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Title: Sleep and Its Derangements
Author: Hammond, William A.
Language: English
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SLEEP AND ITS DERANGEMENTS.



  SLEEP AND ITS DERANGEMENTS.


  BY WILLIAM A. HAMMOND, M.D.,

  PROFESSOR OF DISEASES OF THE MIND AND NERVOUS
  SYSTEM, AND OF CLINICAL MEDICINE IN THE BELLEVUE
  HOSPITAL MEDICAL COLLEGE, NEW YORK; VICE-PRESIDENT
  OF THE ACADEMY OF THE MEDICAL SCIENCES, NATIONAL
  INSTITUTE OF LETTERS, ARTS, AND SCIENCES; LATE
  SURGEON-GENERAL U. S. ARMY, ETC. ETC.


  PHILADELPHIA:
  J. B. LIPPINCOTT & CO.
  1869.



Entered, according to Act of Congress, in the year 1869, by J. B.
LIPPINCOTT & CO., In the Clerk’s Office of the District Court of the
United States for the Eastern District of Pennsylvania.



PREFACE.


The basis of this little volume is a paper on Insomnia, published in the
New York Medical Journal in May and June, 1865. This was subsequently
enlarged and published in a separate form, under the title “Wakefulness,
with an Introductory Chapter on the Physiology of Sleep.”

The very favorable reception which it met with in this country, in Great
Britain, and on the Continent, from the medical press, the profession, and
the public generally, led to the exhaustion of a large edition in a few
months.

The present issue was announced nearly two years ago, and the printing
begun. Increasing professional duties have, however, prevented me
bestowing that continuous labor upon it which was desirable, and hence the
publication has been long delayed. My apologies therefore are due, first,
to my excellent and dear friend, the senior member of the house of J. B.
Lippincott & Co., whose patience I know has been severely tried, but who
has scarcely reproached me for my neglect; and second, to that portion of
the public which has been kind enough to make repeated inquiries relative
to the appearance of this monograph, and which I trust will not be
disappointed, now that it is really published.

  162 WEST 34TH ST., NEW YORK,
    _July 10th, 1869_.



CONTENTS.


                                            PAGE

  CHAPTER I.

    The Necessity for Sleep                    9

  CHAPTER II.

    The Causes of Sleep                       18

  CHAPTER III.

    The Physical Phenomena of Sleep           52

  CHAPTER IV.

    The State of the Mind during Sleep        62

  CHAPTER V.

    The Physiology of Dreams                 107

  CHAPTER VI.

    Morbid Dreams                            147

  CHAPTER VII.

    Somnambulism                             192

  CHAPTER VIII.

    The Pathology of Wakefulness             222

  CHAPTER IX.

    The Exciting Causes of Wakefulness       240

  CHAPTER X.

    The Treatment of Wakefulness             278

  CHAPTER XI.

    Somnolence                               288

  CHAPTER XII.

    Somnolentia, or Sleep Drunkenness        304

  APPENDIX                                   317



SLEEP AND ITS DERANGEMENTS.



CHAPTER I.

THE NECESSITY FOR SLEEP.


The state of general repose which accompanies sleep is of especial value
to the organism in allowing the nutrition of the nervous tissue to go on
at a greater rate than its destructive metamorphosis. The same effect is,
of course, produced upon the other structures of the body; but this is not
of so much importance as regards them, for while we are awake they all
obtain a not inconsiderable amount of rest. Even those actions which are
most continuous, such as respiration and the pulsation of the heart, have
distinct periods of suspension. Thus, after the contraction and dilatation
of the auricles and ventricles of the heart, there is an interval during
which the organ is at rest. This amounts to one-fourth of the time
requisite to make one pulsation and begin another. During six hours of the
twenty-four the heart is, therefore, in a state of complete repose. If we
divide the respiratory act into three equal parts, one will be occupied
in inspiration, one in expiration, and the other by a period of
quiescence. During eight hours of the day, therefore, the muscles of
respiration and the lungs are inactive. And so with the several glands.
Each has its time for rest. And of the voluntary muscles, none, even
during our most untiring waking moments, are kept in continued action.

But for the brain there is no rest, except during sleep, and even this
condition is, as we all know, only one of comparative quietude in many
instances. So long as an individual is awake, there is not a single second
of his life during which the brain is altogether inactive; and even while
he is deprived by sleep of the power of volition, nearly every other
faculty of the mind is capable of being exercised; and several of them, as
the imagination and memory, for instance, are sometimes carried to a pitch
of exaltation not ordinarily reached by direct and voluntary efforts. If
it were not for the fact that all parts of the brain are not in action at
the same time, and that thus some slight measure of repose is afforded, it
would probably be impossible for the organ to maintain itself in a state
of integrity.

During wakefulness therefore the brain is constantly in action, though
this action may be of such a character as not always to make us conscious
of its performance. A great deal of the power of the brain is expended in
the continuance of functional operations necessary to our well-being.
During sleep these are altogether arrested or else very materially
retarded in force and frequency.

Many instances of what Dr. Carpenter very happily calls “unconscious
cerebration” will suggest themselves to the reader. We frequently find
suggestions occurring to us suddenly--suggestions which could only have
arisen as the result of a train of ideas passing through our minds, but of
which we have been unconscious. This function of the brain continues in
sleep, but not with so much force as during wakefulness. The movements of
the heart, of the inspiratory muscles, and of other organs which perform
either dynamic or secretory functions are all rendered less active by
sleep; and during this condition the nervous system generally obtains the
repose which its ceaseless activity during our periods of wakefulness so
imperatively demands. Sleep is thus necessary in order that the body, and
especially the brain and nervous system, may be renovated by the formation
of new tissue to take the place of that which by use has lost its normal
characteristics.

From what has been said it will be seen that the brain is no exception to
the law which prevails throughout the whole domain of organic nature--that
use causes decay. The following extract from another work[1] bears upon
this point, and I think tends to its elucidation.

“During life the fluids and tissues of the body are constantly undergoing
change. New matter is deposited, and the old is removed with ceaseless
activity. The body may be regarded as a complex machine, in which the law,
that force is only generated by decomposition, is fully carried out. Every
motion of the body, every pulsation of the heart, every thought which
emanates from the encephalon is accompanied by the destruction of a
certain amount of tissue. As long as food is supplied in abundance, and
the assimilative functions are not disordered, reparation proceeds as
rapidly as decay, and life is the result; but should nutrition be
arrested, by any cause, for any considerable period, new matter ceases to
be formed, and the organs, worn out, act no longer, and death ensues.

“The animal body differs from any inorganic machine in the fact that it
possesses the power of self-repair. In the steam-engine, for instance, the
fuel which serves for the production of steam, and subsequently for the
creation of force, can do nothing toward the repair of the parts which
have been worn out by use. Day by day, by constant attrition and other
causes, the engine becomes less perfect, and eventually must be put in
order by the workman. In the animal body, however, the material which
serves for the production of force is the body itself, and the substances
which are taken as food are assimilated according to their character by
those organs and parts which require them.

“The body is therefore undergoing continued change. The hair of yesterday
is not the hair of today; the muscle which extends the arm is not
identically the same muscle after as before its action; old material has
been removed and new has been deposited to an equal extent; and though the
weight and form, the chemical constitution and histological character have
been preserved, the identity has been lost.”

All this is especially true of the brain. Its substance is consumed by
every thought, by every action of the will, by every sound that is heard,
by every object that is seen, by every substance that is touched, by every
odor that is smelled, by every painful or pleasurable sensation, and so
each instant of our lives witnesses the decay of some portion of its mass
and the formation of new material to take its place. The necessity for
sleep is due to the fact that during our waking moments the formation of
the new substance does not go on as rapidly as the decay of the old. The
state of comparative repose which attends upon this condition allows the
balance to be restored, and hence the feeling of freshness and
rejuvenation we experience after a sound and healthy sleep. The more
active the mind the greater the necessity for sleep, just as with a
steamer, the greater the number of revolutions its engine makes, the more
imperative is the demand for fuel.

The power with which this necessity can act is oftentimes very great, and
not even the strongest exertion of the will is able to neutralize it. I
have frequently seen soldiers sleep on horseback during night marches,
and have often slept thus myself. Galen on one occasion walked over two
hundred yards while in a sound sleep. He would probably have gone farther
but for the fact of his striking his foot against a stone and thus
awaking.

The Abbé Richard states that once when coming from the country alone and
on foot, sleep overtook him when he was more than half a league from town.
He continued to walk, however, though soundly asleep, over an uneven and
crooked road.[2]

Even when the most stirring events are transpiring, some of the
participants may fall asleep. Sentinels on posts of great danger cannot
always resist the influence. To punish a man with death, therefore, for
yielding to an inexorable law of his being, is not the least of the
barbarous customs which are still in force in civilized armies. During the
battle of the Nile many of the boys engaged in handing ammunition fell
asleep, notwithstanding the noise and confusion of the action and the fear
of punishment. And it is said that on the retreat to Corunna whole
battalions of infantry slept while in rapid march. Even the most acute
bodily sufferings are not always sufficient to prevent sleep. I have seen
individuals who had been exposed to great fatigue, and who had while
enduring it met with accidents requiring surgical interference, sleep
through the pain caused by the knife. Damiens, who attempted the
assassination of Louis XV. of France, and who was sentenced to be torn to
pieces by four horses, was for an hour and a half before his execution
subjected to the most infamous tortures, with red-hot pincers, melted
lead, burning sulphur, boiling oil, and other diabolical contrivances, yet
he slept on the rack, and it was only by continually changing the mode of
torture, so as to give a new sensation, that he was kept awake. He
complained, just before his death, that the deprivation of sleep was the
greatest of all his torments.

Dr. Forbes Winslow[3] quotes from the _Louisville Semi-Monthly Medical
News_ the following case:

“A Chinese merchant had been convicted of murdering his wife, and was
sentenced to die by being deprived of sleep. This painful mode of death
was carried into effect under the following circumstances: The condemned
was placed in prison under the care of three of the police guard, who
relieved each other every alternate hour, and who prevented the prisoner
falling asleep night or day. He thus lived nineteen days without enjoying
any sleep. At the commencement of the eighth day his sufferings were so
intense that he implored the authorities to grant him the blessed
opportunity of being strangled, guillotined, burned to death, drowned,
garroted, shot, quartered, blown up with gunpowder, or put to death in
any conceivable way their humanity or ferocity could invent. This will
give a slight idea of the horrors of death from want of sleep.”

In infants the necessity for sleep is much greater than in adults, and
still more so than in old persons. In the former the formative processes
are much more active than those concerned in disintegration. Hence the
greater necessity for frequent periods of repose. In old persons, on the
contrary, decay predominates over construction, there is a decreased
activity of the brain, the nervous system, and of all other organs, and
thus the demand for rest and recuperation is lessened.

The necessity for sleep is not felt by all organic beings alike. The
differences observed are more due to variations in habits, modes of life,
and inherent organic dispositions, than to any inequality in the size of
the brain, although the latter has been thought by some authors to be the
cause. It has been assumed that the larger the brain the more sleep was
required. Perhaps this is true as regards the individuals of any one
species of animals, but it is not the case when species are compared with
each other. In man, for instance, persons with large heads, as a rule,
have large, well-developed brains, and consequently more cerebral action
than individuals with small brains. There is accordingly a greater waste
of cerebral substance and an increased necessity for repair.

This is not, however, always the case, as some individuals with small
brains have been remarkable for great mental activity.

All animals sleep, and even plants have their periods of comparative
repose. As Lelut says:[4]

“No one is ignorant of the nocturnal repose of plants. I say repose and
nothing else. I do not say diminution or suspension of their sensibility,
for plants have no sensibility. I say diminution of their organic
actions--a diminution which is evident and characteristic in all, more
evident and more characteristic in some. * * *

“Their interior or vital movements are lessened, the flow of the sap and
of other fluids which penetrate and rise in them is retarded. Their more
mobile parts--the leaves, the flowers--show by their falling, their
occlusion, their inclination that their organic actions are diminished,
and that a kind of repose has been initiated, which takes the place of the
lying down, which, with animals, is the condition and the result of
sleep.”



CHAPTER II.

THE CAUSES OF SLEEP.


The exciting cause of natural and periodic sleep is undoubtedly to be
found in the fact that the brain at stated times requires repose, in order
that the cerebral substance which has been decomposed by mental and
nervous action may be replaced by new material. There are other exciting
causes than this, however, for sleep is not always induced by ordinary or
natural influences acting periodically. There are many others, which
within the strict limits of health may cause such a condition of the brain
as to produce sleep.

Authors, in considering sleep, have not always drawn the proper
distinction between the exciting and the immediate cause. Thus Macario,[5]
in alluding to the alleged causes of sleep, says:

“Among physiologists some attribute it to a congestion of blood in the
brain; others to a directly opposite cause, that is, to a diminished
afflux of blood to this organ; some ascribe it to a loss of nervous
fluid, others to a flow of this fluid back to its source; others again
find the cause in the cessation of the motion of the cerebral fibers, or
rather in a partial motion in these fibers. Here I stop, for I could not,
even if I wished, mention all the theories which have prevailed relative
to this subject. I will only add that, in my opinion, the most probable
proximate and immediate cause appears to be feebleness. What seems to
prove this view is the fact that exhaustive hot baths, heat, fatigue, too
great mental application are among the means which produce sleep.”

Undoubtedly the influence mentioned by Macario, and many others which he
might have cited, lead to sleep. They do so through the medium of the
nervous system--causing a certain change to take place in the physical
condition of the brain. We constantly see instances of this transmission
of impressions and the production of palpable effects. Under the influence
of fatigue, the countenance becomes pale; through the actions of certain
emotions, blushing takes place. When we are anxious or suffering or
engaged in intense thought, the perspiration comes out in big drops on our
brows; danger makes some men tremble, grief causes tears to flow. Many
other examples will suggest themselves to the reader. It is surely,
therefore, no assumption to say that certain mental or physical influences
are capable of inducing such an alteration in the state of the brain as
necessarily to cause sleep. These influences or exciting causes I propose
to consider in detail, after having given my views relative to the
condition of the brain which immediately produces sleep.

It is well established as regards other viscera, that during a condition
of activity there is more blood in their tissues than while they are at
rest. It is strange, therefore, that, relative to the brain, the contrary
doctrine should have prevailed so long, and that even now, after the
subject has been so well elucidated by exact observation, it should be the
generally received opinion that during sleep the cerebral tissues are in a
state approaching congestion. Thus Dr. Marshall Hall,[6] while contending
for this view, also advances the theory that there is a special set of
muscles, the duty of which is, by assuming a condition of tonic
contraction, so to compress certain veins as to prevent the return of the
blood from the heart.

