. To bring -this influence into action generally requires only the operation of the -will under circumstances favorable to the object in view. Shutting the -eyes so as to exclude light, getting beyond the sound of noises, -refraining from the employment of the other senses, and avoiding thought -of all kind, will generally, when there is no preventing cause, induce -sleep. To think, and to maintain ourselves in connection with the outward -world by means of our senses requires that the circulation of blood in the -brain shall be active. When we isolate ourselves from external things, and -restrain our thoughts, we lessen the amount of blood in the brain, and -sleep results. It is not, however, always easy for us to do this. The -nervous system is excited, ideas follow each other in rapid succession, -and we lie awake hour after hour vainly trying to forget that we exist. -The more the will is brought to bear upon the subject the more rebellious -is the brain, and the more it will not be forced by such means into a -state of quietude. We must then either let it run riot till it is worn out -by its extravagancies, or we must fatigue it by requiring it to perform -labor which is disagreeable. Just as we might do with an individual of -highly destructive propensities, who was going about pulling down his -neighbors' houses. We might, if we were altogether unable to stop him, let -him alone till he had become thoroughly wearied with his exertions, or we -might divert him from his plan by guiding him to some tough piece of work -which would exhaust his strength sooner than would his original labor. - -Many ways of thus tiring the brain have been proposed. The more irksome -they are, the more likely they are to prove effectual. Counting a hundred -backward many times, listening to monotonous sounds, thinking of some -extremely disagreeable and tiresome subject, with many other devices, have -been suggested, and have proved more or less effectual. Boerhaave[26] -states that he procured sleep by placing a brass pan in such a position -that the patient heard the sound of water which was made to fall into it, -drop by drop. In general terms, monotony predisposes to sleep. Dr. -Dickson[27] quotes Southey's experience as related in the Doctor,[28] and -I also cannot do better than lay it before the reader, particularly as it -indicates several methods which may be more efficacious with others than -the one he found to succeed so admirably. - -"I put my arms out of bed; I turned the pillow for the sake of applying a -cold surface to my cheek; I stretched my feet into the cold corner; I -listened to the river and to the ticking of my watch; I thought of all -sleepy sounds and of all soporific things--the flow of water, the humming -of bees, the motion of a boat, the waving of a field of corn, the nodding -of a mandarin's head on the chimney-piece, a horse in a mill, the opera, -Mr. Humdrum's conversations, Mr. Proser's poems, Mr. Laxative's speeches, -Mr. Lengthy's sermons. I tried the device of my own childhood, and fancied -that the bed rushed with me round and round. At length Morpheus reminded -me of Dr. Torpedo's Divinity Lectures, where the voice, the manner, the -matter, even the very atmosphere and the streamy candlelight were all -alike somnific; when he who, by strong effort, lifted up his head and -forced open the reluctant eyes never failed to see all around him asleep. -Lettuces, cowslip wine, poppy syrup, mandragora, hop pillows, spider's -web pills, and the whole tribe of narcotics, up to bang and the -black-drop, would have failed,--but this was irresistible; and thus, -twenty years after date, I found benefit from having attended the course." - -Frequently the power of the attention is diminished by natural causes. -After the mind has been strained a long time in one particular direction, -and during which period the brain was doubtless replete with blood, the -tension is at last removed, the blood flows out of the brain, the face -becomes pale, and sleep ensues. It is thus, as Macnish[29] says, that "the -finished gratification of all ardent desires has the effect of inducing -slumber; hence after any keen excitement the mind becomes exhausted and -speedily relapses into this state." - -A gentleman recently under my care for a paralytic affection, informed me -that he could at any time render himself sleepy by looking for a few -minutes at a bright light, so as to fatigue the eyes, or by paying -particular attention to the noises in the street, so as to weary the sense -of hearing. It is well known that sleep may be induced by gentle frictions -of various parts of the body, and doubtless the other senses are capable -of being so exhausted, if I may use the expression, as to diminish the -power of the attention, and thus lessen the demand for blood in the brain. -As a consequence, sleep ensues. - -The cutting off of sensorial impressions aids in lessening the power of -the attention and thus predisposes to sleep. Stillness, darkness, the -absence of any decided impression on the skin, and the nonexistence of -odors and flavors, accomplish this end. In these respects, however, habit -exercises great influence, and thus individuals, for instance, who are -accustomed to continual loud noises, cannot sleep when the sound is -interrupted. As we have already seen, however, the predisposition to sleep -is, in healthy persons, generally so great that when it has been long -resisted, no sensation, however strong it may be, can withstand its power. - -_Digestion_ leads to sleep by drawing upon the brain for a portion of its -blood. It is for this reason that we feel sleepy after the ingestion of a -hearty dinner. A lady of my acquaintance is obliged to sleep a little -after each meal. The desire to do so is irresistible; her face becomes -pale; her extremities cold; and she sinks into a quiet slumber, which -lasts fifteen or twenty minutes. In this lady the amount of blood is not -sufficient for the due performance of all the operations of the economy. -The digestive organs imperatively require an increased quantity, and the -flow takes place from the brain; it being the organ with her which can -best spare this fluid. As a rule, persons who eat largely, and have good -digestive powers, sleep a great deal, and many persons are unable to sleep -at night till they have eaten a substantial supper. The lower animals -generally sleep after feeding, especially if the meal has been large. - -_Excessive loss of blood_ produces sleep. We can very readily understand -why this should be so if we adopt the theory which has been supported in -the foregoing pages. It would be exceedingly difficult to explain the fact -upon any other hypothesis. I have seen many instances of somnolency due to -this cause. It acts not only by directly lessening the quantity of blood -in the brain, but also by so enfeebling the heart's action as to prevent a -due supply of blood being sent to the cerebral vessels. - -_Debility_ is almost always accompanied by a disposition to inordinate -sleep. The brain is one of the first organs to feel the effects of a -diminished amount of blood or a depraved quality of this fluid being -supplied, and hence, in old age, or under the influence of a deficient -quantity of food, or through the action of some exhausting disease, there -is generally more sleep than when the physical health is not deteriorated. - -The action of certain medicines, and of other measures capable of causing -sleep, not coming within the range of ordinary application, will be more -appropriately considered hereafter. - - - - -CHAPTER III. - -THE PHYSICAL PHENOMENA OF SLEEP. - - -The approach of sleep is characterized by a languor which is agreeable -when it can be yielded to, but which, when circumstances prevent this, is -far from being pleasant. Many persons are rendered irritable as soon as -they become sleepy, and children are especially liable to manifest ill -temper under the uncomfortable feelings they experience when unable to -indulge the inclination to sleep. It is somewhat difficult to analyze the -various phenomena which go to make up the condition called sleepiness. The -most prominent feelings are an impression of weight in the upper eyelids, -and of a general relaxation of the muscles of the body, but there is -besides an internal sensation of supineness, enervation, and torpor, to -describe which is by no means easy. This sluggishness is closely allied in -character if not altogether identical with that experienced before an -attack of fainting, and is doubtless due to a like cause--a deficient -quantity of blood in the brain. Along with this languor there is a general -obtuseness of all the senses, which increases the separation of the mind -from the external world, already initiated by the physical condition of -the brain. The liveliest scenes cease to engage the attention, and the -most exciting conversation no longer interests. For a time, indeed, such -circumstances may dissipate the inclination for sleep, but eventually -nature obtains the ascendency and consciousness is lost. Before this event -there is usually yawning--a phenomenon strongly indicative of a wearied -attention; the head nods and droops upon the breast, and the body assumes -that position which is most conducive to ease, comfort, and entire -muscular inactivity. - -The order in which the muscles lose their power is in general well marked, -and bears a distinct relation, as Cabanis[30] has pointed out, to the -importance of their functions. Thus, the muscles which move the arms and -legs become relaxed before those which support the head, and the latter -before those which maintain the erectness of the back. This, however, is -not always the case, for, as we have already seen, individuals will -occasionally walk, and keep their position on horseback, while in a sound -sleep, and all of us have seen persons slumbering in church, their heads -dropping on their breasts, but yet firmly holding their prayer-books in -their hands under the pretense of going through the services. - -As regards the senses, the sight is of course the first to be lost in -ordinary cases--the closure of the eyelids interposing a physical -obstruction to the entrance of light. Even when the eyelids have been -removed, or from disease cannot be closed, the sight, nevertheless, is the -first of the special senses to be abolished. Some animals, as the hare for -example, do not shut the eyes when asleep; but even in them the ability to -see disappears before the action of the other senses is suspended. - -These latter are not altogether abolished during sleep; their acuteness is -simply lessened. Taste is the first to fade, and then the smell; hearing -follows, and touch yields last of all, and is most readily re-excited. To -awake a sleeping person, impressions made upon the sense of touch are more -effectual than attempts to arouse through any of the other senses; the -hearing comes next in order, smell next, then taste, and the sight is the -last of all in capacity for excitation. - -During sleep the respiration is slower, deeper, and usually more regular -than during wakefulness. The vigor of the process is lessened, and -therefore there is a diminution of the pulmonary exhalations. In all -probability, also, the ciliated epithelium which lines the air-passages -functionates with reduced activity. Owing to this circumstance and to the -general muscular torpor which prevails, mucus accumulates in the bronchial -tubes and requires to be expectorated on awaking. - -The circulation of the blood is rendered slower. The heart beats with more -regularity, but with diminished force and frequency. As a consequence the -blood is not distributed to distant parts of the body so thoroughly and -rapidly as during wakefulness, and accordingly the extremities readily -lose their heat. Owing to the reduction in the activity of the respiratory -and circulatory functions, the temperature of the whole body falls, and -coldness of the atmosphere is less easily resisted. - -The functions of the several organs concerned in digestion have their -activity increased by sleep. The blood which leaves the brain, goes, as -Durham has shown, to the stomach and other abdominal viscera, and hence -the quantities of the digestive juices are augmented, and the absorption -of the nutritious elements of the food is promoted. - -The urine is excreted in less quantity during sleep than when the -individual is awake and engaged in mental or physical employment, because -the wear and tear of the system is at its minimum. - -The perspiration is likewise reduced in amount by sleep. In warm weather, -however, the effort to go to sleep often causes an increase in the -quantity of this excretion, just as would any other mental or bodily -exertion. This circumstance has led some writers to a conclusion the -reverse of that just expressed. Others, again, have accepted the doctrine -of Sanctorius on this point without stopping to inquire into its -correctness. This author,[31] among other aphorisms relating to sleep, -gives the following: - -"Undisturbed sleep is so great a promoter of perspiration, that in the -space of seven hours, fifty ounces of the concocted perspirable matter do -commonly exhale out of strong bodies. - -"A man sleeping the space of seven hours is wont, insensibly, healthfully, -and without any violence, to perspire twice as much as one awake." - -The observations of Sanctorius with his weighing chair led to a good many -important results, but they were inexact so far as the function of the -skin was concerned, in that they made no division between the loss by this -channel and that which takes place through the lungs, for by perspiration -in the above quotations he means not only the exhalation from the skin, -but the products of respiration--aqueous vapor, carbonic acid, etc. His -apparatus was, besides, very imperfect, and could not possibly have given -the delicate indications which the subject requires. - -Whether the condition of sleep promotes the absorption of morbid growths -and accumulations of fluids is very doubtful. Macnish[32] contends that it -does, but _a priori_ reasoning would rather lead us to an opposite -conclusion. Deficiencies are probably more rapidly made up during sleep -than during wakefulness, and thus ulcers heal with more rapidity, owing to -the increased formation of granulations which takes place; but the -removal of tumors, etc. by natural process involves the operation of -forces the very opposite of those concerned in reparation, and observation -teaches us that sleep is a condition peculiarly favorable to the -deposition of the materials constituting morbid growths. Some writers have -alleged that sleep accelerates the absorption of dropsical effusions, but -the disappearance of such accumulations during the condition in question -is clearly due to the mechanical causes depending upon the position of the -body. - -It has also been asserted that there is an exaltation of the sexual -feeling during sleep. It is difficult to arrive at any very definite -conclusion on this point, but it is probable that here again the position -of the body conjoined with the heat of the bed has much to do in producing -the erotic manifestations occasionally witnessed. Every physician who has -had much to do with cases of the kind knows that sleeping upon the back, -by which means the blood gravitates to the generative organs and to the -lower part of the spinal cord, will often give rise to seminal emissions -with or without erotic dreams, and that such occurrences may generally be -prevented by the individual avoiding the dorsal decubitus and resting upon -one side or the other while asleep. The erections which the generality of -healthy men experience in the morning before rising from bed are likewise -due to the fact that the recumbent posture favors the flow of blood to the -penis and testicles. Such erections are usually unaccompanied by venereal -desire. - -The ganglionic nervous system and the spinal cord continue in action -during sleep, though generally with somewhat diminished power and -sensibility. The reflex faculty of the latter organ is still maintained, -and thus various movements are executed without the consciousness of the -brain being awakened. Somnambulism is clearly a condition of exaltation in -the functions of the spinal cord without the controlling influence of the -cerebrum being brought into action. But, aside from this rather abnormal -phenomenon, there are others which are entirely within the range of -health, and which show that the spinal cord is awake, even though the -sleep be most profound. Thus, for instance, if the position of the sleeper -becomes irksome, it is changed; if the feet become cold, they are drawn up -to a warmer part of the bed; and cases are recorded in which individuals -have risen from bed and emptied a distended bladder without awaking. - -The instances brought forward in a previous chapter of persons riding on -horseback and walking during sleep show the activity of the spinal cord, -and not that the will is exercised; and Cabanis[33] is wrong in the view -which he gives of such phenomena in the following extract. - -Speaking of cases like those just referred to, he says: - -"These rare instances are not the only ones in which movements are -observed produced during sleep by that portion of the will which is awake; -for it is by virtue of certain direct sensations that a sleeping man moves -his arm to brush away the flies from his face, that he draws the cover -around him so as to envelop himself carefully, or that he turns in bed -till he has found a comfortable position. It is the will which during -sleep maintains the contraction of the sphincter of the bladder, -notwithstanding the effort of the urine to escape." - -Such examples as the above we now know to be instances of reflex action, -and as not, therefore, being due to the exercise of the will. - -Sleep favors the occurrence of certain pathological phenomena. Thus -individuals affected with hæmorrhoids have the liability to hemorrhage -increased when they are asleep. Several instances of the kind have come -under my notice. In one the patient lost so large a quantity of blood that -syncope ensued and might have terminated fatally had not his condition -been accidentally discovered. Bleeding from the lungs is also more apt to -occur during sleep in those who are predisposed to it. Darwin states that -a man of about fifty years of age, subject to hæmorrhoids, was also -attacked with hæmoptysis three consecutive nights at about the same -hour--two o'clock--being awakened thereby from a state of very profound -sleep. He was advised to suffer himself to be roused at one o'clock, and -to leave his bed at that hour. He did so with the result not only of -entirely breaking up the hemorrhagic disposition, but also of curing -himself of very violent attacks of headache, to which he had been subject -for many years. - -Epileptic fits are also more liable to occur during sleep than at other -times, a fact not always susceptible of easy explanation. In a case of -epilepsy now under my charge, this proclivity is so well marked that the -patient, a lady, scarcely ever goes to sleep without being attacked. Her -face becomes exceedingly pale just before the fit, and if then seen the -paroxysm can be entirely prevented by waking her. She is never attacked at -other times, and I am trying, with excellent results thus far, the plan of -making her sleep altogether during the day and of waking her as soon as -her face becomes pallid. It is probable that the fits in her case are due -to a diminished amount of blood in the brain, and this supposition is -strengthened by the additional fact that bromide of potassium--a substance -which, as I have shown, lessens the amount of intracranial -blood--invariably rendered her paroxysms more frequent and severe. - -Sleep predisposes to attacks of gout in those who have the gouty -diathesis, and likewise favors exacerbations in several other diseases -which it is scarcely necessary to allude to specifically. The accession of -fever toward night, and the increase which takes place in pain due to -inflammation are generally associated with the approach of night, and have -no direct relation with sleep. - -Certain other morbid phenomena, such as somnambulism and nightmare, which -have a necessary relation with sleep, will be more appropriately -considered in another place. - -On the other hand, sleep controls the manifestations of several diseases, -especially those which are of a convulsive or spasmodic character. Thus -the paroxysms of chorea cease during sleep, as do likewise the spasms of -tetanus and hydrophobia. Headache is also generally relieved by sleep, -though occasionally it is aggravated. - - - - -CHAPTER IV. - -THE STATE OF THE MIND DURING SLEEP. - - -We have seen that though during sleep the operations of the senses are -entirely suspended as regards the effects of ordinary impressions, the -purely animal functions of the body continue in action. The heart beats, -the lungs respire, the stomach, the intestines, and their accessory organs -digest, the skin exhales vapor, and the kidneys secrete urine. With the -central nervous system, however, the case is very different; for while -some parts retain the property of receiving impressions or developing -ideas, others have their actions diminished, exalted, perverted, or -altogether arrested. - -In the first place, there is, undoubtedly, during sleep, a general torpor -of the sensorium, which prevents the appreciation of the ordinary -excitations made upon the organs of the special senses. So far as the -nerves themselves are concerned, there is no loss of their irritability or -conducting power, and the impressions made upon them are, accordingly, -perfectly well conveyed to the brain. The suspension of the operations of -the senses is not therefore due to any loss of function in the optic -nerve, the auditory nerve, the olfactory nerve, the gustatory nerve, or -the cranial or spinal nerves concerned in the sense of touch, but solely -to the inability of the brain to take cognizance of the impressions -conveyed to it. In regard to the cause of this torpor, I have given my -views in a previous chapter. - -Now it must not be supposed that because mild excitations transmitted by -the nerves of the special senses are incapable of making themselves felt, -that therefore the brain is in a state of complete repose throughout all -its parts. So far from such a condition existing, there are very decided -proofs that several faculties are exercised to a degree almost equaling -that reached during wakefulness, and we know that if the irritations made -upon the senses be sufficiently strong, the brain _does_ appreciate them, -and the sleep is broken. This ability to be readily roused through the -senses constitutes one of the main differences between sleep and stupor, -upon which stress has been already laid. - -Relative to the different faculties of the mind as affected by sleep, -great variations are observed. It has been thought by some authors that -several of them are really exalted above the standard attained during -wakefulness, but this is probably a wrong view. The predominance which one -or two mental qualities apparently assume is not due to any absolute -exaggeration of power, but to the suspension of the action of other -faculties, which, when we are not asleep, exercise a governing or -modifying influence. Thus, for instance, as regards the imagination,--the -faculty of all others which appears to be most increased,--we find, when -we carefully study its manifestations in our own persons, that although -there is often great brilliancy in its vagaries, that uncontrolled as it -is by the judgment, the pictures which it paints upon our minds are -usually incongruous and silly in the extreme. Even though the train of -ideas excited by this faculty when we are asleep be rational and coherent, -we are fully conscious on awaking that we are capable of doing much better -by intentionally setting the brain in action and governing it by our will -and judgment. - -Owing to the fact that these two faculties of the mind are incapable of -acting normally during sleep, the imagination is left absolutely without -controlling influence. Indeed, we are often cognizant in those dreams -which take place when we are half awake, of an inability to direct it. The -impressions which it makes upon the mind are, therefore, intense, but of -very little durability. Many stories are told of its power--how problems -have been worked out, poetry and music composed, and great undertakings -planned; but if we could get at the truth, we should probably find that -the imagination of sleep had very little to do with the operations -mentioned. Indeed, it is doubtful if the mind of a sleeping person can -originate ideas. Those which are formed are, as Locke[34] remarks, almost -invariably made up of the waking man's ideas, and are for the most part -very oddly put together; and we are all aware how commonly our dreams are -composed of ideas, or based upon events which have recently occurred to -us. - -In the previous section to the one just quoted, Locke refers to the -exaggeration of ideas which form so common a feature of our mental actions -during sleep. "It is true," he says, "we have sometimes instances of -perception while we are asleep, and retain the memory of those thoughts; -but how extravagant and incoherent for the most part they are, how little -conformable to the perfection and order of a rational being, those -acquainted with dreams need not be told." - -And yet many remarkable stories are related, which tend to show the high -degree of activity possessed by the mind during sleep. Thus it is said of -Tartini,[35] a celebrated musician of the eighteenth century, that one -night he dreamed he had made a compact with the devil, and bound him to -his service. In order to ascertain the musical abilities of his servitor, -he gave him his violin, and commanded him to play a solo. The devil did -so, and performed so admirably that Tartini awoke with the excitement -produced, and seizing his violin, endeavored to repeat the enchanting -air. Although he was unable to do this with entire success, his efforts -were so far effectual that he composed one of the most admired of his -pieces, which in recognition of its source he called the "devil's sonata." - -Coleridge gives the following account of the composition of the fragment, -Kubla Khan: - -"In the summer of 1797, the author, then in ill health, had retired to a -lonely farm-house, between Perlock and Linton, on the Exmoor confines of -Somerset and Devonshire. In consequence of a slight indisposition, an -anodyne had been prescribed, from the effects of which he fell asleep in -his chair at the moment that he was reading the following sentence, or -words of the same substance, in Purchas's Pilgrimage: 'Here the Khan Kubla -commanded a palace to be built, and a stately garden thereunto. And thus -ten miles of fertile ground were inclosed with a wall.' The author -continued for about three hours in a profound sleep, at least of the -external senses, during which time he had the most vivid confidence that -he could have composed not less than from two to three hundred lines, if -that, indeed, can be called composition, in which all the images rose up -before him as _things_ with a parallel production of the corresponding -expression without any sensation or consciousness of effort. On awaking, -he appeared to himself to have a distinct recollection of the whole; and -taking his pen, ink, and paper, instantly and eagerly wrote down the -lines that are here preserved. At this moment he was unfortunately called -out by a person on business from Perlock, and detained by him above an -hour; and on his return to his room, found to his no small surprise and -mortification, that though he still retained some vague and dim -recollection of the general purport of the vision, yet with the exception -of some eight or ten scattered lines and images, all the rest had passed -away like the images on the surface of a stream into which a stone had -been cast, but, alas! without the after restoration of the latter." - -Dr. Cromwell,[36] citing the above instance of poetic inspiration during -sleep, states that, having like Coleridge taken an anodyne during a -painful illness, he composed the following lines of poetry, which he wrote -down within half an hour after awaking. These lines, though displaying -considerable imagination, are not remarkable for any other quality. - -"Lines composed in sleep on the night of January 9th, 1857. - - "SCENE.--_Windsor Forest._ - - "At a vista's end stood the queen one day - Relieved by a sky of the softest hue; - It happen'd that a wood-mist risen new, - Had made that white which should have been blue. - A sunbeam sought on her form to play; - It found a nook in the bowery nave, - Through which with its golden stem to lave - And kiss the leaves of the stately trees - That fluttered and rustled beneath the breeze; - But it touched not her, to whom 'twas given - To walk in a white light pure as heaven." - -In the last two of these instances it is impossible to say whether the -individuals were really asleep or not, as the opium or other narcotic -taken is a very disturbing factor in both conditions, and doubtless was -the exciting cause of the activity in the imagination. No more graphic -account of the effects of opium in arousing the imagination to its highest -pitch has been written than that given by De Quincey.[37] He says: - -"At night when I lay awake in bed, vast processions passed along in -mournful pomp; friezes of never-ending stories, that to my feelings were -as sad and solemn as if they were stories drawn from times before Oedipus -or Priam, before Tyre, before Memphis. And at the same time a -corresponding change took place in my dreams; a theater seemed suddenly -opened and lighted up within my brain, which presented nightly spectacles -of more than earthly splendor." And then, after referring to the various -scenes of architectural magnificence, and of beautiful women which his -imagination conceived, and which forcibly recalls to our minds the -poetical effusions of Coleridge and Cromwell, he gives the details of -another dream, in which he heard music. "A music of preparation, of -awakening suspense; a music like the opening of the Coronation Anthem, and -which like _that_ gave the feeling of a vast march, of infinite cavalcades -filing off, and the tread of innumerable armies." - -In reference to this subject, Dr. Forbes Winslow[38] relates the following -interesting case: - -"A feeble, sensitive lady, suffering from a uterine affection, writes to -us as follows concerning the influence of three or four -sixteenth-of-a-grain doses of hydrochlorate of morphia: 'After taking a -few doses of morphia, I felt a sensation of extreme quiet and wish for -repose, and on closing my eyes, visions, if I may so call them, were -constantly before me, and as constantly changing in their aspect: scenes -from foreign lands; lovely landscapes, with tall, magnificent trees -covered with drooping foliage, which was blown gently against me as I -walked along. Then in an instant I was in a besieged city filled with -armed men. I was carrying an infant, which was snatched from me by a -soldier and killed upon the spot. A Turk was standing by with a scimitar -in his hand, which I seized, and attacking the man who had killed the -child, I fought most furiously with him and killed him. Then I was -surrounded, made prisoner, carried before a judge and accused of the -deed; but I pleaded my own cause with such a burst of eloquence (which, -by-the-by, I am quite incapable of in my right mind) that judge, jury, and -hearers acquitted me at once. Again, I was in an Eastern city visiting an -Oriental lady, who entertained me most charmingly. We sat together on rich -ottomans, and were regaled with supper and confectionery. Then came soft -sounds of music at a distance, while fountains were playing and birds -singing, and dancing girls danced before us, every movement being -accompanied with the tinkling of silver bells attached to their feet. But -all this suddenly changed, and I was entertaining the Oriental lady in my -own house, and in order to please her delicate taste, I had everything -prepared as nearly as possible after the fashion with which she had so -enchanted me. She, however, to my no small surprise, asked for wine, and -took not one, two, or three glasses, but drank freely, until at last I -became terrified that she would have to be carried away intoxicated. While -considering what course I had better adopt, several English officers came -in, and she at once asked them to drink with her, which so shocked my -sense of propriety that the scene changed and I was in darkness. - -"'Then I felt that I was formed of granite, and immovable. Suddenly a -change came again over me, and I found that I consisted of delicate and -fragile basket-work. Then I became a danseuse, delighting an audience and -myself by movements which seemed barely to touch the earth. Presently -beautiful sights came before me, treasures from the depth of the sea, gems -of the brightest hues, gorgeous shells, coral of the richest colors, -sparkling with drops of water, and hung with lovely seaweed. My eager -glances could not take in half the beautiful objects that passed before me -during the incessant changes the visions underwent. Now I was gazing upon -antique brooches and rings from buried cities; now upon a series of -Egyptian vases; now upon sculptured wood-work blackened by time; and -lastly I was buried amid forests of tall trees, such as I had read of but -never seen. - -"'The sights that pleased me most I had power to a certain extent to -prolong, and those that displeased me I could occasionally set aside, and -I awoke myself to full consciousness once or twice while under the -influence of the morphia by an angry exclamation that I would not have it. -I did not once lose my personal identity.' - -"The lady almost invariably suffers more or less from hallucinations of -the foregoing character, if it becomes necessary to administer to her an -opiate: and on analyzing her visions, she can generally refer the -principal portions of them, notwithstanding their confusion and -distortion, to works that she has recently read." - -Opium, in certain doses, increases the amount of blood in the brain, and -this induces a condition very different from that of sleep. In this fact -we have an explanation of the activity of the imagination as one of its -prominent effects. That Coleridge should have composed the Kubla Khan -under its influence is in nowise remarkable. It is probable, however, that -the full influence of his mind was exerted upon it after he awoke to -consciousness, and that the wild fancies excited by the opiate, and based -upon what he had been previously reading, formed the substratum of his -conceptions. In any event, the ideas contained in this fragment are no -more fanciful than those which occurred to De Quincey and the lady whose -case has just been recorded, nor are they more impressively related. - -The imagination may therefore be active during sleep, but we have no -authentic instance on record that it has, unaided by causes which exercise -a powerful influence over the intracranial circulation, led to the -production of any ideas which could not be excelled by the individual when -awake. Perhaps the most striking case in opposition to this opinion is one -detailed by Abercrombie,[39] who says: - -"The following anecdote has been preserved in a family of rank in -Scotland, the descendants of a distinguished lawyer of the last age. This -eminent person had been consulted respecting a case of great importance -and much difficulty, and he had been studying it with intense anxiety and -attention. After several days had been occupied in this manner, he was -observed by his wife to rise from his bed in the night and go to a -writing-desk which stood in the bed-room. He then sat down and wrote a -long letter, which he put carefully by in the desk and returned to bed. -The following morning he told his wife that he had had a most interesting -dream; that he had dreamt of delivering a clear and luminous opinion -respecting a case which had exceedingly perplexed him, and that he would -give anything to recover the train of thought which had passed before him -in his dream. She then directed him to the writing-desk, where he found -the opinion clearly and fully written out, and which was afterwards found -to be perfectly correct." - -It is probable that this gentleman was actually awake when he arose from -the bed and wrote the paper referred to, and that in the morning he -mistook the circumstance for a dream. It is not at all uncommon for such -errors to be committed, especially under the condition of mental anxiety -and fatigue. A gentleman informed me only a short time since that going to -bed after a very exciting day he thought the next morning that he had -dreamed of a fire occurring in the vicinity of his house. To his surprise -his wife informed him that the supposed dream was a reality, and that he -had got up to the window, looked at the fire, conversed with her -concerning it, and that he was at the time fully awake. - -Brierre de Boismont[40] relates the following instance, which is to the -same effect: - -"In a convent in Auvergne, an apothecary was sleeping with several -persons; being attacked with nightmare, he charged his companions with -throwing themselves on him and attempting to strangle him. They all denied -the assertion, telling him that he had passed the night without sleeping, -and in a state of high excitement. In order to convince him of this fact, -they prevailed on him to sleep alone in a room carefully closed, having -previously given him a good supper, and even made him partake of food of a -flatulent nature. The paroxysm returned; but, on this occasion, he swore -that it was the work of a demon, whose face and figure he perfectly -described." - -That the imagination may in its flights during sleep strike upon fancies -which are subsequently developed by the reason into lucid and valuable -ideas, is very probable. It would be strange if from among the innumerable -absurdities and extravagancies to which it attains something fit to be -appropriated by the mind should not occasionally be evolved, and thus -there are many instances mentioned of the starting-point of important -mental operations having been taken during sleep. Some of these may be -based upon fact, but the majority are probably of the class of those just -specified, or occurred at an age of the world when a belief in the -supernatural exercised a greater power over men's minds than it does at -the present day. Among the most striking of them are the following: - -Galen declares that he owed a great part of his knowledge to the -revelations made to him in dreams. Whether this was really the case or not -we can in a measure determine by recalling the fact that he was a believer -in the prophetic nature of dreams, and states that a man having dreamt -that one of his legs was turned into stone, soon afterward became -paralytic in this limb, although there was no evidence of approaching -disease. Galen also conducted his practice by dreams, for an athlete, -having dreamt that he saw red spots, and that the blood was flowing out of -his body, was supposed by Galen to require blood-letting, which operation -was accordingly performed. - -It has been said[41] that the idea of the _Divina Commedia_ occurred to -Dante during sleep. There is nothing at all improbable in this -supposition, though I have been unable to trace it to any definite source. - -Cabanis[42] states that Condillac assured him that often during the course -of his studies he had to leave them unfinished in order to sleep, and that -on awaking he had more than once found the work upon which he was engaged -brought to a conclusion in his brain. - -These were clearly instances of "unconscious cerebration" of that power -which the brain possesses to work out matters which have engaged its -attention, without the consciousness of the individual being aroused to a -knowledge of the labor being performed. It is not unlikely that this kind -of mental activity goes on to some extent during sleep, but as it is of -such a character that the mind does not take cognizance of its operations, -I do not see how the exact period of its performance can be ascertained. - -Jerome Cardan believed that he composed books while asleep, and his case -is often adduced as an example of the height to which the imagination can -attain during sleep. But this great man was superstitious to an extreme -degree; he believed that he had a familiar spirit, from whom he received -intelligence, warnings, and ideas, and asserted that when awake he -frequently saw long processions of men, women, animals, trees, castles, -instruments of various kinds and many figures, different from anything in -this world. His evidence relative to his compositions and mathematical -labors when asleep is not therefore of a trustworthy character. - -As regards the memory in sleep, it is undoubtedly exercised to a -considerable extent. In fact, whatever degree of activity the mind may -then exhibit is based upon events the recollection of which has been -retained. But there is more or less error mingled with a small amount of -truth. The unbridled imagination of the sleeper so distorts the simplest -circumstances as to render their recognition a matter of no small -difficulty, and thus it scarcely if ever happens that events are -reproduced during sleep exactly as they occurred or as they would be -recalled by the mind of the individual when awake. Frequently, also, -recent events which have made a strong impression on our minds are -forgotten, as when we dream of seeing and conversing with persons not long -dead. - -And yet it has sometimes happened that incidents or knowledge which had -long been overlooked or forgotten, or which could not be remembered by any -effort during wakefulness have been strongly depicted during sleep. Thus -Lord Monboddo[43] states that the Countess de Laval, a woman of perfect -veracity and good sense, when ill, spoke during sleep in a language which -none of her attendants understood, and which even she was disposed to -regard as gibberish. A nurse detected the dialect of Brittany; her -mistress had spent her childhood in that province, but had lost all -recollection of the Breton tongue, and could not understand a word of what -she said in her dreams. Her utterances applied, however, exclusively to -the experience of childhood, and were infantile in structure. - -Abercrombie[44] relates the case of a gentleman who was very fond of the -Greek language, and who, in his youth, had made considerable progress in -it. Subsequently being engaged in other pursuits, he so entirely forgot it -that he could not even read the words; often, however, in his dreams he -read Greek works, which he had been accustomed to use at college, and had -a most vivid impression of fully understanding them. - -Many other instances of the action of memory during sleep might be brought -forward, but the subject will be more appropriately considered in the -chapter on dreams. - -The judgment is frequently exercised when we are asleep, but almost -invariably in a perverted manner. In fact we scarcely ever estimate the -events or circumstances which appear to transpire in our dreams at their -real value, and very rarely from correct conceptions of right and wrong. -High-minded and honorable men do not scruple during sleep to sanction the -most atrocious acts, or to regard with complaisance ideas which, in their -waking moments, would fill them with horror. Delicate and refined women -will coolly enter upon a career of crime, and the minds of hardened -villains are filled with the most elevated and noble sentiments. The -deeds which we imagine we perform in our sleep are generally inadequate to -or in excess of what the apparent occasion requires, and we lose so -entirely the ideas of probability and possibility, that no preposterous -vision appears otherwise than as perfectly natural and correct. Thus, a -physician dreamed that he had been transformed into a monolith which stood -grandly and alone in the vast desert of the Sahara, and had so stood for -ages, while generation after generation wasted and melted away around him. -Although unconscious of having organs of sense, this column of granite saw -the mountains growing bald with age, the forests drooping with decay, and -the moss and ivy creeping around its crumbling base.[45] - -But, although in this instance there was some conception of time, as shown -in the association of the evidences of decay with the lapse of years, -there is in general no correct idea on this subject. Without going into -details which more appropriately belong to another division of this -treatise, I quote the following remarkable example from the essay last -cited. It appeared originally in a biographical sketch of Lavalette, -published in the _Revue de Paris_, and is related by Lavalette as -occurring to him while in prison: - -"One night, while I was asleep, the clock of the Palais de Justice struck -twelve and awoke me. I heard the gate open to relieve the sentry, but I -fell asleep again immediately. In this sleep I dreamt that I was standing -in the Rue St. Honore. A melancholy darkness spread around me; all was -still; nevertheless, a slow and uncertain sound soon arose. All of a -sudden, I perceived at the bottom of the street and advancing toward me, a -troop of cavalry,--the men and horses, however, all flayed. The men held -torches in their hands, the red flames of which illuminated faces without -skin, and bloody muscles. Their hollow eyes rolled fearfully in their -sockets, their mouths opened from ear to ear, and helmets of hanging flesh -covered their hideous heads. The horses dragged along their own skins in -the kennels which overflowed with blood on all sides. Pale and disheveled -women appeared and disappeared at the windows in dismal silence; low -inarticulate groans filled the air, and I remained in the street alone -petrified with horror, and deprived of strength sufficient to seek my -safety in flight. This horrible troop continued passing along rapidly in a -gallop, and casting frightful looks upon me. Their march continued, I -thought, for five hours, and they were followed by an immense number of -artillery wagons full of bleeding corpses, whose limbs still quivered; a -disgusting smell of blood and bitumen almost choked me. At length the iron -gates of the prison, shutting with great force, awoke me again. I made my -repeater strike; it was no more than midnight, so that the horrible -phantasmagoria had lasted no more than two or three minutes--that is to -say, the time necessary for relieving the sentry and shutting the gate. -The cold was severe and the watchword short. The next day the turnkey -confirmed my calculations. I, nevertheless, do not remember one single -event in my life the duration of which I have been able more exactly to -calculate, of which the details are deeper engraven on my memory, and of -which I preserve a more perfect consciousness." - -No instance can more strikingly exemplify aberration of the faculty of -judgment than the above. There was no astonishment felt with the horror -experienced, but all the impossible events which appeared to be -transpiring were accepted as facts, which might have taken place in the -regular order of nature. - -An important question connected with the exercise of judgment is: does the -dreamer know that he is dreaming? Some authors assert that this knowledge -is possible, others that it is not. The following account is interesting, -and I therefore transcribe it, especially as it has not to my knowledge -been heretofore published in this country. - -In a letter to the Rev. William Gregory, Dr. Thomas Reid[46] says: - -"About the age of fourteen, I was almost every night unhappy in my sleep -from frightful dreams. Sometimes hanging over a frightful precipice and -just ready to drop down; sometimes pursued for my life and stopped by a -wall or by a sudden loss of all strength; sometimes ready to be devoured -by a wild beast. How long I was plagued by such dreams I do not now -recollect. I believe it was for a year or two at least; and I think they -had quite left me before I was fifteen. In those days I was much given to -what Mr. Addison in one of his Spectators calls castle-building, and, in -my evening solitary walk, which was generally all the exercise I took, my -thoughts would hurry me into some active scene, where I generally -acquitted myself much to my own satisfaction, and in these scenes of -imagination I performed many a gallant exploit. At the same time, in my -dreams, I found myself the most arrant coward that ever was. Not only my -courage, but my strength failed me in every danger, and I often rose from -my bed in the morning in such a panic that it took some time to get the -better of it. I wished very much to get free of these uneasy dreams, which -not only made me unhappy in sleep, but often left a disagreeable -impression in my mind for some part of the following day. I thought it was -worth trying whether it was possible to recollect that it was all a dream, -and that I was in no real danger. I often went to sleep with my mind as -strongly impressed as I could with this thought that I never in my -lifetime was in any real danger, and that every fright I had was a dream. -After many fruitless endeavors to recollect this when the danger appeared, -I effected it at last, and have often, when I was sliding over a precipice -into the abyss, recollected that it was all a dream, and boldly jumped -down. The effect of this commonly was, that I immediately awoke. But I -awoke calm and intrepid, which I thought a great acquisition. After this -my dreams were never very uneasy, and, in a short time, I dreamed not at -all." - -Beattie[47] states that he once dreamed that he was walking on the parapet -of a high bridge. How he came there he did not know, but recollecting that -he was not given to such pranks, he began to think it might all be a -dream, and, finding his situation unpleasant, and being desirous to get -out of it, threw himself headlong from the height, in the belief that the -shock of the fall would restore his senses. The event turned out as he -anticipated. - -Aristotle also asserts that when dreaming of danger, he used to recollect -that he was dreaming, and that he ought not to be frightened. - -A still more remarkable narration is that of Gassendi,[48] which he thus -relates as occurring to himself: - -"A good friend of mine, Louis Charambon, judge of the criminal court at -Digne, had died of the plague. One night, as I slept, I seemed to see him; -I stretched out my arms toward him, and said, 'Hail thou who returnest -from the place of the dead!' Then I stopped, reflecting in my dream as -follows: 'One cannot return from the other world; I am doubtless dreaming; -but if I dream, where am I? Not at Paris, for I came last to Digne. I am -then at Digne, in my house, in my bedroom, in my bed.' And then, as I was -looking for myself in the bed, some noise, I know not what, awoke me." - -In all these and like instances, it is very probable the individuals were -much more awake than asleep, for certainly the power to judge correctly is -not exercised in dreams, involving even the most incongruous -impossibilities. As Dendy[49] says, "if we _know_ that we are dreaming, -the faculty of judgment cannot be inert, and the dream would be known to -be a fallacy." There would therefore be no occasion for any such -management of it as that made use of by Reid and Beattie, or for the -recollection of Aristotle. The dream and the correction of it by the -judgment would go together and there would be no self-deception at -all--not even for an instant. Dreams would accordingly be impossible. The -essential feature of mental activity during sleep, absolute freedom of the -imagination, would not exist. - -Relative to Gassendi's case, it is impossible to believe that he was fully -asleep, and the fact that he was awakened by some noise, the nature of -which was unrecognized, and which was therefore probably slight, tends to -support this view. Moreover, although he was, as he thought, enabled to -detect the fallacy of his dream in one respect, his judgment was -altogether at fault in others. Thus he had great difficulty in making out -where he was, and actually so far lost all idea of his identity with the -person dreaming as to look for himself in his own bed! Certainly an -individual whose judgment was thus much deranged would scarcely be able to -reason correctly as to the fact of his dreaming or not, or to question the -possibility of the dead returning to this world. - -My opinion therefore is, that during sleep the power of bringing the -judgment into action is suspended. We do not actually lose the power of -arriving at a decision, but we cannot exert the faculty of judgment in -accordance with the principles of truth and of correct reasoning. An -opinion may therefore be formed during sleep, but it is more likely to be -wrong than right, and no effort that we can make will enable us to -distinguish the false from the true, or to discriminate between the -possible and the impossible. - -That faculty of the mind--the judgment--which when we are awake is -pre-eminently our guide, can no longer direct us aright. The stores of -experience go for naught, and the mind accepts as truth whatever -preposterous thought the imagination presents to it. We are not entirely -rendered incapable of judging, as some authors assert, but the power to -perceive the logical force of circumstances, to take them at their true -value and to eliminate error from our mental processes, is altogether -arrested, and we arrive at absurd conclusions from impossible premises. - -But there is no doubt that at times the faculty of judgment is suspended -as regards some parts of our mental operations during sleep, and this, to -such an extent, that we are like Gassendi in the case quoted, not capable -of recognizing our own individuality. Thus it is related of Dr. Johnson, -that he had once in a dream a contest of wit with some other person, and -that he was very much mortified by imagining that his opponent had the -better of him. "Now," said he, "one may mark here the effect of sleep in -weakening the power of reflection; for had not my judgment failed me, I -should have seen that the wit of this supposed antagonist, by whose -superiority I felt myself depressed, was as much furnished by me as that -which I thought I had been uttering in my own character." - -Van Goens dreamt that he could not answer questions to which his neighbor -gave correct responses. - -An interesting case, in which the judgment was still more at fault, has -recently come to my knowledge. - -Mrs. C. dreamed that she was Savonarola, and that she was preaching to a -vast assembly in Florence. Among the audience was a lady whom she at once -recognized to be her own self. As Savonarola, she was delighted at this -discovery, for she reflected that she was well acquainted with all Mrs. -C.'s peculiarities and faults of character, and would, therefore, be -enabled to give special emphasis to them in the sermon. She did this so -very effectively that Mrs. C. burst into a torrent of tears, and, with the -emotion thus excited, the lady awoke. It was some time before she was able -to disentangle her mixed up individualities. When she became fully awake -she perceived that the arguments she had employed to bring about the -conversion of herself were puerile in the extreme, and were directed -against characteristics which formed no part of her mental organization, -and against offenses which she had not committed. - -Macario[50] makes the following apposite remarks on the point under -consideration. Referring to the preposterous nature of many dreams, he -says: - -"It is astonishing that all these fantastical and impossible visions seem -to us quite natural, and excite no astonishment. This is because the -judgment and reflection having abdicated, no longer control the -imagination nor co-ordinate the thoughts which rush tumultuously through -the brain of the sleeper, combined only by the power of association. - -"When I say that the judgment and reflection abdicate, it should not be -inferred that they are abolished and no longer exist, for the imagination -could not, unaided by the reason, construct the whimsical and capricious -images of dreams." - -Relative to the power to work out, during sleep, problems involving long -and intricate mental processes, I have already expressed my opinion -adversely. In this view, I am not alone. Rosenkranz,[51] whose -contributions to psychological science cannot be overestimated, and whose -clear and powerful understanding has rarely been excelled, has pointed out -how such operations of the understanding are impossible; for, as he -remarks, intellectual problems cannot be solved during sleep, for such a -thing as intense thought, accompanied by images, is unknown, whilst dreams -consist of a series of images connected by loose and imperfect reasoning. -Feuchtersleben,[52] referring with approval to this opinion of Rosenkranz, -says that he recollects perfectly having dreamt of such problems, and -being happy in their solution, endeavored to retain them in his memory; he -succeeded, but discovered, on awaking, that they were quite unmeaning, and -could only have imposed upon a sleeping imagination. - -Müller[53] says: - -"Sometimes we reason more or less correctly in dreams. We reflect on -problems and rejoice in their solution. But on awaking from such dreams, -the seeming reasoning is frequently found to have been no reasoning at -all, and the solution of the problem over which we had rejoiced, to be -mere nonsense. Sometimes we dream that another person proposes an enigma; -that we cannot solve it and that others are equally incapable of doing so; -but that the person who proposed it, himself gives the explanation. We are -astonished at the solution we had so long labored in vain to find. If we -do not immediately awaken and afterwards reflect on this proposition of an -enigma in our dream, and on its apparent solution, we think it wonderful; -but if we awake immediately after the dream, and are able to compare the -answer with the question, we find that it was mere nonsense." - -And in regard to the knowledge that we are dreaming, the same author[54] -observes that: - -"The indistinctness of the conception in dreams is generally so great that -we are not aware that we dream. The phantasms which are perceived really -exist in our organs of sense. They afford, therefore, in themselves as -strong proof of the actual existence of the objects they represent, as -our own perceptions of real external objects in the waking state; for we -know the latter only by the affections of our senses which they produce. -When, therefore, the mind has lost the faculty of analyzing the -impressions on our senses, there is no reason why the things which they -seem to represent should be supposed unreal. Even in the waking state -phantasms are regarded as real objects when they occur to persons of -feeble intellect. On the other hand, when the dreaming approaches more -nearly to the waking state, we sometimes are conscious that we merely -dream, and still allow the dream to proceed, while we retain this -consciousness of its true nature." - -Sir Benjamin Brodie,[55] in discussing the subject of wonderful -discoveries made in dreams, and abstruse problems worked out, remarks that -it would indeed be strange if among the vast number of combinations which -constitute our dreams, there were not every now and then some having the -semblance of reality; and further, that in many of the stories of great -discoveries made in dreams, there is much of either mistake or -exaggeration, and that if they could have been written down at the time, -they would have been found to be worth little or nothing. - -Another faculty exercised during sleep has been ascribed to the judgment. -It is well known that many persons having made up their minds to awake at -a certain hour invariably do so. I possess this power in a high degree, -and scarcely ever vary a minute from the fixed time. Just as I go to bed I -look at my watch and impress upon my mind the figures on the dial which -represent the hour and minute at which I wish to awake. I give myself no -further anxiety on the subject, and never dream of it, but I always wake -at the desired moment. - -Now I cannot conceive what connection the judgment has with this power. In -the case of alarm clocks set to go off at a certain time, the judgment, as -Jouffroy[56] asserts, may take cognizance of the impression made upon the -ear, and establish the relation between it and the wish to awake at a -certain time. But in cases where the awaking is the result of an idea -conceived before going to sleep, and which is not subsequently recalled, -the judgment cannot act, for this faculty is only exercised upon ideas -which are submitted to it. The brain is, as it were, wound up like the -alarm clock and set to a certain hour. When that hour arrives, an -explosion of nervous force takes place, and the individual awakes. - -Fosgate[57] asserts that the power of judging during sleep is probably as -good as when we are awake, for decisions are made only on the premises -presented in either case, and if those in the former condition are absurd -or unreasonable, the conclusion will likewise be faulty. But this is not -very accurate reasoning; for it is as much the province of the judgment to -determine the validity of the premises as it is to draw a conclusion from -them, and if it cannot recognize the falsity or truth of propositions the -irrational character of which would be readily perceived during -wakefulness, there is not much to be said in favor of its power. - -In fact, however, the conclusions formed in dreams are often without any -logical relation with the premises. Thus, when an individual dreams, as in -the instance previously quoted, that he is a column of stone, it is -contrary to all experience to deduce therefrom the conclusion that he can -see rocks crumbling around him, and can reflect upon the mutability of all -things. The premise of his being a stone pillar being submitted to the -judgment, the proper conclusion would be that he is composed of inorganic -material, is devoid of life, and consequently not possessed of either -sensation or understanding. - -Why the judgment is not properly exercised during sleep we do not know. -Dr. Philip[58] believes that in this condition ideas flow so rapidly that -they are not submitted to the full power of the judgment, and that hence -the absurdity which characterizes them is not perceived. But this -explanation is by no means satisfactory; for a merely swift succession of -ideas is no very serious bar to correct judgment, and when the thoughts -are as preposterous as those which so often occur in dreams, they present -no obstacle at all to a proper estimation of them by the healthy mind. The -cause probably resides in some alteration in the circulation of the blood -in that part of the brain which presides over the judgment, whereby its -power is suspended and the imagination left free to fill the mind with its -incongruous and fantastic images. - -As regards the will, we find very opposite opinions entertained relative -to its activity; but no one, so far as I am aware, appears to have had -correct views upon the subject. Without going into a full discussion of -the views enunciated, it will be sufficient to refer to the ideas on the -point in question which have been expressed by some of the most eminent -philosophers and physiologists. - -In the course of his remarks on sleep, Darwin[59] repeatedly alleges that -during this condition the action of the will is entirely suspended; but he -falls into the singular error of confounding volition with the power of -motion. Thus he says: - -"When by one continued posture in sleep some uneasy sensations are -produced, we either gradually awake by the exertion of volition, or the -muscles connected by habit with such sensations alter the position of the -body; but where the sleep is uncommonly profound, and these uneasy -sensations great, the disease called the incubus or nightmare is produced. -Here the desire of moving the body is painfully exerted; but the power of -moving it, or volition, is incapable of action till we are awake." - -In consequence of this misapprehension of the nature of the will, it is -not easy to arrive at Darwin's ideas on the subject; and the attempt is -rendered still more difficult from the fact that though he repeatedly -states that volition is entirely suspended during sleep, he yet in the -first part of the foregoing quotation makes an individual awake by the -gradual exercise of the power of the will; and then in the last part of -the same paragraph asserts that volition is incapable of action till sleep -is over. - -Mr. Dugald Stewart[60] contends that during sleep the power of volition is -not suspended, but that those operations of the mind and body which depend -on volition cease to be exercised. In his opinion the will loses its -influence over all our powers both of mind and body in consequence of some -physical alteration in the system which we shall never probably be able -to explain. To show in full the views of so distinguished a philosopher as -Mr. Stewart, I quote the following extracts from his remarks on the -subject: - -"In order to illustrate this conclusion [the one above stated] a little -further, it may be proper to remark that if the suspension of our -voluntary operations in sleep be admitted as a fact, there are only two -suppositions which can be formed regarding its cause. The one is that the -power of volition is suspended; the other that the will loses its -influence over those faculties of the mind and those members of the body -which during our waking hours are subjected to its authority. If it can be -shown then that the former supposition is not agreeable to fact, the truth -of the latter seems to follow as a necessary consequence. - -"1. That the power of volition is not suspended during sleep, appears from -the efforts which we are conscious of making while in that situation. We -dream, for instance, that we are in danger, and we attempt to call out for -assistance. The attempt induced is in general unsuccessful, and the sounds -that we emit are feeble and indistinct; but this only confirms, or rather -is a necessary consequence of, the supposition that in sleep the -connection between the will and our voluntary operations is disturbed or -interrupted. The continuance of the power of volition is demonstrated by -the effort, however ineffectual. - -"In like manner, in the course of an alarming dream we are sometimes -conscious of making an exertion to save ourselves by flight from an -apprehended danger; but in spite of all our efforts we continue in bed. In -such cases we commonly dream that we are attempting to escape and are -prevented by some external obstacle; but the fact seems to be that the -body is at that time not subject to the will. During the disturbed rest -which we sometimes have when the body is indisposed, the mind appears to -retain some power over it; but as even in these cases the motions which -are made consist rather of a general agitation of the whole system than of -the regular exertion of a particular member of it with a view to produce a -certain effect, it is reasonable to conclude that in perfectly sound sleep -the mind, although it retains the power of volition, retains no influence -whatever over the bodily organs. - -"In that particular condition of the system which is known by the name of -_incubus_, we are conscious of a total want of power over the body; and I -believe the common opinion is that it is this want of power which -distinguishes the _incubus_ from all the other modifications of sleep. But -the more probable supposition seems to be that every species of sleep is -accompanied with a suspension of the faculty of voluntary motion; and that -the incubus has nothing peculiar in it but this--that the uneasy -sensations which are produced by the accidental posture of the body, and -which we find it impossible to remove by our own efforts, render us -distinctly conscious of our incapacity to move. One thing is certain, that -the instant of our awaking and of our recovering the command of our bodily -organs is one and the same. - -"2. The same conclusion is confirmed by a different view of the subject. -It is probable, as was already observed, that when we are anxious to -procure sleep the state into which we naturally bring the mind approaches -to its state after sleep commences. Now it is manifest that the means -which nature directs us to employ on such occasions is not to suspend the -powers of volition, but to suspend the exertion of those powers whose -exercise depends on volition. If it were necessary that volition should be -suspended before we fall asleep, it would be impossible for us by our own -efforts to hasten the moment of rest. The very supposition of such efforts -is absurd, for it implies a continued will to suspend the acts of the -will. - -"According to the foregoing doctrine with respect to the state of the mind -in sleep, the effort which is produced on our mental operations is -strikingly analogous to that which is produced on our bodily powers. From -the observations which have been already made, it is manifest that in -sleep the body is in a very inconsiderable degree, if at all, subject to -our command. The vital and involuntary motions, however, suffer no -interruption, but go on as when we are awake, in consequence of the -operation of some cause unknown to us. In like manner it would appear -that those operations of the mind which depend on our volition are -suspended, while certain other operations are at least occasionally -carried on. This analogy naturally suggests the idea that all our mental -operations which are independent of our will may continue during sleep; -and that the phenomena of dreaming may, perhaps, be produced by these, -diversified in their apparent effects in consequence of the suspension of -our voluntary powers." - -A very little reflection will suffice to convince the reader that Mr. -Stewart has altogether mistaken the nature of sleep. There is no evidence -to support his view that the body is not subject to the action of the will -during sleep. No change whatever is induced by this condition in the -nerves or muscles of the organism. The first are just as capable as ever -of conducting the nervous fluid, and the muscles do not lose any of their -contractile power. The reason why voluntary movements are not performed in -sleep is simply because the will does not act; and Mr. Stewart is again -wrong in asserting that volition is not then suspended. We do not will any -actions when we are asleep. We _imagine_ we do, and that is all. The -difficulties which encompass us in sleep are, it must be recollected, -purely imaginary, and the efforts we make to escape from them are likewise -the products of our fancy. Herein lies the main error which Mr. Stewart -has committed. He appears to accept the dream for a reality, and to -regard the seeming volitions which occur in it as actual facts; whereas -they are all entirely fictitious. - -An example will serve to make this point still clearer. - -Not long since I dreamed that I stood upon a very high perpendicular -table-land, at the foot of which flowed a river. I thought I experienced -an irresistible desire to approach the brink and to look down. Had I been -awake, such a wish would have been the very last to enter my mind, for I -have an instinctive dread of standing on a height. I dreamed that I threw -myself on my face and crawled to the edge of the cliff. I looked down at -the stream, which scarcely appeared to be as wide as my hand, so great was -the altitude upon which I was placed. As I looked I felt an overpowering -impulse to crawl still farther and to throw myself into the water below. I -imagined that I endeavored with all my will to resist this force, which -appeared to be acting by means altogether external to my organism. My -efforts, however, were all in vain. I could not control my movements, and -gradually I was urged farther and farther over the brink, till at last I -went down into the abyss below. As I struck the water I awoke with a -start. During my imaginary struggle I thought I experienced all the -emotions which such an event if real would have excited, and I was -painfully conscious of my utter inability to escape from the peril of my -situation. Here were circumstances such as, according to Mr. Stewart, -demonstrate the activity of volition, but at the same time show its -inability to act upon the body. But clearly they show no such thing, for -the imaginary volition was to refrain from crawling over a precipice which -did not exist, and over which, therefore, I was not hanging. Such an act -of the will if real, could not in the very nature of the real conditions -of the situation have been carried out--the volition was just as imaginary -as all the other circumstances of the dream. - -Again, it is not always the case that the imaginary acts of the will are -not executed during sleep; and hence it would follow from Mr. Stewart's -argument that the power of the will over the body is not then suspended. -Assuming for the moment that the volitions of sleep are real, as Mr. -Stewart supposes; if it can be shown that they are satisfactorily -performed, it results from his line of reasoning that the will has power -over the body during sleep. Every one who has ever dreamed has at times -had his will carried out to his entire satisfaction. He has ridden horses -when pursued, and has urged them forward with whip and spur so as to -escape from his enemies. Or he has executed the most surprising feats both -with his mind and body, and has performed voluntary deeds which have -excited the admiration of all beholders. Such acts are of course entirely -the product of the imagination, and all the volitions which accompany -them have no firmer basis than the unbridled fancy; but, according to Mr. -Stewart, they would be evidence of the power of the will over the body,--a -power which in reality does not exist; not, however, as Mr. Stewart -supposes from any impediments in the nerves or muscles, but because it is -never exerted. - -So far as relates to movements performed during sleep, such as turning in -bed and assuming more comfortable positions, they have nothing whatever to -do with the will. They are dependent upon the action of the spinal cord, -an organ that is never at rest, and the functions of which were not known -as well when Dr. Darwin and Mr. Stewart wrote as they are now. The same is -true of more complex and longer-continued actions, such as those already -mentioned of individuals riding on horseback, or even walking, during -sleep. - -Cabanis[61] contends that the will is not entirely suspended during sleep; -but, as will be perceived from the following quotation, he bases his -argument upon the fact that movements are produced which he attributes -erroneously to the action of the will, but which, like those previously -referred to, are accomplished by the agency of the spinal cord. He says, -speaking of the instances of persons walking while asleep: - -"These rare cases are not the only ones in which during sleep movements -are produced by what remains of the will; for it is by virtue of certain -direct sensations that a sleeping man moves his arm to brush away the -flies that may be on his face, that he draws up the bedclothes so as to -cover himself carefully; or, as we have already remarked, that he turns -over and endeavors to find a more comfortable position. It is the will -which during sleep maintains the contraction of the sphincter of the -bladder, notwithstanding the effort of the urine to escape; it is the same -power which directs the action of the arm in seeking for the _vase de -nuit_, which knows where to find it, and enables the individual to use it -for several minutes and to return it to its place without being awakened. -Finally, it is not without reason that some physiologists have made the -will concur in the contraction of several muscles, the movements of which -are necessary to the maintenance of respiration during sleep." - -All these movements, and many others of a similar character, are entirely -spinal, and are altogether independent of cerebral influence. Even when we -are awake, we constantly execute muscular actions through the power of the -spinal cord, when the mind is intently occupied with other things. Take -for instance the example of a person playing on the piano, and at the same -time carrying on a conversation. Here the brain is engaged in the one act -and the spinal cord in the other. So long as the player is not expert in -the fingering of the instrument, he cannot divert his attention from his -performance; for the whole power of the mind is required for the proper -appreciation and execution of the music. But after the spinal cord has -become educated to the habit, and he has attained proficiency in the -necessary manipulations, the mind is no longer required to control the -actions and may be directed to other subjects. The arguments of Cabanis, -therefore, in favor of the partial exercise of the will during sleep, are -of no force. - -But the power of the will over the muscles of the body is only one of the -ways in which this faculty is shown. It regulates the thoughts and the -manifestations of emotion when we are awake. How utterly incapable it is -of any such action during sleep we all know. A gentleman, remarkable for -the ability he possesses for controlling his feelings, tells me that when -he is asleep he frequently weeps or laughs at imaginary events, which, if -they really had occurred to him during wakefulness, would give rise to no -such disturbance. He often desires to stop these emotional manifestations, -but is entirely powerless to do so. Most individuals have had similar -experiences. - -The theory that the will is in action during sleep is, therefore, to my -mind untenable. It has probably had its origin in the idea that confounds -it with desire, from which it differs so markedly that it seems strange -the distinction should ever fail of being made. Locke[62] points out very -clearly the differences between the two faculties. In fact they may be -exerted in directly opposite ways. Desire often precedes volition; but we -all, at times, will acts which are contrary to our desire, and desire to -perform others which we are unable to will. - -Reid[63] writes with great perspicuity on this distinction between desire -and will. He says: - -"Desire and will agree in this, that both must have an object of which we -must have some conception; and, therefore, both must be accompanied with -some degree of understanding. But they differ in several things. - -"The object of desire may be anything which appetite, passion, or -affection leads us to pursue; it may be any event which we think good for -us, or for those to whom we are well affected. I may desire meat or drink, -or ease from pain. But to say that I will meat, or will drink, or will -ease from pain, is not English. There is, therefore, a distinction in -common language between desire and will. And the distinction is, that what -we will must be an action and our own action; what we desire may not be -our own action, it may be no action at all. - -"A man desires that his children may be happy, and that they may behave -well. Their being happy is no action at all; their behaving well is not -his action but theirs. - -"With regard to our own actions, we may desire what we do not will, and -will what we do not desire; nay, what we have a great aversion to. - -"A man athirst has a strong desire to drink; but for some particular -reason he determines not to gratify his desire. A judge from a regard to -justice and to the duty of his office dooms a criminal to die; while, from -humanity or particular affection, he desires that he should live. A man -for health may take a nauseous draught, for which he has no desire, but a -great aversion. Desire, therefore, even when its object is some action of -our own, is only an incitement to will; but it is not volition. The -determination of the mind may be not to do what we desire to do. But as -desire is often accompanied by will, we are apt to overlook the -distinction between them." - -That desire is manifested during sleep there can be no doubt; and Mr. -Stewart, although insisting as he does on the distinction between this -faculty and volition, confounds them in his remarks already quoted. A -person suffering from nightmare has a most intense desire to escape from -his imaginary troubles. In my own dream, to which reference has been made, -my desire to restrain myself from crawling over the precipice was exerted -to the utmost; but the will could not be brought into action. Darwin,[64] -when he says that in nightmare "the _desire_ of moving the body is -painfully exerted, but the _power of moving it, or volition_, is incapable -of action till we awake," makes the proper distinction between desire and -will; but, as I have already shown, confounds the latter with another very -different faculty. - -From the foregoing observations it will be seen that during sleep the -three great divisions of the mind are differently affected. - -1. Feeling, embracing sensation and emotion, is suspended, so far as the -first is concerned; but is in full action as regards the second. We do not -see, hear, smell, taste or enjoy the sense of touch in sleep, although the -brain may be aroused into activity and we may awake through the -excitations conveyed to it by the special senses. The emotions have full -play, unrestrained by the will and governed only by the imagination. - -2. The Will or Volition is entirely suspended. - -3. The Thought or Intellect is variously affected in its different powers. -The imagination is active, and the memory may be exercised to a great -extent; but the judgment, perception, conception, abstraction, and reason -are weakened, and sometimes altogether lost. - - - - -CHAPTER V. - -THE PHYSIOLOGY OF DREAMS. - - -The subject of the foregoing chapter is so intimately connected with the -phenomena of dreaming, and I have expressed my views in regard to it at -such length, that but few psychological points remain to be considered in -the present discussion. What I have to say, therefore, in regard to the -physiology of dreaming must be read in connection with the chapter on -"_The State of the Mind during Sleep_," in order that the whole matter may -be fully understood. - -It is contended by some writers that the mind is never at rest, and that -even during the most profound sleep dreams take place, which are either -forgotten immediately, or which make no impression on the memory. That -this view is erroneous is, I think, very evident. If it were correct, the -first object of sleep--rest for the brain--would not be attained. We all -know how fatigued we are, and how indisposed to exertion the brain is, -after a night of continued dreaming, and we can easily imagine what would -be the consequences if such a condition were kept up night after night. To -say that we really do dream not only every night, but every instant of -the night, in fact always and continually when we sleep, but that we -forget our dreams as soon as they are formed, remembering solely those -which are most vivid, is making assertions which not only are without -proof, but which are impossible of proof. For if, as Locke[65] remarks, -the sleeping man on awaking has no recollection of his thoughts, it is -very certain that no one else can recollect them for him. - -The observations of Locke on this point are extremely appropriate, and, to -my mind, very philosophical and logical. After insisting that, sleeping or -waking, a man cannot think without being sensible of it, he says:[66] - -"I grant that the soul of a waking man is never without thought, because -it is the condition of being awake; but whether sleeping without dreaming -be not an affection of the whole man, mind as well as body, may be worth a -waking man's consideration, it being hard to conceive that anything should -think and not be conscious of it. If the soul doth think in a sleeping man -without being conscious of it, I ask, whether during such thinking it has -any pleasure or pain, or be capable of happiness or misery? I am sure the -man is not, any more than the bed or earth he lies on, for to be happy or -miserable without being conscious of it seems to me utterly inconsistent -and impossible. Or if it be possible that the soul can, while the body is -sleeping, have its thinkings, enjoyments, and concerns, its pleasure or -pain, about which the man is not conscious of nor partakes in, it is -certain that Socrates asleep and Socrates awake is not the same person; -but his soul when he sleeps and Socrates the man, consisting of body and -soul when he is waking, are two persons, since waking Socrates has no -knowledge of or concernment for that happiness or misery of his soul which -it enjoys alone by itself while he sleeps without perceiving anything of -it, any more than he has for the happiness or misery of a man in the -Indies whom he knows not; for if we take wholly away all consciousness of -our actions and sensations, especially of pleasure and pain, and the -concernment that accompanies it, it will be hard to know wherein to place -personal identity." - -In a subsequent section of the same chapter, Locke asserts that most men -pass a great part of their lives without dreaming, and that he once knew a -scholar who had no bad memory, who told him he had never dreamed in his -life till after the occurrence of a fever in the twenty-fifth or -twenty-sixth year of his age. - -Examples of persons who have not ordinarily dreamed are adduced by the -ancient writers. Pliny[67] refers to men who never dreamed. Plutarch[68] -alludes to the case of Cleon, who, in living to an advanced age, had yet -never dreamed; and Suetonius[69] declares that before the murder of his -mother he had never dreamed. - -A lady who was under my care for a serious nervous affection declared to -me that she never had had but one dream in her life, and that was after -receiving a severe fall in which she struck her head. - -And yet, notwithstanding the experience of every one that sleep often -happens without the accompaniment of dreams, the great majority of writers -hold the view that the brain is never at rest. Doubtless this opinion has -its origin partly in the doctrine that the mind is a something altogether -independent of and superior to the brain. They appear to be incapable of -appreciating the fact that when the brain is in a state of complete repose -there can be no mental manifestation, and that all intellectual phenomena -are the results of cerebral activity. Another cause for their belief is -the fact that they make no distinction between dreaming and thinking, -whereas it is very evident that the two are not to be placed in the same -category. Thinking is an _action_ which requires cerebral effort, and -which is undertaken with a determinate purpose. We will to think, and we -think what we please; but it is very different with our dreams, which -come and go without any power on our part to regulate or direct them. To -think requires all the faculties of the mind; to dream necessitates only -the memory and the imagination. In thinking, the brain is active in all -its parts; in dreaming, it is nearly entirely quiescent. - -Writers who contend for the doctrine of constant mental activity regard -the brain as the organ or tool of the mind, a structure which the mind -makes use of in order to manifest itself. Such a theory is certain to lead -them into difficulties, and is contrary to all the teaching of physiology. -The full discussion of this question would be out of place here; I will, -therefore, only state that this work is written from the stand-point of -regarding the mind as nothing more than the result of cerebral action. -Just as a good liver secretes good bile, a good candle gives good light, -and good coal a good fire, so does a good brain give a good mind. When the -brain is quiescent there is no mind. - -Lemoine[70] begins his chapter "_On the State of the Mind during Sleep_" -with the assertion that "there is no sleep for the mind." He is obliged, -however, to admit that "when the organs of the body are benumbed by sleep, -the mind appears to be in a particular state; it seems to be submitted to -other laws than those which govern it during wakefulness; it seems to -have lost for a time its most precious faculties." - -During sleep the mind is, as he supposes, in a particular state, for, as -has been shown in the previous chapter, it has lost many of its chief -parts. The laws which govern it are, however, the same which always -regulate it. The body upon which their power is primarily exercised--the -brain--is not in the same condition during sleep as during wakefulness, -and hence the differences in the evidences of cerebral activity. - -Sir William Hamilton[71] is generally considered to have determined -affirmatively the question of the continuance of the action of the brain -during sleep. He caused himself to be aroused from sleep at intervals -through the night, and invariably found that he was disturbed from a -dream, the particulars of which he could always distinctly recollect. But -a full knowledge of the subject he was investigating would have sufficed -to convince Sir William that the conclusion he drew from his experiments -was altogether fallacious. It is well known that dreams are excited by -strong impressions made upon the senses, or by irritations arising in the -internal organs. Thus Baron Trenck relates that when confined in his -dungeon he suffered the pangs of hunger almost continually, and that his -dreams at night were always of delicate meats and sumptuous repasts, -spread before him on luxuriously-furnished tables. The mere excitation of -waking a sleeping person is generally sufficient to give rise to a dream. -Maury, in his very interesting work, to which reference has already been -made, and which will hereafter be more specifically considered, adduces -many examples of dreams produced by sensorial impressions. I have myself -performed many experiments with reference to this point, and have -generally found ample confirmation of Maury's investigations. It may -therefore, I think, be assumed, without any violence to the actual facts -of the cases, that the brain is not always in action, and that there are -times when we sleep without dreaming. - -In the previous chapter the idea is sought to be conveyed that we -originate nothing in our dreams. We may conceive of things which never -existed, or of which we have heard or read, but the images we make of them -are either composed of elements familiar to us, or else are based upon -ideal representations which we have formed in our waking moments. Thus, -before the discovery of America no Europeans ever dreamed of American -Indians, for the reason that nothing existed within their knowledge which -could give any idea of the appearance of such human beings. It is possible -that Columbus and his companions may have dreamed of the continent of -which they were in search and of its natives, but the images formed of the -latter must necessarily have resembled other beings they had seen, or -which they had heard described. After the discovery, however, it was no -unusual thing for the Spaniards and others to have correct images of -Indians appear to them in their dreams. - -Dreams, therefore, must have a foundation, and this is either impressions -made upon the mind at some previous period, or produced during sleep by -bodily sensations. These impressions, however they may be formed, are -subjected to the unrestrained influence of the imagination. - -At first sight it may seem that we often have dreams not excited by actual -sensations, and which have no relation to any events of our lives, or any -ideas which have passed through our minds, but thorough investigation will -invariably reveal the existence of an association between the dream and -some such ideas or events. For instance, a few nights ago I dreamed that a -gentleman, a friend of mine, had invented what he called a "dog-cart -ambulance," a vehicle which he declared was the best ever made for the -transportation of sick or wounded men. On awaking, all the particulars -were fresh in my mind, but I could not for some time perceive why I had -had such a dream. At last I recollected that the morning before a -gentleman had given me a very full description of Prospect Park, in -Brooklyn. The friend of whom I dreamed has charge of the construction of -this Park. His presence was, therefore, fully explained, and as dog-carts -are driven in parks, this link was also accounted for. The ambulance part -was due to the fact that I had that same morning found the card of a -gentleman upon my table who really had invented an ambulance. The -imagination had, therefore, taken these data supplied by the memory, and -had combined them into the incongruous web constituting my dream. - -Dreams are also frequently built upon circumstances which have transpired -many years previously, and which have long since apparently passed from -our recollection. A very striking instance of this kind is related by -Abercrombie,[72] on the authority of Sir Walter Scott. - -"Mr. R. J. Rowland, a gentleman of landed property in the vale of Gala, -was prosecuted for a very considerable sum, the accumulated arrears of -teind (tithe), for which he was said to be indebted to a noble family the -titulars (lay impropriators of the tithe). Mr. R. was strongly impressed -with the belief that his father had, by a form of process peculiar to the -law of Scotland, purchased these teinds from the titular, and, therefore, -that the present prosecution was groundless. But after an industrious -search among his father's papers, an investigation of the public records, -and a careful inquiry among all persons who had transacted law business -for his father, no evidence could be discovered to support his defense. -The period was now near at hand when he conceived the loss of his lawsuit -to be inevitable, and he had formed his determination to ride to Edinburgh -next day, and make the best bargain he could in the way of compromise. He -went to bed with this resolution, and, with all the circumstances of the -case floating upon his mind, had a dream to the following purpose. His -father, who had been many years dead, appeared to him, he thought, and -asked him why he was disturbed in his mind. In dreams men are not -surprised at such apparitions. Mr. R. thought that he informed his father -of the cause of his distress, adding that the payment of a considerable -sum of money was the more unpleasant to him, because he had a stray -consciousness that it was not due, though he was unable to recover any -evidence in support of his belief. 'You are right, my son,' replied the -paternal shade; 'I did acquire right to these teinds, for payment of which -you are now prosecuted. The papers relating to the transaction are in the -hands of Mr. ----, a writer (or attorney), who is now retired from -professional business, and resides at Inveresk, near Edinburgh. He was a -person whom I employed on that occasion for a particular reason, but who -never, on any other occasion, transacted business on my account. It is -very possible,' pursued the vision, 'that Mr. ---- may have forgotten a -matter which is now of a very old date; but you may call it to his -recollection by this token--that when I came to pay his account there was -difficulty in getting change for a Portugal piece of gold, and that we -were forced to drink out the balance at a tavern.' - -"Mr. R. awaked in the morning with all the events of the vision impressed -on his mind, and thought it worth while to ride across the country to -Inveresk, instead of going straight to Edinburgh. When he came there he -waited on the gentleman mentioned in the dream, a very old man; without -saying anything of the vision, he inquired whether he remembered having -conducted such a matter for his deceased father. The old gentleman could -not at first bring the circumstance to his recollection, but, on mention -of the Portugal piece of gold, the whole returned upon his memory; he made -an immediate search for the papers and recovered them, so that Mr. R. -carried to Edinburgh the documents necessary to gain the cause which he -was on the verge of losing." - -A friend has related to me some circumstances in his own case similar to -the above, and illustrating the same points. In the course of his practice -as a lawyer, it became necessary for him to ascertain the exact age of a -client, who was also his cousin. Their grandfather had been a rather -eccentric personage, who had taken a great deal of notice of both his -grandsons--his only direct descendants. He died when they were boys. My -friend often told his cousin that if his grandfather were alive there -would be no difficulty at getting at the desired information, and that he -had a dim recollection of having seen a record kept by the old gentleman, -and of there being some peculiarity about it which he could not recall. -Several months elapsed, and he had given up the idea of attempting to -discover the facts of which he had been in search, when, one night, he -dreamed that his grandfather came to him and said: "You have been trying -to find out when J---- was born; don't you recollect that one afternoon -when we were fishing I read you some lines from an Elzevir Horace, and -showed you how I had made a family record out of the work by inserting a -number of blank leaves at the end? Now, as you know, I devised my library -to the Rev. ---- ----. I was a d----d fool for giving him books which he -will never read! Get the Horace, and you will discover the exact hour at -which J---- was born." In the morning all the particulars of this dream -were fresh in my friend's memory. The reverend gentleman lived in a -neighboring city; my friend took the first train, found the copy of -Horace, and at the end the pages constituting the family record, exactly -as had been described to him in the dream. By no effort of his memory, -however, could he recollect the incidents of the fishing excursion. - -Dr. Macnish,[73] in stating his opinion that dreams are uniformly the -resuscitation or re-embodiment of thoughts which have formerly, in some -shape or other, occupied the mind, relates the following example from his -own experience: - -"I lately dreamed that I walked upon the banks of the great canal in the -neighborhood of Glasgow. On the side opposite to that on which I was, and -within a few feet of the water, stood the splendid portico of the Royal -Exchange. A gentleman whom I knew was standing upon one of the steps, and -we spoke to each other. I then lifted a large stone and poised it in my -hand, when he said that he was certain I could not throw it to a certain -spot, which he pointed out. I made the attempt, and fell short of the -mark. At this moment a well-known friend came up, whom I knew to excel at -_putting_ the stone; but, strange to say, he had lost both his legs, and -walked upon wooden substitutes. This struck me as exceedingly curious, for -my impression was that he had only lost one leg, and had but a single -wooden one. At my desire he took up the stone, and, without difficulty, -threw it beyond the point indicated by the gentleman upon the opposite -side of the canal. The absurdity of this dream is extremely glaring, and -yet, on strictly analyzing it, I find it to be wholly composed of ideas -which passed through my mind on the previous day, assuming a new and -ridiculous arrangement. I can compare it to nothing but to cross reading -in the newspapers, or to that well-known amusement which consists in -putting a number of sentences, each written on a separate piece of paper, -into a hat, shaking the whole, then taking them out, one by one, as they -come, and seeing what kind of medley the heterogeneous compound will make -when thus fortuitously put together. For instance, I had, on the above -day, taken a walk to the canal along with a friend. On returning from it, -I pointed out to him a spot where a new road was forming, and where, a few -days before, one of the workmen had been overwhelmed by a quantity of -rubbish falling upon him, which fairly chopped off one of his legs, and so -much damaged the other that it was feared amputation would be necessary. -Near this very spot there is a park, in which, about a month previously, I -practiced throwing the stone. On passing the Exchange, on my way home, I -expressed regret at the lowness of its situation, and remarked what a fine -effect the portico would have were it placed upon more elevated ground. -Such were the previous circumstances, and let us see how they bear upon -the dream. In the first place, the canal appeared before me. 2. Its -situation is an elevated one. 3. The portico of the Exchange occurring to -my mind as being placed too low became associated with the elevation of -the canal, and I placed it close by on a similar altitude. 4. The -gentleman I had been walking with was the same whom in the dream I saw -standing upon the steps of the portico. 