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   INSOMNIA;
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-Project Gutenberg's Insomnia; and Other Disorders of Sleep, by Henry M. Lyman
-
-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
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-
-
-Title: Insomnia; and Other Disorders of Sleep
-
-Author: Henry M. Lyman
-
-Release Date: August 7, 2013 [EBook #43415]
-
-Language: English
-
-Character set encoding: ISO-8859-1
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-*** START OF THIS PROJECT GUTENBERG EBOOK INSOMNIA, OTHER DISORDERS OF SLEEP ***
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-
-  INSOMNIA;
-  AND OTHER
-  DISORDERS OF SLEEP.
-
-
-  BY HENRY M. LYMAN, A.M., M.D.,
-  Professor of Physiology, and of Diseases
-  of the Nervous System, in Rush Medical
-  College; Professor of Theory and Practice
-  of Medicine, in the Woman's Medical
-  College; and Physician to the Presbyterian
-  Hospital, Chicago, Ill.
-
-
-  CHICAGO:
-  W. T. KEENER,
-  96 WASHINGTON STREET.
-  1885.
-
-
-
-
-COPYRIGHT, 1885.
-
-R. R. DONNELLEY & SONS, PRINTERS, CHICAGO.
-
-
-
-
-PREFACE.
-
-  Tired Nature's sweet restorer, balmy sleep.
-                                      --YOUNG.
-
-
-The regularly recurring incidence of natural sleep forms one of the most
-important subjects for physiological investigation. Were it an event of
-rare occurrence, it would excite a degree of astonishment and alarm equal
-to the agitation now experienced by the spectator of an ordinary attack of
-syncope or of epileptic convulsion. But, so completely does the recurrence
-of sleep harmonize with all the other facts of life that we are as
-indifferent to its nature as we are to every other healthy function of the
-body. It is only when the mind has undertaken a critical observation of
-the bodily and mental changes which accompany and condition the phenomenon
-that we begin to comprehend its wonderful character. Ushered in by a
-waning activity of body and mind that no effort of the will can long
-resist, nothing could more forcibly suggest the idea of approaching
-dissolution if, from the very earliest period of unconscious infancy, we
-had not been accustomed to the dominion of this imperious necessity. The
-remarkable likeness between the fading of consciousness in sleep and its
-extinction in death has, in all ages and among all people, arrested the
-attention of poets and philosophers of every degree.
-
-            Soft repose,
-  A living semblance of the grave,
-
-sang old Thomas Miller; and, describing, in Milton's stately verse, the
-close of his first day in the garden of Eden, Adam says:
-
-                    Gentle sleep
-  First found me, and with soft oppression seized
-  My drowsy sense, untroubled, though I thought
-  I then was passing to my former state
-  Insensible, and forthwith to dissolve.
-
-        How wonderful is death,
-        Death and his brother, Sleep!
-
-exclaims Shelley, echoing the marvellous strains that have come down to us
-from the days of Homer and Hesiod. In that venerable literature Sleep and
-Death are represented as twin brothers, sons of Night; dwelling in the
-lower world of spirits, whence they come forth to perform the will of the
-Olympian Gods.
-
-The prosaic genius of our scientific generation no longer tolerates such
-lively exercise of the imagination. The splendid anthropomorphism of the
-Hebrew poet, looking out upon the silent night, and cheering his soul with
-the sonorous exclamation,
-
-  Behold, he that keepeth Israel
-  Shall neither slumber nor sleep
-
-    *       *       *       *
-
-  For so he giveth his beloved sleep,
-
-has become a mere memory of childhood. Wordsworth understood the full
-significance of this change when he wrote:
-
-  There was a time when meadow, grove, and stream,
-  The earth, and every common sight,
-          To me did seem
-      Apparelled in celestial light,
-  The glory and the freshness of a dream.
-  It is not now as it has been of yore;
-          Turn whereso'er I may,
-              By night or day,
-  The things which I have seen I now can see no more!
-      ... I know, where'er I go,
-  That there has passed away a glory from the earth.
-
-If, however, despite the loss of much that was beautiful and attractive in
-the myths of antiquity, we take advantage of the
-
-  Years that bring the philosophic mind,
-
-we shall surely find in the scientific investigation of sleep enough to
-awaken "thoughts too deep for" words.
-
-
-
-
-CONTENTS.
-
-
-  CHAPTER I. THE NATURE AND CAUSE OF SLEEP.
-
-    Definition of sleep--The invasion of sleep--The hypnagogic
-    state--Depth and duration of sleep--Diagrammatic
-    illustration of the phases of sleep--Modifications of
-    physiological functions produced by sleep--Effect of sleep
-    upon the processes of respiration, circulation,
-    calorification, secretion, and nutrition--Consequences of
-    the progressive invasion of the nervous system by sleep--
-    Effect upon the organs of special sense--Effects observed
-    in the muscular apparatus of the body--Condition of
-    intellectual functions during the invasion of sleep--Does
-    the mind ever sleep?--Arguments adduced by Sir William
-    Hamilton and others to prove the continued activity of the
-    mind during the sleep of the brain--Reasons for supposing
-    that the mind may sleep--Variability of the depth of
-    sleep--Experiments of Kohlshüter to estimate the degree of
-    variation--Alternation of day and night considered as a
-    cause of sleep--Diminution of sensation a cause of sleep--
-    Illustrative observation by Strümpell--Fatigue a cause of
-    sleep--Hypothesis of Obersteiner regarding the cause of
-    sleep--Hypothesis of Pflüger--Production of artificial
-    sleep by impregnation of the brain with narcotic
-    substances--Analogous production of natural sleep by
-    accumulation of cerebral waste-products--Observations
-    regarding the duration of sensory impressions requisite for
-    the excitement of conscious perception--Difference between
-    syncope and sleep--Observations of Mosso regarding the
-    state of the cerebral circulation during sleep--Cause of
-    the change in the cerebral circulation during sleep--
-    Molecular conditions necessary for the production of
-    sleep--Somnolence--Sleeping Dropsy, or Maladie du Sommeil--
-    Coma--Lethargy--Apparent death--Lucid lethargy.                      1
-
-
-  CHAPTER II. INSOMNIA, OR WAKEFULNESS.
-
-    Causes of insomnia--Affections of the organs of special
-    sense--Effects of light--Effect of sound--Impressions upon
-    the organs of smell and taste--Disturbances caused by a
-    high temperature--Atmospheric and electrical disturbances--
-    Effects produced by cold--Hibernation of animals--
-    Disturbances of sleep occasioned by painful sensations--
-    Disorders of the sympathetic nerves--Morbid states of the
-    central nervous organs--Disorders of circulation and
-    nutrition--Hyperæmia of the brain--Anæmia and starvation of
-    the brain--Effects of tea and coffee--Effect of alcohol--
-    Inflammations, degenerations, and tumors affecting the
-    brain--Excitement of the brain by diseased conditions of
-    the blood.                                                          38
-
-
-  CHAPTER III. REMEDIES FOR INSOMNIA.
-
-    Serious consequences of insomnia--Its relation to cerebral
-    diseases--Treatment of insomnia by moderation and control
-    of the cerebral circulation--Remedial agents--Nervous
-    stimulants and nervous sedatives--Heat--Baths--Massage--
-    Electricity--Counter-irritants--Food--Digitalis--Camphor--
-    Musk--Valerian--Cannabis indica--Belladonna--Hyoscyamus--
-    Stramonium--Phosphorus--Acids--Opium--Cold--Alcohol--
-    Paraldehyde--Ether--Chloroform--Chloral--Butylchloral
-    hydrate--Amyl nitrite--Opium and opiates--Bromides--Hops--
-    Gelsemium--Conium.                                                  56
-
-
-  CHAPTER IV. TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.
-
-    Insomnia in acute affections of the brain--In insanity--In
-    chronic alcoholism and delirium tremens--In diseases of the
-    heart and blood-vessels--In angina pectoris--In diseases of
-    the respiratory organs--In asthma--In renal diseases--In
-    diseases of the liver--In gastro-intestinal diseases--In
-    febrile conditions--In rheumatism and gout--In lithæmia--In
-    syphilis--In disorders of nutrition--During pregnancy and
-    after parturition--In spasmodic diseases--In childhood--In
-    old age.                                                            92
-
-
-  CHAPTER V. DREAMS.
-
-    Physiology of perception and of dreaming--Definition of the
-    act of dreaming--Revery--Production of illusions and
-    hallucinations by drugs and by disease--Effects of
-    hasheesh--Effects of acute disease--Association of ideas--
-    Memory of past sensations--Dreams produced by excitement of
-    the different organs of sense--Persistence of
-    dream-impressions after waking--Experience of M.
-    Baillarger--Of Professor Jessen--Belief of savages in the
-    reality of dreams--Sensory dreams--Intellectual dreams--
-    Repetition of dreams--Incoherence of dreams--Cause of the
-    superior vividness of certain dreams--Duration of dreams--
-    Dreams excited by morbid states of the body--Prophetic
-    dreams--Their causes--Clairvoyant dreams--Hallucinatory
-    dreams--Sir Edmund Hornby's experience--Hallucinations--
-    Case related by Dr. E. H. Clarke--Revelation through
-    dreams--Revival of memory in dreams.                               116
-
-
-  CHAPTER VI. SOMNAMBULISM.
-
-    Causes of somnambulism--Physiology of somnambulism--
-    Varieties of the disorder--Maury's classification--
-    Classification of Ball and Chambard--Diagrammatic
-    representation of their classification--Somnambulic
-    lethargy--Illustrative cases--Somnambulic dreams--Night
-    terrors--Somnolentia or sleep-drunkenness--Sleep-walking--
-    Illustrative cases--Condition of the special senses in
-    somnambulism--Relation of memory to the somnambulic
-    paroxysm--Illustrative cases--Occasional recollection of
-    incidents connected with the somnambulic dream--
-    Resemblances between the somnambulic state and the
-    condition of post-epileptic mania--Somnambulic visions--J.
-    P. Frank's case--Mesnet's case--Somnambulic life--Its
-    likeness with the double-consciousness of certain forms of
-    epilepsy--Illustrative cases--General theory of
-    somnambulism.                                                      166
-
-
-  CHAPTER VII. ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.
-
-    Antiquity of the phenomena of hypnotism--Modern
-    observations--Physical conditions favorable to the
-    phenomena--Methods of inducing the hypnotic state--Duration
-    of hypnotic sleep--Rudimentary states of hypnotism--
-    Investigations of the Society for Psychical Research--
-    Mind-reading--Physiological explanation of the process--
-    Charcot's observations on artificial somnambulism--
-    Cataleptic variety of the hypnotic state--Lethargic
-    variety--Somnambulic variety--Hypnotic clairvoyance--
-    Exalted sensibility of the brain in hypnotic states--
-    Susceptibility to suggestions from without--Phenomena of
-    so-called spiritualism--Table-rapping--Planchette--
-    Therapeutical employment of hypnotism--Metaphysical healing.       212
-
-
-
-
-CHAPTER I.
-
-THE NATURE AND CAUSE OF SLEEP.
-
-  Worn out, friend, is every theory,
-  But green the golden tree of life.
-                              --GOETHE.
-
-
-Natural sleep is that condition of physiological repose in which the
-molecular movements of the brain are no longer fully and clearly projected
-upon the field of consciousness. This condition is universally observed in
-all healthy animals; and its recurrence is intimately associated with the
-diurnal revolution of the earth, and the succession of day and night. The
-disappearance of daylight is, for the majority of living creatures, the
-signal for cessation of active life. Though its onset may be for a time
-delayed by an effort of the will, the need of rest at length overcomes all
-opposition, and the most untoward circumstances cannot then prevent the
-access of unconsciousness. The story of the sailor-boy, sleeping on "the
-high and giddy mast," is familiar to every one. An officer in the United
-States Navy has assured me of more than one instance in which men had
-fallen asleep under his own eyes, oppressed by exhaustion, during the roar
-of a long continued bombardment. Thus produced, the relation of cause and
-effect between weariness and sleep becomes very apparent. The refreshing
-influence of such repose points clearly to the restorative character of
-the physiological processes which persist during the suspension of
-consciousness. It also renders evident the final cause of that periodical
-interruption of activity which the brain experiences in common with every
-other living structure.
-
-Sleep is usually preceded for some time by a feeling of sleepiness. This
-sensation, like the analogous sensations of hunger and thirst, represents
-in some measure the progressive diminution of energy throughout the entire
-body; but it is chiefly expressive of the failure of cerebral energy. It
-produces a sense of general heaviness and intellectual dullness; the
-special senses become less alert, the eyelids droop, numerous groups of
-muscles experience the spasmodic contraction of yawning, the head drops
-forward and is recovered with a jerk, the limbs relax, and the whole body
-tends to assume a position convenient for repose. Every school-boy who has
-been compelled to pass an evening hour at a dull lecture, under the eye of
-a martinet monitor, will testify to the suffering which attends any
-unusual prolongation of this period. But, if the natural course of events
-be not obstructed, the stage of mere sleepiness is soon passed, and the
-introductory stage of sleep is entered. This is a state in which the
-individual is neither awake nor fully asleep. It is known as the
-hypnagogic state. During this period the phenomena of simple sleepiness
-become exaggerated to such a degree that the attitude of repose is assumed
-without effort if the body be permitted to follow the natural inclination
-of its different members. The eyes close, the other senses become
-inactive, though the sense of hearing is the most persistent. Released in
-considerable measure from the control of the brain, the reflex energy of
-the spinal cord is at first somewhat exalted. Witness the fibrillary
-twitching of the muscles, and the convulsive state, which may often be
-observed during the stage of somnolence after severe fatigue. The uneasy
-sleeper may even be roused to complete wakefulness by such involuntary
-movements. But, as sleep becomes more profound, the reflex functions of
-the cord are also weakened.[1] As the sensory organs retire from action,
-the intellectual faculties lose their equilibrium. First, the power of
-volition ceases. Then the logical association of ideas comes to an end.
-The reasoning faculty disappears, and judgment is suspended. We become,
-therefore, no longer capable of surprise or astonishment at the vagaries
-of memory and of imagination, the only faculties that remain in action. To
-their more or less unfettered activity we owe the presentation in
-consciousness of those disorderly pictures which, occurring in this stage
-of imperfect sleep, have been termed hypnagogic hallucinations.[2] During
-the early moments of this period an observant person may often retain a
-power of reasoning sufficient to remark the fact of dreaming, and this
-effort of attention may produce a partial awakening; but, usually, the
-subsidence of cerebral function is progressive and rapid. The fire of
-imagination fades, the field of consciousness becomes less and less
-vividly illuminated, the entire nervous apparatus yields to the advancing
-tide, and, finally, the dominion of sleep is fully confirmed. The sleeper
-knows nothing of the external world, and has lost all consciousness of his
-own existence. But the duration of profound repose is brief. From the end
-of the first hour the depth of sleep, at first, rapidly, then, more
-gradually, subsides. Dreams disturb its tranquility, mental activity
-increases, the power of volition revives, and, at the end of six or eight
-hours, the individual is once more awake. The subjoined diagram, borrowed
-from the Dictionaire Encyclopédique des Sciences Médicales, will
-facilitate the apprehension of these successive phases in the course of
-sleep:
-
-  +============================================================+
-  | Organic Life.                                              |
-  |    | Conscious Life.                                       |
-  |    |    | Imaginative Faculties.                           |
-  |    |    |    | Coördinative Faculties.                     |
-  |    |    |    |    | Special Sensation and Voluntary Motion.|
-  |----+----+----+----+----+-----------------------------------|
-  |XXXXXXXXXXXXXXXXXXXXXX  | Normal life.                      |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXX       |First stage of sleep--Hypnagogic   |
-  |                        |  hallucinations.                  |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXX            |Second stage of sleep--Dreaming.   |
-  |------------------------------------------------------------|
-  |XXXXXXX                 |Third stage of sleep.              |
-  |------------------------------------------------------------|
-  |XX                      |Profound sleep.                    |
-  |------------------------------------------------------------|
-  |XXXXXXX                 |First stage of waking.             |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXX            |Second stage of waking--Dreams.    |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXX       |Third stage of waking--Hypnagogic  |
-  |                        |  hallucinations.                  |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXXXXXXX  |Complete awakening.                |
-  +------------------------------------------------------------+
-
-It was formerly believed that during the time of sleep all the processes
-of assimilation and nutrition throughout the body are increased,--in
-short, that it is the season of repair for the waste of tissue incurred
-during the hours of wakeful activity. While it is true that in sleep the
-expenditure of force is greatly reduced, the more exact researches of
-modern physiologists indicate a universal reduction in the rate of all the
-vital processes. The final result, however, is a general renewal of
-energy, because the aggregate income of the tissues is greater than their
-outgo during the suspension of conscious activity. The following
-observations make very apparent the fact of a reduction of physiological
-activity:
-
-_Respiration._--The process of breathing is conducted with greater
-deliberation during the period of sleep. This reduction is one of the most
-notable of the circumstances that first attract the attention of the
-spectator who observes a sleeping person. The average number of
-respirations per minute, in an adult of twenty-five to thirty years of
-age, is sixteen. Quetelet remarked[3] that during sleep this number was
-diminished by about one-fourth. The same fact has been recorded by other
-observers.[4] Mosso has also noted the fact[5] that there is a change in
-the type of respiration, the movements during sleep become less
-diaphragmatic and more largely costal. He furthermore observed that during
-the waking period the act of inspiration consumed 8-12 of the complete
-respiratory phase, but during sleep it was prolonged till it occupied
-10-12 of the same cycle. The interval between the end of expiration and
-the commencement of inspiration was also obliterated by sleep.
-Notwithstanding this relative increase of inspiratory motion, the quantity
-of air that passes through the lungs is considerably reduced by reason of
-the diminished action of the diaphragm. A corresponding reduction of the
-gaseous exchanges between the blood and the external air has been
-determined by the experiments of Pettenkofer and Voit, Boussingault,
-Lewin, and other equally competent observers.[6]
-
-_Circulation._--During sleep the heart beats less frequently than during
-the waking hours. Though a portion of this delay must be attributed to the
-recumbent position, sleep does still further retard the movement of the
-heart. My own observations upon children in bed exhibit a difference of
-twelve to sixteen beats between the pulsations when awake and asleep.
-According to Trousseau[7] the average number of pulsations observed in a
-group of thirty children, varying in age from fifteen days to six months,
-was 140 when awake and 121 when asleep. In another group of twenty-nine
-children, between the ages of six months and twenty-one months, the
-average was 128 when awake and 112 when asleep. The observations of Hohl
-and Allix[8] indicate that among very young children the difference
-between the pulse of sleep and the pulse of wakefulness may equal forty
-beats. According to Guy (_loc. cit._) the pulse is more variable in the
-morning than during the afternoon or evening.
-
-_Temperature._--Aside from the almost hourly fluctuations of the bodily
-temperature, a noticeable sinking of the temperature-curve is observed
-during the hours of sleep. This alone is sufficient to indicate a
-diminished rate of combustion in the tissues. Boussingault found[9] that a
-dove which consumed 255 millegrammes of carbon every hour while awake,
-oxidized only 162 millegrammes when asleep. Scharling also observed that
-the quantities of carbon successively oxidized by the same man when asleep
-and awake bore to each other the ratio of 1:1.237. The observations of
-Demme[10] indicate that increase of bodily temperature during the hours of
-sleep must be considered as the result of pathological processes in the
-tissues. The observations of Allix (_loc. cit._), made upon sixteen
-children during the first twelve days after birth, showed an average fall
-of 0°.38 C. during the hours of sleep. Eight children, between five and
-sixteen months old, exhibited a similar depression of 0°.56 C.; while ten
-children, ranging in age from twenty months to four years of age, averaged
-0°.34 C. less when asleep than when awake.
-
-The well-known experiments of Chossat, who found that the temperature of
-pigeons was from 0°.70 C. to 0°.90 C. higher at noon than at midnight, may
-not be considered satisfactory evidence of the depressing influence of
-sleep, because it is true that the diurnal variations of temperature which
-are conditioned by the vital activities of every animal might be
-sufficient to account for these differences. The experiments of
-Horvath[11] are more convincing. This observer found that the marmots upon
-which he experimented were accustomed to sleep during the winter for about
-four days continuously, and would then remain awake for an equal length of
-time. "During the sleeping period they can be cooled down to such a degree
-that a thermometer introduced into the rectum to the depth of an inch and
-a half indicated only 3°F. above the freezing point. The temperature rose
-rapidly after the animal awoke, so that in the course of an hour it was
-3°F. higher; at the close of the second hour 9°F. higher, and at the end
-of the next half hour about 27°F. * * Neither respiration nor the muscular
-movements were correspondingly augmented." This observation clearly shows
-the powerful influence of cerebral activity upon the liberation of heat
-within the body.
-
-_Secretion._--The functions of the numerous glands throughout the body are
-diminished during sleep. The tears dry up, and the cornea receives less
-moisture. Hence the stickiness of the margins of the eyelids during the
-sleep of a patient suffering with conjunctivitis. He can open his eyes, on
-awaking, only after sufficient time has elapsed to revive the lachrymal
-flow. Exner[12] remarks the diminution of pathological secretion in nasal
-catarrh during the hours of sleep. The mouth in like manner ceases to
-receive its full quota of saliva, and its cavity quickly dries if the lips
-remain open. The secretions of the gastro-intestinal glands vary with the
-contents of the alimentary canal; but in general they are considerably
-diminished, and digestion is correspondingly retarded during the hours of
-sleep. The quantity of urine is lessened during sleep.[13] The elimination
-of urea and of other excrementitious matters is less during the night than
-by day.[14] Unless increased by disease, or by accidental circumstances
-connected with atmospheric temperature and unnecessary clothing, the
-perspiration is also diminished.
-
-_Nutrition._--All the molecular processes of nutrition are reduced by
-sleep. The lowering of the bodily temperature has been already indicated.
-The observations of Helmholtz[15] indicate that the actual liberation of
-heat in the tissues is but little more than one-third of the amount set
-free in an equal period of time during the waking hours. The numerous
-experiments[16] of Boussingault, Henneberg, Scharling, E. Smith,
-Liebermeister, Pettenkofer, Voit, and Lewin, clearly indicate the fact
-that during sleep less oxygen is absorbed, and less carbonic acid gas is
-discharged, by the tissues. Voit found that while, during the daytime, 435
-grammes of oxygen were taken in by a working man, only 326 grammes were
-needed by the same individual during the nocturnal half of the day.
-Artificial sleep occasioned by chloral hydrate produced a similar
-reduction in the consumption of oxygen and in the formation of carbonic
-acid gas. Under the influence of morphine the reduction of CO_{2.} reached
-27 per cent., and the diminution of oxygen amounted to 34 per cent. of the
-quantities furnished during wakeful activity. The comparatively small
-reduction (only 6 per cent.) in the decomposition of the nitrogenous
-elements of the body during the same period, exhibits the close relation
-between the metamorphosis of the non-nitrogenous elements of the tissues
-and the amount of bodily activity.
-
-The experiments of Pettenkofer and Voit, to which allusion has just been
-made, serve also to illustrate the fact that all tissue changes are
-increased by every excitement of the sensory organs of the body, but are
-diminished by the subsidence of peripheral irritations. Hence the
-importance of quiet and darkness when we seek to induce that state of the
-body in which molecular processes should reach their minimum. Since every
-act of perception is attended by an outburst of refuse matter from the
-nervous tissue, the quantity of such excrementitious discharge in any
-given period of time becomes in some sort a measure of the vital activity
-of the organism. Conclusive proof of the diminution of vital function
-during sleep is thus obtained.
-
-It must not, however, be inferred that the general reduction of
-tissue-change, which has thus been established, during the hours of sleep,
-is evidence of a universal and uniform reduction of function throughout
-the body. Sleep seldom falls at once with equal force upon every organ;
-its invasion is progressive. Consequently, certain structures may be fast
-asleep, while others are partly awake,--while still other portions of the
-organism may be in a condition of activity greatly in excess of their
-ordinary wakeful function. Upon this fact depend the phenomena of dreams
-and the various forms of somnambulism. The special senses are usually
-overcome by sleep before the muscular apparatus yields, and the
-cerebro-spinal nervous centres are the last of all to succumb. The eyes,
-for example, cease to see clearly before the eyelids droop, or the muscles
-of the neck give way in the act of nodding. The senses of touch and of
-taste fail next in order, as in the case of the infant gourmand, who may
-be seen falling asleep at supper,--his mouth yet filled with untasted
-sweets from the table before him. The sense of smell is more persistent,
-and its exercise is sometimes an obstacle to the invasion of sleep.
-Witness the effect of powerful odors upon certain persons. The perfume of
-flowering plants in the sleeping chamber is sometimes decidedly annoying
-on this account. A lady of my acquaintance was once awakened out of a
-sound sleep by the smell of tobacco smoke from the pipe of a thoughtless
-burglar who had quietly entered a distant apartment of the house. A sudden
-change of wind, deluging a city with the vapors of a glue-factory or
-rendering establishment, may in like manner disturb the slumbers of
-thousands of people.
-
-The sense of hearing seems to be the most persistent of all the special
-senses. It is not a very uncommon thing for persons to be awakened by the
-sound of their own snoring; or, if not actually aroused by the noise, to
-remain in a condition of repose which seems to be sustained and cheered by
-the regular rhythm of its own music. As a general rule, however, it is
-noteworthy that, when not wholly dormant, each sense finds its sphere of
-activity greatly narrowed by the fact of sleep. Consequently the range of
-perception, if not wholly obliterated, is greatly limited during the time
-of sleep.
-
-While it is true that sleep arrests the voluntary activities of the
-muscles, it is also a fact that all the muscles do not yield at once or in
-equal degree. The extensors of the neck, and the supporters of the spinal
-column, are the first to fail. The patient begins to nod, and is inclined
-to fall forward, before consciousness ceases. The muscles of respiration
-and of circulation continue to contract, though at a diminished rate. The
-vermicular movements of the intestinal coats persist, and in certain
-conditions of ill-health their exaggerated contractions may become a cause
-of imperfect repose. Reflex movements may always be excited during natural
-sleep. Tickling the sole of the foot will cause retraction of the limb;
-and before the complete establishment of sleep, a certain exaltation of
-the spinal reflexes may be observed. Young children may frequently be seen
-in the act of suction with their lips, as if at the breast; and the smile
-of the sleeping infant is a matter of daily remark in every nursery. The
-influence of dreams as an excitant of muscular movement will be hereafter
-discussed.
-
-The variation of intellectual function which appears in sleep serves to
-measure its profundity and to indicate the extent of its invasion. The act
-of perception being dependent upon sensation, it is to be observed that
-the range of perception diminishes so soon as the organs of sense begin
-to yield. Its intensity may not immediately fail, but the breadth of its
-scope is narrowed. Sometimes, however, the act of conscious perception is
-arrested before the organs of sense are sealed. The sleepy reader may
-continue to eye the page before him, perhaps even to read aloud for a
-considerable time after he has ceased to derive any meaning from the words
-of the book. In such cases the organs of perception and conception and
-association of ideas slumber before the bonds of connection between the
-will and the muscular organs have been completely relaxed. Such an example
-affords a valuable illustration of the division of the brain into separate
-mechanisms which, though most intimately related, are nevertheless
-partially independent of each other. Sleep may operate like an invasive
-disease, falling with unequal incidence upon the different structures that
-make up the mass of the brain, paralyzing one portion, while simply
-benumbing another, and even arousing to excessive activity a third.
-Consequently the intellectual functions may be very unequally disturbed,
-and the order of their subsidence may be considerably varied; but, as a
-general rule, the physiological relations of the faculties are respected,
-so that as sensation diminishes, perception fails, the conception of ideas
-is correspondingly hindered, and the association of such ideas as are
-still projected upon the field of consciousness becomes more imperfect.
-The loss of the power of association implies the destruction of memory and
-the impossibility of exercising the reasoning faculty or of forming those
-judgments upon which every act of volition is based. When the brain has
-at length been so far overwhelmed that physical impressions can no longer
-reach the field of consciousness, all manifestation of intellectual life
-is at an end, and the sleeper sleeps a dreamless sleep that leaves no
-trace behind.
-
-It is assumed in the last sentence that the brain may become so far
-transformed by sleep that it ceases for the time to be capable of function
-as the instrument of thought. This conclusion has been questioned by the
-very highest authorities. Sir William Hamilton, Exner, and many others
-have instituted numerous experiments to test the possibility of a
-dreamless sleep. Causing themselves to be suddenly aroused at all hours of
-the night, they invariably found themselves at the instant of awaking
-occupied with the course of a dream. Hence it has been inferred that the
-mind is always alert, even when the body is most thoroughly asleep. In
-explanation of the fact that consciousness contains after deep sleep no
-trace of such mental activity, it is claimed that the act of dreaming of
-which we are aware at the moment of waking is proof of intellectual
-function during the moments which preceded that incident, and that we are
-merely forgetful of all similar processes that occurred during undisturbed
-sleep. The unconsciousness of sleep, according to this theory, is not
-real--it is only apparent through failure of the memory. If this be true,
-memory is the only intellectual faculty of whose inaction we can be sure.
-The period of deep sleep might then be, for all we know to the contrary, a
-period of the most intense and exalted mental activity. But, if so, it is
-quite worthless as a constituent of our conscious existence. It may also
-be objected with equal reason that the dreams which unquestionably occupy
-the field of consciousness at the instant of waking are probably excited
-by the impressions which terminate sleep. The process of waking, though
-often very greatly hurried, is by no means absolutely instantaneous. As we
-shall learn, the time requisite for the evolution of a dream may be
-indefinitely brief. Consequently, it seems better in all such instances to
-assign the period of dreaming to the time of diminishing slumber that
-corresponds to the disturbance by which sleep was terminated.
-
-The only reason for any hesitation in the acceptance of such a proposition
-consists in the reluctance of many philosophers to admit the possibility
-of any interruption in the active life of a spiritual being, such as man
-is conceived to be. But it is difficult to comprehend any valid reason for
-the denial of such interruption. Every form of force, of which we have any
-knowledge, is subject to fluctuations in the course of its phenomenal
-manifestation. When a physical force ceases to exhibit itself in an active
-state, and passes into a potential modification, we are not compelled to
-regard it as extinguished. It is merely latent or inhibited, but always
-ready to take its place again among the kinetic forces of nature. In like
-manner there seems to be no good reason why that spiritual force or
-congeries of forces which constitutes the mind of man may not experience
-analogous transformations in successive periods of action and of repose.
-Such periods of rest occur in sleep, in coma, in disease and
-disorganization of the brain. The mind sleeps, it does not cease to
-exist--probably not even when death dissolves its material substratum.
-
-That the depth of sleep is exceedingly variable is evident in the
-experience of every one. A German physiologist[17] has made a rough
-estimate of the soundness of sleep by comparing the loudness of the noises
-necessary to wake the subject of experiment at regular intervals during
-the course of the night. He arranged a gong with a pendulum attachment,
-and noted the length of the stroke which produced a sound sufficiently
-loud to awaken the patient. In this way the different degrees of intensity
-of the awakening noise could be calculated, and the corresponding depth of
-sleep could be estimated. It was thus concluded that the depth of sleep
-increases rapidly during the first hour, at the end of which time it has
-reached its maximum. During the next half hour it diminishes as rapidly as
-it had increased in the first half hour. During the next hour it still
-further diminishes, almost as much as it increased during the second half
-hour. The remaining ten half hours of the experiment were occupied by a
-comparatively light and gradually diminishing slumber, until the vanishing
-point of sleep was reached at the expiration of eight hours from its
-commencement. This observation corresponds with the general opinion that
-sleep is deepest in the early part of the night. For the same reason
-dreams and wakefulness are most frequent during the early watches of the
-morning.
-
-When considering the causes of sleep it is needful to exclude from view
-those artificial varieties of sleep that are produced by the various
-narcotic drugs, as well as the counterfeits of sleep which result from
-diseased conditions of the body. It is comparatively easy to frame
-hypotheses in explanation of such interruptions of our conscious life;
-but, when we attempt to formulate a theory which shall satisfactorily
-account for the occurrence of natural sleep in healthy animals, the task
-becomes exceedingly difficult.
-
-First among the causes of sleep may be reckoned the alternation of day and
-night. With the disappearance of sunlight all nature sinks into a
-condition of repose.
-
-       "The night brings sleep
-        To the greenwoods deep,
-  To the bird of the woods its nest;
-        To care soft hours,
-        To life new powers,
-  To the sick and the weary--rest!"
-
-In this tendency to nightly inaction man shares with all other living
-creatures. His body thus testifies to the intimacy of its relations with
-all portions of the solar system. Originated in the tropical regions of
-the earth, where day and night are nearly equal, we find in all parts of
-the world the same hereditary need of a period of rest, nearly coincident
-with the duration of the shorter nights of the tropical year. Had the
-birth-place of primeval man been situated within the Arctic circle, it is
-probable that his hours of sleep might have differed considerably from
-the number now needed by the average individual. So powerful are the
-necessities thus dependent upon the harmony between our organization and
-the movements of the earth, that if the habit be formed of sleeping at
-other hours than those which are usually devoted to that purpose, the full
-complement of sleep is still needful to satisfy the demand for rest.
-
-Prominent among the causes which predispose to sleep at night is the
-cessation of a majority of the sensations that are continually pouring in
-upon the brain during the period of daylight. Hence the necessity for
-seclusion in darkened rooms, from which the noises of the daytime are shut
-out, if one would sleep during the long days of the arctic summer, or if
-one would enjoy a midday nap at any season of the year. The close
-dependence of wakefulness upon the constant activity of the organs of
-sensation, is well illustrated by a case related in Hermann's _Handbuch
-der Physiologie_, Vol. II, Part 2, p. 295. A young man had been reduced by
-disease to such a condition of general anæsthesia that the right eye and
-the left ear were the only remaining paths of sensation between his brain
-and the external world. Whenever the sound eye and ear were bandaged so as
-to cut off all communication with the brain, the patient invariably fell
-asleep in the course of two or three minutes after the interruption of
-sensation. In like manner, some people, even in perfect health, are able
-to sleep at any time by simply lying down and closing the eyes. Such
-persons, however, are not often very highly gifted in the intellectual
-sphere. They generally belong to a class of men whose lives are laborious
-and liable to great irregularity and fatigue. Such people labor in the
-open air, where every organ of sense is in a state of continual
-excitement. As soon, therefore, as they can find a quiet corner from which
-the commotion of the elements is excluded, it is only necessary to close
-the eyes--the principal avenue of communication with the outside
-world--and sleep begins at once. This is especially true if severe bodily
-exertion has preceded the opportunity for repose.
-
-Fatigue of any sort is one of the most energetic causes of sleep. The
-impossibility of long sustained exertion is a fact almost too familiar to
-attract attention. Every muscle must be suffered to rest for a time after
-contraction before it can be again contracted. Even the heart and the
-muscles of respiration must be allowed to enjoy regular periods of repose
-many times each minute. These are examples of local rest, not involving
-the entire body. But if the whole body participate in any violent action,
-every part will manifest a consequent disposition to rest. Witness the
-effects of the venereal act. Every muscle is relaxed; the brain, which has
-officiated as the supreme source of energy, experiences exhaustion, and
-sleep frequently terminates the voluptuous paroxysm. In like manner,
-sensations of severe pain, if sufficiently prolonged, become a cause of
-sleep. Prisoners upon the rack have slept through sheer exhaustion while
-undergoing the horrors of torture. Little children frequently fall into a
-deep sleep immediately after painful, though comparatively bloodless,
-surgical operations performed without anæsthetics. The depressing
-emotions, even, may so fatigue the brain as to induce sound sleep through
-reaction from previous excitement. Every wearied portion of the body must
-rest; and when the brain thus rests, sleep is the consequence.
-
-Impressed by the force of such considerations, certain physiologists[18]
-have reasoned from the analogies suggested by a study of the results of
-muscular fatigue, and have suggested an hypothesis accounting for the
-occurrence of sleep by a supposed loading of the cerebral tissues with the
-acid products of their own disassimilation during wakeful activity. The
-acid reaction of the brain and of the nerves after exertion, corresponding
-with the development of acids in the muscular tissues during contraction,
-suggested the probability that an excessive presence of lactic acid and
-its sodic compounds might be the real cause of cerebral torpor and sleep.
-Could this hypothesis be proved, ordinary sleep would take its place along
-with the states of unconsciousness induced by anæsthetics and hypnotics,
-and the lactate of sodium should be found the very best of medicines for
-the relief of wakefulness. Its administration for this purpose, however,
-has yielded only the most discordant and unsatisfactory results. The
-fatigue theory, moreover, is insufficient, since it furnishes no
-explanation of the invincible stupefaction produced by cold, nor does it
-render intelligible the unbroken sleep of the unborn child.
-
-Far more comprehensive is the hypothesis advanced by Pflüger.[19]
-According to this view, the state of wakefulness is maintained by a
-certain degree of activity in the cortical substance of the brain. Like
-all other bodily organs, this substance is renovated by the assimilation
-of nutrient materials derived from the blood. By this process oxygen is
-stored up in chemical combination, forming "explosive compounds," whose
-precise composition is not fully understood. When for any reason the
-supply of oxygen is insufficient, as in hemorrhage, producing cerebral
-anæmia, or in impregnation of the red blood corpuscles with carbonic oxide
-or chloroform, or other substances capable of excluding oxygen from the
-hemoglobin of the corpuscle, the cerebral tissues are imperfectly
-renovated. The explosive constituents of the cortical protoplasm are then
-inadequately renewed after mental activity, and the sensitive portions of
-the brain are no longer fitted to manifest the highest forms of
-intelligent activity. But, when nothing interferes with healthy nutrition,
-the requisite degree of instability in the protoplasm of the brain is
-effected by intussusception of oxygen. Under the influence of the various
-nervous impressions which reach the brain, the unstable protoplasmic
-compounds break up into simpler forms. The motion thus liberated by these
-"explosions" of excitable matter is, in some way at present utterly
-inconceivable, projected upon the field of consciousness where the mind
-dwells; and we are thus brought into conscious relation with the external
-world.
-
-That the capacity for thus signalling across the gulf which divides
-matter from mind is the result of a certain perfection and complexity of
-physical structure is rendered probable by the utter failure of the
-infra-cortical organs alone to impress the conscious intelligence by any
-amount of independent activity. The same thing is also indicated by the
-unconscious sleep of the rudimentary foetal brain, and by the brevity of
-the intervals of wakefulness which mark the life of the new born babe.
-That this capacity is dependent upon a special mobility of the atoms of
-the brain, is shown by the speedy cessation of intelligence which follows
-great reduction of temperature, as in hibernation, or during exposure to
-severe frost. That its exercise is largely dependent upon the activity of
-the senses is proved by interference with their function, as in the case
-above quoted (see p. 18) from the observations of Strümpell.
-
-The dependence of the waking state upon the presence and activity of a
-sufficient quantity of a peculiarly unstable form of protoplasm in the
-brain is an hypothesis which presents no great difficulty of
-comprehension. But how may we explain the lapse from the intelligent
-vivacity of that waking state into the unconscious inactivity of sleep? I
-have elsewhere[20] discussed the manner in which artificial sleep is
-produced by impregnation of the brain with anæsthetic substances that
-interfere with sensibility, and finally produce stupefaction, by hindering
-the normal processes of intra-molecular oxidation in the protoplasm of the
-nervous tissues. The same general line of argument may be extended to
-cover the action of every narcotic agent with which the living substance
-of the body may become surcharged. Accepting, then, the hypothesis
-advocated by Obersteiner and Preyer, it becomes an easy thing to account
-for the gradual onset of sleep by supposing an accumulation of the
-"fatigue producing" products of intra-molecular oxidation. But we cannot
-thus explain the rapid and, as it were, voluntary passage from wide
-awakefulness into a condition of deep sleep, such as may be commonly
-observed among sailors and others who have formed the habit of going at
-once to sleep at regularly recurring hours of the day or night. Certain
-writers have endeavored to account for this fact by imagining a special
-mechanism at the base of the brain (choroid plexuses of the fourth
-ventricle, etc.,) by means of which the current of the blood through the
-brain may be voluntarily diminished, with a consequent arrest of conscious
-activity. But, still adhering to the hypothesis of Pflüger, we shall
-obtain a clearer explanation of the facts by considering the phenomena
-connected with the succession of impressions upon the organs of sense. It
-has been ascertained[21] that such impressions must persist for a certain
-measurable length of time in order to excite conscious perception. A sound
-must be prolonged for at least fourteen-hundredths of a second, a ray of
-light must agitate the retina for about eighteen to twenty-hundredths of a
-second, an ordinary contact with the surface of the skin must continue
-from thirteen to eighteen-hundredths of a second, in order to awaken any
-knowledge of sound and light and tactile sensation. For the simplest act
-of perception from two to four-hundredths of a second are necessary. It
-is, therefore, perfectly reasonable to suppose that when the "explosive
-material" of the brain has been sufficiently "dampened" by the
-accumulation of acid refuse which accompanies prolonged cerebral effort,
-the impressions of sense may no longer suffice to excite in the cortical
-protoplasm vibrations of sufficient length, or following each other in
-sufficiently rapid succession, to sustain consciousness. The cortex of the
-brain may then be likened to a body of water into which bubbles of
-partially soluble gas are introduced from below. When the bubbles are
-large, and when they follow each other rapidly, a continual effervescence
-is maintained upon the surface of the water. But if the size of the
-bubbles be reduced, or if the solvent capacity of the liquid be increased,
-the surface will become almost, if not quite, perfectly tranquil. In some
-such way, without any great danger of error, may we picture forth the
-manner in which the generation of ideas in the field of consciousness is
-related to the molecular movements in the space occupied by the
-protoplasmic substance of the brain. Returning, now, to the rapid
-induction of sleep, we find that it is usually the experience of people
-who lead an active life in the open air, and are compelled to endure
-frequent interruption of their rest. The sailor who is trained to work
-four hours on deck, and then to sleep four hours below, has been virtually
-transformed by this habit into a denizen of a planet where the days and
-the nights are each but four hours long. His bodily functions become
-accommodated to this condition; his nervous organs store up in sleep a
-supply of oxygenated protoplasm sufficient only for an active period of
-four or five hours; so that, when the watch on deck is ended, he is in a
-state as well qualified for sleep as a laborer on shore at the close of a
-day of twelve or fifteen hours. Moreover, the majority of those who can
-thus easily fall asleep are individuals whose waking life is almost
-entirely sustained by external impressions. So soon, therefore, as such
-excitants are shut out by closing the eyes in a place of shelter from the
-sounds and turmoil of the air, comparatively little remains for the
-stimulation of ordinary consciousness, and sleep readily supervenes
-through mere lack of cerebral excitement, especially if the excitable
-matter of the brain has been previously overwhelmed by the products of
-active exertion.
-
-That analogous, though not identical, predisposition to unconsciousness
-may also be rapidly induced by modifications of the cerebral circulation
-is proved by the sudden reduction of cerebral excitability and
-consciousness which occurs during the act of fainting. In this counterfeit
-presentment of sleep the important part played by variations of the blood
-current through the brain is so conspicuous that certain writers have
-attempted to show that genuine sleep is the result of a diminution in the
-flow of blood to the cortex of the brain. An ingenious physician has even
-attempted to relieve insomnia very much as a surgeon might undertake to
-cure a popliteal aneurism--by placing tourniquets on the arteries leading
-to the affected part. But the mere fact that syncope produces
-unconsciousness does not prove that "cerebral anæmia" should be elevated
-to the rank of the principal cause of natural sleep. The nervous process
-is the primary factor. The circulation of the blood is everywhere under
-the immediate control of the nervous system. Consequently, every change in
-the condition of the nervous structures is followed by a corresponding
-change in the state of the circulating apparatus. Wherever an organ is
-aroused to activity, so delicate are the adjustments by which it is
-connected with the brain and with the heart that it is at once irrigated
-by an increased flow of blood. When its functional activity subsides, the
-same mechanism provides for a corresponding reduction in the supply of
-blood to its tissues. The brain itself forms no exception to this law.
-This has been admirably shown by the observations of Professor Mosso, of
-Turin.[22] The learned professor enjoyed the rare opportunity of observing
-three individuals who had suffered the loss of a considerable portion of
-the bony walls of the cranium, exposing the surface of the cerebrum, and
-affording a view of the pulsation of the vessels of the brain. With the
-aid of the cardiograph, the sphygmograph, the hydrosphygmograph, and the
-plethosphygmograph, it became possible to register the circulation of the
-blood in the brain, and to compare that portion of its course with the
-coincident circulation in other parts of the body. It was thus shown that
-every increase of emotional or intellectual activity was attended by an
-increase in the activity of the cerebral circulation. This increase was
-procured at the expense of other portions of the body, which exhibited a
-coincident reduction in the amount of blood received from the heart. The
-occurrence of sleep caused a diminution in the number of respirations,
-and a fall of six or eight beats in the pulse. The volume of the brain and
-its temperature were at the same time slightly reduced, through the
-diversion of blood from the head to other regions of the body. The
-consequent dilatation of the vessels in the extremities was readily
-demonstrated by the use of the plethosphygmograph. The extreme
-sensitiveness of the nervous centers was further illustrated by the fact
-that if, during sleep, a ray of light were directed upon the eyelids, or
-if any organ of sense were moderately excited without waking the patient,
-his respiration was at once accelerated; the heart began to beat more
-rapidly, the vessels of the extremities contracted, and the blood flowed
-more freely into the brain. Similar results accompanied the act of
-dreaming. The return of full consciousness on waking was followed by an
-immediate increase in the activity of the intra-cranial circulation.
-
-The extreme susceptibility of the brain to influences proceeding from
-artificial disturbances in the circulation, was exhibited in the case of
-one of Professor Mosso's patients. By compression of the carotid arteries,
-unconsciousness was induced, and an attack of convulsions was aroused. In
-no other part of the body can a corresponding disturbance of function be
-so quickly produced by similar means. A limb may be rendered bloodless for
-nearly half an hour, by the application of an elastic bandage, and yet its
-sensory nerves will remain capable of transmitting impressions from the
-periphery. But in this case, compression of the carotids for only eight
-seconds was sufficient to abolish consciousness and to excite convulsive
-movements.
-
-In all such observations it is worthy of note that the nervous impression
-is the primary event so long as artificial disturbances are not intruded.
-The changes of blood-pressure and circulation were invariably secondary to
-the excitement of nerve tissue. Sleep, therefore, must be regarded as the
-cause, rather than the consequence, of the so-called cerebral anæmia which
-obtains in the substance of the brain during repose. This condition of
-"anæmia" is nothing more than the relatively lower state of circulation
-which may be remarked in every organ of the body during periods of
-inactivity. Every impression upon the sensory structures of the brain
-occasions a corresponding liberation of motion in those structures. The
-movement thus initiated arouses the vaso-dilator nerves of the cerebral
-vessels and excites the vaso-constrictor nerves of all other portions of
-the vascular apparatus. Hence the superior vascularity of the brain so
-long as the organs of sense are fresh and receptive. Hence the diminishing
-and varying vascularity of the different departments of the brain as sleep
-becomes more or less profound. These modifications of the brain and of its
-circulation are well illustrated by the effects of a moderate degree of
-cold applied to the cutaneous nerves of the body, as not unfrequently
-happens when the night grows cool towards morning. The disturbance of the
-sensitive nerves of the skin is transmitted to the brain. The excitement
-of this organ causes dilatation of its vessels, and increased irritability
-of the cortical instrument of perception. This becomes the starting point
-for the projection of impulses upon the field of consciousness, producing
-dreams, or even a complete awakening from sleep.
-
-The cause of sleep must, therefore, be sought in the molecular structure
-of the brain, rather than in fluctuations of the blood-current. In the
-present state of our knowledge it must be negatively represented as the
-consequence of a deficiency in the amount of movable oxygen in the nervous
-tissue. This deficiency may be the result of immaturity, as in the foetus,
-or in the new-born infant; or it may result from the accumulation of an
-excess of the waste-products of intra-molecular oxidation during
-functional activity--products which hinder the further passage of oxygen
-into stable combination with the oxidizable elements of protoplasm. Sleep
-thus produced differs from the artificial sleep induced by narcotic drugs,
-in the fact that its cause is self-generated by the instrument of thought,
-while narcotic stupor is caused by the intrusion of substances derived
-from without--substances which, like the natural refuse of the living
-cells, more or less completely hinder the processes of oxygenation and
-oxidation within the tissues of the body. Hence the states of healthy
-sleeping and waking must necessarily be self-limited and regularly
-successive; while the state of narcotism is purely accidental, and its
-duration exactly corresponds with the variable length of the period during
-which the body may remain impregnated with the hypnotic agent.
-
-Certain morbid forms of sleep further illustrate its dependence upon the
-persistence of depression in the functional activity of the brain. For
-some persons this seems to constitute their normal condition. They are
-either excessively fat, red-faced, and soaked with beer, or they are pale,
-anæmic, and pulpy, with flabby muscles and a feeble circulation. They fall
-asleep whenever left to themselves, and never seem to be fully aroused to
-active life. The fat boy who figures so amusingly in The Pickwick Papers,
-furnishes a life-like picture of this variety of _somnolence_.
-
-The introductory stage of the eruptive fevers is often characterized by
-somnolence. It also frequently appears as the forerunner of coma in the
-various diseases which terminate in unconsciousness and death. A singular
-example of this has been observed among the negro inhabitants of the
-Atlantic coast of tropical Africa. The disorder is known to English
-writers as _sleeping dropsy_; by the French it is called _maladie du
-sommeil_. It is characterized by daily paroxysms of somnolence which tend
-to become more and more continuous and profound until they are finally
-merged in fatal coma. For our knowledge of the disease we are chiefly
-indebted to the description by Clark,[23] an English surgeon who practised
-in Sierra Leone, and to the monograph by Guerin,[24] a French naval
-surgeon, who had enjoyed exceptional opportunities for observation among
-the laborers who had been carried from Africa to the island of Martinique.
-Similar cases have been occasionally reported in other regions of the
-world, but it is among the Africans that it has been principally remarked.
-The onset of the malady is gradual, commencing with a slight frontal
-headache. After a few days a disposition to sleep after meals is noted.
-This becomes increasingly urgent, and the intervals of sleep are prolonged
-until at length the patient becomes continually soperose. The waking
-periods are marked by a sluggish state of the intellectual faculties. The
-pulse is not accelerated, and it remains full and soft. The veins of the
-sclerotic are turgid, and the eyeball seems unusually prominent. The
-temperature does not increase, but rather tends to diminish its figure.
-The skin is dry and moderately cool. The tongue continues moist, and is
-covered with a white fur. The bowels and the bladder are regularly
-emptied, and the appetite persists with considerable vigor. Finally, the
-patient becomes completely comatose, and dies quietly. Sometimes, however,
-the evolution of the disease is less tranquil. Epileptiform convulsions,
-followed by progressively deepening periods of coma, interrupt its course,
-and a continuous muscular agitation marks the closing scene. At the same
-time the pulse grows weaker and more frequent until its movements cease in
-death. Recovery is almost unknown, though the duration of the disease
-often varies from three months to a year or longer. Examination of the
-body after death yields very negative results; the sinuses and larger
-vessels of the brain are engorged with blood, but no evidence of
-inflammation is anywhere apparent. The other organs present no
-pathological alterations whatever. These observations seem to indicate
-that the disease originates in some form of general blood-poisoning,
-rather than in any local inflammation or degeneration. Dr. Clark has
-called attention to an enlargement of the cervical glands as a feature of
-the malady. According to Dr. G. H. Bachelder,[25] the native physicians
-cure the disease by extirpation of the affected glands. He has also
-observed an initial lesion in the nasal mucous membrane. If this be
-confirmed, the malady will take its place among the forms of somnolence
-produced by infection of the blood.
-
-Between the profound unconsciousness of natural sleep and _coma_ may be
-placed the distinction that the one is always the consequence of healthy
-physiological processes, while the other is always the result either of
-injury, of disease, or of some form of intoxication. Comatose
-unconsciousness may be the result of cerebral compression caused by injury
-of the head, or by the presence of an inflammatory exudation.
-Intra-cranial tumors, embolisms, thrombi, diseases of the cerebral
-arteries, and degenerations of the brain,--in short, every morbid change
-of which the liquids and the solids within the cranium are capable--may
-become the cause of coma. Toxæmic conditions of the circulating fluids of
-the body may benumb the brain with comatose sleep. Few diseases,
-therefore, exist without the possibility of coma as one of their
-consequences--a coma which, however, must not be confounded with the
-genuine sleep which sometimes occupies the larger part of convalescence
-from acute illness. During such convalescence there is a reversion to the
-infantile type of nutrition with all its need of prolonged and frequent
-periods of repose. Like normal sleep, the comatose condition admits
-considerable variation of intensity. The patient may sometimes be
-partially roused, as from the coma of alcoholic intoxication, and he may
-finally recover complete consciousness; but very often the reverse is the
-fact. The coma deepens into paralysis of the respiratory centres, and
-death concludes existence without the slightest manifestation of
-sensibility or intelligence.
-
-_Lethargy_ is a pathological variety of sleep, in which the repose of the
-body is even more complete than in coma. The victim of coma often presents
-a countenance suffused with blood; the pulse beats vigorously, and
-respiration may become stertorous. But in lethargy the abolition of bodily
-movement is almost absolute. In the milder forms of this disorder the
-patient may be partially roused, so as to attempt an answer when
-addressed, appearing like a person in very deep sleep; but in the majority
-of cases he remains insensible, unconscious, and utterly irresponsive to
-ordinary forms of irritation. Respiration and circulation are reduced to a
-minimum, and may, even for a time, become imperceptible. Uncomplicated
-with hysteria, the disorder is rapidly fatal, but, according to
-Rosenthal,[26] hysterical lethargy is never mortal.
-
-Many examples of this disease have been afforded by the records of
-apparent death. I am well acquainted with a lady who, in early childhood,
-had been laid out for burial at the supposed termination of some infantile
-illness. Her mother alone insisted that the child was still alive. After
-some time spent in weeping and expostulation, she applied a blister to the
-thorax of the babe. This soon excited evidences of painful irritation,
-followed by a complete recovery. Still more instructive is the case,
-narrated by Rosenthal,[27] of a young woman, twenty-four years of age,
-who, in consequence of violent emotional excitement, became unconscious,
-and presented no signs of life, though tested by placing a mirror before
-the mouth, and by dropping melted sealing-wax upon the skin. On raising
-her eyelids, the pupils gave no reaction to light; the limbs remained
-perfectly flaccid, and the radial arteries were pulseless. Careful
-auscultation, however, detected a very feeble and intermittent sound in
-the cardiac region. The walls of the chest exhibited no movement, but the
-lateral surfaces of the abdomen presented a slow and almost imperceptible
-oscillation. Gentle faradization of the muscles and nerves of the face,
-arm, and hand, excited definite muscular contractions. By this method
-Rosenthal became satisfied that, although the patient had remained for
-thirty-two hours in this condition, she was only apparently dead. In fact,
-after continuing forty-four hours in a state of suspended animation, she
-awoke spontaneously, made a rapid recovery, and seemed to enjoy as
-comfortable health as an excitable, nervous temperament would permit.
-
-Certain authors make a distinction between lethargy and apparent death;
-but the difference is one of degree rather than of kind. The movements of
-respiration and of circulation, though greatly enfeebled, are readily
-observed in ordinary forms of lethargy; but in apparent death the pulse
-can no longer be discovered, and nothing more than the faintest sound can
-be distinguished in the region of the heart. It, therefore, becomes
-important to have within reach a crucial test of the persistence of
-general vitality. Such evidence, according to Rosenthal, is furnished by
-the faradaic current. Within two or three hours after actual death, the
-muscles cease to respond to the induced current; but in apparent death
-this form of electro-muscular contractility never disappears. Every other
-test that has been proposed has failed under certain circumstances.
-Observation of the changes in muscular temperature during electrical
-excitation is a method better adapted to the laboratory than for clinical
-practice.
-
-_Lucid lethargy._--In certain cases of apparent death the patient exhibits
-all the external appearance of suspended animation, but the power of
-conscious perception does not cease. The senses of sight and hearing
-remain, and are, perhaps, intensified by inhibition of the power of
-voluntary movement. The sufferer sees and hears; perception, emotion,
-memory, the power of reasoning, judgment, volition, all persist. Only the
-power of executing voluntary movements is lacking.
-
-The victims of this variety of apparent death are usually women, or men
-who are characterized by a feminine nervous organization. Great mental
-excitement, fatigue, semi-starvation, and exhausting diseases, are the
-principal exciting causes of the event. The following case, related by my
-friend, Dr. P. S. Hayes, of Chicago, illustrates the phenomena of lucid
-lethargy. The patient was a female physician, about thirty years of age,
-unmarried, and consumptively inclined. During the course of a long and
-wearisome hospital service, she was prostrated with typhoid fever.
-Placing herself under the immediate care of my informant, she was also
-attended by several of the most eminent physicians in the city. After a
-long and exhausting illness she appeared to be dying. In the presence of
-her physician, and surrounded by her relatives, she ceased to breathe. The
-pulse stopped, life seemed to have gone out. Bottles of hot water were
-applied to the limbs, and various restoratives were employed. After a
-considerable time she began again to breathe, and a gradual recovery
-followed. During the whole time of apparent death, consciousness had been
-preserved. She seemed to be looking down from a point above her bed; she
-could see the doctor feeling for her pulse, and was grieved by the sorrow
-of her friends. Ordinary sensation was temporarily suspended, and she
-could not distinguish the contact of the hot-water bottles that were
-applied to her limbs, though actually scalded by their excessive heat.
-Borne upon the wings of an excited imagination, she thought herself
-permitted to look into heaven, but was not suffered to enter its gates. In
-this exaltation of the imagination the reasoning faculties also shared, so
-that certain philosophical problems which had previously baffled her
-intellect were now perfectly comprehensible, and the memory of their
-solution persisted after recovery.
-
-Many similar narratives have been duly authenticated, but the limits of
-the present chapter will not permit a discussion which properly belongs to
-an investigation of the phenomena of trance. The important fact for
-present consideration is the persistence of conscious life, despite the
-appearance of death. In this preservation of consciousness,
-notwithstanding the temporary suspension of certain kinds of sensibility
-and the power of voluntary motion, may be discovered a relationship
-between the phenomena of lucid lethargy and various disturbances of sleep,
-which will be considered in a succeeding chapter.
-
-
-
-
-CHAPTER II.
-
-INSOMNIA, OR WAKEFULNESS.
-
-              Sleep, gentle sleep,
-  Nature's soft nurse, how have I frighted thee
-  That thou no more wilt weigh mine eyelids down
-  And steep my senses in forgetfulness?
-                                  --KING HENRY IV, SECOND PART.
-
-
-We have seen that the condition of normal sleep is determined by a
-peculiar molecular state of the substance of the brain--a modification
-regularly alternating with that by means of which the condition of
-wakefulness is sustained. We have also seen that sleep is liable to
-variations in its intensity, and that its course may be partially
-interrupted by dreams, or even by a more or less complete resumption of
-the movements of locomotion, constituting the different varieties of
-somnambulism. Our attention must now be directed to the consideration of
-those greater disturbances of sleep which either serve to prevent its full
-development, or else to actually interrupt its course, rendering it
-incomplete and fragmentary, or even abolishing it altogether. But,
-inasmuch as the healthy brain, when associated with a healthy body, can
-only by an extraordinary effort of the will be kept awake beyond a certain
-period, and then only for a short time beyond the ordinary interval of
-wakefulness, it follows that the study of the usual causes of insomnia
-must be an investigation of morbid conditions of the bodily functions.
-Sleeplessness, therefore, must result, 1st, from a disturbance of the
-peripheral sensory organs of the nervous system; 2nd, from disordered
-conditions of the sensory nerves and nerve tracts; 3rd, from morbid states
-of the brain; 4th, from any or all of these conditions operating in
-association with each other. We may, therefore, consider, I, _Insomnia
-caused by irritation of the peripheral portions of the sensory apparatus_;
-and, II, _Insomnia caused by morbid states of the central nervous organs_.
-
-
-I. INSOMNIA CAUSED BY IRRITATION OF THE PERIPHERAL PORTIONS OF THE SENSORY
-APPARATUS.
-
-Irritation of the sensory apparatus may be ranked in three classes:
-
-    1. Affections of the organs of special sense.
-
-    2. Affections of the nerves of common sensation.
-
-    3. Affections of the sympathetic nerves.
-
-1. _Affections of the organs of special sense._--Prominent among these is
-the effect of light upon the eye. The darkness of night favors sleep; the
-presence of light hinders its incidence and renders it less profound.
-During the gloom of a total eclipse animals seek their shelter; birds hide
-themselves in their nests; domestic fowls arrange themselves upon the
-roost, and seem quite disconcerted by the speedy return of sunlight.
-Children often find it difficult to sleep in an illuminated room. I have
-known nurses who would sit with a wakeful infant under a powerful gaslight
-till after midnight, and then would express their surprise that the baby
-persisted in gazing at the flame instead of going quietly to sleep. The
-inhabitants of Northern Europe find it necessary to darken their sleeping
-rooms during the long polar day; and travelers in such regions often
-suffer for want of the natural sleep which only darkness affords. Judge
-Caton, writing of his travels in Norway[28] says: "We longed for darkness
-and for night. Do what we could to darken the windows to keep out the
-light, still it was not night as nature makes it, and which the habit of a
-lifetime had rendered necessary to sound repose. Artificial darkness,
-especially when incomplete, is as far from night as artificial light is
-from day.... These sunny nights can hardly conduce to health, they steal
-away so much of sleep. One does not readily get sleepy in the sunshine,
-and then we are so apt to forget to look at the watch to see if it is time
-to retire."
-
-In the tropical regions of the world it is usual for the inhabitants to
-sleep during the middle of the day; but they take great pains to exclude
-the light from their houses during the hours of sleep. The Pacific
-Islanders cover their faces with the bed clothes for the purpose of
-excluding the light while attempting to sleep. Repose thus obtained in the
-daytime often serves to convert the night into a season of wakefulness.
-The Africans sleep and dream away the heated hours of the day, and give up
-considerable portions of the night to festivity in the open air--a
-practice which undoubtedly contributes to the permanence of an inferior
-grade of social life.
-
-Sudden illumination of the sleeping room will frequently awaken the
-sleeper. During the great fire in Chicago, A. D. 1871, many persons were
-thus aroused from their slumbers as the flames lighted up the streets
-adjoining their houses. One of my acquaintances was awakened one night by
-a flash of light from the lantern of a burglar who was moving noiselessly
-about her chamber. The experience of almost every one will testify to the
-effects of sheet-lightning silently illuminating the sky by night. Dreams,
-also, are not unfrequently excited by the incidence of light upon the
-closed eyelids.[29]
-
-The sense of hearing is one of the most persistent of the special senses
-during the incidence of sleep. It is perhaps the most excitable of these
-senses during the period of repose. Long after the subject has become
-immersed in sleep his auditory apparatus remains sensitive to sounds.
-Dreams are often produced by impressions upon the ear. Often in sleep it
-seems as if the sense of hearing remained wakeful and watchful for
-expected signals, as when an alarm clock serves to arouse the sleeper at
-an appointed hour. Sometimes the sleeper may be shaken and tumbled about
-in his bed without waking, but if he be addressed by name he will usually
-reply. It is scarcely probable that the auditory apparatus is any more
-wakeful than other portions of the nervous system, but its external
-portions remain during sleep more completely exposed and adapted to the
-reception of impressions than is possible for the eye and for the organs
-of touch and taste.
-
-The persistent sensitiveness of the ear during sleep is not so much a
-capacity for noticing sounds as a sensibility to variations in sonorous
-impressions. Thus a steady and monotonous noise may, if long continued,
-serve to render one sleepy; but the sudden cessation of the same sound
-will awaken every one. Slowly lulled to sleep by the incessant rumble of
-the engine upon one of the old-fashioned Long Island Sound steamboats, how
-immediate the awakening of a whole cabin full of people, when the wheels
-were suddenly stopped! A recent traveler in Guiana[30] relates a curious
-experience with an Indian magician who undertook to cure him of a slight
-headache and fever. The method of cure consisted in placing the patient at
-night in his hammock, while the magician kept up a hideous succession of
-yells and shouts, shaking the walls and roof of the house with an uproar
-which never ceased for six hours. Before long the patient passed into a
-kind of fitful sleep or stupor, during which he seemed to be suspended in
-a surging ocean of sound. When the noise died away, as if growing fainter
-in the distance, he would rouse up into a semi-conscious state, but when
-it again increased he would fall back into stupor. At last, when the noise
-finally ceased, he awoke completely, but without the slightest relief from
-headache--an experience quite illustrative of the manner in which the
-brain may be affected by sound.
-
-It is not often that the sense of smell becomes the avenue of impressions
-that interfere with sleep. So different are the capacities of individuals
-in this particular that an odor which might severely annoy one person,
-would pass almost unnoticed by another. Large cities are sometimes invaded
-by overwhelming stenches from the various factories which spring up in
-their neighborhood. While it is seldom true that the vapors discharged by
-such establishments are directly deleterious to health, they may become
-indirectly a cause of ill-health through the wakefulness occasioned by
-them among weakly invalids. The smell of smoke in a bed-chamber sometimes
-serves to awaken a sleeper, giving warning of the outbreak of a fire in
-the building. Less energetic odors may disturb the depth of sleep without
-actually waking the patient. Thus Maury records[31] that when he was made
-to inhale the vapor of cologne water while asleep, he dreamed of being in
-the shop of a perfumer.
-
-Excitement of the sense of taste would, doubtless, operate in a similar
-manner; but it is so difficult to arouse this sense without at the same
-time irritating the nerves of common sensation about the mouth, that very
-little can be said regarding the matter. Dreams of gustatory sensations
-are usually of subjective origin, dependent upon some reflex movement, or
-upon some agitation of the organ of memory, within the brain.
-
-If, with Sir William Thompson,[32] we recognize a sixth sense--the sense
-of temperature--it must be admitted that through the varying sensations of
-heat and cold, sleep can be greatly disturbed. Every one will recall to
-mind the story told by Dugald Stewart, of a gentleman who dreamed of
-walking over heated lava on Mt. Ætna when a bottle of hot water was placed
-against his feet, in bed, on account of some slight indisposition. The
-temperature of the air is one of the most important factors in the
-determination of sleep. A high temperature keeps every one awake--a fact
-well known among the unfortunate denizens of the garrets in our great
-cities. Not only is wakefulness the direct result of heat, but it is
-aggravated and embittered by the accompaniments of a torrid
-climate--insects, foul air, and cutaneous disorders. In the East Indies,
-so difficult is sleep under such conditions that the wealthy inhabitants
-compel their servants to cool them all night with the _punkah_, a large,
-swinging fan, suspended above the bed, and kept in motion by means of a
-cord leading outside of the bed-room to the verandah, where the
-_punkah-wallah_ sits and pulls the string while his master sleeps. So
-powerful is the force of habit in the organization of the automatic
-apparatus of the body that, though these punkah-pullers often fall asleep,
-they still continue, without interruption, the successive movements by
-which the fan is kept in operation.
-
-The evil effects of a high temperature are greatly aggravated by the
-presence of humidity in the atmosphere. Dampness interferes with the
-process of exhalation from the surface of the body, which, consequently,
-tends to become overheated. The tissues, under such circumstances, are
-imperfectly defecated, and rapidly pass into a condition of imperfect
-nutrition. This depresses all the functions of the body, and renders the
-nervous system inordinately irritable. Sleep cannot be profound and
-refreshing, because of the over-excitable state of the brain. During the
-long, hot season in tropical countries, it often becomes necessary to
-seek a temporary retreat among the highlands and mountains, in order to
-find a climate sufficiently dry and cool to furnish the condition for
-refreshing sleep. For the same reason many of the inhabitants of the
-Southern United States are forced to spend the summer months in the
-invigorating atmosphere of Minnesota and Northern Michigan. One of the
-most delightful of experiences may be procured on any warm day in summer
-by embarking, at Chicago, upon one of the steamboats bound to Mackinac. At
-the wharf, in the hottest and dirtiest part of the city, all is dust,
-perspiration, and discomfort. The wide cabins are filled with people who
-are tired, thirsty, and discouraged. Sickly, squalling babies swarm in
-numbers sufficient to drive one mad. As the sun goes down, the
-signal-whistle sounds, head-lines and stern-lines are quickly cast off,
-the propeller churns the mire behind the boat. Slowly swings the huge
-fabric away from the shore, gliding between the walls of sun-scorched
-brick that line the stream on either side. At last the light-house at the
-mouth of the river is passed, and we are out upon the blue waves of Lake
-Michigan, with a heavenly breeze searching every crack and cranny of the
-hull. New life animates every form, and presently a great silence pervades
-the brilliant cabins. The children have left their woes behind, and, for
-the first time, in many weeks, perhaps, they and their weary mothers sleep
-the sleep of innocence and peace.
-
-The dependence of a high atmospheric temperature upon the direction of the
-wind renders the course of the aerial currents a matter of great
-importance in relation to sleep. The southerly winds which, in the
-northern hemisphere, are hot and enervating, always produce an increase of
-wakefulness. The winds that blow from the heated deserts of Africa,
-Arabia, and Australia, are greatly dreaded upon this account, as well as
-for the other numerous discomforts which fly in their train. Their
-cessation, and their replacement by a cool, polar current brings relief at
-once. The changes thus produced in the electrical condition of the
-atmosphere doubtless contribute more than is usually known to these
-results. A cloudless sky gives evidence of positive electricity, which is
-much stronger in winter than in summer.[33] Clouds are sometimes positive
-and sometimes negative. According to Fonssagrives[34] the atmospheric
-electricity is positive during northerly winds, and negative during the
-prevalence of winds from the southerly quarters of the horizon. Great
-disturbances of the electrical condition of bodies is often observed
-during the occurrence of the sirocco in North Africa. Arago has related
-the case of an officer in the French army[35] who saw sparks of
-electricity leaping from his epaulettes at every blast of the sirocco
-encountered on a march in the neighborhood of Algiers. Such atmospheric
-disturbances often produce very disagreeable effects upon persons of a
-nervous temperament. According to Fonssagrives (_loc. cit._) such patients
-frequently experience, during the prevalence of storms which traverse
-great distances, a high degree of insomnia, together with headache, pains
-in the limbs, joints, and old injuries, and a general indefinable
-sensation of discomfort. S. Weir Mitchell has carefully traced the
-connection between these phenomena and the variations of barometric
-pressure which accompany the revolving storms that cross the continent in
-a northeasterly direction.[36]
-
-Though the effect of a high atmospheric temperature is unfavorable to
-sleep, an excessive temperature produces the opposite condition. Stupor
-rather than sleep is the consequence of insolation and of exposure to
-great heat from artificial sources. This is a pathological process, and,
-therefore, must not be mistaken for natural sleep. It may result either
-from cerebral congestion, or from cardiac exhaustion, and is characterized
-by an extraordinary bodily temperature and a high rate of mortality.[37]
-So elaborate are the arrangements for the preservation of a uniform
-temperature throughout the body that it is practically impossible for a
-sunstroke to occur unless the regulative apparatus has been previously
-deranged by ill-health.
-
-Excessive cold operates in like manner to produce a condition of stupor
-that tends to a fatal termination. But moderate degrees of cold act as
-excitants of wakefulness. By effecting a contraction of the vessels of the
-skin cutaneous circulation is impeded. The venous side of the circulatory
-apparatus becomes overloaded with blood; the exhalation of carbonic acid
-and the production of heat are reduced. The discomfort that results from
-this disturbance of the natural functions of the tissues is sufficient to
-arouse the brain to wakefulness, just as an imperfect oxidation of the
-blood serves to excite the respiratory centre in the medulla oblongata. It
-is hardly necessary to allude in this connection to the increased flow of
-blood through the brain occasioned by this as by every other excitement of
-the sensorium. Local refrigeration of any portion of the body thus acts as
-a painful excitant of the cerebrum, and produces wakefulness, very much as
-distention of the intestines with gas will keep one awake. It is for this
-reason almost impossible to sleep with cold feet. Conditions of this sort
-are pathological, and are far in excess of the agreeable coolness which
-favors sleep. The effects of progressive diminution of the temperature of
-the air are well illustrated by the hibernation of animals.[38] As the
-temperature of the air diminishes, in winter, animals like the marmot fall
-into a species of sleep. Their movements of respiration and circulation
-are greatly reduced, and their bodily temperature falls, though it always
-remains several degrees above the temperature of the surrounding air. So
-long as the average degree of cold is maintained, the little creature
-sleeps naturally; but, if the air becomes extraordinarily cold, the
-physiological repose of the animal is disturbed. _It becomes uneasy, wakes
-up, and seeks a warmer retreat._ Too great a degree of cold thus becomes a
-cause of wakefulness. If the animal under these circumstances fails to
-secure protection against a falling temperature, it passes into a state of
-lethargy that is often fatal--a pathological condition being substituted
-for the physiological sleep of ordinary hibernation. In like manner the
-human animal may experience the threefold effects of refrigeration: first
-a pleasing coolness that favors sleep; then an uneasy sensation of cold
-which causes wakefulness; and, finally, a lethargy that paralyzes all the
-functions of the body and terminates in death.
-
-2. _Affections of the nerves of common sensation._--Chief among the causes
-of sleeplessness thus produced is pain. This is a modification of feeling,
-caused by excessive or extraordinary excitement of the peripheral nerves
-of sensation. The seat of the excitement may be in the skin or in the
-deeper tissues of the body. Cutaneous pain may be caused by the activity
-of various insects, like flies, mosquitos, fleas and bedbugs, or by the
-presence of certain parasites, such as the itch-mite, or by ordinary
-diseases of the skin, of which notable examples are found in erysipelas,
-erythema, urticaria, lichen, prurigo, certain varieties of eczema and
-psoriasis. The troublesome forms of pruritus which accompany icterus, or
-which may occur without any clearly defined cause, are frequent causes of
-wakefulness. The last mentioned disorder must, however, be sometimes
-recognized as a consequence of central nervous disorder, rather than a
-result of peripheral disease. Witness the frightful itching sometimes
-experienced during the progress of chronic myelitis. All kinds of
-injuries, wounds, ulcers, and other local inflammations are common causes
-of insomnia by reason of the painful impressions transmitted from them to
-the brain. Hence the great importance of anodynes and hypnotic remedies in
-the course of surgical practice. Diseases or injuries of the various
-peripheral nerves are notable causes of sleeplessness. Witness the
-horrible wakefulness caused by neuritis and by neuralgia. The development
-of neuromata in the stumps of amputated limbs may thus become a most
-painful cause of insomnia. Inflammations which encroach upon sensitive
-nerves produce intense pain with consequent loss of sleep. Of this very
-conspicuous examples are furnished by spinal meningitis, and by the
-effects of local periostitis causing compression of the branches of the
-fifth pair of nerves.
-
-3. _Affections of the sympathetic nerves._--So much still remains to be
-learned concerning the pathological functions of the sympathetic nerves
-that it is impossible to assign with any great degree of precision the
-exact amount of interference with sleep that may depend upon disordered
-conditions of this portion of the nervous system. Since their principal
-functions consist in the regulation of the flow of blood and lymph
-throughout the body, and in the control of the processes of nutrition,
-calorification, secretion and excretion, it follows that any considerable
-derangement of their healthy action must be represented by a corresponding
-disturbance of the brain. This may reach the field of consciousness in the
-form of pain, and thus may become a cause of sleeplessness. In all the
-phenomena of inflammation sympathetic nerves play an active part. In
-certain portions of the body, as in the principal viscera, and in the
-periosteal covering of the bones, they are the interstitial nerves of the
-structures. When the body is in a healthy condition these nerves convey
-impulses of a sensory character which do not reach the cerebral organ of
-conscious sensation. But in certain morbid states they become inordinately
-sensitive, and they then serve to convey and probably also to magnify
-sensations to an extent that may cause exquisite pain with all its
-consequences. Witness the pain experienced during the various forms of
-colic. Rheumatic inflammations, pleurisy, pericarditis, peritonitis,
-cystitis, metritis, ovaritis, gastro-enteritis, and other similar diseases
-owe their principal suffering to the affection of the sympathetic nerves
-connected with the respective organs which become the seat of pain.
-Including with the sympathetic nerve the pneumogastric nerve, which
-occupies a functional position between the strictly peripheral and the
-ganglionic nerves, all the various forms of pain and uneasiness
-experienced in the region of the heart and of the lungs may be assigned to
-this system of nerves. Thus the various species of respiratory
-disturbance, such as asthma and dyspnoea from any cause, and the forms of
-palpitation and other cardiac disorder may become causes of wakefulness.
-In like manner the vague and uneasy sensations associated with certain
-varieties of dyspepsia are frequent sources of sleeplessness, not merely
-by reason of the pain which they occasion, but also because of the general
-disorders of nutrition with which they are associated.
-
-
-II. INSOMNIA CAUSED BY MORBID STATES OF THE CENTRAL NERVOUS ORGANS.
-
-So intimately connected are the spinal cord and the brain that their
-disorders may properly be considered together. These may be classified as:
-
-    1. Disorders of circulation and nutrition.
-
-    2. Inflammations and degenerations.
-
-    3. Neoplastic encroachments.
-
-_Disorders of circulation and nutrition._--Hyperæmia of the brain is a
-frequent cause of wakefulness. This may be maintained by an unconscious
-effort of the organ of the will under the influence of any great and
-unusual excitement of the mind. So soon as the mental excitement is
-allayed, the excessive afflux of blood subsides, and the brain becomes
-fitted for sleep. But, if excitement be too far prolonged, the nutrition
-of the nervous centres suffers, and the regulative apparatus of the
-cerebral circulation becomes exhausted, so that the brain cannot rest,
-because its inhibitory centres have lost their power of control over the
-lower ganglia of the organ. The cerebro-spinal centres are then in a
-condition analogous to that of a locomotive engine on which the engineer
-can no longer regulate the production and distribution of steam. Such a
-condition is usually the result of numerous antecedent causes. Long hours
-of work, scanty or improper food, insufficient sleep, bad hygienic
-surroundings and habits, with indulgence in the use of narcotics and
-stimulants, are among the most common causes of the disorder.
-
-Active hyperæmia of the nervous centers has been above mentioned as the
-consequence of cerebral function under unfavorable conditions. But, as the
-disorder persists, its type undergoes a change. We still speak of the
-disorder as functional in its character, but it continually tends to
-become organic. No visible alterations, perhaps, can be detected, but,
-evidently, there are radical changes in the substance of the nervous
-tissue. Nutrition suffers throughout the body to a degree that attracts
-attention. The blood diminishes in quantity and quality, till the patient
-becomes notably anæmic. In this condition the brain is inordinately
-excitable. It is incapable of sustained activity, and the patient may even
-be oppressed by an inclination to constant drowsiness; yet he will be
-unable to sleep soundly, and his sleep will be continually agitated by
-dreams. This state is one of the constant accompaniments of slow
-starvation. The molecular structure of the nervous organs seems to be so
-slightly constructed, under such circumstances, that its equilibrium is
-disturbed by the most trifling incidents. It may be likened to a lofty
-wall of bricks laid up without mortar--"if a fox go up," the entire
-structure may be thrown down with a tremendous noise. Thus the anæmic and
-irritable brain will react excessively under the slightest impression;
-consciousness is invaded by perceptions which would never arise under
-normal conditions of the nervous tissue; and the mind is continually
-aroused. This form of wakefulness is very frequent among women who have
-become anæmic, and among patients who are slowly convalescing from
-exhausting diseases.
-
-It is impossible in every instance to decide whether a given state of
-wakefulness is the result of cerebral hyperæmia or anæmia. In the one case
-the persistence of wakeful activity of the mind is due to excitement of
-the cerebral cells, accompanied by a lavish irrigation of their substance
-with the plasma of the blood. In the other case the excitement is
-occasioned, not so much by increased afflux of the blood, as by a morbid
-instability of the nervous substance. The outcome in both cases is very
-similar--mental excitement and wakefulness.
-
-In a third class of cases the agitation of the brain is produced by the
-direct action of certain chemical agents upon the cortical substance. Tea
-and coffee are familiar examples of such agents. The caffeine, by virtue
-of which they produce their effect, when transported to the brain, enters
-into combination with its protoplasm in such a way as to stimulate
-molecular movement. Perception is thus quickened, and the mind is aroused.
-Sleep is postponed until the effect of the stimulant has subsided. This
-form of wakefulness is quite different from that produced by alcoholic
-drinks. These operate, when taken in small quantities, to favor cerebral
-equilibrium--and consequent equanimity--by producing a general dilatation
-of the smaller blood-vessels. Their anæsthetic influence is favorable to
-sleep, under such circumstances. But, if frequently repeated, these doses
-of alcohol modify the nutrition of the nervous system until, at last, a
-condition of irritable weakness is reached, in which wakefulness of a most
-distressing character is experienced.
-
-_Inflammations, degenerations, and neoplasms._--The early stages of
-inflammation involving the central nervous organs are marked by that form
-of insomnia which is associated with active hyperæmia. The headache and
-painful delirium which accompany the different varieties of meningitis,
-are causes of a wakefulness that persists until the brain is merged in the
-coma of compression. The interstitial changes which cause the various
-forms of insanity, are in like manner causes of wakefulness. Local
-injuries and degenerations of brain-substance, tubercular deposits upon
-the meningies, and all the different forms of intra-cranial tumor, are
-causes of wakefulness, both by reason of the direct irritation which they
-produce, and by reason of the circulatory disturbances which arise in
-their neighborhood.
-
-Finally, it must be observed that wakefulness may result from excitement
-of the brain by irritating substances transported through the blood from
-distant centers of disease in remote organs of the body, or derived from
-articles that have been absorbed with the food and drink, or with the air
-that enters the lungs. Thus wakefulness may accompany cutaneous disorders
-that interfere with perspiration. Imperfect elimination through the liver,
-kidneys and intestines, leaves the blood charged with excrementitious
-substances which arouse the brain to wakefulness. In like manner, various
-poisons, like lead, arsenic, etc., different miasms of telluric origin,
-the products of putrefaction, and the various animal contagia, may produce
-insomnia by their prejudicial effect upon the nutrition of the nervous
-structures throughout the body.
-
-
-
-
-CHAPTER III.
-
-REMEDIES FOR INSOMNIA.
-
-        O, true apothecary!
-  Thy drugs are quick.
-                      --ROMEO AND JULIET.
-
-
-An occasional attack of wakefulness may fall to the lot of any one as a
-consequence of the various disturbances of health or equanimity of mind to
-which all are liable. Occurring as an accident in a state of health, it
-produces merely a feeling of lassitude and weariness during the subsequent
-day. This soon disappears, after a night of refreshing sleep, and the
-subject is nothing worse for the incident. But the recurrence of the
-disorder is a thing to be deprecated, not only for the reason that it
-denotes a departure from the physiological order of life, but because its
-frequent repetition prevents the adequate repair of the tissues of the
-body. The great function of nutrition suffers as a consequence, and the
-patient rapidly falls into a condition of premature old age. When this
-takes place as a result of some temporary error of hygiene, or as a
-consequence of diseases which admit of successful treatment, the patient
-may be restored to health by judicious management, but lost youth and
-elasticity of the tissues can never be fully regained. The most formidable
-cases of insomnia are those for which no adequate cause can be recognized
-in the habits, mode of life, and state of health of the patient. Grave
-and permanent disorder of the brain is then to be feared. Such wakefulness
-is a frequent precursor of acute meningitis in children and adults. It
-frequently ushers in the early, insidious, formative stage of tubercular
-meningitis, and of the infective fevers--notably typhoid fever. It forms
-one of the most suspicious symptoms among the introductory phenomena of
-insanity; and during the course of protracted diseases, its intrusion is
-an omen of most unfavorable augury. It will, therefore, be found useful to
-consider with some degree of detail the circumstances under which insomnia
-may occur, and the best means of averting its onset.
-
-A severely logical reference to previous doctrines regarding the condition
-of the brain during sleep, has led many authors to consider the
-therapeutical treatment of insomnia chiefly as a matter of modification of
-the cerebral circulation. Sleep has been supposed to depend upon a
-comparatively bloodless state of the brain, and wakefulness upon the
-contrary state. For such theorists the treatment of insomnia consists very
-simply in the use of agents which are supposed to be efficacious in
-reducing the flow of blood through the head. Tourniquets, placed upon the
-carotid arteries, occupy a position of great honor in the _armamentarium_
-of such people. Recognizing the fact that changes in the force of the
-circulation accompany and sustain every change in the activity of the
-cerebral cortex, we, however, attach the greatest importance to the
-condition of the nervous substance itself. For a clear understanding of
-the proper mode of medication, it is important to ascertain whether the
-cerebral substance is in a state of normal activity, or whether it is in a
-state of healthy, but excessive, activity, or whether its seeming
-excitement is merely the result of irritable weakness. Since these
-opposite conditions may declare themselves during the course of any
-disease in which insomnia may become a troublesome phenomenon, it is
-impossible to make a classification of diseases upon the basis of these
-different states of the brain. It will, therefore, be found more useful to
-consider the subject of sleeplessness as it ordinarily presents itself
-during the clinical progress of the several forms of disease. It will,
-then, appear that the type of insomnia is liable to variation with the
-course of each individual malady; and its treatment must vary accordingly.
-
-Before proceeding to a discussion of the therapeutics of insomnia in
-connection with particular diseases, it will be advantageous to pass
-briefly in review the different remedies which are useful in the treatment
-of wakefulness. These may be divided into two classes: Nervous stimulants,
-and nervous sedatives. Among the first may be also reckoned food, heat,
-baths, and counter-irritants. Like all nervous stimulants, they promote
-the complete and harmonious action of all parts of the nervous system,
-favoring that equilibrium of the circulation which is most favorable to
-the development of sleep. The second class of agents comprises all such
-remedies as act directly upon the nervous tissue of the brain, depressing
-its functional activity, and hushing to rest those particular organs
-which, by their undue excitement, serve to keep the remainder in a state
-of wakefulness. All these substances produce decided effects upon the
-spinal cord and the peripheral nerves, but it is their operation upon the
-brain which principally interests us in connection with insomnia.
-
-NERVOUS STIMULANTS.
-
-  Heat.
-  Baths.
-  Massage.
-  Electricity.
-  Counter-irritants.
-  Food.
-  Digitalis.
-  Camphor.
-  Musk.
-  Valerian.
-  Cannabis indica.
-  Belladonna.
-  Hyoscyamus.
-  Stramonium.
-  Phosphorus.
-  Acids.
-  Opium.
-
-NERVOUS SEDATIVES.
-
-  Cold.
-  Alcohol.
-  Paraldehyde.
-  Ether.
-  Chloroform.
-  Chloral.
-  Butylchloral hydrate.
-  Amyl nitrite.
-  Opium and opiates.
-  Bromides.
-  Hops.
-  Gelsemium.
-  Conium.
-
-
-NERVOUS STIMULANTS.
-
-It may at first sight seem to be a contradiction in terms when it is
-asserted that sleep may result from the administration of a nervous
-stimulant. This does occur, but only indirectly, and as a consequence of a
-restoration of energy to those portions of the nervous system which serve
-to moderate the activity of the organ of the mind--the cortex of the
-cerebrum.
-
-_Heat_, for example, is an undoubted stimulant. When added to the body in
-quantity sufficient to overcome chilliness, it tends to equalize the
-circulation of the blood, and produces throughout the body a nervous
-equilibrium that prevents any particular organ or member from arousing the
-others to wakefulness.
-
-_Baths._--The application of heat in the form of a warm bath constitutes
-one of the most admirable means of tranquilizing the brain. Children who
-are restless at night are delightfully soothed by a warm bath every night
-and morning. The water should be of an _agreeable_ temperature--this is
-better than any exact figure upon the scale of a thermometer--and the bath
-should not last lounger than ten minutes. Similar baths exercise a happy
-effect upon adult patients who are moderately feverish, nervous, and
-wakeful. If strong enough, they may take a full bath at bedtime; but if
-too feeble to leave the bed, gentle sponging with warm water will prove
-most refreshing, and will usually be followed by restful sleep. The
-well-known derivative effects of hot foot baths scarcely need to be more
-than mentioned in this connection.
-
-Turkish baths form an invaluable adjuvant in the treatment of chronic
-cases of insomnia arising from rheumatic, gouty, and dyspeptic disorders
-of the health. The copious perspiration induced by the heated air of the
-hot chamber is depurative, while the cold douche and the massage with
-which the bath is concluded have a powerful effect to stimulate all the
-functions of the body. By this means the brain is enabled to resume a
-healthier mode of action, and sleep follows as a matter of course.
-
-_Massage._--This constitutes a process of rubbing and kneading the body.
-It has been practiced from time immemorial among the oriental races and
-the Pacific Islanders as a means of relief from fatigue of every kind.
-Among the Japanese the practice of massage is a monopoly in the hands of
-the blind, who are thus enabled to support themselves. Various
-modifications of the oriental method have been introduced under the names
-of _percussion_, _shampooing_, and the _Swedish movement cure_. They all
-possess the common features of friction applied with the hand to the skin,
-compression of the muscles with the hands, and passive movements of the
-different articulations of the limbs and body. For effecting all these
-processes nothing has yet surpassed the Sandwich Island _lomi-lomi_ as
-practised by the court-retainers of the ancient chiefs. As a means of
-relieving fatigue, and of removing muscular soreness, after violent
-exertions of every kind, it is far superior to the imitations performed by
-European and American professional _masseurs_ and _masseuses_. Nervous
-headaches, the pains that accompany spinal irritation, and all conditions
-of restlessness and wakefulness which depend upon exhaustion are relieved
-by this method. The well-known soothing influence of a mother's hand
-stroking the face and forehead of her sleepless child, is an example of
-only one of the effects thus produced by the skillful _masseur_. These
-salutary results must be assigned to the uniform friction of the skin,
-causing the liberation of heat, and modifying the electrical conditions of
-the body. By this, the impressions derived from the peripheral nerves are
-reduced to a more harmonious series. The circulation of blood and lymph is
-rendered more active in the substance of the muscles, and all the
-processes of nutrition are thus stimulated to a degree that restores the
-equilibrium of function throughout the nervous system. Being no longer
-irritated by suffering portions of the body with which it is connected,
-the brain then yields to the effects of its own fatigue, and sleep
-supervenes.