Dr. Carpenter[7] is of the opinion that the first cause of sleep in order
of importance is the pressure exerted by distended blood-vessels upon the
encephalon.

Sir Henry Holland[8] declares that a “degree of pressure is essential to
perfect and uniform sleep.”

Dr. Dickson[9] regards an increased determination of blood to the
cerebral mass, and its consequent congestion in the larger vessels of the
brain, as necessary to the induction of sleep.

In his very excellent work on Epilepsy, Dr. Sieveking[10] says:

“Whether or not there is actually an increase in the amount of blood in
the brain during sleep, and whether, as has been suggested, the choroid
plexuses become turgid or not, we are unable to affirm otherwise than
hypothetically; the evidence is more in favor of cerebral congestion than
of the opposite condition inducing sleep--evidence supplied by physiology
and pathology.” Dr. Sieveking does not, however, state what this evidence
is.

Barthez[11] is of the opinion that during sleep there is a general
plethora of the smaller blood-vessels of the whole body. He does not
appear to have any definite views relative to the condition of the
cerebral circulation.

Cabanis[12] declares that as soon as the necessity for sleep is
experienced, there is an increased flow of blood to the brain.

To come to more popular books than those from which we have quoted, we
find Mr. Lewes,[13] when speaking of the causes of sleep, asserting that:
“It is caused by fatigue, because one of the natural consequences of
continued action is a slight congestion; and it is the _congestion_ which
produces sleep. Of this there are many proofs.” Mr. Lewes omits to specify
these proofs.

Macnish[14] holds the view that sleep is due to a determination of blood
to the head.

That a similar opinion has prevailed from very ancient times, it would be
easy to show. I do not, however, propose to bring forward any further
citations on this point, except the following, from a curious old
black-letter book now before me, in which the views expressed, though
obscure, are perhaps as intelligible as many met with in books of our own
day:

“And the holy scripture in sundrie places doth call death by the name of
sleepe, which is meant in respect of the resurrection; for, as after
sleepe we hope to wake, so after death we hope to rise againe. But that
definition which Paulus Ægineta maketh of sleepe, in my judgment, is most
perfect where he saith: Sleepe is the rest of the pores animall,
proceeding of some profitable humour moistening the braine. For here is
shewed by what means sleepe is caused; that is, by vapours and fumes
rising from the stomache to the head, where through coldness of the braine
they being congealed, doe stop the conduites and waies of the senses, and
so procure sleepe, which thing may plainly be perceived hereby; for that
immediately after meate we are most prone to sleepe, because then the
vapours ascende most abundantly to the braine, and such things as be most
vaporous do most dispose to sleepe, as wine, milke, and such like.”[15]

The theory that sleep is due directly to pressure of blood-vessels, filled
to repletion, upon the cerebral tissues, doubtless originated in the fact
that a comatose condition may be thus induced. This fact has long been
known. Servetus, among other physiological truths, distinctly announces it
in his _Christianismi Restitutio_, when he says:

“_Et quando ventriculi ita opplentur pituita, ut arteriæ ipsæ choroidis ea
immergantur, tunc subito generatur appoplexia._”

Perhaps the theory which prevails at present, of sleep being due to the
pressure of distended blood-vessels upon the choroid plexus, is derived
from these words of Servetus.

That stupor may be produced by pressure upon the brain admits of no doubt.
It is familiarly known to physicians, surgeons, and physiologists; the two
former meet with instances due to pathological causes every day, and the
latter bring it on at will in their laboratories. But this form of coma
and sleep are by no means identical. On the contrary, the only point of
resemblance between the two consists in the fact that both are accompanied
by a loss of volition. It is true, we may often arrive at a correct idea
of a physiological process from determining the causes and phenomena of
its pathological variations, but such a course is always liable to lead to
great errors, and should be conducted with every possible precaution. In
the matter under consideration it is especially of doubtful propriety, for
the reason stated, that coma is not to be regarded as a modification of
sleep, but as a distinct morbid condition. Sir T. C. Morgan,[16] in
alluding to the fact that sleep has been ascribed to a congested state of
the brain, for the reason that in apoplectic stupor the blood-vessels of
that organ are abnormally distended, objects to the theory, on the ground
that it assimilates a dangerous malady to a natural and beneficial
process. He states (what was true at the time he wrote) that the condition
of the circulation through the brain, during sleep, is wholly unknown.

It is important to understand clearly the difference between stupor and
sleep, and it is very certain that the distinction is not always made by
physicians; yet the causes of the two conditions have almost nothing in
common, and the phenomena of each are even more distinct.

1. In the first place, stupor never occurs in the healthy individual,
while sleep is a necessity of life.

2. It is easy to awaken a person from sleep, while it is often impossible
to arouse him from stupor.

3. In sleep the mind may be active, in stupor it is as it were dead.

4. Pressure upon the brain, intense congestion of its vessels, the
circulation of poisoned blood through its substance cause stupor, but do
not induce sleep. For the production of the latter condition a diminished
supply of blood to the brain, as will be fully shown hereafter, is
necessary.

Perhaps no one agent so distinctly points out the difference between sleep
and stupor as opium and its several preparations. A small dose of this
medicine acting as a stimulant increases the activity of the cerebral
circulation, and excites a corresponding increase in the rapidity and
brilliancy of our thoughts. A larger dose lessens the amount of blood in
the brain, and induces sleep. A very large dose sometimes diminishes the
power of the whole nervous system, lessens the activity of the respiratory
function, and hence allows blood which has not been properly subjected to
the influence of the oxygen of the atmosphere to circulate through the
vessels of the brain. There is nothing in the opium itself which produces
excitement, sleep, or stupor, by any direct action upon the brain. All its
effects are due to its influence on the heart and blood-vessels, through
the medium, however, of the nervous system. This point can be made plainer
by adducing the results of some experiments which I have lately performed.

_Experiment._--I placed three dogs of about the same size under the
influence of chloroform, and removed from each a portion of the upper
surface of the skull an inch square. The dura mater was also removed, and
the brain exposed. After the effects of the chloroform had passed
off--some three hours subsequent to the operation--I administered to
number one the fourth of a grain of opium, to number two a grain, and to
number three two grains. The brain of each was at the time in a perfectly
natural condition.

At first the circulation of the blood in the brain was rendered more
active, and the respiration became more hurried. The blood-vessels, as
seen through the openings in the skulls, were fuller and redder than
before the opium was given, and the brain of each animal rose through the
hole in the cranium. Very soon, however, the uniformity which prevailed in
these respects was destroyed. In number one the vessels remained
moderately distended and florid for almost an hour, and then the brain
slowly regained its ordinary appearance. In number two the active
congestion passed off in less than half an hour, and was succeeded by a
condition of very decided shrinking, the surface of the brain having
fallen below the surface of the skull, and become pale. As these changes
supervened, the animal gradually sank into a sound sleep, from which it
could easily be awakened. In number three the surface of the brain became
dark, almost black, from the circulation of blood containing a
superabundance of carbon, and owing to diminished action of the heart and
vessels it sank below the level of the opening, showing, therefore, a
diminished amount of blood in its tissue. At the same time the number of
respirations per minute fell from 26 to 14, and they were much weaker than
before. A condition of complete stupor was also induced from which the
animal could not be aroused. It persisted for two hours. During its
continuance, sensation of all kind was abolished, and the power of motion
was altogether lost.

It might be supposed that the conditions present in numbers two and three
differed only in degree. That this was not the case is shown by the
following experiment:

_Experiment._--To the dogs two and three I administered on the following
day, as before, one and two grains of opium respectively. As soon as the
effects began to be manifested upon the condition of the brain, I opened
the trachea of each, and, inserting the nozzle of a bellows, began the
process of artificial respiration. In both dogs the congestion of the
blood-vessels of the brain disappeared. The brain became collapsed, and
the animals fell into a sound sleep, from which they were easily
awakened. If the action of the bellows was stopped and the animals were
left to their own respiratory efforts, no change ensued in number two, but
in number three the surface of the brain became dark, and stupor resulted.

In order to be perfectly assured upon the subject, I proceeded as follows
with another dog:

_Experiment._--The animal was trephined as was the others, and five grains
of opium given. At the same time the trachea was opened and the process of
artificial respiration instituted. The brain became slightly congested,
then collapsed, and sleep ensued. The sleep was sound, but the animal was
easily awakened by tickling its ear. After I had continued the process for
an hour and a quarter, I removed the nozzle of the bellows, and allowed
the animal to breathe for itself. Immediately the vessels of the brain
were filled with black blood, and the surface of the brain assumed a very
dark appearance.

The dog could no longer be aroused, and died one hour and a quarter after
the process was stopped.

I have only stated those points of the experiments cited which bear upon
the subject under consideration, reserving for another occasion others of
great interest. It is, however, shown that a small dose of opium excites
the mind, because it increases the amount of blood in the brain; that a
moderate dose causes sleep, because it lessens the amount of blood; and
that a large dose produces stupor by impeding the respiratory process,
and hence allowing blood loaded with carbon, and therefore poisonous, to
circulate through the brain.

It is also shown that the condition of the brain during stupor is very
different from that which exists during sleep. In the one case its vessels
are loaded with dark blood; in the other they are comparatively empty, and
the blood remains florid.

I think it will be sufficiently established, in the course of these
remarks, that sleep is directly caused by the circulation of a less
quantity of blood through the cerebral tissues than traverses them while
we are awake. This is the immediate cause of healthy sleep. Its exciting
cause is, as we have seen, the necessity for repair. The condition of the
brain which is favorable to sleep may also be induced by various other
causes, such as heat, cold, narcotics, anæsthetics, intoxicating liquors,
loss of blood, etc. If these agents are allowed to act excessively, or
others, such as carbonic oxide, and all those which interfere with the
oxygenation of the blood, are permitted to exert their influence, stupor
results.

The theory above enunciated, although proposed in a modified form by
Blumenbach several years since, and subsequently supported by facts
brought forward by other observers, has not been received with favor by
any considerable number of physiologists. Before, therefore, detailing my
own experience, I propose to adduce a few of the most striking proofs of
its correctness which I have been able to collect, together with the
opinions of some of those inquirers who have recently studied the subject
from this point of view.

Blumenbach[17] details the case of a young man, eighteen years of age, who
had fallen from an eminence and fractured the frontal bone, on the right
side of the coronal suture. After recovery took place a hiatus remained,
covered only by the integument. While the young man was awake this chasm
was quite superficial, but as soon as sleep ensued it became very deep.
The change was due to the fact that during sleep the brain was in a
collapsed condition. From a careful observation of this case, as well as
from a consideration of the phenomena attendant on the hibernation of
animals, Blumenbach[18] arrives at the conclusion that the proximate cause
of sleep consists in a diminished flow of oxygenated blood to the brain.

Playfair[19] thinks that sleep is due to “a diminished supply of oxygen to
the brain.”

Dendy[20] states that there was, in 1821, at Montpellier, a woman who had
lost part of her skull, and the brain and its membranes lay bare. When she
was in deep sleep the brain remained motionless beneath the crest of the
cranial bones; when she was dreaming it became somewhat elevated; and
when she was awake it was protruded through the fissure in the skull.

Among the most striking proofs of the correctness of the view that sleep
is due to diminished flow of blood to the head, are the experiments of Dr.
Alexander Fleming,[21] late Professor of Medicine, Queen’s College, Cork.
This observer states, that while preparing a lecture on the mode of
operation of narcotic medicines, he conceived the idea of trying the
effect of compressing the carotid arteries on the functions of the brain.
The first experiment was performed on himself, by a friend, with the
effect of causing immediate and deep sleep. The attempt was frequently
made, both on himself and others, and always with success. “A soft humming
in the ears is heard; a sense of tingling steals over the body, and in a
few seconds complete unconsciousness and insensibility supervene, and
continue so long as the pressure is maintained.”

Dr. Fleming adds, that whatever practical value may be attached to his
observations, they are at least important as physiological facts, and as
throwing light on the causes of sleep. It is remarkable that his
experiments have received so little notice from physiologists.

Dr. Bedford Brown,[22] of North Carolina, has recorded an interesting
case of extensive compound fracture of the cranium, in which the
opportunity was afforded him of examining the condition of the cerebral
circulation while the patient was under the influence of an anæsthetic,
preparatory to the operation of trephining being performed. A mixture of
ether and chloroform was used. Dr. Brown says:

“Whenever the anæsthetic influence began to subside, the surface of the
brain presented a florid and injected appearance. The hemorrhage
increased, and the force of the pulsation became much greater. At these
times so great was the alternate heaving and bulging of the brain, that we
were compelled to suspend operations until they were quieted by a
repetition of the remedy. Then the pulsations would diminish, the cerebral
surface recede within the opening of the skull, as if by collapse; the
appearance of the organ becoming pale and shrunken with a cessation of the
bleeding. In fact, we were convinced that diminished vascularity of the
brain was an invariable result of the impression of chloroform or ether.
The changes above alluded to recurred sufficiently often, during the
progress of the operation, in connection with the anæsthetic treatment, to
satisfy us that there could be no mistake as to the cause and effect.”

It will be shown, in the course of the present memoir, that Dr. Brown’s
conclusions, though in the main correct, are erroneous so far as they
relate to the effect of chloroform upon the cerebral circulation; nor
does it appear that he employed this agent unmixed with ether, in the case
which he has recorded so well. He has, probably, based his remarks on this
point upon the phenomena observed when the compound of ether and
chloroform was used--the action of pure chloroform, as regards its effect
upon the quantity of blood circulating through the brain, being the
reverse of that which he claims for it.

But the most philosophical and most carefully digested memoir upon the
proximate cause of sleep, which has yet been published, is that of Mr.
Durham.[23] Although my own experiments in the same direction, and which
will be hereafter detailed, were of prior date, I cheerfully yield all the
honor which may attach to the determination of the question under
consideration to this gentleman, who has not only worked it out
independently, but has anticipated me several years in the publication,
besides carrying his researches to a much further point than my own
extended.

With the view of ascertaining by ocular examination the vascular condition
of the brain during sleep, Durham placed a dog under the influence of
chloroform, and removed with a trephine a portion of bone as large as a
shilling from the parietal region; the dura mater was also cut away.
During the continuance of the anæsthetic influence, the large veins of
the surface of the pia mater were distended, and the smaller vessels were
full of dark-colored blood. The longer the administration of the
chloroform was continued, the greater was the congestion. As the effects
of this agent passed off, the animal sank into a natural sleep, and then
the condition of the brain was very materially changed. Its surface became
pale and sank down below the level of the bone; the veins ceased to be
distended, and many which had been full of dark blood could no longer be
distinguished. When the animal was roused, the surface of the brain became
suffused with a red blush, and it ascended into the opening through the
skull. As the mental excitement increased, the brain became more and more
turgid with blood, and innumerable vessels sprang into sight. The
circulation was also increased in rapidity. After being fed, the animal
fell asleep, and the brain again became contracted and pale. In all these
observations the contrast between the two conditions was exceedingly well
marked.