5. Having related to him the story -of the man who lost one limb and had a chance of losing another, this idea -brings before me a friend with a pair of wooden legs, who, moreover, -appears in connection with patting the stone, as I knew him to excel at -that exercise. There is only one other element in the dream which the -preceding events will not account for, and that is the surprise at the -individual referred to having more than one wooden leg. But why should he -have even one, seeing that in reality he is limbed like other people? This -also I can account for. Two years ago he slightly injured his knee while -leaping a ditch, and I remember jocularly advising him to get it cut off. -I am particular in illustrating this point with regard to dreams, for I -hold that if it were possible to analyze them all, they would invariably -be found to stand in the same relation to the waking state as the above -specimen. The more diversified and incongruous the character of a dream, -and the more remote from the period of its occurrence the circumstances -which suggested it, the more difficult does its analysis become; and, in -point of fact, this process may be impossible, so totally are the elements -of the dream often dissevered from their original sense, and so -ludicrously huddled together." - -A dream which Professor Maas,[74] of Halle, relates as having occurred to -himself, affords an excellent example of the dependence of dreams upon -actual events, and shows how these latter are distorted and perverted by -the imagination of the sleeper. - -"I dreamed once," he says, "that the Pope visited me. He commanded me to -open my desk, and he carefully examined all the papers it contained. While -he was thus employed, a very sparkling diamond fell out of his triple -crown into my desk, of which, however, neither of us took any notice. As -soon as the Pope had withdrawn I retired to bed, but was soon obliged to -rise on account of a thick smoke, the cause of which I had yet to learn. -Upon examination I discovered that the diamond had set fire to the papers -in my desk, and burned them to ashes." - -In analyzing the circumstances which gave rise to this dream, Professor -Maas relates the following events, which constituted its basis: - -"On the preceding evening I was visited by a friend with whom I had a -lively conversation upon Joseph II.'s suppression of monasteries and -convents. With this idea, though I did not become conscious of it in the -dream, was associated the visit which the Pope publicly paid the Emperor -Joseph, at Vienna, in consequence of the measures taken against the -clergy; and with this again was combined, however faintly, the -representation of the visit which had been paid me by my friend. These two -events were, by the subreasoning faculty, compounded into one, according -to the established rule--that things which agree in their parts also -correspond as to the whole; hence the Pope's visit was changed into a -visit paid to me. The subreasoning faculty, then, in order to account for -this extraordinary visit, fixed upon that which was the most important -object in my room--namely, the desk, or rather the papers which it -contained. That a diamond fell out of the triple crown was a collateral -association, which was owing merely to the representation of the desk. -Some days before, when opening the desk, I had broken the crystal of my -watch, which I held in my hand, and the fragments fell among the papers; -hence no further attention was paid to the diamond being a representation -of a collateral series of things. But afterwards the representation of the -sparkling stone was again excited, and became the prevailing idea; hence -it determined the succeeding association. On account of its similarity it -excited the representation of fire, with which it was confounded; hence -arose fire and smoke. But in the event the writings only were burned, not -the desk itself, to which, being of comparatively little value, the -attention was not directed." - -Feuchtersleben[75] takes the same view of dreaming as that enunciated in -this chapter. Thus he says: - -"Dreaming is nothing more than the occupation of the mind in sleep with -the pictorial world of fancy. As the closed or quiescent senses afford it -no materials, the mind, ever active, must make use of the store which -memory retains; but as its motor influence is likewise organically -impeded, it cannot independently dispose of this store. Thus arises a -condition in which the mind looks, as it were, on the play of the images -within itself, and manifests only a faint or partial reaction." - -Locke[76] contends that "the dreams of a sleeping man are all made up of -the waking man's ideas oddly put together." - -Observation and reflection show us that the mind originates nothing during -sleep; it merely remembers--and often in the most chaotic manner--the -thoughts, the fancies, the impressions which have been imagined or -received by the individual when awake. Sometimes ideas are reproduced in -dreams exactly as they have occurred to us in our waking moments, and this -may take place night after night with scarcely the alteration of a single -circumstance. A friend informs me that he is very subject to dreams of -this character, and that on some occasions the repetition has taken place -as many as a dozen times. - -A very striking instance of this kind occurred to me a few years since, -and made a deep impression on my mind. I had just read Schiller's ode to -Laura, as translated by Sir E. Bulwer Lytton, beginning, - - "Who and what gave to me the wish to woo thee?" - -and admired it as a striking piece of versification conveying some noted -philosophical ideas in a forcible and beautiful manner. The following -night I had a very vivid dream of a condition of pre-existence, in which I -imagined myself to be. The connection between the dream and the poem I had -been reading was sufficiently well marked, and did not astonish me. I was, -however, surprised to find that the next night I had exactly the same -dream, and that it was repeated three times subsequently on consecutive -nights. - -The dependence of dreams upon ideas which we have had when awake was well -known to the ancients. Thus Lucius Accius,[77] a poet who lived more than -a hundred and fifty years before the Christian era, says: - - "Quae in vita usurpant homines, cogitant, curant, vident - Quaeque agunt vigilantes, agitantque casi cui in somno accidant, - * * * * * * Minus mirum est." - -Lucretius[78] declares that during sleep we are amused with things which -have made us weep when awake; that circumstances which have pleased us are -recalled to our minds; that objects are presented to us which occupied our -thoughts long before; and that recent events appear still more vividly -before us. - -Petronius Arbiter[79] cites Epicurus to the same effect. Tryphæna having -declared that she had had a dream in which there appeared to her the image -of Neptune she had seen at Baiæ, "Hence you may perceive," observed -Eumolpus, "what a divine man is Epicurus, who so ingeniously ridiculed -these sports of fancy. - - "When in a dream presented to our view - Those airy forms appear so like the true, - No prescient shrine, no god the vision sends, - But every breast its own delusion lends. - For when soft sleep the body wraps in ease, - And from the inactive mass the fancy frees, - What most by day affects, at night returns; - Thus he who shakes proud states, and cities burns, - Sees showers of darts, forced lines, disordered wings, - Blood-reeking fields, and deaths of vanquished kings; - He that by day litigious knots untied, - And charmed the drowsy bench to either side, - By night a crowd of cringing clients sees, - Smiles on the fools and kindly takes their fees; - The miser hides his wealth, new treasure finds; - Through echoing woods his horn the huntsman winds; - The sailor's dream wild scenes of wreck describes; - The wanton lays her snares; the adultress bribes; - Hounds in full cry, in sleep, the hare pursue; - And hapless wretches their old griefs renew."[80] - -It is related of an ancient tyrant that one of his courtiers described to -him a dream in which the courtier had assassinated his master. "You could -not," exclaimed the tyrant, "have dreamed this without having previously -thought of it," and then ordered his immediate execution. - -Now besides this foundation of dreams upon circumstances which have -transpired during our waking moments, they may arise, as has already been -intimated, from impressions made upon the mind during sleep. Sensations -may be so intense as to be partially appreciated by the brain, and yet not -strong enough to cause sleep to be interrupted. In such cases the -imagination seizes the imperfect perception and weaves it into a tissue of -incongruous fancies, which, however, generally bear a more or less -definite relation to the character of the sensorial impression. Many -examples of dreams thus produced are on record, and many others have come -under my own observation. The interest which attaches to phenomena of this -character must be my excuse for quoting some of the more remarkable -instances of this kind which have been brought to my attention. - -The following are related by Abercrombie:[81] - -During the alarm excited in Edinburgh by the apprehension of a French -invasion almost every man was a soldier, and all things had been arranged -in expectation of the landing of the enemy. The first notice was to be -given by the firing of a gun from the Castle, and this was to be followed -by a chain of signals calculated to arouse the country. The gentleman to -whom the dream occurred was a zealous volunteer, and, being in bed between -two and three o'clock in the morning, dreamt of hearing the signal gun. He -imagined that he went at once to the Castle, witnessed the proceeding for -displaying the signals, and saw and heard all the preparations for the -assemblage of the troops. At this time he was roused by his wife, who -awoke in a fright, in consequence of a similar dream. The origin of both -dreams was ascertained in the morning to be the noise produced by the -falling of a pair of tongs in the room above. - -A gentleman dreamt that he had enlisted as a soldier, joined his regiment, -deserted, was apprehended, carried back, condemned to be shot, and at last -led out to execution. At this instant a gun was fired, and he awoke, to -find that a noise in the adjoining room had both produced the dream and -awakened him. - -The next is a very extraordinary case. - -The subject was an officer in the expedition to Louisburg, in 1758. During -his passage in the transport his companions were in the habit of amusing -themselves at his expense. They could produce in him any kind of dream by -whispering in his ear, especially if this was done by a friend with whose -voice he was familiar. Once they conducted him through the whole process -of a quarrel which ended in a duel, and when the parties were supposed to -have met a pistol was put into his hand, which he fired, and was awakened -by the report. On another occasion they found him asleep on the top of a -locker in the cabin, when they made him believe he had fallen overboard, -and exhorted him to save himself by swimming. Then they told him that a -shark was pursuing him, and entreated him to dive for his life. He -instantly did so, and with so much force as to throw himself from the -locker upon the cabin floor, by which he was much bruised, and awakened of -course. After the landing of the army at Louisburg, his friends found him -one day asleep in his tent, and evidently much annoyed by the cannonading. -They then made him believe that he was engaged, when he exhibited great -fear, and showed a decided disposition to run away. Against this they -remonstrated, but at the same time increased his fears by imitating the -groans of the wounded and the dying; and when he asked, as he often did, -who was hit, they named his particular friends. At last they told him that -the man next himself in his company had fallen, when he instantly sprang -from his bed, rushed out of his tent, and was roused from his danger and -his dream by falling over the tent-cords. - -A friend informs me that he has a brother who will carry on a conversation -with any person who whispers to him in his sleep, and that his emotions -are then very readily excited by any pitiful story that may be told him. -Upon awaking, he has a distinct recollection of his dreams, which are -always connected with the ideas communicated. - -I recollect very distinctly the particulars of a dream which I had several -years since, and which was due to an impression conveyed to the brain -through the ear. The dream also illustrates the point previously brought -forward, that a definite conception of time does not enter into the -phenomena of dreams. - -I dreamed that I had taken passage in a steamboat from St. Louis to New -Orleans. Among the passengers was a man who had all the appearance of -being very ill with consumption. He looked more like a ghost than a human -being, and moved noiselessly among the passengers, noticing no one, though -attracting the attention of all. For several days nothing was said between -him and any one, till one morning, as we approached Baton Rouge, he came -to where I was sitting on the guards and began a conversation by asking me -what time it was. I took out my watch, when he instantly took it from my -hand and opened it. "I, too, once had a watch," he said; "but see what I -am now." With these words he threw aside the large cloak he habitually -wore, and I saw that his ribs were entirely bare of skin and flesh. He -then took my watch, and, inserting it between his ribs, said it would make -a very good heart. Continuing his conversation he told me that he had -resolved to blow up the vessel the next day, but that as I had been the -means of supplying him with a heart he would save my life. "When you hear -the whistle blow," he said, "jump overboard, for in an instant afterward -the boat will be in atoms." I thanked him, and he left me. All that day -and the next I endeavored to acquaint my fellow-passengers with the fate -in store for them, but discovered that I had lost the faculty of speech. I -tried to write, but found that my hands were paralyzed. In fact I could -adopt no means to warn them. While I was making these ineffectual efforts, -I heard the whistle of the engine; I rushed to the side of the boat to -plunge overboard, and awoke. The whistle of a steam saw-mill near my house -had just begun to sound, and had awakened me. My whole dream had been -excited by it, and could not have occupied more than a few seconds. - -The following account[82] shows how a dream may be set in action by the -sense of smell. - -"On one occasion during my residence at Birmingham I had to attend many -patients at Coventry, and for their accommodation I visited that place one -day in every week. My temporary residence was at a druggist's shop in the -market-place. Having on one occasion, now to be mentioned, a more than -usual number of engagements, I was obliged to remain one night, and a bed -was provided for me at the residence of a cheesemonger in the same -locality. The house was very old, the rooms very low, and the street very -narrow. It was summer-time, and during the day the cheesemaker had -unpacked a box or barrel of strong old American cheese; the very street -was impregnated with the odor. At night, jaded with my professional -labors, I went to my dormitory, which seemed filled with a strong, cheesy -atmosphere, which affected my stomach greatly, and quite disturbed the -biliary secretions. I tried to produce a more agreeable atmosphere to my -olfactory sense by smoking cigars, but did not succeed. At length, worn -out with fatigue, I tried to sleep, and should have succeeded, but for a -time another source of annoyance prevented me doing so; for in an old wall -behind my head, against which my ancient bed stood, there were numerous -rats gnawing away in real earnest. The crunching they made was indeed -terrific, and I resisted the drowsy god from a dread that these voracious -animals would make a forcible entrance, and might take personal liberties -with my flesh. - -"But at length 'tired nature' ultimately so overpowered me that I slept in -a sort of fever. I was still breathing the cheesy atmosphere, and this, -associated with the marauding rats, so powerfully affected my imagination -that a most horrid dream was the consequence. I fancied myself in some -barbarous country, where, being charged with a political offense, I was -doomed to be incarcerated in a large cheese. And although this curious -prison-house seemed most oppressive, it formed but part of my sufferings; -for scarcely had I become reconciled to my probable fate than to my horror -an army of rats attacked the monster cheese, and soon they seemed to have -effected an entrance, and began to fix themselves in numbers upon my naked -body. The agony I endured was increased by the seeming impossibility to -drive them away, and, fortunately for my sanity, I awoke, but with a hot -head and throbbing temples, and a sense of nausea from the extremely -strong odor of the cheese." - -I have on two occasions that I recollect had dreams which were due to -odors. On one of them the smell of gas escaping in the room excited the -dream of a chemical laboratory; on the other the smell of burning cloth -caused me to dream of a laundry, and of one of the women ironing a -blanket, which she scorched with a hot iron. A lady informs me that a -similar odor produced in her a dream of the house being on fire and the -impossibility of her escaping by reason of all her clothes being burned -up. - -Dreams are very readily excited through impressions made on the special -nerves of sensation. Instances are given of persons sleeping with bottles -of hot water applied to their feet dreaming of walking on burning lava, or -some other hot substance. A patient related to me the particulars of a -dream which occurred to him while he was asleep with a vessel of hot water -applied to the soles of his feet. He had, just before going to sleep, -read in the evening paper an account of the capture of an English -gentleman by Italian brigands. He dreamt that while crossing the Rocky -Mountains he had been attacked by two Mexicans, who, after a long fight, -had succeeded in taking him alive. They conveyed him very hurriedly to -their camp, which was situated in a deep gorge. Here they told him that -unless he revealed to them the means of making gold from copper they would -submit him to torture. In vain he plead ignorance of any such process. -Pulling off his boots and stockings they held his naked feet to the fire -till he shrieked with agony, and awoke to find that the blanket which was -wrapped around the tin vessel containing the hot water had become -disarranged, and that his feet were in direct contact with the hot metal. - -In another case, that of a lady whose lower limbs were paralyzed, -artificial heat was applied during the night to her feet. Frequently her -dreams had reference to this circumstance. On one occasion she dreamed -that she was transformed into a bear, and was being taught to dance by -being made to stand on hot plates of iron. On another, that the house was -on fire, and that the floors were so hot as to burn her feet in her -efforts to escape. Again, that she was wading through a stream of water -which came from a hot spring in the Central Park. - -Another patient, a lady, subject to neuralgic attacks of great severity, -frequently had the lancinating pains give rise to dreams in which she was -stabbed with daggers, cut with knives, torn with pincers, etc. - -Not long since I had an attack of erysipelas, in which the disease -included the head and face. The pain was not severe, and yet it was -sufficient to give rise to the following dream: - -I dreamed that I was taking a cold bath, and that while thus engaged a -Turk, armed with a pair of long pincers, came into the room and began to -pull the hair out of my head. I remonstrated, but was unable to offer any -material resistance, for the reason that the water in which I was lying -suddenly froze, leaving me imbedded in a solid cake of ice. In order to -facilitate his operations, the Turk sponged my head with boiling water, -and then, finding the use of the pincers rather slow work, shaved the hair -off with a red-hot razor. He then rubbed an ointment on the naked scalp, -composed of sulphur, phosphorus, and turpentine, to which he immediately -applied fire. Taking me in his arms he rushed down stairs into the street, -lighting his way with the flame from my burning head. He had not gone far -before he fell down in a fit, and in his struggles gave me a severe blow -between the eyes which instantly deprived me of sight. - -When I awoke in the morning I had a very distinct recollection of this -dream. The incidents were in part due to the fact that I had, two or three -days previously, been reading an account of the insanity of Mohammed, and -of his being subject to attacks of epilepsy. - -The sense of taste is not, for obvious reasons, so productive of dreams as -the other senses, but the experiments of M. Maury and myself, to which -fuller reference will presently be made, show that strong excitations made -upon it are transmitted to the brain; and the following instance, which -has recently come under my immediate observation, is an interesting case -in point. - -A young lady had, in her early childhood, contracted the habit of going to -sleep with her thumb in her mouth. She had tried for several years to -break herself of the practice, but all her attempts were in vain, for even -when by strong mental effort she succeeded in getting to sleep without the -usual accompaniment, it was not long before the unruly member was in its -accustomed place. Finally she hit upon the plan of covering the offending -thumb with extract of aloes just before she went to bed, hoping that if -she put it into her mouth she would instantly awake. But she slept on -through the night, and in the morning found her thumb in her mouth and all -the extract of aloes sucked off. During the night, however, she dreamed -that she was crossing the ocean in a steamer made of wormwood, and that -the vessel was furnished throughout with the same material. The plates, -the dishes, tumblers, chairs, tables, etc. were all of wormwood, and the -emanations so pervaded all parts of the ship that it was impossible to -breathe without tasting the bitterness. Everything that she ate or drank -was likewise, from being in contact with wormwood, so impregnated with the -flavor that the taste was overpowering. When she arrived at Havre she -asked for a glass of water for the purpose of washing the taste from her -mouth, but they brought her an infusion of wormwood, which she gulped down -because she was thirsty, though the sight of it excited nausea. She went -to Paris and consulted a famous physician, M. Sauve Moi, begging him to do -something which would extract the wormwood from her body. He told her -there was but one remedy, and that was ox gall. This he gave her by the -pound, and in a few weeks the wormwood was all gone, but the ox gall had -taken its place, and was fully as bitter and disagreeable. To get rid of -the ox gall she was advised to take counsel of the Pope. She accordingly -went to Rome, and obtained an audience of the Holy Father. He told her -that she must make a pilgrimage to the plain where the pillar of salt -stood, into which Lot's wife was transformed, and must eat a piece of the -salt as big as her thumb. During her journey in search of the pillar of -salt she endured a great many sufferings, but finally triumphed over all -obstacles, and reached the object of her journey. What part to take was -now the question. After a good deal of deliberation she reasoned that as -she had a bad habit of sucking her thumb, it would be very philosophical -to break off this part from the statue, and thus not only get cured of -the bitterness in her mouth, but also of her failing. She did so, put the -piece of salt into her mouth, and awoke to find that she was sucking her -own thumb. - -It might be supposed that the brain during sleep is not excitable through -the sense of sight. Many examples, however, are on record of dreams being -thus produced, and several very interesting cases have come under my own -observation. Among them are the following: - -A gentleman of a nervous and irritable disposition informed me that he had -dreamed of being in heaven and being dazzled by the brilliancy of -everything around him. So great was the light that he hastened to escape -from the pain which it caused in his eyes. In the efforts which he made he -struck his head against the bedpost, and awoke to find that the fire which -he had left smouldering on the hearth had kindled into a bright flame, the -light from which fell full in his face. - -Another, who had been under my care for epilepsy, dreamed that his room -was entered by burglars, and that with lighted candles in their hands they -were searching his drawers and trunks. He related his dream the following -morning, and was told by his mother that she had gone into his room the -previous night, and had held a lighted candle close to his face in order -to see whether or not he was sound asleep. - -No one has more philosophically studied the mode of production of dreams -than M. Maury[83] in his remarkable work to which reference has already -been made. I propose, therefore, to place a brief outline of his -experiments and views before the reader. - -Just before falling asleep, and immediately before becoming fully awake, -many persons are subject to hallucinations partaking of many of the -characteristics belonging to dreams. To them the name of hypnagogic -([Greek: hypnos], _sleep_, and [Greek: agôgeus], _leader_) hallucinations -has been given, _i.e._ hallucinations which lead to sleep. Previous to M. -Maury's investigations, the phenomena in question had attracted some -attention from German and French physiologists, but M. Maury's -investigations, many of which were performed upon himself, throw more -light upon the subject than it has hitherto received. - -According to M. Maury, the persons who most frequently experience these -hypnagogic hallucinations are those who are of an excitable constitution, -and are generally predisposed to hypertrophy of the heart, pericarditis, -and cerebral affections. This may be true, but in two most remarkable -instances which have come under my observation, the type of organization -was the very reverse of this. - -In M. Maury's own case he finds that the hallucinations are more numerous -and more vivid when he experiences, as is frequent with him, a disposition -to cerebral congestion. Thus, when he has headache, nervous pains in the -eyes, the ears, and the nose, and vertigo, the hallucinations make their -appearance as soon as he closes his eyelids. Loss of sleep and severe -intellectual exertions invariably produce them, as do also _cafe noir_ and -champagne, which, by causing headache and insomnia, strongly predispose -him to the hypnagogic hallucinations. On the contrary, calmness of mind, -rest, and country air lessen his liability to them. From the inquiries -made of others by M. Maury, the results of his own experience, as well as -from my own observations, I am well convinced that the hypnagogic -hallucinations are directly the result of an increase in the amount of -blood circulating through the brain rather than to actual congestion as he -supposes. They therefore indicate the existence of a condition unfavorable -to sound sleep. In the chapter devoted to the consideration of wakefulness -the phenomena accompanying cerebral hyperæmia will be more fully -considered. - -The theory which M. Maury proposes in order to account for the existence -of hypnagogic hallucinations further presupposes that as the power of the -attention immediately before sleep begins to be diminished, and the mind -cannot therefore voluntarily and logically arrange its thoughts, it -abandons itself to the imagination, and that thus fancies arise and -disappear unchecked by the other mental faculties. This absence of the -attention need not be of long duration, a second, or even a shorter period -being sufficient. Thus he lay down, and the attention which had been -fully aroused soon became weakened; images appeared, and these partially -reawakened the attention, and the current of his thoughts was resumed, to -be replaced again by hallucinations, and this continued till he was fully -asleep. As an example, he states that on the 30th of November, 1847, he -was reading aloud the _Voyage dans la Russie Méridionale_, by M. Hommaire -de Hell. He had just finished a line when he closed his eyes -instinctively. In this short instant of sleep he saw hypnagogically, but -with the rapidity of light, the figure of a man clothed in a brown robe, -and with a hood on his head like a monk. The appearance of this image -reminded him that he had shut his eyes and ceased reading. He immediately -opened his eyelids and resumed his book. The interruption was practically -nothing, for the person to whom he was reading did not perceive it. - -M. Maury gives numerous examples of these hypnagogic hallucinations, all -tending to show that they are induced by a congested condition of the -cerebral vessels, and that thus, according to the views I have set forth -relative to the condition of the brain in sleep, they are not to be -regarded as precursors of that state, but of stupor. - -In two very interesting cases of these hallucinations, which have come -under my notice, they were brought about by any cause which increased the -quantity of blood in the brain, or retarded the flow of blood from this -organ. Thus, a glass of champagne, or a few drops of laudanum, would -induce them, as also would the recumbent posture, with the head rather -low. - -As showing how readily dreams can be excited by impressions made upon the -senses, M. Maury caused a series of experiments to be performed upon -himself when asleep, which afforded very satisfactory results, and which -are interesting in connection with the points already discussed in the -present chapter. - -1st Experiment. He caused himself to be tickled with a feather on the lips -and inside of the nostrils. He dreamed that he was subjected to a horrible -punishment. A mask of pitch was applied to his face, and then torn roughly -off, taking with it the skin of his lips, nose, and face. - -2d Experiment. A pair of tweezers was held at a little distance from his -ear, and struck with a pair of scissors. He dreamed that he heard the -ringing of bells; this was soon converted into the tocsin, and this -suggested the days of June, 1848. - -3d Experiment. A bottle of eau de Cologne was held to his nose. He dreamed -that he was in a perfumer's shop. This excited visions of the East, and he -dreamed that he was in Cairo in the shop of Jean Marie Farina. Many -surprising adventures occurred to him there, the details of which were -forgotten. - -4th Experiment. A burning lucifer match was held close to his nostrils. He -dreamed that he was at sea (the wind was blowing in through the windows), -and that the magazine of the vessel blew up. - -5th Experiment. He was slightly pinched on the nape of the neck. He -dreamed that a blister was applied, and this recalled the recollection of -a physician who had treated him in his infancy. - -6th Experiment. A piece of red-hot iron was held close enough to him to -communicate a slight sensation of heat. He dreamed that robbers had got -into the house, and were forcing the inmates, by putting their feet to the -fire, to reveal where their money was. The idea of the robber suggested -that of the Duchess d'Abrantes, who he supposed had taken him for her -secretary, and in whose memoirs he had read some account of bandits. - -7th Experiment. The word _parafagaramus_ was pronounced in his ear. He -understood nothing, and awoke with the recollection of a very vague dream. -The word _maman_ was next used many times. He dreamed of different -subjects, but heard a sound like the humming of bees. Several days after, -the experiment was repeated with the words _Azor_, _Castor_, _Léonore_. On -awaking, he recollected that he had heard the last two words, and had -attributed them to one of the persons who had conversed with him in his -dream. - -Another experiment of the same kind showed like the others that it was the -sound of the word and not the idea it conveyed which was perceived by the -brain. Then the words _chandelle_, _haridelle_, were pronounced many times -in rapid succession in his ear. He awoke suddenly, saying to himself, -_c'est elle_. It was impossible for him to recall what idea he had -attached to this dream. - -8th Experiment. A drop of water was allowed to fall on his forehead. He -dreamed that he was in Italy, that he was very warm, and that he was -drinking the wine of Orvieto. - -9th Experiment. A light, surrounded with a piece of red paper, was -repeatedly placed before his eyes. He dreamed of a tempest and lightning, -which suggested the remembrance of a storm he had encountered in the -English Channel in going from Merlaix to Havre. - -These observations are very instructive. They show conclusively that one -very important class of our dreams is due to our bodily sensations. I have -frequently performed analogous experiments on others, and had them -practiced on myself, and have rarely failed in obtaining decided results. -They strongly inculcate the truth of the conclusions arrived at in the -foregoing chapter, and they serve as important data in enabling us to -understand the division of the subject next to be considered. - -In regard to the immediate cause of dreams the opinions of authors are -very diverse. The older writers ascribe them to the rise of vapors from -the stomach, to the visitation of demons, and other fanciful causes. -Bishop Bull[84] declares that he knows from his own experience that -dreams are to be ascribed "to the ministry of those invisible instruments -of God's providence that guide and govern our affairs and concerns, viz., -the angels of God;" and Bishop Ken held a similar view. - -It would neither be possible nor profitable to refer at greater length to -views which positive physiology has overturned. Observation and experiment -have aided us greatly in arriving at definite conclusions on this subject, -and the instances quoted on page 30 of this treatise, even if standing -alone uncontradicted, would go far toward guiding us in the right path. On -page 37 I have referred to the case of a man who, some time after -receiving a severe injury of the head by which a considerable portion of -the skull was lost, came under my professional care. Standing by his -bedside one evening, just after he had gone to sleep, I observed the scalp -slightly rise from the chasm in which it was deeply depressed. I was sure -he was going to awake, but he did not, and very soon he became restless -and agitated, while continuing to sleep. Presently he began to talk, and -it was evident that he was dreaming. In a few minutes the scalp sank down -to its ordinary level when he was asleep, and he became quiet. I called -his wife's attention to the circumstance, and desired her to observe this -condition thereafter when he slept. She subsequently informed me that she -could always tell when he was dreaming from the appearance of the scalp. - -My opinion, therefore, is that dreams are directly caused by an increased -activity of the cerebral circulation over that which exists in profound -sleep. This activity is probably sometimes local and at others general, -and never equals that which prevails in the condition of wakefulness, when -the functions of the brain are at their maximum of energy. This view is -further supported by a consideration of the state of the brain in sleep -and wakefulness, the condition of dreaming being, in a measure, an -intermediate one. Illustrations of the effects produced by a notable -increase in the quantity of blood circulating through the brain will be -given in the chapter on wakefulness. All of these, it will be perceived, -have a direct bearing on the question now under consideration. - - - - -CHAPTER VI. - -MORBID DREAMS. - - -Morbid or pathological dreams are divided by Macario[85] into three -classes: the prodromic, or those which precede diseases; the symptomatic, -or those which occur in the course of diseases; and the essential, or -those which constitute the main features of diseases. As this -classification is natural and simple, I propose to follow it in the -remarks I shall have to make on the subject. - -PRODROMIC DREAMS.--There appears to be no doubt that diseases are -sometimes preceded by dreams which indicate with more or less exactitude -the character of the approaching morbid condition. Many instances of the -kind which have been reported--especially by the earlier authors--are, -however, in all probability merely coincidences; and in others the -relation between the character of the dream and that of the disease is by -no means clear. - -Many cases of dreams indicating the nature of a malady which had not yet -developed itself are referred to by Macario.[86] The instance of Galen's -patient, who dreamed that his leg had become converted into stone, and who -was soon afterward paralyzed in that member, has already been cited. - -The learned Conrad Gesner dreamed that he was bitten in the left side by a -venomous serpent. In a short time a severe carbuncle appeared on the -identical spot, and death ensued in five days. - -M. Teste, formerly minister of justice and then of public works under -Louis Philippe, and who finally died in the Conciergerie, dreamed three -days before his death that he had had an attack of apoplexy. Three days -afterward he died suddenly of that disease. - -A young woman saw in a dream objects apparently confused and dim as -through a thin cloud, and was immediately thereafter attacked with -amblyopia, and threatened with loss of sight. - -A woman, who had been under the care of M. Macario, dreamed at about the -period of her menstrual flow that she spoke to a man who could not answer -her, for the reason that he was dumb. On awaking she discovered that she -had lost her voice. - -Macario himself dreamed one night that he had a severe pain in his throat. -On awaking he felt very well; but a few hours subsequently was attacked -with severe tonsillitis. - -Arnold, of Villanova, dreamed that a black cat bit him in the side. The -next day a carbuncle appeared on the part bitten. - -Dr. Forbes Winslow[87] gives several similar instances. A patient had, for -several weeks before an attack of apoplexy, a series of frightful dreams, -in one of which he imagined he was being scalped by Indians. Others dreamt -of falling down precipices, and of being torn to pieces by wild beasts. -One gentleman dreamed that his house was in flames, and that he was -gradually being consumed to a cinder. This occurred a few days before an -attack of inflammation of the brain. A person, prior to an attack of -epilepsy, dreamt that he was severely lacerated by a tiger; and another, -just before a seizure, dreamt that he was attacked by murderers, and that -they were knocking out his brains with a hammer. - -A barrister, for several years before an attack of cerebral paralysis, was -in the habit of awaking from sleep in a condition of great alarm and -terror without being able to explain the reason for his apprehension. Dr. -Beddoes attended a patient whose first fit succeeded a dream of being -crushed by an avalanche. - -Gratiolet[88] cites additional examples. Thus, Roger d'Oxteryn, Knight of -the Company of Douglas, went to bed in good health. Toward the middle of -the night, he saw in a dream a man affected with the plague and entirely -naked, who attacked him with fury, threw him to the ground after a severe -contest, and, holding him between his thighs, vomited into his mouth. -Three days afterward he was seized with the plague and died. He also -alludes to a case detailed by Gunther, in which a woman dreamt that she -was being flogged with a whip, and on awaking found that she had marks on -her body resembling the scars made by the lash. - -The existence of diseases of the heart and larger vessels is often -revealed by frightful dreams when there is no other evidence of their -presence. Macario states that a young lady was under his care in whom -violent palpitations of the heart were preceded by painful dreams. She -subsequently died of disease of the heart. - -Moreau (de la Sarthe),[89] in a very elaborate treatise on dreams, relates -the case of a French nobleman, whom he had attended during several months -for threatened chronic pericarditis, and who was at first tormented every -night by painful and frightful dreams. These dreams, attracting attention, -gave the earliest indication of the real condition, and excited fears as -to the result, which were soon verified. - -He cites another case in illustration of the fact that periodical -hemorrhages are sometimes preceded by morbid dreams. A physician had, in -his youth, been subject to periodical hemorrhages, but without dreams or -other trouble during sleep. As he advanced in years, the hemorrhages were -not so frequent, but were always preceded by a condition of general -irritation, characterized during wakefulness by heat of skin and frequency -of the pulse, and during sleep by painful dreams. These dreams almost -always related to violent actions, such as giving and receiving heavy -blows, walking on a volcano, or being precipitated into lakes of fire. - -Many cases of insanity being preceded by frightful dreams are on record. -Falret,[90] in calling attention to the remarkable analogy which exists -between mental alienation and dreams, says that it is an incontestable -fact that insanity is often preceded by significant dreams, and that these -constitute the whole essence of the disorder by becoming firmly fixed in -the patient's mind. Thus, he relates that Odier of Geneva was consulted in -1778 by a lady, who, during the night preceding the outbreak of her -insanity, dreamed that her step-mother approached her with a dagger in -order to kill her. This dream made so strong an impression upon her that -she ultimately accredited it as true, and thus became the victim of a -delusion which rendered her a lunatic. He declares that numerous similar -instances have come under his observation, and refers to the case of a -young lady, subject to periodical attacks of mental derangement, whose -paroxysms are always preceded by notable dreams. - -Morel[91] affirms that many patients before becoming completely insane -have frightful dreams, which they regard as evidences that they are about -to lose their reason. Sometimes they are afraid to go to sleep on account -of the terrifying apparitions which then visit them. - -The following cases, related by Dr. Forbes Winslow,[92] are interesting in -this connection: - -"A gentleman, who had previously manifested no appreciable symptoms of -mental disorder, or even of disturbed and anxious thought, retired to bed -apparently in a sane state of mind. Upon arising in the morning, to the -intense terror of his wife, he was found to have lost his senses! He -exhibited his insanity by asserting that he was going to be tried for an -offense which he could not clearly define, and of the nature of which he -had no right conception. He declared that the officers of justice were in -hot pursuit of him,--in fact, he maintained that they were actually in the -house. He begged and implored his wife to protect him. He walked about the -bed-room in a state of great agitation, apprehension, and alarm, stamping -his feet, and wringing his hands in the wildest agony of despair. Upon -inquiring into the history of the case, his wife said that she had not -observed any symptoms that excited her suspicions as to the state of her -husband's mind, but upon being questioned very closely, she admitted that -during the previous night he appeared to have been under the influence of -what she considered to be the nightmare, or a frightful dream. While -apparently asleep he cried out several times, evidently in great distress -of mind, 'Don't come near me!' 'Take them away!' 'Oh, save me; they are -pursuing me!' It is singular that in this case the insanity which was -clearly manifested in the morning appeared like _a continuation of the -same character and train of perturbed thought that existed during his -troubled sleep_ when, according to the wife's account, he was evidently -dreaming." - -Dr. Winslow's second case is equally to the point: "I am indebted to a -medical friend for the particulars of the following case. During the -winter of 1849 he was called to see H. B., about five or six o'clock in -the morning. The patient was the wife of a tailor and mother of three -children. At this time she was rather emaciated and debilitated in bodily -health, and anemic in appearance. She was of a religious turn of mind, and -belonged to the Wesleyan persuasion. On the morning of the narrator's -visit, he found the woman in a state of great mental excitement and under -the influence of hallucinations. She had gone to bed apparently well, but -during the night was the subject of a vivid dream, imagining that she saw -her sister, long since dead and to whom she was much attached, suffering -the pains of hell. When quite awake, no one could persuade her that she -had been under the influence of an agitated dream. She stoutly persisted -in maintaining the reality of her vision. During the whole of that day she -was clearly insane; but on the following morning her mind appeared to have -recovered its balance. She continued tolerably well, mentally, for four -years, with the exception of her occasionally having moments of -despondency arising from real or fancied troubles." * * * - -The further particulars of this case, relating as they do to another -division of the subject,--"sleep-drunkenness," as the Germans designate -it,--will be considered under that head. - -Without pretending to indorse all the conclusions of Albers,--as set forth -in the following summary, and which I quote from a very learned and -philosophical writer,[93]--there is no doubt that some of his dicta are -well founded. - -"Lively dreams are in general a sign of the excitement of nervous action. - -"Soft dreams are a sign of slight irritation of the head; often in nervous -fevers announcing the approach of a favorable crisis. - -"Frightful dreams are a sign of determination of blood to the head. - -"Dreams about fire are in women signs of an impending hemorrhage. - -"Dreams about blood and red objects are signs of inflammatory conditions. - -"Dreams about rain and water are often signs of diseased mucous membranes -and dropsy. - -"Dreams of distorted forms are frequently a sign of abdominal obstructions -and diseases of the liver. - -"Dreams in which the patient sees any part of the body especially -suffering, indicate disease in that part. - -"Dreams about death often precede apoplexy, which is connected with -determination of blood to the head. - -"The nightmare (incubus ephialtes), with great sensitiveness, is a sign of -determination of blood to the chest." - -A very interesting paper on dreaming, by Dr. Thomas More Madden,[94] has -been recently published, and from it I make the following extract: - -"Intermittent fever is often announced, several days before any of the -recognized symptoms set in, by persistent dreams of terrifying character. -I have experienced this in my own person, and heard it confirmed by other -sufferers on the African Coast. The following case of morbid dreaming -ushering in yellow fever, I subjoin in the words of the gentleman to whom -it occurred, himself a medical man holding a high official position on the -Gold Coast where it occurred. - -"'In the early part of 1840, I was an inmate of Cape Coast Castle, and as -some repairs were then being made in the castle, the room assigned to me -was that in which the ill-fated L. E. L. (Mrs. Maclean), the wife of the -governor of Cape Coast, had been found dead, poisoned by prussic acid, not -very long previously. I had known her in London, and had been intimately -acquainted with her history and much interested in it. Her body had been -found on the floor near the door and in front of a window. After a -fatiguing excursion to some of the adjoining British settlements on the -Coast, having retired to rest, I awoke disturbed by a dream of a very -vivid character, in which I imagined that I saw the dead body of the lady -who had died in that chamber lying on the floor before me. On awaking the -image of the corpse kept possession of my imagination. The moon was -shining brightly into the part of the room where the body had been found, -and there, as it seemed to me on awaking, it lay pale and lifeless as it -appeared to me in my dream. - -"'After some minutes I started up, determined to approach the spot where -the body seemed to be. I did so, not without terror, and walking over the -very spot on which the moon was shining, the fact all at once became -evident and obvious that no body was there--that I must have been dreaming -of one. I returned to bed, and had not long fallen asleep when the same -vivid dream recurred; the same waking disturbance occurring while awake. -As long as I lay gazing on the floor I could not dispossess my mind of -that appalling vision; but when I started up and stood erect it vanished -at the first glance. - -"'Again I returned to bed, dozed, dreamt again of poor L. E. L.'s -lamentable end, and of her remains in the same spot; again awoke, and -arose with the same strange results. - -"'There was no more disturbance that night of which, at least, I was -conscious, but when morning came fever was on me in unmistakable force in -its worst form, and partial delirium set in the same night. I was reduced -to the last extremity about the third or fourth night of my illness, when -a conviction seized on my mind that it was absolutely essential to my life -that I should not pass another night in Cape Coast Castle. I caused the -negro servant I had fortunately brought out with me from England to have a -litter prepared for me at dawn, and stretched on this litter, hardly able -to lift hand or foot, I was carried out of my bed by four native soldiers, -and was conveyed to the house of a merchant, and countryman of mine, to -whose care and kindness I owe my life. So much for a visionary precursor -of fever on the west coast of Africa.' - -"In neuralgia, disturbed dreaming is occasionally a prominent symptom. In -an obscure case I was led to make what I believe to be a true diagnosis -from the indications furnished by the patient's dreams. The individual in -question is a man, aged about 45, of an anemic habit, confined by a -sedentary occupation, who, for many years, had suffered from hemicrania, -which lately had become more intense, and the intervals shorter. A couple -of days before the attack his sleep becomes broken by unpleasant dreams, -and when the paroxysm has attained its height, he invariably dreams that -he is the helpless victim of a persecutor, who finishes a series of -torments by driving a stake through his skull. During his recovery from -each attack, he states that his dreams are of a most agreeable character, -though so vague that he cannot give any account of them. The frequent -repetition of his dreams leads me to conclude that there is some osseous -growth within the cranium, and that the vascular distention accompanying -the neuralgic attack occasions pressure upon this, giving rise to the -sensation I have referred to, while the subsequent feeling of comfort -results from that pressure being removed." - -A case has been recently published[95] in which the dream immediately -preceded, or perhaps even accompanied, the morbid action. A German, aged -45, of a nervo-sanguineous temperament, went to bed at 11 P. M., feeling -as well as usual. Between 12 and 1 o'clock he dreamed that he saw his -child lying at his side, dead. He was very much frightened, and at once -awoke, to find that his tongue was paralyzed, and that he could not talk. -The faculty of speech and the ability to move the tongue remained impaired -for four months. - -For several years past I have made inquiries of patients and others -relative to their dreams, and have thus collected a large amount of -material bearing upon the subject. With reference to the point under -consideration, the data in my possession are exceedingly important and -interesting. Among the cases which have come under my observation of -diseases being preceded by morbid dreams, are the following: - -A gentleman, two days before an attack of hemiplegia, dreamed that he was -cut in two exactly down the mesial line, from the chin to the perineum. By -some means union of the divided surfaces was obtained, but he could only -move one side. On awaking, a little numbness existed in the side which he -had dreamed was paralyzed. This soon passed off, and ceased to engage his -attention. The following night he had a somewhat similar dream, and the -next day, toward evening, was seized with the attack which rendered him -hemiplegic. - -Another dreamed one night that a man dressed in black and wearing a black -mask came to him and struck him violently on the leg. He experienced no -pain, however, and the man continued to beat him. In the morning he felt -nothing, with the exception of a slight headache. Nothing unusual was -observed about the leg, and all went on well, until on the fifth day he -had an apoplectic attack, accompanied with hemiplegia, including the leg -which he had in his dream imagined to have been struck. - -A lady, aged forty, who had been a great sufferer from rheumatism for many -years, dreamt one afternoon, while sitting in her chair in front of the -fire, that a boy threw a stone at her, which, striking her on the face, -inflicted a very severe injury. The next day violent inflammation of the -tissues around the facial nerve as it emerges from the stylo mastoid -foramen set in, and paralysis of the nerve followed, due to effusion of -serum, thickening, and consequent pressure. - -A young lady dreamt that she was seized by robbers and compelled to -swallow melted lead. In the morning she felt as well as usual, but toward -the middle of the day was attacked with severe tonsillitis. - -A young man informed me that a day or two before being attacked with acute -meningitis, he had dreamed that he was seized by banditti while traveling -in Spain, and that they had taken his hair out by the roots, causing him -great pain. - -A lady of decided good sense had an epileptic seizure, which was preceded -by a singular dream. She had gone to bed feeling somewhat fatigued with -the labors of the day, which had consisted in attending three or four -morning receptions, winding up with a dinner party. She had scarcely -fallen asleep, when she dreamed that an old man clothed in black -approached her, holding an iron crown of great weight in his hands. As he -came nearer, she perceived that it was her father, who had been dead -several years, but whose features she distinctly recollected. Holding the -crown at arm's length, he said: "My daughter, during my lifetime I was -forced to wear this crown; death relieved me of the burden, but it now -descends to you." Saying which, he placed the crown on her head and -disappeared gradually from her sight. Immediately she felt a great weight -and an intense feeling of constriction in her head. To add to her -distress, she imagined that the rim of the crown was studded on the inside -with sharp points which wounded her forehead, so that the blood streamed -down her face. She awoke with agitation, excited, but felt nothing -uncomfortable. Looking at the clock on the mantle-piece, she found that -she had been in bed exactly thirty-five minutes. She returned to bed and -soon fell asleep, but was again awakened by a similar dream. This time the -apparition reproached her for not being willing to wear the crown. She had -been in bed this last time over three hours before awaking. Again she fell -asleep, and again at broad daylight she was awakened by a like dream. - -She now got up, took a bath, and proceeded to dress herself with her -maid's assistance. Recalling the particulars of her dream, she -recollected that she had heard her father say one day, that in his youth, -while being in England, his native country, he had been subject to -epileptic convulsions consequent on a fall from a tree, and that he had -been cured by having the operation of trephining performed by a -distinguished London surgeon. - -Though by no means superstitious, the dreams made a deep impression upon -her, and her sister, entering the room at the time, she proceeded to -detail them to her. While thus engaged, she suddenly gave a loud scream, -became unconscious, and fell upon the floor in a true epileptic -convulsion. This paroxysm was not a very severe one. It was followed in -about a week by another; and, strange to say, this was preceded as the -other by a dream of her father placing an iron crown on her head and of -pain being thereby produced. Since then several months have elapsed, and -she has had no other attack, owing to the influence of the bromide of -potassium which she continues to take. - -In the case of a gentleman now under my treatment for epilepsy, the fits -are invariably preceded by dreams of difficulties of the head, such as -decapitation, hanging, perforation with an auger, etc. - -A lady, previous to an attack of sciatica, dreamed that she had caught her -foot in a spring-trap, and that before she could be freed it was necessary -to amputate the member. The operation was performed; but as she was -released, a large dog sprang at her and fastened his teeth in her thigh. -She screamed aloud and awoke in her terror. Nothing unusual was perceived -about the leg; but, on getting up in the morning, there was slight pain -along the course of the sciatic nerve, and this before evening was -developed into well-marked sciatica. - -Insanity is frequently preceded by frightful dreams, and I have advanced -several examples to this effect from the experience of others. We should -naturally expect that very often the first manifestations of a diseased -brain should appear during sleep. But dreams are of such a varied -character, and so thoroughly irreconcilable with the normal mental -phenomena of the wakeful state, that it is difficult to say that such or -such a dream is evidence of a diseased mind. As, in some of the cases I -have brought forward, a dream may take so firm a hold of the reason as to -be the exciting cause of insanity, and not simply a sign of its approach, -I am disposed, from my own experience, to regard the frequent repetition -of the same dream as often indicative of a disordered mind, when very -close observation would fail to reveal other evidences. There are, -however, exceptions to this statement, as has been shown in the previous -chapter. - -Several cases, in which insanity was preceded by terrifying dreams, have -come under my observation. In one of them a lady dreamed that she had -committed murder, under circumstances of great atrocity. She cut up the -dead body, but could not, with all her efforts, divide the head, which -resisted her blows, with an axe and other instruments. Finally she filled -the nose, eyes, and mouth with gunpowder, and applied a match. Instead of -exploding, smoke issued slowly from the orifices of the skull, and was -resolved into a human form, which turned out to be that of a police -officer sent to arrest her. She was imprisoned, tried, and sentenced to -execution, by being drowned in a lake of melted sulphur. While the -preparations were being made for the punishment she awoke. She related the -particulars of her dream to several friends, but it apparently made no -great impression on her mind. The next night she dreamed of somewhat -similar circumstances, and for several nights subsequently. On the sixth -day, without any premonition, she attempted to kill herself by plunging a -pair of scissors into her throat, and since that time to her death, which -took place a few months subsequently, was constantly insane. - -In this case there was no direct analogy between the character of her -dream and the type of insanity which ensued. It cannot, therefore, be said -that the dream produced the mental aberration. On the contrary, the dream -was in all probability the first evidence of deranged cerebral action,--a -condition which subsequently became developed into positive insanity. - -The following case is similar to the foregoing in its general features: - -A gentleman who had been unfortunate in some business speculations, -shortly afterward became insane. Previous to this event he was troubled -with frightful dreams, which gave him a great deal of annoyance, and -frequently caused him to awake in terror. One of them occurred several -times, and was of the following character. He dreamed that he was engaged -to be married to a lady of beauty and wealth, and who was, moreover, -possessed of great musical talent. One evening, as he in his dream was -paying her a visit, she placed herself at the piano and began to sing. He -remarked that he did not admire the piece of music she was singing, and -asked her to sing something else. She indignantly refused. Angry words -followed, and in the midst of the dispute she drew a dagger from her bosom -and stabbed herself to the heart. As he rushed forward, horror-struck, to -her assistance, her friends entered the room, and found him with the -dagger in his hand. He was accused of murdering the lady, and, -notwithstanding his protestations of innocence, was tried, found guilty, -and sentenced to be hung. He always awoke at the point when preparations -were being made for his execution. - -A dream may make such a strong impression on the mind as to subsequently -constitute the essential feature of the insane condition. This point has -already been elucidated to some extent in the preceding pages. The -following cases, however, are from my own records of practice. - -A gentleman awoke in the middle of the night, and, calling his wife, told -her he had dreamed that a large fortune had been left him by a miner in -California. He then went to sleep again, but in the morning again repeated -the dream to his wife, and said that "there might be something in it." She -laughed, and remarked that she "hoped it might prove true." About the time -the California steamer was expected, the gentleman was observed to become -very anxious and excited, and was continually talking of his expected -fortune. At last the steamer arrived. He then began asking the postman for -letters from California, went several times a day to the post-office to -make like inquiries, and finally went aboard the steamer and questioned -the officers on the same subject. Then he was sure the letter had -miscarried, and would sit for hours in the most profound melancholy. He -was now recognized by his family as a monomaniac, and strenuous efforts -were made to cure him of his delusion, but they were unsuccessful; and -although now apparently sane on other subjects, he still holds the -erroneous idea which was first given him in his dream of several years -ago. - -A young lady was brought to me in July, 1868, who had been rendered insane -by a dream which took place a few months before I saw her. She went to bed -one night in good health and spirits, though somewhat fatigued in -consequence of having skated a good deal the previous afternoon. In the -morning she told her mother she had committed the "unpardonable sin," and -that there was consequently no hope of her salvation. She based her idea -on a dream she had had, in which an angel appeared to her, and sorrowfully -informed her of her sin and her destiny. When asked to tell what her sin -was, she refused to do so, saying it was too shocking and atrocious to -talk about. She kept to her delusion, and soon settled into a sort of -melancholic stupor, from which it was impossible entirely to rouse her. -Under the use of arsenic, and the acid phosphate of lime of Prof. -Horsford, she gradually recovered her reason. - -The manner in which prodromic dreams are excited is very simple. The -ancients and some modern writers have regarded them as prophetic; but the -true explanation does not require so severe a tax on our powers of belief. -In the previous chapter, it was shown that very slight impressions made -upon the senses during sleep are exaggerated by the partially awakened -brain. The first evidence of approaching paralysis may be a very minute -degree of numbness--so minute that the brain when awake and engaged with -the busy thoughts of active life fails to appreciate it. During sleep, -however, the brain is quiescent, till some exciting cause sets it in -uncontrollable action, and dreaming results. Such a cause may be the -incipient numbness of a limb. A dream of its being turned into stone, or -cut off, or violently struck, is the consequence. The disease goes on -developing, and soon makes its presence unmistakable. - -This explanation applies _mutatis mutandis_ to all prodromic dreams. They -are invariably based upon actual sensations, unless we except the rare -cases which are simply coincidences. - -SYMPTOMATIC DREAMS.--Morbid dreams are so generally met with in the course -of disease, especially in that of the brain and nervous system, that I -never examine a patient without questioning him closely on this point. The -information thus obtained is always valuable, and sometimes constitutes -the most important feature of the investigation. - -_Fevers_ are very often accompanied by frightful dreams. According to -Moreau (de la Sarthe),[96] their occurrence indicates that the attack will -be long, and that there is probably some organic affection present. My own -experience agrees with that of Macario,[97] to the effect of not -confirming these opinions. I have, however, generally observed that the -frequency and intensity of the morbid dreams were in proportion to the -severity of the fever. - -_Diseases of the heart_ are very generally attended with disagreeable -dreams. They are usually short, and, as Macario remarks, relate to -approaching death. The patient starts from sleep in terror, and sometimes -it is difficult to convince him of the reality of his visions. - -_Dyspepsia and other diseases of the intestinal canal_ often give rise to -morbid dreams. They are usually accompanied by a sense of impending -suffocation, and ordinarily consist of frightful images, such as devils, -demons, strange animals and the like. The presence of worms in the -intestines is likewise a frequent cause of such dreams. - -In _chlorosis_ dreams are very common. Occasionally they are of a pleasant -character, but in the majority of cases they are the reverse of this. - -It would be difficult to mention a disease which is not, at some time or -other of its career, an exciting cause of morbid dreams. The most -interesting examples, however, are met with in cases of _insanity and -other cerebral affections_, and frequently the delusions of the dreams are -so mixed up with those which arise during the waking condition, that the -patient is unable to separate them and to determine which are the -consequence of erroneous sensations received when awake, and which are the -results of dreams. The careful examination of almost any insane persons -will also show that they incorporate the fancies of their dreams with the -realities of everyday life. Indeed, the relations of dreaming to insanity -are so interesting and important as to have attracted the marked attention -of alienists and psychologists. - -Cabanis[98] gives Cullen the credit of being the first to point out the -similarity between the phenomena of dreaming and those of delirium, and -himself enters at length into the full discussion of the several questions -involved. A very little reflection will suffice to convince the reader -that the two conditions are strikingly alike. In dreams we never -distinguish the false from the real; the judgment, if exercised at all, -acts in the most erratic manner; we are rarely surprised at the occurrence -of the most improbable circumstances; our characters for the time being -often undergo a radical change, and we perform imaginary acts in our sleep -which are altogether at variance with our actual dispositions. The -hallucinations of sleep we accept as realities just as the insane -individual believes in all the erroneous impressions made upon his senses. -The dreaming person is, in fact, the victim of delusions which, during the -existence of his condition, have a firm hold on his mind and render him in -no essential particular different from the one who suffers from mental -unsoundness. The incoherence present in dreams, and the evident dependence -of the various images upon the suggestion of previous images, are likewise -phenomena of the insane state. - -Even in persons perfectly sane, dreams often produce a very powerful -influence on the mind. Most of us have, on awaking, felt pleased or -disturbed from reflecting upon the circumstances of a dream we have had -during the night, and occasionally the impression has remained through the -entire day. With children this influence is still more strongly shown. As -Sir Henry Holland[99] remarks, the corrections from reason and experience -are less complete in them than in adults. As a consequence, they not -infrequently confuse their dream-visions with the facts of their lives, -and regard the former as real events. The hallucinations of dreams are -also occasionally continued during wakefulness, and hence some persons -have, on awaking, seen the images which had been present to them in their -sleep. - -The celebrated Benedict de Spinoza[100] was once the subject of an -illusion which had its starting-point in a dream. He dreamed that he was -visited by a tall, thin, and black Brazilian, diseased with the itch. He -awoke, and thought he saw such an image standing beside him. - -Muller,[101] in referring to such instances, says: - -"I have myself also very frequently seen these phantasms, but am now less -liable to them than formerly. It has become my custom when I perceive such -images, immediately to open my eyes, and direct them upon the wall or -surrounding objects. The images are then still visible, but quickly fade. -They are seen whichever way the head is turned, but I have not observed -that they moved with the eyes. The answers to the inquiries which I make -every year of the students attending my lectures as to whether they have -experienced anything of the kind, have convinced me that it is a -phenomenon known to comparatively few persons. For among a hundred -students, two or three only, and sometimes only one, have observed it. -This rarity of the phenomena is, however, more apparent than real. I am -satisfied that many persons would perceive these spectres if they learned -to observe their sensations at the proper times. There are, however, -undoubtedly many individuals to whom they never appear, and in my own case -they now sometimes fail to show themselves for several months at a time, -although in my youth they occurred frequently. Jean Paul recommended the -watching of the phantasms which appear to the closed eyes as a means of -inducing sleep." - -If such phenomena take place in persons of healthy brains, the greater -liability of the insane to experience them will readily be admitted. - -The character of dreams, as Macario[102] remarks, varies according to the -type of insanity to which the patient is subject. In melancholia they are -ordinarily sad and depressing, and leave a deep and lasting impression; in -expansive monomania they are gay and exciting; in mania they give evidence -of the extraordinary mental excitement and activity of the subject, and in -duration they are vague, fleeting, and occur but seldom. - -ESSENTIAL MORBID DREAMS.--Under this head are comprehended the various -forms of frightful dreams which are ordinarily designated under the name -of nightmare. It has been my good fortune to have had the opportunity of -carefully studying the phenomena of this singular affection in several -persons of intelligence, and I propose, therefore, detailing the results -of my own experience, after a short historical retrospect, which I hope -will not prove uninteresting. - -Nightmare is characterized by the existence during sleep of a condition of -great uneasiness, the principal features of which are a sense of -suffocation, a feeling of pain or of constriction in some part of the -body, and a dream of a painful character. There are thus two essential -elements of the affection--the bodily and the mental. - -At a very early period the phenomena of nightmare attracted the attention -of physicians. Hippocrates[103] describes it in the following words: "I -have often seen persons in their sleep utter groans and cries, appear as -if suffocated, and throw themselves wildly about until they finally waked. -Then they were in their right minds, but were, nevertheless, pale and -weak." - -The general opinion held at that time was that the phenomena of nightmare -were due to excess of bile and dryness of the blood. This view originated -with Hippocrates, but was more or less modified by subsequent writers. - -After the establishment of Christianity, the conviction began to prevail -that during an attack of nightmare the subject was visited by a demon, -who, for the time being, took possession of his body. Oribasius, in the -fourth century, combated this idea, and endeavored to show that it was a -severe disease, which, if not cured, might lead to apoplexy, mania, or -epilepsy. He located it in the head. - -Aetius also denied the existence of demoniacal agency in nightmare. He -considered it as a prelude to epilepsy, mania, or paralysis. - -During the middle ages nightmare was attributed to the power of the devil. -Imps, male and female, called incubi and succubi respectively, were -supposed to be the active agents in producing the affection. The treatment -was in accordance with the theory, and consisted of prayers and exorcisms. -Not unfrequently the subject of the disease perished at the stake for the -alleged crime of having sexual intercourse with incubi or succubi, -according to sex. - -Even in later times many persons have been found who believed implicitly -in the reality of the visions which they experienced during an attack of -nightmare. Thus Jansen[104] relates that a clergyman came to consult him. -"Monsieur," said he, "if you do not help me I shall certainly go into a -decline, as you see I am thin and pale,--in fact, I am only skin and bone; -naturally I am robust, and of good appearance; now I am scarcely more than -the shadow of a man." - -"What is the matter with you?" said Jansen. "And to what do you attribute -your disease?" - -"I will tell you," answered the clergyman, "and you will assuredly be -astonished at my story. Almost every night a woman, whose figure is not -unknown to me, comes and throws herself on my breast, and embraces me with -such power that I can scarcely breathe. I endeavor to cry out, but she -stifles my voice, and the more I try the less successful I am. I can -neither use my arms to defend myself, nor my legs to escape. She holds me -bound and immovable." - -"But," said the doctor, "what you relate is not in the least surprising. -Your visitor is an imaginary being, a shade, a phantom, an effect of your -imagination." - -"Not so!" exclaimed the patient. "I call God to witness that I have seen -with my own eyes the being of whom I speak, and I have touched her with my -hands. I am awake, and in the full possession of my faculties, when I see -this woman before me. I feel her as she attacks me, and I try to contend -with her, but fear, anxiety, and languor prevent me. I have been to every -one asking for aid to bear up against my horrible fate, and, among others, -I have consulted an old woman, who has the reputation of being very -skillful, and something of a sorceress. She directed me to urinate toward -daylight, and to immediately cover the _pot de chambre_ with the boot of -my right foot. She assured me that on the very day I would do this the -woman would pay me a visit. - -"Although this seemed to me very ridiculous, and although my religion was -altogether against my making any such experiment, I was finally induced, -by reflecting on my sufferings, to follow the advice I had received. I did -so, and, sure enough, on the same day the wicked woman who had so -tormented me came to my apartment, complaining of a horrible pain in the -bladder. All my entreaties and threats, however, were unavailing to induce -her to cease her nocturnal visits." - -Jansen at first could not turn this gentleman from his insane idea, but, -finally, after two hours' conversation, he made him have some just -conception of the nature of his disease, and inspired him with the hope -of a cure. - -Epidemics of nightmare have been noticed, and it likewise sometimes -prevails endemically under certain peculiar forms. Thus vampirism, a -belief in which exists in different parts of the world, is nothing but a -kind of nightmare. Charles Nodier[105] gives some interesting details on -this point, which I do not hesitate to transcribe. - -In Morlachia there is scarcely a hamlet which has not several _vukodlacks_ -or vampires, and there are some, every family of which has its -_vukodlack_, just as every Alpine family has its cretin. The cretin, -however, has a physical infirmity, and with it a morbid state of the brain -and nervous system, which destroys his reason, and prevents him -appreciating his degraded condition. The _vukodlack_, on the contrary, -appreciates all the horror of his morbid perception; he fears and detests -it; he combats it with all his power; he has recourse to medicine, to -prayers, to division of a muscle, to the amputation of a limb, and -sometimes even to suicide. He demands that after his death his children -shall pierce his heart with a spike, and fasten his corpse to the coffin, -so that his dead body, in the sleep of death, may not be able to follow -the instinct of the living body. The _vukodlack_ is, moreover, often a man -of note, often the chief of the tribe, the judge, or the poet. - -Through the sadness which is due to the recollection of his nocturnal -life, the _vukodlack_ exhibits the most generous and lovable traits of -character. It is only during his sleep, when visited with his terrible -dreams, that he is a monster, digging up the dead with his hands, feeding -on their flesh, and waking those around him with his frightful cries. - -The superstition is that during this state of morbid dreaming the soul of -the sleeper quits the body to visit the cemeteries, and feast upon the -remains of the recently dead. - -In Dalmatia the belief is current that there are sorcerers whose delight -is to tear out the hearts of lovers, and to cook and eat them. Nodier -relates the story of a young man about to be married, who was the constant -victim of nightmare, during which he dreamed that he was surrounded by -these sorcerers, ready to pluck his heart from his breast, but who often -awakened just as they were about to proceed to extremities. In order to be -effectually relieved from their visitations, he was advised to avail -himself of the company of an old priest, who had never previously heard of -these horrible dreams, and who did not believe that God would give such -power to the enemies of mankind. After using various forms of exorcism, -the priest went peacefully to sleep in the same room with the patient whom -he was commissioned to defend against the sorcerers. Hardly, however, had -sleep descended upon his eyelids than he thought he saw the demons -hovering over the bed of his friend, alight, and, laughing horribly, -throw themselves on his prostrate body, and with their claws tear open his -breast, and, seizing his heart, devour it with frightful avidity. Unable -to move from his bed, or to utter a sound, he was forced to witness this -terrible scene. At last he awoke to see no one but his companion, pale and -haggard, staggering toward him, and finally falling dead at his feet. - -These two men, adds Nodier, had had similar attacks. What the one dreamed -he saw, the other dreamed he had experienced. - -As an instance of like dreams occurring to many persons at the same time, -the circumstances related by Laurent[106] are worthy of notice. - -"The first battalion of the regiment of Latour d'Auvergne, of which I was -Surgeon-major, while in garrison at Palmi, in Calabria, received orders to -march at once to Tropea in order to oppose the landing from a fleet which -threatened that part of the country. It was in the month of June, and the -troops had to march about forty miles. They started at midnight, and did -not arrive at their destination till seven o'clock in the evening, resting -but little on the way, and suffering much from the heat of the sun. When -they reached Tropea, they found their camp ready and their quarters -prepared, but as the battalion had come from the farthest point, and was -the last to arrive, they were assigned the worst barracks, and thus eight -hundred men were lodged in a place which, in ordinary times, would not -have sufficed for half their number. They were crowded together on straw -placed on the bare ground, and being without covering, were not able to -undress. The building in which they were placed was an old, abandoned -abbey, and the inhabitants had predicted that the battalion would not be -able to stay there all night in peace, as it was frequented by ghosts, -which had disturbed other regiments quartered there. We laughed at their -credulity; but what was our surprise to hear, about midnight, the most -frightful cries issuing from every corner of the abbey, and to see the -soldiers rushing terrified from the building. I questioned them in regard -to the cause of their alarm, and all replied that the devil lived in the -building; that they had seen him enter by an opening into their room, -under the figure of a very large dog, with long black hair, and, throwing -himself upon their chests for an instant, had disappeared through another -opening in the opposite side of the apartment. We laughed at their -consternation, and endeavored to prove to them that the phenomenon was due -to a very simple and natural cause, and was only the effect of their -imagination; but we failed to convince them, nor could we persuade them to -return to their barracks. They passed the night scattered along the -sea-shore, and in various parts of the town. In the morning I questioned -anew the non-commissioned officers and some of the oldest soldiers. They -assured me that they were not accessible to fear; that they did not -believe in dreams or ghosts, but that they were fully persuaded they had -not been deceived as to the reality of the events of the preceding night. -They said they had not fallen asleep when the dog appeared, that they had -obtained a good view of him, and that they were almost suffocated when he -leaped on their breasts. We remained all day at Tropea, and the town being -full of troops, we were forced to retain the same barracks, but we could -not make the soldiers sleep in them again, without our promise that we -would pass the night with them. I went there at half-past eleven with the -commanding officer; the other officers were, more for curiosity's sake -than anything else, distributed in the several rooms. We scarcely expected -to witness a repetition of the events of the preceding night, for the -soldiers had gone to sleep, reassured by the presence of their officers, -who remained awake. But about one o'clock, in all the rooms at the same -time, the cries of the previous night were repeated, and again the -soldiers rushed out to escape the suffocating embrace of the big black -dog. We had all remained awake, watching eagerly for what might happen, -but, as may be supposed, we had seen nothing. - -"The enemy's fleet having disappeared, we returned next day to Palmi. -Since that event we have marched through the Kingdom of Naples in all -directions and in all seasons, but the phenomena have never been -reproduced. We are of opinion that the forced march which the troops had -been obliged to make during a very hot day, by fatiguing the organs of -respiration, had weakened the men, and consequently disposed them to -experience these attacks of nightmare. The constrained position in which -they were obliged to lie, the fact of their being undressed, and the bad -air they were obliged to breathe, doubtless aided in the production." - -A gentleman was, not long since, under my professional charge who was very -subject to attacks of nightmare. Though remarkable for his personal -courage, he confessed that during his paroxysms he was the most arrant -coward in the world. Indeed, so powerful an impression had his frequent -frightful dreams made upon him, that he was afraid to go to sleep, and -would often pass the night engaged in some occupation calculated to keep -him awake. - -The dreams which he had were always of such a character as to inspire -terror, and generally related to demons and strange animals, which seated -themselves on his chest, and tried to tear open his throat. They came on a -few minutes after he fell asleep, and lasted sometimes for more than an -hour. During their continuance he remained perfectly still and quiet, -giving no evidence of the tumult within, beyond the appearance of a cold -sweat over the whole surface of the body. When he awoke, as he always did -when the climax was reached, he started from the bed with a bound, and -with all the evidences of intense fright. After that he was safe for the -remainder of the night. - -I am acquainted with another case in which there are no very obvious -physical symptoms. - -Ordinarily, however, the sufferer groans, and tosses about the bed; he -appears to be endeavoring to speak, and to escape from his imaginary -danger; his face, neck, and chest are flushed; a cold perspiration -appears, especially on his forehead, and he is sometimes seized with a -general trembling of the whole body. The respiration appears to be -particularly disturbed; he gasps for air, and occasionally the breathing -is stertorous. As to the pulse, strange as it may appear, there is rarely -any marked change from the healthy standard, beyond the slight -irregularity induced by the disorder of the respiration. - -Among the mental symptoms, in addition to the fear with which he is -filled, the sufferer is most sensibly impressed with a sense of his utter -helplessness. His will is actively engaged in endeavoring to bring his -muscles into action, but they cannot be made to obey its behests, and he -consequently feels himself powerless to escape from the enemies which -attack him. - -In regard to the kind of images which make their appearance, there is more -or less uniformity. Generally they consist of animals, such as hogs, dogs, -monkeys, or nondescripts created by the imagination of the dreamer. At -other times they are demons of various forms. A gentleman, whose case came -under my notice, was visited almost nightly by a huge black walrus, which -appeared to roll off of a large cake of ice, and, crawling up the bed, to -throw itself on his chest. Another was tormented by an animal, half lion -and half monkey, which seemed to fasten its claws in his throat while -seated on his breast. - -At other times there are no images, but only painful delusions, in which -the dreamer is placed in dangerous positions, or suffers some kind of -torturing operation. Thus a lady informs me that she is subject to -frequent attacks of nightmare, during which she imagines she is standing -on the top of a high mast, and in extreme fear of falling off. Again she -is dragged through a key-hole by some invisible power; and again has her -nose and mouth so tightly closed that she can get no breath of air. - -The _causes_ of nightmare may be divided into the _exciting_ and the -_immediate_. The _exciting causes_ are very numerous. Unusual fatigue, -either of mind or of body, recent emotional disturbance, such as that -produced by fright, anxiety, or anger, and intense mental excitement of -any kind may produce it. I have known a young lady to have a severe attack -the night after a school examination, in which she had been unduly tasked. -Another young lady is sure to be attacked after witnessing a tragedy -performed. A young man, who was under my care for a painful nervous -affection, always had a paroxysm of nightmare during the first sleep after -delivering an address, which he was obliged to do every month for a year -or more. - -Fullness of the stomach, or the eating of indigestible or highly -stimulating food late in the evening, will often cause nightmare. As -Motet[107] remarks: "One of the best-established causes is repletion of -the stomach, and slowness and difficulty of digestion. Let an individual, -habitually systematic, depart for one day from the accustomed regularity -of his meals, let him change the hour of his dinner, and go to bed before -the work of digestion is completed, and it is probable that his sleep will -be troubled, and that nightmare will be the consequence of his -indiscretion. The painful feeling will be induced by distention of the -stomach, by anxiety, and by the restraint given to the movements of the -diaphragm." - -Feculent food would appear to be especially powerful in causing nightmare, -and according to Motet, strong liquors and sparkling wines and coffee are -equally so. I have several times known it produced by the New England dish -of baked pork and beans, and by green Indian-corn eaten just before going -to bed. - -Various morbid affections, such as diseases of the heart, aneurism of the -large arteries, affections of the brain or spinal cord, and diseases of -the digestive or urinary apparatus are often exciting causes of nightmare. -It may originate from painful sensations in any part of the body. Some -women, about the time of the menstrual flow, are particularly liable to -paroxysms of this morbid dreaming. - -Whatever interferes with the respiration or the easy flow of blood to and -from the head may bring on an attack of nightmare. I have known it caused -by the collar of the night-gown being too tight, and by the pillow being -under the head and not under the shoulders, thus putting the head at such -an angle with the body as to constrict the blood-vessels of the neck, and -by the head falling over the side of the bed. I have not been able to -ascertain that sleeping upon the back or on the left side predisposes to -the affection, unless in those cases in which the former position causes -snoring from relaxation of the soft palate. - -The _immediate cause_ of nightmare is undoubtedly the circulation of blood -through the brain which has not been sufficiently aerated. The appearance -of the sufferer is sufficient to indicate this, as the condition of the -cerebral vessels and all the exciting causes act either by retarding the -flow of the venous blood from the brain, or by impeding the respiratory -movements. The effects of emotion, of mental fatigue, and of severe and -long-continued muscular exertion are such that the nervous influence to -the muscles of respiration is increased, or the muscles themselves are -debilitated through this general fatigue of the organism. Fullness of the -stomach acts mechanically, by interfering with the action of the -diaphragm, and constriction about the neck directly increases the flow of -blood through the brain. Certain diseases of the heart and lungs act upon -the function of respiration, and thus interfere with the due oxygenation -of the blood. - -The _treatment_ of morbid dreams presents no points of any difficulty. -When they are the result of impressions made during sleep upon the nerves, -and are the forerunners of disease, it is not very likely that physicians -will be consulted as to their cure. Undoubtedly, however, much can be done -to abate them when they belong to the category of prodromic dreams, as -well as when they are symptomatic of existing disease. Hygienic measures, -such as open-air exercise, attention to diet, and warm baths, and the use -of the oxide of zinc and bromide of potassium, will do much to lessen the -irritability of the nervous system, and to diminish any hyperæmic -condition of the brain. - -Nightmare often requires more active management, though even here we will -ordinarily find the measures above mentioned the most effectual that can -be taken for its treatment. Of course the exciting cause must be -ascertained if possible, and means taken to remove it. This is not always -an easy matter, and frequently cannot be accomplished without a -considerable alteration in the course of life followed by the patient, and -more or less sacrifice on his part. Among hygienic measures, I have -several times found relief follow a sojourn at the sea-shore, and ocean -bathing. Change of air is almost invariably beneficial, and moderate -physical exercise, just to the point of fatigue, can scarcely be dispensed -with. A gentleman, at this moment under my care, has been cured by a -course of gymnastic training, which he took at my instance. The food of -those subject to nightmare should always be plain, easily digestible, and -moderate in quantity. Alcoholic beverages should always be sparingly -taken, especially just before going to bed. Any article of food or drink -known to produce the paroxysm, should of course be omitted altogether. - -As to medicines, the whole round of so-called antispasmodics is usually -tried by routine physicians. I have never seen them do any good. Iron and -bitter tonics are indicated in cases of anæmia or exhaustion. As the -disease is sometimes induced in children by the presence of worms in the -alimentary canal, diligent inquiry should be made relative to symptoms -indicating irritation from these parasites, and if they are found to -exist, anthelmintics should be administered. - -A case of intermittent nightmare, occurring every alternate night, in a -young lady, was recently under my care. No exciting causes could be -discovered, except the probable one of malaria. The affection yielded at -once to the sulphate of quinia. - -Ferrez[108] has published the details of a case of intermittent nightmare -occurring in the person of a Spanish officer, who was attacked after -passing forty-two nights at the bedside of a sick daughter. Every night, -at the same hour, he was awakened by frightful dreams, which, irritating -his brain, produced cramps, convulsive movements, an afflux of blood to -the cerebral tissues, a sadness which he could not conquer, and a -continual and powerful feeling of approaching death. - -The patient, though of strong constitution, became enfeebled and -emaciated. His countenance was pale, the pupils contracted, and his whole -appearance showing the exhaustion consequent upon the battle which he was -obliged continually to fight with his disease. He composed at this time -some verses, describing in graphic terms the deplorable condition of his -mind and body. - -Gymnastics, temperance in eating and drinking, and the study of poetry, -failed to give him relief. Finally he consulted Dr. Ferrez, who advised -him to reveal his state to his family, who hitherto had been kept in -ignorance of his malady, to continue his gymnastics moderately, not to eat -in the evening, to drink only cold water, to use friction over the whole -surface of the body, to apply mustard plasters to the extremities, to -sleep with his head elevated and uncovered, to bathe his head frequently -during the night with cold water, to give up the study of poetry, and to -devote himself to mathematics and political economy. These measures were -rigorously carried out; but his daughter, who had been the involuntary -cause of his disease, prescribed a better remedy than all the others. She -had him waked at midnight, before the occurrence of his paroxysm, and thus -broke up the habit. - -Perhaps no one medicine is so uniformly successful in the ordinary forms -of nightmare as the bromide of potassium, administered in doses of from -twenty to forty grains, three times a day. I have seen a number of cases -which had resisted all hygienic measures, and the simple removal of the -apparent cause, yield to a few doses of this remedy. - -When the affection has lasted a long time, it is more difficult to break -up the acquired habit. In these cases, the plan so successfully employed -by the daughter of the Spanish officer will almost invariably succeed. - -Finally, persons subject to nightmare should so train the mind as to -employ the intellectual faculties systematically, by engaging in some -study requiring their full exercise. The action of the emotions should be -as much as possible controlled, and the reading of sensational stories, or -hearing sensational plays, should be discouraged. By severe mental -training, individuals can do much to regulate the character of their -dreams. It is a well-recognized fact, that intense thought upon subjects -which require the highest degree of intellectual action is not favorable -to the production of dreams of any kind. - - - - -CHAPTER VII. - -SOMNAMBULISM. - - -The phenomena exhibited by a person in the condition of somnambulism are -so wonderful, that they have from the earliest times excited the -superstitious feelings of the ignorant, and claimed the most serious -attention of the learned. To see an individual apparently asleep to the -greater part of surrounding objects, yet so keenly awake to others as to -be able to perform the most intricate actions without the aid of the -senses, is so greatly at variance with the common experience of mankind, -as to call up feelings of astonishment, and perhaps of awe, in the minds -both of the vulgar and those accustomed to scientific investigation. In -those times, when the marvelous exercised so powerful an influence over -mankind, and when all phenomena out of the ordinary course of everyday -life were regarded as supernatural, it was the prevailing belief that the -somnambulist was possessed. Modern science has at last dispelled this -idea, and though it has not yet been able to furnish a rational theory of -somnambulism which will account for all the manifestations of the -affection, it has done much toward elucidating the functions of different -parts of the nervous system, and thus to prepare our minds for a full -understanding of the subject. - -Somnambulism has been defined[109] as "a condition in which certain senses -and faculties are suppressed or rendered thoroughly impassive, while -others prevail in most unwonted exaltation; in which an individual, though -asleep, feels and acts most energetically, holding an anomalous species of -communication with the external world, awake to objects of attention, and -most profoundly torpid to things at the time indifferent; a condition -respecting which most commonly the patient on awaking retains no -recollection; but on any relapse into which, a train of thought and -feeling related to and associated with the antecedent paroxysm will very -often be developed." - -This definition, though unnecessarily long and by no means perfect, will -nevertheless suffice for a general description of the chief phenomena of -the affection. It accords with the generally received theory. My own views -of the nature of somnambulism will appear in the course of the following -remarks. - -In the introduction to his classical work on the subject under -consideration, Bertrand[110] classifies the different kinds of -somnambulism according to their causes. He recognizes-- - -1. A particular nervous temperament which predisposes individuals -otherwise in good health to paroxysms of somnambulism during their -ordinary sleep. - -2. It is sometimes produced in the course of certain diseases, of which it -may be considered a symptom or a crisis. - -3. It is often seen in the course of the proceeding necessary to bring on -the condition known as animal magnetism. - -4. It may result as the consequence of a high degree of mental exaltation. -It is in this case contagious by imitation to such persons as are -submitted to the same influence. - -From these four divisions of causes, Bertrand makes four kinds of -somnambulism--the essential, the symptomatic, the artificial, and the -ecstatic. As he wrote nearly twenty years before the publication of Mr. -Braid's remarkable researches, he was of course unacquainted with that -form of artificial somnambulism now known as hypnotism, and which may -properly be included in his third class. I shall simplify his arrangement -by dividing the several kinds of somnambulism into two classes--the -natural and artificial. - -_Natural somnambulism_ may occur in persons who exhibit no marked -deviations from the standard of health, and in whom there is no very -evident nervous excitability. It is usually, though not always, -manifested during ordinary sleep, and it is common for authors to speak of -it as being necessarily connected with a dream. Thus, Macario[111] says it -is a sleep in which the nervo-motor system and all the other organs are -put in action under the influence of a dream. A few cases cited from other -authors, and from my own experience, will tend to the more complete -elucidation of the symptoms of this curious affection. Bertrand[112] -quotes the following instance from the _Encyclopædia_: - -"The Archbishop of Bordeaux has informed me that when at the seminary he -was acquainted with a young ecclesiastic who was a somnambulist. Curious -to ascertain the nature of the malady, he went every night to the chamber -in which the young man slept. He saw, among other things, that the -ecclesiastic got up, took paper, and composed and wrote sermons. When he -had finished a page, he read it aloud--if one can apply the term to an -action done without the aid of sight. When a word displeased him, he