-
-_Electricity_ is chiefly useful in those cases where it is impossible to
-discover anything but cerebrasthenia as the cause of wakefulness.
-According to Beard and Rockwell,[39] sleep may result from the use of any
-one of the different methods of electrization. The passage of a moderate
-current, either galvanic or faradaic, through any portion of the body
-often produces a temporary feeling of sleepiness; but the long continued
-employment of electricity is needful to effect those changes in cerebral
-nutrition which are necessary for a permanent cure of insomnia. In cases
-of sleeplessness caused by worry and overwork, great benefit is often
-experienced from the daily passage of the faradaic current from the back
-of the neck, or from the pit of the stomach, to the feet. Static
-electricity, and the electric bath, are also very effective in many cases
-of so-called _spinal irritation_ and insomnia.
-
-_Counter-irritants_ are substances which are applied to the surface of the
-body for the purpose of communicating to the superficial sensory nerves
-impulses (irritation) which may serve to inhibit the morbid functions of
-distant or central nervous structures. Various explanations of this
-process have been presented; notably a most ingenious argument by Dr. T.
-Lauder Brunton[40] in favor of the theory of inhibition by interference
-of vibrations--impulses from the periphery interfering with vibrations
-originating in morbid conditions of the central nervous organs--very much
-as darkness is produced by the interference of luminous undulations, and
-silence is effected by interference of sonorous waves in the atmosphere.
-This hypothesis is the one that is most conformable to the present
-requirements of science, and is hereby accepted as the most satisfactory
-explanation of the action of counter-irritants.
-
-The drugs in general use for the purpose of counter-irritation are
-_cantharides_, _capsicum_, _mustard_, _thapsia_, _turpentine_, _aconite_,
-and _croton oil_. _Cups_, _leeches_, and certain special applications of
-_electricity_, also owe much of their virtue to the same power of
-modifying functions at a distance. Under the influence of all these agents
-the molecular vibrations of the brain may be profoundly influenced; pain
-may be annulled, and sleep be procured. The circulation of the blood is so
-powerfully affected by these measures that their good effects are usually
-attributed to the circulatory changes thus produced. But, as in all other
-modifications of the circulation, the nervous tissues and the vascular
-channels must first be reached by influences unconnected with the blood
-itself before its current can be diverted from one region to another. The
-inhibitory action upon the nervous organs is the primary effect. The
-diversion of the circulation is a secondary consequence, by which,
-undoubtedly, the degree of nervous change can be estimated, and by which
-the inhibitory effects in the brain are intensified and sustained.
-
-_Food._--In a considerable number of cases of insomnia, its cause lies in
-an irritable weakness of the nervous tissues. Exhausted by overwork, or
-debilitated by the loss of blood, or half-starved during the course of a
-long illness like typhoid fever, a condition of wakefulness may be
-established which will add to the dangers experienced by the patient. In
-this state there is great restlessness--the sufferer experiences no severe
-pain, but he cannot lie still. This form of sleepless agitation is often
-encountered during the later stages of exhausting diseases; and, if not
-properly treated, it soon leads to a fatal termination. The most important
-remedy for such distress is found in food. This must be soluble,
-diffusible, stimulant, and nutritive. Milk, alcohol, eggs, and meat-juice,
-are the typical representatives of such food. _Milk_ should be as fresh as
-possible, and should be slightly salted, in order to hinder the formation
-of hard curds in the stomach. For young children it may be _peptonized_
-with advantage by gently heating one pint of milk with five grains of
-sodium carbonate and five grains of pancreatic extract dissolved in half a
-pint of water. The mixture may be sufficiently warmed by placing it in a
-bottle immersed for half an hour in a jug of hot water (Fairchild). By
-this process the milk is partly digested before it is drank, thus
-relieving the alimentary canal of a corresponding amount of work.
-
-Furnished in the form of _koumiss_, milk is not only presented in a
-digestible form, but the alcohol and the acids yielded by its fermentation
-are powerful aids to the process of digestion. Fermented milk forms a
-considerable portion of the daily food of the nomad tribes of Central
-Asia, and it is highly esteemed among the Russians in the treatment of
-pulmonary consumption. It is useful in all diseases affecting the
-digestive organs, and can often be tolerated, even by very young children,
-when nothing else will remain in the stomach. Considerable mystery is made
-of its preparation by those who sell it for an enormous price; but its
-composition is really very simple, and its actual cost is within the reach
-of every one. The following formula for its preparation has given great
-satisfaction to many of my patients:
-
-Dilute five quarts of milk with three quarts of hot water. When lukewarm,
-add half a cupfull of sugar of milk (which can be obtained from any
-wholesale druggist), and one bottle of well fermented koumiss (or a little
-yeast). Stir the mixture thoroughly, and let it stand in an open jar, at a
-temperature of about 72° F., till it begins to curdle. Then stir in half a
-cupfull of pulverized coffee sugar, and cork tightly in champagne bottles
-with the best velvet corks. The bottles should be kept quite cool, as
-fermentation proceeds very briskly, and will break the containers if left
-in a warm room. A large ice-box is the best receiver during hot weather.
-The koumiss thus prepared is ready for use at the end of a week. It may be
-most conveniently drawn from the bottle with a champagne tap. The entire
-cost of the article need not exceed seven cents a bottle.
-
-Sleeplessness caused by chronic dyspepsia will often yield to a diet of
-koumiss, when every other remedy has failed. When the stomach is very
-intolerant, it should at first be taken in very small doses, repeated as
-often as every hour. It will soon become possible for the same patient to
-drink two or three quarts each day.
-
-_Eggs_ form one of the most nutritious and easily digested articles of
-diet. They should be taken uncooked, beaten up with milk to which a small
-quantity of wine or spirits and sugar have been added. A glass of eggnogg,
-thus prepared, is invaluable in the insomnia of fevers and other
-conditions of exhaustion.
-
-_Meat-juice_ can be procured in numerous forms. The various soluble
-extracts of meat, Valentine's liquid extract of beef, Murdoch's liquid
-food, all represent the juice that oozes from rare beef. Its nutritive
-value is not very great, but it possesses considerable energy as a
-stimulant. Meat juice, therefore, occupies an important place as an
-excitant of those functions which must be aroused in order to secure the
-proper digestion of other articles of food. It should, therefore, be
-administered in connection with them. As the ordinary meat extracts are
-frequently very unpalatable, they may be administered in fresh broth or
-soup, to which they give body and energy without unpleasantly affecting
-their savory taste.
-
-Neurasthenic patients, whose insomnia results from physical exhaustion,
-should never retire at night without taking some form of light and easily
-digested food. A simple slice of bread, or a piece of plain sponge-cake,
-with a glass of koumiss, forms an excellent model for such a meal.
-
-_Digitalis_ is only indirectly useful as an hypnotic. In cases of cardiac
-disease, with enfeeblement of the heart, dyspnoea, dropsy, and
-sleeplessness, digitalis is often of the greatest service. It has also
-been highly recommended in delirium tremens. Administered in the form of
-an infusion, it has been given in doses of a tablespoonful, every four
-hours, with apparently good effect. Its use is indicated in cases
-characterized by weakness of the heart, with a rapid and feeble pulse.
-Under its influence the state of the circulation improves, delirium
-ceases, and sleep occurs.
-
-_Camphor._--This substance is not an hypnotic, but it forms a valuable
-addition to various hypnotic compounds. It is a cerebral stimulant, and
-aids in the establishment of that nervous tranquility which favors the
-incidence of sleep. It may, therefore, be advantageously associated with
-opiates in the restlessness and insomnia of exhaustion. Tully's Powder, a
-valuable substitute for Dover's Powder, contains camphor. This renders it
-preferable to the ordinary opiates in typhoid fever, and in other
-exhausting diseases.
-
-_Musk_, the dried secretion of the preputial follicles of the musk-deer,
-is a substance which, on account of its high price, is rarely used as an
-hypnotic. Given in doses of ten grains, every two or three hours, it is
-exceedingly valuable (Stillé and Maisch) for the relief of "all those
-nervous phenomena which are represented by the term _ataxia_, and among
-them subsultus tendinum, mild muttering delirium, floccitation, muscæ
-volitantes, and hiccough, with a small, frequent, tremulous or irregular
-pulse, without coma and without collapse. Under these circumstances musk
-tends to produce refreshing sleep, while it calms muscular spasm and
-favors perspiration, while the pulse grows fuller, more regular, and less
-frequent.... In proportion as ataxic prevail over adynamic phenomena is
-musk advantageous." Such conditions are chiefly encountered in typhus,
-typhoid fever, the eruptive fevers, and pneumonia. Musk is very
-efficacious for the relief of "wakefulness resulting from combined mental
-and bodily fatigue--such cases, in fact, as are benefitted by valerian,
-camphor, asafetida, and ammonia."
-
-_Valerian_ and its different preparations form a typical class of agents
-which indirectly favor sleep by their gently stimulant effect upon the
-brain. They are all useful in quieting that form of hysterical excitement
-to which women are liable during the "change of life." That form of
-restlessness, usually resulting from fatigue, in which the patient feels
-as if she cannot sit still, is often relieved very promptly by the
-valerianate of ammonia. Wakefulness caused by neuralgic pains, or by
-exhaustion, often yields readily to scruple doses of valerianate of zinc
-or ammonia. The elixir of the valerianate of ammonia is a very elegant
-preparation of the drug.
-
-_Cannabis Indica._--A cerebral stimulant which produces, at first, an
-agreeable exaltation of the mental faculties. This is followed by a
-condition of delirium, succeeded in its turn by sleep. It is, therefore,
-impossible to use the drug for merely hypnotic purposes; but it is a
-useful adjuvant, in small doses, to other hypnotic remedies. Given in
-doses of 1/2-1 grain, it may be advantageously associated with opiates, or
-with hyoscyamus or belladonna in cases which do not easily tolerate the
-preparations of opium. The tannate of cannabin, given in doses varying
-from five to ten grains, has been recommended as an hypnotic; but, like
-the extract from which it is derived, its effects are rather uncertain.
-The pure alkaloid, cannabin, has been recently introduced as a soporific,
-in doses of three-quarters of a grain to a grain and a half. According to
-Stillé and Maisch, the wakefulness caused by the itching of eczema may be
-relieved by the use of cannabis indica. The uneasy sleep attendant upon
-ungratified sexual appetite may also be relieved in the same way, since
-the drug is decidedly anti-aphrodisiac.
-
-_Belladonna_ is not directly hypnotic, unless given in poisonous doses,
-but its medicinal operation tends to overcome certain conditions that
-hinder sleep. By its anti-spasmodic effects it relieves many forms of
-spasm which would otherwise interfere with sleep. Spasmodic asthma
-furnishes an example of such an affection. This may be relieved by the
-hypodermic injection of atropine. Whooping cough is another disease which
-may be largely controlled by the internal administration of the drug,
-especially by inhalation of a spray that has been medicated with
-belladonna. Neuralgia, especially the form that involves the head, face,
-and intercostal nerves, is greatly mitigated by the use of belladonna, or
-its alkaloid, atropia. Its association with opiates seems to increase
-their hypnotic effect, while at the same time neutralizing their
-disagreeable action. According to Curci,[41] it opposes the tendency of
-opiates to cause cerebral hyperæmia. For this reason it is generally
-advisable to combine sulphate of atropia with sulphate of morphia for
-hypodermic use. Of the former 1-100--1-80 grain may be used with 1/4
-grain of the latter. Certain patients are exceedingly intolerant of
-belladonna and its derivatives, a fact that must be kept in mind,
-especially when using the alkaloid, atropia. Fatal consequences are very
-rare, but uncomfortable dryness of the throat, dilatation of the pupils,
-and some degree of delirium are not uncommon. At the same time it must be
-admitted that in many instances relief from suffering is not obtained
-until these physiological effects of the drug have been manifested.
-
-_Hyoscyamus._--As might be inferred from their close botanical
-relationship, hyoscyamus and belladonna present many points of similarity.
-Their alkaloids are almost identical in chemical and physiological
-properties. The extract of belladonna is considerably stronger than the
-extract of hyoscyamus. Like other solanaceous plants, this is powerfully
-narcotic and anodyne. Sleep is produced only by the use of the drug in
-large doses, which also tend to excite delirium, sometimes even reaching
-to the height of maniacal fury. Children tolerate hyoscyamus in doses
-proportionally larger than can be taken by adults. By many physicians it
-is considered the hypnotic _par excellence_ for children. In the various
-forms of insanity the tranquilizing influence of hyoscyamus is highly
-esteemed. The derivative preparations, hyoscyamine and hyoscyamia, are
-preferable for use in this class of cases. The first may be given in doses
-of 1-16--1 grain; the latter is much more powerful, and should be given in
-doses not exceeding 1-100 grain until the degree of its tolerance has been
-ascertained.
-
-_Stramonium._--This is another of the solanaceous plants, possessing many
-qualities like those found in belladonna. It is not directly hypnotic.
-Poisonous doses produce delirium and persistent insomnia. But its
-anti-spasmodic effect upon the paroxysm of nervous asthma renders it
-indirectly hypnotic in that affection. For the relief of bronchial spasm
-the smoke of the dried leaves should be inhaled in considerable quantity.
-It may be smoked in a pipe; or, mixed with saltpetre, it may be made to
-smoulder upon a tin plate, while the smoke is drawn by inspiration into
-the lungs. Various kinds of medicated pastiles have been prepared, to
-effect a similar result by furnishing the drug in a convenient form for
-use. _Tobacco_ and _lobelia_ operate in a very similar manner upon all
-spasmodic affections of the respiratory passages; but their energy is
-almost too great for the comfort of the patient.
-
-_Phosphorus._--Bartholow has recommended this drug in "cases of
-wakefulness dependent on cerebral anæmia and exhaustion," and in "the
-wakefulness of the aged, accompanied with muscular cramps, feebleness of
-memory, giddiness, and trembling of the voluntary muscles on exertion." In
-minute doses, it is true that phosphorus acts as an irritant of nervous
-tissue. It promotes destructive changes in the tissues of the body, and
-thus produces a temporary excitement which may favor the processes of
-nutrition. Indirectly, it may thus prove beneficial in many cases of
-cerebral exhaustion; but as a direct hypnotic it will be found of very
-little service. It should be given in doses of 1-100 grain every four
-hours.
-
-_Acids._--In those forms of sleeplessness which are dependent upon
-disordered conditions of the digestive apparatus, acids are often useful.
-Their topical effects upon the mucous membrane of the stomach are
-stimulant and alterative; hence they are useful in atonic dyspepsia, where
-there is deficient secretion of the gastric juice. In such cases
-_hydrochloric acid_ and _lactic acid_ are useful. The first should be
-given, in doses of five drops diluted with half a pint of water, after
-each meal. Lactic acid may be given in doses of one or two teaspoonfuls,
-similarly diluted. It has been asserted, on theoretical grounds, that
-lactic acid and the lactate of sodium are directly hypnotic, but its
-experimental use has never given satisfactory results. _Phosphoric acid_
-has been used in the same way, with very similar effects. An impure
-solution of phosphoric acid, known as _Horsford's Acid Phosphate_, has
-been extensively used for its supposed hypnotic properties. It assists
-digestion, stimulates the kidneys, and by its general diffusion promotes
-molecular activity throughout the body. It is thus indirectly beneficial
-in cases of insomnia. No small part of the benefits thus obtained must,
-however, be ascribed to the water with which these acids are diluted. When
-the liver becomes sluggish in its action, nitric acid, in doses of five
-drops diluted with half a pint of water, may be taken every four hours
-with great advantage. Thus used, the mineral acids may often yield
-invaluable service in the treatment of insomnia occasioned by cachectic
-conditions of the body--notably such as are produced by malaria, oxaluria,
-and the so-called phosphatic and rheumatic diatheses.
-
-
-NERVOUS SEDATIVES.
-
-The remedies thus far considered are but indirectly hypnotic in their
-effects, though exceedingly valuable as agents for the production of
-conditions favorable to sleep. We may now pass to the consideration of a
-class of remedies which operate more directly upon the brain to depress
-its energy. They are, therefore, called nervous sedatives, and they
-include the majority of narcotic substances.
-
-_Cold._--The operation of cold upon the body has already been sufficiently
-considered. It only remains to note the effects of cold applied through
-the agency of baths and local refrigerants. A full account of the theory
-and practice of hydrotherapeutics can be found in the second volume of Von
-Ziemssen's _Handbuch der Allgemeinen Therapie_. The English reader will
-find the subject treated at sufficient length in Ringer's _Handbook of
-Therapeutics_.
-
-According to Ringer, the sitz-bath, taken at a temperature between 60° and
-80° F., is very useful to soothe "an irritable restless state of the
-nervous system." It should be employed once or twice a day, from five to
-thirty minutes at a time. Among other beneficial consequences is the
-promotion of quiet sleep.
-
-For the relief of the pungent heat and restlessness which add so much to
-the danger of the specific fevers cold baths have been highly recommended.
-These have been employed with great energy in many of the German
-hospitals; and often with great benefit to the patient. The preferable
-method is the one advised by Von Ziemssen and Immerman. The patient is
-placed in a tub of water at 95° F. This is very gradually cooled down, in
-the course of half an hour, to 60° F. The bath should be repeated from
-three to five times a day, according to the temperature of the patient. By
-this method of treatment the patient is made more comfortable; he becomes
-less restless or delirious, and secures a larger amount of refreshing
-sleep.
-
-The difficulty of administering such a laborious course of baths outside
-of a well equipped hospital renders its adoption almost impossible in
-private practice. Here the physician must rely upon assiduous sponging
-with water of an agreeable temperature. In severe cases, such as measles
-before the appearance of the eruption, scarlet fever during the period of
-heat and agitation, and typhoid fever during the corresponding stage,
-great benefit will be derived from the cold wet sheet. In order to humor
-the prejudices of the laity, this should be wrung out of warm water and
-applied with sufficient deliberation to insure its considerable loss of
-heat. A blanket should first be spread upon an empty bed; the wet sheet
-should be spread over the blanket. The patient must be placed naked upon
-the sheet, which should then be drawn around the entire body, and the
-blanket may be folded around the whole package. Children generally insist
-upon leaving their arms uncovered. This may be allowed with safety in many
-cases, but generally a wet napkin should cover the upper part of the chest
-and the neck which cannot be reached with the sheet when the arms are
-exposed. After remaining from half an hour to two hours in the pack, the
-patient becomes comparatively cool and quiet, and the eruption, if
-delayed, begins to appear. Sleep often occurs as an immediate consequence
-of the relief thus obtained.
-
-Similar good results may be secured by the use of cold affusion in cases
-of high temperature and great restlessness. I well remember a little boy,
-about eight years old, whom I once found rolling and tossing and burning
-up with scarlet fever. Calling for an empty wash-tub, I had him stripped
-and placed upright in the tub. I then began to pour cold water over him
-from a large pitcher. Scarcely had the water touched his skin, before he
-seized the pitcher, and began to drink from it. He was permitted to
-completely slake his thirst, and then the affusion was resumed. After four
-or five gallons of water had been thus poured over him, he was wiped dry,
-and was returned to his bed, where he immediately turned upon his side,
-and fell into a peaceful sleep. A few more affusions relieved him from
-danger, and he made a rapid recovery. Were people less afraid of such
-measures, a considerable portion of the danger in fevers might be
-obviated. Great discretion, however, is necessary in the application of
-such treatment, for Ringer states that he has "seen a child, suffering
-from scarlet fever, killed by an over-energetic employment of cold." The
-temperature of the patient should be carefully noted, and its reduction
-below the normal standard should never be permitted.
-
-_Anæsthetics._--All anæsthetics are hypnotics. In other words, they
-possess the power to abolish consciousness, and thus to produce a
-condition resembling sleep. This is effected by the direct action of the
-anæsthetic substance upon the cellular structure of the brain, reducing
-the molecular movements of the living protoplasm below the degree
-requisite for the excitement of consciousness. This sedative effect is
-preceded by a brief period of cerebral exaltation, occasioned by the
-disturbances caused by the first introduction of the drug into the current
-of the circulation.[42] It is with the subsequent hypnotic effect only
-that we are now concerned. Of the numerous anæsthetic substances that have
-been discovered, but few comparatively have been found sufficiently
-manageable and safe for general use. These are alcohol, paraldehyde,
-ether, compound spirits of ether, chloroform, chloral, butylic chloral,
-and amylic nitrite.
-
-_Alcohol._--The hypnotic effect of alcoholic drinks is very decided,
-though not speedily manifested unless the beverage be taken in
-considerable quantity. Distilled liquors produce the effect of alcohol in
-its simplest form; wines, containing various forms of ether, arouse the
-nervous system more thoroughly and agreeably than the pure alcoholic
-stimulants. Beer and porter are rendered more powerfully narcotic by the
-active principle of hops which they contain. The nutritive substances held
-in solution by these last render them peculiarly appropriate in cases that
-require nourishment as well as rest. The considerable quantity in which
-they must be taken, renders them inconvenient for use in cases of severe
-illness. Wines and distilled liquors are then most available.
-
-Alcohol is principally useful as an hypnotic when wakefulness is
-associated with great bodily exhaustion, such as may be experienced in
-advanced stages of the infective fevers. In such cases the heart is
-weakened, the pulse is rapid and feeble, the muscular apparatus is wasted
-and irritable, the blood is diminished in volume and tends to accumulate
-in the venous channels. Under such conditions the patient is usually
-delirious, tossing from side to side, and quite deprived of sleep. An
-ounce of brandy, repeated at intervals varying according to the severity
-of the symptoms, and given with milk and egg, in the familiar form of
-eggnogg, will often quiet this harassing restlessness, and will procure
-refreshing sleep. The temperature of the patient will then decline; the
-tongue will grow moist; and the delirium will diminish or subside
-altogether. Sometimes, however, a contrary result is observed. Alcohol
-should then be administered with a sparing hand, and it will probably be
-necessary to resort to the bromides or other cerebral sedatives.
-
-The great exhaustion which is manifested in delirium tremens sometimes
-requires the use of alcohol to support the patient, so that sleep may be
-procured. It is in such cases advisable to combine the administration of
-capsicum with that of alcohol. According to Ringer, capsicum should be
-given for this purpose in scruple doses, made into a bolus with honey, and
-repeated every three hours.
-
-Wakefulness caused by neuralgic pains is speedily relieved by full doses
-of alcohol. The various species of abdominal and pelvic neuralgia may thus
-be temporarily suspended. In like manner the "rheumatic" pains which
-afflict the overworked and underfed poor may be calmed for a season
-sufficient to procure sleep. The obvious dangers attendant upon such
-medication, however, need no comment.
-
-Old people not unfrequently suffer with a form of insomnia that is
-associated with feeble and painful digestion. This is probably caused by
-insufficient gastro-intestinal secretion. The use of wine containing a
-large proportion of compound ethers gives relief through the improvement
-in digestion consequent upon the stimulant effect of small doses of
-alcohol and ether. Under their influence the digestive fluids are more
-abundantly secreted, and all the bodily functions are quickened. Such good
-results, however, only follow the moderate use of the stimulant. It must
-never be taken in quantity sufficient to affect the intellectual
-functions, or to disturb any of the normal processes of life. The best
-results, so far as digestion is concerned, are obtained by the use of wine
-with the meals; but a night-cap, in the form of hot toddy, is sometimes
-necessary in addition. This is especially useful if there be any form of
-irritative cough or local excitement, such as the aged sometimes
-experience.
-
-The insomnia that attends excessive fatigue may be very quickly relieved
-by the use of food and alcohol. For this purpose any form of alcoholic
-drink will be found useful. The quantity administered should only be
-sufficient to produce a uniform and general vascular relaxation. By this
-means the circulation is equalized throughout the body, and the brain
-passes into a state of tranquil sleep. Any excess in the use of alcohol
-under such conditions will be followed by headache and discomfort on
-awaking. In all cases the intoxicating dose of alcohol must be avoided,
-if its truly hypnotic effect be desired.
-
-_Paraldehyde._--This is a derivative from ethyl alcohol. It is, when pure,
-a colorless liquid, with an agreeable odor, somewhat like that of ether.
-It is soluble in the proportion of one part in eight or nine of water. It
-may be used internally in doses varying from forty-five to one hundred and
-sixty grains. A watery solution, containing one part to ten, has been
-recommended for internal administration. It may also be given in milk or
-in beer. M. Yvon[43] recommends the following formula:
-
-  Paraldehyde, Gr.     20.0
-  Spirit,             100.0
-  Syr. Simpl.,         75.0
-  Tr. Vanillæ,          5.0
-
-An ounce of this mixture contains forty-five grains of paraldehyde. When
-taken it should be still further diluted with sweetened water, or with
-beer, to obviate, as far as possible, the disagreeable taste of the drug.
-Sleep follows after the lapse of about half an hour, and continues from
-five to seven hours. The physiological action of the medicine is very
-similar to that of chloral hydrate, and its use is indicated in the same
-class of cases to which that drug is appropriate. By many it is considered
-the preferable hypnotic. It has found considerable employment in the
-insane asylums of Europe, and in other institutions where disagreeable
-medication is no obstacle to experiment. In private practice the peculiar
-taste and smell of the article, and its pungent effect upon the mucous
-membranes of the alimentary canal, render its exhibition more difficult.
-But the weight of testimony is in its favor as an hypnotic in all cases,
-uncomplicated with disease of the stomach, in which insomnia is not
-dependent upon pain, and is associated with cerebral hyperæmia. Its
-administration is followed by no unpleasant consequences. Among the insane
-it is particularly recommended during periods of excitement and
-wakefulness. It has been employed with great satisfaction[44] in cases of
-insomnia during the course of such varied diseases as emphysema,
-bronchitis, phthisis, nervous and spinal disorders, diseases of the heart,
-jaundice, chronic rheumatism, and insomnia from other unrecognized causes.
-Undoubtedly, with greater skill in its purification and exhibition, it
-will become one of the most valuable of hypnotic remedies. Almost useless
-for the relief of pain, it is indicated in cases of uncomplicated
-insomnia. Having very little power, in moderate doses, to depress the
-action of the heart, it is preferable to chloral hydrate in cardiac
-diseases and debility. Sleep procured with doses of fifteen to sixty
-grains is calm and refreshing, and is not followed by any disagreeable
-consequence. A certain degree of tolerance is gradually established, so
-that larger doses may become necessary. It has been given in quantities
-amounting to three drachms; but, if large doses be given before the
-development of tolerance, the patient will experience headache,
-uneasiness, nausea, and vomiting, after waking from the sleep thus
-induced. Another advantage possessed by paraldehyde consists in the
-absence of the period of excitement produced by chloral before the advent
-of sleep. It is an hypnotic, without narcotic properties, limiting its
-effects chiefly to the brain, and leaving the spinal cord in a condition
-nearly like that of natural sleep.
-
-_Ether_, though possessed of the greatest value as an agent for the
-production of artificial anæsthesia, is rarely used as a mere hypnotic.
-Diluted with alcohol and ethereal oil, it forms the _Compound Spirit of
-Ether_, or _Hoffmann's Anodyne_. In this form it is well adapted for
-internal administration. It is thus very serviceable in the treatment of
-those forms of insomnia associated with nervous irritability and hysteria.
-For the relief of wakefulness dependent upon a languid circulation, with
-cold feet and flatulence, the anodyne may be given in half-drachm doses
-well diluted with ice water, and repeated every fifteen minutes till
-relief is obtained. Nearly all forms of painful or spasmodic disturbance
-unattended by fever may be thus relieved. For this reason it is
-particularly useful in the treatment of uterine colic and in sleeplessness
-after childbirth, when opiates cannot be tolerated, or are
-contra-indicated on account of their tendency to excite the brain.
-
-_Chloroform_, like ether, is an agent too powerful and too evanescent for
-use as a simple hypnotic. But for the relief of intense suffering caused
-by nervous irritation and spasm it is without any superior. In certain
-minor affections of a spasmodic character it, therefore, forms a valuable
-adjuvant to other remedies. Diluted with alcohol it forms the spirit of
-chloroform, a remedy which is useful in all cases for which the compound
-spirit of ether is usually prescribed. In this form it is an excellent
-addition to various mixtures designed for the relief of spasmodic coughs
-by which sleep is disturbed. Ringer recommends it in the treatment of the
-irritative cough so characteristic of fibroid phthisis. It should also be
-used in cases of spasmodic asthma. The asthmatic paroxysm may frequently
-be arrested by inhalations of the vapor of chloroform or ether; but,
-unfortunately, the lungs soon become tolerant of these agents, and they
-then cease to afford relief. The valuable mixture known by the name
-_chlorodyne_ owes a considerable portion of its efficacy to the presence
-of chloroform as one of its ingredients.
-
-_Chloral._--Until the recent introduction of paraldehyde, chloral hydrate
-has for many years held the first rank as an hypnotic. It is particularly
-useful in wakefulness occasioned by exhaustion of the nervous centres. The
-conclusions of all experienced observers have been most concisely stated
-as follows:[45] "Chloral appears to be indicated when sleeplessness is
-dependent upon a vascularity due to exhaustion rather than to primary
-excitement of the brain; thus it has been found useful when loss of sleep
-follows severe and prolonged mental application or excitement of feeling,
-or accompanies the general debility following acute diseases attended with
-delirium or severe pain, or is associated with acute _mania_, especially
-of the puerperal form. The somewhat analogous condition which exists in
-_delirium tremens_ is very amenable to this medicine, especially in the
-forming stage of the affection known as 'the horrors,' and which so
-frequently follows surgical injuries in drunkards; it is useful also when
-great nervous excitement and restlessness are associated with extravagant
-phantasms. Nevertheless, its depressing effects are to be guarded against
-in this affection as in the different forms of insanity." This caution is
-directed against the frequent and repeated employment of the article in
-chronic cases, on account of the vasomotor paralysis and general cachexia
-thus induced. It is now claimed that many of these consequences may be
-avoided by the substitution of paraldehyde in the place of chloral, but it
-has been shown[46] that similar effects may follow the long continued use
-of this substitute.
-
-Chloral is usually administered by the mouth in doses, for adults, of
-twenty to thirty grains, dissolved in sweetened peppermint water. If the
-first dose does not procure sleep, it may be followed at the expiration of
-an hour by a second dose of twenty grains. This seldom fails to induce
-refreshing sleep. When the medicine cannot be tolerated by the stomach it
-may be given by enema in milk. For this purpose a drachm of chloral should
-be suspended with the white of an egg in half a teacupful of milk.
-
-_Butylchloral hydrate._--This substance has been recommended as a
-substitute for chloral hydrate, in cases of cardiac weakness, on account
-of its being less powerful to depress the action of the heart. It is
-principally useful for the relief of facial neuralgia and hemicrania. As
-an hypnotic it is seldom used. For this purpose it may be given in a
-solution like that of chloral hydrate. For a simple anodyne effect the
-medicine may be given in five-grain doses, repeated every half hour or
-hour. As a means of procuring sleep it may be given in doses ranging from
-fifteen to forty-five grains. Liebreich has given the medicine in drachm
-doses, and recommended it as an hypnotic superior to chloral hydrate. It
-is useful in the sleeplessness of headaches, neuralgia, dysmenorrhoea, and
-chronic phthisis.
-
-_Amyl nitrite._--This drug has been recommended for the relief of insomnia
-resulting from the opium habit. Ringer considers it useful in the flushes
-of heat and other forms of discomfort which sometimes interfere with the
-sleep of women during the change of life. It should be inhaled in the form
-of vapor, from a handkerchief upon which five drops have been poured. The
-quantity will need to be gradually increased, as the system becomes
-tolerant of its effects. The stimulant effect of the medicine renders its
-use in this manner probably less dangerous than the similar employment of
-chloroform. Unlike the other anæsthetics above mentioned, it causes a
-hyperæmic condition of the brain, and is, for this reason, a useful
-hypnotic in cases of aortic obstruction with an insufficient cerebral
-circulation and consequent wakefulness.
-
-_Opium and opiates._--There seems to be no agreement among experimental
-physiologists regarding the manner in which opium produces its effects
-upon the body. By some it is ranked as a stimulant; by others it is
-considered a sedative. These different opinions are probably due on the
-one hand to differences in the dose and strength of the opiates employed,
-and on the other to idiosyncrasies on the part of the individuals
-subjected to experiment. The soporific effect of the drug appears to
-result from its direct action upon the substance of the brain. Under its
-influence the blood tends to accumulate in the veins, and loses its bright
-arterial hue. Small doses are said to contract the capillaries of the
-body, while they are dilated by excessive doses of the drug. From this it
-may be inferred that opium acts, like many other narcotics, as an irritant
-of the tissues when given in minute quantity, and as a paralyzing agent
-when a certain relative amount is exceeded. The experiments of Curci[47]
-indicate that under the influence of irritating doses of morphia the brain
-becomes hyperæmic.
-
-Opium is a remarkably complex substance, no less than nineteen different
-alkaloids having been separated from it. Of these, however, only one has
-stood the test of therapeutical experiment--morphia. Several other
-constituent alkaloids, notably _codeia_, have been lauded as hypnotics,
-but they are, at their best, far inferior to morphia, and may well be
-omitted from the list of sleep producers. But, though the soporific
-properties of opium are chiefly due to the morphia which it contains,
-there are certain points of difference between the action of the two
-medicines that often render a choice desirable. According to Stillé and
-Maisch,[48] morphia does not stimulate circulation and the nervous system
-as much as opium, and its narcotic effects are less decided and speedy,
-though its after effects are more enduring. Opium increases the bodily
-temperature and sense of heat; morphia produces the last effect, but
-diminishes the temperature. Opium at first increases the frequency of the
-pulse, while morphia diminishes it. Opium is of the two the less liable to
-excite nausea and vomiting; hence the superiority of the tinctures and
-aqueous solutions of opium when nausea is specially feared.
-
-Of all the remedies for the relief of pain opiates are the most effectual.
-Before the introduction of the alcoholic hypnotics and the bromides, they
-constituted the principal agents in the treatment of insomnia. Even at the
-present time they are indispensable for the relief of all forms of
-sleeplessness dependent upon pain. A combination of chloral hydrate,
-sodium bromide, and morphine forms one of the most generally useful
-hypnotic compounds ever employed.
-
-Under ordinary circumstances morphia is the preferable opiate for the
-relief of insomnia. The sulphate is most frequently employed, but the
-acetate and the tartrate have been recommended on account of their
-supposed superiority in the formation of solutions that are unirritating
-and permanent in their character. The hypodermic method of administration
-forms the most prompt and efficient mode of procuring the effect of the
-medicine. It should be given in a dose of quarter of a grain about an hour
-before the time when sleep is desired. For some patients a longer time is
-necessary to develop its hypnotic effect. To children the hypnotic dose
-must sometimes be given at three o'clock in the afternoon in order to
-induce sleep at nine o'clock in the evening. As the effect of opiates is
-highly stimulant to the sweat-glands, and is often productive of nausea,
-it is advisable to associate atropine with morphine when thus given. For
-an adult the hundredth of a grain of atropine may be given with every
-quarter of a grain of morphine. The soothing and agreeable effects of
-morphia are thus intensified, while its disagreeable tendencies are
-reduced to a minimum. The injection should be made into the loose areolar
-tissue between the skin and the muscles. Its location is a matter of
-little importance so far as the relief of pain is concerned; but the
-neighborhood of the blood vessels should be avoided, since alarming
-symptoms have been observed after injection into a vein. The outer aspect
-of the arm near the insertion of the deltoid muscle is a favorite site for
-puncture. If, for any reason, the hypodermic use of morphia cannot be
-employed, it may be introduced into the rectum either in solution or in a
-suppository. The bowel should first be washed out with an enema of warm
-water; the opiate may then be introduced. The dose thus exhibited need
-scarcely exceed that usually given by the mouth; but, if the rectum is not
-previously cleansed, a double, or even triple, dose may be required.
-
-As an hypnotic morphia is chiefly useful in phthisis, in cardiac dyspnoea,
-in diseases of the stomach which cause insomnia, in fevers with
-prostration and delirium, in delirium tremens, in mania, and in the
-majority of painful or spasmodic diseases. If the patient be violently
-excited, the opiate should be combined with small doses of tartar emetic,
-ipecac, or tincture of aconite. But in the chronic diseases it is
-desirable to avoid its continuous administration, not only on account of
-the risk of creating the opium habit, but also by reason of the injurious
-effects of the drug upon digestion and nutrition.
-
-_Codeine_ is a mild hypnotic which may be used in doses about twice as
-large as those of morphine. It is expensive and not very efficient, but
-may be sometimes prescribed with advantage when moral considerations
-render the use of ordinary opiates inexpedient.
-
-_Lactucarium_ may be classed with the weaker opiates. It possesses very
-little value. Its fluid extract is sometimes prescribed at night to allay
-the cough of pulmonary consumption, so as to favor sleep.
-
-_Bromides._--According to Mitchell, Echeverria, and Bartholow, the
-soporific energy of the bromides may be ranked as follows: Lithium bromide
-first, sodium bromide second, potassium bromide third. Hammond praises
-calcium bromide. Hydrobromic acid is also employed as an hypnotic in
-certain cases. As a clinical fact the bromides of sodium and potassium are
-most frequently employed for the relief of insomnia. Of these the second
-is most useful when sleeplessness is associated with the phenomena of
-irritability; the first is less energetic in its effects upon the motor
-structures of the body.
-
-The bromides act upon the protoplasmic constituents of the body, directly
-inhibiting their functional energy. Upon the spinal cord they act to
-diminish reflex excitability. Under their influence the receptivity and
-functional capacity of the brain is reduced. The minute blood vessels
-contract in consequence of the inactivity of the tissues which they
-supply. A lethargic sleep is thus induced.
-
-For the reasons above stated the bromides find their greatest opportunity
-for usefulness in cases of over-excitement and exhaustion of the brain.
-When the cortical cells have degenerated into a condition of irritable
-weakness, characterized by inordinate instability of substance, the
-bromides serve to steady the fabric by retarding those movements of
-disintegration which produce morbid wakefulness. Almost useless in cases
-marked by active congestion of the brain, they are invaluable in the
-insomnia produced by excessive mental exertion, care, emotion, worry and
-fatigue. The wakefulness of hysteria, of asthenic mania, and of sexual
-excitement, is often greatly relieved by the administration of the
-bromides. The prodromic stage of delirium tremens, before any violent
-outbreak, and the wakefulness of convalescence from acute diseases are
-often cured by their use. Mental disturbances and morbid impulses
-associated with pregnancy or the puerperal state may be dispelled in the
-same way. The screaming fits of night terrors in children are benefitted
-by these medicines. They seem to increase the efficacy of chloral,
-chloroform, ether, cannabis indica, hyoscyamus, belladonna, and the
-opiates.
-
-The hypnotic dose of hydrobromic acid is twenty-five grains, largely
-diluted with sweetened water. For this reason, and for its disagreeable
-taste, it is not an eligible preparation. Lithium and calcium bromides may
-be given in scruple doses every hour or two till sleep is produced. Sodium
-and potassium bromides should be given in doses of thirty or forty grains
-every two hours.
-
-It is sometimes remarked that instead of favoring sleep the bromides only
-increase wakefulness. In such cases opiates and alcoholic stimulants are
-usually indicated.
-
-_Hops._--The principal sedative constituent of this plant is the yellow
-glandular powder found in the strobiles; this is called _lupulin_. Hops do
-not exhibit any directly narcotic property; but they serve to allay
-nervous excitement, and thus favor the occurrence of sleep. They are
-principally useful in cases of irritability of the bladder and sexual
-organs; in dyspepsia caused by irritable weakness of the stomach; and in
-the exhaustion of delirium tremens. The infusion is the best preparation
-for internal use. It may be taken in doses of one or two ounces, as
-required. Lupulin may be given in doses of ten grains or more. Its fluid
-extract is prescribed, fifteen or twenty minims in sweetened water
-whenever needed. The best method, however, of securing the beneficial
-effects of the medicine consists in the administration of a mild beer that
-is rich in hops. A glass at bedtime often forms a sufficient hypnotic.
-
-_Gelsemium_ is a very powerful agent for depressing the pulse and the
-functional activity of the spinal cord. It thus favors the induction of
-sleep in cases attended with violent excitement, such as may be witnessed
-in acute mania. It has been employed in the treatment of delirium tremens;
-but the poisonous qualities of the plant render its use somewhat
-dangerous. The toxic effects are sometimes developed quite suddenly, and
-in a manner very alarming to the laity. For these reasons it is not to be
-recommended as a soporific, unless the patient can be continually under
-the eye of the physician or of an intelligent nurse.
-
-_Conium_ has been found useful in the insomnia of mania, not through any
-narcotic property of its own, but by reason of its sedative effects upon
-the spinal cord and nerves. Under its influence the excitement of the
-patient is so far reduced that other hypnotic remedies can produce their
-effect. For this purpose Squibb's fluid extract, in doses of about
-one-third of a drachm, or one-sixtieth of a grain of coniine, may be given
-sufficiently often to repress excitement. The alkaloid may be given
-hypodermically, and in gradually increasing doses. With it should be
-associated other remedies, like hyoscyamus and chloral hydrate, in order
-to procure sleep.[49]
-
-
-
-
-CHAPTER IV.
-
-TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.
-
-  Take thou this phial, being then in bed,
-  And this distilled liquor drink thou off;
-  When presently, through all thy veins shall run
-  A cold and drowsy humor, which shall seize
-  Each vital spirit.
-                                --ROMEO AND JULIET.
-
-
-Excluding from consideration all cases of insomnia arising from painful
-injuries or diseases of the external portions of the body, which belong to
-the province of surgical therapeutics, we may profitably commence with the
-variety of wakefulness that is excited by disorder of the brain and its
-membranes. This includes the different forms of meningitis, the cerebral
-disturbances which constitute insanity, cerebral exhaustion, and chronic
-alcoholism.
-
-_Insomnia in acute affections of the brain._--Acute intra-cranial
-inflammations may result from general diseases, like rheumatism, the
-eruptive fevers, tubercular infiltration, insolation, the development of
-tumors, or syphilitic growths. In all such cases the earlier stages are
-marked by a painful exaggeration of cerebral function which renders sleep
-impossible. The wakefulness of this stage soon becomes complicated with
-delirium; and the whole is finally merged in a fatal coma. Cerebral
-excitement is the principal feature which arrests attention. This is
-accompanied by an inordinate determination of blood to the head, producing
-that cerebral hyperæmia which figures so largely in the works of the
-humoral pathologists. The treatment of acute inflammation becomes the best
-means of relieving this excitement, allaying the hyperæmia, and procuring
-sleep. The treatment should be derivative, counter-irritant, and
-calmative. The first indication must be fulfilled by the exhibition of an
-active purge. Ten grains of calomel with five grains of sodium bicarbonate
-may be given for this purpose. Leeches or wet cups should be applied to
-the temples, or to the back of the neck. The feet should be placed for a
-short time in a hot foot-bath, and an ice-cap must be drawn over the
-scalp. The internal medication must consist of arterial sedatives and
-cerebral depressants. For the first, tincture of aconite forms an
-admirable example--better even than the tartar emetic so much lauded by
-Graves. Aconite may be given with the bromides. When sleeplessness in an
-acute meningitis is accompanied by severe pain, an excellent combination
-will be found in the following:
-
-  [R.] Morph. Sulph.               gr. 1/4
-       Chloral Hydrat,
-       Sodii Bromid. a a           [dr] iv.
-       Tr. Aconit., rad.           gtt. xxv.
-       Tr. Cardam. Co.             [dr]i .
-       Aquæ, q. s. ad.             [oz] i.
-
-  Sig.--A teaspoonful every two hours, till relieved.
-
-As the disease progresses, the quantity of morphia should be reduced. In
-epidemic cerebro-spinal meningitis, opiates may be safely employed in
-much larger doses than are tolerated in the simple forms of the disease.
-When in doubt regarding the proper hypnotic the bromides alone should be
-used. Chloral hydrate may also be safely employed in the first and second
-stages of meningitis; but if given in full doses near the close of the
-second stage it sometimes seems to hasten the appearance of coma.
-
-_Insomnia in insanity._--Persistent insomnia is often one of the
-premonitory symptoms of insanity. It is likely to present itself as a most
-formidable complication at any stage of the disease. To consider aright
-the relations that exist between sleeplessness and insanity would far
-exceed the limits of this work; we can only review the leading indications
-for its treatment. It is occasioned either by an excited state of the
-brain, accompanied by hyperæmia and general functional exaltation, or by
-an exhausted and irritable condition of the cerebral substance. The first
-of these two varieties of wakefulness is encountered in cases of violent
-maniacal excitement where the disorder is comparatively recent, and the
-bodily vigor has not been depressed by long continued disease. The
-indications for treatment call for sedative measures. Leeches behind the
-ears and the application of the ice-cap are sometimes of great service.
-Derivative action upon the bowels with aloetic purgatives has often
-yielded good results. In like manner, hot mustard foot baths are
-recommended. The soothing effect of a warm bath at 90°-95° F. is sometimes
-sufficient to calm excitement, and to induce sleep. The combined effect of
-cold applications to the scalp and a warm bath to the general surface is
-still more tranquillizing. This method of treatment is particularly useful
-in maniacal forms of insanity, and in certain cases of
-melancholia--especially those in which the skin is dry and the secretions
-are disordered.
-
-Cold affusions and shower baths have been employed for their revulsive and
-sedative effect in mania. This mode of treatment is sometimes effectual,
-but is not without risk.
-
-The medicinal treatment of insomnia is frequently facilitated by the
-measures above indicated. In cases of great excitement with restlessness
-and bodily agitation, it is desirable to arrest the movements which are
-wearying the patient and keeping him awake. This may be accomplished by
-the use of conium, as indicated by Kiernan (_loc. cit._). Twenty minims of
-Squibb's fluid extract may be given for the first dose. Half this quantity
-should be repeated every half hour until the patient becomes quite calm.
-Bromide of potassium and hydrate of chloral in drachm doses should be
-given in connection with conium. Recently, paraldehyde has been employed
-as a substitute for chloral. These remedies reduce cerebral excitement,
-and favor the induction of sleep which is at least refreshing, if not
-curative of the disease. They should not, however, be used habitually, for
-fear of producing the characteristic consequences of over-dosing with such
-drugs.
-
-The varieties of insanity in which depression and exhaustion are the
-prominent features require different management. Nutritious food,
-alcoholic restoratives and stimulant doses of opiate remedies are most
-serviceable. The sleeplessness of melancholia and of paretic dementia may
-be thus relieved. Opium may be given in the form of a pill, or in the
-deodorized tincture. The old fashioned "black-drop" is highly esteemed by
-some. Others prefer the salts of morphia. If cerebral hyperæmia be present
-in these cases, it is usually associated with asthenic conditions of the
-brain, indicated by paleness of the face and weakness of the pulse. The
-hyperæmic state is then easily overcome by the administration of alcohol
-or of chloral with an opiate. If opiates alone are given in cases of
-insanity with great depression, there is danger that death by syncope may
-occur, precisely as it sometimes happens in delirium tremens when treated
-with large and frequent doses of opium.
-
-Cases are occasionally encountered which receive no relief from opiates.
-The remedy seems only to aggravate the existing irritability and insomnia.
-For such patients the tincture of hyoscyamus may be employed in doses
-ranging from two to four or even six drachms. Associated with bromide of
-potassium and hydrate of chloral, it has been used with great success.
-Spitzka prefers the simple tincture rather than the fashionable alkaloid,
-hyoscyamia.
-
-Cannabis indica associated with bromide of potassium is a useful hypnotic
-in cases of moderate depression and excitement. Clouston finds as a result
-of his experiments that "forty-five grains of bromide of potassium and
-forty-five minims of the tincture of cannabis indica are rather more than
-equivalent to a drachm of laudanum as a means of allaying maniacal
-excitement."[50] In his recent work,[51] the same author deprecates the
-use of opiates in states of depression, and advises the substitution of
-tincture of cannabis indica (x min.) and bromide of potassium (xx grs.).
-He also emphasizes the importance of abundant exercise in the open air, as
-the best hypnotic in every case that can be trusted abroad.
-
-_Insomnia in Chronic Alcoholism and Delirium Tremens._--The insomnia of
-chronic alcoholism is dependent upon the extensive morbid changes produced
-in the digestive apparatus and in the nervous system by the habitual use
-of alcoholic drinks. Sleep becomes greatly disturbed and unrefreshing. It
-is frequently broken by horrible dreams. The successful treatment of this
-condition requires complete abandonment of the use of alcohol, and a
-general correction of the condition of the alimentary canal. For the
-immediate relief of insomnia, full doses of bromide of sodium will be of
-service. Strong infusions of hops may be given _ad libitum_. Cannabis
-indica, in the form of the extract, so as to avoid the use of alcohol in
-the tincture, is of service. Hypodermic injections of morphia are
-frequently employed, but should be avoided if possible, for fear of the
-opium habit. Chloral hydrate is exceedingly useful, but should be given in
-milk, and as seldom as possible, for fear of adding to the injuries
-already sustained by the stomach. For the same reason the use of
-paraldehyde in such cases is quite inadmissable.
-
-When chronic alcoholism has culminated in _delirium tremens_, more
-energetic measures become necessary in order to procure sleep. If the
-patient be of a vigorous constitution, and if the delirium be very active,
-tartar emetic with morphia may be given, as advised by Graves. Large doses
-of tincture of digitalis, sometimes reaching an ounce every four hours,
-were used by Jones, of Jersey. Capsicum, in scruple doses every three
-hours, is said to induce sleep in many cases of delirium,[52] especially
-in exhausted conditions of the circulatory organs. Hydrate of chloral and
-bromide of sodium, each in scruple doses, may be given every two hours.
-Opiates should be used with moderation, and all attempts to induce
-profound narcosis should be avoided. Drachm doses of tincture of cannabis
-indica and of compound spirit of ether, may be given when a diffusible
-stimulant must be associated with the soporific. In desperate cases it is
-sometimes necessary to resort to inhalation of ether, but if sudden death
-should occur, it would be popularly ascribed to the effects of the
-anæsthetic. By reason of a certain tendency to death from syncope during
-this disease, it is imprudent to place such patients under the influence
-of chloroform or the other stronger anæsthetics.
-
-_Insomnia in diseases of the heart and blood vessels._--I can fully
-indorse the opinion of Ringer regarding the beneficial effects of morphia
-in the treatment of the wakefulness caused by advanced diseases of the
-circulatory organs, "In such a case, the comfort afforded by a hypodermic
-injection is almost incredible.... In cardiac dyspnoea, a sixth of a grain
-twice or three times a week often suffices, but the dose and frequency in
-severe cases must be gradually increased to a quarter of a grain each
-night. Doctors are often afraid to administer morphia in the case of a
-patient propped up in bed, with livid ears, nose and nails, with distended
-jugulars and dropsical extremities, with weak, frequent and irregular
-pulse. They dread lest the morphia should weaken the heart, make the
-patient worse, if not kill him outright. This fear is quite groundless,"
-if the opiate be given in moderate doses. It is the stimulant effect of
-the medicine that is safe and useful.
-
-When wakefulness is caused by _angina pectoris_, or by simple cardiac
-neuralgia, such as sometimes follows excessive use of tobacco, relief may
-be obtained through the exhibition of alcoholic stimulants, hydrate of
-chloral, or nitrite of amyl. These remedies act more speedily than
-morphia, and may be associated with it, to the great advantage of the
-patient. They should not be habitually used, however, in cases of cardiac
-exhaustion, as their chronic employment favors accumulation of blood in
-the right side of the heart, with a tendency to paralysis of the cardiac
-muscles. It is in stenosis of the coronary arteries, and in aortic
-obstruction, that nitrite of amyl and nitro-glycerine are most useful. The
-insomnia that results from the remote consequences of these diseases is
-often relieved by remedies which assist the circulation of blood. For this
-purpose digitalis is the most useful stimulant in mitral disease;
-nitro-glycerine, in aortic valvular lesion.
-
-_Insomnia in diseases of the respiratory organs._--Pleuritic pain and its
-consequent wakefulness may be relieved with opiates, guarded by
-appropriate vascular sedatives. Dover's powder, or morphia and aconite,
-form excellent examples of the remedies most useful, so long as the lungs
-are not overwhelmed by excessive exudations into the pleural cavities.
-Pneumonia and bronchitis are accompanied by wakefulness, in their earlier
-stages, as a consequence of harassing cough. This may be allayed by the
-judicious use of expectorants and sedatives. If symptoms of asphyxia
-appear, indicated by blueness of the lips and nails, opiates should never
-be given. Respiratory stimulants are then indicated, and sleep must be
-allured by the use of alcoholic beverages and moderate doses of chloral
-hydrate, with musk and camphor. The early, irritative cough of incipient
-pulmonary consumption may be soothed with camphor and opium. Paregoric and
-a demulcent, like Iceland moss tea, or flaxseed tea slightly acidulated
-with lemon-juice, form an excellent type of such a compound. But the
-chronic duration of the disease renders the constant use of opiates
-undesirable. Chloral hydrate, for the same reason, cannot be given without
-intermission. It is well in such cases to employ the different alcoholic
-beverages at bedtime. Inhalation of warm vapor, and respiration of air
-charged with ether, or carbolic acid, will often quiet an irritative
-cough. In advanced cases belladonna is useful, to check the profuse
-sweating and to calm the thoracic pain that hinders sleep. In the later
-stages of the disease, when relief from suffering is the only end in view,
-morphia and dilute hydrocyanic acid will often render quite tolerable the
-few remaining nights of life.
-
-One of the most distressing forms of insomnia is occasioned by the
-different varieties of asthma. Dyspnoea is the feature that is common to
-them all, and is the principal exciting cause of wakefulness. In recent
-cases, which are characterized by spasm, the various anti-spasmodics are
-useful. Tincture of lobelia, tartar emetic, and ipecac, are of great
-service. Inhalations of ether or of chloroform, or of nitrite of amyl,
-will often cut short a paroxysm; but the nervous system soon becomes
-tolerant of their action. Chloral hydrate and alcoholic stimulants are
-less vigorous, and cannot be long tolerated by the stomach, especially if
-there be a gouty diathesis behind the disease. The fumes of burning
-pastiles containing nitre and stramonium leaves are often of great service
-if so breathed as to thoroughly fill the lungs with the smoke. In like
-manner, the smoke from smouldering nitre-paper, or from cigarettes that
-have been dipped in an arsenical solution, is sometimes useful. Air
-charged with ozone has been found curative in some inveterate cases.
-Hyoscyamus, belladonna, and tobacco, have been recommended. It may even
-become necessary to employ hypodermic injections of morphia.
-
-If, however, the disease should resist all these anti-spasmodics and
-soporifics, besides the remedies addressed to the predisposing causes of
-the malady, the only thing that remains is a change of locality. Many very
-desperate cases have thus been restored to health and comfort.
-
-_Insomnia in renal disease._--In the acute forms of renal disorder this is
-usually caused by pain and fever. It is, therefore, to be relieved with
-opiates given in connection with such arterial sedatives and diaphoretics
-as each individual case may require. But the tendency of inflammatory
-diseases of the kidney to merge in uræmia must not be forgotten, and the
-soporific must be used in such cases with great caution. For this reason
-hyoscyamus is often preferable to an opiate. In extreme dropsical
-conditions the measures that are useful for the reduction of anasarca
-constitute the most efficient means for the induction of sleep. In
-nephritic colic pain is too severe to admit of any rest while it lasts.
-The general treatment of colic is all that can occupy the attention until
-relief is secured. The dyspnoea and wakefulness sometimes experienced in
-advanced cases of Bright's disease may be greatly relieved by the
-judicious use of morphia, very much as in the similar disorder occasioned
-by chronic diseases of the heart.
-
-_Insomnia in diseases of the liver._--Inasmuch as the majority of these
-diseases interfere with the formation and proper discharge of bile it is
-desirable to avoid, as far as possible, the use of opiates in the
-disturbances of sleep that are so commonly consequent upon disorder of the
-liver. Simple restlessness at night can usually be obviated by the
-ordinary treatment that is remedial of the disease by which it is caused.
-But it often happens that hypnotic remedies must also be employed.
-Hyoscyamus, belladonna, chloral hydrate, and compound spirit of ether, are
-frequently useful. Sometimes when the evacuations exhibit a deficiency of
-biliary coloring matter, a grain of opium, with a few grains of calomel,
-forms a very efficient hypnotic. Alcoholic soporifics are not well
-tolerated when the gastro-intestinal mucous membrane is diseased. Biliary
-colic demands treatment similar to that that is required in nephritic
-attacks. Warm baths, fomentations, and a broad belt of oiled silk around
-the body, are very grateful, and are favorable to the induction of sleep.
-A course of nitro-muriatic acid, internally and externally, is often
-useful when wakefulness is associated with torpidity of the liver.[53]
-
-_Insomnia in gastro-intestinal diseases._--In acute inflammatory
-conditions of the stomach and bowels, sleep must be invited by the use of
-opiates. Bismuth and morphia, with hydrocyanic acid, are the favorite
-means of obtaining relief. Opium in solid form is sometimes preferable
-when a slowly developed and long continued impression is desired. Warm
-baths and hot poultices also give great relief.
-
-In all chronic affections of the alimentary canal opiates must be used
-with great caution, for fear of the opium habit, unless the case be
-incurable. Cancer of the stomach requires their free use. The milder
-disorders should be managed largely with hygienic treatment. The diet
-should be so regulated as to prevent the liberation of gas in the
-intestines, for their distention in this way is fatal to refreshing sleep.
-A gentle aperient or a large injection of warm water, often proves itself
-decidedly soporific in such cases. Catarrhal conditions of the mucous
-membrane prohibit the entire class of alcoholic and ethereal soporifics.
-Nervous and atonic dyspepsias are often benefitted by the use of bitter
-beer, and by drachm doses of brandy or whisky largely diluted. These
-should be taken at mealtime, or with food at bedtime. A glass of hot
-water shortly before retiring is often useful.
-
-The relief of insomnia in dyspeptic derangement, however, must not be
-sought through the administration of anodynes and hypnotics alone. Only
-when the entire life of the patient has been regulated upon a
-physiological basis can refreshing sleep be obtained. Change of habits,
-change of occupation, change of locality--these are the only curative
-measures in a vast number of the cases of wakefulness that occur in modern
-life. Alcohol, tobacco, tea, coffee, foul air, late hours, and mental
-excitement, are the principal causes which must be abolished before
-healthy sleep can be enjoyed.
-
-_Insomnia in febrile conditions._--In the early stages of all acute fevers
-wakefulness is a very common incident. It is then occasioned by irritation
-of the brain, and must, therefore, be relieved with opiates. If the
-patient is not depressed by the disease, the opium should be associated
-with tartar emetic or aconite, or ipecac. Dover's powder is very useful in
-such conditions. In malarial fevers wakefulness should be combatted with
-full doses of quinine in addition to the opiate. Gelsemium is sometimes a
-very satisfactory remedy--especially in the febrile attacks to which
-children are liable. If any evidence of cerebral hyperæmia be observed, it
-is well to give chloral hydrate and the bromides. Hyoscyamus, belladonna,
-and cannabis indica are useful when the pupils are contracted and when
-spasmodic symptoms are present. Lukewarm baths, wet packs, and cool
-sponging are exceedingly grateful, and often assist in the evolution of a
-suppressed eruption in the exanthematous fevers.
-
-In the later stages of fever a condition of cerebral exhaustion is
-sometimes encountered. Irritable weakness caused by starvation of the
-brain is the prominent feature. The pulse is small and weak. The patient
-tosses and rolls from side to side. He is perhaps greatly emaciated by an
-illness of considerable duration. An elevated temperature requires
-frequent sponging of the body.
-
-Opium, alcohol, and liquid food, are the best hypnotics in such cases. The
-acetum opii and the deodorized tincture of opium are among the best
-preparations of the drug, by reason of their stimulant effect. The
-equivalent of two grains of opium with a full glass of eggnogg, will often
-procure sleep for such a patient. If there be evidence of blood stasis,
-with blueness of the nails, hypostatic pneumonia, etc., musk and strychnia
-should be given in place of opium, and the circulation should be assisted
-with carbonate of ammonia, as follows:
-
-  [R.] Ammon. carb.,          gr. v.
-       Spt. chloroform,       gtt. xx.
-       Aq. camphor,           [oz] ss.
-
-To be given in a little milk, as required. Chloral and the bromides are of
-comparatively little value in all cases where there is considerable
-depression of the vital forces.
-
-_Insomnia in rheumatism and gout._--Opium in a diaphoretic preparation,
-and associated with alkalies or with colchicum, has always been the most
-approved remedy for sleeplessness in the acute forms of these painful
-diseases. Salicylic acid and the salicylates have in great measure
-superseded the use of opiates for the relief of pain and wakefulness in
-rheumatism, but they are not always efficient. Opiates, with or without
-chloral, must then be used. Sometimes a painful case that has resisted all
-other remedial agents yields promptly to the action of a series of
-blisters. The chronic forms of rheumatism require the use of stimulant
-diaphoretics, anodyne liniments containing chloroform and belladonna, and
-chloral hydrate, or even a Dover's powder, at night.
-
-Acute gout is rarely seen in this country, but its rudimentary forms,
-described by Da Costa as _lithæmia_,[54] are not uncommon. They are
-associated with wakefulness of a very troublesome character, which only
-yields to a persistent and long continued course of treatment directed
-against the diathesis. Careful regulation of the diet, change of air, and
-anti-arthritic remedies, are of infinitely greater service than any
-particular hypnotic drug.
-
-_Insomnia in syphilis._--In advanced stages of syphilitic cachexia, a
-variety of wakefulness independent of pain is sometimes observed. It is
-marked by a tendency to wake at a fixed hour of the night, frequently
-about two o'clock in the morning, after which time sleep is impossible.
-The symptoms of constitutional disease are not prominent in these cases,
-but the history and the evident cachexia make their nature apparent. They
-usually yield to a mercurial treatment. In their comparative freedom from
-severe pain, such patients present a striking contrast to certain cases
-of syphilitic rheumatism, or neuralgia. The nocturnal suffering in such
-instances is frightful. It can be finally overcome by anti-syphilitic
-treatment; but, while waiting for the radical cure, palliatives are
-needed. Chlorodyne and similar combinations of all the anodyne drugs
-afford the most effectual means of relief. I have sometimes found it
-necessary to increase the dose until the characteristic delirium produced
-by solanaceous drugs was manifested. The relief thus procured sometimes
-continues for many days after the cessation of hypnotic medication.
-
-_Insomnia in various disorders of nutrition._--The wakefulness experienced
-by syphilitic patients is not peculiar to their cachexia. It is a result
-of blood disorder and impoverishment that is common among the victims of
-rheumatism, lithæmia, syphilis, malarial poisoning, cancerous dyscrasia,
-chronic toxæmia of every form, and ordinary anæmia. Imperfect blood supply
-deteriorates the nutrition of the brain, and renders it so excitable that
-sleep is interrupted so soon as the period of profound repose is past.
-This occupies about four hours (see p. 16), hence the patient who falls
-asleep at ten o'clock is ready to wake up at two in the morning, and only
-sleeps again, if at all, when wearied with tossing till daylight. Such
-patients often derive great benefit from a morning nap thus obtained
-between the hours of five and seven.
-
-The most successful treatment of this variety of insomnia is that form of
-medication which is addressed to the particular cause of the cachexia or
-dyscrasia. But the palliative treatment necessitated by the immediate
-suffering of the patient will often tax to the uttermost the ingenuity of
-the physician. Usually, there is a chronic atonic dyspepsia, or a chronic
-catarrhal gastro-enteritis, or a combination of both conditions, to be
-remedied. Gently stimulating laxatives are needed for the relief of these
-disorders. An animal diet is most easily digested. Milk and rare
-beefsteaks supply this form of nutriment, to which must be added oranges,
-grapes and lemons, to prevent the development of incipient scurvy. The
-kidneys may be excited with small doses of iodide of potassium or chlorate
-of potassium. Only after a considerable course of elimination are "tonics"
-admissible. For the immediate relief of the insomnia by which the patient
-is exhausted, a rather complex method is needful. Such subjects often pass
-the day in tolerable comfort, but, as evening advances, the wearied brain
-becomes irritable, and bedtime finds the patient in an excited state which
-cannot be easily overcome by large and repeated doses of chloral.
-Paraldehyde is too disagreeable to be used with impunity, and only towards
-morning does the sufferer yield to the narcotism induced by successive
-doses of chloral and bromide. A night thus occupied adds nothing to the
-vigor of the individual, and its frequent repetition will most surely lead
-to starvation of the nerve-centers,--perhaps to consequent
-"chloral-mania."
-
-When the tendency to cerebral irritation becomes thus apparent, great
-assistance can be obtained by a resort to the use of opium, combined with
-tartar emetic and camphor. A pill containing one grain each of opium and
-camphor, with one-twelfth or one-sixteenth of a grain of tartar emetic,
-should be given early in the evening. This calms the brain, and prepares
-the way for a moderate dose of chloral at bedtime. In this way sleep can
-be procured with much less expenditure of nervous force and medicine than
-is wasted in the ordinary routine method. The rest thus obtained is
-followed by less depression than when it follows stupefaction with large
-quantities of an exciting narcotic.
-
-_Insomnia during pregnancy, and after parturition._--Closely akin to the
-insomnia of anæmia is the wakefulness experienced by hysterical subjects.
-The irritable weakness of their brains renders them peculiarly liable to
-disturbances of sleep. The state of pregnancy often serves to fill their
-nights with excitement sufficient to interfere with quiet rest. Loss of
-blood during parturition, by the induction of temporary anæmia, may
-greatly aggravate this condition.
-
-The suppression of nervous irritability is the principal indication for
-treatment. This may be temporarily accomplished by the use of the
-bromides. But these must be reinforced by an ample dietary, with stimulant
-nervines and anti-spasmodics. Good wine, camphor, valerian, hyoscyamus,
-cannabis indica, and occasional doses of opium, will generally suffice to
-induce the needful repose. If confinement in bed precludes muscular
-movement for any length of time, passive exercise must be secured through
-the aid of massage.
-
-_Insomnia in spasmodic diseases._--This class of ailments will usually be
-encountered among patients who are enfeebled by unfavorable conditions of
-health, either congenital or acquired. Together with the specific
-treatment appropriate to the particular disorder, it often becomes
-necessary to make use of hypnotic remedies against sleeplessness. Thus
-chorea may sometimes reach a degree of inveteracy that renders sleep
-impossible. Alcohol and chloral hydrate must then be given in large and
-frequent doses. A laryngeal catarrh may excite spasmodic croup--a disorder
-speedily relieved with chloral hydrate. Old people of a nervous
-temperament sometimes experience paroxysms of a similar character,
-interfering with sleep whenever they suffer a catarrhal attack. Liberal
-doses of assafoetida and a Dover's powder at night, associated with a
-course of antilithic treatment, afford great relief. Iodide of potassium,
-in the majority of asthmatic affections; the bromides and gelsemium in
-cases marked by excitability of the spinal cord; valerian, musk,
-assafoetida, camphor, and carbonate of ammonia, in cases of cerebro-spinal
-weakness and irritability; oxide of zinc, quinine, and chloral hydrate,
-when weariness and exhaustion are connected with a hyperæmic condition of
-the brain; such are the principal remedies against this variety of
-insomnia. Convulsions, if frequently repeated, may be subdued by the
-inhalation of ether or chloroform, until a sufficient quantity of the
-bromide of potassium can be introduced into the system.
-
-_Insomnia in childhood._--According to Vierordt,[55] the duration of sleep
-in the first week of life is only interrupted by the act of nursing.
-During the first month the infant should sleep at least two hours after
-each meal, waking only three or four hours out of the twenty-four. This
-period gradually increases; but, when a year old, the healthy child still
-sleeps more than he wakes. During the second and third years, he should
-sleep for ten or eleven hours at night, besides a nap of two hours in the
-daytime. After the fourth or fifth year, the daily nap may be
-discontinued. The fifth and sixth years require ten hours of sleep at
-night. From the seventh to the eleventh year, nine hours are needed. After
-the twelfth year, eight hours are sufficient.
-
-The causes of wakefulness are as numerous among children as among adults.
-Jacobi[56] insists upon the importance of attention to the ventilation of
-the bed-chamber, and to the quality of the bed. Everything must be light,
-airy and cool. He gives utterance to universal experience when he asserts
-that great heat can be endured by day without harm, if only the night
-brings coolness and rest.
-
-Hunger is sometimes a cause of wakefulness among young children. Partial
-starvation endured for a considerable time induces somnolence. The
-opposite condition of repletion may also excite wakefulness through
-painful distension of the stomach and bowels. Earache, terminating in
-abscess, often prevents sleep, sometimes without discovery of the cause
-until a discharge of pus enlightens the diagnosis. Persistent wakefulness
-without evident cause should arouse a suspicion of incipient tubercular
-meningitis. Slight elevations of temperature at night sometimes occasion
-sleeplessness, which may be overcome with quinine in doses of two to five
-grains at bedtime.
-
-Wakefulness sometimes occurs merely as the result of a bad habit. This is
-usually observed among delicate children of a nervous temperament, whose
-inclinations have never been thwarted. Such patients have been sometimes
-cured, after the failure of a long and expensive course of treatment with
-homoeopathic globules, by the adoption of a systematic moral training
-reinforced by an occasional forcible application of the parental hand to
-the gluteal region of the child. Of course such a method must not be
-recommended without certain knowledge that no lurking disease of the
-nervous system has escaped detection. Fretfulness and wakefulness are not
-associated with proper living and good health. Their cause must generally
-be sought upon the surface of the body and in its internal cavities.
-
-Much relief in the insomnia of children can be obtained from the use of
-lukewarm baths at bedtime. Supper should be a light but sufficient meal.
-Every disorder of digestion should be regulated as it occurs. Painful
-affections may be quieted with Dover's powder. Feverish and irritable
-conditions yield frequently to aperients, or to gelsemium and quinine.
-Night terrors and screaming fits should be calmed with chloral hydrate and
-the bromide of sodium. As a general sedative and hypnotic for children
-hyoscyamus has an excellent reputation. It may be given in considerable
-doses with perfect safety and the best results. For patients in early life
-it seems to fill the place occupied by cannabis indica in the medication
-of adults.
-
-_Insomnia in old age._--The highest physical perfection is reached before
-the fortieth year of life. Between this age and the forty-fifth year man's
-vigor begins to decline. The power of accommodation diminishes,
-necessitating the use of spectacles; adipose tissues begin to load the
-body; the hair grows thin, and begins to bleach. The processes of
-nutrition and of disassimilation become more sluggish; the appetites and
-passions gradually subside. Sometimes the moderation of nervous
-excitability thus effected permits indulgences of the appetite for food
-that were impossible during earlier years--the nervous dyspeptic can
-tolerate dainties which would formerly have been unendurable. Less
-disturbed by the solicitations of sense, the powers of reasoning and of
-judgment enlarge their authority. Under favorable circumstances this
-period of life may continue for about twenty years, when old age develops.
-From the sixtieth to the eightieth year the progress of decline is rapidly
-accelerated, and life is normally terminated between the eightieth and
-eighty-fifth years of existence. The rare examples of greater longevity
-are too few in number to warrant the assumption that a century of years is
-the physiological complement of life.
-
-As old age advances, the time of sleep is slightly abridged. The moderated
-activity of the body requires only a diminished rate of repair to make
-good the waste of the tissues. Less sleep, therefore, is needed. But the
-liability of age to the incidence of arthritic diseases, rheumatism, and
-disorders of the heart, blood vessels, digestive apparatus, and urinary
-organs, renders the period of decline particularly subject to those
-varieties of sleeplessness which depend upon such derangements of health.
-The nutrition of the brain suffers under such circumstances, and the
-substance of the organ becomes morbidly irritable. Insomnia among the aged
-often owes its cause to these unwholesome conditions. The biography of the
-celebrated Carlyle affords numerous illustrations of this variety of
-wakefulness. Disease of the cerebral blood vessels sometimes originates a
-series of changes differing only in degree and intensity from the
-classical type of chronic periencephalitis. This is characterized by many
-of the minor phenomena of general paresis, only occasionally rising to the
-level of that disease. Wakefulness is one of the most troublesome symptoms
-of this disorder. Its management requires attention to all the details of
-excretion and nutrition. The diet must be carefully selected with
-reference to failure of the digestive function. Milk and water should be
-preferred for drink, and the great emunctory organs of the body must be
-carefully stimulated and sustained. A judicious choice of climate may
-accomplish much for the comfort of the patient. The mild, insular climate
-of Florida, or of New Providence, or of the Sandwich Islands, affords
-superior advantages for the relief of sleepless sufferers in the northern
-temperate zone of the American continent, who need the soothing influence
-of a continual open air bath.
-
-During the latest stages of decline, when the cortex of the brain has
-become considerably atrophied, the opposite of wakefulness is experienced.
-Intellectual operations become less vigorous, and the patient passes
-lengthening periods of time in sleep. This is a genuine relapse into the
-apathy of infancy. The apparatus of thought is worn out, and the old man
-sinks gradually into the sleep from which there is no awakening.
-
-The treatment of insomnia, therefore, resolves itself into the removal of
-all special and temporary causes of wakefulness, with attention to the
-general hygiene of the patient, and careful regulation of his diet,
-habits, and occupation. Pain must be quelled with anodynes. Cerebral
-excitement must be calmed, in sthenic cases, with anti-spasmodics and
-sedatives--in asthenic subjects it must be overcome with food and nervous
-stimulants. Since many patients present a combination of these apparently
-opposite conditions, there is room for a great display of penetration and
-tact in the management of complex cases. While seeking for the immediate
-relief of present suffering, the ulterior consequences of treatment must
-always be kept in view, and the particular cachexia or dyscrasia must be
-thoroughly appreciated by the physician in his choice of remedies.
-
-
-
-
-CHAPTER V.
-
-DREAMS.
-
-  Behold, this dreamer cometh!
-                        GENESIS, XXXVII, 19.
-
-
-The harmonious activity of all parts of the nervous system is
-indispensable to the highest exercise of the conscious mind. Healthy
-intellectual life is the perfectly balanced outcome of the complex polygon
-of forces which has its seat within the brain. In the waking condition
-this "moving equilibrium," as it has been happily termed,[57] is sustained
-by the convergent impulses which are continually entering the brain
-through the pathways afforded by the several senses. Our waking hours are
-occupied with the ideas and with the associated trains of thought which
-are thus projected upon the field of consciousness. As a consequence of
-the harmonious function of the organs of sense, each one supplementing and
-correcting the information furnished by the others, a continuous process
-of perception and logical thought is maintained. But, along with the
-procession of ideas which are clearly conceived by the mind, the field of
-consciousness is also invaded by a cloud of half formed perceptions, which
-are too imperfect and fleeting to occupy the attention. As in the act of
-vision, though the periphery of the visual field is crowded with a whole
-world of objects dimly perceived without challenging particular attention,
-only the center of that field furnishing clear images to the brain, so the
-eye of the mind comprehends only a few of the impressions which enter the
-sphere of consciousness. The swarm of unnoticed perceptions, however, is
-none the less the result of abiding sensory impressions graven in the
-substance of the brain, from which, through the action of memory, they may
-at any favorable moment reënter consciousness. Sleep does not wholly
-arrest this process. A certain amount of projection into the field of
-consciousness continues, even during profound repose; and the ideas thus
-aroused form the material of our dreams.
-
-It has already been remarked that the invasion of sleep is not an
-instantaneous process. One by one the senses fall asleep, and long before
-the final cessation of their activity, sleepiness hinders their function.
-Hence a progressive narrowing of the range of external perception; hence a
-reduction of the vividness of impressions derived from the outside world;
-hence, also, a simplification of the actions and reactions which
-constitute the "polygon of forces" active within the brain. But the
-suppression of certain lines in this polygon does not suppress life, nor
-does it necessarily destroy consciousness. It only occasions a
-redistribution of force, and a proportionate narrowing of the stream of
-related ideas. Since this process of suppression, just mentioned, is not
-an absolute quantity, but a variable factor, the polygon of physical
-forces within the brain and the corresponding succession of ideas in
-consciousness must necessarily be in a state of continual change.
-Consequently, our dreams must be as variable as the clouds that drift upon
-the currents of the air. As, on a hot day in summer, when the equatorial
-draught has ceased to guide the wind, we may observe all manner of local
-tides among the masses of vapor which arise from the earth, so, in sleep,
-when the guiding influence of the senses is withdrawn, the ideas that
-still arise are chiefly dependent for their origin and association upon
-the automatic and endogenous activities of the brain. Undisturbed by
-impulses from the external world, the brain seems then to become more
-sensitive to impressions that have their origin within the body. An
-overloaded stomach, an enfeebled heart, a turgid sexual apparatus, or an
-irritable nervous ganglion, may become the source of irregular and
-uncompensated impulses which, without disturbing the organs of special
-sense, may invade the cerebral cortex, and may there set in motion a whole
-battery of mechanisms whose influence upon consciousness would remain
-quite unnoticed were the external senses in full operation.
-
-Still another cause for the production of dreams is to be found in the
-more or less complete suspension of the power of volition which
-accompanies sleep. Every act of attention is the result of exercise of the
-will. But the perfect exercise of the will is dependent upon the perfect
-development and wakefulness of the brain. So soon as sleep begins to
-invade the brain, the will begins to lose its normal incitement to action,
-and finally it becomes almost wholly disconnected from the muscular
-organs. In this state the sleeper may desire to perform some act--he may
-wish to move his limbs or to cry out aloud, but he can move neither hand
-nor foot, he cannot utter a sound. In other instances a partial connection
-between the will and the locomotive organs persists, and various orderly
-movements can still be produced. In like manner the control of the will
-over the succession and association of ideas may be either wholly, or only
-partially, lost in sleep. The deeper the sleep the more complete the loss
-of such control; hence the greater incoherence as well as feebleness of
-impression which is characteristic of dreams when sleep is profound. The
-vivid and panoramic succession of visual conceptions which constitutes a
-"vision," occurs during light and partial sleep, when the will is still
-capable of in some measure guiding the procession of ideas.
-
-For a similar reason the higher faculty of judgment, and especially the
-power of arriving at moral conclusions, is in great measure suspended
-during sleep. Like the power of volition, the activity of the moral sense
-is dependent upon a certain functional perfection in the brain. When the
-capacity of the brain is depressed by drugs or by disease, or by sleep,
-the moral sensibilities are the first to disappear. Hence the non-moral
-character of the impressions usually experienced during the act of
-dreaming. We feel neither surprise nor regret at the incidents of ordinary
-dreams. It is only when the border line of wakefulness is reached that the
-dreamer feels ashamed of walking naked in his dream, or feels compunction
-for an act of crime, or experiences emotions of joy or sorrow in
-connection with the incidents of his vision.
-
-A dream may, therefore, be defined as the occupation of the field of
-consciousness during sleep by a succession of ideas more or less
-completely withdrawn from the guidance of the senses and from the control
-of the will. A great variety of dreams may thus be admitted, ranging all
-the way from those products of mere absence of mind which constitute
-_revery_, down to the faintest and feeblest stirrings of consciousness
-which have been always observed during the act of waking from the
-profoundest sleep.
-
-Considerable light may be thrown upon the production of dreams if we
-consider attentively the manner in which illusions and hallucinations are
-excited by the use of drugs or by disease during the waking state. When
-engaged in experimenting upon myself with different medicines, I once took
-a dose of hasheesh sufficient to produce the peculiar effects of the drug.
-Sitting quietly in my chair, the first unusual sensation was an agreeable
-feeling of coolness diffusing itself over the surface of the body, as if
-some one were gently fanning me on a hot day. A feeling of causeless
-amusement began to occupy my mind. I seemed to be smiling all over without
-any apparent reason for hilarity. Then the walls of the room in which I
-sat seemed to recede to a vast distance. My attention became riveted upon
-a little picture which hung against the wall before me. It was a sunset
-scene, painted upon a canvas scarcely larger than my hand. As the wall
-upon which it was placed seemed to recede, the canvas expanded until I
-beheld a glorious landscape bounded by a range of snow-capped mountains
-flushed with purple light from the setting sun. As I sat, admiring this
-splendid scene, the gilded frame of the painting became alive with winged
-fairies and cherubs, peeping out from behind the moulding, and bending
-over its margin to look into the picture. Then the ceiling of the room and
-the sky of the picture seemed to blend in one common expanse of ethereal
-blue; the sunlight faded from the mountain peaks; stars began to appear in
-the firmament; the little imps and fairies disappeared; and, presently,
-everything resumed its natural appearance.
-
-In this experience the departure from healthy cerebral function consisted
-in an exaltation of certain forms of sensibility while others were
-depressed. The succession of visual images was initiated by the visible
-objects around me, but it was enriched by the association of ideas
-furnished through the stimulation of memory. The sunset glow, the
-snow-capped mountains, the starry sky, were familiar objects, suggested
-from memory by the items grouped in the picture. In like manner, the
-cherubs who climbed upon its gilded frame were merely the glorified
-products of memory, probably suggested by the fact that it was a _picture_
-upon which my attention was fixed--one picture reminding me of others
-which I had seen. The loss of proportion in the view--the exaggeration and
-distortion of all the relations of time and space, which made the unreal
-seem real, and conferred grandeur upon commonplace objects, was
-undoubtedly occasioned by a modification in the molecular structure of the
-organs of special sense and of perception under the influence of hasheesh.
-The change thus effected was of a character to diminish the force of
-sensory impressions derived through the aid of the muscles and nerves of
-the eye and the ear and the skin, while at the same time exaggerating the
-processes of memory and association in connection with impressions
-originating within the brain. In this way was produced a sort of confusion
-between the external world and the ideal world within, rendering it
-difficult to distinguish the one from the other. Hence the impossibility
-of estimating aright the relation of time and space to the visual
-impressions upon which attention was fixed. The result was a waking dream
-which differed from ordinary revery chiefly in the intensity of the
-impressions that occupied the mind.
-
-A somewhat similar process is sometimes experienced as a consequence of
-cerebral disorder unconnected with the effects of drugs. During the
-invasion of measles, having taken no medicine but sage tea, I remember, as
-night approached, a strange succession of illusions. My head seemed to
-expand to the size of a bushel basket; then it would slowly contract
-again. My body seemed to grow out of shape into the most distorted forms
-of rickets. Audible sounds seemed to come from the most remote distances.
-Impending shadows of a great darkness hovered over the bed. Waves of heat,
-and tingling darts of numbness traversed my limbs. These singular and
-rather uncomfortable sensations continued until relieved by an ordinary
-Dover's powder.
-
-In this experience the confusion of ideas, though less agreeable, was
-essentially similar to that occasioned by the action of the hasheesh. In
-both cases there was the same diminution of the intensity of external
-sensation accompanied by an exaggeration of internal impressions. The
-brain and the nerves were in a condition of irritable weakness, caused by
-disease, which interfered with the normal generation and association of
-ideas. Having thus partially escaped from the control of the senses and
-the will, the mutilated succession of ideas which reached the field of
-consciousness could only be perceived as a series of illusions. Here,
-again, was a waking dream, of origin and course analogous to the illusions
-and hallucinations which accompany every form of delirium.
-
-It is not alone under the influence of disease or of drugs that the
-automatic action of the brain furnishes ideas for the inspection of the
-mind. Riding, one day, in a street-car, and reading a philosophical work,
-I came upon a paragraph devoted to a discussion of the doctrine of the
-association of ideas. Immediately, out of memory, flashed a momentary
-vision of the quarter deck of the old frigate, United States, upon which
-appeared the figure of a very small midshipman, talking to a gigantic
-personage, the captain of the ship. This was an incident which I had
-actually witnessed forty years before. I was, at first, somewhat puzzled
-in the attempt to account for the occurrence of a vision so apparently
-incongruous with the subject matter of the book; but a little reflection
-convinced me that the exciting cause of this seemingly involuntary act of
-memory was really the idea of association suggested by the book. This had
-unconsciously aroused the apparatus of association in the brain, and the
-particular scene thus brought before the mind had been further suggested
-by the circumstance that the last object, external to the printed page,
-upon which I had fixed my attention, was a large ship, lying in the river,
-near the bridge, just crossed by the car in which I rode.
-
-Numerous other examples of a similar character might be related to
-illustrate the fact that the brain is a reservoir of sensory impressions,
-some of which, at the moment of their original incidence, have aroused the
-mind to a greater or less degree of conscious attention, and have then all
-lapsed into a latent or potential condition. But, though latent, they are
-none the less persistent, and only await the suppression of other
-inhibitory forces to become once more capable of arousing attention. Such
-inhibitory impulses are continually furnished by the action of the sensory
-organs on the one hand, and by the energy of the mind upon the other. So
-soon, therefore, as the organs of sense and of voluntary impulse are
-sealed with sleep, if the remaining portions of the brain are still
-operative, and are left to their own unrestrained activity, a more or less
-disorderly series of ideas occupies the mind. This constitutes a dream.
-The difference, therefore, between waking thought and a dream is analogous
-to the difference between a page upon which the words have been arranged
-in a rational order, and another page upon which some of the same words
-have been set down at random. Inasmuch as the majority of our sensations
-are derived through the organs of sight, and since the larger portion of
-the sensory region of the cortex of the brain is concerned in the act of
-vision, it is no more than might be expected that the ideas suggested in
-sleep should generally proceed from the visual apparatus of the brain. The
-superior power of visual impressions to attract attention may also serve
-to explain the fact that the majority of dreams are composed of images
-that were originally perceived in the act of vision. Hence our dreams, for
-the most part, constitute a series of pictures undisturbed by sound, or by
-other forms of sensation. But this is not always so. It is highly probable
-that when the organs of external sense are allowed to sleep without
-disturbance, our dreams consist of visual impressions alone. But, if any
-unusual sound, or smell, or other sensation is experienced during sleep,
-it may penetrate the field of consciousness, and may become the starting
-point of a dream quite filled with sounds. Thus a young lady, who had
-passed the evening at a musical concert, was aroused, soon after retiring,
-by the striking of a clock which had been recently placed in her chamber.
-At the moment of waking, she was dreaming of an orchestral performance of
-Wagner's music. Doubtless the dream was suggested by the unaccustomed
-sound of the clock.
-
-The possibility of thus suggesting, and in some degree guiding, the form
-and course of a dream, has been often demonstrated.[58] One of my early
-schoolmates, a boy of remarkably susceptible nervous temperament,
-furnished an excellent example of this species of direction. Tickling his
-nose with a straw made him dream that a dragon-fly was assaulting his
-face. On another occasion, a few drops of vinegar placed upon his tongue
-caused him to dream of eating oranges. Again, one of his companions
-roguishly breathing in his ear the statement that the schoolmaster was
-after him with a long rattan, he bounded out of bed, and could scarcely
-be restrained from bursting out of doors in his evident alarm. I was
-myself awakened, one night, by the ringing, as it seemed, of my doorbell;
-but, hastening at once to the door, no one was there. As I was expecting a
-call from a certain patient, I concluded that the bell had been rung by an
-impatient messenger who could not wait. Falling again asleep, I was a
-second time startled by a similar ring. Looking out of the window above
-the door, it was evident that no one was there. I finally concluded that
-the sound must have been perceived in a dream, and I recalled the fact
-that each time, as I woke, the sound of a carriage, passing the house, had
-attracted my attention. Undoubtedly, the state of expectancy in which I
-was sleeping had operated as the predisposing cause of dreaming, and the
-noise of wheels upon the pavement had served as the exciting cause of a
-dream in which the sound-vibrations communicated to the brain had produced
-by an association of ideas the particular perception which, though asleep,
-I was waiting to receive.
-
-In certain cases the impression produced by a dream is so vivid that a
-considerable time after waking must elapse before it can be relegated to
-its true position in the world of hallucinations. Dreaming, once, that my
-wife called to me from another room, I instantly awoke; and only the fact
-that she was with me could satisfy me that it was all a dream. Taine[59]
-relates that "M. Baillarger dreamed one night that a certain person had
-been appointed editor of a newspaper; in the morning he believed it to be
-true, and mentioned it to several persons who were interested to hear
-it;--the effect of the dream persisted all the forenoon, as strongly as
-that of a real sensation; at last, about three o'clock, as he was stepping
-into his carriage, the illusion passed off; he comprehended that he had
-been dreaming."
-
-The following incident from the experience of Prof. Jessen, physician to
-the insane asylum in Homheim, near Kiel,[60] still further illustrates
-this form of hallucination:
-
-"On a wintry morning," writes the professor, "between five and six
-o'clock, I was aroused, as I thought, by the head nurse, who reported to
-me that some people had come for one of the male patients, and who at the
-same time asked me whether I had any particular orders to give. I replied
-that the patient might depart, and after he had left the room I turned
-around to go to sleep again. All at once it struck me that I had
-previously not heard anything regarding the intended departure of this
-patient, but that only the prospective departure of a woman of the same
-name had been reported to me. This compelled me to inquire more
-particularly after the circumstances, and accordingly I lighted a candle,
-rose, dressed myself, and went to the room of the head nurse. To my
-surprise I found him only half dressed, and, in reply to my inquiry after
-the people who had called for the patient, he said, with an expression of
-astonishment, that he did not know anything of it, as he had but just left
-his bed, and no one had called him. This answer did not arouse my
-consciousness, but I rejoined that then the steward must have been in my
-room, and that I should accordingly go to see and ask him regarding the
-matter. When descending a few steps in the middle of the corridor which
-led to the room of the steward, I suddenly became conscious of having
-dreamed only what until that moment I had believed to be an experience
-whose reality I had not doubted in the least."
-
-In some instances the fact of having dreamed is never recognized, and the
-dreamer carries through life the delusion that his vision was an actual
-occurrence. Among the Indians of Guiana, and the same thing is true of
-many other savages, dreams are looked upon as actual events in which the
-dreamer is visited by spirits or even by other living men. A recent
-English traveler[61] says: "It becomes important, therefore, fully to
-recognize the complete belief of the Indian in the reality of his
-dream-life, and in the unbroken continuity of this with his working life.