To obviate any possible effects due to atmospheric pressure, watch-glasses
were applied to the opening in the skull, and securely cemented to the
edges with Canada balsam. The phenomena observed did not differ from those
previously noticed; and, in fact, many repetitions of the experiment gave
like results.

Durham, in the next place, applied ligatures to the jugular and vertebral
veins, with the effect--as was to be expected--of producing intense
congestion of the brain, attended with coma. This last condition he very
properly separates from sleep, which is never caused by pressure from the
veins. He likens sleep to the state induced by preventing the access of
blood to the brain through the carotids, but does not allude to Fleming’s
researches on this point.

From his observations, Durham deduces the following conclusions:

“1. Pressure of distended veins upon the brain is not the cause of sleep,
for during sleep the veins are not distended; and when they are, symptoms
and appearances arise which differ from those which characterize sleep.

“2. During sleep the brain is in a comparatively bloodless condition, and
the blood in the encephalic vessels is not only diminished in quantity,
but moves with diminished rapidity.

“3. The condition of the cerebral circulation during sleep is, from
physical causes, that which is most favorable to the nutrition of the
brain tissue; and, on the other hand, the condition which prevails during
waking is associated with mental activity, because it is that which is
most favorable to oxydation of the brain substance, and to various changes
in its chemical constitution.

“4. The blood which is derived from the brain during sleep is distributed
to the alimentary and excretory organs.

“5. Whatever increases the activity of the cerebral circulation tends to
preserve wakefulness; and whatever decreases the activity of the cerebral
circulation, and, at the same time, is not inconsistent with the general
health of the body, tends to induce and favor sleep. Such circumstances
may act primarily through the nervous or through the vascular system.
Among those which act through the nervous system, may be instanced the
presence or absence of impressions upon the senses, and the presence or
absence of exciting ideas. Among those which act through the vascular
system, may be mentioned unnaturally or naturally increased or decreased
force or frequency of the heart’s action.

“6. A probable explanation of the reason why quiescence of the brain
normally follows its activity, is suggested by the recognized analogical
fact that the products of chemical action interfere with the continuance
of the action by which they are produced.”

Luys,[24] after stating the two opposite views relative to the state of
the cerebral circulation during sleep, gives his adhesion on principles of
analogy to that which holds to a diminished afflux of blood. Taking the
condition of the salivary glands during their periods of inaction as the
basis of his argument, he says:

“We are then naturally led, in making the application of known facts to
those which are yet unknown, to say that the nervous tissue and the
glandular tissue present, between themselves, the closest analogy, so far
as circulatory phenomena and the double alternation of their periods of
activity and repose are concerned. And that if the period during which the
gland reconstitutes its immediate principles corresponds to a period of
reduced activity of circulatory phenomena--to a state of relative
anæmia--and that when it functionates it is awakened to a state in which
its capillaries are turgid with blood, it is very admissible that the same
circulatory conditions should be present in the nervous tissue, and that
the period of inactivity, or of sleep, should be characterized by an
anemic state. Inversely, the period of activity or wakefulness should be
marked by an acceleration of the flow of blood, and by a kind of erethism
of the vascular element.”

Having thus, in as succinct a manner as possible, brought forward the
principal observations relative to the immediate cause of sleep, which up
to the present time have been published, I come, in the next place, to
detail the result of my own researches.

In 1854 a man came under my observation who had, through a frightful
railroad accident, lost about eighteen square inches of his skull. There
was thus a fissure of his cranium three inches wide and six inches long.
The lost portion consisted of a great part of the left parietal, and part
of the frontal, occipital, and right parietal bones. The man, who was
employed as a wood chopper, was subject to severe and frequent epileptic
fits, during which I often attended him. In the course of my treatment, I
soon became acquainted with the fact that, at the beginning of the
comatose condition which succeeded the fits, there was invariably an
elevation of that portion of the scalp covering the deficiency in the
cranium. As the stupor passed away, and sleep from which he could easily
be aroused ensued, the scalp gradually became depressed. When the man was
awake, the region of scalp in question was always nearly on a level with
the upper surface of the cranial bones. I also noticed on several
occasions that during natural sleep the fissure was deeper, and that in
the instant of awaking, the scalp covering it rose to a much higher level.

After my attention was thus drawn to this subject, I observed that in
young infants the portion of scalp covering the anterior fontanelle was
always depressed during sleep, and elevated during wakefulness.

During the summer of 1860 I undertook a series of experiments, with the
view of ascertaining the condition of the cerebral circulation during
sleep, of which the following is a brief abstract:

A medium-sized dog was trephined over the left parietal bone, close to the
sagittal suture, having previously been placed under the full anæsthetic
influence of ether. The opening made by the trephine was enlarged with a
pair of strong bone-forceps, so as to expose the dura mater to the extent
of a full square inch. This membrane was then cut away and the brain
brought into view. It was sunk below the inner surface of the skull, and
but few vessels were visible. Those which could be perceived, however,
evidently conveyed dark blood, and the whole exposed surface of the brain
was of a purple color. As the anæsthetic influence passed off, the
circulation of the blood in the brain became more active. The purple hue
faded away, and numerous small vessels filled with red blood became
visible; at the same time the volume of the brain increased, and when the
animal became fully aroused, the organ protruded through the opening in
the skull to such an extent that, at the most prominent part, its surface
was more than a quarter of an inch above the external surface of the
cranium. While the dog continued awake, the condition and position of the
brain remained unchanged. After the lapse of half an hour, sleep ensued.
While this state was coming on I watched the brain very attentively. Its
volume slowly decreased; many of its smaller blood-vessels became
invisible, and finally it was so much contracted that its surface, pale
and apparently deprived of blood, was far below the level of the cranial
wall.

Two hours subsequently the animal was again etherized, in order that the
influence of the ether upon the cerebral circulation might be observed
from the commencement. At the time the dog was awake, and had a few
minutes previously eaten a little meat and drank a small quantity of
water. The brain protruded through the opening in the skull, and its
surface was of a pink hue, with numerous red vessels ramifying over it.
The ether was administered by applying to the muzzle of the animal a towel
folded into the shape of a funnel, and containing a small sponge saturated
with the agent.

As soon as the dog commenced to inspire the ether, the appearance of the
brain underwent a change of color, and its volume became less. As the
process of etherization was continued, the color of the surface darkened
to a deep purple, and it ceased to protrude through the opening. Finally,
when a state of complete anæsthesia was reached, it was perceived that the
surface of the brain was far below the level of the cranial fissure, and
that its vessels conveyed black blood alone.

Gradually the animal regained its consciousness; the vessels resumed their
red color, and the brain was again elevated to its former position. In
this last experiment there did not appear to be any congestion of the
brain. Had this condition existed, it would have been difficult to account
for the diminution in bulk, which certainly took place. There was
evidently less blood in the cerebral tissue than there had been previously
at the etherization; but this blood, instead of being oxygenated, was
loaded with excrementitial matters, and consequently was not fitted to
maintain the brain in a condition of activity.

The following morning, the dog being quite lively, I removed the sutures
which had been placed in the skin, covering the hole in the cranium, with
the view of ascertaining the effects of chloroform upon the brain, when
introduced into the system by inhalation. Suppuration had not yet taken
place, and the parts were in good condition. The opening in the skull was
completely filled by the brain, and the surface of the latter was
traversed by a great many small vessels carrying red blood. The chloroform
was administered in the same way in which the ether had been given the
previous day.

In a few seconds the change in color of the blood circulating in the
vessels began to take place, but there was no sinking of the brain below
the level of the chasm in the skull. On the contrary, its protrusion was
greater than before the commencement of the experiment. There was thus not
only unoxygenated blood circulating to too great an extent through the
brain, but there was very decided congestion.

The foregoing experiments were frequently repeated on other dogs, and also
on rabbits, with like results. Within a short period I have in part gone
over the ground again, without observing any essential point of difference
in the effects produced.

I have never repeated Fleming’s experiment on the human subject, except in
one instance, and then sleep, or a condition resembling it, was
instantaneously produced. As soon as the pressure was removed from the
carotids, the individual gained his consciousness. On dogs and rabbits,
however, I have performed it frequently, and though if the pressure be
continued for longer than one minute, convulsions generally ensue, a state
of insensibility resembling natural sleep is always the first result.
Lately, I have had, through the kindness of my friend, Dr. Van Buren, the
opportunity of examining a case which affords strong confirmation of the
correctness of the preceding views. It was that of a lady in whom both
common carotids were tied for a cirsoid aneurism, involving a great
portion of the right side of the scalp. One carotid was tied by the late
Dr. J. Kearney Rogers, and the other by Dr. Van Buren, seven years ago,
with the effect of arresting the progress of the disease. No peculiar
symptoms were observed in consequence of these operations, except the
supervention of persistent drowsiness, which was especially well marked
after the last operation, and which, even now, is at times quite
troublesome.

We thus see that the _immediate_ cause of sleep is a diminution of the
quantity of blood circulating in the vessels of the brain, and that the
_exciting_ cause of periodical and natural sleep is the necessity which
exists that the loss of substance which the brain has undergone, during
its state of greatest activity, should be restored. To use the simile of
the steam-engine again, the fires are lowered and the operatives go to
work to repair damages and put the machine in order for next day’s work.

Whatever other cause is capable of lessening the quantity of blood in the
brain is also capable of inducing sleep. There is no exception to this
law, and hence we are frequently able to produce this condition at will.
Several of these factors have been already referred to, but it will be
interesting to consider them all somewhat more at length.

_Heat._--Most persons in our climate, and in those of higher temperatures,
have felt the influence of heat in causing drowsiness, and eventually
sleep, if the action is powerful enough and sufficiently prolonged. It is
not difficult to understand the mode by which heat acts in giving rise to
sleep. During the prevalence of high temperatures the blood flows in
increased proportion to the surface of the body and to the extremities,
and consequently the quantity in the brain is diminished. Sleep
accordingly results unless the irritation induced by the heat is so great
as to excite the nervous system. Heat applied directly to the head exerts,
of course, a directly contrary effect upon the cerebral circulation, as we
see in sun-stroke. Here there is internal cerebral congestion, loss of
consciousness, stupor, etc.

That the effect of heat is to dilate the vessels of the part subjected to
its influence, can be ascertained by putting the arm or leg into hot
water. The swelling of the blood-vessels is then very distinctly seen. It
will be shown hereafter that one of the best means of causing sleep in
morbid wakefulness is the warm-bath.

_Cold._--A slight degree of cold excites wakefulness at first, but if the
constitution be strong the effect is to predispose to sleep. This it does
by reason of the determination of blood to the surface of the body which
moderate cold induces in vigorous persons. The ruddy complexion and warmth
of the hands and feet produced in such individuals under the action of
this influence are well known.

But if the cold be very intense, or the reduction of temperature sudden,
the system, even of the strongest persons, cannot maintain a resistance,
and then a very different series of phenomena result. Stupor, not sleep,
is the consequence. The blood-vessels of the surface of the body contract
and the blood accumulates in the internal organs, the brain among them.
Many instances are on record showing the effect of extreme cold in
producing stupor and even death. One of the most remarkable of these is
that related by Captain Cook, in regard to an excursion of Sir Joseph
Banks, Dr. Solander, and nine others, over the hills of Terra del Fuego.
Dr. Solander, knowing from his experience in Northern Europe that the
stupor produced by severe cold would terminate in death unless resisted,
urged his companions to keep in motion when they began to feel drowsy.
“Whoever sits down will sleep,” said he, “and whoever sleeps will rise no
more.” Yet he was the first to feel this irresistible desire for repose,
and entreated his companions to allow him to lie down. He was roused from
his stupor with great difficulty and carried to a fire, when he revived.
Two black men of the party, whose organizations were not so robust as
those of the whites, perished. Dr. Whiting[25] relates the case of Dr.
Edward Daniel Clark, the celebrated traveler, who on one occasion came
very near losing his life by cold. He had performed divine service at a
church near Cambridge, and was returning home on horseback, when he felt
himself becoming very cold and sleepy. Knowing the danger of yielding to
the influence which was creeping over him, he put his horse into a fast
trot, hoping thereby to arouse himself from the alarming torpor. This
means proving unavailing, he got down and led his horse, walking as fast
as he could. This, however, did not long succeed. The bridle dropped from
his arm, his legs became weaker and weaker, and he was just sinking to the
ground when a gentleman who knew him came up in a carriage and rescued
him.

I have often myself noticed this effect of cold in producing numbness and
drowsiness, and on one occasion was nearly overcome by it. I was crossing
the mountain ridge between Cebolleta and Covero, in New Mexico, when the
thermometer fell in about two hours from 52° to 22° Fahrenheit. So great
was the effect upon me that if I had had much farther to go I should
probably have succumbed. As it was, I reached a rancho in time to be
relieved, though several minutes elapsed before I was able to speak. The
sensations experienced were rather agreeable than otherwise. There was a
great desire to rest and to yield to the languor which was present, and
there was a feeling of recklessness which rendered me perfectly
indifferent to the consequences. I should have dismounted from my horse
and given way to the longing for repose if I had been able to do so. I
have several times experienced very similar effects from change of air. A
few years since I was so drowsy at the sea-coast, whither I had gone from
a hot city, that it was with difficulty I could keep awake, even when
engaged in active physical exercise.

Another potent cause of sleep, and one of which we generally avail
ourselves, is the _diminution of the power of the attention_. To bring
this influence into action generally requires only the operation of the
will under circumstances favorable to the object in view. Shutting the
eyes so as to exclude light, getting beyond the sound of noises,
refraining from the employment of the other senses, and avoiding thought
of all kind, will generally, when there is no preventing cause, induce
sleep. To think, and to maintain ourselves in connection with the outward
world by means of our senses requires that the circulation of blood in the
brain shall be active. When we isolate ourselves from external things, and
restrain our thoughts, we lessen the amount of blood in the brain, and
sleep results. It is not, however, always easy for us to do this. The
nervous system is excited, ideas follow each other in rapid succession,
and we lie awake hour after hour vainly trying to forget that we exist.
The more the will is brought to bear upon the subject the more rebellious
is the brain, and the more it will not be forced by such means into a
state of quietude. We must then either let it run riot till it is worn out
by its extravagancies, or we must fatigue it by requiring it to perform
labor which is disagreeable. Just as we might do with an individual of
highly destructive propensities, who was going about pulling down his
neighbors’ houses. We might, if we were altogether unable to stop him, let
him alone till he had become thoroughly wearied with his exertions, or we
might divert him from his plan by guiding him to some tough piece of work
which would exhaust his strength sooner than would his original labor.