wrote -the necessary corrections with great exactness. I have seen the beginning -of one of his sermons which he wrote in the somnambulistic state, and -thought it well composed and correctly written; but there was an -alteration which surprised me. Having used the expression _ce divin -enfant_, he thought as he read it over that he would change the word -_divin_ for _adorable_. He therefore effaced the first word, and wrote the -second above it. He then perceived that the word _ce_ properly placed -before _divin_ would not do before adorable; he therefore added a _t_ to -the preceding letters, so that the expression read _cet adorable enfant_. -The same person, an eye-witness of these facts, in order to ascertain -whether or not the somnambulist made use of his eyes, put a card under his -chin in such a manner as to prevent his seeing the paper on the table; but -he still continued to write. Wishing still to discover whether or not he -distinguished different objects placed before him, the Archbishop took -away the paper on which he wrote and substituted several other kinds at -different times; but he always perceived the change because the pieces -were of various sizes. When a piece exactly like his own was placed before -him he used it, and wrote his corrections on the places corresponding to -those on his own paper. It was by this means that portions of his -nocturnal compositions were obtained. These the Archbishop has had the -goodness to send to me. The most astonishing among them was a piece of -music written with great exactitude. A cane had served him for a -ruler--the clef, the flats, and the sharps were all in their right places. -All the notes were first made as circles, and then those which required it -were blackened with ink. The words were all written below. Once they were -in such large characters that they did not come directly under their -proper notes. He soon, however, perceived his error, and corrected it by -effacing what he had written and writing it over again. - -"One night, in the middle of winter, he imagined himself to be walking on -the bank of a river and seeing a child fall in. The severity of the -weather did not prevent him from determining to save it. He threw himself -on his bed in the posture of a man swimming, went through all the motions, -and, after becoming well fatigued with the severity of this exercise, he -felt a bundle of the bedclothes, which he took to be the drowning child. -He seized it with one hand, while he continued to swim with the other, in -order to regain the bank of the imaginary river. Finally, he placed the -bundle in a place which he evidently determined to be dry land, and rose, -shivering, with his teeth chattering as though he had emerged from icy -water. He remarked to the by-standers that he was frozen, that he would -die of cold, and that his blood was like ice. He then asked for a glass of -brandy in order to restore his vitality; but there being none at hand, a -glass of water was given him instead. He, however, detected the difference -and asked peremptorily for brandy--calling attention to the great danger -he incurred from the cold. Some brandy was finally obtained. He drank it -with much satisfaction, and remarked that he felt much better. -Nevertheless, he did not awake, and, returning to bed, slept tranquilly -the rest of the night." - -Gassendi[113] had in his service a young man who every night arose in his -sleep, descended into the cellar and drew some wine from a cask. -Frequently he went out into the streets in the middle of the night, -sometimes even he went into the country and walked on stilts, in order to -cross a rapid stream which ran around the city. If he happened to awake -from his sleep after having crossed this torrent, he was afraid to recross -it so as to return home. Gassendi relates that when this man waked in the -course of his perambulations he suddenly found himself in darkness, but as -he had the faculty of remembering all that had taken place during his -dream, and of recognizing the place where he found himself, he was able to -grope his way to his bed. The darkness, therefore, which was an obstacle -to the exercise of his sight when he was awake, was no impediment when he -was in the state of somnambulism. - -Dr. Prichard[114] cites from Muratori[115] the cases of Forari and -Negretti, which are curious instances of the affection in question. - -"Signor Augustin Forari was an Italian nobleman, dark, thin, melancholic, -and cold-blooded, addicted to the study of the abstract sciences. His -attacks occurred at the waning of the moon, and were stronger in the -autumn and winter than in the summer. An eye-witness, Vigneul Marville, -gave the following description of them: - -"One evening, toward the end of October, we played at various games after -dinner; Signor Augustin took a part in them along with the rest of the -company, and afterward retired to repose. At eleven o'clock, his servant -told us that his master would walk that night, and that we might come and -watch him. I examined him after some time with a candle in my hand. He was -lying upon his back and sleeping with open, staring, unmoved eyes. We were -told that this was a sure sign that he would walk in his sleep. I felt his -hands and found them extremely cold, and his pulse beat so slowly that his -blood appeared not to circulate. We played a tric-trac till the spectacle -began. It was about midnight, when Signor Augustin drew aside the -bed-curtains with violence, arose and put on his clothes. I went up to him -and held the light under his eyes. He took no notice of it, although his -eyes were open and staring. Before he put on his hat, he fastened on his -sword-belt, which hung on the bedpost; his sword had been removed. Signor -Augustin then went in and out of several rooms, approached the fire, -warmed himself in an arm-chair, and went thence into a closet where he had -his wardrobe. He sought something in it, put all the things into disorder, -and, having set them right again, locked the door and put the key into his -pocket. He went to the door of the chamber, opened it and stepped out on -the staircase. When he came below, one of us made a noise by accident; he -appeared frightened, and hastened his steps. His servant desired us to -move softly and not to speak, or he would become out of his mind; and -sometimes he ran as if he were pursued, if the least noise was made by -those standing around him. He then went into a large court and to the -stable, stroked his horse, bridled it, and looked for the saddle to put on -it. As he did not find it in the accustomed place, he appeared confused. -He then mounted his horse and galloped to the house-door. He found this -shut, dismounted and knocked with a stone, which he picked up, several -times at the door. After many unsuccessful efforts, he remounted and led -his horse to the watering-place--which was at the other end of the -court--let him drink, tied him to a post and went quietly to the house. -Upon hearing a noise, which the servants made in the kitchen, he listened -attentively, went to the door and held his ear to the keyhole. After some -time he went to the other side, and into a parlor in which was a -billiard-table. He walked around it several times and acted the motions of -a player. He then went to a harpsichord, on which he was accustomed to -practice, and played a few irregular airs. After having moved about for -two hours, he went to his room and threw himself upon his bed, clothed as -he was, and the next morning we found him in the same state; for as often -as his attack came on he slept afterward from eight to ten hours. The -servants declared that they could only put an end to his paroxysms either -by tickling him on the soles of his feet, or by blowing a trumpet in his -ears." - -The history of Negretti was published separately by two physicians, -Righellini and Pigatti, who were both eye-witnesses of the curious facts -which they relate. - -"Negretti was about twenty-four years old, was a sleep-walker from his -eleventh year; but his attacks only occurred in the month of March, -lasting at farthest till the month of April. He was a servant of the -Marquis Luigi Sale. On the evening of the 16th of March, 1740, after going -to sleep on a bench in the kitchen, he began first to talk, then walked -about, went to the dining-room and spread a table for dinner, placed -himself behind a chair with a plate in his hand as if waiting on his -master. After waiting until he thought his master had dined, he removed -the table, put away all the materials in a basket, which he locked in a -cupboard. He afterward warmed a bed, locked up the house, and prepared for -his nightly rest. Being then awakened, and asked if he remembered what he -had been doing, he answered no. This, however, was not always; he often -recollected what he had been doing. Pigatti says he would awake when water -was thrown into his face, or when his eyes were forcibly opened. According -to Maffei, he then remained sometimes faint and stupid. Righellini -assured Muratori that his eyes were firmly closed during the paroxysm, and -that when a candle was put near to them, he took no notice of it. -Sometimes he struck himself against the wall and even hurt himself -severely. Hence it would seem that he was directed in his movements by -habit, and had no actual perception of external objects. This is confirmed -by the assurance that if anybody pushed him, he got out of the way and -moved his arms rapidly about on every side; and that when he was in a -place of which he had no distinct knowledge, he felt with his hands all -the objects about him, and displayed much inaccuracy in his proceedings; -but in places to which he was accustomed he was under no confusion, but -went through his business very cleverly. Pigatti shut a door through which -he had just passed; he struck himself against it in returning. The writer -last mentioned was confident that Negretti could not see. He sometimes -carried about with him a candle, as if to give him light in his -employment; but on a bottle being substituted, took it and carried it, -fancying that it was a candle. He once said during his sleep that he must -go and hold a light to his master in his coach. Righellini followed him -closely, and remarked that he stood still at the corners of the streets -with his torch in his hand not lighted, and waited awhile in order that -the coach which he supposed to be following might pass through the place -where light was required. On the eighteenth of March he went through -nearly the same process as before in laying a table, etc., and then went -to the kitchen and sat down to supper. Signor Righellini observed him, in -company with many other cavalieri very curious to see him eat. At once he -said, as recollecting himself, 'How can I so forget? To-day is Friday and -I must not dine.' He then locked up everything and went to bed. On another -occasion he ate several cakes of bread and some salad which he had just -before demanded of the cook. He then went with a lighted candle into the -cellar and drew wine, which he drank. All these acts he performed as -usual, and carried a tray upon which were wineglasses and knives, turning -obliquely when passing through a narrow doorway, but avoiding any -accident." - -Macario[116] cites from I. Franck the case of a young peasant, aged about -sixteen, and endowed with a degree of intelligence above his age and -condition, who was rendered somnambulic by the grief caused by the sudden -death of his father. A few weeks after this event, he dreamed that he saw -two unknown and frightful-looking men who advanced slowly toward his bed, -and in menacing language ordered him to rise immediately and accompany -them, threatening that if he refused they would return the following night -and take him by force. This dream had so strong an effect upon him that he -became melancholic. Two days afterward, while he was sleeping quietly, he -dreamed that his father's spirit came to him, accompanied by the two men -who had previously visited him, and ordered them to seize his son, -notwithstanding his resistance, and to carry him off. - -The young man dreamed that he was transported through a delightful country -of vast extent; he heard the harmonious sounds from flutes and other -musical instruments; he saw young people dancing on the charming plains, -and he ate to satiety of delicious viands. Immediately the scene changed; -his father's spirit disappeared, and his ferocious companions carried him -high up into the air and then suddenly let him fall into a barrel. The -servants returning with the cows, found the young man in the stable shut -up in an empty barrel, scantily covered, and almost dead with cold and -fright. Restored by frictions and warmth, he had no recollection of -anything connected with his situation beside the dream above recorded. At -the end of a week, he again rose from bed in his sleep, but finding the -door locked, he returned and remained quiet. In a short time the disease -ceased entirely. - -The same author also quotes from Franck the case of a Jewish tailor, who, -during the attacks of somnambulism to which he was subject, recited in a -low voice his customary prayers in Hebrew. When he came to certain parts -he raised his voice, called out aloud, and imitated the gestures of the -rabbis in the synagogues. While thus engaged his eyes were wide open, and -the pupils insensible to the stimulus of light. Then his face became pale, -he presented the appearance of weeping, his whole body was covered with a -cold, profuse sweat, and his pulse rose to 130. This crisis was followed -by a tranquil prayer, to which sooner or later another access of fury -succeeded; and this series continued for an hour or two, or till his -prayers had been repeated for the prescribed period. - -When strongly shaken he awoke with a startled manner, but if left to -himself fell asleep again, and resumed his prayers at the place where he -had been interrupted. When awake he declared that he had no recollection -of what had happened during his sleep. The paroxysms appeared every day -except Tuesday. The patient had a brother who was also a somnambulist. - -These cases will give an idea of somnambulism as it has been witnessed by -other observers, or as its phenomena have impressed them. The following -instances of the disease have come under my own notice. - -A young lady, of great personal attractions, had the misfortune to lose -her mother by death from cholera. Several other members of the family -suffered from the disease, she alone escaping, though almost worn out with -fatigue, excitement, and grief. A year after these events, her father -removed from the West to New York, bringing her with him and putting her -at the head of his household. She had not been long in New York, before -she became affected with symptoms resembling those met with in chorea. The -muscles of the face were in almost constant action, and though she had not -altogether lost the power to control them by her will, it was difficult at -times for her to do so. She soon began to talk in her sleep, and finally -was found one night by her father, as he came home, endeavoring to open -the street-door. She was then, as he said, sound asleep, and had to be -violently shaken to be aroused. After this she made the attempt every -night to get out of bed, but was generally prevented by a nurse who slept -in the same room with her, and who was awakened by the noise she made in -the room. - -Her father now consulted me in regard to the case, and invited me to the -house in order to witness the somnambulic acts for myself. One night, -therefore, I went to his residence and waited for the expected -manifestations. The nurse had received orders not to interfere with her -charge on this occasion, unless it was evident that injury would result, -and to notify us of the beginning of the performance. - -About twelve o'clock she came down stairs and informed us that the young -lady had risen from her bed and was about to dress herself. I went up -stairs, accompanied by her father, and met her in the upper hall partly -dressed. She was walking very slowly and deliberately, her head elevated, -her eyes open, her lips unclosed, and her hands hanging loosely by her -side. We stood aside to let her pass. Without noticing us, she descended -the stairs to the parlor, we following her. Taking a match, which she had -brought with her from her own room, she rubbed it several times on the -under side of the marble mantle-piece until it caught fire, and then, -turning on the gas, lit it. She next threw herself into an arm-chair and -looked fixedly toward a portrait of her mother which hung over the -mantle-piece. While she was in this position, I carefully examined her -countenance, and performed several experiments with the view of -ascertaining the condition of the senses as to activity. - -She was very pale, more so than was natural to her; her eyes were wide -open and did not wink when the hand was brought suddenly in close -proximity to them; the muscles of the face, which when she was awake were -almost constantly in action, were now perfectly still; her pulse was -regular in rhythm and force, and beat 82 per minute, and the respiration -was uniform and slow. - -I held a large book between her eyes and the picture she was apparently -looking at, so that she could not possibly see it. She nevertheless -continued to gaze in the same direction as if no obstacle were interposed. -I then made several motions as if about to strike her in the face. She -made no attempt to ward off the blows, nor did she give the slightest sign -that she saw my actions. I touched the cornea of each eye with a -lead-pencil I had in my hand, but even this did not make her close her -eyelids. I was entirely satisfied that she did not see--at least with her -eyes. - -I held a lighted sulphur-match under her nose, so that she could not avoid -inhaling the sulphurous acid gas which escaped. She gave no evidence of -feeling any irritation. Cologne and other perfumes, and smelling-salts -likewise failed to make any obvious impression on her olfactory nerves. - -Through her partially opened mouth, I introduced a piece of bread soaked -in lemon-juice. She evidently failed to perceive the sour taste. Another -piece of bread, saturated with a solution of quinine, was equally -ineffectual. The two pieces of bread remained in her mouth for a full -minute, and were then chewed and swallowed. - -She now arose from her chair and began to pace the room in an agitated -manner; she wrung her hands, sobbed, and wept violently. While she was -acting in this way, I struck two books together several times so as to -make loud noises close to her ears. This failed to interrupt her. - -I then took her by the hand and led her back to the chair in which she had -previously been sitting. She made no resistance, but sat down quietly and -soon became perfectly calm. - -Scratching the back of her hand with a pin, pulling her hair, and pinching -her face, appeared to excite no sensation. - -I then took off her slippers, and tickled the soles of her feet. She at -once drew them away, but no laughter was produced. As often as this -experiment was repeated, the feet were drawn up. The spinal cord was -therefore awake. - -She had now been down stairs about twenty minutes. Desiring to awake her, -I shook her by the shoulders quite violently for several seconds, without -success. I then took her head between my hands and shook it. This proved -effectual in a little while. She awoke suddenly, looked around her for an -instant, as if endeavoring to comprehend her situation, and then burst -into a fit of hysterical sobbing. When she recovered her equanimity, she -had no recollection of anything that had passed, or of having had a dream -of any kind. - -A gentleman of very nervous temperament informs me that upon one occasion -he dreamed that his place of business was on fire. He got up in his sleep, -dressed himself, and walked a distance of over a mile to his store. He was -aroused by the private watchman, who stopped him while in the act of -looking through the grating of the door, under the impression at first -that he had caught a burglar. - -A young lady who some time since was under my care for intense periodical -headaches, informed me that, just previous to each attack, she walked in -her sleep, but had never any recollection of what she did while in the -somnambulic state. Her mother stated that when her daughter was in this -condition, she did not use her eyes, although they were wide open, nor -did she appear to hear loud noises made close to her ears. - -In relation to the activity of the senses during somnambulism, there is -great diversity of opinion among those who have studied the affection. -This is doubtless due to the fact that somnambulists differ among -themselves as regards the use they make of their senses--some availing -themselves of the aid they can derive from these sources, while others do -not appear to employ them at all. - -Thus it is stated that Negretti kept his eyes closed, and yet when a box -of snuff was handed to him, he took a pinch without hesitation; and the -young ecclesiastic whose case I have already quoted, performed even more -complex acts than this. - -Castelli, a young somnambulist and a student of pharmacy, performed many -astonishing acts during his paroxysms. One night he was found in the -somnambulic condition, translating a passage from the Italian into French, -and searching out the words in a dictionary. Prichard[117] assumes from -this fact that he must have seen the words. He states further, that -somnambulists have been known to write and even to correct their -compositions, and to do other acts which could not possibly have been -performed without sight. While it is certainly true that somnambulists -have done all these things, it is equally certain that they have often -performed them without the aid of their eyes. In the case of Castelli, a -candle was on the table, which some one who saw him extinguished. He -immediately arose, and lighted it, although there was no occasion for his -doing so, as the room was well lit with other candles.[118] These he had -not observed, but was only cognizant of the one which he probably did not -see, but which was in relation with him through some more subtle channel. - -Many somnambulists are known to have acted as though they saw in rooms -which were perfectly dark. A gentleman informs me that his wife frequently -walks in her sleep, and performs many somnambulic acts in entire darkness. -On one occasion she went into a dark closet, and, opening a trunk, began -to arrange the contents. It contained clothing of various kinds, which had -been put into it the day before without being sorted. She classified all -the articles, such as stockings, handkerchiefs, shirts, etc., without -making a single mistake--and without the possibility of being assisted by -light sufficient for ordinary eyesight. - -Bertrand[119] refers to the case of a young lady who was accustomed to -rise from her bed in a state of somnambulism and to write in complete -darkness. A remarkable feature of this instance was, that if the least -light, even that of the moon, entered the room, she was unable to write. -She could only do so in the most perfect obscurity. - -In the case of the young lady, the particulars of which, with my -experiments, I have related, the sense of sight was certainly not -employed, nor were the other senses awake to ordinary excitations. - -On the other hand, it is evident that some somnambulists make use of their -eyes and their other organs of sense in the ordinary way, when the -excitations made upon them are in relation with the train of thought or -ecstatic condition which prevails. - -Macario,[120] in reference to this point, says: - -"Somnambulists are insensible to external impressions, except those which -are in relation with their ideas, their thoughts, and their feelings. It -is thus that persons, the subjects of somnambulism, will pass before -objects or individuals without seeing them, although they may have their -eyes open. This phenomenon occurs often to individuals who are fully -awake, although in a less degree. Thus when we are strongly preoccupied -with any subject, the objects which surround us make no impression on our -senses or our mind. Archimedes while meditating on a discovery, was an -entire stranger to all that was going on around him. A part only of his -brain was awake and active. While thus engaged, Syracuse was taken by the -enemy, and he was not diverted from his thoughts either by the chant of -victory by the conqueror, or by the cries and groans of the wounded and -the dying." - -As regards the sense of hearing, it is doubtless true that somnambulists -rarely exercise it. There have been cases in which replies have been made -to questions; but such answers have been given automatically, and not as -if the mind took cognizance of the subject. A person intently engaged in -reading, will often answer questions without suffering his train of -thought to be interrupted. When he has ceased his study, he is surprised -when told that he has been conversing. - -The sense of taste appears to be very inactive in general, though in a few -cases it has been manifested. The same is true in even a greater degree -with the sense of smell. - -The sense of touch is very differently affected, for so far from being -diminished in its action, it is invariably unduly exalted. Though the eyes -do not see, the ears hear, the tongue taste, or the nose smell, the -somnambulist has one sense which is fully awake, and by which he is -enabled to guide himself through the most devious passages in dangerous -paths. - -In this fact it appears to me we have a strong argument in favor of the -theory of somnambulism which I have already referred to, and which appears -to me to be supported by much additional evidence. I propose this view not -without hesitation; but much study of the phenomena of somnambulism, and -of analogous states of the nervous system, has certainly tended to -convince me of its general correctness, and I am not without the hope that -other students of neurology will find it reconcilable with their -observations and experiments. - -In my opinion, somnambulism is a condition of the organism in which -through profound sleep the action of the encephalic ganglia is so -materially lessened that the spinal cord becomes able to control and -direct the body in its movements. - -That the spinal cord even in the waking state constantly exercises this -power, is a matter of common observation. I have already alluded to some -of the facts which establish this proposition; but, for the purpose of -giving as complete and connected a view as possible of all the points -which bear upon the theory of somnambulism above enunciated, I shall not -hesitate to recall them to the recollection of the reader, and to bring -forward other circumstances which appear to be in relation with the -question. - -If an individual engaged in reading a book allows his mind to be diverted -to some other subject than that of which he is reading, he continues to -see the words, which make no impression upon his brain, and he turns over -the leaf whenever he reaches the bottom of a page with as much regularity -as though he comprehended every word he has read. He suddenly, perhaps, -brings back his mind to the subject of his book, and then he finds that -he has perused several pages without having received the slightest idea of -their contents. - -Again: when, for instance, we are walking in the street and thinking of -some engrossing circumstance, we turn the right corners and find ourselves -where we intended to go, without being able to recall any events connected -with the act of getting there. - -In such instances as these--and many others might be adduced--the brain -has been occupied with a train of thought so deeply that it has taken no -cognizance or superintendence of the actions of the body. The spinal cord -has received the several sensorial impressions, and has furnished the -nervous force necessary to the performance of the various physical acts -concerned in turning over the leaves, avoiding obstacles, taking the right -route, and stopping in front of the right door. - -All cases of what are called "absence of mind" belong to the same -category. Here the brain is completely preoccupied with a subject of -absorbing interest, and does not take cognizance of the events which are -transpiring around. An individual, for instance, is engaged in solving an -abstruse mathematical problem. The whole power of the brain is taken up in -this labor, and is not diverted by circumstances of minor importance. -Whatever actions these circumstances may require, are performed through -the force originating in the spinal cord. - -The phenomena of reverie are similar in some respects to those of -somnambulism. In this condition the mind pursues a train of reasoning -often of the most fanciful character, but yet so abstract and intense, -that though actions may be performed by the body, they have no relation -with the current of thought, but are essentially automatic, and made in -obedience to sensorial impressions which are not perceived by the brain. -Thus a person in a state of reverie will answer questions, obey commands -involving a good deal of muscular action, and perform other complex acts, -without disturbing the connection of his ideas. When the state of mental -occupation has disappeared, there is no recollection of the acts which may -have been performed. Memory resides in the brain and can only take -cognizance of those things which make an impression on the mind, or of -those ideas which originate in the encephalon. - -In the case of a person performing on a piano, and at the same time -carrying on a conversation, we have a most striking illustration of the -diverse though harmonious action of the brain and spinal cord. Here the -mind is engaged with ideas, and the spinal cord directs the manipulations -necessary to the proper rendering of the musical composition. A person who -is not proficient in the use of this instrument, cannot at the same time -play and converse with ease, because the spinal cord has not yet acquired -a sufficient degree of automatism, and the mind cannot be divided in its -action. - -Darwin gives a very striking example of the independent action of the -brain and spinal cord. A young lady was playing on the piano a very -difficult musical composition, which she performed with great skill and -care, though she was observed to be agitated and preoccupied. When she had -finished, she burst into tears. She had been intently watching the -death-struggles of a favorite bird. Though her brain was thus absorbed, -the spinal cord had not been diverted from the office of carrying on the -muscular and automatic actions required by her musical performance. - -The brain cannot entertain two ideas or initiate two acts at the same -time. A person cannot, for example, think of a lamp and a book -simultaneously; the thought of the one and the thought of the other will -be found to alternate by any one who feels inclined to make the -experiment, and not to exist at the same time. Neither can the brain think -and simultaneously will. Whatever volitional acts it performs, are -distinct from thought, and clearly separated from it by the element of -time. - -Now in all sleep there is more or less somnambulism, because the brain, -according as the sleep is more or less profound, is more or less removed -from the sphere of action. If this quiescent state of the brain is -accompanied, as it frequently is in nervous and excitable persons, by an -exalted condition of the spinal cord, we have the higher order of -somnambulic phenomena produced, such as walking and the performance of -complex and apparently systematic movements; if the sleep of the brain be -somewhat less profound, and the spinal cord less excitable, the -somnambulic manifestations do not extend beyond sleep-talking; a still -less degree of cerebral inaction and spinal irritability produces simply a -restless sleep and a little muttering; and when the sleep is perfectly -natural, and the nervous system of the individual well balanced, the -movements do not extend beyond changing the position of the head and limbs -and turning over in bed. - -As regards the power of the spinal cord to supply the nervous force -requisite for the performance of such actions as those specified, I do not -think there can be any question. Much observation and many experiments -have convinced me that the importance of the spinal cord as a center of -intellection and volition has been unwarrantably ignored. It is of course -not a matter for doubt that the faculty of consciousness is latent in the -spinal cord so long as the brain is in a state of activity, and that the -faculty of memory does not reside in it at all. When the brain acts, it -ordinarily assumes the control of the cord; but there are times, -especially during the course of certain diseases, when the latter obtains -the mastery over the superior organ and dominates with terrible power. - -The actions initiated by the spinal cord are more or less automatic in -their character--though not altogether so. The motions of a frog deprived -of its brain, show a certain amount of intellection and volition. That -they are not more extensive is probably due to the fact that all the -organs of the senses, except that of touch, have been removed with the -brain. In persons engaged in intense thought and performing actions not in -accordance therewith, the impressions made upon the organs of the senses -are not appreciated by the brain, but pass through its substance to the -spinal cord with which they are in connection by continuity of structure, -and which initiates the subsequent actions. - -In the somnambulic individual the brain is still more incapable of -receiving sensorial impressions. Whatever sense is therefore exercised -during the condition of somnambulism, owes its activity to the spinal -cord; but in most cases of the state in question, the brain is so -profoundly asleep that it does not even transmit impressions to the cord, -and hence there are no sensations at all, except that of touch, unless the -irritations capable of exciting them are extraordinarily great. - -In artificial somnambulism--the hypnotism of Braid--the spinal cord -acquires a very high degree of susceptibility to sensorial impressions, -and the brain is even more incapable than in natural somnambulism of -asserting its superiority. But the consideration of this interesting -branch of the subject does not enter into the plan of the present work. - -The _causes_ of somnambulism are generally to be found inherent in the -organism of the individual, though they may be excited to activity by -many circumstances which are capable of exhausting the nervous system or -producing emotional disturbance. Young persons are more subject than those -of maturer age, and there are few children who do not exhibit at some time -or other manifestations of the condition in question, such as muttering -and talking in their sleep, laughing, crying, or getting out of bed. -Persons of the nervous temperament are those most liable to be affected. -In four cases of chorea which have come under my care, the subjects were -sleep-walkers in their youth, and the young lady whose case I have related -was choreic at the time. - -In regard to the _treatment_ there is not much to be said. In the great -majority of cases the affection yields readily to appropriate measures; -the most efficacious of which consists in means adapted to break up the -habit. This may be done by waking the patient before the expected -paroxysm, or by placing a tub of cold water so that the feet will be put -into it on the attempt to leave the bed. Full exercise in the open air, -the avoidance of luxurious habits, and sleeping with the head well raised, -are always beneficial. - -Of medicines, I have no experience except with the bromide of potassium, -and those calculated to improve the tone of the nervous system. The former -I have used in two cases with entire success. One of them was that of the -young lady, the details of whose case I have related; the other that of a -gentleman, forty years of age, who became somnambulic from mental -excitement, due to the extensive business operations in which he was -engaged. Large doses of this remedy--forty to sixty grains taken at -bedtime, and smaller doses, ten to thirty grains, taken twice through the -day--broke up the habit entirely in a few weeks. Among the other remedies, -I have employed phosphorus, strychnia, and iron with manifest advantage. -Cold baths are generally useful. I am acquainted with a young lady who -cured herself by taking a cold bath every night just before going to bed. -The so-called antispasmodics can scarcely be useful. - -Much may be done also by suitable mental training. The reading of exciting -fictions, and the witnessing of sensational theatrical exhibitions, are -always prejudicial to persons subject to attacks of somnambulism. - - - - -CHAPTER VIII. - -THE PATHOLOGY OF WAKEFULNESS. - - -As nations advance in civilization and refinement, affections of the -nervous system become more frequent, because progress in these directions -is necessarily accompanied by an increase in the wear and tear of those -organs through which perceptions are received and emotions excited; and, -in addition, the mode of life, as regards food, clothing, occupation, and -habits, is being constantly removed farther from that standard which a -regard for hygienic considerations would establish as most advantageous. -If, as we have every reason to believe, each thought involves the -destruction of a certain amount of nervous tissue, we can very well -understand why, as we go forward in enlightenment and in all the elements -of material and intellectual progress, we are at the same time, unless we -also advance in the knowledge of the laws of our being, hurrying ourselves -with rapid strides to a state of existence in which there is neither waste -nor repair. - -I am far, however, from desiring to be understood as intimating that a -high state of civilization is antagonistic to long life or health. What is -lost in these directions as regards the nervous system is more than made -up by the increased provision afforded for comfort in other ways. But -while we have improved the hygienic condition of our cities and dwellings; -while we as a rule clothe our bodies according to the principles of -sanitary science and common sense; and while cleanliness of person has -become the rule, and filthiness the exception, we have made little or no -progress in the hygienic management of those organs which place us in -relation with the world, and a healthy condition of which is so essential -to our happiness. - -Among the many derangements in the normal operation of the nervous system, -induced by irregular or excessive cerebral action, those which relate to -the function of sleep are certainly not the least in importance, whether -regard be had to the actual comfort of the individual or to the serious -consequences to which they may give rise. To the consideration of some of -these morbid conditions I propose to devote the remainder of the present -volume, and first to inquire into the most important of them, wakefulness -or insomnia. - -As a symptom of various diseases which affect the human organism, -wakefulness is sufficiently well recognized by systematic writers on the -practice of medicine, though, even here, it is very certain that its -pathology has seldom been clearly made out. As a functional disorder of -the brain, arising from inordinate mental activity, it has received -scarcely any notice. This neglect has, doubtless, been in a great measure -due to the fact that it is only within late years that the condition in -question has become so common as to attract much attention. At present -there are, probably, but few physicians engaged in extensive practice in -any of our large cities who do not in the course of the year meet with -several cases of obstinate wakefulness, unaccompanied, in the early stages -at least, by any other prominent disorder of the system. - -In my opinion, no one cause is so productive of cerebral affections as -persistent wakefulness, for not only is the brain prevented from obtaining -rest, but it is kept in a state of erethism, which, if not relieved, must -sooner or later end in organic disease. Southey laid the seeds of that -disorder which terminated in the loss of his intellect, by watching at the -bedside of his sick wife during the night, after the excessive literary -labors of the day.[121] Newton's mind also suffered in the later years of -his life through deprivation of sleep;[122] and Dr. Forbes Winslow, in -remarking on Southey's case, says: "No brain can remain in permanent -health that has been overtasked by nightly vigils still more than by daily -labor."[123] - -Renaudin,[124] in a very philosophical essay, calls attention to the fact -that persistent wakefulness is sooner or later followed by insanity; and -Maury[125] states his opinion to the same effect. The remarks of Dr. -Ray[126] upon this subject are so apposite that I reproduce them in part, -commending at the same time the little book from which they are taken to -the attention of the reader. - -"A periodical renewal of the nervous energies as often as once a day is an -institution of nature, none the less necessary to the well-being of the -animal economy, because in some degree under the control of the will. To -disregard its requirements with impunity is no more possible than it is to -violate any other organic law with impunity, and no man need flatter -himself that he may systematically intrench upon the hours usually devoted -to rest and still retain the freshness and elasticity of his faculties. -With the same kindliness that marks all the arrangements of the animal -economy, this condition is attended with many pleasing sensations and -salutary effects, gently alluring us to seek the renovation which it -offers. 'While I am asleep,' says the immortal Sancho Panza, 'I have -neither fear nor hope; neither trouble nor glory; and blessings on him -who invented sleep,--the mantle that covers all human thoughts; the food -that appeases hunger; the drink that quenches thirst; the fire that warms; -the cold that moderates heat; and, lastly, the general coin that purchases -all things; the balance and weight that make the shepherd equal to the -king and the simple to the wise.' The ill effects of insufficient sleep -may be witnessed on some of the principal organic functions, but it is the -brain and nervous system that suffer chiefly and in the first instance. -The consequences of a too protracted vigil are too well known to be -mistaken, and many a person is suffering, unconscious of the cause, from -the habit of irregular and insufficient sleep. One of its most common -effects is a degree of nervous irritability and peevishness, which even -the happiest self-discipline can scarcely control. That buoyancy of the -feelings, that cheerful, hopeful, trusting temper that springs far more -from organic conditions than from mature and definite convictions, give -way to a spirit of dissatisfaction and dejection; while the even demeanor, -the measured activity, are replaced either by a lassitude that renders any -exertion painful, or an impatience and restlessness not very conducive to -happiness. Upon the intellectual powers the mischief is still more -serious. They not only lose that healthy activity which combines and -regulates their movements in the happiest manner, but they are no longer -capable of movements, once perfectly easy. The conceptions cease to be -clear and well defined, the power of endurance is weakened, inward -perceptions are confounded with outward unhappiness, and illusory images -obtrude themselves unbidden upon the mind. This kind of disturbance may -pass sooner or later into actual insanity, and many a noble spirit has -been utterly prostrated by habitual loss of rest." - -CASE I.--Some years ago a case similar in several respects to that of -Southey came under my observation. A gentleman of superior mind and of -great powers of application spent from sixteen to eighteen hours each day -in severe literary labor. This of itself would have been a heavy strain to -most persons, but he went regularly to bed and slept soundly six hours -each night, and it is possible that he might have continued this mode of -life for several years without serious inconvenience, when his wife was -suddenly taken ill. His anxiety on her account was very great, and he -spent nearly the whole night by her bedside, sleeping only for about an -hour toward morning. After three weeks passed in this manner, his wife was -pronounced out of danger, but he found it impossible to resume his former -habits. He could neither study nor sleep. The nights were passed in -walking the floor of his chamber or in tossing restlessly on his bed. -There were no pain, no fever, no disorder of any other organ. There was -nothing but ceaseless activity of the mind and an utter inability to -sleep. Stimulants and narcotics only increased the violence of his -symptoms, and every other means employed failed to give relief. The danger -of his situation was pointed out to him and travel recommended. He -followed the advice, and though it was several months before he was -completely relieved, his condition began at once to improve. He was taught -a lesson which has not been without influence, in causing him to task his -mental faculties less severely. - -CASE II.--Another, an intimate friend, who occupied an important public -position, gave so much time and attention to his duties, which were of a -highly laborious character, that he deprived himself of the amount of -sleep to which he had previously been accustomed. It was rarely the case -that he got to bed before two or three o'clock in the morning, and then an -hour or two was always occupied in active intellection. The consequence -was that he finally broke down through want of the mental repose so -essential to him. Inflammation of the brain ensued, and this terminated in -acute insanity, from which he died. - -It would be easy to bring forward other instances of which I am perfectly -cognizant, or which have been cited by authors in illustration of the -point in question, but it is scarcely necessary to enlarge further upon -this portion of the subject. We should be careful, however, not to mistake -the effect for the cause, an error which is often committed in this as -well as in other matters. It is well known that many cases of insanity are -marked in the early stages by persistent insomnia. Doubtless this is -frequently a consequence of the morbid action already set up in the brain; -but much observation has satisfied me that it is more often the cause of -the cerebral aberration, and that by proper medical treatment the mental -excitement may be generally allayed. Certainly the means most commonly -resorted to in such instances are adopted without the full consideration -so imperatively necessary, and consequently are fully as liable to -increase as to lessen the disturbance. - -We cannot employ too much care in doing everything in our power to prevent -the occurrence of those slight attacks of cerebral congestion, which, -though perhaps scarcely observable at the time, are yet fraught with very -serious consequences. Persons have had their whole characters changed by -an apparently trifling interference with the circulation of blood in the -head. A person of my acquaintance was naturally of good disposition, -amiable in his character, and considerate in his dealings with others; but -after an attack of vertigo, attended with unconsciousness of but a few -moments' duration, his whole mental organization underwent a radical -change. He became deceitful, morose, and exceedingly overbearing and -tyrannical toward all with whom he came in contact, and whom it was safe -for him to maltreat. Tuke and Bucknill[127] refer to the case of a lady -whose character had always been distinguished for conscientiousness, whose -religious education had been of a somber kind, and who, suffering under an -attack of small-pox attended with congestion of the brain, recovered, with -the natural bent of her disposition greatly exaggerated. The irritability -of conscience had become an actual disease, destroying the happiness of -the individual and rendering her incompetent to discharge any of the -duties of life. The same authors also mention the instance of a -distinguished admiral who had always been remarkable for pride and -liability to passionate anger, becoming the subject of cerebral -excitement, loss of sleep, and general feverishness consequent upon the -chagrin caused by a supposed neglect by the government. - -In primary insomnia there is always an increase in the quantity of blood -circulating in the brain. This is either absolute or relative. The former -is the case when there has been no exhausting disease, hemorrhage, or -other debilitating influence in operation, and while, though general good -health exists, the amount of blood in the cranium is augmented; the -latter, when from any cause the system has become reduced, and when, while -this condition prevails, a temporary activity takes place in the cerebral -circulation. The first may properly be called active, the latter passive -insomnia. In the one there is more blood in the brain than is normally -present; in the other, though there may be less blood than in health, the -quantity is increased over the amount to which the brain has in a measure -accustomed itself. - -Thus if we suppose the cerebral vessels of a healthy brain to contain -ordinarily a pint of blood, and the amount to be increased to a pint and a -half, and continued at this standard for several consecutive days, a state -of active insomnia ensues. If, on the other hand, this pint should be -reduced to a gill by any cause producing general debility, such as -hemorrhage, starvation, or disease, and then by some exciting mental -emotion, the excessive use of alcoholic liquors, or other influence acting -for a considerable period, be increased to half a pint, a condition of -passive insomnia would be produced--the latter condition resulting not -from a disturbance of the normal relation existing between the _intra_ and -_extra_ cranial blood, but of that which has been established by morbific -causes, and to which the organism has become habituated. - -CASE III.--The following is a good example of the active form of morbid -wakefulness: - -A short time since a gentleman was under my charge in whose case the only -deviation from health which could be perceived was an utter inability to -sleep. Being by profession a broker, and passing his days, and a great -portion of his nights, in the stock and gold rooms, during a period of -great financial excitement, his brain had been kept so continually in a -state of intense action that it was impossible for him, when he went to -bed, to compose his mind so as to allow of sleep ensuing. Thoughts similar -to those which were excited during his business operations were in full -flow, notwithstanding all his efforts to banish them. Calculations were -entered into, and speculations were constantly being formed with as great -or even greater facility than during the day. Many of the latter were of -the most extravagant character, a fact of which he was fully aware at the -time, but he nevertheless found it impossible to refrain from indulging in -them. All his other functions were performed with regularity. His appetite -was good, he took a not inconsiderable amount of exercise, and he -committed no excesses of any kind except as regarded his brain. When I -first saw him he had not slept for six nights, although he had taken large -quantities of brandy, morphine, and laudanum; but beyond a slight feeling -of confusion in his mind at times, and a little pain in his eyeballs, he -experienced no unpleasant sensations during the day. As soon, however, as -his head touched the pillow, and he tried to get to sleep, a feeling of -the most intense uneasiness came over him, while at the same time his face -and ears became hot and flushed. His mental faculties were roused into -increased action; he tossed restlessly from one side of the bed to the -other, and by the time morning came he was thoroughly exhausted, mentally -and physically. A cold bath and a breakfast of two large cups of coffee, -beefsteak and eggs, set him up for the balance of the day, till he retired -to bed, when the phenomena of the previous night would be repeated. - -In this case I conceived that the blood-vessels of the brain, from -overdistention, had lost, in a great measure, their contractile power, and -that a larger quantity of blood was, in consequence, circulating within -the cranium than was normal. The vessels were therefore in a condition -very similar to that of a bladder in which, from the desire to urinate -having been too long resisted, contraction cannot be induced even by the -most strenuous exertion of the will. As the gentleman was of strong, -athletic build, and otherwise in full health, blood-letting would -undoubtedly have proved of great service; but, for reasons which will -appear hereafter, I determined to try a remedy less likely to do harm, and -fully as capable of doing good. I administered thirty grains of the -bromide of potassium at six o'clock in the evening, and repeated the dose -at ten, directing him to go to bed half an hour subsequently. The first -dose produced a decided sedative action, and the second was still more -effectual in calming the mental excitement. When he lay down, his mind was -not disturbed by a flow of thoughts, and he fell almost unconsciously into -a quiet sleep, from which he did not awake till near seven o'clock the -following morning. There were no unpleasant symptoms of any kind; on the -contrary, he felt strengthened and refreshed. The next night one dose was -administered at about bedtime, which was also followed by a sound and -invigorating sleep. No further treatment was given, as on the following -night sleep came naturally. - -Sir Benjamin Brodie,[128] without, however, making the distinction I have -insisted upon, refers to the active or sthenic type of wakefulness in the -following quotations from a little work which should be in the hands of -all who are interested in the philosophy of the mind. - -Speaking of the causes of the wakefulness of some persons, he says: "At -the same time there is no doubt that there is sometimes a morbid condition -of the nervous system, the nature of which we cannot well explain, which -is incompatible with sleep. The patient says, 'I feel fatigued and wearied -and want to go to sleep, but I cannot sleep.'" - -In asserting as he does that this kind of wakefulness is sometimes the -forerunner of mental derangement, Sir Benjamin is supported by many cases -detailed by authors on psychological medicine, and the following, which he -gives,[129] is directly to the point: - -"A gentleman of my acquaintance in whose family circumstances had occurred -which were to him sources of intense anxiety, passed six entire days and -nights without sleep. At the end of this time he became affected with -illusions of such a nature that it was necessary to place him in -confinement. After some time he recovered perfectly. He had never shown -any signs of mental derangement before, nor has any one of his family, and -he has never since been similarly affected. This was an extreme case. But -do not examples of the want of sleep, proving very similar results, though -in a very much less degree, occur under our observation constantly? How -altered is the state of mind in any one of us after even two sleepless -nights! Many a person who under ordinary circumstances is cheerful and -unsuspicious, becomes not only irritable and peevish, but also labors -under actual, though transitory, illusions; such, for example, as thinking -that others neglect him or affront him who have not the smallest intention -of doing either the one or the other." - -Cases similar to the following, which is one of the passive variety of -wakefulness, are by no means uncommon. - -CASE IV.--A lady, aged about thirty-five, unmarried, and of rather -delicate constitution, consulted me in regard to persistent wakefulness, -with which she had been affected for nearly a month. According to the -account which she gave me, she had received a severe mental shock, which -had not lost its influence when a subject of great anxiety was forced upon -her consideration. Her menstrual period, which had been due about ten days -before she came under my notice, had been anticipated by a week, and the -flow was prolonged much above the ordinary time. She had, therefore, lost -a good deal of blood, and was, in consequence, greatly reduced in -strength. This, conjoined with the exhaustion due to the long-continued -wakefulness, rendered her condition a much more serious one than would -otherwise have been the case. - -She had taken large doses of laudanum, of ether, and of valerian, together -with many other medicines, the names of which I do not now recollect, -besides employing a variety of means of traditional efficacy. All had, -however, been useless. Homoeopathy was then tried with an equal want of -success. When I first saw her she was nervous and irritable, her hands -trembled violently upon the slightest exertion of their muscles, her eyes -were bloodshot, the pupils contracted, and the lids opened to the widest -possible extent. There was a constant buzzing in the ears, and the sense -of hearing was much more acute than was natural. There was also increased -sensibility of all that portion of the surface of the body (the skin of -the hands, arms, legs, back, and breast) which I submitted to examination -with the æsthesiometer. Her pulse was 98, irritable, small, and weak. - -At night all her symptoms were increased in violence. Her mind was filled -with the most grotesque images which it was possible for the imagination -to conceive, and with trains of ideas of the most exaggerated and -improbable character. These succeeded each other with a regularity so well -marked that she was able to foresee the routine night after night. "No -one," she said, "can imagine the weariness I feel, or the horror with -which I look forward to the long rows of too-familiar phantoms and -thoughts which I know will visit me before morning. There is one set," she -continued, "which always comes as the clock strikes two. No matter what -may be passing through my mind it is banished by this. It consists of a -woman with very long hair, who sits on a rock by the sea-side, with her -face buried in her hands. Presently a man armed with a long sword comes up -behind her, and, clutching her by the hair, drags her to the ground. He -puts his knee on her breast, and still holding her hair, cuts it off, and -binds her with it, hand and foot. He then commences to pile stones on her, -and continues to do so till she is entirely covered, notwithstanding her -piercing shrieks, which I hear as distinctly as I do real sounds. Turning -then to the sea he cries out, 'Julia, you are avenged. My vow is -accomplished. Come! come!' He then draws a dagger from his breast and -stabs himself to the heart. He falls over the pile of stones he has -raised, and instantly hundreds of little devils not more than a foot high -swarm around his body, and finally carry it off through the air. My horror -at all this is extreme. For more than an hour the scene is passing before -me, and though I know it is all purely imaginary, I cannot shake off the -terror it induces." - -I questioned this lady closely, and found that she was very intelligent, -and fully sensible of the unreality of all her visions. There was no -evidence whatever of the slightest tendency to insanity, but there was a -condition present which would surely terminate in the loss of her reason -if not quickly removed. I regarded her symptoms as indicating a state of -passive cerebral congestion, and as calling for stimulants rather than -what are called sedatives. I directed, therefore, that she should take an -ounce of whisky, properly diluted, every hour, commencing six hours before -bedtime; that she should immerse her whole body except her head in water, -at the temperature of 98° F., for half an hour just before retiring for -the night, and, instead of lying down, should sit up in an easy chair and -try to sleep in that position. - -I administered the whisky upon the same principle that governs us when we -apply stimulating lotions to an inflamed eye, or give alcoholic liquors in -passive congestions of other parts of the body. The warm bath was -prescribed with a view to its dilating action upon the blood-vessels -exposed to its influence; and the sitting position with the object of -facilitating the flow of blood from the head, and impeding its return -through the carotids and vertebrals. - -All these measures I had employed previously with success, in many cases -of inability to sleep due to delirium tremens, and which is almost always -of the passive or asthenic form. In the instance under consideration their -action was all that could be desired. At ten o'clock, having taken the -whisky and bath as directed, she sat down to sleep in a comfortable -chair, and, as her mother informed me, was asleep in less than half an -hour. She awoke about three o'clock, but soon fell asleep again after -another dose of whisky, and remained in this condition till about nine -o'clock in the morning. She then took breakfast, feeling very much -refreshed, but was unable to remain awake longer than two or three hours, -but, taking to her chair, slept soundly till evening. That night she was -again overcome with sleep, and it was passed very much as was the previous -one. No further medicine was required, and after a few nights she went to -bed as had been her custom, and slept soundly till morning. Under the use -of iron and lager beer she recovered her health and strength. - -The foregoing cases are given as examples of the two forms of morbid -wakefulness or insomnia to which I wish to call attention. They show that, -though the cause in each variety may be essentially the same, the means of -relief are not altogether identical. It is important, therefore, to -discriminate between them. But the main point upon which it is necessary -to insist is, that in morbid wakefulness, whether occurring in strong or -weak persons, there is always an excessive amount of blood circulating -through the substance of the brain. In the course of the discussion of the -points involved in the physiology of sleep, this subject was incidentally -noticed. In the following chapter, however, it will be dwelt upon with -more particularity. - - - - -CHAPTER IX. - -THE EXCITING CAUSES OF WAKEFULNESS. - - -Every cause capable of increasing the amount of blood ordinarily -circulating through the brain may give rise to wakefulness. As these -causes are more or less under the control of the individual, it is -important that they should be fully considered. - -An increased amount of blood is attracted to the brain, and wakefulness is -produced: - -1st. _By long-continued or excessive intellectual action, or any powerful -emotion of the mind._--Every organ of the body, the condition of which -admits of being ascertained by ocular examination, invariably contains -more blood in its tissues when in a state of activity than when its -functions are temporarily suspended. We are hence, _a priori_, justified -in assuming that the law is equally applicable to the brain, but we are -not forced to rely entirely upon reasoning from analogy. It has been shown -already that during sleep the circulation of blood within the cranium is -at its minimum, both as regards quantity and rapidity, and that as soon as -the individual awakes there is an immediate afflux of this fluid to the -cerebral tissues. All of us are familiar with the facts that, during -severe mental labor, or while under the influence of some exciting -emotion, the vessels of the head and neck become distended, the head feels -full, the face is flushed, and the perspiration of the parts in question -is increased in quantity. Within certain limits the more blood there is in -the brain the more actively its functions are performed, and so well known -is this fact that some persons, who require to exercise the several -faculties of the mind to an extreme degree, make use of stimulating -ingesta for the purpose of accomplishing the object in view. - -A moderate degree of cerebral activity is undoubtedly beneficial. Exercise -strengthens the mind and improves its faculties, if it is succeeded by a -proper period of repose, during which the vessels are emptied to some -extent of their contents, and are thus enabled to recover their tone. If, -however, the brain is often kept for long periods on the stretch, during -which the vessels are filled to repletion, they cannot contract even when -the degree of cerebral activity is diminished. Wakefulness results as a -necessary consequence, and every day renders the condition of the -individual worse, because time also brings the force of habit into -operation. - -It is not to be denied, however, that many individuals are able to live in -comparative health for long periods with but little or no sleep. Thus it -is stated[130] that Boerhaave did not "close his eyes in sleep for a -period of _six_ weeks, in consequence of his brain being overwrought by -intense thought on a profound subject of study." Sir Gilbert Blane[131] -says he was informed by General Pichegru, that for a whole year, while -engaged in active campaign operations, he slept but one hour out of the -twenty-four. Such statements as these, however, and others to the same -effect which have been made, must be accepted with some allowance. Many -persons sleep unconsciously, and we all know how common it is for -individuals to deny having slept when we have been eye-witnesses of their -somnolency. I should consider it impossible for a person to enjoy good -health if deprived for even a few weeks of half his ordinary amount of -sleep; and it is very probable that Boerhaave's standard of health, never -high, was very much lowered by his protracted vigils. - -So long as the attention is kept fully aroused, the blood-vessels of the -brain are distended, and it is possible for an individual to remain awake -while this condition exists. When the attention begins to flag, the -tendency is for the vessels to contract, and for sleep to ensue. This -disposition may not, however, be strong enough to restore the full -measure of contractility to vessels that have been long overdistended, and -then insomnia results. - -To this increase in the amount of blood circulating in the brain, many -instances of hallucination have been due. It has already been shown that -strong mental emotions determine an augmented flow of blood to the -cerebral vessels, and cause the production of spectral illusions. In all -such cases there is a marked tendency to insomnia present. The account -given by Nicolai, a celebrated German bookseller of the last century, of -his own disorder, is so interesting and appropriate that I quote it in -full. It has never to my knowledge been published in this country. - -"During the ten latter months of the year 1790 I had experienced several -melancholy incidents which deeply affected me, particularly in September, -from which time I suffered an almost uninterrupted series of misfortunes -that affected me with the most poignant grief. I was accustomed to be bled -twice a year, and this had been done on the 9th of July but was omitted to -be repeated at the end of the year 1790. I had, in 1783, been suddenly -taken with a violent vertigo, which my physicians attributed to -obstructions in the fixed vessels of the abdomen brought on by a sedentary -life and a continual exertion of the mind. This indisposition was -successfully removed by means of a more strict diet. In the beginning I -had found the use of leeches applied to the arms particularly beneficial, -and they were afterward repeated two or three times annually when I felt -congestions in the head. The last leeches which had been put on previous -to the appearance of the phantasms of which I am about to speak, had been -applied on the 1st of March, 1790; less blood had consequently been -evacuated in 1790 than was usual with me, and from September I was -constantly occupied in business which required the most unremitted -exertions, and which was rendered still more perplexing by frequent -interruptions. - -"I had, in January and February of the year 1791, the additional -misfortune to experience several extremely unpleasant circumstances, which -were followed on the 24th of February by a most violent altercation. My -wife and another person came into my apartment in the morning in order to -console me, but I was too much agitated by a series of incidents which had -most powerfully affected my moral feelings to be capable of attending to -them. On a sudden I perceived, at about the distance of ten steps, a form -like that of a deceased person. I pointed at it, asking my wife if she did -not see it. It was natural that she should not see anything; my question, -therefore, alarmed her very much, and she sent immediately for a -physician. The phantom continued for about eight minutes. I grew at length -more calm, and being extremely exhausted, fell into a restless sleep which -lasted about half an hour. The physician ascribed the appearance to -violent mental emotion, and hoped there would be no return; but the -violent agitation of my mind had in some way disordered my nerves and -produced further consequences which deserve a more minute description. - -"At four in the afternoon the form which I had seen in the morning -reappeared. I was by myself when this happened, and being rather uneasy at -the incident, went to my wife's apartment, but there likewise I was -accompanied by the apparition, which, however, at intervals disappeared, -and always presented itself in a standing posture. About six o'clock there -appeared also several walking figures which had no connection with the -first. - -"After the first day the figure of the deceased person no longer appeared, -but its place was supplied by many other phantasms, sometimes representing -acquaintances, but mostly strangers. Those whom I knew were composed of -living and deceased persons, but the number of the latter was -comparatively small. I observed that the persons with whom I daily -conversed did not appear as phantasms, these representing chiefly persons -who lived at some distance from me. - -"These phantasms seemed equally clear and distinct at all times and under -all circumstances, both when I was by myself and when I was in company, -and as well in the day as at night, and in my own house as well as abroad; -they were, however, less frequent when I was in the house of a friend, and -rarely appeared to me in the street. When I shut my eyes these phantasms -would sometimes vanish entirely, though there were instances when I beheld -them with my eyes closed; yet when they disappeared on such occasions, -they generally returned when I opened my eyes. I conversed sometimes with -my physician and my wife of the phantasms which at the moment surrounded -me. They appeared more frequently walking than at rest, nor were they -constantly present. They frequently did not come for some time, but always -reappeared for a longer or shorter period, either singly or in company, -the latter, however, being most frequently the case. I generally saw human -forms of both sexes, but they usually seemed not to take the smallest -notice of each other, moving as in a market-place where all are eager to -pass through the avenue; at times, however, they seemed to be transacting -business with each other. I saw also several times people on horseback, -dogs and birds. All these phantasms appeared to me in their natural size, -and as distinct as if alive, exhibiting different shades of carnation in -the uncovered parts as well as different colors and fashions in their -dresses, though the colors seemed somewhat paler than in real nature. None -of the figures appeared particularly terrible, comical, or disgusting, -most of them being of an indifferent shape, and some presenting a pleasing -aspect. The longer these phantoms continued to visit me the more -frequently did they return, while at the same time they increased in -number. About four weeks after they had first appeared, I also began to -hear them talk. The phantoms sometimes conversed among themselves, but -more frequently addressed their discourse to me: their speeches were -commonly short and never of an unpleasant turn. At different times there -appeared to me both dear and sensible friends of both sexes, whose -addresses tended to appease my grief, which had not yet wholly subsided: -their consolatory speeches were in general addressed to me when I was -alone. Sometimes, however, I was accosted by these consoling friends while -I was engaged in company, and not unfrequently while real persons were -speaking to me. These consolatory addresses consisted sometimes of abrupt -phrases, and at other times they were regularly executed. - -"Though my mind and body were in a tolerable state of sanity all this -time, and these phantasms became so familiar to me that they did not cause -me the slightest uneasiness, and though I even sometimes amused myself -with surveying them, and spoke jocularly of them to my physician and my -wife, I yet did not neglect to use proper medicines, especially when they -began to haunt me the whole day and even at night, as soon as I waked. - -"At last it was agreed that leeches should be again applied to me as -formerly, which was actually done, April 20th, 1791, at eleven o'clock in -the morning. No person was with me besides the surgeon, but during the -operation my chamber was crowded with human phantasms of all -descriptions. This continued uninterruptedly till about half an hour after -four o'clock, just when my digestion commenced. I then perceived that they -began to move more slowly. Soon after their color began to fade, and at -seven o'clock they were entirely white. But they moved very little, though -the forms were as distinct as before, growing, however, by degrees more -obscure yet not fewer in number, as had generally been the case. The -phantoms did not withdraw, nor did they vanish, a circumstance which, -previous to that time, had frequently happened. They now seemed to -dissolve in the air, while fragments of some of them continued visible for -a considerable time. About eight o'clock the room was entirely cleared of -my fantastic visitors. - -"Since that time I have felt twice or three times a sensation as if these -phantasms were going to reappear, without, however, actually seeing -anything. The same sensation surprised me just before I drew up this -account, while I was examining some papers relative to these apparitions, -which I had drawn up in the year 1791." - -While it is doubtless true that variations in the amount of blood in the -brain are dependent upon nervous action, it is equally certain that this -latter is increased or lessened according as the brain is in a more or -less hyperæmic condition. These factors, therefore, react upon each other, -and consequently the resulting insomnia is more aggravated than would -otherwise be the case. - -Instances of insomnia dependent upon intense intellectual exertion have -already been given, but the following, which I extract from my note-book, -will not, I think, prove uninteresting or uninstructive: - -CASE V.--A gentleman, aged thirty-nine, unmarried, of correct habits, and -good general health, consulted me on the 19th of April, 1865, in reference -to a peculiar nervous affection with which he had suffered for several -months. He stated to me that, being engaged upon a literary labor of some -importance, he had given the greater part of his time to the studies -necessary to its being carried on with success, and was conscious of -having overtasked his mental powers. So great, however, was his ambition -to excel in his undertaking, that he had persevered notwithstanding the -admonitions of friends, and the still more pointed warnings he had -received from his own sensations. Instead of sleeping, as had been his -custom, from seven to eight hours, he rarely, for nearly a year, had slept -more than four hours out of the twenty-four, and frequently even less than -this. He did not, however, feel the want of sleep. In fact he was never -sleepy, and if this had been the only ill consequence of his severe -application I should probably not have had him under my charge at all, so -little weight did he attach to the condition which it was of the first -importance should be relieved. - -The symptom of disordered action which attracted his attention most was an -inability to concentrate his mind upon subjects about which he wished to -write. There was no difficulty in maintaining a connected line of -reasoning, except when he attempted to put his ideas on paper, and then he -found it utterly impossible to direct his thoughts in a methodical way. He -conversed with me very intelligently in reference to his case, and was -perfectly conscious of the difficulty under which he labored. As an -instance of the character of his disease, he said that the day before he -came to see me he had reflected to his entire satisfaction upon certain -points in literature which he was investigating, and that when he came to -read over what he had written he found it was a tissue of the most arrant -nonsense. The subject of his thoughts was the Greek drama, and the ideas -in reference to it, which he communicated to me, were in the highest -degree logical and interesting. He then showed me the first page of what -he had written, and though he was annoyed at the nonsensical strains of -his language, he could not at the same time conceal his amusement at its -utter absurdity. I quote a few lines from this paper. - -"The rise of the Greek drama is not to be associated with the Homeric age -of minstrelsy, nor to be discovered in the Cimmerian darkness of the -North. It rests upon a foundation far anterior to either. It is found in -the hearts of those men who look beyond a mere utilitarian idea, and who -are able to conceive of the existence of beauty without the disturbance -due to causes inseparably connected with the barbarism from which Greece -emerged into that mythical age which created a god for every river and -forest, and for every emotion of the heart or element of the mind. Lyric -poetry and philosophy may claim the precedence of antiquity, but the power -that could draw tears from eyes that had never before wept, or cause the -hardened lines of stoicism to relax in smiles, is not to be despised or -even elevated upon a pinnacle of greatness." - -At the time of writing, his thoughts flowed so rapidly that he was not -conscious of the disconnected nature of his composition. If he stopped, -however, to read it over, he at once saw how thoroughly it misrepresented -his conceptions. No matter what the subject, the same thing happened, and -even the most trivial notes could not be written without language being -used which was either perfectly without relation to the ideas he wished to -communicate, or else in direct opposition to them. For instance, wishing -to obtain a book from a friend, he found he had written the prayer of -Socrates which concludes the Phædrus of Plato. On another occasion, -intending to indite an epistle to a lady who had sent him a volume of her -poems, he discovered, when half through his letter, that he had requested -her to accept one of his own books, and had then gone on to give his views -relative to suicide and matrimony. - -Upon questioning him, I ascertained that he went to bed generally about -two o'clock in the morning; that he lay awake for an hour at least, during -which his mind was exceedingly active; and that he rose between six and -seven, took a sponge-bath, and ate a light breakfast. He then went to -work, spending the day in reading, and in dictating to his sister, who -wrote out his language _verbatim_. At six o'clock he dined plainly, and -then again resumed his labors. He drank neither tea, coffee, nor any -alcoholic liquor. Occasionally he took a cup of chocolate at breakfast. - -The only indications of a disordered system other than those I have -mentioned were, that his pulse was too frequent (104), that it was -irritable and irregular; that he had had several attacks of slight vertigo -and headache; that his eyes were brilliant and somewhat congested, and -that pressure upon the closed lids caused considerable pain. His bowels, -contrary to what might have been reasonably expected, were regular, and -his appetite was generally good. His urine contained an excess of urea and -of phosphates; oxalate of lime was also present. There was nothing in his -condition which appeared to give him the least anxiety, beyond the -impossibility of controlling his thoughts when writing, and this he -attributed directly to overexertion of his mental powers. He had, however, -tried the effect of suspending his studies for two or three weeks, but had -not perceived that any benefit was derived from this procedure. He had, -therefore, returned to his occupations. - -I told him very plainly that, unless he was prepared to forego his -literary labors for several weeks at least, he would be in great danger of -permanent injury to his mind; but that with the avoidance of severe mental -exertion, and by the aid of other measures, I believed he could be -restored. He demurred somewhat to the first condition, but finally -promised to follow my advice implicitly. - -Although I was unable to explain the fact that mental aberration should -only be manifested when he wrote, I was confident that his condition was -clearly the result of intense hyperæmia of the brain, and that if this -could be dissipated, and sound, regular, and sufficient sleep be produced, -the mental trouble would also vanish. I therefore directed that half a -dozen dry cups should be applied to the nape of the neck every evening, -that he should take a warm bath directly afterward, and that, while in the -bath, cold water should be poured on his head. Instead of lying down when -he attempted to sleep, I advised that he should assume the sitting -posture, supporting his head on a hair pillow. All literary labor was to -cease. Instead of the books he was in the habit of studying, he was to -read novels. He was to compose himself for sleep at eleven o'clock at -night, and was to rise punctually at seven; take his sponge-bath as usual, -and, after eating a moderate breakfast, to do anything he liked, except -studying or writing, till twelve o'clock, when he was to take a walk for -an hour, then eat a biscuit, read light literature till four, and then -ride on horseback till six, at which hour he was to dine, simply, but to -the extent his appetite prompted him. He had been in the habit of smoking -one cigar a day (after dinner), and I allowed him to continue in this -indulgence. - -I am thus particular in stating my instructions, because I determined to -see what could be done by hygienic measures, and others directed to the -relief of the supposed cerebral congestion, without resorting to the use -of drugs, so long as it was probable they would not be required. Opium and -other medicines of the narcotic class would, I was satisfied, do more harm -than good; bromide of potassium I reserved for use, should it become -necessary to employ it. - -I have every reason to believe that he complied faithfully with the -directions given him, and ere long marks of decided improvement were -visible. His pulse had fallen to 80, was regular and full; there was no -more headache or vertigo; his eyes had lost their bloodshot appearance, -and above all, his sleep had become sound, and was of from seven to eight -hours' duration nightly. As soon as he got settled in his easy chair for -the night his eyelids began to close, and he slept steadily on till it was -time for him to get up for the day. Three weeks were necessary to bring -about these results in full, although amendment was manifested from the -first. Yesterday, May 18th, I wrote him a note, requesting his permission -to make use of his case in illustration of this memoir. The following is -his answer: it is the first time he has written a line for a month: - - "MY DEAR DOCTOR:--If, in your opinion, my case is possessed of any - value in a pathological point of view, I hope you will make such use - of it as will best serve the ends of science. I make only one - condition. You know I am a literary man, and that my reputation as a - student and author would suffer in the estimation of the critics were - I suspected of insanity. It takes very little to form a foundation for - such an assumption, and, perhaps, in my case, there would be more - truth than fiction in the notion as applied to me. With the exception, - therefore, of giving my name, you are at perfect liberty to dish me up - for the satisfaction of all your medical friends. - - "I shall come and see you to-morrow, and in the mean time believe me - ever, - - "Yours sincerely and gratefully, - "---- ---- ----." - - "P.S.--I have read the above over, and to my great delight find that I - have said what I wanted to say. I would stand on my head with joy, - were it not that you were desirous of keeping as much blood out of my - noddle as possible. _Laus Deo._ Can I go to work Monday?" - -I had no intention of letting him "go to work" on Monday, or for at least -two weeks subsequently. I was of the opinion, however, that after that -time he could resume his labors to a slight extent, and gradually extend -them--not to the limit they formerly reached, but to that degree which, -while they would add to his reputation as a man of learning, would not -exhaust the organ which it was so essential for his objects to preserve in -a condition of unimpaired vigor. The result has been all that either he or -myself could have desired. - -CASE VI.--A youth of fifteen was brought to me by his father, on the 16th -of August, to be treated for obstinate wakefulness, the consequence of -severe mental exertion at school several weeks previously. He had not -attended school since the last of June, but had scarcely slept more than -an hour or two each night since that time, according to his own and his -father's statement. He was a healthy, well-grown lad, with a good -appetite, and nothing unusual in his appearance beyond a slight look of -weariness and anxiety in his face. During the day there were no -hallucinations of any kind, and toward evening he invariably felt -overpowered with sleep. As soon, however, as he lay down he heard voices -repeating extracts from the lessons he had recently been learning, and his -mind became occupied with imaginary scenes in which the gods and goddesses -of mythology and the heroes and poets of antiquity played prominent parts, -and the whole power of his attention was thus kept engaged with these and -other scenes which were formed with astonishing rapidity. Toward morning -he fell into an uneasy slumber, and awoke feeling more weary even than -when he had gone to bed. - -Medicines, among which opium was the chief, had been employed without -success. On the contrary, his condition was manifestly rendered worse -through their influence. Laudanum, of which he had taken large quantities, -always caused headache, without producing the least amelioration in his -symptoms. Notwithstanding the palpable connection which existed between -the wakefulness and his former intense mental application, he had been -allowed to continue his studies, and when he came to me had a Latin -grammar in his hand, which he had been diligently studying in the street -railway car! - -After some very plain conversation with the father, relative to the great -danger to which he was subjecting his son, by thus inordinately taxing his -mind, I directed the entire cessation of all studies for the present, and -an entire change of associations by a visit to the sea-shore, and free -indulgence in bathing, fishing, and other recreations. I likewise advised -the use, for a few nights, of small doses of bromide of potassium. My -advice was implicitly followed, and a few days since I received a visit -from the boy's father, and was told by him that his son's health had been -completely restored. I recommended that the visit to the sea-side should -be prolonged a week or two, that the return to study should be gradual, -and that the boy's eagerness to learn should be somewhat restrained by -occupations and amusements requiring but little mental exertion. - -CASE VII.--An eminent banker consulted me for the purpose of being, as he -said, "put to sleep." He informed me that he was engaged in a series of -financial operations which, if successful, would be the means of adding -largely to his fortune, but that owing to loss of sleep he was unable to -give them that careful and full attention which their importance demanded. -"I go to bed," he said, "feeling very much exhausted, and dead with sleep, -but I am kept awake nearly the whole night by the activity of my thoughts, -which run on with a rapidity which astonishes me. Toward morning I get a -little sleep, but I arise unrefreshed, and go to my business with a -feeling of fullness in my head, and a sensation of weariness, which -altogether unfit me for the duties of the day. The consequence is that I -cannot concentrate my attention upon the matters which ought to engage it, -and that I am in danger of losing a great deal of money simply from lack -of mental power to follow the train of operations which I have set in -action." - -On examining this gentleman, I found his face flushed, his eyes bloodshot, -his pulse small, weak, and frequent (104), and his manner excited. He -complained of almost constant vertigo, and a feeling when he walked as -though his feet did not rest firmly on the ground or support his entire -weight. His appetite was capricious, and he maintained his strength mainly -by drinking champagne, of which he imbibed two bottles a day, taking in -addition "brandy and soda," as occasion seemed to require. - -I informed him that his case was a very simple one, and that I could -safely promise to put him to sleep provided he would agree to follow my -directions implicitly. - -This he said he would do. - -I told him that in the first place he must leave town and travel for a -week, and in the second place take the oxide of zinc. To the first -condition he objected strenuously; but the argument which I adduced, that -if he did not he would probably go to an insane asylum within the period -specified, somewhat startled him, and he yielded a reluctant consent. - -He started off that day, and returned in exactly a week, having, as he -said, slept eight hours every night during his absence. All his -disagreeable symptoms had disappeared, and he was enabled to resume his -business with his mental faculties in their full vigor. - - * * * * * - -2d. _Those positions of the body which tend to impede the flow of blood -from the brain, and at the same time do not obstruct its passage through -the arteries, while causing hyperæmia, also produce insomnia._ - -Several cases have come under my observation in which the influence of -position as affecting the disposition to sleep was well marked. It is very -evident that the recumbent posture is more favorable to a state of -congestion of the brain than the erect, or semi-erect. Individuals who, by -excessive mental exertion, have lessened the contractility of the cerebral -vessels, almost always experience great difficulty in getting to sleep -after lying down, even though previous to so doing they may have been very -drowsy. A gentleman, who was a patient of mine a few weeks since, informed -me that several years ago he had an attack of wakefulness, which lasted -for three or four months, and which was particularly characterized by -inability to sleep while lying in bed. While sitting in his office he -would often fall asleep in his chair, and previous to going to bed he -would be overcome by drowsiness. The moment, however, that he lay down, -his mind was aroused into activity, and all sleepiness disappeared. He -left off work, traveled, and in a short time recovered perfectly. It will -be recollected that in the other cases I have cited in this memoir, the -phenomena were always more strongly marked after the persons affected lay -down; and I have always insisted upon the avoidance of the recumbent -posture as one of the most important means to be employed in the cure of -insomnia. The following is one of the cases referred to above. - -CASE VIII.--A gentleman in extensive legal practice requested my advice -for persistent wakefulness, with which he had been affected for several -weeks, in consequence of unremitting attention to a case in which his -sympathies had become greatly interested. For somewhat over a month he -had, as he informed me, slept but for an hour or two each day. After -dinner he was able to procure this much sleep in his chair, but at night, -when he lay down, all his efforts were unavailing. He felt the want of -repose very much, and he described the sensation of weariness of body and -mind as almost insupportable. So great was this desire for sleep that, -notwithstanding repeated disappointments, he was confident each night of -being able to secure it, but invariably as soon as he lay down all -inclination vanished, and he passed the night in that condition of painful -restlessness which had now become horrible to him. There was no very great -mental activity, and no hallucinations of sight, but when his head touched -the pillow a low buzzing sound, which apparently had its origin in the -ears, was heard, and remained there to keep him awake. He could not shut -out this noise, no matter how energetically he endeavored to render -himself oblivious to it, and all the means, such as opium, chloroform, and -alcoholic liquors of various kinds, which he tried in the hope of -obtaining relief, only aggravated the difficulty. - -His general health, ordinarily excellent, had latterly began to give way. -His bowels were torpid, he had little or no appetite, and he was almost -daily subject to severe attacks of headache. He was conscious, too, of a -very decided change in his disposition. From having been of rather social -tendencies, he had become morose and gloomy, disliking even the -companionship of his most intimate friends. There was also a very decided -impairment of his memory, and he was sensible of the fact that the power -of concentrating his attention upon subjects of even minor importance was -materially weakened. In conversation he miscalled names, and misplaced -events and things. Thus he called Pittsburg _Pittstown_, said _aunt_ -several times when he should have said uncle, and confounded _Newark_ with -New York. By attention to hygienic measures, avoidance of the recumbent -position, and the use of moderate doses of bromide of potassium, he soon -obtained a due amount of sleep, and the other symptoms of a disordered -mental and physical organism gradually disappeared. - -Dr. Handfield Jones[132] relates a case in which the influence of position -was strongly marked. "A gentleman aged twenty-four, after considerable -mental strain, experienced the following symptoms: He was thoroughly weary -and drowsy at the close of the day, and felt, as well he might, the need -of nature's restorer; scarcely, however, had he laid down his head, when -the cerebral arteries began to throb forcibly, and soon all inclination -for sleep was banished, and for hours he lay wide awake, but deadly weary. -The _causa mali_ here was evidently deficient tonicity in the cerebral -arteries, or more exactly paresis of their vasa motor nerves. As the -arteries relaxed they admitted an undue flow of blood to the brain, which -goaded the weary tissue to abnormal action." - -De Boismont[133] refers to a case, on the authority of M. Moreau, in which -an individual was able to obtain hallucinations of sight by inclining his -head a little forward. By this movement the return of blood from the head -was impeded, and thus there was an exaltation of certain of the cerebral -functions. Wakefulness is nothing more than an exaggeration of the normal -functions of the brain. For this organ to act with vigor, an increased -flow of blood is necessary. If this flow is continued, without proper -periods of repose, a state of erethism and insomnia is produced. Instances -have been recorded in which persons have found it necessary to assume the -recumbent position whenever they had any severe mental labor to perform. -The following extract, bearing upon this point, from a work[134] already -quoted, is interesting: - -"The posture of supination will unavoidably induce that increased flow of -blood to the brain which, under certain states of this fluid, is so -essential to the production of brilliant waking thoughts; and are indeed -attained so often by another mode--the swallowing of opium. - -"A gentleman of high attainment was constantly haunted by a specter when -he retired to rest, which seemed to attempt his life. When he raised -himself in bed _the phantom vanished, but reappeared_ as he resumed the -recumbent position. - -"Some persons always retire to bed when they wish to think; and it is well -known that Pope was often wont to ring for pens, ink, and paper in the -night, at Lord Bolingbroke's, that he might record, ere it was lost, that -most sublime or fanciful poesy which flashed through his mind as he lay in -bed. Such, also, was the propensity of Margaret, Duchess of Newcastle, who -(according to Cibber, or rather Shiel, the _real_ author of the 'Lives of -the Poets') kept a great many young ladies about her person, who -occasionally wrote what she dictated. Some of them slept in a room -contiguous to that in which her grace lay, and were ready, at the call of -her bell, to rise any hour of the night to write down her conceptions, -lest they should escape her memory. - -"Henricus ab Heeres (in his 'Obs. Med.') says that when he was a professor -he used to rise in the night, open his desk, compose much, shut his desk, -and again to bed. On his waking, he was conscious of nothing but the -happy result of his composition. - -"The engineer Brindley even retired to bed for a _day or two_, when he was -reflecting on a grand or scientific project. - -"I deny not that the darkness or stillness of night may have had some -influence during this inspiration. I may also allow that some individuals -compose best while they are walking, but this _peripatetic_ exertion is -calculated itself to produce what we term determination of blood to the -head. I have heard of a most remarkable instance of the power of position -in influencing mental energy in a German student who was accustomed to -study and compose with his head on the ground, and his feet elevated and -resting against the wall. - -"And this is a fragment of a passage from Tissot, on the subject of -monomania. - -"----'Nous avons vu étudier dans cette académie, il n'y a pas long temps, -un jeune homme de mérite, qui _s'étant mis dans la tête_ de découvrir la -quadrature du cercle, est mort, fou, à l'Hôtel Dieu à Paris.'