-It is easy to show this belief by many incidents which came under my
-notice. For instance, one morning, when it was important to me to get away
-from a camp on the Essequibo River, at which I had been detained for some
-days by the illness of some of my Indian companions, I found that one of
-the invalids, a young Macusi, though better in health, was so enraged
-against me that he refused to stir, for he declared that, with great want
-of consideration for his weak health, I had taken him out during the night
-and had made him haul the canoe up a series of difficult cataracts.
-Nothing could persuade him that this was but a dream, and it was some time
-before he was so far pacified as to throw himself sulkily into the bottom
-of the canoe. At that time we were all suffering from a great scarcity of
-food, and hunger having its usual effect in producing vivid dreams,
-similar effects frequently occurred. More than once the men declared in
-the morning that some absent men, whom they named, had come during the
-night and had beaten or otherwise maltreated them; and they insisted upon
-much rubbing of the bruised parts of their bodies."
-
-It is highly probable that from these facts, and from others of a similar
-character, may be derived the true explanation of many of the supposed
-examples of intercourse with divine or angelic persons which occupy so
-important a place in early mythology. An incident in the childhood of the
-prophet Samuel can scarcely admit of any other interpretation. In other
-cases, notwithstanding the intensity of the dream, its true character is
-recognized by the dreamer during the very act of vision. Thus, I once
-dreamed that I saw a young girl standing before me. So vivid was the
-perception, that the actual presence of such a person could not have
-produced a more perfect impression upon the waking brain. Yet, at the same
-instant, I comprehended the fact that it was merely a dream, and remarked
-the difference between the intensity of the visual image in this and in
-other dreams. Such speedy recognition of the hallucination does not always
-accompany the act of waking out of a dream. In some cases, as we shall
-have occasion to see, the images which have figured in a dream are still
-perceived for a certain period of time after awaking.
-
-The majority of dreams are composed of visual images. The dreamer looks
-upon a picture which changes silently before his eyes, without appealing
-to any other sense than that of sight. But in certain cases any other
-sense may become excited, producing illusions or hallucinations as perfect
-as the images of healthy vision. They may be suggested by external
-impressions, as in my dream of a ring at the door bell, which proved to be
-an auditory illusion excited by the sound of passing carriage wheels; or
-they may, at least apparently, find their starting point in accidental
-states of the bodily organization. If attention be paid to this matter, it
-will be observed that all unusual modes of dreaming, and all extraordinary
-vividness of dream-impressions can be connected with some departure from
-the physiological conditions of quiet sleep. Either disease, or
-exhaustion, or emotional disturbance, or narcotic intoxication of the
-brain may be noted as the immediate cause of such derangement of the
-cerebral functions. After drinking several cups of coffee before retiring,
-I dreamed of a large yellow flower which exhaled a very fragrant odor.
-During the same night I also dreamed of drinking wine, which agreeably
-excited the senses of taste and of smell. Upon another occasion, having
-been disturbed by the entrance of burglars into my house, I dreamed that a
-burglar was fumbling under my pillow, and was raising my head and
-shoulders with the mattress upon which I slept. I seemed to feel the
-changes of pressure and of contact as distinctly as if awake. The
-connection of voluptuous illusions with erotic dreams is too familiar to
-require particular mention.
-
-Dreams are not always limited to the revival and combination of the images
-of sensation. Intellectual combinations are sometimes thus presented to
-the mind. The most familiar illustrations of this fact are furnished by
-the experience of mathematicians who have worked out mathematical problems
-in their dreams. One of my patients, an expert book-keeper, dreamed of
-adding up six columns of figures at once. In the morning he still
-remembered his dream; and, on adding up the columns, found that he had
-actually produced the right sum in each case. A college student of my
-acquaintance, who was puzzled by a geometrical proposition, wrote out the
-correct solution during his sleep. This was something more than simple
-dreaming; it trenched upon actual somnambulism. Another acquaintance
-dreamed of being in heaven, and, while there, experienced relief from
-doubt regarding certain theological doctrines which had previously
-exercised his mind. I have myself composed several sentences during the
-course of a dream, and have, while dreaming, sometimes esteemed them
-worthy of preservation; but my waking recollection has never coincided in
-this particular with the opinions formed during sleep.
-
-Great difference between dreams may be remarked in their coherence and
-continuity of evolution. Some are composed of the most inconsistent
-elements without order or logical arrangement. In others the incidents
-follow very closely in the line of a natural and rational development, so
-that the dreamer seems to be present as a spectator of a perfectly
-coherent drama. It is probable that these differences depend upon
-variations in the degree of completeness with which the different parts of
-the brain and of the body are overwhelmed by sleep. If different and
-widely separated portions are sufficiently wakeful to suggest ideas to the
-mind, the resulting congeries will consist of discordant and incoherent
-elements. But if wakefulness is limited to a particular organ of the body
-or to a circumscribed territory of the brain, the resulting impressions in
-consciousness should be correspondingly restricted, and will manifest a
-more orderly connection with each other. In some cases a tendency to
-simultaneous wakefulness of particular portions of the cerebral register
-seems to become habitual, so that the same set of ideas may be often
-renewed in the same order during sleep, constituting a repetition of the
-same dream. In this way I have frequently dreamed of a volcanic eruption
-of molten lava from a lofty mountain. This frequent revival of the same
-train of images is probably due to the fact that in childhood I actually
-witnessed a volcanic outbreak, and that a very highly colored picture of
-Vesuvius in eruption hangs in my sitting room, so that my brain has become
-profoundly impressed with this particular image. When other portions of
-the brain are asleep, if the special region concerned with this picture be
-aroused, the mind receives the same impression which it received when
-first excited by that portion of the organ of memory.
-
-As a general thing, however, dreams do not possess any such compactness
-and coherence. They are usually derived from many different portions of
-the cerebral organ, even when they seem to exhibit a fluently connected
-course. Thus, I dreamed, one night, that I was walking in a garden filled
-with peculiar oriental shrubbery. In this garden I discovered one of my
-brothers and a friend, who is widely known in literary circles, engaged in
-flying a kite. With great adroitness they had succeeded in causing the
-kite-string to describe in the air the outline of the letter Z. I
-congratulated them on the adoption of so truly scientific a method of
-kite-flying; telling them, also, that I had once succeeded in making a
-kite-string describe a fourth line, thus: [Symbol] As they expressed
-surprise at this, I told them that in the May number of the Atlantic
-Monthly, for 1883, they would find an article on this method of
-kite-flying, written by Oliver Wendell Holmes.
-
-Nothing can seem more absurd than such a sequence of ideas. They follow
-each other without a break, yet without any logical coherence, very like
-the order in which ideas arise to occupy the mind of an insane person.
-Indeed, such dreams suggest the doctrine that the condition of a dreamer's
-brain is functionally identical with what obtains in certain forms of
-insanity. At first sight it would seem as if such a dream could have no
-possible basis in fact. But a brief retrospection enabled me to trace each
-individual item to its source in memory, and I was able to construct the
-following key to the vision: During the previous evening I had been
-examining a number of East Indian photographs. Among the most remarkable
-of them was a picture of the glorious gardens of the Taj, at Agra. Another
-represented the ruined Buddhist tower at Sarnath, a structure remarkable
-for the numerous triangular figures carved as ornaments upon its sides.
-Hence the garden and the zigzag kite-string in the dream. During the day
-before, while conversing with a neighbor regarding the financial
-misfortunes of an acquaintance, I had remarked that if he had stopped
-kite-flying, and had settled down to legitimate business at last, he would
-doubtless do well in the future. Hence the kite. I had recently received
-an interesting letter from my literary friend in which he had mentioned my
-brother. Hence the two principal actors of the dream. Just before
-retiring, that night, I had discussed with my wife the subject of
-subscribing for a number of periodical magazines. Hence the Atlantic
-Monthly; and, as the celebrated Oliver Wendell Holmes was the author most
-intimately associated in my mind with that periodical, his introduction
-among the characters of the dream followed most naturally in accordance
-with the law of the association of ideas.
-
-The question is continually asked, why are certain dreams so vivid and so
-easily remembered, while others are of the faintest and most evanescent
-character? My own experience leads me to believe that there is a morbid
-element underlying all unusually vivid dreams. It is not merely because of
-differences in the depth of sleep. The flitting fancies which occupy the
-introduction and the termination of sleep, rarely possess any power to fix
-the attention or to linger in memory. But, if the body be disturbed by
-anything which causes a departure from the even course of health, such as
-follows unusual or violent emotion, or an attack of illness, or an
-insufficient alimentation, or great and sudden changes of atmospheric
-pressure, the visions of the night become wonderfully exaggerated in every
-particular. During a voyage at sea, while suffering considerably with
-thirst, one night I dreamed that a fountain of sparkling water suddenly
-appeared before me. A young girl dipped a pitcher in the flowing stream,
-and held it out, all dripping with delicious coolness, for me to drink.
-Pressing eagerly forward, I awoke, to find myself sitting up in my narrow
-berth, with hands extended for the draught. Every narrative of shipwreck
-is filled with similar experiences. Slow starvation is always accompanied
-by dreams of singular intensity and persistence. As an illustration of the
-corresponding influence of previous emotion, I may cite the experience of
-a friend who had been greatly shocked by reading the account of the manner
-in which the lunatic, Freeman, had killed his little son in imitation of
-Abraham's contemplated sacrifice of Isaac. This gentleman dreamed that he
-was about to sacrifice his favorite daughter. He called her to him; told
-her that he was about to cut off her head as a religious sacrifice; and
-took up the knife for that purpose. She exclaimed, "Oh, papa! I have never
-disobeyed you yet!" and extended her neck, to receive the fatal stroke,
-when he awoke, trembling in every limb, and drenched with perspiration.
-For a long time the horror of this dream affected him as terribly as if it
-had been an actual experience.
-
-It is usually difficult to arrive at any exact estimate of the time
-occupied by a dream; but it appears certain that in some instances the
-succession of images excited during sleep must be exceedingly rapid.
-Abercrombie, in his work on the "_Intellectual Powers and the
-Investigation of Truth_," p. 275, has related several illustrative
-examples of this fact. In my own experience, one night, as I lay half
-asleep, I heard the watchman on his round, as usual, examining the
-fastenings of my front door. At once I began to dream that I was
-revisiting my father's house, the home of my childhood. The family were at
-breakfast in the front parlor, while I walked through the back rooms,
-examining the doors and the windows, and found it impossible to close and
-to fasten them. I then took a bath, dressed myself, and walked out into a
-large garden behind the house. It was filled with tropical trees, of which
-some were young. The old ones, which I recognized after an absence of
-thirty years, astonished me by their surprising luxuriance. A lovely,
-trailing convolvulus, in full bloom, attracted my admiration. After
-walking for some time I came upon a plum tree which was very small when I
-left home, and had now reached a height not exceeding twelve feet. This
-slow growth excited considerable surprise on my part. Returning to the
-house, I passed the day with my parents, and, at night, undertook to shut
-up the house, but could not fasten any of the doors or windows. This
-caused me great uneasiness, for there was a large gypsy camp not far from
-the east end of the building. My anxiety was presently justified by a
-noise in the parlor. Hastening to the door, and looking into the room, I
-saw a large painting disappearing through a hole in the wall next to the
-encampment of thieves. I immediately cried out, to frighten away the
-robbers; and was awakened by my wife, shaking me, and asking what was the
-matter, just in time to hear the watchman walking down the front steps,
-after the completion of the investigation which had suggested my dream.
-
-Another experience may serve to illustrate the fact that dreams are
-greatly intensified by illness, and that their duration may be exceedingly
-brief. Suffering, one night, from an attack of intestinal colic, marked by
-a rapid succession of painful paroxysms, between which, however, I fell
-asleep without the aid of medicine, I dreamed in one of these snatches of
-slumber that I was walking with my brother on the road to the volcano of
-Kilauea. In my hand were four diamond shirt buttons. They were white, and
-were covered with fine asbestos wool. My brother's wife expressed serious
-doubts regarding their value; but I at once reminded her that the Emperor
-of China had given to the English Ambassador, for presentation to the
-Queen of England, a number of diamonds which were so rough and so cheap in
-appearance that the ambassador, who was also a marquis, could not suppress
-his contempt as he received the gift. But, when carried to London, and cut
-by the royal jewelers, their brilliance had astonished everyone. I now
-desired to deposit my diamonds with a jeweler, for safe-keeping. My
-brother recommended a house near the volcano, but I had seen another, a
-few squares further up the road, and accordingly resorted thither. Not
-finding any satisfactory evidence of business, I retraced my steps to the
-place first recommended. Entering the door, I found myself in a narrow
-room, with a long, low counter on one side. Behind this were several men,
-and several cases filled with jewelry. I handed my buttons to a large,
-good-looking fellow, who was bustling around in his shirt-sleeves. He
-immediately put one of the jewels into his mouth, when I heard something
-crack, as if either his teeth or the diamond had split. Consoling myself
-with the recollection that, if broken, a diamond could be mended with
-cement, I asked for a certificate of deposit. While this was being
-written, the entire building slipped away from over us, and glided down
-the slope of the mountain, towards the ocean, leaving us, and all that had
-been within the house, uncovered in the open air. This did not disconcert
-any one. The jeweler finished his writing; I pocketed the receipt, and
-with my brother pursued our walk through the mountain forests beyond the
-crater of the volcano. Presently we arrived at an eminence from which we
-could look down upon the ocean, and could see the line of the coast
-prolonged for many miles on either side of a cape of land. The western
-coast was very grand--mountain promontories rising behind each other as
-far as the eye could reach. Having feasted our eyes with this magnificent
-panorama of earth and sea and sky, we turned away in the direction of a
-grove, in which was visible a large building of stone, with castellated
-walls, and turrets with pointed roofs at the corners. My brother informed
-me that this was a German settlement, called Little Clacius. Approaching
-the castle, we were received in a magnificent hall by a beautiful woman
-who offered to conduct us through the building. She led us through a
-series of lofty rooms, splendidly painted, gilded, frescoed, and furnished
-with inlaid tables and polished chairs. On either side were ranged large
-vases, in which grew what I seemed instinctively to recognize by the name
-of the Lace Mimosa--each plant consisting of a flat sheet of green
-lace-work, like a coralline, studded with lovely pale yellow blossoms.
-Passing through three such rooms, we entered a fourth, across the floor of
-which our fair guide whirled herself with a pirouette into the presence of
-a young woman clad in a richly figured dressing-gown, drawn lightly around
-her form as she sat in an easy chair, nursing her baby. We were formally
-introduced to this lady, who received us with the most evident
-indifference, a circumstance which gave us no concern, for the view from
-the open window at once engrossed my attention. Directly before me was a
-shining river, pouring down the mountain side and falling about fifteen
-feet into a deep dark pool that widened beneath the window from which I
-gazed. High banks, covered with magnificent trees, sloped down into the
-water, and cast their shadows across its rippling surface, forming a most
-charming landscape. The breadth of the scene, the depth of the coloring,
-the perfection and the multiplicity of all the details that pressed upon
-the attention, could not have been surpassed in vividness by any real
-existence. I was admiring the view, and was beginning to feel surprised
-that so large a river could exist in such a place, when I was suddenly
-awakened by a renewal of the intermittent pain.
-
-In this example each individual detail could have been easily traced to
-its source in memory. Pictures, and actually existent scenery furnished
-the detached items which were combined in a brain that for the time being
-was released from the control of the reason and the will. Irritated by
-painful sensations the brain was inordinately excitable, and sleep was
-less profound. Hence the remarkable intensity of the pictures which were
-presented to the eye of the mind. The indescribable richness and variety
-of the vision was probably due to the fact of extensive bodily
-disturbance, opening a wide range of territory from which impressions were
-communicated to the morbidly sensitive brain. The unusual permanence of
-the whole dream in memory may be explained by the observation of Maury,
-that the ease with which dreams are recollected varies inversely with the
-depth of the sleep in which they occur. Dreams which are produced in sound
-sleep are seldom recalled after waking, because they are but slightly
-connected with impressions received by the brain during wakefulness.[62]
-But dreams which occupy the mind when sleep is light and partial are
-excited by cerebral movements which are closely associated with external
-impressions that originate either at the moment of awaking or immediately
-after that event; consequently, the bond of union between the ideas of the
-dream and our waking ideas is nearly if not quite as perfect as the bonds
-which serve to connect the thoughts that occupy any portion of our
-conscious life. Hence such dreams are more easily reproduced from memory
-by any disposition that arouses a retrograde association of ideas.
-
-The dream above related, though excited by an unhealthy condition of the
-body, was not at all disagreeable. But it is often the case that disorders
-of particular organs serve to originate visions with special and evident
-characteristics related to their source. Thus, one of my patients, during
-an attack of uterine and hemorrhoidal congestion, would dream that a heavy
-weight had been laid upon the lower part of the abdomen. On another
-occasion, having gone to sleep, apparently in perfect health, she dreamed
-of a terrible pain in the head, and that her husband and a physician were
-applying a cupping glass to the back of her neck. This woke her up, and
-she found that she was actually suffering with a very severe headache.
-Another lady, shortly after confinement, dreamed that her baby had teeth,
-and that it was biting her nipple. Next day she discovered a tender spot
-in the breast, which rapidly developed a mammary abscess. Forbes
-Winslow[63] has collected a considerable number of similar cases. In
-certain instances not only have dreams been originated by special local
-pain, but the incipient stages of insanity have been revealed by
-exaggerated dreams. One of my patients, for a considerable time before the
-evolution of an attack of melancholia, would dream, every night, that a
-big black dog came into her bed. Another, who suffered with cardiac
-palpitation, caused by excessive tea-drinking, was often visited in sleep
-by a mocking imp who seated himself upon the pit of her stomach, and
-pressed her ribs together with his hands.
-
-The distress or alarm which accompanies such dreams is sometimes
-sufficient to arouse the sleeper. Often, however, he strives, in his
-vision, to escape from some impending horror, or to lift up his voice in
-a cry for help, but the will is powerless to reach the necessary muscles,
-and no movement results. In such cases the portion of the brain in which
-the will resides is awake, but the conducting fibres which intervene
-between the cortex of the brain and the locomotive ganglia in the
-cerebro-spinal axis are asleep, and cannot be sufficiently aroused to
-transmit the impulses derived from the action of the will.
-
-In all ages of the world a belief in the prophetic character of certain
-dreams has prevailed. Numerous examples are recorded in which a warning
-intimation of approaching disaster has been thus received. Thus the holy
-evangelist, St. Matthew, relates that Joseph, the husband of Mary, was
-guided by dreams to escape with his family from the murderous designs of
-Herod and of his son Archelaus. The literature of the middle ages is
-filled with similar narratives. Coming down to recent times, it is not
-difficult to gather numerous examples of dreams which have been excited by
-presentiments of good or evil. A lady who was about to embark upon the
-ill-fated steamer Arctic, dreamed so vividly of shipwreck that she refused
-to take passage, and thus escaped the frightful disaster which overwhelmed
-the ship and its numerous passengers. Max Simon[64] relates the case of a
-lady who, in spite of a similar warning, embarked upon a steamship and
-lost her life, through the explosion of the boiler during the voyage. On
-another occasion[65] a noble lady dreamed that a wing of the palace in
-which her children were sleeping was about to fall down. Starting up, she
-called her waiting maids, and insisted that they should bring the children
-to her chamber. The women endeavored to calm her agitation, quoting an old
-proverb to the effect that "dreams go by contraries." As she persisted in
-her commands, they feigned obedience, but soon returned to say that the
-young princes were sleeping too quietly to be removed. The princess would
-not be thus composed; and at last the servants reluctantly brought the
-little boys from their room. They had scarcely reached their mother's
-apartments, when the disaster of which she had dreamed was realized, and
-the bedroom from which they had just been carried, was crushed into a mass
-of ruins.
-
-The ancient explanation of such events consisted in a reference to the
-Deity, who was supposed to address his favorites through the medium of
-dreams. The modern skeptical explanation views all such revelations as
-mere accidents. Among the myriads of dreamers, say the "five-sense
-philosophers," the infinite variety of combinations which disturb the
-brain during sleep, cannot fail to produce occasionally such coincidences.
-When these are of a striking character, the seemingly prophetic vision is
-remembered, but the cases of discrepancies between vision and result are
-not recorded, and are soon forgotten. This opinion may very probably be
-correct in the vast majority of instances; but, if so, we are not in a
-position to assert any scientific demonstration of the fact. There is,
-moreover, so far as the ancient religious view is concerned, a certain
-transcendental sense in which it is true that God may guide his creatures
-through the agency of dreams, as well as in a thousand other different
-ways; but this metaphysical process we can no more comprehend than we can
-understand or explain the interaction of mind and matter in the brain. The
-psycho-physiologist must content himself, at present, with the attempt to
-show that it may not be incompatible with natural law for coming events to
-cast their shadows before them through the forms of a dream. The following
-observations lend color to such a possibility.
-
-The extraordinary susceptibility of the brain during certain conditions of
-sleep has already been noted as a cause for the superior vividness of
-coloring and intensity of action which sometimes characterizes our dreams.
-In this respect a slightly morbid condition of the brain, comparable to
-the effects of hasheesh, probably exists. In such cases the brain may be
-disturbed to a degree sufficient for the awakening of consciousness by
-causes that would ordinarily be powerless to reveal themselves. Recording
-his experience of an earthquake at Lesina, in the night of Sept. 8, 1884,
-Buschick states, in the Journal of the Austrian Meteorological Society,
-that a few seconds before the shock he was awakened with a feeling of
-strange discomfort and apprehension. Once before, on a similar occasion,
-he had been in like manner aroused from sleep just before the commencement
-of an earthquake, probably by a feeble and ordinarily imperceptible
-agitation of the soil. At a time when I was for many months severely
-overtasked, I always woke up in the night whenever about to receive a call
-to a patient. Before the sound of footsteps became audible on the
-sidewalk, I would wake. Presently some one would be heard, approaching the
-house, and then the doorbell would ring. So often was this experience
-repeated, that I learned to expect a summons whenever awakened during the
-night. Gradually, however, as my health improved with rest, this morbid
-excitability disappeared, and has never been renewed. It seems probable
-that in this example the sensitiveness of the brain during sleep was so
-great that audible impressions were received with vigor sufficient to
-awake consciousness before they were sufficiently strong to arrest the
-attention when actually awake. The extreme sensibility of the brain, under
-certain conditions, to impressions from a distance, is further illustrated
-by the experience of persons laboring under diseases which produce serious
-departures from a healthy cerebral circulation. Thus, one of my patients,
-while suffering with cerebral hyperæmia, could hear children talking half
-a mile away, at a distance where no one else could hear them. This
-susceptibility is doubtless the foundation of many well authenticated
-cases of presentiment. Another of my patients, a lady of remarkably
-sensitive nervous organization, though otherwise in apparently good
-health, was one evening lying alone upon her bed. Suddenly, she became
-greatly agitated with the conviction that something had happened to her
-husband, who had not yet returned from his place of business. He
-presently, however, came quietly into the house, and greeted his wife as
-usual. She exclaimed at once, "What has happened to you, my dear?"
-"Nothing," he replied. "Yes," she said, "something has happened, just now;
-I felt that you were in trouble." "Oh, yes," answered he, after a moment's
-reflection, "as I was passing by the park, on my way home, two men tried
-to stop my horse, but I whipped up, and got away from them without any
-trouble."
-
-On another occasion the same patient was one day suddenly oppressed by a
-conviction that something had happened to her mother and sister, who were
-driving together at some distance from home. After a short time they
-actually returned in a sorry plight, without their carriage. The horse had
-run away, upsetting them upon the road.
-
-In all these cases it is worthy of remark that there was present an
-unusual degree of cerebral erethism. Solicitude, weariness, anxiety,
-inordinate irritability of the brain. It is possible that under such
-conditions one may hear premonitory sounds, may in some sort feel distant
-agitations which our healthy organs are usually incapable of apprehending.
-When such a brain during sleep is unoccupied with the ordinary objects of
-sensation, feeble impulses, which usually remain unnoticed, may sometimes
-suffice to arrest the attention. We may thus explain the possibility of
-impressions derived from distant events passing into the consciousness of
-a dreamer, and arousing hallucinations of which the immediate cerebral
-mechanism is the same as that of the ordinary hypnagogic hallucination.
-Thus, the Rev. Canon Warburton relates the following experience[66]:
-
-"Somewhere about the year 1848 I went up from Oxford to stay a day or two
-with my brother.... When I got to his chambers I found a note on the table
-apologising for his absence, and saying that he had gone to a dance
-somewhere in the West End, and intended to be home soon after one
-o'clock. Instead of going to bed, I dozed in an arm-chair, but started up
-wide awake exactly at one, ejaculating, 'By Jove, he's down!' and seeing
-him come out of a drawing-room into a brightly illuminated landing,
-catching his foot in the edge of the top stair, and falling headlong, just
-saving himself by his elbows and hands. (The house was one which I had
-never seen, nor did I know where it was.) Thinking very little of the
-matter, I fell a-doze again for half an hour, and was awakened by my
-brother suddenly coming in and saying, 'Oh, there you are! I have just had
-as narrow an escape of breaking my neck as I ever had in my life. Coming
-out of the ball-room, I caught my foot, and tumbled full length down the
-stairs.'"
-
-An incident of this character might very properly be ranked as a mere
-coincidence, were it not for the fact that it is one only of a
-considerable number of well attested acts of vision connected either with
-the hypnagogic state or with the act of dreaming itself. The comparative
-rarity of such events lends them a marvelous aspect; yet there is really
-nothing about them any more wonderful or preternatural than the
-demonstrated possibility of telegraphic signaling across the sea without
-the intervention of an electric wire.[67] Under ordinary circumstances a
-metallic conductor must serve as the avenue of communication between
-distant stations; but if a sufficiently sensitive piece of apparatus be
-placed in contact with the water on either side of an arm of the sea,
-communications may be transmitted from one to the other by a diffusion of
-impulses through the entire body of water.
-
-In like manner we ordinarily see and hear and feel as a consequence of
-cerebral excitement occasioned by specific impressions concentrated
-through the organs of sight and hearing and touch. But it is quite
-reasonable to believe in the possible existence of a brain so delicately
-organized as to be capable of reacting to impressions which are too
-diffuse and too feeble to arouse the ordinary apparatus of sensation. With
-such a brain it might be possible to experience perception without
-eye-sight. Evidence furnished by the facts of somnambulism and hypnotism
-indicates that the receptivity of the brain may become temporarily exalted
-to a degree which warrants the inference that clairvoyance itself may be
-thus brought within the capacity of certain peculiarly sensitive
-organizations. The same extraordinary receptivity occasionally seems to
-attend the act of dreaming. For example, one of my acquaintances, a lady
-of a highly wrought nervous temperament, the wife of a distinguished
-physician in a neighboring State, dreamed one night that a favorite
-cousin, a beautiful little girl, who lived at a distance of twelve or
-fifteen miles, was very dangerously ill. She saw the child lying on its
-mother's lap, evidently at the point of death, when some one brought a tub
-of warm water and proceeded to give the patient a bath. This revived the
-little one so that she recovered. The dream made a very considerable
-impression upon my friend, by reason of its peculiar character, and
-because dreaming was for her a very unusual experience. Next morning she
-rose as usual, but during the forenoon she was startled by the receipt of
-a message requesting her to come at once to the house of her uncle, as his
-little daughter had been taken suddenly ill with the croup, and had
-expired during the preceding night. Hastening to the bereaved household,
-she found her aunt sitting with the dead child on her lap, precisely as
-she had appeared in the dream. The little girl had been suddenly attacked
-during the night, and, as she lay gasping in her mother's arms, some one
-advised a warm bath, and brought a tub of water into the room for that
-purpose. Unfortunately, just as they were hopefully preparing to dip the
-child into the water, she had ceased to breathe.
-
-The lack of conformity between the conclusion of this dream and the actual
-fact reminds one of the blurring of the images that are transferred from
-one brain to another in the acts of telepathy recently investigated by the
-Society for Psychical Research. Something similar is frequently observed
-in connection with the phenomena of hypnotism. The hypnotised subject does
-not always perceive clearly or wholly the sensation that is suggested by
-the agent who operates upon his brain.
-
-For another example of apparently clairvoyant dreaming, I am indebted to a
-friend, a well-known gentleman of unimpeachable veracity, who, when a
-young man in the army, during the war of the great rebellion, was taken
-very ill, and was sent home to New England from one of the most remote
-outposts of the campaign. No one of his family had the slightest
-information or suspicion of his illness, until the night before his
-arrival, when his father dreamed that the absent son was sick, and would
-arrive the next day, at an hour unusual for travelers coming from the
-South. So vivid was this dream, and so powerful was its influence upon the
-mind of the dreamer, that he went at the specified hour to the railway
-station, with a carriage full of blankets and pillows, to receive his son.
-When the train arrived, and the invalid actually appeared, the mutual
-astonishment of father and son can better be imagined than described.
-
-In a recent work on hypnotism,[68] Fischer has related several personal
-experiences of a similar transfer of impressions during the waking state.
-It is highly probable that if such impressions are received by a sleeping
-brain, they may operate like other suggestive irritants to produce dreams,
-which may be sometimes so vigorously projected upon the consciousness of
-the dreamer that he may be awakened, and may still perceive the evolution
-of his dream as an hallucination, even after waking. Thus, on one
-occasion, during a malarial fever, I dreamed of seeing a friend who lived
-at a great distance. So vivid was the impression that I started up awake;
-and there, at the foot of the bed, in broad daylight, was my friend,
-looking calmly at me. Several seconds, at least, were required to
-dissipate the vision. In an article already quoted,[69] Sir Edmund Hornby,
-late Chief Judge of the Supreme Consular Court of China and Japan, "who
-describes himself as 'a lawyer by education, family, and tradition,
-wanting in imagination, and no believer in miracles,'" relates his
-experience of a similar spectral visitation. After stating that "it was
-his habit at Shanghai to allow reporters to come to his house in the
-evening, to get his written judgment for the next day's paper," he says:
-
-"They generally availed themselves of the opportunity, especially one
-reporter, who was also the editor of an evening paper. He was a peculiar
-man, reticent about himself, and I imagine had a history. In appearance he
-was also peculiar. I only knew him as a reporter, and had no other
-relations with him. On the day when the event occurred, in 1875 or 1876, I
-went to my study an hour or two after dinner, and wrote out my judgment.
-It was then about half-past eleven. I rang for the butler, gave him the
-envelope, and told him to give it to the reporter who should call for it.
-I was in bed before twelve. I am a very light sleeper, and my wife a very
-heavy one. Indeed, it is difficult to rouse her out of her first sleep.
-The bed--a French one--faced the fire-place; on the mantel-piece was a
-clock, and the gas in the chandelier was turned down, but only so low as
-to admit of my seeing the time at any time of the night, for--waking
-easily and frequently--I often smoked a cigarette before I went to sleep
-again, and always desired to know the hour.
-
-"I had gone to sleep, when I was awakened by hearing a tap at the study
-door, but thinking it might be the butler--looking to see if the fire were
-safe and the gas turned off--I turned over with the view of getting to
-sleep again. Before I did so, I heard a tap at my bed-room door. Still
-thinking it might be the butler, who might have something to say, I said,
-'Come in.' The door opened, and, to my surprise, in walked Mr. ----. I sat
-up and said, 'You have mistaken the door; but the butler has the judgment,
-so go and get it.' Instead of leaving the room he came to the foot edge of
-the bed. I said, 'Mr. ----, you forget yourself! Have the goodness to walk
-out directly. This is rather an abuse of my favor.' He looked deadly pale,
-but was dressed in his usual dress, and was certainly quite sober, and
-said, 'I know that I am guilty of an unwarrantable intrusion, but finding
-that you were not in your study I have ventured to come here.' I was
-losing my temper, but something in the man's manner disinclined me to jump
-out of bed to eject him by force. So I said, simply, 'This is too bad,
-really; pray, leave the room at once.' Instead of doing so he put one hand
-on the foot-rail, and gently, and as if in pain, sat down on the foot of
-the bed. I glanced at the clock, and saw that it was about twenty minutes
-past one. I said, 'The butler has had the judgment since half-past eleven;
-go and get it.' He said, 'Pray forgive me; if you knew all the
-circumstances, you would. Time presses. Pray give me a _précis_ of your
-judgment, and I will take a note in my book of it,' drawing his reporter's
-book out of his breast pocket. I said, 'I will do nothing of the kind. Go
-down stairs, find the butler, and don't disturb me--you will wake my
-wife--otherwise I shall have to put you out!' He slightly moved his hand.
-I said, 'Who let you in?' He answered, 'No one.' 'Confound it,' I said,
-'What the devil do you mean? Are you drunk?' He replied, 'No, and never
-shall be again; but I pray your lordship give me your decision, for my
-time is short.' I said, 'You don't seem to care about _my_ time, and this
-is the last time I will ever allow a reporter in my house.' He stopped me
-short, saying, 'This is the _last_ time I shall ever see you anywhere.'
-
-"Well, fearful that this commotion might arouse and frighten my wife, I
-shortly gave him the gist of my judgment in as few words as I could. He
-seemed to be taking it down in short-hand; it might have taken two or
-three minutes. When I finished, he rose, thanked me for excusing his
-intrusion and for the consideration I had always shown him and his
-colleagues, opened the door and went away. I looked at the clock; it was
-on the stroke of half-past one.
-
-(Lady Hornby now awoke, thinking she had heard talking; and her husband
-told her what had happened, and repeated the account when dressing next
-morning.)
-
-"I went to the court a little before ten. The usher came into my room to
-robe me, when he said, 'A sad thing happened last night, sir. Poor ----was
-found dead in his room.' I said, 'Bless my soul! dear me! What did he die
-of, and when?' 'Well, sir, it appears he went up to his room as usual at
-ten to work at his papers. His wife went up about twelve to ask him when
-he would be ready for bed. He said, "I have only the judge's judgment to
-get ready, and then I have finished." As he did not come, she went up
-again, about a quarter to one, to his room and peeped in, and thought she
-saw him writing, but she did not disturb him. At half-past one she again
-went to him and spoke to him at the door. As he did not answer she thought
-he had fallen asleep, so she went up to rouse him. To her horror he was
-dead. On the floor was his note book, which I have brought away. She sent
-for the doctor, who arrived a little after two, and said he had been dead,
-he concluded, about an hour.' I looked at the note book. There was the
-usual heading:
-
-    "'In the Supreme Court, before the Chief Judge.
-
-    ---- _v._ ----
-
-    "'The Chief Judge gave judgment this morning in this case to the
-    following effect'--and then followed a few lines of indecipherable
-    shorthand.
-
-    "I sent for the magistrate who would act as coroner, and desired him
-    to examine Mr. ----'s wife and servants as to whether Mr. ---- had
-    left his home, or could possibly have left it without their knowledge,
-    between eleven and one on the previous night. The result of the
-    inquest showed he died of some form of heart disease, and had not, and
-    could not have left the house without the knowledge of at least his
-    wife, if not of his servants. Not wishing to air my 'spiritual
-    experience' for the benefit of the press or the public, I kept the
-    matter at the time to myself, only mentioning it to my Puisne Judge
-    and to one or two friends; but when I got home to tiffin I asked my
-    wife to tell me as nearly as she could remember what I had said to her
-    during the night, and I made a brief note of her replies and of the
-    facts.
-
-    "As I said then, so I say now--I was not asleep, but wide awake. After
-    a lapse of nine years my memory is quite clear on the subject. I have
-    not the least doubt, I saw the man--have not the least doubt that the
-    conversation took place between us.
-
-    "I may add that I had examined the butler in the morning--who had
-    given me back the MS. in the envelope when I went to the court after
-    breakfast--as to whether he had locked the door as usual, and if any
-    one could have got in. He said that he had done everything as usual,
-    adding that no one could have got in if even he had not _locked_ the
-    door, as there was no handle outside--which there was not. I examined
-    the coolies and other servants, who all said they opened the door as
-    usual that morning--turned the key and undid the chains, and I have no
-    doubt they spoke the truth. The servants' apartments were separated
-    from the house, but communicated with it by the gallery at the back,
-    some distance from the entrance hall.
-
-    "The reporter's residence was about a mile and a quarter from where I
-    lived, and his infirmities prevented him from walking any distance
-    except slowly; in fact, he almost invariably drove.
-
-        "EDMUND HORNBY."
-
-The publication of this remarkable story led to its correction in several
-important particulars. From the _North China Herald_ (August, 1884) it
-appears that not only was Sir Edmund's memory defective in connection with
-several of the minor details of the narrative, but he had also been either
-wholly misinformed, or was quite forgetful regarding the actual time of
-the editor's death. That person was, in fact, alive and in his usual
-health at the time of his supposed apparition in the judge's chamber, and
-did not die till between eight and nine o'clock on the same morning. He
-had "attended a temperance committee meeting the night before, and had
-left about half-past ten in good health and excellent spirits.... He
-slept at home, rose shortly before eight, and visited his office to
-arrange some _matter_ for that day's paper. He then returned to his room
-to dress, and in a few minutes afterward was found dead upon the floor."
-
-Between these conflicting witnesses it is of course impossible to decide.
-But for our purpose that is quite unnecessary. It is clear that Sir Edmund
-believed that the visible image of an acquaintance had appeared before him
-in his chamber at night. It is also evident that the judge was a man whose
-nerves had been damaged, probably by tobacco--for he was a "light
-sleeper"--waking often, and indulging in the luxury of a cigarette during
-the course of the night. If we may credit the writer in the _Herald_, his
-brain was in a process of deterioration, proved by the decidedly
-treacherous character of his memory. The whole story, therefore, becomes
-exceedingly instructive as an illustration of the manner in which a belief
-in apparitions may be originated. The most probable explanation of the
-incident is found in the hypothesis of a dream excited in an irritable
-brain that had been aroused by the preparation of the manuscript which had
-occupied the thoughts of the judge immediately before retiring for the
-night. The course of this dream was so vivid that the sleeper awoke, but
-continued, like some other dreamers similarly awakened, to witness the
-evolution of his vision in the form of a genuine hallucination. A
-remarkable example of a similar production of hallucination through
-disease of the brain is related by the late Dr. E. H. Clarke.[70] One of
-his patients, a vigorous old gentleman, of eighty years, a great lover of
-music, and a frequent attendant at operas and concerts, retired one night
-at the usual hour, and in his usual health. He soon fell asleep, "and
-slept well till about two A. M., when he was awakened by the sound of
-music, which seemed to come from the street near his house. Thinking a
-serenade was going on, he got up to ascertain where it was, but discovered
-nothing. The sound ceased when he arose. On returning to bed, he heard the
-sound of music again, and was at the same time surprised by the appearance
-of three persons, standing near each other in his chamber, opposite the
-foot of his bed. It was his habit to sleep with the gaslight burning
-feebly, near the head of his bed. He turned the gas on to its full power,
-and inspected the intruders. They appeared to be musicians, who were
-humming and singing, as if in preparation for a musical performance. He
-rang a bell, which summoned his man servant. John soon arrived, and was
-ordered to put the strangers out. 'There is nobody here, sir,' was John's
-reply to the order. For a moment Mr. A. was not only amazed, but alarmed.
-'What!' he exclaimed, 'do you see no one there?' 'No one,' said John. 'Go
-where those chairs are, and move them,' was Mr. A.'s next direction. John
-did so. The strangers stepped aside, but did not go out. By this time Mr.
-A. had gathered his wits about him, and was satisfied that he was the
-victim of a hallucination; and he determined to observe its phenomena
-carefully. Accordingly, he bade his servant depart, and prepared to watch
-his visitors. But they were so life-like and human, that he was again
-staggered, and recalling John, told him to go for the house-keeper. She
-soon came, and on being interrogated, confirmed John's statements that
-there were no strangers in the chamber and no sounds to be heard.
-Convinced by the testimony of two witnesses, Mr. A. yielded to the
-decision of his reason, and again resolved to go on with the investigation
-of the strange phenomena. The musicians had now resumed their position,
-near the window and opposite the foot of the bed. Mr. A. turned the light
-of the gas full upon them. He looked at his watch, which marked the hour
-of half-past two. He then arranged his pillows, so as to sit almost
-upright in bed, and waited for the next scene of the play. He was able to
-note the size, form, dress, and faces of the performers. One was a large
-man, who bore some resemblance to Brignoli. The two others were of less
-size, and shorter stature than their companions. All were habited in dress
-coats, with white waist coats, and wore white cravats and white gloves.
-After a little time spent in coughing and clearing their throats, they
-began to sing. They sang at first a few simple airs, 'Sweet Home' among
-others. They then attempted more difficult music, and gave selections from
-Beethoven and Mozart. Between the pieces they chatted with each other in a
-foreign language, which Mr. A. took to be Italian, but they did not
-address him. Occasionally they changed their position, turned in various
-directions, and part of the time sat down. Mr. A. said the singing was
-excellent; he had rarely heard better. After the first feeling of surprise
-and amazement had passed away, he enjoyed the music exceedingly. The
-performance continued in this way for some time, when it suddenly came to
-an end. The singing ceased, and the singers vanished. He looked at his
-watch, and found that the time was four o'clock. The concert in his brain
-had lasted nearly an hour and a half, almost the length of an ordinary
-concert. He reflected for a while upon this strange occurrence, but not
-being able to arrive at any satisfactory explanation of it, he turned his
-gas down and went to sleep. The next morning he called at my office, as
-previously stated, to ascertain if possible what pranks his brain had been
-playing, and if he should regard them as warning of his approaching
-departure."
-
-In this case the patient was suffering from "a moderate degree of
-deafness, persistent tinnitus aurium, occasional vertigo, and slight loss
-of memory." Towards the close of life, two or three years later,
-"incoherence, delirium, stupor, and the like, indicated with sufficient
-certainty the presence of severe cerebral disease." The remarkable
-hallucination which he experienced was undoubtedly the product of the
-morbid changes which were progressing in his brain.
-
-These cases form an ascending series which illustrates the receptive and
-constructive capacities of the human brain when its sensory apparatus has
-become unusually or morbidly excitable. But this preternatural mobility
-may display itself in other departments besides those of mere
-sense-perception. The sphere of pure intellect may thus be invaded by
-ideas springing from impressions which address the reasoning faculties
-alone, so that in sleep a dream may lead the judgment to decisive
-conclusions that were scarcely recognized or heeded during the hours of
-wakefulness. In this way we may learn to understand how the anxieties
-experienced by the husband of the Virgin Mary may have ripened into a
-dream, of intensity sufficient to guide his subsequent action. Nothing
-could be more natural for one, like him, ignorant of physiology and of
-second causes in general, than the ascription of such an event to the
-immediate intervention of the Great First Cause--the only cause which he
-could rationally apprehend. Hence the universal primitive belief that in
-dreams God spake to man. Upon this belief was laid the foundation of many
-of the religious convictions which have grown and ripened with the
-progress of the race until their shadowy origin has been well nigh
-forgotten.
-
-Many are wont to affirm that the age of illumination through the
-intervention of dreams is past, but there is no good reason for the belief
-that such dreams may not still occur. A lady, carefully educated in the
-doctrines of the popular theology, had been very much distressed by the
-unruly behavior of her only child, a little imp who had scarcely learned
-to talk. While thus depressed in spirits she dreamed that the Day of
-Judgment had come. She found herself with her husband and child and the
-whole human race assembled upon the face of the earth, waiting in agony
-for the awful decision of their fate. Finally the heavens were opened, and
-Jesus appeared, dividing the wicked from the good. As he drew near the
-place where she was standing, she could no longer endure her anxiety
-regarding the destiny of her daughter; she rushed forward, and implored
-the Divine Judge to spare her child. With a look of ineffable compassion
-he assured the trembling suppliant that her prayer was granted, and she
-awoke in a state of great agitation, but much comforted as to the future
-of her little girl, who in due course of time grew up to be a very
-exemplary young woman. Now, if the dream of Joseph was a revelation, a
-dream like this is quite as worthy of similar estimation. They both
-occurred as the result of analogous conditions of the brain and mind, and
-were both excited by second causes of a similar character. It is
-impossible for any one to show that the relation between the First Cause
-and either set of second causes was any more intimate and special in one
-case than in the other.
-
-The wonderful exaltation of certain faculties during the unequal sleep of
-the different organs of the mind, is usually to be considered as something
-relative rather than absolute. But there is little reason to doubt that
-sometimes the excitement of the waking portions of the brain does really
-transcend the ordinary functional capacity of the structure. Under such
-conditions the undivided concentration of attention upon the comparatively
-limited circle of ideas which are thus produced, greatly increases the
-intensity of the resulting impressions upon the mind in consciousness.
-Hence the grandeur of the visions which may thus arise; hence, also, the
-possibility of their construction in accordance with fact rather than with
-fancy; as in the case of the visions of the ancient Hebrew prophets. As
-the darkness of night, by shutting out the earth from sight, opens our
-eyes to the glory of the starry sky, so, in like manner, sleep, by closing
-the senses against the distractions of the external world, may sometimes
-afford the conditions enabling a richly gifted intellect to comprehend the
-course and the destination of those deep and silent streams of thought
-which move on, unnoticed during the hours of wakeful life.
-
-Whatever may be true of this matter of fore-sight, it is certain that
-under similar conditions the memory of past events may be so quickened as
-to yield results quite comparable with actual clairvoyance. A good
-illustration of this has been recorded by Abercrombie.[71] A gentleman
-named Rowland had been prosecuted for certain arrears of tithe which he
-believed had been long previously paid by his deceased father. "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 defence. 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, as 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 strong 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. awoke 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 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."
-
-Here it would be a valuable addition to knowledge if the parties in the
-history just related could be subjected to intelligent interrogation.
-Enough, however, may be discovered in the narrative to render it certain
-that the dream was merely a revival in consciousness of knowledge that had
-been long previously forgotten. There was a vague recollection of some
-such information evidently struggling for recognition; otherwise Mr. R.
-could not have held the belief in spite of the lack of evidence, that his
-father had paid the tithes in dispute. He had probably heard from his
-father some account of a transaction which had taken place so long before
-that the only surviving actor, the aged lawyer, had forgotten everything
-about it, and could only recall the event through the associations
-connected with the Portugal piece of gold. In the lawyer's case the
-cerebral register only needed the stimulus afforded by the association of
-ideas, in order to make it again place before the mind impressions which
-had long subsided below the level of consciousness. For Mr. R., sleep
-afforded the limitation of cerebral function needful for a concentration
-of attention sufficient to penetrate to the level of the residual
-vibrations which persisted as the sole representatives of the original
-impressions through which his knowledge of the event had been primitively
-obtained. Parallel examples are furnished by the cases of individuals who,
-upon their death-beds, during the dissolution of the brain, have resumed a
-long disused vocabulary, speaking the language and thinking the thoughts
-of their childhood. "He 'babbled of green fields,'" said Mistress Quickly,
-narrating the closing scenes in the life of the famous Sir John Falstaff.
-Dr. Rush[72] relates the case of a learned Italian gentleman who, "in the
-beginning of the yellow fever which terminated his life, ... spoke English
-only; in the middle of the disease, he spoke French only; but on the day
-of his death, he spoke only in the language of his native country." In
-like manner the old Swedish settlers in Philadelphia who had forgotten
-their native language, or, at least, had not spoken it for half a century,
-would pray in Swedish on their death-beds.[73] Sleep and dissolution
-operate alike to release the lower levels of the mnemonic apparatus from
-the overshadowing influence of later impressions, so that, like an ancient
-palimpsest, it presents once more its long-forgotten characters for
-inspection by the mind.
-
-
-
-
-CHAPTER VI.
-
-SOMNAMBULISM.
-
-    A great perturbation in nature! to receive at once the benefit of
-    sleep, and do the effects of watching.                 --MACBETH.
-
-
-We have seen that in certain cases dreams manifest a tendency to pass into
-action. Thus, the dream with which I was on one occasion occupied became
-so amusing that I was awakened by a paroxysm of laughter that continued
-for some time after the termination of the dream. Sometimes the actions
-which are thus determined become more complicated, but do not suffice to
-arouse the sleeper. He continues to dream, and to act out his dream. This
-constitutes the ordinary form of somnambulism. It is a special affection
-of the nervous system encountered chiefly among persons of a decidedly
-neurotic constitution--especially among the victims of hysteria, epilepsy,
-and insanity. Sometimes occurring in cases apparently characterized by
-perfect health, it will usually be discovered by careful inquiry that the
-subject is nevertheless connected by near relationship with a neurotic
-stock. In a third class of patients the neuropathic diathesis is not
-congenital, but is the acquired result of particular injuries or diseases
-of the head. It is also observed sometimes as a consequence of transitory
-functional disturbances of the brain connected with the period of
-convalescence from diseases that profoundly affect the nutrition of the
-nervous system. In all cases, however, it is probable that a special
-nervous temperament exists as a predisposing cause of the phenomena, for
-the majority of people can sustain injuries of the head, or of the
-peripheral nervous system, and can pass through all kinds of illness
-without exhibiting any tendency to somnambulism. As the nervous
-temperament is the peculiar property of children and of the female sex, it
-is among them that the affection is usually observed. Before the age of
-puberty, however, the differential peculiarities of sex are not sufficient
-to produce any great preponderance in either direction; and small boys
-are, therefore, perhaps as frequently somnambulistic as their little
-sisters. Like other neuropathic disorders, this predisposition is
-frequently met with as an hereditary attribute which may be handed down
-from generation to generation. Occurring in the experience of young
-children, it frequently ceases when they arrive at years of maturity. Not
-always, however, thus ceasing as a consequence of improvement in the
-general health, but because of the substitution of some more serious
-disorder.
-
-The phenomena of ordinary somnambulism are manifested, like the dreams out
-of which they arise, during the period of sleep. But, while dreams most
-frequently occur during the later portion of the night, after the deepest
-sleep is past, somnambulism usually occurs in the earlier part of the
-night, during the deepest sleep. As a consequence of this fact,
-consciousness is seldom affected by the molecular play of the brain during
-the somnambulic excursion. The sleepwalker knows nothing, and remembers
-nothing of the incidents in which he has been an active agent; while the
-dreamer seems to be more nearly awake. His consciousness is partially
-aroused by the play of memory and of imagination, and he can remember the
-spectacle which constituted his dream. The phenomena of somnambulism
-necessitate the participation of a larger number of faculties than are
-needed for the production of a dream, but their activities are coördinated
-upon a plane, so to speak, lower than the platform upon which the elements
-of dreams are arranged. Consequently, though the elements of the
-somnambulic process may be far more numerous and various than the elements
-of a dream, they may be less capable of rising into the realm of
-consciousness. Such a process may differ from the phenomena of ordinary
-life only in the fact of unconsciousness; and, when concluded, it leaves
-no traces in the memory of the waking state. In other instances, on the
-contrary, so many nervous functions may be suppressed, and so great may be
-the intensity of the remaining cerebral processes, that the resulting
-phenomena scarcely differ from an ordinary dream in which consciousness is
-aroused, and the waking memory is durably impressed. Between these
-extremes lie opportunities for an indefinite number of combinations;
-consequently the forms and degrees of somnambulism present a very great
-variety of manifestation. Maury[74] reduces these to five principal forms:
-First, simple movement of the limbs in connection with that partial sleep
-of the intellectual faculties which produces ordinary dreams. Second,
-_somniation_, a state in which the patient unconsciously performs such
-actions as have become so far habitual that, though complicated in their
-character, they constitute genuine cerebral reflexes. Third,
-_noctambulism_, or sleep-walking, in which the action, though complicated
-in its character, and different from the ordinary waking occupations of
-the patient, appears to be the result of automatic processes, constituting
-a dream that is acted out in time and space. Fourth, _somnambulism_ with
-exaltation of the faculties, producing delirium with conscious movements
-during the crisis. Fifth, _somnambulic life_, or double consciousness, in
-which, with the exception of certain special modifications of
-intelligence, the conduct of the patient during the paroxysm does not
-perceptibly differ from that of the waking state, so that the subject
-seems to experience two successive though disconnected personalities.
-
-The exact relation between these different degrees of somnambulism has
-been further elucidated by MM. Ball and Chambard.[75] Starting with the
-proposition that normal healthy existence is a state in which the
-functions of organic life furnish a basis for nervous sensibility and
-motion, by means of which the imaginative faculties (imagination and
-memory), associated with the coördinative faculties (attention, judgment,
-volition), are sufficiently stimulated to maintain a state of
-consciousness, they show that the first stage of sleep consists in the
-suppression of bodily motion and sensibility. The second stage consists in
-the further suppression of the coördinative faculties. The third stage is
-marked by the loss of memory and imagination. In the most profound and
-perfect sleep the functions of organic life alone remain. The process of
-awaking consists in the revival of the faculties in the inverse order of
-their extinction. Dreams occur during the period in which motion,
-sensation, and the coördinative faculties are in abeyance; but
-somnambulism may accompany each of the stages of sleep. Its simplest form
-is perhaps the rarest; corresponding to Maury's fifth variety. In this
-form the functions of organic life are intact; motion and sensibility seem
-unchanged; the intellectual faculties display their usual activity; but
-the ordinary consciousness is never aroused. So far as the normal life of
-the subject is concerned, he is active, sensible, intelligent, but
-unconscious; and when the paroxysm is terminated memory contains no
-account of its events. Such paroxysms may occur but once in the life-time
-of an individual, or they may be repeated at stated intervals,
-constituting an alternate succession of mental states without connection
-in consciousness. This is called the somnambulic life, or double
-consciousness, several examples of which will be related upon another
-page.
-
-The second form of somnambulism results from the abolition of
-consciousness and the more or less complete suppression of the
-coördinative faculties of the mind. Memory and imagination, released in
-great measure from the control of the higher intellectual faculties, and
-excited by such vestiges of sensation as still persist, create a species
-of delirium in which mutilated sensations, half formed thoughts and
-disproportioned volitions combine to produce a variety of actions. In
-this condition the patient dreams, and acts out his dream. He is a
-somnambulic dreamer.
-
-In the third degree of somnambulism, consciousness and the entire range of
-intellectual faculties have disappeared. The individual resembles a
-creature from which the cerebral hemispheres have been removed. He is
-little better than a living automaton, guided only by impressions received
-from without. In this condition the movements of the body may become
-wholly responsive to the will of another--a prominent characteristic of
-artificial somnambulism or hypnotism.
-
-A fourth degree of somnambulism is marked by the disappearance of
-consciousness, intellect, sensibility, and the power of motion. Only the
-lower functions of organic life remain. The patient merely lives, he
-neither thinks nor acts. This constitutes the state of somnambulic
-lethargy, a condition which differs from deep sleep only in the fact that
-under the influence of external impulses or of partial awaking it may
-easily pass into the second form of the affection, the somnambulic dream.
-
-Such is the classification of MM. Ball and Chambard. It possesses the
-merit of great precision and clearness. If the warning which its authors
-themselves utter against its too literal acceptance be respected, it will
-be found to afford a very convenient explanation of the manner in which
-the various degrees of somnambulism are reached. But it must be remembered
-that between these pronounced and definite forms exist a great number of
-intermediate degrees. Partial revivals and temporary resurrections of the
-higher faculties of the mind may intrude themselves among the activities
-which depend upon lower functions; as, for example, when the ordinary
-unconsciousness of lethargy is briefly interrupted by an event which may
-remain permanently fixed in memory after waking, even though all other
-concurrent incidents were unnoticed and left no trace behind. Keeping this
-caution in mind, the following diagram will be found useful:
-
-  +=======================================================================+
-  |           |Organic|Sensibility:|Imaginative|Coördinative|Consciousness|
-  |           | Life  |   Motion   | Faculties:|  Faculties:|             |
-  |           |       |            |   Memory, |  Judgment, |             |
-  |           |       |            |Imagination| Attention, |             |
-  |           |       |            |           |  Volition  |             |
-  |-----------|-----------------------------------------------------------|
-  |Normal life|XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX       |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | life      |XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                   |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | dream     |XXXXXXXXXXXXXXXXXXXXXXXXXX                                 |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | automatism|XXXXXXXXXXXXXX                                             |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | lethargy  |XX                                                         |
-  +-----------------------------------------------------------------------+
-
-The close parallel between this diagram and the one on page 4, which
-illustrates the course of sleep, will be at once remarked. The difference
-between the two states cannot be thus diagrammatically expressed. It is
-the difference between sleep in a healthy, normal subject, and sleep as
-modified by the somnambulistic temperament. This may be either the result
-of disease or of congenital defect of cerebral organization. What the
-particular structural difference may be, it must be impossible to decide,
-until it shall become possible to state the reason why one brain shall
-behave only in a normal manner, while another presents all the vagaries of
-hysteria, somnambulism,--perhaps even of insanity. That the affection is
-hereditary is a matter of common observation. One of my patients who is
-somnambulistic--walking in his sleep, climbing over the roof of his house,
-etc.--is the son of a father who was also a noctambulist, and who once
-fractured his leg by falling from a step as he was walking down stairs in
-his sleep. A grand-daughter is both a somniloquist and a somnambulist.
-
-Returning now to the classification adopted by Ball and Chambard, it will
-be found interesting to consider a few illustrative examples of the
-different forms and degrees of the affection under consideration.
-
-_Somnambulic Lethargy._--This condition represents the form which
-outwardly resembles profound sleep. It may occur as a paroxysm without
-relation to other forms of the affection, or, according to my own
-observation, more frequently associated with other forms of somnambulism.
-Thus, one of my patients, a lady about thirty-five years of age, having
-accidentally fallen into the hands of a noted empiric, by whom, for a
-slight attack of tonsillitis, she was vigorously dosed with atropia,
-digitalis and calabar bean, finally passed into a somnambulic state
-corresponding to the somnambulic life of the preceding table. This
-continued about five weeks, when she became completely lethargic, and was
-transferred to my care. In this condition she remained unconscious, almost
-perfectly insensible, with pupils somewhat contracted and sluggish before
-the light, with a feeble and slightly accelerated pulse, a moderately
-elevated temperature, bowels and bladder insensible to their contents,
-mouth and throat filled with an offensive mucous secretion. By great
-urgency she could be sufficiently roused to open her mouth, so as to
-permit cleansing the cavity, and to swallow liquid food. Swallowing was
-effected very slowly, and only after the liquid had remained for some time
-in the fauces. At the end of about three weeks the patient began to
-exhibit more vitality. She could be more easily aroused, began to dream
-and to have hallucinations that were finally prolonged out of sleep into
-wakefulness. In the course of a few hours she was fully herself again,
-after eight weeks of unconsciousness.
-
-This form of lethargy is characterized by the complete unconsciousness
-which persists during its course. Its duration is variable, sometimes
-continuing for a few minutes only; sometimes lasting through many days and
-weeks. Dr. W. T. Gairdner, Professor of Medicine in the University of
-Glasgow,[76] reports the case of a woman who remained for over one hundred
-and sixty days in a condition of lethargic stupor. "The patient was the
-mother of a family, and had lived a strictly domestic and (up to a short
-time before her seizure) healthy and regular life. There were no peculiar
-moral and religious problems to perplex the situation. There was no
-history of inveterate hysteria, or of long continued rapt contemplation;
-nor has there been the slightest evidence of any craving after notoriety,
-either before the attack or since its termination. The moral atmosphere,
-in short, surrounding the phenomena, is altogether unfavorable to
-exaggeration and imposture, for which, indeed, no reasonable motive can be
-assigned. Nevertheless, under these very commonplace conditions,
-concurring with some degree of melancholy or mental despondency after
-delivery, but during a convalescence otherwise normal, Mrs.
-McI----presents to our notice a condition of suspended consciousness and
-disordered innervation in no degree less extreme than the 'trances' or
-cataleptic attacks which have been recorded as the result of the most
-aggravated hysteria, or as the miracles of religious ecstasy and profound
-mental emotion. She becomes for the long period of over one hundred and
-sixty days continuously an almost mindless automaton, connected with the
-external world only through a few insignificant reflexes and through the
-organic functions. She is fed, almost without resistance, through the
-stomach-tube; she defecates and urinates (during much the greater part of
-the time) unconsciously; she is absolutely passive as regards everything
-that demands spontaneous movement, and betrays almost no sign of
-sensation, general or special, when subjected to the severest tests that
-can be applied short of physical injury. But while her senses were thus
-shut, and her volitions in suspense to an extent much beyond ordinary
-sleep, there was, nevertheless, a _sleep within the sleep_. The
-periodicity of day and night was maintained by some change in the
-condition of the innervation, of which snoring was the sole indication.
-She was not convulsed, nor paralyzed, nor delirious; the singing,
-laughing, weeping, adoring ecstasies of hysteria and of religious
-excitement were wholly wanting; nor were there during many months such
-intervals of normal consciousness as are observed in almost all the
-recorded cases of hysterical coma and of catalepsy. The statue-like pose,
-moreover, and the _flexibilitas cerea_ of typical catalepsy, are absent in
-this case. The return to consciousness was followed or accompanied by a
-return of all the normal functions of mind and body; there is now no
-incoherence, nor even distorted perceptions, as of a dream-life occupying
-the somnolent imagination for months, and therefore all the more hard to
-reconcile with realities. She is self-possessed, but unobtrusive, easily
-managed, and betraying only natural emotion; she persists in maintaining
-that the whole period of the apparent unconsciousness is a complete blank
-to her recollection. She is grateful for her recovery, but manifests no
-craving for sympathy, and no tendency, as yet, to revert to any morbid
-condition of despondency, such as was described at the commencement of the
-attack. In connection with this last point, although there is no evidence
-of her having been personally insane, it is not to be denied that her
-family history contains strong presumptions of a hereditary predisposition
-bearing in that direction."
-
-These cases must not be confounded with the examples of _lucid lethargy_,
-to which allusion has been made in a previous chapter. Somnambulic
-lethargy is a condition in which the cerebrum is wholly inert. In lucid
-lethargy, although there is complete loss of general sensibility and of
-the power of voluntary motion, the field of consciousness is continually
-enlightened by perceptions derived from one or more of the special senses,
-so that the subject is conscious of much that transpires in his immediate
-neighborhood. These two forms of lethargy sometimes alternate in the
-experience of the same individual, constituting a portion of the
-indefinitely varied manifestations of hystero-epilepsy. Grasset relates
-the case[77] of a little girl, ten years old, who suffered with various
-forms of hysteria, which were finally replaced by attacks of stupor,
-lasting several hours. After a time these crises of "nervous sleep" were
-transformed into more ordinary attacks of somnambulism, in which,
-"although the child's eyes are shut, she sees and hears everything during
-the crises, knows who comes into the room by their step and walk. If
-anything unpleasant is said to her, or if they threaten to wet her, or
-make her smell something, she gets angry, and pushes everything violently
-away that is offered to her. She replies by signs to all questions, and if
-she wants anything, asks for it by gesture: if she wants to drink, she
-puts her finger to her lips as if in the act of sucking, and if not
-understood, becomes irritated, gets up, and leads the father or mother to
-the sideboard or cupboard, where the things she wants are, and always with
-the eyes shut. She is able to go through the whole house, I do not say
-quite alone, because they do not allow her to walk alone, but with help,
-and she directs the way wherever she wishes to go. During the crises she
-even sometimes amuses herself with a little dog, which she makes jump over
-a stick resting on the cross-bars of two chairs opposite each other; and
-according as she wishes the dog to jump higher or lower, she moves the
-stick to the lower or higher bars of the chairs, and that with eyes always
-shut spasmodically. During the whole attack she cannot talk; but towards
-the end she speaks, although not yet recovered from her state of
-somnambulism. When the crisis is over, the child remembers nothing of what
-she has said or done in her sleep, and is much surprised at everything
-told her."
-
-_Somnambulic Dreams._--The preceding cases illustrate the variable
-character of the manifestations of somnambulism, and may also serve as an
-introduction to the more common form of the affection, in which the
-patient experiences a dream, probably excited by the same causes that
-produce ordinary dreams, and also acts out his dream. The differences
-between an ordinary dream and a somnambulic dream lie in the fact that the
-one produces an often vivid impression upon consciousness and memory,
-while the other is entirely expended upon the organs of external
-expression. Starting probably from the same portion of the brain, the
-physiological dream sets in motion the cortical structures which are in
-immediate relation with conscious memory; the impulses of the somnambulic
-dream, on the contrary, are directed towards the lower portions of the
-nervous system, where they serve to excite the organs of locomotion and
-expression, which are destitute of every form of mnemonic register.
-Consequently, the somnambulist retains no recollection of the incidents of
-his dream.
-
-The simplest form of this affection is presented by the restless child who
-talks, cries out, and brandishes its fists in sleep. In the majority of
-instances these manifestations create little more disturbance than the
-half uttered yelping of a dog that barks in its sleep. But in some cases
-the outbreak assumes a distressing, if not an alarming character,
-constituting the affection known by the name of _night terrors_. The
-disorder is usually observed in young children of a highly nervous
-temperament, before the conclusion of their second dentition. The little
-patients are generally of neurotic lineage. Insanity, hysteria,
-neurasthenia, epilepsy, chorea, and nervous dyspepsia, are often
-discovered among their near relatives. Not unfrequently they have been, or
-will become, choreic. The attack is often preceded by symptoms of
-indigestion and constipation; but the exciting cause may be usually traced
-in the commotion of a brain that has been wearied by the exertions of the
-previous day. The child starts up out of an apparently sound sleep, crying
-with seeming alarm, calling for his mother, and staring wildly around,
-with every possible expression of terror. Sometimes he jumps from his
-couch, and runs headlong into a corner, or seeks concealment under the
-bed, as if escaping from some frightful object. The eyes are open, tears
-flow, perspiration covers the skin, there is the greatest excitement, and
-the little one, clinging convulsively to its parent, will not be quieted.
-Only after a number of minutes does the child seem to recover the power of
-recognizing his friends. Presently, however, he lies down, and falls
-immediately asleep, waking in the morning without the slightest
-remembrance of the unpleasant event.
-
-Such paroxysms occur during the early part of the night, one or two hours
-after bedtime, when sleep is passing from its maximum intensity to an
-inferior degree of depth. This, moreover, is the time when the controlling
-power of the sensory apparatus over other portions of the nervous system
-has already reached its minimum. The spinal centres and those
-intra-cranial ganglia which do not share in the full measure of this
-repose are therefore in a condition of relative exaltation. Disturbances
-of internal origin, consequently, produce inordinate excitement of these
-waking portions of the nervous apparatus. The abnormal quality of this
-excitement is attested both by the history of the patient, and by the fact
-that it does not pervade the whole brain. The distribution of motion
-through the cerebrum is hindered, so that certain portions of the organ
-remain asleep while other regions are thrown into a state of tumultuous
-uproar. Such disconnection of the different organs of the nervous system,
-by withdrawing particular ganglia from the inhibitory influence of the
-other centres, gives opportunity for violent explosions of nervous force.
-
-Somewhat similar in their origin are those acts of unconscious violence
-which sometimes occur during the process of sudden awakening out of sound
-sleep. The patient is usually a deep but uneasy sleeper, who is only
-aroused imperfectly and with difficulty when the attempt to awaken him is
-made. Under such circumstances the disturbance to which he is subjected
-serves as the exciting cause of a dream which, like the ordinary
-somnambulist, he puts into action before he is fully waked. On recovering
-complete consciousness, he may retain no recollection of the events of
-his dream, and may also experience as great a degree of astonishment at
-the results of his violence as if he had taken no part in its display. A
-gentleman of my acquaintance, who had suffered considerable uneasiness
-regarding burglars, was, one night, startled by a noise in his room.
-Jumping up suddenly, he grasped a pistol and fired it in the direction of
-a figure dimly perceived near the bed. On waking fully out of sleep, he
-found that he had inflicted a wound upon the hand of his wife whose
-movements had disturbed him. Another unfortunate, who was once under my
-observation for undoubted insanity, was in like manner aroused out of
-sleep by a supposed noise, probably heard in a dream. With a pistol in
-each hand, he commenced firing wildly in every direction, fatally wounding
-his wife who was in bed at his side. When completely awakened he had no
-recollection of what had occurred, and was overwhelmed by the event.
-
-Wharton and Stillé[78] have collected a number of similar examples of this
-disorder, to which the term _somnolentia_ or _sleep-drunkenness_ has been
-applied. Its connection with morbid disturbance of the brain is usually
-very evident. Obviously, the moral responsibility of the agent in such
-cases is identical with that of the ordinary somnambulist, or of the
-subject of epileptic mania.
-
-Ordinarily, however, the somnambulic dream is less agitated. The patient
-merely continues the movements with which he was occupied at the moment of
-falling asleep, as in the case of Galen, who, though long an unbeliever
-of the tales regarding sleepy soldiers who had unconsciously continued to
-march with their comrades, at last found himself in a similar manner
-walking a considerable distance after he had been overtaken by sleep while
-journeying on foot. In other cases the phenomena though intimately
-connected with the daily occupations of the subject, present themselves in
-a form somewhat detached from the waking life. Such are the common
-experiences of children who get out of bed, and walk around the house,
-seeking their playthings, or pulling their clothes out of the drawers in
-which they have been laid. Sometimes the events of the day have evidently
-suggested the deeds of the night. One of my little acquaintances will
-leave her bed, walk into another room, seat herself by her mother's
-work-basket, thread a needle, and proceed to sew up the imaginary holes in
-her dress. One of my early playmates, in like manner, after puzzling over
-a difficult sum in arithmetic, before retiring, arose in his sleep, took
-paper and a pencil from his mother's desk, and proceeded before her eyes
-to work out the correct answer. Another, tempted probably by a vision of
-ripe grapes upon the trellis, climbed out of his window upon the roof of a
-shed. Unfortunately, the certainty with which somnambulists usually direct
-their movements seemed to fail him. He fell heavily to the ground, where
-he awoke to find himself seriously injured.
-
-An excellent example of a still more complicated series of actions during
-somnambulism is quoted by P. Max Simon.[79] It illustrates a majority of
-the facts which have been already brought forward, and will well reward
-careful consideration. "A young clergyman was in the habit of getting up
-in his sleep, taking paper, composing and writing sermons. When he had
-finished a page, he would read it over, if an action performed without the
-assistance of sight can be called _reading_. If dissatisfied with
-anything, he would blot it out, and then write the corrections with great
-accuracy in their appropriate place above the line. In one of these
-sermons he made a correction which was quite remarkable. Having in one
-place written the words _ce divin enfant_, on revising the page he decided
-to substitute the word _adorable_ instead of the word _divin_. He
-therefore blotted out this last word and placed the other immediately over
-it; then, perceiving the word _ce_, which was proper enough before the
-word _divin_, lacked the terminal letter _t_ that was needed before a
-vowel, he very adroitly added the necessary letter, so that the amended
-sentence correctly read _cet adorable enfant_. In order to ascertain
-whether the somnambulist made any use of his eyes, a cardboard was placed
-under his chin in such a way as to completely obstruct the view of the
-paper upon the table; but he continued to write without paying any
-attention to the obstacle. In order to ascertain whether he was aware of
-the presence of the objects which were before his eyes, the paper upon
-which he was writing was taken away, and a number of other sheets were
-successively slipped into its place; but he always noticed the
-substitution, because they differed in size. When an exactly similar piece
-was substituted, he accepted it as his own, and wrote down the corrections
-at the points which corresponded exactly with the writing upon the page
-which had been removed. It was by means of this ingenious stratagem that
-some of his nocturnal compositions were preserved.
-
-"The most astonishing thing of all," continues the author of this article,
-"was the exact composition of music. A cane served him as a ruler. With it
-he ruled at equal distances the five necessary lines, putting in their
-proper place the clef, the flats and the sharps. Finally, he inscribed the
-notes, at first all in outline, but, when he had finished, he blackened
-those which should be dark. The words of the song were written below. On
-one occasion he happened to write them with too large a hand, so that they
-were not placed directly under their corresponding notes. He soon
-perceived this defect, and, in order to amend it, he blotted out what he
-had done by drawing his hand over it, and then rewrote the line of music
-lower down the page with all the precision imaginable.
-
-"Another singular thing of a different sort, which was not less
-remarkable. One night, in the middle of winter, he dreamed that he was
-walking on the bank of a river, and saw a child fall into the water where
-he was drowning. The severity of the cold did not hinder him from hurrying
-to the rescue. He threw himself at full length upon his bed, in the
-position of a man who is swimming, and imitated all his movements. After
-having fatigued himself for some time with this exercise, he felt a
-portion of the coverlid gathered in a heap on one corner of the bed. He
-believed this to be the child; grasped it in one hand, and with the other
-went through the motions of swimming back to the bank of the supposed
-river. There he laid down his burden, and came out, shivering and
-chattering his teeth as if he were really getting out of an icy river. To
-the bystanders he said that he was freezing, and would die of cold, that
-his blood was all turned to ice; he must have a glass of brandy to warm
-him. Not having any, they gave him some water which chanced to be in the
-room; he tasted it, recognized the deception, and called, with greater
-emphasis than before, for brandy, insisting upon the magnitude of the
-danger which threatened his health. A glass of liquor was finally given to
-him; he drank it with pleasure, and spoke of the great relief which it
-afforded him. Notwithstanding all these incidents, he did not wake, but
-went to bed, and slept most profoundly."
-
-An equally instructive case is related by my distinguished colleague,
-Prof. J. Adams Allen.[80] The subject of the observation was a medical
-student who resided in Professor Allen's house during a portion of the
-time covered by the narrative.
-
-"About the summer of 1847, a somewhat dilapidated bass-viol, which was a
-kind of heir-loom in the family, was brought into the house, and he
-devoted spare moments to learning how to play upon it. Unfortunately, the
-antiquity of the instrument had told upon its keys, and unless they were
-wetted at each time of use, it would not remain in tune. He was
-determined, however, to command its notes, and succeeded. His somnambulic
-walks, thereafter, led him from his chamber to the parlor, and to the
-bass-viol, and the family would be awakened in the small hours by the
-inevitable tuning up prelude, mingled with slipping of the old keys, and
-quiet objurgations upon his part. Sometimes the bridge would fall down
-when the keys slipped, and sometimes a string would snap or escape from
-the keys, nevertheless he would persevere, repair damages, tune up, and
-then execute all varieties of music of which the machine was capable, not
-unfrequently accompanying it with his voice. All this would be done in
-total darkness. When any one entered the room with a light, he took not
-the least notice, although when spoken to he would reply in monosyllables
-or with considerable asperity. His face was usually flushed, although
-sometimes pale--the features immobile and passive, the eye open, pupil
-dilated, the surface glazed, and the lids apparently motionless. The
-extremities warm and the pulse full, frequent and soft. Very often the
-skin would be bathed with free perspiration. Remarkably sensitive to
-titillations when awake, there seemed total absence of reflex movements
-from this cause whilst in the somnambulic state.
-
-"As he extended his acquaintance with music and musical instruments, his
-feats became wonderful. Whilst in attendance upon the Medical College at
-La Porte, the household looked forward with high anticipations to the
-hours when his skillful touch of the melodeon would wake them. He had a
-voice of the purest tone and very considerable compass, in fact of rare
-sweetness. I am enabled to say from a multitude of observations, that he
-played with a precision and skill while asleep that he could not
-approximate while awake. Besides this, he would execute music which he
-had heard, perhaps, but once, the evening previous or after a long
-interval--no note of which he could recall in his waking moments. His
-memory here seemed wonderfully exalted. If interrupted, he was irritable
-in the extreme, but would go on with his music exactly from the point of
-interruption.
-
-"Among the numberless exhibitions of his somnambulism, I have time only to
-notice a few of the most striking.
-
-"Whilst attending lectures at Ann Arbor, where I was then lecturing on
-Physiology, I requested his assistance in enlarging some of the drawings
-illustrative of minute anatomy and histology, for use in class
-demonstrations. He entered into the work with great zeal, and proved very
-expert and rapid in execution. One evening, previous to the day on which I
-was about to lecture on the kidney, I wished the cuts in Carpenter's
-Physiology, illustrating the tubular arrangement, etc., were ready. He had
-an engagement for the evening, but said he would try and prepare them in
-the morning. During the night he rose, dressed himself, played a few tunes
-on the guitar, part of the time singing (and, by the way, the guitar was
-about as dilapidated as the bass-viol before noticed, and he had to knot
-one or two of the strings first), and then arranged the drawing paper,
-prepared his India ink and brushes, took the parallels and pencils and
-laid off the space, and worked for half an hour or more rapidly and
-perfectly, nearly completing the figures on pp. 596 and 597 of Carpenter's
-Principles, in the edition of 1853.... These drawings are now in the
-series used for illustration in Rush Medical College. Although we had a
-light in the room while watching him, he went on with his work entirely
-regardless of it. Before completing the work, he went to bed and slept
-until the usual hour in the morning, when at the breakfast he asked if he
-had been up in the night, as he had _dreamed_ that he had. This was the
-only time he ever remembered even dreaming about being up or occupied in
-anything. He had by this time become so fully aware of his habits, that
-nothing of the sort astonished him. Shortly after this he went to spend
-the night with a fellow student, but a little after midnight he rose,
-dressed himself, and went out, followed by the other gentleman, walked
-down to the Exchange Hotel, where there were a number of his acquaintances
-and others waiting for a train of cars due at that time. Some one rallied
-him on his being out so late, but being cautioned by his companion, they
-did not attempt to awake him, but watched his movements. On being invited,
-he took a glass of ale, and then said he would only have time to go home
-and get his dinner before the afternoon lecture hour. He walked with his
-friend to our door, and was indignant to find it locked. His room-mate (a
-cousin) admitted him and awakened myself and wife. He asked if dinner was
-ready, and seemed astonished that it was not; then said he would get a
-drink of water and be off, 'for old D. (one of the faculty) would be mad
-if he was late.' I told him he had plenty of time and he need not be in a
-hurry. He then walked into the kitchen, drank a tumblerful of water, and,
-looking up to the clock, although it was totally dark, remarked the time,
-and started for the front door. I then told him that I was not feeling
-well, was pretty blue, and wished he would sit down and play euchre with
-us. This seemed to please him, and he took off his overcoat and said he
-had as lief play until 'old D.' was through lecturing, as to go.
-
-"His cousin sat down at the table with us, and we played 'three-handed
-(cut-throat) euchre.' He paid not the slightest attention to us, although
-we passed the cards backwards and forwards between us, exchanging hands,
-and everything we could do to attract his attention. He dealt the cards in
-his turn, correctly, and played 'according to Hoyle.' In one hand, spades
-were trumps, and he held the jack of clubs. Clubs being led, he first
-threw down this jack, then quickly picked it up, saying, 'I forgot that
-was the left bower.' It is somewhat humiliating to record that,
-notwithstanding our tricks and devices, he beat us in the game.
-
-"On its conclusion, he got up hastily and insisted upon going to the
-college. We only prevented him this time, by throwing water in his
-face--the only method, by the way, in which we could awake him without
-great violence. Pungent odors, ammonia, camphor, etc., he seemed to
-disregard, or merely pushed away the object.
-
-"On regaining consciousness, he always appeared like one stunned, or
-suffering from a severe shock. The influence upon the pulse and nervous
-system was always so severe, that we never awaked him at these times if we
-could avoid it.
-
-"Whenever a little out of health, as from trifling attacks of indigestion,
-or after watching with the sick, or fatigue, he would be sure to be up
-and doing something notable in the somnambulic state.
-
-"One of the most remarkable of his exploits occurred several years after
-the incident just given. I think it was in 1860 or 1861.... In the rounds
-of his practice he had a patient, about whom he was very anxious. It was
-in the coldest winter weather, and the residence of the patient was about
-two miles distant. Visiting him early in the evening, he found him in a
-state so unsatisfactory, that he informed the family that if he did not
-find him better the next visit, he should change the medicine entirely. On
-rising the next morning, he went to the barn to put his horse to the
-cutter for an early start. He was a little puzzled at finding things
-somewhat misplaced, but supposed some person had been at the stable in
-search of a missing article. On visiting the patient, he was gratified to
-find a marked improvement. He inquired when the improvement commenced, and
-was answered, 'Immediately after taking the powders which he had given in
-the night.' The truth flashed upon him at once, but concealing his
-emotion, he inquired, with as careless an air as he could assume, 'About
-what time was it when I was here?' They replied, 'Between two and three
-o'clock.' This proved to have been the case, as he was afterwards told by
-the family where he boarded. He had been giving the patient some fluid
-medicine, which he ordered discontinued, and then put up several powders,
-such as he had concluded upon the night previous, combining them as usual,
-and administering the first one himself."
-
-The foregoing examples illustrate the fact that ordinary vision is not
-necessary to guide the movements of the somnambulist. Sometimes the
-patient walks about with open eyes; on other occasions they are firmly
-closed. It is generally admitted that the tactile and muscular senses are
-greatly exalted, so that they furnish guiding sensations which are
-sufficient to direct the most complicated movements. The history of the
-medical student observed by Dr. Allen shows how preternaturally sensitive
-the organs of vision may become--actually seeing the clock in the dark
-during the somnambulic paroxysm. When one considers the remarkably
-hyperæsthetic condition of the senses in certain other forms of nervous
-disorder, it is not surprising that sensory impressions which would be
-wholly neglected in a healthy waking state, may become sufficient to
-excite perceptions and to guide the movements which they have aroused. It
-is undoubtedly true that in certain cases the somnambulist does derive
-some information through the medium of the eyes--does really see; but it
-is also a fact that he only sees, hears, tastes and feels the objects
-which are immediately related with the action of his dream. It appears
-also that an impression derived from any organ of sense may suffice to
-arouse any other or all of the internal organs of perception, so that the
-patient seems to see, to hear, and even to taste objects which he knows
-only through the sense of touch. Sometimes the image thus externalized
-coincides with the actual reality; but often this is not the case, as, in
-the experience of the young clergyman, the somnambulist seemed to see the
-paper which he only perceived through contact with his fingers. The image
-thus created corresponded exactly with the external fact; but when a
-similar contact with a pile of bed-clothes excited the illusion of a
-drowning child in his grasp, the internal image did not in the least
-correspond with the external object, and he probably derived no
-information through the sense of sight in either case. In another
-instance, however, as we shall learn upon another page, the subject is so
-far dependent upon the sense of sight that its obstruction is sufficient
-to arrest his movements, as certainly as if he were awake.
-
-Ordinarily the memory is not impressed by the events of the somnambulic
-dream, but we have already learned that it is sometimes affected precisely
-as in common dreaming. One of my little acquaintances could not find her
-night-dress when she went to bed one night. She was therefore obliged to
-wear a gown that was old and ragged. Later in the evening her sister
-discovered the missing garment, and laid it over a chair in the bed-room.
-In the morning the night-dresses had changed place, and the ragged one
-occupied the chair. This occasioned considerable surprise, until the child
-remembered that during the night she had dreamed that two of her playmates
-had come to sleep with her, and that she felt so mortified at being seen
-in a ragged dress that she got out of bed and changed her night-gown.
-Sometimes the events of a somnambulic paroxysm are remembered during a
-subsequent attack, though they are forgotten during the interval, as in a
-case, reported by Macario, of a young girl who had been violated during
-somnambulic sleep. On awaking she had no idea of anything that had
-occurred, but during a subsequent paroxysm she told her mother all that
-had happened.[81] In certain cases a dim recollection of some particular
-incident may be retained, as in the case of my patient who was for eight
-weeks in the somnambulic state. On recovery, the only thing that she could
-remember was a momentary glimpse of some one who was holding up his
-fingers before her eyes. Meeting the physician, subsequently to her
-recovery, who had thus attempted to arouse her attention, she recognized
-in his countenance the features which had momentarily impressed her
-consciousness during the period of somnambulic life.
-
-It is seldom observed that somnambulism is attended with dangerous
-tendencies, yet they are sometimes present. One of my patients once took
-by mistake ninety grains of chloral at a single dose. While under its
-effects she got out of bed, walked into her sister's room, shook her fist
-in her face, and swore furiously at her. On awaking, next morning, she was
-greatly shocked by the account of this dreadful behavior, so utterly at
-variance with her usual temper and character. Another somnambulic patient
-one night rushed into her mother's room, violently accusing her of
-stealing her pocket-book, and threatening vengeance if it were not
-returned. Such patients sometimes mislay the articles with which they
-occupy themselves during a paroxysm, and on waking they erroneously infer
-that they have been robbed. Sometimes, as in the celebrated case related
-by Mesnet, the natural propensities of the individual seem to be released
-from all restraint, and brutal instincts guide the actions of the
-somnambulist, who then steals, or eats and drinks with the voracity of a
-savage. Ball and Chambard (_loc. cit._) have collected a number of
-examples in which impulses to suicide or other forms of violence were
-manifested under such circumstances. Obviously, where the moral sense is
-asleep, and where the affection is the result of causes beyond the control
-of the patient, he cannot be held morally responsible for the consequences
-of such actions. His condition closely resembles that of the victim of
-epileptic mania who delivers himself during a paroxysm to all degrees of
-furious and homicidal violence, without retaining the slightest
-recollection of the fact after its conclusion. The closeness of the
-parallel between these two disorders is rendered further apparent by the
-circumstance that although all memory of the events of epileptic mania is
-usually abolished, it does sometimes persist after the termination of the
-attack. Thus, one of my epileptic patients for a time manifested symptoms
-of insanity after every fit. During one of these paroxysms he imagined
-that the sparrows on the housetop were all singing a particular tune which
-had attracted his attention shortly before the convulsion. Then it seemed
-to him that the breathing of his sleeping child whispered the same tune.
-Placing his hand upon the bosom of his wife, her breathing assumed the
-same musical character. Calling upon his family to listen to the wonderful
-music, they all asserted that they too could hear it. It was a
-considerable time after his recovery before he could be convinced that
-this vividly remembered experience was a pure illusion. The members of
-his family had been cautioned against contradicting their father during
-his paroxysms; consequently, when he asked if they could hear the melody
-which delighted him, they answered affirmatively, and thus confirmed him
-in his delusion. To the ordinary form of epileptic mania such paroxysms
-sustain a relation similar to that subsisting between ordinary dreams and
-the somnambulic experience.
-
-In like manner as it is often remarked that certain dreams betray a
-condition of unusual cerebral excitement, so do certain cases of
-somnambulism manifest a delirious exaltation of the faculties in action.
-This characteristic often belongs to the night-terrors of children. It is
-a condition in which the brain is occupied by the scenery of a vivid and
-highly dramatic vision which dominates the actions of the subject. This
-was most conspicuously shown in the following case, from J. P. Frank,[82]
-and in certain periods of the paroxysms observed by Mesnet (p. 198).
-Frank's patient was a healthy and well nurtured young German girl, who
-during the wars of 1812 had been terribly alarmed by a party of French
-soldiers who had broken into the house and threatened to kill her father.
-The next day at the same hour she passed into a somnambulic state, which
-lasted till sunset. After a brief introductory period of agitation, she
-uttered a deep sigh, which was rather a sob than a sigh, and fell into a
-profound sleep. Presently she smiled, her countenance seemed lighted with
-inspiration, her right arm was raised in the air, and the left was
-directed towards the earth. In this cataleptic attitude she remained for
-about a minute. She then seemed to have decided what to do; from an
-imaginary cartridge-box behind her back she pulled out a cartridge, bit
-off the end, poured out the powder upon her fist as if she were priming a
-musket. She then went through the motions of loading a gun, ramming down
-the wad with an imaginary ramrod, and cried out in French, a language
-which she had never heard before: "Marche! Ou est le baron? Sacré nom de
-Dieu!" Repeating the violent ejaculations and threats addressed by the
-soldiers to her father, she exhibited the utmost terror; her body was
-covered with a cold sweat, and she seemed ready to faint away. At this
-moment she woke up, called impatiently for her handkerchief, with which
-she wiped the perspiration from her face, and resumed her ordinary
-avocations as if nothing had happened.
-
-Still more remarkable was the case reported by Dr. Mesnet.[83] From the
-excellent translation prepared by T. J. Huse, M. D.,[84] the following
-sketch has been outlined:
-
-The patient, aet. 27 years, received in one of the battles near Sedan,
-during the Franco-Prussian war, a bullet wound which fractured the left
-parietal bone. His right arm was almost immediately paralyzed; after a few
-minutes the paralysis involved the right leg, and he lost consciousness.
-It was only after the lapse of three weeks that he recovered his senses.
-He was finally taken to Paris, where the paralysis gradually disappeared.
-From a period some three or four months after the reception of the injury,
-he began to manifest periodical attacks of somnambulism, at intervals of
-fifteen to thirty days with an average duration of fifteen to thirty
-hours. During the whole of this time his life presented two essentially
-distinct phases--the one normal, the other pathological. In the normal
-condition he was able to gain a livelihood. He had been a clerk in several
-houses, a singer in a _café_, and while in the hospital had made himself
-useful and agreeable. The somnambulic attacks which he experienced were
-characterized by an instantaneous onset, resulting in the abolition of all
-his senses except the tactile sense. Sight was perhaps partially
-persistent, for on many occasions he seemed to be impressed by brilliant
-objects, but he was obliged to employ the sense of touch in order to
-understand their form, volume, etc. During all these crises his gait was
-easy, his attitude calm, his countenance peaceful; his eyes were widely
-open, with dilated pupils; the forehead and brows were contracted; there
-was an incessant nystagmus, indicating a disordered state in the brain; he
-was continually mumbling or muttering. When walking in a familiar locality
-he moved with perfect freedom; but if in a strange place, or if obstacles
-were placed in his way, he examined the obstructions by feeling of them
-with his hands, and turned easily aside. If any attempt was made to change
-his direction, or to quicken or retard his pace, he allowed himself to be
-directed like a mere automaton, continuing to walk in any way thus chosen
-for him. He would also eat, drink, smoke, dress himself, walk out, and
-retire to bed as usual. These processes seemed to be effected as a result
-of previous habit, without any actual consciousness or feeling. He ate
-voraciously without discernment, and drank in the same manner ordinary
-wine, wine of quinine, water, assafoetida, without exhibiting any evidence
-of sensation whatever.