Many ways of thus tiring the brain have been proposed. The more irksome
they are, the more likely they are to prove effectual. Counting a hundred
backward many times, listening to monotonous sounds, thinking of some
extremely disagreeable and tiresome subject, with many other devices, have
been suggested, and have proved more or less effectual. Boerhaave[26]
states that he procured sleep by placing a brass pan in such a position
that the patient heard the sound of water which was made to fall into it,
drop by drop. In general terms, monotony predisposes to sleep. Dr.
Dickson[27] quotes Southey’s experience as related in the Doctor,[28] and
I also cannot do better than lay it before the reader, particularly as it
indicates several methods which may be more efficacious with others than
the one he found to succeed so admirably.

“I put my arms out of bed; I turned the pillow for the sake of applying a
cold surface to my cheek; I stretched my feet into the cold corner; I
listened to the river and to the ticking of my watch; I thought of all
sleepy sounds and of all soporific things--the flow of water, the humming
of bees, the motion of a boat, the waving of a field of corn, the nodding
of a mandarin’s head on the chimney-piece, a horse in a mill, the opera,
Mr. Humdrum’s conversations, Mr. Proser’s poems, Mr. Laxative’s speeches,
Mr. Lengthy’s sermons. I tried the device of my own childhood, and fancied
that the bed rushed with me round and round. At length Morpheus reminded
me of Dr. Torpedo’s Divinity Lectures, where the voice, the manner, the
matter, even the very atmosphere and the streamy candlelight were all
alike somnific; when he who, by strong effort, lifted up his head and
forced open the reluctant eyes never failed to see all around him asleep.
Lettuces, cowslip wine, poppy syrup, mandragora, hop pillows, spider’s
web pills, and the whole tribe of narcotics, up to bang and the
black-drop, would have failed,--but this was irresistible; and thus,
twenty years after date, I found benefit from having attended the course.”

Frequently the power of the attention is diminished by natural causes.
After the mind has been strained a long time in one particular direction,
and during which period the brain was doubtless replete with blood, the
tension is at last removed, the blood flows out of the brain, the face
becomes pale, and sleep ensues. It is thus, as Macnish[29] says, that “the
finished gratification of all ardent desires has the effect of inducing
slumber; hence after any keen excitement the mind becomes exhausted and
speedily relapses into this state.”

A gentleman recently under my care for a paralytic affection, informed me
that he could at any time render himself sleepy by looking for a few
minutes at a bright light, so as to fatigue the eyes, or by paying
particular attention to the noises in the street, so as to weary the sense
of hearing. It is well known that sleep may be induced by gentle frictions
of various parts of the body, and doubtless the other senses are capable
of being so exhausted, if I may use the expression, as to diminish the
power of the attention, and thus lessen the demand for blood in the brain.
As a consequence, sleep ensues.

The cutting off of sensorial impressions aids in lessening the power of
the attention and thus predisposes to sleep. Stillness, darkness, the
absence of any decided impression on the skin, and the nonexistence of
odors and flavors, accomplish this end. In these respects, however, habit
exercises great influence, and thus individuals, for instance, who are
accustomed to continual loud noises, cannot sleep when the sound is
interrupted. As we have already seen, however, the predisposition to sleep
is, in healthy persons, generally so great that when it has been long
resisted, no sensation, however strong it may be, can withstand its power.

_Digestion_ leads to sleep by drawing upon the brain for a portion of its
blood. It is for this reason that we feel sleepy after the ingestion of a
hearty dinner. A lady of my acquaintance is obliged to sleep a little
after each meal. The desire to do so is irresistible; her face becomes
pale; her extremities cold; and she sinks into a quiet slumber, which
lasts fifteen or twenty minutes. In this lady the amount of blood is not
sufficient for the due performance of all the operations of the economy.
The digestive organs imperatively require an increased quantity, and the
flow takes place from the brain; it being the organ with her which can
best spare this fluid. As a rule, persons who eat largely, and have good
digestive powers, sleep a great deal, and many persons are unable to sleep
at night till they have eaten a substantial supper. The lower animals
generally sleep after feeding, especially if the meal has been large.

_Excessive loss of blood_ produces sleep. We can very readily understand
why this should be so if we adopt the theory which has been supported in
the foregoing pages. It would be exceedingly difficult to explain the fact
upon any other hypothesis. I have seen many instances of somnolency due to
this cause. It acts not only by directly lessening the quantity of blood
in the brain, but also by so enfeebling the heart’s action as to prevent a
due supply of blood being sent to the cerebral vessels.

_Debility_ is almost always accompanied by a disposition to inordinate
sleep. The brain is one of the first organs to feel the effects of a
diminished amount of blood or a depraved quality of this fluid being
supplied, and hence, in old age, or under the influence of a deficient
quantity of food, or through the action of some exhausting disease, there
is generally more sleep than when the physical health is not deteriorated.

The action of certain medicines, and of other measures capable of causing
sleep, not coming within the range of ordinary application, will be more
appropriately considered hereafter.



CHAPTER III.

THE PHYSICAL PHENOMENA OF SLEEP.


The approach of sleep is characterized by a languor which is agreeable
when it can be yielded to, but which, when circumstances prevent this, is
far from being pleasant. Many persons are rendered irritable as soon as
they become sleepy, and children are especially liable to manifest ill
temper under the uncomfortable feelings they experience when unable to
indulge the inclination to sleep. It is somewhat difficult to analyze the
various phenomena which go to make up the condition called sleepiness. The
most prominent feelings are an impression of weight in the upper eyelids,
and of a general relaxation of the muscles of the body, but there is
besides an internal sensation of supineness, enervation, and torpor, to
describe which is by no means easy. This sluggishness is closely allied in
character if not altogether identical with that experienced before an
attack of fainting, and is doubtless due to a like cause--a deficient
quantity of blood in the brain. Along with this languor there is a general
obtuseness of all the senses, which increases the separation of the mind
from the external world, already initiated by the physical condition of
the brain. The liveliest scenes cease to engage the attention, and the
most exciting conversation no longer interests. For a time, indeed, such
circumstances may dissipate the inclination for sleep, but eventually
nature obtains the ascendency and consciousness is lost. Before this event
there is usually yawning--a phenomenon strongly indicative of a wearied
attention; the head nods and droops upon the breast, and the body assumes
that position which is most conducive to ease, comfort, and entire
muscular inactivity.

The order in which the muscles lose their power is in general well marked,
and bears a distinct relation, as Cabanis[30] has pointed out, to the
importance of their functions. Thus, the muscles which move the arms and
legs become relaxed before those which support the head, and the latter
before those which maintain the erectness of the back. This, however, is
not always the case, for, as we have already seen, individuals will
occasionally walk, and keep their position on horseback, while in a sound
sleep, and all of us have seen persons slumbering in church, their heads
dropping on their breasts, but yet firmly holding their prayer-books in
their hands under the pretense of going through the services.

As regards the senses, the sight is of course the first to be lost in
ordinary cases--the closure of the eyelids interposing a physical
obstruction to the entrance of light. Even when the eyelids have been
removed, or from disease cannot be closed, the sight, nevertheless, is the
first of the special senses to be abolished. Some animals, as the hare for
example, do not shut the eyes when asleep; but even in them the ability to
see disappears before the action of the other senses is suspended.

These latter are not altogether abolished during sleep; their acuteness is
simply lessened. Taste is the first to fade, and then the smell; hearing
follows, and touch yields last of all, and is most readily re-excited. To
awake a sleeping person, impressions made upon the sense of touch are more
effectual than attempts to arouse through any of the other senses; the
hearing comes next in order, smell next, then taste, and the sight is the
last of all in capacity for excitation.

During sleep the respiration is slower, deeper, and usually more regular
than during wakefulness. The vigor of the process is lessened, and
therefore there is a diminution of the pulmonary exhalations. In all
probability, also, the ciliated epithelium which lines the air-passages
functionates with reduced activity. Owing to this circumstance and to the
general muscular torpor which prevails, mucus accumulates in the bronchial
tubes and requires to be expectorated on awaking.

The circulation of the blood is rendered slower. The heart beats with more
regularity, but with diminished force and frequency. As a consequence the
blood is not distributed to distant parts of the body so thoroughly and
rapidly as during wakefulness, and accordingly the extremities readily
lose their heat. Owing to the reduction in the activity of the respiratory
and circulatory functions, the temperature of the whole body falls, and
coldness of the atmosphere is less easily resisted.

The functions of the several organs concerned in digestion have their
activity increased by sleep. The blood which leaves the brain, goes, as
Durham has shown, to the stomach and other abdominal viscera, and hence
the quantities of the digestive juices are augmented, and the absorption
of the nutritious elements of the food is promoted.

The urine is excreted in less quantity during sleep than when the
individual is awake and engaged in mental or physical employment, because
the wear and tear of the system is at its minimum.

The perspiration is likewise reduced in amount by sleep. In warm weather,
however, the effort to go to sleep often causes an increase in the
quantity of this excretion, just as would any other mental or bodily
exertion. This circumstance has led some writers to a conclusion the
reverse of that just expressed. Others, again, have accepted the doctrine
of Sanctorius on this point without stopping to inquire into its
correctness. This author,[31] among other aphorisms relating to sleep,
gives the following:

“Undisturbed sleep is so great a promoter of perspiration, that in the
space of seven hours, fifty ounces of the concocted perspirable matter do
commonly exhale out of strong bodies.

“A man sleeping the space of seven hours is wont, insensibly, healthfully,
and without any violence, to perspire twice as much as one awake.”

The observations of Sanctorius with his weighing chair led to a good many
important results, but they were inexact so far as the function of the
skin was concerned, in that they made no division between the loss by this
channel and that which takes place through the lungs, for by perspiration
in the above quotations he means not only the exhalation from the skin,
but the products of respiration--aqueous vapor, carbonic acid, etc. His
apparatus was, besides, very imperfect, and could not possibly have given
the delicate indications which the subject requires.

Whether the condition of sleep promotes the absorption of morbid growths
and accumulations of fluids is very doubtful. Macnish[32] contends that it
does, but _a priori_ reasoning would rather lead us to an opposite
conclusion. Deficiencies are probably more rapidly made up during sleep
than during wakefulness, and thus ulcers heal with more rapidity, owing to
the increased formation of granulations which takes place; but the
removal of tumors, etc. by natural process involves the operation of
forces the very opposite of those concerned in reparation, and observation
teaches us that sleep is a condition peculiarly favorable to the
deposition of the materials constituting morbid growths. Some writers have
alleged that sleep accelerates the absorption of dropsical effusions, but
the disappearance of such accumulations during the condition in question
is clearly due to the mechanical causes depending upon the position of the
body.

It has also been asserted that there is an exaltation of the sexual
feeling during sleep. It is difficult to arrive at any very definite
conclusion on this point, but it is probable that here again the position
of the body conjoined with the heat of the bed has much to do in producing
the erotic manifestations occasionally witnessed. Every physician who has
had much to do with cases of the kind knows that sleeping upon the back,
by which means the blood gravitates to the generative organs and to the
lower part of the spinal cord, will often give rise to seminal emissions
with or without erotic dreams, and that such occurrences may generally be
prevented by the individual avoiding the dorsal decubitus and resting upon
one side or the other while asleep. The erections which the generality of
healthy men experience in the morning before rising from bed are likewise
due to the fact that the recumbent posture favors the flow of blood to the
penis and testicles. Such erections are usually unaccompanied by venereal
desire.

The ganglionic nervous system and the spinal cord continue in action
during sleep, though generally with somewhat diminished power and
sensibility. The reflex faculty of the latter organ is still maintained,
and thus various movements are executed without the consciousness of the
brain being awakened. Somnambulism is clearly a condition of exaltation in
the functions of the spinal cord without the controlling influence of the
cerebrum being brought into action. But, aside from this rather abnormal
phenomenon, there are others which are entirely within the range of
health, and which show that the spinal cord is awake, even though the
sleep be most profound. Thus, for instance, if the position of the sleeper
becomes irksome, it is changed; if the feet become cold, they are drawn up
to a warmer part of the bed; and cases are recorded in which individuals
have risen from bed and emptied a distended bladder without awaking.

The instances brought forward in a previous chapter of persons riding on
horseback and walking during sleep show the activity of the spinal cord,
and not that the will is exercised; and Cabanis[33] is wrong in the view
which he gives of such phenomena in the following extract.

Speaking of cases like those just referred to, he says:

“These rare instances are not the only ones in which movements are
observed produced during sleep by that portion of the will which is awake;
for it is by virtue of certain direct sensations that a sleeping man moves
his arm to brush away the flies from his face, that he draws the cover
around him so as to envelop himself carefully, or that he turns in bed
till he has found a comfortable position. It is the will which during
sleep maintains the contraction of the sphincter of the bladder,
notwithstanding the effort of the urine to escape.”

Such examples as the above we now know to be instances of reflex action,
and as not, therefore, being due to the exercise of the will.

Sleep favors the occurrence of certain pathological phenomena. Thus
individuals affected with hæmorrhoids have the liability to hemorrhage
increased when they are asleep. Several instances of the kind have come
under my notice. In one the patient lost so large a quantity of blood that
syncope ensued and might have terminated fatally had not his condition
been accidentally discovered. Bleeding from the lungs is also more apt to
occur during sleep in those who are predisposed to it. Darwin states that
a man of about fifty years of age, subject to hæmorrhoids, was also
attacked with hæmoptysis three consecutive nights at about the same
hour--two o’clock--being awakened thereby from a state of very profound
sleep. He was advised to suffer himself to be roused at one o’clock, and
to leave his bed at that hour. He did so with the result not only of
entirely breaking up the hemorrhagic disposition, but also of curing
himself of very violent attacks of headache, to which he had been subject
for many years.

Epileptic fits are also more liable to occur during sleep than at other
times, a fact not always susceptible of easy explanation. In a case of
epilepsy now under my charge, this proclivity is so well marked that the
patient, a lady, scarcely ever goes to sleep without being attacked. Her
face becomes exceedingly pale just before the fit, and if then seen the
paroxysm can be entirely prevented by waking her. She is never attacked at
other times, and I am trying, with excellent results thus far, the plan of
making her sleep altogether during the day and of waking her as soon as
her face becomes pallid. It is probable that the fits in her case are due
to a diminished amount of blood in the brain, and this supposition is
strengthened by the additional fact that bromide of potassium--a substance
which, as I have shown, lessens the amount of intracranial
blood--invariably rendered her paroxysms more frequent and severe.