[135] - -"You will smile when I tell you that the tints of the landscape are -brighter to our eyes if we _reverse the position of the head_." - -Tissot, in the work to which reference has just been made, cites an -instance in which position was taken advantage of to solve a problem in -mathematics. A gentleman, remarkable for his accuracy in calculation, for -a wager _lay down on a bed_ and wrought, by mere strength of memory, a -question in geometrical progression, while another person, in another -apartment, performed the same operation with pen and ink. When both had -finished, the one who had worked mentally repeated his product, which -amounted to sixteen figures, and, insisting that the other gentleman was -wrong, desired him to read over his different products. On this being done -he pointed out the place where the first mistake lay, and which had run -through the whole. He paid very dearly, however, for gaining his wager, as -for a considerable time he had a swimming in his head, pains in his eyes, -and severe headaches upon attempting any mathematical labor. - -Sir Walter Scott has said somewhere, that the half hour _passed in bed_, -after waking in the morning, was the part of the day during which he -conceived his best thoughts. - -Dr. Forbes Winslow[136] makes some excellent remarks upon the relations -existing between position and wakefulness. He says: - -"In some types of insanity the patient's mind is altogether absorbed in -the contemplation of a frightful spectral illusion. Under these -circumstances the unhappy sufferer is afraid to close his eyes in sleep -from an intense fear and dread that he will then fall an easy prey to the -horrible phantasms which his morbid imagination has called into existence, -and which, he imagines, follow him in all his movements. The patient so -afflicted declares he will not sleep, and resolutely repudiates and -perseveringly ignores all disposition to slumber. On many occasions he -obstinately refuses to go to bed, or to place himself in a recumbent -position. He will battle with his attendant if he attempts to convey him -to bed. He insists on remaining in the chair, in standing in an erect -position all night, and often determinately walks about the room when -those near him are in profound repose. In these cases the hallucinations -appear to be most exquisitely and acutely vivid when the patient is placed -in a recumbent position, on account, it is supposed, of the mechanical -facilities thus afforded for the blood gravitating freely to the head. - -"A gentleman who appeared free during the day from any acute -hallucinations, never could lie on his back without being distressingly -harassed by a number of frightful imps, whom he imagined to be dancing -fantastically around him during the night. Under these circumstances, -undisturbed sleep, while in bed, could never be obtained. He was in the -habit of sleeping in an arm-chair for some time in consequence of these -symptoms. He, however, eventually recovered, and has been for several -years entirely free from all hallucinations." - -It has frequently occurred to me to notice the increase in the number and -intensity of the hallucinations of patients affected with delirium tremens -as soon as they assumed the recumbent position. The difficulty of sleeping -is in such cases always correspondingly augmented. - - * * * * * - -3d. _An increased amount of blood is determined to the brain, and -wakefulness is produced by certain substances used as food or medicine._ - -Daily experience assures us of the truth of this proposition. In general -terms, it may be said that all those substances which, when ingested into -the system, increase the force and frequency of the heart's action, cause -also a hyperæmic condition of the brain and tend to the supervention of -wakefulness. - -Chief among these agents are to be placed alcohol, opium, belladonna, -stramonium, Indian hemp, tea, and coffee. It is true that the first two of -these, when taken in large quantities, sometimes give rise to a comatose -condition. This, however, as has already been shown, is not a consequence -of an increased amount of blood in the brain, but results from the -circulation in that organ of blood which has not been duly oxygenated by -respiration. My experiments on this head have been many, and show -conclusively that neither alcohol nor opium possesses any stupefying -effect, if means be taken to insure the full aeration of the blood. If, -however, these substances be administered beyond a certain limit, they so -act upon the nerves which supply the respiratory muscles as to interfere -with the process of respiration, and hence the blood is not sufficiently -subjected to the action of the atmosphere. Unaerated blood therefore -circulates in the brain, and coma--not sleep--is produced. - -No substance is capable of acting as a direct hypnotic, except that which -lessens the amount of blood in the brain. In small doses alcohol and opium -do this indirectly, through their stimulating properties exerted upon -overdistended blood-vessels, as has been shown in regard to the first -named in a case already cited; but they never so act upon the healthy -brain. In the normal state of this organ their action in small doses is -always that of excitants. The word "small" is of course used in a relative -sense. What is a small dose for one person may be a large one for another, -and _vice versa_. - -In this connection it is scarcely necessary to dwell at any length upon -the wakefulness produced by delirium tremens from the excessive ingestion -of alcohol or opium. In the _post-mortem_ examinations--four only--which I -have made of individuals dying from this affection as the result of the -immediate use of alcohol, the brain was invariably found congested. Either -hyperæmia or its consequence, effusion of serum, is the ordinary -pathological condition discovered in such cases. - -In regard to opium, most practitioners have doubtless noticed the effect -which it and its preparations frequently produce in preventing sleep. I -have known one dose of half a grain of opium keep a patient awake for -three consecutive days and nights, during the whole of which period -intense mental excitement was present. As is well known, the Malays, when -they wish _to run amuck_, bring on the necessary degree of cerebral -stimulation by the use of opium. During the condition thus produced -insomnia is always present. It is certainly true, however, that in -moderately large doses opium acts as a direct hypnotic, and the same may -be said of other narcotics. - -Belladonna, stramonium, and Indian hemp likewise produce congestion of the -brain and wakefulness. The latter, under the name of hashish,[137] is -still used in the East to bring on a state of delirium, and, if rumor is -to be credited, has its votaries in this country. Tea and coffee act in a -similar but far less powerful manner. As one of the results of experiments -with these substances, instituted upon myself, I found that the -circulation of the blood was rendered more active.[138] Their influence in -preventing sleep is well known to the generality of people, and this -effect is doubtless entirely due to their action upon the heart and -blood-vessels by which the amount of blood in the brain is increased. In -persons of fair and thin skins, who are not accustomed to the use of -either of these beverages, the face can be seen to flush after they have -been taken; and I have frequently met with persons in whom their use was -always followed by suffusion of the eyes, and a feeling of fullness within -the head. Their power to increase the force and brilliancy of our -thoughts, and to sustain the mind under depressing influences, has long -been recognized, and is to be ascribed to the same cause as that which -prevents sleep. - - * * * * * - -4th. _Wakefulness is also caused by functional derangements of certain -organs of the body, whereby an increase in the amount of blood in the -brain is produced._ - -Under this head are embraced those cases of sleeplessness due to exalted -sensibility of the nervous system. They are chiefly met with in persons -of feeble constitution. The slightest impression made upon the skin, or -any other organ of sense, is converted into a sensation out of all -proportion to the exciting cause. There is thus a condition of general -hyperæsthesia which greatly tends to the prevention of sound and -refreshing sleep. The following case illustrates very well the phenomena -of the state in question: - -CASE IX.--A lady recently came under my care for extreme wakefulness, the -result, as she correctly supposed, of debility. During the month of August -she had resided in a malarious region, and had had a series of attacks of -intermittent fever before she would consent to take quinine for its cure. -By the time the disease was conquered she had become very much reduced, -and her constitution had received a shock from which it will probably not -recover for several years. I saw her for the first time on the 26th of -September, and she was then so feeble that she was unable to be out of her -bed for more than an hour or two each day. Her nervous system was in an -exceedingly irritable condition, the least noise startled her, she was -unable to bear the full light of day, and so sensitive was her skin, that -the light clothes she wore caused her the greatest uneasiness. She -informed me that she had scarcely slept for seventeen days and nights, and -though I received this statement with some grains of allowance, I was very -sure, from her general appearance, that she was suffering from insomnia. -At night the feeling of general discomfort was greatly increased, the -weight of the bedclothes was insupportable, and she passed the hours -tossing restlessly on her bed or in walking the floor. By morning she was -feverish, irritable, and thoroughly exhausted. A cup of coffee and a -little buttered toast constituted her breakfast, after which she felt -somewhat revived. - -Conceiving that all the symptoms were referable to debility and passive -cerebral congestion, I advised nutritious food, tonics, stimulants, -exercise in the open air, the warm bath, cold water to the head, and the -avoidance of the recumbent posture. Amendment began almost immediately, -and by the end of a week the hyperæsthesia had disappeared, and she slept -soundly and sufficiently. - -In reference to this form of wakefulness, Dr. Handfield Jones[139] makes -some judicious observations. He says: "A girl recently under my care with -very various and marked signs of prostration of nerve-power, suffered for -many months with exceedingly restless nights, the cause of which appeared -to be chiefly great hyperæsthesia. Although she improved materially in -other respects, she did not sleep well until she was removed from London -to a healthy part of the country. I have had several patients, two -especially, both temperate males, who for a length of time were quite -dependent for good rest at night on wine taken either on going to bed or -in the course of the night. * * * It is not easy to form a precise idea of -the state of the nervous centers in which a 'nightcap,' as above -mentioned, is so effectual in procuring sleep. Debility is certainly one -marked pattern of it, but there must be surely another, even more -important, as the most profound debility does not, by any means, always -interfere with sound sleep, nay, rather seems to conditionate it. This -other element, we are much disposed to think, is hyperæsthesia, or -irritability, which, as already noticed, commonly increases _pari passu_ -with weakness. The condition may be compared with that of neuralgia, when -it is beginning to give way under treatment, and is so readily reproduced -by anything which causes exhaustion. Now, as the stimulant recruits the -exhausted nerve force, the hyperæsthesia ceases, and the brain tissue -subsides into a state of calm repose. It may be added here that it is -often well to give not only a stimulant, but also some digestible -nourishment about the time of going to rest, or even in the course of the -night when debility to a serious extent exists. It is quite certain that a -craving empty stomach is by no means favorable to quiet slumber, and in -this point of view moderate suppers are far from being unsuitable to many -invalids. I well remember the case of a lady who, the night after a -natural confinement, woke up with severe gastric disorder and flatulence, -which resisted various medications, but subsided immediately after a -plate of cold meat and some brandy and water. Among the various -soporifics, I doubt if there be any more potent, especially for the weakly -and hyperæsthetic, than prolonged exposure to the cold open air. This -should be so managed as not to cause great fatigue, and if well timed and -followed by a sufficient meal, it will be found an admirable preparation -for sound nightly slumber." - -In the foregoing remarks it is perceived that Dr. Jones fails to recognize -the state of passive congestion of the brain which in cases such as he -describes, and in many similar ones which have come under my care, is -almost invariably present. It is this feature which, in addition to the -debility, gives so marked a character to the species of insomnia under -consideration. The hyperæsthesia, like the wakefulness, is merely a result -of the cerebral hyperæmia. - -Several cases of insomnia, the result of disordered menstruation, have -come under my observation. We can very well understand how, in women -suffering from suppression of this function, a slight degree of cerebral -hyperæmia and consequent wakefulness should result. About the climacteric -time of life, when irregularities in the menstrual flow are very common, -there is quite generally extreme sleeplessness as each period approaches, -which is not ordinarily relieved till the catamenia make their appearance. -In such cases measures directed to the relief of the existent congestion -of the brain will generally prove effectual in causing natural sleep. - -Irregular or deficient action of the heart and blood-vessels is a frequent -cause of wakefulness. One of the principal results of such disordered -action of the circulatory organs is coldness of the extremities, and an -attendant condition of repletion of the central vessels. As a consequence -there is in these cases almost invariably great wakefulness. As Dr. -Cheyne[140] has remarked, many a delicate female, from going to bed with -cold feet, is deprived of hours of sleep in the early part of the night, -and thereby falls into nervous complaints, obstinate dyspepsia, and -uterine irregularity, who might have escaped had the circulation of the -surface of the body been properly sustained. - -There are cases, however, of habitual cold feet, accompanied by -wakefulness, which are not so much due to deficient power in the heart as -to disordered nervous action. But, whatever the cause, there is always, -while the condition exists, an excessive amount of blood in the cranial -vessels. An instance of the kind came under my observation several years -ago in the person of an army officer, of strong constitution and otherwise -of good health. Heat applied to the extremities gave only temporary -relief, and stimulants taken internally were equally inefficacious. He was -finally entirely cured by the repeated passage of the direct galvanic -current through the sciatic and crural nerves and their branches. - -Indigestion is quite a common cause of wakefulness, even when no marked -disagreeable sensations are experienced in the digestive organs. A full -meal, especially if it be of highly seasoned or otherwise improper food, -will often keep the offending individual awake the greater part of the -night. We know that apoplexy is especially apt to occur soon after the -stomach has been overloaded with food. The return of the blood from the -head is impeded, and the rupture of an intercranial vessel, or an effusion -of serum, is the result of the cerebral congestion. Insomnia is a milder -effect of the same cause. - -There are several other abnormal conditions of the system in which -wakefulness plays an important part, but their consideration would lead us -into the discussion of the phenomena of many diseases of which it is -simply a symptom, or of secondary consequence. The remarks which have been -made in regard to it have reference to its existence as an evidence of -slight cerebral congestion, and therefore as being of sufficient -importance to demand the aid of both physician and patient in effecting -its cure. - - - - -CHAPTER X. - -THE TREATMENT OF WAKEFULNESS. - - -The principles which should prevail in the treatment of wakefulness are -indicated to some extent by the remarks which have already been made. If -the views which I have given relative to the pathology of this affection -be correct, there can be no doubt in regard to the means to be employed -for its cure. Happily, theory and practice are in perfect accord in -respect to the therapeutical measures to be adopted. These may be arranged -into two classes: - -1st. Those which by their tendency to soothe the nervous system, or to -distract the attention, diminish the action of the heart and -blood-vessels, or correct irregularities in their function, and thus -lessen the amount of blood in the brain. - -2d. Those which directly, either mechanically or through a specific effect -upon the circulatory organs, produce a similar effect. - -Under the first head are embraced many agencies which from time immemorial -have been known to cause sleep. Among them are music, monotonous sounds, -gentle frictions of the surface of the body, soft undulatory movements, -the repetition by the insomnolent of a series of words till the attention -is diverted from the exciting emotion which engages it, and many others of -similar character which individuals have devised for themselves. In slight -cases the measures belonging to this class often prove effectual, but in -persistent insomnia they are generally altogether nugatory. - -Under the second head we shall find comprehended the means which are -chiefly to be relied on in the treatment of cases of morbid wakefulness. - -Chief among them are embraced those measures which tend to improve the -general health of the patient, and which are chiefly of a hygienic -character. Whatever causes produce an irritable condition of the nervous -system, indirectly at least increase the disposition to wakefulness. It is -important, therefore, that these should be thoroughly understood and -avoided, and I accordingly propose to consider them at some length. - -_Food._--While it is an error to suppose, as is generally done, that a -moderately full meal, eaten shortly before bedtime, is necessarily -productive of wakefulness, there is no doubt that this condition is -induced by an excessive quantity of irritating or indigestible food. A -hearty supper of plainly cooked and nutritious food rather predisposes to -sleep. Most of us have experienced the drowsiness which so often follows -dinner. This is due to the fact that the process of digestion requires an -increased amount of blood in the organs which perform it, and -consequently the brain receives a less quantity. A tendency to sleep is -therefore induced. It is a natural and healthy predisposition, and when -yielded to moderately conduces to a more complete assimilation of the food -than would otherwise take place. When, however, the food ingested is not -such as is merely sufficient for the wants of the system, but is -inordinate in amount, or irritating in quality, the hypnotic effect is -neutralized, and often a state of wakefulness supervenes, from the fact -that the quantity of blood circulating in the brain is augmented instead -of being diminished. This last result is induced either by the pressure of -the overloaded stomach upon the abdominal vessels or through a reflex -action on the heart, by which it is excited to increased activity. - -In young children, who are very susceptible to the influence of causes -acting upon the nervous system, we often see both sleep and wakefulness -result as direct effects of eating. When the quantity of milk taken has -not been excessive, the child quietly drops asleep at the breast. On the -contrary, when a superabundance has been ingested, it either remains awake -or the sleep is disturbed. In adults it is, as has already been mentioned, -not uncommon for apoplexy to ensue upon a large meal of improper food. - -In order, therefore, that a disposition to wakefulness may be removed, it -is essential that attention should be paid to the diet of the affected -individual. As a rule, people are underfed. This is especially the case -with women, who too generally indulge in what may be called "slops," to -the exclusion of good, solid, nutritious food derived in great part from -the animal kingdom. By such a faulty diet the tone of the system is -lowered, and local congestions of different parts of the body are -produced. If the brain be one of these, wakefulness results. - -Most of the cases of insomnia which occur in women are of the passive -variety, and require not only nutritious food, but _stimulants_. Of the -latter, _whisky_ is generally to be preferred as acting rapidly, as less -likely to disagree with the stomach than many kinds of wine, and as being -purer than the stuff ordinarily sold as brandy. As a good stimulant, and -at the same time tonic, nothing can be preferable to _Tarragona wine_, -drunk at dinner to the extent of a glass or two. It possesses all the -essential qualities of pure port, and is much more reliable and wholesome -than the mixture of elderberry juice and alcohol which passes for this -latter wine. Next to Tarragona wine must be ranked good _lager beer_. - -Although the effect of _coffee_ is generally such as to induce -sleeplessness, there are cases in which its action is directly the -reverse. I have had several slight cases of passive wakefulness under my -care which were entirely and speedily cured by a cup of strong coffee -taken for three or four nights in succession at bedtime. It is especially -useful in females of languid circulation, and a consequent tendency to -internal congestions. - -Stimulants such as those mentioned, and others which might be noticed, it -must be clearly understood are only useful in the asthenic or passive form -of insomnia; in the sthenic or active form of the affection they are -altogether inadmissible, and if employed will certainly increase the -difficulty. - -The good effects of moderate but regular _physical exercise_ in -dissipating wakefulness can scarcely be overestimated. It is almost -impossible to produce any permanently beneficial influence without the aid -of this powerful tonic. To be of any material service, the exercise should -be taken in the open air, and should extend to the point of inducing a -slight feeling of fatigue. - -The _warm bath_ is also a very valuable means of determining blood from -the head, and calming nervous irritability. Frequently, especially in -children, I have found that simply putting the feet in water of the -temperature of 100° F. has been sufficient to induce a sound and healthy -sleep, when laudanum and other means have failed. - -_Cold water_, applied directly to the scalp, is often of great effect in -diminishing the amount of blood in the brain. It is not admissible in the -asthenic form of wakefulness. When the individual is strong, the heart -beating with force and frequency, and the mental excitement great, its -influence is almost invariably good. The exact temperature is a matter -for the judgment of the physician. I have often used it as cold as ice -could make it, 32° F., or thereabouts. - -In the action of cold water, applied to the head in cases of insomnia, we -have another proof of the real nature of this affection. It is known that -in Thibet mothers place their wakeful children in such positions as will -admit of a small stream of cold water falling from a slight elevation upon -the head. I have in some work--on which I cannot now lay my hands--read a -very full account of this custom, and seen a cut representing the process. -The children very soon fall into a quiet sleep. I have often seen the -application of the cold _douche_ to the heads of refractory prisoners -bring on a deep sleep. - -The effects of _position_ in aid of other remedies have also been alluded -to. I make use of its advantages in all severe cases of insomnia which -come under my charge, and we have, in its efficacy, additional -confirmation of the correctness of the theory that the condition of the -brain in such cases is one of hyperæmia. - -Among the more purely medicinal agents, _bromide of potassium_ occupies -the first place, and can almost always be used with advantage to diminish -the amount of blood in the brain, and to allay any excitement of the -nervous system that may be present in the sthenic form of insomnia. That -the first named of these effects follows its use, I have recently -ascertained by experiments upon living animals, the details of which will -be given at another time. Suffice it now to say, that I have administered -it to dogs whose brains had been exposed to view by trephining the skull, -and that I have invariably found it to lessen the quantity of blood -circulating within the cranium, and to produce a shrinking of the brain -from this cause. Moreover, we have only to observe its effects upon the -human subject to be convinced that this is one of the most important -results of its employment. The flushed face, the throbbing of the carotids -and temporals, the suffusion of the eyes, the feeling of fullness in the -head, all disappear as if by magic under its use. It may be given in doses -of from ten to thirty grains--the latter quantity is seldom required, but -may be taken with perfect safety in severe cases. - -Another very admirable preparation is the _oxide of zinc_. This substance -appears to be especially beneficial in those cases of wakefulness due to -excessive mental exertion or anxiety of mind. I usually prescribe it in -doses of two grains, three times a day, the last dose being taken just at -bedtime. - -_Opium_ I very seldom employ in the treatment of wakefulness, from the -facts that its effects vary so greatly in accordance with the dose, and -that its action is not limited to the simple induction of sleep. There are -cases, however, in which its influence is decidedly beneficial. Care -should be taken to give it in sufficiently large but not excessive -quantities. The influence of opium in lessening the amount of blood in -the brain is very distinctly recognized by Dr. Handfield Jones, and also -by Dr. Alfred Stillé.[141] Both these authors account in this manner for -its hypnotic effect. As has been shown, my own experiments tend strongly -to confirm this reasoning. - -_Hyoscyamus_ is more generally admissible. It is especially indicated in -those cases which are accompanied by great nervous irritability. It is -difficult to obtain any preparation of this drug which retains its -virtues. I have usually employed the tincture in doses of from one to two -drachms. I do not think, however, that it possesses any advantages over -bromide of potassium, or that it is even equal in any respect to this -agent. - -In regard to _valerian_, _assafoetida_, and other _antispasmodics_, I have -nothing to say in commendation. _Tonics_ are, however, almost always -useful, even in the active form of the affection. Among them _quinine_ and -_iron_ are more generally indicated. - -When wakefulness is a consequence of functional derangement of distant -organs, the measures of relief must be directed to the cure of the primary -disease, in order to produce any permanent alleviation of the cerebral -difficulty. - -In those cases of insomnia dependent upon severe and long-continued mental -exertion, all means will fail to remedy the trouble unless the affected -individual consents to use his brain in a rational manner. Proper -intervals of relaxation should be insisted upon, and in some cases it may -be necessary to suspend all intense intellectual effort for a time. When -the means will permit, travel can always be undertaken with advantage. It -is surprising sometimes to see how rapidly the brain recovers its tone, -and the system generally recuperates through the change of associations -and scenes incident to travel. - -The disposition of the age seems to be to ignore the fact that the nervous -system can exhaust itself by excessive intellectual labor. A short time -since intelligence was received from abroad that one of the most -distinguished men of Great Britain had committed suicide, in consequence -of insanity produced by overexertion of his mind. Thus one more victim is -added to the long list of those who have disregarded the laws of their -being; and again we are reminded that there is a limit to the exercise of -our intellectual powers, beyond which we cannot pass with safety.[142] - - - - -CHAPTER XI. - -SOMNOLENCE. - - -Somnolence or drowsiness is generally regarded, when persistent, as being -more strongly indicative of organic changes in the structure of the brain -than is any other derangement of sleep. - -This opinion is mainly, if not entirely, due to the fact that it is -confounded with stupor, from which, both in its causes and effects, as has -already been shown, it differs in every essential respect. - -Somnolence is nothing more than an inordinate tendency to sleep. When -manifested in a slight degree it is difficult, without careful examination -and a thorough inquiry into the history of the case, to distinguish it -from moderate stupor. It is of course very important that the distinction -should be made; for, in reality, somnolence is ordinarily no very serious -disorder, and is generally symptomatic of eccentric disease, whereas -stupor almost invariably results from organic brain affections, from -cerebral injuries, or the circulation of poisoned blood through the -encephalic blood-vessels. - -Whatever lessens the amount of blood normally circulating through the -cerebral vessels, tends to the production of somnolence. It is hence a -condition frequently witnessed in those whose powers of life have been -reduced by long-continued disease, by excesses of various kinds, or by -affections which essentially consist in enfeeblement of the organism. It -is generally met with in the aged, in whom the circulatory organs have -lost their pristine vigor. - -Many cases of very troublesome and persistent somnolence, having an origin -such as I have mentioned, have come under my notice: ordinarily they -present no difficult features of treatment, the indications being to -increase the tone of the system by stimulants, tonics, nutritious food, -and moderate exercise in the open air. These measures will invariably -succeed if there be no organic difficulty. - -Somnolence, however, is sometimes due to structural changes which -interfere with the free passage of blood through the cerebral vessels. It -may hence be caused by emboli, which, obstructing the arteries, prevent -the normal amount of blood reaching the brain substance. It may also be -caused by tumors, which, pressing on the arteries supplying the brain, act -in like manner. In such cases it is of secondary importance. - -A very curious affection, known as the "Sleepy Disease," has been -described as endemic in certain regions of Africa. The following -extract[143] gives a graphic description of the malady: - -"Having procured a guide, we crossed the river, and at the mouth of -Logan's Creek we exchanged our boat for a large canoe, in which we -followed the windings of the deep and narrow inlet for nearly two miles. -This brought us to a village of six huts. Without ceremony we entered the -dwelling of the old queen (who was busied about her household affairs), -and looked around for her granddaughter, to see whom was the principal -object of our excursion. On my former visit to Maumee's town, four or five -months ago, this girl excited a great deal of admiration by her beauty and -charming simplicity. She was then thirteen or fourteen years of age--a -bright mulatto, with large and soft black eyes, and the most brilliantly -white teeth in the world. Her figure, though small, is perfectly -symmetrical. She is the darling of the old queen, whose affections exhaust -themselves upon her with all the passionate fire of her temperament, and -the more unreasonably because the girl's own mother is dead. - -"We entered the hut, as I have said, without ceremony, and looked about us -for the beautiful granddaughter; but, on beholding the object of our -search, a kind of remorse and dread came over us, such as often affects -those who intrude upon the awfulness of slumber. The girl lay asleep in -the adjoining apartment, on a mat that was spread over the hard ground, -and with no pillow beneath her cheek. One arm was by her side, the other -above her head, and she slept so quietly, and drew such imperceptible -breath, that I scarcely thought her alive. - -"With some little difficulty she was aroused, and awoke with a frightened -cry,--a strange and broken murmur,--as if she were looking dimly out of -her sleep, and knew not whether our figures were real, or only the -fantasies of a dream. Her eyes were wild and glassy, and she seemed to be -in pain. While awake, there was a nervous twitching about her mouth and in -her fingers; but, being again extended upon the mat, and left to herself, -these symptoms of disquietude passed away, and she almost immediately sank -again into the deep and heavy sleep in which we found her. As her eyes -gradually closed their lids, the sunbeams struggling through the small -crevices between the reeds of the hut glimmered down about her head. -Perhaps it was only the nervous motion of her fingers, but it seemed as if -she were trying to catch the golden rays of the sun and make playthings of -them, or else to draw them into her soul and illuminate the slumber that -looked so misty and dark to us. - -"This poor doomed girl had been suffering--no, not suffering; for, except -when forcibly aroused, there appeared to be no uneasiness,--but she had -been lingering two months in a disease peculiar to Africa: it is called -the 'Sleepy Disease,' and is considered incurable. The persons attacked by -it are those who take little exercise, and live principally on vegetables, -particularly cassady and rice. Some ascribe it altogether to the cassady, -which is supposed to be strongly narcotic--not improbably the climate has -much influence, the disease being most prevalent in low and marshy -situations. Irresistible drowsiness continually weighs down the patient, -who can be kept awake only for the few moments necessary to take a little -food. When this lethargy has lasted three or four months, death comes with -a tread that the patient cannot hear--and makes the slumber but a little -more sound. - -"I found the aspect of Maumee's beautiful granddaughter inconceivably -affecting. It was strange to behold her so quietly involved in sleep from -which it might be supposed she would awake so full of youthful life, and -yet to know that this was no refreshing slumber, but a spell in which she -was fading away from the eyes that loved her. Whatever might chance, be it -grief or joy, the effect would be the same. Whoever should shake her by -the arm--whether the accents of a friend fell fully on the ear, or those -of strangers like ourselves,--the only response would be that troubled -cry, as of a spirit that hovered on the confines of both worlds and could -have sympathy with neither. And yet, withal, it seemed so easy to cry to -her, 'Awake! Enjoy your life! Cast off this noontide slumber!' But only -the peal of the last trumpet will summon her out of that mysterious -sleep." - -Another and later account of this singular disease has recently been given -by M. Dumoutier,[144] surgeon in the French Navy. - -According to this observer, the affection commonly called the -"sleep-disease" (maladie du sommeil) is met with only among the negroes of -the coast, and principally those of the Gaboon and of Congo, becoming more -rare towards the north. The most prominent symptoms are an irresistible -tendency to sleep, and a feeling of torpor and numbness. The patient does -not complain of pain, and yet there is a general weakness of the limbs, -the gait is tottering, the sensibility is perverted, and the hands -imperfectly grasp the objects they attempt to seize. During the sleep the -fecal matters and the urine are passed involuntarily. The respiration is -normal, and the digestion regular. These were the principal symptoms -observed in those cases which came under M. Dumoutier's notice: observing -the disease only in the persons of captives coming from the interior, he -ascribes it to nostalgia, _ennui_, and other moral causes. Two autopsies -made by his colleagues revealed no abnormal condition of the brain, the -spinal cord, or their membranes. - -The treatment employed--quinia, strychnia, and iron--had no effect. A -temporary improvement was obtained by causing the patients to take part in -the amusements of their companions. Electricity seemed likewise to retard -somewhat the progress of the disease. - -The fact that no organic difficulty of the brain was discovered after -death, is strong proof that the somnolency was due to some cause affecting -the intra-cranial circulation. That the amount of blood was lessened, and -that thus a permanent anæmia of the brain was produced, can scarcely be -doubted, when regard is had to the observations and experiments recorded -in the foregoing pages of this work. Probably the primary derangement was -seated in the sympathetic nerve and its ganglia, it having been well -settled by familiar observations, and by recent contributions to -physiology and pathology, that one of the chief functions of this system -is to regulate the caliber of the blood-vessels, and thus to determine the -amount of blood circulating through an organ or part of the body. - -Numerous cases of protracted sleep are on record. Some of them are -evidently fanciful and exaggerated, but others are doubtless well founded. -One of the most remarkable of these is related, among many others, by -Wanley.[145] - -"One Samuel Chelton, of Finsbury, near Bath, a laboring man, about -twenty-five years of age, of a robust habit of body, not fat, but fleshy, -and of dark-brown hair, happened, on the 13th of May, 1694, and without -visible cause, to fall into a very profound sleep, out of which he could -by no means be aroused by those about him till after a month's time, when -he arose of himself and went to his husbandry business as usual. He slept, -ate, and drank as before, but did not speak a word till about a month -after. All the time he slept, victuals and drink stood by him, which were -spent every day, and used by him, as was supposed, though no person saw -him eat or drink all the while. After this period he continued free from -drowsiness or sleepiness till the 9th of April, 1696, when he fell into -his sleeping fit again, as he had done before. After some time his friends -were prevailed on to try what effect medicines might have upon him. -Accordingly, Mr. Gills, an apothecary, bled, blistered, cupped, and -scarified him, and used all the external irritating medicines he could -think of, but to no purpose; and after the first fortnight he was never -observed to open his eyes: victuals stood by him as before, which he ate -of now and then, but no one ever saw him eat or evacuate, though he did -both very regularly, as he had occasion; and sometimes he was found fast -asleep with the pot in his hand in bed, and sometimes with his mouth full -of meat. In this manner he lay about ten weeks, and then he could eat -nothing at all, for his jaws seemed to be set, and his teeth clinched so -close that, notwithstanding all the art that could be used with -instruments, his mouth could not be opened to put anything into it to -support him. At last, those about him observing a hole in his teeth, made -by holding his pipe, they now and then poured some tent into his mouth -through a quill. And this was all he took for six weeks and four days; but -it amounted to no more than three pints or two quarts. He had made water -only once, and never had a stool all that time. - -"On the 7th of August, which was seventeen weeks from the 9th of April, -when he began to sleep, he awaked, put on his clothes, and walked about -the room, not knowing he had slept above a night; nor could he be -persuaded he had lain so long, till, going into the fields, he found -everybody busy getting in their harvest, and he remembered very well when -he fell asleep that they were sowing their barley and oats, which he then -saw ripe and fit to be cut down. There was one thing remarkable: though -his blood was somewhat wasted with lying so long in bed and fasting for -about six weeks, yet a gentleman assured Dr. Oliver that when he saw -him--which was the first day of his coming abroad--he looked brisker than -ever he saw him in his life before; and on asking him whether the bed had -made him sore, he assured this gentleman that he never felt this or any -other inconvenience, and that he had not the least remembrance of anything -that passed, or what was done to him, all that while. So that he went -again to his husbandry, as he was wont to do, and remained well till -August 17th, 1697, when, in the morning, he complained of a shivering and -a coldness in his back. He vomited once or twice, and the same day fell -into his sleeping fit again. Dr. Oliver, going to see him, found him -asleep, with a cup of beer and a piece of bread and cheese upon a stool by -his bed, within his reach. The doctor felt his pulse, which at that time -was regular, and he also found his heart beat very regular, and his -breathing easy and free. The doctor only observed that his pulse beat a -little too strong. He was in a breathing sweat, and had an agreeable -warmth all over his body. The doctor then put his mouth to his ear, and -called him as loud as he could several times by his name, pulled him by -the shoulders, pinched his nose, stopped his nose and mouth together as -long as he could without choking him, but to no purpose, for all this time -he did not give the least sign of being sensible. The doctor lifted up his -eyelids, and found his eyeballs drawn up under his eyebrows and fixed -without any motion. The doctor then held under one nostril, for a -considerable time, a vial with spirits of sal ammoniac, extracted from -quicklime; he then injected it several times up the same nostril; and -though he had poured into it almost half an ounce of this fiery spirit, it -only made his nose run, and his eyelids shiver and tremble a little. The -doctor, finding no success with this, crammed that nostril with white -powder of hellebore, and waited some time in the room to see what effects -all these together might have upon him; but he never gave any sign that he -felt what the doctor had done, nor discovered any manner of uneasiness, by -stirring any part of his body, that the doctor could observe. - -"After all these experiments the doctor left him, being pretty well -satisfied that he was asleep, and no sullen counterfeit, as some people -supposed. On the doctor's relating what he had observed, several gentlemen -from Bath went out to see him, and found him in the same condition the -doctor had left him in the day before, only his nose was inflamed and very -much swelled, and his lips and the inside of his nostrils were blistered -and scabby, occasioned by the spirits and the hellebore. About ten days -after the doctor had seen him, Mr. Woolner, an apothecary, finding his -pulse beat very high, drew about fourteen ounces of blood from the arm, -and tied it up, and left it as he found him; and Mr. Woolner assured the -doctor that he never made the least motion when he pricked him, nor all -the while his arm was bleeding. Several other experiments were tried by -those who went to see him from Bath, but all to no purpose. The doctor saw -him again the latter end of September, and found him just in the same -position, lying in his bed, but his pulse now was not so strong, nor had -he any sweats, as when the doctor saw him before. He tried him again by -stopping his nose and mouth, but to no purpose; and a gentleman ran a -large pin into his arm to the very bone, but he gave no signs of his being -sensible to what was done to him. During all this time the doctor was -assured that nobody had seen him either eat or drink, though they watched -him as closely as possible,--but food and drink always stood by him, and -they observed that sometimes once a day, and sometimes once in two days, -all was gone. It was further observed that he never dirtied his bed, but -always went to the pot. In this manner he lay till the 19th of November, -when his mother, hearing him make a noise, immediately ran up to him and -found him eating. She asked him how he did. He replied, 'Very well, thank -God.' She asked him again which he liked best, bread and butter, or bread -and cheese. He answered, 'Bread and cheese.' Upon this the woman, -overjoyed, left him to acquaint his brother, and both coming straight up -into the chamber to speak to him, they found him as fast asleep as ever, -and could not by any means awake him. From this time to the end of -January, or beginning of February, he did not sleep so profoundly as -before; for, when they called him by his name, he seemed to hear them, and -became somewhat sensible, though he could not make them any answer. His -eyes were not shut so close, and he had frequently great tremblings of his -eyelids, upon which they expected every day that he would awake, which did -not happen till about the time mentioned, when he awoke perfectly well, -but remembered nothing that had happened all the while. It was observed -that he was very little altered in his flesh; he only complained that the -cold hindered him more than usual, but he presently went to his labor, as -he had done before." - -The case of Mary Lyall is quoted by Macnish, from the 8th volume of the -Transactions of the Royal Society of Edinburgh, as follows:[146] - -"This woman fell asleep on the morning of the 27th of June, and continued -in that state till the evening of the 30th of the same month, when she -awoke and remained in her usual way till the 1st of July, when she again -fell asleep, and continued so till the 8th of August. She was bled, -blistered, immersed in the hot and cold bath, and stimulated in almost -every possible way, without having any consciousness of what was going on. -For the first seven days she continued motionless, and exhibited no -inclination to eat. At the end of that time she began to move her left -hand, and, by pointing to her mouth, signified a wish for food. She took -readily what was given to her. Still she evinced no symptoms of hearing, -and made no other kind of bodily movement than of her left hand. Her right -hand and arm particularly appeared completely dead and bereft of feeling, -and even when pricked with a pin, so as to draw blood, never shrunk in the -least degree. At the same time she instantly drew back her left arm -whenever it was touched by the point of the pin. She continued to take -food whenever it was offered to her. For the first two weeks her pulse -generally stood at 50, during the third and fourth week about 60, and on -the day before her recovery at 70 or 72. Her breathing was soft and almost -imperceptible, but during the night-time she occasionally drew it more -strongly, like a person who has just fallen asleep. She evinced no symptom -of hearing till about four days before her recovery. On being -interrogated after this event upon her extraordinary state, she mentioned -that she had no knowledge of anything that had happened--that she had -never been conscious of either having needed or received food, or of -having been blistered; and expressed most surprise on finding her head -shaved. She had merely the idea of having passed a long night in sleep." - -Many other cases might be referred to; but as their general features are -similar to the two cited, it is unnecessary to quote them. The following -instance occurring in this country presents some features of interest. It -is reported by Dr. C. A. Hart,[147] of this city. - -"Miss Susan C. Godsy, aged 22, of bilious temperament, has been in a -somnolent state since 1849, being then eight years of age. Up to within a -year of that period she had enjoyed excellent health, she being then -attacked with intermittent fever, in the treatment of which opium was -extensively used. This was erroneously supposed to have induced her -present condition. Soon after her recovery, excessive somnolency began to -develop itself, which in 1857 became more profound after an attack of -scarlatina anginosa, followed by measles. The lucid intervals will occur -from four to six times a day, and last for from five to six minutes; at -which periods she will generally take some nourishment, and then relapse -into a profound slumber, from which it is impossible to arouse her. - -"In point of general physique there is nothing specially worthy of note, -except the comparative plumpness during such a long maintenance of the -recumbent posture, with very little muscular exercise. She is about the -average height of her sex, with cranial development possibly a little in -excess. The hands and feet are both exceedingly small, the nails of which -have not grown any since her present condition began. - - * * * * * - -"The catamenia commenced between the fourteenth and fifteenth years, and -are generally very irregular and painful; but, when anything like -regularity is attained, the flow occurs about every six weeks. - - * * * * * - -"None of the special senses are in the least diminished or perverted; -there has been neither squinting nor excessive dilatation of the pupils. -The irides both respond readily to the stimulus of light. While -interrogating the mother, a convulsive movement of the entire body took -place, apparently more violent in the upper than in the lower extremities. -The arms, hands, and feet were in rapid motion. At the subsidence of this, -consciousness was established; and the young lady herself, being -questioned about her condition, replied in a clear and comprehensible -manner, though merely using monosyllables. When asked if she suffered any -pain in her head, she replied yes, but without locating it; if in the -back, yes; if about the chest or abdomen, no. She was lucid about five -minutes, during which time a number of questions were asked her, but -without eliciting any further information. She took no food or medicine -during this interval of consciousness, and went to sleep while being -questioned, remaining in that state during the rest of the time we were -there--about half an hour--her rest being perfectly tranquil with the -exception of a slight convulsive movement." - -These cases of protracted sleep present many analogies with the condition -of hibernation which certain of the lower animals enter into at stated -periods. Doubtless the state of the brain is the same, and is one of -anæmia. - -It has never been my fortune to witness a case of protracted sleep. -Regarding the starting-point of the disorder as being situated in the -sympathetic system, I should be disposed to employ the direct galvanic -current in the treatment--placing the positive pole over the sympathetic -nerve in the neck, and the negative over the opposite scapula. This I -would do, using a battery of thirty-two or a less number of pairs, every -day, for from five to ten minutes. - - - - -CHAPTER XII. - -SOMNOLENTIA, OR SLEEP DRUNKENNESS. - - -By somnolentia, or sleep drunkenness, is understood a condition in which -some of the mental faculties and senses are fully aroused, others -partially so, while others remain as they are in profound sleep. It is -therefore an imperfect sleep, or rather a combination of wakefulness and -sleep. The phenomena peculiar to it are frequently met with in children, -in whom they may be excited through the influence of a dream, but which at -other times have no such origin. The condition in question is only induced -by the sudden waking of a person. - -A very excellent account of sleep drunkenness, in its medico-legal -relations, is given by Wharton and Stillé,[148] who have quoted several -interesting cases from German and other authors, which I do not hesitate -to transfer to these pages. - -"A sentry fell asleep during his watch, and, being suddenly aroused by the -officer in command, attacked the latter with his sword, and would have -killed him but for the interposition of the by-standers. The result of the -medical examination was, that the act was involuntary and irresponsible, -being the result of a violent confusion of mind consequent upon the sudden -waking from a profound sleep. - -"A day-laborer killed his wife with a wagon-tire, the blow being struck -immediately on his starting up from a deep sleep from which he was -forcibly awakened. In this case there was collateral evidence that the -defendant was seized, on awaking, with a delusion that a 'woman in white' -had snatched his wife from his side and was carrying her away, and that -his agony of mind was so great that his whole body was bathed in -perspiration. - -"A young man, named A. F., about twenty years of age, was living with his -parents in great apparent harmony, his father and himself being alike -distinguished for their great fondness for hunting. In consequence of -danger from nocturnal attacks, they were in the habit of taking their arms -with them into their chambers when they went to bed. On the afternoon of -September 1st, 1839, the father and son having just returned from hunting, -their danger became the subject of particular conversation. The next day -the hunting was repeated, and on their return, after taking supper with -every evidence of good feeling, they retired for the night, the son to his -own room, and his father and mother to theirs. Both father and son took -their loaded arms with them. At one o'clock the father got up to go into -the entry, and on his return jarred against the door, on which the son -instantly sprang up, seized his gun, and discharged it at his father, -giving him a fatal wound in the breast, at the same time exclaiming, 'Dog, -what do you want here?' The father immediately fell to the ground; and the -son, then recognizing him, sank on the floor, crying, 'Oh, Jesus! it is my -father!' - -"The evidence was that the whole family were subject to great restlessness -in their sleep, and that the defendant in particular was affected with a -tendency to be easily distressed by dreams, which lasted for about five -minutes, on waking, before their effect was entirely dissipated. His own -version of the affair was: 'I must have fired the gun in my sleep; it was -moonshine, and we were accustomed to talk and walk in our sleep. I -recollect hearing something jar; I jumped up, seized my gun, and fired -when I heard the noise; I recollect seeing nothing, nor am I conscious of -having spoken. The night was so bright that everything could have been -seen. I must have been under the delusion that thieves had broken in.' The -opinion of the medical experts was, that the act was committed during the -condition of sleep drunkenness, and that, accordingly, it was not that of -a free and responsible agent." - -The same authors quote the following case of Dr. Meister, from Herke's -Zeitschrift: - -"I was obliged," says the doctor, "to take a journey of eight miles on a -very hot summer's day--my seat being with my back to the horses, and the -sun directly in my face. On reaching the place of destination, and being -very weary and with a slight headache, I laid myself down, with my clothes -on, on a couch. I fell at once asleep, my head having slipped under the -back of the settee. My sleep was deep, and, as far as I can recollect, -without dreams. When it became dark, the lady of the house came with a -light into the room. I suddenly awoke, but, for the first time in my life, -without collecting myself. I was seized with a sudden agony of mind, and, -picturing the object which was entering the house as a specter, I sprang -up and seized a stool, which, in my terror, I would have thrown at the -supposed shade. Fortunately I was recalled to consciousness by the -firmness and tact of the lady herself, who, with the greatest presence of -mind, succeeded in composing my attention until I was entirely awakened." - -Hoffbauer[149] relates the particulars of a case which has passed into the -annals of medical jurisprudence as one of great importance. - -"Bernard Schidmaizig awoke suddenly at midnight. At the same moment he saw -a frightful phantom (at least so his imagination depicted it) standing -near him. That which appeared to his vision seemed to be a veritable -specter; and fear and the darkness of the night prevented him recognizing -anything with distinctness. With a feeble voice, he twice called out, 'Who -goes there?' He received no answer, and imagined that the apparition was -approaching him. Deprived for the instant of his reason, he jumped from -his bed, seized a hatchet which he generally kept near him, and with this -weapon attacked the imaginary specter. To see this apparition, to cry, -'Who goes there?' to seize the hatchet, were all done in a moment: he had -not an instant for reflection. At the first blow the phantom was struck to -the earth; Schidmaizig heard a deep groan. This sound, and the noise of -the imaginary phantom falling to the ground, fully awakened him; and -suddenly the thought struck him that he had assaulted his wife, who slept -with him. He threw himself on his knees, raised the head of the wounded -person, saw the injury he had inflicted, and the blood which flowed, and -with a voice full of anguish cried, 'Susannah! Susannah! come to -yourself!' He then called his eldest daughter, aged about eight -years--ordered her to see if her mother was recovering, and to tell her -grandmother what he had done. It was in reality his wife; and she died the -next day from the effects of the blow." - -As Hoffbauer remarks, "This man did not enjoy the free use of his senses; -he did not know what he saw; he believed that he was repulsing a sudden -attack. He very soon recognized the place where he ordinarily slept; it -was natural that he should seize his hatchet,--since he had taken the -precaution to place it near him,--but the idea of his wife, and of the -possibility of having killed her, were the last thoughts that entered his -mind." - -Seafield[150] quotes from the Express (London) of January 5th, 1859, the -following case of sleep drunkenness: - -"Yesterday the Marylebone Police Court was crowded to excess, in -consequence of a report which had been circulated, that a woman was in -custody for killing her child by throwing it from a first-floor window -into the street. The rumor in regard to the murder happily turned out to -be untrue; but it will be seen from the subjoined evidence that it was a -providential circumstance that the lives of three children were not -sacrificed by their mother while acting under the influence of a dream. - -"At two o'clock the prisoner, Esther Griggs, was placed at the bar before -Mr. Broughton. - -"Mr. Lewis, of Ely Place, appeared for her; and Mr. Tubbs, relieving -officer of Marylebone, attended on behalf of the board of guardians of the -parish, to watch the case. - -"The prisoner, who evidently felt the serious situation in which she was -placed, was seated during the proceedings. - -"The first witness called was Sergeant Simmons, 20 D, who said, 'At -half-past one o'clock this morning, while on duty in East Street, -Manchester Square, I heard a female voice exclaim, "Oh, my children! Save -my children!" I went to the house, No. 71, from whence the cries -proceeded, and the landlord opened the door. I went up-stairs, accompanied -by two other constables, and, while making our way to the first floor, I -heard the smashing of glass. I knocked at the door, which I found was -fastened, and said, "Open it; the police are here." The prisoner, who was -in her night-dress, kept on exclaiming, "Save my children!" and at length, -after stumbling over something, let me and my brother officers in. When we -entered, we found the room in total darkness; and it was only by the aid -of our lanterns that we could distinguish anything in the room. On the bed -there was a child five years old, and another, three years of age, by her -side. Everything in the room was in confusion. She kept crying out, -"Where's my baby? Have they caught it? I must have thrown it out of the -window." The baby must have been thrown out as I was going up-stairs; for -before getting into the room I heard something fall. I left a constable in -charge of the prisoner; and I ascertained that the child which had been -thrown from the window had been taken to the infirmary of Marylebone -Workhouse. She told me she had been dreaming that her little boy had said -that the house was on fire, and that what she had done was with the view -of preventing her children from being burned to death. I have no doubt,' -added the witness, 'that if I and the other constable had not gone to the -room all three of the children would have been thrown into the street.' - -"Mr. Broughton.--'How long do you suppose the cry of "Oh, save my -children!" continued?' - -"Witness.--'I should think about five minutes.' (In continuation, he said -he went to 38 Harley Street, where the husband lives, in the service of a -gentleman, and gave him information of what had occurred. The injured -infant was only eighteen months old.) - -"By Mr. Lewis.--'From the excited state in which the prisoner was, I did -not at the time take her into custody. She went to the infirmary along -with her husband, to see how the child was going on, and what hurt it had -sustained. I had understood that the surgeon had said it was a species of -nightmare which the prisoner was laboring under when the act was -committed. The window had not been thrown up. The child was thrust through -a pane of glass, the fragments of which fell into the street.' - -"Humphreys, 180 D.--'I heard the breaking of glass, and saw what I -imagined to be a bundle come out of the window, and, on taking it up, I -found it to be a female infant. There was blood running from its temples, -and it was insensible. I took it to the infirmary.' - -"Pollard, 314 D.--'I heard loud cries of "Oh, save my children!" and when -I was in her room she said, "Has anybody caught my baby Lizzie?" One of -the little boys, about three years old, and who was clinging to his -mother, had blood upon his clothes. He had upon his breast some marks, -which appeared to have been caused by cuts from glass. He left me to take -care of the prisoner while he went for her husband. She told me she had no -wish to hurt any of her children, and that it was all through a dream.' - -"Mr. Henry Tyrwhitt Smith, surgeon of the Marylebone Infirmary, was next -called, and said, 'That when the infant was brought to him, soon after one -in the morning, he found, upon examining it, that it was suffering from -concussion of the brain. It was quite insensible, and decidedly in danger -now. The parietal bone is broken, and death might ensue in the event of an -effusion of blood on the brain.' - -"By Mr. Lewis.--'I cannot say that I have not heard of an instance where -parties have committed acts to which a dream had impelled them.' - -"Mr. Lewis submitted to the magistrate that there had been no attempt to -murder the infant. The prisoner had always evinced a kindly feeling toward -her children, and he (the learned gentleman) hoped that the magistrate -would allow the husband to have her under his care during the temporary -remand which would of course take place. The dream under which the act -was committed showed that she had not, at the time, any consciousness of -what she was doing. - -"Mr. Tubbs said he did not attend in the capacity of a prosecutor, but he -appeared on behalf of the board of guardians; and he put it to the -magistrate whether there would be any objections, under the circumstances, -to allow the prisoner to be bailed, her husband being security for her -reappearance. - -"Mr. Broughton _considered that it would be a most dangerous doctrine to -lay down, to say that because a person was dreaming while committing an -offense, that they were not culpable for their acts_. A woman, on these -grounds, might get up in the middle of the night and cut her husband's -throat, and, when brought up for the offense, turn round and say that she -had done the act while under the influence of a dream. He (the worthy -magistrate) considered the case to be one of a serious nature; and in the -event of death ensuing, an inquest would be held on the body. He could not -think of taking bail in so serious a case, but would remand the prisoner -till Tuesday next, and during her present excited state she would be taken -care of in the infirmary. - -"The prisoner was then removed to the cells by Ansted, the jailer, sobbing -most bitterly. - -"The recorder, at the subsequent sessions at the Central Criminal Court, -in his address to the grand jury, took a somewhat more rational view of -the case than that entertained by Mr. Broughton. - -"'If the prisoner,' said the recorder, 'really did the act under the idea -that it was the best mode of insuring the safety of the child, it appeared -to him that, under such circumstances, it would be a question whether the -grand jury would be justified in coming to the conclusion that the -criminal was guilty of a criminal act.' - -"The grand jury threw out the bill." - -Several cases of sleep drunkenness have come under my own notice. - -A gentleman was roused one night by his wife, who heard the street-door -bell ring. He got up, and, without paying attention to what she said, -dragged the sheets off of the bed, tore them hurriedly into strips, and -proceeded to tie the pieces together. She finally succeeded in bringing -him to himself, when he said he thought the house was on fire, and he was -providing means for their escape. He did not recollect having had any -dream of the kind, but was under the impression that the idea had occurred -to him at the instant of his awaking. - -Another was suddenly aroused from a sound sleep by the slamming of a -window shutter by the wind. He sprang instantly from his bed, and, seizing -a chair that was near, hurled it with all his strength against the window. -The noise of the breaking of glass fully awakened him. He explained that -he imagined some one was trying to get into the house and had let his -pistol fall on the floor, thereby producing the noise which had startled -him. - -A lady informed me that upon one occasion she had gone to bed very tired, -but was suddenly startled from her sleep by a voice calling her by name. -Without stopping a moment, she arose, put on her shoes and stockings, lit -a candle, took a loaded pistol from a shelf near her husband's head, -cocked it, and was leaving the room, the pistol in one hand and the candle -in the other, when she was seized by her husband. She turned, recognized -him at once, and would have fallen to the floor had he not caught her in -his arms. Her husband, who slept in the same bed with her, had heard one -of the children cry in an adjoining room, and had called her. She, hearing -his voice, had partially awakened, but had conceived the idea that he had -called to her from another part of the house, where some danger menaced -him. She had acted upon this supposition, and was perfectly conscious of -every movement she had made. - -It does not appear that some persons are more liable to attacks of sleep -drunkenness than others. Neither do I know of any means by which its -occurrence could be prevented. It is a natural phenomenon, to which all -are liable. It is more important in its medico-legal relations than any -other. - - - - -APPENDIX. - -ADDITIONAL OBSERVATIONS RELATIVE TO THE PHYSIOLOGY OF SLEEP.[151] - - -Since the chapter on the Physiology of Sleep was written, I have, by -additional experiments, satisfied myself that the theory then enunciated -is correct in every essential particular. - -By means of an instrument adapted to show the extent of cerebral pressure, -and which I first described nearly two years ago, I have been enabled to -arrive at very positive results. In every instance the pressure was -lessened during sleep and was increased during wakefulness. The -experiments were performed upon dogs and rabbits. Briefly, the instrument -consists of a brass tube, which is screwed into a round hole made in the -skull with a trephine. Both ends of this tube are open, but into the upper -is screwed another brass tube, the lower end of which is closed by a piece -of very thin sheet india-rubber, and the upper end with a brass cap, into -which is fastened a glass tube. This inner arrangement contains colored -water, and to the glass tube a scale is affixed. - -This second brass tube is screwed into the first, till the thin rubber -presses upon the dura mater and the level of the colored water stands at -0, which is in the middle of the scale. Now, when the animal goes to -sleep, the liquid falls in the tube, showing that the cerebral pressure -has been diminished,--an event which can only take place in consequence of -a reduction in the quantity of blood circulating through the brain. As -soon as the animal awakes, the liquid rises at once. Nothing can exceed -the conclusiveness of experiments of this character. No mere theorizing -can avail against them. - - - - -FOOTNOTES: - -[1] See the author's Treatise on Hygiene, page 92. - -[2] La Théorie des Songes. Paris, 1766, p. 206. - -[3] On Obscure Diseases of the Brain, etc. London, 1860, p. 604, note. - -[4] Physiologie de la Pensée. Recherche Critique des Rapports du Corps à -l'Esprit. Deuxième édition. Paris, 1862, t. ii. p. 440. - -[5] Du Sommeil, des Rêves et du Somnambulisme, etc. Lyon, 1857, p. 14. - -[6] Observations in Medicine. Second Series, p. 27. - -[7] Art. _Sleep_. Cyclopedia of Anatomy and Physiology, vol. iv. part 1, -p. 681. - -[8] Chapters on Mental Physiology. London, 1852, p. 105. - -[9] Essays on Life, Sleep, Pain, etc. Philadelphia, 1852, pp. 63 and 64. - -[10] Epilepsy and Epileptiform Seizures. London, 1858, p. 123. - -[11] Nouveaux Éléments de la Science de l'Homme. 3me édition. Paris, 1858, -vol. ii. p. 7, et seq. - -[12] Rapports du Physique et du Morale de l'Homme. Paris, 1824, p. 379. - -[13] The Physiology of Common Life. New York, 1860, vol. ii. p. 305. - -[14] Philosophy of Sleep. Second edition, 1850, p. 5. - -[15] The Haven of Health, chiefly made for the comfort of Students, and -consequently for all those that have a care for their health, etc. By -Thomas Cogan, Master of Arts and Batchelor of Physic. London, 1612, p. -332. - -[16] Sketches of the Philosophy of Life. London, 1819, p. 262. - -[17] Elements of Physiology. Translated by John Elliotson, M.D., etc. 4th -edition. London, 1828, p. 191. - -[18] Op. cit. p. 282, et seq. - -[19] Northern Journal of Medicine, No. 1, 1844, p. 34. - -[20] The Philosophy of Mystery. London, 1841, p. 283. - -[21] British and Foreign Medico-Chirurgical Review, Am. ed., April, 1855, -p. 404. - -[22] American Journal of the Medical Sciences, October, 1860, p. 399. - -[23] The Physiology of Sleep. By Arthur E. Durham. Guy's Hospital Reports, -3d Series, vol. vi. 1860, p. 149. - -[24] Recherches sur la Système Nerveux Cerebro-Spinal, sa Structure, ses -Fonctions et ses Maladies. Paris, 1865, p. 448. - -[25] Cyclopedia of Practical Medicine, article _Cold_. - -[26] Cyclopedia of Anatomy and Physiology, vol. iv., part 1, p. 681, -article _Sleep_. - -[27] Essays on Life, Sleep, and Pain. Philadelphia, 1852, p. 87. - -[28] The Doctor, etc., edited by Rev. John Wood Warter. London. - -[29] Op. cit., p. 5. - -[30] Rapports du Physique et du Morale de l'Homme. Paris, 1825, tome ii. -p. 381. - -[31] Medicina Statica; or Rules of Health, etc. London, 1676, p. 106 et -seq. - -[32] Op. cit., p. 6. - -[33] Op. cit., tome ii. p. 385. - -[34] An Essay concerning Human Understanding. Book ii. sect. 17. - -[35] Encyclopedia Americana,--Philadelphia, 1832, vol. xii. p. 143, art. -Tartini; and L'Imagination considérée dans ses Effets directs sur l'Homme -et les Animaux, etc. Par J. B. Demangeon. Seconde édition. Paris, 1829, p. -161. - -[36] The Soul and the Future Life. Appendix viii. Quoted by Seafield in -"The Literature and Curiosities of Dreams," etc. London, 1865. Vol. ii. p. -229. - -[37] Confessions of an English Opium-eater. Boston, 1866, p. 109. - -[38] Journal of Psychological Medicine and Mental Pathology. July, 1859, -p. 44. - -[39] Inquiries concerning the Intellectual Powers and the Investigation of -Truth. Tenth edition. London, 1840, p. 304. - -[40] History of Dreams, Visions, Apparitions, etc. Philadelphia, 1855, p. -184. - -[41] Macario, Du Sommeil, des Rêves et du Somnambulisme. Paris, 1857, p. -59. - -[42] Op. cit., tome ii. p. 395. - -[43] Ancient Metaphysics. Quoted in Dr. Forbes Winslow's Medical Critic -and Psychological Journal. No. vi., April, 1862, p. 206. - -[44] Op. cit., p. 283. - -[45] Dream Thought and Dream Life. Medical Critic and Psychological -Journal, No. vi., April, 1862, p. 199. - -[46] Account of the Life and Writings of Thomas Reid, D.D., p. cxliv., -prefixed to Essays on the Powers of the Human Mind. By Thomas Reid, D.D., -etc. Edinburgh, 1803, vol. i. - -[47] Dissertations, Moral and Critical. London, 1783, art. Dreaming, p. -222. - -[48] Syntagma Philosophicum. Pars 71, Lib. viii. Opera Omnia, tome i. -Lugduni, 1658. - -[49] Philosophy of Mystery. London, 1841, p. 208. - -[50] Op. cit., p. 286. - -[51] Psychologie; oder der Wissenschaft von Subjectiven Geist. 2ten -Auflage. Ebberfeld, 1843, p. 144. - -[52] The Principles of Medical Psychology, etc. Sydenham Society -Translation, p. 167. - -[53] Elements of Physiology. Translated from the German, with Notes, by -William Baly, M.D., etc. London, 1842, vol. ii. p. 1417. - -[54] Op. cit., p. 1418. - -[55] Psychological Inquiries. Part i. London, 1856, p. 153. - -[56] Du Sommeil--Mélanges Philosophiques. Seconde édition. Paris, 1838, p. -301. - -[57] Sleep Psychologically considered with reference to Sensation and -Memory. New York, 1850, p. 74. - -[58] An Inquiry into the Nature of Sleep and Death. London, 1834, p. 152. -(Reprinted from the Philosophical Transactions for 1833.) - -[59] Zoonomia; or, The Laws of Organic Life. Am. ed., vol. i. -Philadelphia, 1818, p. 153. - -[60] Elements of the Philosophy of the Human Mind. Am. ed. Boston, 1818, -vol. i. p. 184. - -[61] Op. cit., t. ii. p. 376, et seq. Article Du Sommeil en particulier. - -[62] An Essay Concerning Human Understanding, chapter xxi. section 30. - -[63] Essays on the Powers of the Human Mind, vol. iii. Edinburgh, 1803, p. -77. - -[64] Op. cit., p. 155. - -[65] An Essay Concerning the Human Understanding, book ii. section 17. - -[66] Op. et loc. cit., section 11. - -[67] Historia Naturalis, lib. x. cap. lxxv., "De Somno Animalium." - -[68] De defectu oraculorum. - -[69] De Vita, xii. Cæsarum, Nero, cap. xlvi. - -[70] Op. cit., p. 63. - -[71] Lectures on Metaphysics, vol. i. p. 323. - -[72] Inquiries Concerning the Intellectual Powers and the Investigation of -Truth. Tenth edition. London, 1840, p. 283. - -[73] Op. cit., p. 10. - -[74] Quoted in Dendy's Philosophy of Mystery. London, 1841, p. 225. - -[75] The Principles of Medical Psychology, etc. Sydenham Society -Translation. London, 1847, p. 163. - -[76] Op. cit., book ii. sec. 17. - -[77] Cited by M. l'Abbé Richard in _La Théorie des Songes_. Paris, 1766, -p. 32. - -[78] De Rerum Natura, l. iv. v. 959. - -[79] Satyricon. Bohn's edition. London, 1854, p. 307. - -[80] In the above quotation I have slightly altered Kelly's version in -Bohn's edition of Petronius. The original Latin is fully as forcible and -true to nature as the translation. - -[81] Op. cit., p. 275, et seq. - -[82] Journal of Psychological Medicine. July, 1856. - -[83] Le Sommeil et les Rêves; Études Psychologiques, etc. Troisième -édition. Paris, 1865. - -[84] Sermon on the Office of the Holy Angels toward the Faithful, quoted -by Seafield. Op. cit., vol. i. p. 157. - -[85] Op. cit., p. 86. - -[86] Op. cit., p. 88, et seq. - -[87] On Obscure Diseases of the Brain and Disorders of the Mind, etc., -London, 1860, p. 611, et seq. - -[88] Anatomie Comparée du Système Nerveux, etc. Par MM. Leuret et -Gratiolet. Paris, 1839-1857, t. ii. 517, et seq. - -[89] Art. Rêves, in Grand Dictionnaire de Médecine. - -[90] Des Maladies Mentales et des Asiles d'Aliénés, etc., Paris, 1864, p. -221. - -[91] Traité des Maladies Mentales, Paris, 1860, p. 457. - -[92] On Obscure Diseases of the Brain and Disorders of the Mind, etc., -London, 1860, p. 614. - -[93] The Principles of Medical Psychology. Being the Outlines of a Course -of Lectures, by Baron Ernst von Feuchtersleben, M.D. Sydenham Society -Translation, p. 198. - -[94] Medical Press and Circular; also Quarterly Journal of Psychological -Medicine and Medical Jurisprudence, vol. i. p. 276. - -[95] Medical Investigator; also Quarterly Journal of Psychological -Medicine, etc., April, 1868, p. 405. - -[96] Op. cit., art. _Rêves_. - -[97] Op. cit., p. 95. - -[98] Rapports du Physique et du Morale de l'Homme. Paris, 1824, tome -second, p. 359. - -[99] Chapters on Mental Physiology. London, 1852, p. 126. - -[100] B. D. S. Opera Posthuma, 1677, Epistola xxx. p. 471. In the course -of this letter to his friend, Peter Balling, Spinoza says: - -"Quum quodam mane, lucesente jam cælo, ex somnio gravissima evigilarem -imagines, quæ mihi in somnio occurrerant, tam vividè ob oculos -versabantur, ac si res finissent veræ, et præsertim cujusdam nigri et -scabiosi Brasiliani, quem nunquam antea videram. Hæc imago partem maximam -disparebat, quando, ut me alia re oblectarem, oculus in librum, vel aliud -quid defigibam; quamprimium verò oculos à tali objecto rursus avertebam, -sine attentione in aliquid oculos defigendo, mihi eadem ejusdem Æthiopis -imago eâdem vividètate, et per vices apparebat, donec paulatim circa caput -disparetet." - -[101] Elements of Physiology, translated by Baly, vol. ii. p. 1394. - -[102] Op. cit., p. 93. - -[103] [Greek: Peri ierês noso.] - -[104] Quoted from I. Franck by Macario, op. cit., p. 100. - -[105] De quelques Phénomènes du Sommeil. Oeuvres Complets, tome v. p. -170-175. - -[106] Grand Dictionnaire de Médecine, t. xxxiv., art. Incubi, par M. -Parent. - -[107] Nouveau Dictionnaire de Médecine et de Chirurgie Pratiques, tome -sixième, Paris, 1867, art. Cauchemar. - -[108] Gazette Médicale de Lyon, 15 Mai, 1856; also Macario, op. cit., p. -104. - -[109] British and Foreign Medico-Chirurgical Review, April, 1845, vol. -xix. p. 441. - -[110] Traité du Somnambulisme et des différentes Modifications qu'il -présente. Paris, 1823. - -[111] Op. cit., p. 117. - -[112] Op. cit., p. 2. - -[113] Quoted by Bertrand, op. cit., p. 15. - -[114] Cyclopædia of Practical Medicine. American edition, vol. iv. p. 196, -article Somnambulism. - -[115] Della Forza della Fantasia Umana. Venezia, 1766. - -[116] Op. cit., p. 127. - -[117] Article Somnambulism, in the Cyclopædia of Practical Medicine, vol. -iv. p 198, American edition. - -[118] Bertrand, op. cit., p. 17. - -[119] Op. cit., p. 18. - -[120] Op. cit., p. 132. - -[121] The Scenery and Poetry of the English Lakes. By Charles Mackay, -LL.D. - -[122] Life of Sir Isaac Newton. By Sir David Brewster, vol ii. p. 240. - -[123] On Obscure Diseases of the Brain, etc. London, 1860, p. 609. - -[124] Sur l'Influence Pathologique de l'Insomnie. Annales -Médico-Psychologiques, 3me Série, t. iii. p. 384, et seq. - -[125] Le Sommeil et les Rêves. 3me éd. Paris, 1865, p. 9. - -[126] Mental Hygiene. Boston, 1863, p. 97. - -[127] A Manual of Psychological Medicine, etc. London, 1858, p. 375. - -[128] Psychological Inquiries. Third edition, London, 1856, p. 141. - -[129] Op. cit. p. 142. - -[130] On Obscure Diseases of the Brain, etc. By Forbes Winslow, M.D. -London, 1860, p. 604. - -[131] Medical Logic, p. 81, quoted in Cyclopedia of Anatomy and -Physiology, vol iv. part i. p. 686. - -[132] Clinical Observations on Functional Nervous Disorders. London, 1864, -p. 284. - -[133] A History of Dreams, Visions, Apparitions, etc. American edition. -Philadelphia, 1855. - -[134] The Philosophy of Mystery. By Walter Cooper Dendy. London, 1841, -page 290. - -[135] It is perhaps scarcely necessary to call attention to the fact that -Mr. Dendy has altogether mistaken the signification of the words in the -above quotation from Tissot, printed in italics. He appears to think they -mean _being put on his head_, a translation which would make very great -nonsense out of the whole extract. The words will be found in Tissot's -_Avis aux Gens de Lettres et aux Personnes sédentaires sur leur Santé_, -Paris, 1768, p. 28, and in English, in a translation entitled "_A Treatise -on the Diseases of Literary and Sedentary Persons_," Edinburgh, 1772, p. -26. The work is well worthy of attention even at this day, as containing -many most interesting facts and important suggestions. - -[136] On Obscure Diseases of the Brain, etc., p. 607. - -[137] The word _assassin_ is derived from the word _hashish_, from the -fact that a sect in the East called _Assassins_ made use of _hashish_ to -induce the temporary insanity during which their crimes were perpetrated. -See _History of the Assassins_, by the Chevalier Joseph von Hammer, -translated from the German by O. C. Wood, M.D., London, 1835, p. 233, -note. - -[138] Physiological Memoirs, 1863, p. 24, _et seq._ - -[139] On Functional Nervous Disorders. London, 1864, p. 282. - -[140] Cyclopedia of Practical Medicine, vol. iv., art. Wakefulness. - -[141] Therapeutics and Materia Medica, 2d edition, Philadelphia, 1864, -vol. ii. page 659. - -[142] The instance alluded to, that of Admiral Fitzroy, is thus commented -upon by the _Spectator_ of May 6th, 1865: - -"Admiral Fitzroy, the well-known meteorologist, committed suicide on -Monday morning at his own house. He had overworked himself of late; found -that he was losing his memory; became sleepless, and resorted to opium to -obtain ease, which aggravated his symptoms. His doctor had warned him that -he ran great risk of paralysis, but from a false tenderness did not at -once compel him to give up labor." - -The _London Review_ of the same date says: "He (Admiral Fitzroy) acquired -that terrible inability to sleep, which is one of the most dreadful of -those means by which nature avenges the abuse of the mental powers, and he -was forced to take opium at night; at one time to an extent which -threatened serious consequences." - -[143] Journal of an African Cruiser, quoted in Curiosities of Modern -Travel, London, 1846, p. 239. - -[144] Gazette des Hôpitaux, Oct. 13, 1868. - -[145] Wonders of the Little World, etc., London, 1806, vol. ii. p. 394; -quoted from Universal Magazine, vol. viii. p. 312. - -[146] Op. cit. - -[147] New York Medical Journal, December, 1867. - -[148] A Treatise on Medical Jurisprudence, Philadelphia, 1855, p. 120. - -[149] Médecine légale relative aux Aliénés et aux Sourds-Muets, ou les -Lois appliquées aux Désordres de l'Intelligence. Traduit de l'Allemande -par A. M. Chambeyron, avec des Notes par MM. Esquirol et Itard. Paris, -1827, p. 256. - -[150] The Literature and Curiosities of Dreams, etc., London, 1865, vol. -ii. p. 332. - -[151] See New York Medical Gazette and Quarterly Journal of Psychological -Medicine and Medical Jurisprudence, January, 1869, p. 47. - - - - -Transcriber's Notes: - -Passages in italics are indicated by _italics_. - -The original text includes Greek characters that have been replaced with -transliterations in this text version. - - - - - - -End of Project Gutenberg's Sleep and Its Derangements, by William A. 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Hammond—A Project Gutenberg eBook @@ -49,46 +49,7 @@ </style> </head> <body> - - -<pre> - -Project Gutenberg's Sleep and Its Derangements, by William A. Hammond - -This eBook is for the use of anyone anywhere at no cost and with -almost no restrictions whatsoever. You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: Sleep and Its Derangements - -Author: William A. 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You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: Sleep and Its Derangements - -Author: William A. Hammond - -Release Date: October 5, 2013 [EBook #43887] - -Language: English - -Character set encoding: ASCII - -*** START OF THIS PROJECT GUTENBERG EBOOK SLEEP AND ITS DERANGEMENTS *** - - - - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive.) - - - - - - - - - -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 Abbe 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." - - - - -CHAPTER II. - -THE CAUSES OF SLEEP. - - -The exciting cause of natural and periodic sleep is undoubtedly to be -found in the fact that the brain at stated times requires repose, in order -that the cerebral substance which has been decomposed by mental and -nervous action may be replaced by new material. There are other exciting -causes than this, however, for sleep is not always induced by ordinary or -natural influences acting periodically. There are many others, which -within the strict limits of health may cause such a condition of the brain -as to produce sleep. - -Authors, in considering sleep, have not always drawn the proper -distinction between the exciting and the immediate cause. Thus Macario,[5] -in alluding to the alleged causes of sleep, says: - -"Among physiologists some attribute it to a congestion of blood in the -brain; others to a directly opposite cause, that is, to a diminished -afflux of blood to this organ; some ascribe it to a loss of nervous -fluid, others to a flow of this fluid back to its source; others again -find the cause in the cessation of the motion of the cerebral fibers, or -rather in a partial motion in these fibers. Here I stop, for I could not, -even if I wished, mention all the theories which have prevailed relative -to this subject. I will only add that, in my opinion, the most probable -proximate and immediate cause appears to be feebleness. What seems to -prove this view is the fact that exhaustive hot baths, heat, fatigue, too -great mental application are among the means which produce sleep." - -Undoubtedly the influence mentioned by Macario, and many others which he -might have cited, lead to sleep. They do so through the medium of the -nervous system--causing a certain change to take place in the physical -condition of the brain. We constantly see instances of this transmission -of impressions and the production of palpable effects. Under the influence -of fatigue, the countenance becomes pale; through the actions of certain -emotions, blushing takes place. When we are anxious or suffering or -engaged in intense thought, the perspiration comes out in big drops on our -brows; danger makes some men tremble, grief causes tears to flow. Many -other examples will suggest themselves to the reader. It is surely, -therefore, no assumption to say that certain mental or physical influences -are capable of inducing such an alteration in the state of the brain as -necessarily to cause sleep. These influences or exciting causes I propose -to consider in detail, after having given my views relative to the -condition of the brain which immediately produces sleep. - -It is well established as regards other viscera, that during a condition -of activity there is more blood in their tissues than while they are at -rest. It is strange, therefore, that, relative to the brain, the contrary -doctrine should have prevailed so long, and that even now, after the -subject has been so well elucidated by exact observation, it should be the -generally received opinion that during sleep the cerebral tissues are in a -state approaching congestion. Thus Dr. Marshall Hall,[6] while contending -for this view, also advances the theory that there is a special set of -muscles, the duty of which is, by assuming a condition of tonic -contraction, so to compress certain veins as to prevent the return of the -blood from the heart. - -Dr. Carpenter[7] is of the opinion that the first cause of sleep in order -of importance is the pressure exerted by distended blood-vessels upon the -encephalon. - -Sir Henry Holland[8] declares that a "degree of pressure is essential to -perfect and uniform sleep." - -Dr. Dickson[9] regards an increased determination of blood to the -cerebral mass, and its consequent congestion in the larger vessels of the -brain, as necessary to the induction of sleep. - -In his very excellent work on Epilepsy, Dr. Sieveking[10] says: - -"Whether or not there is actually an increase in the amount of blood in -the brain during sleep, and whether, as has been suggested, the choroid -plexuses become turgid or not, we are unable to affirm otherwise than -hypothetically; the evidence is more in favor of cerebral congestion than -of the opposite condition inducing sleep--evidence supplied by physiology -and pathology." Dr. Sieveking does not, however, state what this evidence -is. - -Barthez[11] is of the opinion that during sleep there is a general -plethora of the smaller blood-vessels of the whole body. He does not -appear to have any definite views relative to the condition of the -cerebral circulation. - -Cabanis[12] declares that as soon as the necessity for sleep is -experienced, there is an increased flow of blood to the brain. - -To come to more popular books than those from which we have quoted, we -find Mr. Lewes,[13] when speaking of the causes of sleep, asserting that: -"It is caused by fatigue, because one of the natural consequences of -continued action is a slight congestion; and it is the _congestion_ which -produces sleep. Of this there are many proofs." Mr. Lewes omits to specify -these proofs. - -Macnish[14] holds the view that sleep is due to a determination of blood -to the head. - -That a similar opinion has prevailed from very ancient times, it would be -easy to show. I do not, however, propose to bring forward any further -citations on this point, except the following, from a curious old -black-letter book now before me, in which the views expressed, though -obscure, are perhaps as intelligible as many met with in books of our own -day: - -"And the holy scripture in sundrie places doth call death by the name of -sleepe, which is meant in respect of the resurrection; for, as after -sleepe we hope to wake, so after death we hope to rise againe. But that -definition which Paulus AEgineta maketh of sleepe, in my judgment, is most -perfect where he saith: Sleepe is the rest of the pores animall, -proceeding of some profitable humour moistening the braine. For here is -shewed by what means sleepe is caused; that is, by vapours and fumes -rising from the stomache to the head, where through coldness of the braine -they being congealed, doe stop the conduites and waies of the senses, and -so procure sleepe, which thing may plainly be perceived hereby; for that -immediately after meate we are most prone to sleepe, because then the -vapours ascende most abundantly to the braine, and such things as be most -vaporous do most dispose to sleepe, as wine, milke, and such like."[15] - -The theory that sleep is due directly to pressure of blood-vessels, filled -to repletion, upon the cerebral tissues, doubtless originated in the fact -that a comatose condition may be thus induced. This fact has long been -known. Servetus, among other physiological truths, distinctly announces it -in his _Christianismi Restitutio_, when he says: - -"_Et quando ventriculi ita opplentur pituita, ut arteriae ipsae choroidis ea -immergantur, tunc subito generatur appoplexia._" - -Perhaps the theory which prevails at present, of sleep being due to the -pressure of distended blood-vessels upon the choroid plexus, is derived -from these words of Servetus. - -That stupor may be produced by pressure upon the brain admits of no doubt. -It is familiarly known to physicians, surgeons, and physiologists; the two -former meet with instances due to pathological causes every day, and the -latter bring it on at will in their laboratories. But this form of coma -and sleep are by no means identical. On the contrary, the only point of -resemblance between the two consists in the fact that both are accompanied -by a loss of volition. It is true, we may often arrive at a correct idea -of a physiological process from determining the causes and phenomena of -its pathological variations, but such a course is always liable to lead to -great errors, and should be conducted with every possible precaution. In -the matter under consideration it is especially of doubtful propriety, for -the reason stated, that coma is not to be regarded as a modification of -sleep, but as a distinct morbid condition. Sir T. C. Morgan,[16] in -alluding to the fact that sleep has been ascribed to a congested state of -the brain, for the reason that in apoplectic stupor the blood-vessels of -that organ are abnormally distended, objects to the theory, on the ground -that it assimilates a dangerous malady to a natural and beneficial -process. He states (what was true at the time he wrote) that the condition -of the circulation through the brain, during sleep, is wholly unknown. - -It is important to understand clearly the difference between stupor and -sleep, and it is very certain that the distinction is not always made by -physicians; yet the causes of the two conditions have almost nothing in -common, and the phenomena of each are even more distinct. - -1. In the first place, stupor never occurs in the healthy individual, -while sleep is a necessity of life. - -2. It is easy to awaken a person from sleep, while it is often impossible -to arouse him from stupor. - -3. In sleep the mind may be active, in stupor it is as it were dead. - -4. Pressure upon the brain, intense congestion of its vessels, the -circulation of poisoned blood through its substance cause stupor, but do -not induce sleep. For the production of the latter condition a diminished -supply of blood to the brain, as will be fully shown hereafter, is -necessary. - -Perhaps no one agent so distinctly points out the difference between sleep -and stupor as opium and its several preparations. A small dose of this -medicine acting as a stimulant increases the activity of the cerebral -circulation, and excites a corresponding increase in the rapidity and -brilliancy of our thoughts. A larger dose lessens the amount of blood in -the brain, and induces sleep. A very large dose sometimes diminishes the -power of the whole nervous system, lessens the activity of the respiratory -function, and hence allows blood which has not been properly subjected to -the influence of the oxygen of the atmosphere to circulate through the -vessels of the brain. There is nothing in the opium itself which produces -excitement, sleep, or stupor, by any direct action upon the brain. All its -effects are due to its influence on the heart and blood-vessels, through -the medium, however, of the nervous system. This point can be made plainer -by adducing the results of some experiments which I have lately performed. - -_Experiment._--I placed three dogs of about the same size under the -influence of chloroform, and removed from each a portion of the upper -surface of the skull an inch square. The dura mater was also removed, and -the brain exposed. After the effects of the chloroform had passed -off--some three hours subsequent to the operation--I administered to -number one the fourth of a grain of opium, to number two a grain, and to -number three two grains. The brain of each was at the time in a perfectly -natural condition. - -At first the circulation of the blood in the brain was rendered more -active, and the respiration became more hurried. The blood-vessels, as -seen through the openings in the skulls, were fuller and redder than -before the opium was given, and the brain of each animal rose through the -hole in the cranium. Very soon, however, the uniformity which prevailed in -these respects was destroyed. In number one the vessels remained -moderately distended and florid for almost an hour, and then the brain -slowly regained its ordinary appearance. In number two the active -congestion passed off in less than half an hour, and was succeeded by a -condition of very decided shrinking, the surface of the brain having -fallen below the surface of the skull, and become pale. As these changes -supervened, the animal gradually sank into a sound sleep, from which it -could easily be awakened. In number three the surface of the brain became -dark, almost black, from the circulation of blood containing a -superabundance of carbon, and owing to diminished action of the heart and -vessels it sank below the level of the opening, showing, therefore, a -diminished amount of blood in its tissue. At the same time the number of -respirations per minute fell from 26 to 14, and they were much weaker than -before. A condition of complete stupor was also induced from which the -animal could not be aroused. It persisted for two hours. During its -continuance, sensation of all kind was abolished, and the power of motion -was altogether lost. - -It might be supposed that the conditions present in numbers two and three -differed only in degree. That this was not the case is shown by the -following experiment: - -_Experiment._--To the dogs two and three I administered on the following -day, as before, one and two grains of opium respectively. As soon as the -effects began to be manifested upon the condition of the brain, I opened -the trachea of each, and, inserting the nozzle of a bellows, began the -process of artificial respiration. In both dogs the congestion of the -blood-vessels of the brain disappeared. The brain became collapsed, and -the animals fell into a sound sleep, from which they were easily -awakened. If the action of the bellows was stopped and the animals were -left to their own respiratory efforts, no change ensued in number two, but -in number three the surface of the brain became dark, and stupor resulted. - -In order to be perfectly assured upon the subject, I proceeded as follows -with another dog: - -_Experiment._--The animal was trephined as was the others, and five grains -of opium given. At the same time the trachea was opened and the process of -artificial respiration instituted. The brain became slightly congested, -then collapsed, and sleep ensued. The sleep was sound, but the animal was -easily awakened by tickling its ear. After I had continued the process for -an hour and a quarter, I removed the nozzle of the bellows, and allowed -the animal to breathe for itself. Immediately the vessels of the brain -were filled with black blood, and the surface of the brain assumed a very -dark appearance. - -The dog could no longer be aroused, and died one hour and a quarter after -the process was stopped. - -I have only stated those points of the experiments cited which bear upon -the subject under consideration, reserving for another occasion others of -great interest. It is, however, shown that a small dose of opium excites -the mind, because it increases the amount of blood in the brain; that a -moderate dose causes sleep, because it lessens the amount of blood; and -that a large dose produces stupor by impeding the respiratory process, -and hence allowing blood loaded with carbon, and therefore poisonous, to -circulate through the brain. - -It is also shown that the condition of the brain during stupor is very -different from that which exists during sleep. In the one case its vessels -are loaded with dark blood; in the other they are comparatively empty, and -the blood remains florid. - -I think it will be sufficiently established, in the course of these -remarks, that sleep is directly caused by the circulation of a less -quantity of blood through the cerebral tissues than traverses them while -we are awake. This is the immediate cause of healthy sleep. Its exciting -cause is, as we have seen, the necessity for repair. The condition of the -brain which is favorable to sleep may also be induced by various other -causes, such as heat, cold, narcotics, anaesthetics, intoxicating liquors, -loss of blood, etc. If these agents are allowed to act excessively, or -others, such as carbonic oxide, and all those which interfere with the -oxygenation of the blood, are permitted to exert their influence, stupor -results. - -The theory above enunciated, although proposed in a modified form by -Blumenbach several years since, and subsequently supported by facts -brought forward by other observers, has not been received with favor by -any considerable number of physiologists. Before, therefore, detailing my -own experience, I propose to adduce a few of the most striking proofs of -its correctness which I have been able to collect, together with the -opinions of some of those inquirers who have recently studied the subject -from this point of view. - -Blumenbach[17] details the case of a young man, eighteen years of age, who -had fallen from an eminence and fractured the frontal bone, on the right -side of the coronal suture. After recovery took place a hiatus remained, -covered only by the integument. While the young man was awake this chasm -was quite superficial, but as soon as sleep ensued it became very deep. -The change was due to the fact that during sleep the brain was in a -collapsed condition. From a careful observation of this case, as well as -from a consideration of the phenomena attendant on the hibernation of -animals, Blumenbach[18] arrives at the conclusion that the proximate cause -of sleep consists in a diminished flow of oxygenated blood to the brain. - -Playfair[19] thinks that sleep is due to "a diminished supply of oxygen to -the brain." - -Dendy[20] states that there was, in 1821, at Montpellier, a woman who had -lost part of her skull, and the brain and its membranes lay bare. When she -was in deep sleep the brain remained motionless beneath the crest of the -cranial bones; when she was dreaming it became somewhat elevated; and -when she was awake it was protruded through the fissure in the skull. - -Among the most striking proofs of the correctness of the view that sleep -is due to diminished flow of blood to the head, are the experiments of Dr. -Alexander Fleming,[21] late Professor of Medicine, Queen's College, Cork. -This observer states, that while preparing a lecture on the mode of -operation of narcotic medicines, he conceived the idea of trying the -effect of compressing the carotid arteries on the functions of the brain. -The first experiment was performed on himself, by a friend, with the -effect of causing immediate and deep sleep. The attempt was frequently -made, both on himself and others, and always with success. "A soft humming -in the ears is heard; a sense of tingling steals over the body, and in a -few seconds complete unconsciousness and insensibility supervene, and -continue so long as the pressure is maintained." - -Dr. Fleming adds, that whatever practical value may be attached to his -observations, they are at least important as physiological facts, and as -throwing light on the causes of sleep. It is remarkable that his -experiments have received so little notice from physiologists. - -Dr. Bedford Brown,[22] of North Carolina, has recorded an interesting -case of extensive compound fracture of the cranium, in which the -opportunity was afforded him of examining the condition of the cerebral -circulation while the patient was under the influence of an anaesthetic, -preparatory to the operation of trephining being performed. A mixture of -ether and chloroform was used. Dr. Brown says: - -"Whenever the anaesthetic influence began to subside, the surface of the -brain presented a florid and injected appearance. The hemorrhage -increased, and the force of the pulsation became much greater. At these -times so great was the alternate heaving and bulging of the brain, that we -were compelled to suspend operations until they were quieted by a -repetition of the remedy. Then the pulsations would diminish, the cerebral -surface recede within the opening of the skull, as if by collapse; the -appearance of the organ becoming pale and shrunken with a cessation of the -bleeding. In fact, we were convinced that diminished vascularity of the -brain was an invariable result of the impression of chloroform or ether. -The changes above alluded to recurred sufficiently often, during the -progress of the operation, in connection with the anaesthetic treatment, to -satisfy us that there could be no mistake as to the cause and effect." - -It will be shown, in the course of the present memoir, that Dr. Brown's -conclusions, though in the main correct, are erroneous so far as they -relate to the effect of chloroform upon the cerebral circulation; nor -does it appear that he employed this agent unmixed with ether, in the case -which he has recorded so well. He has, probably, based his remarks on this -point upon the phenomena observed when the compound of ether and -chloroform was used--the action of pure chloroform, as regards its effect -upon the quantity of blood circulating through the brain, being the -reverse of that which he claims for it. - -But the most philosophical and most carefully digested memoir upon the -proximate cause of sleep, which has yet been published, is that of Mr. -Durham.