-
-While under treatment in the Saint Antoine Hospital, this patient was
-carefully studied by Dr. Mesnet and by Alfred Maury, the celebrated
-author. They found that by means of impressions upon his tactile
-sensibility it was possible during any one of his paroxysms to suggest
-certain modes of action which were reproduced whenever he was again placed
-in the same conditions. Thus, "he was promenading in the garden, under a
-grove of trees, when some one put back into his hand the cane which he had
-let fall a few moments previously. He felt of it, turned his hand several
-times around the curved handle of the cane, became attentive, seemed to
-listen, and suddenly cried out, 'hurry!' then, 'there they are! there are
-at least twenty of them, to the two of us! we shall get the better of
-them!' and then, carrying his hand behind his back, as if to get a
-cartridge, he went through the movements of loading his musket, crouched
-at full length in the grass, concealing his head behind a tree, in the
-posture of a sharp-shooter, and following with his gun at his shoulder all
-the movements of the enemy whom he seemed to see close at hand. This scene
-often repeated in detail during the course of the observations, has seemed
-to each of us the most complete expression of an hallucination called up
-by an illusion of touch, which, giving to a cane the properties of a gun,
-awakened in this person remembrances of his last campaign, and reproduced
-the struggle in which he was so grievously wounded."
-
-On another occasion the patient was at the end of a corridor, near a door
-that was locked; he "passed his hands over this door, found the knob,
-grasped it, and attempted to open it; failing to accomplish this, he
-sought for the keyhole, then for the key, which, however, was not there;
-then, passing his fingers over the screws which secured the lock, he
-endeavored to seize them and turn them for the purpose of detaching the
-lock. _This entire series of actions bears witness to an effort of his
-mind connected with the object before him._ He was on the point of leaving
-the door and turning towards another room, when I held up before his eyes
-a bunch of seven or eight keys; he did not see them; I jingled them loudly
-at his ear; he did not notice them; placing them in his hand, he
-immediately took hold of them, and tried them one by one in the keyhole,
-without finding the single one which could fit; he then left the place,
-and went into one of the wards, taking in his passage various articles
-with which he filled his pockets; at length he came to a little table used
-for the records of the wards. He then passed his hands over the table, but
-it was empty; in feeling of it, however, he came across the handle of a
-drawer; opening it, _he took up a pen, and all at once this pen suggested
-to him the idea of writing_; for at that moment he began to ransack the
-drawer, taking out and placing on the table several sheets of paper, and
-also an inkstand. He then sat down and commenced a letter, in which he
-recommended himself to his commanding officer for his good conduct and
-bravery, and made application for the military medal. This letter was
-written with many mistakes in it, but these were identical as regards
-expression and orthography with all that we have seen him make in his
-healthy state. While the patient was writing, he aided us in an experiment
-that encouraged to immediately examine in what degree the sense of sight
-assisted in the performance of this action. The facility with which he
-traced his letters, and followed the lines upon the paper, left no doubt
-concerning the exercise of vision upon the writing; but, in order to make
-the proof satisfactory, we have several times interposed a thick plate of
-sheet-iron between his hands and his eyes when he was writing; and,
-although all the visual rays were intercepted, he did not immediately
-break off the line he had begun; he still continued to trace a few words
-written in an almost illegible manner with the letters entangled in each
-other; then finally he stopped without manifesting either discontent or
-impatience. The obstacle removed, he finished the uncompleted line, and
-began another. _The sense of sight was therefore in full activity, and
-essential to the written expression of the patient._" Other observations
-showed that the sense of sight was only roused at the instance of touch,
-and that its exercise remained limited to those objects alone with which
-it was actually connected by the touch.
-
-On another occasion he passed through a long ward of patients, "taking
-indiscriminately every article that came within his reach, and concealing
-them afterwards under the quilt, under a mattress, under a chair-cover,
-and under a pile of sheets. Arrived in the garden, he took from his pocket
-a book of cigarette papers, opened it, and detached a leaf from it; then
-took out his tobacco and rolled a cigarette with the dexterity of one who
-is accustomed to this proceeding. He searched for his match-box, lighted
-his cigarette with a match, which falling still burning on the ground, he
-extinguished by placing his foot upon it; then smoked his cigarette while
-strolling back and forth to the entire extent of the garden, without any
-of these actions presenting the slightest deviation in their manner from
-the ordinary method. Everything that he did was the faithful reproduction
-of his ordinary round of life.
-
-"This first cigarette terminated, he prepared to make another, when we
-stepped up and began to interpose obstacles.... He searched vainly in his
-pocket for his tobacco, as we had filched it. He searched for it in
-another pocket, going through all his clothes until he came back to look
-for it in the first pocket, when his face expressed surprise. I offered
-him his tobacco-pouch, but he did not perceive it; I held it near his
-eyes, yet he still did not perceive it; even when I shook it just in front
-of his nose, he did not notice it. But when I placed it in contact with
-his hand, he seized it and completed his cigarette directly. Just as he
-was about to light his cigarette with one of his matches, I blew it out
-and offered him instead a lighted match which I held in my own hand; he
-did not perceive it; I brought it so close to his eyes as to singe a few
-lashes, yet he still did not perceive it, neither did he make the
-slightest motion of blinking.... _The patient sees certain objects and
-does not perceive others; his sense of sight receives impressions from
-all objects in personal relation with himself through the touch, and does
-not receive impressions, on the contrary, from things external to him; he
-perceives his own match, but does not perceive mine._"
-
-During the course of this observation the patient gave evidence that the
-memory of his former occupation as a professional singer had been revived.
-He began to hum some of the familiar airs, and then proceeded to his room
-in the hospital, where he carefully dressed himself as if for a public
-performance. "On his bed he chanced to meet with several numbers of a
-periodical romance, which he turned rapidly over without finding that for
-which he was searching.... I took one of those numbers, rolled it up, and
-putting it into his hand in that condition, satisfied his want by this
-semblance of a roll of music, for he then took his cane, and traversed the
-ward with a slow step, well contented. When stopped on his way, for the
-purpose of taking off the coat he was wearing (which had been foisted on
-him by one of the observers), he permitted it without offering any
-resistance.... At this moment the sun lit up with a bright ray a glass
-window that closed the lodge on the side towards the court.... This ray
-must have given him the impression of a footlight, for he at once placed
-himself before it, readjusted his toilet, opened the roll of paper which
-he carried in his hand, and softly hummed an air, running his eyes over
-the pages as he slowly turned them, and marking with his hand a measure
-that was perfectly rhythmical. Then he sang aloud, in a highly agreeable
-manner, giving his song the correct expression, a patriotic ballad to
-which we all listened with pleasure. This first selection terminated, he
-sang a second, and afterwards a third. We then saw him take out his
-handkerchief to wipe his face. I offered him a wine-glass of a strong
-mixture of vinegar and water, which he did not notice; I placed the glass
-under his nose without his perceiving the smell of the vinegar; I put it
-into his hand, and he drank it without complaining of any unpleasant
-sensation."
-
-The conclusions which may be drawn from this remarkable history have been
-sufficiently expressed by Dr. Mesnet[85] in the following words:
-
-"The disturbance which these functional perversions of the nervous system
-bring into the course of life, extends not only to the organs of sense,
-and to intellectual actions properly so called, but it also sometimes
-awakens some instinctive excitation which surrenders the individual
-without any defence, and destitute of rational discernment, to the most
-deplorable impulses. He acts with the semblance of a freedom which he does
-not possess; he seems to prepare and to combine certain actions in the
-light of conscious volition, when he is in reality only a blind
-instrument, obedient to the irresistible mandates of an unconscious
-impulse."
-
-The bearing of these conclusions upon the question of the moral
-responsibility of the somnambulist needs no further advertisement.
-
-The likeness of certain features of such cases to the phenomena of
-hypnotism is worthy of note. In this particular there is an evident
-likeness between the cerebral susceptibility of the ordinary dreamer, the
-somnambulist, and the hypnotised subject. All are alike in a condition
-which renders their imagination and their volition subservient to guiding
-sensations from without, so that their movements may be directed by the
-will of another. We have seen how the course of an ordinary dream may be
-modified by such suggestions. The history of the patient just related,
-illustrates the manner in which the actions of a somnambulic dreamer may
-be controlled by the will of a spectator. The ordinary phenomena of
-hypnotism exhibit the same subjection to the will of another. It is
-probable that a considerable part of the superior notoriety which belongs
-to this feature of hypnotism, is due merely to the fact that natural
-somnambulism is rarely made the object of such experiments and
-observations as are daily applied to the subjects of artificial
-somnambulism.
-
-_Somnambulic Life._--We come now to the last term of the series, the
-simplest, yet perhaps the rarest form of the affection. In this form, the
-patient seems perfectly awake; he is in possession of all his senses; he
-is capable of sustained and rational volition; he lives and behaves, in
-short, like any other person. But his life is divided into periods which
-are, so far as consciousness is concerned, completely distinct from each
-other. This double-consciousness may be exhibited but once in a lifetime,
-or it may be frequently repeated, so that the patient oscillates between
-the two states until it becomes doubtful which is the natural condition
-and which is the acquired. These states of double-consciousness are
-divided from each other by a more or less complete break in the chain of
-memory. The residual strata which, so to speak, have been deposited from
-the sea of events upon the floor of memory, have become broken and
-"faulted." The line of rupture marks the division between the two fields
-of consciousness; they no longer lie in the same plane, consequently there
-can be little or no continuity of memory between them. The events which
-transpire in one state affect the mind so long as, and whenever it is in
-connection with the cerebral register which is fitted to that state; as
-soon as the connection is shifted, the mind takes cognizance of the events
-that are recorded upon the other portion of the register, but, for want of
-physical continuity between the different portions of the record, the mind
-cannot at once receive a continuously connected report from the entire
-organ of recollection. From this results a mode of life essentially
-similar to the life of certain epileptics who are ushered by each seizure
-into a state of apparently conscious activity of which they have no
-recollection after recovery. Thus, one of my epileptic patients, who was
-subject to seizures, both of the convulsive and the non-convulsive form of
-the disease, on one occasion left home, after a fit, and traveled a
-considerable distance into the country, putting up for the night at
-taverns and farm houses, and apparently behaving like any other
-respectable citizen. It was three weeks before he came to himself. On
-recovering his normal consciousness, the period of his wanderings was a
-perfect blank in his memory. Such attacks are usually of shorter duration,
-and are more frequently associated with hysteria; bearing to the
-hysterical paroxysm the same relation which they share with the epileptic
-fit. When the predisposing temperament exists, a great variety of
-excitations may serve to produce the phenomena, so that unless careful
-observation is employed, the truly somnambulic character of the paroxysm
-may easily be overlooked. Thus, the true nature of the affection was not
-suspected by the early attendants of the patient who became the subject of
-lethargic stupor, as related on page 173. Under the influence of powerful
-drugs acting upon a highly sensitive nervous organization, she became, at
-first, "hystericky." She manifested great distress, complained bitterly of
-her sufferings, passed through the ordeal of several consultations, was
-subjected to a considerable surgical operation, and only ceased to appear
-conscious at the expiration of five weeks, when she passed into the
-lethargic state previously described. At the time of my first visit, just
-before the commencement of stupor, she walked into the room where I was
-waiting, greeted me with her usual affability, gave me some account of her
-sensations, and neither did nor said anything that could lead me to
-suspect that she was not in her normal frame of mind. But, with the
-exception of the single incident mentioned on page 193, the entire period
-from the commencement of her medication to the close of the lethargic
-stupor was utterly blotted out of her recollection.
-
-Macnish[86] relates a similar case of a young lady who "unexpectedly, and
-without any forewarning, fell into a profound sleep which continued
-several hours beyond the ordinary term. On waking, she was discovered to
-have lost every trace of acquired knowledge. Her memory was _tabula
-rasa_--all vestiges, both of words and things, were obliterated and gone.
-It was found necessary for her to learn everything again. She even
-acquired, by new efforts, the art of spelling, reading, writing, and
-calculating; and gradually became acquainted with the persons and objects
-around, like a being for the first time brought into the world. In these
-exercises she made considerable proficiency. But, after a few months,
-another fit of somnolency supervened. On rousing from it, she found
-herself restored to the state she was in before the first paroxysm; but
-was wholly ignorant of every event and occurrence that had befallen her
-afterward. During four years and upwards she has passed periodically from
-one state to the other, always after a long and sound sleep.... The former
-condition of her existence she now calls the Old State, and the latter the
-New State; and she is as unconscious of her double character as two
-distinct persons are of their respective natures. For example, in her old
-state she possesses all the original knowledge; in her new state only what
-she acquired since. If a lady or gentleman be introduced to her in the old
-state, or _vice versa_ (and so of all other matters), to know them
-satisfactorily she must learn them in both states. In the old state, she
-possesses fine powers of penmanship, while in the new, she writes a poor,
-awkward hand, not having had time or means to become expert. Both the lady
-and her family are now capable of conducting the affair without
-embarrassment. By simply knowing whether she is in the old or new state,
-they regulate the intercourse, and govern themselves accordingly."
-
-Another remarkable case was reported at length by Dr. Azam, of
-Bordeaux.[87] The principal facts are given in a translation by Dr. J. I.
-Tucker in the _Chicago Journal of Nervous and Mental Disease_.[88] The
-patient was a young woman who began to exhibit the symptoms of hysteria at
-the age of puberty, and from that time till the present, a period of
-nearly thirty years, she has lived a double life, passing alternately from
-normal life into somnambulic life. These transitions were ushered in by a
-sharp pain in both temples, followed by a species of stupor, lasting about
-ten minutes. She would then open her eyes, apparently awake, and would
-remain in the condition of somnambulic life for an hour or two, when the
-languor and sleepiness would reappear for a few minutes, after which she
-would awaken in her normal state. At first these paroxysms were renewed
-every five or six hours; but, as she grew older, they occurred less
-frequently, and were greatly prolonged, until, finally, the periods of
-somnambulic life considerably exceeded the duration of normal life. During
-normal life she was hypochondriacal, hysterical, and a sufferer with
-neuralgia. During somnambulic life she was free from pain, lively,
-imaginative, and coquettish. While in this state of existence she
-remembered the events of her entire life--normal or otherwise; but on
-returning to her natural mode of life, she retained no recollection of her
-somnambulic periods. Memory, during normal life, was limited to anterior
-normal periods. As time advanced, this peculiar mode of existence became
-an increasing source of inconvenience and mental distress, often leading
-the superficial observer to suppose that she was insane.
-
-This case differs from the others in the circumstance that the period of
-somnambulic life was more vigorous and healthy than the ordinary
-condition. This seems to suggest an explanation of the forgetfulness which
-marked the period of normal life. During that period the functions of the
-brain were depressed, so that its molecular movements could not reach the
-level of the field of consciousness occupied during the second period.
-Other observations, such as that of Sir Henry Holland,[89] who, while
-exhausted by fatigue, lost all recollection of the German language until
-he was restored by rest and food, indicate that such defects of memory
-depend upon a deficient nutrition of the brain substance--a condition
-which is undoubtedly associated with an enfeebled cerebral circulation. We
-may, therefore, suppose that in Dr. Azam's case the paroxysms of
-somnambulic life were induced by periodical discharges of force within the
-brain, causing an improvement in the circulation of blood, and a
-corresponding gain in health and general vivacity. Such exaltation of the
-faculties would be perfectly consistent with an exercise of memory
-covering all the events of life. But, when, as in cases like that reported
-by Macnish, and by myself, somnambulic life is the result either of
-disease or simple somnambulic sleep, it is a condition in which, as in
-physiological sleep, the cerebral functions, taken as a whole, are
-depressed rather than exalted. The resulting train of ideas is developed
-upon a plane below the level of ordinary consciousness, and is,
-consequently, as easily forgotten as the dreams which are developed during
-sleep.
-
-Such, then, are the principal characteristics of somnambulism--a state in
-which dreams are supplemented by more or less complete and appropriate
-action; ordinarily without subsequent recollection of either dream or
-action. The somnambulic dream usually occurs during or soon after the
-period of deepest sleep, when the influences of the external world are
-most completely suppressed. Released from the control of its sensory
-portion, the remainder of the brain awakens, and becomes aroused to a
-condition of relative exaltation. No longer distracted by the
-solicitations of external sense, the attention is concentrated upon the
-hallucinations which constitute the dream. In the simpler forms of
-noctambulism only the automatic locomotive apparatus is awakened, and the
-sleeper moves in accordance with the impressions derived from habit, aided
-by actual exaltation of the muscular and tactile senses. But, in some of
-the more complicated cases, a certain amount of special sensibility seems
-to exist. The patient is capable of exercising just that amount of
-perception which is necessary to accomplish his purpose, though blind and
-deaf and insensible to every other impression. The more complete the
-waking of the sense-organs, the closer the resemblance to the condition of
-ordinary life, or even to the condition of ecstasy, in which cerebral
-exaltation is the prominent feature, and in which the power of
-recollection generally persists. Accordingly, it sometimes happens that
-the somnambulist can recall the events of his paroxysm. In such cases the
-power of recollection is due to the same conditions that control the
-recollection of our ordinary dreams. But the phenomena of ordinary
-somnambulism are as completely as possible removed from all connection
-with the mental actions which arise directly from the operation of the
-senses. By reason of such isolation the ordinary association of ideas
-affords no help to the memory, and the dream remains in oblivion. Alfred
-Maury expresses the opinion[90] that the principal cause of forgetfulness
-of the events of somnambulism consists in the exhaustion of the cerebral
-elements through the intensity of the excitement to which they have been
-subjected during the paroxysm. Doubtless this, in certain cases, may
-contribute to the loss of memory, but it should be remembered that the
-excitement may be relative rather than absolute. Certain elements wake
-while others are asleep; and these waking cells may be aroused to a degree
-far in excess of what is usual during the sleep of the brain without
-attaining to the level of their diurnal activity. The mind, undisturbed by
-external impressions, gives its attention to the operation of these waking
-organs, and a dream with all its consequences, somnambulic or otherwise,
-is the result. In other words, the plane of consciousness, so to speak, is
-lowered in sleep to the level of these molecular vibrations. But when the
-entire brain has been completely reawakened, the residual vibrations of
-those elements which yielded the physical basis of the dream, and which,
-had they originally occurred during the waking state, might have persisted
-with energy sufficient to furnish a groundwork for recollection of the
-ideas which they had first suggested, are no longer sufficiently forcible
-to be felt in consciousness. Recollection of mental states thus generated
-must necessarily be impossible under such conditions. Sometimes, however,
-the somnambulist who, while awake, had forgotten all the incidents of his
-somnambulic experience, can remember, in a subsequent paroxysm, all that
-occurred during the preceding attack. Facts of this kind have been
-observed in the waking life of certain hysterical persons, but the
-apparent doubling of their personality is connected with the waking state,
-or with its semblance, while in ordinary somnambulism it is only during
-sleep that the alternations of memory and forgetfulness occur. A similar
-recollection of previous visions is sometimes experienced in dreams,
-showing a close relationship between the dreams of sleep and of
-somnambulism. The bond of association between events thus isolated in time
-must be sought in a renewal of like conditions of the brain during the
-successive periods of somnambulic exaltation. We must suppose that the
-molecules which were in a state of excitement during the first paroxysm
-are again aroused in a similar manner after a period of waking quiescence.
-If, during sleep, their movements, though of an exalted character, have
-only just sufficed to arouse consciousness in the form of a dream, it is
-scarcely probable that during the phase of comparative inactivity which
-supervenes when the whole brain is awake, their residual motion could
-disturb the sphere of consciousness. Hence the time occupied by their
-somnambulic vigor must remain a blank in memory during the waking state.
-But, when the original state of relative exaltation has been reproduced by
-a second paroxysm of disorder, if the same molecular movements be in any
-way renewed, the conditions of memory are fulfilled; consciousness is once
-more aroused as before, and the patient remembers the dream or the events
-of the previous attack.
-
-
-
-
-CHAPTER VII.
-
-ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.
-
-  There are more things in heaven and earth, Horatio,
-  Than are dreamt of in your philosophy.
-                                      --HAMLET.
-
-
-The phenomena of somnambulism are of apparently spontaneous origin, during
-ordinary sleep. But from the remotest antiquity it has been known that
-certain persons may be thrown into an artificial sleep which closely
-resembles the condition of the somnambulist. Such a degree of
-susceptibility is not common to all persons. Heidenhain, experimenting
-upon his class of medical students, found only one in twelve who was thus
-susceptible. My own experiments lead me to think that American medical
-students are less easily influenced in this direction. Charcot, whose
-field of observation covers the inmates of the Salpêtrière Hospital, finds
-the best examples of the hypnotic state among the hystero-epileptic
-females in that asylum. To the experiments of Heidenhain, in Germany, of
-Braid, in England, and of Charcot, in France, we are indebted for the most
-thoroughly scientific observation and interpretation of the phenomena of
-hypnotism.
-
-The antecedent physical condition most favorable to the development of the
-hypnotic state is a highly unstable constitution of the nervous system.
-For this reason the larger number of qualified subjects is furnished by
-the female sex--especially by those who possess the hysterical
-temperament. Frequent repetition of hypnotic exercises renders the subject
-still more susceptible. Heidenhain was, at first, inclined to the belief
-that such experiences were not prejudicial to the health of the subject,
-but the observations of Harting, in the University of Utrecht, and of
-Milne-Edwards, in Paris,[91] have demonstrated the fact of danger to the
-health of animals subjected to similar experiments. Hysterical patients
-have often exhibited considerable exhaustion after hypnotic exhibition in
-the hospitals of Paris (Charcot and Richer), consequently, it cannot be
-admitted that the practice is devoid of risk to the health of the
-individual.
-
-Numerous methods of inducing the hypnotic state have been employed. The
-greater number consist in artificial modification of the condition of the
-brain through the agency of sensory impressions originated upon the
-periphery of the body. The simplest form of such influence is presented by
-the results of gentle friction of the skin with the palm of the hand or
-the tips of the fingers. Many an aching head has thus been relieved, many
-a restless sufferer soothed to sleep. In like manner, a susceptible
-subject may be hypnotized by any continuous and gentle excitement of the
-senses of sight, hearing, and touch. Concentration of the attention upon a
-brilliant object, like a piece of polished metal or a small mirror,
-especially if it be placed a little above the level of the eyes, and so
-near that considerable convergence of the eyeballs is necessary for
-distinct vision, affords a very efficient means of inducing artificial
-somnambulism. Certain persons may be readily hypnotized by gently pressing
-the eyelids together, and at the same time making slight pressure upon the
-eyeballs. Others pass into this condition by merely closing their eyes,
-and remaining motionless in a quiet room.
-
-The phenomena of artificial somnambulism are frequently developed through
-the agency of impressions derived directly from the sphere of
-consciousness. The intellectual effort of trying to sit still and think of
-nothing is sometimes sufficient to induce the hypnotic state. The ordinary
-devices by means of which wakeful people are taught to beguile sleep, by
-counting, or by repeating long lists of names, etc., all belong to this
-category. Compulsory attention to any continuous intellectual process,
-like adding up a column of figures, or trying to read a dull book, is
-sometimes effectual. If, with these, or with similar acts of attention, be
-associated the expectation that something unusual is about to occur, as
-when the individual is aware of being the subject of an experiment, the
-evolution of the somnambulic condition is greatly facilitated. Thus, one
-of the most recent methods, consists in merely sitting, for half an hour
-or more, with the back towards the patient. Attention, curiosity, and
-expectation, are thus excited, and a susceptible person soon begins to
-manifest some of the numerous and various forms of the hypnotic state.
-Heidenhain caused one of his students thus to go to sleep in broad
-daylight, by simply assuring him that he should hypnotize him from a
-distance at a particular hour of the afternoon. The monks of Mt. Athos
-were accustomed to hypnotize themselves by fixing their eyes and their
-thoughts upon the navel; hence the reputation of omphaloscopy as an aid to
-ecstatic meditation.
-
-The duration of hypnotic sleep is as variable as that of its prototype in
-natural somnambulism. The patient usually wakes spontaneously, after a few
-minutes or hours. Sometimes, however, the period of insensibility is
-greatly prolonged. If it be desirable to awaken the subject of experiment,
-a simple reversal of the movements by which sleep was induced may suffice.
-The paroxysm may be terminated by almost any sudden and energetic appeal
-to the senses, like an electric shock, a sudden illumination of the eye
-with vivid light, or a sharp puff of air upon the face.
-
-The simplest phenomena connected with the hypnotic state are those
-transferences of cerebral perceptions which have been investigated by the
-Society for Psychical Research.[92] Certain sensitive persons, when
-blindfolded, are capable of reproducing with considerable accuracy visual
-images that have been impressed upon the mind of another. The sensitive
-subject is blindfolded and placed before a table with pencil and paper.
-Another person then goes out of the room, and gazes at some kind of
-drawing, geometrical figure, or other object selected without possibility
-of collusion with the subject of experiment. This person then returns to
-the room, and places his hand upon the head of the subject, at the same
-time fixing his attention upon the mental picture of the object. Presently
-the blindfolded subject takes the pencil and reproduces on paper a rough
-drawing of the object in question. In some cases it is found possible to
-effect this transfer of impressions without actual physical contact,--the
-agent merely standing behind the sensitive subject and concentrating his
-thought upon the selected object. Closely akin to this is the method of
-muscle-reading, popularly known as _mind-reading_. The sensitive is
-blindfolded, and then presses against his forehead the hand of the person
-by whom he is to be guided. Almost immediately a tremor pervades his
-muscles, and he yields all his movements to the guiding influence of the
-individual with whom he is in contact. If now an object be concealed in
-any place that is known to the agent, the concentration of that person's
-attention upon the hiding place suffices to direct the "mind-reader," who
-immediately drags his companion to the given locality.
-
-The explanation of these phenomena consists in a recognition of the fact
-that certain persons are gifted with nervous organs which are sensitive
-and responsive to nervous impulses and muscular movements that are too
-delicate for recognition by the percipient apparatus of ordinary mankind.
-The more complicated forms of artificial somnambulism result from the
-complication and exaggeration of the results of this inordinate
-sensitiveness through the agency of artificial sleep. As in natural
-somnambulism, so in the hypnotic state, certain organs become totally
-anæsthetic, while the sensibility of others is wonderfully exalted.
-Cutaneous sensation may be completely abolished, and the patient may
-become utterly insensible to every painful impression. The reflex
-functions may be either suppressed or exaggerated, and the special senses
-of sight and hearing may be exalted to the highest degree. While in this
-condition the hyperæsthetic condition of the brain renders the subject
-peculiarly susceptible to impressions from the will of another, so that
-all his actions are obedient to the guiding influence of the person under
-whose control he has passed.
-
-According to Charcot,[93] three principal types of artificial somnambulism
-may be remarked among the hysterical subjects upon whom he experimented:
-(1) the _cataleptic_, (2) the _lethargic_, and (3) the _somnambulic_. Of
-these the first may be developed primarily by any abrupt and powerful
-impression upon a sensory organ. Gazing upon a brilliant light, fixing the
-eyes upon a piece of polished metal, or upon the shining eyes of a second
-person, the sudden clangor of a Chinese gong, may suffice to induce the
-cataleptic state. Dumontpallier[94] reports the case of a young woman who
-accidentally hypnotized herself by gazing into the mirror before which she
-was dressing her hair. This cataleptic state may also be secondarily
-induced by merely opening the eyes of a patient in whom a condition of
-hypnotic lethargy has been previously developed. If only one eye be thus
-opened, the corresponding side of the body alone becomes cataleptic.
-Closing the eyes causes the disappearance of this symptom, with complete
-restoration of the purely lethargic state. During the cataleptic condition
-the several tendinous reflexes disappear, neuro-muscular
-hyper-excitability ceases, the skin becomes insensible, but the special
-senses, particularly those of sight and hearing, maintain a partial
-activity. In this half-awakened state the senses may become avenues of
-suggestion from without for the production of movements; but, if left to
-themselves, the limbs remain motionless.
-
-The _lethargic state_ may be induced by simply pressing together the
-eyelids of the subject, or by causing him to fix his gaze upon some
-definite object. The paroxysm begins with a deep inspiration, causing a
-peculiar laryngeal sound, followed sometimes by the appearance of a little
-foam on the lips. The eyelids are either wholly or partially closed, and
-are in a state of continual tremulous motion. The eyeballs are generally
-turned upwards and inwards. The muscles are completely relaxed. The
-tendinous reflexes are exaggerated; pressure over a muscle, or upon a
-nerve, arouses a peculiar contracture of synergic muscles and groups of
-muscles that are supplied by the excited nerve trunk. The facial muscles,
-however, do not thus become contractured; they merely contract during the
-application of the stimulus. If the lethargic subject be rendered
-cataleptic by opening the eyes, these contractures persist even after
-waking; and they can only be dispelled by renewing the lethargic state
-before resorting to pressure upon the antagonistic muscles--the process by
-which contractures peculiar to this species of lethargy may always be
-annulled. By the approach of a magnet to a contractured limb, the rigidity
-may be completely transferred to the corresponding muscles upon the
-opposite side of the body. If upon a limb of a lethargic subject who has
-been rendered cataleptic by opening the eyes, an Esmarch's band be
-applied, pressure over the bloodless muscles excites no contracture until
-the band is removed. A contracture is then developed, and it may be
-transferred to the opposite limb by the approach of a magnet. To this
-phenomenon has been applied the term _latent contracture_.
-
-The extraordinary muscular excitability manifested by these subjects is
-further illustrated by an observation recorded by Dumontpallier.[95] If
-one end of an India rubber tube, half an inch in diameter, and five or six
-yards in length, be applied over a muscle in the leg, and if the other end
-be in like manner connected with a watch, every movement of the second
-hand will be followed by a slight contraction in the muscle. The same
-result follows connection with the wire of a telephone; and, if a
-microphone be introduced into the circuit, the incidence of a ray of light
-upon the instrument, or even its reflection from the conjunctival surface
-of the eye of a spectator, will arouse a responsive muscular contraction.
-Charcot has also seen muscular motion upon the opposite side of the body
-when a mild galvanic current was applied to the parietal surface of the
-skull, presumably over the motor centres of the corresponding half of the
-brain.
-
-During these manifestations of muscular hyper-excitability, there is
-complete insensibility to pain, but the senses of sight and hearing seem
-to preserve some degree of activity. The subject, however, does not often
-exhibit any susceptibility to influence by suggestion.
-
-The _somnambulic state_ may be directly induced by fixed attention with
-the eyes, by feeble and monotonous excitement of the senses, by passing
-the hands over the face and arms of the subject, and by many other
-processes of analogous character. This variety constitutes the ordinary
-form of hypnotic sleep. It may be very easily developed during either the
-lethargic or the cataleptic state as a consequence of pressure or of
-gentle friction upon the top of the head. Thus Heidenhain, in the course
-of his experiments, caused muscular paralysis by rubbing the scalp.
-Friction of one side of the head occasioned paralysis of the opposite side
-of the body without notable affection of the consciousness of the subject.
-The eyes and the eyelids behave as in the lethargic state. The subject
-seems to be asleep, but there is less muscular relaxation than in the
-lethargic variety. There is no exaggeration of the tendinous reflexes, and
-muscular hyper-excitability is absent. But by lightly touching or
-breathing upon the surface of a limb, its muscles may be thrown into a
-condition of rigidity which differs from the contracture of the lethargic
-state, in the fact that it does not yield to excitement of the
-antagonistic muscles, though yielding readily to a sudden repetition of
-the same form of excitement by which it was originally produced. Thus a
-subject under my own observation who, by pressure upon the eyeballs, was
-rendered insensible to every form of painful stimulation, would
-immediately pass into a state of perfect rigidity, if his limbs and body
-were rubbed for a few seconds with the palm of the hand. While in this
-condition, if the heels were placed upon a chair and the back of the head
-upon another, not only could the entire weight of the body be thus
-supported, but also the additional weight of another full-grown man,
-sitting upon his body, without causing any more yielding than if it had
-been a log of wood that was lying across the chairs. From the immobility
-of the cataleptic state this rigidity differs by its greater degree of
-resistance to passive motion. Though insensibility to pain may be
-perfectly developed in this state, there is generally an exalted condition
-of certain forms of cutaneous sensibility, and of the muscular sense.
-Strange perversions of other special senses are sometimes remarked. Thus,
-Cohn[96] discovered that a patient who was naturally color-blind, was
-able, when unilaterally hypnotized, "to distinguish colors which were
-otherwise undistinguishable." Conversely, when the cataleptic state is
-induced, the healthy eye becomes incapable of discerning colors. Spasm of
-accommodation is also present, and is one of the earliest demonstrable
-symptoms of the hypnotic condition.
-
-These remarkable exaggerations and perversions of sensibility have been
-the cause on the one hand, of much skepticism regarding the verity of the
-phenomena of hypnotism, and, on the other, of much credulity, extending
-even to a belief in the existence of supernatural and miraculous powers.
-The extraordinary character of these experiences is well illustrated by
-the following letter from Lieut. J. M. Brooke, of the United States Navy,
-to President Wayland, of Brown University. It may be found in "Wayland's
-Intellectual Philosophy."
-
-    "WASHINGTON, Oct. 27th, 1851.
-
-    "SIR--It affords me pleasure to comply with your request, made through
-    my brother William, relative to some experiments performed on board
-    the United States steamer 'Princeton,' in the latter part of the year
-    1847, she being then on a cruise in the Mediterranean. Nathaniel
-    Bishop, the subject of the experiments, was a mulatto, about
-    twenty-six years of age, in good health, but of an excitable
-    disposition. The first experiment was of the magnetic or mesmeric
-    sleep, which overpowered him in thirty minutes from the commencement
-    of the passes made in the ordinary way, accompanied with a steadfast
-    gaze and effort of the will that he should sleep.
-
-    "In this state he was insensible to all voices but mine, unless I
-    directed or willed him to hear others; he was also insensible to such
-    amount of pain as one might inflict without injury, that is, what
-    would have been pain to another. He would obey my directions to
-    whistle, dance or sing. When aroused from this sleep he had no
-    recollection of what occurred while in it. That such an influence
-    could be exerted, I was already aware, having previously witnessed
-    satisfactory experiments. Of clairvoyance I had never been convinced;
-    indeed, considered it nothing but a sort of dreaming produced by the
-    will of the operator. I became aware of its truth rather through
-    accident than design.
-
-    "It happened, one day, that some of my brother officers asked a
-    question which the others could not answer. Bishop, who had been a few
-    moments before in a mesmeric sleep, gave the desired information,
-    speaking with confidence and apparent accuracy. As the information
-    related to something which it seemed almost impossible to know without
-    seeing, we were very much surprised. It struck me that he might be
-    clairvoyant; and I at once asked him to tell me the time by a watch
-    kept in the binnacle, on the spar or upper deck, we being on the berth
-    or lower deck. He answered correctly, as I found upon looking at the
-    watch, allowing eight or nine seconds for time occupied in getting on
-    deck. I then asked him many questions with regard to objects at a
-    distance, which he answered, and, as far as I could ascertain,
-    correctly.
-
-    "For example, one evening, while at anchor in the port of Genoa, the
-    captain was on shore. I asked Bishop, in the presence of several
-    officers, where the captain then was. He replied, 'At the opera with
-    Mr. Lester, the consul.' 'What does he say?' I inquired. Bishop
-    appeared to listen, and in a moment replied: 'The captain tells Mr.
-    Lester that he was much pleased with the port of Xavia; that the
-    authorities treated him with much consideration.' Upon this, one of
-    the officers laughed, and said that when the captain returned he would
-    ask him. He did so, saying, 'Captain, we have been listening to your
-    conversation while on shore.' 'Very well,' remarked the captain,
-    'what did I say?' expecting some jest. Then the officer repeated what
-    the captain had said of Xavia and its authorities. 'Ah,' said the
-    captain, 'who was at the opera? I did not see any of the officers
-    there.' The lieutenant then explained the matter. The captain
-    confirmed its truth, and seemed much surprised, as there had been no
-    other communication with the shore during the evening. I may remark
-    that we touched at several ports between Xavia and Genoa.
-
-    "On another occasion, an officer being on shore, I directed Bishop to
-    examine his pockets; he made several motions with his hands, as if
-    actually drawing something from the officer's pockets, saying, 'Here
-    is a handkerchief and a box; what a curious thing! full of little
-    white sticks with blue ends. What are they, Mr. Brooke?' I replied,
-    'Perhaps they are matches.' 'So they are,' he exclaimed. My companion,
-    expecting the officer mentioned, went on deck, and meeting him at the
-    gangway, asked, 'What have you in your pockets?' 'Nothing,' he
-    replied. 'But have you not a box of matches?' 'Oh, yes!' said he. 'How
-    did you know it? I bought them just before I came on board. The
-    matches are peculiar, made of white wax with blue ends.'
-
-    "The surgeons of the 'Princeton' ridiculed these experiments, upon
-    which I requested one of them (Farquharson) to test for himself, which
-    he consented to do. With some care he placed Bishop and myself in one
-    corner of the apartment, and then took a position some ten feet
-    distant, concealing between his hands a watch, the long hand of which
-    traversed the dial. He first asked for a description of the watch. To
-    which Bishop replied, ''Tis a funny watch, the second hand jumps.'
-
-    "The doctor then asked him to tell the minute and second, which he
-    did; directly afterwards exclaiming, 'The second hand has stopped!'
-    which was the case, Dr. Farquharson having stopped it. 'Well,' said
-    the doctor, 'to what second does it point, and to what hour, and what
-    minute is it now?' Bishop answered correctly, adding, ''Tis going
-    again.' He then told twice in succession the minute and second.
-
-    "The doctor was convinced, saying that it was contrary to reason, but
-    he must believe. I then proposed that the doctor should mark; and
-    directed Bishop to look in his mother's house, in Lancaster, Pa.,
-    (where he had never been) for a clock; he said there was one, and told
-    the time by it; one of the officers calculated the difference in time
-    for the longitudes of Lancaster and Genoa, and the clock was found to
-    agree within five minutes of the watch time."
-
-Such clairvoyance is very rare; in fact, it is difficult, at first
-thought, to believe in its existence. Nor should its alleged possession
-be credited in any instance until all possibility of deception has been
-excluded. The example just related seems to be, in this respect, one of
-the best, for the reason of its occurrence in a little group of men whose
-isolation and thorough acquaintance with each other must have reduced the
-chances of simulation to the lowest degree. When carefully considered,
-moreover, it is apparent that the exaltation of the functions of sight and
-of hearing in this case was not different in kind or in degree from that
-that has already been recorded in connection with certain cases of natural
-somnambulism and of dreaming. The condition of the brain is probably
-identical in all such instances; it is the mode of its induction that is
-subject to variation. The remarkable feature of the hypnotic state
-consists in its production at the pleasure of either the subject or of the
-agent under whose control he has passed; whereas the phenomena of natural
-somnambulism and of the clairvoyant dream occur only during sleep, and
-independently of the will of the patient.
-
-Another singular fact in this connection is the receptivity of the
-hypnotized brain for suggestions from the minds of other persons. Usually,
-the patient is insensible to all communications which do not emanate from
-the agent by whom he is held in control; but in certain cases it is
-probable that the brain is more or less open to impressions of a
-particular sort from any source. Numerous examples illustrate the manner
-in which the course of an ordinary dream may be thus directed. The
-hypnotic dream is far more easily modified by suggestions from without.
-The simplest examples of this are exhibited by the hypnotized subject who
-walks, jumps, lies down, executes every variety of pantomime, in obedience
-to the commands of his director. Somewhat more complicated are the actions
-that are developed through excitement of the imitative faculties. Every
-movement of the director _that can be perceived by the subject_ will be at
-once reproduced. Dr. Fischer relates[97] the case of a patient who,
-although exceedingly ignorant of the art of music, was able, during the
-hypnotic paroxysm, to sing with Jenny Lind all kinds of songs, so
-accurately that it was impossible to distinguish their separate voices.
-Expression of the various emotions and passions may also be provoked by
-merely placing the subject in the several attitudes characteristic of such
-feelings.
-
-In the lower grades of the hypnotic state, consciousness is not abolished,
-and the subsequent recollection of events during the experience may be
-quite perfect. In such cases illusions and hallucinations, that were
-excited by suggestions from the controlling mind of another, survive in
-memory, and become the causes of serious delusion. Witness, for example,
-the manner in which excitable people, partially hypnotized in a so-called
-"spiritual circle," believe in the reality of the illusions which have
-occupied their powers of perception during a "seance." To this inferior
-grade of self-induced hypnotism belong all those conditions of sensory
-hyperæsthesia by means of which certain persons are enabled to read the
-hidden thoughts of others. This capacity is, essentially, a mere
-exaltation of that power which all mankind shares in a greater or less
-degree. In every instance it has been remarked that the ordinary "medium"
-can only respond correctly to questions for which the true answer is
-present in the mind of the questioner. To all other interrogatories the
-replies are delivered purely under the influence of random suggestion. In
-some cases the pathway of communication lies through actual bodily
-contact, as in ordinary "mind-reading," where the invisible molecular
-oscillations of the muscular elements of one person serve to guide the
-perceptions and movements of another. But, more frequently, the
-transmission of ideas is effected through the action of the facial and
-ocular muscles. From these organs of expression the "table-rapper," or the
-"planchette-writer," reads the unspoken thoughts of the questioner, in a
-manner very like, yet vastly more delicate than that by which deaf mutes
-are taught to interpret the movements of the lips of persons with whom
-they converse. This fact is clearly illustrated by the experience of
-Maury,[98] in an interview with a celebrated table-rapper who, without the
-slightest hesitation, made known to him the age, name, and date of death
-of a brother whom he had lost. She also gave the same information
-regarding his father, and pronounced the names of other persons upon whom
-he had fixed his attention. But, if he turned away his face, or if he
-concealed his eyes so that the woman could no longer scrutinize their
-expression, her responses became entirely uncertain and destitute of
-conformity with fact.
-
-The induction of the hypnotic state, if not too often repeated, is
-sometimes of considerable service in the relief of various functional
-disorders of a painful character. This fact, enthusiastically announced,
-many years ago, by Dr. Braid, has recently been freshly brought forward
-through the experiments of Fischer,[99] Wiehe,[100] Rieger,[101] and
-others. In our own country this method of treatment has not yet been
-adopted by many in the medical profession, though its efficacy in a
-particular class of cases is not denied. Outside of professional circles,
-however, it is exploited to a considerable extent under the strange
-misnomer of Metaphysical Healing. But, as De Watteville has truly
-remarked,[102] "the time is near when the curative influence of hypnotism
-will be submitted to the same scrutiny as its physiological and
-psychological import has undergone."
-
-
-THE END.
-
-
-
-
-INDEX.
-
-
-  Acids, 71
-    hydrobromic, 88
-    hydrochloric, 72
-    hydrocyanic, 100
-    hydrocyanic, in gastric disease, 103
-    lactic, 72
-    nitric, 72
-    nitro-muriatic, in hepatic insomnia, 103
-    phosphoric, 72
-
-  Aconite, 63, 93, 100
-
-  Africa, maladie du sommeil of, 30
-    winds from the deserts of, effect of, 46
-
-  Africans, habits of, regarding sleep, 40
-    victims of the maladie du sommeil, 30
-
-  Alcohol, 76
-    effect of, upon the brain, 54
-    in angina pectoris, 99
-    in asthma, 101
-    in chorea, 110
-    in dyspepsia, 103
-    in fever, 105
-    in hepatic diseases, 102
-
-  Allen, Prof. J. Adams, case of somnambulism observed by, 185
-
-  Allix, observations of, regarding bodily temperature in sleep, 7
-
-  Allix and Hohl, observations of, regarding the pulse in sleep, 6
-
-  Aloetic purgatives in insanity, 94
-
-  Ammonia, in fever, 105
-
-  Amyl nitrite, 84
-    in angina pectoris, 99
-    in asthma, 101
-
-  Anæmia of the brain, 53
-
-  Anæsthetics, 75
-
-  Angelic visitors, delusions regarding, 129
-
-  Angina pectoris, 99
-
-  Anti-spasmodic effects of belladonna, 69
-
-  Apparent death, 34
-    crucial test of, 35
-
-  Arabia, effects of wind from the deserts of, 46
-
-  Arago, observations of, regarding atmospheric electricity, 46
-
-  Arsenic, in asthma, 101
-
-  Atropia, 69
-
-  Atropine, use of, with opiates, 87
-
-  Artificial sleep, effect of, upon the process of oxidation, 9
-    mode of production of, 22
-
-  Artificial somnambulism, 214
-    cataleptic form of, 219
-    lethargic form of, 220
-    recollection of the events of, 227
-    somnambulic form of, 222
-    three varieties of, 219
-
-  Assafoetida, use of, in insomnia, 110
-
-  Assimilation, rate of, in sleep, 5
-
-  Association of ideas, cessation of, in sleep, 3
-    effect of, 123
-
-  Asphyxia, 100
-
-  Asthma, insomnia caused by, 101
-    relieved by atropine, 69
-    relieved by chloroform, 82
-    relieved by ether, 82
-    relieved by iodide of potassium, 110
-    relieved by lobelia, 71
-    relieved by stramonium, 71
-    relieved by tobacco, 71
-
-  Atmospheric electricity, effects of, 46
-
-  Australia, effect of winds from the deserts of, 46
-
-  Azam, a case of somnambulic life observed by, 208
-
-
-  Bachelder, Dr. G. H., observations of, on the maladie du sommeil, 32
-
-  Baillarger, hallucination excited by dreaming, 126
-
-  Ball and Chambard, classification of the varieties of somnambulism, 169
-
-  Baths, use of, as nervous stimulants, 60
-    cold, 73, 95
-    in fever, 104
-    in insomnia, 112
-    in scarlet fever, 76
-    shower, 95
-    warm, 94
-
-  Bartholow, on the use of phosphorus, 71
-
-  Beard and Rockwell, on the use of electricity, 62
-
-  Beer, effect of, 76
-
-  Belladonna, 69, 100
-    use of, in asthma, 101
-    use of, in fever, 104
-    use of, in hepatic diseases, 102
-
-  Bismuth, use of, in gastric diseases, 103
-
-  Bladder, insomnia in irritability of, 90
-
-  Blisters, use of, in rheumatism, 106
-
-  Blood, control of its circulation by the nervous system, 26
-
-  Bombardment, sleep during, 1
-
-  Boussingault, experiments of, on the process of oxidation in the
-        tissues, 9
-    observations of, on respiration in sleep, 6
-    observations of, regarding the bodily temperature in sleep, 7
-
-  Brain, consequences of inordinate excitability of, 159, 161
-    exalted receptivity of, during the waking state, 150
-    exalted susceptibility of, in sleep and dreaming, 144, 150
-    the, its division into separate mechanisms, 13
-    the, a reservoir of sensory impressions, 124
-
-  Brandy, use of, in wakefulness, 77
-
-  Bromide of potassium, use of, in insanity, 95
-    of sodium, use of, in chronic alcoholism, 97
-    of sodium, use of, in delirium tremens, 98
-
-  Bromides, the, 88
-    use of, in convulsions, 110
-    use of, in delirium, 77
-    use of, in fever, 104
-    use of, in night terrors, 112
-    use of, in pregnancy, and after parturition, 109
-    use of, with chloral and morphia, 86
-
-  Brooke, Lieut. J. M., observations of, regarding hypnotic clairvoyance,
-        224
-
-  Bronchitis, insomnia caused by, 100
-    insomnia of, relieved with paraldehyde, 80
-
-  Brunton, Dr. T. Lauder, his theory of counter-irritation, 62
-
-  Butylchloral hydrate, 83
-
-  Buschick, experience of, in waking before earthquakes, 144
-
-
-  Caffeine, effect of, upon the brain, 54
-
-  Camphor, 67
-    use of, in asphyxia, 100
-    use of, in fevers, 105
-    use of, in the insomnia of cachexia, 108
-    use of, after parturition, 109
-
-  Cannabin, 69
-
-  Cannabin tannate, 68
-
-  Cannabis indica, 68
-    anti-aphrodisiac effect of, 69
-    use of, in delirium tremens, 98
-    use of, in fever, 104
-    use of, in insanity, 96, 97
-    use of, in pregnancy, 109
-    use of, as a substitute for hyoscyamus, 113
-
-  Cantharides, 63
-
-  Capsicum, 63
-
-  Capsicum, use of, in the insomnia of delirium tremens, 77, 98
-
-  Carbolic acid, vapor of, for relief of cough, 100
-
-  Carbon, oxidation of, during sleep, 7
-
-  Carbonic acid gas, discharge of, during sleep, 9
-
-  Cardiac debility, use of butylchloral in, 83
-
-  Cardiac disease, insomnia of, treated with paraldehyde, 80
-    treated with digitalis, 66
-
-  Cardiac dyspnoea, relieved with opiates, 87, 98
-
-  Cardiac neuralgia, 99
-
-  Carotid arteries, compression of, for relief of insomnia, 25, 27, 57
-
-  Cataleptic form of artificial somnambulism, 219
-
-  Catarrh, nasal, effect of sleep upon, 8
-
-  Caton, Judge John D., on the difficulty of sleep during the continuous
-        daylight of summer in Norway, 40
-
-  Cerebral activity, effect of, upon bodily temperature, 8
-
-  Cerebral anæmia and its cause during sleep, 25, 28
-    use of phosphorus for, 71
-
-  Cerebral circulation, dependence of consciousness upon, 25, 27
-    during sleep, observations upon, by Professor Mosso, 26
-
-  Cerebral exhaustion, benefited by the use of phosphorus, 71
-    in fever, 105
-
-  Cerebral hyperæmia, effects of, 145
-    insomnia of, treatment with paraldehyde, 80
-
-  Cerebral irritation in cachectic states, 108
-
-  Cerebro-spinal meningitis, use of opiates in, 93
-
-  Cerebro-spinal weakness, 110
-
-  Change of life, use of valerian during, 68
-
-  Chicago, embarkation from, 45
-    the great fire in, 40
-
-  Child-birth, insomnia after, 81
-
-  Chloral, 82
-
-  Chloral hydrate, influence of, upon oxidation in the tissues, 9
-    association of, with morphia and bromides, 86
-    use of, in angina pectoris, 99
-    use of, in asthma, 101
-    use of, in cachexias with insomnia, 109
-    use of, in chorea, 110
-    use of, in chronic alcoholism, 97
-    use of, in delirium tremens, 98
-    use of, in fevers, 104
-    use of, in hepatic diseases, 102
-    use of, in insanity, 95
-    use of, in meningitis, 94
-    use of, in night terrors, 112
-    use of, in respiratory diseases, 100
-
-  Chlorodyne, 82
-    use of, in syphilitic neuralgia, 107
-
-  Chloroform, 81
-    use of, in asthma, 101
-    use of, in convulsions, 110
-    spirit of, in the treatment of fevers, 105
-
-  Chossat, observations of, on the temperature of pigeons, 7
-
-  Circulation of blood, its regulation by the nervous system, 26
-    disorders of, 52
-    modified by counter-irritation, 63
-    state of, during sleep, 6
-
-  Clairvoyance, hypothetical explanation of, 148
-    in dreams, 146, 148, 149
-    in dreaming, and in natural somnambulism, 226
-    in the hypnotic state, 224
-
-  Clark, observations of, on the sleeping dropsy, 30
-
-  Codeia, 85
-
-  Codeine, 88
-
-  Coffee, effects of, upon the brain, 54
-
-  Cold, a nervous sedative, 73
-
-  Cold baths, 73
-
-  Cold, excessive, a cause of stupor, 47
-
-  Colic, uterine, relief of, 81
-
-  Color-blindness, effect of hypnotism upon, 223
-
-  Coma, 32
-
-  Coniine, 91
-
-  Conium, 90, 95
-
-  Consciousness, duration of the sensations required for its excitement, 23
-    state of, during sleep, 14
-
-  Convulsions, excited by compression of the carotid arteries, 27
-    treatment of, 110
-
-  Cough, spasmodic, treatment with spirit of chloroform, 82
-
-  Counter irritants, 62
-
-  Croton oil, 63
-
-  Cups, counter irritation with, 63, 93
-
-  Curci, observations of, regarding belladonna, 69
-    regarding morphia, 85
-
-  Cutaneous disorders, causes of insomnia, 55
-
-
-  DaCosta, on lithæmia, 106
-
-  Darkness, favorable to sleep, 18
-
-  Day and night, alternation of, a cause of sleep, 17
-
-  Death, apparent, 34
-    test of, 35
-
-  Degeneration of the brain, 55
-
-  Demme, observations of, on bodily temperature in sleep, 7
-
-  Delirium, 54
-    excited by hyoscyamus, 70
-    excited by stramonium, 71
-    of exhaustion, 77
-    treatment of, with musk, 67
-
-  Delirium tremens, treatment of, with alcohol, 77
-    with bromides, 89
-    with capsicum, 77
-    with chloral, 82
-    with digitalis, 67
-
-  Delusions, caused by dreams, 128
-
-  Depressing emotions, a cause of sleep, 19
-
-  Diagram, illustrating the stages of sleep, 4
-    the varieties of somnambulism, 172
-
-  Digitalis, indirectly hypnotic effect of, 66
-    treatment of delirium tremens with, 98
-
-  Diminution of energy, represented by sleepiness, 2
-
-  Disease and dissolution, revival of memory in, 165
-
-  Dover's powder, 67, 100, 104, 110, 112
-
-  Double consciousness, 204, 206
-
-  Dreams, 116
-    analysis of, 133
-    at the moment of waking, 14
-    brevity of, 15
-    causes of, 118
-    cause of special vividness of, 134
-    clairvoyant, 146, 148, 149
-    coherence of, 131
-    definition of, 120
-    dependence of, upon partial sleep of the brain, 11
-    duration of, 135
-    excited by gustatory sensation, 43, 125, 130
-      by heat, 43
-      by painful diseases, 141
-      by sensory impressions during sleep, 29
-      by sounds, 41
-    incoherence of, 133
-    intellectual combinations in, 131
-    mode of their production, 124
-    primitive belief in the divine origin of, 160
-    prophetic, 142, 143
-    recollection of, 140
-    relation of, to depth of sleep, 4
-    relation of, to waking hallucinations, 126
-    resemblance of, to the mental processes of insanity, 133
-    revival of memory in, 162
-    somnambulic, 178
-    state of volition during, 141
-    suggested by external impulses, 125, 130
-    theory of, 116
-    waking, 123
-
-  Dropsy, treatment of, with digitalis, 66
-
-  Dumontpallier, case of self-hypnotism related by, 219
-
-  Duration of sleep, 110
-
-  Dyspnoea, cardiac, 98
-    treatment of, with digitalis, 66
-
-  Dyspeptic insomnia, 104
-
-
-  East Indies, climate of, a cause of insomnia, 44
-
-  Eggs, as an article of food, 66
-
-  Electrical test of apparent death, 35
-
-  Electricity, atmospheric, 46
-    use of, 62, 63
-
-  Emphysema, insomnia of, relieved with paraldehyde, 80
-
-  Energy, diminution of, represented by sleepiness, 2
-    renewal of, by sleep, 5
-
-  Epilepsy, double consciousness in, 205
-
-  Ether, hypnotic effect of, 81
-    inhalation of, 98
-    use of, in asthma, 101
-    use of, in convulsions, 110
-    use of, in irritative cough, 100
-
-  Ether, compound spirit of, 81
-    use of, in delirium tremens, 98
-    use of, in hepatic diseases, 102
-
-  Excrementitious substances, causes of insomnia, 55
-
-  Exhaustion, a cause of sleep, 19
-    relief of with alcoholic stimulants, 76
-    states of, 64
-    use of musk in, 68
-
-  Exner, experiments of, to test the possibility of dreamless sleep, 14
-
-  Eye, state of its secretions during sleep, 8
-
-
-  Facial neuralgia, treatment of, with butylchloral, 83
-
-  Fainting, a counterfeit of sleep, 25
-
-  Fatigue, a cause of sleep, 19
-
-  Fatigue theory of sleep, 20
-
-  Fevers, eruptive, treatment of with musk, 68
-    infective, 57
-    typhoid, 57
-    treatment of with cold baths, 73
-
-  Flaxseed tea, 100
-
-  Florida, climate of, in insomnia, 114
-
-  Fonssagrives, observations of, regarding atmospheric electricity and
-        insomnia, 46
-
-  Food, lack of, a cause of insomnia, 63
-
-  Foot-baths, hot, in the treatment of insomnia, 93, 94
-
-  Force, fluctuations of, 15
-    kinetic, 15
-    potential, 15
-
-  Frank, J. P., case of somnambulism related by, 195
-
-  Functional nervous disorders, treatment of with hypnotism, 229
-
-
-  Gairdner, W. T., case of somnambulic lethargy reported by, 174
-
-  Gastro-intestinal glands, state of their secretions during sleep, 8
-
-  Gelsemium, 90
-    treatment of fever with, 104
-    use of, in the wakefulness of children, 112
-
-  Generation of ideas, relation of, to molecular movements in the brain, 24
-
-  Grasset, case of somnambulism related by, 177
-
-  Guérin, observations of, on the _maladie du sommeil_, 30
-
-  Guiana, delusions among the Indians of, founded upon dreams, 128
-    travels in, 42
-
-  Guy, observations of, regarding the pulse in sleep, 7
-
-
-  Hallucination, case of, related by Dr. E. H. Clarke, 156
-    experienced by Sir Edmund Hornby, 150
-    production of, by drugs, 120
-    sometimes excited by dreams, 126, 150
-
-  Hamilton, Sir William, experiments of, on the possibility of dreamless
-        sleep, 14
-
-  Hasheesh, visions excited by, 120
-
-  Hayes, Dr. P. S., case of lucid lethargy reported by, 35
-
-  Headache, 54
-
-  Hearing, persistence of during sleep, 41
-    sense of, during sleep, 11
-
-  Heart, pulsation of, in sleep, 6
-
-  Heat, a cause of insomnia, 44
-    a nervous stimulant, 59
-    effects of excessive, 47
-    liberation of, during sleep, 9
-
-  Heidenhain, observations of, on hypnotism, 214
-
-  Helmholtz, observations of, on liberation of heat during sleep, 9
-
-  Hemicrania, treatment of, with butylchloral, 83
-
-  Henneberg, experiments of, on oxidation in the tissues, 9
-
-  Hibernation, phenomena of, 48
-
-  Hoffmann's anodyne, 81
-
-  Hohl and Allix, observations of, on the pulse in sleep, 6
-
-  Holland, Sir Henry, observations of, regarding the loss of memory during
-        exhaustion, 209
-
-  Hops, 90
-    treatment of chronic alcoholism with, 97
-
-  Hornby, Sir Edmund, experience of hallucination, 150
-
-  Horsford's Acid Phosphate, 72
-
-  Horvath, observations of, on the temperature of hibernating marmots, 8
-
-  Hunger, 2
-
-  Hydrobromic acid, 88
-
-  Hydrochloric acid, useful in atonic dyspepsia, 72
-
-  Hydrocyanic acid, 100
-    in gastric diseases, 103
-
-  Hyosciamia, 70, 96
-
-  Hyosciamine, 70
-
-  Hyoscyamus, 70
-    use of, after parturition, 109
-    use of, in asthma, 101
-    use of, in fever, 104
-    use of, in hepatic diseases, 102
-    use of, in insanity, 96
-    use of, in insomnia of children, 112
-    use of, in renal diseases, 102
-
-  Hyperæmia of the brain, 52, 54, 110
-
-  Hypnagogic hallucinations, 3, 4
-
-  Hypnagogic state, 2
-
-  Hypnotic sleep, duration of, 217
-
-  Hypnotic sleep, clairvoyance in, 224
-    condition of the special senses in, 223
-    conditions favorable to, 214
-    exaltation of the imitative faculty during, 227
-    methods of inducing, 215
-    perception during, 149
-
-  Hypnotism, 214
-    likeness of, to somnambulism, 203
-    observations of Braid, 214, 229
-    observations of Charcot, 214, 219, 221
-    observations of Cohn, 223
-    observations of De Watteville, 229
-    observations of Dumontpallier, 219, 221
-    observations of Fischer, 150, 227
-    observations of Harting, 215
-    observations of Heidenhain, 214, 215, 216, 222
-    observations of Milne-Edwards, 215
-    observations of Rieger, 229
-    observations of Wiehe, 229
-    receptivity of the brain to suggestions during, 226
-    suggestion of ideas during, 226
-    therapeutical use of, 228
-
-  Hysteria, a cause of double consciousness, 205
-
-  Hysterical excitement, treatment of, 68
-
-
-  Ice-cap, in the treatment of acute affections of the brain, 93
-
-  Iceland moss, for the relief of cough, 100
-
-  Ideas, their dependence upon molecular movements in the brain, 24
-
-  Illusions, excited by disease and by drugs, 120, 122
-
-  Imagination, persistence of, in sleep, 3
-
-  Imitative faculties, exaltation of, in hypnotic states, 227
-
-  Immermann, on cold baths, 73
-
-  Impulses to violence during somnambulism, 193
-
-  Im Thurn, Everard F., on dreams among the Indians of Guiana, 128
-
-  Indians, of Guiana, magic practices among, 42
-
-  Inflammations affecting the brain, 54
-
-  Inhalations, medicated, 100
-
-  Injuries of the brain, 55
-
-  Insanity, 54, 57, 70, 133
-
-  Insomnia, 38
-
-  Insomnia, causes of, 39
-    caused by aortic obstruction, 84
-    caused by asthma, 101
-    caused by cardiac disorders, 51
-    caused by cold, 47
-    caused by contagia of animal origin, 55
-    caused by cutaneous disorders, 49, 55
-    caused by dyspepsia, 51
-    caused by electrical disturbances, 46
-    caused by excrementitious substances, 55
-    caused by fatigue, 78
-    caused by heat, 44, 46
-    caused by heat and humidity, 44
-    caused by icterus, 49
-    caused by inflammations, 50
-    caused by insects, 49
-    caused by itching in myelitis, 49
-    caused by itch-mite, 49
-    caused by light, 39
-    caused by malaria, 72
-    caused by meningitis, 50
-    caused by miasms, 55
-    caused by morbid states of the central nervous organs, 51
-    caused by neuralgia, 50
-    caused by neuritis, 50
-    caused by neuromata, 50
-    caused by oxaluria, 72
-    caused by pain, 49
-    caused by parasites, 49
-    caused by periostitis, 50
-    caused by phosphatic diathesis, 72
-    caused by pneumogastric disorder, 51
-    caused by poisons, 55
-    caused by products of putrefaction, 55
-    caused by respiratory disorders, 51
-    caused by rheumatic diathesis, 72
-    caused by sounds, 41
-    caused by smells, 42
-    caused by stramonium, 71
-    caused by sympathetic nerve disorder, 50
-
-  Insomnia, occurrence of, after childbirth, 81
-    occurrence of, after parturition, 109
-    occurrence of, during acute affections of the brain, 92
-    occurrence of, during bronchitis, 80
-    occurrence of, during cardiac diseases, 66, 80, 87
-    occurrence of, during change of life in women, 84
-    occurrence of, during childhood, 110
-    occurrence of, during chorea, 110
-    occurrence of, during chronic alcoholism, 97
-    occurrence of, during chronic phthisis, 84
-    occurrence of, during delirium tremens, 87, 90, 97
-    occurrence of, during diseases of the heart and blood-vessels, 98
-    occurrence of, during diseases of the liver, 102
-    occurrence of, during diseases of the respiratory organs, 99
-    occurrence of, during disorders of nutrition, 107
-    occurrence of, during dysmenorrhoea, 84
-    occurrence of, during emphysema, 80
-    occurrence of, during febrile conditions and fevers, 87, 104
-    occurrence of, during gastric and intestinal disorders, 87, 103
-    occurrence of, during gout and rheumatism, 103, 107
-    occurrence of, during headache, 84
-    occurrence of, during hysteria, 81, 89
-    occurrence of, during insanity, 94
-    occurrence of, during irritability of the bladder, 90
-    occurrence of, during irritability of the sexual organs, 90
-    occurrence of, during irritative dyspepsia, 90
-    occurrence of, during jaundice, 80
-    occurrence of, during lithæmia, 106, 107
-    occurrence of, during mania, 87, 89, 90
-    occurrence of, during melancholia, 96
-    occurrence of, during mental exhaustion, 89
-    occurrence of, during nervous disorders, 80
-    occurrence of, during neuralgia, 84
-    occurrence of, during old age, 78, 113
-    occurrence of, during opium habit, 84
-    occurrence of, during paretic dementia, 96
-    occurrence of, during phthisis, 80, 87
-    occurrence of, during pregnancy, 89, 109
-    occurrence of, during the puerperal state, 89
-    occurrence of, during renal diseases, 101
-    occurrence of, during rheumatism and gout, 105, 107
-    occurrence of, during sexual excitement, 89
-    occurrence of, during spasmodic diseases, 109
-    occurrence of, during states of exhaustion, 67
-    occurrence of, during syphilis, 106, 107
-
-  Insomnia, relation of, to states of the cerebral circulation, 57
-    relief of, by compression of the carotid arteries, 25
-
-  Iodide of potassium, treatment of asthma with, 110
-
-  Ipecac, treatment of asthma with, 101
-
-  Irritability of the brain, 53, 54
-
-  Itching of eczema, relieved with cannabis indica, 69
-
-
-  Jacobi, A., on wakefulness of children, 111
-
-  Japanese, use of massage among, 61
-
-  Jaundice, insomnia of, treatment with paraldehyde, 80
-
-  Jessen, case of hallucination caused by dreaming, 127
-
-  Joseph, St., dreams of, 142, 160
-
-  Judgment, suspension of, during sleep, 3
-
-
-  Kohlschütter, experiments of, to measure the depth of sleep, 16
-
-  Koumiss, 64
-
-
-  Lactic acid, hypnotic effects of, 72
-
-  Lactate of sodium, hypnotic effects of, 20, 72
-
-  Lactucarium, 88
-
-  Latent contracture, 221
-
-  Leeches, use of, 63, 93, 94
-
-  Lethargic form of artificial somnambulism, 220
-
-  Lethargy, 33
-    produced by excessive cold, 48
-
-  Lewin, observations of, on respiration during sleep, 6
-    experiments of, on oxidation in the tissues, 9
-
-  Liebermeister, experiments of, on oxidation in the tissues, 9
-
-  Life, normal, 4
-    possibility of intermissions in its active manifestation, 15
-
-  Light, interference of, with sleep, 40, 41
-
-  Liquors, effects of, 76
-
-  Lithæmia, a cause of insomnia, 106
-
-  Lithium bromide, 88
-
-  Lobelia, anti-spasmodic effects of, 71, 101
-
-  Lomi-lomi, 61
-
-  Lucid lethargy, 35
-    contrasted with somnambulic lethargy, 176
-
-  Lupulin, 90
-
-
-  Macario, case of somnambulism, reported by, 192
-
-  Mackinac, voyage to, 45
-
-  Macnish, case of somnambulic life, reported by, 206
-
-  Maladie du sommeil, 30
-
-  Malaria, treatment of insomnia, caused by, 72
-
-  Mania, use of chloral in, 82
-
-  Marmot, hibernation of, 48
-    temperature of, during hibernation, 8
-
-  Massage, 60, 109
-
-  Matter and mind, communication between, 22
-
-  Maury, A., classification of the varieties of somnambulism, 168
-    experience of, with table-rapping, 228
-    theory of, regarding forgetfulness of the events of somnambulism, 211
-
-  Measles, use of baths in, 74
-
-  Meat juice, 66
-
-  Memory, effect of physical exhaustion, 209
-    exaltation of, in somnambulism, 187
-    persistence of, in sleep, 3
-    relation of, to phenomena of somnambulism, 192
-    revival of, during disease and dissolution, 165
-    revival of, during dreaming, 162
-
-  Meningitis, 54, 57
-
-  Mental activity during sleep, 14
-
-  Mesnet, case of somnambulism related by, 196
-
-  Metaphysical healing, 229
-
-  Michigan, Lake, voyage upon, 45
-    Northern, summer climate of, favorable to sleep, 45
-
-  Milk, peptonized, 64
-
-  Mind and matter, communication between, 22
-    alternate states of action and repose, 15
-    sleep of, 15
-    state of, during sleep, 14
-
-  Mind-reading, 218, 227
-
-  Minnesota, summer climate of, favorable to sleep, 45
-
-  Mitchell, S. Weir, observations of, regarding effect of variable
-        barometric pressure, 47
-
-  Molecular movement, its relation to the generation of ideas, 24
-
-  Moral responsibility in somnambulism, 203
-
-  Morphia, 97, 98, 100, 101
-
-  Morphine, influence of, on oxidation in the tissues, 10
-
-  Mosso, Professor, on the circulation of blood during sleep, 26
-    on respiration during sleep, 5
-
-  Mouth, condition of, during sleep, 8
-
-  Muscles, effect of sleep upon, 12
-    fibrillary twitching of, during sleep, 3
-
-  Muscle-reading, 218
-
-  Musk, 67, 100, 105
-
-  Mustard, 63
-
-
-  Nasal catarrh, state of secretion during sleep, 8
-
-  Narcotic stupor, 29
-
-  Nerves, of common sensation, affections of, 39, 49
-    pneumogastric, 51
-    sympathetic, affections of, causes of insomnia, 50
-
-  Nervous disorders, insomnia of, relieved with paraldehyde, 80
-    hypnotic treatment of, 229
-
-  Nervous irritation, effect of, on tissue change, 10
-    sedatives, 58, 59
-    stimulants, 58, 59
-    system, its control over the circulatory apparatus, 26
-
-  Neuralgia, cardiac, 99
-    treatment of, with alcohol, 77
-    treatment of, with belladonna, 69
-    treatment of, with preparations of valerian, 68
-
-  Neurasthenic patients, 66
-
-  New Providence, climate of, beneficial in insomnia, 114
-
-  Night and day, alternation of, a cause of sleep, 17
-
-  Night terrors, 179
-    treatment of, 89, 112
-
-  Nitric acid, 72
-
-  Noctambulism, 169
-
-  Noise, sleep prevented by, 41
-
-  North China Herald, criticism of Sir E. Hornby's narrative, 155
-
-  Norway, difficulty of sleeping during the summer, 40
-
-  Nutrition, effect of sleep upon, 5, 9
-    disorders of, 52
-
-
-  Obersteiner, his theory of sleep, 20
-
-  Odors, effect of, upon sleep, 11
-
-  Old age, decline of life in, 113
-
-  Omphaloscopy, 217
-
-  Opium and opiates, 84, 98
-
-  Opiates, use of, in treatment of cachexias, 108
-    use of, in treatment of fever, 104, 105
-    use of, in treatment of gastric disease, 103
-    use of, in treatment of insanity, 96
-    use of, in treatment of renal diseases, 102
-    use of, in treatment of rheumatism, 105
-
-  Oxaluria, insomnia caused by, 72
-
-  Oxygen, absorption of, during sleep, 9
-
-  Ozone, use of, in the treatment of asthma, 101
-
-
-  Pacific Islanders, habits of, regarding sleep in the daytime, 40
-    use of massage among, 61
-
-  Pain, a cause of sleep, 19
-
-  Paraldehyde, 79, 95, 97, 108
-
-  Paregoric, 100
-
-  Perception, effect of, upon nervous tissue, 10
-    duration of, necessary to arouse consciousness, 23
-    range of, circumscribed by sleep, 12
-    transfer of, in telepathy and hypnotism, 217
-
-  Percussion, 61
-
-  Perspiration, secretion of, during sleep, 9
-
-  Pettenkofer, experiments of, on oxidation in the tissues, 9
-    experiments of, on respiration in sleep, 6
-
-  Pettenkofer and Voit, on tissue changes, 10
-
-  Pflüger, hypothesis of, regarding the cause of sleep, 21
-
-  Phosphatic diathesis, a cause of insomnia, 72
-
-  Phosphoric acid, 72
-
-  Phosphorus, 71
-
-  Phthisis, cough of, relieved with lactucarium, 88
-    insomnia of, relieved with paraldehyde, 80
-    treatment of, with opiates, 87
-
-  Physiological activity, reduction of, during sleep, 5
-
-  Physiological cause of somnambulism, 180
-
-  Planchette-writing, 228
-
-  Pleuritic pain, 99
-
-  Pneumogastric nerves, insomnia caused by affections of, 51
-
-  Pneumonia, 68, 100
-
-  Porter, effects of, 76
-
-  Potassium bromide, 88
-
-  Preyer, his theory of sleep, 20
-
-  Psychical Research, Society for, investigations by, 149, 217
-
-  Pulse, state of, during sleep, 6
-
-  Punkah, use of, to promote sleep, 44
-
-
-  Quetelet, observations of, on respiration during sleep, 5
-
-  Quinine and opium, use of, in fever, 104
-
-
-  Reasoning powers, arrest of, during sleep, 3
-
-  Recollection of the events of artificial somnambulism, 227
-    of the events of natural somnambulism, 188
-
-  Reflex movements during sleep, 12
-
-  Refrigeration, threefold effect of, 49
-
-  Relation between molecular movement and the generation of ideas, 24
-
-  Respiration during sleep, 5
-
-  Revelation through dreams, 160
-
-  Revery, nature of, 120
-
-  Rheumatic diathesis, a cause of insomnia, 72
-
-  Rosenthal, observations of, regarding lethargy, 33, 34
-    observations regarding apparent death, 35
-
-  Rush, Dr., observations of, on the revival of memory in dissolution, 165
-
-
-  Sailors, sleeping during a bombardment, 1
-
-  Sailor-boy, sleeping on a mast, 1
-
-  Salicylic acid, treatment of rheumatism with, 106
-
-  Saliva, secretion of, during sleep, 8
-
-  Samuel the prophet, dream of, 129
-
-  Sandwich Islands, climate of, for relief of insomnia, 114
-
-  Scarlet fever, treatment of, with baths, 74, 75
-
-  Scharling, observations of, regarding bodily temperature during sleep, 7
-    experiments of, on oxidation in the tissues, 9
-
-  Screaming fits of children, 112
-
-  Secretion, state of, during sleep, 8
-
-  Sedatives, nervous, 59, 73
-
-  Self-hypnotism, 219
-
-  Sensory excitement, effect of, upon the cerebral circulation, 27, 28
-
-  Sensory organs, condition of, during somnambulism, 191
-
-  Sexual organs, irritability of, 90
-
-  Shampooing, 61
-
-  Simon, P. Max, case of somnambulism related by, 182
-    dream related by, 142
-
-  Sleep, affected by certain winds, 45
-    artificial, mode of its production, 22
-    caused by the alternation of day and night, 17
-    caused by depressing emotions, 19
-    caused by exhaustion, 19
-    caused by fatigue, 19
-    caused by painful impressions, 19
-    caused by the venereal act, 19
-    definition of, 1
-    dreamless, 14
-    duration of, 4, 110
-    effects of its invasion upon the intellectual faculties, 13
-    effect of, upon consciousness, 13, 14
-    fatigue theory of, 20
-    favored by darkness, 18
-    favored by the suppression of sensation, 18
-    hindered by heat, 44
-    hindered by light, 39
-    hindered by smells, 42
-    hindered by sounds, 41
-    introductory stage of, 2
-    invasion of, 10, 117
-    measure of its depth by the experiments of Kohlschütter, 16
-    Obersteiner's theory of, 20
-    Pflüger's hypothesis regarding the cause of, 21
-    preceded by sleepiness, 2
-    Preyer's theory of, 20
-    rapid induction of, in certain cases, 24
-    relation between the duration of, and the average length of the night,
-        17
-    stages of, 4
-    the cause of, 29
-    unequal incidence of, upon different portions of the brain, 13
-
-  Sleep-drunkenness, 180, 181
-
-  Sleepiness, precursive of sleep, 2
-
-  Sleeping dropsy, 30
-
-  Sleeplessness, causes of, 39
-
-  Smells, abolition of sleep by, 42
-
-  Smile, during sleep, 12
-
-  Smith, E., experiments of, on oxidation in the tissues, 9
-
-  Snoring, occasional interruption of sleep by, 11
-
-  Society for Psychical Research, investigations by, 149, 217
-
-  Sodium bromide, 88
-
-  Somniation, 169
-
-  Somnambulic dreams, 171, 178, 181
-    recollections of, 188
-
-  Somnambulic form of artificial somnambulism, 222
-
-  Somnambulic lethargy, 171, 173
-    contrasted with lucid lethargy, 176
-
-  Somnambulic life, 169, 204
-    a case of, 206
-    a case of, related by Azam, 208
-    a case of, related by Macnish, 206
-
-  Somnambulism, 166
-    artificial, 214
-    case of, related by Prof. J. Adams Allen, 185
-    case of, related by J. P. Frank, 195
-    case of, related by Macario, 192
-    case of, related by Mesnet, 196
-    case of, related by P. Max Simon, 182
-    causes of, 166
-    condition of sensory organs during, 191
-    dependence of, upon partial sleep of the brain, 11
-    likeness of, to hypnotism, 203
-    moral responsibility in, 203
-    phenomena of, 167, 210
-    physiological cause of, 180
-    relation of memory with events of, 192
-    varieties of, according to A. Maury, 168
-    varieties of, according to Ball and Chambard, 169
-    varieties of, diagrammatically exhibited, 172
-    violent impulses during, 193
-
-  Somnolence, 30
-
-  Somnolentia, 180, 181
-
-  Sound, effect of, to hinder sleep, 42
-    effect of, to induce sleep, 42
-
-  Spasmodic croup, 110
-
-  Special sense organs, affections of, 39
-
-  Special senses, condition of, during invasion of sleep, 11
-    perversion of, during the hypnotic state, 223
-
-  Spinal cord, irritability of, 110
-    reflex energy of, during sleep, 3
-
-  Spinal irritation, 62
-
-  Spirit of chloroform, 81
-
-  Spiritual circle, manifestations in, 227
-
-  Stewart, Dugald, observation of, 43
-
-  Stimulants after parturition, 109
-    in fever, 105
-    nervous, 59
-
-  Stramonium, 70, 101
-
-  Strümpell, observations of, regarding sleep produced by suppression of
-        sensation, 18
-
-  Strychnia, 105
-
-  Stupor produced by excessive heat or cold, 47
-
-  Subsultus tendinum, treatment of, with musk, 67
-
-  Suction, involuntary, during infantile sleep, 12
-
-  Suppression of sensation, a cause of sleep, 18
-
-  Swedish movement cure, 61
-
-  Sympathetic nerves, affections of, 39, 50
-
-
-  Table-rapping, method of communication in, 228
-
-  Tannate of cannabin, 68
-
-  Tartar emetic, use of, in asthma, 101
-    use of, in delirium tremens, 98
-    use of, in fever, 104
-    use of, with opium, 108
-
-  Taste, relation of, to insomnia, 43
-
-  Tea, effect of, upon the brain, 54
-
-  Telegraphy without a wire, through water, 147
-
-  Telepathy, investigation of, by the Society for Psychical Research, 149
-
-  Temperature, of the body, during sleep, 7
-    sense of, 43
-
-  Thapsia, 63
-
-  Theory of sleep, Obersteiner's, 20
-    Pflüger's, 21
-    Preyer's, 20
-
-  Thirst, 2
-
-  Thompson, Sir William, his doctrine concerning a sixth sense, 43
-
-  Tickling, effect of during sleep, 12
-
-  Tobacco, anti-spasmodic effect of, 71, 99, 101
-
-  Transfer of perceptions, 217
-
-  Trousseau, observations of, on the pulse during sleep, 6
-
-  Tuberculosis of the cerebral membranes, 55
-
-  Tully's Powder, 67
-
-  Tumors of the brain, 55
-
-  Turkish baths, 60
-
-  Turpentine, 63
-
-  Typhoid fever, insomnia during, 64
-    treatment of, with baths, 74
-    treatment of, with musk, 68
-    treatment of, with Tully's Powder, 67
-
-  Typhus fever, treatment of, with musk, 68
-
-
-  Unconsciousness, produced by compression of the carotid arteries, 27
-    relation of, to modifications of the cerebral circulation, 25
-
-  Urea, elimination of, during sleep, 9
-
-  Urine, secretion of, during sleep, 9
-
-  Uterine colic, 81
-
-
-  Valerian, 68, 109
-
-  Valerianate of ammonia, 68
-    of zinc, 68
-
-  Venereal act, a cause of sleep, 19
-
-  Vierordt, observations of, on the duration of sleep, 110
-
-  Visions, character of, 119
-    of the ancient prophets, 161
-
-  Voit, observations of, on oxidation in the tissues, 9
-    on respiration during sleep, 6
-
-  Volition, cessation of, during sleep, 3
-
-
-  Wakefulness, 38
-    causes of, 39
-    dependence of, upon instability of cerebral protoplasm, 22
-
-  Warburton, Rev. Canon, clairvoyant dream of, 146
-
-  Weariness, a cause of sleep, 1
-
-  Wharton and Stillé, on sleep-drunkenness, 181
-
-  Whooping-cough, treatment of, with belladonna, 69
-
-  Wind, effect of, upon sleep, 45
-
-  Wine, effects of, 76
-    use of, in the insomnia of old age, 78
-
-
-  Ziemssen, von, on the use of baths, 73
-
-
-
-
-FOOTNOTES:
-
-[1] Rosenbach, _Zeitschr. f. klin. med._ 1881. _Brain_, Vol. IV, p. 138.
-
-[2] Alfred Maury, _Le Sommeil et les Rêves_, Chap. IV.
-
-[3] Hermann's _Handbuch der Physiologie_, Vol. IV, Part II, p. 98.
-
-[4] _Handbuch der Kinderkrankheiten_, Vol. I, p. 346.
-
-[5] _Handbuch der Physiologie_, Vol. IV, Pt. II, p. 217.
-
-[6] _Op. cit._, pp. 142 and 456.
-
-[7] _Dic. Encyc. des Sci. Méd._, Art. SOMMEIL, pp. 277.
-
-[8] Quoted by Vierordt, _Handbuch der Kinderkrankheiten_, Vol. I, p. 307.
-
-[9] _Dic. Encyc. des. Méd._, Ie série, t. XV, p. 75.
-
-[10] _Handbuch der Kinderkrankheiten_, Vol. I, p. 383.
-
-[11] _Carpenter's Physiology_, 8th edition, p. 560.
-
-[12] _Handbuch der Physiologie_, Vol. II, Pt. II, p. 297.
-
-[13] Quincke, _Archiv. f. Experim. Pathol._, Vol. VII, p. 115.
-
-[14] _Carpenter's Physiology_, 8th edition, p. 526, _Handbuch der
-Kinderkrankheiten_, 2d edition, Vol. I, p. 373.
-
-[15] _Dic. Encyc. des Sci. Méd._, IIIe Série, Vol. X, p. 268.
-
-[16] _Handbuch der Physiologie_, Vol. V, p. 142-156.
-
-[17] Kohlschütter, _Messungen der Festigkeit des Schlafes. Dissert._
-Leipzig, 1862, _und Zeitschrift f. rat. Med._, 1863. Quoted, Hermann's
-_Handbuch der Physiologie_, Vol. II, Pt. II, p. 295.
-
-[18] _Obersteiner, Zur Theorie des Schlafes, Zeitschr. f. Psych._ XXIX.
-_Preyer, Ueber die Ursachen des Schlafes._ Vortrag. Stuttgart bei Enke.
-1877, und centralbl. f. d. Med. Wiss. 1875. S. 577.
-
-[19] _Theorie des Schlafes._ Arch. f. d. ges. Physiol. X, 468.
-
-[20] _Artificial Anæsthesia and Anæsthetics_, pp. 15-17.
-
-[21] _Carpenter's Physiology_, 8th ed., p. 852.
-
-[22] _Sulla Circolazione del Sangue nel Cervello dell'Uomo._ Abstract in
-_Brain_, Vol. IV, p. 100.
-
-[23] _Transactions of the London Epidemiological Society_, Vol. I, p. 116.
-
-[24] _De la maladie du sommeil_, 1869.
-
-[25] _The Medical Record_, July 1, 1882, p. 23.
-
-[26] _Real. Encyc. der ges. Heilkunde_, VIII, 276.
-
-[27] _Op. cit._ p. 276.
-
-[28] _A Summer in Norway_, by John Dean Caton, pp. 251 and 311.
-
-[29] A. Maury, op. cit., p. 156.
-
-[30] _Among the Indians of Guiana._ By Everard F. Im Thurn.
-
-[31] _Le Sommeil et les Rêves_, p. 154.
-
-[32] _Nature_, Vol. XXIX, pp. 438-462.
-
-[33] _Ganot's Physics._
-
-[34] _Dic. Encyc. des Sci. Méd._, Art. CLIMAT.
-
-[35] _Comptes-rendus Acad. des Sci._, 1840, t. XI, p. 823.
-
-[36] _Am. Journ. Med. Sci._, April, 1877, p. 305.
-
-[37] A remarkable illustration of this will be found related in _The
-Lancet_, July 26, 1884, p. 112.
-
-[38] _Dic. Encyc. des Sci. Méd._, Art. FROID, p. 139.
-
-[39] _Medical and Surgical Electricity_, 4th ed., p. 413.
-
-[40] _Nature_, March, 1883.
-
-[41] _Lo Sperimentale_, April, 1884.
-
-[42] _Artificial Anæsthesia and Anæsthetics_, pp. 20-28. William Wood &
-Co., New York, 1881.
-
-[43] _Bull. gén. de Thérap._, 1884, 2{o} Livr.
-
-[44] _Centralblatt für klin. med._, 1884. Nr. 12.
-
-[45] _The National Dispensatory_, 1884, p. 433.
-
-[46] _Deutsche Med. wochenschr._, 1883, Nr. 49.
-
-[47] _Lo Sperimentale_, April, 1884.
-
-[48] _The National Dispensatory_, 1884, p. 993.
-
-[49] Kiernan, _Journ. Nerv. and Mental Diseases_, Vol. X, p. 234.
-
-[50] _Psychological Medicine_, Bucknill and Tuke, 4th ed., p. 731.
-
-[51] _Clinical Lectures on Mental Diseases._
-
-[52] _Ringer's Therapeutics_, 10th ed., p. 421.
-
-[53] C. H. Jones, _Functional Nervous Disorders_, p. 284.
-
-[54] _Am. Jour. Med. Sci._, Oct., 1881, p. 313.
-
-[55] _Handbuch der Kinderkrankheiten_, Vol. I., p. 214.
-
-[56] _Op. cit._, Vol. I., Pt. 2, p. 153.
-
-[57] Herbert Spencer, _First Principles_, p. 486.
-
-[58] A. Maury. _Le Sommeil et les Rêves_, p. 154.
-
-[59] _On Intelligence_, p. 61.
-
-[60] Wharton and Stillé's _Medical Jurisprudence_, Third Edition, Vol. I,
-p. 482.
-
-[61] _Among the Indians of Guiana._ By Everard F. Im Thurn. London: 1883,
-p. 344.
-
-[62] A. Maury, _Le Sommeil et les Rêves_, p. 219 et seq.
-
-[63] _Obscure Diseases of the Brain and Mind._ Philadelphia, 1866, pp.
-394-398.
-
-[64] _Le Monde des Rêves_, p. 88.
-
-[65] _Op. cit._, p. 91.
-
-[66] _The Nineteenth Century_, July, 1884, p. 71.
-
-[67] _Nature_, October, 16, 1884, p. 596.
-
-[68] _Lebensmagnetismus oder Hypnotismus_, von Dr. E. L. Fischer, pp.
-71-73.
-
-[69] _The Nineteenth Century_, July, 1884, p. 89.
-
-[70] _Visions: A Study of False Sight_, p. 39.
-
-[71] _Inquiries concerning the Intellectual Powers_, tenth edition, p.
-283.
-
-[72] _Medical Inquiries and Observations upon Diseases of the Mind_, p.
-277.
-
-[73] _Loc. cit._
-
-[74] _Le Sommeil et les Rêves_, p. 248.
-
-[75] _Dic. Encyc. des Sci. Méd._, Article SOMNAMBULISME NATUREL.
-
-[76] _The Lancet_, Dec. 22, 1883, p. 1,078, and Jan. 5, 1884, p 5.
-
-[77] _Brain_, Jan., 1884, p. 454.
-
-[78] _Medical Jurisprudence_, 3d ed., Vol. I, pp. 464-471.
-
-[79] _Le Monde des Rêves_, p. 257.
-
-[80] _Chicago Medical Journal_, 1869, p. 650.
-
-[81] Maury, _Le Sommeil et les Rêves_, p. 234.
-
-[82] _Pathologie interne._
-
-[83] _L' Union Médicale_, July 21st and 23d, 1874.
-
-[84] _Chicago Journ. of Nervous and Mental Diseases_, Vol. II, p. 48.
-
-[85] _Loc. cit._
-
-[86] _Philosophy of Sleep_, p. 167.
-
-[87] _Revue Scientifique_, May 20, Sept. 16, 1876; Dec. 22, 1877; March 8,
-1879.
-
-[88] Vol. III, p. 584.
-
-[89] _Chapters on Mental Physiology_, p. 160.
-
-[90] _Le Sommeil et les Rêves_, p. 226.
-
-[91] _Lancet_, July 29, 1882, p. 164.
-
-[92] _Transactions of the Society_, etc., Vols. I, II, III.
-
-[93] _Le Progrès Médical_, Feb. 18, 1882, p. 124.
-
-[94] _Le Progrès Médical_, March 25, 1882, p. 223.
-
-[95] _Le Progrès Médical_, Jan. 14, 1882, p. 25.
-
-[96] _Brain_, Vol. III, p. 394.
-
-[97] _Op. cit._, p. 18.
-
-[98] _Le Sommeil et les Rêves_, p. 361.
-
-[99] _Op. cit._
-
-[100] _Berlin. Klin. Wochenschr_, January, 1884.
-
-[101] _Der Hypnotismus_, Jena, 1884.
-
-[102] _Brain_, July, 1884, p. 278.
-
-
-
-
-Transcriber's Notes:
-
-Passages in italics are indicated by _italics_.
-
-Superscripted characters are indicated by {superscript}.
-
-Subscripted characters are indicated by _{subscript}.
-
-The original text contains letters with diacritical marks that are not
-represented in this text version.
-
-The original text includes Prescription [R.], dram [dr], and ounce [oz]
-sybmols.