Sleep predisposes to attacks of gout in those who have the gouty
diathesis, and likewise favors exacerbations in several other diseases
which it is scarcely necessary to allude to specifically. The accession of
fever toward night, and the increase which takes place in pain due to
inflammation are generally associated with the approach of night, and have
no direct relation with sleep.

Certain other morbid phenomena, such as somnambulism and nightmare, which
have a necessary relation with sleep, will be more appropriately
considered in another place.

On the other hand, sleep controls the manifestations of several diseases,
especially those which are of a convulsive or spasmodic character. Thus
the paroxysms of chorea cease during sleep, as do likewise the spasms of
tetanus and hydrophobia. Headache is also generally relieved by sleep,
though occasionally it is aggravated.



CHAPTER IV.

THE STATE OF THE MIND DURING SLEEP.


We have seen that though during sleep the operations of the senses are
entirely suspended as regards the effects of ordinary impressions, the
purely animal functions of the body continue in action. The heart beats,
the lungs respire, the stomach, the intestines, and their accessory organs
digest, the skin exhales vapor, and the kidneys secrete urine. With the
central nervous system, however, the case is very different; for while
some parts retain the property of receiving impressions or developing
ideas, others have their actions diminished, exalted, perverted, or
altogether arrested.

In the first place, there is, undoubtedly, during sleep, a general torpor
of the sensorium, which prevents the appreciation of the ordinary
excitations made upon the organs of the special senses. So far as the
nerves themselves are concerned, there is no loss of their irritability or
conducting power, and the impressions made upon them are, accordingly,
perfectly well conveyed to the brain. The suspension of the operations of
the senses is not therefore due to any loss of function in the optic
nerve, the auditory nerve, the olfactory nerve, the gustatory nerve, or
the cranial or spinal nerves concerned in the sense of touch, but solely
to the inability of the brain to take cognizance of the impressions
conveyed to it. In regard to the cause of this torpor, I have given my
views in a previous chapter.

Now it must not be supposed that because mild excitations transmitted by
the nerves of the special senses are incapable of making themselves felt,
that therefore the brain is in a state of complete repose throughout all
its parts. So far from such a condition existing, there are very decided
proofs that several faculties are exercised to a degree almost equaling
that reached during wakefulness, and we know that if the irritations made
upon the senses be sufficiently strong, the brain _does_ appreciate them,
and the sleep is broken. This ability to be readily roused through the
senses constitutes one of the main differences between sleep and stupor,
upon which stress has been already laid.

Relative to the different faculties of the mind as affected by sleep,
great variations are observed. It has been thought by some authors that
several of them are really exalted above the standard attained during
wakefulness, but this is probably a wrong view. The predominance which one
or two mental qualities apparently assume is not due to any absolute
exaggeration of power, but to the suspension of the action of other
faculties, which, when we are not asleep, exercise a governing or
modifying influence. Thus, for instance, as regards the imagination,--the
faculty of all others which appears to be most increased,--we find, when
we carefully study its manifestations in our own persons, that although
there is often great brilliancy in its vagaries, that uncontrolled as it
is by the judgment, the pictures which it paints upon our minds are
usually incongruous and silly in the extreme. Even though the train of
ideas excited by this faculty when we are asleep be rational and coherent,
we are fully conscious on awaking that we are capable of doing much better
by intentionally setting the brain in action and governing it by our will
and judgment.

Owing to the fact that these two faculties of the mind are incapable of
acting normally during sleep, the imagination is left absolutely without
controlling influence. Indeed, we are often cognizant in those dreams
which take place when we are half awake, of an inability to direct it. The
impressions which it makes upon the mind are, therefore, intense, but of
very little durability. Many stories are told of its power--how problems
have been worked out, poetry and music composed, and great undertakings
planned; but if we could get at the truth, we should probably find that
the imagination of sleep had very little to do with the operations
mentioned. Indeed, it is doubtful if the mind of a sleeping person can
originate ideas. Those which are formed are, as Locke[34] remarks, almost
invariably made up of the waking man’s ideas, and are for the most part
very oddly put together; and we are all aware how commonly our dreams are
composed of ideas, or based upon events which have recently occurred to
us.

In the previous section to the one just quoted, Locke refers to the
exaggeration of ideas which form so common a feature of our mental actions
during sleep. “It is true,” he says, “we have sometimes instances of
perception while we are asleep, and retain the memory of those thoughts;
but how extravagant and incoherent for the most part they are, how little
conformable to the perfection and order of a rational being, those
acquainted with dreams need not be told.”

And yet many remarkable stories are related, which tend to show the high
degree of activity possessed by the mind during sleep. Thus it is said of
Tartini,[35] a celebrated musician of the eighteenth century, that one
night he dreamed he had made a compact with the devil, and bound him to
his service. In order to ascertain the musical abilities of his servitor,
he gave him his violin, and commanded him to play a solo. The devil did
so, and performed so admirably that Tartini awoke with the excitement
produced, and seizing his violin, endeavored to repeat the enchanting
air. Although he was unable to do this with entire success, his efforts
were so far effectual that he composed one of the most admired of his
pieces, which in recognition of its source he called the “devil’s sonata.”

Coleridge gives the following account of the composition of the fragment,
Kubla Khan:

“In the summer of 1797, the author, then in ill health, had retired to a
lonely farm-house, between Perlock and Linton, on the Exmoor confines of
Somerset and Devonshire. In consequence of a slight indisposition, an
anodyne had been prescribed, from the effects of which he fell asleep in
his chair at the moment that he was reading the following sentence, or
words of the same substance, in Purchas’s Pilgrimage: ‘Here the Khan Kubla
commanded a palace to be built, and a stately garden thereunto. And thus
ten miles of fertile ground were inclosed with a wall.’ The author
continued for about three hours in a profound sleep, at least of the
external senses, during which time he had the most vivid confidence that
he could have composed not less than from two to three hundred lines, if
that, indeed, can be called composition, in which all the images rose up
before him as _things_ with a parallel production of the corresponding
expression without any sensation or consciousness of effort. On awaking,
he appeared to himself to have a distinct recollection of the whole; and
taking his pen, ink, and paper, instantly and eagerly wrote down the
lines that are here preserved. At this moment he was unfortunately called
out by a person on business from Perlock, and detained by him above an
hour; and on his return to his room, found to his no small surprise and
mortification, that though he still retained some vague and dim
recollection of the general purport of the vision, yet with the exception
of some eight or ten scattered lines and images, all the rest had passed
away like the images on the surface of a stream into which a stone had
been cast, but, alas! without the after restoration of the latter.”

Dr. Cromwell,[36] citing the above instance of poetic inspiration during
sleep, states that, having like Coleridge taken an anodyne during a
painful illness, he composed the following lines of poetry, which he wrote
down within half an hour after awaking. These lines, though displaying
considerable imagination, are not remarkable for any other quality.

“Lines composed in sleep on the night of January 9th, 1857.

  “SCENE.--_Windsor Forest._

  “At a vista’s end stood the queen one day
   Relieved by a sky of the softest hue;
   It happen’d that a wood-mist risen new,
   Had made that white which should have been blue.
   A sunbeam sought on her form to play;
   It found a nook in the bowery nave,
   Through which with its golden stem to lave
   And kiss the leaves of the stately trees
   That fluttered and rustled beneath the breeze;
   But it touched not her, to whom ’twas given
   To walk in a white light pure as heaven.”

In the last two of these instances it is impossible to say whether the
individuals were really asleep or not, as the opium or other narcotic
taken is a very disturbing factor in both conditions, and doubtless was
the exciting cause of the activity in the imagination. No more graphic
account of the effects of opium in arousing the imagination to its highest
pitch has been written than that given by De Quincey.[37] He says:

“At night when I lay awake in bed, vast processions passed along in
mournful pomp; friezes of never-ending stories, that to my feelings were
as sad and solemn as if they were stories drawn from times before Œdipus
or Priam, before Tyre, before Memphis. And at the same time a
corresponding change took place in my dreams; a theater seemed suddenly
opened and lighted up within my brain, which presented nightly spectacles
of more than earthly splendor.” And then, after referring to the various
scenes of architectural magnificence, and of beautiful women which his
imagination conceived, and which forcibly recalls to our minds the
poetical effusions of Coleridge and Cromwell, he gives the details of
another dream, in which he heard music. “A music of preparation, of
awakening suspense; a music like the opening of the Coronation Anthem, and
which like _that_ gave the feeling of a vast march, of infinite cavalcades
filing off, and the tread of innumerable armies.”

In reference to this subject, Dr. Forbes Winslow[38] relates the following
interesting case:

“A feeble, sensitive lady, suffering from a uterine affection, writes to
us as follows concerning the influence of three or four
sixteenth-of-a-grain doses of hydrochlorate of morphia: ‘After taking a
few doses of morphia, I felt a sensation of extreme quiet and wish for
repose, and on closing my eyes, visions, if I may so call them, were
constantly before me, and as constantly changing in their aspect: scenes
from foreign lands; lovely landscapes, with tall, magnificent trees
covered with drooping foliage, which was blown gently against me as I
walked along. Then in an instant I was in a besieged city filled with
armed men. I was carrying an infant, which was snatched from me by a
soldier and killed upon the spot. A Turk was standing by with a scimitar
in his hand, which I seized, and attacking the man who had killed the
child, I fought most furiously with him and killed him. Then I was
surrounded, made prisoner, carried before a judge and accused of the
deed; but I pleaded my own cause with such a burst of eloquence (which,
by-the-by, I am quite incapable of in my right mind) that judge, jury, and
hearers acquitted me at once. Again, I was in an Eastern city visiting an
Oriental lady, who entertained me most charmingly. We sat together on rich
ottomans, and were regaled with supper and confectionery. Then came soft
sounds of music at a distance, while fountains were playing and birds
singing, and dancing girls danced before us, every movement being
accompanied with the tinkling of silver bells attached to their feet. But
all this suddenly changed, and I was entertaining the Oriental lady in my
own house, and in order to please her delicate taste, I had everything
prepared as nearly as possible after the fashion with which she had so
enchanted me. She, however, to my no small surprise, asked for wine, and
took not one, two, or three glasses, but drank freely, until at last I
became terrified that she would have to be carried away intoxicated. While
considering what course I had better adopt, several English officers came
in, and she at once asked them to drink with her, which so shocked my
sense of propriety that the scene changed and I was in darkness.

“‘Then I felt that I was formed of granite, and immovable. Suddenly a
change came again over me, and I found that I consisted of delicate and
fragile basket-work. Then I became a danseuse, delighting an audience and
myself by movements which seemed barely to touch the earth. Presently
beautiful sights came before me, treasures from the depth of the sea, gems
of the brightest hues, gorgeous shells, coral of the richest colors,
sparkling with drops of water, and hung with lovely seaweed. My eager
glances could not take in half the beautiful objects that passed before me
during the incessant changes the visions underwent. Now I was gazing upon
antique brooches and rings from buried cities; now upon a series of
Egyptian vases; now upon sculptured wood-work blackened by time; and
lastly I was buried amid forests of tall trees, such as I had read of but
never seen.

“‘The sights that pleased me most I had power to a certain extent to
prolong, and those that displeased me I could occasionally set aside, and
I awoke myself to full consciousness once or twice while under the
influence of the morphia by an angry exclamation that I would not have it.
I did not once lose my personal identity.’

“The lady almost invariably suffers more or less from hallucinations of
the foregoing character, if it becomes necessary to administer to her an
opiate: and on analyzing her visions, she can generally refer the
principal portions of them, notwithstanding their confusion and
distortion, to works that she has recently read.”

Opium, in certain doses, increases the amount of blood in the brain, and
this induces a condition very different from that of sleep. In this fact
we have an explanation of the activity of the imagination as one of its
prominent effects. That Coleridge should have composed the Kubla Khan
under its influence is in nowise remarkable. It is probable, however, that
the full influence of his mind was exerted upon it after he awoke to
consciousness, and that the wild fancies excited by the opiate, and based
upon what he had been previously reading, formed the substratum of his
conceptions. In any event, the ideas contained in this fragment are no
more fanciful than those which occurred to De Quincey and the lady whose
case has just been recorded, nor are they more impressively related.

The imagination may therefore be active during sleep, but we have no
authentic instance on record that it has, unaided by causes which exercise
a powerful influence over the intracranial circulation, led to the
production of any ideas which could not be excelled by the individual when
awake. Perhaps the most striking case in opposition to this opinion is one
detailed by Abercrombie,[39] who says:

“The following anecdote has been preserved in a family of rank in
Scotland, the descendants of a distinguished lawyer of the last age. This
eminent person had been consulted respecting a case of great importance
and much difficulty, and he had been studying it with intense anxiety and
attention. After several days had been occupied in this manner, he was
observed by his wife to rise from his bed in the night and go to a
writing-desk which stood in the bed-room. He then sat down and wrote a
long letter, which he put carefully by in the desk and returned to bed.
The following morning he told his wife that he had had a most interesting
dream; that he had dreamt of delivering a clear and luminous opinion
respecting a case which had exceedingly perplexed him, and that he would
give anything to recover the train of thought which had passed before him
in his dream. She then directed him to the writing-desk, where he found
the opinion clearly and fully written out, and which was afterwards found
to be perfectly correct.”

It is probable that this gentleman was actually awake when he arose from
the bed and wrote the paper referred to, and that in the morning he
mistook the circumstance for a dream. It is not at all uncommon for such
errors to be committed, especially under the condition of mental anxiety
and fatigue. A gentleman informed me only a short time since that going to
bed after a very exciting day he thought the next morning that he had
dreamed of a fire occurring in the vicinity of his house. To his surprise
his wife informed him that the supposed dream was a reality, and that he
had got up to the window, looked at the fire, conversed with her
concerning it, and that he was at the time fully awake.

Brierre de Boismont[40] relates the following instance, which is to the
same effect:

“In a convent in Auvergne, an apothecary was sleeping with several
persons; being attacked with nightmare, he charged his companions with
throwing themselves on him and attempting to strangle him. They all denied
the assertion, telling him that he had passed the night without sleeping,
and in a state of high excitement. In order to convince him of this fact,
they prevailed on him to sleep alone in a room carefully closed, having
previously given him a good supper, and even made him partake of food of a
flatulent nature. The paroxysm returned; but, on this occasion, he swore
that it was the work of a demon, whose face and figure he perfectly
described.”