[23] Although my own experiments in the same direction, and which -will be hereafter detailed, were of prior date, I cheerfully yield all the -honor which may attach to the determination of the question under -consideration to this gentleman, who has not only worked it out -independently, but has anticipated me several years in the publication, -besides carrying his researches to a much further point than my own -extended. - -With the view of ascertaining by ocular examination the vascular condition -of the brain during sleep, Durham placed a dog under the influence of -chloroform, and removed with a trephine a portion of bone as large as a -shilling from the parietal region; the dura mater was also cut away. -During the continuance of the anaesthetic influence, the large veins of -the surface of the pia mater were distended, and the smaller vessels were -full of dark-colored blood. The longer the administration of the -chloroform was continued, the greater was the congestion. As the effects -of this agent passed off, the animal sank into a natural sleep, and then -the condition of the brain was very materially changed. Its surface became -pale and sank down below the level of the bone; the veins ceased to be -distended, and many which had been full of dark blood could no longer be -distinguished. When the animal was roused, the surface of the brain became -suffused with a red blush, and it ascended into the opening through the -skull. As the mental excitement increased, the brain became more and more -turgid with blood, and innumerable vessels sprang into sight. The -circulation was also increased in rapidity. After being fed, the animal -fell asleep, and the brain again became contracted and pale. In all these -observations the contrast between the two conditions was exceedingly well -marked. - -To obviate any possible effects due to atmospheric pressure, watch-glasses -were applied to the opening in the skull, and securely cemented to the -edges with Canada balsam. The phenomena observed did not differ from those -previously noticed; and, in fact, many repetitions of the experiment gave -like results. - -Durham, in the next place, applied ligatures to the jugular and vertebral -veins, with the effect--as was to be expected--of producing intense -congestion of the brain, attended with coma. This last condition he very -properly separates from sleep, which is never caused by pressure from the -veins. He likens sleep to the state induced by preventing the access of -blood to the brain through the carotids, but does not allude to Fleming's -researches on this point. - -From his observations, Durham deduces the following conclusions: - -"1. Pressure of distended veins upon the brain is not the cause of sleep, -for during sleep the veins are not distended; and when they are, symptoms -and appearances arise which differ from those which characterize sleep. - -"2. During sleep the brain is in a comparatively bloodless condition, and -the blood in the encephalic vessels is not only diminished in quantity, -but moves with diminished rapidity. - -"3. The condition of the cerebral circulation during sleep is, from -physical causes, that which is most favorable to the nutrition of the -brain tissue; and, on the other hand, the condition which prevails during -waking is associated with mental activity, because it is that which is -most favorable to oxydation of the brain substance, and to various changes -in its chemical constitution. - -"4. The blood which is derived from the brain during sleep is distributed -to the alimentary and excretory organs. - -"5. Whatever increases the activity of the cerebral circulation tends to -preserve wakefulness; and whatever decreases the activity of the cerebral -circulation, and, at the same time, is not inconsistent with the general -health of the body, tends to induce and favor sleep. Such circumstances -may act primarily through the nervous or through the vascular system. -Among those which act through the nervous system, may be instanced the -presence or absence of impressions upon the senses, and the presence or -absence of exciting ideas. Among those which act through the vascular -system, may be mentioned unnaturally or naturally increased or decreased -force or frequency of the heart's action. - -"6. A probable explanation of the reason why quiescence of the brain -normally follows its activity, is suggested by the recognized analogical -fact that the products of chemical action interfere with the continuance -of the action by which they are produced." - -Luys,[24] after stating the two opposite views relative to the state of -the cerebral circulation during sleep, gives his adhesion on principles of -analogy to that which holds to a diminished afflux of blood. Taking the -condition of the salivary glands during their periods of inaction as the -basis of his argument, he says: - -"We are then naturally led, in making the application of known facts to -those which are yet unknown, to say that the nervous tissue and the -glandular tissue present, between themselves, the closest analogy, so far -as circulatory phenomena and the double alternation of their periods of -activity and repose are concerned. And that if the period during which the -gland reconstitutes its immediate principles corresponds to a period of -reduced activity of circulatory phenomena--to a state of relative -anaemia--and that when it functionates it is awakened to a state in which -its capillaries are turgid with blood, it is very admissible that the same -circulatory conditions should be present in the nervous tissue, and that -the period of inactivity, or of sleep, should be characterized by an -anemic state. Inversely, the period of activity or wakefulness should be -marked by an acceleration of the flow of blood, and by a kind of erethism -of the vascular element." - -Having thus, in as succinct a manner as possible, brought forward the -principal observations relative to the immediate cause of sleep, which up -to the present time have been published, I come, in the next place, to -detail the result of my own researches. - -In 1854 a man came under my observation who had, through a frightful -railroad accident, lost about eighteen square inches of his skull. There -was thus a fissure of his cranium three inches wide and six inches long. -The lost portion consisted of a great part of the left parietal, and part -of the frontal, occipital, and right parietal bones. The man, who was -employed as a wood chopper, was subject to severe and frequent epileptic -fits, during which I often attended him. In the course of my treatment, I -soon became acquainted with the fact that, at the beginning of the -comatose condition which succeeded the fits, there was invariably an -elevation of that portion of the scalp covering the deficiency in the -cranium. As the stupor passed away, and sleep from which he could easily -be aroused ensued, the scalp gradually became depressed. When the man was -awake, the region of scalp in question was always nearly on a level with -the upper surface of the cranial bones. I also noticed on several -occasions that during natural sleep the fissure was deeper, and that in -the instant of awaking, the scalp covering it rose to a much higher level. - -After my attention was thus drawn to this subject, I observed that in -young infants the portion of scalp covering the anterior fontanelle was -always depressed during sleep, and elevated during wakefulness. - -During the summer of 1860 I undertook a series of experiments, with the -view of ascertaining the condition of the cerebral circulation during -sleep, of which the following is a brief abstract: - -A medium-sized dog was trephined over the left parietal bone, close to the -sagittal suture, having previously been placed under the full anaesthetic -influence of ether. The opening made by the trephine was enlarged with a -pair of strong bone-forceps, so as to expose the dura mater to the extent -of a full square inch. This membrane was then cut away and the brain -brought into view. It was sunk below the inner surface of the skull, and -but few vessels were visible. Those which could be perceived, however, -evidently conveyed dark blood, and the whole exposed surface of the brain -was of a purple color. As the anaesthetic influence passed off, the -circulation of the blood in the brain became more active. The purple hue -faded away, and numerous small vessels filled with red blood became -visible; at the same time the volume of the brain increased, and when the -animal became fully aroused, the organ protruded through the opening in -the skull to such an extent that, at the most prominent part, its surface -was more than a quarter of an inch above the external surface of the -cranium. While the dog continued awake, the condition and position of the -brain remained unchanged. After the lapse of half an hour, sleep ensued. -While this state was coming on I watched the brain very attentively. Its -volume slowly decreased; many of its smaller blood-vessels became -invisible, and finally it was so much contracted that its surface, pale -and apparently deprived of blood, was far below the level of the cranial -wall. - -Two hours subsequently the animal was again etherized, in order that the -influence of the ether upon the cerebral circulation might be observed -from the commencement. At the time the dog was awake, and had a few -minutes previously eaten a little meat and drank a small quantity of -water. The brain protruded through the opening in the skull, and its -surface was of a pink hue, with numerous red vessels ramifying over it. -The ether was administered by applying to the muzzle of the animal a towel -folded into the shape of a funnel, and containing a small sponge saturated -with the agent. - -As soon as the dog commenced to inspire the ether, the appearance of the -brain underwent a change of color, and its volume became less. As the -process of etherization was continued, the color of the surface darkened -to a deep purple, and it ceased to protrude through the opening. Finally, -when a state of complete anaesthesia was reached, it was perceived that the -surface of the brain was far below the level of the cranial fissure, and -that its vessels conveyed black blood alone. - -Gradually the animal regained its consciousness; the vessels resumed their -red color, and the brain was again elevated to its former position. In -this last experiment there did not appear to be any congestion of the -brain. Had this condition existed, it would have been difficult to account -for the diminution in bulk, which certainly took place. There was -evidently less blood in the cerebral tissue than there had been previously -at the etherization; but this blood, instead of being oxygenated, was -loaded with excrementitial matters, and consequently was not fitted to -maintain the brain in a condition of activity. - -The following morning, the dog being quite lively, I removed the sutures -which had been placed in the skin, covering the hole in the cranium, with -the view of ascertaining the effects of chloroform upon the brain, when -introduced into the system by inhalation. Suppuration had not yet taken -place, and the parts were in good condition. The opening in the skull was -completely filled by the brain, and the surface of the latter was -traversed by a great many small vessels carrying red blood. The chloroform -was administered in the same way in which the ether had been given the -previous day. - -In a few seconds the change in color of the blood circulating in the -vessels began to take place, but there was no sinking of the brain below -the level of the chasm in the skull. On the contrary, its protrusion was -greater than before the commencement of the experiment. There was thus not -only unoxygenated blood circulating to too great an extent through the -brain, but there was very decided congestion. - -The foregoing experiments were frequently repeated on other dogs, and also -on rabbits, with like results. Within a short period I have in part gone -over the ground again, without observing any essential point of difference -in the effects produced. - -I have never repeated Fleming's experiment on the human subject, except in -one instance, and then sleep, or a condition resembling it, was -instantaneously produced. As soon as the pressure was removed from the -carotids, the individual gained his consciousness. On dogs and rabbits, -however, I have performed it frequently, and though if the pressure be -continued for longer than one minute, convulsions generally ensue, a state -of insensibility resembling natural sleep is always the first result. -Lately, I have had, through the kindness of my friend, Dr. Van Buren, the -opportunity of examining a case which affords strong confirmation of the -correctness of the preceding views. It was that of a lady in whom both -common carotids were tied for a cirsoid aneurism, involving a great -portion of the right side of the scalp. One carotid was tied by the late -Dr. J. Kearney Rogers, and the other by Dr. Van Buren, seven years ago, -with the effect of arresting the progress of the disease. No peculiar -symptoms were observed in consequence of these operations, except the -supervention of persistent drowsiness, which was especially well marked -after the last operation, and which, even now, is at times quite -troublesome. - -We thus see that the _immediate_ cause of sleep is a diminution of the -quantity of blood circulating in the vessels of the brain, and that the -_exciting_ cause of periodical and natural sleep is the necessity which -exists that the loss of substance which the brain has undergone, during -its state of greatest activity, should be restored. To use the simile of -the steam-engine again, the fires are lowered and the operatives go to -work to repair damages and put the machine in order for next day's work. - -Whatever other cause is capable of lessening the quantity of blood in the -brain is also capable of inducing sleep. There is no exception to this -law, and hence we are frequently able to produce this condition at will. -Several of these factors have been already referred to, but it will be -interesting to consider them all somewhat more at length. - -_Heat._--Most persons in our climate, and in those of higher temperatures, -have felt the influence of heat in causing drowsiness, and eventually -sleep, if the action is powerful enough and sufficiently prolonged. It is -not difficult to understand the mode by which heat acts in giving rise to -sleep. During the prevalence of high temperatures the blood flows in -increased proportion to the surface of the body and to the extremities, -and consequently the quantity in the brain is diminished. Sleep -accordingly results unless the irritation induced by the heat is so great -as to excite the nervous system. Heat applied directly to the head exerts, -of course, a directly contrary effect upon the cerebral circulation, as we -see in sun-stroke. Here there is internal cerebral congestion, loss of -consciousness, stupor, etc. - -That the effect of heat is to dilate the vessels of the part subjected to -its influence, can be ascertained by putting the arm or leg into hot -water. The swelling of the blood-vessels is then very distinctly seen. It -will be shown hereafter that one of the best means of causing sleep in -morbid wakefulness is the warm-bath. - -_Cold._--A slight degree of cold excites wakefulness at first, but if the -constitution be strong the effect is to predispose to sleep. This it does -by reason of the determination of blood to the surface of the body which -moderate cold induces in vigorous persons. The ruddy complexion and warmth -of the hands and feet produced in such individuals under the action of -this influence are well known. - -But if the cold be very intense, or the reduction of temperature sudden, -the system, even of the strongest persons, cannot maintain a resistance, -and then a very different series of phenomena result. Stupor, not sleep, -is the consequence. The blood-vessels of the surface of the body contract -and the blood accumulates in the internal organs, the brain among them. -Many instances are on record showing the effect of extreme cold in -producing stupor and even death. One of the most remarkable of these is -that related by Captain Cook, in regard to an excursion of Sir Joseph -Banks, Dr. Solander, and nine others, over the hills of Terra del Fuego. -Dr. Solander, knowing from his experience in Northern Europe that the -stupor produced by severe cold would terminate in death unless resisted, -urged his companions to keep in motion when they began to feel drowsy. -"Whoever sits down will sleep," said he, "and whoever sleeps will rise no -more." Yet he was the first to feel this irresistible desire for repose, -and entreated his companions to allow him to lie down. He was roused from -his stupor with great difficulty and carried to a fire, when he revived. -Two black men of the party, whose organizations were not so robust as -those of the whites, perished. Dr. Whiting[25] relates the case of Dr. -Edward Daniel Clark, the celebrated traveler, who on one occasion came -very near losing his life by cold. He had performed divine service at a -church near Cambridge, and was returning home on horseback, when he felt -himself becoming very cold and sleepy. Knowing the danger of yielding to -the influence which was creeping over him, he put his horse into a fast -trot, hoping thereby to arouse himself from the alarming torpor. This -means proving unavailing, he got down and led his horse, walking as fast -as he could. This, however, did not long succeed. The bridle dropped from -his arm, his legs became weaker and weaker, and he was just sinking to the -ground when a gentleman who knew him came up in a carriage and rescued -him. - -I have often myself noticed this effect of cold in producing numbness and -drowsiness, and on one occasion was nearly overcome by it. I was crossing -the mountain ridge between Cebolleta and Covero, in New Mexico, when the -thermometer fell in about two hours from 52 deg. to 22 deg. Fahrenheit. So great -was the effect upon me that if I had had much farther to go I should -probably have succumbed. As it was, I reached a rancho in time to be -relieved, though several minutes elapsed before I was able to speak. The -sensations experienced were rather agreeable than otherwise. There was a -great desire to rest and to yield to the languor which was present, and -there was a feeling of recklessness which rendered me perfectly -indifferent to the consequences. I should have dismounted from my horse -and given way to the longing for repose if I had been able to do so. I -have several times experienced very similar effects from change of air. A -few years since I was so drowsy at the sea-coast, whither I had gone from -a hot city, that it was with difficulty I could keep awake, even when -engaged in active physical exercise. - -Another potent cause of sleep, and one of which we generally avail -ourselves, is the _diminution of the power of the attention_. To bring -this influence into action generally requires only the operation of the -will under circumstances favorable to the object in view. Shutting the -eyes so as to exclude light, getting beyond the sound of noises, -refraining from the employment of the other senses, and avoiding thought -of all kind, will generally, when there is no preventing cause, induce -sleep. To think, and to maintain ourselves in connection with the outward -world by means of our senses requires that the circulation of blood in the -brain shall be active. When we isolate ourselves from external things, and -restrain our thoughts, we lessen the amount of blood in the brain, and -sleep results. It is not, however, always easy for us to do this. The -nervous system is excited, ideas follow each other in rapid succession, -and we lie awake hour after hour vainly trying to forget that we exist. -The more the will is brought to bear upon the subject the more rebellious -is the brain, and the more it will not be forced by such means into a -state of quietude. We must then either let it run riot till it is worn out -by its extravagancies, or we must fatigue it by requiring it to perform -labor which is disagreeable. Just as we might do with an individual of -highly destructive propensities, who was going about pulling down his -neighbors' houses. We might, if we were altogether unable to stop him, let -him alone till he had become thoroughly wearied with his exertions, or we -might divert him from his plan by guiding him to some tough piece of work -which would exhaust his strength sooner than would his original labor. - -Many ways of thus tiring the brain have been proposed. The more irksome -they are, the more likely they are to prove effectual. Counting a hundred -backward many times, listening to monotonous sounds, thinking of some -extremely disagreeable and tiresome subject, with many other devices, have -been suggested, and have proved more or less effectual. Boerhaave[26] -states that he procured sleep by placing a brass pan in such a position -that the patient heard the sound of water which was made to fall into it, -drop by drop. In general terms, monotony predisposes to sleep. Dr. -Dickson[27] quotes Southey's experience as related in the Doctor,[28] and -I also cannot do better than lay it before the reader, particularly as it -indicates several methods which may be more efficacious with others than -the one he found to succeed so admirably. - -"I put my arms out of bed; I turned the pillow for the sake of applying a -cold surface to my cheek; I stretched my feet into the cold corner; I -listened to the river and to the ticking of my watch; I thought of all -sleepy sounds and of all soporific things--the flow of water, the humming -of bees, the motion of a boat, the waving of a field of corn, the nodding -of a mandarin's head on the chimney-piece, a horse in a mill, the opera, -Mr. Humdrum's conversations, Mr. Proser's poems, Mr. Laxative's speeches, -Mr. Lengthy's sermons. I tried the device of my own childhood, and fancied -that the bed rushed with me round and round. At length Morpheus reminded -me of Dr. Torpedo's Divinity Lectures, where the voice, the manner, the -matter, even the very atmosphere and the streamy candlelight were all -alike somnific; when he who, by strong effort, lifted up his head and -forced open the reluctant eyes never failed to see all around him asleep. -Lettuces, cowslip wine, poppy syrup, mandragora, hop pillows, spider's -web pills, and the whole tribe of narcotics, up to bang and the -black-drop, would have failed,--but this was irresistible; and thus, -twenty years after date, I found benefit from having attended the course." - -Frequently the power of the attention is diminished by natural causes. -After the mind has been strained a long time in one particular direction, -and during which period the brain was doubtless replete with blood, the -tension is at last removed, the blood flows out of the brain, the face -becomes pale, and sleep ensues. It is thus, as Macnish[29] says, that "the -finished gratification of all ardent desires has the effect of inducing -slumber; hence after any keen excitement the mind becomes exhausted and -speedily relapses into this state." - -A gentleman recently under my care for a paralytic affection, informed me -that he could at any time render himself sleepy by looking for a few -minutes at a bright light, so as to fatigue the eyes, or by paying -particular attention to the noises in the street, so as to weary the sense -of hearing. It is well known that sleep may be induced by gentle frictions -of various parts of the body, and doubtless the other senses are capable -of being so exhausted, if I may use the expression, as to diminish the -power of the attention, and thus lessen the demand for blood in the brain. -As a consequence, sleep ensues. - -The cutting off of sensorial impressions aids in lessening the power of -the attention and thus predisposes to sleep. Stillness, darkness, the -absence of any decided impression on the skin, and the nonexistence of -odors and flavors, accomplish this end. In these respects, however, habit -exercises great influence, and thus individuals, for instance, who are -accustomed to continual loud noises, cannot sleep when the sound is -interrupted. As we have already seen, however, the predisposition to sleep -is, in healthy persons, generally so great that when it has been long -resisted, no sensation, however strong it may be, can withstand its power. - -_Digestion_ leads to sleep by drawing upon the brain for a portion of its -blood. It is for this reason that we feel sleepy after the ingestion of a -hearty dinner. A lady of my acquaintance is obliged to sleep a little -after each meal. The desire to do so is irresistible; her face becomes -pale; her extremities cold; and she sinks into a quiet slumber, which -lasts fifteen or twenty minutes. In this lady the amount of blood is not -sufficient for the due performance of all the operations of the economy. -The digestive organs imperatively require an increased quantity, and the -flow takes place from the brain; it being the organ with her which can -best spare this fluid. As a rule, persons who eat largely, and have good -digestive powers, sleep a great deal, and many persons are unable to sleep -at night till they have eaten a substantial supper. The lower animals -generally sleep after feeding, especially if the meal has been large. - -_Excessive loss of blood_ produces sleep. We can very readily understand -why this should be so if we adopt the theory which has been supported in -the foregoing pages. It would be exceedingly difficult to explain the fact -upon any other hypothesis. I have seen many instances of somnolency due to -this cause. It acts not only by directly lessening the quantity of blood -in the brain, but also by so enfeebling the heart's action as to prevent a -due supply of blood being sent to the cerebral vessels. - -_Debility_ is almost always accompanied by a disposition to inordinate -sleep. The brain is one of the first organs to feel the effects of a -diminished amount of blood or a depraved quality of this fluid being -supplied, and hence, in old age, or under the influence of a deficient -quantity of food, or through the action of some exhausting disease, there -is generally more sleep than when the physical health is not deteriorated. - -The action of certain medicines, and of other measures capable of causing -sleep, not coming within the range of ordinary application, will be more -appropriately considered hereafter. - - - - -CHAPTER III. - -THE PHYSICAL PHENOMENA OF SLEEP. - - -The approach of sleep is characterized by a languor which is agreeable -when it can be yielded to, but which, when circumstances prevent this, is -far from being pleasant. Many persons are rendered irritable as soon as -they become sleepy, and children are especially liable to manifest ill -temper under the uncomfortable feelings they experience when unable to -indulge the inclination to sleep. It is somewhat difficult to analyze the -various phenomena which go to make up the condition called sleepiness. The -most prominent feelings are an impression of weight in the upper eyelids, -and of a general relaxation of the muscles of the body, but there is -besides an internal sensation of supineness, enervation, and torpor, to -describe which is by no means easy. This sluggishness is closely allied in -character if not altogether identical with that experienced before an -attack of fainting, and is doubtless due to a like cause--a deficient -quantity of blood in the brain. Along with this languor there is a general -obtuseness of all the senses, which increases the separation of the mind -from the external world, already initiated by the physical condition of -the brain. The liveliest scenes cease to engage the attention, and the -most exciting conversation no longer interests. For a time, indeed, such -circumstances may dissipate the inclination for sleep, but eventually -nature obtains the ascendency and consciousness is lost. Before this event -there is usually yawning--a phenomenon strongly indicative of a wearied -attention; the head nods and droops upon the breast, and the body assumes -that position which is most conducive to ease, comfort, and entire -muscular inactivity. - -The order in which the muscles lose their power is in general well marked, -and bears a distinct relation, as Cabanis[30] has pointed out, to the -importance of their functions. Thus, the muscles which move the arms and -legs become relaxed before those which support the head, and the latter -before those which maintain the erectness of the back. This, however, is -not always the case, for, as we have already seen, individuals will -occasionally walk, and keep their position on horseback, while in a sound -sleep, and all of us have seen persons slumbering in church, their heads -dropping on their breasts, but yet firmly holding their prayer-books in -their hands under the pretense of going through the services. - -As regards the senses, the sight is of course the first to be lost in -ordinary cases--the closure of the eyelids interposing a physical -obstruction to the entrance of light. Even when the eyelids have been -removed, or from disease cannot be closed, the sight, nevertheless, is the -first of the special senses to be abolished. Some animals, as the hare for -example, do not shut the eyes when asleep; but even in them the ability to -see disappears before the action of the other senses is suspended. - -These latter are not altogether abolished during sleep; their acuteness is -simply lessened. Taste is the first to fade, and then the smell; hearing -follows, and touch yields last of all, and is most readily re-excited. To -awake a sleeping person, impressions made upon the sense of touch are more -effectual than attempts to arouse through any of the other senses; the -hearing comes next in order, smell next, then taste, and the sight is the -last of all in capacity for excitation. - -During sleep the respiration is slower, deeper, and usually more regular -than during wakefulness. The vigor of the process is lessened, and -therefore there is a diminution of the pulmonary exhalations. In all -probability, also, the ciliated epithelium which lines the air-passages -functionates with reduced activity. Owing to this circumstance and to the -general muscular torpor which prevails, mucus accumulates in the bronchial -tubes and requires to be expectorated on awaking. - -The circulation of the blood is rendered slower. The heart beats with more -regularity, but with diminished force and frequency. As a consequence the -blood is not distributed to distant parts of the body so thoroughly and -rapidly as during wakefulness, and accordingly the extremities readily -lose their heat. Owing to the reduction in the activity of the respiratory -and circulatory functions, the temperature of the whole body falls, and -coldness of the atmosphere is less easily resisted. - -The functions of the several organs concerned in digestion have their -activity increased by sleep. The blood which leaves the brain, goes, as -Durham has shown, to the stomach and other abdominal viscera, and hence -the quantities of the digestive juices are augmented, and the absorption -of the nutritious elements of the food is promoted. - -The urine is excreted in less quantity during sleep than when the -individual is awake and engaged in mental or physical employment, because -the wear and tear of the system is at its minimum. - -The perspiration is likewise reduced in amount by sleep. In warm weather, -however, the effort to go to sleep often causes an increase in the -quantity of this excretion, just as would any other mental or bodily -exertion. This circumstance has led some writers to a conclusion the -reverse of that just expressed. Others, again, have accepted the doctrine -of Sanctorius on this point without stopping to inquire into its -correctness. This author,[31] among other aphorisms relating to sleep, -gives the following: - -"Undisturbed sleep is so great a promoter of perspiration, that in the -space of seven hours, fifty ounces of the concocted perspirable matter do -commonly exhale out of strong bodies. - -"A man sleeping the space of seven hours is wont, insensibly, healthfully, -and without any violence, to perspire twice as much as one awake." - -The observations of Sanctorius with his weighing chair led to a good many -important results, but they were inexact so far as the function of the -skin was concerned, in that they made no division between the loss by this -channel and that which takes place through the lungs, for by perspiration -in the above quotations he means not only the exhalation from the skin, -but the products of respiration--aqueous vapor, carbonic acid, etc. His -apparatus was, besides, very imperfect, and could not possibly have given -the delicate indications which the subject requires. - -Whether the condition of sleep promotes the absorption of morbid growths -and accumulations of fluids is very doubtful. Macnish[32] contends that it -does, but _a priori_ reasoning would rather lead us to an opposite -conclusion. Deficiencies are probably more rapidly made up during sleep -than during wakefulness, and thus ulcers heal with more rapidity, owing to -the increased formation of granulations which takes place; but the -removal of tumors, etc. by natural process involves the operation of -forces the very opposite of those concerned in reparation, and observation -teaches us that sleep is a condition peculiarly favorable to the -deposition of the materials constituting morbid growths. Some writers have -alleged that sleep accelerates the absorption of dropsical effusions, but -the disappearance of such accumulations during the condition in question -is clearly due to the mechanical causes depending upon the position of the -body. - -It has also been asserted that there is an exaltation of the sexual -feeling during sleep. It is difficult to arrive at any very definite -conclusion on this point, but it is probable that here again the position -of the body conjoined with the heat of the bed has much to do in producing -the erotic manifestations occasionally witnessed. Every physician who has -had much to do with cases of the kind knows that sleeping upon the back, -by which means the blood gravitates to the generative organs and to the -lower part of the spinal cord, will often give rise to seminal emissions -with or without erotic dreams, and that such occurrences may generally be -prevented by the individual avoiding the dorsal decubitus and resting upon -one side or the other while asleep. The erections which the generality of -healthy men experience in the morning before rising from bed are likewise -due to the fact that the recumbent posture favors the flow of blood to the -penis and testicles. Such erections are usually unaccompanied by venereal -desire. - -The ganglionic nervous system and the spinal cord continue in action -during sleep, though generally with somewhat diminished power and -sensibility. The reflex faculty of the latter organ is still maintained, -and thus various movements are executed without the consciousness of the -brain being awakened. Somnambulism is clearly a condition of exaltation in -the functions of the spinal cord without the controlling influence of the -cerebrum being brought into action. But, aside from this rather abnormal -phenomenon, there are others which are entirely within the range of -health, and which show that the spinal cord is awake, even though the -sleep be most profound. Thus, for instance, if the position of the sleeper -becomes irksome, it is changed; if the feet become cold, they are drawn up -to a warmer part of the bed; and cases are recorded in which individuals -have risen from bed and emptied a distended bladder without awaking. - -The instances brought forward in a previous chapter of persons riding on -horseback and walking during sleep show the activity of the spinal cord, -and not that the will is exercised; and Cabanis[33] is wrong in the view -which he gives of such phenomena in the following extract. - -Speaking of cases like those just referred to, he says: - -"These rare instances are not the only ones in which movements are -observed produced during sleep by that portion of the will which is awake; -for it is by virtue of certain direct sensations that a sleeping man moves -his arm to brush away the flies from his face, that he draws the cover -around him so as to envelop himself carefully, or that he turns in bed -till he has found a comfortable position. It is the will which during -sleep maintains the contraction of the sphincter of the bladder, -notwithstanding the effort of the urine to escape." - -Such examples as the above we now know to be instances of reflex action, -and as not, therefore, being due to the exercise of the will. - -Sleep favors the occurrence of certain pathological phenomena. Thus -individuals affected with haemorrhoids have the liability to hemorrhage -increased when they are asleep. Several instances of the kind have come -under my notice. In one the patient lost so large a quantity of blood that -syncope ensued and might have terminated fatally had not his condition -been accidentally discovered. Bleeding from the lungs is also more apt to -occur during sleep in those who are predisposed to it. Darwin states that -a man of about fifty years of age, subject to haemorrhoids, was also -attacked with haemoptysis three consecutive nights at about the same -hour--two o'clock--being awakened thereby from a state of very profound -sleep. He was advised to suffer himself to be roused at one o'clock, and -to leave his bed at that hour. He did so with the result not only of -entirely breaking up the hemorrhagic disposition, but also of curing -himself of very violent attacks of headache, to which he had been subject -for many years. - -Epileptic fits are also more liable to occur during sleep than at other -times, a fact not always susceptible of easy explanation. In a case of -epilepsy now under my charge, this proclivity is so well marked that the -patient, a lady, scarcely ever goes to sleep without being attacked. Her -face becomes exceedingly pale just before the fit, and if then seen the -paroxysm can be entirely prevented by waking her. She is never attacked at -other times, and I am trying, with excellent results thus far, the plan of -making her sleep altogether during the day and of waking her as soon as -her face becomes pallid. It is probable that the fits in her case are due -to a diminished amount of blood in the brain, and this supposition is -strengthened by the additional fact that bromide of potassium--a substance -which, as I have shown, lessens the amount of intracranial -blood--invariably rendered her paroxysms more frequent and severe. - -Sleep predisposes to attacks of gout in those who have the gouty -diathesis, and likewise favors exacerbations in several other diseases -which it is scarcely necessary to allude to specifically. The accession of -fever toward night, and the increase which takes place in pain due to -inflammation are generally associated with the approach of night, and have -no direct relation with sleep. - -Certain other morbid phenomena, such as somnambulism and nightmare, which -have a necessary relation with sleep, will be more appropriately -considered in another place. - -On the other hand, sleep controls the manifestations of several diseases, -especially those which are of a convulsive or spasmodic character. Thus -the paroxysms of chorea cease during sleep, as do likewise the spasms of -tetanus and hydrophobia. Headache is also generally relieved by sleep, -though occasionally it is aggravated. - - - - -CHAPTER IV. - -THE STATE OF THE MIND DURING SLEEP. - - -We have seen that though during sleep the operations of the senses are -entirely suspended as regards the effects of ordinary impressions, the -purely animal functions of the body continue in action. The heart beats, -the lungs respire, the stomach, the intestines, and their accessory organs -digest, the skin exhales vapor, and the kidneys secrete urine. With the -central nervous system, however, the case is very different; for while -some parts retain the property of receiving impressions or developing -ideas, others have their actions diminished, exalted, perverted, or -altogether arrested. - -In the first place, there is, undoubtedly, during sleep, a general torpor -of the sensorium, which prevents the appreciation of the ordinary -excitations made upon the organs of the special senses. So far as the -nerves themselves are concerned, there is no loss of their irritability or -conducting power, and the impressions made upon them are, accordingly, -perfectly well conveyed to the brain. The suspension of the operations of -the senses is not therefore due to any loss of function in the optic -nerve, the auditory nerve, the olfactory nerve, the gustatory nerve, or -the cranial or spinal nerves concerned in the sense of touch, but solely -to the inability of the brain to take cognizance of the impressions -conveyed to it. In regard to the cause of this torpor, I have given my -views in a previous chapter. - -Now it must not be supposed that because mild excitations transmitted by -the nerves of the special senses are incapable of making themselves felt, -that therefore the brain is in a state of complete repose throughout all -its parts. So far from such a condition existing, there are very decided -proofs that several faculties are exercised to a degree almost equaling -that reached during wakefulness, and we know that if the irritations made -upon the senses be sufficiently strong, the brain _does_ appreciate them, -and the sleep is broken. This ability to be readily roused through the -senses constitutes one of the main differences between sleep and stupor, -upon which stress has been already laid. - -Relative to the different faculties of the mind as affected by sleep, -great variations are observed. It has been thought by some authors that -several of them are really exalted above the standard attained during -wakefulness, but this is probably a wrong view. The predominance which one -or two mental qualities apparently assume is not due to any absolute -exaggeration of power, but to the suspension of the action of other -faculties, which, when we are not asleep, exercise a governing or -modifying influence. Thus, for instance, as regards the imagination,--the -faculty of all others which appears to be most increased,--we find, when -we carefully study its manifestations in our own persons, that although -there is often great brilliancy in its vagaries, that uncontrolled as it -is by the judgment, the pictures which it paints upon our minds are -usually incongruous and silly in the extreme. Even though the train of -ideas excited by this faculty when we are asleep be rational and coherent, -we are fully conscious on awaking that we are capable of doing much better -by intentionally setting the brain in action and governing it by our will -and judgment. - -Owing to the fact that these two faculties of the mind are incapable of -acting normally during sleep, the imagination is left absolutely without -controlling influence. Indeed, we are often cognizant in those dreams -which take place when we are half awake, of an inability to direct it. The -impressions which it makes upon the mind are, therefore, intense, but of -very little durability. Many stories are told of its power--how problems -have been worked out, poetry and music composed, and great undertakings -planned; but if we could get at the truth, we should probably find that -the imagination of sleep had very little to do with the operations -mentioned. Indeed, it is doubtful if the mind of a sleeping person can -originate ideas. Those which are formed are, as Locke[34] remarks, almost -invariably made up of the waking man's ideas, and are for the most part -very oddly put together; and we are all aware how commonly our dreams are -composed of ideas, or based upon events which have recently occurred to -us. - -In the previous section to the one just quoted, Locke refers to the -exaggeration of ideas which form so common a feature of our mental actions -during sleep. "It is true," he says, "we have sometimes instances of -perception while we are asleep, and retain the memory of those thoughts; -but how extravagant and incoherent for the most part they are, how little -conformable to the perfection and order of a rational being, those -acquainted with dreams need not be told." - -And yet many remarkable stories are related, which tend to show the high -degree of activity possessed by the mind during sleep. Thus it is said of -Tartini,[35] a celebrated musician of the eighteenth century, that one -night he dreamed he had made a compact with the devil, and bound him to -his service. In order to ascertain the musical abilities of his servitor, -he gave him his violin, and commanded him to play a solo. The devil did -so, and performed so admirably that Tartini awoke with the excitement -produced, and seizing his violin, endeavored to repeat the enchanting -air. Although he was unable to do this with entire success, his efforts -were so far effectual that he composed one of the most admired of his -pieces, which in recognition of its source he called the "devil's sonata." - -Coleridge gives the following account of the composition of the fragment, -Kubla Khan: - -"In the summer of 1797, the author, then in ill health, had retired to a -lonely farm-house, between Perlock and Linton, on the Exmoor confines of -Somerset and Devonshire. In consequence of a slight indisposition, an -anodyne had been prescribed, from the effects of which he fell asleep in -his chair at the moment that he was reading the following sentence, or -words of the same substance, in Purchas's Pilgrimage: 'Here the Khan Kubla -commanded a palace to be built, and a stately garden thereunto. And thus -ten miles of fertile ground were inclosed with a wall.' The author -continued for about three hours in a profound sleep, at least of the -external senses, during which time he had the most vivid confidence that -he could have composed not less than from two to three hundred lines, if -that, indeed, can be called composition, in which all the images rose up -before him as _things_ with a parallel production of the corresponding -expression without any sensation or consciousness of effort. On awaking, -he appeared to himself to have a distinct recollection of the whole; and -taking his pen, ink, and paper, instantly and eagerly wrote down the -lines that are here preserved. At this moment he was unfortunately called -out by a person on business from Perlock, and detained by him above an -hour; and on his return to his room, found to his no small surprise and -mortification, that though he still retained some vague and dim -recollection of the general purport of the vision, yet with the exception -of some eight or ten scattered lines and images, all the rest had passed -away like the images on the surface of a stream into which a stone had -been cast, but, alas! without the after restoration of the latter." - -Dr. Cromwell,[36] citing the above instance of poetic inspiration during -sleep, states that, having like Coleridge taken an anodyne during a -painful illness, he composed the following lines of poetry, which he wrote -down within half an hour after awaking. These lines, though displaying -considerable imagination, are not remarkable for any other quality. - -"Lines composed in sleep on the night of January 9th, 1857. - - "SCENE.--_Windsor Forest._ - - "At a vista's end stood the queen one day - Relieved by a sky of the softest hue; - It happen'd that a wood-mist risen new, - Had made that white which should have been blue. - A sunbeam sought on her form to play; - It found a nook in the bowery nave, - Through which with its golden stem to lave - And kiss the leaves of the stately trees - That fluttered and rustled beneath the breeze; - But it touched not her, to whom 'twas given - To walk in a white light pure as heaven." - -In the last two of these instances it is impossible to say whether the -individuals were really asleep or not, as the opium or other narcotic -taken is a very disturbing factor in both conditions, and doubtless was -the exciting cause of the activity in the imagination. No more graphic -account of the effects of opium in arousing the imagination to its highest -pitch has been written than that given by De Quincey.[37] He says: - -"At night when I lay awake in bed, vast processions passed along in -mournful pomp; friezes of never-ending stories, that to my feelings were -as sad and solemn as if they were stories drawn from times before Oedipus -or Priam, before Tyre, before Memphis. And at the same time a -corresponding change took place in my dreams; a theater seemed suddenly -opened and lighted up within my brain, which presented nightly spectacles -of more than earthly splendor." And then, after referring to the various -scenes of architectural magnificence, and of beautiful women which his -imagination conceived, and which forcibly recalls to our minds the -poetical effusions of Coleridge and Cromwell, he gives the details of -another dream, in which he heard music. "A music of preparation, of -awakening suspense; a music like the opening of the Coronation Anthem, and -which like _that_ gave the feeling of a vast march, of infinite cavalcades -filing off, and the tread of innumerable armies." - -In reference to this subject, Dr. Forbes Winslow[38] relates the following -interesting case: - -"A feeble, sensitive lady, suffering from a uterine affection, writes to -us as follows concerning the influence of three or four -sixteenth-of-a-grain doses of hydrochlorate of morphia: 'After taking a -few doses of morphia, I felt a sensation of extreme quiet and wish for -repose, and on closing my eyes, visions, if I may so call them, were -constantly before me, and as constantly changing in their aspect: scenes -from foreign lands; lovely landscapes, with tall, magnificent trees -covered with drooping foliage, which was blown gently against me as I -walked along. Then in an instant I was in a besieged city filled with -armed men. I was carrying an infant, which was snatched from me by a -soldier and killed upon the spot. A Turk was standing by with a scimitar -in his hand, which I seized, and attacking the man who had killed the -child, I fought most furiously with him and killed him. Then I was -surrounded, made prisoner, carried before a judge and accused of the -deed; but I pleaded my own cause with such a burst of eloquence (which, -by-the-by, I am quite incapable of in my right mind) that judge, jury, and -hearers acquitted me at once. Again, I was in an Eastern city visiting an -Oriental lady, who entertained me most charmingly. We sat together on rich -ottomans, and were regaled with supper and confectionery. Then came soft -sounds of music at a distance, while fountains were playing and birds -singing, and dancing girls danced before us, every movement being -accompanied with the tinkling of silver bells attached to their feet. But -all this suddenly changed, and I was entertaining the Oriental lady in my -own house, and in order to please her delicate taste, I had everything -prepared as nearly as possible after the fashion with which she had so -enchanted me. She, however, to my no small surprise, asked for wine, and -took not one, two, or three glasses, but drank freely, until at last I -became terrified that she would have to be carried away intoxicated. While -considering what course I had better adopt, several English officers came -in, and she at once asked them to drink with her, which so shocked my -sense of propriety that the scene changed and I was in darkness. - -"'Then I felt that I was formed of granite, and immovable. Suddenly a -change came again over me, and I found that I consisted of delicate and -fragile basket-work. Then I became a danseuse, delighting an audience and -myself by movements which seemed barely to touch the earth. Presently -beautiful sights came before me, treasures from the depth of the sea, gems -of the brightest hues, gorgeous shells, coral of the richest colors, -sparkling with drops of water, and hung with lovely seaweed. My eager -glances could not take in half the beautiful objects that passed before me -during the incessant changes the visions underwent. Now I was gazing upon -antique brooches and rings from buried cities; now upon a series of -Egyptian vases; now upon sculptured wood-work blackened by time; and -lastly I was buried amid forests of tall trees, such as I had read of but -never seen. - -"'The sights that pleased me most I had power to a certain extent to -prolong, and those that displeased me I could occasionally set aside, and -I awoke myself to full consciousness once or twice while under the -influence of the morphia by an angry exclamation that I would not have it. -I did not once lose my personal identity.' - -"The lady almost invariably suffers more or less from hallucinations of -the foregoing character, if it becomes necessary to administer to her an -opiate: and on analyzing her visions, she can generally refer the -principal portions of them, notwithstanding their confusion and -distortion, to works that she has recently read." - -Opium, in certain doses, increases the amount of blood in the brain, and -this induces a condition very different from that of sleep. In this fact -we have an explanation of the activity of the imagination as one of its -prominent effects. That Coleridge should have composed the Kubla Khan -under its influence is in nowise remarkable. It is probable, however, that -the full influence of his mind was exerted upon it after he awoke to -consciousness, and that the wild fancies excited by the opiate, and based -upon what he had been previously reading, formed the substratum of his -conceptions. In any event, the ideas contained in this fragment are no -more fanciful than those which occurred to De Quincey and the lady whose -case has just been recorded, nor are they more impressively related. - -The imagination may therefore be active during sleep, but we have no -authentic instance on record that it has, unaided by causes which exercise -a powerful influence over the intracranial circulation, led to the -production of any ideas which could not be excelled by the individual when -awake. Perhaps the most striking case in opposition to this opinion is one -detailed by Abercrombie,[39] who says: - -"The following anecdote has been preserved in a family of rank in -Scotland, the descendants of a distinguished lawyer of the last age. This -eminent person had been consulted respecting a case of great importance -and much difficulty, and he had been studying it with intense anxiety and -attention. After several days had been occupied in this manner, he was -observed by his wife to rise from his bed in the night and go to a -writing-desk which stood in the bed-room. He then sat down and wrote a -long letter, which he put carefully by in the desk and returned to bed. -The following morning he told his wife that he had had a most interesting -dream; that he had dreamt of delivering a clear and luminous opinion -respecting a case which had exceedingly perplexed him, and that he would -give anything to recover the train of thought which had passed before him -in his dream. She then directed him to the writing-desk, where he found -the opinion clearly and fully written out, and which was afterwards found -to be perfectly correct." - -It is probable that this gentleman was actually awake when he arose from -the bed and wrote the paper referred to, and that in the morning he -mistook the circumstance for a dream. It is not at all uncommon for such -errors to be committed, especially under the condition of mental anxiety -and fatigue. A gentleman informed me only a short time since that going to -bed after a very exciting day he thought the next morning that he had -dreamed of a fire occurring in the vicinity of his house. To his surprise -his wife informed him that the supposed dream was a reality, and that he -had got up to the window, looked at the fire, conversed with her -concerning it, and that he was at the time fully awake. - -Brierre de Boismont[40] relates the following instance, which is to the -same effect: - -"In a convent in Auvergne, an apothecary was sleeping with several -persons; being attacked with nightmare, he charged his companions with -throwing themselves on him and attempting to strangle him. They all denied -the assertion, telling him that he had passed the night without sleeping, -and in a state of high excitement. In order to convince him of this fact, -they prevailed on him to sleep alone in a room carefully closed, having -previously given him a good supper, and even made him partake of food of a -flatulent nature. The paroxysm returned; but, on this occasion, he swore -that it was the work of a demon, whose face and figure he perfectly -described." - -That the imagination may in its flights during sleep strike upon fancies -which are subsequently developed by the reason into lucid and valuable -ideas, is very probable. It would be strange if from among the innumerable -absurdities and extravagancies to which it attains something fit to be -appropriated by the mind should not occasionally be evolved, and thus -there are many instances mentioned of the starting-point of important -mental operations having been taken during sleep. Some of these may be -based upon fact, but the majority are probably of the class of those just -specified, or occurred at an age of the world when a belief in the -supernatural exercised a greater power over men's minds than it does at -the present day. Among the most striking of them are the following: - -Galen declares that he owed a great part of his knowledge to the -revelations made to him in dreams. Whether this was really the case or not -we can in a measure determine by recalling the fact that he was a believer -in the prophetic nature of dreams, and states that a man having dreamt -that one of his legs was turned into stone, soon afterward became -paralytic in this limb, although there was no evidence of approaching -disease. Galen also conducted his practice by dreams, for an athlete, -having dreamt that he saw red spots, and that the blood was flowing out of -his body, was supposed by Galen to require blood-letting, which operation -was accordingly performed. - -It has been said[41] that the idea of the _Divina Commedia_ occurred to -Dante during sleep. There is nothing at all improbable in this -supposition, though I have been unable to trace it to any definite source. - -Cabanis[42] states that Condillac assured him that often during the course -of his studies he had to leave them unfinished in order to sleep, and that -on awaking he had more than once found the work upon which he was engaged -brought to a conclusion in his brain. - -These were clearly instances of "unconscious cerebration" of that power -which the brain possesses to work out matters which have engaged its -attention, without the consciousness of the individual being aroused to a -knowledge of the labor being performed. It is not unlikely that this kind -of mental activity goes on to some extent during sleep, but as it is of -such a character that the mind does not take cognizance of its operations, -I do not see how the exact period of its performance can be ascertained. - -Jerome Cardan believed that he composed books while asleep, and his case -is often adduced as an example of the height to which the imagination can -attain during sleep. But this great man was superstitious to an extreme -degree; he believed that he had a familiar spirit, from whom he received -intelligence, warnings, and ideas, and asserted that when awake he -frequently saw long processions of men, women, animals, trees, castles, -instruments of various kinds and many figures, different from anything in -this world. His evidence relative to his compositions and mathematical -labors when asleep is not therefore of a trustworthy character. - -As regards the memory in sleep, it is undoubtedly exercised to a -considerable extent. In fact, whatever degree of activity the mind may -then exhibit is based upon events the recollection of which has been -retained. But there is more or less error mingled with a small amount of -truth. The unbridled imagination of the sleeper so distorts the simplest -circumstances as to render their recognition a matter of no small -difficulty, and thus it scarcely if ever happens that events are -reproduced during sleep exactly as they occurred or as they would be -recalled by the mind of the individual when awake. Frequently, also, -recent events which have made a strong impression on our minds are -forgotten, as when we dream of seeing and conversing with persons not long -dead. - -And yet it has sometimes happened that incidents or knowledge which had -long been overlooked or forgotten, or which could not be remembered by any -effort during wakefulness have been strongly depicted during sleep. Thus -Lord Monboddo[43] states that the Countess de Laval, a woman of perfect -veracity and good sense, when ill, spoke during sleep in a language which -none of her attendants understood, and which even she was disposed to -regard as gibberish. A nurse detected the dialect of Brittany; her -mistress had spent her childhood in that province, but had lost all -recollection of the Breton tongue, and could not understand a word of what -she said in her dreams. Her utterances applied, however, exclusively to -the experience of childhood, and were infantile in structure. - -Abercrombie[44] relates the case of a gentleman who was very fond of the -Greek language, and who, in his youth, had made considerable progress in -it. Subsequently being engaged in other pursuits, he so entirely forgot it -that he could not even read the words; often, however, in his dreams he -read Greek works, which he had been accustomed to use at college, and had -a most vivid impression of fully understanding them. - -Many other instances of the action of memory during sleep might be brought -forward, but the subject will be more appropriately considered in the -chapter on dreams. - -The judgment is frequently exercised when we are asleep, but almost -invariably in a perverted manner. In fact we scarcely ever estimate the -events or circumstances which appear to transpire in our dreams at their -real value, and very rarely from correct conceptions of right and wrong. -High-minded and honorable men do not scruple during sleep to sanction the -most atrocious acts, or to regard with complaisance ideas which, in their -waking moments, would fill them with horror. Delicate and refined women -will coolly enter upon a career of crime, and the minds of hardened -villains are filled with the most elevated and noble sentiments. The -deeds which we imagine we perform in our sleep are generally inadequate to -or in excess of what the apparent occasion requires, and we lose so -entirely the ideas of probability and possibility, that no preposterous -vision appears otherwise than as perfectly natural and correct. Thus, a -physician dreamed that he had been transformed into a monolith which stood -grandly and alone in the vast desert of the Sahara, and had so stood for -ages, while generation after generation wasted and melted away around him. -Although unconscious of having organs of sense, this column of granite saw -the mountains growing bald with age, the forests drooping with decay, and -the moss and ivy creeping around its crumbling base.[45] - -But, although in this instance there was some conception of time, as shown -in the association of the evidences of decay with the lapse of years, -there is in general no correct idea on this subject. Without going into -details which more appropriately belong to another division of this -treatise, I quote the following remarkable example from the essay last -cited. It appeared originally in a biographical sketch of Lavalette, -published in the _Revue de Paris_, and is related by Lavalette as -occurring to him while in prison: - -"One night, while I was asleep, the clock of the Palais de Justice struck -twelve and awoke me. I heard the gate open to relieve the sentry, but I -fell asleep again immediately. In this sleep I dreamt that I was standing -in the Rue St. Honore. A melancholy darkness spread around me; all was -still; nevertheless, a slow and uncertain sound soon arose. All of a -sudden, I perceived at the bottom of the street and advancing toward me, a -troop of cavalry,--the men and horses, however, all flayed. The men held -torches in their hands, the red flames of which illuminated faces without -skin, and bloody muscles. Their hollow eyes rolled fearfully in their -sockets, their mouths opened from ear to ear, and helmets of hanging flesh -covered their hideous heads. The horses dragged along their own skins in -the kennels which overflowed with blood on all sides. Pale and disheveled -women appeared and disappeared at the windows in dismal silence; low -inarticulate groans filled the air, and I remained in the street alone -petrified with horror, and deprived of strength sufficient to seek my -safety in flight. This horrible troop continued passing along rapidly in a -gallop, and casting frightful looks upon me. Their march continued, I -thought, for five hours, and they were followed by an immense number of -artillery wagons full of bleeding corpses, whose limbs still quivered; a -disgusting smell of blood and bitumen almost choked me. At length the iron -gates of the prison, shutting with great force, awoke me again. I made my -repeater strike; it was no more than midnight, so that the horrible -phantasmagoria had lasted no more than two or three minutes--that is to -say, the time necessary for relieving the sentry and shutting the gate. -The cold was severe and the watchword short. The next day the turnkey -confirmed my calculations. I, nevertheless, do not remember one single -event in my life the duration of which I have been able more exactly to -calculate, of which the details are deeper engraven on my memory, and of -which I preserve a more perfect consciousness." - -No instance can more strikingly exemplify aberration of the faculty of -judgment than the above. There was no astonishment felt with the horror -experienced, but all the impossible events which appeared to be -transpiring were accepted as facts, which might have taken place in the -regular order of nature. - -An important question connected with the exercise of judgment is: does the -dreamer know that he is dreaming? Some authors assert that this knowledge -is possible, others that it is not. The following account is interesting, -and I therefore transcribe it, especially as it has not to my knowledge -been heretofore published in this country. - -In a letter to the Rev. William Gregory, Dr. Thomas Reid[46] says: - -"About the age of fourteen, I was almost every night unhappy in my sleep -from frightful dreams. Sometimes hanging over a frightful precipice and -just ready to drop down; sometimes pursued for my life and stopped by a -wall or by a sudden loss of all strength; sometimes ready to be devoured -by a wild beast. How long I was plagued by such dreams I do not now -recollect. I believe it was for a year or two at least; and I think they -had quite left me before I was fifteen. In those days I was much given to -what Mr. Addison in one of his Spectators calls castle-building, and, in -my evening solitary walk, which was generally all the exercise I took, my -thoughts would hurry me into some active scene, where I generally -acquitted myself much to my own satisfaction, and in these scenes of -imagination I performed many a gallant exploit. At the same time, in my -dreams, I found myself the most arrant coward that ever was. Not only my -courage, but my strength failed me in every danger, and I often rose from -my bed in the morning in such a panic that it took some time to get the -better of it. I wished very much to get free of these uneasy dreams, which -not only made me unhappy in sleep, but often left a disagreeable -impression in my mind for some part of the following day. I thought it was -worth trying whether it was possible to recollect that it was all a dream, -and that I was in no real danger. I often went to sleep with my mind as -strongly impressed as I could with this thought that I never in my -lifetime was in any real danger, and that every fright I had was a dream. -After many fruitless endeavors to recollect this when the danger appeared, -I effected it at last, and have often, when I was sliding over a precipice -into the abyss, recollected that it was all a dream, and boldly jumped -down. The effect of this commonly was, that I immediately awoke. But I -awoke calm and intrepid, which I thought a great acquisition. After this -my dreams were never very uneasy, and, in a short time, I dreamed not at -all." - -Beattie[47] states that he once dreamed that he was walking on the parapet -of a high bridge. How he came there he did not know, but recollecting that -he was not given to such pranks, he began to think it might all be a -dream, and, finding his situation unpleasant, and being desirous to get -out of it, threw himself headlong from the height, in the belief that the -shock of the fall would restore his senses. The event turned out as he -anticipated. - -Aristotle also asserts that when dreaming of danger, he used to recollect -that he was dreaming, and that he ought not to be frightened. - -A still more remarkable narration is that of Gassendi,[48] which he thus -relates as occurring to himself: - -"A good friend of mine, Louis Charambon, judge of the criminal court at -Digne, had died of the plague. One night, as I slept, I seemed to see him; -I stretched out my arms toward him, and said, 'Hail thou who returnest -from the place of the dead!' Then I stopped, reflecting in my dream as -follows: 'One cannot return from the other world; I am doubtless dreaming; -but if I dream, where am I? Not at Paris, for I came last to Digne. I am -then at Digne, in my house, in my bedroom, in my bed.' And then, as I was -looking for myself in the bed, some noise, I know not what, awoke me." - -In all these and like instances, it is very probable the individuals were -much more awake than asleep, for certainly the power to judge correctly is -not exercised in dreams, involving even the most incongruous -impossibilities. As Dendy[49] says, "if we _know_ that we are dreaming, -the faculty of judgment cannot be inert, and the dream would be known to -be a fallacy." There would therefore be no occasion for any such -management of it as that made use of by Reid and Beattie, or for the -recollection of Aristotle. The dream and the correction of it by the -judgment would go together and there would be no self-deception at -all--not even for an instant. Dreams would accordingly be impossible. The -essential feature of mental activity during sleep, absolute freedom of the -imagination, would not exist. - -Relative to Gassendi's case, it is impossible to believe that he was fully -asleep, and the fact that he was awakened by some noise, the nature of -which was unrecognized, and which was therefore probably slight, tends to -support this view. Moreover, although he was, as he thought, enabled to -detect the fallacy of his dream in one respect, his judgment was -altogether at fault in others. Thus he had great difficulty in making out -where he was, and actually so far lost all idea of his identity with the -person dreaming as to look for himself in his own bed! Certainly an -individual whose judgment was thus much deranged would scarcely be able to -reason correctly as to the fact of his dreaming or not, or to question the -possibility of the dead returning to this world. - -My opinion therefore is, that during sleep the power of bringing the -judgment into action is suspended. We do not actually lose the power of -arriving at a decision, but we cannot exert the faculty of judgment in -accordance with the principles of truth and of correct reasoning. An -opinion may therefore be formed during sleep, but it is more likely to be -wrong than right, and no effort that we can make will enable us to -distinguish the false from the true, or to discriminate between the -possible and the impossible. - -That faculty of the mind--the judgment--which when we are awake is -pre-eminently our guide, can no longer direct us aright. The stores of -experience go for naught, and the mind accepts as truth whatever -preposterous thought the imagination presents to it. We are not entirely -rendered incapable of judging, as some authors assert, but the power to -perceive the logical force of circumstances, to take them at their true -value and to eliminate error from our mental processes, is altogether -arrested, and we arrive at absurd conclusions from impossible premises. - -But there is no doubt that at times the faculty of judgment is suspended -as regards some parts of our mental operations during sleep, and this, to -such an extent, that we are like Gassendi in the case quoted, not capable -of recognizing our own individuality. Thus it is related of Dr. Johnson, -that he had once in a dream a contest of wit with some other person, and -that he was very much mortified by imagining that his opponent had the -better of him. "Now," said he, "one may mark here the effect of sleep in -weakening the power of reflection; for had not my judgment failed me, I -should have seen that the wit of this supposed antagonist, by whose -superiority I felt myself depressed, was as much furnished by me as that -which I thought I had been uttering in my own character." - -Van Goens dreamt that he could not answer questions to which his neighbor -gave correct responses. - -An interesting case, in which the judgment was still more at fault, has -recently come to my knowledge. - -Mrs. C. dreamed that she was Savonarola, and that she was preaching to a -vast assembly in Florence. Among the audience was a lady whom she at once -recognized to be her own self. As Savonarola, she was delighted at this -discovery, for she reflected that she was well acquainted with all Mrs. -C.'s peculiarities and faults of character, and would, therefore, be -enabled to give special emphasis to them in the sermon. She did this so -very effectively that Mrs. C. burst into a torrent of tears, and, with the -emotion thus excited, the lady awoke. It was some time before she was able -to disentangle her mixed up individualities. When she became fully awake -she perceived that the arguments she had employed to bring about the -conversion of herself were puerile in the extreme, and were directed -against characteristics which formed no part of her mental organization, -and against offenses which she had not committed. - -Macario[50] makes the following apposite remarks on the point under -consideration. Referring to the preposterous nature of many dreams, he -says: - -"It is astonishing that all these fantastical and impossible visions seem -to us quite natural, and excite no astonishment. This is because the -judgment and reflection having abdicated, no longer control the -imagination nor co-ordinate the thoughts which rush tumultuously through -the brain of the sleeper, combined only by the power of association. - -"When I say that the judgment and reflection abdicate, it should not be -inferred that they are abolished and no longer exist, for the imagination -could not, unaided by the reason, construct the whimsical and capricious -images of dreams." - -Relative to the power to work out, during sleep, problems involving long -and intricate mental processes, I have already expressed my opinion -adversely. In this view, I am not alone. Rosenkranz,[51] whose -contributions to psychological science cannot be overestimated, and whose -clear and powerful understanding has rarely been excelled, has pointed out -how such operations of the understanding are impossible; for, as he -remarks, intellectual problems cannot be solved during sleep, for such a -thing as intense thought, accompanied by images, is unknown, whilst dreams -consist of a series of images connected by loose and imperfect reasoning. -Feuchtersleben,[52] referring with approval to this opinion of Rosenkranz, -says that he recollects perfectly having dreamt of such problems, and -being happy in their solution, endeavored to retain them in his memory; he -succeeded, but discovered, on awaking, that they were quite unmeaning, and -could only have imposed upon a sleeping imagination. - -Mueller[53] says: - -"Sometimes we reason more or less correctly in dreams. We reflect on -problems and rejoice in their solution. But on awaking from such dreams, -the seeming reasoning is frequently found to have been no reasoning at -all, and the solution of the problem over which we had rejoiced, to be -mere nonsense. Sometimes we dream that another person proposes an enigma; -that we cannot solve it and that others are equally incapable of doing so; -but that the person who proposed it, himself gives the explanation. We are -astonished at the solution we had so long labored in vain to find. If we -do not immediately awaken and afterwards reflect on this proposition of an -enigma in our dream, and on its apparent solution, we think it wonderful; -but if we awake immediately after the dream, and are able to compare the -answer with the question, we find that it was mere nonsense." - -And in regard to the knowledge that we are dreaming, the same author[54] -observes that: - -"The indistinctness of the conception in dreams is generally so great that -we are not aware that we dream. The phantasms which are perceived really -exist in our organs of sense. They afford, therefore, in themselves as -strong proof of the actual existence of the objects they represent, as -our own perceptions of real external objects in the waking state; for we -know the latter only by the affections of our senses which they produce. -When, therefore, the mind has lost the faculty of analyzing the -impressions on our senses, there is no reason why the things which they -seem to represent should be supposed unreal. Even in the waking state -phantasms are regarded as real objects when they occur to persons of -feeble intellect. On the other hand, when the dreaming approaches more -nearly to the waking state, we sometimes are conscious that we merely -dream, and still allow the dream to proceed, while we retain this -consciousness of its true nature." - -Sir Benjamin Brodie,[55] in discussing the subject of wonderful -discoveries made in dreams, and abstruse problems worked out, remarks that -it would indeed be strange if among the vast number of combinations which -constitute our dreams, there were not every now and then some having the -semblance of reality; and further, that in many of the stories of great -discoveries made in dreams, there is much of either mistake or -exaggeration, and that if they could have been written down at the time, -they would have been found to be worth little or nothing. - -Another faculty exercised during sleep has been ascribed to the judgment. -It is well known that many persons having made up their minds to awake at -a certain hour invariably do so. I possess this power in a high degree, -and scarcely ever vary a minute from the fixed time. Just as I go to bed I -look at my watch and impress upon my mind the figures on the dial which -represent the hour and minute at which I wish to awake. I give myself no -further anxiety on the subject, and never dream of it, but I always wake -at the desired moment. - -Now I cannot conceive what connection the judgment has with this power. In -the case of alarm clocks set to go off at a certain time, the judgment, as -Jouffroy[56] asserts, may take cognizance of the impression made upon the -ear, and establish the relation between it and the wish to awake at a -certain time. But in cases where the awaking is the result of an idea -conceived before going to sleep, and which is not subsequently recalled, -the judgment cannot act, for this faculty is only exercised upon ideas -which are submitted to it. The brain is, as it were, wound up like the -alarm clock and set to a certain hour. When that hour arrives, an -explosion of nervous force takes place, and the individual awakes. - -Fosgate[57] asserts that the power of judging during sleep is probably as -good as when we are awake, for decisions are made only on the premises -presented in either case, and if those in the former condition are absurd -or unreasonable, the conclusion will likewise be faulty. But this is not -very accurate reasoning; for it is as much the province of the judgment to -determine the validity of the premises as it is to draw a conclusion from -them, and if it cannot recognize the falsity or truth of propositions the -irrational character of which would be readily perceived during -wakefulness, there is not much to be said in favor of its power. - -In fact, however, the conclusions formed in dreams are often without any -logical relation with the premises. Thus, when an individual dreams, as in -the instance previously quoted, that he is a column of stone, it is -contrary to all experience to deduce therefrom the conclusion that he can -see rocks crumbling around him, and can reflect upon the mutability of all -things. The premise of his being a stone pillar being submitted to the -judgment, the proper conclusion would be that he is composed of inorganic -material, is devoid of life, and consequently not possessed of either -sensation or understanding. - -Why the judgment is not properly exercised during sleep we do not know. -Dr. Philip[58] believes that in this condition ideas flow so rapidly that -they are not submitted to the full power of the judgment, and that hence -the absurdity which characterizes them is not perceived. But this -explanation is by no means satisfactory; for a merely swift succession of -ideas is no very serious bar to correct judgment, and when the thoughts -are as preposterous as those which so often occur in dreams, they present -no obstacle at all to a proper estimation of them by the healthy mind. The -cause probably resides in some alteration in the circulation of the blood -in that part of the brain which presides over the judgment, whereby its -power is suspended and the imagination left free to fill the mind with its -incongruous and fantastic images. - -As regards the will, we find very opposite opinions entertained relative -to its activity; but no one, so far as I am aware, appears to have had -correct views upon the subject. Without going into a full discussion of -the views enunciated, it will be sufficient to refer to the ideas on the -point in question which have been expressed by some of the most eminent -philosophers and physiologists. - -In the course of his remarks on sleep, Darwin[59] repeatedly alleges that -during this condition the action of the will is entirely suspended; but he -falls into the singular error of confounding volition with the power of -motion. Thus he says: - -"When by one continued posture in sleep some uneasy sensations are -produced, we either gradually awake by the exertion of volition, or the -muscles connected by habit with such sensations alter the position of the -body; but where the sleep is uncommonly profound, and these uneasy -sensations great, the disease called the incubus or nightmare is produced. -Here the desire of moving the body is painfully exerted; but the power of -moving it, or volition, is incapable of action till we are awake." - -In consequence of this misapprehension of the nature of the will, it is -not easy to arrive at Darwin's ideas on the subject; and the attempt is -rendered still more difficult from the fact that though he repeatedly -states that volition is entirely suspended during sleep, he yet in the -first part of the foregoing quotation makes an individual awake by the -gradual exercise of the power of the will; and then in the last part of -the same paragraph asserts that volition is incapable of action till sleep -is over. - -Mr. Dugald Stewart[60] contends that during sleep the power of volition is -not suspended, but that those operations of the mind and body which depend -on volition cease to be exercised. In his opinion the will loses its -influence over all our powers both of mind and body in consequence of some -physical alteration in the system which we shall never probably be able -to explain. To show in full the views of so distinguished a philosopher as -Mr. Stewart, I quote the following extracts from his remarks on the -subject: - -"In order to illustrate this conclusion [the one above stated] a little -further, it may be proper to remark that if the suspension of our -voluntary operations in sleep be admitted as a fact, there are only two -suppositions which can be formed regarding its cause. The one is that the -power of volition is suspended; the other that the will loses its -influence over those faculties of the mind and those members of the body -which during our waking hours are subjected to its authority. If it can be -shown then that the former supposition is not agreeable to fact, the truth -of the latter seems to follow as a necessary consequence. - -"1. That the power of volition is not suspended during sleep, appears from -the efforts which we are conscious of making while in that situation. We -dream, for instance, that we are in danger, and we attempt to call out for -assistance. The attempt induced is in general unsuccessful, and the sounds -that we emit are feeble and indistinct; but this only confirms, or rather -is a necessary consequence of, the supposition that in sleep the -connection between the will and our voluntary operations is disturbed or -interrupted. The continuance of the power of volition is demonstrated by -the effort, however ineffectual. - -"In like manner, in the course of an alarming dream we are sometimes -conscious of making an exertion to save ourselves by flight from an -apprehended danger; but in spite of all our efforts we continue in bed. In -such cases we commonly dream that we are attempting to escape and are -prevented by some external obstacle; but the fact seems to be that the -body is at that time not subject to the will. During the disturbed rest -which we sometimes have when the body is indisposed, the mind appears to -retain some power over it; but as even in these cases the motions which -are made consist rather of a general agitation of the whole system than of -the regular exertion of a particular member of it with a view to produce a -certain effect, it is reasonable to conclude that in perfectly sound sleep -the mind, although it retains the power of volition, retains no influence -whatever over the bodily organs. - -"In that particular condition of the system which is known by the name of -_incubus_, we are conscious of a total want of power over the body; and I -believe the common opinion is that it is this want of power which -distinguishes the _incubus_ from all the other modifications of sleep. But -the more probable supposition seems to be that every species of sleep is -accompanied with a suspension of the faculty of voluntary motion; and that -the incubus has nothing peculiar in it but this--that the uneasy -sensations which are produced by the accidental posture of the body, and -which we find it impossible to remove by our own efforts, render us -distinctly conscious of our incapacity to move. One thing is certain, that -the instant of our awaking and of our recovering the command of our bodily -organs is one and the same. - -"2. The same conclusion is confirmed by a different view of the subject. -It is probable, as was already observed, that when we are anxious to -procure sleep the state into which we naturally bring the mind approaches -to its state after sleep commences. Now it is manifest that the means -which nature directs us to employ on such occasions is not to suspend the -powers of volition, but to suspend the exertion of those powers whose -exercise depends on volition. If it were necessary that volition should be -suspended before we fall asleep, it would be impossible for us by our own -efforts to hasten the moment of rest. The very supposition of such efforts -is absurd, for it implies a continued will to suspend the acts of the -will. - -"According to the foregoing doctrine with respect to the state of the mind -in sleep, the effort which is produced on our mental operations is -strikingly analogous to that which is produced on our bodily powers. From -the observations which have been already made, it is manifest that in -sleep the body is in a very inconsiderable degree, if at all, subject to -our command. The vital and involuntary motions, however, suffer no -interruption, but go on as when we are awake, in consequence of the -operation of some cause unknown to us. In like manner it would appear -that those operations of the mind which depend on our volition are -suspended, while certain other operations are at least occasionally -carried on. This analogy naturally suggests the idea that all our mental -operations which are independent of our will may continue during sleep; -and that the phenomena of dreaming may, perhaps, be produced by these, -diversified in their apparent effects in consequence of the suspension of -our voluntary powers." - -A very little reflection will suffice to convince the reader that Mr. -Stewart has altogether mistaken the nature of sleep. There is no evidence -to support his view that the body is not subject to the action of the will -during sleep. No change whatever is induced by this condition in the -nerves or muscles of the organism. The first are just as capable as ever -of conducting the nervous fluid, and the muscles do not lose any of their -contractile power. The reason why voluntary movements are not performed in -sleep is simply because the will does not act; and Mr. Stewart is again -wrong in asserting that volition is not then suspended. We do not will any -actions when we are asleep. We _imagine_ we do, and that is all. The -difficulties which encompass us in sleep are, it must be recollected, -purely imaginary, and the efforts we make to escape from them are likewise -the products of our fancy. Herein lies the main error which Mr. Stewart -has committed. He appears to accept the dream for a reality, and to -regard the seeming volitions which occur in it as actual facts; whereas -they are all entirely fictitious. - -An example will serve to make this point still clearer. - -Not long since I dreamed that I stood upon a very high perpendicular -table-land, at the foot of which flowed a river. I thought I experienced -an irresistible desire to approach the brink and to look down. Had I been -awake, such a wish would have been the very last to enter my mind, for I -have an instinctive dread of standing on a height. I dreamed that I threw -myself on my face and crawled to the edge of the cliff. I looked down at -the stream, which scarcely appeared to be as wide as my hand, so great was -the altitude upon which I was placed. As I looked I felt an overpowering -impulse to crawl still farther and to throw myself into the water below. I -imagined that I endeavored with all my will to resist this force, which -appeared to be acting by means altogether external to my organism. My -efforts, however, were all in vain. I could not control my movements, and -gradually I was urged farther and farther over the brink, till at last I -went down into the abyss below. As I struck the water I awoke with a -start. During my imaginary struggle I thought I experienced all the -emotions which such an event if real would have excited, and I was -painfully conscious of my utter inability to escape from the peril of my -situation. Here were circumstances such as, according to Mr. Stewart, -demonstrate the activity of volition, but at the same time show its -inability to act upon the body. But clearly they show no such thing, for -the imaginary volition was to refrain from crawling over a precipice which -did not exist, and over which, therefore, I was not hanging. Such an act -of the will if real, could not in the very nature of the real conditions -of the situation have been carried out--the volition was just as imaginary -as all the other circumstances of the dream. - -Again, it is not always the case that the imaginary acts of the will are -not executed during sleep; and hence it would follow from Mr. Stewart's -argument that the power of the will over the body is not then suspended. -Assuming for the moment that the volitions of sleep are real, as Mr. -Stewart supposes; if it can be shown that they are satisfactorily -performed, it results from his line of reasoning that the will has power -over the body during sleep. Every one who has ever dreamed has at times -had his will carried out to his entire satisfaction. He has ridden horses -when pursued, and has urged them forward with whip and spur so as to -escape from his enemies. Or he has executed the most surprising feats both -with his mind and body, and has performed voluntary deeds which have -excited the admiration of all beholders. Such acts are of course entirely -the product of the imagination, and all the volitions which accompany -them have no firmer basis than the unbridled fancy; but, according to Mr. -Stewart, they would be evidence of the power of the will over the body,--a -power which in reality does not exist; not, however, as Mr. Stewart -supposes from any impediments in the nerves or muscles, but because it is -never exerted. - -So far as relates to movements performed during sleep, such as turning in -bed and assuming more comfortable positions, they have nothing whatever to -do with the will. They are dependent upon the action of the spinal cord, -an organ that is never at rest, and the functions of which were not known -as well when Dr. Darwin and Mr. Stewart wrote as they are now. The same is -true of more complex and longer-continued actions, such as those already -mentioned of individuals riding on horseback, or even walking, during -sleep. - -Cabanis[61] contends that the will is not entirely suspended during sleep; -but, as will be perceived from the following quotation, he bases his -argument upon the fact that movements are produced which he attributes -erroneously to the action of the will, but which, like those previously -referred to, are accomplished by the agency of the spinal cord. He says, -speaking of the instances of persons walking while asleep: - -"These rare cases are not the only ones in which during sleep movements -are produced by what remains of the will; for it is by virtue of certain -direct sensations that a sleeping man moves his arm to brush away the -flies that may be on his face, that he draws up the bedclothes so as to -cover himself carefully; or, as we have already remarked, that he turns -over and endeavors to find a more comfortable position. It is the will -which during sleep maintains the contraction of the sphincter of the -bladder, notwithstanding the effort of the urine to escape; it is the same -power which directs the action of the arm in seeking for the _vase de -nuit_, which knows where to find it, and enables the individual to use it -for several minutes and to return it to its place without being awakened. -Finally, it is not without reason that some physiologists have made the -will concur in the contraction of several muscles, the movements of which -are necessary to the maintenance of respiration during sleep." - -All these movements, and many others of a similar character, are entirely -spinal, and are altogether independent of cerebral influence. Even when we -are awake, we constantly execute muscular actions through the power of the -spinal cord, when the mind is intently occupied with other things. Take -for instance the example of a person playing on the piano, and at the same -time carrying on a conversation. Here the brain is engaged in the one act -and the spinal cord in the other. So long as the player is not expert in -the fingering of the instrument, he cannot divert his attention from his -performance; for the whole power of the mind is required for the proper -appreciation and execution of the music. But after the spinal cord has -become educated to the habit, and he has attained proficiency in the -necessary manipulations, the mind is no longer required to control the -actions and may be directed to other subjects. The arguments of Cabanis, -therefore, in favor of the partial exercise of the will during sleep, are -of no force. - -But the power of the will over the muscles of the body is only one of the -ways in which this faculty is shown. It regulates the thoughts and the -manifestations of emotion when we are awake. How utterly incapable it is -of any such action during sleep we all know. A gentleman, remarkable for -the ability he possesses for controlling his feelings, tells me that when -he is asleep he frequently weeps or laughs at imaginary events, which, if -they really had occurred to him during wakefulness, would give rise to no -such disturbance. He often desires to stop these emotional manifestations, -but is entirely powerless to do so. Most individuals have had similar -experiences. - -The theory that the will is in action during sleep is, therefore, to my -mind untenable. It has probably had its origin in the idea that confounds -it with desire, from which it differs so markedly that it seems strange -the distinction should ever fail of being made. Locke[62] points out very -clearly the differences between the two faculties. In fact they may be -exerted in directly opposite ways. Desire often precedes volition; but we -all, at times, will acts which are contrary to our desire, and desire to -perform others which we are unable to will. - -Reid[63] writes with great perspicuity on this distinction between desire -and will. He says: - -"Desire and will agree in this, that both must have an object of which we -must have some conception; and, therefore, both must be accompanied with -some degree of understanding. But they differ in several things. - -"The object of desire may be anything which appetite, passion, or -affection leads us to pursue; it may be any event which we think good for -us, or for those to whom we are well affected. I may desire meat or drink, -or ease from pain. But to say that I will meat, or will drink, or will -ease from pain, is not English. There is, therefore, a distinction in -common language between desire and will. And the distinction is, that what -we will must be an action and our own action; what we desire may not be -our own action, it may be no action at all. - -"A man desires that his children may be happy, and that they may behave -well. Their being happy is no action at all; their behaving well is not -his action but theirs. - -"With regard to our own actions, we may desire what we do not will, and -will what we do not desire; nay, what we have a great aversion to. - -"A man athirst has a strong desire to drink; but for some particular -reason he determines not to gratify his desire. A judge from a regard to -justice and to the duty of his office dooms a criminal to die; while, from -humanity or particular affection, he desires that he should live. A man -for health may take a nauseous draught, for which he has no desire, but a -great aversion. Desire, therefore, even when its object is some action of -our own, is only an incitement to will; but it is not volition. The -determination of the mind may be not to do what we desire to do. But as -desire is often accompanied by will, we are apt to overlook the -distinction between them." - -That desire is manifested during sleep there can be no doubt; and Mr. -Stewart, although insisting as he does on the distinction between this -faculty and volition, confounds them in his remarks already quoted. A -person suffering from nightmare has a most intense desire to escape from -his imaginary troubles. In my own dream, to which reference has been made, -my desire to restrain myself from crawling over the precipice was exerted -to the utmost; but the will could not be brought into action. Darwin,[64] -when he says that in nightmare "the _desire_ of moving the body is -painfully exerted, but the _power of moving it, or volition_, is incapable -of action till we awake," makes the proper distinction between desire and -will; but, as I have already shown, confounds the latter with another very -different faculty. - -From the foregoing observations it will be seen that during sleep the -three great divisions of the mind are differently affected. - -1. Feeling, embracing sensation and emotion, is suspended, so far as the -first is concerned; but is in full action as regards the second. We do not -see, hear, smell, taste or enjoy the sense of touch in sleep, although the -brain may be aroused into activity and we may awake through the -excitations conveyed to it by the special senses. The emotions have full -play, unrestrained by the will and governed only by the imagination. - -2. The Will or Volition is entirely suspended. - -3. The Thought or Intellect is variously affected in its different powers. -The imagination is active, and the memory may be exercised to a great -extent; but the judgment, perception, conception, abstraction, and reason -are weakened, and sometimes altogether lost. - - - - -CHAPTER V. - -THE PHYSIOLOGY OF DREAMS. - - -The subject of the foregoing chapter is so intimately connected with the -phenomena of dreaming, and I have expressed my views in regard to it at -such length, that but few psychological points remain to be considered in -the present discussion. What I have to say, therefore, in regard to the -physiology of dreaming must be read in connection with the chapter on -"_The State of the Mind during Sleep_," in order that the whole matter may -be fully understood. - -It is contended by some writers that the mind is never at rest, and that -even during the most profound sleep dreams take place, which are either -forgotten immediately, or which make no impression on the memory. That -this view is erroneous is, I think, very evident. If it were correct, the -first object of sleep--rest for the brain--would not be attained. We all -know how fatigued we are, and how indisposed to exertion the brain is, -after a night of continued dreaming, and we can easily imagine what would -be the consequences if such a condition were kept up night after night. To -say that we really do dream not only every night, but every instant of -the night, in fact always and continually when we sleep, but that we -forget our dreams as soon as they are formed, remembering solely those -which are most vivid, is making assertions which not only are without -proof, but which are impossible of proof. For if, as Locke[65] remarks, -the sleeping man on awaking has no recollection of his thoughts, it is -very certain that no one else can recollect them for him. - -The observations of Locke on this point are extremely appropriate, and, to -my mind, very philosophical and logical. After insisting that, sleeping or -waking, a man cannot think without being sensible of it, he says:[66] - -"I grant that the soul of a waking man is never without thought, because -it is the condition of being awake; but whether sleeping without dreaming -be not an affection of the whole man, mind as well as body, may be worth a -waking man's consideration, it being hard to conceive that anything should -think and not be conscious of it. If the soul doth think in a sleeping man -without being conscious of it, I ask, whether during such thinking it has -any pleasure or pain, or be capable of happiness or misery? I am sure the -man is not, any more than the bed or earth he lies on, for to be happy or -miserable without being conscious of it seems to me utterly inconsistent -and impossible. Or if it be possible that the soul can, while the body is -sleeping, have its thinkings, enjoyments, and concerns, its pleasure or -pain, about which the man is not conscious of nor partakes in, it is -certain that Socrates asleep and Socrates awake is not the same person; -but his soul when he sleeps and Socrates the man, consisting of body and -soul when he is waking, are two persons, since waking Socrates has no -knowledge of or concernment for that happiness or misery of his soul which -it enjoys alone by itself while he sleeps without perceiving anything of -it, any more than he has for the happiness or misery of a man in the -Indies whom he knows not; for if we take wholly away all consciousness of -our actions and sensations, especially of pleasure and pain, and the -concernment that accompanies it, it will be hard to know wherein to place -personal identity." - -In a subsequent section of the same chapter, Locke asserts that most men -pass a great part of their lives without dreaming, and that he once knew a -scholar who had no bad memory, who told him he had never dreamed in his -life till after the occurrence of a fever in the twenty-fifth or -twenty-sixth year of his age. - -Examples of persons who have not ordinarily dreamed are adduced by the -ancient writers. Pliny[67] refers to men who never dreamed. Plutarch[68] -alludes to the case of Cleon, who, in living to an advanced age, had yet -never dreamed; and Suetonius[69] declares that before the murder of his -mother he had never dreamed. - -A lady who was under my care for a serious nervous affection declared to -me that she never had had but one dream in her life, and that was after -receiving a severe fall in which she struck her head. - -And yet, notwithstanding the experience of every one that sleep often -happens without the accompaniment of dreams, the great majority of writers -hold the view that the brain is never at rest. Doubtless this opinion has -its origin partly in the doctrine that the mind is a something altogether -independent of and superior to the brain. They appear to be incapable of -appreciating the fact that when the brain is in a state of complete repose -there can be no mental manifestation, and that all intellectual phenomena -are the results of cerebral activity. Another cause for their belief is -the fact that they make no distinction between dreaming and thinking, -whereas it is very evident that the two are not to be placed in the same -category. Thinking is an _action_ which requires cerebral effort, and -which is undertaken with a determinate purpose. We will to think, and we -think what we please; but it is very different with our dreams, which -come and go without any power on our part to regulate or direct them. To -think requires all the faculties of the mind; to dream necessitates only -the memory and the imagination. In thinking, the brain is active in all -its parts; in dreaming, it is nearly entirely quiescent. - -Writers who contend for the doctrine of constant mental activity regard -the brain as the organ or tool of the mind, a structure which the mind -makes use of in order to manifest itself. Such a theory is certain to lead -them into difficulties, and is contrary to all the teaching of physiology. -The full discussion of this question would be out of place here; I will, -therefore, only state that this work is written from the stand-point of -regarding the mind as nothing more than the result of cerebral action. -Just as a good liver secretes good bile, a good candle gives good light, -and good coal a good fire, so does a good brain give a good mind. When the -brain is quiescent there is no mind. - -Lemoine[70] begins his chapter "_On the State of the Mind during Sleep_" -with the assertion that "there is no sleep for the mind." He is obliged, -however, to admit that "when the organs of the body are benumbed by sleep, -the mind appears to be in a particular state; it seems to be submitted to -other laws than those which govern it during wakefulness; it seems to -have lost for a time its most precious faculties." - -During sleep the mind is, as he supposes, in a particular state, for, as -has been shown in the previous chapter, it has lost many of its chief -parts. The laws which govern it are, however, the same which always -regulate it. The body upon which their power is primarily exercised--the -brain--is not in the same condition during sleep as during wakefulness, -and hence the differences in the evidences of cerebral activity. - -Sir William Hamilton[71] is generally considered to have determined -affirmatively the question of the continuance of the action of the brain -during sleep. He caused himself to be aroused from sleep at intervals -through the night, and invariably found that he was disturbed from a -dream, the particulars of which he could always distinctly recollect. But -a full knowledge of the subject he was investigating would have sufficed -to convince Sir William that the conclusion he drew from his experiments -was altogether fallacious. It is well known that dreams are excited by -strong impressions made upon the senses, or by irritations arising in the -internal organs. Thus Baron Trenck relates that when confined in his -dungeon he suffered the pangs of hunger almost continually, and that his -dreams at night were always of delicate meats and sumptuous repasts, -spread before him on luxuriously-furnished tables. The mere excitation of -waking a sleeping person is generally sufficient to give rise to a dream. -Maury, in his very interesting work, to which reference has already been -made, and which will hereafter be more specifically considered, adduces -many examples of dreams produced by sensorial impressions. I have myself -performed many experiments with reference to this point, and have -generally found ample confirmation of Maury's investigations. It may -therefore, I think, be assumed, without any violence to the actual facts -of the cases, that the brain is not always in action, and that there are -times when we sleep without dreaming. - -In the previous chapter the idea is sought to be conveyed that we -originate nothing in our dreams. We may conceive of things which never -existed, or of which we have heard or read, but the images we make of them -are either composed of elements familiar to us, or else are based upon -ideal representations which we have formed in our waking moments. Thus, -before the discovery of America no Europeans ever dreamed of American -Indians, for the reason that nothing existed within their knowledge which -could give any idea of the appearance of such human beings. It is possible -that Columbus and his companions may have dreamed of the continent of -which they were in search and of its natives, but the images formed of the -latter must necessarily have resembled other beings they had seen, or -which they had heard described. After the discovery, however, it was no -unusual thing for the Spaniards and others to have correct images of -Indians appear to them in their dreams. - -Dreams, therefore, must have a foundation, and this is either impressions -made upon the mind at some previous period, or produced during sleep by -bodily sensations. These impressions, however they may be formed, are -subjected to the unrestrained influence of the imagination. - -At first sight it may seem that we often have dreams not excited by actual -sensations, and which have no relation to any events of our lives, or any -ideas which have passed through our minds, but thorough investigation will -invariably reveal the existence of an association between the dream and -some such ideas or events. For instance, a few nights ago I dreamed that a -gentleman, a friend of mine, had invented what he called a "dog-cart -ambulance," a vehicle which he declared was the best ever made for the -transportation of sick or wounded men. On awaking, all the particulars -were fresh in my mind, but I could not for some time perceive why I had -had such a dream. At last I recollected that the morning before a -gentleman had given me a very full description of Prospect Park, in -Brooklyn. The friend of whom I dreamed has charge of the construction of -this Park. His presence was, therefore, fully explained, and as dog-carts -are driven in parks, this link was also accounted for. The ambulance part -was due to the fact that I had that same morning found the card of a -gentleman upon my table who really had invented an ambulance. The -imagination had, therefore, taken these data supplied by the memory, and -had combined them into the incongruous web constituting my dream. - -Dreams are also frequently built upon circumstances which have transpired -many years previously, and which have long since apparently passed from -our recollection. A very striking instance of this kind is related by -Abercrombie,[72] on the authority of Sir Walter Scott. - -"Mr. R. J. Rowland, a gentleman of landed property in the vale of Gala, -was prosecuted for a very considerable sum, the accumulated arrears of -teind (tithe), for which he was said to be indebted to a noble family the -titulars (lay impropriators of the tithe). Mr. R. was strongly impressed -with the belief that his father had, by a form of process peculiar to the -law of Scotland, purchased these teinds from the titular, and, therefore, -that the present prosecution was groundless. But after an industrious -search among his father's papers, an investigation of the public records, -and a careful inquiry among all persons who had transacted law business -for his father, no evidence could be discovered to support his defense. -The period was now near at hand when he conceived the loss of his lawsuit -to be inevitable, and he had formed his determination to ride to Edinburgh -next day, and make the best bargain he could in the way of compromise. He -went to bed with this resolution, and, with all the circumstances of the -case floating upon his mind, had a dream to the following purpose. His -father, who had been many years dead, appeared to him, he thought, and -asked him why he was disturbed in his mind. In dreams men are not -surprised at such apparitions. Mr. R. thought that he informed his father -of the cause of his distress, adding that the payment of a considerable -sum of money was the more unpleasant to him, because he had a stray -consciousness that it was not due, though he was unable to recover any -evidence in support of his belief. 