-
-
-
-
-
-
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-Henry M. Lyman
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 <p><a name='f_102' id='f_102' href='#fna_102'>[102]</a> <i>Brain</i>, July, 1884, p. 278.</p>
 
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-Project Gutenberg's Insomnia; and Other Disorders of Sleep, by Henry M. Lyman
-
-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: Insomnia; and Other Disorders of Sleep
-
-Author: Henry M. Lyman
-
-Release Date: August 7, 2013 [EBook #43415]
-
-Language: English
-
-Character set encoding: ASCII
-
-*** START OF THIS PROJECT GUTENBERG EBOOK INSOMNIA, OTHER DISORDERS OF SLEEP ***
-
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-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.)
-
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-
-
-  INSOMNIA;
-  AND OTHER
-  DISORDERS OF SLEEP.
-
-
-  BY HENRY M. LYMAN, A.M., M.D.,
-  Professor of Physiology, and of Diseases
-  of the Nervous System, in Rush Medical
-  College; Professor of Theory and Practice
-  of Medicine, in the Woman's Medical
-  College; and Physician to the Presbyterian
-  Hospital, Chicago, Ill.
-
-
-  CHICAGO:
-  W. T. KEENER,
-  96 WASHINGTON STREET.
-  1885.
-
-
-
-
-COPYRIGHT, 1885.
-
-R. R. DONNELLEY & SONS, PRINTERS, CHICAGO.
-
-
-
-
-PREFACE.
-
-  Tired Nature's sweet restorer, balmy sleep.
-                                      --YOUNG.
-
-
-The regularly recurring incidence of natural sleep forms one of the most
-important subjects for physiological investigation. Were it an event of
-rare occurrence, it would excite a degree of astonishment and alarm equal
-to the agitation now experienced by the spectator of an ordinary attack of
-syncope or of epileptic convulsion. But, so completely does the recurrence
-of sleep harmonize with all the other facts of life that we are as
-indifferent to its nature as we are to every other healthy function of the
-body. It is only when the mind has undertaken a critical observation of
-the bodily and mental changes which accompany and condition the phenomenon
-that we begin to comprehend its wonderful character. Ushered in by a
-waning activity of body and mind that no effort of the will can long
-resist, nothing could more forcibly suggest the idea of approaching
-dissolution if, from the very earliest period of unconscious infancy, we
-had not been accustomed to the dominion of this imperious necessity. The
-remarkable likeness between the fading of consciousness in sleep and its
-extinction in death has, in all ages and among all people, arrested the
-attention of poets and philosophers of every degree.
-
-            Soft repose,
-  A living semblance of the grave,
-
-sang old Thomas Miller; and, describing, in Milton's stately verse, the
-close of his first day in the garden of Eden, Adam says:
-
-                    Gentle sleep
-  First found me, and with soft oppression seized
-  My drowsy sense, untroubled, though I thought
-  I then was passing to my former state
-  Insensible, and forthwith to dissolve.
-
-        How wonderful is death,
-        Death and his brother, Sleep!
-
-exclaims Shelley, echoing the marvellous strains that have come down to us
-from the days of Homer and Hesiod. In that venerable literature Sleep and
-Death are represented as twin brothers, sons of Night; dwelling in the
-lower world of spirits, whence they come forth to perform the will of the
-Olympian Gods.
-
-The prosaic genius of our scientific generation no longer tolerates such
-lively exercise of the imagination. The splendid anthropomorphism of the
-Hebrew poet, looking out upon the silent night, and cheering his soul with
-the sonorous exclamation,
-
-  Behold, he that keepeth Israel
-  Shall neither slumber nor sleep
-
-    *       *       *       *
-
-  For so he giveth his beloved sleep,
-
-has become a mere memory of childhood. Wordsworth understood the full
-significance of this change when he wrote:
-
-  There was a time when meadow, grove, and stream,
-  The earth, and every common sight,
-          To me did seem
-      Apparelled in celestial light,
-  The glory and the freshness of a dream.
-  It is not now as it has been of yore;
-          Turn whereso'er I may,
-              By night or day,
-  The things which I have seen I now can see no more!
-      ... I know, where'er I go,
-  That there has passed away a glory from the earth.
-
-If, however, despite the loss of much that was beautiful and attractive in
-the myths of antiquity, we take advantage of the
-
-  Years that bring the philosophic mind,
-
-we shall surely find in the scientific investigation of sleep enough to
-awaken "thoughts too deep for" words.
-
-
-
-
-CONTENTS.
-
-
-  CHAPTER I. THE NATURE AND CAUSE OF SLEEP.
-
-    Definition of sleep--The invasion of sleep--The hypnagogic
-    state--Depth and duration of sleep--Diagrammatic
-    illustration of the phases of sleep--Modifications of
-    physiological functions produced by sleep--Effect of sleep
-    upon the processes of respiration, circulation,
-    calorification, secretion, and nutrition--Consequences of
-    the progressive invasion of the nervous system by sleep--
-    Effect upon the organs of special sense--Effects observed
-    in the muscular apparatus of the body--Condition of
-    intellectual functions during the invasion of sleep--Does
-    the mind ever sleep?--Arguments adduced by Sir William
-    Hamilton and others to prove the continued activity of the
-    mind during the sleep of the brain--Reasons for supposing
-    that the mind may sleep--Variability of the depth of
-    sleep--Experiments of Kohlshueter to estimate the degree of
-    variation--Alternation of day and night considered as a
-    cause of sleep--Diminution of sensation a cause of sleep--
-    Illustrative observation by Struempell--Fatigue a cause of
-    sleep--Hypothesis of Obersteiner regarding the cause of
-    sleep--Hypothesis of Pflueger--Production of artificial
-    sleep by impregnation of the brain with narcotic
-    substances--Analogous production of natural sleep by
-    accumulation of cerebral waste-products--Observations
-    regarding the duration of sensory impressions requisite for
-    the excitement of conscious perception--Difference between
-    syncope and sleep--Observations of Mosso regarding the
-    state of the cerebral circulation during sleep--Cause of
-    the change in the cerebral circulation during sleep--
-    Molecular conditions necessary for the production of
-    sleep--Somnolence--Sleeping Dropsy, or Maladie du Sommeil--
-    Coma--Lethargy--Apparent death--Lucid lethargy.                      1
-
-
-  CHAPTER II. INSOMNIA, OR WAKEFULNESS.
-
-    Causes of insomnia--Affections of the organs of special
-    sense--Effects of light--Effect of sound--Impressions upon
-    the organs of smell and taste--Disturbances caused by a
-    high temperature--Atmospheric and electrical disturbances--
-    Effects produced by cold--Hibernation of animals--
-    Disturbances of sleep occasioned by painful sensations--
-    Disorders of the sympathetic nerves--Morbid states of the
-    central nervous organs--Disorders of circulation and
-    nutrition--Hyperaemia of the brain--Anaemia and starvation of
-    the brain--Effects of tea and coffee--Effect of alcohol--
-    Inflammations, degenerations, and tumors affecting the
-    brain--Excitement of the brain by diseased conditions of
-    the blood.                                                          38
-
-
-  CHAPTER III. REMEDIES FOR INSOMNIA.
-
-    Serious consequences of insomnia--Its relation to cerebral
-    diseases--Treatment of insomnia by moderation and control
-    of the cerebral circulation--Remedial agents--Nervous
-    stimulants and nervous sedatives--Heat--Baths--Massage--
-    Electricity--Counter-irritants--Food--Digitalis--Camphor--
-    Musk--Valerian--Cannabis indica--Belladonna--Hyoscyamus--
-    Stramonium--Phosphorus--Acids--Opium--Cold--Alcohol--
-    Paraldehyde--Ether--Chloroform--Chloral--Butylchloral
-    hydrate--Amyl nitrite--Opium and opiates--Bromides--Hops--
-    Gelsemium--Conium.                                                  56
-
-
-  CHAPTER IV. TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.
-
-    Insomnia in acute affections of the brain--In insanity--In
-    chronic alcoholism and delirium tremens--In diseases of the
-    heart and blood-vessels--In angina pectoris--In diseases of
-    the respiratory organs--In asthma--In renal diseases--In
-    diseases of the liver--In gastro-intestinal diseases--In
-    febrile conditions--In rheumatism and gout--In lithaemia--In
-    syphilis--In disorders of nutrition--During pregnancy and
-    after parturition--In spasmodic diseases--In childhood--In
-    old age.                                                            92
-
-
-  CHAPTER V. DREAMS.
-
-    Physiology of perception and of dreaming--Definition of the
-    act of dreaming--Revery--Production of illusions and
-    hallucinations by drugs and by disease--Effects of
-    hasheesh--Effects of acute disease--Association of ideas--
-    Memory of past sensations--Dreams produced by excitement of
-    the different organs of sense--Persistence of
-    dream-impressions after waking--Experience of M.
-    Baillarger--Of Professor Jessen--Belief of savages in the
-    reality of dreams--Sensory dreams--Intellectual dreams--
-    Repetition of dreams--Incoherence of dreams--Cause of the
-    superior vividness of certain dreams--Duration of dreams--
-    Dreams excited by morbid states of the body--Prophetic
-    dreams--Their causes--Clairvoyant dreams--Hallucinatory
-    dreams--Sir Edmund Hornby's experience--Hallucinations--
-    Case related by Dr. E. H. Clarke--Revelation through
-    dreams--Revival of memory in dreams.                               116
-
-
-  CHAPTER VI. SOMNAMBULISM.
-
-    Causes of somnambulism--Physiology of somnambulism--
-    Varieties of the disorder--Maury's classification--
-    Classification of Ball and Chambard--Diagrammatic
-    representation of their classification--Somnambulic
-    lethargy--Illustrative cases--Somnambulic dreams--Night
-    terrors--Somnolentia or sleep-drunkenness--Sleep-walking--
-    Illustrative cases--Condition of the special senses in
-    somnambulism--Relation of memory to the somnambulic
-    paroxysm--Illustrative cases--Occasional recollection of
-    incidents connected with the somnambulic dream--
-    Resemblances between the somnambulic state and the
-    condition of post-epileptic mania--Somnambulic visions--J.
-    P. Frank's case--Mesnet's case--Somnambulic life--Its
-    likeness with the double-consciousness of certain forms of
-    epilepsy--Illustrative cases--General theory of
-    somnambulism.                                                      166
-
-
-  CHAPTER VII. ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.
-
-    Antiquity of the phenomena of hypnotism--Modern
-    observations--Physical conditions favorable to the
-    phenomena--Methods of inducing the hypnotic state--Duration
-    of hypnotic sleep--Rudimentary states of hypnotism--
-    Investigations of the Society for Psychical Research--
-    Mind-reading--Physiological explanation of the process--
-    Charcot's observations on artificial somnambulism--
-    Cataleptic variety of the hypnotic state--Lethargic
-    variety--Somnambulic variety--Hypnotic clairvoyance--
-    Exalted sensibility of the brain in hypnotic states--
-    Susceptibility to suggestions from without--Phenomena of
-    so-called spiritualism--Table-rapping--Planchette--
-    Therapeutical employment of hypnotism--Metaphysical healing.       212
-
-
-
-
-CHAPTER I.
-
-THE NATURE AND CAUSE OF SLEEP.
-
-  Worn out, friend, is every theory,
-  But green the golden tree of life.
-                              --GOETHE.
-
-
-Natural sleep is that condition of physiological repose in which the
-molecular movements of the brain are no longer fully and clearly projected
-upon the field of consciousness. This condition is universally observed in
-all healthy animals; and its recurrence is intimately associated with the
-diurnal revolution of the earth, and the succession of day and night. The
-disappearance of daylight is, for the majority of living creatures, the
-signal for cessation of active life. Though its onset may be for a time
-delayed by an effort of the will, the need of rest at length overcomes all
-opposition, and the most untoward circumstances cannot then prevent the
-access of unconsciousness. The story of the sailor-boy, sleeping on "the
-high and giddy mast," is familiar to every one. An officer in the United
-States Navy has assured me of more than one instance in which men had
-fallen asleep under his own eyes, oppressed by exhaustion, during the roar
-of a long continued bombardment. Thus produced, the relation of cause and
-effect between weariness and sleep becomes very apparent. The refreshing
-influence of such repose points clearly to the restorative character of
-the physiological processes which persist during the suspension of
-consciousness. It also renders evident the final cause of that periodical
-interruption of activity which the brain experiences in common with every
-other living structure.
-
-Sleep is usually preceded for some time by a feeling of sleepiness. This
-sensation, like the analogous sensations of hunger and thirst, represents
-in some measure the progressive diminution of energy throughout the entire
-body; but it is chiefly expressive of the failure of cerebral energy. It
-produces a sense of general heaviness and intellectual dullness; the
-special senses become less alert, the eyelids droop, numerous groups of
-muscles experience the spasmodic contraction of yawning, the head drops
-forward and is recovered with a jerk, the limbs relax, and the whole body
-tends to assume a position convenient for repose. Every school-boy who has
-been compelled to pass an evening hour at a dull lecture, under the eye of
-a martinet monitor, will testify to the suffering which attends any
-unusual prolongation of this period. But, if the natural course of events
-be not obstructed, the stage of mere sleepiness is soon passed, and the
-introductory stage of sleep is entered. This is a state in which the
-individual is neither awake nor fully asleep. It is known as the
-hypnagogic state. During this period the phenomena of simple sleepiness
-become exaggerated to such a degree that the attitude of repose is assumed
-without effort if the body be permitted to follow the natural inclination
-of its different members. The eyes close, the other senses become
-inactive, though the sense of hearing is the most persistent. Released in
-considerable measure from the control of the brain, the reflex energy of
-the spinal cord is at first somewhat exalted. Witness the fibrillary
-twitching of the muscles, and the convulsive state, which may often be
-observed during the stage of somnolence after severe fatigue. The uneasy
-sleeper may even be roused to complete wakefulness by such involuntary
-movements. But, as sleep becomes more profound, the reflex functions of
-the cord are also weakened.[1] As the sensory organs retire from action,
-the intellectual faculties lose their equilibrium. First, the power of
-volition ceases. Then the logical association of ideas comes to an end.
-The reasoning faculty disappears, and judgment is suspended. We become,
-therefore, no longer capable of surprise or astonishment at the vagaries
-of memory and of imagination, the only faculties that remain in action. To
-their more or less unfettered activity we owe the presentation in
-consciousness of those disorderly pictures which, occurring in this stage
-of imperfect sleep, have been termed hypnagogic hallucinations.[2] During
-the early moments of this period an observant person may often retain a
-power of reasoning sufficient to remark the fact of dreaming, and this
-effort of attention may produce a partial awakening; but, usually, the
-subsidence of cerebral function is progressive and rapid. The fire of
-imagination fades, the field of consciousness becomes less and less
-vividly illuminated, the entire nervous apparatus yields to the advancing
-tide, and, finally, the dominion of sleep is fully confirmed. The sleeper
-knows nothing of the external world, and has lost all consciousness of his
-own existence. But the duration of profound repose is brief. From the end
-of the first hour the depth of sleep, at first, rapidly, then, more
-gradually, subsides. Dreams disturb its tranquility, mental activity
-increases, the power of volition revives, and, at the end of six or eight
-hours, the individual is once more awake. The subjoined diagram, borrowed
-from the Dictionaire Encyclopedique des Sciences Medicales, will
-facilitate the apprehension of these successive phases in the course of
-sleep:
-
-  +============================================================+
-  | Organic Life.                                              |
-  |    | Conscious Life.                                       |
-  |    |    | Imaginative Faculties.                           |
-  |    |    |    | Coordinative Faculties.                     |
-  |    |    |    |    | Special Sensation and Voluntary Motion.|
-  |----+----+----+----+----+-----------------------------------|
-  |XXXXXXXXXXXXXXXXXXXXXX  | Normal life.                      |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXX       |First stage of sleep--Hypnagogic   |
-  |                        |  hallucinations.                  |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXX            |Second stage of sleep--Dreaming.   |
-  |------------------------------------------------------------|
-  |XXXXXXX                 |Third stage of sleep.              |
-  |------------------------------------------------------------|
-  |XX                      |Profound sleep.                    |
-  |------------------------------------------------------------|
-  |XXXXXXX                 |First stage of waking.             |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXX            |Second stage of waking--Dreams.    |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXX       |Third stage of waking--Hypnagogic  |
-  |                        |  hallucinations.                  |
-  |------------------------------------------------------------|
-  |XXXXXXXXXXXXXXXXXXXXXX  |Complete awakening.                |
-  +------------------------------------------------------------+
-
-It was formerly believed that during the time of sleep all the processes
-of assimilation and nutrition throughout the body are increased,--in
-short, that it is the season of repair for the waste of tissue incurred
-during the hours of wakeful activity. While it is true that in sleep the
-expenditure of force is greatly reduced, the more exact researches of
-modern physiologists indicate a universal reduction in the rate of all the
-vital processes. The final result, however, is a general renewal of
-energy, because the aggregate income of the tissues is greater than their
-outgo during the suspension of conscious activity. The following
-observations make very apparent the fact of a reduction of physiological
-activity:
-
-_Respiration._--The process of breathing is conducted with greater
-deliberation during the period of sleep. This reduction is one of the most
-notable of the circumstances that first attract the attention of the
-spectator who observes a sleeping person. The average number of
-respirations per minute, in an adult of twenty-five to thirty years of
-age, is sixteen. Quetelet remarked[3] that during sleep this number was
-diminished by about one-fourth. The same fact has been recorded by other
-observers.[4] Mosso has also noted the fact[5] that there is a change in
-the type of respiration, the movements during sleep become less
-diaphragmatic and more largely costal. He furthermore observed that during
-the waking period the act of inspiration consumed 8-12 of the complete
-respiratory phase, but during sleep it was prolonged till it occupied
-10-12 of the same cycle. The interval between the end of expiration and
-the commencement of inspiration was also obliterated by sleep.
-Notwithstanding this relative increase of inspiratory motion, the quantity
-of air that passes through the lungs is considerably reduced by reason of
-the diminished action of the diaphragm. A corresponding reduction of the
-gaseous exchanges between the blood and the external air has been
-determined by the experiments of Pettenkofer and Voit, Boussingault,
-Lewin, and other equally competent observers.[6]
-
-_Circulation._--During sleep the heart beats less frequently than during
-the waking hours. Though a portion of this delay must be attributed to the
-recumbent position, sleep does still further retard the movement of the
-heart. My own observations upon children in bed exhibit a difference of
-twelve to sixteen beats between the pulsations when awake and asleep.
-According to Trousseau[7] the average number of pulsations observed in a
-group of thirty children, varying in age from fifteen days to six months,
-was 140 when awake and 121 when asleep. In another group of twenty-nine
-children, between the ages of six months and twenty-one months, the
-average was 128 when awake and 112 when asleep. The observations of Hohl
-and Allix[8] indicate that among very young children the difference
-between the pulse of sleep and the pulse of wakefulness may equal forty
-beats. According to Guy (_loc. cit._) the pulse is more variable in the
-morning than during the afternoon or evening.
-
-_Temperature._--Aside from the almost hourly fluctuations of the bodily
-temperature, a noticeable sinking of the temperature-curve is observed
-during the hours of sleep. This alone is sufficient to indicate a
-diminished rate of combustion in the tissues. Boussingault found[9] that a
-dove which consumed 255 millegrammes of carbon every hour while awake,
-oxidized only 162 millegrammes when asleep. Scharling also observed that
-the quantities of carbon successively oxidized by the same man when asleep
-and awake bore to each other the ratio of 1:1.237. The observations of
-Demme[10] indicate that increase of bodily temperature during the hours of
-sleep must be considered as the result of pathological processes in the
-tissues. The observations of Allix (_loc. cit._), made upon sixteen
-children during the first twelve days after birth, showed an average fall
-of 0 deg.38 C. during the hours of sleep. Eight children, between five and
-sixteen months old, exhibited a similar depression of 0 deg.56 C.; while ten
-children, ranging in age from twenty months to four years of age, averaged
-0 deg.34 C. less when asleep than when awake.
-
-The well-known experiments of Chossat, who found that the temperature of
-pigeons was from 0 deg.70 C. to 0 deg.90 C. higher at noon than at midnight, may
-not be considered satisfactory evidence of the depressing influence of
-sleep, because it is true that the diurnal variations of temperature which
-are conditioned by the vital activities of every animal might be
-sufficient to account for these differences. The experiments of
-Horvath[11] are more convincing. This observer found that the marmots upon
-which he experimented were accustomed to sleep during the winter for about
-four days continuously, and would then remain awake for an equal length of
-time. "During the sleeping period they can be cooled down to such a degree
-that a thermometer introduced into the rectum to the depth of an inch and
-a half indicated only 3 deg.F. above the freezing point. The temperature rose
-rapidly after the animal awoke, so that in the course of an hour it was
-3 deg.F. higher; at the close of the second hour 9 deg.F. higher, and at the end
-of the next half hour about 27 deg.F. * * Neither respiration nor the muscular
-movements were correspondingly augmented." This observation clearly shows
-the powerful influence of cerebral activity upon the liberation of heat
-within the body.
-
-_Secretion._--The functions of the numerous glands throughout the body are
-diminished during sleep. The tears dry up, and the cornea receives less
-moisture. Hence the stickiness of the margins of the eyelids during the
-sleep of a patient suffering with conjunctivitis. He can open his eyes, on
-awaking, only after sufficient time has elapsed to revive the lachrymal
-flow. Exner[12] remarks the diminution of pathological secretion in nasal
-catarrh during the hours of sleep. The mouth in like manner ceases to
-receive its full quota of saliva, and its cavity quickly dries if the lips
-remain open. The secretions of the gastro-intestinal glands vary with the
-contents of the alimentary canal; but in general they are considerably
-diminished, and digestion is correspondingly retarded during the hours of
-sleep. The quantity of urine is lessened during sleep.[13] The elimination
-of urea and of other excrementitious matters is less during the night than
-by day.[14] Unless increased by disease, or by accidental circumstances
-connected with atmospheric temperature and unnecessary clothing, the
-perspiration is also diminished.
-
-_Nutrition._--All the molecular processes of nutrition are reduced by
-sleep. The lowering of the bodily temperature has been already indicated.
-The observations of Helmholtz[15] indicate that the actual liberation of
-heat in the tissues is but little more than one-third of the amount set
-free in an equal period of time during the waking hours. The numerous
-experiments[16] of Boussingault, Henneberg, Scharling, E. Smith,
-Liebermeister, Pettenkofer, Voit, and Lewin, clearly indicate the fact
-that during sleep less oxygen is absorbed, and less carbonic acid gas is
-discharged, by the tissues. Voit found that while, during the daytime, 435
-grammes of oxygen were taken in by a working man, only 326 grammes were
-needed by the same individual during the nocturnal half of the day.
-Artificial sleep occasioned by chloral hydrate produced a similar
-reduction in the consumption of oxygen and in the formation of carbonic
-acid gas. Under the influence of morphine the reduction of CO_{2.} reached
-27 per cent., and the diminution of oxygen amounted to 34 per cent. of the
-quantities furnished during wakeful activity. The comparatively small
-reduction (only 6 per cent.) in the decomposition of the nitrogenous
-elements of the body during the same period, exhibits the close relation
-between the metamorphosis of the non-nitrogenous elements of the tissues
-and the amount of bodily activity.
-
-The experiments of Pettenkofer and Voit, to which allusion has just been
-made, serve also to illustrate the fact that all tissue changes are
-increased by every excitement of the sensory organs of the body, but are
-diminished by the subsidence of peripheral irritations. Hence the
-importance of quiet and darkness when we seek to induce that state of the
-body in which molecular processes should reach their minimum. Since every
-act of perception is attended by an outburst of refuse matter from the
-nervous tissue, the quantity of such excrementitious discharge in any
-given period of time becomes in some sort a measure of the vital activity
-of the organism. Conclusive proof of the diminution of vital function
-during sleep is thus obtained.
-
-It must not, however, be inferred that the general reduction of
-tissue-change, which has thus been established, during the hours of sleep,
-is evidence of a universal and uniform reduction of function throughout
-the body. Sleep seldom falls at once with equal force upon every organ;
-its invasion is progressive. Consequently, certain structures may be fast
-asleep, while others are partly awake,--while still other portions of the
-organism may be in a condition of activity greatly in excess of their
-ordinary wakeful function. Upon this fact depend the phenomena of dreams
-and the various forms of somnambulism. The special senses are usually
-overcome by sleep before the muscular apparatus yields, and the
-cerebro-spinal nervous centres are the last of all to succumb. The eyes,
-for example, cease to see clearly before the eyelids droop, or the muscles
-of the neck give way in the act of nodding. The senses of touch and of
-taste fail next in order, as in the case of the infant gourmand, who may
-be seen falling asleep at supper,--his mouth yet filled with untasted
-sweets from the table before him. The sense of smell is more persistent,
-and its exercise is sometimes an obstacle to the invasion of sleep.
-Witness the effect of powerful odors upon certain persons. The perfume of
-flowering plants in the sleeping chamber is sometimes decidedly annoying
-on this account. A lady of my acquaintance was once awakened out of a
-sound sleep by the smell of tobacco smoke from the pipe of a thoughtless
-burglar who had quietly entered a distant apartment of the house. A sudden
-change of wind, deluging a city with the vapors of a glue-factory or
-rendering establishment, may in like manner disturb the slumbers of
-thousands of people.
-
-The sense of hearing seems to be the most persistent of all the special
-senses. It is not a very uncommon thing for persons to be awakened by the
-sound of their own snoring; or, if not actually aroused by the noise, to
-remain in a condition of repose which seems to be sustained and cheered by
-the regular rhythm of its own music. As a general rule, however, it is
-noteworthy that, when not wholly dormant, each sense finds its sphere of
-activity greatly narrowed by the fact of sleep. Consequently the range of
-perception, if not wholly obliterated, is greatly limited during the time
-of sleep.
-
-While it is true that sleep arrests the voluntary activities of the
-muscles, it is also a fact that all the muscles do not yield at once or in
-equal degree. The extensors of the neck, and the supporters of the spinal
-column, are the first to fail. The patient begins to nod, and is inclined
-to fall forward, before consciousness ceases. The muscles of respiration
-and of circulation continue to contract, though at a diminished rate. The
-vermicular movements of the intestinal coats persist, and in certain
-conditions of ill-health their exaggerated contractions may become a cause
-of imperfect repose. Reflex movements may always be excited during natural
-sleep. Tickling the sole of the foot will cause retraction of the limb;
-and before the complete establishment of sleep, a certain exaltation of
-the spinal reflexes may be observed. Young children may frequently be seen
-in the act of suction with their lips, as if at the breast; and the smile
-of the sleeping infant is a matter of daily remark in every nursery. The
-influence of dreams as an excitant of muscular movement will be hereafter
-discussed.
-
-The variation of intellectual function which appears in sleep serves to
-measure its profundity and to indicate the extent of its invasion. The act
-of perception being dependent upon sensation, it is to be observed that
-the range of perception diminishes so soon as the organs of sense begin
-to yield. Its intensity may not immediately fail, but the breadth of its
-scope is narrowed. Sometimes, however, the act of conscious perception is
-arrested before the organs of sense are sealed. The sleepy reader may
-continue to eye the page before him, perhaps even to read aloud for a
-considerable time after he has ceased to derive any meaning from the words
-of the book. In such cases the organs of perception and conception and
-association of ideas slumber before the bonds of connection between the
-will and the muscular organs have been completely relaxed. Such an example
-affords a valuable illustration of the division of the brain into separate
-mechanisms which, though most intimately related, are nevertheless
-partially independent of each other. Sleep may operate like an invasive
-disease, falling with unequal incidence upon the different structures that
-make up the mass of the brain, paralyzing one portion, while simply
-benumbing another, and even arousing to excessive activity a third.
-Consequently the intellectual functions may be very unequally disturbed,
-and the order of their subsidence may be considerably varied; but, as a
-general rule, the physiological relations of the faculties are respected,
-so that as sensation diminishes, perception fails, the conception of ideas
-is correspondingly hindered, and the association of such ideas as are
-still projected upon the field of consciousness becomes more imperfect.
-The loss of the power of association implies the destruction of memory and
-the impossibility of exercising the reasoning faculty or of forming those
-judgments upon which every act of volition is based. When the brain has
-at length been so far overwhelmed that physical impressions can no longer
-reach the field of consciousness, all manifestation of intellectual life
-is at an end, and the sleeper sleeps a dreamless sleep that leaves no
-trace behind.
-
-It is assumed in the last sentence that the brain may become so far
-transformed by sleep that it ceases for the time to be capable of function
-as the instrument of thought. This conclusion has been questioned by the
-very highest authorities. Sir William Hamilton, Exner, and many others
-have instituted numerous experiments to test the possibility of a
-dreamless sleep. Causing themselves to be suddenly aroused at all hours of
-the night, they invariably found themselves at the instant of awaking
-occupied with the course of a dream. Hence it has been inferred that the
-mind is always alert, even when the body is most thoroughly asleep. In
-explanation of the fact that consciousness contains after deep sleep no
-trace of such mental activity, it is claimed that the act of dreaming of
-which we are aware at the moment of waking is proof of intellectual
-function during the moments which preceded that incident, and that we are
-merely forgetful of all similar processes that occurred during undisturbed
-sleep. The unconsciousness of sleep, according to this theory, is not
-real--it is only apparent through failure of the memory. If this be true,
-memory is the only intellectual faculty of whose inaction we can be sure.
-The period of deep sleep might then be, for all we know to the contrary, a
-period of the most intense and exalted mental activity. But, if so, it is
-quite worthless as a constituent of our conscious existence. It may also
-be objected with equal reason that the dreams which unquestionably occupy
-the field of consciousness at the instant of waking are probably excited
-by the impressions which terminate sleep. The process of waking, though
-often very greatly hurried, is by no means absolutely instantaneous. As we
-shall learn, the time requisite for the evolution of a dream may be
-indefinitely brief. Consequently, it seems better in all such instances to
-assign the period of dreaming to the time of diminishing slumber that
-corresponds to the disturbance by which sleep was terminated.
-
-The only reason for any hesitation in the acceptance of such a proposition
-consists in the reluctance of many philosophers to admit the possibility
-of any interruption in the active life of a spiritual being, such as man
-is conceived to be. But it is difficult to comprehend any valid reason for
-the denial of such interruption. Every form of force, of which we have any
-knowledge, is subject to fluctuations in the course of its phenomenal
-manifestation. When a physical force ceases to exhibit itself in an active
-state, and passes into a potential modification, we are not compelled to
-regard it as extinguished. It is merely latent or inhibited, but always
-ready to take its place again among the kinetic forces of nature. In like
-manner there seems to be no good reason why that spiritual force or
-congeries of forces which constitutes the mind of man may not experience
-analogous transformations in successive periods of action and of repose.
-Such periods of rest occur in sleep, in coma, in disease and
-disorganization of the brain. The mind sleeps, it does not cease to
-exist--probably not even when death dissolves its material substratum.
-
-That the depth of sleep is exceedingly variable is evident in the
-experience of every one. A German physiologist[17] has made a rough
-estimate of the soundness of sleep by comparing the loudness of the noises
-necessary to wake the subject of experiment at regular intervals during
-the course of the night. He arranged a gong with a pendulum attachment,
-and noted the length of the stroke which produced a sound sufficiently
-loud to awaken the patient. In this way the different degrees of intensity
-of the awakening noise could be calculated, and the corresponding depth of
-sleep could be estimated. It was thus concluded that the depth of sleep
-increases rapidly during the first hour, at the end of which time it has
-reached its maximum. During the next half hour it diminishes as rapidly as
-it had increased in the first half hour. During the next hour it still
-further diminishes, almost as much as it increased during the second half
-hour. The remaining ten half hours of the experiment were occupied by a
-comparatively light and gradually diminishing slumber, until the vanishing
-point of sleep was reached at the expiration of eight hours from its
-commencement. This observation corresponds with the general opinion that
-sleep is deepest in the early part of the night. For the same reason
-dreams and wakefulness are most frequent during the early watches of the
-morning.
-
-When considering the causes of sleep it is needful to exclude from view
-those artificial varieties of sleep that are produced by the various
-narcotic drugs, as well as the counterfeits of sleep which result from
-diseased conditions of the body. It is comparatively easy to frame
-hypotheses in explanation of such interruptions of our conscious life;
-but, when we attempt to formulate a theory which shall satisfactorily
-account for the occurrence of natural sleep in healthy animals, the task
-becomes exceedingly difficult.
-
-First among the causes of sleep may be reckoned the alternation of day and
-night. With the disappearance of sunlight all nature sinks into a
-condition of repose.
-
-       "The night brings sleep
-        To the greenwoods deep,
-  To the bird of the woods its nest;
-        To care soft hours,
-        To life new powers,
-  To the sick and the weary--rest!"
-
-In this tendency to nightly inaction man shares with all other living
-creatures. His body thus testifies to the intimacy of its relations with
-all portions of the solar system. Originated in the tropical regions of
-the earth, where day and night are nearly equal, we find in all parts of
-the world the same hereditary need of a period of rest, nearly coincident
-with the duration of the shorter nights of the tropical year. Had the
-birth-place of primeval man been situated within the Arctic circle, it is
-probable that his hours of sleep might have differed considerably from
-the number now needed by the average individual. So powerful are the
-necessities thus dependent upon the harmony between our organization and
-the movements of the earth, that if the habit be formed of sleeping at
-other hours than those which are usually devoted to that purpose, the full
-complement of sleep is still needful to satisfy the demand for rest.
-
-Prominent among the causes which predispose to sleep at night is the
-cessation of a majority of the sensations that are continually pouring in
-upon the brain during the period of daylight. Hence the necessity for
-seclusion in darkened rooms, from which the noises of the daytime are shut
-out, if one would sleep during the long days of the arctic summer, or if
-one would enjoy a midday nap at any season of the year. The close
-dependence of wakefulness upon the constant activity of the organs of
-sensation, is well illustrated by a case related in Hermann's _Handbuch
-der Physiologie_, Vol. II, Part 2, p. 295. A young man had been reduced by
-disease to such a condition of general anaesthesia that the right eye and
-the left ear were the only remaining paths of sensation between his brain
-and the external world. Whenever the sound eye and ear were bandaged so as
-to cut off all communication with the brain, the patient invariably fell
-asleep in the course of two or three minutes after the interruption of
-sensation. In like manner, some people, even in perfect health, are able
-to sleep at any time by simply lying down and closing the eyes. Such
-persons, however, are not often very highly gifted in the intellectual
-sphere. They generally belong to a class of men whose lives are laborious
-and liable to great irregularity and fatigue. Such people labor in the
-open air, where every organ of sense is in a state of continual
-excitement. As soon, therefore, as they can find a quiet corner from which
-the commotion of the elements is excluded, it is only necessary to close
-the eyes--the principal avenue of communication with the outside
-world--and sleep begins at once. This is especially true if severe bodily
-exertion has preceded the opportunity for repose.
-
-Fatigue of any sort is one of the most energetic causes of sleep. The
-impossibility of long sustained exertion is a fact almost too familiar to
-attract attention. Every muscle must be suffered to rest for a time after
-contraction before it can be again contracted. Even the heart and the
-muscles of respiration must be allowed to enjoy regular periods of repose
-many times each minute. These are examples of local rest, not involving
-the entire body. But if the whole body participate in any violent action,
-every part will manifest a consequent disposition to rest. Witness the
-effects of the venereal act. Every muscle is relaxed; the brain, which has
-officiated as the supreme source of energy, experiences exhaustion, and
-sleep frequently terminates the voluptuous paroxysm. In like manner,
-sensations of severe pain, if sufficiently prolonged, become a cause of
-sleep. Prisoners upon the rack have slept through sheer exhaustion while
-undergoing the horrors of torture. Little children frequently fall into a
-deep sleep immediately after painful, though comparatively bloodless,
-surgical operations performed without anaesthetics. The depressing
-emotions, even, may so fatigue the brain as to induce sound sleep through
-reaction from previous excitement. Every wearied portion of the body must
-rest; and when the brain thus rests, sleep is the consequence.
-
-Impressed by the force of such considerations, certain physiologists[18]
-have reasoned from the analogies suggested by a study of the results of
-muscular fatigue, and have suggested an hypothesis accounting for the
-occurrence of sleep by a supposed loading of the cerebral tissues with the
-acid products of their own disassimilation during wakeful activity. The
-acid reaction of the brain and of the nerves after exertion, corresponding
-with the development of acids in the muscular tissues during contraction,
-suggested the probability that an excessive presence of lactic acid and
-its sodic compounds might be the real cause of cerebral torpor and sleep.
-Could this hypothesis be proved, ordinary sleep would take its place along
-with the states of unconsciousness induced by anaesthetics and hypnotics,
-and the lactate of sodium should be found the very best of medicines for
-the relief of wakefulness. Its administration for this purpose, however,
-has yielded only the most discordant and unsatisfactory results. The
-fatigue theory, moreover, is insufficient, since it furnishes no
-explanation of the invincible stupefaction produced by cold, nor does it
-render intelligible the unbroken sleep of the unborn child.
-
-Far more comprehensive is the hypothesis advanced by Pflueger.[19]
-According to this view, the state of wakefulness is maintained by a
-certain degree of activity in the cortical substance of the brain. Like
-all other bodily organs, this substance is renovated by the assimilation
-of nutrient materials derived from the blood. By this process oxygen is
-stored up in chemical combination, forming "explosive compounds," whose
-precise composition is not fully understood. When for any reason the
-supply of oxygen is insufficient, as in hemorrhage, producing cerebral
-anaemia, or in impregnation of the red blood corpuscles with carbonic oxide
-or chloroform, or other substances capable of excluding oxygen from the
-hemoglobin of the corpuscle, the cerebral tissues are imperfectly
-renovated. The explosive constituents of the cortical protoplasm are then
-inadequately renewed after mental activity, and the sensitive portions of
-the brain are no longer fitted to manifest the highest forms of
-intelligent activity. But, when nothing interferes with healthy nutrition,
-the requisite degree of instability in the protoplasm of the brain is
-effected by intussusception of oxygen. Under the influence of the various
-nervous impressions which reach the brain, the unstable protoplasmic
-compounds break up into simpler forms. The motion thus liberated by these
-"explosions" of excitable matter is, in some way at present utterly
-inconceivable, projected upon the field of consciousness where the mind
-dwells; and we are thus brought into conscious relation with the external
-world.
-
-That the capacity for thus signalling across the gulf which divides
-matter from mind is the result of a certain perfection and complexity of
-physical structure is rendered probable by the utter failure of the
-infra-cortical organs alone to impress the conscious intelligence by any
-amount of independent activity. The same thing is also indicated by the
-unconscious sleep of the rudimentary foetal brain, and by the brevity of
-the intervals of wakefulness which mark the life of the new born babe.
-That this capacity is dependent upon a special mobility of the atoms of
-the brain, is shown by the speedy cessation of intelligence which follows
-great reduction of temperature, as in hibernation, or during exposure to
-severe frost. That its exercise is largely dependent upon the activity of
-the senses is proved by interference with their function, as in the case
-above quoted (see p. 18) from the observations of Struempell.
-
-The dependence of the waking state upon the presence and activity of a
-sufficient quantity of a peculiarly unstable form of protoplasm in the
-brain is an hypothesis which presents no great difficulty of
-comprehension. But how may we explain the lapse from the intelligent
-vivacity of that waking state into the unconscious inactivity of sleep? I
-have elsewhere[20] discussed the manner in which artificial sleep is
-produced by impregnation of the brain with anaesthetic substances that
-interfere with sensibility, and finally produce stupefaction, by hindering
-the normal processes of intra-molecular oxidation in the protoplasm of the
-nervous tissues. The same general line of argument may be extended to
-cover the action of every narcotic agent with which the living substance
-of the body may become surcharged. Accepting, then, the hypothesis
-advocated by Obersteiner and Preyer, it becomes an easy thing to account
-for the gradual onset of sleep by supposing an accumulation of the
-"fatigue producing" products of intra-molecular oxidation. But we cannot
-thus explain the rapid and, as it were, voluntary passage from wide
-awakefulness into a condition of deep sleep, such as may be commonly
-observed among sailors and others who have formed the habit of going at
-once to sleep at regularly recurring hours of the day or night. Certain
-writers have endeavored to account for this fact by imagining a special
-mechanism at the base of the brain (choroid plexuses of the fourth
-ventricle, etc.,) by means of which the current of the blood through the
-brain may be voluntarily diminished, with a consequent arrest of conscious
-activity. But, still adhering to the hypothesis of Pflueger, we shall
-obtain a clearer explanation of the facts by considering the phenomena
-connected with the succession of impressions upon the organs of sense. It
-has been ascertained[21] that such impressions must persist for a certain
-measurable length of time in order to excite conscious perception. A sound
-must be prolonged for at least fourteen-hundredths of a second, a ray of
-light must agitate the retina for about eighteen to twenty-hundredths of a
-second, an ordinary contact with the surface of the skin must continue
-from thirteen to eighteen-hundredths of a second, in order to awaken any
-knowledge of sound and light and tactile sensation. For the simplest act
-of perception from two to four-hundredths of a second are necessary. It
-is, therefore, perfectly reasonable to suppose that when the "explosive
-material" of the brain has been sufficiently "dampened" by the
-accumulation of acid refuse which accompanies prolonged cerebral effort,
-the impressions of sense may no longer suffice to excite in the cortical
-protoplasm vibrations of sufficient length, or following each other in
-sufficiently rapid succession, to sustain consciousness. The cortex of the
-brain may then be likened to a body of water into which bubbles of
-partially soluble gas are introduced from below. When the bubbles are
-large, and when they follow each other rapidly, a continual effervescence
-is maintained upon the surface of the water. But if the size of the
-bubbles be reduced, or if the solvent capacity of the liquid be increased,
-the surface will become almost, if not quite, perfectly tranquil. In some
-such way, without any great danger of error, may we picture forth the
-manner in which the generation of ideas in the field of consciousness is
-related to the molecular movements in the space occupied by the
-protoplasmic substance of the brain. Returning, now, to the rapid
-induction of sleep, we find that it is usually the experience of people
-who lead an active life in the open air, and are compelled to endure
-frequent interruption of their rest. The sailor who is trained to work
-four hours on deck, and then to sleep four hours below, has been virtually
-transformed by this habit into a denizen of a planet where the days and
-the nights are each but four hours long. His bodily functions become
-accommodated to this condition; his nervous organs store up in sleep a
-supply of oxygenated protoplasm sufficient only for an active period of
-four or five hours; so that, when the watch on deck is ended, he is in a
-state as well qualified for sleep as a laborer on shore at the close of a
-day of twelve or fifteen hours. Moreover, the majority of those who can
-thus easily fall asleep are individuals whose waking life is almost
-entirely sustained by external impressions. So soon, therefore, as such
-excitants are shut out by closing the eyes in a place of shelter from the
-sounds and turmoil of the air, comparatively little remains for the
-stimulation of ordinary consciousness, and sleep readily supervenes
-through mere lack of cerebral excitement, especially if the excitable
-matter of the brain has been previously overwhelmed by the products of
-active exertion.
-
-That analogous, though not identical, predisposition to unconsciousness
-may also be rapidly induced by modifications of the cerebral circulation
-is proved by the sudden reduction of cerebral excitability and
-consciousness which occurs during the act of fainting. In this counterfeit
-presentment of sleep the important part played by variations of the blood
-current through the brain is so conspicuous that certain writers have
-attempted to show that genuine sleep is the result of a diminution in the
-flow of blood to the cortex of the brain. An ingenious physician has even
-attempted to relieve insomnia very much as a surgeon might undertake to
-cure a popliteal aneurism--by placing tourniquets on the arteries leading
-to the affected part. But the mere fact that syncope produces
-unconsciousness does not prove that "cerebral anaemia" should be elevated
-to the rank of the principal cause of natural sleep. The nervous process
-is the primary factor. The circulation of the blood is everywhere under
-the immediate control of the nervous system. Consequently, every change in
-the condition of the nervous structures is followed by a corresponding
-change in the state of the circulating apparatus. Wherever an organ is
-aroused to activity, so delicate are the adjustments by which it is
-connected with the brain and with the heart that it is at once irrigated
-by an increased flow of blood. When its functional activity subsides, the
-same mechanism provides for a corresponding reduction in the supply of
-blood to its tissues. The brain itself forms no exception to this law.
-This has been admirably shown by the observations of Professor Mosso, of
-Turin.[22] The learned professor enjoyed the rare opportunity of observing
-three individuals who had suffered the loss of a considerable portion of
-the bony walls of the cranium, exposing the surface of the cerebrum, and
-affording a view of the pulsation of the vessels of the brain. With the
-aid of the cardiograph, the sphygmograph, the hydrosphygmograph, and the
-plethosphygmograph, it became possible to register the circulation of the
-blood in the brain, and to compare that portion of its course with the
-coincident circulation in other parts of the body. It was thus shown that
-every increase of emotional or intellectual activity was attended by an
-increase in the activity of the cerebral circulation. This increase was
-procured at the expense of other portions of the body, which exhibited a
-coincident reduction in the amount of blood received from the heart. The
-occurrence of sleep caused a diminution in the number of respirations,
-and a fall of six or eight beats in the pulse. The volume of the brain and
-its temperature were at the same time slightly reduced, through the
-diversion of blood from the head to other regions of the body. The
-consequent dilatation of the vessels in the extremities was readily
-demonstrated by the use of the plethosphygmograph. The extreme
-sensitiveness of the nervous centers was further illustrated by the fact
-that if, during sleep, a ray of light were directed upon the eyelids, or
-if any organ of sense were moderately excited without waking the patient,
-his respiration was at once accelerated; the heart began to beat more
-rapidly, the vessels of the extremities contracted, and the blood flowed
-more freely into the brain. Similar results accompanied the act of
-dreaming. The return of full consciousness on waking was followed by an
-immediate increase in the activity of the intra-cranial circulation.
-
-The extreme susceptibility of the brain to influences proceeding from
-artificial disturbances in the circulation, was exhibited in the case of
-one of Professor Mosso's patients. By compression of the carotid arteries,
-unconsciousness was induced, and an attack of convulsions was aroused. In
-no other part of the body can a corresponding disturbance of function be
-so quickly produced by similar means. A limb may be rendered bloodless for
-nearly half an hour, by the application of an elastic bandage, and yet its
-sensory nerves will remain capable of transmitting impressions from the
-periphery. But in this case, compression of the carotids for only eight
-seconds was sufficient to abolish consciousness and to excite convulsive
-movements.
-
-In all such observations it is worthy of note that the nervous impression
-is the primary event so long as artificial disturbances are not intruded.
-The changes of blood-pressure and circulation were invariably secondary to
-the excitement of nerve tissue. Sleep, therefore, must be regarded as the
-cause, rather than the consequence, of the so-called cerebral anaemia which
-obtains in the substance of the brain during repose. This condition of
-"anaemia" is nothing more than the relatively lower state of circulation
-which may be remarked in every organ of the body during periods of
-inactivity. Every impression upon the sensory structures of the brain
-occasions a corresponding liberation of motion in those structures. The
-movement thus initiated arouses the vaso-dilator nerves of the cerebral
-vessels and excites the vaso-constrictor nerves of all other portions of
-the vascular apparatus. Hence the superior vascularity of the brain so
-long as the organs of sense are fresh and receptive. Hence the diminishing
-and varying vascularity of the different departments of the brain as sleep
-becomes more or less profound. These modifications of the brain and of its
-circulation are well illustrated by the effects of a moderate degree of
-cold applied to the cutaneous nerves of the body, as not unfrequently
-happens when the night grows cool towards morning. The disturbance of the
-sensitive nerves of the skin is transmitted to the brain. The excitement
-of this organ causes dilatation of its vessels, and increased irritability
-of the cortical instrument of perception. This becomes the starting point
-for the projection of impulses upon the field of consciousness, producing
-dreams, or even a complete awakening from sleep.
-
-The cause of sleep must, therefore, be sought in the molecular structure
-of the brain, rather than in fluctuations of the blood-current. In the
-present state of our knowledge it must be negatively represented as the
-consequence of a deficiency in the amount of movable oxygen in the nervous
-tissue. This deficiency may be the result of immaturity, as in the foetus,
-or in the new-born infant; or it may result from the accumulation of an
-excess of the waste-products of intra-molecular oxidation during
-functional activity--products which hinder the further passage of oxygen
-into stable combination with the oxidizable elements of protoplasm. Sleep
-thus produced differs from the artificial sleep induced by narcotic drugs,
-in the fact that its cause is self-generated by the instrument of thought,
-while narcotic stupor is caused by the intrusion of substances derived
-from without--substances which, like the natural refuse of the living
-cells, more or less completely hinder the processes of oxygenation and
-oxidation within the tissues of the body. Hence the states of healthy
-sleeping and waking must necessarily be self-limited and regularly
-successive; while the state of narcotism is purely accidental, and its
-duration exactly corresponds with the variable length of the period during
-which the body may remain impregnated with the hypnotic agent.
-
-Certain morbid forms of sleep further illustrate its dependence upon the
-persistence of depression in the functional activity of the brain. For
-some persons this seems to constitute their normal condition. They are
-either excessively fat, red-faced, and soaked with beer, or they are pale,
-anaemic, and pulpy, with flabby muscles and a feeble circulation. They fall
-asleep whenever left to themselves, and never seem to be fully aroused to
-active life. The fat boy who figures so amusingly in The Pickwick Papers,
-furnishes a life-like picture of this variety of _somnolence_.
-
-The introductory stage of the eruptive fevers is often characterized by
-somnolence. It also frequently appears as the forerunner of coma in the
-various diseases which terminate in unconsciousness and death. A singular
-example of this has been observed among the negro inhabitants of the
-Atlantic coast of tropical Africa. The disorder is known to English
-writers as _sleeping dropsy_; by the French it is called _maladie du
-sommeil_. It is characterized by daily paroxysms of somnolence which tend
-to become more and more continuous and profound until they are finally
-merged in fatal coma. For our knowledge of the disease we are chiefly
-indebted to the description by Clark,[23] an English surgeon who practised
-in Sierra Leone, and to the monograph by Guerin,[24] a French naval
-surgeon, who had enjoyed exceptional opportunities for observation among
-the laborers who had been carried from Africa to the island of Martinique.
-Similar cases have been occasionally reported in other regions of the
-world, but it is among the Africans that it has been principally remarked.
-The onset of the malady is gradual, commencing with a slight frontal
-headache. After a few days a disposition to sleep after meals is noted.
-This becomes increasingly urgent, and the intervals of sleep are prolonged
-until at length the patient becomes continually soperose. The waking
-periods are marked by a sluggish state of the intellectual faculties. The
-pulse is not accelerated, and it remains full and soft. The veins of the
-sclerotic are turgid, and the eyeball seems unusually prominent. The
-temperature does not increase, but rather tends to diminish its figure.
-The skin is dry and moderately cool. The tongue continues moist, and is
-covered with a white fur. The bowels and the bladder are regularly
-emptied, and the appetite persists with considerable vigor. Finally, the
-patient becomes completely comatose, and dies quietly. Sometimes, however,
-the evolution of the disease is less tranquil. Epileptiform convulsions,
-followed by progressively deepening periods of coma, interrupt its course,
-and a continuous muscular agitation marks the closing scene. At the same
-time the pulse grows weaker and more frequent until its movements cease in
-death. Recovery is almost unknown, though the duration of the disease
-often varies from three months to a year or longer. Examination of the
-body after death yields very negative results; the sinuses and larger
-vessels of the brain are engorged with blood, but no evidence of
-inflammation is anywhere apparent. The other organs present no
-pathological alterations whatever. These observations seem to indicate
-that the disease originates in some form of general blood-poisoning,
-rather than in any local inflammation or degeneration. Dr. Clark has
-called attention to an enlargement of the cervical glands as a feature of
-the malady. According to Dr. G. H. Bachelder,[25] the native physicians
-cure the disease by extirpation of the affected glands. He has also
-observed an initial lesion in the nasal mucous membrane. If this be
-confirmed, the malady will take its place among the forms of somnolence
-produced by infection of the blood.
-
-Between the profound unconsciousness of natural sleep and _coma_ may be
-placed the distinction that the one is always the consequence of healthy
-physiological processes, while the other is always the result either of
-injury, of disease, or of some form of intoxication. Comatose
-unconsciousness may be the result of cerebral compression caused by injury
-of the head, or by the presence of an inflammatory exudation.
-Intra-cranial tumors, embolisms, thrombi, diseases of the cerebral
-arteries, and degenerations of the brain,--in short, every morbid change
-of which the liquids and the solids within the cranium are capable--may
-become the cause of coma. Toxaemic conditions of the circulating fluids of
-the body may benumb the brain with comatose sleep. Few diseases,
-therefore, exist without the possibility of coma as one of their
-consequences--a coma which, however, must not be confounded with the
-genuine sleep which sometimes occupies the larger part of convalescence
-from acute illness. During such convalescence there is a reversion to the
-infantile type of nutrition with all its need of prolonged and frequent
-periods of repose. Like normal sleep, the comatose condition admits
-considerable variation of intensity. The patient may sometimes be
-partially roused, as from the coma of alcoholic intoxication, and he may
-finally recover complete consciousness; but very often the reverse is the
-fact. The coma deepens into paralysis of the respiratory centres, and
-death concludes existence without the slightest manifestation of
-sensibility or intelligence.
-
-_Lethargy_ is a pathological variety of sleep, in which the repose of the
-body is even more complete than in coma. The victim of coma often presents
-a countenance suffused with blood; the pulse beats vigorously, and
-respiration may become stertorous. But in lethargy the abolition of bodily
-movement is almost absolute. In the milder forms of this disorder the
-patient may be partially roused, so as to attempt an answer when
-addressed, appearing like a person in very deep sleep; but in the majority
-of cases he remains insensible, unconscious, and utterly irresponsive to
-ordinary forms of irritation. Respiration and circulation are reduced to a
-minimum, and may, even for a time, become imperceptible. Uncomplicated
-with hysteria, the disorder is rapidly fatal, but, according to
-Rosenthal,[26] hysterical lethargy is never mortal.
-
-Many examples of this disease have been afforded by the records of
-apparent death. I am well acquainted with a lady who, in early childhood,
-had been laid out for burial at the supposed termination of some infantile
-illness. Her mother alone insisted that the child was still alive. After
-some time spent in weeping and expostulation, she applied a blister to the
-thorax of the babe. This soon excited evidences of painful irritation,
-followed by a complete recovery. Still more instructive is the case,
-narrated by Rosenthal,[27] of a young woman, twenty-four years of age,
-who, in consequence of violent emotional excitement, became unconscious,
-and presented no signs of life, though tested by placing a mirror before
-the mouth, and by dropping melted sealing-wax upon the skin. On raising
-her eyelids, the pupils gave no reaction to light; the limbs remained
-perfectly flaccid, and the radial arteries were pulseless. Careful
-auscultation, however, detected a very feeble and intermittent sound in
-the cardiac region. The walls of the chest exhibited no movement, but the
-lateral surfaces of the abdomen presented a slow and almost imperceptible
-oscillation. Gentle faradization of the muscles and nerves of the face,
-arm, and hand, excited definite muscular contractions. By this method
-Rosenthal became satisfied that, although the patient had remained for
-thirty-two hours in this condition, she was only apparently dead. In fact,
-after continuing forty-four hours in a state of suspended animation, she
-awoke spontaneously, made a rapid recovery, and seemed to enjoy as
-comfortable health as an excitable, nervous temperament would permit.
-
-Certain authors make a distinction between lethargy and apparent death;
-but the difference is one of degree rather than of kind. The movements of
-respiration and of circulation, though greatly enfeebled, are readily
-observed in ordinary forms of lethargy; but in apparent death the pulse
-can no longer be discovered, and nothing more than the faintest sound can
-be distinguished in the region of the heart. It, therefore, becomes
-important to have within reach a crucial test of the persistence of
-general vitality. Such evidence, according to Rosenthal, is furnished by
-the faradaic current. Within two or three hours after actual death, the
-muscles cease to respond to the induced current; but in apparent death
-this form of electro-muscular contractility never disappears. Every other
-test that has been proposed has failed under certain circumstances.
-Observation of the changes in muscular temperature during electrical
-excitation is a method better adapted to the laboratory than for clinical
-practice.
-
-_Lucid lethargy._--In certain cases of apparent death the patient exhibits
-all the external appearance of suspended animation, but the power of
-conscious perception does not cease. The senses of sight and hearing
-remain, and are, perhaps, intensified by inhibition of the power of
-voluntary movement. The sufferer sees and hears; perception, emotion,
-memory, the power of reasoning, judgment, volition, all persist. Only the
-power of executing voluntary movements is lacking.
-
-The victims of this variety of apparent death are usually women, or men
-who are characterized by a feminine nervous organization. Great mental
-excitement, fatigue, semi-starvation, and exhausting diseases, are the
-principal exciting causes of the event. The following case, related by my
-friend, Dr. P. S. Hayes, of Chicago, illustrates the phenomena of lucid
-lethargy. The patient was a female physician, about thirty years of age,
-unmarried, and consumptively inclined. During the course of a long and
-wearisome hospital service, she was prostrated with typhoid fever.
-Placing herself under the immediate care of my informant, she was also
-attended by several of the most eminent physicians in the city. After a
-long and exhausting illness she appeared to be dying. In the presence of
-her physician, and surrounded by her relatives, she ceased to breathe. The
-pulse stopped, life seemed to have gone out. Bottles of hot water were
-applied to the limbs, and various restoratives were employed. After a
-considerable time she began again to breathe, and a gradual recovery
-followed. During the whole time of apparent death, consciousness had been
-preserved. She seemed to be looking down from a point above her bed; she
-could see the doctor feeling for her pulse, and was grieved by the sorrow
-of her friends. Ordinary sensation was temporarily suspended, and she
-could not distinguish the contact of the hot-water bottles that were
-applied to her limbs, though actually scalded by their excessive heat.
-Borne upon the wings of an excited imagination, she thought herself
-permitted to look into heaven, but was not suffered to enter its gates. In
-this exaltation of the imagination the reasoning faculties also shared, so
-that certain philosophical problems which had previously baffled her
-intellect were now perfectly comprehensible, and the memory of their
-solution persisted after recovery.
-
-Many similar narratives have been duly authenticated, but the limits of
-the present chapter will not permit a discussion which properly belongs to
-an investigation of the phenomena of trance. The important fact for
-present consideration is the persistence of conscious life, despite the
-appearance of death. In this preservation of consciousness,
-notwithstanding the temporary suspension of certain kinds of sensibility
-and the power of voluntary motion, may be discovered a relationship
-between the phenomena of lucid lethargy and various disturbances of sleep,
-which will be considered in a succeeding chapter.
-
-
-
-
-CHAPTER II.
-
-INSOMNIA, OR WAKEFULNESS.
-
-              Sleep, gentle sleep,
-  Nature's soft nurse, how have I frighted thee
-  That thou no more wilt weigh mine eyelids down
-  And steep my senses in forgetfulness?
-                                  --KING HENRY IV, SECOND PART.
-
-
-We have seen that the condition of normal sleep is determined by a
-peculiar molecular state of the substance of the brain--a modification
-regularly alternating with that by means of which the condition of
-wakefulness is sustained. We have also seen that sleep is liable to
-variations in its intensity, and that its course may be partially
-interrupted by dreams, or even by a more or less complete resumption of
-the movements of locomotion, constituting the different varieties of
-somnambulism. Our attention must now be directed to the consideration of
-those greater disturbances of sleep which either serve to prevent its full
-development, or else to actually interrupt its course, rendering it
-incomplete and fragmentary, or even abolishing it altogether. But,
-inasmuch as the healthy brain, when associated with a healthy body, can
-only by an extraordinary effort of the will be kept awake beyond a certain
-period, and then only for a short time beyond the ordinary interval of
-wakefulness, it follows that the study of the usual causes of insomnia
-must be an investigation of morbid conditions of the bodily functions.
-Sleeplessness, therefore, must result, 1st, from a disturbance of the
-peripheral sensory organs of the nervous system; 2nd, from disordered
-conditions of the sensory nerves and nerve tracts; 3rd, from morbid states
-of the brain; 4th, from any or all of these conditions operating in
-association with each other. We may, therefore, consider, I, _Insomnia
-caused by irritation of the peripheral portions of the sensory apparatus_;
-and, II, _Insomnia caused by morbid states of the central nervous organs_.
-
-
-I. INSOMNIA CAUSED BY IRRITATION OF THE PERIPHERAL PORTIONS OF THE SENSORY
-APPARATUS.
-
-Irritation of the sensory apparatus may be ranked in three classes:
-
-    1. Affections of the organs of special sense.
-
-    2. Affections of the nerves of common sensation.
-
-    3. Affections of the sympathetic nerves.
-
-1. _Affections of the organs of special sense._--Prominent among these is
-the effect of light upon the eye. The darkness of night favors sleep; the
-presence of light hinders its incidence and renders it less profound.
-During the gloom of a total eclipse animals seek their shelter; birds hide
-themselves in their nests; domestic fowls arrange themselves upon the
-roost, and seem quite disconcerted by the speedy return of sunlight.
-Children often find it difficult to sleep in an illuminated room. I have
-known nurses who would sit with a wakeful infant under a powerful gaslight
-till after midnight, and then would express their surprise that the baby
-persisted in gazing at the flame instead of going quietly to sleep. The
-inhabitants of Northern Europe find it necessary to darken their sleeping
-rooms during the long polar day; and travelers in such regions often
-suffer for want of the natural sleep which only darkness affords. Judge
-Caton, writing of his travels in Norway[28] says: "We longed for darkness
-and for night. Do what we could to darken the windows to keep out the
-light, still it was not night as nature makes it, and which the habit of a
-lifetime had rendered necessary to sound repose. Artificial darkness,
-especially when incomplete, is as far from night as artificial light is
-from day.... These sunny nights can hardly conduce to health, they steal
-away so much of sleep. One does not readily get sleepy in the sunshine,
-and then we are so apt to forget to look at the watch to see if it is time
-to retire."
-
-In the tropical regions of the world it is usual for the inhabitants to
-sleep during the middle of the day; but they take great pains to exclude
-the light from their houses during the hours of sleep. The Pacific
-Islanders cover their faces with the bed clothes for the purpose of
-excluding the light while attempting to sleep. Repose thus obtained in the
-daytime often serves to convert the night into a season of wakefulness.
-The Africans sleep and dream away the heated hours of the day, and give up
-considerable portions of the night to festivity in the open air--a
-practice which undoubtedly contributes to the permanence of an inferior
-grade of social life.
-
-Sudden illumination of the sleeping room will frequently awaken the
-sleeper. During the great fire in Chicago, A. D. 1871, many persons were
-thus aroused from their slumbers as the flames lighted up the streets
-adjoining their houses. One of my acquaintances was awakened one night by
-a flash of light from the lantern of a burglar who was moving noiselessly
-about her chamber. The experience of almost every one will testify to the
-effects of sheet-lightning silently illuminating the sky by night. Dreams,
-also, are not unfrequently excited by the incidence of light upon the
-closed eyelids.[29]
-
-The sense of hearing is one of the most persistent of the special senses
-during the incidence of sleep. It is perhaps the most excitable of these
-senses during the period of repose. Long after the subject has become
-immersed in sleep his auditory apparatus remains sensitive to sounds.
-Dreams are often produced by impressions upon the ear. Often in sleep it
-seems as if the sense of hearing remained wakeful and watchful for
-expected signals, as when an alarm clock serves to arouse the sleeper at
-an appointed hour. Sometimes the sleeper may be shaken and tumbled about
-in his bed without waking, but if he be addressed by name he will usually
-reply. It is scarcely probable that the auditory apparatus is any more
-wakeful than other portions of the nervous system, but its external
-portions remain during sleep more completely exposed and adapted to the
-reception of impressions than is possible for the eye and for the organs
-of touch and taste.
-
-The persistent sensitiveness of the ear during sleep is not so much a
-capacity for noticing sounds as a sensibility to variations in sonorous
-impressions. Thus a steady and monotonous noise may, if long continued,
-serve to render one sleepy; but the sudden cessation of the same sound
-will awaken every one. Slowly lulled to sleep by the incessant rumble of
-the engine upon one of the old-fashioned Long Island Sound steamboats, how
-immediate the awakening of a whole cabin full of people, when the wheels
-were suddenly stopped! A recent traveler in Guiana[30] relates a curious
-experience with an Indian magician who undertook to cure him of a slight
-headache and fever. The method of cure consisted in placing the patient at
-night in his hammock, while the magician kept up a hideous succession of
-yells and shouts, shaking the walls and roof of the house with an uproar
-which never ceased for six hours. Before long the patient passed into a
-kind of fitful sleep or stupor, during which he seemed to be suspended in
-a surging ocean of sound. When the noise died away, as if growing fainter
-in the distance, he would rouse up into a semi-conscious state, but when
-it again increased he would fall back into stupor. At last, when the noise
-finally ceased, he awoke completely, but without the slightest relief from
-headache--an experience quite illustrative of the manner in which the
-brain may be affected by sound.
-
-It is not often that the sense of smell becomes the avenue of impressions
-that interfere with sleep. So different are the capacities of individuals
-in this particular that an odor which might severely annoy one person,
-would pass almost unnoticed by another. Large cities are sometimes invaded
-by overwhelming stenches from the various factories which spring up in
-their neighborhood. While it is seldom true that the vapors discharged by
-such establishments are directly deleterious to health, they may become
-indirectly a cause of ill-health through the wakefulness occasioned by
-them among weakly invalids. The smell of smoke in a bed-chamber sometimes
-serves to awaken a sleeper, giving warning of the outbreak of a fire in
-the building. Less energetic odors may disturb the depth of sleep without
-actually waking the patient. Thus Maury records[31] that when he was made
-to inhale the vapor of cologne water while asleep, he dreamed of being in
-the shop of a perfumer.
-
-Excitement of the sense of taste would, doubtless, operate in a similar
-manner; but it is so difficult to arouse this sense without at the same
-time irritating the nerves of common sensation about the mouth, that very
-little can be said regarding the matter. Dreams of gustatory sensations
-are usually of subjective origin, dependent upon some reflex movement, or
-upon some agitation of the organ of memory, within the brain.
-
-If, with Sir William Thompson,[32] we recognize a sixth sense--the sense
-of temperature--it must be admitted that through the varying sensations of
-heat and cold, sleep can be greatly disturbed. Every one will recall to
-mind the story told by Dugald Stewart, of a gentleman who dreamed of
-walking over heated lava on Mt. AEtna when a bottle of hot water was placed
-against his feet, in bed, on account of some slight indisposition. The
-temperature of the air is one of the most important factors in the
-determination of sleep. A high temperature keeps every one awake--a fact
-well known among the unfortunate denizens of the garrets in our great
-cities. Not only is wakefulness the direct result of heat, but it is
-aggravated and embittered by the accompaniments of a torrid
-climate--insects, foul air, and cutaneous disorders. In the East Indies,
-so difficult is sleep under such conditions that the wealthy inhabitants
-compel their servants to cool them all night with the _punkah_, a large,
-swinging fan, suspended above the bed, and kept in motion by means of a
-cord leading outside of the bed-room to the verandah, where the
-_punkah-wallah_ sits and pulls the string while his master sleeps. So
-powerful is the force of habit in the organization of the automatic
-apparatus of the body that, though these punkah-pullers often fall asleep,
-they still continue, without interruption, the successive movements by
-which the fan is kept in operation.
-
-The evil effects of a high temperature are greatly aggravated by the
-presence of humidity in the atmosphere. Dampness interferes with the
-process of exhalation from the surface of the body, which, consequently,
-tends to become overheated. The tissues, under such circumstances, are
-imperfectly defecated, and rapidly pass into a condition of imperfect
-nutrition. This depresses all the functions of the body, and renders the
-nervous system inordinately irritable. Sleep cannot be profound and
-refreshing, because of the over-excitable state of the brain. During the
-long, hot season in tropical countries, it often becomes necessary to
-seek a temporary retreat among the highlands and mountains, in order to
-find a climate sufficiently dry and cool to furnish the condition for
-refreshing sleep. For the same reason many of the inhabitants of the
-Southern United States are forced to spend the summer months in the
-invigorating atmosphere of Minnesota and Northern Michigan. One of the
-most delightful of experiences may be procured on any warm day in summer
-by embarking, at Chicago, upon one of the steamboats bound to Mackinac. At
-the wharf, in the hottest and dirtiest part of the city, all is dust,
-perspiration, and discomfort. The wide cabins are filled with people who
-are tired, thirsty, and discouraged. Sickly, squalling babies swarm in
-numbers sufficient to drive one mad. As the sun goes down, the
-signal-whistle sounds, head-lines and stern-lines are quickly cast off,
-the propeller churns the mire behind the boat. Slowly swings the huge
-fabric away from the shore, gliding between the walls of sun-scorched
-brick that line the stream on either side. At last the light-house at the
-mouth of the river is passed, and we are out upon the blue waves of Lake
-Michigan, with a heavenly breeze searching every crack and cranny of the
-hull. New life animates every form, and presently a great silence pervades
-the brilliant cabins. The children have left their woes behind, and, for
-the first time, in many weeks, perhaps, they and their weary mothers sleep
-the sleep of innocence and peace.
-
-The dependence of a high atmospheric temperature upon the direction of the
-wind renders the course of the aerial currents a matter of great
-importance in relation to sleep. The southerly winds which, in the
-northern hemisphere, are hot and enervating, always produce an increase of
-wakefulness. The winds that blow from the heated deserts of Africa,
-Arabia, and Australia, are greatly dreaded upon this account, as well as
-for the other numerous discomforts which fly in their train. Their
-cessation, and their replacement by a cool, polar current brings relief at
-once. The changes thus produced in the electrical condition of the
-atmosphere doubtless contribute more than is usually known to these
-results. A cloudless sky gives evidence of positive electricity, which is
-much stronger in winter than in summer.[33] Clouds are sometimes positive
-and sometimes negative. According to Fonssagrives[34] the atmospheric
-electricity is positive during northerly winds, and negative during the
-prevalence of winds from the southerly quarters of the horizon. Great
-disturbances of the electrical condition of bodies is often observed
-during the occurrence of the sirocco in North Africa. Arago has related
-the case of an officer in the French army[35] who saw sparks of
-electricity leaping from his epaulettes at every blast of the sirocco
-encountered on a march in the neighborhood of Algiers. Such atmospheric
-disturbances often produce very disagreeable effects upon persons of a
-nervous temperament. According to Fonssagrives (_loc. cit._) such patients
-frequently experience, during the prevalence of storms which traverse
-great distances, a high degree of insomnia, together with headache, pains
-in the limbs, joints, and old injuries, and a general indefinable
-sensation of discomfort. S. Weir Mitchell has carefully traced the
-connection between these phenomena and the variations of barometric
-pressure which accompany the revolving storms that cross the continent in
-a northeasterly direction.[36]
-
-Though the effect of a high atmospheric temperature is unfavorable to
-sleep, an excessive temperature produces the opposite condition. Stupor
-rather than sleep is the consequence of insolation and of exposure to
-great heat from artificial sources. This is a pathological process, and,
-therefore, must not be mistaken for natural sleep. It may result either
-from cerebral congestion, or from cardiac exhaustion, and is characterized
-by an extraordinary bodily temperature and a high rate of mortality.[37]
-So elaborate are the arrangements for the preservation of a uniform
-temperature throughout the body that it is practically impossible for a
-sunstroke to occur unless the regulative apparatus has been previously
-deranged by ill-health.
-
-Excessive cold operates in like manner to produce a condition of stupor
-that tends to a fatal termination. But moderate degrees of cold act as
-excitants of wakefulness. By effecting a contraction of the vessels of the
-skin cutaneous circulation is impeded. The venous side of the circulatory
-apparatus becomes overloaded with blood; the exhalation of carbonic acid
-and the production of heat are reduced. The discomfort that results from
-this disturbance of the natural functions of the tissues is sufficient to
-arouse the brain to wakefulness, just as an imperfect oxidation of the
-blood serves to excite the respiratory centre in the medulla oblongata. It
-is hardly necessary to allude in this connection to the increased flow of
-blood through the brain occasioned by this as by every other excitement of
-the sensorium. Local refrigeration of any portion of the body thus acts as
-a painful excitant of the cerebrum, and produces wakefulness, very much as
-distention of the intestines with gas will keep one awake. It is for this
-reason almost impossible to sleep with cold feet. Conditions of this sort
-are pathological, and are far in excess of the agreeable coolness which
-favors sleep. The effects of progressive diminution of the temperature of
-the air are well illustrated by the hibernation of animals.[38] As the
-temperature of the air diminishes, in winter, animals like the marmot fall
-into a species of sleep. Their movements of respiration and circulation
-are greatly reduced, and their bodily temperature falls, though it always
-remains several degrees above the temperature of the surrounding air. So
-long as the average degree of cold is maintained, the little creature
-sleeps naturally; but, if the air becomes extraordinarily cold, the
-physiological repose of the animal is disturbed. _It becomes uneasy, wakes
-up, and seeks a warmer retreat._ Too great a degree of cold thus becomes a
-cause of wakefulness. If the animal under these circumstances fails to
-secure protection against a falling temperature, it passes into a state of
-lethargy that is often fatal--a pathological condition being substituted
-for the physiological sleep of ordinary hibernation. In like manner the
-human animal may experience the threefold effects of refrigeration: first
-a pleasing coolness that favors sleep; then an uneasy sensation of cold
-which causes wakefulness; and, finally, a lethargy that paralyzes all the
-functions of the body and terminates in death.
-
-2. _Affections of the nerves of common sensation._--Chief among the causes
-of sleeplessness thus produced is pain. This is a modification of feeling,
-caused by excessive or extraordinary excitement of the peripheral nerves
-of sensation. The seat of the excitement may be in the skin or in the
-deeper tissues of the body. Cutaneous pain may be caused by the activity
-of various insects, like flies, mosquitos, fleas and bedbugs, or by the
-presence of certain parasites, such as the itch-mite, or by ordinary
-diseases of the skin, of which notable examples are found in erysipelas,
-erythema, urticaria, lichen, prurigo, certain varieties of eczema and
-psoriasis. The troublesome forms of pruritus which accompany icterus, or
-which may occur without any clearly defined cause, are frequent causes of
-wakefulness. The last mentioned disorder must, however, be sometimes
-recognized as a consequence of central nervous disorder, rather than a
-result of peripheral disease. Witness the frightful itching sometimes
-experienced during the progress of chronic myelitis. All kinds of
-injuries, wounds, ulcers, and other local inflammations are common causes
-of insomnia by reason of the painful impressions transmitted from them to
-the brain. Hence the great importance of anodynes and hypnotic remedies in
-the course of surgical practice. Diseases or injuries of the various
-peripheral nerves are notable causes of sleeplessness. Witness the
-horrible wakefulness caused by neuritis and by neuralgia. The development
-of neuromata in the stumps of amputated limbs may thus become a most
-painful cause of insomnia. Inflammations which encroach upon sensitive
-nerves produce intense pain with consequent loss of sleep. Of this very
-conspicuous examples are furnished by spinal meningitis, and by the
-effects of local periostitis causing compression of the branches of the
-fifth pair of nerves.
-
-3. _Affections of the sympathetic nerves._--So much still remains to be
-learned concerning the pathological functions of the sympathetic nerves
-that it is impossible to assign with any great degree of precision the
-exact amount of interference with sleep that may depend upon disordered
-conditions of this portion of the nervous system. Since their principal
-functions consist in the regulation of the flow of blood and lymph
-throughout the body, and in the control of the processes of nutrition,
-calorification, secretion and excretion, it follows that any considerable
-derangement of their healthy action must be represented by a corresponding
-disturbance of the brain. This may reach the field of consciousness in the
-form of pain, and thus may become a cause of sleeplessness. In all the
-phenomena of inflammation sympathetic nerves play an active part. In
-certain portions of the body, as in the principal viscera, and in the
-periosteal covering of the bones, they are the interstitial nerves of the
-structures. When the body is in a healthy condition these nerves convey
-impulses of a sensory character which do not reach the cerebral organ of
-conscious sensation. But in certain morbid states they become inordinately
-sensitive, and they then serve to convey and probably also to magnify
-sensations to an extent that may cause exquisite pain with all its
-consequences. Witness the pain experienced during the various forms of
-colic. Rheumatic inflammations, pleurisy, pericarditis, peritonitis,
-cystitis, metritis, ovaritis, gastro-enteritis, and other similar diseases
-owe their principal suffering to the affection of the sympathetic nerves
-connected with the respective organs which become the seat of pain.
-Including with the sympathetic nerve the pneumogastric nerve, which
-occupies a functional position between the strictly peripheral and the
-ganglionic nerves, all the various forms of pain and uneasiness
-experienced in the region of the heart and of the lungs may be assigned to
-this system of nerves. Thus the various species of respiratory
-disturbance, such as asthma and dyspnoea from any cause, and the forms of
-palpitation and other cardiac disorder may become causes of wakefulness.
-In like manner the vague and uneasy sensations associated with certain
-varieties of dyspepsia are frequent sources of sleeplessness, not merely
-by reason of the pain which they occasion, but also because of the general
-disorders of nutrition with which they are associated.
-
-
-II. INSOMNIA CAUSED BY MORBID STATES OF THE CENTRAL NERVOUS ORGANS.
-
-So intimately connected are the spinal cord and the brain that their
-disorders may properly be considered together. These may be classified as:
-
-    1. Disorders of circulation and nutrition.
-
-    2. Inflammations and degenerations.
-
-    3. Neoplastic encroachments.
-
-_Disorders of circulation and nutrition._--Hyperaemia of the brain is a
-frequent cause of wakefulness. This may be maintained by an unconscious
-effort of the organ of the will under the influence of any great and
-unusual excitement of the mind. So soon as the mental excitement is
-allayed, the excessive afflux of blood subsides, and the brain becomes
-fitted for sleep. But, if excitement be too far prolonged, the nutrition
-of the nervous centres suffers, and the regulative apparatus of the
-cerebral circulation becomes exhausted, so that the brain cannot rest,
-because its inhibitory centres have lost their power of control over the
-lower ganglia of the organ. The cerebro-spinal centres are then in a
-condition analogous to that of a locomotive engine on which the engineer
-can no longer regulate the production and distribution of steam. Such a
-condition is usually the result of numerous antecedent causes. Long hours
-of work, scanty or improper food, insufficient sleep, bad hygienic
-surroundings and habits, with indulgence in the use of narcotics and
-stimulants, are among the most common causes of the disorder.
-
-Active hyperaemia of the nervous centers has been above mentioned as the
-consequence of cerebral function under unfavorable conditions. But, as the
-disorder persists, its type undergoes a change. We still speak of the
-disorder as functional in its character, but it continually tends to
-become organic. No visible alterations, perhaps, can be detected, but,
-evidently, there are radical changes in the substance of the nervous
-tissue. Nutrition suffers throughout the body to a degree that attracts
-attention. The blood diminishes in quantity and quality, till the patient
-becomes notably anaemic. In this condition the brain is inordinately
-excitable. It is incapable of sustained activity, and the patient may even
-be oppressed by an inclination to constant drowsiness; yet he will be
-unable to sleep soundly, and his sleep will be continually agitated by
-dreams. This state is one of the constant accompaniments of slow
-starvation. The molecular structure of the nervous organs seems to be so
-slightly constructed, under such circumstances, that its equilibrium is
-disturbed by the most trifling incidents. It may be likened to a lofty
-wall of bricks laid up without mortar--"if a fox go up," the entire
-structure may be thrown down with a tremendous noise. Thus the anaemic and
-irritable brain will react excessively under the slightest impression;
-consciousness is invaded by perceptions which would never arise under
-normal conditions of the nervous tissue; and the mind is continually
-aroused. This form of wakefulness is very frequent among women who have
-become anaemic, and among patients who are slowly convalescing from
-exhausting diseases.
-
-It is impossible in every instance to decide whether a given state of
-wakefulness is the result of cerebral hyperaemia or anaemia. In the one case
-the persistence of wakeful activity of the mind is due to excitement of
-the cerebral cells, accompanied by a lavish irrigation of their substance
-with the plasma of the blood. In the other case the excitement is
-occasioned, not so much by increased afflux of the blood, as by a morbid
-instability of the nervous substance. The outcome in both cases is very
-similar--mental excitement and wakefulness.
-
-In a third class of cases the agitation of the brain is produced by the
-direct action of certain chemical agents upon the cortical substance. Tea
-and coffee are familiar examples of such agents. The caffeine, by virtue
-of which they produce their effect, when transported to the brain, enters
-into combination with its protoplasm in such a way as to stimulate
-molecular movement. Perception is thus quickened, and the mind is aroused.
-Sleep is postponed until the effect of the stimulant has subsided. This
-form of wakefulness is quite different from that produced by alcoholic
-drinks. These operate, when taken in small quantities, to favor cerebral
-equilibrium--and consequent equanimity--by producing a general dilatation
-of the smaller blood-vessels. Their anaesthetic influence is favorable to
-sleep, under such circumstances. But, if frequently repeated, these doses
-of alcohol modify the nutrition of the nervous system until, at last, a
-condition of irritable weakness is reached, in which wakefulness of a most
-distressing character is experienced.
-
-_Inflammations, degenerations, and neoplasms._--The early stages of
-inflammation involving the central nervous organs are marked by that form
-of insomnia which is associated with active hyperaemia. The headache and
-painful delirium which accompany the different varieties of meningitis,
-are causes of a wakefulness that persists until the brain is merged in the
-coma of compression. The interstitial changes which cause the various
-forms of insanity, are in like manner causes of wakefulness. Local
-injuries and degenerations of brain-substance, tubercular deposits upon
-the meningies, and all the different forms of intra-cranial tumor, are
-causes of wakefulness, both by reason of the direct irritation which they
-produce, and by reason of the circulatory disturbances which arise in
-their neighborhood.
-
-Finally, it must be observed that wakefulness may result from excitement
-of the brain by irritating substances transported through the blood from
-distant centers of disease in remote organs of the body, or derived from
-articles that have been absorbed with the food and drink, or with the air
-that enters the lungs. Thus wakefulness may accompany cutaneous disorders
-that interfere with perspiration. Imperfect elimination through the liver,
-kidneys and intestines, leaves the blood charged with excrementitious
-substances which arouse the brain to wakefulness. In like manner, various
-poisons, like lead, arsenic, etc., different miasms of telluric origin,
-the products of putrefaction, and the various animal contagia, may produce
-insomnia by their prejudicial effect upon the nutrition of the nervous
-structures throughout the body.
-
-
-
-
-CHAPTER III.
-
-REMEDIES FOR INSOMNIA.
-
-        O, true apothecary!
-  Thy drugs are quick.
-                      --ROMEO AND JULIET.
-
-
-An occasional attack of wakefulness may fall to the lot of any one as a
-consequence of the various disturbances of health or equanimity of mind to
-which all are liable. Occurring as an accident in a state of health, it
-produces merely a feeling of lassitude and weariness during the subsequent
-day. This soon disappears, after a night of refreshing sleep, and the
-subject is nothing worse for the incident. But the recurrence of the
-disorder is a thing to be deprecated, not only for the reason that it
-denotes a departure from the physiological order of life, but because its
-frequent repetition prevents the adequate repair of the tissues of the
-body. The great function of nutrition suffers as a consequence, and the
-patient rapidly falls into a condition of premature old age. When this
-takes place as a result of some temporary error of hygiene, or as a
-consequence of diseases which admit of successful treatment, the patient
-may be restored to health by judicious management, but lost youth and
-elasticity of the tissues can never be fully regained. The most formidable
-cases of insomnia are those for which no adequate cause can be recognized
-in the habits, mode of life, and state of health of the patient. Grave
-and permanent disorder of the brain is then to be feared. Such wakefulness
-is a frequent precursor of acute meningitis in children and adults. It
-frequently ushers in the early, insidious, formative stage of tubercular
-meningitis, and of the infective fevers--notably typhoid fever. It forms
-one of the most suspicious symptoms among the introductory phenomena of
-insanity; and during the course of protracted diseases, its intrusion is
-an omen of most unfavorable augury. It will, therefore, be found useful to
-consider with some degree of detail the circumstances under which insomnia
-may occur, and the best means of averting its onset.
-
-A severely logical reference to previous doctrines regarding the condition
-of the brain during sleep, has led many authors to consider the
-therapeutical treatment of insomnia chiefly as a matter of modification of
-the cerebral circulation. Sleep has been supposed to depend upon a
-comparatively bloodless state of the brain, and wakefulness upon the
-contrary state. For such theorists the treatment of insomnia consists very
-simply in the use of agents which are supposed to be efficacious in
-reducing the flow of blood through the head. Tourniquets, placed upon the
-carotid arteries, occupy a position of great honor in the _armamentarium_
-of such people. Recognizing the fact that changes in the force of the
-circulation accompany and sustain every change in the activity of the
-cerebral cortex, we, however, attach the greatest importance to the
-condition of the nervous substance itself. For a clear understanding of
-the proper mode of medication, it is important to ascertain whether the
-cerebral substance is in a state of normal activity, or whether it is in a
-state of healthy, but excessive, activity, or whether its seeming
-excitement is merely the result of irritable weakness. Since these
-opposite conditions may declare themselves during the course of any
-disease in which insomnia may become a troublesome phenomenon, it is
-impossible to make a classification of diseases upon the basis of these
-different states of the brain. It will, therefore, be found more useful to
-consider the subject of sleeplessness as it ordinarily presents itself
-during the clinical progress of the several forms of disease. It will,
-then, appear that the type of insomnia is liable to variation with the
-course of each individual malady; and its treatment must vary accordingly.
-
-Before proceeding to a discussion of the therapeutics of insomnia in
-connection with particular diseases, it will be advantageous to pass
-briefly in review the different remedies which are useful in the treatment
-of wakefulness. These may be divided into two classes: Nervous stimulants,
-and nervous sedatives. Among the first may be also reckoned food, heat,
-baths, and counter-irritants. Like all nervous stimulants, they promote
-the complete and harmonious action of all parts of the nervous system,
-favoring that equilibrium of the circulation which is most favorable to
-the development of sleep. The second class of agents comprises all such
-remedies as act directly upon the nervous tissue of the brain, depressing
-its functional activity, and hushing to rest those particular organs
-which, by their undue excitement, serve to keep the remainder in a state
-of wakefulness. All these substances produce decided effects upon the
-spinal cord and the peripheral nerves, but it is their operation upon the
-brain which principally interests us in connection with insomnia.
-
-NERVOUS STIMULANTS.
-
-  Heat.
-  Baths.
-  Massage.
-  Electricity.
-  Counter-irritants.
-  Food.
-  Digitalis.
-  Camphor.
-  Musk.
-  Valerian.
-  Cannabis indica.
-  Belladonna.
-  Hyoscyamus.
-  Stramonium.
-  Phosphorus.
-  Acids.
-  Opium.
-
-NERVOUS SEDATIVES.
-
-  Cold.
-  Alcohol.
-  Paraldehyde.
-  Ether.
-  Chloroform.
-  Chloral.
-  Butylchloral hydrate.
-  Amyl nitrite.
-  Opium and opiates.
-  Bromides.
-  Hops.
-  Gelsemium.
-  Conium.
-
-
-NERVOUS STIMULANTS.
-
-It may at first sight seem to be a contradiction in terms when it is
-asserted that sleep may result from the administration of a nervous
-stimulant. This does occur, but only indirectly, and as a consequence of a
-restoration of energy to those portions of the nervous system which serve
-to moderate the activity of the organ of the mind--the cortex of the
-cerebrum.
-
-_Heat_, for example, is an undoubted stimulant. When added to the body in
-quantity sufficient to overcome chilliness, it tends to equalize the
-circulation of the blood, and produces throughout the body a nervous
-equilibrium that prevents any particular organ or member from arousing the
-others to wakefulness.
-
-_Baths._--The application of heat in the form of a warm bath constitutes
-one of the most admirable means of tranquilizing the brain. Children who
-are restless at night are delightfully soothed by a warm bath every night
-and morning. The water should be of an _agreeable_ temperature--this is
-better than any exact figure upon the scale of a thermometer--and the bath
-should not last lounger than ten minutes. Similar baths exercise a happy
-effect upon adult patients who are moderately feverish, nervous, and
-wakeful. If strong enough, they may take a full bath at bedtime; but if
-too feeble to leave the bed, gentle sponging with warm water will prove
-most refreshing, and will usually be followed by restful sleep. The
-well-known derivative effects of hot foot baths scarcely need to be more
-than mentioned in this connection.
-
-Turkish baths form an invaluable adjuvant in the treatment of chronic
-cases of insomnia arising from rheumatic, gouty, and dyspeptic disorders
-of the health. The copious perspiration induced by the heated air of the
-hot chamber is depurative, while the cold douche and the massage with
-which the bath is concluded have a powerful effect to stimulate all the
-functions of the body. By this means the brain is enabled to resume a
-healthier mode of action, and sleep follows as a matter of course.
-
-_Massage._--This constitutes a process of rubbing and kneading the body.
-It has been practiced from time immemorial among the oriental races and
-the Pacific Islanders as a means of relief from fatigue of every kind.
-Among the Japanese the practice of massage is a monopoly in the hands of
-the blind, who are thus enabled to support themselves. Various
-modifications of the oriental method have been introduced under the names
-of _percussion_, _shampooing_, and the _Swedish movement cure_. They all
-possess the common features of friction applied with the hand to the skin,
-compression of the muscles with the hands, and passive movements of the
-different articulations of the limbs and body. For effecting all these
-processes nothing has yet surpassed the Sandwich Island _lomi-lomi_ as
-practised by the court-retainers of the ancient chiefs. As a means of
-relieving fatigue, and of removing muscular soreness, after violent
-exertions of every kind, it is far superior to the imitations performed by
-European and American professional _masseurs_ and _masseuses_. Nervous
-headaches, the pains that accompany spinal irritation, and all conditions
-of restlessness and wakefulness which depend upon exhaustion are relieved
-by this method. The well-known soothing influence of a mother's hand
-stroking the face and forehead of her sleepless child, is an example of
-only one of the effects thus produced by the skillful _masseur_. These
-salutary results must be assigned to the uniform friction of the skin,
-causing the liberation of heat, and modifying the electrical conditions of
-the body. By this, the impressions derived from the peripheral nerves are
-reduced to a more harmonious series. The circulation of blood and lymph is
-rendered more active in the substance of the muscles, and all the
-processes of nutrition are thus stimulated to a degree that restores the
-equilibrium of function throughout the nervous system. Being no longer
-irritated by suffering portions of the body with which it is connected,
-the brain then yields to the effects of its own fatigue, and sleep
-supervenes.