That the imagination may in its flights during sleep strike upon fancies
which are subsequently developed by the reason into lucid and valuable
ideas, is very probable. It would be strange if from among the innumerable
absurdities and extravagancies to which it attains something fit to be
appropriated by the mind should not occasionally be evolved, and thus
there are many instances mentioned of the starting-point of important
mental operations having been taken during sleep. Some of these may be
based upon fact, but the majority are probably of the class of those just
specified, or occurred at an age of the world when a belief in the
supernatural exercised a greater power over men’s minds than it does at
the present day. Among the most striking of them are the following:

Galen declares that he owed a great part of his knowledge to the
revelations made to him in dreams. Whether this was really the case or not
we can in a measure determine by recalling the fact that he was a believer
in the prophetic nature of dreams, and states that a man having dreamt
that one of his legs was turned into stone, soon afterward became
paralytic in this limb, although there was no evidence of approaching
disease. Galen also conducted his practice by dreams, for an athlete,
having dreamt that he saw red spots, and that the blood was flowing out of
his body, was supposed by Galen to require blood-letting, which operation
was accordingly performed.

It has been said[41] that the idea of the _Divina Commedia_ occurred to
Dante during sleep. There is nothing at all improbable in this
supposition, though I have been unable to trace it to any definite source.

Cabanis[42] states that Condillac assured him that often during the course
of his studies he had to leave them unfinished in order to sleep, and that
on awaking he had more than once found the work upon which he was engaged
brought to a conclusion in his brain.

These were clearly instances of “unconscious cerebration” of that power
which the brain possesses to work out matters which have engaged its
attention, without the consciousness of the individual being aroused to a
knowledge of the labor being performed. It is not unlikely that this kind
of mental activity goes on to some extent during sleep, but as it is of
such a character that the mind does not take cognizance of its operations,
I do not see how the exact period of its performance can be ascertained.

Jerome Cardan believed that he composed books while asleep, and his case
is often adduced as an example of the height to which the imagination can
attain during sleep. But this great man was superstitious to an extreme
degree; he believed that he had a familiar spirit, from whom he received
intelligence, warnings, and ideas, and asserted that when awake he
frequently saw long processions of men, women, animals, trees, castles,
instruments of various kinds and many figures, different from anything in
this world. His evidence relative to his compositions and mathematical
labors when asleep is not therefore of a trustworthy character.

As regards the memory in sleep, it is undoubtedly exercised to a
considerable extent. In fact, whatever degree of activity the mind may
then exhibit is based upon events the recollection of which has been
retained. But there is more or less error mingled with a small amount of
truth. The unbridled imagination of the sleeper so distorts the simplest
circumstances as to render their recognition a matter of no small
difficulty, and thus it scarcely if ever happens that events are
reproduced during sleep exactly as they occurred or as they would be
recalled by the mind of the individual when awake. Frequently, also,
recent events which have made a strong impression on our minds are
forgotten, as when we dream of seeing and conversing with persons not long
dead.

And yet it has sometimes happened that incidents or knowledge which had
long been overlooked or forgotten, or which could not be remembered by any
effort during wakefulness have been strongly depicted during sleep. Thus
Lord Monboddo[43] states that the Countess de Laval, a woman of perfect
veracity and good sense, when ill, spoke during sleep in a language which
none of her attendants understood, and which even she was disposed to
regard as gibberish. A nurse detected the dialect of Brittany; her
mistress had spent her childhood in that province, but had lost all
recollection of the Breton tongue, and could not understand a word of what
she said in her dreams. Her utterances applied, however, exclusively to
the experience of childhood, and were infantile in structure.

Abercrombie[44] relates the case of a gentleman who was very fond of the
Greek language, and who, in his youth, had made considerable progress in
it. Subsequently being engaged in other pursuits, he so entirely forgot it
that he could not even read the words; often, however, in his dreams he
read Greek works, which he had been accustomed to use at college, and had
a most vivid impression of fully understanding them.

Many other instances of the action of memory during sleep might be brought
forward, but the subject will be more appropriately considered in the
chapter on dreams.

The judgment is frequently exercised when we are asleep, but almost
invariably in a perverted manner. In fact we scarcely ever estimate the
events or circumstances which appear to transpire in our dreams at their
real value, and very rarely from correct conceptions of right and wrong.
High-minded and honorable men do not scruple during sleep to sanction the
most atrocious acts, or to regard with complaisance ideas which, in their
waking moments, would fill them with horror. Delicate and refined women
will coolly enter upon a career of crime, and the minds of hardened
villains are filled with the most elevated and noble sentiments. The
deeds which we imagine we perform in our sleep are generally inadequate to
or in excess of what the apparent occasion requires, and we lose so
entirely the ideas of probability and possibility, that no preposterous
vision appears otherwise than as perfectly natural and correct. Thus, a
physician dreamed that he had been transformed into a monolith which stood
grandly and alone in the vast desert of the Sahara, and had so stood for
ages, while generation after generation wasted and melted away around him.
Although unconscious of having organs of sense, this column of granite saw
the mountains growing bald with age, the forests drooping with decay, and
the moss and ivy creeping around its crumbling base.[45]

But, although in this instance there was some conception of time, as shown
in the association of the evidences of decay with the lapse of years,
there is in general no correct idea on this subject. Without going into
details which more appropriately belong to another division of this
treatise, I quote the following remarkable example from the essay last
cited. It appeared originally in a biographical sketch of Lavalette,
published in the _Revue de Paris_, and is related by Lavalette as
occurring to him while in prison:

“One night, while I was asleep, the clock of the Palais de Justice struck
twelve and awoke me. I heard the gate open to relieve the sentry, but I
fell asleep again immediately. In this sleep I dreamt that I was standing
in the Rue St. Honore. A melancholy darkness spread around me; all was
still; nevertheless, a slow and uncertain sound soon arose. All of a
sudden, I perceived at the bottom of the street and advancing toward me, a
troop of cavalry,--the men and horses, however, all flayed. The men held
torches in their hands, the red flames of which illuminated faces without
skin, and bloody muscles. Their hollow eyes rolled fearfully in their
sockets, their mouths opened from ear to ear, and helmets of hanging flesh
covered their hideous heads. The horses dragged along their own skins in
the kennels which overflowed with blood on all sides. Pale and disheveled
women appeared and disappeared at the windows in dismal silence; low
inarticulate groans filled the air, and I remained in the street alone
petrified with horror, and deprived of strength sufficient to seek my
safety in flight. This horrible troop continued passing along rapidly in a
gallop, and casting frightful looks upon me. Their march continued, I
thought, for five hours, and they were followed by an immense number of
artillery wagons full of bleeding corpses, whose limbs still quivered; a
disgusting smell of blood and bitumen almost choked me. At length the iron
gates of the prison, shutting with great force, awoke me again. I made my
repeater strike; it was no more than midnight, so that the horrible
phantasmagoria had lasted no more than two or three minutes--that is to
say, the time necessary for relieving the sentry and shutting the gate.
The cold was severe and the watchword short. The next day the turnkey
confirmed my calculations. I, nevertheless, do not remember one single
event in my life the duration of which I have been able more exactly to
calculate, of which the details are deeper engraven on my memory, and of
which I preserve a more perfect consciousness.”

No instance can more strikingly exemplify aberration of the faculty of
judgment than the above. There was no astonishment felt with the horror
experienced, but all the impossible events which appeared to be
transpiring were accepted as facts, which might have taken place in the
regular order of nature.

An important question connected with the exercise of judgment is: does the
dreamer know that he is dreaming? Some authors assert that this knowledge
is possible, others that it is not. The following account is interesting,
and I therefore transcribe it, especially as it has not to my knowledge
been heretofore published in this country.

In a letter to the Rev. William Gregory, Dr. Thomas Reid[46] says:

“About the age of fourteen, I was almost every night unhappy in my sleep
from frightful dreams. Sometimes hanging over a frightful precipice and
just ready to drop down; sometimes pursued for my life and stopped by a
wall or by a sudden loss of all strength; sometimes ready to be devoured
by a wild beast. How long I was plagued by such dreams I do not now
recollect. I believe it was for a year or two at least; and I think they
had quite left me before I was fifteen. In those days I was much given to
what Mr. Addison in one of his Spectators calls castle-building, and, in
my evening solitary walk, which was generally all the exercise I took, my
thoughts would hurry me into some active scene, where I generally
acquitted myself much to my own satisfaction, and in these scenes of
imagination I performed many a gallant exploit. At the same time, in my
dreams, I found myself the most arrant coward that ever was. Not only my
courage, but my strength failed me in every danger, and I often rose from
my bed in the morning in such a panic that it took some time to get the
better of it. I wished very much to get free of these uneasy dreams, which
not only made me unhappy in sleep, but often left a disagreeable
impression in my mind for some part of the following day. I thought it was
worth trying whether it was possible to recollect that it was all a dream,
and that I was in no real danger. I often went to sleep with my mind as
strongly impressed as I could with this thought that I never in my
lifetime was in any real danger, and that every fright I had was a dream.
After many fruitless endeavors to recollect this when the danger appeared,
I effected it at last, and have often, when I was sliding over a precipice
into the abyss, recollected that it was all a dream, and boldly jumped
down. The effect of this commonly was, that I immediately awoke. But I
awoke calm and intrepid, which I thought a great acquisition. After this
my dreams were never very uneasy, and, in a short time, I dreamed not at
all.”

Beattie[47] states that he once dreamed that he was walking on the parapet
of a high bridge. How he came there he did not know, but recollecting that
he was not given to such pranks, he began to think it might all be a
dream, and, finding his situation unpleasant, and being desirous to get
out of it, threw himself headlong from the height, in the belief that the
shock of the fall would restore his senses. The event turned out as he
anticipated.

Aristotle also asserts that when dreaming of danger, he used to recollect
that he was dreaming, and that he ought not to be frightened.

A still more remarkable narration is that of Gassendi,[48] which he thus
relates as occurring to himself:

“A good friend of mine, Louis Charambon, judge of the criminal court at
Digne, had died of the plague. One night, as I slept, I seemed to see him;
I stretched out my arms toward him, and said, ‘Hail thou who returnest
from the place of the dead!’ Then I stopped, reflecting in my dream as
follows: ‘One cannot return from the other world; I am doubtless dreaming;
but if I dream, where am I? Not at Paris, for I came last to Digne. I am
then at Digne, in my house, in my bedroom, in my bed.’ And then, as I was
looking for myself in the bed, some noise, I know not what, awoke me.”

In all these and like instances, it is very probable the individuals were
much more awake than asleep, for certainly the power to judge correctly is
not exercised in dreams, involving even the most incongruous
impossibilities. As Dendy[49] says, “if we _know_ that we are dreaming,
the faculty of judgment cannot be inert, and the dream would be known to
be a fallacy.” There would therefore be no occasion for any such
management of it as that made use of by Reid and Beattie, or for the
recollection of Aristotle. The dream and the correction of it by the
judgment would go together and there would be no self-deception at
all--not even for an instant. Dreams would accordingly be impossible. The
essential feature of mental activity during sleep, absolute freedom of the
imagination, would not exist.

Relative to Gassendi’s case, it is impossible to believe that he was fully
asleep, and the fact that he was awakened by some noise, the nature of
which was unrecognized, and which was therefore probably slight, tends to
support this view. Moreover, although he was, as he thought, enabled to
detect the fallacy of his dream in one respect, his judgment was
altogether at fault in others. Thus he had great difficulty in making out
where he was, and actually so far lost all idea of his identity with the
person dreaming as to look for himself in his own bed! Certainly an
individual whose judgment was thus much deranged would scarcely be able to
reason correctly as to the fact of his dreaming or not, or to question the
possibility of the dead returning to this world.

My opinion therefore is, that during sleep the power of bringing the
judgment into action is suspended. We do not actually lose the power of
arriving at a decision, but we cannot exert the faculty of judgment in
accordance with the principles of truth and of correct reasoning. An
opinion may therefore be formed during sleep, but it is more likely to be
wrong than right, and no effort that we can make will enable us to
distinguish the false from the true, or to discriminate between the
possible and the impossible.

That faculty of the mind--the judgment--which when we are awake is
pre-eminently our guide, can no longer direct us aright. The stores of
experience go for naught, and the mind accepts as truth whatever
preposterous thought the imagination presents to it. We are not entirely
rendered incapable of judging, as some authors assert, but the power to
perceive the logical force of circumstances, to take them at their true
value and to eliminate error from our mental processes, is altogether
arrested, and we arrive at absurd conclusions from impossible premises.

But there is no doubt that at times the faculty of judgment is suspended
as regards some parts of our mental operations during sleep, and this, to
such an extent, that we are like Gassendi in the case quoted, not capable
of recognizing our own individuality. Thus it is related of Dr. Johnson,
that he had once in a dream a contest of wit with some other person, and
that he was very much mortified by imagining that his opponent had the
better of him. “Now,” said he, “one may mark here the effect of sleep in
weakening the power of reflection; for had not my judgment failed me, I
should have seen that the wit of this supposed antagonist, by whose
superiority I felt myself depressed, was as much furnished by me as that
which I thought I had been uttering in my own character.”

Van Goens dreamt that he could not answer questions to which his neighbor
gave correct responses.

An interesting case, in which the judgment was still more at fault, has
recently come to my knowledge.

Mrs. C. dreamed that she was Savonarola, and that she was preaching to a
vast assembly in Florence. Among the audience was a lady whom she at once
recognized to be her own self. As Savonarola, she was delighted at this
discovery, for she reflected that she was well acquainted with all Mrs.
C.’s peculiarities and faults of character, and would, therefore, be
enabled to give special emphasis to them in the sermon. She did this so
very effectively that Mrs. C. burst into a torrent of tears, and, with the
emotion thus excited, the lady awoke. It was some time before she was able
to disentangle her mixed up individualities. When she became fully awake
she perceived that the arguments she had employed to bring about the
conversion of herself were puerile in the extreme, and were directed
against characteristics which formed no part of her mental organization,
and against offenses which she had not committed.

Macario[50] makes the following apposite remarks on the point under
consideration. Referring to the preposterous nature of many dreams, he
says:

“It is astonishing that all these fantastical and impossible visions seem
to us quite natural, and excite no astonishment. This is because the
judgment and reflection having abdicated, no longer control the
imagination nor co-ordinate the thoughts which rush tumultuously through
the brain of the sleeper, combined only by the power of association.

“When I say that the judgment and reflection abdicate, it should not be
inferred that they are abolished and no longer exist, for the imagination
could not, unaided by the reason, construct the whimsical and capricious
images of dreams.”