'You are right, my son,' replied the -paternal shade; 'I did acquire right to these teinds, for payment of which -you are now prosecuted. The papers relating to the transaction are in the -hands of Mr. ----, a writer (or attorney), who is now retired from -professional business, and resides at Inveresk, near Edinburgh. He was a -person whom I employed on that occasion for a particular reason, but who -never, on any other occasion, transacted business on my account. It is -very possible,' pursued the vision, 'that Mr. ---- may have forgotten a -matter which is now of a very old date; but you may call it to his -recollection by this token--that when I came to pay his account there was -difficulty in getting change for a Portugal piece of gold, and that we -were forced to drink out the balance at a tavern.' - -"Mr. R. awaked in the morning with all the events of the vision impressed -on his mind, and thought it worth while to ride across the country to -Inveresk, instead of going straight to Edinburgh. When he came there he -waited on the gentleman mentioned in the dream, a very old man; without -saying anything of the vision, he inquired whether he remembered having -conducted such a matter for his deceased father. The old gentleman could -not at first bring the circumstance to his recollection, but, on mention -of the Portugal piece of gold, the whole returned upon his memory; he made -an immediate search for the papers and recovered them, so that Mr. R. -carried to Edinburgh the documents necessary to gain the cause which he -was on the verge of losing." - -A friend has related to me some circumstances in his own case similar to -the above, and illustrating the same points. In the course of his practice -as a lawyer, it became necessary for him to ascertain the exact age of a -client, who was also his cousin. Their grandfather had been a rather -eccentric personage, who had taken a great deal of notice of both his -grandsons--his only direct descendants. He died when they were boys. My -friend often told his cousin that if his grandfather were alive there -would be no difficulty at getting at the desired information, and that he -had a dim recollection of having seen a record kept by the old gentleman, -and of there being some peculiarity about it which he could not recall. -Several months elapsed, and he had given up the idea of attempting to -discover the facts of which he had been in search, when, one night, he -dreamed that his grandfather came to him and said: "You have been trying -to find out when J---- was born; don't you recollect that one afternoon -when we were fishing I read you some lines from an Elzevir Horace, and -showed you how I had made a family record out of the work by inserting a -number of blank leaves at the end? Now, as you know, I devised my library -to the Rev. ---- ----. I was a d----d fool for giving him books which he -will never read! Get the Horace, and you will discover the exact hour at -which J---- was born." In the morning all the particulars of this dream -were fresh in my friend's memory. The reverend gentleman lived in a -neighboring city; my friend took the first train, found the copy of -Horace, and at the end the pages constituting the family record, exactly -as had been described to him in the dream. By no effort of his memory, -however, could he recollect the incidents of the fishing excursion. - -Dr. Macnish,[73] in stating his opinion that dreams are uniformly the -resuscitation or re-embodiment of thoughts which have formerly, in some -shape or other, occupied the mind, relates the following example from his -own experience: - -"I lately dreamed that I walked upon the banks of the great canal in the -neighborhood of Glasgow. On the side opposite to that on which I was, and -within a few feet of the water, stood the splendid portico of the Royal -Exchange. A gentleman whom I knew was standing upon one of the steps, and -we spoke to each other. I then lifted a large stone and poised it in my -hand, when he said that he was certain I could not throw it to a certain -spot, which he pointed out. I made the attempt, and fell short of the -mark. At this moment a well-known friend came up, whom I knew to excel at -_putting_ the stone; but, strange to say, he had lost both his legs, and -walked upon wooden substitutes. This struck me as exceedingly curious, for -my impression was that he had only lost one leg, and had but a single -wooden one. At my desire he took up the stone, and, without difficulty, -threw it beyond the point indicated by the gentleman upon the opposite -side of the canal. The absurdity of this dream is extremely glaring, and -yet, on strictly analyzing it, I find it to be wholly composed of ideas -which passed through my mind on the previous day, assuming a new and -ridiculous arrangement. I can compare it to nothing but to cross reading -in the newspapers, or to that well-known amusement which consists in -putting a number of sentences, each written on a separate piece of paper, -into a hat, shaking the whole, then taking them out, one by one, as they -come, and seeing what kind of medley the heterogeneous compound will make -when thus fortuitously put together. For instance, I had, on the above -day, taken a walk to the canal along with a friend. On returning from it, -I pointed out to him a spot where a new road was forming, and where, a few -days before, one of the workmen had been overwhelmed by a quantity of -rubbish falling upon him, which fairly chopped off one of his legs, and so -much damaged the other that it was feared amputation would be necessary. -Near this very spot there is a park, in which, about a month previously, I -practiced throwing the stone. On passing the Exchange, on my way home, I -expressed regret at the lowness of its situation, and remarked what a fine -effect the portico would have were it placed upon more elevated ground. -Such were the previous circumstances, and let us see how they bear upon -the dream. In the first place, the canal appeared before me. 2. Its -situation is an elevated one. 3. The portico of the Exchange occurring to -my mind as being placed too low became associated with the elevation of -the canal, and I placed it close by on a similar altitude. 4. The -gentleman I had been walking with was the same whom in the dream I saw -standing upon the steps of the portico. 5. Having related to him the story -of the man who lost one limb and had a chance of losing another, this idea -brings before me a friend with a pair of wooden legs, who, moreover, -appears in connection with patting the stone, as I knew him to excel at -that exercise. There is only one other element in the dream which the -preceding events will not account for, and that is the surprise at the -individual referred to having more than one wooden leg. But why should he -have even one, seeing that in reality he is limbed like other people? This -also I can account for. Two years ago he slightly injured his knee while -leaping a ditch, and I remember jocularly advising him to get it cut off. -I am particular in illustrating this point with regard to dreams, for I -hold that if it were possible to analyze them all, they would invariably -be found to stand in the same relation to the waking state as the above -specimen. The more diversified and incongruous the character of a dream, -and the more remote from the period of its occurrence the circumstances -which suggested it, the more difficult does its analysis become; and, in -point of fact, this process may be impossible, so totally are the elements -of the dream often dissevered from their original sense, and so -ludicrously huddled together." - -A dream which Professor Maas,[74] of Halle, relates as having occurred to -himself, affords an excellent example of the dependence of dreams upon -actual events, and shows how these latter are distorted and perverted by -the imagination of the sleeper. - -"I dreamed once," he says, "that the Pope visited me. He commanded me to -open my desk, and he carefully examined all the papers it contained. While -he was thus employed, a very sparkling diamond fell out of his triple -crown into my desk, of which, however, neither of us took any notice. As -soon as the Pope had withdrawn I retired to bed, but was soon obliged to -rise on account of a thick smoke, the cause of which I had yet to learn. -Upon examination I discovered that the diamond had set fire to the papers -in my desk, and burned them to ashes." - -In analyzing the circumstances which gave rise to this dream, Professor -Maas relates the following events, which constituted its basis: - -"On the preceding evening I was visited by a friend with whom I had a -lively conversation upon Joseph II.'s suppression of monasteries and -convents. With this idea, though I did not become conscious of it in the -dream, was associated the visit which the Pope publicly paid the Emperor -Joseph, at Vienna, in consequence of the measures taken against the -clergy; and with this again was combined, however faintly, the -representation of the visit which had been paid me by my friend. These two -events were, by the subreasoning faculty, compounded into one, according -to the established rule--that things which agree in their parts also -correspond as to the whole; hence the Pope's visit was changed into a -visit paid to me. The subreasoning faculty, then, in order to account for -this extraordinary visit, fixed upon that which was the most important -object in my room--namely, the desk, or rather the papers which it -contained. That a diamond fell out of the triple crown was a collateral -association, which was owing merely to the representation of the desk. -Some days before, when opening the desk, I had broken the crystal of my -watch, which I held in my hand, and the fragments fell among the papers; -hence no further attention was paid to the diamond being a representation -of a collateral series of things. But afterwards the representation of the -sparkling stone was again excited, and became the prevailing idea; hence -it determined the succeeding association. On account of its similarity it -excited the representation of fire, with which it was confounded; hence -arose fire and smoke. But in the event the writings only were burned, not -the desk itself, to which, being of comparatively little value, the -attention was not directed." - -Feuchtersleben[75] takes the same view of dreaming as that enunciated in -this chapter. Thus he says: - -"Dreaming is nothing more than the occupation of the mind in sleep with -the pictorial world of fancy. As the closed or quiescent senses afford it -no materials, the mind, ever active, must make use of the store which -memory retains; but as its motor influence is likewise organically -impeded, it cannot independently dispose of this store. Thus arises a -condition in which the mind looks, as it were, on the play of the images -within itself, and manifests only a faint or partial reaction." - -Locke[76] contends that "the dreams of a sleeping man are all made up of -the waking man's ideas oddly put together." - -Observation and reflection show us that the mind originates nothing during -sleep; it merely remembers--and often in the most chaotic manner--the -thoughts, the fancies, the impressions which have been imagined or -received by the individual when awake. Sometimes ideas are reproduced in -dreams exactly as they have occurred to us in our waking moments, and this -may take place night after night with scarcely the alteration of a single -circumstance. A friend informs me that he is very subject to dreams of -this character, and that on some occasions the repetition has taken place -as many as a dozen times. - -A very striking instance of this kind occurred to me a few years since, -and made a deep impression on my mind. I had just read Schiller's ode to -Laura, as translated by Sir E. Bulwer Lytton, beginning, - - "Who and what gave to me the wish to woo thee?" - -and admired it as a striking piece of versification conveying some noted -philosophical ideas in a forcible and beautiful manner. The following -night I had a very vivid dream of a condition of pre-existence, in which I -imagined myself to be. The connection between the dream and the poem I had -been reading was sufficiently well marked, and did not astonish me. I was, -however, surprised to find that the next night I had exactly the same -dream, and that it was repeated three times subsequently on consecutive -nights. - -The dependence of dreams upon ideas which we have had when awake was well -known to the ancients. Thus Lucius Accius,[77] a poet who lived more than -a hundred and fifty years before the Christian era, says: - - "Quae in vita usurpant homines, cogitant, curant, vident - Quaeque agunt vigilantes, agitantque casi cui in somno accidant, - * * * * * * Minus mirum est." - -Lucretius[78] declares that during sleep we are amused with things which -have made us weep when awake; that circumstances which have pleased us are -recalled to our minds; that objects are presented to us which occupied our -thoughts long before; and that recent events appear still more vividly -before us. - -Petronius Arbiter[79] cites Epicurus to the same effect. Tryphaena having -declared that she had had a dream in which there appeared to her the image -of Neptune she had seen at Baiae, "Hence you may perceive," observed -Eumolpus, "what a divine man is Epicurus, who so ingeniously ridiculed -these sports of fancy. - - "When in a dream presented to our view - Those airy forms appear so like the true, - No prescient shrine, no god the vision sends, - But every breast its own delusion lends. - For when soft sleep the body wraps in ease, - And from the inactive mass the fancy frees, - What most by day affects, at night returns; - Thus he who shakes proud states, and cities burns, - Sees showers of darts, forced lines, disordered wings, - Blood-reeking fields, and deaths of vanquished kings; - He that by day litigious knots untied, - And charmed the drowsy bench to either side, - By night a crowd of cringing clients sees, - Smiles on the fools and kindly takes their fees; - The miser hides his wealth, new treasure finds; - Through echoing woods his horn the huntsman winds; - The sailor's dream wild scenes of wreck describes; - The wanton lays her snares; the adultress bribes; - Hounds in full cry, in sleep, the hare pursue; - And hapless wretches their old griefs renew."[80] - -It is related of an ancient tyrant that one of his courtiers described to -him a dream in which the courtier had assassinated his master. "You could -not," exclaimed the tyrant, "have dreamed this without having previously -thought of it," and then ordered his immediate execution. - -Now besides this foundation of dreams upon circumstances which have -transpired during our waking moments, they may arise, as has already been -intimated, from impressions made upon the mind during sleep. Sensations -may be so intense as to be partially appreciated by the brain, and yet not -strong enough to cause sleep to be interrupted. In such cases the -imagination seizes the imperfect perception and weaves it into a tissue of -incongruous fancies, which, however, generally bear a more or less -definite relation to the character of the sensorial impression. Many -examples of dreams thus produced are on record, and many others have come -under my own observation. The interest which attaches to phenomena of this -character must be my excuse for quoting some of the more remarkable -instances of this kind which have been brought to my attention. - -The following are related by Abercrombie:[81] - -During the alarm excited in Edinburgh by the apprehension of a French -invasion almost every man was a soldier, and all things had been arranged -in expectation of the landing of the enemy. The first notice was to be -given by the firing of a gun from the Castle, and this was to be followed -by a chain of signals calculated to arouse the country. The gentleman to -whom the dream occurred was a zealous volunteer, and, being in bed between -two and three o'clock in the morning, dreamt of hearing the signal gun. He -imagined that he went at once to the Castle, witnessed the proceeding for -displaying the signals, and saw and heard all the preparations for the -assemblage of the troops. At this time he was roused by his wife, who -awoke in a fright, in consequence of a similar dream. The origin of both -dreams was ascertained in the morning to be the noise produced by the -falling of a pair of tongs in the room above. - -A gentleman dreamt that he had enlisted as a soldier, joined his regiment, -deserted, was apprehended, carried back, condemned to be shot, and at last -led out to execution. At this instant a gun was fired, and he awoke, to -find that a noise in the adjoining room had both produced the dream and -awakened him. - -The next is a very extraordinary case. - -The subject was an officer in the expedition to Louisburg, in 1758. During -his passage in the transport his companions were in the habit of amusing -themselves at his expense. They could produce in him any kind of dream by -whispering in his ear, especially if this was done by a friend with whose -voice he was familiar. Once they conducted him through the whole process -of a quarrel which ended in a duel, and when the parties were supposed to -have met a pistol was put into his hand, which he fired, and was awakened -by the report. On another occasion they found him asleep on the top of a -locker in the cabin, when they made him believe he had fallen overboard, -and exhorted him to save himself by swimming. Then they told him that a -shark was pursuing him, and entreated him to dive for his life. He -instantly did so, and with so much force as to throw himself from the -locker upon the cabin floor, by which he was much bruised, and awakened of -course. After the landing of the army at Louisburg, his friends found him -one day asleep in his tent, and evidently much annoyed by the cannonading. -They then made him believe that he was engaged, when he exhibited great -fear, and showed a decided disposition to run away. Against this they -remonstrated, but at the same time increased his fears by imitating the -groans of the wounded and the dying; and when he asked, as he often did, -who was hit, they named his particular friends. At last they told him that -the man next himself in his company had fallen, when he instantly sprang -from his bed, rushed out of his tent, and was roused from his danger and -his dream by falling over the tent-cords. - -A friend informs me that he has a brother who will carry on a conversation -with any person who whispers to him in his sleep, and that his emotions -are then very readily excited by any pitiful story that may be told him. -Upon awaking, he has a distinct recollection of his dreams, which are -always connected with the ideas communicated. - -I recollect very distinctly the particulars of a dream which I had several -years since, and which was due to an impression conveyed to the brain -through the ear. The dream also illustrates the point previously brought -forward, that a definite conception of time does not enter into the -phenomena of dreams. - -I dreamed that I had taken passage in a steamboat from St. Louis to New -Orleans. Among the passengers was a man who had all the appearance of -being very ill with consumption. He looked more like a ghost than a human -being, and moved noiselessly among the passengers, noticing no one, though -attracting the attention of all. For several days nothing was said between -him and any one, till one morning, as we approached Baton Rouge, he came -to where I was sitting on the guards and began a conversation by asking me -what time it was. I took out my watch, when he instantly took it from my -hand and opened it. "I, too, once had a watch," he said; "but see what I -am now." With these words he threw aside the large cloak he habitually -wore, and I saw that his ribs were entirely bare of skin and flesh. He -then took my watch, and, inserting it between his ribs, said it would make -a very good heart. Continuing his conversation he told me that he had -resolved to blow up the vessel the next day, but that as I had been the -means of supplying him with a heart he would save my life. "When you hear -the whistle blow," he said, "jump overboard, for in an instant afterward -the boat will be in atoms." I thanked him, and he left me. All that day -and the next I endeavored to acquaint my fellow-passengers with the fate -in store for them, but discovered that I had lost the faculty of speech. I -tried to write, but found that my hands were paralyzed. In fact I could -adopt no means to warn them. While I was making these ineffectual efforts, -I heard the whistle of the engine; I rushed to the side of the boat to -plunge overboard, and awoke. The whistle of a steam saw-mill near my house -had just begun to sound, and had awakened me. My whole dream had been -excited by it, and could not have occupied more than a few seconds. - -The following account[82] shows how a dream may be set in action by the -sense of smell. - -"On one occasion during my residence at Birmingham I had to attend many -patients at Coventry, and for their accommodation I visited that place one -day in every week. My temporary residence was at a druggist's shop in the -market-place. Having on one occasion, now to be mentioned, a more than -usual number of engagements, I was obliged to remain one night, and a bed -was provided for me at the residence of a cheesemonger in the same -locality. The house was very old, the rooms very low, and the street very -narrow. It was summer-time, and during the day the cheesemaker had -unpacked a box or barrel of strong old American cheese; the very street -was impregnated with the odor. At night, jaded with my professional -labors, I went to my dormitory, which seemed filled with a strong, cheesy -atmosphere, which affected my stomach greatly, and quite disturbed the -biliary secretions. I tried to produce a more agreeable atmosphere to my -olfactory sense by smoking cigars, but did not succeed. At length, worn -out with fatigue, I tried to sleep, and should have succeeded, but for a -time another source of annoyance prevented me doing so; for in an old wall -behind my head, against which my ancient bed stood, there were numerous -rats gnawing away in real earnest. The crunching they made was indeed -terrific, and I resisted the drowsy god from a dread that these voracious -animals would make a forcible entrance, and might take personal liberties -with my flesh. - -"But at length 'tired nature' ultimately so overpowered me that I slept in -a sort of fever. I was still breathing the cheesy atmosphere, and this, -associated with the marauding rats, so powerfully affected my imagination -that a most horrid dream was the consequence. I fancied myself in some -barbarous country, where, being charged with a political offense, I was -doomed to be incarcerated in a large cheese. And although this curious -prison-house seemed most oppressive, it formed but part of my sufferings; -for scarcely had I become reconciled to my probable fate than to my horror -an army of rats attacked the monster cheese, and soon they seemed to have -effected an entrance, and began to fix themselves in numbers upon my naked -body. The agony I endured was increased by the seeming impossibility to -drive them away, and, fortunately for my sanity, I awoke, but with a hot -head and throbbing temples, and a sense of nausea from the extremely -strong odor of the cheese." - -I have on two occasions that I recollect had dreams which were due to -odors. On one of them the smell of gas escaping in the room excited the -dream of a chemical laboratory; on the other the smell of burning cloth -caused me to dream of a laundry, and of one of the women ironing a -blanket, which she scorched with a hot iron. A lady informs me that a -similar odor produced in her a dream of the house being on fire and the -impossibility of her escaping by reason of all her clothes being burned -up. - -Dreams are very readily excited through impressions made on the special -nerves of sensation. Instances are given of persons sleeping with bottles -of hot water applied to their feet dreaming of walking on burning lava, or -some other hot substance. A patient related to me the particulars of a -dream which occurred to him while he was asleep with a vessel of hot water -applied to the soles of his feet. He had, just before going to sleep, -read in the evening paper an account of the capture of an English -gentleman by Italian brigands. He dreamt that while crossing the Rocky -Mountains he had been attacked by two Mexicans, who, after a long fight, -had succeeded in taking him alive. They conveyed him very hurriedly to -their camp, which was situated in a deep gorge. Here they told him that -unless he revealed to them the means of making gold from copper they would -submit him to torture. In vain he plead ignorance of any such process. -Pulling off his boots and stockings they held his naked feet to the fire -till he shrieked with agony, and awoke to find that the blanket which was -wrapped around the tin vessel containing the hot water had become -disarranged, and that his feet were in direct contact with the hot metal. - -In another case, that of a lady whose lower limbs were paralyzed, -artificial heat was applied during the night to her feet. Frequently her -dreams had reference to this circumstance. On one occasion she dreamed -that she was transformed into a bear, and was being taught to dance by -being made to stand on hot plates of iron. On another, that the house was -on fire, and that the floors were so hot as to burn her feet in her -efforts to escape. Again, that she was wading through a stream of water -which came from a hot spring in the Central Park. - -Another patient, a lady, subject to neuralgic attacks of great severity, -frequently had the lancinating pains give rise to dreams in which she was -stabbed with daggers, cut with knives, torn with pincers, etc. - -Not long since I had an attack of erysipelas, in which the disease -included the head and face. The pain was not severe, and yet it was -sufficient to give rise to the following dream: - -I dreamed that I was taking a cold bath, and that while thus engaged a -Turk, armed with a pair of long pincers, came into the room and began to -pull the hair out of my head. I remonstrated, but was unable to offer any -material resistance, for the reason that the water in which I was lying -suddenly froze, leaving me imbedded in a solid cake of ice. In order to -facilitate his operations, the Turk sponged my head with boiling water, -and then, finding the use of the pincers rather slow work, shaved the hair -off with a red-hot razor. He then rubbed an ointment on the naked scalp, -composed of sulphur, phosphorus, and turpentine, to which he immediately -applied fire. Taking me in his arms he rushed down stairs into the street, -lighting his way with the flame from my burning head. He had not gone far -before he fell down in a fit, and in his struggles gave me a severe blow -between the eyes which instantly deprived me of sight. - -When I awoke in the morning I had a very distinct recollection of this -dream. The incidents were in part due to the fact that I had, two or three -days previously, been reading an account of the insanity of Mohammed, and -of his being subject to attacks of epilepsy. - -The sense of taste is not, for obvious reasons, so productive of dreams as -the other senses, but the experiments of M. Maury and myself, to which -fuller reference will presently be made, show that strong excitations made -upon it are transmitted to the brain; and the following instance, which -has recently come under my immediate observation, is an interesting case -in point. - -A young lady had, in her early childhood, contracted the habit of going to -sleep with her thumb in her mouth. She had tried for several years to -break herself of the practice, but all her attempts were in vain, for even -when by strong mental effort she succeeded in getting to sleep without the -usual accompaniment, it was not long before the unruly member was in its -accustomed place. Finally she hit upon the plan of covering the offending -thumb with extract of aloes just before she went to bed, hoping that if -she put it into her mouth she would instantly awake. But she slept on -through the night, and in the morning found her thumb in her mouth and all -the extract of aloes sucked off. During the night, however, she dreamed -that she was crossing the ocean in a steamer made of wormwood, and that -the vessel was furnished throughout with the same material. The plates, -the dishes, tumblers, chairs, tables, etc. were all of wormwood, and the -emanations so pervaded all parts of the ship that it was impossible to -breathe without tasting the bitterness. Everything that she ate or drank -was likewise, from being in contact with wormwood, so impregnated with the -flavor that the taste was overpowering. When she arrived at Havre she -asked for a glass of water for the purpose of washing the taste from her -mouth, but they brought her an infusion of wormwood, which she gulped down -because she was thirsty, though the sight of it excited nausea. She went -to Paris and consulted a famous physician, M. Sauve Moi, begging him to do -something which would extract the wormwood from her body. He told her -there was but one remedy, and that was ox gall. This he gave her by the -pound, and in a few weeks the wormwood was all gone, but the ox gall had -taken its place, and was fully as bitter and disagreeable. To get rid of -the ox gall she was advised to take counsel of the Pope. She accordingly -went to Rome, and obtained an audience of the Holy Father. He told her -that she must make a pilgrimage to the plain where the pillar of salt -stood, into which Lot's wife was transformed, and must eat a piece of the -salt as big as her thumb. During her journey in search of the pillar of -salt she endured a great many sufferings, but finally triumphed over all -obstacles, and reached the object of her journey. What part to take was -now the question. After a good deal of deliberation she reasoned that as -she had a bad habit of sucking her thumb, it would be very philosophical -to break off this part from the statue, and thus not only get cured of -the bitterness in her mouth, but also of her failing. She did so, put the -piece of salt into her mouth, and awoke to find that she was sucking her -own thumb. - -It might be supposed that the brain during sleep is not excitable through -the sense of sight. Many examples, however, are on record of dreams being -thus produced, and several very interesting cases have come under my own -observation. Among them are the following: - -A gentleman of a nervous and irritable disposition informed me that he had -dreamed of being in heaven and being dazzled by the brilliancy of -everything around him. So great was the light that he hastened to escape -from the pain which it caused in his eyes. In the efforts which he made he -struck his head against the bedpost, and awoke to find that the fire which -he had left smouldering on the hearth had kindled into a bright flame, the -light from which fell full in his face. - -Another, who had been under my care for epilepsy, dreamed that his room -was entered by burglars, and that with lighted candles in their hands they -were searching his drawers and trunks. He related his dream the following -morning, and was told by his mother that she had gone into his room the -previous night, and had held a lighted candle close to his face in order -to see whether or not he was sound asleep. - -No one has more philosophically studied the mode of production of dreams -than M. Maury[83] in his remarkable work to which reference has already -been made. I propose, therefore, to place a brief outline of his -experiments and views before the reader. - -Just before falling asleep, and immediately before becoming fully awake, -many persons are subject to hallucinations partaking of many of the -characteristics belonging to dreams. To them the name of hypnagogic -([Greek: hypnos], _sleep_, and [Greek: agogeus], _leader_) hallucinations -has been given, _i.e._ hallucinations which lead to sleep. Previous to M. -Maury's investigations, the phenomena in question had attracted some -attention from German and French physiologists, but M. Maury's -investigations, many of which were performed upon himself, throw more -light upon the subject than it has hitherto received. - -According to M. Maury, the persons who most frequently experience these -hypnagogic hallucinations are those who are of an excitable constitution, -and are generally predisposed to hypertrophy of the heart, pericarditis, -and cerebral affections. This may be true, but in two most remarkable -instances which have come under my observation, the type of organization -was the very reverse of this. - -In M. Maury's own case he finds that the hallucinations are more numerous -and more vivid when he experiences, as is frequent with him, a disposition -to cerebral congestion. Thus, when he has headache, nervous pains in the -eyes, the ears, and the nose, and vertigo, the hallucinations make their -appearance as soon as he closes his eyelids. Loss of sleep and severe -intellectual exertions invariably produce them, as do also _cafe noir_ and -champagne, which, by causing headache and insomnia, strongly predispose -him to the hypnagogic hallucinations. On the contrary, calmness of mind, -rest, and country air lessen his liability to them. From the inquiries -made of others by M. Maury, the results of his own experience, as well as -from my own observations, I am well convinced that the hypnagogic -hallucinations are directly the result of an increase in the amount of -blood circulating through the brain rather than to actual congestion as he -supposes. They therefore indicate the existence of a condition unfavorable -to sound sleep. In the chapter devoted to the consideration of wakefulness -the phenomena accompanying cerebral hyperaemia will be more fully -considered. - -The theory which M. Maury proposes in order to account for the existence -of hypnagogic hallucinations further presupposes that as the power of the -attention immediately before sleep begins to be diminished, and the mind -cannot therefore voluntarily and logically arrange its thoughts, it -abandons itself to the imagination, and that thus fancies arise and -disappear unchecked by the other mental faculties. This absence of the -attention need not be of long duration, a second, or even a shorter period -being sufficient. Thus he lay down, and the attention which had been -fully aroused soon became weakened; images appeared, and these partially -reawakened the attention, and the current of his thoughts was resumed, to -be replaced again by hallucinations, and this continued till he was fully -asleep. As an example, he states that on the 30th of November, 1847, he -was reading aloud the _Voyage dans la Russie Meridionale_, by M. Hommaire -de Hell. He had just finished a line when he closed his eyes -instinctively. In this short instant of sleep he saw hypnagogically, but -with the rapidity of light, the figure of a man clothed in a brown robe, -and with a hood on his head like a monk. The appearance of this image -reminded him that he had shut his eyes and ceased reading. He immediately -opened his eyelids and resumed his book. The interruption was practically -nothing, for the person to whom he was reading did not perceive it. - -M. Maury gives numerous examples of these hypnagogic hallucinations, all -tending to show that they are induced by a congested condition of the -cerebral vessels, and that thus, according to the views I have set forth -relative to the condition of the brain in sleep, they are not to be -regarded as precursors of that state, but of stupor. - -In two very interesting cases of these hallucinations, which have come -under my notice, they were brought about by any cause which increased the -quantity of blood in the brain, or retarded the flow of blood from this -organ. Thus, a glass of champagne, or a few drops of laudanum, would -induce them, as also would the recumbent posture, with the head rather -low. - -As showing how readily dreams can be excited by impressions made upon the -senses, M. Maury caused a series of experiments to be performed upon -himself when asleep, which afforded very satisfactory results, and which -are interesting in connection with the points already discussed in the -present chapter. - -1st Experiment. He caused himself to be tickled with a feather on the lips -and inside of the nostrils. He dreamed that he was subjected to a horrible -punishment. A mask of pitch was applied to his face, and then torn roughly -off, taking with it the skin of his lips, nose, and face. - -2d Experiment. A pair of tweezers was held at a little distance from his -ear, and struck with a pair of scissors. He dreamed that he heard the -ringing of bells; this was soon converted into the tocsin, and this -suggested the days of June, 1848. - -3d Experiment. A bottle of eau de Cologne was held to his nose. He dreamed -that he was in a perfumer's shop. This excited visions of the East, and he -dreamed that he was in Cairo in the shop of Jean Marie Farina. Many -surprising adventures occurred to him there, the details of which were -forgotten. - -4th Experiment. A burning lucifer match was held close to his nostrils. He -dreamed that he was at sea (the wind was blowing in through the windows), -and that the magazine of the vessel blew up. - -5th Experiment. He was slightly pinched on the nape of the neck. He -dreamed that a blister was applied, and this recalled the recollection of -a physician who had treated him in his infancy. - -6th Experiment. A piece of red-hot iron was held close enough to him to -communicate a slight sensation of heat. He dreamed that robbers had got -into the house, and were forcing the inmates, by putting their feet to the -fire, to reveal where their money was. The idea of the robber suggested -that of the Duchess d'Abrantes, who he supposed had taken him for her -secretary, and in whose memoirs he had read some account of bandits. - -7th Experiment. The word _parafagaramus_ was pronounced in his ear. He -understood nothing, and awoke with the recollection of a very vague dream. -The word _maman_ was next used many times. He dreamed of different -subjects, but heard a sound like the humming of bees. Several days after, -the experiment was repeated with the words _Azor_, _Castor_, _Leonore_. On -awaking, he recollected that he had heard the last two words, and had -attributed them to one of the persons who had conversed with him in his -dream. - -Another experiment of the same kind showed like the others that it was the -sound of the word and not the idea it conveyed which was perceived by the -brain. Then the words _chandelle_, _haridelle_, were pronounced many times -in rapid succession in his ear. He awoke suddenly, saying to himself, -_c'est elle_. It was impossible for him to recall what idea he had -attached to this dream. - -8th Experiment. A drop of water was allowed to fall on his forehead. He -dreamed that he was in Italy, that he was very warm, and that he was -drinking the wine of Orvieto. - -9th Experiment. A light, surrounded with a piece of red paper, was -repeatedly placed before his eyes. He dreamed of a tempest and lightning, -which suggested the remembrance of a storm he had encountered in the -English Channel in going from Merlaix to Havre. - -These observations are very instructive. They show conclusively that one -very important class of our dreams is due to our bodily sensations. I have -frequently performed analogous experiments on others, and had them -practiced on myself, and have rarely failed in obtaining decided results. -They strongly inculcate the truth of the conclusions arrived at in the -foregoing chapter, and they serve as important data in enabling us to -understand the division of the subject next to be considered. - -In regard to the immediate cause of dreams the opinions of authors are -very diverse. The older writers ascribe them to the rise of vapors from -the stomach, to the visitation of demons, and other fanciful causes. -Bishop Bull[84] declares that he knows from his own experience that -dreams are to be ascribed "to the ministry of those invisible instruments -of God's providence that guide and govern our affairs and concerns, viz., -the angels of God;" and Bishop Ken held a similar view. - -It would neither be possible nor profitable to refer at greater length to -views which positive physiology has overturned. Observation and experiment -have aided us greatly in arriving at definite conclusions on this subject, -and the instances quoted on page 30 of this treatise, even if standing -alone uncontradicted, would go far toward guiding us in the right path. On -page 37 I have referred to the case of a man who, some time after -receiving a severe injury of the head by which a considerable portion of -the skull was lost, came under my professional care. Standing by his -bedside one evening, just after he had gone to sleep, I observed the scalp -slightly rise from the chasm in which it was deeply depressed. I was sure -he was going to awake, but he did not, and very soon he became restless -and agitated, while continuing to sleep. Presently he began to talk, and -it was evident that he was dreaming. In a few minutes the scalp sank down -to its ordinary level when he was asleep, and he became quiet. I called -his wife's attention to the circumstance, and desired her to observe this -condition thereafter when he slept. She subsequently informed me that she -could always tell when he was dreaming from the appearance of the scalp. - -My opinion, therefore, is that dreams are directly caused by an increased -activity of the cerebral circulation over that which exists in profound -sleep. This activity is probably sometimes local and at others general, -and never equals that which prevails in the condition of wakefulness, when -the functions of the brain are at their maximum of energy. This view is -further supported by a consideration of the state of the brain in sleep -and wakefulness, the condition of dreaming being, in a measure, an -intermediate one. Illustrations of the effects produced by a notable -increase in the quantity of blood circulating through the brain will be -given in the chapter on wakefulness. All of these, it will be perceived, -have a direct bearing on the question now under consideration. - - - - -CHAPTER VI. - -MORBID DREAMS. - - -Morbid or pathological dreams are divided by Macario[85] into three -classes: the prodromic, or those which precede diseases; the symptomatic, -or those which occur in the course of diseases; and the essential, or -those which constitute the main features of diseases. As this -classification is natural and simple, I propose to follow it in the -remarks I shall have to make on the subject. - -PRODROMIC DREAMS.--There appears to be no doubt that diseases are -sometimes preceded by dreams which indicate with more or less exactitude -the character of the approaching morbid condition. Many instances of the -kind which have been reported--especially by the earlier authors--are, -however, in all probability merely coincidences; and in others the -relation between the character of the dream and that of the disease is by -no means clear. - -Many cases of dreams indicating the nature of a malady which had not yet -developed itself are referred to by Macario.[86] The instance of Galen's -patient, who dreamed that his leg had become converted into stone, and who -was soon afterward paralyzed in that member, has already been cited. - -The learned Conrad Gesner dreamed that he was bitten in the left side by a -venomous serpent. In a short time a severe carbuncle appeared on the -identical spot, and death ensued in five days. - -M. Teste, formerly minister of justice and then of public works under -Louis Philippe, and who finally died in the Conciergerie, dreamed three -days before his death that he had had an attack of apoplexy. Three days -afterward he died suddenly of that disease. - -A young woman saw in a dream objects apparently confused and dim as -through a thin cloud, and was immediately thereafter attacked with -amblyopia, and threatened with loss of sight. - -A woman, who had been under the care of M. Macario, dreamed at about the -period of her menstrual flow that she spoke to a man who could not answer -her, for the reason that he was dumb. On awaking she discovered that she -had lost her voice. - -Macario himself dreamed one night that he had a severe pain in his throat. -On awaking he felt very well; but a few hours subsequently was attacked -with severe tonsillitis. - -Arnold, of Villanova, dreamed that a black cat bit him in the side. The -next day a carbuncle appeared on the part bitten. - -Dr. Forbes Winslow[87] gives several similar instances. A patient had, for -several weeks before an attack of apoplexy, a series of frightful dreams, -in one of which he imagined he was being scalped by Indians. Others dreamt -of falling down precipices, and of being torn to pieces by wild beasts. -One gentleman dreamed that his house was in flames, and that he was -gradually being consumed to a cinder. This occurred a few days before an -attack of inflammation of the brain. A person, prior to an attack of -epilepsy, dreamt that he was severely lacerated by a tiger; and another, -just before a seizure, dreamt that he was attacked by murderers, and that -they were knocking out his brains with a hammer. - -A barrister, for several years before an attack of cerebral paralysis, was -in the habit of awaking from sleep in a condition of great alarm and -terror without being able to explain the reason for his apprehension. Dr. -Beddoes attended a patient whose first fit succeeded a dream of being -crushed by an avalanche. - -Gratiolet[88] cites additional examples. Thus, Roger d'Oxteryn, Knight of -the Company of Douglas, went to bed in good health. Toward the middle of -the night, he saw in a dream a man affected with the plague and entirely -naked, who attacked him with fury, threw him to the ground after a severe -contest, and, holding him between his thighs, vomited into his mouth. -Three days afterward he was seized with the plague and died. He also -alludes to a case detailed by Gunther, in which a woman dreamt that she -was being flogged with a whip, and on awaking found that she had marks on -her body resembling the scars made by the lash. - -The existence of diseases of the heart and larger vessels is often -revealed by frightful dreams when there is no other evidence of their -presence. Macario states that a young lady was under his care in whom -violent palpitations of the heart were preceded by painful dreams. She -subsequently died of disease of the heart. - -Moreau (de la Sarthe),[89] in a very elaborate treatise on dreams, relates -the case of a French nobleman, whom he had attended during several months -for threatened chronic pericarditis, and who was at first tormented every -night by painful and frightful dreams. These dreams, attracting attention, -gave the earliest indication of the real condition, and excited fears as -to the result, which were soon verified. - -He cites another case in illustration of the fact that periodical -hemorrhages are sometimes preceded by morbid dreams. A physician had, in -his youth, been subject to periodical hemorrhages, but without dreams or -other trouble during sleep. As he advanced in years, the hemorrhages were -not so frequent, but were always preceded by a condition of general -irritation, characterized during wakefulness by heat of skin and frequency -of the pulse, and during sleep by painful dreams. These dreams almost -always related to violent actions, such as giving and receiving heavy -blows, walking on a volcano, or being precipitated into lakes of fire. - -Many cases of insanity being preceded by frightful dreams are on record. -Falret,[90] in calling attention to the remarkable analogy which exists -between mental alienation and dreams, says that it is an incontestable -fact that insanity is often preceded by significant dreams, and that these -constitute the whole essence of the disorder by becoming firmly fixed in -the patient's mind. Thus, he relates that Odier of Geneva was consulted in -1778 by a lady, who, during the night preceding the outbreak of her -insanity, dreamed that her step-mother approached her with a dagger in -order to kill her. This dream made so strong an impression upon her that -she ultimately accredited it as true, and thus became the victim of a -delusion which rendered her a lunatic. He declares that numerous similar -instances have come under his observation, and refers to the case of a -young lady, subject to periodical attacks of mental derangement, whose -paroxysms are always preceded by notable dreams. - -Morel[91] affirms that many patients before becoming completely insane -have frightful dreams, which they regard as evidences that they are about -to lose their reason. Sometimes they are afraid to go to sleep on account -of the terrifying apparitions which then visit them. - -The following cases, related by Dr. Forbes Winslow,[92] are interesting in -this connection: - -"A gentleman, who had previously manifested no appreciable symptoms of -mental disorder, or even of disturbed and anxious thought, retired to bed -apparently in a sane state of mind. Upon arising in the morning, to the -intense terror of his wife, he was found to have lost his senses! He -exhibited his insanity by asserting that he was going to be tried for an -offense which he could not clearly define, and of the nature of which he -had no right conception. He declared that the officers of justice were in -hot pursuit of him,--in fact, he maintained that they were actually in the -house. He begged and implored his wife to protect him. He walked about the -bed-room in a state of great agitation, apprehension, and alarm, stamping -his feet, and wringing his hands in the wildest agony of despair. Upon -inquiring into the history of the case, his wife said that she had not -observed any symptoms that excited her suspicions as to the state of her -husband's mind, but upon being questioned very closely, she admitted that -during the previous night he appeared to have been under the influence of -what she considered to be the nightmare, or a frightful dream. While -apparently asleep he cried out several times, evidently in great distress -of mind, 'Don't come near me!' 'Take them away!' 'Oh, save me; they are -pursuing me!' It is singular that in this case the insanity which was -clearly manifested in the morning appeared like _a continuation of the -same character and train of perturbed thought that existed during his -troubled sleep_ when, according to the wife's account, he was evidently -dreaming." - -Dr. Winslow's second case is equally to the point: "I am indebted to a -medical friend for the particulars of the following case. During the -winter of 1849 he was called to see H. B., about five or six o'clock in -the morning. The patient was the wife of a tailor and mother of three -children. At this time she was rather emaciated and debilitated in bodily -health, and anemic in appearance. She was of a religious turn of mind, and -belonged to the Wesleyan persuasion. On the morning of the narrator's -visit, he found the woman in a state of great mental excitement and under -the influence of hallucinations. She had gone to bed apparently well, but -during the night was the subject of a vivid dream, imagining that she saw -her sister, long since dead and to whom she was much attached, suffering -the pains of hell. When quite awake, no one could persuade her that she -had been under the influence of an agitated dream. She stoutly persisted -in maintaining the reality of her vision. During the whole of that day she -was clearly insane; but on the following morning her mind appeared to have -recovered its balance. She continued tolerably well, mentally, for four -years, with the exception of her occasionally having moments of -despondency arising from real or fancied troubles." * * * - -The further particulars of this case, relating as they do to another -division of the subject,--"sleep-drunkenness," as the Germans designate -it,--will be considered under that head. - -Without pretending to indorse all the conclusions of Albers,--as set forth -in the following summary, and which I quote from a very learned and -philosophical writer,[93]--there is no doubt that some of his dicta are -well founded. - -"Lively dreams are in general a sign of the excitement of nervous action. - -"Soft dreams are a sign of slight irritation of the head; often in nervous -fevers announcing the approach of a favorable crisis. - -"Frightful dreams are a sign of determination of blood to the head. - -"Dreams about fire are in women signs of an impending hemorrhage. - -"Dreams about blood and red objects are signs of inflammatory conditions. - -"Dreams about rain and water are often signs of diseased mucous membranes -and dropsy. - -"Dreams of distorted forms are frequently a sign of abdominal obstructions -and diseases of the liver. - -"Dreams in which the patient sees any part of the body especially -suffering, indicate disease in that part. - -"Dreams about death often precede apoplexy, which is connected with -determination of blood to the head. - -"The nightmare (incubus ephialtes), with great sensitiveness, is a sign of -determination of blood to the chest." - -A very interesting paper on dreaming, by Dr. Thomas More Madden,[94] has -been recently published, and from it I make the following extract: - -"Intermittent fever is often announced, several days before any of the -recognized symptoms set in, by persistent dreams of terrifying character. -I have experienced this in my own person, and heard it confirmed by other -sufferers on the African Coast. The following case of morbid dreaming -ushering in yellow fever, I subjoin in the words of the gentleman to whom -it occurred, himself a medical man holding a high official position on the -Gold Coast where it occurred. - -"'In the early part of 1840, I was an inmate of Cape Coast Castle, and as -some repairs were then being made in the castle, the room assigned to me -was that in which the ill-fated L. E. L. (Mrs. Maclean), the wife of the -governor of Cape Coast, had been found dead, poisoned by prussic acid, not -very long previously. I had known her in London, and had been intimately -acquainted with her history and much interested in it. Her body had been -found on the floor near the door and in front of a window. After a -fatiguing excursion to some of the adjoining British settlements on the -Coast, having retired to rest, I awoke disturbed by a dream of a very -vivid character, in which I imagined that I saw the dead body of the lady -who had died in that chamber lying on the floor before me. On awaking the -image of the corpse kept possession of my imagination. The moon was -shining brightly into the part of the room where the body had been found, -and there, as it seemed to me on awaking, it lay pale and lifeless as it -appeared to me in my dream. - -"'After some minutes I started up, determined to approach the spot where -the body seemed to be. I did so, not without terror, and walking over the -very spot on which the moon was shining, the fact all at once became -evident and obvious that no body was there--that I must have been dreaming -of one. I returned to bed, and had not long fallen asleep when the same -vivid dream recurred; the same waking disturbance occurring while awake. -As long as I lay gazing on the floor I could not dispossess my mind of -that appalling vision; but when I started up and stood erect it vanished -at the first glance. - -"'Again I returned to bed, dozed, dreamt again of poor L. E. L.'s -lamentable end, and of her remains in the same spot; again awoke, and -arose with the same strange results. - -"'There was no more disturbance that night of which, at least, I was -conscious, but when morning came fever was on me in unmistakable force in -its worst form, and partial delirium set in the same night. I was reduced -to the last extremity about the third or fourth night of my illness, when -a conviction seized on my mind that it was absolutely essential to my life -that I should not pass another night in Cape Coast Castle. I caused the -negro servant I had fortunately brought out with me from England to have a -litter prepared for me at dawn, and stretched on this litter, hardly able -to lift hand or foot, I was carried out of my bed by four native soldiers, -and was conveyed to the house of a merchant, and countryman of mine, to -whose care and kindness I owe my life. So much for a visionary precursor -of fever on the west coast of Africa.' - -"In neuralgia, disturbed dreaming is occasionally a prominent symptom. In -an obscure case I was led to make what I believe to be a true diagnosis -from the indications furnished by the patient's dreams. The individual in -question is a man, aged about 45, of an anemic habit, confined by a -sedentary occupation, who, for many years, had suffered from hemicrania, -which lately had become more intense, and the intervals shorter. A couple -of days before the attack his sleep becomes broken by unpleasant dreams, -and when the paroxysm has attained its height, he invariably dreams that -he is the helpless victim of a persecutor, who finishes a series of -torments by driving a stake through his skull. During his recovery from -each attack, he states that his dreams are of a most agreeable character, -though so vague that he cannot give any account of them. The frequent -repetition of his dreams leads me to conclude that there is some osseous -growth within the cranium, and that the vascular distention accompanying -the neuralgic attack occasions pressure upon this, giving rise to the -sensation I have referred to, while the subsequent feeling of comfort -results from that pressure being removed." - -A case has been recently published[95] in which the dream immediately -preceded, or perhaps even accompanied, the morbid action. A German, aged -45, of a nervo-sanguineous temperament, went to bed at 11 P. M., feeling -as well as usual. Between 12 and 1 o'clock he dreamed that he saw his -child lying at his side, dead. He was very much frightened, and at once -awoke, to find that his tongue was paralyzed, and that he could not talk. -The faculty of speech and the ability to move the tongue remained impaired -for four months. - -For several years past I have made inquiries of patients and others -relative to their dreams, and have thus collected a large amount of -material bearing upon the subject. With reference to the point under -consideration, the data in my possession are exceedingly important and -interesting. Among the cases which have come under my observation of -diseases being preceded by morbid dreams, are the following: - -A gentleman, two days before an attack of hemiplegia, dreamed that he was -cut in two exactly down the mesial line, from the chin to the perineum. By -some means union of the divided surfaces was obtained, but he could only -move one side. On awaking, a little numbness existed in the side which he -had dreamed was paralyzed. This soon passed off, and ceased to engage his -attention. The following night he had a somewhat similar dream, and the -next day, toward evening, was seized with the attack which rendered him -hemiplegic. - -Another dreamed one night that a man dressed in black and wearing a black -mask came to him and struck him violently on the leg. He experienced no -pain, however, and the man continued to beat him. In the morning he felt -nothing, with the exception of a slight headache. Nothing unusual was -observed about the leg, and all went on well, until on the fifth day he -had an apoplectic attack, accompanied with hemiplegia, including the leg -which he had in his dream imagined to have been struck. - -A lady, aged forty, who had been a great sufferer from rheumatism for many -years, dreamt one afternoon, while sitting in her chair in front of the -fire, that a boy threw a stone at her, which, striking her on the face, -inflicted a very severe injury. The next day violent inflammation of the -tissues around the facial nerve as it emerges from the stylo mastoid -foramen set in, and paralysis of the nerve followed, due to effusion of -serum, thickening, and consequent pressure. - -A young lady dreamt that she was seized by robbers and compelled to -swallow melted lead. In the morning she felt as well as usual, but toward -the middle of the day was attacked with severe tonsillitis. - -A young man informed me that a day or two before being attacked with acute -meningitis, he had dreamed that he was seized by banditti while traveling -in Spain, and that they had taken his hair out by the roots, causing him -great pain. - -A lady of decided good sense had an epileptic seizure, which was preceded -by a singular dream. She had gone to bed feeling somewhat fatigued with -the labors of the day, which had consisted in attending three or four -morning receptions, winding up with a dinner party. She had scarcely -fallen asleep, when she dreamed that an old man clothed in black -approached her, holding an iron crown of great weight in his hands. As he -came nearer, she perceived that it was her father, who had been dead -several years, but whose features she distinctly recollected. Holding the -crown at arm's length, he said: "My daughter, during my lifetime I was -forced to wear this crown; death relieved me of the burden, but it now -descends to you." Saying which, he placed the crown on her head and -disappeared gradually from her sight. Immediately she felt a great weight -and an intense feeling of constriction in her head. To add to her -distress, she imagined that the rim of the crown was studded on the inside -with sharp points which wounded her forehead, so that the blood streamed -down her face. She awoke with agitation, excited, but felt nothing -uncomfortable. Looking at the clock on the mantle-piece, she found that -she had been in bed exactly thirty-five minutes. She returned to bed and -soon fell asleep, but was again awakened by a similar dream. This time the -apparition reproached her for not being willing to wear the crown. She had -been in bed this last time over three hours before awaking. Again she fell -asleep, and again at broad daylight she was awakened by a like dream. - -She now got up, took a bath, and proceeded to dress herself with her -maid's assistance. Recalling the particulars of her dream, she -recollected that she had heard her father say one day, that in his youth, -while being in England, his native country, he had been subject to -epileptic convulsions consequent on a fall from a tree, and that he had -been cured by having the operation of trephining performed by a -distinguished London surgeon. - -Though by no means superstitious, the dreams made a deep impression upon -her, and her sister, entering the room at the time, she proceeded to -detail them to her. While thus engaged, she suddenly gave a loud scream, -became unconscious, and fell upon the floor in a true epileptic -convulsion. This paroxysm was not a very severe one. It was followed in -about a week by another; and, strange to say, this was preceded as the -other by a dream of her father placing an iron crown on her head and of -pain being thereby produced. Since then several months have elapsed, and -she has had no other attack, owing to the influence of the bromide of -potassium which she continues to take. - -In the case of a gentleman now under my treatment for epilepsy, the fits -are invariably preceded by dreams of difficulties of the head, such as -decapitation, hanging, perforation with an auger, etc. - -A lady, previous to an attack of sciatica, dreamed that she had caught her -foot in a spring-trap, and that before she could be freed it was necessary -to amputate the member. The operation was performed; but as she was -released, a large dog sprang at her and fastened his teeth in her thigh. -She screamed aloud and awoke in her terror. Nothing unusual was perceived -about the leg; but, on getting up in the morning, there was slight pain -along the course of the sciatic nerve, and this before evening was -developed into well-marked sciatica. - -Insanity is frequently preceded by frightful dreams, and I have advanced -several examples to this effect from the experience of others. We should -naturally expect that very often the first manifestations of a diseased -brain should appear during sleep. But dreams are of such a varied -character, and so thoroughly irreconcilable with the normal mental -phenomena of the wakeful state, that it is difficult to say that such or -such a dream is evidence of a diseased mind. As, in some of the cases I -have brought forward, a dream may take so firm a hold of the reason as to -be the exciting cause of insanity, and not simply a sign of its approach, -I am disposed, from my own experience, to regard the frequent repetition -of the same dream as often indicative of a disordered mind, when very -close observation would fail to reveal other evidences. There are, -however, exceptions to this statement, as has been shown in the previous -chapter. - -Several cases, in which insanity was preceded by terrifying dreams, have -come under my observation. In one of them a lady dreamed that she had -committed murder, under circumstances of great atrocity. She cut up the -dead body, but could not, with all her efforts, divide the head, which -resisted her blows, with an axe and other instruments. Finally she filled -the nose, eyes, and mouth with gunpowder, and applied a match. Instead of -exploding, smoke issued slowly from the orifices of the skull, and was -resolved into a human form, which turned out to be that of a police -officer sent to arrest her. She was imprisoned, tried, and sentenced to -execution, by being drowned in a lake of melted sulphur. While the -preparations were being made for the punishment she awoke. She related the -particulars of her dream to several friends, but it apparently made no -great impression on her mind. The next night she dreamed of somewhat -similar circumstances, and for several nights subsequently. On the sixth -day, without any premonition, she attempted to kill herself by plunging a -pair of scissors into her throat, and since that time to her death, which -took place a few months subsequently, was constantly insane. - -In this case there was no direct analogy between the character of her -dream and the type of insanity which ensued. It cannot, therefore, be said -that the dream produced the mental aberration. On the contrary, the dream -was in all probability the first evidence of deranged cerebral action,--a -condition which subsequently became developed into positive insanity. - -The following case is similar to the foregoing in its general features: - -A gentleman who had been unfortunate in some business speculations, -shortly afterward became insane. Previous to this event he was troubled -with frightful dreams, which gave him a great deal of annoyance, and -frequently caused him to awake in terror. One of them occurred several -times, and was of the following character. He dreamed that he was engaged -to be married to a lady of beauty and wealth, and who was, moreover, -possessed of great musical talent. One evening, as he in his dream was -paying her a visit, she placed herself at the piano and began to sing. He -remarked that he did not admire the piece of music she was singing, and -asked her to sing something else. She indignantly refused. Angry words -followed, and in the midst of the dispute she drew a dagger from her bosom -and stabbed herself to the heart. As he rushed forward, horror-struck, to -her assistance, her friends entered the room, and found him with the -dagger in his hand. He was accused of murdering the lady, and, -notwithstanding his protestations of innocence, was tried, found guilty, -and sentenced to be hung. He always awoke at the point when preparations -were being made for his execution. - -A dream may make such a strong impression on the mind as to subsequently -constitute the essential feature of the insane condition. This point has -already been elucidated to some extent in the preceding pages. The -following cases, however, are from my own records of practice. - -A gentleman awoke in the middle of the night, and, calling his wife, told -her he had dreamed that a large fortune had been left him by a miner in -California. He then went to sleep again, but in the morning again repeated -the dream to his wife, and said that "there might be something in it." She -laughed, and remarked that she "hoped it might prove true." About the time -the California steamer was expected, the gentleman was observed to become -very anxious and excited, and was continually talking of his expected -fortune. At last the steamer arrived. He then began asking the postman for -letters from California, went several times a day to the post-office to -make like inquiries, and finally went aboard the steamer and questioned -the officers on the same subject. Then he was sure the letter had -miscarried, and would sit for hours in the most profound melancholy. He -was now recognized by his family as a monomaniac, and strenuous efforts -were made to cure him of his delusion, but they were unsuccessful; and -although now apparently sane on other subjects, he still holds the -erroneous idea which was first given him in his dream of several years -ago. - -A young lady was brought to me in July, 1868, who had been rendered insane -by a dream which took place a few months before I saw her. She went to bed -one night in good health and spirits, though somewhat fatigued in -consequence of having skated a good deal the previous afternoon. In the -morning she told her mother she had committed the "unpardonable sin," and -that there was consequently no hope of her salvation. She based her idea -on a dream she had had, in which an angel appeared to her, and sorrowfully -informed her of her sin and her destiny. When asked to tell what her sin -was, she refused to do so, saying it was too shocking and atrocious to -talk about. She kept to her delusion, and soon settled into a sort of -melancholic stupor, from which it was impossible entirely to rouse her. -Under the use of arsenic, and the acid phosphate of lime of Prof. -Horsford, she gradually recovered her reason. - -The manner in which prodromic dreams are excited is very simple. The -ancients and some modern writers have regarded them as prophetic; but the -true explanation does not require so severe a tax on our powers of belief. -In the previous chapter, it was shown that very slight impressions made -upon the senses during sleep are exaggerated by the partially awakened -brain. The first evidence of approaching paralysis may be a very minute -degree of numbness--so minute that the brain when awake and engaged with -the busy thoughts of active life fails to appreciate it. During sleep, -however, the brain is quiescent, till some exciting cause sets it in -uncontrollable action, and dreaming results. Such a cause may be the -incipient numbness of a limb. A dream of its being turned into stone, or -cut off, or violently struck, is the consequence. The disease goes on -developing, and soon makes its presence unmistakable. - -This explanation applies _mutatis mutandis_ to all prodromic dreams. They -are invariably based upon actual sensations, unless we except the rare -cases which are simply coincidences. - -SYMPTOMATIC DREAMS.--Morbid dreams are so generally met with in the course -of disease, especially in that of the brain and nervous system, that I -never examine a patient without questioning him closely on this point. The -information thus obtained is always valuable, and sometimes constitutes -the most important feature of the investigation. - -_Fevers_ are very often accompanied by frightful dreams. According to -Moreau (de la Sarthe),[96] their occurrence indicates that the attack will -be long, and that there is probably some organic affection present. My own -experience agrees with that of Macario,[97] to the effect of not -confirming these opinions. I have, however, generally observed that the -frequency and intensity of the morbid dreams were in proportion to the -severity of the fever. - -_Diseases of the heart_ are very generally attended with disagreeable -dreams. They are usually short, and, as Macario remarks, relate to -approaching death. The patient starts from sleep in terror, and sometimes -it is difficult to convince him of the reality of his visions. - -_Dyspepsia and other diseases of the intestinal canal_ often give rise to -morbid dreams. They are usually accompanied by a sense of impending -suffocation, and ordinarily consist of frightful images, such as devils, -demons, strange animals and the like. The presence of worms in the -intestines is likewise a frequent cause of such dreams. - -In _chlorosis_ dreams are very common. Occasionally they are of a pleasant -character, but in the majority of cases they are the reverse of this. - -It would be difficult to mention a disease which is not, at some time or -other of its career, an exciting cause of morbid dreams. The most -interesting examples, however, are met with in cases of _insanity and -other cerebral affections_, and frequently the delusions of the dreams are -so mixed up with those which arise during the waking condition, that the -patient is unable to separate them and to determine which are the -consequence of erroneous sensations received when awake, and which are the -results of dreams. The careful examination of almost any insane persons -will also show that they incorporate the fancies of their dreams with the -realities of everyday life. Indeed, the relations of dreaming to insanity -are so interesting and important as to have attracted the marked attention -of alienists and psychologists. - -Cabanis[98] gives Cullen the credit of being the first to point out the -similarity between the phenomena of dreaming and those of delirium, and -himself enters at length into the full discussion of the several questions -involved. A very little reflection will suffice to convince the reader -that the two conditions are strikingly alike. In dreams we never -distinguish the false from the real; the judgment, if exercised at all, -acts in the most erratic manner; we are rarely surprised at the occurrence -of the most improbable circumstances; our characters for the time being -often undergo a radical change, and we perform imaginary acts in our sleep -which are altogether at variance with our actual dispositions. The -hallucinations of sleep we accept as realities just as the insane -individual believes in all the erroneous impressions made upon his senses. -The dreaming person is, in fact, the victim of delusions which, during the -existence of his condition, have a firm hold on his mind and render him in -no essential particular different from the one who suffers from mental -unsoundness. The incoherence present in dreams, and the evident dependence -of the various images upon the suggestion of previous images, are likewise -phenomena of the insane state. - -Even in persons perfectly sane, dreams often produce a very powerful -influence on the mind. Most of us have, on awaking, felt pleased or -disturbed from reflecting upon the circumstances of a dream we have had -during the night, and occasionally the impression has remained through the -entire day. With children this influence is still more strongly shown. As -Sir Henry Holland[99] remarks, the corrections from reason and experience -are less complete in them than in adults. As a consequence, they not -infrequently confuse their dream-visions with the facts of their lives, -and regard the former as real events. The hallucinations of dreams are -also occasionally continued during wakefulness, and hence some persons -have, on awaking, seen the images which had been present to them in their -sleep. - -The celebrated Benedict de Spinoza[100] was once the subject of an -illusion which had its starting-point in a dream. He dreamed that he was -visited by a tall, thin, and black Brazilian, diseased with the itch. He -awoke, and thought he saw such an image standing beside him. - -Muller,[101] in referring to such instances, says: - -"I have myself also very frequently seen these phantasms, but am now less -liable to them than formerly. It has become my custom when I perceive such -images, immediately to open my eyes, and direct them upon the wall or -surrounding objects. The images are then still visible, but quickly fade. -They are seen whichever way the head is turned, but I have not observed -that they moved with the eyes. The answers to the inquiries which I make -every year of the students attending my lectures as to whether they have -experienced anything of the kind, have convinced me that it is a -phenomenon known to comparatively few persons. For among a hundred -students, two or three only, and sometimes only one, have observed it. -This rarity of the phenomena is, however, more apparent than real. I am -satisfied that many persons would perceive these spectres if they learned -to observe their sensations at the proper times. There are, however, -undoubtedly many individuals to whom they never appear, and in my own case -they now sometimes fail to show themselves for several months at a time, -although in my youth they occurred frequently. Jean Paul recommended the -watching of the phantasms which appear to the closed eyes as a means of -inducing sleep." - -If such phenomena take place in persons of healthy brains, the greater -liability of the insane to experience them will readily be admitted. - -The character of dreams, as Macario[102] remarks, varies according to the -type of insanity to which the patient is subject. In melancholia they are -ordinarily sad and depressing, and leave a deep and lasting impression; in -expansive monomania they are gay and exciting; in mania they give evidence -of the extraordinary mental excitement and activity of the subject, and in -duration they are vague, fleeting, and occur but seldom. - -ESSENTIAL MORBID DREAMS.