-
-_Electricity_ is chiefly useful in those cases where it is impossible to
-discover anything but cerebrasthenia as the cause of wakefulness.
-According to Beard and Rockwell,[39] sleep may result from the use of any
-one of the different methods of electrization. The passage of a moderate
-current, either galvanic or faradaic, through any portion of the body
-often produces a temporary feeling of sleepiness; but the long continued
-employment of electricity is needful to effect those changes in cerebral
-nutrition which are necessary for a permanent cure of insomnia. In cases
-of sleeplessness caused by worry and overwork, great benefit is often
-experienced from the daily passage of the faradaic current from the back
-of the neck, or from the pit of the stomach, to the feet. Static
-electricity, and the electric bath, are also very effective in many cases
-of so-called _spinal irritation_ and insomnia.
-
-_Counter-irritants_ are substances which are applied to the surface of the
-body for the purpose of communicating to the superficial sensory nerves
-impulses (irritation) which may serve to inhibit the morbid functions of
-distant or central nervous structures. Various explanations of this
-process have been presented; notably a most ingenious argument by Dr. T.
-Lauder Brunton[40] in favor of the theory of inhibition by interference
-of vibrations--impulses from the periphery interfering with vibrations
-originating in morbid conditions of the central nervous organs--very much
-as darkness is produced by the interference of luminous undulations, and
-silence is effected by interference of sonorous waves in the atmosphere.
-This hypothesis is the one that is most conformable to the present
-requirements of science, and is hereby accepted as the most satisfactory
-explanation of the action of counter-irritants.
-
-The drugs in general use for the purpose of counter-irritation are
-_cantharides_, _capsicum_, _mustard_, _thapsia_, _turpentine_, _aconite_,
-and _croton oil_. _Cups_, _leeches_, and certain special applications of
-_electricity_, also owe much of their virtue to the same power of
-modifying functions at a distance. Under the influence of all these agents
-the molecular vibrations of the brain may be profoundly influenced; pain
-may be annulled, and sleep be procured. The circulation of the blood is so
-powerfully affected by these measures that their good effects are usually
-attributed to the circulatory changes thus produced. But, as in all other
-modifications of the circulation, the nervous tissues and the vascular
-channels must first be reached by influences unconnected with the blood
-itself before its current can be diverted from one region to another. The
-inhibitory action upon the nervous organs is the primary effect. The
-diversion of the circulation is a secondary consequence, by which,
-undoubtedly, the degree of nervous change can be estimated, and by which
-the inhibitory effects in the brain are intensified and sustained.
-
-_Food._--In a considerable number of cases of insomnia, its cause lies in
-an irritable weakness of the nervous tissues. Exhausted by overwork, or
-debilitated by the loss of blood, or half-starved during the course of a
-long illness like typhoid fever, a condition of wakefulness may be
-established which will add to the dangers experienced by the patient. In
-this state there is great restlessness--the sufferer experiences no severe
-pain, but he cannot lie still. This form of sleepless agitation is often
-encountered during the later stages of exhausting diseases; and, if not
-properly treated, it soon leads to a fatal termination. The most important
-remedy for such distress is found in food. This must be soluble,
-diffusible, stimulant, and nutritive. Milk, alcohol, eggs, and meat-juice,
-are the typical representatives of such food. _Milk_ should be as fresh as
-possible, and should be slightly salted, in order to hinder the formation
-of hard curds in the stomach. For young children it may be _peptonized_
-with advantage by gently heating one pint of milk with five grains of
-sodium carbonate and five grains of pancreatic extract dissolved in half a
-pint of water. The mixture may be sufficiently warmed by placing it in a
-bottle immersed for half an hour in a jug of hot water (Fairchild). By
-this process the milk is partly digested before it is drank, thus
-relieving the alimentary canal of a corresponding amount of work.
-
-Furnished in the form of _koumiss_, milk is not only presented in a
-digestible form, but the alcohol and the acids yielded by its fermentation
-are powerful aids to the process of digestion. Fermented milk forms a
-considerable portion of the daily food of the nomad tribes of Central
-Asia, and it is highly esteemed among the Russians in the treatment of
-pulmonary consumption. It is useful in all diseases affecting the
-digestive organs, and can often be tolerated, even by very young children,
-when nothing else will remain in the stomach. Considerable mystery is made
-of its preparation by those who sell it for an enormous price; but its
-composition is really very simple, and its actual cost is within the reach
-of every one. The following formula for its preparation has given great
-satisfaction to many of my patients:
-
-Dilute five quarts of milk with three quarts of hot water. When lukewarm,
-add half a cupfull of sugar of milk (which can be obtained from any
-wholesale druggist), and one bottle of well fermented koumiss (or a little
-yeast). Stir the mixture thoroughly, and let it stand in an open jar, at a
-temperature of about 72 deg. F., till it begins to curdle. Then stir in half a
-cupfull of pulverized coffee sugar, and cork tightly in champagne bottles
-with the best velvet corks. The bottles should be kept quite cool, as
-fermentation proceeds very briskly, and will break the containers if left
-in a warm room. A large ice-box is the best receiver during hot weather.
-The koumiss thus prepared is ready for use at the end of a week. It may be
-most conveniently drawn from the bottle with a champagne tap. The entire
-cost of the article need not exceed seven cents a bottle.
-
-Sleeplessness caused by chronic dyspepsia will often yield to a diet of
-koumiss, when every other remedy has failed. When the stomach is very
-intolerant, it should at first be taken in very small doses, repeated as
-often as every hour. It will soon become possible for the same patient to
-drink two or three quarts each day.
-
-_Eggs_ form one of the most nutritious and easily digested articles of
-diet. They should be taken uncooked, beaten up with milk to which a small
-quantity of wine or spirits and sugar have been added. A glass of eggnogg,
-thus prepared, is invaluable in the insomnia of fevers and other
-conditions of exhaustion.
-
-_Meat-juice_ can be procured in numerous forms. The various soluble
-extracts of meat, Valentine's liquid extract of beef, Murdoch's liquid
-food, all represent the juice that oozes from rare beef. Its nutritive
-value is not very great, but it possesses considerable energy as a
-stimulant. Meat juice, therefore, occupies an important place as an
-excitant of those functions which must be aroused in order to secure the
-proper digestion of other articles of food. It should, therefore, be
-administered in connection with them. As the ordinary meat extracts are
-frequently very unpalatable, they may be administered in fresh broth or
-soup, to which they give body and energy without unpleasantly affecting
-their savory taste.
-
-Neurasthenic patients, whose insomnia results from physical exhaustion,
-should never retire at night without taking some form of light and easily
-digested food. A simple slice of bread, or a piece of plain sponge-cake,
-with a glass of koumiss, forms an excellent model for such a meal.
-
-_Digitalis_ is only indirectly useful as an hypnotic. In cases of cardiac
-disease, with enfeeblement of the heart, dyspnoea, dropsy, and
-sleeplessness, digitalis is often of the greatest service. It has also
-been highly recommended in delirium tremens. Administered in the form of
-an infusion, it has been given in doses of a tablespoonful, every four
-hours, with apparently good effect. Its use is indicated in cases
-characterized by weakness of the heart, with a rapid and feeble pulse.
-Under its influence the state of the circulation improves, delirium
-ceases, and sleep occurs.
-
-_Camphor._--This substance is not an hypnotic, but it forms a valuable
-addition to various hypnotic compounds. It is a cerebral stimulant, and
-aids in the establishment of that nervous tranquility which favors the
-incidence of sleep. It may, therefore, be advantageously associated with
-opiates in the restlessness and insomnia of exhaustion. Tully's Powder, a
-valuable substitute for Dover's Powder, contains camphor. This renders it
-preferable to the ordinary opiates in typhoid fever, and in other
-exhausting diseases.
-
-_Musk_, the dried secretion of the preputial follicles of the musk-deer,
-is a substance which, on account of its high price, is rarely used as an
-hypnotic. Given in doses of ten grains, every two or three hours, it is
-exceedingly valuable (Stille and Maisch) for the relief of "all those
-nervous phenomena which are represented by the term _ataxia_, and among
-them subsultus tendinum, mild muttering delirium, floccitation, muscae
-volitantes, and hiccough, with a small, frequent, tremulous or irregular
-pulse, without coma and without collapse. Under these circumstances musk
-tends to produce refreshing sleep, while it calms muscular spasm and
-favors perspiration, while the pulse grows fuller, more regular, and less
-frequent.... In proportion as ataxic prevail over adynamic phenomena is
-musk advantageous." Such conditions are chiefly encountered in typhus,
-typhoid fever, the eruptive fevers, and pneumonia. Musk is very
-efficacious for the relief of "wakefulness resulting from combined mental
-and bodily fatigue--such cases, in fact, as are benefitted by valerian,
-camphor, asafetida, and ammonia."
-
-_Valerian_ and its different preparations form a typical class of agents
-which indirectly favor sleep by their gently stimulant effect upon the
-brain. They are all useful in quieting that form of hysterical excitement
-to which women are liable during the "change of life." That form of
-restlessness, usually resulting from fatigue, in which the patient feels
-as if she cannot sit still, is often relieved very promptly by the
-valerianate of ammonia. Wakefulness caused by neuralgic pains, or by
-exhaustion, often yields readily to scruple doses of valerianate of zinc
-or ammonia. The elixir of the valerianate of ammonia is a very elegant
-preparation of the drug.
-
-_Cannabis Indica._--A cerebral stimulant which produces, at first, an
-agreeable exaltation of the mental faculties. This is followed by a
-condition of delirium, succeeded in its turn by sleep. It is, therefore,
-impossible to use the drug for merely hypnotic purposes; but it is a
-useful adjuvant, in small doses, to other hypnotic remedies. Given in
-doses of 1/2-1 grain, it may be advantageously associated with opiates, or
-with hyoscyamus or belladonna in cases which do not easily tolerate the
-preparations of opium. The tannate of cannabin, given in doses varying
-from five to ten grains, has been recommended as an hypnotic; but, like
-the extract from which it is derived, its effects are rather uncertain.
-The pure alkaloid, cannabin, has been recently introduced as a soporific,
-in doses of three-quarters of a grain to a grain and a half. According to
-Stille and Maisch, the wakefulness caused by the itching of eczema may be
-relieved by the use of cannabis indica. The uneasy sleep attendant upon
-ungratified sexual appetite may also be relieved in the same way, since
-the drug is decidedly anti-aphrodisiac.
-
-_Belladonna_ is not directly hypnotic, unless given in poisonous doses,
-but its medicinal operation tends to overcome certain conditions that
-hinder sleep. By its anti-spasmodic effects it relieves many forms of
-spasm which would otherwise interfere with sleep. Spasmodic asthma
-furnishes an example of such an affection. This may be relieved by the
-hypodermic injection of atropine. Whooping cough is another disease which
-may be largely controlled by the internal administration of the drug,
-especially by inhalation of a spray that has been medicated with
-belladonna. Neuralgia, especially the form that involves the head, face,
-and intercostal nerves, is greatly mitigated by the use of belladonna, or
-its alkaloid, atropia. Its association with opiates seems to increase
-their hypnotic effect, while at the same time neutralizing their
-disagreeable action. According to Curci,[41] it opposes the tendency of
-opiates to cause cerebral hyperaemia. For this reason it is generally
-advisable to combine sulphate of atropia with sulphate of morphia for
-hypodermic use. Of the former 1-100--1-80 grain may be used with 1/4
-grain of the latter. Certain patients are exceedingly intolerant of
-belladonna and its derivatives, a fact that must be kept in mind,
-especially when using the alkaloid, atropia. Fatal consequences are very
-rare, but uncomfortable dryness of the throat, dilatation of the pupils,
-and some degree of delirium are not uncommon. At the same time it must be
-admitted that in many instances relief from suffering is not obtained
-until these physiological effects of the drug have been manifested.
-
-_Hyoscyamus._--As might be inferred from their close botanical
-relationship, hyoscyamus and belladonna present many points of similarity.
-Their alkaloids are almost identical in chemical and physiological
-properties. The extract of belladonna is considerably stronger than the
-extract of hyoscyamus. Like other solanaceous plants, this is powerfully
-narcotic and anodyne. Sleep is produced only by the use of the drug in
-large doses, which also tend to excite delirium, sometimes even reaching
-to the height of maniacal fury. Children tolerate hyoscyamus in doses
-proportionally larger than can be taken by adults. By many physicians it
-is considered the hypnotic _par excellence_ for children. In the various
-forms of insanity the tranquilizing influence of hyoscyamus is highly
-esteemed. The derivative preparations, hyoscyamine and hyoscyamia, are
-preferable for use in this class of cases. The first may be given in doses
-of 1-16--1 grain; the latter is much more powerful, and should be given in
-doses not exceeding 1-100 grain until the degree of its tolerance has been
-ascertained.
-
-_Stramonium._--This is another of the solanaceous plants, possessing many
-qualities like those found in belladonna. It is not directly hypnotic.
-Poisonous doses produce delirium and persistent insomnia. But its
-anti-spasmodic effect upon the paroxysm of nervous asthma renders it
-indirectly hypnotic in that affection. For the relief of bronchial spasm
-the smoke of the dried leaves should be inhaled in considerable quantity.
-It may be smoked in a pipe; or, mixed with saltpetre, it may be made to
-smoulder upon a tin plate, while the smoke is drawn by inspiration into
-the lungs. Various kinds of medicated pastiles have been prepared, to
-effect a similar result by furnishing the drug in a convenient form for
-use. _Tobacco_ and _lobelia_ operate in a very similar manner upon all
-spasmodic affections of the respiratory passages; but their energy is
-almost too great for the comfort of the patient.
-
-_Phosphorus._--Bartholow has recommended this drug in "cases of
-wakefulness dependent on cerebral anaemia and exhaustion," and in "the
-wakefulness of the aged, accompanied with muscular cramps, feebleness of
-memory, giddiness, and trembling of the voluntary muscles on exertion." In
-minute doses, it is true that phosphorus acts as an irritant of nervous
-tissue. It promotes destructive changes in the tissues of the body, and
-thus produces a temporary excitement which may favor the processes of
-nutrition. Indirectly, it may thus prove beneficial in many cases of
-cerebral exhaustion; but as a direct hypnotic it will be found of very
-little service. It should be given in doses of 1-100 grain every four
-hours.
-
-_Acids._--In those forms of sleeplessness which are dependent upon
-disordered conditions of the digestive apparatus, acids are often useful.
-Their topical effects upon the mucous membrane of the stomach are
-stimulant and alterative; hence they are useful in atonic dyspepsia, where
-there is deficient secretion of the gastric juice. In such cases
-_hydrochloric acid_ and _lactic acid_ are useful. The first should be
-given, in doses of five drops diluted with half a pint of water, after
-each meal. Lactic acid may be given in doses of one or two teaspoonfuls,
-similarly diluted. It has been asserted, on theoretical grounds, that
-lactic acid and the lactate of sodium are directly hypnotic, but its
-experimental use has never given satisfactory results. _Phosphoric acid_
-has been used in the same way, with very similar effects. An impure
-solution of phosphoric acid, known as _Horsford's Acid Phosphate_, has
-been extensively used for its supposed hypnotic properties. It assists
-digestion, stimulates the kidneys, and by its general diffusion promotes
-molecular activity throughout the body. It is thus indirectly beneficial
-in cases of insomnia. No small part of the benefits thus obtained must,
-however, be ascribed to the water with which these acids are diluted. When
-the liver becomes sluggish in its action, nitric acid, in doses of five
-drops diluted with half a pint of water, may be taken every four hours
-with great advantage. Thus used, the mineral acids may often yield
-invaluable service in the treatment of insomnia occasioned by cachectic
-conditions of the body--notably such as are produced by malaria, oxaluria,
-and the so-called phosphatic and rheumatic diatheses.
-
-
-NERVOUS SEDATIVES.
-
-The remedies thus far considered are but indirectly hypnotic in their
-effects, though exceedingly valuable as agents for the production of
-conditions favorable to sleep. We may now pass to the consideration of a
-class of remedies which operate more directly upon the brain to depress
-its energy. They are, therefore, called nervous sedatives, and they
-include the majority of narcotic substances.
-
-_Cold._--The operation of cold upon the body has already been sufficiently
-considered. It only remains to note the effects of cold applied through
-the agency of baths and local refrigerants. A full account of the theory
-and practice of hydrotherapeutics can be found in the second volume of Von
-Ziemssen's _Handbuch der Allgemeinen Therapie_. The English reader will
-find the subject treated at sufficient length in Ringer's _Handbook of
-Therapeutics_.
-
-According to Ringer, the sitz-bath, taken at a temperature between 60 deg. and
-80 deg. F., is very useful to soothe "an irritable restless state of the
-nervous system." It should be employed once or twice a day, from five to
-thirty minutes at a time. Among other beneficial consequences is the
-promotion of quiet sleep.
-
-For the relief of the pungent heat and restlessness which add so much to
-the danger of the specific fevers cold baths have been highly recommended.
-These have been employed with great energy in many of the German
-hospitals; and often with great benefit to the patient. The preferable
-method is the one advised by Von Ziemssen and Immerman. The patient is
-placed in a tub of water at 95 deg. F. This is very gradually cooled down, in
-the course of half an hour, to 60 deg. F. The bath should be repeated from
-three to five times a day, according to the temperature of the patient. By
-this method of treatment the patient is made more comfortable; he becomes
-less restless or delirious, and secures a larger amount of refreshing
-sleep.
-
-The difficulty of administering such a laborious course of baths outside
-of a well equipped hospital renders its adoption almost impossible in
-private practice. Here the physician must rely upon assiduous sponging
-with water of an agreeable temperature. In severe cases, such as measles
-before the appearance of the eruption, scarlet fever during the period of
-heat and agitation, and typhoid fever during the corresponding stage,
-great benefit will be derived from the cold wet sheet. In order to humor
-the prejudices of the laity, this should be wrung out of warm water and
-applied with sufficient deliberation to insure its considerable loss of
-heat. A blanket should first be spread upon an empty bed; the wet sheet
-should be spread over the blanket. The patient must be placed naked upon
-the sheet, which should then be drawn around the entire body, and the
-blanket may be folded around the whole package. Children generally insist
-upon leaving their arms uncovered. This may be allowed with safety in many
-cases, but generally a wet napkin should cover the upper part of the chest
-and the neck which cannot be reached with the sheet when the arms are
-exposed. After remaining from half an hour to two hours in the pack, the
-patient becomes comparatively cool and quiet, and the eruption, if
-delayed, begins to appear. Sleep often occurs as an immediate consequence
-of the relief thus obtained.
-
-Similar good results may be secured by the use of cold affusion in cases
-of high temperature and great restlessness. I well remember a little boy,
-about eight years old, whom I once found rolling and tossing and burning
-up with scarlet fever. Calling for an empty wash-tub, I had him stripped
-and placed upright in the tub. I then began to pour cold water over him
-from a large pitcher. Scarcely had the water touched his skin, before he
-seized the pitcher, and began to drink from it. He was permitted to
-completely slake his thirst, and then the affusion was resumed. After four
-or five gallons of water had been thus poured over him, he was wiped dry,
-and was returned to his bed, where he immediately turned upon his side,
-and fell into a peaceful sleep. A few more affusions relieved him from
-danger, and he made a rapid recovery. Were people less afraid of such
-measures, a considerable portion of the danger in fevers might be
-obviated. Great discretion, however, is necessary in the application of
-such treatment, for Ringer states that he has "seen a child, suffering
-from scarlet fever, killed by an over-energetic employment of cold." The
-temperature of the patient should be carefully noted, and its reduction
-below the normal standard should never be permitted.
-
-_Anaesthetics._--All anaesthetics are hypnotics. In other words, they
-possess the power to abolish consciousness, and thus to produce a
-condition resembling sleep. This is effected by the direct action of the
-anaesthetic substance upon the cellular structure of the brain, reducing
-the molecular movements of the living protoplasm below the degree
-requisite for the excitement of consciousness. This sedative effect is
-preceded by a brief period of cerebral exaltation, occasioned by the
-disturbances caused by the first introduction of the drug into the current
-of the circulation.[42] It is with the subsequent hypnotic effect only
-that we are now concerned. Of the numerous anaesthetic substances that have
-been discovered, but few comparatively have been found sufficiently
-manageable and safe for general use. These are alcohol, paraldehyde,
-ether, compound spirits of ether, chloroform, chloral, butylic chloral,
-and amylic nitrite.
-
-_Alcohol._--The hypnotic effect of alcoholic drinks is very decided,
-though not speedily manifested unless the beverage be taken in
-considerable quantity. Distilled liquors produce the effect of alcohol in
-its simplest form; wines, containing various forms of ether, arouse the
-nervous system more thoroughly and agreeably than the pure alcoholic
-stimulants. Beer and porter are rendered more powerfully narcotic by the
-active principle of hops which they contain. The nutritive substances held
-in solution by these last render them peculiarly appropriate in cases that
-require nourishment as well as rest. The considerable quantity in which
-they must be taken, renders them inconvenient for use in cases of severe
-illness. Wines and distilled liquors are then most available.
-
-Alcohol is principally useful as an hypnotic when wakefulness is
-associated with great bodily exhaustion, such as may be experienced in
-advanced stages of the infective fevers. In such cases the heart is
-weakened, the pulse is rapid and feeble, the muscular apparatus is wasted
-and irritable, the blood is diminished in volume and tends to accumulate
-in the venous channels. Under such conditions the patient is usually
-delirious, tossing from side to side, and quite deprived of sleep. An
-ounce of brandy, repeated at intervals varying according to the severity
-of the symptoms, and given with milk and egg, in the familiar form of
-eggnogg, will often quiet this harassing restlessness, and will procure
-refreshing sleep. The temperature of the patient will then decline; the
-tongue will grow moist; and the delirium will diminish or subside
-altogether. Sometimes, however, a contrary result is observed. Alcohol
-should then be administered with a sparing hand, and it will probably be
-necessary to resort to the bromides or other cerebral sedatives.
-
-The great exhaustion which is manifested in delirium tremens sometimes
-requires the use of alcohol to support the patient, so that sleep may be
-procured. It is in such cases advisable to combine the administration of
-capsicum with that of alcohol. According to Ringer, capsicum should be
-given for this purpose in scruple doses, made into a bolus with honey, and
-repeated every three hours.
-
-Wakefulness caused by neuralgic pains is speedily relieved by full doses
-of alcohol. The various species of abdominal and pelvic neuralgia may thus
-be temporarily suspended. In like manner the "rheumatic" pains which
-afflict the overworked and underfed poor may be calmed for a season
-sufficient to procure sleep. The obvious dangers attendant upon such
-medication, however, need no comment.
-
-Old people not unfrequently suffer with a form of insomnia that is
-associated with feeble and painful digestion. This is probably caused by
-insufficient gastro-intestinal secretion. The use of wine containing a
-large proportion of compound ethers gives relief through the improvement
-in digestion consequent upon the stimulant effect of small doses of
-alcohol and ether. Under their influence the digestive fluids are more
-abundantly secreted, and all the bodily functions are quickened. Such good
-results, however, only follow the moderate use of the stimulant. It must
-never be taken in quantity sufficient to affect the intellectual
-functions, or to disturb any of the normal processes of life. The best
-results, so far as digestion is concerned, are obtained by the use of wine
-with the meals; but a night-cap, in the form of hot toddy, is sometimes
-necessary in addition. This is especially useful if there be any form of
-irritative cough or local excitement, such as the aged sometimes
-experience.
-
-The insomnia that attends excessive fatigue may be very quickly relieved
-by the use of food and alcohol. For this purpose any form of alcoholic
-drink will be found useful. The quantity administered should only be
-sufficient to produce a uniform and general vascular relaxation. By this
-means the circulation is equalized throughout the body, and the brain
-passes into a state of tranquil sleep. Any excess in the use of alcohol
-under such conditions will be followed by headache and discomfort on
-awaking. In all cases the intoxicating dose of alcohol must be avoided,
-if its truly hypnotic effect be desired.
-
-_Paraldehyde._--This is a derivative from ethyl alcohol. It is, when pure,
-a colorless liquid, with an agreeable odor, somewhat like that of ether.
-It is soluble in the proportion of one part in eight or nine of water. It
-may be used internally in doses varying from forty-five to one hundred and
-sixty grains. A watery solution, containing one part to ten, has been
-recommended for internal administration. It may also be given in milk or
-in beer. M. Yvon[43] recommends the following formula:
-
-  Paraldehyde, Gr.     20.0
-  Spirit,             100.0
-  Syr. Simpl.,         75.0
-  Tr. Vanillae,          5.0
-
-An ounce of this mixture contains forty-five grains of paraldehyde. When
-taken it should be still further diluted with sweetened water, or with
-beer, to obviate, as far as possible, the disagreeable taste of the drug.
-Sleep follows after the lapse of about half an hour, and continues from
-five to seven hours. The physiological action of the medicine is very
-similar to that of chloral hydrate, and its use is indicated in the same
-class of cases to which that drug is appropriate. By many it is considered
-the preferable hypnotic. It has found considerable employment in the
-insane asylums of Europe, and in other institutions where disagreeable
-medication is no obstacle to experiment. In private practice the peculiar
-taste and smell of the article, and its pungent effect upon the mucous
-membranes of the alimentary canal, render its exhibition more difficult.
-But the weight of testimony is in its favor as an hypnotic in all cases,
-uncomplicated with disease of the stomach, in which insomnia is not
-dependent upon pain, and is associated with cerebral hyperaemia. Its
-administration is followed by no unpleasant consequences. Among the insane
-it is particularly recommended during periods of excitement and
-wakefulness. It has been employed with great satisfaction[44] in cases of
-insomnia during the course of such varied diseases as emphysema,
-bronchitis, phthisis, nervous and spinal disorders, diseases of the heart,
-jaundice, chronic rheumatism, and insomnia from other unrecognized causes.
-Undoubtedly, with greater skill in its purification and exhibition, it
-will become one of the most valuable of hypnotic remedies. Almost useless
-for the relief of pain, it is indicated in cases of uncomplicated
-insomnia. Having very little power, in moderate doses, to depress the
-action of the heart, it is preferable to chloral hydrate in cardiac
-diseases and debility. Sleep procured with doses of fifteen to sixty
-grains is calm and refreshing, and is not followed by any disagreeable
-consequence. A certain degree of tolerance is gradually established, so
-that larger doses may become necessary. It has been given in quantities
-amounting to three drachms; but, if large doses be given before the
-development of tolerance, the patient will experience headache,
-uneasiness, nausea, and vomiting, after waking from the sleep thus
-induced. Another advantage possessed by paraldehyde consists in the
-absence of the period of excitement produced by chloral before the advent
-of sleep. It is an hypnotic, without narcotic properties, limiting its
-effects chiefly to the brain, and leaving the spinal cord in a condition
-nearly like that of natural sleep.
-
-_Ether_, though possessed of the greatest value as an agent for the
-production of artificial anaesthesia, is rarely used as a mere hypnotic.
-Diluted with alcohol and ethereal oil, it forms the _Compound Spirit of
-Ether_, or _Hoffmann's Anodyne_. In this form it is well adapted for
-internal administration. It is thus very serviceable in the treatment of
-those forms of insomnia associated with nervous irritability and hysteria.
-For the relief of wakefulness dependent upon a languid circulation, with
-cold feet and flatulence, the anodyne may be given in half-drachm doses
-well diluted with ice water, and repeated every fifteen minutes till
-relief is obtained. Nearly all forms of painful or spasmodic disturbance
-unattended by fever may be thus relieved. For this reason it is
-particularly useful in the treatment of uterine colic and in sleeplessness
-after childbirth, when opiates cannot be tolerated, or are
-contra-indicated on account of their tendency to excite the brain.
-
-_Chloroform_, like ether, is an agent too powerful and too evanescent for
-use as a simple hypnotic. But for the relief of intense suffering caused
-by nervous irritation and spasm it is without any superior. In certain
-minor affections of a spasmodic character it, therefore, forms a valuable
-adjuvant to other remedies. Diluted with alcohol it forms the spirit of
-chloroform, a remedy which is useful in all cases for which the compound
-spirit of ether is usually prescribed. In this form it is an excellent
-addition to various mixtures designed for the relief of spasmodic coughs
-by which sleep is disturbed. Ringer recommends it in the treatment of the
-irritative cough so characteristic of fibroid phthisis. It should also be
-used in cases of spasmodic asthma. The asthmatic paroxysm may frequently
-be arrested by inhalations of the vapor of chloroform or ether; but,
-unfortunately, the lungs soon become tolerant of these agents, and they
-then cease to afford relief. The valuable mixture known by the name
-_chlorodyne_ owes a considerable portion of its efficacy to the presence
-of chloroform as one of its ingredients.
-
-_Chloral._--Until the recent introduction of paraldehyde, chloral hydrate
-has for many years held the first rank as an hypnotic. It is particularly
-useful in wakefulness occasioned by exhaustion of the nervous centres. The
-conclusions of all experienced observers have been most concisely stated
-as follows:[45] "Chloral appears to be indicated when sleeplessness is
-dependent upon a vascularity due to exhaustion rather than to primary
-excitement of the brain; thus it has been found useful when loss of sleep
-follows severe and prolonged mental application or excitement of feeling,
-or accompanies the general debility following acute diseases attended with
-delirium or severe pain, or is associated with acute _mania_, especially
-of the puerperal form. The somewhat analogous condition which exists in
-_delirium tremens_ is very amenable to this medicine, especially in the
-forming stage of the affection known as 'the horrors,' and which so
-frequently follows surgical injuries in drunkards; it is useful also when
-great nervous excitement and restlessness are associated with extravagant
-phantasms. Nevertheless, its depressing effects are to be guarded against
-in this affection as in the different forms of insanity." This caution is
-directed against the frequent and repeated employment of the article in
-chronic cases, on account of the vasomotor paralysis and general cachexia
-thus induced. It is now claimed that many of these consequences may be
-avoided by the substitution of paraldehyde in the place of chloral, but it
-has been shown[46] that similar effects may follow the long continued use
-of this substitute.
-
-Chloral is usually administered by the mouth in doses, for adults, of
-twenty to thirty grains, dissolved in sweetened peppermint water. If the
-first dose does not procure sleep, it may be followed at the expiration of
-an hour by a second dose of twenty grains. This seldom fails to induce
-refreshing sleep. When the medicine cannot be tolerated by the stomach it
-may be given by enema in milk. For this purpose a drachm of chloral should
-be suspended with the white of an egg in half a teacupful of milk.
-
-_Butylchloral hydrate._--This substance has been recommended as a
-substitute for chloral hydrate, in cases of cardiac weakness, on account
-of its being less powerful to depress the action of the heart. It is
-principally useful for the relief of facial neuralgia and hemicrania. As
-an hypnotic it is seldom used. For this purpose it may be given in a
-solution like that of chloral hydrate. For a simple anodyne effect the
-medicine may be given in five-grain doses, repeated every half hour or
-hour. As a means of procuring sleep it may be given in doses ranging from
-fifteen to forty-five grains. Liebreich has given the medicine in drachm
-doses, and recommended it as an hypnotic superior to chloral hydrate. It
-is useful in the sleeplessness of headaches, neuralgia, dysmenorrhoea, and
-chronic phthisis.
-
-_Amyl nitrite._--This drug has been recommended for the relief of insomnia
-resulting from the opium habit. Ringer considers it useful in the flushes
-of heat and other forms of discomfort which sometimes interfere with the
-sleep of women during the change of life. It should be inhaled in the form
-of vapor, from a handkerchief upon which five drops have been poured. The
-quantity will need to be gradually increased, as the system becomes
-tolerant of its effects. The stimulant effect of the medicine renders its
-use in this manner probably less dangerous than the similar employment of
-chloroform. Unlike the other anaesthetics above mentioned, it causes a
-hyperaemic condition of the brain, and is, for this reason, a useful
-hypnotic in cases of aortic obstruction with an insufficient cerebral
-circulation and consequent wakefulness.
-
-_Opium and opiates._--There seems to be no agreement among experimental
-physiologists regarding the manner in which opium produces its effects
-upon the body. By some it is ranked as a stimulant; by others it is
-considered a sedative. These different opinions are probably due on the
-one hand to differences in the dose and strength of the opiates employed,
-and on the other to idiosyncrasies on the part of the individuals
-subjected to experiment. The soporific effect of the drug appears to
-result from its direct action upon the substance of the brain. Under its
-influence the blood tends to accumulate in the veins, and loses its bright
-arterial hue. Small doses are said to contract the capillaries of the
-body, while they are dilated by excessive doses of the drug. From this it
-may be inferred that opium acts, like many other narcotics, as an irritant
-of the tissues when given in minute quantity, and as a paralyzing agent
-when a certain relative amount is exceeded. The experiments of Curci[47]
-indicate that under the influence of irritating doses of morphia the brain
-becomes hyperaemic.
-
-Opium is a remarkably complex substance, no less than nineteen different
-alkaloids having been separated from it. Of these, however, only one has
-stood the test of therapeutical experiment--morphia. Several other
-constituent alkaloids, notably _codeia_, have been lauded as hypnotics,
-but they are, at their best, far inferior to morphia, and may well be
-omitted from the list of sleep producers. But, though the soporific
-properties of opium are chiefly due to the morphia which it contains,
-there are certain points of difference between the action of the two
-medicines that often render a choice desirable. According to Stille and
-Maisch,[48] morphia does not stimulate circulation and the nervous system
-as much as opium, and its narcotic effects are less decided and speedy,
-though its after effects are more enduring. Opium increases the bodily
-temperature and sense of heat; morphia produces the last effect, but
-diminishes the temperature. Opium at first increases the frequency of the
-pulse, while morphia diminishes it. Opium is of the two the less liable to
-excite nausea and vomiting; hence the superiority of the tinctures and
-aqueous solutions of opium when nausea is specially feared.
-
-Of all the remedies for the relief of pain opiates are the most effectual.
-Before the introduction of the alcoholic hypnotics and the bromides, they
-constituted the principal agents in the treatment of insomnia. Even at the
-present time they are indispensable for the relief of all forms of
-sleeplessness dependent upon pain. A combination of chloral hydrate,
-sodium bromide, and morphine forms one of the most generally useful
-hypnotic compounds ever employed.
-
-Under ordinary circumstances morphia is the preferable opiate for the
-relief of insomnia. The sulphate is most frequently employed, but the
-acetate and the tartrate have been recommended on account of their
-supposed superiority in the formation of solutions that are unirritating
-and permanent in their character. The hypodermic method of administration
-forms the most prompt and efficient mode of procuring the effect of the
-medicine. It should be given in a dose of quarter of a grain about an hour
-before the time when sleep is desired. For some patients a longer time is
-necessary to develop its hypnotic effect. To children the hypnotic dose
-must sometimes be given at three o'clock in the afternoon in order to
-induce sleep at nine o'clock in the evening. As the effect of opiates is
-highly stimulant to the sweat-glands, and is often productive of nausea,
-it is advisable to associate atropine with morphine when thus given. For
-an adult the hundredth of a grain of atropine may be given with every
-quarter of a grain of morphine. The soothing and agreeable effects of
-morphia are thus intensified, while its disagreeable tendencies are
-reduced to a minimum. The injection should be made into the loose areolar
-tissue between the skin and the muscles. Its location is a matter of
-little importance so far as the relief of pain is concerned; but the
-neighborhood of the blood vessels should be avoided, since alarming
-symptoms have been observed after injection into a vein. The outer aspect
-of the arm near the insertion of the deltoid muscle is a favorite site for
-puncture. If, for any reason, the hypodermic use of morphia cannot be
-employed, it may be introduced into the rectum either in solution or in a
-suppository. The bowel should first be washed out with an enema of warm
-water; the opiate may then be introduced. The dose thus exhibited need
-scarcely exceed that usually given by the mouth; but, if the rectum is not
-previously cleansed, a double, or even triple, dose may be required.
-
-As an hypnotic morphia is chiefly useful in phthisis, in cardiac dyspnoea,
-in diseases of the stomach which cause insomnia, in fevers with
-prostration and delirium, in delirium tremens, in mania, and in the
-majority of painful or spasmodic diseases. If the patient be violently
-excited, the opiate should be combined with small doses of tartar emetic,
-ipecac, or tincture of aconite. But in the chronic diseases it is
-desirable to avoid its continuous administration, not only on account of
-the risk of creating the opium habit, but also by reason of the injurious
-effects of the drug upon digestion and nutrition.
-
-_Codeine_ is a mild hypnotic which may be used in doses about twice as
-large as those of morphine. It is expensive and not very efficient, but
-may be sometimes prescribed with advantage when moral considerations
-render the use of ordinary opiates inexpedient.
-
-_Lactucarium_ may be classed with the weaker opiates. It possesses very
-little value. Its fluid extract is sometimes prescribed at night to allay
-the cough of pulmonary consumption, so as to favor sleep.
-
-_Bromides._--According to Mitchell, Echeverria, and Bartholow, the
-soporific energy of the bromides may be ranked as follows: Lithium bromide
-first, sodium bromide second, potassium bromide third. Hammond praises
-calcium bromide. Hydrobromic acid is also employed as an hypnotic in
-certain cases. As a clinical fact the bromides of sodium and potassium are
-most frequently employed for the relief of insomnia. Of these the second
-is most useful when sleeplessness is associated with the phenomena of
-irritability; the first is less energetic in its effects upon the motor
-structures of the body.
-
-The bromides act upon the protoplasmic constituents of the body, directly
-inhibiting their functional energy. Upon the spinal cord they act to
-diminish reflex excitability. Under their influence the receptivity and
-functional capacity of the brain is reduced. The minute blood vessels
-contract in consequence of the inactivity of the tissues which they
-supply. A lethargic sleep is thus induced.
-
-For the reasons above stated the bromides find their greatest opportunity
-for usefulness in cases of over-excitement and exhaustion of the brain.
-When the cortical cells have degenerated into a condition of irritable
-weakness, characterized by inordinate instability of substance, the
-bromides serve to steady the fabric by retarding those movements of
-disintegration which produce morbid wakefulness. Almost useless in cases
-marked by active congestion of the brain, they are invaluable in the
-insomnia produced by excessive mental exertion, care, emotion, worry and
-fatigue. The wakefulness of hysteria, of asthenic mania, and of sexual
-excitement, is often greatly relieved by the administration of the
-bromides. The prodromic stage of delirium tremens, before any violent
-outbreak, and the wakefulness of convalescence from acute diseases are
-often cured by their use. Mental disturbances and morbid impulses
-associated with pregnancy or the puerperal state may be dispelled in the
-same way. The screaming fits of night terrors in children are benefitted
-by these medicines. They seem to increase the efficacy of chloral,
-chloroform, ether, cannabis indica, hyoscyamus, belladonna, and the
-opiates.
-
-The hypnotic dose of hydrobromic acid is twenty-five grains, largely
-diluted with sweetened water. For this reason, and for its disagreeable
-taste, it is not an eligible preparation. Lithium and calcium bromides may
-be given in scruple doses every hour or two till sleep is produced. Sodium
-and potassium bromides should be given in doses of thirty or forty grains
-every two hours.
-
-It is sometimes remarked that instead of favoring sleep the bromides only
-increase wakefulness. In such cases opiates and alcoholic stimulants are
-usually indicated.
-
-_Hops._--The principal sedative constituent of this plant is the yellow
-glandular powder found in the strobiles; this is called _lupulin_. Hops do
-not exhibit any directly narcotic property; but they serve to allay
-nervous excitement, and thus favor the occurrence of sleep. They are
-principally useful in cases of irritability of the bladder and sexual
-organs; in dyspepsia caused by irritable weakness of the stomach; and in
-the exhaustion of delirium tremens. The infusion is the best preparation
-for internal use. It may be taken in doses of one or two ounces, as
-required. Lupulin may be given in doses of ten grains or more. Its fluid
-extract is prescribed, fifteen or twenty minims in sweetened water
-whenever needed. The best method, however, of securing the beneficial
-effects of the medicine consists in the administration of a mild beer that
-is rich in hops. A glass at bedtime often forms a sufficient hypnotic.
-
-_Gelsemium_ is a very powerful agent for depressing the pulse and the
-functional activity of the spinal cord. It thus favors the induction of
-sleep in cases attended with violent excitement, such as may be witnessed
-in acute mania. It has been employed in the treatment of delirium tremens;
-but the poisonous qualities of the plant render its use somewhat
-dangerous. The toxic effects are sometimes developed quite suddenly, and
-in a manner very alarming to the laity. For these reasons it is not to be
-recommended as a soporific, unless the patient can be continually under
-the eye of the physician or of an intelligent nurse.
-
-_Conium_ has been found useful in the insomnia of mania, not through any
-narcotic property of its own, but by reason of its sedative effects upon
-the spinal cord and nerves. Under its influence the excitement of the
-patient is so far reduced that other hypnotic remedies can produce their
-effect. For this purpose Squibb's fluid extract, in doses of about
-one-third of a drachm, or one-sixtieth of a grain of coniine, may be given
-sufficiently often to repress excitement. The alkaloid may be given
-hypodermically, and in gradually increasing doses. With it should be
-associated other remedies, like hyoscyamus and chloral hydrate, in order
-to procure sleep.[49]
-
-
-
-
-CHAPTER IV.
-
-TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.
-
-  Take thou this phial, being then in bed,
-  And this distilled liquor drink thou off;
-  When presently, through all thy veins shall run
-  A cold and drowsy humor, which shall seize
-  Each vital spirit.
-                                --ROMEO AND JULIET.
-
-
-Excluding from consideration all cases of insomnia arising from painful
-injuries or diseases of the external portions of the body, which belong to
-the province of surgical therapeutics, we may profitably commence with the
-variety of wakefulness that is excited by disorder of the brain and its
-membranes. This includes the different forms of meningitis, the cerebral
-disturbances which constitute insanity, cerebral exhaustion, and chronic
-alcoholism.
-
-_Insomnia in acute affections of the brain._--Acute intra-cranial
-inflammations may result from general diseases, like rheumatism, the
-eruptive fevers, tubercular infiltration, insolation, the development of
-tumors, or syphilitic growths. In all such cases the earlier stages are
-marked by a painful exaggeration of cerebral function which renders sleep
-impossible. The wakefulness of this stage soon becomes complicated with
-delirium; and the whole is finally merged in a fatal coma. Cerebral
-excitement is the principal feature which arrests attention. This is
-accompanied by an inordinate determination of blood to the head, producing
-that cerebral hyperaemia which figures so largely in the works of the
-humoral pathologists. The treatment of acute inflammation becomes the best
-means of relieving this excitement, allaying the hyperaemia, and procuring
-sleep. The treatment should be derivative, counter-irritant, and
-calmative. The first indication must be fulfilled by the exhibition of an
-active purge. Ten grains of calomel with five grains of sodium bicarbonate
-may be given for this purpose. Leeches or wet cups should be applied to
-the temples, or to the back of the neck. The feet should be placed for a
-short time in a hot foot-bath, and an ice-cap must be drawn over the
-scalp. The internal medication must consist of arterial sedatives and
-cerebral depressants. For the first, tincture of aconite forms an
-admirable example--better even than the tartar emetic so much lauded by
-Graves. Aconite may be given with the bromides. When sleeplessness in an
-acute meningitis is accompanied by severe pain, an excellent combination
-will be found in the following:
-
-  [R.] Morph. Sulph.               gr. 1/4
-       Chloral Hydrat,
-       Sodii Bromid. a a           [dr] iv.
-       Tr. Aconit., rad.           gtt. xxv.
-       Tr. Cardam. Co.             [dr]i .
-       Aquae, q. s. ad.             [oz] i.
-
-  Sig.--A teaspoonful every two hours, till relieved.
-
-As the disease progresses, the quantity of morphia should be reduced. In
-epidemic cerebro-spinal meningitis, opiates may be safely employed in
-much larger doses than are tolerated in the simple forms of the disease.
-When in doubt regarding the proper hypnotic the bromides alone should be
-used. Chloral hydrate may also be safely employed in the first and second
-stages of meningitis; but if given in full doses near the close of the
-second stage it sometimes seems to hasten the appearance of coma.
-
-_Insomnia in insanity._--Persistent insomnia is often one of the
-premonitory symptoms of insanity. It is likely to present itself as a most
-formidable complication at any stage of the disease. To consider aright
-the relations that exist between sleeplessness and insanity would far
-exceed the limits of this work; we can only review the leading indications
-for its treatment. It is occasioned either by an excited state of the
-brain, accompanied by hyperaemia and general functional exaltation, or by
-an exhausted and irritable condition of the cerebral substance. The first
-of these two varieties of wakefulness is encountered in cases of violent
-maniacal excitement where the disorder is comparatively recent, and the
-bodily vigor has not been depressed by long continued disease. The
-indications for treatment call for sedative measures. Leeches behind the
-ears and the application of the ice-cap are sometimes of great service.
-Derivative action upon the bowels with aloetic purgatives has often
-yielded good results. In like manner, hot mustard foot baths are
-recommended. The soothing effect of a warm bath at 90 deg.-95 deg. F. is sometimes
-sufficient to calm excitement, and to induce sleep. The combined effect of
-cold applications to the scalp and a warm bath to the general surface is
-still more tranquillizing. This method of treatment is particularly useful
-in maniacal forms of insanity, and in certain cases of
-melancholia--especially those in which the skin is dry and the secretions
-are disordered.
-
-Cold affusions and shower baths have been employed for their revulsive and
-sedative effect in mania. This mode of treatment is sometimes effectual,
-but is not without risk.
-
-The medicinal treatment of insomnia is frequently facilitated by the
-measures above indicated. In cases of great excitement with restlessness
-and bodily agitation, it is desirable to arrest the movements which are
-wearying the patient and keeping him awake. This may be accomplished by
-the use of conium, as indicated by Kiernan (_loc. cit._). Twenty minims of
-Squibb's fluid extract may be given for the first dose. Half this quantity
-should be repeated every half hour until the patient becomes quite calm.
-Bromide of potassium and hydrate of chloral in drachm doses should be
-given in connection with conium. Recently, paraldehyde has been employed
-as a substitute for chloral. These remedies reduce cerebral excitement,
-and favor the induction of sleep which is at least refreshing, if not
-curative of the disease. They should not, however, be used habitually, for
-fear of producing the characteristic consequences of over-dosing with such
-drugs.
-
-The varieties of insanity in which depression and exhaustion are the
-prominent features require different management. Nutritious food,
-alcoholic restoratives and stimulant doses of opiate remedies are most
-serviceable. The sleeplessness of melancholia and of paretic dementia may
-be thus relieved. Opium may be given in the form of a pill, or in the
-deodorized tincture. The old fashioned "black-drop" is highly esteemed by
-some. Others prefer the salts of morphia. If cerebral hyperaemia be present
-in these cases, it is usually associated with asthenic conditions of the
-brain, indicated by paleness of the face and weakness of the pulse. The
-hyperaemic state is then easily overcome by the administration of alcohol
-or of chloral with an opiate. If opiates alone are given in cases of
-insanity with great depression, there is danger that death by syncope may
-occur, precisely as it sometimes happens in delirium tremens when treated
-with large and frequent doses of opium.
-
-Cases are occasionally encountered which receive no relief from opiates.
-The remedy seems only to aggravate the existing irritability and insomnia.
-For such patients the tincture of hyoscyamus may be employed in doses
-ranging from two to four or even six drachms. Associated with bromide of
-potassium and hydrate of chloral, it has been used with great success.
-Spitzka prefers the simple tincture rather than the fashionable alkaloid,
-hyoscyamia.
-
-Cannabis indica associated with bromide of potassium is a useful hypnotic
-in cases of moderate depression and excitement. Clouston finds as a result
-of his experiments that "forty-five grains of bromide of potassium and
-forty-five minims of the tincture of cannabis indica are rather more than
-equivalent to a drachm of laudanum as a means of allaying maniacal
-excitement."[50] In his recent work,[51] the same author deprecates the
-use of opiates in states of depression, and advises the substitution of
-tincture of cannabis indica (x min.) and bromide of potassium (xx grs.).
-He also emphasizes the importance of abundant exercise in the open air, as
-the best hypnotic in every case that can be trusted abroad.
-
-_Insomnia in Chronic Alcoholism and Delirium Tremens._--The insomnia of
-chronic alcoholism is dependent upon the extensive morbid changes produced
-in the digestive apparatus and in the nervous system by the habitual use
-of alcoholic drinks. Sleep becomes greatly disturbed and unrefreshing. It
-is frequently broken by horrible dreams. The successful treatment of this
-condition requires complete abandonment of the use of alcohol, and a
-general correction of the condition of the alimentary canal. For the
-immediate relief of insomnia, full doses of bromide of sodium will be of
-service. Strong infusions of hops may be given _ad libitum_. Cannabis
-indica, in the form of the extract, so as to avoid the use of alcohol in
-the tincture, is of service. Hypodermic injections of morphia are
-frequently employed, but should be avoided if possible, for fear of the
-opium habit. Chloral hydrate is exceedingly useful, but should be given in
-milk, and as seldom as possible, for fear of adding to the injuries
-already sustained by the stomach. For the same reason the use of
-paraldehyde in such cases is quite inadmissable.
-
-When chronic alcoholism has culminated in _delirium tremens_, more
-energetic measures become necessary in order to procure sleep. If the
-patient be of a vigorous constitution, and if the delirium be very active,
-tartar emetic with morphia may be given, as advised by Graves. Large doses
-of tincture of digitalis, sometimes reaching an ounce every four hours,
-were used by Jones, of Jersey. Capsicum, in scruple doses every three
-hours, is said to induce sleep in many cases of delirium,[52] especially
-in exhausted conditions of the circulatory organs. Hydrate of chloral and
-bromide of sodium, each in scruple doses, may be given every two hours.
-Opiates should be used with moderation, and all attempts to induce
-profound narcosis should be avoided. Drachm doses of tincture of cannabis
-indica and of compound spirit of ether, may be given when a diffusible
-stimulant must be associated with the soporific. In desperate cases it is
-sometimes necessary to resort to inhalation of ether, but if sudden death
-should occur, it would be popularly ascribed to the effects of the
-anaesthetic. By reason of a certain tendency to death from syncope during
-this disease, it is imprudent to place such patients under the influence
-of chloroform or the other stronger anaesthetics.
-
-_Insomnia in diseases of the heart and blood vessels._--I can fully
-indorse the opinion of Ringer regarding the beneficial effects of morphia
-in the treatment of the wakefulness caused by advanced diseases of the
-circulatory organs, "In such a case, the comfort afforded by a hypodermic
-injection is almost incredible.... In cardiac dyspnoea, a sixth of a grain
-twice or three times a week often suffices, but the dose and frequency in
-severe cases must be gradually increased to a quarter of a grain each
-night. Doctors are often afraid to administer morphia in the case of a
-patient propped up in bed, with livid ears, nose and nails, with distended
-jugulars and dropsical extremities, with weak, frequent and irregular
-pulse. They dread lest the morphia should weaken the heart, make the
-patient worse, if not kill him outright. This fear is quite groundless,"
-if the opiate be given in moderate doses. It is the stimulant effect of
-the medicine that is safe and useful.
-
-When wakefulness is caused by _angina pectoris_, or by simple cardiac
-neuralgia, such as sometimes follows excessive use of tobacco, relief may
-be obtained through the exhibition of alcoholic stimulants, hydrate of
-chloral, or nitrite of amyl. These remedies act more speedily than
-morphia, and may be associated with it, to the great advantage of the
-patient. They should not be habitually used, however, in cases of cardiac
-exhaustion, as their chronic employment favors accumulation of blood in
-the right side of the heart, with a tendency to paralysis of the cardiac
-muscles. It is in stenosis of the coronary arteries, and in aortic
-obstruction, that nitrite of amyl and nitro-glycerine are most useful. The
-insomnia that results from the remote consequences of these diseases is
-often relieved by remedies which assist the circulation of blood. For this
-purpose digitalis is the most useful stimulant in mitral disease;
-nitro-glycerine, in aortic valvular lesion.
-
-_Insomnia in diseases of the respiratory organs._--Pleuritic pain and its
-consequent wakefulness may be relieved with opiates, guarded by
-appropriate vascular sedatives. Dover's powder, or morphia and aconite,
-form excellent examples of the remedies most useful, so long as the lungs
-are not overwhelmed by excessive exudations into the pleural cavities.
-Pneumonia and bronchitis are accompanied by wakefulness, in their earlier
-stages, as a consequence of harassing cough. This may be allayed by the
-judicious use of expectorants and sedatives. If symptoms of asphyxia
-appear, indicated by blueness of the lips and nails, opiates should never
-be given. Respiratory stimulants are then indicated, and sleep must be
-allured by the use of alcoholic beverages and moderate doses of chloral
-hydrate, with musk and camphor. The early, irritative cough of incipient
-pulmonary consumption may be soothed with camphor and opium. Paregoric and
-a demulcent, like Iceland moss tea, or flaxseed tea slightly acidulated
-with lemon-juice, form an excellent type of such a compound. But the
-chronic duration of the disease renders the constant use of opiates
-undesirable. Chloral hydrate, for the same reason, cannot be given without
-intermission. It is well in such cases to employ the different alcoholic
-beverages at bedtime. Inhalation of warm vapor, and respiration of air
-charged with ether, or carbolic acid, will often quiet an irritative
-cough. In advanced cases belladonna is useful, to check the profuse
-sweating and to calm the thoracic pain that hinders sleep. In the later
-stages of the disease, when relief from suffering is the only end in view,
-morphia and dilute hydrocyanic acid will often render quite tolerable the
-few remaining nights of life.
-
-One of the most distressing forms of insomnia is occasioned by the
-different varieties of asthma. Dyspnoea is the feature that is common to
-them all, and is the principal exciting cause of wakefulness. In recent
-cases, which are characterized by spasm, the various anti-spasmodics are
-useful. Tincture of lobelia, tartar emetic, and ipecac, are of great
-service. Inhalations of ether or of chloroform, or of nitrite of amyl,
-will often cut short a paroxysm; but the nervous system soon becomes
-tolerant of their action. Chloral hydrate and alcoholic stimulants are
-less vigorous, and cannot be long tolerated by the stomach, especially if
-there be a gouty diathesis behind the disease. The fumes of burning
-pastiles containing nitre and stramonium leaves are often of great service
-if so breathed as to thoroughly fill the lungs with the smoke. In like
-manner, the smoke from smouldering nitre-paper, or from cigarettes that
-have been dipped in an arsenical solution, is sometimes useful. Air
-charged with ozone has been found curative in some inveterate cases.
-Hyoscyamus, belladonna, and tobacco, have been recommended. It may even
-become necessary to employ hypodermic injections of morphia.
-
-If, however, the disease should resist all these anti-spasmodics and
-soporifics, besides the remedies addressed to the predisposing causes of
-the malady, the only thing that remains is a change of locality. Many very
-desperate cases have thus been restored to health and comfort.
-
-_Insomnia in renal disease._--In the acute forms of renal disorder this is
-usually caused by pain and fever. It is, therefore, to be relieved with
-opiates given in connection with such arterial sedatives and diaphoretics
-as each individual case may require. But the tendency of inflammatory
-diseases of the kidney to merge in uraemia must not be forgotten, and the
-soporific must be used in such cases with great caution. For this reason
-hyoscyamus is often preferable to an opiate. In extreme dropsical
-conditions the measures that are useful for the reduction of anasarca
-constitute the most efficient means for the induction of sleep. In
-nephritic colic pain is too severe to admit of any rest while it lasts.
-The general treatment of colic is all that can occupy the attention until
-relief is secured. The dyspnoea and wakefulness sometimes experienced in
-advanced cases of Bright's disease may be greatly relieved by the
-judicious use of morphia, very much as in the similar disorder occasioned
-by chronic diseases of the heart.
-
-_Insomnia in diseases of the liver._--Inasmuch as the majority of these
-diseases interfere with the formation and proper discharge of bile it is
-desirable to avoid, as far as possible, the use of opiates in the
-disturbances of sleep that are so commonly consequent upon disorder of the
-liver. Simple restlessness at night can usually be obviated by the
-ordinary treatment that is remedial of the disease by which it is caused.
-But it often happens that hypnotic remedies must also be employed.
-Hyoscyamus, belladonna, chloral hydrate, and compound spirit of ether, are
-frequently useful. Sometimes when the evacuations exhibit a deficiency of
-biliary coloring matter, a grain of opium, with a few grains of calomel,
-forms a very efficient hypnotic. Alcoholic soporifics are not well
-tolerated when the gastro-intestinal mucous membrane is diseased. Biliary
-colic demands treatment similar to that that is required in nephritic
-attacks. Warm baths, fomentations, and a broad belt of oiled silk around
-the body, are very grateful, and are favorable to the induction of sleep.
-A course of nitro-muriatic acid, internally and externally, is often
-useful when wakefulness is associated with torpidity of the liver.[53]
-
-_Insomnia in gastro-intestinal diseases._--In acute inflammatory
-conditions of the stomach and bowels, sleep must be invited by the use of
-opiates. Bismuth and morphia, with hydrocyanic acid, are the favorite
-means of obtaining relief. Opium in solid form is sometimes preferable
-when a slowly developed and long continued impression is desired. Warm
-baths and hot poultices also give great relief.
-
-In all chronic affections of the alimentary canal opiates must be used
-with great caution, for fear of the opium habit, unless the case be
-incurable. Cancer of the stomach requires their free use. The milder
-disorders should be managed largely with hygienic treatment. The diet
-should be so regulated as to prevent the liberation of gas in the
-intestines, for their distention in this way is fatal to refreshing sleep.
-A gentle aperient or a large injection of warm water, often proves itself
-decidedly soporific in such cases. Catarrhal conditions of the mucous
-membrane prohibit the entire class of alcoholic and ethereal soporifics.
-Nervous and atonic dyspepsias are often benefitted by the use of bitter
-beer, and by drachm doses of brandy or whisky largely diluted. These
-should be taken at mealtime, or with food at bedtime. A glass of hot
-water shortly before retiring is often useful.
-
-The relief of insomnia in dyspeptic derangement, however, must not be
-sought through the administration of anodynes and hypnotics alone. Only
-when the entire life of the patient has been regulated upon a
-physiological basis can refreshing sleep be obtained. Change of habits,
-change of occupation, change of locality--these are the only curative
-measures in a vast number of the cases of wakefulness that occur in modern
-life. Alcohol, tobacco, tea, coffee, foul air, late hours, and mental
-excitement, are the principal causes which must be abolished before
-healthy sleep can be enjoyed.
-
-_Insomnia in febrile conditions._--In the early stages of all acute fevers
-wakefulness is a very common incident. It is then occasioned by irritation
-of the brain, and must, therefore, be relieved with opiates. If the
-patient is not depressed by the disease, the opium should be associated
-with tartar emetic or aconite, or ipecac. Dover's powder is very useful in
-such conditions. In malarial fevers wakefulness should be combatted with
-full doses of quinine in addition to the opiate. Gelsemium is sometimes a
-very satisfactory remedy--especially in the febrile attacks to which
-children are liable. If any evidence of cerebral hyperaemia be observed, it
-is well to give chloral hydrate and the bromides. Hyoscyamus, belladonna,
-and cannabis indica are useful when the pupils are contracted and when
-spasmodic symptoms are present. Lukewarm baths, wet packs, and cool
-sponging are exceedingly grateful, and often assist in the evolution of a
-suppressed eruption in the exanthematous fevers.
-
-In the later stages of fever a condition of cerebral exhaustion is
-sometimes encountered. Irritable weakness caused by starvation of the
-brain is the prominent feature. The pulse is small and weak. The patient
-tosses and rolls from side to side. He is perhaps greatly emaciated by an
-illness of considerable duration. An elevated temperature requires
-frequent sponging of the body.
-
-Opium, alcohol, and liquid food, are the best hypnotics in such cases. The
-acetum opii and the deodorized tincture of opium are among the best
-preparations of the drug, by reason of their stimulant effect. The
-equivalent of two grains of opium with a full glass of eggnogg, will often
-procure sleep for such a patient. If there be evidence of blood stasis,
-with blueness of the nails, hypostatic pneumonia, etc., musk and strychnia
-should be given in place of opium, and the circulation should be assisted
-with carbonate of ammonia, as follows:
-
-  [R.] Ammon. carb.,          gr. v.
-       Spt. chloroform,       gtt. xx.
-       Aq. camphor,           [oz] ss.
-
-To be given in a little milk, as required. Chloral and the bromides are of
-comparatively little value in all cases where there is considerable
-depression of the vital forces.
-
-_Insomnia in rheumatism and gout._--Opium in a diaphoretic preparation,
-and associated with alkalies or with colchicum, has always been the most
-approved remedy for sleeplessness in the acute forms of these painful
-diseases. Salicylic acid and the salicylates have in great measure
-superseded the use of opiates for the relief of pain and wakefulness in
-rheumatism, but they are not always efficient. Opiates, with or without
-chloral, must then be used. Sometimes a painful case that has resisted all
-other remedial agents yields promptly to the action of a series of
-blisters. The chronic forms of rheumatism require the use of stimulant
-diaphoretics, anodyne liniments containing chloroform and belladonna, and
-chloral hydrate, or even a Dover's powder, at night.
-
-Acute gout is rarely seen in this country, but its rudimentary forms,
-described by Da Costa as _lithaemia_,[54] are not uncommon. They are
-associated with wakefulness of a very troublesome character, which only
-yields to a persistent and long continued course of treatment directed
-against the diathesis. Careful regulation of the diet, change of air, and
-anti-arthritic remedies, are of infinitely greater service than any
-particular hypnotic drug.
-
-_Insomnia in syphilis._--In advanced stages of syphilitic cachexia, a
-variety of wakefulness independent of pain is sometimes observed. It is
-marked by a tendency to wake at a fixed hour of the night, frequently
-about two o'clock in the morning, after which time sleep is impossible.
-The symptoms of constitutional disease are not prominent in these cases,
-but the history and the evident cachexia make their nature apparent. They
-usually yield to a mercurial treatment. In their comparative freedom from
-severe pain, such patients present a striking contrast to certain cases
-of syphilitic rheumatism, or neuralgia. The nocturnal suffering in such
-instances is frightful. It can be finally overcome by anti-syphilitic
-treatment; but, while waiting for the radical cure, palliatives are
-needed. Chlorodyne and similar combinations of all the anodyne drugs
-afford the most effectual means of relief. I have sometimes found it
-necessary to increase the dose until the characteristic delirium produced
-by solanaceous drugs was manifested. The relief thus procured sometimes
-continues for many days after the cessation of hypnotic medication.
-
-_Insomnia in various disorders of nutrition._--The wakefulness experienced
-by syphilitic patients is not peculiar to their cachexia. It is a result
-of blood disorder and impoverishment that is common among the victims of
-rheumatism, lithaemia, syphilis, malarial poisoning, cancerous dyscrasia,
-chronic toxaemia of every form, and ordinary anaemia. Imperfect blood supply
-deteriorates the nutrition of the brain, and renders it so excitable that
-sleep is interrupted so soon as the period of profound repose is past.
-This occupies about four hours (see p. 16), hence the patient who falls
-asleep at ten o'clock is ready to wake up at two in the morning, and only
-sleeps again, if at all, when wearied with tossing till daylight. Such
-patients often derive great benefit from a morning nap thus obtained
-between the hours of five and seven.
-
-The most successful treatment of this variety of insomnia is that form of
-medication which is addressed to the particular cause of the cachexia or
-dyscrasia. But the palliative treatment necessitated by the immediate
-suffering of the patient will often tax to the uttermost the ingenuity of
-the physician. Usually, there is a chronic atonic dyspepsia, or a chronic
-catarrhal gastro-enteritis, or a combination of both conditions, to be
-remedied. Gently stimulating laxatives are needed for the relief of these
-disorders. An animal diet is most easily digested. Milk and rare
-beefsteaks supply this form of nutriment, to which must be added oranges,
-grapes and lemons, to prevent the development of incipient scurvy. The
-kidneys may be excited with small doses of iodide of potassium or chlorate
-of potassium. Only after a considerable course of elimination are "tonics"
-admissible. For the immediate relief of the insomnia by which the patient
-is exhausted, a rather complex method is needful. Such subjects often pass
-the day in tolerable comfort, but, as evening advances, the wearied brain
-becomes irritable, and bedtime finds the patient in an excited state which
-cannot be easily overcome by large and repeated doses of chloral.
-Paraldehyde is too disagreeable to be used with impunity, and only towards
-morning does the sufferer yield to the narcotism induced by successive
-doses of chloral and bromide. A night thus occupied adds nothing to the
-vigor of the individual, and its frequent repetition will most surely lead
-to starvation of the nerve-centers,--perhaps to consequent
-"chloral-mania."
-
-When the tendency to cerebral irritation becomes thus apparent, great
-assistance can be obtained by a resort to the use of opium, combined with
-tartar emetic and camphor. A pill containing one grain each of opium and
-camphor, with one-twelfth or one-sixteenth of a grain of tartar emetic,
-should be given early in the evening. This calms the brain, and prepares
-the way for a moderate dose of chloral at bedtime. In this way sleep can
-be procured with much less expenditure of nervous force and medicine than
-is wasted in the ordinary routine method. The rest thus obtained is
-followed by less depression than when it follows stupefaction with large
-quantities of an exciting narcotic.
-
-_Insomnia during pregnancy, and after parturition._--Closely akin to the
-insomnia of anaemia is the wakefulness experienced by hysterical subjects.
-The irritable weakness of their brains renders them peculiarly liable to
-disturbances of sleep. The state of pregnancy often serves to fill their
-nights with excitement sufficient to interfere with quiet rest. Loss of
-blood during parturition, by the induction of temporary anaemia, may
-greatly aggravate this condition.
-
-The suppression of nervous irritability is the principal indication for
-treatment. This may be temporarily accomplished by the use of the
-bromides. But these must be reinforced by an ample dietary, with stimulant
-nervines and anti-spasmodics. Good wine, camphor, valerian, hyoscyamus,
-cannabis indica, and occasional doses of opium, will generally suffice to
-induce the needful repose. If confinement in bed precludes muscular
-movement for any length of time, passive exercise must be secured through
-the aid of massage.
-
-_Insomnia in spasmodic diseases._--This class of ailments will usually be
-encountered among patients who are enfeebled by unfavorable conditions of
-health, either congenital or acquired. Together with the specific
-treatment appropriate to the particular disorder, it often becomes
-necessary to make use of hypnotic remedies against sleeplessness. Thus
-chorea may sometimes reach a degree of inveteracy that renders sleep
-impossible. Alcohol and chloral hydrate must then be given in large and
-frequent doses. A laryngeal catarrh may excite spasmodic croup--a disorder
-speedily relieved with chloral hydrate. Old people of a nervous
-temperament sometimes experience paroxysms of a similar character,
-interfering with sleep whenever they suffer a catarrhal attack. Liberal
-doses of assafoetida and a Dover's powder at night, associated with a
-course of antilithic treatment, afford great relief. Iodide of potassium,
-in the majority of asthmatic affections; the bromides and gelsemium in
-cases marked by excitability of the spinal cord; valerian, musk,
-assafoetida, camphor, and carbonate of ammonia, in cases of cerebro-spinal
-weakness and irritability; oxide of zinc, quinine, and chloral hydrate,
-when weariness and exhaustion are connected with a hyperaemic condition of
-the brain; such are the principal remedies against this variety of
-insomnia. Convulsions, if frequently repeated, may be subdued by the
-inhalation of ether or chloroform, until a sufficient quantity of the
-bromide of potassium can be introduced into the system.
-
-_Insomnia in childhood._--According to Vierordt,[55] the duration of sleep
-in the first week of life is only interrupted by the act of nursing.
-During the first month the infant should sleep at least two hours after
-each meal, waking only three or four hours out of the twenty-four. This
-period gradually increases; but, when a year old, the healthy child still
-sleeps more than he wakes. During the second and third years, he should
-sleep for ten or eleven hours at night, besides a nap of two hours in the
-daytime. After the fourth or fifth year, the daily nap may be
-discontinued. The fifth and sixth years require ten hours of sleep at
-night. From the seventh to the eleventh year, nine hours are needed. After
-the twelfth year, eight hours are sufficient.
-
-The causes of wakefulness are as numerous among children as among adults.
-Jacobi[56] insists upon the importance of attention to the ventilation of
-the bed-chamber, and to the quality of the bed. Everything must be light,
-airy and cool. He gives utterance to universal experience when he asserts
-that great heat can be endured by day without harm, if only the night
-brings coolness and rest.
-
-Hunger is sometimes a cause of wakefulness among young children. Partial
-starvation endured for a considerable time induces somnolence. The
-opposite condition of repletion may also excite wakefulness through
-painful distension of the stomach and bowels. Earache, terminating in
-abscess, often prevents sleep, sometimes without discovery of the cause
-until a discharge of pus enlightens the diagnosis. Persistent wakefulness
-without evident cause should arouse a suspicion of incipient tubercular
-meningitis. Slight elevations of temperature at night sometimes occasion
-sleeplessness, which may be overcome with quinine in doses of two to five
-grains at bedtime.
-
-Wakefulness sometimes occurs merely as the result of a bad habit. This is
-usually observed among delicate children of a nervous temperament, whose
-inclinations have never been thwarted. Such patients have been sometimes
-cured, after the failure of a long and expensive course of treatment with
-homoeopathic globules, by the adoption of a systematic moral training
-reinforced by an occasional forcible application of the parental hand to
-the gluteal region of the child. Of course such a method must not be
-recommended without certain knowledge that no lurking disease of the
-nervous system has escaped detection. Fretfulness and wakefulness are not
-associated with proper living and good health. Their cause must generally
-be sought upon the surface of the body and in its internal cavities.
-
-Much relief in the insomnia of children can be obtained from the use of
-lukewarm baths at bedtime. Supper should be a light but sufficient meal.
-Every disorder of digestion should be regulated as it occurs. Painful
-affections may be quieted with Dover's powder. Feverish and irritable
-conditions yield frequently to aperients, or to gelsemium and quinine.
-Night terrors and screaming fits should be calmed with chloral hydrate and
-the bromide of sodium. As a general sedative and hypnotic for children
-hyoscyamus has an excellent reputation. It may be given in considerable
-doses with perfect safety and the best results. For patients in early life
-it seems to fill the place occupied by cannabis indica in the medication
-of adults.
-
-_Insomnia in old age._--The highest physical perfection is reached before
-the fortieth year of life. Between this age and the forty-fifth year man's
-vigor begins to decline. The power of accommodation diminishes,
-necessitating the use of spectacles; adipose tissues begin to load the
-body; the hair grows thin, and begins to bleach. The processes of
-nutrition and of disassimilation become more sluggish; the appetites and
-passions gradually subside. Sometimes the moderation of nervous
-excitability thus effected permits indulgences of the appetite for food
-that were impossible during earlier years--the nervous dyspeptic can
-tolerate dainties which would formerly have been unendurable. Less
-disturbed by the solicitations of sense, the powers of reasoning and of
-judgment enlarge their authority. Under favorable circumstances this
-period of life may continue for about twenty years, when old age develops.
-From the sixtieth to the eightieth year the progress of decline is rapidly
-accelerated, and life is normally terminated between the eightieth and
-eighty-fifth years of existence. The rare examples of greater longevity
-are too few in number to warrant the assumption that a century of years is
-the physiological complement of life.
-
-As old age advances, the time of sleep is slightly abridged. The moderated
-activity of the body requires only a diminished rate of repair to make
-good the waste of the tissues. Less sleep, therefore, is needed. But the
-liability of age to the incidence of arthritic diseases, rheumatism, and
-disorders of the heart, blood vessels, digestive apparatus, and urinary
-organs, renders the period of decline particularly subject to those
-varieties of sleeplessness which depend upon such derangements of health.
-The nutrition of the brain suffers under such circumstances, and the
-substance of the organ becomes morbidly irritable. Insomnia among the aged
-often owes its cause to these unwholesome conditions. The biography of the
-celebrated Carlyle affords numerous illustrations of this variety of
-wakefulness. Disease of the cerebral blood vessels sometimes originates a
-series of changes differing only in degree and intensity from the
-classical type of chronic periencephalitis. This is characterized by many
-of the minor phenomena of general paresis, only occasionally rising to the
-level of that disease. Wakefulness is one of the most troublesome symptoms
-of this disorder. Its management requires attention to all the details of
-excretion and nutrition. The diet must be carefully selected with
-reference to failure of the digestive function. Milk and water should be
-preferred for drink, and the great emunctory organs of the body must be
-carefully stimulated and sustained. A judicious choice of climate may
-accomplish much for the comfort of the patient. The mild, insular climate
-of Florida, or of New Providence, or of the Sandwich Islands, affords
-superior advantages for the relief of sleepless sufferers in the northern
-temperate zone of the American continent, who need the soothing influence
-of a continual open air bath.
-
-During the latest stages of decline, when the cortex of the brain has
-become considerably atrophied, the opposite of wakefulness is experienced.
-Intellectual operations become less vigorous, and the patient passes
-lengthening periods of time in sleep. This is a genuine relapse into the
-apathy of infancy. The apparatus of thought is worn out, and the old man
-sinks gradually into the sleep from which there is no awakening.
-
-The treatment of insomnia, therefore, resolves itself into the removal of
-all special and temporary causes of wakefulness, with attention to the
-general hygiene of the patient, and careful regulation of his diet,
-habits, and occupation. Pain must be quelled with anodynes. Cerebral
-excitement must be calmed, in sthenic cases, with anti-spasmodics and
-sedatives--in asthenic subjects it must be overcome with food and nervous
-stimulants. Since many patients present a combination of these apparently
-opposite conditions, there is room for a great display of penetration and
-tact in the management of complex cases. While seeking for the immediate
-relief of present suffering, the ulterior consequences of treatment must
-always be kept in view, and the particular cachexia or dyscrasia must be
-thoroughly appreciated by the physician in his choice of remedies.
-
-
-
-
-CHAPTER V.
-
-DREAMS.
-
-  Behold, this dreamer cometh!
-                        GENESIS, XXXVII, 19.
-
-
-The harmonious activity of all parts of the nervous system is
-indispensable to the highest exercise of the conscious mind. Healthy
-intellectual life is the perfectly balanced outcome of the complex polygon
-of forces which has its seat within the brain. In the waking condition
-this "moving equilibrium," as it has been happily termed,[57] is sustained
-by the convergent impulses which are continually entering the brain
-through the pathways afforded by the several senses. Our waking hours are
-occupied with the ideas and with the associated trains of thought which
-are thus projected upon the field of consciousness. As a consequence of
-the harmonious function of the organs of sense, each one supplementing and
-correcting the information furnished by the others, a continuous process
-of perception and logical thought is maintained. But, along with the
-procession of ideas which are clearly conceived by the mind, the field of
-consciousness is also invaded by a cloud of half formed perceptions, which
-are too imperfect and fleeting to occupy the attention. As in the act of
-vision, though the periphery of the visual field is crowded with a whole
-world of objects dimly perceived without challenging particular attention,
-only the center of that field furnishing clear images to the brain, so the
-eye of the mind comprehends only a few of the impressions which enter the
-sphere of consciousness. The swarm of unnoticed perceptions, however, is
-none the less the result of abiding sensory impressions graven in the
-substance of the brain, from which, through the action of memory, they may
-at any favorable moment reenter consciousness. Sleep does not wholly
-arrest this process. A certain amount of projection into the field of
-consciousness continues, even during profound repose; and the ideas thus
-aroused form the material of our dreams.
-
-It has already been remarked that the invasion of sleep is not an
-instantaneous process. One by one the senses fall asleep, and long before
-the final cessation of their activity, sleepiness hinders their function.
-Hence a progressive narrowing of the range of external perception; hence a
-reduction of the vividness of impressions derived from the outside world;
-hence, also, a simplification of the actions and reactions which
-constitute the "polygon of forces" active within the brain. But the
-suppression of certain lines in this polygon does not suppress life, nor
-does it necessarily destroy consciousness. It only occasions a
-redistribution of force, and a proportionate narrowing of the stream of
-related ideas. Since this process of suppression, just mentioned, is not
-an absolute quantity, but a variable factor, the polygon of physical
-forces within the brain and the corresponding succession of ideas in
-consciousness must necessarily be in a state of continual change.
-Consequently, our dreams must be as variable as the clouds that drift upon
-the currents of the air. As, on a hot day in summer, when the equatorial
-draught has ceased to guide the wind, we may observe all manner of local
-tides among the masses of vapor which arise from the earth, so, in sleep,
-when the guiding influence of the senses is withdrawn, the ideas that
-still arise are chiefly dependent for their origin and association upon
-the automatic and endogenous activities of the brain. Undisturbed by
-impulses from the external world, the brain seems then to become more
-sensitive to impressions that have their origin within the body. An
-overloaded stomach, an enfeebled heart, a turgid sexual apparatus, or an
-irritable nervous ganglion, may become the source of irregular and
-uncompensated impulses which, without disturbing the organs of special
-sense, may invade the cerebral cortex, and may there set in motion a whole
-battery of mechanisms whose influence upon consciousness would remain
-quite unnoticed were the external senses in full operation.
-
-Still another cause for the production of dreams is to be found in the
-more or less complete suspension of the power of volition which
-accompanies sleep. Every act of attention is the result of exercise of the
-will. But the perfect exercise of the will is dependent upon the perfect
-development and wakefulness of the brain. So soon as sleep begins to
-invade the brain, the will begins to lose its normal incitement to action,
-and finally it becomes almost wholly disconnected from the muscular
-organs. In this state the sleeper may desire to perform some act--he may
-wish to move his limbs or to cry out aloud, but he can move neither hand
-nor foot, he cannot utter a sound. In other instances a partial connection
-between the will and the locomotive organs persists, and various orderly
-movements can still be produced. In like manner the control of the will
-over the succession and association of ideas may be either wholly, or only
-partially, lost in sleep. The deeper the sleep the more complete the loss
-of such control; hence the greater incoherence as well as feebleness of
-impression which is characteristic of dreams when sleep is profound. The
-vivid and panoramic succession of visual conceptions which constitutes a
-"vision," occurs during light and partial sleep, when the will is still
-capable of in some measure guiding the procession of ideas.
-
-For a similar reason the higher faculty of judgment, and especially the
-power of arriving at moral conclusions, is in great measure suspended
-during sleep. Like the power of volition, the activity of the moral sense
-is dependent upon a certain functional perfection in the brain. When the
-capacity of the brain is depressed by drugs or by disease, or by sleep,
-the moral sensibilities are the first to disappear. Hence the non-moral
-character of the impressions usually experienced during the act of
-dreaming. We feel neither surprise nor regret at the incidents of ordinary
-dreams. It is only when the border line of wakefulness is reached that the
-dreamer feels ashamed of walking naked in his dream, or feels compunction
-for an act of crime, or experiences emotions of joy or sorrow in
-connection with the incidents of his vision.
-
-A dream may, therefore, be defined as the occupation of the field of
-consciousness during sleep by a succession of ideas more or less
-completely withdrawn from the guidance of the senses and from the control
-of the will. A great variety of dreams may thus be admitted, ranging all
-the way from those products of mere absence of mind which constitute
-_revery_, down to the faintest and feeblest stirrings of consciousness
-which have been always observed during the act of waking from the
-profoundest sleep.
-
-Considerable light may be thrown upon the production of dreams if we
-consider attentively the manner in which illusions and hallucinations are
-excited by the use of drugs or by disease during the waking state. When
-engaged in experimenting upon myself with different medicines, I once took
-a dose of hasheesh sufficient to produce the peculiar effects of the drug.
-Sitting quietly in my chair, the first unusual sensation was an agreeable
-feeling of coolness diffusing itself over the surface of the body, as if
-some one were gently fanning me on a hot day. A feeling of causeless
-amusement began to occupy my mind. I seemed to be smiling all over without
-any apparent reason for hilarity. Then the walls of the room in which I
-sat seemed to recede to a vast distance. My attention became riveted upon
-a little picture which hung against the wall before me. It was a sunset
-scene, painted upon a canvas scarcely larger than my hand. As the wall
-upon which it was placed seemed to recede, the canvas expanded until I
-beheld a glorious landscape bounded by a range of snow-capped mountains
-flushed with purple light from the setting sun. As I sat, admiring this
-splendid scene, the gilded frame of the painting became alive with winged
-fairies and cherubs, peeping out from behind the moulding, and bending
-over its margin to look into the picture. Then the ceiling of the room and
-the sky of the picture seemed to blend in one common expanse of ethereal
-blue; the sunlight faded from the mountain peaks; stars began to appear in
-the firmament; the little imps and fairies disappeared; and, presently,
-everything resumed its natural appearance.
-
-In this experience the departure from healthy cerebral function consisted
-in an exaltation of certain forms of sensibility while others were
-depressed. The succession of visual images was initiated by the visible
-objects around me, but it was enriched by the association of ideas
-furnished through the stimulation of memory. The sunset glow, the
-snow-capped mountains, the starry sky, were familiar objects, suggested
-from memory by the items grouped in the picture. In like manner, the
-cherubs who climbed upon its gilded frame were merely the glorified
-products of memory, probably suggested by the fact that it was a _picture_
-upon which my attention was fixed--one picture reminding me of others
-which I had seen. The loss of proportion in the view--the exaggeration and
-distortion of all the relations of time and space, which made the unreal
-seem real, and conferred grandeur upon commonplace objects, was
-undoubtedly occasioned by a modification in the molecular structure of the
-organs of special sense and of perception under the influence of hasheesh.
-The change thus effected was of a character to diminish the force of
-sensory impressions derived through the aid of the muscles and nerves of
-the eye and the ear and the skin, while at the same time exaggerating the
-processes of memory and association in connection with impressions
-originating within the brain. In this way was produced a sort of confusion
-between the external world and the ideal world within, rendering it
-difficult to distinguish the one from the other. Hence the impossibility
-of estimating aright the relation of time and space to the visual
-impressions upon which attention was fixed. The result was a waking dream
-which differed from ordinary revery chiefly in the intensity of the
-impressions that occupied the mind.
-
-A somewhat similar process is sometimes experienced as a consequence of
-cerebral disorder unconnected with the effects of drugs. During the
-invasion of measles, having taken no medicine but sage tea, I remember, as
-night approached, a strange succession of illusions. My head seemed to
-expand to the size of a bushel basket; then it would slowly contract
-again. My body seemed to grow out of shape into the most distorted forms
-of rickets. Audible sounds seemed to come from the most remote distances.
-Impending shadows of a great darkness hovered over the bed. Waves of heat,
-and tingling darts of numbness traversed my limbs. These singular and
-rather uncomfortable sensations continued until relieved by an ordinary
-Dover's powder.
-
-In this experience the confusion of ideas, though less agreeable, was
-essentially similar to that occasioned by the action of the hasheesh. In
-both cases there was the same diminution of the intensity of external
-sensation accompanied by an exaggeration of internal impressions. The
-brain and the nerves were in a condition of irritable weakness, caused by
-disease, which interfered with the normal generation and association of
-ideas. Having thus partially escaped from the control of the senses and
-the will, the mutilated succession of ideas which reached the field of
-consciousness could only be perceived as a series of illusions. Here,
-again, was a waking dream, of origin and course analogous to the illusions
-and hallucinations which accompany every form of delirium.
-
-It is not alone under the influence of disease or of drugs that the
-automatic action of the brain furnishes ideas for the inspection of the
-mind. Riding, one day, in a street-car, and reading a philosophical work,
-I came upon a paragraph devoted to a discussion of the doctrine of the
-association of ideas. Immediately, out of memory, flashed a momentary
-vision of the quarter deck of the old frigate, United States, upon which
-appeared the figure of a very small midshipman, talking to a gigantic
-personage, the captain of the ship. This was an incident which I had
-actually witnessed forty years before. I was, at first, somewhat puzzled
-in the attempt to account for the occurrence of a vision so apparently
-incongruous with the subject matter of the book; but a little reflection
-convinced me that the exciting cause of this seemingly involuntary act of
-memory was really the idea of association suggested by the book. This had
-unconsciously aroused the apparatus of association in the brain, and the
-particular scene thus brought before the mind had been further suggested
-by the circumstance that the last object, external to the printed page,
-upon which I had fixed my attention, was a large ship, lying in the river,
-near the bridge, just crossed by the car in which I rode.
-
-Numerous other examples of a similar character might be related to
-illustrate the fact that the brain is a reservoir of sensory impressions,
-some of which, at the moment of their original incidence, have aroused the
-mind to a greater or less degree of conscious attention, and have then all
-lapsed into a latent or potential condition. But, though latent, they are
-none the less persistent, and only await the suppression of other
-inhibitory forces to become once more capable of arousing attention. Such
-inhibitory impulses are continually furnished by the action of the sensory
-organs on the one hand, and by the energy of the mind upon the other. So
-soon, therefore, as the organs of sense and of voluntary impulse are
-sealed with sleep, if the remaining portions of the brain are still
-operative, and are left to their own unrestrained activity, a more or less
-disorderly series of ideas occupies the mind. This constitutes a dream.
-The difference, therefore, between waking thought and a dream is analogous
-to the difference between a page upon which the words have been arranged
-in a rational order, and another page upon which some of the same words
-have been set down at random. Inasmuch as the majority of our sensations
-are derived through the organs of sight, and since the larger portion of
-the sensory region of the cortex of the brain is concerned in the act of
-vision, it is no more than might be expected that the ideas suggested in
-sleep should generally proceed from the visual apparatus of the brain. The
-superior power of visual impressions to attract attention may also serve
-to explain the fact that the majority of dreams are composed of images
-that were originally perceived in the act of vision. Hence our dreams, for
-the most part, constitute a series of pictures undisturbed by sound, or by
-other forms of sensation. But this is not always so. It is highly probable
-that when the organs of external sense are allowed to sleep without
-disturbance, our dreams consist of visual impressions alone. But, if any
-unusual sound, or smell, or other sensation is experienced during sleep,
-it may penetrate the field of consciousness, and may become the starting
-point of a dream quite filled with sounds. Thus a young lady, who had
-passed the evening at a musical concert, was aroused, soon after retiring,
-by the striking of a clock which had been recently placed in her chamber.
-At the moment of waking, she was dreaming of an orchestral performance of
-Wagner's music. Doubtless the dream was suggested by the unaccustomed
-sound of the clock.
-
-The possibility of thus suggesting, and in some degree guiding, the form
-and course of a dream, has been often demonstrated.[58] One of my early
-schoolmates, a boy of remarkably susceptible nervous temperament,
-furnished an excellent example of this species of direction. Tickling his
-nose with a straw made him dream that a dragon-fly was assaulting his
-face. On another occasion, a few drops of vinegar placed upon his tongue
-caused him to dream of eating oranges. Again, one of his companions
-roguishly breathing in his ear the statement that the schoolmaster was
-after him with a long rattan, he bounded out of bed, and could scarcely
-be restrained from bursting out of doors in his evident alarm. I was
-myself awakened, one night, by the ringing, as it seemed, of my doorbell;
-but, hastening at once to the door, no one was there. As I was expecting a
-call from a certain patient, I concluded that the bell had been rung by an
-impatient messenger who could not wait. Falling again asleep, I was a
-second time startled by a similar ring. Looking out of the window above
-the door, it was evident that no one was there. I finally concluded that
-the sound must have been perceived in a dream, and I recalled the fact
-that each time, as I woke, the sound of a carriage, passing the house, had
-attracted my attention. Undoubtedly, the state of expectancy in which I
-was sleeping had operated as the predisposing cause of dreaming, and the
-noise of wheels upon the pavement had served as the exciting cause of a
-dream in which the sound-vibrations communicated to the brain had produced
-by an association of ideas the particular perception which, though asleep,
-I was waiting to receive.
-
-In certain cases the impression produced by a dream is so vivid that a
-considerable time after waking must elapse before it can be relegated to
-its true position in the world of hallucinations. Dreaming, once, that my
-wife called to me from another room, I instantly awoke; and only the fact
-that she was with me could satisfy me that it was all a dream. Taine[59]
-relates that "M. Baillarger dreamed one night that a certain person had
-been appointed editor of a newspaper; in the morning he believed it to be
-true, and mentioned it to several persons who were interested to hear
-it;--the effect of the dream persisted all the forenoon, as strongly as
-that of a real sensation; at last, about three o'clock, as he was stepping
-into his carriage, the illusion passed off; he comprehended that he had
-been dreaming."
-
-The following incident from the experience of Prof. Jessen, physician to
-the insane asylum in Homheim, near Kiel,[60] still further illustrates
-this form of hallucination:
-
-"On a wintry morning," writes the professor, "between five and six
-o'clock, I was aroused, as I thought, by the head nurse, who reported to
-me that some people had come for one of the male patients, and who at the
-same time asked me whether I had any particular orders to give. I replied
-that the patient might depart, and after he had left the room I turned
-around to go to sleep again. All at once it struck me that I had
-previously not heard anything regarding the intended departure of this
-patient, but that only the prospective departure of a woman of the same
-name had been reported to me. This compelled me to inquire more
-particularly after the circumstances, and accordingly I lighted a candle,
-rose, dressed myself, and went to the room of the head nurse. To my
-surprise I found him only half dressed, and, in reply to my inquiry after
-the people who had called for the patient, he said, with an expression of
-astonishment, that he did not know anything of it, as he had but just left
-his bed, and no one had called him. This answer did not arouse my
-consciousness, but I rejoined that then the steward must have been in my
-room, and that I should accordingly go to see and ask him regarding the
-matter. When descending a few steps in the middle of the corridor which
-led to the room of the steward, I suddenly became conscious of having
-dreamed only what until that moment I had believed to be an experience
-whose reality I had not doubted in the least."
-
-In some instances the fact of having dreamed is never recognized, and the
-dreamer carries through life the delusion that his vision was an actual
-occurrence. Among the Indians of Guiana, and the same thing is true of
-many other savages, dreams are looked upon as actual events in which the
-dreamer is visited by spirits or even by other living men. A recent
-English traveler[61] says: "It becomes important, therefore, fully to
-recognize the complete belief of the Indian in the reality of his
-dream-life, and in the unbroken continuity of this with his working life.