Relative to the power to work out, during sleep, problems involving long
and intricate mental processes, I have already expressed my opinion
adversely. In this view, I am not alone. Rosenkranz,[51] whose
contributions to psychological science cannot be overestimated, and whose
clear and powerful understanding has rarely been excelled, has pointed out
how such operations of the understanding are impossible; for, as he
remarks, intellectual problems cannot be solved during sleep, for such a
thing as intense thought, accompanied by images, is unknown, whilst dreams
consist of a series of images connected by loose and imperfect reasoning.
Feuchtersleben,[52] referring with approval to this opinion of Rosenkranz,
says that he recollects perfectly having dreamt of such problems, and
being happy in their solution, endeavored to retain them in his memory; he
succeeded, but discovered, on awaking, that they were quite unmeaning, and
could only have imposed upon a sleeping imagination.

Müller[53] says:

“Sometimes we reason more or less correctly in dreams. We reflect on
problems and rejoice in their solution. But on awaking from such dreams,
the seeming reasoning is frequently found to have been no reasoning at
all, and the solution of the problem over which we had rejoiced, to be
mere nonsense. Sometimes we dream that another person proposes an enigma;
that we cannot solve it and that others are equally incapable of doing so;
but that the person who proposed it, himself gives the explanation. We are
astonished at the solution we had so long labored in vain to find. If we
do not immediately awaken and afterwards reflect on this proposition of an
enigma in our dream, and on its apparent solution, we think it wonderful;
but if we awake immediately after the dream, and are able to compare the
answer with the question, we find that it was mere nonsense.”

And in regard to the knowledge that we are dreaming, the same author[54]
observes that:

“The indistinctness of the conception in dreams is generally so great that
we are not aware that we dream. The phantasms which are perceived really
exist in our organs of sense. They afford, therefore, in themselves as
strong proof of the actual existence of the objects they represent, as
our own perceptions of real external objects in the waking state; for we
know the latter only by the affections of our senses which they produce.
When, therefore, the mind has lost the faculty of analyzing the
impressions on our senses, there is no reason why the things which they
seem to represent should be supposed unreal. Even in the waking state
phantasms are regarded as real objects when they occur to persons of
feeble intellect. On the other hand, when the dreaming approaches more
nearly to the waking state, we sometimes are conscious that we merely
dream, and still allow the dream to proceed, while we retain this
consciousness of its true nature.”

Sir Benjamin Brodie,[55] in discussing the subject of wonderful
discoveries made in dreams, and abstruse problems worked out, remarks that
it would indeed be strange if among the vast number of combinations which
constitute our dreams, there were not every now and then some having the
semblance of reality; and further, that in many of the stories of great
discoveries made in dreams, there is much of either mistake or
exaggeration, and that if they could have been written down at the time,
they would have been found to be worth little or nothing.

Another faculty exercised during sleep has been ascribed to the judgment.
It is well known that many persons having made up their minds to awake at
a certain hour invariably do so. I possess this power in a high degree,
and scarcely ever vary a minute from the fixed time. Just as I go to bed I
look at my watch and impress upon my mind the figures on the dial which
represent the hour and minute at which I wish to awake. I give myself no
further anxiety on the subject, and never dream of it, but I always wake
at the desired moment.

Now I cannot conceive what connection the judgment has with this power. In
the case of alarm clocks set to go off at a certain time, the judgment, as
Jouffroy[56] asserts, may take cognizance of the impression made upon the
ear, and establish the relation between it and the wish to awake at a
certain time. But in cases where the awaking is the result of an idea
conceived before going to sleep, and which is not subsequently recalled,
the judgment cannot act, for this faculty is only exercised upon ideas
which are submitted to it. The brain is, as it were, wound up like the
alarm clock and set to a certain hour. When that hour arrives, an
explosion of nervous force takes place, and the individual awakes.

Fosgate[57] asserts that the power of judging during sleep is probably as
good as when we are awake, for decisions are made only on the premises
presented in either case, and if those in the former condition are absurd
or unreasonable, the conclusion will likewise be faulty. But this is not
very accurate reasoning; for it is as much the province of the judgment to
determine the validity of the premises as it is to draw a conclusion from
them, and if it cannot recognize the falsity or truth of propositions the
irrational character of which would be readily perceived during
wakefulness, there is not much to be said in favor of its power.

In fact, however, the conclusions formed in dreams are often without any
logical relation with the premises. Thus, when an individual dreams, as in
the instance previously quoted, that he is a column of stone, it is
contrary to all experience to deduce therefrom the conclusion that he can
see rocks crumbling around him, and can reflect upon the mutability of all
things. The premise of his being a stone pillar being submitted to the
judgment, the proper conclusion would be that he is composed of inorganic
material, is devoid of life, and consequently not possessed of either
sensation or understanding.

Why the judgment is not properly exercised during sleep we do not know.
Dr. Philip[58] believes that in this condition ideas flow so rapidly that
they are not submitted to the full power of the judgment, and that hence
the absurdity which characterizes them is not perceived. But this
explanation is by no means satisfactory; for a merely swift succession of
ideas is no very serious bar to correct judgment, and when the thoughts
are as preposterous as those which so often occur in dreams, they present
no obstacle at all to a proper estimation of them by the healthy mind. The
cause probably resides in some alteration in the circulation of the blood
in that part of the brain which presides over the judgment, whereby its
power is suspended and the imagination left free to fill the mind with its
incongruous and fantastic images.

As regards the will, we find very opposite opinions entertained relative
to its activity; but no one, so far as I am aware, appears to have had
correct views upon the subject. Without going into a full discussion of
the views enunciated, it will be sufficient to refer to the ideas on the
point in question which have been expressed by some of the most eminent
philosophers and physiologists.

In the course of his remarks on sleep, Darwin[59] repeatedly alleges that
during this condition the action of the will is entirely suspended; but he
falls into the singular error of confounding volition with the power of
motion. Thus he says:

“When by one continued posture in sleep some uneasy sensations are
produced, we either gradually awake by the exertion of volition, or the
muscles connected by habit with such sensations alter the position of the
body; but where the sleep is uncommonly profound, and these uneasy
sensations great, the disease called the incubus or nightmare is produced.
Here the desire of moving the body is painfully exerted; but the power of
moving it, or volition, is incapable of action till we are awake.”

In consequence of this misapprehension of the nature of the will, it is
not easy to arrive at Darwin’s ideas on the subject; and the attempt is
rendered still more difficult from the fact that though he repeatedly
states that volition is entirely suspended during sleep, he yet in the
first part of the foregoing quotation makes an individual awake by the
gradual exercise of the power of the will; and then in the last part of
the same paragraph asserts that volition is incapable of action till sleep
is over.

Mr. Dugald Stewart[60] contends that during sleep the power of volition is
not suspended, but that those operations of the mind and body which depend
on volition cease to be exercised. In his opinion the will loses its
influence over all our powers both of mind and body in consequence of some
physical alteration in the system which we shall never probably be able
to explain. To show in full the views of so distinguished a philosopher as
Mr. Stewart, I quote the following extracts from his remarks on the
subject:

“In order to illustrate this conclusion [the one above stated] a little
further, it may be proper to remark that if the suspension of our
voluntary operations in sleep be admitted as a fact, there are only two
suppositions which can be formed regarding its cause. The one is that the
power of volition is suspended; the other that the will loses its
influence over those faculties of the mind and those members of the body
which during our waking hours are subjected to its authority. If it can be
shown then that the former supposition is not agreeable to fact, the truth
of the latter seems to follow as a necessary consequence.

“1. That the power of volition is not suspended during sleep, appears from
the efforts which we are conscious of making while in that situation. We
dream, for instance, that we are in danger, and we attempt to call out for
assistance. The attempt induced is in general unsuccessful, and the sounds
that we emit are feeble and indistinct; but this only confirms, or rather
is a necessary consequence of, the supposition that in sleep the
connection between the will and our voluntary operations is disturbed or
interrupted. The continuance of the power of volition is demonstrated by
the effort, however ineffectual.

“In like manner, in the course of an alarming dream we are sometimes
conscious of making an exertion to save ourselves by flight from an
apprehended danger; but in spite of all our efforts we continue in bed. In
such cases we commonly dream that we are attempting to escape and are
prevented by some external obstacle; but the fact seems to be that the
body is at that time not subject to the will. During the disturbed rest
which we sometimes have when the body is indisposed, the mind appears to
retain some power over it; but as even in these cases the motions which
are made consist rather of a general agitation of the whole system than of
the regular exertion of a particular member of it with a view to produce a
certain effect, it is reasonable to conclude that in perfectly sound sleep
the mind, although it retains the power of volition, retains no influence
whatever over the bodily organs.

“In that particular condition of the system which is known by the name of
_incubus_, we are conscious of a total want of power over the body; and I
believe the common opinion is that it is this want of power which
distinguishes the _incubus_ from all the other modifications of sleep. But
the more probable supposition seems to be that every species of sleep is
accompanied with a suspension of the faculty of voluntary motion; and that
the incubus has nothing peculiar in it but this--that the uneasy
sensations which are produced by the accidental posture of the body, and
which we find it impossible to remove by our own efforts, render us
distinctly conscious of our incapacity to move. One thing is certain, that
the instant of our awaking and of our recovering the command of our bodily
organs is one and the same.

“2. The same conclusion is confirmed by a different view of the subject.
It is probable, as was already observed, that when we are anxious to
procure sleep the state into which we naturally bring the mind approaches
to its state after sleep commences. Now it is manifest that the means
which nature directs us to employ on such occasions is not to suspend the
powers of volition, but to suspend the exertion of those powers whose
exercise depends on volition. If it were necessary that volition should be
suspended before we fall asleep, it would be impossible for us by our own
efforts to hasten the moment of rest. The very supposition of such efforts
is absurd, for it implies a continued will to suspend the acts of the
will.

“According to the foregoing doctrine with respect to the state of the mind
in sleep, the effort which is produced on our mental operations is
strikingly analogous to that which is produced on our bodily powers. From
the observations which have been already made, it is manifest that in
sleep the body is in a very inconsiderable degree, if at all, subject to
our command. The vital and involuntary motions, however, suffer no
interruption, but go on as when we are awake, in consequence of the
operation of some cause unknown to us. In like manner it would appear
that those operations of the mind which depend on our volition are
suspended, while certain other operations are at least occasionally
carried on. This analogy naturally suggests the idea that all our mental
operations which are independent of our will may continue during sleep;
and that the phenomena of dreaming may, perhaps, be produced by these,
diversified in their apparent effects in consequence of the suspension of
our voluntary powers.”

A very little reflection will suffice to convince the reader that Mr.
Stewart has altogether mistaken the nature of sleep. There is no evidence
to support his view that the body is not subject to the action of the will
during sleep. No change whatever is induced by this condition in the
nerves or muscles of the organism. The first are just as capable as ever
of conducting the nervous fluid, and the muscles do not lose any of their
contractile power. The reason why voluntary movements are not performed in
sleep is simply because the will does not act; and Mr. Stewart is again
wrong in asserting that volition is not then suspended. We do not will any
actions when we are asleep. We _imagine_ we do, and that is all. The
difficulties which encompass us in sleep are, it must be recollected,
purely imaginary, and the efforts we make to escape from them are likewise
the products of our fancy. Herein lies the main error which Mr. Stewart
has committed. He appears to accept the dream for a reality, and to
regard the seeming volitions which occur in it as actual facts; whereas
they are all entirely fictitious.

An example will serve to make this point still clearer.

Not long since I dreamed that I stood upon a very high perpendicular
table-land, at the foot of which flowed a river. I thought I experienced
an irresistible desire to approach the brink and to look down. Had I been
awake, such a wish would have been the very last to enter my mind, for I
have an instinctive dread of standing on a height. I dreamed that I threw
myself on my face and crawled to the edge of the cliff. I looked down at
the stream, which scarcely appeared to be as wide as my hand, so great was
the altitude upon which I was placed. As I looked I felt an overpowering
impulse to crawl still farther and to throw myself into the water below. I
imagined that I endeavored with all my will to resist this force, which
appeared to be acting by means altogether external to my organism. My
efforts, however, were all in vain. I could not control my movements, and
gradually I was urged farther and farther over the brink, till at last I
went down into the abyss below. As I struck the water I awoke with a
start. During my imaginary struggle I thought I experienced all the
emotions which such an event if real would have excited, and I was
painfully conscious of my utter inability to escape from the peril of my
situation. Here were circumstances such as, according to Mr. Stewart,
demonstrate the activity of volition, but at the same time show its
inability to act upon the body. But clearly they show no such thing, for
the imaginary volition was to refrain from crawling over a precipice which
did not exist, and over which, therefore, I was not hanging. Such an act
of the will if real, could not in the very nature of the real conditions
of the situation have been carried out--the volition was just as imaginary
as all the other circumstances of the dream.

Again, it is not always the case that the imaginary acts of the will are
not executed during sleep; and hence it would follow from Mr. Stewart’s
argument that the power of the will over the body is not then suspended.
Assuming for the moment that the volitions of sleep are real, as Mr.
Stewart supposes; if it can be shown that they are satisfactorily
performed, it results from his line of reasoning that the will has power
over the body during sleep. Every one who has ever dreamed has at times
had his will carried out to his entire satisfaction. He has ridden horses
when pursued, and has urged them forward with whip and spur so as to
escape from his enemies. Or he has executed the most surprising feats both
with his mind and body, and has performed voluntary deeds which have
excited the admiration of all beholders. Such acts are of course entirely
the product of the imagination, and all the volitions which accompany
them have no firmer basis than the unbridled fancy; but, according to Mr.
Stewart, they would be evidence of the power of the will over the body,--a
power which in reality does not exist; not, however, as Mr. Stewart
supposes from any impediments in the nerves or muscles, but because it is
never exerted.

So far as relates to movements performed during sleep, such as turning in
bed and assuming more comfortable positions, they have nothing whatever to
do with the will. They are dependent upon the action of the spinal cord,
an organ that is never at rest, and the functions of which were not known
as well when Dr. Darwin and Mr. Stewart wrote as they are now. The same is
true of more complex and longer-continued actions, such as those already
mentioned of individuals riding on horseback, or even walking, during
sleep.

Cabanis[61] contends that the will is not entirely suspended during sleep;
but, as will be perceived from the following quotation, he bases his
argument upon the fact that movements are produced which he attributes
erroneously to the action of the will, but which, like those previously
referred to, are accomplished by the agency of the spinal cord. He says,
speaking of the instances of persons walking while asleep:

“These rare cases are not the only ones in which during sleep movements
are produced by what remains of the will; for it is by virtue of certain
direct sensations that a sleeping man moves his arm to brush away the
flies that may be on his face, that he draws up the bedclothes so as to
cover himself carefully; or, as we have already remarked, that he turns
over and endeavors to find a more comfortable position. It is the will
which during sleep maintains the contraction of the sphincter of the
bladder, notwithstanding the effort of the urine to escape; it is the same
power which directs the action of the arm in seeking for the _vase de
nuit_, which knows where to find it, and enables the individual to use it
for several minutes and to return it to its place without being awakened.
Finally, it is not without reason that some physiologists have made the
will concur in the contraction of several muscles, the movements of which
are necessary to the maintenance of respiration during sleep.”