--Under this head are comprehended the various -forms of frightful dreams which are ordinarily designated under the name -of nightmare. It has been my good fortune to have had the opportunity of -carefully studying the phenomena of this singular affection in several -persons of intelligence, and I propose, therefore, detailing the results -of my own experience, after a short historical retrospect, which I hope -will not prove uninteresting. - -Nightmare is characterized by the existence during sleep of a condition of -great uneasiness, the principal features of which are a sense of -suffocation, a feeling of pain or of constriction in some part of the -body, and a dream of a painful character. There are thus two essential -elements of the affection--the bodily and the mental. - -At a very early period the phenomena of nightmare attracted the attention -of physicians. Hippocrates[103] describes it in the following words: "I -have often seen persons in their sleep utter groans and cries, appear as -if suffocated, and throw themselves wildly about until they finally waked. -Then they were in their right minds, but were, nevertheless, pale and -weak." - -The general opinion held at that time was that the phenomena of nightmare -were due to excess of bile and dryness of the blood. This view originated -with Hippocrates, but was more or less modified by subsequent writers. - -After the establishment of Christianity, the conviction began to prevail -that during an attack of nightmare the subject was visited by a demon, -who, for the time being, took possession of his body. Oribasius, in the -fourth century, combated this idea, and endeavored to show that it was a -severe disease, which, if not cured, might lead to apoplexy, mania, or -epilepsy. He located it in the head. - -Aetius also denied the existence of demoniacal agency in nightmare. He -considered it as a prelude to epilepsy, mania, or paralysis. - -During the middle ages nightmare was attributed to the power of the devil. -Imps, male and female, called incubi and succubi respectively, were -supposed to be the active agents in producing the affection. The treatment -was in accordance with the theory, and consisted of prayers and exorcisms. -Not unfrequently the subject of the disease perished at the stake for the -alleged crime of having sexual intercourse with incubi or succubi, -according to sex. - -Even in later times many persons have been found who believed implicitly -in the reality of the visions which they experienced during an attack of -nightmare. Thus Jansen[104] relates that a clergyman came to consult him. -"Monsieur," said he, "if you do not help me I shall certainly go into a -decline, as you see I am thin and pale,--in fact, I am only skin and bone; -naturally I am robust, and of good appearance; now I am scarcely more than -the shadow of a man." - -"What is the matter with you?" said Jansen. "And to what do you attribute -your disease?" - -"I will tell you," answered the clergyman, "and you will assuredly be -astonished at my story. Almost every night a woman, whose figure is not -unknown to me, comes and throws herself on my breast, and embraces me with -such power that I can scarcely breathe. I endeavor to cry out, but she -stifles my voice, and the more I try the less successful I am. I can -neither use my arms to defend myself, nor my legs to escape. She holds me -bound and immovable." - -"But," said the doctor, "what you relate is not in the least surprising. -Your visitor is an imaginary being, a shade, a phantom, an effect of your -imagination." - -"Not so!" exclaimed the patient. "I call God to witness that I have seen -with my own eyes the being of whom I speak, and I have touched her with my -hands. I am awake, and in the full possession of my faculties, when I see -this woman before me. I feel her as she attacks me, and I try to contend -with her, but fear, anxiety, and languor prevent me. I have been to every -one asking for aid to bear up against my horrible fate, and, among others, -I have consulted an old woman, who has the reputation of being very -skillful, and something of a sorceress. She directed me to urinate toward -daylight, and to immediately cover the _pot de chambre_ with the boot of -my right foot. She assured me that on the very day I would do this the -woman would pay me a visit. - -"Although this seemed to me very ridiculous, and although my religion was -altogether against my making any such experiment, I was finally induced, -by reflecting on my sufferings, to follow the advice I had received. I did -so, and, sure enough, on the same day the wicked woman who had so -tormented me came to my apartment, complaining of a horrible pain in the -bladder. All my entreaties and threats, however, were unavailing to induce -her to cease her nocturnal visits." - -Jansen at first could not turn this gentleman from his insane idea, but, -finally, after two hours' conversation, he made him have some just -conception of the nature of his disease, and inspired him with the hope -of a cure. - -Epidemics of nightmare have been noticed, and it likewise sometimes -prevails endemically under certain peculiar forms. Thus vampirism, a -belief in which exists in different parts of the world, is nothing but a -kind of nightmare. Charles Nodier[105] gives some interesting details on -this point, which I do not hesitate to transcribe. - -In Morlachia there is scarcely a hamlet which has not several _vukodlacks_ -or vampires, and there are some, every family of which has its -_vukodlack_, just as every Alpine family has its cretin. The cretin, -however, has a physical infirmity, and with it a morbid state of the brain -and nervous system, which destroys his reason, and prevents him -appreciating his degraded condition. The _vukodlack_, on the contrary, -appreciates all the horror of his morbid perception; he fears and detests -it; he combats it with all his power; he has recourse to medicine, to -prayers, to division of a muscle, to the amputation of a limb, and -sometimes even to suicide. He demands that after his death his children -shall pierce his heart with a spike, and fasten his corpse to the coffin, -so that his dead body, in the sleep of death, may not be able to follow -the instinct of the living body. The _vukodlack_ is, moreover, often a man -of note, often the chief of the tribe, the judge, or the poet. - -Through the sadness which is due to the recollection of his nocturnal -life, the _vukodlack_ exhibits the most generous and lovable traits of -character. It is only during his sleep, when visited with his terrible -dreams, that he is a monster, digging up the dead with his hands, feeding -on their flesh, and waking those around him with his frightful cries. - -The superstition is that during this state of morbid dreaming the soul of -the sleeper quits the body to visit the cemeteries, and feast upon the -remains of the recently dead. - -In Dalmatia the belief is current that there are sorcerers whose delight -is to tear out the hearts of lovers, and to cook and eat them. Nodier -relates the story of a young man about to be married, who was the constant -victim of nightmare, during which he dreamed that he was surrounded by -these sorcerers, ready to pluck his heart from his breast, but who often -awakened just as they were about to proceed to extremities. In order to be -effectually relieved from their visitations, he was advised to avail -himself of the company of an old priest, who had never previously heard of -these horrible dreams, and who did not believe that God would give such -power to the enemies of mankind. After using various forms of exorcism, -the priest went peacefully to sleep in the same room with the patient whom -he was commissioned to defend against the sorcerers. Hardly, however, had -sleep descended upon his eyelids than he thought he saw the demons -hovering over the bed of his friend, alight, and, laughing horribly, -throw themselves on his prostrate body, and with their claws tear open his -breast, and, seizing his heart, devour it with frightful avidity. Unable -to move from his bed, or to utter a sound, he was forced to witness this -terrible scene. At last he awoke to see no one but his companion, pale and -haggard, staggering toward him, and finally falling dead at his feet. - -These two men, adds Nodier, had had similar attacks. What the one dreamed -he saw, the other dreamed he had experienced. - -As an instance of like dreams occurring to many persons at the same time, -the circumstances related by Laurent[106] are worthy of notice. - -"The first battalion of the regiment of Latour d'Auvergne, of which I was -Surgeon-major, while in garrison at Palmi, in Calabria, received orders to -march at once to Tropea in order to oppose the landing from a fleet which -threatened that part of the country. It was in the month of June, and the -troops had to march about forty miles. They started at midnight, and did -not arrive at their destination till seven o'clock in the evening, resting -but little on the way, and suffering much from the heat of the sun. When -they reached Tropea, they found their camp ready and their quarters -prepared, but as the battalion had come from the farthest point, and was -the last to arrive, they were assigned the worst barracks, and thus eight -hundred men were lodged in a place which, in ordinary times, would not -have sufficed for half their number. They were crowded together on straw -placed on the bare ground, and being without covering, were not able to -undress. The building in which they were placed was an old, abandoned -abbey, and the inhabitants had predicted that the battalion would not be -able to stay there all night in peace, as it was frequented by ghosts, -which had disturbed other regiments quartered there. We laughed at their -credulity; but what was our surprise to hear, about midnight, the most -frightful cries issuing from every corner of the abbey, and to see the -soldiers rushing terrified from the building. I questioned them in regard -to the cause of their alarm, and all replied that the devil lived in the -building; that they had seen him enter by an opening into their room, -under the figure of a very large dog, with long black hair, and, throwing -himself upon their chests for an instant, had disappeared through another -opening in the opposite side of the apartment. We laughed at their -consternation, and endeavored to prove to them that the phenomenon was due -to a very simple and natural cause, and was only the effect of their -imagination; but we failed to convince them, nor could we persuade them to -return to their barracks. They passed the night scattered along the -sea-shore, and in various parts of the town. In the morning I questioned -anew the non-commissioned officers and some of the oldest soldiers. They -assured me that they were not accessible to fear; that they did not -believe in dreams or ghosts, but that they were fully persuaded they had -not been deceived as to the reality of the events of the preceding night. -They said they had not fallen asleep when the dog appeared, that they had -obtained a good view of him, and that they were almost suffocated when he -leaped on their breasts. We remained all day at Tropea, and the town being -full of troops, we were forced to retain the same barracks, but we could -not make the soldiers sleep in them again, without our promise that we -would pass the night with them. I went there at half-past eleven with the -commanding officer; the other officers were, more for curiosity's sake -than anything else, distributed in the several rooms. We scarcely expected -to witness a repetition of the events of the preceding night, for the -soldiers had gone to sleep, reassured by the presence of their officers, -who remained awake. But about one o'clock, in all the rooms at the same -time, the cries of the previous night were repeated, and again the -soldiers rushed out to escape the suffocating embrace of the big black -dog. We had all remained awake, watching eagerly for what might happen, -but, as may be supposed, we had seen nothing. - -"The enemy's fleet having disappeared, we returned next day to Palmi. -Since that event we have marched through the Kingdom of Naples in all -directions and in all seasons, but the phenomena have never been -reproduced. We are of opinion that the forced march which the troops had -been obliged to make during a very hot day, by fatiguing the organs of -respiration, had weakened the men, and consequently disposed them to -experience these attacks of nightmare. The constrained position in which -they were obliged to lie, the fact of their being undressed, and the bad -air they were obliged to breathe, doubtless aided in the production." - -A gentleman was, not long since, under my professional charge who was very -subject to attacks of nightmare. Though remarkable for his personal -courage, he confessed that during his paroxysms he was the most arrant -coward in the world. Indeed, so powerful an impression had his frequent -frightful dreams made upon him, that he was afraid to go to sleep, and -would often pass the night engaged in some occupation calculated to keep -him awake. - -The dreams which he had were always of such a character as to inspire -terror, and generally related to demons and strange animals, which seated -themselves on his chest, and tried to tear open his throat. They came on a -few minutes after he fell asleep, and lasted sometimes for more than an -hour. During their continuance he remained perfectly still and quiet, -giving no evidence of the tumult within, beyond the appearance of a cold -sweat over the whole surface of the body. When he awoke, as he always did -when the climax was reached, he started from the bed with a bound, and -with all the evidences of intense fright. After that he was safe for the -remainder of the night. - -I am acquainted with another case in which there are no very obvious -physical symptoms. - -Ordinarily, however, the sufferer groans, and tosses about the bed; he -appears to be endeavoring to speak, and to escape from his imaginary -danger; his face, neck, and chest are flushed; a cold perspiration -appears, especially on his forehead, and he is sometimes seized with a -general trembling of the whole body. The respiration appears to be -particularly disturbed; he gasps for air, and occasionally the breathing -is stertorous. As to the pulse, strange as it may appear, there is rarely -any marked change from the healthy standard, beyond the slight -irregularity induced by the disorder of the respiration. - -Among the mental symptoms, in addition to the fear with which he is -filled, the sufferer is most sensibly impressed with a sense of his utter -helplessness. His will is actively engaged in endeavoring to bring his -muscles into action, but they cannot be made to obey its behests, and he -consequently feels himself powerless to escape from the enemies which -attack him. - -In regard to the kind of images which make their appearance, there is more -or less uniformity. Generally they consist of animals, such as hogs, dogs, -monkeys, or nondescripts created by the imagination of the dreamer. At -other times they are demons of various forms. A gentleman, whose case came -under my notice, was visited almost nightly by a huge black walrus, which -appeared to roll off of a large cake of ice, and, crawling up the bed, to -throw itself on his chest. Another was tormented by an animal, half lion -and half monkey, which seemed to fasten its claws in his throat while -seated on his breast. - -At other times there are no images, but only painful delusions, in which -the dreamer is placed in dangerous positions, or suffers some kind of -torturing operation. Thus a lady informs me that she is subject to -frequent attacks of nightmare, during which she imagines she is standing -on the top of a high mast, and in extreme fear of falling off. Again she -is dragged through a key-hole by some invisible power; and again has her -nose and mouth so tightly closed that she can get no breath of air. - -The _causes_ of nightmare may be divided into the _exciting_ and the -_immediate_. The _exciting causes_ are very numerous. Unusual fatigue, -either of mind or of body, recent emotional disturbance, such as that -produced by fright, anxiety, or anger, and intense mental excitement of -any kind may produce it. I have known a young lady to have a severe attack -the night after a school examination, in which she had been unduly tasked. -Another young lady is sure to be attacked after witnessing a tragedy -performed. A young man, who was under my care for a painful nervous -affection, always had a paroxysm of nightmare during the first sleep after -delivering an address, which he was obliged to do every month for a year -or more. - -Fullness of the stomach, or the eating of indigestible or highly -stimulating food late in the evening, will often cause nightmare. As -Motet[107] remarks: "One of the best-established causes is repletion of -the stomach, and slowness and difficulty of digestion. Let an individual, -habitually systematic, depart for one day from the accustomed regularity -of his meals, let him change the hour of his dinner, and go to bed before -the work of digestion is completed, and it is probable that his sleep will -be troubled, and that nightmare will be the consequence of his -indiscretion. The painful feeling will be induced by distention of the -stomach, by anxiety, and by the restraint given to the movements of the -diaphragm." - -Feculent food would appear to be especially powerful in causing nightmare, -and according to Motet, strong liquors and sparkling wines and coffee are -equally so. I have several times known it produced by the New England dish -of baked pork and beans, and by green Indian-corn eaten just before going -to bed. - -Various morbid affections, such as diseases of the heart, aneurism of the -large arteries, affections of the brain or spinal cord, and diseases of -the digestive or urinary apparatus are often exciting causes of nightmare. -It may originate from painful sensations in any part of the body. Some -women, about the time of the menstrual flow, are particularly liable to -paroxysms of this morbid dreaming. - -Whatever interferes with the respiration or the easy flow of blood to and -from the head may bring on an attack of nightmare. I have known it caused -by the collar of the night-gown being too tight, and by the pillow being -under the head and not under the shoulders, thus putting the head at such -an angle with the body as to constrict the blood-vessels of the neck, and -by the head falling over the side of the bed. I have not been able to -ascertain that sleeping upon the back or on the left side predisposes to -the affection, unless in those cases in which the former position causes -snoring from relaxation of the soft palate. - -The _immediate cause_ of nightmare is undoubtedly the circulation of blood -through the brain which has not been sufficiently aerated. The appearance -of the sufferer is sufficient to indicate this, as the condition of the -cerebral vessels and all the exciting causes act either by retarding the -flow of the venous blood from the brain, or by impeding the respiratory -movements. The effects of emotion, of mental fatigue, and of severe and -long-continued muscular exertion are such that the nervous influence to -the muscles of respiration is increased, or the muscles themselves are -debilitated through this general fatigue of the organism. Fullness of the -stomach acts mechanically, by interfering with the action of the -diaphragm, and constriction about the neck directly increases the flow of -blood through the brain. Certain diseases of the heart and lungs act upon -the function of respiration, and thus interfere with the due oxygenation -of the blood. - -The _treatment_ of morbid dreams presents no points of any difficulty. -When they are the result of impressions made during sleep upon the nerves, -and are the forerunners of disease, it is not very likely that physicians -will be consulted as to their cure. Undoubtedly, however, much can be done -to abate them when they belong to the category of prodromic dreams, as -well as when they are symptomatic of existing disease. Hygienic measures, -such as open-air exercise, attention to diet, and warm baths, and the use -of the oxide of zinc and bromide of potassium, will do much to lessen the -irritability of the nervous system, and to diminish any hyperaemic -condition of the brain. - -Nightmare often requires more active management, though even here we will -ordinarily find the measures above mentioned the most effectual that can -be taken for its treatment. Of course the exciting cause must be -ascertained if possible, and means taken to remove it. This is not always -an easy matter, and frequently cannot be accomplished without a -considerable alteration in the course of life followed by the patient, and -more or less sacrifice on his part. Among hygienic measures, I have -several times found relief follow a sojourn at the sea-shore, and ocean -bathing. Change of air is almost invariably beneficial, and moderate -physical exercise, just to the point of fatigue, can scarcely be dispensed -with. A gentleman, at this moment under my care, has been cured by a -course of gymnastic training, which he took at my instance. The food of -those subject to nightmare should always be plain, easily digestible, and -moderate in quantity. Alcoholic beverages should always be sparingly -taken, especially just before going to bed. Any article of food or drink -known to produce the paroxysm, should of course be omitted altogether. - -As to medicines, the whole round of so-called antispasmodics is usually -tried by routine physicians. I have never seen them do any good. Iron and -bitter tonics are indicated in cases of anaemia or exhaustion. As the -disease is sometimes induced in children by the presence of worms in the -alimentary canal, diligent inquiry should be made relative to symptoms -indicating irritation from these parasites, and if they are found to -exist, anthelmintics should be administered. - -A case of intermittent nightmare, occurring every alternate night, in a -young lady, was recently under my care. No exciting causes could be -discovered, except the probable one of malaria. The affection yielded at -once to the sulphate of quinia. - -Ferrez[108] has published the details of a case of intermittent nightmare -occurring in the person of a Spanish officer, who was attacked after -passing forty-two nights at the bedside of a sick daughter. Every night, -at the same hour, he was awakened by frightful dreams, which, irritating -his brain, produced cramps, convulsive movements, an afflux of blood to -the cerebral tissues, a sadness which he could not conquer, and a -continual and powerful feeling of approaching death. - -The patient, though of strong constitution, became enfeebled and -emaciated. His countenance was pale, the pupils contracted, and his whole -appearance showing the exhaustion consequent upon the battle which he was -obliged continually to fight with his disease. He composed at this time -some verses, describing in graphic terms the deplorable condition of his -mind and body. - -Gymnastics, temperance in eating and drinking, and the study of poetry, -failed to give him relief. Finally he consulted Dr. Ferrez, who advised -him to reveal his state to his family, who hitherto had been kept in -ignorance of his malady, to continue his gymnastics moderately, not to eat -in the evening, to drink only cold water, to use friction over the whole -surface of the body, to apply mustard plasters to the extremities, to -sleep with his head elevated and uncovered, to bathe his head frequently -during the night with cold water, to give up the study of poetry, and to -devote himself to mathematics and political economy. These measures were -rigorously carried out; but his daughter, who had been the involuntary -cause of his disease, prescribed a better remedy than all the others. She -had him waked at midnight, before the occurrence of his paroxysm, and thus -broke up the habit. - -Perhaps no one medicine is so uniformly successful in the ordinary forms -of nightmare as the bromide of potassium, administered in doses of from -twenty to forty grains, three times a day. I have seen a number of cases -which had resisted all hygienic measures, and the simple removal of the -apparent cause, yield to a few doses of this remedy. - -When the affection has lasted a long time, it is more difficult to break -up the acquired habit. In these cases, the plan so successfully employed -by the daughter of the Spanish officer will almost invariably succeed. - -Finally, persons subject to nightmare should so train the mind as to -employ the intellectual faculties systematically, by engaging in some -study requiring their full exercise. The action of the emotions should be -as much as possible controlled, and the reading of sensational stories, or -hearing sensational plays, should be discouraged. By severe mental -training, individuals can do much to regulate the character of their -dreams. It is a well-recognized fact, that intense thought upon subjects -which require the highest degree of intellectual action is not favorable -to the production of dreams of any kind. - - - - -CHAPTER VII. - -SOMNAMBULISM. - - -The phenomena exhibited by a person in the condition of somnambulism are -so wonderful, that they have from the earliest times excited the -superstitious feelings of the ignorant, and claimed the most serious -attention of the learned. To see an individual apparently asleep to the -greater part of surrounding objects, yet so keenly awake to others as to -be able to perform the most intricate actions without the aid of the -senses, is so greatly at variance with the common experience of mankind, -as to call up feelings of astonishment, and perhaps of awe, in the minds -both of the vulgar and those accustomed to scientific investigation. In -those times, when the marvelous exercised so powerful an influence over -mankind, and when all phenomena out of the ordinary course of everyday -life were regarded as supernatural, it was the prevailing belief that the -somnambulist was possessed. Modern science has at last dispelled this -idea, and though it has not yet been able to furnish a rational theory of -somnambulism which will account for all the manifestations of the -affection, it has done much toward elucidating the functions of different -parts of the nervous system, and thus to prepare our minds for a full -understanding of the subject. - -Somnambulism has been defined[109] as "a condition in which certain senses -and faculties are suppressed or rendered thoroughly impassive, while -others prevail in most unwonted exaltation; in which an individual, though -asleep, feels and acts most energetically, holding an anomalous species of -communication with the external world, awake to objects of attention, and -most profoundly torpid to things at the time indifferent; a condition -respecting which most commonly the patient on awaking retains no -recollection; but on any relapse into which, a train of thought and -feeling related to and associated with the antecedent paroxysm will very -often be developed." - -This definition, though unnecessarily long and by no means perfect, will -nevertheless suffice for a general description of the chief phenomena of -the affection. It accords with the generally received theory. My own views -of the nature of somnambulism will appear in the course of the following -remarks. - -In the introduction to his classical work on the subject under -consideration, Bertrand[110] classifies the different kinds of -somnambulism according to their causes. He recognizes-- - -1. A particular nervous temperament which predisposes individuals -otherwise in good health to paroxysms of somnambulism during their -ordinary sleep. - -2. It is sometimes produced in the course of certain diseases, of which it -may be considered a symptom or a crisis. - -3. It is often seen in the course of the proceeding necessary to bring on -the condition known as animal magnetism. - -4. It may result as the consequence of a high degree of mental exaltation. -It is in this case contagious by imitation to such persons as are -submitted to the same influence. - -From these four divisions of causes, Bertrand makes four kinds of -somnambulism--the essential, the symptomatic, the artificial, and the -ecstatic. As he wrote nearly twenty years before the publication of Mr. -Braid's remarkable researches, he was of course unacquainted with that -form of artificial somnambulism now known as hypnotism, and which may -properly be included in his third class. I shall simplify his arrangement -by dividing the several kinds of somnambulism into two classes--the -natural and artificial. - -_Natural somnambulism_ may occur in persons who exhibit no marked -deviations from the standard of health, and in whom there is no very -evident nervous excitability. It is usually, though not always, -manifested during ordinary sleep, and it is common for authors to speak of -it as being necessarily connected with a dream. Thus, Macario[111] says it -is a sleep in which the nervo-motor system and all the other organs are -put in action under the influence of a dream. A few cases cited from other -authors, and from my own experience, will tend to the more complete -elucidation of the symptoms of this curious affection. Bertrand[112] -quotes the following instance from the _Encyclopaedia_: - -"The Archbishop of Bordeaux has informed me that when at the seminary he -was acquainted with a young ecclesiastic who was a somnambulist. Curious -to ascertain the nature of the malady, he went every night to the chamber -in which the young man slept. He saw, among other things, that the -ecclesiastic got up, took paper, and composed and wrote sermons. When he -had finished a page, he read it aloud--if one can apply the term to an -action done without the aid of sight. When a word displeased him, he wrote -the necessary corrections with great exactness. I have seen the beginning -of one of his sermons which he wrote in the somnambulistic state, and -thought it well composed and correctly written; but there was an -alteration which surprised me. Having used the expression _ce divin -enfant_, he thought as he read it over that he would change the word -_divin_ for _adorable_. He therefore effaced the first word, and wrote the -second above it. He then perceived that the word _ce_ properly placed -before _divin_ would not do before adorable; he therefore added a _t_ to -the preceding letters, so that the expression read _cet adorable enfant_. -The same person, an eye-witness of these facts, in order to ascertain -whether or not the somnambulist made use of his eyes, put a card under his -chin in such a manner as to prevent his seeing the paper on the table; but -he still continued to write. Wishing still to discover whether or not he -distinguished different objects placed before him, the Archbishop took -away the paper on which he wrote and substituted several other kinds at -different times; but he always perceived the change because the pieces -were of various sizes. When a piece exactly like his own was placed before -him he used it, and wrote his corrections on the places corresponding to -those on his own paper. It was by this means that portions of his -nocturnal compositions were obtained. These the Archbishop has had the -goodness to send to me. The most astonishing among them was a piece of -music written with great exactitude. A cane had served him for a -ruler--the clef, the flats, and the sharps were all in their right places. -All the notes were first made as circles, and then those which required it -were blackened with ink. The words were all written below. Once they were -in such large characters that they did not come directly under their -proper notes. He soon, however, perceived his error, and corrected it by -effacing what he had written and writing it over again. - -"One night, in the middle of winter, he imagined himself to be walking on -the bank of a river and seeing a child fall in. The severity of the -weather did not prevent him from determining to save it. He threw himself -on his bed in the posture of a man swimming, went through all the motions, -and, after becoming well fatigued with the severity of this exercise, he -felt a bundle of the bedclothes, which he took to be the drowning child. -He seized it with one hand, while he continued to swim with the other, in -order to regain the bank of the imaginary river. Finally, he placed the -bundle in a place which he evidently determined to be dry land, and rose, -shivering, with his teeth chattering as though he had emerged from icy -water. He remarked to the by-standers that he was frozen, that he would -die of cold, and that his blood was like ice. He then asked for a glass of -brandy in order to restore his vitality; but there being none at hand, a -glass of water was given him instead. He, however, detected the difference -and asked peremptorily for brandy--calling attention to the great danger -he incurred from the cold. Some brandy was finally obtained. He drank it -with much satisfaction, and remarked that he felt much better. -Nevertheless, he did not awake, and, returning to bed, slept tranquilly -the rest of the night." - -Gassendi[113] had in his service a young man who every night arose in his -sleep, descended into the cellar and drew some wine from a cask. -Frequently he went out into the streets in the middle of the night, -sometimes even he went into the country and walked on stilts, in order to -cross a rapid stream which ran around the city. If he happened to awake -from his sleep after having crossed this torrent, he was afraid to recross -it so as to return home. Gassendi relates that when this man waked in the -course of his perambulations he suddenly found himself in darkness, but as -he had the faculty of remembering all that had taken place during his -dream, and of recognizing the place where he found himself, he was able to -grope his way to his bed. The darkness, therefore, which was an obstacle -to the exercise of his sight when he was awake, was no impediment when he -was in the state of somnambulism. - -Dr. Prichard[114] cites from Muratori[115] the cases of Forari and -Negretti, which are curious instances of the affection in question. - -"Signor Augustin Forari was an Italian nobleman, dark, thin, melancholic, -and cold-blooded, addicted to the study of the abstract sciences. His -attacks occurred at the waning of the moon, and were stronger in the -autumn and winter than in the summer. An eye-witness, Vigneul Marville, -gave the following description of them: - -"One evening, toward the end of October, we played at various games after -dinner; Signor Augustin took a part in them along with the rest of the -company, and afterward retired to repose. At eleven o'clock, his servant -told us that his master would walk that night, and that we might come and -watch him. I examined him after some time with a candle in my hand. He was -lying upon his back and sleeping with open, staring, unmoved eyes. We were -told that this was a sure sign that he would walk in his sleep. I felt his -hands and found them extremely cold, and his pulse beat so slowly that his -blood appeared not to circulate. We played a tric-trac till the spectacle -began. It was about midnight, when Signor Augustin drew aside the -bed-curtains with violence, arose and put on his clothes. I went up to him -and held the light under his eyes. He took no notice of it, although his -eyes were open and staring. Before he put on his hat, he fastened on his -sword-belt, which hung on the bedpost; his sword had been removed. Signor -Augustin then went in and out of several rooms, approached the fire, -warmed himself in an arm-chair, and went thence into a closet where he had -his wardrobe. He sought something in it, put all the things into disorder, -and, having set them right again, locked the door and put the key into his -pocket. He went to the door of the chamber, opened it and stepped out on -the staircase. When he came below, one of us made a noise by accident; he -appeared frightened, and hastened his steps. His servant desired us to -move softly and not to speak, or he would become out of his mind; and -sometimes he ran as if he were pursued, if the least noise was made by -those standing around him. He then went into a large court and to the -stable, stroked his horse, bridled it, and looked for the saddle to put on -it. As he did not find it in the accustomed place, he appeared confused. -He then mounted his horse and galloped to the house-door. He found this -shut, dismounted and knocked with a stone, which he picked up, several -times at the door. After many unsuccessful efforts, he remounted and led -his horse to the watering-place--which was at the other end of the -court--let him drink, tied him to a post and went quietly to the house. -Upon hearing a noise, which the servants made in the kitchen, he listened -attentively, went to the door and held his ear to the keyhole. After some -time he went to the other side, and into a parlor in which was a -billiard-table. He walked around it several times and acted the motions of -a player. He then went to a harpsichord, on which he was accustomed to -practice, and played a few irregular airs. After having moved about for -two hours, he went to his room and threw himself upon his bed, clothed as -he was, and the next morning we found him in the same state; for as often -as his attack came on he slept afterward from eight to ten hours. The -servants declared that they could only put an end to his paroxysms either -by tickling him on the soles of his feet, or by blowing a trumpet in his -ears." - -The history of Negretti was published separately by two physicians, -Righellini and Pigatti, who were both eye-witnesses of the curious facts -which they relate. - -"Negretti was about twenty-four years old, was a sleep-walker from his -eleventh year; but his attacks only occurred in the month of March, -lasting at farthest till the month of April. He was a servant of the -Marquis Luigi Sale. On the evening of the 16th of March, 1740, after going -to sleep on a bench in the kitchen, he began first to talk, then walked -about, went to the dining-room and spread a table for dinner, placed -himself behind a chair with a plate in his hand as if waiting on his -master. After waiting until he thought his master had dined, he removed -the table, put away all the materials in a basket, which he locked in a -cupboard. He afterward warmed a bed, locked up the house, and prepared for -his nightly rest. Being then awakened, and asked if he remembered what he -had been doing, he answered no. This, however, was not always; he often -recollected what he had been doing. Pigatti says he would awake when water -was thrown into his face, or when his eyes were forcibly opened. According -to Maffei, he then remained sometimes faint and stupid. Righellini -assured Muratori that his eyes were firmly closed during the paroxysm, and -that when a candle was put near to them, he took no notice of it. -Sometimes he struck himself against the wall and even hurt himself -severely. Hence it would seem that he was directed in his movements by -habit, and had no actual perception of external objects. This is confirmed -by the assurance that if anybody pushed him, he got out of the way and -moved his arms rapidly about on every side; and that when he was in a -place of which he had no distinct knowledge, he felt with his hands all -the objects about him, and displayed much inaccuracy in his proceedings; -but in places to which he was accustomed he was under no confusion, but -went through his business very cleverly. Pigatti shut a door through which -he had just passed; he struck himself against it in returning. The writer -last mentioned was confident that Negretti could not see. He sometimes -carried about with him a candle, as if to give him light in his -employment; but on a bottle being substituted, took it and carried it, -fancying that it was a candle. He once said during his sleep that he must -go and hold a light to his master in his coach. Righellini followed him -closely, and remarked that he stood still at the corners of the streets -with his torch in his hand not lighted, and waited awhile in order that -the coach which he supposed to be following might pass through the place -where light was required. On the eighteenth of March he went through -nearly the same process as before in laying a table, etc., and then went -to the kitchen and sat down to supper. Signor Righellini observed him, in -company with many other cavalieri very curious to see him eat. At once he -said, as recollecting himself, 'How can I so forget? To-day is Friday and -I must not dine.' He then locked up everything and went to bed. On another -occasion he ate several cakes of bread and some salad which he had just -before demanded of the cook. He then went with a lighted candle into the -cellar and drew wine, which he drank. All these acts he performed as -usual, and carried a tray upon which were wineglasses and knives, turning -obliquely when passing through a narrow doorway, but avoiding any -accident." - -Macario[116] cites from I. Franck the case of a young peasant, aged about -sixteen, and endowed with a degree of intelligence above his age and -condition, who was rendered somnambulic by the grief caused by the sudden -death of his father. A few weeks after this event, he dreamed that he saw -two unknown and frightful-looking men who advanced slowly toward his bed, -and in menacing language ordered him to rise immediately and accompany -them, threatening that if he refused they would return the following night -and take him by force. This dream had so strong an effect upon him that he -became melancholic. Two days afterward, while he was sleeping quietly, he -dreamed that his father's spirit came to him, accompanied by the two men -who had previously visited him, and ordered them to seize his son, -notwithstanding his resistance, and to carry him off. - -The young man dreamed that he was transported through a delightful country -of vast extent; he heard the harmonious sounds from flutes and other -musical instruments; he saw young people dancing on the charming plains, -and he ate to satiety of delicious viands. Immediately the scene changed; -his father's spirit disappeared, and his ferocious companions carried him -high up into the air and then suddenly let him fall into a barrel. The -servants returning with the cows, found the young man in the stable shut -up in an empty barrel, scantily covered, and almost dead with cold and -fright. Restored by frictions and warmth, he had no recollection of -anything connected with his situation beside the dream above recorded. At -the end of a week, he again rose from bed in his sleep, but finding the -door locked, he returned and remained quiet. In a short time the disease -ceased entirely. - -The same author also quotes from Franck the case of a Jewish tailor, who, -during the attacks of somnambulism to which he was subject, recited in a -low voice his customary prayers in Hebrew. When he came to certain parts -he raised his voice, called out aloud, and imitated the gestures of the -rabbis in the synagogues. While thus engaged his eyes were wide open, and -the pupils insensible to the stimulus of light. Then his face became pale, -he presented the appearance of weeping, his whole body was covered with a -cold, profuse sweat, and his pulse rose to 130. This crisis was followed -by a tranquil prayer, to which sooner or later another access of fury -succeeded; and this series continued for an hour or two, or till his -prayers had been repeated for the prescribed period. - -When strongly shaken he awoke with a startled manner, but if left to -himself fell asleep again, and resumed his prayers at the place where he -had been interrupted. When awake he declared that he had no recollection -of what had happened during his sleep. The paroxysms appeared every day -except Tuesday. The patient had a brother who was also a somnambulist. - -These cases will give an idea of somnambulism as it has been witnessed by -other observers, or as its phenomena have impressed them. The following -instances of the disease have come under my own notice. - -A young lady, of great personal attractions, had the misfortune to lose -her mother by death from cholera. Several other members of the family -suffered from the disease, she alone escaping, though almost worn out with -fatigue, excitement, and grief. A year after these events, her father -removed from the West to New York, bringing her with him and putting her -at the head of his household. She had not been long in New York, before -she became affected with symptoms resembling those met with in chorea. The -muscles of the face were in almost constant action, and though she had not -altogether lost the power to control them by her will, it was difficult at -times for her to do so. She soon began to talk in her sleep, and finally -was found one night by her father, as he came home, endeavoring to open -the street-door. She was then, as he said, sound asleep, and had to be -violently shaken to be aroused. After this she made the attempt every -night to get out of bed, but was generally prevented by a nurse who slept -in the same room with her, and who was awakened by the noise she made in -the room. - -Her father now consulted me in regard to the case, and invited me to the -house in order to witness the somnambulic acts for myself. One night, -therefore, I went to his residence and waited for the expected -manifestations. The nurse had received orders not to interfere with her -charge on this occasion, unless it was evident that injury would result, -and to notify us of the beginning of the performance. - -About twelve o'clock she came down stairs and informed us that the young -lady had risen from her bed and was about to dress herself. I went up -stairs, accompanied by her father, and met her in the upper hall partly -dressed. She was walking very slowly and deliberately, her head elevated, -her eyes open, her lips unclosed, and her hands hanging loosely by her -side. We stood aside to let her pass. Without noticing us, she descended -the stairs to the parlor, we following her. Taking a match, which she had -brought with her from her own room, she rubbed it several times on the -under side of the marble mantle-piece until it caught fire, and then, -turning on the gas, lit it. She next threw herself into an arm-chair and -looked fixedly toward a portrait of her mother which hung over the -mantle-piece. While she was in this position, I carefully examined her -countenance, and performed several experiments with the view of -ascertaining the condition of the senses as to activity. - -She was very pale, more so than was natural to her; her eyes were wide -open and did not wink when the hand was brought suddenly in close -proximity to them; the muscles of the face, which when she was awake were -almost constantly in action, were now perfectly still; her pulse was -regular in rhythm and force, and beat 82 per minute, and the respiration -was uniform and slow. - -I held a large book between her eyes and the picture she was apparently -looking at, so that she could not possibly see it. She nevertheless -continued to gaze in the same direction as if no obstacle were interposed. -I then made several motions as if about to strike her in the face. She -made no attempt to ward off the blows, nor did she give the slightest sign -that she saw my actions. I touched the cornea of each eye with a -lead-pencil I had in my hand, but even this did not make her close her -eyelids. I was entirely satisfied that she did not see--at least with her -eyes. - -I held a lighted sulphur-match under her nose, so that she could not avoid -inhaling the sulphurous acid gas which escaped. She gave no evidence of -feeling any irritation. Cologne and other perfumes, and smelling-salts -likewise failed to make any obvious impression on her olfactory nerves. - -Through her partially opened mouth, I introduced a piece of bread soaked -in lemon-juice. She evidently failed to perceive the sour taste. Another -piece of bread, saturated with a solution of quinine, was equally -ineffectual. The two pieces of bread remained in her mouth for a full -minute, and were then chewed and swallowed. - -She now arose from her chair and began to pace the room in an agitated -manner; she wrung her hands, sobbed, and wept violently. While she was -acting in this way, I struck two books together several times so as to -make loud noises close to her ears. This failed to interrupt her. - -I then took her by the hand and led her back to the chair in which she had -previously been sitting. She made no resistance, but sat down quietly and -soon became perfectly calm. - -Scratching the back of her hand with a pin, pulling her hair, and pinching -her face, appeared to excite no sensation. - -I then took off her slippers, and tickled the soles of her feet. She at -once drew them away, but no laughter was produced. As often as this -experiment was repeated, the feet were drawn up. The spinal cord was -therefore awake. - -She had now been down stairs about twenty minutes. Desiring to awake her, -I shook her by the shoulders quite violently for several seconds, without -success. I then took her head between my hands and shook it. This proved -effectual in a little while. She awoke suddenly, looked around her for an -instant, as if endeavoring to comprehend her situation, and then burst -into a fit of hysterical sobbing. When she recovered her equanimity, she -had no recollection of anything that had passed, or of having had a dream -of any kind. - -A gentleman of very nervous temperament informs me that upon one occasion -he dreamed that his place of business was on fire. He got up in his sleep, -dressed himself, and walked a distance of over a mile to his store. He was -aroused by the private watchman, who stopped him while in the act of -looking through the grating of the door, under the impression at first -that he had caught a burglar. - -A young lady who some time since was under my care for intense periodical -headaches, informed me that, just previous to each attack, she walked in -her sleep, but had never any recollection of what she did while in the -somnambulic state. Her mother stated that when her daughter was in this -condition, she did not use her eyes, although they were wide open, nor -did she appear to hear loud noises made close to her ears. - -In relation to the activity of the senses during somnambulism, there is -great diversity of opinion among those who have studied the affection. -This is doubtless due to the fact that somnambulists differ among -themselves as regards the use they make of their senses--some availing -themselves of the aid they can derive from these sources, while others do -not appear to employ them at all. - -Thus it is stated that Negretti kept his eyes closed, and yet when a box -of snuff was handed to him, he took a pinch without hesitation; and the -young ecclesiastic whose case I have already quoted, performed even more -complex acts than this. - -Castelli, a young somnambulist and a student of pharmacy, performed many -astonishing acts during his paroxysms. One night he was found in the -somnambulic condition, translating a passage from the Italian into French, -and searching out the words in a dictionary. Prichard[117] assumes from -this fact that he must have seen the words. He states further, that -somnambulists have been known to write and even to correct their -compositions, and to do other acts which could not possibly have been -performed without sight. While it is certainly true that somnambulists -have done all these things, it is equally certain that they have often -performed them without the aid of their eyes. In the case of Castelli, a -candle was on the table, which some one who saw him extinguished. He -immediately arose, and lighted it, although there was no occasion for his -doing so, as the room was well lit with other candles.[118] These he had -not observed, but was only cognizant of the one which he probably did not -see, but which was in relation with him through some more subtle channel. - -Many somnambulists are known to have acted as though they saw in rooms -which were perfectly dark. A gentleman informs me that his wife frequently -walks in her sleep, and performs many somnambulic acts in entire darkness. -On one occasion she went into a dark closet, and, opening a trunk, began -to arrange the contents. It contained clothing of various kinds, which had -been put into it the day before without being sorted. She classified all -the articles, such as stockings, handkerchiefs, shirts, etc., without -making a single mistake--and without the possibility of being assisted by -light sufficient for ordinary eyesight. - -Bertrand[119] refers to the case of a young lady who was accustomed to -rise from her bed in a state of somnambulism and to write in complete -darkness. A remarkable feature of this instance was, that if the least -light, even that of the moon, entered the room, she was unable to write. -She could only do so in the most perfect obscurity. - -In the case of the young lady, the particulars of which, with my -experiments, I have related, the sense of sight was certainly not -employed, nor were the other senses awake to ordinary excitations. - -On the other hand, it is evident that some somnambulists make use of their -eyes and their other organs of sense in the ordinary way, when the -excitations made upon them are in relation with the train of thought or -ecstatic condition which prevails. - -Macario,[120] in reference to this point, says: - -"Somnambulists are insensible to external impressions, except those which -are in relation with their ideas, their thoughts, and their feelings. It -is thus that persons, the subjects of somnambulism, will pass before -objects or individuals without seeing them, although they may have their -eyes open. This phenomenon occurs often to individuals who are fully -awake, although in a less degree. Thus when we are strongly preoccupied -with any subject, the objects which surround us make no impression on our -senses or our mind. Archimedes while meditating on a discovery, was an -entire stranger to all that was going on around him. A part only of his -brain was awake and active. While thus engaged, Syracuse was taken by the -enemy, and he was not diverted from his thoughts either by the chant of -victory by the conqueror, or by the cries and groans of the wounded and -the dying." - -As regards the sense of hearing, it is doubtless true that somnambulists -rarely exercise it. There have been cases in which replies have been made -to questions; but such answers have been given automatically, and not as -if the mind took cognizance of the subject. A person intently engaged in -reading, will often answer questions without suffering his train of -thought to be interrupted. When he has ceased his study, he is surprised -when told that he has been conversing. - -The sense of taste appears to be very inactive in general, though in a few -cases it has been manifested. The same is true in even a greater degree -with the sense of smell. - -The sense of touch is very differently affected, for so far from being -diminished in its action, it is invariably unduly exalted. Though the eyes -do not see, the ears hear, the tongue taste, or the nose smell, the -somnambulist has one sense which is fully awake, and by which he is -enabled to guide himself through the most devious passages in dangerous -paths. - -In this fact it appears to me we have a strong argument in favor of the -theory of somnambulism which I have already referred to, and which appears -to me to be supported by much additional evidence. I propose this view not -without hesitation; but much study of the phenomena of somnambulism, and -of analogous states of the nervous system, has certainly tended to -convince me of its general correctness, and I am not without the hope that -other students of neurology will find it reconcilable with their -observations and experiments. - -In my opinion, somnambulism is a condition of the organism in which -through profound sleep the action of the encephalic ganglia is so -materially lessened that the spinal cord becomes able to control and -direct the body in its movements. - -That the spinal cord even in the waking state constantly exercises this -power, is a matter of common observation. I have already alluded to some -of the facts which establish this proposition; but, for the purpose of -giving as complete and connected a view as possible of all the points -which bear upon the theory of somnambulism above enunciated, I shall not -hesitate to recall them to the recollection of the reader, and to bring -forward other circumstances which appear to be in relation with the -question. - -If an individual engaged in reading a book allows his mind to be diverted -to some other subject than that of which he is reading, he continues to -see the words, which make no impression upon his brain, and he turns over -the leaf whenever he reaches the bottom of a page with as much regularity -as though he comprehended every word he has read. He suddenly, perhaps, -brings back his mind to the subject of his book, and then he finds that -he has perused several pages without having received the slightest idea of -their contents. - -Again: when, for instance, we are walking in the street and thinking of -some engrossing circumstance, we turn the right corners and find ourselves -where we intended to go, without being able to recall any events connected -with the act of getting there. - -In such instances as these--and many others might be adduced--the brain -has been occupied with a train of thought so deeply that it has taken no -cognizance or superintendence of the actions of the body. The spinal cord -has received the several sensorial impressions, and has furnished the -nervous force necessary to the performance of the various physical acts -concerned in turning over the leaves, avoiding obstacles, taking the right -route, and stopping in front of the right door. - -All cases of what are called "absence of mind" belong to the same -category. Here the brain is completely preoccupied with a subject of -absorbing interest, and does not take cognizance of the events which are -transpiring around. An individual, for instance, is engaged in solving an -abstruse mathematical problem. The whole power of the brain is taken up in -this labor, and is not diverted by circumstances of minor importance. -Whatever actions these circumstances may require, are performed through -the force originating in the spinal cord. - -The phenomena of reverie are similar in some respects to those of -somnambulism. In this condition the mind pursues a train of reasoning -often of the most fanciful character, but yet so abstract and intense, -that though actions may be performed by the body, they have no relation -with the current of thought, but are essentially automatic, and made in -obedience to sensorial impressions which are not perceived by the brain. -Thus a person in a state of reverie will answer questions, obey commands -involving a good deal of muscular action, and perform other complex acts, -without disturbing the connection of his ideas. When the state of mental -occupation has disappeared, there is no recollection of the acts which may -have been performed. Memory resides in the brain and can only take -cognizance of those things which make an impression on the mind, or of -those ideas which originate in the encephalon. - -In the case of a person performing on a piano, and at the same time -carrying on a conversation, we have a most striking illustration of the -diverse though harmonious action of the brain and spinal cord. Here the -mind is engaged with ideas, and the spinal cord directs the manipulations -necessary to the proper rendering of the musical composition. A person who -is not proficient in the use of this instrument, cannot at the same time -play and converse with ease, because the spinal cord has not yet acquired -a sufficient degree of automatism, and the mind cannot be divided in its -action. - -Darwin gives a very striking example of the independent action of the -brain and spinal cord. A young lady was playing on the piano a very -difficult musical composition, which she performed with great skill and -care, though she was observed to be agitated and preoccupied. When she had -finished, she burst into tears. She had been intently watching the -death-struggles of a favorite bird. Though her brain was thus absorbed, -the spinal cord had not been diverted from the office of carrying on the -muscular and automatic actions required by her musical performance. - -The brain cannot entertain two ideas or initiate two acts at the same -time. A person cannot, for example, think of a lamp and a book -simultaneously; the thought of the one and the thought of the other will -be found to alternate by any one who feels inclined to make the -experiment, and not to exist at the same time. Neither can the brain think -and simultaneously will. Whatever volitional acts it performs, are -distinct from thought, and clearly separated from it by the element of -time. - -Now in all sleep there is more or less somnambulism, because the brain, -according as the sleep is more or less profound, is more or less removed -from the sphere of action. If this quiescent state of the brain is -accompanied, as it frequently is in nervous and excitable persons, by an -exalted condition of the spinal cord, we have the higher order of -somnambulic phenomena produced, such as walking and the performance of -complex and apparently systematic movements; if the sleep of the brain be -somewhat less profound, and the spinal cord less excitable, the -somnambulic manifestations do not extend beyond sleep-talking; a still -less degree of cerebral inaction and spinal irritability produces simply a -restless sleep and a little muttering; and when the sleep is perfectly -natural, and the nervous system of the individual well balanced, the -movements do not extend beyond changing the position of the head and limbs -and turning over in bed. - -As regards the power of the spinal cord to supply the nervous force -requisite for the performance of such actions as those specified, I do not -think there can be any question. Much observation and many experiments -have convinced me that the importance of the spinal cord as a center of -intellection and volition has been unwarrantably ignored. It is of course -not a matter for doubt that the faculty of consciousness is latent in the -spinal cord so long as the brain is in a state of activity, and that the -faculty of memory does not reside in it at all. When the brain acts, it -ordinarily assumes the control of the cord; but there are times, -especially during the course of certain diseases, when the latter obtains -the mastery over the superior organ and dominates with terrible power. - -The actions initiated by the spinal cord are more or less automatic in -their character--though not altogether so. The motions of a frog deprived -of its brain, show a certain amount of intellection and volition. That -they are not more extensive is probably due to the fact that all the -organs of the senses, except that of touch, have been removed with the -brain. In persons engaged in intense thought and performing actions not in -accordance therewith, the impressions made upon the organs of the senses -are not appreciated by the brain, but pass through its substance to the -spinal cord with which they are in connection by continuity of structure, -and which initiates the subsequent actions. - -In the somnambulic individual the brain is still more incapable of -receiving sensorial impressions. Whatever sense is therefore exercised -during the condition of somnambulism, owes its activity to the spinal -cord; but in most cases of the state in question, the brain is so -profoundly asleep that it does not even transmit impressions to the cord, -and hence there are no sensations at all, except that of touch, unless the -irritations capable of exciting them are extraordinarily great. - -In artificial somnambulism--the hypnotism of Braid--the spinal cord -acquires a very high degree of susceptibility to sensorial impressions, -and the brain is even more incapable than in natural somnambulism of -asserting its superiority. But the consideration of this interesting -branch of the subject does not enter into the plan of the present work. - -The _causes_ of somnambulism are generally to be found inherent in the -organism of the individual, though they may be excited to activity by -many circumstances which are capable of exhausting the nervous system or -producing emotional disturbance. Young persons are more subject than those -of maturer age, and there are few children who do not exhibit at some time -or other manifestations of the condition in question, such as muttering -and talking in their sleep, laughing, crying, or getting out of bed. -Persons of the nervous temperament are those most liable to be affected. -In four cases of chorea which have come under my care, the subjects were -sleep-walkers in their youth, and the young lady whose case I have related -was choreic at the time. - -In regard to the _treatment_ there is not much to be said. In the great -majority of cases the affection yields readily to appropriate measures; -the most efficacious of which consists in means adapted to break up the -habit. This may be done by waking the patient before the expected -paroxysm, or by placing a tub of cold water so that the feet will be put -into it on the attempt to leave the bed. Full exercise in the open air, -the avoidance of luxurious habits, and sleeping with the head well raised, -are always beneficial. - -Of medicines, I have no experience except with the bromide of potassium, -and those calculated to improve the tone of the nervous system. The former -I have used in two cases with entire success. One of them was that of the -young lady, the details of whose case I have related; the other that of a -gentleman, forty years of age, who became somnambulic from mental -excitement, due to the extensive business operations in which he was -engaged. Large doses of this remedy--forty to sixty grains taken at -bedtime, and smaller doses, ten to thirty grains, taken twice through the -day--broke up the habit entirely in a few weeks. Among the other remedies, -I have employed phosphorus, strychnia, and iron with manifest advantage. -Cold baths are generally useful. I am acquainted with a young lady who -cured herself by taking a cold bath every night just before going to bed. -The so-called antispasmodics can scarcely be useful. - -Much may be done also by suitable mental training. The reading of exciting -fictions, and the witnessing of sensational theatrical exhibitions, are -always prejudicial to persons subject to attacks of somnambulism. - - - - -CHAPTER VIII. - -THE PATHOLOGY OF WAKEFULNESS. - - -As nations advance in civilization and refinement, affections of the -nervous system become more frequent, because progress in these directions -is necessarily accompanied by an increase in the wear and tear of those -organs through which perceptions are received and emotions excited; and, -in addition, the mode of life, as regards food, clothing, occupation, and -habits, is being constantly removed farther from that standard which a -regard for hygienic considerations would establish as most advantageous. -If, as we have every reason to believe, each thought involves the -destruction of a certain amount of nervous tissue, we can very well -understand why, as we go forward in enlightenment and in all the elements -of material and intellectual progress, we are at the same time, unless we -also advance in the knowledge of the laws of our being, hurrying ourselves -with rapid strides to a state of existence in which there is neither waste -nor repair. - -I am far, however, from desiring to be understood as intimating that a -high state of civilization is antagonistic to long life or health. What is -lost in these directions as regards the nervous system is more than made -up by the increased provision afforded for comfort in other ways. But -while we have improved the hygienic condition of our cities and dwellings; -while we as a rule clothe our bodies according to the principles of -sanitary science and common sense; and while cleanliness of person has -become the rule, and filthiness the exception, we have made little or no -progress in the hygienic management of those organs which place us in -relation with the world, and a healthy condition of which is so essential -to our happiness. - -Among the many derangements in the normal operation of the nervous system, -induced by irregular or excessive cerebral action, those which relate to -the function of sleep are certainly not the least in importance, whether -regard be had to the actual comfort of the individual or to the serious -consequences to which they may give rise. To the consideration of some of -these morbid conditions I propose to devote the remainder of the present -volume, and first to inquire into the most important of them, wakefulness -or insomnia. - -As a symptom of various diseases which affect the human organism, -wakefulness is sufficiently well recognized by systematic writers on the -practice of medicine, though, even here, it is very certain that its -pathology has seldom been clearly made out. As a functional disorder of -the brain, arising from inordinate mental activity, it has received -scarcely any notice. This neglect has, doubtless, been in a great measure -due to the fact that it is only within late years that the condition in -question has become so common as to attract much attention. At present -there are, probably, but few physicians engaged in extensive practice in -any of our large cities who do not in the course of the year meet with -several cases of obstinate wakefulness, unaccompanied, in the early stages -at least, by any other prominent disorder of the system. - -In my opinion, no one cause is so productive of cerebral affections as -persistent wakefulness, for not only is the brain prevented from obtaining -rest, but it is kept in a state of erethism, which, if not relieved, must -sooner or later end in organic disease. Southey laid the seeds of that -disorder which terminated in the loss of his intellect, by watching at the -bedside of his sick wife during the night, after the excessive literary -labors of the day.[121] Newton's mind also suffered in the later years of -his life through deprivation of sleep;[122] and Dr. Forbes Winslow, in -remarking on Southey's case, says: "No brain can remain in permanent -health that has been overtasked by nightly vigils still more than by daily -labor."[123] - -Renaudin,[124] in a very philosophical essay, calls attention to the fact -that persistent wakefulness is sooner or later followed by insanity; and -Maury[125] states his opinion to the same effect. The remarks of Dr. -Ray[126] upon this subject are so apposite that I reproduce them in part, -commending at the same time the little book from which they are taken to -the attention of the reader. - -"A periodical renewal of the nervous energies as often as once a day is an -institution of nature, none the less necessary to the well-being of the -animal economy, because in some degree under the control of the will. To -disregard its requirements with impunity is no more possible than it is to -violate any other organic law with impunity, and no man need flatter -himself that he may systematically intrench upon the hours usually devoted -to rest and still retain the freshness and elasticity of his faculties. -With the same kindliness that marks all the arrangements of the animal -economy, this condition is attended with many pleasing sensations and -salutary effects, gently alluring us to seek the renovation which it -offers. 'While I am asleep,' says the immortal Sancho Panza, 'I have -neither fear nor hope; neither trouble nor glory; and blessings on him -who invented sleep,--the mantle that covers all human thoughts; the food -that appeases hunger; the drink that quenches thirst; the fire that warms; -the cold that moderates heat; and, lastly, the general coin that purchases -all things; the balance and weight that make the shepherd equal to the -king and the simple to the wise.' The ill effects of insufficient sleep -may be witnessed on some of the principal organic functions, but it is the -brain and nervous system that suffer chiefly and in the first instance. -The consequences of a too protracted vigil are too well known to be -mistaken, and many a person is suffering, unconscious of the cause, from -the habit of irregular and insufficient sleep. One of its most common -effects is a degree of nervous irritability and peevishness, which even -the happiest self-discipline can scarcely control. That buoyancy of the -feelings, that cheerful, hopeful, trusting temper that springs far more -from organic conditions than from mature and definite convictions, give -way to a spirit of dissatisfaction and dejection; while the even demeanor, -the measured activity, are replaced either by a lassitude that renders any -exertion painful, or an impatience and restlessness not very conducive to -happiness. Upon the intellectual powers the mischief is still more -serious. They not only lose that healthy activity which combines and -regulates their movements in the happiest manner, but they are no longer -capable of movements, once perfectly easy. The conceptions cease to be -clear and well defined, the power of endurance is weakened, inward -perceptions are confounded with outward unhappiness, and illusory images -obtrude themselves unbidden upon the mind. This kind of disturbance may -pass sooner or later into actual insanity, and many a noble spirit has -been utterly prostrated by habitual loss of rest." - -CASE I.--Some years ago a case similar in several respects to that of -Southey came under my observation. A gentleman of superior mind and of -great powers of application spent from sixteen to eighteen hours each day -in severe literary labor. This of itself would have been a heavy strain to -most persons, but he went regularly to bed and slept soundly six hours -each night, and it is possible that he might have continued this mode of -life for several years without serious inconvenience, when his wife was -suddenly taken ill. His anxiety on her account was very great, and he -spent nearly the whole night by her bedside, sleeping only for about an -hour toward morning. After three weeks passed in this manner, his wife was -pronounced out of danger, but he found it impossible to resume his former -habits. He could neither study nor sleep. The nights were passed in -walking the floor of his chamber or in tossing restlessly on his bed. -There were no pain, no fever, no disorder of any other organ. There was -nothing but ceaseless activity of the mind and an utter inability to -sleep. Stimulants and narcotics only increased the violence of his -symptoms, and every other means employed failed to give relief. The danger -of his situation was pointed out to him and travel recommended. He -followed the advice, and though it was several months before he was -completely relieved, his condition began at once to improve. He was taught -a lesson which has not been without influence, in causing him to task his -mental faculties less severely. - -CASE II.--Another, an intimate friend, who occupied an important public -position, gave so much time and attention to his duties, which were of a -highly laborious character, that he deprived himself of the amount of -sleep to which he had previously been accustomed. It was rarely the case -that he got to bed before two or three o'clock in the morning, and then an -hour or two was always occupied in active intellection. The consequence -was that he finally broke down through want of the mental repose so -essential to him. Inflammation of the brain ensued, and this terminated in -acute insanity, from which he died. - -It would be easy to bring forward other instances of which I am perfectly -cognizant, or which have been cited by authors in illustration of the -point in question, but it is scarcely necessary to enlarge further upon -this portion of the subject. We should be careful, however, not to mistake -the effect for the cause, an error which is often committed in this as -well as in other matters. It is well known that many cases of insanity are -marked in the early stages by persistent insomnia. Doubtless this is -frequently a consequence of the morbid action already set up in the brain; -but much observation has satisfied me that it is more often the cause of -the cerebral aberration, and that by proper medical treatment the mental -excitement may be generally allayed. Certainly the means most commonly -resorted to in such instances are adopted without the full consideration -so imperatively necessary, and consequently are fully as liable to -increase as to lessen the disturbance. - -We cannot employ too much care in doing everything in our power to prevent -the occurrence of those slight attacks of cerebral congestion, which, -though perhaps scarcely observable at the time, are yet fraught with very -serious consequences. Persons have had their whole characters changed by -an apparently trifling interference with the circulation of blood in the -head. A person of my acquaintance was naturally of good disposition, -amiable in his character, and considerate in his dealings with others; but -after an attack of vertigo, attended with unconsciousness of but a few -moments' duration, his whole mental organization underwent a radical -change. He became deceitful, morose, and exceedingly overbearing and -tyrannical toward all with whom he came in contact, and whom it was safe -for him to maltreat. Tuke and Bucknill[127] refer to the case of a lady -whose character had always been distinguished for conscientiousness, whose -religious education had been of a somber kind, and who, suffering under an -attack of small-pox attended with congestion of the brain, recovered, with -the natural bent of her disposition greatly exaggerated. The irritability -of conscience had become an actual disease, destroying the happiness of -the individual and rendering her incompetent to discharge any of the -duties of life. The same authors also mention the instance of a -distinguished admiral who had always been remarkable for pride and -liability to passionate anger, becoming the subject of cerebral -excitement, loss of sleep, and general feverishness consequent upon the -chagrin caused by a supposed neglect by the government. - -In primary insomnia there is always an increase in the quantity of blood -circulating in the brain. This is either absolute or relative. The former -is the case when there has been no exhausting disease, hemorrhage, or -other debilitating influence in operation, and while, though general good -health exists, the amount of blood in the cranium is augmented; the -latter, when from any cause the system has become reduced, and when, while -this condition prevails, a temporary activity takes place in the cerebral -circulation. The first may properly be called active, the latter passive -insomnia. In the one there is more blood in the brain than is normally -present; in the other, though there may be less blood than in health, the -quantity is increased over the amount to which the brain has in a measure -accustomed itself. - -Thus if we suppose the cerebral vessels of a healthy brain to contain -ordinarily a pint of blood, and the amount to be increased to a pint and a -half, and continued at this standard for several consecutive days, a state -of active insomnia ensues. If, on the other hand, this pint should be -reduced to a gill by any cause producing general debility, such as -hemorrhage, starvation, or disease, and then by some exciting mental -emotion, the excessive use of alcoholic liquors, or other influence acting -for a considerable period, be increased to half a pint, a condition of -passive insomnia would be produced--the latter condition resulting not -from a disturbance of the normal relation existing between the _intra_ and -_extra_ cranial blood, but of that which has been established by morbific -causes, and to which the organism has become habituated. - -CASE III.--The following is a good example of the active form of morbid -wakefulness: - -A short time since a gentleman was under my charge in whose case the only -deviation from health which could be perceived was an utter inability to -sleep. Being by profession a broker, and passing his days, and a great -portion of his nights, in the stock and gold rooms, during a period of -great financial excitement, his brain had been kept so continually in a -state of intense action that it was impossible for him, when he went to -bed, to compose his mind so as to allow of sleep ensuing. Thoughts similar -to those which were excited during his business operations were in full -flow, notwithstanding all his efforts to banish them. Calculations were -entered into, and speculations were constantly being formed with as great -or even greater facility than during the day. Many of the latter were of -the most extravagant character, a fact of which he was fully aware at the -time, but he nevertheless found it impossible to refrain from indulging in -them. All his other functions were performed with regularity. His appetite -was good, he took a not inconsiderable amount of exercise, and he -committed no excesses of any kind except as regarded his brain. When I -first saw him he had not slept for six nights, although he had taken large -quantities of brandy, morphine, and laudanum; but beyond a slight feeling -of confusion in his mind at times, and a little pain in his eyeballs, he -experienced no unpleasant sensations during the day. As soon, however, as -his head touched the pillow, and he tried to get to sleep, a feeling of -the most intense uneasiness came over him, while at the same time his face -and ears became hot and flushed. His mental faculties were roused into -increased action; he tossed restlessly from one side of the bed to the -other, and by the time morning came he was thoroughly exhausted, mentally -and physically. A cold bath and a breakfast of two large cups of coffee, -beefsteak and eggs, set him up for the balance of the day, till he retired -to bed, when the phenomena of the previous night would be repeated. - -In this case I conceived that the blood-vessels of the brain, from -overdistention, had lost, in a great measure, their contractile power, and -that a larger quantity of blood was, in consequence, circulating within -the cranium than was normal. The vessels were therefore in a condition -very similar to that of a bladder in which, from the desire to urinate -having been too long resisted, contraction cannot be induced even by the -most strenuous exertion of the will. As the gentleman was of strong, -athletic build, and otherwise in full health, blood-letting would -undoubtedly have proved of great service; but, for reasons which will -appear hereafter, I determined to try a remedy less likely to do harm, and -fully as capable of doing good. I administered thirty grains of the -bromide of potassium at six o'clock in the evening, and repeated the dose -at ten, directing him to go to bed half an hour subsequently. The first -dose produced a decided sedative action, and the second was still more -effectual in calming the mental excitement. When he lay down, his mind was -not disturbed by a flow of thoughts, and he fell almost unconsciously into -a quiet sleep, from which he did not awake till near seven o'clock the -following morning. There were no unpleasant symptoms of any kind; on the -contrary, he felt strengthened and refreshed. The next night one dose was -administered at about bedtime, which was also followed by a sound and -invigorating sleep. No further treatment was given, as on the following -night sleep came naturally. - -Sir Benjamin Brodie,[128] without, however, making the distinction I have -insisted upon, refers to the active or sthenic type of wakefulness in the -following quotations from a little work which should be in the hands of -all who are interested in the philosophy of the mind. - -Speaking of the causes of the wakefulness of some persons, he says: "At -the same time there is no doubt that there is sometimes a morbid condition -of the nervous system, the nature of which we cannot well explain, which -is incompatible with sleep. The patient says, 'I feel fatigued and wearied -and want to go to sleep, but I cannot sleep.'" - -In asserting as he does that this kind of wakefulness is sometimes the -forerunner of mental derangement, Sir Benjamin is supported by many cases -detailed by authors on psychological medicine, and the following, which he -gives,[129] is directly to the point: - -"A gentleman of my acquaintance in whose family circumstances had occurred -which were to him sources of intense anxiety, passed six entire days and -nights without sleep. At the end of this time he became affected with -illusions of such a nature that it was necessary to place him in -confinement. After some time he recovered perfectly. He had never shown -any signs of mental derangement before, nor has any one of his family, and -he has never since been similarly affected. This was an extreme case. But -do not examples of the want of sleep, proving very similar results, though -in a very much less degree, occur under our observation constantly? How -altered is the state of mind in any one of us after even two sleepless -nights! Many a person who under ordinary circumstances is cheerful and -unsuspicious, becomes not only irritable and peevish, but also labors -under actual, though transitory, illusions; such, for example, as thinking -that others neglect him or affront him who have not the smallest intention -of doing either the one or the other." - -Cases similar to the following, which is one of the passive variety of -wakefulness, are by no means uncommon. - -CASE IV.--A lady, aged about thirty-five, unmarried, and of rather -delicate constitution, consulted me in regard to persistent wakefulness, -with which she had been affected for nearly a month. According to the -account which she gave me, she had received a severe mental shock, which -had not lost its influence when a subject of great anxiety was forced upon -her consideration. Her menstrual period, which had been due about ten days -before she came under my notice, had been anticipated by a week, and the -flow was prolonged much above the ordinary time. She had, therefore, lost -a good deal of blood, and was, in consequence, greatly reduced in -strength. This, conjoined with the exhaustion due to the long-continued -wakefulness, rendered her condition a much more serious one than would -otherwise have been the case. - -She had taken large doses of laudanum, of ether, and of valerian, together -with many other medicines, the names of which I do not now recollect, -besides employing a variety of means of traditional efficacy. All had, -however, been useless. Homoeopathy was then tried with an equal want of -success. When I first saw her she was nervous and irritable, her hands -trembled violently upon the slightest exertion of their muscles, her eyes -were bloodshot, the pupils contracted, and the lids opened to the widest -possible extent. There was a constant buzzing in the ears, and the sense -of hearing was much more acute than was natural. There was also increased -sensibility of all that portion of the surface of the body (the skin of -the hands, arms, legs, back, and breast) which I submitted to examination -with the aesthesiometer. Her pulse was 98, irritable, small, and weak. - -At night all her symptoms were increased in violence. Her mind was filled -with the most grotesque images which it was possible for the imagination -to conceive, and with trains of ideas of the most exaggerated and -improbable character. These succeeded each other with a regularity so well -marked that she was able to foresee the routine night after night. "No -one," she said, "can imagine the weariness I feel, or the horror with -which I look forward to the long rows of too-familiar phantoms and -thoughts which I know will visit me before morning. There is one set," she -continued, "which always comes as the clock strikes two. No matter what -may be passing through my mind it is banished by this. It consists of a -woman with very long hair, who sits on a rock by the sea-side, with her -face buried in her hands. Presently a man armed with a long sword comes up -behind her, and, clutching her by the hair, drags her to the ground. He -puts his knee on her breast, and still holding her hair, cuts it off, and -binds her with it, hand and foot. He then commences to pile stones on her, -and continues to do so till she is entirely covered, notwithstanding her -piercing shrieks, which I hear as distinctly as I do real sounds. Turning -then to the sea he cries out, 'Julia, you are avenged. My vow is -accomplished. Come! come!' He then draws a dagger from his breast and -stabs himself to the heart. He falls over the pile of stones he has -raised, and instantly hundreds of little devils not more than a foot high -swarm around his body, and finally carry it off through the air. My horror -at all this is extreme. For more than an hour the scene is passing before -me, and though I know it is all purely imaginary, I cannot shake off the -terror it induces." - -I questioned this lady closely, and found that she was very intelligent, -and fully sensible of the unreality of all her visions. There was no -evidence whatever of the slightest tendency to insanity, but there was a -condition present which would surely terminate in the loss of her reason -if not quickly removed. I regarded her symptoms as indicating a state of -passive cerebral congestion, and as calling for stimulants rather than -what are called sedatives. I directed, therefore, that she should take an -ounce of whisky, properly diluted, every hour, commencing six hours before -bedtime; that she should immerse her whole body except her head in water, -at the temperature of 98 deg. F., for half an hour just before retiring for -the night, and, instead of lying down, should sit up in an easy chair and -try to sleep in that position. - -I administered the whisky upon the same principle that governs us when we -apply stimulating lotions to an inflamed eye, or give alcoholic liquors in -passive congestions of other parts of the body. The warm bath was -prescribed with a view to its dilating action upon the blood-vessels -exposed to its influence; and the sitting position with the object of -facilitating the flow of blood from the head, and impeding its return -through the carotids and vertebrals. - -All these measures I had employed previously with success, in many cases -of inability to sleep due to delirium tremens, and which is almost always -of the passive or asthenic form. In the instance under consideration their -action was all that could be desired. At ten o'clock, having taken the -whisky and bath as directed, she sat down to sleep in a comfortable -chair, and, as her mother informed me, was asleep in less than half an -hour. She awoke about three o'clock, but soon fell asleep again after -another dose of whisky, and remained in this condition till about nine -o'clock in the morning. She then took breakfast, feeling very much -refreshed, but was unable to remain awake longer than two or three hours, -but, taking to her chair, slept soundly till evening. That night she was -again overcome with sleep, and it was passed very much as was the previous -one. No further medicine was required, and after a few nights she went to -bed as had been her custom, and slept soundly till morning. Under the use -of iron and lager beer she recovered her health and strength. - -The foregoing cases are given as examples of the two forms of morbid -wakefulness or insomnia to which I wish to call attention. They show that, -though the cause in each variety may be essentially the same, the means of -relief are not altogether identical. It is important, therefore, to -discriminate between them. But the main point upon which it is necessary -to insist is, that in morbid wakefulness, whether occurring in strong or -weak persons, there is always an excessive amount of blood circulating -through the substance of the brain. In the course of the discussion of the -points involved in the physiology of sleep, this subject was incidentally -noticed. In the following chapter, however, it will be dwelt upon with -more particularity. - - - - -CHAPTER IX. - -THE EXCITING CAUSES OF WAKEFULNESS. - - -Every cause capable of increasing the amount of blood ordinarily -circulating through the brain may give rise to wakefulness. As these -causes are more or less under the control of the individual, it is -important that they should be fully considered. - -An increased amount of blood is attracted to the brain, and wakefulness is -produced: - -1st. _By long-continued or excessive intellectual action, or any powerful -emotion of the mind._--Every organ of the body, the condition of which -admits of being ascertained by ocular examination, invariably contains -more blood in its tissues when in a state of activity than when its -functions are temporarily suspended. We are hence, _a priori_, justified -in assuming that the law is equally applicable to the brain, but we are -not forced to rely entirely upon reasoning from analogy. It has been shown -already that during sleep the circulation of blood within the cranium is -at its minimum, both as regards quantity and rapidity, and that as soon as -the individual awakes there is an immediate afflux of this fluid to the -cerebral tissues. All of us are familiar with the facts that, during -severe mental labor, or while under the influence of some exciting -emotion, the vessels of the head and neck become distended, the head feels -full, the face is flushed, and the perspiration of the parts in question -is increased in quantity. Within certain limits the more blood there is in -the brain the more actively its functions are performed, and so well known -is this fact that some persons, who require to exercise the several -faculties of the mind to an extreme degree, make use of stimulating -ingesta for the purpose of accomplishing the object in view. - -A moderate degree of cerebral activity is undoubtedly beneficial. Exercise -strengthens the mind and improves its faculties, if it is succeeded by a -proper period of repose, during which the vessels are emptied to some -extent of their contents, and are thus enabled to recover their tone. If, -however, the brain is often kept for long periods on the stretch, during -which the vessels are filled to repletion, they cannot contract even when -the degree of cerebral activity is diminished. Wakefulness results as a -necessary consequence, and every day renders the condition of the -individual worse, because time also brings the force of habit into -operation. - -It is not to be denied, however, that many individuals are able to live in -comparative health for long periods with but little or no sleep. Thus it -is stated[130] that Boerhaave did not "close his eyes in sleep for a -period of _six_ weeks, in consequence of his brain being overwrought by -intense thought on a profound subject of study." Sir Gilbert Blane[131] -says he was informed by General Pichegru, that for a whole year, while -engaged in active campaign operations, he slept but one hour out of the -twenty-four. Such statements as these, however, and others to the same -effect which have been made, must be accepted with some allowance. Many -persons sleep unconsciously, and we all know how common it is for -individuals to deny having slept when we have been eye-witnesses of their -somnolency. I should consider it impossible for a person to enjoy good -health if deprived for even a few weeks of half his ordinary amount of -sleep; and it is very probable that Boerhaave's standard of health, never -high, was very much lowered by his protracted vigils. - -So long as the attention is kept fully aroused, the blood-vessels of the -brain are distended, and it is possible for an individual to remain awake -while this condition exists. When the attention begins to flag, the -tendency is for the vessels to contract, and for sleep to ensue. This -disposition may not, however, be strong enough to restore the full -measure of contractility to vessels that have been long overdistended, and -then insomnia results. - -To this increase in the amount of blood circulating in the brain, many -instances of hallucination have been due. It has already been shown that -strong mental emotions determine an augmented flow of blood to the -cerebral vessels, and cause the production of spectral illusions. In all -such cases there is a marked tendency to insomnia present. The account -given by Nicolai, a celebrated German bookseller of the last century, of -his own disorder, is so interesting and appropriate that I quote it in -full. It has never to my knowledge been published in this country. - -"During the ten latter months of the year 1790 I had experienced several -melancholy incidents which deeply affected me, particularly in September, -from which time I suffered an almost uninterrupted series of misfortunes -that affected me with the most poignant grief. I was accustomed to be bled -twice a year, and this had been done on the 9th of July but was omitted to -be repeated at the end of the year 1790. I had, in 1783, been suddenly -taken with a violent vertigo, which my physicians attributed to -obstructions in the fixed vessels of the abdomen brought on by a sedentary -life and a continual exertion of the mind. This indisposition was -successfully removed by means of a more strict diet. In the beginning I -had found the use of leeches applied to the arms particularly beneficial, -and they were afterward repeated two or three times annually when I felt -congestions in the head. The last leeches which had been put on previous -to the appearance of the phantasms of which I am about to speak, had been -applied on the 1st of March, 1790; less blood had consequently been -evacuated in 1790 than was usual with me, and from September I was -constantly occupied in business which required the most unremitted -exertions, and which was rendered still more perplexing by frequent -interruptions. - -"I had, in January and February of the year 1791, the additional -misfortune to experience several extremely unpleasant circumstances, which -were followed on the 24th of February by a most violent altercation. My -wife and another person came into my apartment in the morning in order to -console me, but I was too much agitated by a series of incidents which had -most powerfully affected my moral feelings to be capable of attending to -them. On a sudden I perceived, at about the distance of ten steps, a form -like that of a deceased person. I pointed at it, asking my wife if she did -not see it. It was natural that she should not see anything; my question, -therefore, alarmed her very much, and she sent immediately for a -physician. The phantom continued for about eight minutes. I grew at length -more calm, and being extremely exhausted, fell into a restless sleep which -lasted about half an hour. The physician ascribed the appearance to -violent mental emotion, and hoped there would be no return; but the -violent agitation of my mind had in some way disordered my nerves and -produced further consequences which deserve a more minute description. - -"At four in the afternoon the form which I had seen in the morning -reappeared. I was by myself when this happened, and being rather uneasy at -the incident, went to my wife's apartment, but there likewise I was -accompanied by the apparition, which, however, at intervals disappeared, -and always presented itself in a standing posture. About six o'clock there -appeared also several walking figures which had no connection with the -first. - -"After the first day the figure of the deceased person no longer appeared, -but its place was supplied by many other phantasms, sometimes representing -acquaintances, but mostly strangers. Those whom I knew were composed of -living and deceased persons, but the number of the latter was -comparatively small. I observed that the persons with whom I daily -conversed did not appear as phantasms, these representing chiefly persons -who lived at some distance from me. - -"These phantasms seemed equally clear and distinct at all times and under -all circumstances, both when I was by myself and when I was in company, -and as well in the day as at night, and in my own house as well as abroad; -they were, however, less frequent when I was in the house of a friend, and -rarely appeared to me in the street. When I shut my eyes these phantasms -would sometimes vanish entirely, though there were instances when I beheld -them with my eyes closed; yet when they disappeared on such occasions, -they generally returned when I opened my eyes. I conversed sometimes with -my physician and my wife of the phantasms which at the moment surrounded -me. They appeared more frequently walking than at rest, nor were they -constantly present. They frequently did not come for some time, but always -reappeared for a longer or shorter period, either singly or in company, -the latter, however, being most frequently the case. I generally saw human -forms of both sexes, but they usually seemed not to take the smallest -notice of each other, moving as in a market-place where all are eager to -pass through the avenue; at times, however, they seemed to be transacting -business with each other. I saw also several times people on horseback, -dogs and birds. All these phantasms appeared to me in their natural size, -and as distinct as if alive, exhibiting different shades of carnation in -the uncovered parts as well as different colors and fashions in their -dresses, though the colors seemed somewhat paler than in real nature. None -of the figures appeared particularly terrible, comical, or disgusting, -most of them being of an indifferent shape, and some presenting a pleasing -aspect. The longer these phantoms continued to visit me the more -frequently did they return, while at the same time they increased in -number. About four weeks after they had first appeared, I also began to -hear them talk. The phantoms sometimes conversed among themselves, but -more frequently addressed their discourse to me: their speeches were -commonly short and never of an unpleasant turn. At different times there -appeared to me both dear and sensible friends of both sexes, whose -addresses tended to appease my grief, which had not yet wholly subsided: -their consolatory speeches were in general addressed to me when I was -alone. Sometimes, however, I was accosted by these consoling friends while -I was engaged in company, and not unfrequently while real persons were -speaking to me. These consolatory addresses consisted sometimes of abrupt -phrases, and at other times they were regularly executed. - -"Though my mind and body were in a tolerable state of sanity all this -time, and these phantasms became so familiar to me that they did not cause -me the slightest uneasiness, and though I even sometimes amused myself -with surveying them, and spoke jocularly of them to my physician and my -wife, I yet did not neglect to use proper medicines, especially when they -began to haunt me the whole day and even at night, as soon as I waked. - -"At last it was agreed that leeches should be again applied to me as -formerly, which was actually done, April 20th, 1791, at eleven o'clock in -the morning. No person was with me besides the surgeon, but during the -operation my chamber was crowded with human phantasms of all -descriptions. This continued uninterruptedly till about half an hour after -four o'clock, just when my digestion commenced. I then perceived that they -began to move more slowly. Soon after their color began to fade, and at -seven o'clock they were entirely white. But they moved very little, though -the forms were as distinct as before, growing, however, by degrees more -obscure yet not fewer in number, as had generally been the case. The -phantoms did not withdraw, nor did they vanish, a circumstance which, -previous to that time, had frequently happened. They now seemed to -dissolve in the air, while fragments of some of them continued visible for -a considerable time. About eight o'clock the room was entirely cleared of -my fantastic visitors. - -"Since that time I have felt twice or three times a sensation as if these -phantasms were going to reappear, without, however, actually seeing -anything. The same sensation surprised me just before I drew up this -account, while I was examining some papers relative to these apparitions, -which I had drawn up in the year 1791." - -While it is doubtless true that variations in the amount of blood in the -brain are dependent upon nervous action, it is equally certain that this -latter is increased or lessened according as the brain is in a more or -less hyperaemic condition. These factors, therefore, react upon each other, -and consequently the resulting insomnia is more aggravated than would -otherwise be the case. - -Instances of insomnia dependent upon intense intellectual exertion have -already been given, but the following, which I extract from my note-book, -will not, I think, prove uninteresting or uninstructive: - -CASE V.--A gentleman, aged thirty-nine, unmarried, of correct habits, and -good general health, consulted me on the 19th of April, 1865, in reference -to a peculiar nervous affection with which he had suffered for several -months. He stated to me that, being engaged upon a literary labor of some -importance, he had given the greater part of his time to the studies -necessary to its being carried on with success, and was conscious of -having overtasked his mental powers. So great, however, was his ambition -to excel in his undertaking, that he had persevered notwithstanding the -admonitions of friends, and the still more pointed warnings he had -received from his own sensations. Instead of sleeping, as had been his -custom, from seven to eight hours, he rarely, for nearly a year, had slept -more than four hours out of the twenty-four, and frequently even less than -this. He did not, however, feel the want of sleep. In fact he was never -sleepy, and if this had been the only ill consequence of his severe -application I should probably not have had him under my charge at all, so -little weight did he attach to the condition which it was of the first -importance should be relieved. - -The symptom of disordered action which attracted his attention most was an -inability to concentrate his mind upon subjects about which he wished to -write. There was no difficulty in maintaining a connected line of -reasoning, except when he attempted to put his ideas on paper, and then he -found it utterly impossible to direct his thoughts in a methodical way. He -conversed with me very intelligently in reference to his case, and was -perfectly conscious of the difficulty under which he labored. As an -instance of the character of his disease, he said that the day before he -came to see me he had reflected to his entire satisfaction upon certain -points in literature which he was investigating, and that when he came to -read over what he had written he found it was a tissue of the most arrant -nonsense. The subject of his thoughts was the Greek drama, and the ideas -in reference to it, which he communicated to me, were in the highest -degree logical and interesting. He then showed me the first page of what -he had written, and though he was annoyed at the nonsensical strains of -his language, he could not at the same time conceal his amusement at its -utter absurdity. I quote a few lines from this paper. - -"The rise of the Greek drama is not to be associated with the Homeric age -of minstrelsy, nor to be discovered in the Cimmerian darkness of the -North. It rests upon a foundation far anterior to either. It is found in -the hearts of those men who look beyond a mere utilitarian idea, and who -are able to conceive of the existence of beauty without the disturbance -due to causes inseparably connected with the barbarism from which Greece -emerged into that mythical age which created a god for every river and -forest, and for every emotion of the heart or element of the mind. Lyric -poetry and philosophy may claim the precedence of antiquity, but the power -that could draw tears from eyes that had never before wept, or cause the -hardened lines of stoicism to relax in smiles, is not to be despised or -even elevated upon a pinnacle of greatness." - -At the time of writing, his thoughts flowed so rapidly that he was not -conscious of the disconnected nature of his composition. If he stopped, -however, to read it over, he at once saw how thoroughly it misrepresented -his conceptions. No matter what the subject, the same thing happened, and -even the most trivial notes could not be written without language being -used which was either perfectly without relation to the ideas he wished to -communicate, or else in direct opposition to them. For instance, wishing -to obtain a book from a friend, he found he had written the prayer of -Socrates which concludes the Phaedrus of Plato. On another occasion, -intending to indite an epistle to a lady who had sent him a volume of her -poems, he discovered, when half through his letter, that he had requested -her to accept one of his own books, and had then gone on to give his views -relative to suicide and matrimony. - -Upon questioning him, I ascertained that he went to bed generally about -two o'clock in the morning; that he lay awake for an hour at least, during -which his mind was exceedingly active; and that he rose between six and -seven, took a sponge-bath, and ate a light breakfast. He then went to -work, spending the day in reading, and in dictating to his sister, who -wrote out his language _verbatim_. At six o'clock he dined plainly, and -then again resumed his labors. He drank neither tea, coffee, nor any -alcoholic liquor. Occasionally he took a cup of chocolate at breakfast. - -The only indications of a disordered system other than those I have -mentioned were, that his pulse was too frequent (104), that it was -irritable and irregular; that he had had several attacks of slight vertigo -and headache; that his eyes were brilliant and somewhat congested, and -that pressure upon the closed lids caused considerable pain. His bowels, -contrary to what might have been reasonably expected, were regular, and -his appetite was generally good. His urine contained an excess of urea and -of phosphates; oxalate of lime was also present. There was nothing in his -condition which appeared to give him the least anxiety, beyond the -impossibility of controlling his thoughts when writing, and this he -attributed directly to overexertion of his mental powers. He had, however, -tried the effect of suspending his studies for two or three weeks, but had -not perceived that any benefit was derived from this procedure. He had, -therefore, returned to his occupations. - -I told him very plainly that, unless he was prepared to forego his -literary labors for several weeks at least, he would be in great danger of -permanent injury to his mind; but that with the avoidance of severe mental -exertion, and by the aid of other measures, I believed he could be -restored. He demurred somewhat to the first condition, but finally -promised to follow my advice implicitly. - -Although I was unable to explain the fact that mental aberration should -only be manifested when he wrote, I was confident that his condition was -clearly the result of intense hyperaemia of the brain, and that if this -could be dissipated, and sound, regular, and sufficient sleep be produced, -the mental trouble would also vanish. I therefore directed that half a -dozen dry cups should be applied to the nape of the neck every evening, -that he should take a warm bath directly afterward, and that, while in the -bath, cold water should be poured on his head. Instead of lying down when -he attempted to sleep, I advised that he should assume the sitting -posture, supporting his head on a hair pillow. All literary labor was to -cease. Instead of the books he was in the habit of studying, he was to -read novels. He was to compose himself for sleep at eleven o'clock at -night, and was to rise punctually at seven; take his sponge-bath as usual, -and, after eating a moderate breakfast, to do anything he liked, except -studying or writing, till twelve o'clock, when he was to take a walk for -an hour, then eat a biscuit, read light literature till four, and then -ride on horseback till six, at which hour he was to dine, simply, but to -the extent his appetite prompted him. He had been in the habit of smoking -one cigar a day (after dinner), and I allowed him to continue in this -indulgence. - -I am thus particular in stating my instructions, because I determined to -see what could be done by hygienic measures, and others directed to the -relief of the supposed cerebral congestion, without resorting to the use -of drugs, so long as it was probable they would not be required. Opium and -other medicines of the narcotic class would, I was satisfied, do more harm -than good; bromide of potassium I reserved for use, should it become -necessary to employ it. - -I have every reason to believe that he complied faithfully with the -directions given him, and ere long marks of decided improvement were -visible. His pulse had fallen to 80, was regular and full; there was no -more headache or vertigo; his eyes had lost their bloodshot appearance, -and above all, his sleep had become sound, and was of from seven to eight -hours' duration nightly. As soon as he got settled in his easy chair for -the night his eyelids began to close, and he slept steadily on till it was -time for him to get up for the day. Three weeks were necessary to bring -about these results in full, although amendment was manifested from the -first. Yesterday, May 18th, I wrote him a note, requesting his permission -to make use of his case in illustration of this memoir. The following is -his answer: it is the first time he has written a line for a month: - - "MY DEAR DOCTOR:--If, in your opinion, my case is possessed of any - value in a pathological point of view, I hope you will make such use - of it as will best serve the ends of science. I make only one - condition. You know I am a literary man, and that my reputation as a - student and author would suffer in the estimation of the critics were - I suspected of insanity. It takes very little to form a foundation for - such an assumption, and, perhaps, in my case, there would be more - truth than fiction in the notion as applied to me. With the exception, - therefore, of giving my name, you are at perfect liberty to dish me up - for the satisfaction of all your medical friends. - - "I shall come and see you to-morrow, and in the mean time believe me - ever, - - "Yours sincerely and gratefully, - "---- ---- ----." - - "P.S.