-It is easy to show this belief by many incidents which came under my
-notice. For instance, one morning, when it was important to me to get away
-from a camp on the Essequibo River, at which I had been detained for some
-days by the illness of some of my Indian companions, I found that one of
-the invalids, a young Macusi, though better in health, was so enraged
-against me that he refused to stir, for he declared that, with great want
-of consideration for his weak health, I had taken him out during the night
-and had made him haul the canoe up a series of difficult cataracts.
-Nothing could persuade him that this was but a dream, and it was some time
-before he was so far pacified as to throw himself sulkily into the bottom
-of the canoe. At that time we were all suffering from a great scarcity of
-food, and hunger having its usual effect in producing vivid dreams,
-similar effects frequently occurred. More than once the men declared in
-the morning that some absent men, whom they named, had come during the
-night and had beaten or otherwise maltreated them; and they insisted upon
-much rubbing of the bruised parts of their bodies."
-
-It is highly probable that from these facts, and from others of a similar
-character, may be derived the true explanation of many of the supposed
-examples of intercourse with divine or angelic persons which occupy so
-important a place in early mythology. An incident in the childhood of the
-prophet Samuel can scarcely admit of any other interpretation. In other
-cases, notwithstanding the intensity of the dream, its true character is
-recognized by the dreamer during the very act of vision. Thus, I once
-dreamed that I saw a young girl standing before me. So vivid was the
-perception, that the actual presence of such a person could not have
-produced a more perfect impression upon the waking brain. Yet, at the same
-instant, I comprehended the fact that it was merely a dream, and remarked
-the difference between the intensity of the visual image in this and in
-other dreams. Such speedy recognition of the hallucination does not always
-accompany the act of waking out of a dream. In some cases, as we shall
-have occasion to see, the images which have figured in a dream are still
-perceived for a certain period of time after awaking.
-
-The majority of dreams are composed of visual images. The dreamer looks
-upon a picture which changes silently before his eyes, without appealing
-to any other sense than that of sight. But in certain cases any other
-sense may become excited, producing illusions or hallucinations as perfect
-as the images of healthy vision. They may be suggested by external
-impressions, as in my dream of a ring at the door bell, which proved to be
-an auditory illusion excited by the sound of passing carriage wheels; or
-they may, at least apparently, find their starting point in accidental
-states of the bodily organization. If attention be paid to this matter, it
-will be observed that all unusual modes of dreaming, and all extraordinary
-vividness of dream-impressions can be connected with some departure from
-the physiological conditions of quiet sleep. Either disease, or
-exhaustion, or emotional disturbance, or narcotic intoxication of the
-brain may be noted as the immediate cause of such derangement of the
-cerebral functions. After drinking several cups of coffee before retiring,
-I dreamed of a large yellow flower which exhaled a very fragrant odor.
-During the same night I also dreamed of drinking wine, which agreeably
-excited the senses of taste and of smell. Upon another occasion, having
-been disturbed by the entrance of burglars into my house, I dreamed that a
-burglar was fumbling under my pillow, and was raising my head and
-shoulders with the mattress upon which I slept. I seemed to feel the
-changes of pressure and of contact as distinctly as if awake. The
-connection of voluptuous illusions with erotic dreams is too familiar to
-require particular mention.
-
-Dreams are not always limited to the revival and combination of the images
-of sensation. Intellectual combinations are sometimes thus presented to
-the mind. The most familiar illustrations of this fact are furnished by
-the experience of mathematicians who have worked out mathematical problems
-in their dreams. One of my patients, an expert book-keeper, dreamed of
-adding up six columns of figures at once. In the morning he still
-remembered his dream; and, on adding up the columns, found that he had
-actually produced the right sum in each case. A college student of my
-acquaintance, who was puzzled by a geometrical proposition, wrote out the
-correct solution during his sleep. This was something more than simple
-dreaming; it trenched upon actual somnambulism. Another acquaintance
-dreamed of being in heaven, and, while there, experienced relief from
-doubt regarding certain theological doctrines which had previously
-exercised his mind. I have myself composed several sentences during the
-course of a dream, and have, while dreaming, sometimes esteemed them
-worthy of preservation; but my waking recollection has never coincided in
-this particular with the opinions formed during sleep.
-
-Great difference between dreams may be remarked in their coherence and
-continuity of evolution. Some are composed of the most inconsistent
-elements without order or logical arrangement. In others the incidents
-follow very closely in the line of a natural and rational development, so
-that the dreamer seems to be present as a spectator of a perfectly
-coherent drama. It is probable that these differences depend upon
-variations in the degree of completeness with which the different parts of
-the brain and of the body are overwhelmed by sleep. If different and
-widely separated portions are sufficiently wakeful to suggest ideas to the
-mind, the resulting congeries will consist of discordant and incoherent
-elements. But if wakefulness is limited to a particular organ of the body
-or to a circumscribed territory of the brain, the resulting impressions in
-consciousness should be correspondingly restricted, and will manifest a
-more orderly connection with each other. In some cases a tendency to
-simultaneous wakefulness of particular portions of the cerebral register
-seems to become habitual, so that the same set of ideas may be often
-renewed in the same order during sleep, constituting a repetition of the
-same dream. In this way I have frequently dreamed of a volcanic eruption
-of molten lava from a lofty mountain. This frequent revival of the same
-train of images is probably due to the fact that in childhood I actually
-witnessed a volcanic outbreak, and that a very highly colored picture of
-Vesuvius in eruption hangs in my sitting room, so that my brain has become
-profoundly impressed with this particular image. When other portions of
-the brain are asleep, if the special region concerned with this picture be
-aroused, the mind receives the same impression which it received when
-first excited by that portion of the organ of memory.
-
-As a general thing, however, dreams do not possess any such compactness
-and coherence. They are usually derived from many different portions of
-the cerebral organ, even when they seem to exhibit a fluently connected
-course. Thus, I dreamed, one night, that I was walking in a garden filled
-with peculiar oriental shrubbery. In this garden I discovered one of my
-brothers and a friend, who is widely known in literary circles, engaged in
-flying a kite. With great adroitness they had succeeded in causing the
-kite-string to describe in the air the outline of the letter Z. I
-congratulated them on the adoption of so truly scientific a method of
-kite-flying; telling them, also, that I had once succeeded in making a
-kite-string describe a fourth line, thus: [Symbol] As they expressed
-surprise at this, I told them that in the May number of the Atlantic
-Monthly, for 1883, they would find an article on this method of
-kite-flying, written by Oliver Wendell Holmes.
-
-Nothing can seem more absurd than such a sequence of ideas. They follow
-each other without a break, yet without any logical coherence, very like
-the order in which ideas arise to occupy the mind of an insane person.
-Indeed, such dreams suggest the doctrine that the condition of a dreamer's
-brain is functionally identical with what obtains in certain forms of
-insanity. At first sight it would seem as if such a dream could have no
-possible basis in fact. But a brief retrospection enabled me to trace each
-individual item to its source in memory, and I was able to construct the
-following key to the vision: During the previous evening I had been
-examining a number of East Indian photographs. Among the most remarkable
-of them was a picture of the glorious gardens of the Taj, at Agra. Another
-represented the ruined Buddhist tower at Sarnath, a structure remarkable
-for the numerous triangular figures carved as ornaments upon its sides.
-Hence the garden and the zigzag kite-string in the dream. During the day
-before, while conversing with a neighbor regarding the financial
-misfortunes of an acquaintance, I had remarked that if he had stopped
-kite-flying, and had settled down to legitimate business at last, he would
-doubtless do well in the future. Hence the kite. I had recently received
-an interesting letter from my literary friend in which he had mentioned my
-brother. Hence the two principal actors of the dream. Just before
-retiring, that night, I had discussed with my wife the subject of
-subscribing for a number of periodical magazines. Hence the Atlantic
-Monthly; and, as the celebrated Oliver Wendell Holmes was the author most
-intimately associated in my mind with that periodical, his introduction
-among the characters of the dream followed most naturally in accordance
-with the law of the association of ideas.
-
-The question is continually asked, why are certain dreams so vivid and so
-easily remembered, while others are of the faintest and most evanescent
-character? My own experience leads me to believe that there is a morbid
-element underlying all unusually vivid dreams. It is not merely because of
-differences in the depth of sleep. The flitting fancies which occupy the
-introduction and the termination of sleep, rarely possess any power to fix
-the attention or to linger in memory. But, if the body be disturbed by
-anything which causes a departure from the even course of health, such as
-follows unusual or violent emotion, or an attack of illness, or an
-insufficient alimentation, or great and sudden changes of atmospheric
-pressure, the visions of the night become wonderfully exaggerated in every
-particular. During a voyage at sea, while suffering considerably with
-thirst, one night I dreamed that a fountain of sparkling water suddenly
-appeared before me. A young girl dipped a pitcher in the flowing stream,
-and held it out, all dripping with delicious coolness, for me to drink.
-Pressing eagerly forward, I awoke, to find myself sitting up in my narrow
-berth, with hands extended for the draught. Every narrative of shipwreck
-is filled with similar experiences. Slow starvation is always accompanied
-by dreams of singular intensity and persistence. As an illustration of the
-corresponding influence of previous emotion, I may cite the experience of
-a friend who had been greatly shocked by reading the account of the manner
-in which the lunatic, Freeman, had killed his little son in imitation of
-Abraham's contemplated sacrifice of Isaac. This gentleman dreamed that he
-was about to sacrifice his favorite daughter. He called her to him; told
-her that he was about to cut off her head as a religious sacrifice; and
-took up the knife for that purpose. She exclaimed, "Oh, papa! I have never
-disobeyed you yet!" and extended her neck, to receive the fatal stroke,
-when he awoke, trembling in every limb, and drenched with perspiration.
-For a long time the horror of this dream affected him as terribly as if it
-had been an actual experience.
-
-It is usually difficult to arrive at any exact estimate of the time
-occupied by a dream; but it appears certain that in some instances the
-succession of images excited during sleep must be exceedingly rapid.
-Abercrombie, in his work on the "_Intellectual Powers and the
-Investigation of Truth_," p. 275, has related several illustrative
-examples of this fact. In my own experience, one night, as I lay half
-asleep, I heard the watchman on his round, as usual, examining the
-fastenings of my front door. At once I began to dream that I was
-revisiting my father's house, the home of my childhood. The family were at
-breakfast in the front parlor, while I walked through the back rooms,
-examining the doors and the windows, and found it impossible to close and
-to fasten them. I then took a bath, dressed myself, and walked out into a
-large garden behind the house. It was filled with tropical trees, of which
-some were young. The old ones, which I recognized after an absence of
-thirty years, astonished me by their surprising luxuriance. A lovely,
-trailing convolvulus, in full bloom, attracted my admiration. After
-walking for some time I came upon a plum tree which was very small when I
-left home, and had now reached a height not exceeding twelve feet. This
-slow growth excited considerable surprise on my part. Returning to the
-house, I passed the day with my parents, and, at night, undertook to shut
-up the house, but could not fasten any of the doors or windows. This
-caused me great uneasiness, for there was a large gypsy camp not far from
-the east end of the building. My anxiety was presently justified by a
-noise in the parlor. Hastening to the door, and looking into the room, I
-saw a large painting disappearing through a hole in the wall next to the
-encampment of thieves. I immediately cried out, to frighten away the
-robbers; and was awakened by my wife, shaking me, and asking what was the
-matter, just in time to hear the watchman walking down the front steps,
-after the completion of the investigation which had suggested my dream.
-
-Another experience may serve to illustrate the fact that dreams are
-greatly intensified by illness, and that their duration may be exceedingly
-brief. Suffering, one night, from an attack of intestinal colic, marked by
-a rapid succession of painful paroxysms, between which, however, I fell
-asleep without the aid of medicine, I dreamed in one of these snatches of
-slumber that I was walking with my brother on the road to the volcano of
-Kilauea. In my hand were four diamond shirt buttons. They were white, and
-were covered with fine asbestos wool. My brother's wife expressed serious
-doubts regarding their value; but I at once reminded her that the Emperor
-of China had given to the English Ambassador, for presentation to the
-Queen of England, a number of diamonds which were so rough and so cheap in
-appearance that the ambassador, who was also a marquis, could not suppress
-his contempt as he received the gift. But, when carried to London, and cut
-by the royal jewelers, their brilliance had astonished everyone. I now
-desired to deposit my diamonds with a jeweler, for safe-keeping. My
-brother recommended a house near the volcano, but I had seen another, a
-few squares further up the road, and accordingly resorted thither. Not
-finding any satisfactory evidence of business, I retraced my steps to the
-place first recommended. Entering the door, I found myself in a narrow
-room, with a long, low counter on one side. Behind this were several men,
-and several cases filled with jewelry. I handed my buttons to a large,
-good-looking fellow, who was bustling around in his shirt-sleeves. He
-immediately put one of the jewels into his mouth, when I heard something
-crack, as if either his teeth or the diamond had split. Consoling myself
-with the recollection that, if broken, a diamond could be mended with
-cement, I asked for a certificate of deposit. While this was being
-written, the entire building slipped away from over us, and glided down
-the slope of the mountain, towards the ocean, leaving us, and all that had
-been within the house, uncovered in the open air. This did not disconcert
-any one. The jeweler finished his writing; I pocketed the receipt, and
-with my brother pursued our walk through the mountain forests beyond the
-crater of the volcano. Presently we arrived at an eminence from which we
-could look down upon the ocean, and could see the line of the coast
-prolonged for many miles on either side of a cape of land. The western
-coast was very grand--mountain promontories rising behind each other as
-far as the eye could reach. Having feasted our eyes with this magnificent
-panorama of earth and sea and sky, we turned away in the direction of a
-grove, in which was visible a large building of stone, with castellated
-walls, and turrets with pointed roofs at the corners. My brother informed
-me that this was a German settlement, called Little Clacius. Approaching
-the castle, we were received in a magnificent hall by a beautiful woman
-who offered to conduct us through the building. She led us through a
-series of lofty rooms, splendidly painted, gilded, frescoed, and furnished
-with inlaid tables and polished chairs. On either side were ranged large
-vases, in which grew what I seemed instinctively to recognize by the name
-of the Lace Mimosa--each plant consisting of a flat sheet of green
-lace-work, like a coralline, studded with lovely pale yellow blossoms.
-Passing through three such rooms, we entered a fourth, across the floor of
-which our fair guide whirled herself with a pirouette into the presence of
-a young woman clad in a richly figured dressing-gown, drawn lightly around
-her form as she sat in an easy chair, nursing her baby. We were formally
-introduced to this lady, who received us with the most evident
-indifference, a circumstance which gave us no concern, for the view from
-the open window at once engrossed my attention. Directly before me was a
-shining river, pouring down the mountain side and falling about fifteen
-feet into a deep dark pool that widened beneath the window from which I
-gazed. High banks, covered with magnificent trees, sloped down into the
-water, and cast their shadows across its rippling surface, forming a most
-charming landscape. The breadth of the scene, the depth of the coloring,
-the perfection and the multiplicity of all the details that pressed upon
-the attention, could not have been surpassed in vividness by any real
-existence. I was admiring the view, and was beginning to feel surprised
-that so large a river could exist in such a place, when I was suddenly
-awakened by a renewal of the intermittent pain.
-
-In this example each individual detail could have been easily traced to
-its source in memory. Pictures, and actually existent scenery furnished
-the detached items which were combined in a brain that for the time being
-was released from the control of the reason and the will. Irritated by
-painful sensations the brain was inordinately excitable, and sleep was
-less profound. Hence the remarkable intensity of the pictures which were
-presented to the eye of the mind. The indescribable richness and variety
-of the vision was probably due to the fact of extensive bodily
-disturbance, opening a wide range of territory from which impressions were
-communicated to the morbidly sensitive brain. The unusual permanence of
-the whole dream in memory may be explained by the observation of Maury,
-that the ease with which dreams are recollected varies inversely with the
-depth of the sleep in which they occur. Dreams which are produced in sound
-sleep are seldom recalled after waking, because they are but slightly
-connected with impressions received by the brain during wakefulness.[62]
-But dreams which occupy the mind when sleep is light and partial are
-excited by cerebral movements which are closely associated with external
-impressions that originate either at the moment of awaking or immediately
-after that event; consequently, the bond of union between the ideas of the
-dream and our waking ideas is nearly if not quite as perfect as the bonds
-which serve to connect the thoughts that occupy any portion of our
-conscious life. Hence such dreams are more easily reproduced from memory
-by any disposition that arouses a retrograde association of ideas.
-
-The dream above related, though excited by an unhealthy condition of the
-body, was not at all disagreeable. But it is often the case that disorders
-of particular organs serve to originate visions with special and evident
-characteristics related to their source. Thus, one of my patients, during
-an attack of uterine and hemorrhoidal congestion, would dream that a heavy
-weight had been laid upon the lower part of the abdomen. On another
-occasion, having gone to sleep, apparently in perfect health, she dreamed
-of a terrible pain in the head, and that her husband and a physician were
-applying a cupping glass to the back of her neck. This woke her up, and
-she found that she was actually suffering with a very severe headache.
-Another lady, shortly after confinement, dreamed that her baby had teeth,
-and that it was biting her nipple. Next day she discovered a tender spot
-in the breast, which rapidly developed a mammary abscess. Forbes
-Winslow[63] has collected a considerable number of similar cases. In
-certain instances not only have dreams been originated by special local
-pain, but the incipient stages of insanity have been revealed by
-exaggerated dreams. One of my patients, for a considerable time before the
-evolution of an attack of melancholia, would dream, every night, that a
-big black dog came into her bed. Another, who suffered with cardiac
-palpitation, caused by excessive tea-drinking, was often visited in sleep
-by a mocking imp who seated himself upon the pit of her stomach, and
-pressed her ribs together with his hands.
-
-The distress or alarm which accompanies such dreams is sometimes
-sufficient to arouse the sleeper. Often, however, he strives, in his
-vision, to escape from some impending horror, or to lift up his voice in
-a cry for help, but the will is powerless to reach the necessary muscles,
-and no movement results. In such cases the portion of the brain in which
-the will resides is awake, but the conducting fibres which intervene
-between the cortex of the brain and the locomotive ganglia in the
-cerebro-spinal axis are asleep, and cannot be sufficiently aroused to
-transmit the impulses derived from the action of the will.
-
-In all ages of the world a belief in the prophetic character of certain
-dreams has prevailed. Numerous examples are recorded in which a warning
-intimation of approaching disaster has been thus received. Thus the holy
-evangelist, St. Matthew, relates that Joseph, the husband of Mary, was
-guided by dreams to escape with his family from the murderous designs of
-Herod and of his son Archelaus. The literature of the middle ages is
-filled with similar narratives. Coming down to recent times, it is not
-difficult to gather numerous examples of dreams which have been excited by
-presentiments of good or evil. A lady who was about to embark upon the
-ill-fated steamer Arctic, dreamed so vividly of shipwreck that she refused
-to take passage, and thus escaped the frightful disaster which overwhelmed
-the ship and its numerous passengers. Max Simon[64] relates the case of a
-lady who, in spite of a similar warning, embarked upon a steamship and
-lost her life, through the explosion of the boiler during the voyage. On
-another occasion[65] a noble lady dreamed that a wing of the palace in
-which her children were sleeping was about to fall down. Starting up, she
-called her waiting maids, and insisted that they should bring the children
-to her chamber. The women endeavored to calm her agitation, quoting an old
-proverb to the effect that "dreams go by contraries." As she persisted in
-her commands, they feigned obedience, but soon returned to say that the
-young princes were sleeping too quietly to be removed. The princess would
-not be thus composed; and at last the servants reluctantly brought the
-little boys from their room. They had scarcely reached their mother's
-apartments, when the disaster of which she had dreamed was realized, and
-the bedroom from which they had just been carried, was crushed into a mass
-of ruins.
-
-The ancient explanation of such events consisted in a reference to the
-Deity, who was supposed to address his favorites through the medium of
-dreams. The modern skeptical explanation views all such revelations as
-mere accidents. Among the myriads of dreamers, say the "five-sense
-philosophers," the infinite variety of combinations which disturb the
-brain during sleep, cannot fail to produce occasionally such coincidences.
-When these are of a striking character, the seemingly prophetic vision is
-remembered, but the cases of discrepancies between vision and result are
-not recorded, and are soon forgotten. This opinion may very probably be
-correct in the vast majority of instances; but, if so, we are not in a
-position to assert any scientific demonstration of the fact. There is,
-moreover, so far as the ancient religious view is concerned, a certain
-transcendental sense in which it is true that God may guide his creatures
-through the agency of dreams, as well as in a thousand other different
-ways; but this metaphysical process we can no more comprehend than we can
-understand or explain the interaction of mind and matter in the brain. The
-psycho-physiologist must content himself, at present, with the attempt to
-show that it may not be incompatible with natural law for coming events to
-cast their shadows before them through the forms of a dream. The following
-observations lend color to such a possibility.
-
-The extraordinary susceptibility of the brain during certain conditions of
-sleep has already been noted as a cause for the superior vividness of
-coloring and intensity of action which sometimes characterizes our dreams.
-In this respect a slightly morbid condition of the brain, comparable to
-the effects of hasheesh, probably exists. In such cases the brain may be
-disturbed to a degree sufficient for the awakening of consciousness by
-causes that would ordinarily be powerless to reveal themselves. Recording
-his experience of an earthquake at Lesina, in the night of Sept. 8, 1884,
-Buschick states, in the Journal of the Austrian Meteorological Society,
-that a few seconds before the shock he was awakened with a feeling of
-strange discomfort and apprehension. Once before, on a similar occasion,
-he had been in like manner aroused from sleep just before the commencement
-of an earthquake, probably by a feeble and ordinarily imperceptible
-agitation of the soil. At a time when I was for many months severely
-overtasked, I always woke up in the night whenever about to receive a call
-to a patient. Before the sound of footsteps became audible on the
-sidewalk, I would wake. Presently some one would be heard, approaching the
-house, and then the doorbell would ring. So often was this experience
-repeated, that I learned to expect a summons whenever awakened during the
-night. Gradually, however, as my health improved with rest, this morbid
-excitability disappeared, and has never been renewed. It seems probable
-that in this example the sensitiveness of the brain during sleep was so
-great that audible impressions were received with vigor sufficient to
-awake consciousness before they were sufficiently strong to arrest the
-attention when actually awake. The extreme sensibility of the brain, under
-certain conditions, to impressions from a distance, is further illustrated
-by the experience of persons laboring under diseases which produce serious
-departures from a healthy cerebral circulation. Thus, one of my patients,
-while suffering with cerebral hyperaemia, could hear children talking half
-a mile away, at a distance where no one else could hear them. This
-susceptibility is doubtless the foundation of many well authenticated
-cases of presentiment. Another of my patients, a lady of remarkably
-sensitive nervous organization, though otherwise in apparently good
-health, was one evening lying alone upon her bed. Suddenly, she became
-greatly agitated with the conviction that something had happened to her
-husband, who had not yet returned from his place of business. He
-presently, however, came quietly into the house, and greeted his wife as
-usual. She exclaimed at once, "What has happened to you, my dear?"
-"Nothing," he replied. "Yes," she said, "something has happened, just now;
-I felt that you were in trouble." "Oh, yes," answered he, after a moment's
-reflection, "as I was passing by the park, on my way home, two men tried
-to stop my horse, but I whipped up, and got away from them without any
-trouble."
-
-On another occasion the same patient was one day suddenly oppressed by a
-conviction that something had happened to her mother and sister, who were
-driving together at some distance from home. After a short time they
-actually returned in a sorry plight, without their carriage. The horse had
-run away, upsetting them upon the road.
-
-In all these cases it is worthy of remark that there was present an
-unusual degree of cerebral erethism. Solicitude, weariness, anxiety,
-inordinate irritability of the brain. It is possible that under such
-conditions one may hear premonitory sounds, may in some sort feel distant
-agitations which our healthy organs are usually incapable of apprehending.
-When such a brain during sleep is unoccupied with the ordinary objects of
-sensation, feeble impulses, which usually remain unnoticed, may sometimes
-suffice to arrest the attention. We may thus explain the possibility of
-impressions derived from distant events passing into the consciousness of
-a dreamer, and arousing hallucinations of which the immediate cerebral
-mechanism is the same as that of the ordinary hypnagogic hallucination.
-Thus, the Rev. Canon Warburton relates the following experience[66]:
-
-"Somewhere about the year 1848 I went up from Oxford to stay a day or two
-with my brother.... When I got to his chambers I found a note on the table
-apologising for his absence, and saying that he had gone to a dance
-somewhere in the West End, and intended to be home soon after one
-o'clock. Instead of going to bed, I dozed in an arm-chair, but started up
-wide awake exactly at one, ejaculating, 'By Jove, he's down!' and seeing
-him come out of a drawing-room into a brightly illuminated landing,
-catching his foot in the edge of the top stair, and falling headlong, just
-saving himself by his elbows and hands. (The house was one which I had
-never seen, nor did I know where it was.) Thinking very little of the
-matter, I fell a-doze again for half an hour, and was awakened by my
-brother suddenly coming in and saying, 'Oh, there you are! I have just had
-as narrow an escape of breaking my neck as I ever had in my life. Coming
-out of the ball-room, I caught my foot, and tumbled full length down the
-stairs.'"
-
-An incident of this character might very properly be ranked as a mere
-coincidence, were it not for the fact that it is one only of a
-considerable number of well attested acts of vision connected either with
-the hypnagogic state or with the act of dreaming itself. The comparative
-rarity of such events lends them a marvelous aspect; yet there is really
-nothing about them any more wonderful or preternatural than the
-demonstrated possibility of telegraphic signaling across the sea without
-the intervention of an electric wire.[67] Under ordinary circumstances a
-metallic conductor must serve as the avenue of communication between
-distant stations; but if a sufficiently sensitive piece of apparatus be
-placed in contact with the water on either side of an arm of the sea,
-communications may be transmitted from one to the other by a diffusion of
-impulses through the entire body of water.
-
-In like manner we ordinarily see and hear and feel as a consequence of
-cerebral excitement occasioned by specific impressions concentrated
-through the organs of sight and hearing and touch. But it is quite
-reasonable to believe in the possible existence of a brain so delicately
-organized as to be capable of reacting to impressions which are too
-diffuse and too feeble to arouse the ordinary apparatus of sensation. With
-such a brain it might be possible to experience perception without
-eye-sight. Evidence furnished by the facts of somnambulism and hypnotism
-indicates that the receptivity of the brain may become temporarily exalted
-to a degree which warrants the inference that clairvoyance itself may be
-thus brought within the capacity of certain peculiarly sensitive
-organizations. The same extraordinary receptivity occasionally seems to
-attend the act of dreaming. For example, one of my acquaintances, a lady
-of a highly wrought nervous temperament, the wife of a distinguished
-physician in a neighboring State, dreamed one night that a favorite
-cousin, a beautiful little girl, who lived at a distance of twelve or
-fifteen miles, was very dangerously ill. She saw the child lying on its
-mother's lap, evidently at the point of death, when some one brought a tub
-of warm water and proceeded to give the patient a bath. This revived the
-little one so that she recovered. The dream made a very considerable
-impression upon my friend, by reason of its peculiar character, and
-because dreaming was for her a very unusual experience. Next morning she
-rose as usual, but during the forenoon she was startled by the receipt of
-a message requesting her to come at once to the house of her uncle, as his
-little daughter had been taken suddenly ill with the croup, and had
-expired during the preceding night. Hastening to the bereaved household,
-she found her aunt sitting with the dead child on her lap, precisely as
-she had appeared in the dream. The little girl had been suddenly attacked
-during the night, and, as she lay gasping in her mother's arms, some one
-advised a warm bath, and brought a tub of water into the room for that
-purpose. Unfortunately, just as they were hopefully preparing to dip the
-child into the water, she had ceased to breathe.
-
-The lack of conformity between the conclusion of this dream and the actual
-fact reminds one of the blurring of the images that are transferred from
-one brain to another in the acts of telepathy recently investigated by the
-Society for Psychical Research. Something similar is frequently observed
-in connection with the phenomena of hypnotism. The hypnotised subject does
-not always perceive clearly or wholly the sensation that is suggested by
-the agent who operates upon his brain.
-
-For another example of apparently clairvoyant dreaming, I am indebted to a
-friend, a well-known gentleman of unimpeachable veracity, who, when a
-young man in the army, during the war of the great rebellion, was taken
-very ill, and was sent home to New England from one of the most remote
-outposts of the campaign. No one of his family had the slightest
-information or suspicion of his illness, until the night before his
-arrival, when his father dreamed that the absent son was sick, and would
-arrive the next day, at an hour unusual for travelers coming from the
-South. So vivid was this dream, and so powerful was its influence upon the
-mind of the dreamer, that he went at the specified hour to the railway
-station, with a carriage full of blankets and pillows, to receive his son.
-When the train arrived, and the invalid actually appeared, the mutual
-astonishment of father and son can better be imagined than described.
-
-In a recent work on hypnotism,[68] Fischer has related several personal
-experiences of a similar transfer of impressions during the waking state.
-It is highly probable that if such impressions are received by a sleeping
-brain, they may operate like other suggestive irritants to produce dreams,
-which may be sometimes so vigorously projected upon the consciousness of
-the dreamer that he may be awakened, and may still perceive the evolution
-of his dream as an hallucination, even after waking. Thus, on one
-occasion, during a malarial fever, I dreamed of seeing a friend who lived
-at a great distance. So vivid was the impression that I started up awake;
-and there, at the foot of the bed, in broad daylight, was my friend,
-looking calmly at me. Several seconds, at least, were required to
-dissipate the vision. In an article already quoted,[69] Sir Edmund Hornby,
-late Chief Judge of the Supreme Consular Court of China and Japan, "who
-describes himself as 'a lawyer by education, family, and tradition,
-wanting in imagination, and no believer in miracles,'" relates his
-experience of a similar spectral visitation. After stating that "it was
-his habit at Shanghai to allow reporters to come to his house in the
-evening, to get his written judgment for the next day's paper," he says:
-
-"They generally availed themselves of the opportunity, especially one
-reporter, who was also the editor of an evening paper. He was a peculiar
-man, reticent about himself, and I imagine had a history. In appearance he
-was also peculiar. I only knew him as a reporter, and had no other
-relations with him. On the day when the event occurred, in 1875 or 1876, I
-went to my study an hour or two after dinner, and wrote out my judgment.
-It was then about half-past eleven. I rang for the butler, gave him the
-envelope, and told him to give it to the reporter who should call for it.
-I was in bed before twelve. I am a very light sleeper, and my wife a very
-heavy one. Indeed, it is difficult to rouse her out of her first sleep.
-The bed--a French one--faced the fire-place; on the mantel-piece was a
-clock, and the gas in the chandelier was turned down, but only so low as
-to admit of my seeing the time at any time of the night, for--waking
-easily and frequently--I often smoked a cigarette before I went to sleep
-again, and always desired to know the hour.
-
-"I had gone to sleep, when I was awakened by hearing a tap at the study
-door, but thinking it might be the butler--looking to see if the fire were
-safe and the gas turned off--I turned over with the view of getting to
-sleep again. Before I did so, I heard a tap at my bed-room door. Still
-thinking it might be the butler, who might have something to say, I said,
-'Come in.' The door opened, and, to my surprise, in walked Mr. ----. I sat
-up and said, 'You have mistaken the door; but the butler has the judgment,
-so go and get it.' Instead of leaving the room he came to the foot edge of
-the bed. I said, 'Mr. ----, you forget yourself! Have the goodness to walk
-out directly. This is rather an abuse of my favor.' He looked deadly pale,
-but was dressed in his usual dress, and was certainly quite sober, and
-said, 'I know that I am guilty of an unwarrantable intrusion, but finding
-that you were not in your study I have ventured to come here.' I was
-losing my temper, but something in the man's manner disinclined me to jump
-out of bed to eject him by force. So I said, simply, 'This is too bad,
-really; pray, leave the room at once.' Instead of doing so he put one hand
-on the foot-rail, and gently, and as if in pain, sat down on the foot of
-the bed. I glanced at the clock, and saw that it was about twenty minutes
-past one. I said, 'The butler has had the judgment since half-past eleven;
-go and get it.' He said, 'Pray forgive me; if you knew all the
-circumstances, you would. Time presses. Pray give me a _precis_ of your
-judgment, and I will take a note in my book of it,' drawing his reporter's
-book out of his breast pocket. I said, 'I will do nothing of the kind. Go
-down stairs, find the butler, and don't disturb me--you will wake my
-wife--otherwise I shall have to put you out!' He slightly moved his hand.
-I said, 'Who let you in?' He answered, 'No one.' 'Confound it,' I said,
-'What the devil do you mean? Are you drunk?' He replied, 'No, and never
-shall be again; but I pray your lordship give me your decision, for my
-time is short.' I said, 'You don't seem to care about _my_ time, and this
-is the last time I will ever allow a reporter in my house.' He stopped me
-short, saying, 'This is the _last_ time I shall ever see you anywhere.'
-
-"Well, fearful that this commotion might arouse and frighten my wife, I
-shortly gave him the gist of my judgment in as few words as I could. He
-seemed to be taking it down in short-hand; it might have taken two or
-three minutes. When I finished, he rose, thanked me for excusing his
-intrusion and for the consideration I had always shown him and his
-colleagues, opened the door and went away. I looked at the clock; it was
-on the stroke of half-past one.
-
-(Lady Hornby now awoke, thinking she had heard talking; and her husband
-told her what had happened, and repeated the account when dressing next
-morning.)
-
-"I went to the court a little before ten. The usher came into my room to
-robe me, when he said, 'A sad thing happened last night, sir. Poor ----was
-found dead in his room.' I said, 'Bless my soul! dear me! What did he die
-of, and when?' 'Well, sir, it appears he went up to his room as usual at
-ten to work at his papers. His wife went up about twelve to ask him when
-he would be ready for bed. He said, "I have only the judge's judgment to
-get ready, and then I have finished." As he did not come, she went up
-again, about a quarter to one, to his room and peeped in, and thought she
-saw him writing, but she did not disturb him. At half-past one she again
-went to him and spoke to him at the door. As he did not answer she thought
-he had fallen asleep, so she went up to rouse him. To her horror he was
-dead. On the floor was his note book, which I have brought away. She sent
-for the doctor, who arrived a little after two, and said he had been dead,
-he concluded, about an hour.' I looked at the note book. There was the
-usual heading:
-
-    "'In the Supreme Court, before the Chief Judge.
-
-    ---- _v._ ----
-
-    "'The Chief Judge gave judgment this morning in this case to the
-    following effect'--and then followed a few lines of indecipherable
-    shorthand.
-
-    "I sent for the magistrate who would act as coroner, and desired him
-    to examine Mr. ----'s wife and servants as to whether Mr. ---- had
-    left his home, or could possibly have left it without their knowledge,
-    between eleven and one on the previous night. The result of the
-    inquest showed he died of some form of heart disease, and had not, and
-    could not have left the house without the knowledge of at least his
-    wife, if not of his servants. Not wishing to air my 'spiritual
-    experience' for the benefit of the press or the public, I kept the
-    matter at the time to myself, only mentioning it to my Puisne Judge
-    and to one or two friends; but when I got home to tiffin I asked my
-    wife to tell me as nearly as she could remember what I had said to her
-    during the night, and I made a brief note of her replies and of the
-    facts.
-
-    "As I said then, so I say now--I was not asleep, but wide awake. After
-    a lapse of nine years my memory is quite clear on the subject. I have
-    not the least doubt, I saw the man--have not the least doubt that the
-    conversation took place between us.
-
-    "I may add that I had examined the butler in the morning--who had
-    given me back the MS. in the envelope when I went to the court after
-    breakfast--as to whether he had locked the door as usual, and if any
-    one could have got in. He said that he had done everything as usual,
-    adding that no one could have got in if even he had not _locked_ the
-    door, as there was no handle outside--which there was not. I examined
-    the coolies and other servants, who all said they opened the door as
-    usual that morning--turned the key and undid the chains, and I have no
-    doubt they spoke the truth. The servants' apartments were separated
-    from the house, but communicated with it by the gallery at the back,
-    some distance from the entrance hall.
-
-    "The reporter's residence was about a mile and a quarter from where I
-    lived, and his infirmities prevented him from walking any distance
-    except slowly; in fact, he almost invariably drove.
-
-        "EDMUND HORNBY."
-
-The publication of this remarkable story led to its correction in several
-important particulars. From the _North China Herald_ (August, 1884) it
-appears that not only was Sir Edmund's memory defective in connection with
-several of the minor details of the narrative, but he had also been either
-wholly misinformed, or was quite forgetful regarding the actual time of
-the editor's death. That person was, in fact, alive and in his usual
-health at the time of his supposed apparition in the judge's chamber, and
-did not die till between eight and nine o'clock on the same morning. He
-had "attended a temperance committee meeting the night before, and had
-left about half-past ten in good health and excellent spirits.... He
-slept at home, rose shortly before eight, and visited his office to
-arrange some _matter_ for that day's paper. He then returned to his room
-to dress, and in a few minutes afterward was found dead upon the floor."
-
-Between these conflicting witnesses it is of course impossible to decide.
-But for our purpose that is quite unnecessary. It is clear that Sir Edmund
-believed that the visible image of an acquaintance had appeared before him
-in his chamber at night. It is also evident that the judge was a man whose
-nerves had been damaged, probably by tobacco--for he was a "light
-sleeper"--waking often, and indulging in the luxury of a cigarette during
-the course of the night. If we may credit the writer in the _Herald_, his
-brain was in a process of deterioration, proved by the decidedly
-treacherous character of his memory. The whole story, therefore, becomes
-exceedingly instructive as an illustration of the manner in which a belief
-in apparitions may be originated. The most probable explanation of the
-incident is found in the hypothesis of a dream excited in an irritable
-brain that had been aroused by the preparation of the manuscript which had
-occupied the thoughts of the judge immediately before retiring for the
-night. The course of this dream was so vivid that the sleeper awoke, but
-continued, like some other dreamers similarly awakened, to witness the
-evolution of his vision in the form of a genuine hallucination. A
-remarkable example of a similar production of hallucination through
-disease of the brain is related by the late Dr. E. H. Clarke.[70] One of
-his patients, a vigorous old gentleman, of eighty years, a great lover of
-music, and a frequent attendant at operas and concerts, retired one night
-at the usual hour, and in his usual health. He soon fell asleep, "and
-slept well till about two A. M., when he was awakened by the sound of
-music, which seemed to come from the street near his house. Thinking a
-serenade was going on, he got up to ascertain where it was, but discovered
-nothing. The sound ceased when he arose. On returning to bed, he heard the
-sound of music again, and was at the same time surprised by the appearance
-of three persons, standing near each other in his chamber, opposite the
-foot of his bed. It was his habit to sleep with the gaslight burning
-feebly, near the head of his bed. He turned the gas on to its full power,
-and inspected the intruders. They appeared to be musicians, who were
-humming and singing, as if in preparation for a musical performance. He
-rang a bell, which summoned his man servant. John soon arrived, and was
-ordered to put the strangers out. 'There is nobody here, sir,' was John's
-reply to the order. For a moment Mr. A. was not only amazed, but alarmed.
-'What!' he exclaimed, 'do you see no one there?' 'No one,' said John. 'Go
-where those chairs are, and move them,' was Mr. A.'s next direction. John
-did so. The strangers stepped aside, but did not go out. By this time Mr.
-A. had gathered his wits about him, and was satisfied that he was the
-victim of a hallucination; and he determined to observe its phenomena
-carefully. Accordingly, he bade his servant depart, and prepared to watch
-his visitors. But they were so life-like and human, that he was again
-staggered, and recalling John, told him to go for the house-keeper. She
-soon came, and on being interrogated, confirmed John's statements that
-there were no strangers in the chamber and no sounds to be heard.
-Convinced by the testimony of two witnesses, Mr. A. yielded to the
-decision of his reason, and again resolved to go on with the investigation
-of the strange phenomena. The musicians had now resumed their position,
-near the window and opposite the foot of the bed. Mr. A. turned the light
-of the gas full upon them. He looked at his watch, which marked the hour
-of half-past two. He then arranged his pillows, so as to sit almost
-upright in bed, and waited for the next scene of the play. He was able to
-note the size, form, dress, and faces of the performers. One was a large
-man, who bore some resemblance to Brignoli. The two others were of less
-size, and shorter stature than their companions. All were habited in dress
-coats, with white waist coats, and wore white cravats and white gloves.
-After a little time spent in coughing and clearing their throats, they
-began to sing. They sang at first a few simple airs, 'Sweet Home' among
-others. They then attempted more difficult music, and gave selections from
-Beethoven and Mozart. Between the pieces they chatted with each other in a
-foreign language, which Mr. A. took to be Italian, but they did not
-address him. Occasionally they changed their position, turned in various
-directions, and part of the time sat down. Mr. A. said the singing was
-excellent; he had rarely heard better. After the first feeling of surprise
-and amazement had passed away, he enjoyed the music exceedingly. The
-performance continued in this way for some time, when it suddenly came to
-an end. The singing ceased, and the singers vanished. He looked at his
-watch, and found that the time was four o'clock. The concert in his brain
-had lasted nearly an hour and a half, almost the length of an ordinary
-concert. He reflected for a while upon this strange occurrence, but not
-being able to arrive at any satisfactory explanation of it, he turned his
-gas down and went to sleep. The next morning he called at my office, as
-previously stated, to ascertain if possible what pranks his brain had been
-playing, and if he should regard them as warning of his approaching
-departure."
-
-In this case the patient was suffering from "a moderate degree of
-deafness, persistent tinnitus aurium, occasional vertigo, and slight loss
-of memory." Towards the close of life, two or three years later,
-"incoherence, delirium, stupor, and the like, indicated with sufficient
-certainty the presence of severe cerebral disease." The remarkable
-hallucination which he experienced was undoubtedly the product of the
-morbid changes which were progressing in his brain.
-
-These cases form an ascending series which illustrates the receptive and
-constructive capacities of the human brain when its sensory apparatus has
-become unusually or morbidly excitable. But this preternatural mobility
-may display itself in other departments besides those of mere
-sense-perception. The sphere of pure intellect may thus be invaded by
-ideas springing from impressions which address the reasoning faculties
-alone, so that in sleep a dream may lead the judgment to decisive
-conclusions that were scarcely recognized or heeded during the hours of
-wakefulness. In this way we may learn to understand how the anxieties
-experienced by the husband of the Virgin Mary may have ripened into a
-dream, of intensity sufficient to guide his subsequent action. Nothing
-could be more natural for one, like him, ignorant of physiology and of
-second causes in general, than the ascription of such an event to the
-immediate intervention of the Great First Cause--the only cause which he
-could rationally apprehend. Hence the universal primitive belief that in
-dreams God spake to man. Upon this belief was laid the foundation of many
-of the religious convictions which have grown and ripened with the
-progress of the race until their shadowy origin has been well nigh
-forgotten.
-
-Many are wont to affirm that the age of illumination through the
-intervention of dreams is past, but there is no good reason for the belief
-that such dreams may not still occur. A lady, carefully educated in the
-doctrines of the popular theology, had been very much distressed by the
-unruly behavior of her only child, a little imp who had scarcely learned
-to talk. While thus depressed in spirits she dreamed that the Day of
-Judgment had come. She found herself with her husband and child and the
-whole human race assembled upon the face of the earth, waiting in agony
-for the awful decision of their fate. Finally the heavens were opened, and
-Jesus appeared, dividing the wicked from the good. As he drew near the
-place where she was standing, she could no longer endure her anxiety
-regarding the destiny of her daughter; she rushed forward, and implored
-the Divine Judge to spare her child. With a look of ineffable compassion
-he assured the trembling suppliant that her prayer was granted, and she
-awoke in a state of great agitation, but much comforted as to the future
-of her little girl, who in due course of time grew up to be a very
-exemplary young woman. Now, if the dream of Joseph was a revelation, a
-dream like this is quite as worthy of similar estimation. They both
-occurred as the result of analogous conditions of the brain and mind, and
-were both excited by second causes of a similar character. It is
-impossible for any one to show that the relation between the First Cause
-and either set of second causes was any more intimate and special in one
-case than in the other.
-
-The wonderful exaltation of certain faculties during the unequal sleep of
-the different organs of the mind, is usually to be considered as something
-relative rather than absolute. But there is little reason to doubt that
-sometimes the excitement of the waking portions of the brain does really
-transcend the ordinary functional capacity of the structure. Under such
-conditions the undivided concentration of attention upon the comparatively
-limited circle of ideas which are thus produced, greatly increases the
-intensity of the resulting impressions upon the mind in consciousness.
-Hence the grandeur of the visions which may thus arise; hence, also, the
-possibility of their construction in accordance with fact rather than with
-fancy; as in the case of the visions of the ancient Hebrew prophets. As
-the darkness of night, by shutting out the earth from sight, opens our
-eyes to the glory of the starry sky, so, in like manner, sleep, by closing
-the senses against the distractions of the external world, may sometimes
-afford the conditions enabling a richly gifted intellect to comprehend the
-course and the destination of those deep and silent streams of thought
-which move on, unnoticed during the hours of wakeful life.
-
-Whatever may be true of this matter of fore-sight, it is certain that
-under similar conditions the memory of past events may be so quickened as
-to yield results quite comparable with actual clairvoyance. A good
-illustration of this has been recorded by Abercrombie.[71] A gentleman
-named Rowland had been prosecuted for certain arrears of tithe which he
-believed had been long previously paid by his deceased father. "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 defence. 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, as 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 strong 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. awoke 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 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."
-
-Here it would be a valuable addition to knowledge if the parties in the
-history just related could be subjected to intelligent interrogation.
-Enough, however, may be discovered in the narrative to render it certain
-that the dream was merely a revival in consciousness of knowledge that had
-been long previously forgotten. There was a vague recollection of some
-such information evidently struggling for recognition; otherwise Mr. R.
-could not have held the belief in spite of the lack of evidence, that his
-father had paid the tithes in dispute. He had probably heard from his
-father some account of a transaction which had taken place so long before
-that the only surviving actor, the aged lawyer, had forgotten everything
-about it, and could only recall the event through the associations
-connected with the Portugal piece of gold. In the lawyer's case the
-cerebral register only needed the stimulus afforded by the association of
-ideas, in order to make it again place before the mind impressions which
-had long subsided below the level of consciousness. For Mr. R., sleep
-afforded the limitation of cerebral function needful for a concentration
-of attention sufficient to penetrate to the level of the residual
-vibrations which persisted as the sole representatives of the original
-impressions through which his knowledge of the event had been primitively
-obtained. Parallel examples are furnished by the cases of individuals who,
-upon their death-beds, during the dissolution of the brain, have resumed a
-long disused vocabulary, speaking the language and thinking the thoughts
-of their childhood. "He 'babbled of green fields,'" said Mistress Quickly,
-narrating the closing scenes in the life of the famous Sir John Falstaff.
-Dr. Rush[72] relates the case of a learned Italian gentleman who, "in the
-beginning of the yellow fever which terminated his life, ... spoke English
-only; in the middle of the disease, he spoke French only; but on the day
-of his death, he spoke only in the language of his native country." In
-like manner the old Swedish settlers in Philadelphia who had forgotten
-their native language, or, at least, had not spoken it for half a century,
-would pray in Swedish on their death-beds.[73] Sleep and dissolution
-operate alike to release the lower levels of the mnemonic apparatus from
-the overshadowing influence of later impressions, so that, like an ancient
-palimpsest, it presents once more its long-forgotten characters for
-inspection by the mind.
-
-
-
-
-CHAPTER VI.
-
-SOMNAMBULISM.
-
-    A great perturbation in nature! to receive at once the benefit of
-    sleep, and do the effects of watching.                 --MACBETH.
-
-
-We have seen that in certain cases dreams manifest a tendency to pass into
-action. Thus, the dream with which I was on one occasion occupied became
-so amusing that I was awakened by a paroxysm of laughter that continued
-for some time after the termination of the dream. Sometimes the actions
-which are thus determined become more complicated, but do not suffice to
-arouse the sleeper. He continues to dream, and to act out his dream. This
-constitutes the ordinary form of somnambulism. It is a special affection
-of the nervous system encountered chiefly among persons of a decidedly
-neurotic constitution--especially among the victims of hysteria, epilepsy,
-and insanity. Sometimes occurring in cases apparently characterized by
-perfect health, it will usually be discovered by careful inquiry that the
-subject is nevertheless connected by near relationship with a neurotic
-stock. In a third class of patients the neuropathic diathesis is not
-congenital, but is the acquired result of particular injuries or diseases
-of the head. It is also observed sometimes as a consequence of transitory
-functional disturbances of the brain connected with the period of
-convalescence from diseases that profoundly affect the nutrition of the
-nervous system. In all cases, however, it is probable that a special
-nervous temperament exists as a predisposing cause of the phenomena, for
-the majority of people can sustain injuries of the head, or of the
-peripheral nervous system, and can pass through all kinds of illness
-without exhibiting any tendency to somnambulism. As the nervous
-temperament is the peculiar property of children and of the female sex, it
-is among them that the affection is usually observed. Before the age of
-puberty, however, the differential peculiarities of sex are not sufficient
-to produce any great preponderance in either direction; and small boys
-are, therefore, perhaps as frequently somnambulistic as their little
-sisters. Like other neuropathic disorders, this predisposition is
-frequently met with as an hereditary attribute which may be handed down
-from generation to generation. Occurring in the experience of young
-children, it frequently ceases when they arrive at years of maturity. Not
-always, however, thus ceasing as a consequence of improvement in the
-general health, but because of the substitution of some more serious
-disorder.
-
-The phenomena of ordinary somnambulism are manifested, like the dreams out
-of which they arise, during the period of sleep. But, while dreams most
-frequently occur during the later portion of the night, after the deepest
-sleep is past, somnambulism usually occurs in the earlier part of the
-night, during the deepest sleep. As a consequence of this fact,
-consciousness is seldom affected by the molecular play of the brain during
-the somnambulic excursion. The sleepwalker knows nothing, and remembers
-nothing of the incidents in which he has been an active agent; while the
-dreamer seems to be more nearly awake. His consciousness is partially
-aroused by the play of memory and of imagination, and he can remember the
-spectacle which constituted his dream. The phenomena of somnambulism
-necessitate the participation of a larger number of faculties than are
-needed for the production of a dream, but their activities are coordinated
-upon a plane, so to speak, lower than the platform upon which the elements
-of dreams are arranged. Consequently, though the elements of the
-somnambulic process may be far more numerous and various than the elements
-of a dream, they may be less capable of rising into the realm of
-consciousness. Such a process may differ from the phenomena of ordinary
-life only in the fact of unconsciousness; and, when concluded, it leaves
-no traces in the memory of the waking state. In other instances, on the
-contrary, so many nervous functions may be suppressed, and so great may be
-the intensity of the remaining cerebral processes, that the resulting
-phenomena scarcely differ from an ordinary dream in which consciousness is
-aroused, and the waking memory is durably impressed. Between these
-extremes lie opportunities for an indefinite number of combinations;
-consequently the forms and degrees of somnambulism present a very great
-variety of manifestation. Maury[74] reduces these to five principal forms:
-First, simple movement of the limbs in connection with that partial sleep
-of the intellectual faculties which produces ordinary dreams. Second,
-_somniation_, a state in which the patient unconsciously performs such
-actions as have become so far habitual that, though complicated in their
-character, they constitute genuine cerebral reflexes. Third,
-_noctambulism_, or sleep-walking, in which the action, though complicated
-in its character, and different from the ordinary waking occupations of
-the patient, appears to be the result of automatic processes, constituting
-a dream that is acted out in time and space. Fourth, _somnambulism_ with
-exaltation of the faculties, producing delirium with conscious movements
-during the crisis. Fifth, _somnambulic life_, or double consciousness, in
-which, with the exception of certain special modifications of
-intelligence, the conduct of the patient during the paroxysm does not
-perceptibly differ from that of the waking state, so that the subject
-seems to experience two successive though disconnected personalities.
-
-The exact relation between these different degrees of somnambulism has
-been further elucidated by MM. Ball and Chambard.[75] Starting with the
-proposition that normal healthy existence is a state in which the
-functions of organic life furnish a basis for nervous sensibility and
-motion, by means of which the imaginative faculties (imagination and
-memory), associated with the coordinative faculties (attention, judgment,
-volition), are sufficiently stimulated to maintain a state of
-consciousness, they show that the first stage of sleep consists in the
-suppression of bodily motion and sensibility. The second stage consists in
-the further suppression of the coordinative faculties. The third stage is
-marked by the loss of memory and imagination. In the most profound and
-perfect sleep the functions of organic life alone remain. The process of
-awaking consists in the revival of the faculties in the inverse order of
-their extinction. Dreams occur during the period in which motion,
-sensation, and the coordinative faculties are in abeyance; but
-somnambulism may accompany each of the stages of sleep. Its simplest form
-is perhaps the rarest; corresponding to Maury's fifth variety. In this
-form the functions of organic life are intact; motion and sensibility seem
-unchanged; the intellectual faculties display their usual activity; but
-the ordinary consciousness is never aroused. So far as the normal life of
-the subject is concerned, he is active, sensible, intelligent, but
-unconscious; and when the paroxysm is terminated memory contains no
-account of its events. Such paroxysms may occur but once in the life-time
-of an individual, or they may be repeated at stated intervals,
-constituting an alternate succession of mental states without connection
-in consciousness. This is called the somnambulic life, or double
-consciousness, several examples of which will be related upon another
-page.
-
-The second form of somnambulism results from the abolition of
-consciousness and the more or less complete suppression of the
-coordinative faculties of the mind. Memory and imagination, released in
-great measure from the control of the higher intellectual faculties, and
-excited by such vestiges of sensation as still persist, create a species
-of delirium in which mutilated sensations, half formed thoughts and
-disproportioned volitions combine to produce a variety of actions. In
-this condition the patient dreams, and acts out his dream. He is a
-somnambulic dreamer.
-
-In the third degree of somnambulism, consciousness and the entire range of
-intellectual faculties have disappeared. The individual resembles a
-creature from which the cerebral hemispheres have been removed. He is
-little better than a living automaton, guided only by impressions received
-from without. In this condition the movements of the body may become
-wholly responsive to the will of another--a prominent characteristic of
-artificial somnambulism or hypnotism.
-
-A fourth degree of somnambulism is marked by the disappearance of
-consciousness, intellect, sensibility, and the power of motion. Only the
-lower functions of organic life remain. The patient merely lives, he
-neither thinks nor acts. This constitutes the state of somnambulic
-lethargy, a condition which differs from deep sleep only in the fact that
-under the influence of external impulses or of partial awaking it may
-easily pass into the second form of the affection, the somnambulic dream.
-
-Such is the classification of MM. Ball and Chambard. It possesses the
-merit of great precision and clearness. If the warning which its authors
-themselves utter against its too literal acceptance be respected, it will
-be found to afford a very convenient explanation of the manner in which
-the various degrees of somnambulism are reached. But it must be remembered
-that between these pronounced and definite forms exist a great number of
-intermediate degrees. Partial revivals and temporary resurrections of the
-higher faculties of the mind may intrude themselves among the activities
-which depend upon lower functions; as, for example, when the ordinary
-unconsciousness of lethargy is briefly interrupted by an event which may
-remain permanently fixed in memory after waking, even though all other
-concurrent incidents were unnoticed and left no trace behind. Keeping this
-caution in mind, the following diagram will be found useful:
-
-  +=======================================================================+
-  |           |Organic|Sensibility:|Imaginative|Coordinative|Consciousness|
-  |           | Life  |   Motion   | Faculties:|  Faculties:|             |
-  |           |       |            |   Memory, |  Judgment, |             |
-  |           |       |            |Imagination| Attention, |             |
-  |           |       |            |           |  Volition  |             |
-  |-----------|-----------------------------------------------------------|
-  |Normal life|XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX       |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | life      |XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                   |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | dream     |XXXXXXXXXXXXXXXXXXXXXXXXXX                                 |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | automatism|XXXXXXXXXXXXXX                                             |
-  |-----------|-----------------------------------------------------------|
-  |Somnambulic|                                                           |
-  | lethargy  |XX                                                         |
-  +-----------------------------------------------------------------------+
-
-The close parallel between this diagram and the one on page 4, which
-illustrates the course of sleep, will be at once remarked. The difference
-between the two states cannot be thus diagrammatically expressed. It is
-the difference between sleep in a healthy, normal subject, and sleep as
-modified by the somnambulistic temperament. This may be either the result
-of disease or of congenital defect of cerebral organization. What the
-particular structural difference may be, it must be impossible to decide,
-until it shall become possible to state the reason why one brain shall
-behave only in a normal manner, while another presents all the vagaries of
-hysteria, somnambulism,--perhaps even of insanity. That the affection is
-hereditary is a matter of common observation. One of my patients who is
-somnambulistic--walking in his sleep, climbing over the roof of his house,
-etc.--is the son of a father who was also a noctambulist, and who once
-fractured his leg by falling from a step as he was walking down stairs in
-his sleep. A grand-daughter is both a somniloquist and a somnambulist.
-
-Returning now to the classification adopted by Ball and Chambard, it will
-be found interesting to consider a few illustrative examples of the
-different forms and degrees of the affection under consideration.
-
-_Somnambulic Lethargy._--This condition represents the form which
-outwardly resembles profound sleep. It may occur as a paroxysm without
-relation to other forms of the affection, or, according to my own
-observation, more frequently associated with other forms of somnambulism.
-Thus, one of my patients, a lady about thirty-five years of age, having
-accidentally fallen into the hands of a noted empiric, by whom, for a
-slight attack of tonsillitis, she was vigorously dosed with atropia,
-digitalis and calabar bean, finally passed into a somnambulic state
-corresponding to the somnambulic life of the preceding table. This
-continued about five weeks, when she became completely lethargic, and was
-transferred to my care. In this condition she remained unconscious, almost
-perfectly insensible, with pupils somewhat contracted and sluggish before
-the light, with a feeble and slightly accelerated pulse, a moderately
-elevated temperature, bowels and bladder insensible to their contents,
-mouth and throat filled with an offensive mucous secretion. By great
-urgency she could be sufficiently roused to open her mouth, so as to
-permit cleansing the cavity, and to swallow liquid food. Swallowing was
-effected very slowly, and only after the liquid had remained for some time
-in the fauces. At the end of about three weeks the patient began to
-exhibit more vitality. She could be more easily aroused, began to dream
-and to have hallucinations that were finally prolonged out of sleep into
-wakefulness. In the course of a few hours she was fully herself again,
-after eight weeks of unconsciousness.
-
-This form of lethargy is characterized by the complete unconsciousness
-which persists during its course. Its duration is variable, sometimes
-continuing for a few minutes only; sometimes lasting through many days and
-weeks. Dr. W. T. Gairdner, Professor of Medicine in the University of
-Glasgow,[76] reports the case of a woman who remained for over one hundred
-and sixty days in a condition of lethargic stupor. "The patient was the
-mother of a family, and had lived a strictly domestic and (up to a short
-time before her seizure) healthy and regular life. There were no peculiar
-moral and religious problems to perplex the situation. There was no
-history of inveterate hysteria, or of long continued rapt contemplation;
-nor has there been the slightest evidence of any craving after notoriety,
-either before the attack or since its termination. The moral atmosphere,
-in short, surrounding the phenomena, is altogether unfavorable to
-exaggeration and imposture, for which, indeed, no reasonable motive can be
-assigned. Nevertheless, under these very commonplace conditions,
-concurring with some degree of melancholy or mental despondency after
-delivery, but during a convalescence otherwise normal, Mrs.
-McI----presents to our notice a condition of suspended consciousness and
-disordered innervation in no degree less extreme than the 'trances' or
-cataleptic attacks which have been recorded as the result of the most
-aggravated hysteria, or as the miracles of religious ecstasy and profound
-mental emotion. She becomes for the long period of over one hundred and
-sixty days continuously an almost mindless automaton, connected with the
-external world only through a few insignificant reflexes and through the
-organic functions. She is fed, almost without resistance, through the
-stomach-tube; she defecates and urinates (during much the greater part of
-the time) unconsciously; she is absolutely passive as regards everything
-that demands spontaneous movement, and betrays almost no sign of
-sensation, general or special, when subjected to the severest tests that
-can be applied short of physical injury. But while her senses were thus
-shut, and her volitions in suspense to an extent much beyond ordinary
-sleep, there was, nevertheless, a _sleep within the sleep_. The
-periodicity of day and night was maintained by some change in the
-condition of the innervation, of which snoring was the sole indication.
-She was not convulsed, nor paralyzed, nor delirious; the singing,
-laughing, weeping, adoring ecstasies of hysteria and of religious
-excitement were wholly wanting; nor were there during many months such
-intervals of normal consciousness as are observed in almost all the
-recorded cases of hysterical coma and of catalepsy. The statue-like pose,
-moreover, and the _flexibilitas cerea_ of typical catalepsy, are absent in
-this case. The return to consciousness was followed or accompanied by a
-return of all the normal functions of mind and body; there is now no
-incoherence, nor even distorted perceptions, as of a dream-life occupying
-the somnolent imagination for months, and therefore all the more hard to
-reconcile with realities. She is self-possessed, but unobtrusive, easily
-managed, and betraying only natural emotion; she persists in maintaining
-that the whole period of the apparent unconsciousness is a complete blank
-to her recollection. She is grateful for her recovery, but manifests no
-craving for sympathy, and no tendency, as yet, to revert to any morbid
-condition of despondency, such as was described at the commencement of the
-attack. In connection with this last point, although there is no evidence
-of her having been personally insane, it is not to be denied that her
-family history contains strong presumptions of a hereditary predisposition
-bearing in that direction."
-
-These cases must not be confounded with the examples of _lucid lethargy_,
-to which allusion has been made in a previous chapter. Somnambulic
-lethargy is a condition in which the cerebrum is wholly inert. In lucid
-lethargy, although there is complete loss of general sensibility and of
-the power of voluntary motion, the field of consciousness is continually
-enlightened by perceptions derived from one or more of the special senses,
-so that the subject is conscious of much that transpires in his immediate
-neighborhood. These two forms of lethargy sometimes alternate in the
-experience of the same individual, constituting a portion of the
-indefinitely varied manifestations of hystero-epilepsy. Grasset relates
-the case[77] of a little girl, ten years old, who suffered with various
-forms of hysteria, which were finally replaced by attacks of stupor,
-lasting several hours. After a time these crises of "nervous sleep" were
-transformed into more ordinary attacks of somnambulism, in which,
-"although the child's eyes are shut, she sees and hears everything during
-the crises, knows who comes into the room by their step and walk. If
-anything unpleasant is said to her, or if they threaten to wet her, or
-make her smell something, she gets angry, and pushes everything violently
-away that is offered to her. She replies by signs to all questions, and if
-she wants anything, asks for it by gesture: if she wants to drink, she
-puts her finger to her lips as if in the act of sucking, and if not
-understood, becomes irritated, gets up, and leads the father or mother to
-the sideboard or cupboard, where the things she wants are, and always with
-the eyes shut. She is able to go through the whole house, I do not say
-quite alone, because they do not allow her to walk alone, but with help,
-and she directs the way wherever she wishes to go. During the crises she
-even sometimes amuses herself with a little dog, which she makes jump over
-a stick resting on the cross-bars of two chairs opposite each other; and
-according as she wishes the dog to jump higher or lower, she moves the
-stick to the lower or higher bars of the chairs, and that with eyes always
-shut spasmodically. During the whole attack she cannot talk; but towards
-the end she speaks, although not yet recovered from her state of
-somnambulism. When the crisis is over, the child remembers nothing of what
-she has said or done in her sleep, and is much surprised at everything
-told her."
-
-_Somnambulic Dreams._--The preceding cases illustrate the variable
-character of the manifestations of somnambulism, and may also serve as an
-introduction to the more common form of the affection, in which the
-patient experiences a dream, probably excited by the same causes that
-produce ordinary dreams, and also acts out his dream. The differences
-between an ordinary dream and a somnambulic dream lie in the fact that the
-one produces an often vivid impression upon consciousness and memory,
-while the other is entirely expended upon the organs of external
-expression. Starting probably from the same portion of the brain, the
-physiological dream sets in motion the cortical structures which are in
-immediate relation with conscious memory; the impulses of the somnambulic
-dream, on the contrary, are directed towards the lower portions of the
-nervous system, where they serve to excite the organs of locomotion and
-expression, which are destitute of every form of mnemonic register.
-Consequently, the somnambulist retains no recollection of the incidents of
-his dream.
-
-The simplest form of this affection is presented by the restless child who
-talks, cries out, and brandishes its fists in sleep. In the majority of
-instances these manifestations create little more disturbance than the
-half uttered yelping of a dog that barks in its sleep. But in some cases
-the outbreak assumes a distressing, if not an alarming character,
-constituting the affection known by the name of _night terrors_. The
-disorder is usually observed in young children of a highly nervous
-temperament, before the conclusion of their second dentition. The little
-patients are generally of neurotic lineage. Insanity, hysteria,
-neurasthenia, epilepsy, chorea, and nervous dyspepsia, are often
-discovered among their near relatives. Not unfrequently they have been, or
-will become, choreic. The attack is often preceded by symptoms of
-indigestion and constipation; but the exciting cause may be usually traced
-in the commotion of a brain that has been wearied by the exertions of the
-previous day. The child starts up out of an apparently sound sleep, crying
-with seeming alarm, calling for his mother, and staring wildly around,
-with every possible expression of terror. Sometimes he jumps from his
-couch, and runs headlong into a corner, or seeks concealment under the
-bed, as if escaping from some frightful object. The eyes are open, tears
-flow, perspiration covers the skin, there is the greatest excitement, and
-the little one, clinging convulsively to its parent, will not be quieted.
-Only after a number of minutes does the child seem to recover the power of
-recognizing his friends. Presently, however, he lies down, and falls
-immediately asleep, waking in the morning without the slightest
-remembrance of the unpleasant event.
-
-Such paroxysms occur during the early part of the night, one or two hours
-after bedtime, when sleep is passing from its maximum intensity to an
-inferior degree of depth. This, moreover, is the time when the controlling
-power of the sensory apparatus over other portions of the nervous system
-has already reached its minimum. The spinal centres and those
-intra-cranial ganglia which do not share in the full measure of this
-repose are therefore in a condition of relative exaltation. Disturbances
-of internal origin, consequently, produce inordinate excitement of these
-waking portions of the nervous apparatus. The abnormal quality of this
-excitement is attested both by the history of the patient, and by the fact
-that it does not pervade the whole brain. The distribution of motion
-through the cerebrum is hindered, so that certain portions of the organ
-remain asleep while other regions are thrown into a state of tumultuous
-uproar. Such disconnection of the different organs of the nervous system,
-by withdrawing particular ganglia from the inhibitory influence of the
-other centres, gives opportunity for violent explosions of nervous force.
-
-Somewhat similar in their origin are those acts of unconscious violence
-which sometimes occur during the process of sudden awakening out of sound
-sleep. The patient is usually a deep but uneasy sleeper, who is only
-aroused imperfectly and with difficulty when the attempt to awaken him is
-made. Under such circumstances the disturbance to which he is subjected
-serves as the exciting cause of a dream which, like the ordinary
-somnambulist, he puts into action before he is fully waked. On recovering
-complete consciousness, he may retain no recollection of the events of
-his dream, and may also experience as great a degree of astonishment at
-the results of his violence as if he had taken no part in its display. A
-gentleman of my acquaintance, who had suffered considerable uneasiness
-regarding burglars, was, one night, startled by a noise in his room.
-Jumping up suddenly, he grasped a pistol and fired it in the direction of
-a figure dimly perceived near the bed. On waking fully out of sleep, he
-found that he had inflicted a wound upon the hand of his wife whose
-movements had disturbed him. Another unfortunate, who was once under my
-observation for undoubted insanity, was in like manner aroused out of
-sleep by a supposed noise, probably heard in a dream. With a pistol in
-each hand, he commenced firing wildly in every direction, fatally wounding
-his wife who was in bed at his side. When completely awakened he had no
-recollection of what had occurred, and was overwhelmed by the event.
-
-Wharton and Stille[78] have collected a number of similar examples of this
-disorder, to which the term _somnolentia_ or _sleep-drunkenness_ has been
-applied. Its connection with morbid disturbance of the brain is usually
-very evident. Obviously, the moral responsibility of the agent in such
-cases is identical with that of the ordinary somnambulist, or of the
-subject of epileptic mania.
-
-Ordinarily, however, the somnambulic dream is less agitated. The patient
-merely continues the movements with which he was occupied at the moment of
-falling asleep, as in the case of Galen, who, though long an unbeliever
-of the tales regarding sleepy soldiers who had unconsciously continued to
-march with their comrades, at last found himself in a similar manner
-walking a considerable distance after he had been overtaken by sleep while
-journeying on foot. In other cases the phenomena though intimately
-connected with the daily occupations of the subject, present themselves in
-a form somewhat detached from the waking life. Such are the common
-experiences of children who get out of bed, and walk around the house,
-seeking their playthings, or pulling their clothes out of the drawers in
-which they have been laid. Sometimes the events of the day have evidently
-suggested the deeds of the night. One of my little acquaintances will
-leave her bed, walk into another room, seat herself by her mother's
-work-basket, thread a needle, and proceed to sew up the imaginary holes in
-her dress. One of my early playmates, in like manner, after puzzling over
-a difficult sum in arithmetic, before retiring, arose in his sleep, took
-paper and a pencil from his mother's desk, and proceeded before her eyes
-to work out the correct answer. Another, tempted probably by a vision of
-ripe grapes upon the trellis, climbed out of his window upon the roof of a
-shed. Unfortunately, the certainty with which somnambulists usually direct
-their movements seemed to fail him. He fell heavily to the ground, where
-he awoke to find himself seriously injured.
-
-An excellent example of a still more complicated series of actions during
-somnambulism is quoted by P. Max Simon.[79] It illustrates a majority of
-the facts which have been already brought forward, and will well reward
-careful consideration. "A young clergyman was in the habit of getting up
-in his sleep, taking paper, composing and writing sermons. When he had
-finished a page, he would read it over, if an action performed without the
-assistance of sight can be called _reading_. If dissatisfied with
-anything, he would blot it out, and then write the corrections with great
-accuracy in their appropriate place above the line. In one of these
-sermons he made a correction which was quite remarkable. Having in one
-place written the words _ce divin enfant_, on revising the page he decided
-to substitute the word _adorable_ instead of the word _divin_. He
-therefore blotted out this last word and placed the other immediately over
-it; then, perceiving the word _ce_, which was proper enough before the
-word _divin_, lacked the terminal letter _t_ that was needed before a
-vowel, he very adroitly added the necessary letter, so that the amended
-sentence correctly read _cet adorable enfant_. In order to ascertain
-whether the somnambulist made any use of his eyes, a cardboard was placed
-under his chin in such a way as to completely obstruct the view of the
-paper upon the table; but he continued to write without paying any
-attention to the obstacle. In order to ascertain whether he was aware of
-the presence of the objects which were before his eyes, the paper upon
-which he was writing was taken away, and a number of other sheets were
-successively slipped into its place; but he always noticed the
-substitution, because they differed in size. When an exactly similar piece
-was substituted, he accepted it as his own, and wrote down the corrections
-at the points which corresponded exactly with the writing upon the page
-which had been removed. It was by means of this ingenious stratagem that
-some of his nocturnal compositions were preserved.
-
-"The most astonishing thing of all," continues the author of this article,
-"was the exact composition of music. A cane served him as a ruler. With it
-he ruled at equal distances the five necessary lines, putting in their
-proper place the clef, the flats and the sharps. Finally, he inscribed the
-notes, at first all in outline, but, when he had finished, he blackened
-those which should be dark. The words of the song were written below. On
-one occasion he happened to write them with too large a hand, so that they
-were not placed directly under their corresponding notes. He soon
-perceived this defect, and, in order to amend it, he blotted out what he
-had done by drawing his hand over it, and then rewrote the line of music
-lower down the page with all the precision imaginable.
-
-"Another singular thing of a different sort, which was not less
-remarkable. One night, in the middle of winter, he dreamed that he was
-walking on the bank of a river, and saw a child fall into the water where
-he was drowning. The severity of the cold did not hinder him from hurrying
-to the rescue. He threw himself at full length upon his bed, in the
-position of a man who is swimming, and imitated all his movements. After
-having fatigued himself for some time with this exercise, he felt a
-portion of the coverlid gathered in a heap on one corner of the bed. He
-believed this to be the child; grasped it in one hand, and with the other
-went through the motions of swimming back to the bank of the supposed
-river. There he laid down his burden, and came out, shivering and
-chattering his teeth as if he were really getting out of an icy river. To
-the bystanders he said that he was freezing, and would die of cold, that
-his blood was all turned to ice; he must have a glass of brandy to warm
-him. Not having any, they gave him some water which chanced to be in the
-room; he tasted it, recognized the deception, and called, with greater
-emphasis than before, for brandy, insisting upon the magnitude of the
-danger which threatened his health. A glass of liquor was finally given to
-him; he drank it with pleasure, and spoke of the great relief which it
-afforded him. Notwithstanding all these incidents, he did not wake, but
-went to bed, and slept most profoundly."
-
-An equally instructive case is related by my distinguished colleague,
-Prof. J. Adams Allen.[80] The subject of the observation was a medical
-student who resided in Professor Allen's house during a portion of the
-time covered by the narrative.
-
-"About the summer of 1847, a somewhat dilapidated bass-viol, which was a
-kind of heir-loom in the family, was brought into the house, and he
-devoted spare moments to learning how to play upon it. Unfortunately, the
-antiquity of the instrument had told upon its keys, and unless they were
-wetted at each time of use, it would not remain in tune. He was
-determined, however, to command its notes, and succeeded. His somnambulic
-walks, thereafter, led him from his chamber to the parlor, and to the
-bass-viol, and the family would be awakened in the small hours by the
-inevitable tuning up prelude, mingled with slipping of the old keys, and
-quiet objurgations upon his part. Sometimes the bridge would fall down
-when the keys slipped, and sometimes a string would snap or escape from
-the keys, nevertheless he would persevere, repair damages, tune up, and
-then execute all varieties of music of which the machine was capable, not
-unfrequently accompanying it with his voice. All this would be done in
-total darkness. When any one entered the room with a light, he took not
-the least notice, although when spoken to he would reply in monosyllables
-or with considerable asperity. His face was usually flushed, although
-sometimes pale--the features immobile and passive, the eye open, pupil
-dilated, the surface glazed, and the lids apparently motionless. The
-extremities warm and the pulse full, frequent and soft. Very often the
-skin would be bathed with free perspiration. Remarkably sensitive to
-titillations when awake, there seemed total absence of reflex movements
-from this cause whilst in the somnambulic state.
-
-"As he extended his acquaintance with music and musical instruments, his
-feats became wonderful. Whilst in attendance upon the Medical College at
-La Porte, the household looked forward with high anticipations to the
-hours when his skillful touch of the melodeon would wake them. He had a
-voice of the purest tone and very considerable compass, in fact of rare
-sweetness. I am enabled to say from a multitude of observations, that he
-played with a precision and skill while asleep that he could not
-approximate while awake. Besides this, he would execute music which he
-had heard, perhaps, but once, the evening previous or after a long
-interval--no note of which he could recall in his waking moments. His
-memory here seemed wonderfully exalted. If interrupted, he was irritable
-in the extreme, but would go on with his music exactly from the point of
-interruption.
-
-"Among the numberless exhibitions of his somnambulism, I have time only to
-notice a few of the most striking.
-
-"Whilst attending lectures at Ann Arbor, where I was then lecturing on
-Physiology, I requested his assistance in enlarging some of the drawings
-illustrative of minute anatomy and histology, for use in class
-demonstrations. He entered into the work with great zeal, and proved very
-expert and rapid in execution. One evening, previous to the day on which I
-was about to lecture on the kidney, I wished the cuts in Carpenter's
-Physiology, illustrating the tubular arrangement, etc., were ready. He had
-an engagement for the evening, but said he would try and prepare them in
-the morning. During the night he rose, dressed himself, played a few tunes
-on the guitar, part of the time singing (and, by the way, the guitar was
-about as dilapidated as the bass-viol before noticed, and he had to knot
-one or two of the strings first), and then arranged the drawing paper,
-prepared his India ink and brushes, took the parallels and pencils and
-laid off the space, and worked for half an hour or more rapidly and
-perfectly, nearly completing the figures on pp. 596 and 597 of Carpenter's
-Principles, in the edition of 1853.... These drawings are now in the
-series used for illustration in Rush Medical College. Although we had a
-light in the room while watching him, he went on with his work entirely
-regardless of it. Before completing the work, he went to bed and slept
-until the usual hour in the morning, when at the breakfast he asked if he
-had been up in the night, as he had _dreamed_ that he had. This was the
-only time he ever remembered even dreaming about being up or occupied in
-anything. He had by this time become so fully aware of his habits, that
-nothing of the sort astonished him. Shortly after this he went to spend
-the night with a fellow student, but a little after midnight he rose,
-dressed himself, and went out, followed by the other gentleman, walked
-down to the Exchange Hotel, where there were a number of his acquaintances
-and others waiting for a train of cars due at that time. Some one rallied
-him on his being out so late, but being cautioned by his companion, they
-did not attempt to awake him, but watched his movements. On being invited,
-he took a glass of ale, and then said he would only have time to go home
-and get his dinner before the afternoon lecture hour. He walked with his
-friend to our door, and was indignant to find it locked. His room-mate (a
-cousin) admitted him and awakened myself and wife. He asked if dinner was
-ready, and seemed astonished that it was not; then said he would get a
-drink of water and be off, 'for old D. (one of the faculty) would be mad
-if he was late.' I told him he had plenty of time and he need not be in a
-hurry. He then walked into the kitchen, drank a tumblerful of water, and,
-looking up to the clock, although it was totally dark, remarked the time,
-and started for the front door. I then told him that I was not feeling
-well, was pretty blue, and wished he would sit down and play euchre with
-us. This seemed to please him, and he took off his overcoat and said he
-had as lief play until 'old D.' was through lecturing, as to go.
-
-"His cousin sat down at the table with us, and we played 'three-handed
-(cut-throat) euchre.' He paid not the slightest attention to us, although
-we passed the cards backwards and forwards between us, exchanging hands,
-and everything we could do to attract his attention. He dealt the cards in
-his turn, correctly, and played 'according to Hoyle.' In one hand, spades
-were trumps, and he held the jack of clubs. Clubs being led, he first
-threw down this jack, then quickly picked it up, saying, 'I forgot that
-was the left bower.' It is somewhat humiliating to record that,
-notwithstanding our tricks and devices, he beat us in the game.
-
-"On its conclusion, he got up hastily and insisted upon going to the
-college. We only prevented him this time, by throwing water in his
-face--the only method, by the way, in which we could awake him without
-great violence. Pungent odors, ammonia, camphor, etc., he seemed to
-disregard, or merely pushed away the object.
-
-"On regaining consciousness, he always appeared like one stunned, or
-suffering from a severe shock. The influence upon the pulse and nervous
-system was always so severe, that we never awaked him at these times if we
-could avoid it.
-
-"Whenever a little out of health, as from trifling attacks of indigestion,
-or after watching with the sick, or fatigue, he would be sure to be up
-and doing something notable in the somnambulic state.
-
-"One of the most remarkable of his exploits occurred several years after
-the incident just given. I think it was in 1860 or 1861.... In the rounds
-of his practice he had a patient, about whom he was very anxious. It was
-in the coldest winter weather, and the residence of the patient was about
-two miles distant. Visiting him early in the evening, he found him in a
-state so unsatisfactory, that he informed the family that if he did not
-find him better the next visit, he should change the medicine entirely. On
-rising the next morning, he went to the barn to put his horse to the
-cutter for an early start. He was a little puzzled at finding things
-somewhat misplaced, but supposed some person had been at the stable in
-search of a missing article. On visiting the patient, he was gratified to
-find a marked improvement. He inquired when the improvement commenced, and
-was answered, 'Immediately after taking the powders which he had given in
-the night.' The truth flashed upon him at once, but concealing his
-emotion, he inquired, with as careless an air as he could assume, 'About
-what time was it when I was here?' They replied, 'Between two and three
-o'clock.' This proved to have been the case, as he was afterwards told by
-the family where he boarded. He had been giving the patient some fluid
-medicine, which he ordered discontinued, and then put up several powders,
-such as he had concluded upon the night previous, combining them as usual,
-and administering the first one himself."
-
-The foregoing examples illustrate the fact that ordinary vision is not
-necessary to guide the movements of the somnambulist. Sometimes the
-patient walks about with open eyes; on other occasions they are firmly
-closed. It is generally admitted that the tactile and muscular senses are
-greatly exalted, so that they furnish guiding sensations which are
-sufficient to direct the most complicated movements. The history of the
-medical student observed by Dr. Allen shows how preternaturally sensitive
-the organs of vision may become--actually seeing the clock in the dark
-during the somnambulic paroxysm. When one considers the remarkably
-hyperaesthetic condition of the senses in certain other forms of nervous
-disorder, it is not surprising that sensory impressions which would be
-wholly neglected in a healthy waking state, may become sufficient to
-excite perceptions and to guide the movements which they have aroused. It
-is undoubtedly true that in certain cases the somnambulist does derive
-some information through the medium of the eyes--does really see; but it
-is also a fact that he only sees, hears, tastes and feels the objects
-which are immediately related with the action of his dream. It appears
-also that an impression derived from any organ of sense may suffice to
-arouse any other or all of the internal organs of perception, so that the
-patient seems to see, to hear, and even to taste objects which he knows
-only through the sense of touch. Sometimes the image thus externalized
-coincides with the actual reality; but often this is not the case, as, in
-the experience of the young clergyman, the somnambulist seemed to see the
-paper which he only perceived through contact with his fingers. The image
-thus created corresponded exactly with the external fact; but when a
-similar contact with a pile of bed-clothes excited the illusion of a
-drowning child in his grasp, the internal image did not in the least
-correspond with the external object, and he probably derived no
-information through the sense of sight in either case. In another
-instance, however, as we shall learn upon another page, the subject is so
-far dependent upon the sense of sight that its obstruction is sufficient
-to arrest his movements, as certainly as if he were awake.
-
-Ordinarily the memory is not impressed by the events of the somnambulic
-dream, but we have already learned that it is sometimes affected precisely
-as in common dreaming. One of my little acquaintances could not find her
-night-dress when she went to bed one night. She was therefore obliged to
-wear a gown that was old and ragged. Later in the evening her sister
-discovered the missing garment, and laid it over a chair in the bed-room.
-In the morning the night-dresses had changed place, and the ragged one
-occupied the chair. This occasioned considerable surprise, until the child
-remembered that during the night she had dreamed that two of her playmates
-had come to sleep with her, and that she felt so mortified at being seen
-in a ragged dress that she got out of bed and changed her night-gown.
-Sometimes the events of a somnambulic paroxysm are remembered during a
-subsequent attack, though they are forgotten during the interval, as in a
-case, reported by Macario, of a young girl who had been violated during
-somnambulic sleep. On awaking she had no idea of anything that had
-occurred, but during a subsequent paroxysm she told her mother all that
-had happened.[81] In certain cases a dim recollection of some particular
-incident may be retained, as in the case of my patient who was for eight
-weeks in the somnambulic state. On recovery, the only thing that she could
-remember was a momentary glimpse of some one who was holding up his
-fingers before her eyes. Meeting the physician, subsequently to her
-recovery, who had thus attempted to arouse her attention, she recognized
-in his countenance the features which had momentarily impressed her
-consciousness during the period of somnambulic life.
-
-It is seldom observed that somnambulism is attended with dangerous
-tendencies, yet they are sometimes present. One of my patients once took
-by mistake ninety grains of chloral at a single dose. While under its
-effects she got out of bed, walked into her sister's room, shook her fist
-in her face, and swore furiously at her. On awaking, next morning, she was
-greatly shocked by the account of this dreadful behavior, so utterly at
-variance with her usual temper and character. Another somnambulic patient
-one night rushed into her mother's room, violently accusing her of
-stealing her pocket-book, and threatening vengeance if it were not
-returned. Such patients sometimes mislay the articles with which they
-occupy themselves during a paroxysm, and on waking they erroneously infer
-that they have been robbed. Sometimes, as in the celebrated case related
-by Mesnet, the natural propensities of the individual seem to be released
-from all restraint, and brutal instincts guide the actions of the
-somnambulist, who then steals, or eats and drinks with the voracity of a
-savage. Ball and Chambard (_loc. cit._) have collected a number of
-examples in which impulses to suicide or other forms of violence were
-manifested under such circumstances. Obviously, where the moral sense is
-asleep, and where the affection is the result of causes beyond the control
-of the patient, he cannot be held morally responsible for the consequences
-of such actions. His condition closely resembles that of the victim of
-epileptic mania who delivers himself during a paroxysm to all degrees of
-furious and homicidal violence, without retaining the slightest
-recollection of the fact after its conclusion. The closeness of the
-parallel between these two disorders is rendered further apparent by the
-circumstance that although all memory of the events of epileptic mania is
-usually abolished, it does sometimes persist after the termination of the
-attack. Thus, one of my epileptic patients for a time manifested symptoms
-of insanity after every fit. During one of these paroxysms he imagined
-that the sparrows on the housetop were all singing a particular tune which
-had attracted his attention shortly before the convulsion. Then it seemed
-to him that the breathing of his sleeping child whispered the same tune.
-Placing his hand upon the bosom of his wife, her breathing assumed the
-same musical character. Calling upon his family to listen to the wonderful
-music, they all asserted that they too could hear it. It was a
-considerable time after his recovery before he could be convinced that
-this vividly remembered experience was a pure illusion. The members of
-his family had been cautioned against contradicting their father during
-his paroxysms; consequently, when he asked if they could hear the melody
-which delighted him, they answered affirmatively, and thus confirmed him
-in his delusion. To the ordinary form of epileptic mania such paroxysms
-sustain a relation similar to that subsisting between ordinary dreams and
-the somnambulic experience.
-
-In like manner as it is often remarked that certain dreams betray a
-condition of unusual cerebral excitement, so do certain cases of
-somnambulism manifest a delirious exaltation of the faculties in action.
-This characteristic often belongs to the night-terrors of children. It is
-a condition in which the brain is occupied by the scenery of a vivid and
-highly dramatic vision which dominates the actions of the subject. This
-was most conspicuously shown in the following case, from J. P. Frank,[82]
-and in certain periods of the paroxysms observed by Mesnet (p. 198).
-Frank's patient was a healthy and well nurtured young German girl, who
-during the wars of 1812 had been terribly alarmed by a party of French
-soldiers who had broken into the house and threatened to kill her father.
-The next day at the same hour she passed into a somnambulic state, which
-lasted till sunset. After a brief introductory period of agitation, she
-uttered a deep sigh, which was rather a sob than a sigh, and fell into a
-profound sleep. Presently she smiled, her countenance seemed lighted with
-inspiration, her right arm was raised in the air, and the left was
-directed towards the earth. In this cataleptic attitude she remained for
-about a minute. She then seemed to have decided what to do; from an
-imaginary cartridge-box behind her back she pulled out a cartridge, bit
-off the end, poured out the powder upon her fist as if she were priming a
-musket. She then went through the motions of loading a gun, ramming down
-the wad with an imaginary ramrod, and cried out in French, a language
-which she had never heard before: "Marche! Ou est le baron? Sacre nom de
-Dieu!" Repeating the violent ejaculations and threats addressed by the
-soldiers to her father, she exhibited the utmost terror; her body was
-covered with a cold sweat, and she seemed ready to faint away. At this
-moment she woke up, called impatiently for her handkerchief, with which
-she wiped the perspiration from her face, and resumed her ordinary
-avocations as if nothing had happened.
-
-Still more remarkable was the case reported by Dr. Mesnet.[83] From the
-excellent translation prepared by T. J. Huse, M. D.,[84] the following
-sketch has been outlined:
-
-The patient, aet. 27 years, received in one of the battles near Sedan,
-during the Franco-Prussian war, a bullet wound which fractured the left
-parietal bone. His right arm was almost immediately paralyzed; after a few
-minutes the paralysis involved the right leg, and he lost consciousness.
-It was only after the lapse of three weeks that he recovered his senses.
-He was finally taken to Paris, where the paralysis gradually disappeared.
-From a period some three or four months after the reception of the injury,
-he began to manifest periodical attacks of somnambulism, at intervals of
-fifteen to thirty days with an average duration of fifteen to thirty
-hours. During the whole of this time his life presented two essentially
-distinct phases--the one normal, the other pathological. In the normal
-condition he was able to gain a livelihood. He had been a clerk in several
-houses, a singer in a _cafe_, and while in the hospital had made himself
-useful and agreeable. The somnambulic attacks which he experienced were
-characterized by an instantaneous onset, resulting in the abolition of all
-his senses except the tactile sense. Sight was perhaps partially
-persistent, for on many occasions he seemed to be impressed by brilliant
-objects, but he was obliged to employ the sense of touch in order to
-understand their form, volume, etc. During all these crises his gait was
-easy, his attitude calm, his countenance peaceful; his eyes were widely
-open, with dilated pupils; the forehead and brows were contracted; there
-was an incessant nystagmus, indicating a disordered state in the brain; he
-was continually mumbling or muttering. When walking in a familiar locality
-he moved with perfect freedom; but if in a strange place, or if obstacles
-were placed in his way, he examined the obstructions by feeling of them
-with his hands, and turned easily aside. If any attempt was made to change
-his direction, or to quicken or retard his pace, he allowed himself to be
-directed like a mere automaton, continuing to walk in any way thus chosen
-for him. He would also eat, drink, smoke, dress himself, walk out, and
-retire to bed as usual. These processes seemed to be effected as a result
-of previous habit, without any actual consciousness or feeling. He ate
-voraciously without discernment, and drank in the same manner ordinary
-wine, wine of quinine, water, assafoetida, without exhibiting any evidence
-of sensation whatever.
-
-While under treatment in the Saint Antoine Hospital, this patient was
-carefully studied by Dr. Mesnet and by Alfred Maury, the celebrated
-author. They found that by means of impressions upon his tactile
-sensibility it was possible during any one of his paroxysms to suggest
-certain modes of action which were reproduced whenever he was again placed
-in the same conditions. Thus, "he was promenading in the garden, under a
-grove of trees, when some one put back into his hand the cane which he had
-let fall a few moments previously. He felt of it, turned his hand several
-times around the curved handle of the cane, became attentive, seemed to
-listen, and suddenly cried out, 'hurry!' then, 'there they are! there are
-at least twenty of them, to the two of us! we shall get the better of
-them!' and then, carrying his hand behind his back, as if to get a
-cartridge, he went through the movements of loading his musket, crouched
-at full length in the grass, concealing his head behind a tree, in the
-posture of a sharp-shooter, and following with his gun at his shoulder all
-the movements of the enemy whom he seemed to see close at hand. This scene
-often repeated in detail during the course of the observations, has seemed
-to each of us the most complete expression of an hallucination called up
-by an illusion of touch, which, giving to a cane the properties of a gun,
-awakened in this person remembrances of his last campaign, and reproduced
-the struggle in which he was so grievously wounded."
-
-On another occasion the patient was at the end of a corridor, near a door
-that was locked; he "passed his hands over this door, found the knob,
-grasped it, and attempted to open it; failing to accomplish this, he
-sought for the keyhole, then for the key, which, however, was not there;
-then, passing his fingers over the screws which secured the lock, he
-endeavored to seize them and turn them for the purpose of detaching the
-lock. _This entire series of actions bears witness to an effort of his
-mind connected with the object before him._ He was on the point of leaving
-the door and turning towards another room, when I held up before his eyes
-a bunch of seven or eight keys; he did not see them; I jingled them loudly
-at his ear; he did not notice them; placing them in his hand, he
-immediately took hold of them, and tried them one by one in the keyhole,
-without finding the single one which could fit; he then left the place,
-and went into one of the wards, taking in his passage various articles
-with which he filled his pockets; at length he came to a little table used
-for the records of the wards. He then passed his hands over the table, but
-it was empty; in feeling of it, however, he came across the handle of a
-drawer; opening it, _he took up a pen, and all at once this pen suggested
-to him the idea of writing_; for at that moment he began to ransack the
-drawer, taking out and placing on the table several sheets of paper, and
-also an inkstand. He then sat down and commenced a letter, in which he
-recommended himself to his commanding officer for his good conduct and
-bravery, and made application for the military medal. This letter was
-written with many mistakes in it, but these were identical as regards
-expression and orthography with all that we have seen him make in his
-healthy state. While the patient was writing, he aided us in an experiment
-that encouraged to immediately examine in what degree the sense of sight
-assisted in the performance of this action. The facility with which he
-traced his letters, and followed the lines upon the paper, left no doubt
-concerning the exercise of vision upon the writing; but, in order to make
-the proof satisfactory, we have several times interposed a thick plate of
-sheet-iron between his hands and his eyes when he was writing; and,
-although all the visual rays were intercepted, he did not immediately
-break off the line he had begun; he still continued to trace a few words
-written in an almost illegible manner with the letters entangled in each
-other; then finally he stopped without manifesting either discontent or
-impatience. The obstacle removed, he finished the uncompleted line, and
-began another. _The sense of sight was therefore in full activity, and
-essential to the written expression of the patient._" Other observations
-showed that the sense of sight was only roused at the instance of touch,
-and that its exercise remained limited to those objects alone with which
-it was actually connected by the touch.
-
-On another occasion he passed through a long ward of patients, "taking
-indiscriminately every article that came within his reach, and concealing
-them afterwards under the quilt, under a mattress, under a chair-cover,
-and under a pile of sheets. Arrived in the garden, he took from his pocket
-a book of cigarette papers, opened it, and detached a leaf from it; then
-took out his tobacco and rolled a cigarette with the dexterity of one who
-is accustomed to this proceeding. He searched for his match-box, lighted
-his cigarette with a match, which falling still burning on the ground, he
-extinguished by placing his foot upon it; then smoked his cigarette while
-strolling back and forth to the entire extent of the garden, without any
-of these actions presenting the slightest deviation in their manner from
-the ordinary method. Everything that he did was the faithful reproduction
-of his ordinary round of life.
-
-"This first cigarette terminated, he prepared to make another, when we
-stepped up and began to interpose obstacles.... He searched vainly in his
-pocket for his tobacco, as we had filched it. He searched for it in
-another pocket, going through all his clothes until he came back to look
-for it in the first pocket, when his face expressed surprise. I offered
-him his tobacco-pouch, but he did not perceive it; I held it near his
-eyes, yet he still did not perceive it; even when I shook it just in front
-of his nose, he did not notice it. But when I placed it in contact with
-his hand, he seized it and completed his cigarette directly. Just as he
-was about to light his cigarette with one of his matches, I blew it out
-and offered him instead a lighted match which I held in my own hand; he
-did not perceive it; I brought it so close to his eyes as to singe a few
-lashes, yet he still did not perceive it, neither did he make the
-slightest motion of blinking.... _The patient sees certain objects and
-does not perceive others; his sense of sight receives impressions from
-all objects in personal relation with himself through the touch, and does
-not receive impressions, on the contrary, from things external to him; he
-perceives his own match, but does not perceive mine._"
-
-During the course of this observation the patient gave evidence that the
-memory of his former occupation as a professional singer had been revived.
-He began to hum some of the familiar airs, and then proceeded to his room
-in the hospital, where he carefully dressed himself as if for a public
-performance. "On his bed he chanced to meet with several numbers of a
-periodical romance, which he turned rapidly over without finding that for
-which he was searching.... I took one of those numbers, rolled it up, and
-putting it into his hand in that condition, satisfied his want by this
-semblance of a roll of music, for he then took his cane, and traversed the
-ward with a slow step, well contented. When stopped on his way, for the
-purpose of taking off the coat he was wearing (which had been foisted on
-him by one of the observers), he permitted it without offering any
-resistance.... At this moment the sun lit up with a bright ray a glass
-window that closed the lodge on the side towards the court.... This ray
-must have given him the impression of a footlight, for he at once placed
-himself before it, readjusted his toilet, opened the roll of paper which
-he carried in his hand, and softly hummed an air, running his eyes over
-the pages as he slowly turned them, and marking with his hand a measure
-that was perfectly rhythmical. Then he sang aloud, in a highly agreeable
-manner, giving his song the correct expression, a patriotic ballad to
-which we all listened with pleasure. This first selection terminated, he
-sang a second, and afterwards a third. We then saw him take out his
-handkerchief to wipe his face. I offered him a wine-glass of a strong
-mixture of vinegar and water, which he did not notice; I placed the glass
-under his nose without his perceiving the smell of the vinegar; I put it
-into his hand, and he drank it without complaining of any unpleasant
-sensation."
-
-The conclusions which may be drawn from this remarkable history have been
-sufficiently expressed by Dr. Mesnet[85] in the following words:
-
-"The disturbance which these functional perversions of the nervous system
-bring into the course of life, extends not only to the organs of sense,
-and to intellectual actions properly so called, but it also sometimes
-awakens some instinctive excitation which surrenders the individual
-without any defence, and destitute of rational discernment, to the most
-deplorable impulses. He acts with the semblance of a freedom which he does
-not possess; he seems to prepare and to combine certain actions in the
-light of conscious volition, when he is in reality only a blind
-instrument, obedient to the irresistible mandates of an unconscious
-impulse."
-
-The bearing of these conclusions upon the question of the moral
-responsibility of the somnambulist needs no further advertisement.
-
-The likeness of certain features of such cases to the phenomena of
-hypnotism is worthy of note. In this particular there is an evident
-likeness between the cerebral susceptibility of the ordinary dreamer, the
-somnambulist, and the hypnotised subject. All are alike in a condition
-which renders their imagination and their volition subservient to guiding
-sensations from without, so that their movements may be directed by the
-will of another. We have seen how the course of an ordinary dream may be
-modified by such suggestions. The history of the patient just related,
-illustrates the manner in which the actions of a somnambulic dreamer may
-be controlled by the will of a spectator. The ordinary phenomena of
-hypnotism exhibit the same subjection to the will of another. It is
-probable that a considerable part of the superior notoriety which belongs
-to this feature of hypnotism, is due merely to the fact that natural
-somnambulism is rarely made the object of such experiments and
-observations as are daily applied to the subjects of artificial
-somnambulism.
-
-_Somnambulic Life._--We come now to the last term of the series, the
-simplest, yet perhaps the rarest form of the affection. In this form, the
-patient seems perfectly awake; he is in possession of all his senses; he
-is capable of sustained and rational volition; he lives and behaves, in
-short, like any other person. But his life is divided into periods which
-are, so far as consciousness is concerned, completely distinct from each
-other. This double-consciousness may be exhibited but once in a lifetime,
-or it may be frequently repeated, so that the patient oscillates between
-the two states until it becomes doubtful which is the natural condition
-and which is the acquired. These states of double-consciousness are
-divided from each other by a more or less complete break in the chain of
-memory. The residual strata which, so to speak, have been deposited from
-the sea of events upon the floor of memory, have become broken and
-"faulted." The line of rupture marks the division between the two fields
-of consciousness; they no longer lie in the same plane, consequently there
-can be little or no continuity of memory between them. The events which
-transpire in one state affect the mind so long as, and whenever it is in
-connection with the cerebral register which is fitted to that state; as
-soon as the connection is shifted, the mind takes cognizance of the events
-that are recorded upon the other portion of the register, but, for want of
-physical continuity between the different portions of the record, the mind
-cannot at once receive a continuously connected report from the entire
-organ of recollection. From this results a mode of life essentially
-similar to the life of certain epileptics who are ushered by each seizure
-into a state of apparently conscious activity of which they have no
-recollection after recovery. Thus, one of my epileptic patients, who was
-subject to seizures, both of the convulsive and the non-convulsive form of
-the disease, on one occasion left home, after a fit, and traveled a
-considerable distance into the country, putting up for the night at
-taverns and farm houses, and apparently behaving like any other
-respectable citizen. It was three weeks before he came to himself. On
-recovering his normal consciousness, the period of his wanderings was a
-perfect blank in his memory. Such attacks are usually of shorter duration,
-and are more frequently associated with hysteria; bearing to the
-hysterical paroxysm the same relation which they share with the epileptic
-fit. When the predisposing temperament exists, a great variety of
-excitations may serve to produce the phenomena, so that unless careful
-observation is employed, the truly somnambulic character of the paroxysm
-may easily be overlooked. Thus, the true nature of the affection was not
-suspected by the early attendants of the patient who became the subject of
-lethargic stupor, as related on page 173. Under the influence of powerful
-drugs acting upon a highly sensitive nervous organization, she became, at
-first, "hystericky." She manifested great distress, complained bitterly of
-her sufferings, passed through the ordeal of several consultations, was
-subjected to a considerable surgical operation, and only ceased to appear
-conscious at the expiration of five weeks, when she passed into the
-lethargic state previously described. At the time of my first visit, just
-before the commencement of stupor, she walked into the room where I was
-waiting, greeted me with her usual affability, gave me some account of her
-sensations, and neither did nor said anything that could lead me to
-suspect that she was not in her normal frame of mind. But, with the
-exception of the single incident mentioned on page 193, the entire period
-from the commencement of her medication to the close of the lethargic
-stupor was utterly blotted out of her recollection.
-
-Macnish[86] relates a similar case of a young lady who "unexpectedly, and
-without any forewarning, fell into a profound sleep which continued
-several hours beyond the ordinary term. On waking, she was discovered to
-have lost every trace of acquired knowledge. Her memory was _tabula
-rasa_--all vestiges, both of words and things, were obliterated and gone.
-It was found necessary for her to learn everything again. She even
-acquired, by new efforts, the art of spelling, reading, writing, and
-calculating; and gradually became acquainted with the persons and objects
-around, like a being for the first time brought into the world. In these
-exercises she made considerable proficiency. But, after a few months,
-another fit of somnolency supervened. On rousing from it, she found
-herself restored to the state she was in before the first paroxysm; but
-was wholly ignorant of every event and occurrence that had befallen her
-afterward. During four years and upwards she has passed periodically from
-one state to the other, always after a long and sound sleep.... The former
-condition of her existence she now calls the Old State, and the latter the
-New State; and she is as unconscious of her double character as two
-distinct persons are of their respective natures. For example, in her old
-state she possesses all the original knowledge; in her new state only what
-she acquired since. If a lady or gentleman be introduced to her in the old
-state, or _vice versa_ (and so of all other matters), to know them
-satisfactorily she must learn them in both states. In the old state, she
-possesses fine powers of penmanship, while in the new, she writes a poor,
-awkward hand, not having had time or means to become expert. Both the lady
-and her family are now capable of conducting the affair without
-embarrassment. By simply knowing whether she is in the old or new state,
-they regulate the intercourse, and govern themselves accordingly."
-
-Another remarkable case was reported at length by Dr. Azam, of
-Bordeaux.[87] The principal facts are given in a translation by Dr. J. I.
-Tucker in the _Chicago Journal of Nervous and Mental Disease_.[88] The
-patient was a young woman who began to exhibit the symptoms of hysteria at
-the age of puberty, and from that time till the present, a period of
-nearly thirty years, she has lived a double life, passing alternately from
-normal life into somnambulic life. These transitions were ushered in by a
-sharp pain in both temples, followed by a species of stupor, lasting about
-ten minutes. She would then open her eyes, apparently awake, and would
-remain in the condition of somnambulic life for an hour or two, when the
-languor and sleepiness would reappear for a few minutes, after which she
-would awaken in her normal state. At first these paroxysms were renewed
-every five or six hours; but, as she grew older, they occurred less
-frequently, and were greatly prolonged, until, finally, the periods of
-somnambulic life considerably exceeded the duration of normal life. During
-normal life she was hypochondriacal, hysterical, and a sufferer with
-neuralgia. During somnambulic life she was free from pain, lively,
-imaginative, and coquettish. While in this state of existence she
-remembered the events of her entire life--normal or otherwise; but on
-returning to her natural mode of life, she retained no recollection of her
-somnambulic periods. Memory, during normal life, was limited to anterior
-normal periods. As time advanced, this peculiar mode of existence became
-an increasing source of inconvenience and mental distress, often leading
-the superficial observer to suppose that she was insane.
-
-This case differs from the others in the circumstance that the period of
-somnambulic life was more vigorous and healthy than the ordinary
-condition. This seems to suggest an explanation of the forgetfulness which
-marked the period of normal life. During that period the functions of the
-brain were depressed, so that its molecular movements could not reach the
-level of the field of consciousness occupied during the second period.
-Other observations, such as that of Sir Henry Holland,[89] who, while
-exhausted by fatigue, lost all recollection of the German language until
-he was restored by rest and food, indicate that such defects of memory
-depend upon a deficient nutrition of the brain substance--a condition
-which is undoubtedly associated with an enfeebled cerebral circulation. We
-may, therefore, suppose that in Dr. Azam's case the paroxysms of
-somnambulic life were induced by periodical discharges of force within the
-brain, causing an improvement in the circulation of blood, and a
-corresponding gain in health and general vivacity. Such exaltation of the
-faculties would be perfectly consistent with an exercise of memory
-covering all the events of life. But, when, as in cases like that reported
-by Macnish, and by myself, somnambulic life is the result either of
-disease or simple somnambulic sleep, it is a condition in which, as in
-physiological sleep, the cerebral functions, taken as a whole, are
-depressed rather than exalted. The resulting train of ideas is developed
-upon a plane below the level of ordinary consciousness, and is,
-consequently, as easily forgotten as the dreams which are developed during
-sleep.
-
-Such, then, are the principal characteristics of somnambulism--a state in
-which dreams are supplemented by more or less complete and appropriate
-action; ordinarily without subsequent recollection of either dream or
-action. The somnambulic dream usually occurs during or soon after the
-period of deepest sleep, when the influences of the external world are
-most completely suppressed. Released from the control of its sensory
-portion, the remainder of the brain awakens, and becomes aroused to a
-condition of relative exaltation. No longer distracted by the
-solicitations of external sense, the attention is concentrated upon the
-hallucinations which constitute the dream. In the simpler forms of
-noctambulism only the automatic locomotive apparatus is awakened, and the
-sleeper moves in accordance with the impressions derived from habit, aided
-by actual exaltation of the muscular and tactile senses. But, in some of
-the more complicated cases, a certain amount of special sensibility seems
-to exist. The patient is capable of exercising just that amount of
-perception which is necessary to accomplish his purpose, though blind and
-deaf and insensible to every other impression. The more complete the
-waking of the sense-organs, the closer the resemblance to the condition of
-ordinary life, or even to the condition of ecstasy, in which cerebral
-exaltation is the prominent feature, and in which the power of
-recollection generally persists. Accordingly, it sometimes happens that
-the somnambulist can recall the events of his paroxysm. In such cases the
-power of recollection is due to the same conditions that control the
-recollection of our ordinary dreams. But the phenomena of ordinary
-somnambulism are as completely as possible removed from all connection
-with the mental actions which arise directly from the operation of the
-senses. By reason of such isolation the ordinary association of ideas
-affords no help to the memory, and the dream remains in oblivion. Alfred
-Maury expresses the opinion[90] that the principal cause of forgetfulness
-of the events of somnambulism consists in the exhaustion of the cerebral
-elements through the intensity of the excitement to which they have been
-subjected during the paroxysm. Doubtless this, in certain cases, may
-contribute to the loss of memory, but it should be remembered that the
-excitement may be relative rather than absolute. Certain elements wake
-while others are asleep; and these waking cells may be aroused to a degree
-far in excess of what is usual during the sleep of the brain without
-attaining to the level of their diurnal activity. The mind, undisturbed by
-external impressions, gives its attention to the operation of these waking
-organs, and a dream with all its consequences, somnambulic or otherwise,
-is the result. In other words, the plane of consciousness, so to speak, is
-lowered in sleep to the level of these molecular vibrations. But when the
-entire brain has been completely reawakened, the residual vibrations of
-those elements which yielded the physical basis of the dream, and which,
-had they originally occurred during the waking state, might have persisted
-with energy sufficient to furnish a groundwork for recollection of the
-ideas which they had first suggested, are no longer sufficiently forcible
-to be felt in consciousness. Recollection of mental states thus generated
-must necessarily be impossible under such conditions. Sometimes, however,
-the somnambulist who, while awake, had forgotten all the incidents of his
-somnambulic experience, can remember, in a subsequent paroxysm, all that
-occurred during the preceding attack. Facts of this kind have been
-observed in the waking life of certain hysterical persons, but the
-apparent doubling of their personality is connected with the waking state,
-or with its semblance, while in ordinary somnambulism it is only during
-sleep that the alternations of memory and forgetfulness occur. A similar
-recollection of previous visions is sometimes experienced in dreams,
-showing a close relationship between the dreams of sleep and of
-somnambulism. The bond of association between events thus isolated in time
-must be sought in a renewal of like conditions of the brain during the
-successive periods of somnambulic exaltation. We must suppose that the
-molecules which were in a state of excitement during the first paroxysm
-are again aroused in a similar manner after a period of waking quiescence.
-If, during sleep, their movements, though of an exalted character, have
-only just sufficed to arouse consciousness in the form of a dream, it is
-scarcely probable that during the phase of comparative inactivity which
-supervenes when the whole brain is awake, their residual motion could
-disturb the sphere of consciousness. Hence the time occupied by their
-somnambulic vigor must remain a blank in memory during the waking state.
-But, when the original state of relative exaltation has been reproduced by
-a second paroxysm of disorder, if the same molecular movements be in any
-way renewed, the conditions of memory are fulfilled; consciousness is once
-more aroused as before, and the patient remembers the dream or the events
-of the previous attack.
-
-
-
-
-CHAPTER VII.
-
-ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.
-
-  There are more things in heaven and earth, Horatio,
-  Than are dreamt of in your philosophy.
-                                      --HAMLET.
-
-
-The phenomena of somnambulism are of apparently spontaneous origin, during
-ordinary sleep. But from the remotest antiquity it has been known that
-certain persons may be thrown into an artificial sleep which closely
-resembles the condition of the somnambulist. Such a degree of
-susceptibility is not common to all persons. Heidenhain, experimenting
-upon his class of medical students, found only one in twelve who was thus
-susceptible. My own experiments lead me to think that American medical
-students are less easily influenced in this direction. Charcot, whose
-field of observation covers the inmates of the Salpetriere Hospital, finds
-the best examples of the hypnotic state among the hystero-epileptic
-females in that asylum. To the experiments of Heidenhain, in Germany, of
-Braid, in England, and of Charcot, in France, we are indebted for the most
-thoroughly scientific observation and interpretation of the phenomena of
-hypnotism.
-
-The antecedent physical condition most favorable to the development of the
-hypnotic state is a highly unstable constitution of the nervous system.
-For this reason the larger number of qualified subjects is furnished by
-the female sex--especially by those who possess the hysterical
-temperament. Frequent repetition of hypnotic exercises renders the subject
-still more susceptible. Heidenhain was, at first, inclined to the belief
-that such experiences were not prejudicial to the health of the subject,
-but the observations of Harting, in the University of Utrecht, and of
-Milne-Edwards, in Paris,[91] have demonstrated the fact of danger to the
-health of animals subjected to similar experiments. Hysterical patients
-have often exhibited considerable exhaustion after hypnotic exhibition in
-the hospitals of Paris (Charcot and Richer), consequently, it cannot be
-admitted that the practice is devoid of risk to the health of the
-individual.
-
-Numerous methods of inducing the hypnotic state have been employed. The
-greater number consist in artificial modification of the condition of the
-brain through the agency of sensory impressions originated upon the
-periphery of the body. The simplest form of such influence is presented by
-the results of gentle friction of the skin with the palm of the hand or
-the tips of the fingers. Many an aching head has thus been relieved, many
-a restless sufferer soothed to sleep. In like manner, a susceptible
-subject may be hypnotized by any continuous and gentle excitement of the
-senses of sight, hearing, and touch. Concentration of the attention upon a
-brilliant object, like a piece of polished metal or a small mirror,
-especially if it be placed a little above the level of the eyes, and so
-near that considerable convergence of the eyeballs is necessary for
-distinct vision, affords a very efficient means of inducing artificial
-somnambulism. Certain persons may be readily hypnotized by gently pressing
-the eyelids together, and at the same time making slight pressure upon the
-eyeballs. Others pass into this condition by merely closing their eyes,
-and remaining motionless in a quiet room.
-
-The phenomena of artificial somnambulism are frequently developed through
-the agency of impressions derived directly from the sphere of
-consciousness. The intellectual effort of trying to sit still and think of
-nothing is sometimes sufficient to induce the hypnotic state. The ordinary
-devices by means of which wakeful people are taught to beguile sleep, by
-counting, or by repeating long lists of names, etc., all belong to this
-category. Compulsory attention to any continuous intellectual process,
-like adding up a column of figures, or trying to read a dull book, is
-sometimes effectual. If, with these, or with similar acts of attention, be
-associated the expectation that something unusual is about to occur, as
-when the individual is aware of being the subject of an experiment, the
-evolution of the somnambulic condition is greatly facilitated. Thus, one
-of the most recent methods, consists in merely sitting, for half an hour
-or more, with the back towards the patient. Attention, curiosity, and
-expectation, are thus excited, and a susceptible person soon begins to
-manifest some of the numerous and various forms of the hypnotic state.
-Heidenhain caused one of his students thus to go to sleep in broad
-daylight, by simply assuring him that he should hypnotize him from a
-distance at a particular hour of the afternoon. The monks of Mt. Athos
-were accustomed to hypnotize themselves by fixing their eyes and their
-thoughts upon the navel; hence the reputation of omphaloscopy as an aid to
-ecstatic meditation.
-
-The duration of hypnotic sleep is as variable as that of its prototype in
-natural somnambulism. The patient usually wakes spontaneously, after a few
-minutes or hours. Sometimes, however, the period of insensibility is
-greatly prolonged. If it be desirable to awaken the subject of experiment,
-a simple reversal of the movements by which sleep was induced may suffice.
-The paroxysm may be terminated by almost any sudden and energetic appeal
-to the senses, like an electric shock, a sudden illumination of the eye
-with vivid light, or a sharp puff of air upon the face.
-
-The simplest phenomena connected with the hypnotic state are those
-transferences of cerebral perceptions which have been investigated by the
-Society for Psychical Research.[92] Certain sensitive persons, when
-blindfolded, are capable of reproducing with considerable accuracy visual
-images that have been impressed upon the mind of another. The sensitive
-subject is blindfolded and placed before a table with pencil and paper.
-Another person then goes out of the room, and gazes at some kind of
-drawing, geometrical figure, or other object selected without possibility
-of collusion with the subject of experiment. This person then returns to
-the room, and places his hand upon the head of the subject, at the same
-time fixing his attention upon the mental picture of the object. Presently
-the blindfolded subject takes the pencil and reproduces on paper a rough
-drawing of the object in question. In some cases it is found possible to
-effect this transfer of impressions without actual physical contact,--the
-agent merely standing behind the sensitive subject and concentrating his
-thought upon the selected object. Closely akin to this is the method of
-muscle-reading, popularly known as _mind-reading_. The sensitive is
-blindfolded, and then presses against his forehead the hand of the person
-by whom he is to be guided. Almost immediately a tremor pervades his
-muscles, and he yields all his movements to the guiding influence of the
-individual with whom he is in contact. If now an object be concealed in
-any place that is known to the agent, the concentration of that person's
-attention upon the hiding place suffices to direct the "mind-reader," who
-immediately drags his companion to the given locality.
-
-The explanation of these phenomena consists in a recognition of the fact
-that certain persons are gifted with nervous organs which are sensitive
-and responsive to nervous impulses and muscular movements that are too
-delicate for recognition by the percipient apparatus of ordinary mankind.
-The more complicated forms of artificial somnambulism result from the
-complication and exaggeration of the results of this inordinate
-sensitiveness through the agency of artificial sleep. As in natural
-somnambulism, so in the hypnotic state, certain organs become totally
-anaesthetic, while the sensibility of others is wonderfully exalted.
-Cutaneous sensation may be completely abolished, and the patient may
-become utterly insensible to every painful impression. The reflex
-functions may be either suppressed or exaggerated, and the special senses
-of sight and hearing may be exalted to the highest degree. While in this
-condition the hyperaesthetic condition of the brain renders the subject
-peculiarly susceptible to impressions from the will of another, so that
-all his actions are obedient to the guiding influence of the person under
-whose control he has passed.
-
-According to Charcot,[93] three principal types of artificial somnambulism
-may be remarked among the hysterical subjects upon whom he experimented:
-(1) the _cataleptic_, (2) the _lethargic_, and (3) the _somnambulic_. Of
-these the first may be developed primarily by any abrupt and powerful
-impression upon a sensory organ. Gazing upon a brilliant light, fixing the
-eyes upon a piece of polished metal, or upon the shining eyes of a second
-person, the sudden clangor of a Chinese gong, may suffice to induce the
-cataleptic state. Dumontpallier[94] reports the case of a young woman who
-accidentally hypnotized herself by gazing into the mirror before which she
-was dressing her hair. This cataleptic state may also be secondarily
-induced by merely opening the eyes of a patient in whom a condition of
-hypnotic lethargy has been previously developed. If only one eye be thus
-opened, the corresponding side of the body alone becomes cataleptic.
-Closing the eyes causes the disappearance of this symptom, with complete
-restoration of the purely lethargic state. During the cataleptic condition
-the several tendinous reflexes disappear, neuro-muscular
-hyper-excitability ceases, the skin becomes insensible, but the special
-senses, particularly those of sight and hearing, maintain a partial
-activity. In this half-awakened state the senses may become avenues of
-suggestion from without for the production of movements; but, if left to
-themselves, the limbs remain motionless.
-
-The _lethargic state_ may be induced by simply pressing together the
-eyelids of the subject, or by causing him to fix his gaze upon some
-definite object. The paroxysm begins with a deep inspiration, causing a
-peculiar laryngeal sound, followed sometimes by the appearance of a little
-foam on the lips. The eyelids are either wholly or partially closed, and
-are in a state of continual tremulous motion. The eyeballs are generally
-turned upwards and inwards. The muscles are completely relaxed. The
-tendinous reflexes are exaggerated; pressure over a muscle, or upon a
-nerve, arouses a peculiar contracture of synergic muscles and groups of
-muscles that are supplied by the excited nerve trunk. The facial muscles,
-however, do not thus become contractured; they merely contract during the
-application of the stimulus. If the lethargic subject be rendered
-cataleptic by opening the eyes, these contractures persist even after
-waking; and they can only be dispelled by renewing the lethargic state
-before resorting to pressure upon the antagonistic muscles--the process by
-which contractures peculiar to this species of lethargy may always be
-annulled. By the approach of a magnet to a contractured limb, the rigidity
-may be completely transferred to the corresponding muscles upon the
-opposite side of the body. If upon a limb of a lethargic subject who has
-been rendered cataleptic by opening the eyes, an Esmarch's band be
-applied, pressure over the bloodless muscles excites no contracture until
-the band is removed. A contracture is then developed, and it may be
-transferred to the opposite limb by the approach of a magnet. To this
-phenomenon has been applied the term _latent contracture_.
-
-The extraordinary muscular excitability manifested by these subjects is
-further illustrated by an observation recorded by Dumontpallier.[95] If
-one end of an India rubber tube, half an inch in diameter, and five or six
-yards in length, be applied over a muscle in the leg, and if the other end
-be in like manner connected with a watch, every movement of the second
-hand will be followed by a slight contraction in the muscle. The same
-result follows connection with the wire of a telephone; and, if a
-microphone be introduced into the circuit, the incidence of a ray of light
-upon the instrument, or even its reflection from the conjunctival surface
-of the eye of a spectator, will arouse a responsive muscular contraction.
-Charcot has also seen muscular motion upon the opposite side of the body
-when a mild galvanic current was applied to the parietal surface of the
-skull, presumably over the motor centres of the corresponding half of the
-brain.
-
-During these manifestations of muscular hyper-excitability, there is
-complete insensibility to pain, but the senses of sight and hearing seem
-to preserve some degree of activity. The subject, however, does not often
-exhibit any susceptibility to influence by suggestion.
-
-The _somnambulic state_ may be directly induced by fixed attention with
-the eyes, by feeble and monotonous excitement of the senses, by passing
-the hands over the face and arms of the subject, and by many other
-processes of analogous character. This variety constitutes the ordinary
-form of hypnotic sleep. It may be very easily developed during either the
-lethargic or the cataleptic state as a consequence of pressure or of
-gentle friction upon the top of the head. Thus Heidenhain, in the course
-of his experiments, caused muscular paralysis by rubbing the scalp.
-Friction of one side of the head occasioned paralysis of the opposite side
-of the body without notable affection of the consciousness of the subject.
-The eyes and the eyelids behave as in the lethargic state. The subject
-seems to be asleep, but there is less muscular relaxation than in the
-lethargic variety. There is no exaggeration of the tendinous reflexes, and
-muscular hyper-excitability is absent. But by lightly touching or
-breathing upon the surface of a limb, its muscles may be thrown into a
-condition of rigidity which differs from the contracture of the lethargic
-state, in the fact that it does not yield to excitement of the
-antagonistic muscles, though yielding readily to a sudden repetition of
-the same form of excitement by which it was originally produced. Thus a
-subject under my own observation who, by pressure upon the eyeballs, was
-rendered insensible to every form of painful stimulation, would
-immediately pass into a state of perfect rigidity, if his limbs and body
-were rubbed for a few seconds with the palm of the hand. While in this
-condition, if the heels were placed upon a chair and the back of the head
-upon another, not only could the entire weight of the body be thus
-supported, but also the additional weight of another full-grown man,
-sitting upon his body, without causing any more yielding than if it had
-been a log of wood that was lying across the chairs. From the immobility
-of the cataleptic state this rigidity differs by its greater degree of
-resistance to passive motion. Though insensibility to pain may be
-perfectly developed in this state, there is generally an exalted condition
-of certain forms of cutaneous sensibility, and of the muscular sense.
-Strange perversions of other special senses are sometimes remarked. Thus,
-Cohn[96] discovered that a patient who was naturally color-blind, was
-able, when unilaterally hypnotized, "to distinguish colors which were
-otherwise undistinguishable." Conversely, when the cataleptic state is
-induced, the healthy eye becomes incapable of discerning colors. Spasm of
-accommodation is also present, and is one of the earliest demonstrable
-symptoms of the hypnotic condition.
-
-These remarkable exaggerations and perversions of sensibility have been
-the cause on the one hand, of much skepticism regarding the verity of the
-phenomena of hypnotism, and, on the other, of much credulity, extending
-even to a belief in the existence of supernatural and miraculous powers.
-The extraordinary character of these experiences is well illustrated by
-the following letter from Lieut. J. M. Brooke, of the United States Navy,
-to President Wayland, of Brown University. It may be found in "Wayland's
-Intellectual Philosophy."
-
-    "WASHINGTON, Oct. 27th, 1851.
-
-    "SIR--It affords me pleasure to comply with your request, made through
-    my brother William, relative to some experiments performed on board
-    the United States steamer 'Princeton,' in the latter part of the year
-    1847, she being then on a cruise in the Mediterranean. Nathaniel
-    Bishop, the subject of the experiments, was a mulatto, about
-    twenty-six years of age, in good health, but of an excitable
-    disposition. The first experiment was of the magnetic or mesmeric
-    sleep, which overpowered him in thirty minutes from the commencement
-    of the passes made in the ordinary way, accompanied with a steadfast
-    gaze and effort of the will that he should sleep.
-
-    "In this state he was insensible to all voices but mine, unless I
-    directed or willed him to hear others; he was also insensible to such
-    amount of pain as one might inflict without injury, that is, what
-    would have been pain to another. He would obey my directions to
-    whistle, dance or sing. When aroused from this sleep he had no
-    recollection of what occurred while in it. That such an influence
-    could be exerted, I was already aware, having previously witnessed
-    satisfactory experiments. Of clairvoyance I had never been convinced;
-    indeed, considered it nothing but a sort of dreaming produced by the
-    will of the operator. I became aware of its truth rather through
-    accident than design.
-
-    "It happened, one day, that some of my brother officers asked a
-    question which the others could not answer. Bishop, who had been a few
-    moments before in a mesmeric sleep, gave the desired information,
-    speaking with confidence and apparent accuracy. As the information
-    related to something which it seemed almost impossible to know without
-    seeing, we were very much surprised. It struck me that he might be
-    clairvoyant; and I at once asked him to tell me the time by a watch
-    kept in the binnacle, on the spar or upper deck, we being on the berth
-    or lower deck. He answered correctly, as I found upon looking at the
-    watch, allowing eight or nine seconds for time occupied in getting on
-    deck. I then asked him many questions with regard to objects at a
-    distance, which he answered, and, as far as I could ascertain,
-    correctly.
-
-    "For example, one evening, while at anchor in the port of Genoa, the
-    captain was on shore. I asked Bishop, in the presence of several
-    officers, where the captain then was. He replied, 'At the opera with
-    Mr. Lester, the consul.' 'What does he say?' I inquired. Bishop
-    appeared to listen, and in a moment replied: 'The captain tells Mr.
-    Lester that he was much pleased with the port of Xavia; that the
-    authorities treated him with much consideration.' Upon this, one of
-    the officers laughed, and said that when the captain returned he would
-    ask him. He did so, saying, 'Captain, we have been listening to your
-    conversation while on shore.' 'Very well,' remarked the captain,
-    'what did I say?' expecting some jest. Then the officer repeated what
-    the captain had said of Xavia and its authorities. 'Ah,' said the
-    captain, 'who was at the opera? I did not see any of the officers
-    there.' The lieutenant then explained the matter. The captain
-    confirmed its truth, and seemed much surprised, as there had been no
-    other communication with the shore during the evening. I may remark
-    that we touched at several ports between Xavia and Genoa.
-
-    "On another occasion, an officer being on shore, I directed Bishop to
-    examine his pockets; he made several motions with his hands, as if
-    actually drawing something from the officer's pockets, saying, 'Here
-    is a handkerchief and a box; what a curious thing! full of little
-    white sticks with blue ends. What are they, Mr. Brooke?' I replied,
-    'Perhaps they are matches.' 'So they are,' he exclaimed. My companion,
-    expecting the officer mentioned, went on deck, and meeting him at the
-    gangway, asked, 'What have you in your pockets?' 'Nothing,' he
-    replied. 'But have you not a box of matches?' 'Oh, yes!' said he. 'How
-    did you know it? I bought them just before I came on board. The
-    matches are peculiar, made of white wax with blue ends.'
-
-    "The surgeons of the 'Princeton' ridiculed these experiments, upon
-    which I requested one of them (Farquharson) to test for himself, which
-    he consented to do. With some care he placed Bishop and myself in one
-    corner of the apartment, and then took a position some ten feet
-    distant, concealing between his hands a watch, the long hand of which
-    traversed the dial. He first asked for a description of the watch. To
-    which Bishop replied, ''Tis a funny watch, the second hand jumps.'
-
-    "The doctor then asked him to tell the minute and second, which he
-    did; directly afterwards exclaiming, 'The second hand has stopped!'
-    which was the case, Dr. Farquharson having stopped it. 'Well,' said
-    the doctor, 'to what second does it point, and to what hour, and what
-    minute is it now?' Bishop answered correctly, adding, ''Tis going
-    again.' He then told twice in succession the minute and second.
-
-    "The doctor was convinced, saying that it was contrary to reason, but
-    he must believe. I then proposed that the doctor should mark; and
-    directed Bishop to look in his mother's house, in Lancaster, Pa.,
-    (where he had never been) for a clock; he said there was one, and told
-    the time by it; one of the officers calculated the difference in time
-    for the longitudes of Lancaster and Genoa, and the clock was found to
-    agree within five minutes of the watch time."
-
-Such clairvoyance is very rare; in fact, it is difficult, at first
-thought, to believe in its existence. Nor should its alleged possession
-be credited in any instance until all possibility of deception has been
-excluded. The example just related seems to be, in this respect, one of
-the best, for the reason of its occurrence in a little group of men whose
-isolation and thorough acquaintance with each other must have reduced the
-chances of simulation to the lowest degree. When carefully considered,
-moreover, it is apparent that the exaltation of the functions of sight and
-of hearing in this case was not different in kind or in degree from that
-that has already been recorded in connection with certain cases of natural
-somnambulism and of dreaming. The condition of the brain is probably
-identical in all such instances; it is the mode of its induction that is
-subject to variation. The remarkable feature of the hypnotic state
-consists in its production at the pleasure of either the subject or of the
-agent under whose control he has passed; whereas the phenomena of natural
-somnambulism and of the clairvoyant dream occur only during sleep, and
-independently of the will of the patient.
-
-Another singular fact in this connection is the receptivity of the
-hypnotized brain for suggestions from the minds of other persons. Usually,
-the patient is insensible to all communications which do not emanate from
-the agent by whom he is held in control; but in certain cases it is
-probable that the brain is more or less open to impressions of a
-particular sort from any source. Numerous examples illustrate the manner
-in which the course of an ordinary dream may be thus directed. The
-hypnotic dream is far more easily modified by suggestions from without.
-The simplest examples of this are exhibited by the hypnotized subject who
-walks, jumps, lies down, executes every variety of pantomime, in obedience
-to the commands of his director. Somewhat more complicated are the actions
-that are developed through excitement of the imitative faculties. Every
-movement of the director _that can be perceived by the subject_ will be at
-once reproduced. Dr. Fischer relates[97] the case of a patient who,
-although exceedingly ignorant of the art of music, was able, during the
-hypnotic paroxysm, to sing with Jenny Lind all kinds of songs, so
-accurately that it was impossible to distinguish their separate voices.
-Expression of the various emotions and passions may also be provoked by
-merely placing the subject in the several attitudes characteristic of such
-feelings.
-
-In the lower grades of the hypnotic state, consciousness is not abolished,
-and the subsequent recollection of events during the experience may be
-quite perfect. In such cases illusions and hallucinations, that were
-excited by suggestions from the controlling mind of another, survive in
-memory, and become the causes of serious delusion. Witness, for example,
-the manner in which excitable people, partially hypnotized in a so-called
-"spiritual circle," believe in the reality of the illusions which have
-occupied their powers of perception during a "seance." To this inferior
-grade of self-induced hypnotism belong all those conditions of sensory
-hyperaesthesia by means of which certain persons are enabled to read the
-hidden thoughts of others. This capacity is, essentially, a mere
-exaltation of that power which all mankind shares in a greater or less
-degree. In every instance it has been remarked that the ordinary "medium"
-can only respond correctly to questions for which the true answer is
-present in the mind of the questioner. To all other interrogatories the
-replies are delivered purely under the influence of random suggestion. In
-some cases the pathway of communication lies through actual bodily
-contact, as in ordinary "mind-reading," where the invisible molecular
-oscillations of the muscular elements of one person serve to guide the
-perceptions and movements of another. But, more frequently, the
-transmission of ideas is effected through the action of the facial and
-ocular muscles. From these organs of expression the "table-rapper," or the
-"planchette-writer," reads the unspoken thoughts of the questioner, in a
-manner very like, yet vastly more delicate than that by which deaf mutes
-are taught to interpret the movements of the lips of persons with whom
-they converse. This fact is clearly illustrated by the experience of
-Maury,[98] in an interview with a celebrated table-rapper who, without the
-slightest hesitation, made known to him the age, name, and date of death
-of a brother whom he had lost. She also gave the same information
-regarding his father, and pronounced the names of other persons upon whom
-he had fixed his attention. But, if he turned away his face, or if he
-concealed his eyes so that the woman could no longer scrutinize their
-expression, her responses became entirely uncertain and destitute of
-conformity with fact.
-
-The induction of the hypnotic state, if not too often repeated, is
-sometimes of considerable service in the relief of various functional
-disorders of a painful character. This fact, enthusiastically announced,
-many years ago, by Dr. Braid, has recently been freshly brought forward
-through the experiments of Fischer,[99] Wiehe,[100] Rieger,[101] and
-others. In our own country this method of treatment has not yet been
-adopted by many in the medical profession, though its efficacy in a
-particular class of cases is not denied. Outside of professional circles,
-however, it is exploited to a considerable extent under the strange
-misnomer of Metaphysical Healing. But, as De Watteville has truly
-remarked,[102] "the time is near when the curative influence of hypnotism
-will be submitted to the same scrutiny as its physiological and
-psychological import has undergone."
-
-
-THE END.
-
-
-
-
-INDEX.
-
-
-  Acids, 71
-    hydrobromic, 88
-    hydrochloric, 72
-    hydrocyanic, 100
-    hydrocyanic, in gastric disease, 103
-    lactic, 72
-    nitric, 72
-    nitro-muriatic, in hepatic insomnia, 103
-    phosphoric, 72
-
-  Aconite, 63, 93, 100
-
-  Africa, maladie du sommeil of, 30
-    winds from the deserts of, effect of, 46
-
-  Africans, habits of, regarding sleep, 40
-    victims of the maladie du sommeil, 30
-
-  Alcohol, 76
-    effect of, upon the brain, 54
-    in angina pectoris, 99
-    in asthma, 101
-    in chorea, 110
-    in dyspepsia, 103
-    in fever, 105
-    in hepatic diseases, 102
-
-  Allen, Prof. J. Adams, case of somnambulism observed by, 185
-
-  Allix, observations of, regarding bodily temperature in sleep, 7
-
-  Allix and Hohl, observations of, regarding the pulse in sleep, 6
-
-  Aloetic purgatives in insanity, 94
-
-  Ammonia, in fever, 105
-
-  Amyl nitrite, 84
-    in angina pectoris, 99
-    in asthma, 101
-
-  Anaemia of the brain, 53
-
-  Anaesthetics, 75
-
-  Angelic visitors, delusions regarding, 129
-
-  Angina pectoris, 99
-
-  Anti-spasmodic effects of belladonna, 69
-
-  Apparent death, 34
-    crucial test of, 35
-
-  Arabia, effects of wind from the deserts of, 46
-
-  Arago, observations of, regarding atmospheric electricity, 46
-
-  Arsenic, in asthma, 101
-
-  Atropia, 69
-
-  Atropine, use of, with opiates, 87
-
-  Artificial sleep, effect of, upon the process of oxidation, 9
-    mode of production of, 22
-
-  Artificial somnambulism, 214
-    cataleptic form of, 219
-    lethargic form of, 220
-    recollection of the events of, 227
-    somnambulic form of, 222
-    three varieties of, 219
-
-  Assafoetida, use of, in insomnia, 110
-
-  Assimilation, rate of, in sleep, 5
-
-  Association of ideas, cessation of, in sleep, 3
-    effect of, 123
-
-  Asphyxia, 100
-
-  Asthma, insomnia caused by, 101
-    relieved by atropine, 69
-    relieved by chloroform, 82
-    relieved by ether, 82
-    relieved by iodide of potassium, 110
-    relieved by lobelia, 71
-    relieved by stramonium, 71
-    relieved by tobacco, 71
-
-  Atmospheric electricity, effects of, 46
-
-  Australia, effect of winds from the deserts of, 46
-
-  Azam, a case of somnambulic life observed by, 208
-
-
-  Bachelder, Dr. G. H., observations of, on the maladie du sommeil, 32
-
-  Baillarger, hallucination excited by dreaming, 126
-
-  Ball and Chambard, classification of the varieties of somnambulism, 169
-
-  Baths, use of, as nervous stimulants, 60
-    cold, 73, 95
-    in fever, 104
-    in insomnia, 112
-    in scarlet fever, 76
-    shower, 95
-    warm, 94
-
-  Bartholow, on the use of phosphorus, 71
-
-  Beard and Rockwell, on the use of electricity, 62
-
-  Beer, effect of, 76
-
-  Belladonna, 69, 100
-    use of, in asthma, 101
-    use of, in fever, 104
-    use of, in hepatic diseases, 102
-
-  Bismuth, use of, in gastric diseases, 103
-
-  Bladder, insomnia in irritability of, 90
-
-  Blisters, use of, in rheumatism, 106
-
-  Blood, control of its circulation by the nervous system, 26
-
-  Bombardment, sleep during, 1
-
-  Boussingault, experiments of, on the process of oxidation in the
-        tissues, 9
-    observations of, on respiration in sleep, 6
-    observations of, regarding the bodily temperature in sleep, 7
-
-  Brain, consequences of inordinate excitability of, 159, 161
-    exalted receptivity of, during the waking state, 150
-    exalted susceptibility of, in sleep and dreaming, 144, 150
-    the, its division into separate mechanisms, 13
-    the, a reservoir of sensory impressions, 124
-
-  Brandy, use of, in wakefulness, 77
-
-  Bromide of potassium, use of, in insanity, 95
-    of sodium, use of, in chronic alcoholism, 97
-    of sodium, use of, in delirium tremens, 98
-
-  Bromides, the, 88
-    use of, in convulsions, 110
-    use of, in delirium, 77
-    use of, in fever, 104
-    use of, in night terrors, 112
-    use of, in pregnancy, and after parturition, 109
-    use of, with chloral and morphia, 86
-
-  Brooke, Lieut. J. M., observations of, regarding hypnotic clairvoyance,
-        224
-
-  Bronchitis, insomnia caused by, 100
-    insomnia of, relieved with paraldehyde, 80
-
-  Brunton, Dr. T. Lauder, his theory of counter-irritation, 62
-
-  Butylchloral hydrate, 83
-
-  Buschick, experience of, in waking before earthquakes, 144
-
-
-  Caffeine, effect of, upon the brain, 54
-
-  Camphor, 67
-    use of, in asphyxia, 100
-    use of, in fevers, 105
-    use of, in the insomnia of cachexia, 108
-    use of, after parturition, 109
-
-  Cannabin, 69
-
-  Cannabin tannate, 68
-
-  Cannabis indica, 68
-    anti-aphrodisiac effect of, 69
-    use of, in delirium tremens, 98
-    use of, in fever, 104
-    use of, in insanity, 96, 97
-    use of, in pregnancy, 109
-    use of, as a substitute for hyoscyamus, 113
-
-  Cantharides, 63
-
-  Capsicum, 63
-
-  Capsicum, use of, in the insomnia of delirium tremens, 77, 98
-
-  Carbolic acid, vapor of, for relief of cough, 100
-
-  Carbon, oxidation of, during sleep, 7
-
-  Carbonic acid gas, discharge of, during sleep, 9
-
-  Cardiac debility, use of butylchloral in, 83
-
-  Cardiac disease, insomnia of, treated with paraldehyde, 80
-    treated with digitalis, 66
-
-  Cardiac dyspnoea, relieved with opiates, 87, 98
-
-  Cardiac neuralgia, 99
-
-  Carotid arteries, compression of, for relief of insomnia, 25, 27, 57
-
-  Cataleptic form of artificial somnambulism, 219
-
-  Catarrh, nasal, effect of sleep upon, 8
-
-  Caton, Judge John D., on the difficulty of sleep during the continuous
-        daylight of summer in Norway, 40
-
-  Cerebral activity, effect of, upon bodily temperature, 8
-
-  Cerebral anaemia and its cause during sleep, 25, 28
-    use of phosphorus for, 71
-
-  Cerebral circulation, dependence of consciousness upon, 25, 27
-    during sleep, observations upon, by Professor Mosso, 26
-
-  Cerebral exhaustion, benefited by the use of phosphorus, 71
-    in fever, 105
-
-  Cerebral hyperaemia, effects of, 145
-    insomnia of, treatment with paraldehyde, 80
-
-  Cerebral irritation in cachectic states, 108
-
-  Cerebro-spinal meningitis, use of opiates in, 93
-
-  Cerebro-spinal weakness, 110
-
-  Change of life, use of valerian during, 68
-
-  Chicago, embarkation from, 45
-    the great fire in, 40
-
-  Child-birth, insomnia after, 81
-
-  Chloral, 82
-
-  Chloral hydrate, influence of, upon oxidation in the tissues, 9
-    association of, with morphia and bromides, 86
-    use of, in angina pectoris, 99
-    use of, in asthma, 101
-    use of, in cachexias with insomnia, 109
-    use of, in chorea, 110
-    use of, in chronic alcoholism, 97
-    use of, in delirium tremens, 98
-    use of, in fevers, 104
-    use of, in hepatic diseases, 102
-    use of, in insanity, 95
-    use of, in meningitis, 94
-    use of, in night terrors, 112
-    use of, in respiratory diseases, 100
-
-  Chlorodyne, 82
-    use of, in syphilitic neuralgia, 107
-
-  Chloroform, 81
-    use of, in asthma, 101
-    use of, in convulsions, 110
-    spirit of, in the treatment of fevers, 105
-
-  Chossat, observations of, on the temperature of pigeons, 7
-
-  Circulation of blood, its regulation by the nervous system, 26
-    disorders of, 52
-    modified by counter-irritation, 63
-    state of, during sleep, 6
-
-  Clairvoyance, hypothetical explanation of, 148
-    in dreams, 146, 148, 149
-    in dreaming, and in natural somnambulism, 226
-    in the hypnotic state, 224
-
-  Clark, observations of, on the sleeping dropsy, 30
-
-  Codeia, 85
-
-  Codeine, 88
-
-  Coffee, effects of, upon the brain, 54
-
-  Cold, a nervous sedative, 73
-
-  Cold baths, 73
-
-  Cold, excessive, a cause of stupor, 47
-
-  Colic, uterine, relief of, 81
-
-  Color-blindness, effect of hypnotism upon, 223
-
-  Coma, 32
-
-  Coniine, 91
-
-  Conium, 90, 95
-
-  Consciousness, duration of the sensations required for its excitement, 23
-    state of, during sleep, 14
-
-  Convulsions, excited by compression of the carotid arteries, 27
-    treatment of, 110
-
-  Cough, spasmodic, treatment with spirit of chloroform, 82
-
-  Counter irritants, 62
-
-  Croton oil, 63
-
-  Cups, counter irritation with, 63, 93
-
-  Curci, observations of, regarding belladonna, 69
-    regarding morphia, 85
-
-  Cutaneous disorders, causes of insomnia, 55
-
-
-  DaCosta, on lithaemia, 106
-
-  Darkness, favorable to sleep, 18
-
-  Day and night, alternation of, a cause of sleep, 17
-
-  Death, apparent, 34
-    test of, 35
-
-  Degeneration of the brain, 55
-
-  Demme, observations of, on bodily temperature in sleep, 7
-
-  Delirium, 54
-    excited by hyoscyamus, 70
-    excited by stramonium, 71
-    of exhaustion, 77
-    treatment of, with musk, 67
-
-  Delirium tremens, treatment of, with alcohol, 77
-    with bromides, 89
-    with capsicum, 77
-    with chloral, 82
-    with digitalis, 67
-
-  Delusions, caused by dreams, 128
-
-  Depressing emotions, a cause of sleep, 19
-
-  Diagram, illustrating the stages of sleep, 4
-    the varieties of somnambulism, 172
-
-  Digitalis, indirectly hypnotic effect of, 66
-    treatment of delirium tremens with, 98
-
-  Diminution of energy, represented by sleepiness, 2
-
-  Disease and dissolution, revival of memory in, 165
-
-  Dover's powder, 67, 100, 104, 110, 112
-
-  Double consciousness, 204, 206
-
-  Dreams, 116
-    analysis of, 133
-    at the moment of waking, 14
-    brevity of, 15
-    causes of, 118
-    cause of special vividness of, 134
-    clairvoyant, 146, 148, 149
-    coherence of, 131
-    definition of, 120
-    dependence of, upon partial sleep of the brain, 11
-    duration of, 135
-    excited by gustatory sensation, 43, 125, 130
-      by heat, 43
-      by painful diseases, 141
-      by sensory impressions during sleep, 29
-      by sounds, 41
-    incoherence of, 133
-    intellectual combinations in, 131
-    mode of their production, 124
-    primitive belief in the divine origin of, 160
-    prophetic, 142, 143
-    recollection of, 140
-    relation of, to depth of sleep, 4
-    relation of, to waking hallucinations, 126
-    resemblance of, to the mental processes of insanity, 133
-    revival of memory in, 162
-    somnambulic, 178
-    state of volition during, 141
-    suggested by external impulses, 125, 130
-    theory of, 116
-    waking, 123
-
-  Dropsy, treatment of, with digitalis, 66
-
-  Dumontpallier, case of self-hypnotism related by, 219
-
-  Duration of sleep, 110
-
-  Dyspnoea, cardiac, 98
-    treatment of, with digitalis, 66
-
-  Dyspeptic insomnia, 104
-
-
-  East Indies, climate of, a cause of insomnia, 44
-
-  Eggs, as an article of food, 66
-
-  Electrical test of apparent death, 35
-
-  Electricity, atmospheric, 46
-    use of, 62, 63
-
-  Emphysema, insomnia of, relieved with paraldehyde, 80
-
-  Energy, diminution of, represented by sleepiness, 2
-    renewal of, by sleep, 5
-
-  Epilepsy, double consciousness in, 205
-
-  Ether, hypnotic effect of, 81
-    inhalation of, 98
-    use of, in asthma, 101
-    use of, in convulsions, 110
-    use of, in irritative cough, 100
-
-  Ether, compound spirit of, 81
-    use of, in delirium tremens, 98
-    use of, in hepatic diseases, 102
-
-  Excrementitious substances, causes of insomnia, 55
-
-  Exhaustion, a cause of sleep, 19
-    relief of with alcoholic stimulants, 76
-    states of, 64
-    use of musk in, 68
-
-  Exner, experiments of, to test the possibility of dreamless sleep, 14
-
-  Eye, state of its secretions during sleep, 8
-
-
-  Facial neuralgia, treatment of, with butylchloral, 83
-
-  Fainting, a counterfeit of sleep, 25
-
-  Fatigue, a cause of sleep, 19
-
-  Fatigue theory of sleep, 20
-
-  Fevers, eruptive, treatment of with musk, 68
-    infective, 57
-    typhoid, 57
-    treatment of with cold baths, 73
-
-  Flaxseed tea, 100
-
-  Florida, climate of, in insomnia, 114
-
-  Fonssagrives, observations of, regarding atmospheric electricity and
-        insomnia, 46
-
-  Food, lack of, a cause of insomnia, 63
-
-  Foot-baths, hot, in the treatment of insomnia, 93, 94
-
-  Force, fluctuations of, 15
-    kinetic, 15
-    potential, 15
-
-  Frank, J. P., case of somnambulism related by, 195
-
-  Functional nervous disorders, treatment of with hypnotism, 229
-
-
-  Gairdner, W. T., case of somnambulic lethargy reported by, 174
-
-  Gastro-intestinal glands, state of their secretions during sleep, 8
-
-  Gelsemium, 90
-    treatment of fever with, 104
-    use of, in the wakefulness of children, 112
-
-  Generation of ideas, relation of, to molecular movements in the brain, 24
-
-  Grasset, case of somnambulism related by, 177
-
-  Guerin, observations of, on the _maladie du sommeil_, 30
-
-  Guiana, delusions among the Indians of, founded upon dreams, 128
-    travels in, 42
-
-  Guy, observations of, regarding the pulse in sleep, 7
-
-
-  Hallucination, case of, related by Dr. E. H. Clarke, 156
-    experienced by Sir Edmund Hornby, 150
-    production of, by drugs, 120
-    sometimes excited by dreams, 126, 150
-
-  Hamilton, Sir William, experiments of, on the possibility of dreamless
-        sleep, 14
-
-  Hasheesh, visions excited by, 120
-
-  Hayes, Dr. P. S., case of lucid lethargy reported by, 35
-
-  Headache, 54
-
-  Hearing, persistence of during sleep, 41
-    sense of, during sleep, 11
-
-  Heart, pulsation of, in sleep, 6
-
-  Heat, a cause of insomnia, 44
-    a nervous stimulant, 59
-    effects of excessive, 47
-    liberation of, during sleep, 9
-
-  Heidenhain, observations of, on hypnotism, 214
-
-  Helmholtz, observations of, on liberation of heat during sleep, 9
-
-  Hemicrania, treatment of, with butylchloral, 83
-
-  Henneberg, experiments of, on oxidation in the tissues, 9
-
-  Hibernation, phenomena of, 48
-
-  Hoffmann's anodyne, 81
-
-  Hohl and Allix, observations of, on the pulse in sleep, 6
-
-  Holland, Sir Henry, observations of, regarding the loss of memory during
-        exhaustion, 209
-
-  Hops, 90
-    treatment of chronic alcoholism with, 97
-
-  Hornby, Sir Edmund, experience of hallucination, 150
-
-  Horsford's Acid Phosphate, 72
-
-  Horvath, observations of, on the temperature of hibernating marmots, 8
-
-  Hunger, 2
-
-  Hydrobromic acid, 88
-
-  Hydrochloric acid, useful in atonic dyspepsia, 72
-
-  Hydrocyanic acid, 100
-    in gastric diseases, 103
-
-  Hyosciamia, 70, 96
-
-  Hyosciamine, 70
-
-  Hyoscyamus, 70
-    use of, after parturition, 109
-    use of, in asthma, 101
-    use of, in fever, 104
-    use of, in hepatic diseases, 102
-    use of, in insanity, 96
-    use of, in insomnia of children, 112
-    use of, in renal diseases, 102
-
-  Hyperaemia of the brain, 52, 54, 110
-
-  Hypnagogic hallucinations, 3, 4
-
-  Hypnagogic state, 2
-
-  Hypnotic sleep, duration of, 217
-
-  Hypnotic sleep, clairvoyance in, 224
-    condition of the special senses in, 223
-    conditions favorable to, 214
-    exaltation of the imitative faculty during, 227
-    methods of inducing, 215
-    perception during, 149
-
-  Hypnotism, 214
-    likeness of, to somnambulism, 203
-    observations of Braid, 214, 229
-    observations of Charcot, 214, 219, 221
-    observations of Cohn, 223
-    observations of De Watteville, 229
-    observations of Dumontpallier, 219, 221
-    observations of Fischer, 150, 227
-    observations of Harting, 215
-    observations of Heidenhain, 214, 215, 216, 222
-    observations of Milne-Edwards, 215
-    observations of Rieger, 229
-    observations of Wiehe, 229
-    receptivity of the brain to suggestions during, 226
-    suggestion of ideas during, 226
-    therapeutical use of, 228
-
-  Hysteria, a cause of double consciousness, 205
-
-  Hysterical excitement, treatment of, 68
-
-
-  Ice-cap, in the treatment of acute affections of the brain, 93
-
-  Iceland moss, for the relief of cough, 100
-
-  Ideas, their dependence upon molecular movements in the brain, 24
-
-  Illusions, excited by disease and by drugs, 120, 122
-
-  Imagination, persistence of, in sleep, 3
-
-  Imitative faculties, exaltation of, in hypnotic states, 227
-
-  Immermann, on cold baths, 73
-
-  Impulses to violence during somnambulism, 193
-
-  Im Thurn, Everard F., on dreams among the Indians of Guiana, 128
-
-  Indians, of Guiana, magic practices among, 42
-
-  Inflammations affecting the brain, 54
-
-  Inhalations, medicated, 100
-
-  Injuries of the brain, 55
-
-  Insanity, 54, 57, 70, 133
-
-  Insomnia, 38
-
-  Insomnia, causes of, 39
-    caused by aortic obstruction, 84
-    caused by asthma, 101
-    caused by cardiac disorders, 51
-    caused by cold, 47
-    caused by contagia of animal origin, 55
-    caused by cutaneous disorders, 49, 55
-    caused by dyspepsia, 51
-    caused by electrical disturbances, 46
-    caused by excrementitious substances, 55
-    caused by fatigue, 78
-    caused by heat, 44, 46
-    caused by heat and humidity, 44
-    caused by icterus, 49
-    caused by inflammations, 50
-    caused by insects, 49
-    caused by itching in myelitis, 49
-    caused by itch-mite, 49
-    caused by light, 39
-    caused by malaria, 72
-    caused by meningitis, 50
-    caused by miasms, 55
-    caused by morbid states of the central nervous organs, 51
-    caused by neuralgia, 50
-    caused by neuritis, 50
-    caused by neuromata, 50
-    caused by oxaluria, 72
-    caused by pain, 49
-    caused by parasites, 49
-    caused by periostitis, 50
-    caused by phosphatic diathesis, 72
-    caused by pneumogastric disorder, 51
-    caused by poisons, 55
-    caused by products of putrefaction, 55
-    caused by respiratory disorders, 51
-    caused by rheumatic diathesis, 72
-    caused by sounds, 41
-    caused by smells, 42
-    caused by stramonium, 71
-    caused by sympathetic nerve disorder, 50
-
-  Insomnia, occurrence of, after childbirth, 81
-    occurrence of, after parturition, 109
-    occurrence of, during acute affections of the brain, 92
-    occurrence of, during bronchitis, 80
-    occurrence of, during cardiac diseases, 66, 80, 87
-    occurrence of, during change of life in women, 84
-    occurrence of, during childhood, 110
-    occurrence of, during chorea, 110
-    occurrence of, during chronic alcoholism, 97
-    occurrence of, during chronic phthisis, 84
-    occurrence of, during delirium tremens, 87, 90, 97
-    occurrence of, during diseases of the heart and blood-vessels, 98
-    occurrence of, during diseases of the liver, 102
-    occurrence of, during diseases of the respiratory organs, 99
-    occurrence of, during disorders of nutrition, 107
-    occurrence of, during dysmenorrhoea, 84
-    occurrence of, during emphysema, 80
-    occurrence of, during febrile conditions and fevers, 87, 104
-    occurrence of, during gastric and intestinal disorders, 87, 103
-    occurrence of, during gout and rheumatism, 103, 107
-    occurrence of, during headache, 84
-    occurrence of, during hysteria, 81, 89
-    occurrence of, during insanity, 94
-    occurrence of, during irritability of the bladder, 90
-    occurrence of, during irritability of the sexual organs, 90
-    occurrence of, during irritative dyspepsia, 90
-    occurrence of, during jaundice, 80
-    occurrence of, during lithaemia, 106, 107
-    occurrence of, during mania, 87, 89, 90
-    occurrence of, during melancholia, 96
-    occurrence of, during mental exhaustion, 89
-    occurrence of, during nervous disorders, 80
-    occurrence of, during neuralgia, 84
-    occurrence of, during old age, 78, 113
-    occurrence of, during opium habit, 84
-    occurrence of, during paretic dementia, 96
-    occurrence of, during phthisis, 80, 87
-    occurrence of, during pregnancy, 89, 109
-    occurrence of, during the puerperal state, 89
-    occurrence of, during renal diseases, 101
-    occurrence of, during rheumatism and gout, 105, 107
-    occurrence of, during sexual excitement, 89
-    occurrence of, during spasmodic diseases, 109
-    occurrence of, during states of exhaustion, 67
-    occurrence of, during syphilis, 106, 107
-
-  Insomnia, relation of, to states of the cerebral circulation, 57
-    relief of, by compression of the carotid arteries, 25
-
-  Iodide of potassium, treatment of asthma with, 110
-
-  Ipecac, treatment of asthma with, 101
-
-  Irritability of the brain, 53, 54
-
-  Itching of eczema, relieved with cannabis indica, 69
-
-
-  Jacobi, A., on wakefulness of children, 111
-
-  Japanese, use of massage among, 61
-
-  Jaundice, insomnia of, treatment with paraldehyde, 80
-
-  Jessen, case of hallucination caused by dreaming, 127
-
-  Joseph, St., dreams of, 142, 160
-
-  Judgment, suspension of, during sleep, 3
-
-
-  Kohlschuetter, experiments of, to measure the depth of sleep, 16
-
-  Koumiss, 64
-
-
-  Lactic acid, hypnotic effects of, 72
-
-  Lactate of sodium, hypnotic effects of, 20, 72
-
-  Lactucarium, 88
-
-  Latent contracture, 221
-
-  Leeches, use of, 63, 93, 94
-
-  Lethargic form of artificial somnambulism, 220
-
-  Lethargy, 33
-    produced by excessive cold, 48
-
-  Lewin, observations of, on respiration during sleep, 6
-    experiments of, on oxidation in the tissues, 9
-
-  Liebermeister, experiments of, on oxidation in the tissues, 9
-
-  Life, normal, 4
-    possibility of intermissions in its active manifestation, 15
-
-  Light, interference of, with sleep, 40, 41
-
-  Liquors, effects of, 76
-
-  Lithaemia, a cause of insomnia, 106
-
-  Lithium bromide, 88
-
-  Lobelia, anti-spasmodic effects of, 71, 101
-
-  Lomi-lomi, 61
-
-  Lucid lethargy, 35
-    contrasted with somnambulic lethargy, 176
-
-  Lupulin, 90
-
-
-  Macario, case of somnambulism, reported by, 192
-
-  Mackinac, voyage to, 45
-
-  Macnish, case of somnambulic life, reported by, 206
-
-  Maladie du sommeil, 30
-
-  Malaria, treatment of insomnia, caused by, 72
-
-  Mania, use of chloral in, 82
-
-  Marmot, hibernation of, 48
-    temperature of, during hibernation, 8
-
-  Massage, 60, 109
-
-  Matter and mind, communication between, 22
-
-  Maury, A., classification of the varieties of somnambulism, 168
-    experience of, with table-rapping, 228
-    theory of, regarding forgetfulness of the events of somnambulism, 211
-
-  Measles, use of baths in, 74
-
-  Meat juice, 66
-
-  Memory, effect of physical exhaustion, 209
-    exaltation of, in somnambulism, 187
-    persistence of, in sleep, 3
-    relation of, to phenomena of somnambulism, 192
-    revival of, during disease and dissolution, 165
-    revival of, during dreaming, 162
-
-  Meningitis, 54, 57
-
-  Mental activity during sleep, 14
-
-  Mesnet, case of somnambulism related by, 196
-
-  Metaphysical healing, 229
-
-  Michigan, Lake, voyage upon, 45
-    Northern, summer climate of, favorable to sleep, 45
-
-  Milk, peptonized, 64
-
-  Mind and matter, communication between, 22
-    alternate states of action and repose, 15
-    sleep of, 15
-    state of, during sleep, 14
-
-  Mind-reading, 218, 227
-
-  Minnesota, summer climate of, favorable to sleep, 45
-
-  Mitchell, S. Weir, observations of, regarding effect of variable
-        barometric pressure, 47
-
-  Molecular movement, its relation to the generation of ideas, 24
-
-  Moral responsibility in somnambulism, 203
-
-  Morphia, 97, 98, 100, 101
-
-  Morphine, influence of, on oxidation in the tissues, 10
-
-  Mosso, Professor, on the circulation of blood during sleep, 26
-    on respiration during sleep, 5
-
-  Mouth, condition of, during sleep, 8
-
-  Muscles, effect of sleep upon, 12
-    fibrillary twitching of, during sleep, 3
-
-  Muscle-reading, 218
-
-  Musk, 67, 100, 105
-
-  Mustard, 63
-
-
-  Nasal catarrh, state of secretion during sleep, 8
-
-  Narcotic stupor, 29
-
-  Nerves, of common sensation, affections of, 39, 49
-    pneumogastric, 51
-    sympathetic, affections of, causes of insomnia, 50
-
-  Nervous disorders, insomnia of, relieved with paraldehyde, 80
-    hypnotic treatment of, 229
-
-  Nervous irritation, effect of, on tissue change, 10
-    sedatives, 58, 59
-    stimulants, 58, 59
-    system, its control over the circulatory apparatus, 26
-
-  Neuralgia, cardiac, 99
-    treatment of, with alcohol, 77
-    treatment of, with belladonna, 69
-    treatment of, with preparations of valerian, 68
-
-  Neurasthenic patients, 66
-
-  New Providence, climate of, beneficial in insomnia, 114
-
-  Night and day, alternation of, a cause of sleep, 17
-
-  Night terrors, 179
-    treatment of, 89, 112
-
-  Nitric acid, 72
-
-  Noctambulism, 169
-
-  Noise, sleep prevented by, 41
-
-  North China Herald, criticism of Sir E. Hornby's narrative, 155
-
-  Norway, difficulty of sleeping during the summer, 40
-
-  Nutrition, effect of sleep upon, 5, 9
-    disorders of, 52
-
-
-  Obersteiner, his theory of sleep, 20
-
-  Odors, effect of, upon sleep, 11
-
-  Old age, decline of life in, 113
-
-  Omphaloscopy, 217
-
-  Opium and opiates, 84, 98
-
-  Opiates, use of, in treatment of cachexias, 108
-    use of, in treatment of fever, 104, 105
-    use of, in treatment of gastric disease, 103
-    use of, in treatment of insanity, 96
-    use of, in treatment of renal diseases, 102
-    use of, in treatment of rheumatism, 105
-
-  Oxaluria, insomnia caused by, 72
-
-  Oxygen, absorption of, during sleep, 9
-
-  Ozone, use of, in the treatment of asthma, 101
-
-
-  Pacific Islanders, habits of, regarding sleep in the daytime, 40
-    use of massage among, 61
-
-  Pain, a cause of sleep, 19
-
-  Paraldehyde, 79, 95, 97, 108
-
-  Paregoric, 100
-
-  Perception, effect of, upon nervous tissue, 10
-    duration of, necessary to arouse consciousness, 23
-    range of, circumscribed by sleep, 12
-    transfer of, in telepathy and hypnotism, 217
-
-  Percussion, 61
-
-  Perspiration, secretion of, during sleep, 9
-
-  Pettenkofer, experiments of, on oxidation in the tissues, 9
-    experiments of, on respiration in sleep, 6
-
-  Pettenkofer and Voit, on tissue changes, 10
-
-  Pflueger, hypothesis of, regarding the cause of sleep, 21
-
-  Phosphatic diathesis, a cause of insomnia, 72
-
-  Phosphoric acid, 72
-
-  Phosphorus, 71
-
-  Phthisis, cough of, relieved with lactucarium, 88
-    insomnia of, relieved with paraldehyde, 80
-    treatment of, with opiates, 87
-
-  Physiological activity, reduction of, during sleep, 5
-
-  Physiological cause of somnambulism, 180
-
-  Planchette-writing, 228
-
-  Pleuritic pain, 99
-
-  Pneumogastric nerves, insomnia caused by affections of, 51
-
-  Pneumonia, 68, 100
-
-  Porter, effects of, 76
-
-  Potassium bromide, 88
-
-  Preyer, his theory of sleep, 20
-
-  Psychical Research, Society for, investigations by, 149, 217
-
-  Pulse, state of, during sleep, 6
-
-  Punkah, use of, to promote sleep, 44
-
-
-  Quetelet, observations of, on respiration during sleep, 5
-
-  Quinine and opium, use of, in fever, 104
-
-
-  Reasoning powers, arrest of, during sleep, 3
-
-  Recollection of the events of artificial somnambulism, 227
-    of the events of natural somnambulism, 188
-
-  Reflex movements during sleep, 12
-
-  Refrigeration, threefold effect of, 49
-
-  Relation between molecular movement and the generation of ideas, 24
-
-  Respiration during sleep, 5
-
-  Revelation through dreams, 160
-
-  Revery, nature of, 120
-
-  Rheumatic diathesis, a cause of insomnia, 72
-
-  Rosenthal, observations of, regarding lethargy, 33, 34
-    observations regarding apparent death, 35
-
-  Rush, Dr., observations of, on the revival of memory in dissolution, 165
-
-
-  Sailors, sleeping during a bombardment, 1
-
-  Sailor-boy, sleeping on a mast, 1
-
-  Salicylic acid, treatment of rheumatism with, 106
-
-  Saliva, secretion of, during sleep, 8
-
-  Samuel the prophet, dream of, 129
-
-  Sandwich Islands, climate of, for relief of insomnia, 114
-
-  Scarlet fever, treatment of, with baths, 74, 75
-
-  Scharling, observations of, regarding bodily temperature during sleep, 7
-    experiments of, on oxidation in the tissues, 9
-
-  Screaming fits of children, 112
-
-  Secretion, state of, during sleep, 8
-
-  Sedatives, nervous, 59, 73
-
-  Self-hypnotism, 219
-
-  Sensory excitement, effect of, upon the cerebral circulation, 27, 28
-
-  Sensory organs, condition of, during somnambulism, 191
-
-  Sexual organs, irritability of, 90
-
-  Shampooing, 61
-
-  Simon, P. Max, case of somnambulism related by, 182
-    dream related by, 142
-
-  Sleep, affected by certain winds, 45
-    artificial, mode of its production, 22
-    caused by the alternation of day and night, 17
-    caused by depressing emotions, 19
-    caused by exhaustion, 19
-    caused by fatigue, 19
-    caused by painful impressions, 19
-    caused by the venereal act, 19
-    definition of, 1
-    dreamless, 14
-    duration of, 4, 110
-    effects of its invasion upon the intellectual faculties, 13
-    effect of, upon consciousness, 13, 14
-    fatigue theory of, 20
-    favored by darkness, 18
-    favored by the suppression of sensation, 18
-    hindered by heat, 44
-    hindered by light, 39
-    hindered by smells, 42
-    hindered by sounds, 41
-    introductory stage of, 2
-    invasion of, 10, 117
-    measure of its depth by the experiments of Kohlschuetter, 16
-    Obersteiner's theory of, 20
-    Pflueger's hypothesis regarding the cause of, 21
-    preceded by sleepiness, 2
-    Preyer's theory of, 20
-    rapid induction of, in certain cases, 24
-    relation between the duration of, and the average length of the night,
-        17
-    stages of, 4
-    the cause of, 29
-    unequal incidence of, upon different portions of the brain, 13
-
-  Sleep-drunkenness, 180, 181
-
-  Sleepiness, precursive of sleep, 2
-
-  Sleeping dropsy, 30
-
-  Sleeplessness, causes of, 39
-
-  Smells, abolition of sleep by, 42
-
-  Smile, during sleep, 12
-
-  Smith, E., experiments of, on oxidation in the tissues, 9
-
-  Snoring, occasional interruption of sleep by, 11
-
-  Society for Psychical Research, investigations by, 149, 217
-
-  Sodium bromide, 88
-
-  Somniation, 169
-
-  Somnambulic dreams, 171, 178, 181
-    recollections of, 188
-
-  Somnambulic form of artificial somnambulism, 222
-
-  Somnambulic lethargy, 171, 173
-    contrasted with lucid lethargy, 176
-
-  Somnambulic life, 169, 204
-    a case of, 206
-    a case of, related by Azam, 208
-    a case of, related by Macnish, 206
-
-  Somnambulism, 166
-    artificial, 214
-    case of, related by Prof. J. Adams Allen, 185
-    case of, related by J. P. Frank, 195
-    case of, related by Macario, 192
-    case of, related by Mesnet, 196
-    case of, related by P. Max Simon, 182
-    causes of, 166
-    condition of sensory organs during, 191
-    dependence of, upon partial sleep of the brain, 11
-    likeness of, to hypnotism, 203
-    moral responsibility in, 203
-    phenomena of, 167, 210
-    physiological cause of, 180
-    relation of memory with events of, 192
-    varieties of, according to A. Maury, 168
-    varieties of, according to Ball and Chambard, 169
-    varieties of, diagrammatically exhibited, 172
-    violent impulses during, 193
-
-  Somnolence, 30
-
-  Somnolentia, 180, 181
-
-  Sound, effect of, to hinder sleep, 42
-    effect of, to induce sleep, 42
-
-  Spasmodic croup, 110
-
-  Special sense organs, affections of, 39
-
-  Special senses, condition of, during invasion of sleep, 11
-    perversion of, during the hypnotic state, 223
-
-  Spinal cord, irritability of, 110
-    reflex energy of, during sleep, 3
-
-  Spinal irritation, 62
-
-  Spirit of chloroform, 81
-
-  Spiritual circle, manifestations in, 227
-
-  Stewart, Dugald, observation of, 43
-
-  Stimulants after parturition, 109
-    in fever, 105
-    nervous, 59
-
-  Stramonium, 70, 101
-
-  Struempell, observations of, regarding sleep produced by suppression of
-        sensation, 18
-
-  Strychnia, 105
-
-  Stupor produced by excessive heat or cold, 47
-
-  Subsultus tendinum, treatment of, with musk, 67
-
-  Suction, involuntary, during infantile sleep, 12
-
-  Suppression of sensation, a cause of sleep, 18
-
-  Swedish movement cure, 61
-
-  Sympathetic nerves, affections of, 39, 50
-
-
-  Table-rapping, method of communication in, 228
-
-  Tannate of cannabin, 68
-
-  Tartar emetic, use of, in asthma, 101
-    use of, in delirium tremens, 98
-    use of, in fever, 104
-    use of, with opium, 108
-
-  Taste, relation of, to insomnia, 43
-
-  Tea, effect of, upon the brain, 54
-
-  Telegraphy without a wire, through water, 147
-
-  Telepathy, investigation of, by the Society for Psychical Research, 149
-
-  Temperature, of the body, during sleep, 7
-    sense of, 43
-
-  Thapsia, 63
-
-  Theory of sleep, Obersteiner's, 20
-    Pflueger's, 21
-    Preyer's, 20
-
-  Thirst, 2
-
-  Thompson, Sir William, his doctrine concerning a sixth sense, 43
-
-  Tickling, effect of during sleep, 12
-
-  Tobacco, anti-spasmodic effect of, 71, 99, 101
-
-  Transfer of perceptions, 217
-
-  Trousseau, observations of, on the pulse during sleep, 6
-
-  Tuberculosis of the cerebral membranes, 55
-
-  Tully's Powder, 67
-
-  Tumors of the brain, 55
-
-  Turkish baths, 60
-
-  Turpentine, 63
-
-  Typhoid fever, insomnia during, 64
-    treatment of, with baths, 74
-    treatment of, with musk, 68
-    treatment of, with Tully's Powder, 67
-
-  Typhus fever, treatment of, with musk, 68
-
-
-  Unconsciousness, produced by compression of the carotid arteries, 27
-    relation of, to modifications of the cerebral circulation, 25
-
-  Urea, elimination of, during sleep, 9
-
-  Urine, secretion of, during sleep, 9
-
-  Uterine colic, 81
-
-
-  Valerian, 68, 109
-
-  Valerianate of ammonia, 68
-    of zinc, 68
-
-  Venereal act, a cause of sleep, 19
-
-  Vierordt, observations of, on the duration of sleep, 110
-
-  Visions, character of, 119
-    of the ancient prophets, 161
-
-  Voit, observations of, on oxidation in the tissues, 9
-    on respiration during sleep, 6
-
-  Volition, cessation of, during sleep, 3
-
-
-  Wakefulness, 38
-    causes of, 39
-    dependence of, upon instability of cerebral protoplasm, 22
-
-  Warburton, Rev. Canon, clairvoyant dream of, 146
-
-  Weariness, a cause of sleep, 1
-
-  Wharton and Stille, on sleep-drunkenness, 181
-
-  Whooping-cough, treatment of, with belladonna, 69
-
-  Wind, effect of, upon sleep, 45
-
-  Wine, effects of, 76
-    use of, in the insomnia of old age, 78
-
-
-  Ziemssen, von, on the use of baths, 73
-
-
-
-
-FOOTNOTES:
-
-[1] Rosenbach, _Zeitschr. f. klin. med._ 1881. _Brain_, Vol. IV, p. 138.
-
-[2] Alfred Maury, _Le Sommeil et les Reves_, Chap. IV.
-
-[3] Hermann's _Handbuch der Physiologie_, Vol. IV, Part II, p. 98.
-
-[4] _Handbuch der Kinderkrankheiten_, Vol. I, p. 346.
-
-[5] _Handbuch der Physiologie_, Vol. IV, Pt. II, p. 217.
-
-[6] _Op. cit._, pp. 142 and 456.
-
-[7] _Dic. Encyc. des Sci. Med._, Art. SOMMEIL, pp. 277.
-
-[8] Quoted by Vierordt, _Handbuch der Kinderkrankheiten_, Vol. I, p. 307.
-
-[9] _Dic. Encyc. des. Med._, Ie serie, t. XV, p. 75.
-
-[10] _Handbuch der Kinderkrankheiten_, Vol. I, p. 383.
-
-[11] _Carpenter's Physiology_, 8th edition, p. 560.
-
-[12] _Handbuch der Physiologie_, Vol. II, Pt. II, p. 297.
-
-[13] Quincke, _Archiv. f. Experim. Pathol._, Vol. VII, p. 115.
-
-[14] _Carpenter's Physiology_, 8th edition, p. 526, _Handbuch der
-Kinderkrankheiten_, 2d edition, Vol. I, p. 373.
-
-[15] _Dic. Encyc. des Sci. Med._, IIIe Serie, Vol. X, p. 268.
-
-[16] _Handbuch der Physiologie_, Vol. V, p. 142-156.
-
-[17] Kohlschuetter, _Messungen der Festigkeit des Schlafes. Dissert._
-Leipzig, 1862, _und Zeitschrift f. rat. Med._, 1863. Quoted, Hermann's
-_Handbuch der Physiologie_, Vol. II, Pt. II, p. 295.
-
-[18] _Obersteiner, Zur Theorie des Schlafes, Zeitschr. f. Psych._ XXIX.
-_Preyer, Ueber die Ursachen des Schlafes._ Vortrag. Stuttgart bei Enke.
-1877, und centralbl. f. d. Med. Wiss. 1875. S. 577.
-
-[19] _Theorie des Schlafes._ Arch. f. d. ges. Physiol. X, 468.
-
-[20] _Artificial Anaesthesia and Anaesthetics_, pp. 15-17.
-
-[21] _Carpenter's Physiology_, 8th ed., p. 852.
-
-[22] _Sulla Circolazione del Sangue nel Cervello dell'Uomo._ Abstract in
-_Brain_, Vol. IV, p. 100.
-
-[23] _Transactions of the London Epidemiological Society_, Vol. I, p. 116.
-
-[24] _De la maladie du sommeil_, 1869.
-
-[25] _The Medical Record_, July 1, 1882, p. 23.
-
-[26] _Real. Encyc. der ges. Heilkunde_, VIII, 276.
-
-[27] _Op. cit._ p. 276.
-
-[28] _A Summer in Norway_, by John Dean Caton, pp. 251 and 311.
-
-[29] A. Maury, op. cit., p. 156.
-
-[30] _Among the Indians of Guiana._ By Everard F. Im Thurn.
-
-[31] _Le Sommeil et les Reves_, p. 154.
-
-[32] _Nature_, Vol. XXIX, pp. 438-462.
-
-[33] _Ganot's Physics._
-
-[34] _Dic. Encyc. des Sci. Med._, Art. CLIMAT.
-
-[35] _Comptes-rendus Acad. des Sci._, 1840, t. XI, p. 823.
-
-[36] _Am. Journ. Med. Sci._, April, 1877, p. 305.
-
-[37] A remarkable illustration of this will be found related in _The
-Lancet_, July 26, 1884, p. 112.
-
-[38] _Dic. Encyc. des Sci. Med._, Art. FROID, p. 139.
-
-[39] _Medical and Surgical Electricity_, 4th ed., p. 413.
-
-[40] _Nature_, March, 1883.
-
-[41] _Lo Sperimentale_, April, 1884.
-
-[42] _Artificial Anaesthesia and Anaesthetics_, pp. 20-28. William Wood &
-Co., New York, 1881.
-
-[43] _Bull. gen. de Therap._, 1884, 2{o} Livr.
-
-[44] _Centralblatt fuer klin. med._, 1884. Nr. 12.
-
-[45] _The National Dispensatory_, 1884, p. 433.
-
-[46] _Deutsche Med. wochenschr._, 1883, Nr. 49.
-
-[47] _Lo Sperimentale_, April, 1884.
-
-[48] _The National Dispensatory_, 1884, p. 993.
-
-[49] Kiernan, _Journ. Nerv. and Mental Diseases_, Vol. X, p. 234.
-
-[50] _Psychological Medicine_, Bucknill and Tuke, 4th ed., p. 731.
-
-[51] _Clinical Lectures on Mental Diseases._
-
-[52] _Ringer's Therapeutics_, 10th ed., p. 421.
-
-[53] C. H. Jones, _Functional Nervous Disorders_, p. 284.
-
-[54] _Am. Jour. Med. Sci._, Oct., 1881, p. 313.
-
-[55] _Handbuch der Kinderkrankheiten_, Vol. I., p. 214.
-
-[56] _Op. cit._, Vol. I., Pt. 2, p. 153.
-
-[57] Herbert Spencer, _First Principles_, p. 486.
-
-[58] A. Maury. _Le Sommeil et les Reves_, p. 154.
-
-[59] _On Intelligence_, p. 61.
-
-[60] Wharton and Stille's _Medical Jurisprudence_, Third Edition, Vol. I,
-p. 482.
-
-[61] _Among the Indians of Guiana._ By Everard F. Im Thurn. London: 1883,
-p. 344.
-
-[62] A. Maury, _Le Sommeil et les Reves_, p. 219 et seq.
-
-[63] _Obscure Diseases of the Brain and Mind._ Philadelphia, 1866, pp.
-394-398.
-
-[64] _Le Monde des Reves_, p. 88.
-
-[65] _Op. cit._, p. 91.
-
-[66] _The Nineteenth Century_, July, 1884, p. 71.
-
-[67] _Nature_, October, 16, 1884, p. 596.
-
-[68] _Lebensmagnetismus oder Hypnotismus_, von Dr. E. L. Fischer, pp.
-71-73.
-
-[69] _The Nineteenth Century_, July, 1884, p. 89.
-
-[70] _Visions: A Study of False Sight_, p. 39.
-
-[71] _Inquiries concerning the Intellectual Powers_, tenth edition, p.
-283.
-
-[72] _Medical Inquiries and Observations upon Diseases of the Mind_, p.
-277.
-
-[73] _Loc. cit._
-
-[74] _Le Sommeil et les Reves_, p. 248.
-
-[75] _Dic. Encyc. des Sci. Med._, Article SOMNAMBULISME NATUREL.
-
-[76] _The Lancet_, Dec. 22, 1883, p. 1,078, and Jan. 5, 1884, p 5.
-
-[77] _Brain_, Jan., 1884, p. 454.
-
-[78] _Medical Jurisprudence_, 3d ed., Vol. I, pp. 464-471.
-
-[79] _Le Monde des Reves_, p. 257.
-
-[80] _Chicago Medical Journal_, 1869, p. 650.
-
-[81] Maury, _Le Sommeil et les Reves_, p. 234.
-
-[82] _Pathologie interne._
-
-[83] _L' Union Medicale_, July 21st and 23d, 1874.
-
-[84] _Chicago Journ. of Nervous and Mental Diseases_, Vol. II, p. 48.
-
-[85] _Loc. cit._
-
-[86] _Philosophy of Sleep_, p. 167.
-
-[87] _Revue Scientifique_, May 20, Sept. 16, 1876; Dec. 22, 1877; March 8,
-1879.
-
-[88] Vol. III, p. 584.
-
-[89] _Chapters on Mental Physiology_, p. 160.
-
-[90] _Le Sommeil et les Reves_, p. 226.
-
-[91] _Lancet_, July 29, 1882, p. 164.
-
-[92] _Transactions of the Society_, etc., Vols. I, II, III.
-
-[93] _Le Progres Medical_, Feb. 18, 1882, p. 124.
-
-[94] _Le Progres Medical_, March 25, 1882, p. 223.
-
-[95] _Le Progres Medical_, Jan. 14, 1882, p. 25.
-
-[96] _Brain_, Vol. III, p. 394.
-
-[97] _Op. cit._, p. 18.
-
-[98] _Le Sommeil et les Reves_, p. 361.
-
-[99] _Op. cit._
-
-[100] _Berlin. Klin. Wochenschr_, January, 1884.
-
-[101] _Der Hypnotismus_, Jena, 1884.
-
-[102] _Brain_, July, 1884, p. 278.
-
-
-
-
-Transcriber's Notes:
-
-Passages in italics are indicated by _italics_.
-
-Superscripted characters are indicated by {superscript}.
-
-Subscripted characters are indicated by _{subscript}.
-
-The original text contains letters with diacritical marks that are not
-represented in this text version.
-
-The original text includes Prescription [R.], dram [dr], and ounce [oz]
-sybmols.
-
-
-
-
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