--I have read the above over, and to my great delight find that I - have said what I wanted to say. I would stand on my head with joy, - were it not that you were desirous of keeping as much blood out of my - noddle as possible. _Laus Deo._ Can I go to work Monday?" - -I had no intention of letting him "go to work" on Monday, or for at least -two weeks subsequently. I was of the opinion, however, that after that -time he could resume his labors to a slight extent, and gradually extend -them--not to the limit they formerly reached, but to that degree which, -while they would add to his reputation as a man of learning, would not -exhaust the organ which it was so essential for his objects to preserve in -a condition of unimpaired vigor. The result has been all that either he or -myself could have desired. - -CASE VI.--A youth of fifteen was brought to me by his father, on the 16th -of August, to be treated for obstinate wakefulness, the consequence of -severe mental exertion at school several weeks previously. He had not -attended school since the last of June, but had scarcely slept more than -an hour or two each night since that time, according to his own and his -father's statement. He was a healthy, well-grown lad, with a good -appetite, and nothing unusual in his appearance beyond a slight look of -weariness and anxiety in his face. During the day there were no -hallucinations of any kind, and toward evening he invariably felt -overpowered with sleep. As soon, however, as he lay down he heard voices -repeating extracts from the lessons he had recently been learning, and his -mind became occupied with imaginary scenes in which the gods and goddesses -of mythology and the heroes and poets of antiquity played prominent parts, -and the whole power of his attention was thus kept engaged with these and -other scenes which were formed with astonishing rapidity. Toward morning -he fell into an uneasy slumber, and awoke feeling more weary even than -when he had gone to bed. - -Medicines, among which opium was the chief, had been employed without -success. On the contrary, his condition was manifestly rendered worse -through their influence. Laudanum, of which he had taken large quantities, -always caused headache, without producing the least amelioration in his -symptoms. Notwithstanding the palpable connection which existed between -the wakefulness and his former intense mental application, he had been -allowed to continue his studies, and when he came to me had a Latin -grammar in his hand, which he had been diligently studying in the street -railway car! - -After some very plain conversation with the father, relative to the great -danger to which he was subjecting his son, by thus inordinately taxing his -mind, I directed the entire cessation of all studies for the present, and -an entire change of associations by a visit to the sea-shore, and free -indulgence in bathing, fishing, and other recreations. I likewise advised -the use, for a few nights, of small doses of bromide of potassium. My -advice was implicitly followed, and a few days since I received a visit -from the boy's father, and was told by him that his son's health had been -completely restored. I recommended that the visit to the sea-side should -be prolonged a week or two, that the return to study should be gradual, -and that the boy's eagerness to learn should be somewhat restrained by -occupations and amusements requiring but little mental exertion. - -CASE VII.--An eminent banker consulted me for the purpose of being, as he -said, "put to sleep." He informed me that he was engaged in a series of -financial operations which, if successful, would be the means of adding -largely to his fortune, but that owing to loss of sleep he was unable to -give them that careful and full attention which their importance demanded. -"I go to bed," he said, "feeling very much exhausted, and dead with sleep, -but I am kept awake nearly the whole night by the activity of my thoughts, -which run on with a rapidity which astonishes me. Toward morning I get a -little sleep, but I arise unrefreshed, and go to my business with a -feeling of fullness in my head, and a sensation of weariness, which -altogether unfit me for the duties of the day. The consequence is that I -cannot concentrate my attention upon the matters which ought to engage it, -and that I am in danger of losing a great deal of money simply from lack -of mental power to follow the train of operations which I have set in -action." - -On examining this gentleman, I found his face flushed, his eyes bloodshot, -his pulse small, weak, and frequent (104), and his manner excited. He -complained of almost constant vertigo, and a feeling when he walked as -though his feet did not rest firmly on the ground or support his entire -weight. His appetite was capricious, and he maintained his strength mainly -by drinking champagne, of which he imbibed two bottles a day, taking in -addition "brandy and soda," as occasion seemed to require. - -I informed him that his case was a very simple one, and that I could -safely promise to put him to sleep provided he would agree to follow my -directions implicitly. - -This he said he would do. - -I told him that in the first place he must leave town and travel for a -week, and in the second place take the oxide of zinc. To the first -condition he objected strenuously; but the argument which I adduced, that -if he did not he would probably go to an insane asylum within the period -specified, somewhat startled him, and he yielded a reluctant consent. - -He started off that day, and returned in exactly a week, having, as he -said, slept eight hours every night during his absence. All his -disagreeable symptoms had disappeared, and he was enabled to resume his -business with his mental faculties in their full vigor. - - * * * * * - -2d. _Those positions of the body which tend to impede the flow of blood -from the brain, and at the same time do not obstruct its passage through -the arteries, while causing hyperaemia, also produce insomnia._ - -Several cases have come under my observation in which the influence of -position as affecting the disposition to sleep was well marked. It is very -evident that the recumbent posture is more favorable to a state of -congestion of the brain than the erect, or semi-erect. Individuals who, by -excessive mental exertion, have lessened the contractility of the cerebral -vessels, almost always experience great difficulty in getting to sleep -after lying down, even though previous to so doing they may have been very -drowsy. A gentleman, who was a patient of mine a few weeks since, informed -me that several years ago he had an attack of wakefulness, which lasted -for three or four months, and which was particularly characterized by -inability to sleep while lying in bed. While sitting in his office he -would often fall asleep in his chair, and previous to going to bed he -would be overcome by drowsiness. The moment, however, that he lay down, -his mind was aroused into activity, and all sleepiness disappeared. He -left off work, traveled, and in a short time recovered perfectly. It will -be recollected that in the other cases I have cited in this memoir, the -phenomena were always more strongly marked after the persons affected lay -down; and I have always insisted upon the avoidance of the recumbent -posture as one of the most important means to be employed in the cure of -insomnia. The following is one of the cases referred to above. - -CASE VIII.--A gentleman in extensive legal practice requested my advice -for persistent wakefulness, with which he had been affected for several -weeks, in consequence of unremitting attention to a case in which his -sympathies had become greatly interested. For somewhat over a month he -had, as he informed me, slept but for an hour or two each day. After -dinner he was able to procure this much sleep in his chair, but at night, -when he lay down, all his efforts were unavailing. He felt the want of -repose very much, and he described the sensation of weariness of body and -mind as almost insupportable. So great was this desire for sleep that, -notwithstanding repeated disappointments, he was confident each night of -being able to secure it, but invariably as soon as he lay down all -inclination vanished, and he passed the night in that condition of painful -restlessness which had now become horrible to him. There was no very great -mental activity, and no hallucinations of sight, but when his head touched -the pillow a low buzzing sound, which apparently had its origin in the -ears, was heard, and remained there to keep him awake. He could not shut -out this noise, no matter how energetically he endeavored to render -himself oblivious to it, and all the means, such as opium, chloroform, and -alcoholic liquors of various kinds, which he tried in the hope of -obtaining relief, only aggravated the difficulty. - -His general health, ordinarily excellent, had latterly began to give way. -His bowels were torpid, he had little or no appetite, and he was almost -daily subject to severe attacks of headache. He was conscious, too, of a -very decided change in his disposition. From having been of rather social -tendencies, he had become morose and gloomy, disliking even the -companionship of his most intimate friends. There was also a very decided -impairment of his memory, and he was sensible of the fact that the power -of concentrating his attention upon subjects of even minor importance was -materially weakened. In conversation he miscalled names, and misplaced -events and things. Thus he called Pittsburg _Pittstown_, said _aunt_ -several times when he should have said uncle, and confounded _Newark_ with -New York. By attention to hygienic measures, avoidance of the recumbent -position, and the use of moderate doses of bromide of potassium, he soon -obtained a due amount of sleep, and the other symptoms of a disordered -mental and physical organism gradually disappeared. - -Dr. Handfield Jones[132] relates a case in which the influence of position -was strongly marked. "A gentleman aged twenty-four, after considerable -mental strain, experienced the following symptoms: He was thoroughly weary -and drowsy at the close of the day, and felt, as well he might, the need -of nature's restorer; scarcely, however, had he laid down his head, when -the cerebral arteries began to throb forcibly, and soon all inclination -for sleep was banished, and for hours he lay wide awake, but deadly weary. -The _causa mali_ here was evidently deficient tonicity in the cerebral -arteries, or more exactly paresis of their vasa motor nerves. As the -arteries relaxed they admitted an undue flow of blood to the brain, which -goaded the weary tissue to abnormal action." - -De Boismont[133] refers to a case, on the authority of M. Moreau, in which -an individual was able to obtain hallucinations of sight by inclining his -head a little forward. By this movement the return of blood from the head -was impeded, and thus there was an exaltation of certain of the cerebral -functions. Wakefulness is nothing more than an exaggeration of the normal -functions of the brain. For this organ to act with vigor, an increased -flow of blood is necessary. If this flow is continued, without proper -periods of repose, a state of erethism and insomnia is produced. Instances -have been recorded in which persons have found it necessary to assume the -recumbent position whenever they had any severe mental labor to perform. -The following extract, bearing upon this point, from a work[134] already -quoted, is interesting: - -"The posture of supination will unavoidably induce that increased flow of -blood to the brain which, under certain states of this fluid, is so -essential to the production of brilliant waking thoughts; and are indeed -attained so often by another mode--the swallowing of opium. - -"A gentleman of high attainment was constantly haunted by a specter when -he retired to rest, which seemed to attempt his life. When he raised -himself in bed _the phantom vanished, but reappeared_ as he resumed the -recumbent position. - -"Some persons always retire to bed when they wish to think; and it is well -known that Pope was often wont to ring for pens, ink, and paper in the -night, at Lord Bolingbroke's, that he might record, ere it was lost, that -most sublime or fanciful poesy which flashed through his mind as he lay in -bed. Such, also, was the propensity of Margaret, Duchess of Newcastle, who -(according to Cibber, or rather Shiel, the _real_ author of the 'Lives of -the Poets') kept a great many young ladies about her person, who -occasionally wrote what she dictated. Some of them slept in a room -contiguous to that in which her grace lay, and were ready, at the call of -her bell, to rise any hour of the night to write down her conceptions, -lest they should escape her memory. - -"Henricus ab Heeres (in his 'Obs. Med.') says that when he was a professor -he used to rise in the night, open his desk, compose much, shut his desk, -and again to bed. On his waking, he was conscious of nothing but the -happy result of his composition. - -"The engineer Brindley even retired to bed for a _day or two_, when he was -reflecting on a grand or scientific project. - -"I deny not that the darkness or stillness of night may have had some -influence during this inspiration. I may also allow that some individuals -compose best while they are walking, but this _peripatetic_ exertion is -calculated itself to produce what we term determination of blood to the -head. I have heard of a most remarkable instance of the power of position -in influencing mental energy in a German student who was accustomed to -study and compose with his head on the ground, and his feet elevated and -resting against the wall. - -"And this is a fragment of a passage from Tissot, on the subject of -monomania. - -"----'Nous avons vu etudier dans cette academie, il n'y a pas long temps, -un jeune homme de merite, qui _s'etant mis dans la tete_ de decouvrir la -quadrature du cercle, est mort, fou, a l'Hotel Dieu a Paris.'[135] - -"You will smile when I tell you that the tints of the landscape are -brighter to our eyes if we _reverse the position of the head_." - -Tissot, in the work to which reference has just been made, cites an -instance in which position was taken advantage of to solve a problem in -mathematics. A gentleman, remarkable for his accuracy in calculation, for -a wager _lay down on a bed_ and wrought, by mere strength of memory, a -question in geometrical progression, while another person, in another -apartment, performed the same operation with pen and ink. When both had -finished, the one who had worked mentally repeated his product, which -amounted to sixteen figures, and, insisting that the other gentleman was -wrong, desired him to read over his different products. On this being done -he pointed out the place where the first mistake lay, and which had run -through the whole. He paid very dearly, however, for gaining his wager, as -for a considerable time he had a swimming in his head, pains in his eyes, -and severe headaches upon attempting any mathematical labor. - -Sir Walter Scott has said somewhere, that the half hour _passed in bed_, -after waking in the morning, was the part of the day during which he -conceived his best thoughts. - -Dr. Forbes Winslow[136] makes some excellent remarks upon the relations -existing between position and wakefulness. He says: - -"In some types of insanity the patient's mind is altogether absorbed in -the contemplation of a frightful spectral illusion. Under these -circumstances the unhappy sufferer is afraid to close his eyes in sleep -from an intense fear and dread that he will then fall an easy prey to the -horrible phantasms which his morbid imagination has called into existence, -and which, he imagines, follow him in all his movements. The patient so -afflicted declares he will not sleep, and resolutely repudiates and -perseveringly ignores all disposition to slumber. On many occasions he -obstinately refuses to go to bed, or to place himself in a recumbent -position. He will battle with his attendant if he attempts to convey him -to bed. He insists on remaining in the chair, in standing in an erect -position all night, and often determinately walks about the room when -those near him are in profound repose. In these cases the hallucinations -appear to be most exquisitely and acutely vivid when the patient is placed -in a recumbent position, on account, it is supposed, of the mechanical -facilities thus afforded for the blood gravitating freely to the head. - -"A gentleman who appeared free during the day from any acute -hallucinations, never could lie on his back without being distressingly -harassed by a number of frightful imps, whom he imagined to be dancing -fantastically around him during the night. Under these circumstances, -undisturbed sleep, while in bed, could never be obtained. He was in the -habit of sleeping in an arm-chair for some time in consequence of these -symptoms. He, however, eventually recovered, and has been for several -years entirely free from all hallucinations." - -It has frequently occurred to me to notice the increase in the number and -intensity of the hallucinations of patients affected with delirium tremens -as soon as they assumed the recumbent position. The difficulty of sleeping -is in such cases always correspondingly augmented. - - * * * * * - -3d. _An increased amount of blood is determined to the brain, and -wakefulness is produced by certain substances used as food or medicine._ - -Daily experience assures us of the truth of this proposition. In general -terms, it may be said that all those substances which, when ingested into -the system, increase the force and frequency of the heart's action, cause -also a hyperaemic condition of the brain and tend to the supervention of -wakefulness. - -Chief among these agents are to be placed alcohol, opium, belladonna, -stramonium, Indian hemp, tea, and coffee. It is true that the first two of -these, when taken in large quantities, sometimes give rise to a comatose -condition. This, however, as has already been shown, is not a consequence -of an increased amount of blood in the brain, but results from the -circulation in that organ of blood which has not been duly oxygenated by -respiration. My experiments on this head have been many, and show -conclusively that neither alcohol nor opium possesses any stupefying -effect, if means be taken to insure the full aeration of the blood. If, -however, these substances be administered beyond a certain limit, they so -act upon the nerves which supply the respiratory muscles as to interfere -with the process of respiration, and hence the blood is not sufficiently -subjected to the action of the atmosphere. Unaerated blood therefore -circulates in the brain, and coma--not sleep--is produced. - -No substance is capable of acting as a direct hypnotic, except that which -lessens the amount of blood in the brain. In small doses alcohol and opium -do this indirectly, through their stimulating properties exerted upon -overdistended blood-vessels, as has been shown in regard to the first -named in a case already cited; but they never so act upon the healthy -brain. In the normal state of this organ their action in small doses is -always that of excitants. The word "small" is of course used in a relative -sense. What is a small dose for one person may be a large one for another, -and _vice versa_. - -In this connection it is scarcely necessary to dwell at any length upon -the wakefulness produced by delirium tremens from the excessive ingestion -of alcohol or opium. In the _post-mortem_ examinations--four only--which I -have made of individuals dying from this affection as the result of the -immediate use of alcohol, the brain was invariably found congested. Either -hyperaemia or its consequence, effusion of serum, is the ordinary -pathological condition discovered in such cases. - -In regard to opium, most practitioners have doubtless noticed the effect -which it and its preparations frequently produce in preventing sleep. I -have known one dose of half a grain of opium keep a patient awake for -three consecutive days and nights, during the whole of which period -intense mental excitement was present. As is well known, the Malays, when -they wish _to run amuck_, bring on the necessary degree of cerebral -stimulation by the use of opium. During the condition thus produced -insomnia is always present. It is certainly true, however, that in -moderately large doses opium acts as a direct hypnotic, and the same may -be said of other narcotics. - -Belladonna, stramonium, and Indian hemp likewise produce congestion of the -brain and wakefulness. The latter, under the name of hashish,[137] is -still used in the East to bring on a state of delirium, and, if rumor is -to be credited, has its votaries in this country. Tea and coffee act in a -similar but far less powerful manner. As one of the results of experiments -with these substances, instituted upon myself, I found that the -circulation of the blood was rendered more active.[138] Their influence in -preventing sleep is well known to the generality of people, and this -effect is doubtless entirely due to their action upon the heart and -blood-vessels by which the amount of blood in the brain is increased. In -persons of fair and thin skins, who are not accustomed to the use of -either of these beverages, the face can be seen to flush after they have -been taken; and I have frequently met with persons in whom their use was -always followed by suffusion of the eyes, and a feeling of fullness within -the head. Their power to increase the force and brilliancy of our -thoughts, and to sustain the mind under depressing influences, has long -been recognized, and is to be ascribed to the same cause as that which -prevents sleep. - - * * * * * - -4th. _Wakefulness is also caused by functional derangements of certain -organs of the body, whereby an increase in the amount of blood in the -brain is produced._ - -Under this head are embraced those cases of sleeplessness due to exalted -sensibility of the nervous system. They are chiefly met with in persons -of feeble constitution. The slightest impression made upon the skin, or -any other organ of sense, is converted into a sensation out of all -proportion to the exciting cause. There is thus a condition of general -hyperaesthesia which greatly tends to the prevention of sound and -refreshing sleep. The following case illustrates very well the phenomena -of the state in question: - -CASE IX.--A lady recently came under my care for extreme wakefulness, the -result, as she correctly supposed, of debility. During the month of August -she had resided in a malarious region, and had had a series of attacks of -intermittent fever before she would consent to take quinine for its cure. -By the time the disease was conquered she had become very much reduced, -and her constitution had received a shock from which it will probably not -recover for several years. I saw her for the first time on the 26th of -September, and she was then so feeble that she was unable to be out of her -bed for more than an hour or two each day. Her nervous system was in an -exceedingly irritable condition, the least noise startled her, she was -unable to bear the full light of day, and so sensitive was her skin, that -the light clothes she wore caused her the greatest uneasiness. She -informed me that she had scarcely slept for seventeen days and nights, and -though I received this statement with some grains of allowance, I was very -sure, from her general appearance, that she was suffering from insomnia. -At night the feeling of general discomfort was greatly increased, the -weight of the bedclothes was insupportable, and she passed the hours -tossing restlessly on her bed or in walking the floor. By morning she was -feverish, irritable, and thoroughly exhausted. A cup of coffee and a -little buttered toast constituted her breakfast, after which she felt -somewhat revived. - -Conceiving that all the symptoms were referable to debility and passive -cerebral congestion, I advised nutritious food, tonics, stimulants, -exercise in the open air, the warm bath, cold water to the head, and the -avoidance of the recumbent posture. Amendment began almost immediately, -and by the end of a week the hyperaesthesia had disappeared, and she slept -soundly and sufficiently. - -In reference to this form of wakefulness, Dr. Handfield Jones[139] makes -some judicious observations. He says: "A girl recently under my care with -very various and marked signs of prostration of nerve-power, suffered for -many months with exceedingly restless nights, the cause of which appeared -to be chiefly great hyperaesthesia. Although she improved materially in -other respects, she did not sleep well until she was removed from London -to a healthy part of the country. I have had several patients, two -especially, both temperate males, who for a length of time were quite -dependent for good rest at night on wine taken either on going to bed or -in the course of the night. * * * It is not easy to form a precise idea of -the state of the nervous centers in which a 'nightcap,' as above -mentioned, is so effectual in procuring sleep. Debility is certainly one -marked pattern of it, but there must be surely another, even more -important, as the most profound debility does not, by any means, always -interfere with sound sleep, nay, rather seems to conditionate it. This -other element, we are much disposed to think, is hyperaesthesia, or -irritability, which, as already noticed, commonly increases _pari passu_ -with weakness. The condition may be compared with that of neuralgia, when -it is beginning to give way under treatment, and is so readily reproduced -by anything which causes exhaustion. Now, as the stimulant recruits the -exhausted nerve force, the hyperaesthesia ceases, and the brain tissue -subsides into a state of calm repose. It may be added here that it is -often well to give not only a stimulant, but also some digestible -nourishment about the time of going to rest, or even in the course of the -night when debility to a serious extent exists. It is quite certain that a -craving empty stomach is by no means favorable to quiet slumber, and in -this point of view moderate suppers are far from being unsuitable to many -invalids. I well remember the case of a lady who, the night after a -natural confinement, woke up with severe gastric disorder and flatulence, -which resisted various medications, but subsided immediately after a -plate of cold meat and some brandy and water. Among the various -soporifics, I doubt if there be any more potent, especially for the weakly -and hyperaesthetic, than prolonged exposure to the cold open air. This -should be so managed as not to cause great fatigue, and if well timed and -followed by a sufficient meal, it will be found an admirable preparation -for sound nightly slumber." - -In the foregoing remarks it is perceived that Dr. Jones fails to recognize -the state of passive congestion of the brain which in cases such as he -describes, and in many similar ones which have come under my care, is -almost invariably present. It is this feature which, in addition to the -debility, gives so marked a character to the species of insomnia under -consideration. The hyperaesthesia, like the wakefulness, is merely a result -of the cerebral hyperaemia. - -Several cases of insomnia, the result of disordered menstruation, have -come under my observation. We can very well understand how, in women -suffering from suppression of this function, a slight degree of cerebral -hyperaemia and consequent wakefulness should result. About the climacteric -time of life, when irregularities in the menstrual flow are very common, -there is quite generally extreme sleeplessness as each period approaches, -which is not ordinarily relieved till the catamenia make their appearance. -In such cases measures directed to the relief of the existent congestion -of the brain will generally prove effectual in causing natural sleep. - -Irregular or deficient action of the heart and blood-vessels is a frequent -cause of wakefulness. One of the principal results of such disordered -action of the circulatory organs is coldness of the extremities, and an -attendant condition of repletion of the central vessels. As a consequence -there is in these cases almost invariably great wakefulness. As Dr. -Cheyne[140] has remarked, many a delicate female, from going to bed with -cold feet, is deprived of hours of sleep in the early part of the night, -and thereby falls into nervous complaints, obstinate dyspepsia, and -uterine irregularity, who might have escaped had the circulation of the -surface of the body been properly sustained. - -There are cases, however, of habitual cold feet, accompanied by -wakefulness, which are not so much due to deficient power in the heart as -to disordered nervous action. But, whatever the cause, there is always, -while the condition exists, an excessive amount of blood in the cranial -vessels. An instance of the kind came under my observation several years -ago in the person of an army officer, of strong constitution and otherwise -of good health. Heat applied to the extremities gave only temporary -relief, and stimulants taken internally were equally inefficacious. He was -finally entirely cured by the repeated passage of the direct galvanic -current through the sciatic and crural nerves and their branches. - -Indigestion is quite a common cause of wakefulness, even when no marked -disagreeable sensations are experienced in the digestive organs. A full -meal, especially if it be of highly seasoned or otherwise improper food, -will often keep the offending individual awake the greater part of the -night. We know that apoplexy is especially apt to occur soon after the -stomach has been overloaded with food. The return of the blood from the -head is impeded, and the rupture of an intercranial vessel, or an effusion -of serum, is the result of the cerebral congestion. Insomnia is a milder -effect of the same cause. - -There are several other abnormal conditions of the system in which -wakefulness plays an important part, but their consideration would lead us -into the discussion of the phenomena of many diseases of which it is -simply a symptom, or of secondary consequence. The remarks which have been -made in regard to it have reference to its existence as an evidence of -slight cerebral congestion, and therefore as being of sufficient -importance to demand the aid of both physician and patient in effecting -its cure. - - - - -CHAPTER X. - -THE TREATMENT OF WAKEFULNESS. - - -The principles which should prevail in the treatment of wakefulness are -indicated to some extent by the remarks which have already been made. If -the views which I have given relative to the pathology of this affection -be correct, there can be no doubt in regard to the means to be employed -for its cure. Happily, theory and practice are in perfect accord in -respect to the therapeutical measures to be adopted. These may be arranged -into two classes: - -1st. Those which by their tendency to soothe the nervous system, or to -distract the attention, diminish the action of the heart and -blood-vessels, or correct irregularities in their function, and thus -lessen the amount of blood in the brain. - -2d. Those which directly, either mechanically or through a specific effect -upon the circulatory organs, produce a similar effect. - -Under the first head are embraced many agencies which from time immemorial -have been known to cause sleep. Among them are music, monotonous sounds, -gentle frictions of the surface of the body, soft undulatory movements, -the repetition by the insomnolent of a series of words till the attention -is diverted from the exciting emotion which engages it, and many others of -similar character which individuals have devised for themselves. In slight -cases the measures belonging to this class often prove effectual, but in -persistent insomnia they are generally altogether nugatory. - -Under the second head we shall find comprehended the means which are -chiefly to be relied on in the treatment of cases of morbid wakefulness. - -Chief among them are embraced those measures which tend to improve the -general health of the patient, and which are chiefly of a hygienic -character. Whatever causes produce an irritable condition of the nervous -system, indirectly at least increase the disposition to wakefulness. It is -important, therefore, that these should be thoroughly understood and -avoided, and I accordingly propose to consider them at some length. - -_Food._--While it is an error to suppose, as is generally done, that a -moderately full meal, eaten shortly before bedtime, is necessarily -productive of wakefulness, there is no doubt that this condition is -induced by an excessive quantity of irritating or indigestible food. A -hearty supper of plainly cooked and nutritious food rather predisposes to -sleep. Most of us have experienced the drowsiness which so often follows -dinner. This is due to the fact that the process of digestion requires an -increased amount of blood in the organs which perform it, and -consequently the brain receives a less quantity. A tendency to sleep is -therefore induced. It is a natural and healthy predisposition, and when -yielded to moderately conduces to a more complete assimilation of the food -than would otherwise take place. When, however, the food ingested is not -such as is merely sufficient for the wants of the system, but is -inordinate in amount, or irritating in quality, the hypnotic effect is -neutralized, and often a state of wakefulness supervenes, from the fact -that the quantity of blood circulating in the brain is augmented instead -of being diminished. This last result is induced either by the pressure of -the overloaded stomach upon the abdominal vessels or through a reflex -action on the heart, by which it is excited to increased activity. - -In young children, who are very susceptible to the influence of causes -acting upon the nervous system, we often see both sleep and wakefulness -result as direct effects of eating. When the quantity of milk taken has -not been excessive, the child quietly drops asleep at the breast. On the -contrary, when a superabundance has been ingested, it either remains awake -or the sleep is disturbed. In adults it is, as has already been mentioned, -not uncommon for apoplexy to ensue upon a large meal of improper food. - -In order, therefore, that a disposition to wakefulness may be removed, it -is essential that attention should be paid to the diet of the affected -individual. As a rule, people are underfed. This is especially the case -with women, who too generally indulge in what may be called "slops," to -the exclusion of good, solid, nutritious food derived in great part from -the animal kingdom. By such a faulty diet the tone of the system is -lowered, and local congestions of different parts of the body are -produced. If the brain be one of these, wakefulness results. - -Most of the cases of insomnia which occur in women are of the passive -variety, and require not only nutritious food, but _stimulants_. Of the -latter, _whisky_ is generally to be preferred as acting rapidly, as less -likely to disagree with the stomach than many kinds of wine, and as being -purer than the stuff ordinarily sold as brandy. As a good stimulant, and -at the same time tonic, nothing can be preferable to _Tarragona wine_, -drunk at dinner to the extent of a glass or two. It possesses all the -essential qualities of pure port, and is much more reliable and wholesome -than the mixture of elderberry juice and alcohol which passes for this -latter wine. Next to Tarragona wine must be ranked good _lager beer_. - -Although the effect of _coffee_ is generally such as to induce -sleeplessness, there are cases in which its action is directly the -reverse. I have had several slight cases of passive wakefulness under my -care which were entirely and speedily cured by a cup of strong coffee -taken for three or four nights in succession at bedtime. It is especially -useful in females of languid circulation, and a consequent tendency to -internal congestions. - -Stimulants such as those mentioned, and others which might be noticed, it -must be clearly understood are only useful in the asthenic or passive form -of insomnia; in the sthenic or active form of the affection they are -altogether inadmissible, and if employed will certainly increase the -difficulty. - -The good effects of moderate but regular _physical exercise_ in -dissipating wakefulness can scarcely be overestimated. It is almost -impossible to produce any permanently beneficial influence without the aid -of this powerful tonic. To be of any material service, the exercise should -be taken in the open air, and should extend to the point of inducing a -slight feeling of fatigue. - -The _warm bath_ is also a very valuable means of determining blood from -the head, and calming nervous irritability. Frequently, especially in -children, I have found that simply putting the feet in water of the -temperature of 100 deg. F. has been sufficient to induce a sound and healthy -sleep, when laudanum and other means have failed. - -_Cold water_, applied directly to the scalp, is often of great effect in -diminishing the amount of blood in the brain. It is not admissible in the -asthenic form of wakefulness. When the individual is strong, the heart -beating with force and frequency, and the mental excitement great, its -influence is almost invariably good. The exact temperature is a matter -for the judgment of the physician. I have often used it as cold as ice -could make it, 32 deg. F., or thereabouts. - -In the action of cold water, applied to the head in cases of insomnia, we -have another proof of the real nature of this affection. It is known that -in Thibet mothers place their wakeful children in such positions as will -admit of a small stream of cold water falling from a slight elevation upon -the head. I have in some work--on which I cannot now lay my hands--read a -very full account of this custom, and seen a cut representing the process. -The children very soon fall into a quiet sleep. I have often seen the -application of the cold _douche_ to the heads of refractory prisoners -bring on a deep sleep. - -The effects of _position_ in aid of other remedies have also been alluded -to. I make use of its advantages in all severe cases of insomnia which -come under my charge, and we have, in its efficacy, additional -confirmation of the correctness of the theory that the condition of the -brain in such cases is one of hyperaemia. - -Among the more purely medicinal agents, _bromide of potassium_ occupies -the first place, and can almost always be used with advantage to diminish -the amount of blood in the brain, and to allay any excitement of the -nervous system that may be present in the sthenic form of insomnia. That -the first named of these effects follows its use, I have recently -ascertained by experiments upon living animals, the details of which will -be given at another time. Suffice it now to say, that I have administered -it to dogs whose brains had been exposed to view by trephining the skull, -and that I have invariably found it to lessen the quantity of blood -circulating within the cranium, and to produce a shrinking of the brain -from this cause. Moreover, we have only to observe its effects upon the -human subject to be convinced that this is one of the most important -results of its employment. The flushed face, the throbbing of the carotids -and temporals, the suffusion of the eyes, the feeling of fullness in the -head, all disappear as if by magic under its use. It may be given in doses -of from ten to thirty grains--the latter quantity is seldom required, but -may be taken with perfect safety in severe cases. - -Another very admirable preparation is the _oxide of zinc_. This substance -appears to be especially beneficial in those cases of wakefulness due to -excessive mental exertion or anxiety of mind. I usually prescribe it in -doses of two grains, three times a day, the last dose being taken just at -bedtime. - -_Opium_ I very seldom employ in the treatment of wakefulness, from the -facts that its effects vary so greatly in accordance with the dose, and -that its action is not limited to the simple induction of sleep. There are -cases, however, in which its influence is decidedly beneficial. Care -should be taken to give it in sufficiently large but not excessive -quantities. The influence of opium in lessening the amount of blood in -the brain is very distinctly recognized by Dr. Handfield Jones, and also -by Dr. Alfred Stille.[141] Both these authors account in this manner for -its hypnotic effect. As has been shown, my own experiments tend strongly -to confirm this reasoning. - -_Hyoscyamus_ is more generally admissible. It is especially indicated in -those cases which are accompanied by great nervous irritability. It is -difficult to obtain any preparation of this drug which retains its -virtues. I have usually employed the tincture in doses of from one to two -drachms. I do not think, however, that it possesses any advantages over -bromide of potassium, or that it is even equal in any respect to this -agent. - -In regard to _valerian_, _assafoetida_, and other _antispasmodics_, I have -nothing to say in commendation. _Tonics_ are, however, almost always -useful, even in the active form of the affection. Among them _quinine_ and -_iron_ are more generally indicated. - -When wakefulness is a consequence of functional derangement of distant -organs, the measures of relief must be directed to the cure of the primary -disease, in order to produce any permanent alleviation of the cerebral -difficulty. - -In those cases of insomnia dependent upon severe and long-continued mental -exertion, all means will fail to remedy the trouble unless the affected -individual consents to use his brain in a rational manner. Proper -intervals of relaxation should be insisted upon, and in some cases it may -be necessary to suspend all intense intellectual effort for a time. When -the means will permit, travel can always be undertaken with advantage. It -is surprising sometimes to see how rapidly the brain recovers its tone, -and the system generally recuperates through the change of associations -and scenes incident to travel. - -The disposition of the age seems to be to ignore the fact that the nervous -system can exhaust itself by excessive intellectual labor. A short time -since intelligence was received from abroad that one of the most -distinguished men of Great Britain had committed suicide, in consequence -of insanity produced by overexertion of his mind. Thus one more victim is -added to the long list of those who have disregarded the laws of their -being; and again we are reminded that there is a limit to the exercise of -our intellectual powers, beyond which we cannot pass with safety.[142] - - - - -CHAPTER XI. - -SOMNOLENCE. - - -Somnolence or drowsiness is generally regarded, when persistent, as being -more strongly indicative of organic changes in the structure of the brain -than is any other derangement of sleep. - -This opinion is mainly, if not entirely, due to the fact that it is -confounded with stupor, from which, both in its causes and effects, as has -already been shown, it differs in every essential respect. - -Somnolence is nothing more than an inordinate tendency to sleep. When -manifested in a slight degree it is difficult, without careful examination -and a thorough inquiry into the history of the case, to distinguish it -from moderate stupor. It is of course very important that the distinction -should be made; for, in reality, somnolence is ordinarily no very serious -disorder, and is generally symptomatic of eccentric disease, whereas -stupor almost invariably results from organic brain affections, from -cerebral injuries, or the circulation of poisoned blood through the -encephalic blood-vessels. - -Whatever lessens the amount of blood normally circulating through the -cerebral vessels, tends to the production of somnolence. It is hence a -condition frequently witnessed in those whose powers of life have been -reduced by long-continued disease, by excesses of various kinds, or by -affections which essentially consist in enfeeblement of the organism. It -is generally met with in the aged, in whom the circulatory organs have -lost their pristine vigor. - -Many cases of very troublesome and persistent somnolence, having an origin -such as I have mentioned, have come under my notice: ordinarily they -present no difficult features of treatment, the indications being to -increase the tone of the system by stimulants, tonics, nutritious food, -and moderate exercise in the open air. These measures will invariably -succeed if there be no organic difficulty. - -Somnolence, however, is sometimes due to structural changes which -interfere with the free passage of blood through the cerebral vessels. It -may hence be caused by emboli, which, obstructing the arteries, prevent -the normal amount of blood reaching the brain substance. It may also be -caused by tumors, which, pressing on the arteries supplying the brain, act -in like manner. In such cases it is of secondary importance. - -A very curious affection, known as the "Sleepy Disease," has been -described as endemic in certain regions of Africa. The following -extract[143] gives a graphic description of the malady: - -"Having procured a guide, we crossed the river, and at the mouth of -Logan's Creek we exchanged our boat for a large canoe, in which we -followed the windings of the deep and narrow inlet for nearly two miles. -This brought us to a village of six huts. Without ceremony we entered the -dwelling of the old queen (who was busied about her household affairs), -and looked around for her granddaughter, to see whom was the principal -object of our excursion. On my former visit to Maumee's town, four or five -months ago, this girl excited a great deal of admiration by her beauty and -charming simplicity. She was then thirteen or fourteen years of age--a -bright mulatto, with large and soft black eyes, and the most brilliantly -white teeth in the world. Her figure, though small, is perfectly -symmetrical. She is the darling of the old queen, whose affections exhaust -themselves upon her with all the passionate fire of her temperament, and -the more unreasonably because the girl's own mother is dead. - -"We entered the hut, as I have said, without ceremony, and looked about us -for the beautiful granddaughter; but, on beholding the object of our -search, a kind of remorse and dread came over us, such as often affects -those who intrude upon the awfulness of slumber. The girl lay asleep in -the adjoining apartment, on a mat that was spread over the hard ground, -and with no pillow beneath her cheek. One arm was by her side, the other -above her head, and she slept so quietly, and drew such imperceptible -breath, that I scarcely thought her alive. - -"With some little difficulty she was aroused, and awoke with a frightened -cry,--a strange and broken murmur,--as if she were looking dimly out of -her sleep, and knew not whether our figures were real, or only the -fantasies of a dream. Her eyes were wild and glassy, and she seemed to be -in pain. While awake, there was a nervous twitching about her mouth and in -her fingers; but, being again extended upon the mat, and left to herself, -these symptoms of disquietude passed away, and she almost immediately sank -again into the deep and heavy sleep in which we found her. As her eyes -gradually closed their lids, the sunbeams struggling through the small -crevices between the reeds of the hut glimmered down about her head. -Perhaps it was only the nervous motion of her fingers, but it seemed as if -she were trying to catch the golden rays of the sun and make playthings of -them, or else to draw them into her soul and illuminate the slumber that -looked so misty and dark to us. - -"This poor doomed girl had been suffering--no, not suffering; for, except -when forcibly aroused, there appeared to be no uneasiness,--but she had -been lingering two months in a disease peculiar to Africa: it is called -the 'Sleepy Disease,' and is considered incurable. The persons attacked by -it are those who take little exercise, and live principally on vegetables, -particularly cassady and rice. Some ascribe it altogether to the cassady, -which is supposed to be strongly narcotic--not improbably the climate has -much influence, the disease being most prevalent in low and marshy -situations. Irresistible drowsiness continually weighs down the patient, -who can be kept awake only for the few moments necessary to take a little -food. When this lethargy has lasted three or four months, death comes with -a tread that the patient cannot hear--and makes the slumber but a little -more sound. - -"I found the aspect of Maumee's beautiful granddaughter inconceivably -affecting. It was strange to behold her so quietly involved in sleep from -which it might be supposed she would awake so full of youthful life, and -yet to know that this was no refreshing slumber, but a spell in which she -was fading away from the eyes that loved her. Whatever might chance, be it -grief or joy, the effect would be the same. Whoever should shake her by -the arm--whether the accents of a friend fell fully on the ear, or those -of strangers like ourselves,--the only response would be that troubled -cry, as of a spirit that hovered on the confines of both worlds and could -have sympathy with neither. And yet, withal, it seemed so easy to cry to -her, 'Awake! Enjoy your life! Cast off this noontide slumber!' But only -the peal of the last trumpet will summon her out of that mysterious -sleep." - -Another and later account of this singular disease has recently been given -by M. Dumoutier,[144] surgeon in the French Navy. - -According to this observer, the affection commonly called the -"sleep-disease" (maladie du sommeil) is met with only among the negroes of -the coast, and principally those of the Gaboon and of Congo, becoming more -rare towards the north. The most prominent symptoms are an irresistible -tendency to sleep, and a feeling of torpor and numbness. The patient does -not complain of pain, and yet there is a general weakness of the limbs, -the gait is tottering, the sensibility is perverted, and the hands -imperfectly grasp the objects they attempt to seize. During the sleep the -fecal matters and the urine are passed involuntarily. The respiration is -normal, and the digestion regular. These were the principal symptoms -observed in those cases which came under M. Dumoutier's notice: observing -the disease only in the persons of captives coming from the interior, he -ascribes it to nostalgia, _ennui_, and other moral causes. Two autopsies -made by his colleagues revealed no abnormal condition of the brain, the -spinal cord, or their membranes. - -The treatment employed--quinia, strychnia, and iron--had no effect. A -temporary improvement was obtained by causing the patients to take part in -the amusements of their companions. Electricity seemed likewise to retard -somewhat the progress of the disease. - -The fact that no organic difficulty of the brain was discovered after -death, is strong proof that the somnolency was due to some cause affecting -the intra-cranial circulation. That the amount of blood was lessened, and -that thus a permanent anaemia of the brain was produced, can scarcely be -doubted, when regard is had to the observations and experiments recorded -in the foregoing pages of this work. Probably the primary derangement was -seated in the sympathetic nerve and its ganglia, it having been well -settled by familiar observations, and by recent contributions to -physiology and pathology, that one of the chief functions of this system -is to regulate the caliber of the blood-vessels, and thus to determine the -amount of blood circulating through an organ or part of the body. - -Numerous cases of protracted sleep are on record. Some of them are -evidently fanciful and exaggerated, but others are doubtless well founded. -One of the most remarkable of these is related, among many others, by -Wanley.[145] - -"One Samuel Chelton, of Finsbury, near Bath, a laboring man, about -twenty-five years of age, of a robust habit of body, not fat, but fleshy, -and of dark-brown hair, happened, on the 13th of May, 1694, and without -visible cause, to fall into a very profound sleep, out of which he could -by no means be aroused by those about him till after a month's time, when -he arose of himself and went to his husbandry business as usual. He slept, -ate, and drank as before, but did not speak a word till about a month -after. All the time he slept, victuals and drink stood by him, which were -spent every day, and used by him, as was supposed, though no person saw -him eat or drink all the while. After this period he continued free from -drowsiness or sleepiness till the 9th of April, 1696, when he fell into -his sleeping fit again, as he had done before. After some time his friends -were prevailed on to try what effect medicines might have upon him. -Accordingly, Mr. Gills, an apothecary, bled, blistered, cupped, and -scarified him, and used all the external irritating medicines he could -think of, but to no purpose; and after the first fortnight he was never -observed to open his eyes: victuals stood by him as before, which he ate -of now and then, but no one ever saw him eat or evacuate, though he did -both very regularly, as he had occasion; and sometimes he was found fast -asleep with the pot in his hand in bed, and sometimes with his mouth full -of meat. In this manner he lay about ten weeks, and then he could eat -nothing at all, for his jaws seemed to be set, and his teeth clinched so -close that, notwithstanding all the art that could be used with -instruments, his mouth could not be opened to put anything into it to -support him. At last, those about him observing a hole in his teeth, made -by holding his pipe, they now and then poured some tent into his mouth -through a quill. And this was all he took for six weeks and four days; but -it amounted to no more than three pints or two quarts. He had made water -only once, and never had a stool all that time. - -"On the 7th of August, which was seventeen weeks from the 9th of April, -when he began to sleep, he awaked, put on his clothes, and walked about -the room, not knowing he had slept above a night; nor could he be -persuaded he had lain so long, till, going into the fields, he found -everybody busy getting in their harvest, and he remembered very well when -he fell asleep that they were sowing their barley and oats, which he then -saw ripe and fit to be cut down. There was one thing remarkable: though -his blood was somewhat wasted with lying so long in bed and fasting for -about six weeks, yet a gentleman assured Dr. Oliver that when he saw -him--which was the first day of his coming abroad--he looked brisker than -ever he saw him in his life before; and on asking him whether the bed had -made him sore, he assured this gentleman that he never felt this or any -other inconvenience, and that he had not the least remembrance of anything -that passed, or what was done to him, all that while. So that he went -again to his husbandry, as he was wont to do, and remained well till -August 17th, 1697, when, in the morning, he complained of a shivering and -a coldness in his back. He vomited once or twice, and the same day fell -into his sleeping fit again. Dr. Oliver, going to see him, found him -asleep, with a cup of beer and a piece of bread and cheese upon a stool by -his bed, within his reach. The doctor felt his pulse, which at that time -was regular, and he also found his heart beat very regular, and his -breathing easy and free. The doctor only observed that his pulse beat a -little too strong. He was in a breathing sweat, and had an agreeable -warmth all over his body. The doctor then put his mouth to his ear, and -called him as loud as he could several times by his name, pulled him by -the shoulders, pinched his nose, stopped his nose and mouth together as -long as he could without choking him, but to no purpose, for all this time -he did not give the least sign of being sensible. The doctor lifted up his -eyelids, and found his eyeballs drawn up under his eyebrows and fixed -without any motion. The doctor then held under one nostril, for a -considerable time, a vial with spirits of sal ammoniac, extracted from -quicklime; he then injected it several times up the same nostril; and -though he had poured into it almost half an ounce of this fiery spirit, it -only made his nose run, and his eyelids shiver and tremble a little. The -doctor, finding no success with this, crammed that nostril with white -powder of hellebore, and waited some time in the room to see what effects -all these together might have upon him; but he never gave any sign that he -felt what the doctor had done, nor discovered any manner of uneasiness, by -stirring any part of his body, that the doctor could observe. - -"After all these experiments the doctor left him, being pretty well -satisfied that he was asleep, and no sullen counterfeit, as some people -supposed. On the doctor's relating what he had observed, several gentlemen -from Bath went out to see him, and found him in the same condition the -doctor had left him in the day before, only his nose was inflamed and very -much swelled, and his lips and the inside of his nostrils were blistered -and scabby, occasioned by the spirits and the hellebore. About ten days -after the doctor had seen him, Mr. Woolner, an apothecary, finding his -pulse beat very high, drew about fourteen ounces of blood from the arm, -and tied it up, and left it as he found him; and Mr. Woolner assured the -doctor that he never made the least motion when he pricked him, nor all -the while his arm was bleeding. Several other experiments were tried by -those who went to see him from Bath, but all to no purpose. The doctor saw -him again the latter end of September, and found him just in the same -position, lying in his bed, but his pulse now was not so strong, nor had -he any sweats, as when the doctor saw him before. He tried him again by -stopping his nose and mouth, but to no purpose; and a gentleman ran a -large pin into his arm to the very bone, but he gave no signs of his being -sensible to what was done to him. During all this time the doctor was -assured that nobody had seen him either eat or drink, though they watched -him as closely as possible,--but food and drink always stood by him, and -they observed that sometimes once a day, and sometimes once in two days, -all was gone. It was further observed that he never dirtied his bed, but -always went to the pot. In this manner he lay till the 19th of November, -when his mother, hearing him make a noise, immediately ran up to him and -found him eating. She asked him how he did. He replied, 'Very well, thank -God.' She asked him again which he liked best, bread and butter, or bread -and cheese. He answered, 'Bread and cheese.' Upon this the woman, -overjoyed, left him to acquaint his brother, and both coming straight up -into the chamber to speak to him, they found him as fast asleep as ever, -and could not by any means awake him. From this time to the end of -January, or beginning of February, he did not sleep so profoundly as -before; for, when they called him by his name, he seemed to hear them, and -became somewhat sensible, though he could not make them any answer. His -eyes were not shut so close, and he had frequently great tremblings of his -eyelids, upon which they expected every day that he would awake, which did -not happen till about the time mentioned, when he awoke perfectly well, -but remembered nothing that had happened all the while. It was observed -that he was very little altered in his flesh; he only complained that the -cold hindered him more than usual, but he presently went to his labor, as -he had done before." - -The case of Mary Lyall is quoted by Macnish, from the 8th volume of the -Transactions of the Royal Society of Edinburgh, as follows:[146] - -"This woman fell asleep on the morning of the 27th of June, and continued -in that state till the evening of the 30th of the same month, when she -awoke and remained in her usual way till the 1st of July, when she again -fell asleep, and continued so till the 8th of August. She was bled, -blistered, immersed in the hot and cold bath, and stimulated in almost -every possible way, without having any consciousness of what was going on. -For the first seven days she continued motionless, and exhibited no -inclination to eat. At the end of that time she began to move her left -hand, and, by pointing to her mouth, signified a wish for food. She took -readily what was given to her. Still she evinced no symptoms of hearing, -and made no other kind of bodily movement than of her left hand. Her right -hand and arm particularly appeared completely dead and bereft of feeling, -and even when pricked with a pin, so as to draw blood, never shrunk in the -least degree. At the same time she instantly drew back her left arm -whenever it was touched by the point of the pin. She continued to take -food whenever it was offered to her. For the first two weeks her pulse -generally stood at 50, during the third and fourth week about 60, and on -the day before her recovery at 70 or 72. Her breathing was soft and almost -imperceptible, but during the night-time she occasionally drew it more -strongly, like a person who has just fallen asleep. She evinced no symptom -of hearing till about four days before her recovery. On being -interrogated after this event upon her extraordinary state, she mentioned -that she had no knowledge of anything that had happened--that she had -never been conscious of either having needed or received food, or of -having been blistered; and expressed most surprise on finding her head -shaved. She had merely the idea of having passed a long night in sleep." - -Many other cases might be referred to; but as their general features are -similar to the two cited, it is unnecessary to quote them. The following -instance occurring in this country presents some features of interest. It -is reported by Dr. C. A. Hart,[147] of this city. - -"Miss Susan C. Godsy, aged 22, of bilious temperament, has been in a -somnolent state since 1849, being then eight years of age. Up to within a -year of that period she had enjoyed excellent health, she being then -attacked with intermittent fever, in the treatment of which opium was -extensively used. This was erroneously supposed to have induced her -present condition. Soon after her recovery, excessive somnolency began to -develop itself, which in 1857 became more profound after an attack of -scarlatina anginosa, followed by measles. The lucid intervals will occur -from four to six times a day, and last for from five to six minutes; at -which periods she will generally take some nourishment, and then relapse -into a profound slumber, from which it is impossible to arouse her. - -"In point of general physique there is nothing specially worthy of note, -except the comparative plumpness during such a long maintenance of the -recumbent posture, with very little muscular exercise. She is about the -average height of her sex, with cranial development possibly a little in -excess. The hands and feet are both exceedingly small, the nails of which -have not grown any since her present condition began. - - * * * * * - -"The catamenia commenced between the fourteenth and fifteenth years, and -are generally very irregular and painful; but, when anything like -regularity is attained, the flow occurs about every six weeks. - - * * * * * - -"None of the special senses are in the least diminished or perverted; -there has been neither squinting nor excessive dilatation of the pupils. -The irides both respond readily to the stimulus of light. While -interrogating the mother, a convulsive movement of the entire body took -place, apparently more violent in the upper than in the lower extremities. -The arms, hands, and feet were in rapid motion. At the subsidence of this, -consciousness was established; and the young lady herself, being -questioned about her condition, replied in a clear and comprehensible -manner, though merely using monosyllables. When asked if she suffered any -pain in her head, she replied yes, but without locating it; if in the -back, yes; if about the chest or abdomen, no. She was lucid about five -minutes, during which time a number of questions were asked her, but -without eliciting any further information. She took no food or medicine -during this interval of consciousness, and went to sleep while being -questioned, remaining in that state during the rest of the time we were -there--about half an hour--her rest being perfectly tranquil with the -exception of a slight convulsive movement." - -These cases of protracted sleep present many analogies with the condition -of hibernation which certain of the lower animals enter into at stated -periods. Doubtless the state of the brain is the same, and is one of -anaemia. - -It has never been my fortune to witness a case of protracted sleep. -Regarding the starting-point of the disorder as being situated in the -sympathetic system, I should be disposed to employ the direct galvanic -current in the treatment--placing the positive pole over the sympathetic -nerve in the neck, and the negative over the opposite scapula. This I -would do, using a battery of thirty-two or a less number of pairs, every -day, for from five to ten minutes. - - - - -CHAPTER XII. - -SOMNOLENTIA, OR SLEEP DRUNKENNESS. - - -By somnolentia, or sleep drunkenness, is understood a condition in which -some of the mental faculties and senses are fully aroused, others -partially so, while others remain as they are in profound sleep. It is -therefore an imperfect sleep, or rather a combination of wakefulness and -sleep. The phenomena peculiar to it are frequently met with in children, -in whom they may be excited through the influence of a dream, but which at -other times have no such origin. The condition in question is only induced -by the sudden waking of a person. - -A very excellent account of sleep drunkenness, in its medico-legal -relations, is given by Wharton and Stille,[148] who have quoted several -interesting cases from German and other authors, which I do not hesitate -to transfer to these pages. - -"A sentry fell asleep during his watch, and, being suddenly aroused by the -officer in command, attacked the latter with his sword, and would have -killed him but for the interposition of the by-standers. The result of the -medical examination was, that the act was involuntary and irresponsible, -being the result of a violent confusion of mind consequent upon the sudden -waking from a profound sleep. - -"A day-laborer killed his wife with a wagon-tire, the blow being struck -immediately on his starting up from a deep sleep from which he was -forcibly awakened. In this case there was collateral evidence that the -defendant was seized, on awaking, with a delusion that a 'woman in white' -had snatched his wife from his side and was carrying her away, and that -his agony of mind was so great that his whole body was bathed in -perspiration. - -"A young man, named A. F., about twenty years of age, was living with his -parents in great apparent harmony, his father and himself being alike -distinguished for their great fondness for hunting. In consequence of -danger from nocturnal attacks, they were in the habit of taking their arms -with them into their chambers when they went to bed. On the afternoon of -September 1st, 1839, the father and son having just returned from hunting, -their danger became the subject of particular conversation. The next day -the hunting was repeated, and on their return, after taking supper with -every evidence of good feeling, they retired for the night, the son to his -own room, and his father and mother to theirs. Both father and son took -their loaded arms with them. At one o'clock the father got up to go into -the entry, and on his return jarred against the door, on which the son -instantly sprang up, seized his gun, and discharged it at his father, -giving him a fatal wound in the breast, at the same time exclaiming, 'Dog, -what do you want here?' The father immediately fell to the ground; and the -son, then recognizing him, sank on the floor, crying, 'Oh, Jesus! it is my -father!' - -"The evidence was that the whole family were subject to great restlessness -in their sleep, and that the defendant in particular was affected with a -tendency to be easily distressed by dreams, which lasted for about five -minutes, on waking, before their effect was entirely dissipated. His own -version of the affair was: 'I must have fired the gun in my sleep; it was -moonshine, and we were accustomed to talk and walk in our sleep. I -recollect hearing something jar; I jumped up, seized my gun, and fired -when I heard the noise; I recollect seeing nothing, nor am I conscious of -having spoken. The night was so bright that everything could have been -seen. I must have been under the delusion that thieves had broken in.' The -opinion of the medical experts was, that the act was committed during the -condition of sleep drunkenness, and that, accordingly, it was not that of -a free and responsible agent." - -The same authors quote the following case of Dr. Meister, from Herke's -Zeitschrift: - -"I was obliged," says the doctor, "to take a journey of eight miles on a -very hot summer's day--my seat being with my back to the horses, and the -sun directly in my face. On reaching the place of destination, and being -very weary and with a slight headache, I laid myself down, with my clothes -on, on a couch. I fell at once asleep, my head having slipped under the -back of the settee. My sleep was deep, and, as far as I can recollect, -without dreams. When it became dark, the lady of the house came with a -light into the room. I suddenly awoke, but, for the first time in my life, -without collecting myself. I was seized with a sudden agony of mind, and, -picturing the object which was entering the house as a specter, I sprang -up and seized a stool, which, in my terror, I would have thrown at the -supposed shade. Fortunately I was recalled to consciousness by the -firmness and tact of the lady herself, who, with the greatest presence of -mind, succeeded in composing my attention until I was entirely awakened." - -Hoffbauer[149] relates the particulars of a case which has passed into the -annals of medical jurisprudence as one of great importance. - -"Bernard Schidmaizig awoke suddenly at midnight. At the same moment he saw -a frightful phantom (at least so his imagination depicted it) standing -near him. That which appeared to his vision seemed to be a veritable -specter; and fear and the darkness of the night prevented him recognizing -anything with distinctness. With a feeble voice, he twice called out, 'Who -goes there?' He received no answer, and imagined that the apparition was -approaching him. Deprived for the instant of his reason, he jumped from -his bed, seized a hatchet which he generally kept near him, and with this -weapon attacked the imaginary specter. To see this apparition, to cry, -'Who goes there?' to seize the hatchet, were all done in a moment: he had -not an instant for reflection. At the first blow the phantom was struck to -the earth; Schidmaizig heard a deep groan. This sound, and the noise of -the imaginary phantom falling to the ground, fully awakened him; and -suddenly the thought struck him that he had assaulted his wife, who slept -with him. He threw himself on his knees, raised the head of the wounded -person, saw the injury he had inflicted, and the blood which flowed, and -with a voice full of anguish cried, 'Susannah! Susannah! come to -yourself!' He then called his eldest daughter, aged about eight -years--ordered her to see if her mother was recovering, and to tell her -grandmother what he had done. It was in reality his wife; and she died the -next day from the effects of the blow." - -As Hoffbauer remarks, "This man did not enjoy the free use of his senses; -he did not know what he saw; he believed that he was repulsing a sudden -attack. He very soon recognized the place where he ordinarily slept; it -was natural that he should seize his hatchet,--since he had taken the -precaution to place it near him,--but the idea of his wife, and of the -possibility of having killed her, were the last thoughts that entered his -mind." - -Seafield[150] quotes from the Express (London) of January 5th, 1859, the -following case of sleep drunkenness: - -"Yesterday the Marylebone Police Court was crowded to excess, in -consequence of a report which had been circulated, that a woman was in -custody for killing her child by throwing it from a first-floor window -into the street. The rumor in regard to the murder happily turned out to -be untrue; but it will be seen from the subjoined evidence that it was a -providential circumstance that the lives of three children were not -sacrificed by their mother while acting under the influence of a dream. - -"At two o'clock the prisoner, Esther Griggs, was placed at the bar before -Mr. Broughton. - -"Mr. Lewis, of Ely Place, appeared for her; and Mr. Tubbs, relieving -officer of Marylebone, attended on behalf of the board of guardians of the -parish, to watch the case. - -"The prisoner, who evidently felt the serious situation in which she was -placed, was seated during the proceedings. - -"The first witness called was Sergeant Simmons, 20 D, who said, 'At -half-past one o'clock this morning, while on duty in East Street, -Manchester Square, I heard a female voice exclaim, "Oh, my children! Save -my children!" I went to the house, No. 71, from whence the cries -proceeded, and the landlord opened the door. I went up-stairs, accompanied -by two other constables, and, while making our way to the first floor, I -heard the smashing of glass. I knocked at the door, which I found was -fastened, and said, "Open it; the police are here." The prisoner, who was -in her night-dress, kept on exclaiming, "Save my children!" and at length, -after stumbling over something, let me and my brother officers in. When we -entered, we found the room in total darkness; and it was only by the aid -of our lanterns that we could distinguish anything in the room. On the bed -there was a child five years old, and another, three years of age, by her -side. Everything in the room was in confusion. She kept crying out, -"Where's my baby? Have they caught it? I must have thrown it out of the -window." The baby must have been thrown out as I was going up-stairs; for -before getting into the room I heard something fall. I left a constable in -charge of the prisoner; and I ascertained that the child which had been -thrown from the window had been taken to the infirmary of Marylebone -Workhouse. She told me she had been dreaming that her little boy had said -that the house was on fire, and that what she had done was with the view -of preventing her children from being burned to death. I have no doubt,' -added the witness, 'that if I and the other constable had not gone to the -room all three of the children would have been thrown into the street.' - -"Mr. Broughton.--'How long do you suppose the cry of "Oh, save my -children!" continued?' - -"Witness.--'I should think about five minutes.' (In continuation, he said -he went to 38 Harley Street, where the husband lives, in the service of a -gentleman, and gave him information of what had occurred. The injured -infant was only eighteen months old.) - -"By Mr. Lewis.--'From the excited state in which the prisoner was, I did -not at the time take her into custody. She went to the infirmary along -with her husband, to see how the child was going on, and what hurt it had -sustained. I had understood that the surgeon had said it was a species of -nightmare which the prisoner was laboring under when the act was -committed. The window had not been thrown up. The child was thrust through -a pane of glass, the fragments of which fell into the street.' - -"Humphreys, 180 D.--'I heard the breaking of glass, and saw what I -imagined to be a bundle come out of the window, and, on taking it up, I -found it to be a female infant. There was blood running from its temples, -and it was insensible. I took it to the infirmary.' - -"Pollard, 314 D.--'I heard loud cries of "Oh, save my children!" and when -I was in her room she said, "Has anybody caught my baby Lizzie?" One of -the little boys, about three years old, and who was clinging to his -mother, had blood upon his clothes. He had upon his breast some marks, -which appeared to have been caused by cuts from glass. He left me to take -care of the prisoner while he went for her husband. She told me she had no -wish to hurt any of her children, and that it was all through a dream.' - -"Mr. Henry Tyrwhitt Smith, surgeon of the Marylebone Infirmary, was next -called, and said, 'That when the infant was brought to him, soon after one -in the morning, he found, upon examining it, that it was suffering from -concussion of the brain. It was quite insensible, and decidedly in danger -now. The parietal bone is broken, and death might ensue in the event of an -effusion of blood on the brain.' - -"By Mr. Lewis.--'I cannot say that I have not heard of an instance where -parties have committed acts to which a dream had impelled them.' - -"Mr. Lewis submitted to the magistrate that there had been no attempt to -murder the infant. The prisoner had always evinced a kindly feeling toward -her children, and he (the learned gentleman) hoped that the magistrate -would allow the husband to have her under his care during the temporary -remand which would of course take place. The dream under which the act -was committed showed that she had not, at the time, any consciousness of -what she was doing. - -"Mr. Tubbs said he did not attend in the capacity of a prosecutor, but he -appeared on behalf of the board of guardians; and he put it to the -magistrate whether there would be any objections, under the circumstances, -to allow the prisoner to be bailed, her husband being security for her -reappearance. - -"Mr. Broughton _considered that it would be a most dangerous doctrine to -lay down, to say that because a person was dreaming while committing an -offense, that they were not culpable for their acts_. A woman, on these -grounds, might get up in the middle of the night and cut her husband's -throat, and, when brought up for the offense, turn round and say that she -had done the act while under the influence of a dream. He (the worthy -magistrate) considered the case to be one of a serious nature; and in the -event of death ensuing, an inquest would be held on the body. He could not -think of taking bail in so serious a case, but would remand the prisoner -till Tuesday next, and during her present excited state she would be taken -care of in the infirmary. - -"The prisoner was then removed to the cells by Ansted, the jailer, sobbing -most bitterly. - -"The recorder, at the subsequent sessions at the Central Criminal Court, -in his address to the grand jury, took a somewhat more rational view of -the case than that entertained by Mr. Broughton. - -"'If the prisoner,' said the recorder, 'really did the act under the idea -that it was the best mode of insuring the safety of the child, it appeared -to him that, under such circumstances, it would be a question whether the -grand jury would be justified in coming to the conclusion that the -criminal was guilty of a criminal act.' - -"The grand jury threw out the bill." - -Several cases of sleep drunkenness have come under my own notice. - -A gentleman was roused one night by his wife, who heard the street-door -bell ring. He got up, and, without paying attention to what she said, -dragged the sheets off of the bed, tore them hurriedly into strips, and -proceeded to tie the pieces together. She finally succeeded in bringing -him to himself, when he said he thought the house was on fire, and he was -providing means for their escape. He did not recollect having had any -dream of the kind, but was under the impression that the idea had occurred -to him at the instant of his awaking. - -Another was suddenly aroused from a sound sleep by the slamming of a -window shutter by the wind. He sprang instantly from his bed, and, seizing -a chair that was near, hurled it with all his strength against the window. -The noise of the breaking of glass fully awakened him. He explained that -he imagined some one was trying to get into the house and had let his -pistol fall on the floor, thereby producing the noise which had startled -him. - -A lady informed me that upon one occasion she had gone to bed very tired, -but was suddenly startled from her sleep by a voice calling her by name. -Without stopping a moment, she arose, put on her shoes and stockings, lit -a candle, took a loaded pistol from a shelf near her husband's head, -cocked it, and was leaving the room, the pistol in one hand and the candle -in the other, when she was seized by her husband. She turned, recognized -him at once, and would have fallen to the floor had he not caught her in -his arms. Her husband, who slept in the same bed with her, had heard one -of the children cry in an adjoining room, and had called her. She, hearing -his voice, had partially awakened, but had conceived the idea that he had -called to her from another part of the house, where some danger menaced -him. She had acted upon this supposition, and was perfectly conscious of -every movement she had made. - -It does not appear that some persons are more liable to attacks of sleep -drunkenness than others. Neither do I know of any means by which its -occurrence could be prevented. It is a natural phenomenon, to which all -are liable. It is more important in its medico-legal relations than any -other. - - - - -APPENDIX. - -ADDITIONAL OBSERVATIONS RELATIVE TO THE PHYSIOLOGY OF SLEEP.[151] - - -Since the chapter on the Physiology of Sleep was written, I have, by -additional experiments, satisfied myself that the theory then enunciated -is correct in every essential particular. - -By means of an instrument adapted to show the extent of cerebral pressure, -and which I first described nearly two years ago, I have been enabled to -arrive at very positive results. In every instance the pressure was -lessened during sleep and was increased during wakefulness. The -experiments were performed upon dogs and rabbits. Briefly, the instrument -consists of a brass tube, which is screwed into a round hole made in the -skull with a trephine. Both ends of this tube are open, but into the upper -is screwed another brass tube, the lower end of which is closed by a piece -of very thin sheet india-rubber, and the upper end with a brass cap, into -which is fastened a glass tube. This inner arrangement contains colored -water, and to the glass tube a scale is affixed. - -This second brass tube is screwed into the first, till the thin rubber -presses upon the dura mater and the level of the colored water stands at -0, which is in the middle of the scale. Now, when the animal goes to -sleep, the liquid falls in the tube, showing that the cerebral pressure -has been diminished,--an event which can only take place in consequence of -a reduction in the quantity of blood circulating through the brain. As -soon as the animal awakes, the liquid rises at once. Nothing can exceed -the conclusiveness of experiments of this character. No mere theorizing -can avail against them. - - - - -FOOTNOTES: - -[1] See the author's Treatise on Hygiene, page 92. - -[2] La Theorie des Songes. Paris, 1766, p. 206. - -[3] On Obscure Diseases of the Brain, etc. London, 1860, p. 604, note. - -[4] Physiologie de la Pensee. Recherche Critique des Rapports du Corps a -l'Esprit. Deuxieme edition. Paris, 1862, t. ii. p. 440. - -[5] Du Sommeil, des Reves et du Somnambulisme, etc. Lyon, 1857, p. 14. - -[6] Observations in Medicine. Second Series, p. 27. - -[7] Art. _Sleep_. Cyclopedia of Anatomy and Physiology, vol. iv. part 1, -p. 681. - -[8] Chapters on Mental Physiology. London, 1852, p. 105. - -[9] Essays on Life, Sleep, Pain, etc. Philadelphia, 1852, pp. 63 and 64. - -[10] Epilepsy and Epileptiform Seizures. London, 1858, p. 123. - -[11] Nouveaux Elements de la Science de l'Homme. 3me edition. Paris, 1858, -vol. ii. p. 7, et seq. - -[12] Rapports du Physique et du Morale de l'Homme. Paris, 1824, p. 379. - -[13] The Physiology of Common Life. New York, 1860, vol. ii. p. 305. - -[14] Philosophy of Sleep. Second edition, 1850, p. 5. - -[15] The Haven of Health, chiefly made for the comfort of Students, and -consequently for all those that have a care for their health, etc. By -Thomas Cogan, Master of Arts and Batchelor of Physic. London, 1612, p. -332. - -[16] Sketches of the Philosophy of Life. London, 1819, p. 262. - -[17] Elements of Physiology. Translated by John Elliotson, M.D., etc. 4th -edition. London, 1828, p. 191. - -[18] Op. cit. p. 282, et seq. - -[19] Northern Journal of Medicine, No. 1, 1844, p. 34. - -[20] The Philosophy of Mystery. London, 1841, p. 283. - -[21] British and Foreign Medico-Chirurgical Review, Am. ed., April, 1855, -p. 404. - -[22] American Journal of the Medical Sciences, October, 1860, p. 399. - -[23] The Physiology of Sleep. By Arthur E. Durham. Guy's Hospital Reports, -3d Series, vol. vi. 1860, p. 149. - -[24] Recherches sur la Systeme Nerveux Cerebro-Spinal, sa Structure, ses -Fonctions et ses Maladies. Paris, 1865, p. 448. - -[25] Cyclopedia of Practical Medicine, article _Cold_. - -[26] Cyclopedia of Anatomy and Physiology, vol. iv., part 1, p. 681, -article _Sleep_. - -[27] Essays on Life, Sleep, and Pain. Philadelphia, 1852, p. 87. - -[28] The Doctor, etc., edited by Rev. John Wood Warter. London. - -[29] Op. cit., p. 5. - -[30] Rapports du Physique et du Morale de l'Homme. Paris, 1825, tome ii. -p. 381. - -[31] Medicina Statica; or Rules of Health, etc. London, 1676, p. 106 et -seq. - -[32] Op. cit., p. 6. - -[33] Op. cit., tome ii. p. 385. - -[34] An Essay concerning Human Understanding. Book ii. sect. 17. - -[35] Encyclopedia Americana,--Philadelphia, 1832, vol. xii. p. 143, art. -Tartini; and L'Imagination consideree dans ses Effets directs sur l'Homme -et les Animaux, etc. Par J. B. Demangeon. Seconde edition. Paris, 1829, p. -161. - -[36] The Soul and the Future Life. Appendix viii. Quoted by Seafield in -"The Literature and Curiosities of Dreams," etc. London, 1865. Vol. ii. p. -229. - -[37] Confessions of an English Opium-eater. Boston, 1866, p. 109. - -[38] Journal of Psychological Medicine and Mental Pathology. July, 1859, -p. 44. - -[39] Inquiries concerning the Intellectual Powers and the Investigation of -Truth. Tenth edition. London, 1840, p. 304. - -[40] History of Dreams, Visions, Apparitions, etc. Philadelphia, 1855, p. -184. - -[41] Macario, Du Sommeil, des Reves et du Somnambulisme. Paris, 1857, p. -59. - -[42] Op. cit., tome ii. p. 395. - -[43] Ancient Metaphysics. Quoted in Dr. Forbes Winslow's Medical Critic -and Psychological Journal. No. vi., April, 1862, p. 206. - -[44] Op. cit., p. 283. - -[45] Dream Thought and Dream Life. Medical Critic and Psychological -Journal, No. vi., April, 1862, p. 199. - -[46] Account of the Life and Writings of Thomas Reid, D.D., p. cxliv., -prefixed to Essays on the Powers of the Human Mind. By Thomas Reid, D.D., -etc. Edinburgh, 1803, vol. i. - -[47] Dissertations, Moral and Critical. London, 1783, art. Dreaming, p. -222. - -[48] Syntagma Philosophicum. Pars 71, Lib. viii. Opera Omnia, tome i. -Lugduni, 1658. - -[49] Philosophy of Mystery. London, 1841, p. 208. - -[50] Op. cit., p. 286. - -[51] Psychologie; oder der Wissenschaft von Subjectiven Geist. 2ten -Auflage. Ebberfeld, 1843, p. 144. - -[52] The Principles of Medical Psychology, etc. Sydenham Society -Translation, p. 167. - -[53] Elements of Physiology. Translated from the German, with Notes, by -William Baly, M.D., etc. London, 1842, vol. ii. p. 1417. - -[54] Op. cit., p. 1418. - -[55] Psychological Inquiries. Part i. London, 1856, p. 153. - -[56] Du Sommeil--Melanges Philosophiques. Seconde edition. Paris, 1838, p. -301. - -[57] Sleep Psychologically considered with reference to Sensation and -Memory. New York, 1850, p. 74. - -[58] An Inquiry into the Nature of Sleep and Death. London, 1834, p. 152. -(Reprinted from the Philosophical Transactions for 1833.) - -[59] Zoonomia; or, The Laws of Organic Life. Am. ed., vol. i. -Philadelphia, 1818, p. 153. - -[60] Elements of the Philosophy of the Human Mind. Am. ed. Boston, 1818, -vol. i. p. 184. - -[61] Op. cit., t. ii. p. 376, et seq. Article Du Sommeil en particulier. - -[62] An Essay Concerning Human Understanding, chapter xxi. section 30. - -[63] Essays on the Powers of the Human Mind, vol. iii. Edinburgh, 1803, p. -77. - -[64] Op. cit., p. 155. - -[65] An Essay Concerning the Human Understanding, book ii. section 17. - -[66] Op. et loc. cit., section 11. - -[67] Historia Naturalis, lib. x. cap. lxxv., "De Somno Animalium." - -[68] De defectu oraculorum. - -[69] De Vita, xii. Caesarum, Nero, cap. xlvi. - -[70] Op. cit., p. 63. - -[71] Lectures on Metaphysics, vol. i. p. 323. - -[72] Inquiries Concerning the Intellectual Powers and the Investigation of -Truth. Tenth edition. London, 1840, p. 283. - -[73] Op. cit., p. 10. - -[74] Quoted in Dendy's Philosophy of Mystery. London, 1841, p. 225. - -[75] The Principles of Medical Psychology, etc. Sydenham Society -Translation. London, 1847, p. 163. - -[76] Op. cit., book ii. sec. 17. - -[77] Cited by M. l'Abbe Richard in _La Theorie des Songes_. Paris, 1766, -p. 32. - -[78] De Rerum Natura, l. iv. v. 959. - -[79] Satyricon. Bohn's edition. London, 1854, p. 307. - -[80] In the above quotation I have slightly altered Kelly's version in -Bohn's edition of Petronius. The original Latin is fully as forcible and -true to nature as the translation. - -[81] Op. cit., p. 275, et seq. - -[82] Journal of Psychological Medicine. July, 1856. - -[83] Le Sommeil et les Reves; Etudes Psychologiques, etc. Troisieme -edition. Paris, 1865. - -[84] Sermon on the Office of the Holy Angels toward the Faithful, quoted -by Seafield. Op. cit., vol. i. p. 157. - -[85] Op. cit., p. 86. - -[86] Op. cit., p. 88, et seq. - -[87] On Obscure Diseases of the Brain and Disorders of the Mind, etc., -London, 1860, p. 611, et seq. - -[88] Anatomie Comparee du Systeme Nerveux, etc. Par MM. Leuret et -Gratiolet. Paris, 1839-1857, t. ii. 517, et seq. - -[89] Art. Reves, in Grand Dictionnaire de Medecine. - -[90] Des Maladies Mentales et des Asiles d'Alienes, etc., Paris, 1864, p. -221. - -[91] Traite des Maladies Mentales, Paris, 1860, p. 457. - -[92] On Obscure Diseases of the Brain and Disorders of the Mind, etc., -London, 1860, p. 614. - -[93] The Principles of Medical Psychology. Being the Outlines of a Course -of Lectures, by Baron Ernst von Feuchtersleben, M.D. Sydenham Society -Translation, p. 198. - -[94] Medical Press and Circular; also Quarterly Journal of Psychological -Medicine and Medical Jurisprudence, vol. i. p. 276. - -[95] Medical Investigator; also Quarterly Journal of Psychological -Medicine, etc., April, 1868, p. 405. - -[96] Op. cit., art. _Reves_. - -[97] Op. cit., p. 95. - -[98] Rapports du Physique et du Morale de l'Homme. Paris, 1824, tome -second, p. 359. - -[99] Chapters on Mental Physiology. London, 1852, p. 126. - -[100] B. D. S. Opera Posthuma, 1677, Epistola xxx. p. 471. In the course -of this letter to his friend, Peter Balling, Spinoza says: - -"Quum quodam mane, lucesente jam caelo, ex somnio gravissima evigilarem -imagines, quae mihi in somnio occurrerant, tam vivide ob oculos -versabantur, ac si res finissent verae, et praesertim cujusdam nigri et -scabiosi Brasiliani, quem nunquam antea videram. Haec imago partem maximam -disparebat, quando, ut me alia re oblectarem, oculus in librum, vel aliud -quid defigibam; quamprimium vero oculos a tali objecto rursus avertebam, -sine attentione in aliquid oculos defigendo, mihi eadem ejusdem AEthiopis -imago eadem vividetate, et per vices apparebat, donec paulatim circa caput -disparetet." - -[101] Elements of Physiology, translated by Baly, vol. ii. p. 1394. - -[102] Op. cit., p. 93. - -[103] [Greek: Peri ieres noso.] - -[104] Quoted from I. Franck by Macario, op. cit., p. 100. - -[105] De quelques Phenomenes du Sommeil. Oeuvres Complets, tome v. p. -170-175. - -[106] Grand Dictionnaire de Medecine, t. xxxiv., art. Incubi, par M. -Parent. - -[107] Nouveau Dictionnaire de Medecine et de Chirurgie Pratiques, tome -sixieme, Paris, 1867, art. Cauchemar. - -[108] Gazette Medicale de Lyon, 15 Mai, 1856; also Macario, op. cit., p. -104. - -[109] British and Foreign Medico-Chirurgical Review, April, 1845, vol. -xix. p. 441. - -[110] Traite du Somnambulisme et des differentes Modifications qu'il -presente. Paris, 1823. - -[111] Op. cit., p. 117. - -[112] Op. cit., p. 2. - -[113] Quoted by Bertrand, op. cit., p. 15. - -[114] Cyclopaedia of Practical Medicine. American edition, vol. iv. p. 196, -article Somnambulism. - -[115] Della Forza della Fantasia Umana. Venezia, 1766. - -[116] Op. cit., p. 127. - -[117] Article Somnambulism, in the Cyclopaedia of Practical Medicine, vol. -iv. p 198, American edition. - -[118] Bertrand, op. cit., p. 17. - -[119] Op. cit., p. 18. - -[120] Op. cit., p. 132. - -[121] The Scenery and Poetry of the English Lakes. By Charles Mackay, -LL.D. - -[122] Life of Sir Isaac Newton. By Sir David Brewster, vol ii. p. 240. - -[123] On Obscure Diseases of the Brain, etc. London, 1860, p. 609. - -[124] Sur l'Influence Pathologique de l'Insomnie. Annales -Medico-Psychologiques, 3me Serie, t. iii. p. 384, et seq. - -[125] Le Sommeil et les Reves. 3me ed. Paris, 1865, p. 9. - -[126] Mental Hygiene. Boston, 1863, p. 97. - -[127] A Manual of Psychological Medicine, etc. London, 1858, p. 375. - -[128] Psychological Inquiries. Third edition, London, 1856, p. 141. - -[129] Op. cit. p. 142. - -[130] On Obscure Diseases of the Brain, etc. By Forbes Winslow, M.D. -London, 1860, p. 604. - -[131] Medical Logic, p. 81, quoted in Cyclopedia of Anatomy and -Physiology, vol iv. part i. p. 686. - -[132] Clinical Observations on Functional Nervous Disorders. London, 1864, -p. 284. - -[133] A History of Dreams, Visions, Apparitions, etc. American edition. -Philadelphia, 1855. - -[134] The Philosophy of Mystery. By Walter Cooper Dendy. London, 1841, -page 290. - -[135] It is perhaps scarcely necessary to call attention to the fact that -Mr. Dendy has altogether mistaken the signification of the words in the -above quotation from Tissot, printed in italics. He appears to think they -mean _being put on his head_, a translation which would make very great -nonsense out of the whole extract. The words will be found in Tissot's -_Avis aux Gens de Lettres et aux Personnes sedentaires sur leur Sante_, -Paris, 1768, p. 28, and in English, in a translation entitled "_A Treatise -on the Diseases of Literary and Sedentary Persons_," Edinburgh, 1772, p. -26. The work is well worthy of attention even at this day, as containing -many most interesting facts and important suggestions. - -[136] On Obscure Diseases of the Brain, etc., p. 607. - -[137] The word _assassin_ is derived from the word _hashish_, from the -fact that a sect in the East called _Assassins_ made use of _hashish_ to -induce the temporary insanity during which their crimes were perpetrated. -See _History of the Assassins_, by the Chevalier Joseph von Hammer, -translated from the German by O. C. Wood, M.D., London, 1835, p. 233, -note. - -[138] Physiological Memoirs, 1863, p. 24, _et seq._ - -[139] On Functional Nervous Disorders. London, 1864, p. 282. - -[140] Cyclopedia of Practical Medicine, vol. iv., art. Wakefulness. - -[141] Therapeutics and Materia Medica, 2d edition, Philadelphia, 1864, -vol. ii. page 659. - -[142] The instance alluded to, that of Admiral Fitzroy, is thus commented -upon by the _Spectator_ of May 6th, 1865: - -"Admiral Fitzroy, the well-known meteorologist, committed suicide on -Monday morning at his own house. He had overworked himself of late; found -that he was losing his memory; became sleepless, and resorted to opium to -obtain ease, which aggravated his symptoms. His doctor had warned him that -he ran great risk of paralysis, but from a false tenderness did not at -once compel him to give up labor." - -The _London Review_ of the same date says: "He (Admiral Fitzroy) acquired -that terrible inability to sleep, which is one of the most dreadful of -those means by which nature avenges the abuse of the mental powers, and he -was forced to take opium at night; at one time to an extent which -threatened serious consequences." - -[143] Journal of an African Cruiser, quoted in Curiosities of Modern -Travel, London, 1846, p. 239. - -[144] Gazette des Hopitaux, Oct. 13, 1868. - -[145] Wonders of the Little World, etc., London, 1806, vol. ii. p. 394; -quoted from Universal Magazine, vol. viii. p. 312. - -[146] Op. cit. - -[147] New York Medical Journal, December, 1867. - -[148] A Treatise on Medical Jurisprudence, Philadelphia, 1855, p. 120. - -[149] Medecine legale relative aux Alienes et aux Sourds-Muets, ou les -Lois appliquees aux Desordres de l'Intelligence. Traduit de l'Allemande -par A. M. Chambeyron, avec des Notes par MM. Esquirol et Itard. Paris, -1827, p. 256. - -[150] The Literature and Curiosities of Dreams, etc., London, 1865, vol. -ii. p. 332. - -[151] See New York Medical Gazette and Quarterly Journal of Psychological -Medicine and Medical Jurisprudence, January, 1869, p. 47. - - - - -Transcriber's Notes: - -Passages in italics are indicated by _italics_. - -The original text includes Greek characters that have been replaced with -transliterations in this text version. - - - - - - -End of Project Gutenberg's Sleep and Its Derangements, by William A. 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