All these movements, and many others of a similar character, are entirely
spinal, and are altogether independent of cerebral influence. Even when we
are awake, we constantly execute muscular actions through the power of the
spinal cord, when the mind is intently occupied with other things. Take
for instance the example of a person playing on the piano, and at the same
time carrying on a conversation. Here the brain is engaged in the one act
and the spinal cord in the other. So long as the player is not expert in
the fingering of the instrument, he cannot divert his attention from his
performance; for the whole power of the mind is required for the proper
appreciation and execution of the music. But after the spinal cord has
become educated to the habit, and he has attained proficiency in the
necessary manipulations, the mind is no longer required to control the
actions and may be directed to other subjects. The arguments of Cabanis,
therefore, in favor of the partial exercise of the will during sleep, are
of no force.

But the power of the will over the muscles of the body is only one of the
ways in which this faculty is shown. It regulates the thoughts and the
manifestations of emotion when we are awake. How utterly incapable it is
of any such action during sleep we all know. A gentleman, remarkable for
the ability he possesses for controlling his feelings, tells me that when
he is asleep he frequently weeps or laughs at imaginary events, which, if
they really had occurred to him during wakefulness, would give rise to no
such disturbance. He often desires to stop these emotional manifestations,
but is entirely powerless to do so. Most individuals have had similar
experiences.

The theory that the will is in action during sleep is, therefore, to my
mind untenable. It has probably had its origin in the idea that confounds
it with desire, from which it differs so markedly that it seems strange
the distinction should ever fail of being made. Locke[62] points out very
clearly the differences between the two faculties. In fact they may be
exerted in directly opposite ways. Desire often precedes volition; but we
all, at times, will acts which are contrary to our desire, and desire to
perform others which we are unable to will.

Reid[63] writes with great perspicuity on this distinction between desire
and will. He says:

“Desire and will agree in this, that both must have an object of which we
must have some conception; and, therefore, both must be accompanied with
some degree of understanding. But they differ in several things.

“The object of desire may be anything which appetite, passion, or
affection leads us to pursue; it may be any event which we think good for
us, or for those to whom we are well affected. I may desire meat or drink,
or ease from pain. But to say that I will meat, or will drink, or will
ease from pain, is not English. There is, therefore, a distinction in
common language between desire and will. And the distinction is, that what
we will must be an action and our own action; what we desire may not be
our own action, it may be no action at all.

“A man desires that his children may be happy, and that they may behave
well. Their being happy is no action at all; their behaving well is not
his action but theirs.

“With regard to our own actions, we may desire what we do not will, and
will what we do not desire; nay, what we have a great aversion to.

“A man athirst has a strong desire to drink; but for some particular
reason he determines not to gratify his desire. A judge from a regard to
justice and to the duty of his office dooms a criminal to die; while, from
humanity or particular affection, he desires that he should live. A man
for health may take a nauseous draught, for which he has no desire, but a
great aversion. Desire, therefore, even when its object is some action of
our own, is only an incitement to will; but it is not volition. The
determination of the mind may be not to do what we desire to do. But as
desire is often accompanied by will, we are apt to overlook the
distinction between them.”

That desire is manifested during sleep there can be no doubt; and Mr.
Stewart, although insisting as he does on the distinction between this
faculty and volition, confounds them in his remarks already quoted. A
person suffering from nightmare has a most intense desire to escape from
his imaginary troubles. In my own dream, to which reference has been made,
my desire to restrain myself from crawling over the precipice was exerted
to the utmost; but the will could not be brought into action. Darwin,[64]
when he says that in nightmare “the _desire_ of moving the body is
painfully exerted, but the _power of moving it, or volition_, is incapable
of action till we awake,” makes the proper distinction between desire and
will; but, as I have already shown, confounds the latter with another very
different faculty.

From the foregoing observations it will be seen that during sleep the
three great divisions of the mind are differently affected.

1. Feeling, embracing sensation and emotion, is suspended, so far as the
first is concerned; but is in full action as regards the second. We do not
see, hear, smell, taste or enjoy the sense of touch in sleep, although the
brain may be aroused into activity and we may awake through the
excitations conveyed to it by the special senses. The emotions have full
play, unrestrained by the will and governed only by the imagination.

2. The Will or Volition is entirely suspended.

3. The Thought or Intellect is variously affected in its different powers.
The imagination is active, and the memory may be exercised to a great
extent; but the judgment, perception, conception, abstraction, and reason
are weakened, and sometimes altogether lost.



CHAPTER V.

THE PHYSIOLOGY OF DREAMS.


The subject of the foregoing chapter is so intimately connected with the
phenomena of dreaming, and I have expressed my views in regard to it at
such length, that but few psychological points remain to be considered in
the present discussion. What I have to say, therefore, in regard to the
physiology of dreaming must be read in connection with the chapter on
“_The State of the Mind during Sleep_,” in order that the whole matter may
be fully understood.

It is contended by some writers that the mind is never at rest, and that
even during the most profound sleep dreams take place, which are either
forgotten immediately, or which make no impression on the memory. That
this view is erroneous is, I think, very evident. If it were correct, the
first object of sleep--rest for the brain--would not be attained. We all
know how fatigued we are, and how indisposed to exertion the brain is,
after a night of continued dreaming, and we can easily imagine what would
be the consequences if such a condition were kept up night after night. To
say that we really do dream not only every night, but every instant of
the night, in fact always and continually when we sleep, but that we
forget our dreams as soon as they are formed, remembering solely those
which are most vivid, is making assertions which not only are without
proof, but which are impossible of proof. For if, as Locke[65] remarks,
the sleeping man on awaking has no recollection of his thoughts, it is
very certain that no one else can recollect them for him.

The observations of Locke on this point are extremely appropriate, and, to
my mind, very philosophical and logical. After insisting that, sleeping or
waking, a man cannot think without being sensible of it, he says:[66]

“I grant that the soul of a waking man is never without thought, because
it is the condition of being awake; but whether sleeping without dreaming
be not an affection of the whole man, mind as well as body, may be worth a
waking man’s consideration, it being hard to conceive that anything should
think and not be conscious of it. If the soul doth think in a sleeping man
without being conscious of it, I ask, whether during such thinking it has
any pleasure or pain, or be capable of happiness or misery? I am sure the
man is not, any more than the bed or earth he lies on, for to be happy or
miserable without being conscious of it seems to me utterly inconsistent
and impossible. Or if it be possible that the soul can, while the body is
sleeping, have its thinkings, enjoyments, and concerns, its pleasure or
pain, about which the man is not conscious of nor partakes in, it is
certain that Socrates asleep and Socrates awake is not the same person;
but his soul when he sleeps and Socrates the man, consisting of body and
soul when he is waking, are two persons, since waking Socrates has no
knowledge of or concernment for that happiness or misery of his soul which
it enjoys alone by itself while he sleeps without perceiving anything of
it, any more than he has for the happiness or misery of a man in the
Indies whom he knows not; for if we take wholly away all consciousness of
our actions and sensations, especially of pleasure and pain, and the
concernment that accompanies it, it will be hard to know wherein to place
personal identity.”

In a subsequent section of the same chapter, Locke asserts that most men
pass a great part of their lives without dreaming, and that he once knew a
scholar who had no bad memory, who told him he had never dreamed in his
life till after the occurrence of a fever in the twenty-fifth or
twenty-sixth year of his age.

Examples of persons who have not ordinarily dreamed are adduced by the
ancient writers. Pliny[67] refers to men who never dreamed. Plutarch[68]
alludes to the case of Cleon, who, in living to an advanced age, had yet
never dreamed; and Suetonius[69] declares that before the murder of his
mother he had never dreamed.

A lady who was under my care for a serious nervous affection declared to
me that she never had had but one dream in her life, and that was after
receiving a severe fall in which she struck her head.

And yet, notwithstanding the experience of every one that sleep often
happens without the accompaniment of dreams, the great majority of writers
hold the view that the brain is never at rest. Doubtless this opinion has
its origin partly in the doctrine that the mind is a something altogether
independent of and superior to the brain. They appear to be incapable of
appreciating the fact that when the brain is in a state of complete repose
there can be no mental manifestation, and that all intellectual phenomena
are the results of cerebral activity. Another cause for their belief is
the fact that they make no distinction between dreaming and thinking,
whereas it is very evident that the two are not to be placed in the same
category. Thinking is an _action_ which requires cerebral effort, and
which is undertaken with a determinate purpose. We will to think, and we
think what we please; but it is very different with our dreams, which
come and go without any power on our part to regulate or direct them. To
think requires all the faculties of the mind; to dream necessitates only
the memory and the imagination. In thinking, the brain is active in all
its parts; in dreaming, it is nearly entirely quiescent.

Writers who contend for the doctrine of constant mental activity regard
the brain as the organ or tool of the mind, a structure which the mind
makes use of in order to manifest itself. Such a theory is certain to lead
them into difficulties, and is contrary to all the teaching of physiology.
The full discussion of this question would be out of place here; I will,
therefore, only state that this work is written from the stand-point of
regarding the mind as nothing more than the result of cerebral action.
Just as a good liver secretes good bile, a good candle gives good light,
and good coal a good fire, so does a good brain give a good mind. When the
brain is quiescent there is no mind.

Lemoine[70] begins his chapter “_On the State of the Mind during Sleep_”
with the assertion that “there is no sleep for the mind.” He is obliged,
however, to admit that “when the organs of the body are benumbed by sleep,
the mind appears to be in a particular state; it seems to be submitted to
other laws than those which govern it during wakefulness; it seems to
have lost for a time its most precious faculties.”

During sleep the mind is, as he supposes, in a particular state, for, as
has been shown in the previous chapter, it has lost many of its chief
parts. The laws which govern it are, however, the same which always
regulate it. The body upon which their power is primarily exercised--the
brain--is not in the same condition during sleep as during wakefulness,
and hence the differences in the evidences of cerebral activity.

Sir William Hamilton[71] is generally considered to have determined
affirmatively the question of the continuance of the action of the brain
during sleep. He caused himself to be aroused from sleep at intervals
through the night, and invariably found that he was disturbed from a
dream, the particulars of which he could always distinctly recollect. But
a full knowledge of the subject he was investigating would have sufficed
to convince Sir William that the conclusion he drew from his experiments
was altogether fallacious. It is well known that dreams are excited by
strong impressions made upon the senses, or by irritations arising in the
internal organs. Thus Baron Trenck relates that when confined in his
dungeon he suffered the pangs of hunger almost continually, and that his
dreams at night were always of delicate meats and sumptuous repasts,
spread before him on luxuriously-furnished tables. The mere excitation of
waking a sleeping person is generally sufficient to give rise to a dream.
Maury, in his very interesting work, to which reference has already been
made, and which will hereafter be more specifically considered, adduces
many examples of dreams produced by sensorial impressions. I have myself
performed many experiments with reference to this point, and have
generally found ample confirmation of Maury’s investigations. It may
therefore, I think, be assumed, without any violence to the actual facts
of the cases, that the brain is not always in action, and that there are
times when we sleep without dreaming.

In the previous chapter the idea is sought to be conveyed that we
originate nothing in our dreams. We may conceive of things which never
existed, or of which we have heard or read, but the images we make of them
are either composed of elements familiar to us, or else are based upon
ideal representations which we have formed in our waking moments. Thus,
before the discovery of America no Europeans ever dreamed of American
Indians, for the reason that nothing existed within their knowledge which
could give any idea of the appearance of such human beings. It is possible
that Columbus and his companions may have dreamed of the continent of
which they were in search and of its natives, but the images formed of the
latter must necessarily have resembled other beings they had seen, or
which they had heard described. After the discovery, however, it was no
unusual thing for the Spaniards and others to have correct images of
Indians appear to them in their dreams.

Dreams, therefore, must have a foundation, and this is either impressions
made upon the mind at some previous period, or produced during sleep by
bodily sensations. These impressions, however they may be formed, are
subjected to the unrestrained influence of the imagination.

At first sight it may seem that we often have dreams not excited by actual
sensations, and which have no relation to any events of our lives, or any
ideas which have passed through our minds, but thorough investigation will
invariably reveal the existence of an association between the dream and
some such ideas or events. For instance, a few nights ago I dreamed that a
gentleman, a friend of mine, had invented what he called a “dog-cart
ambulance,” a vehicle which he declared was the best ever made for the
transportation of sick or wounded men. On awaking, all the particulars
were fresh in my mind, but I could not for some time perceive why I had
had such a dream. At last I recollected that the morning before a
gentleman had given me a very full description of Prospect Park, in
Brooklyn. The friend of whom I dreamed has charge of the construction of
this Park. His presence was, therefore, fully explained, and as dog-carts
are driven in parks, this link was also accounted for. The ambulance part
was due to the fact that I had that same morning found the card of a
gentleman upon my table who really had invented an ambulance. The
imagination had, therefore, taken these data supplied by the memory, and
had combined them into the incongruous web constituting my dream.

Dreams are also frequently built upon circumstances which have transpired
many years previously, and which have long since apparently passed from
our recollection. A very striking instance of this kind is related by
Abercrombie,[72] on the authority of Sir Walter Scott.

“Mr. R. J. Rowland, a gentleman of landed property in the vale of Gala,
was prosecuted for a very considerable sum, the accumulated arrears of
teind (tithe), for which he was said to be indebted to a noble family the
titulars (lay impropriators of the tithe). Mr. R. was strongly impressed
with the belief that his father had, by a form of process peculiar to the
law of Scotland, purchased these teinds from the titular, and, therefore,
that the present prosecution was groundless. But after an industrious
search among his father’s papers, an investigation of the public records,
and a careful inquiry among all persons who had transacted law business
for his father, no evidence could be discovered to support his defense.
The period was now near at hand when he conceived the loss of his lawsuit
to be inevitable, and he had formed his determination to ride to Edinburgh
next day, and make the best bargain he could in the way of compromise. He
went to bed with this resolution, and, with all the circumstances of the
case floating upon his mind, had a dream to the following purpose. His
father, who had been many years dead, appeared to him, he thought, and
asked him why he was disturbed in his mind. In dreams men are not
surprised at such apparitions. Mr. R. thought that he informed his father
of the cause of his distress, adding that the payment of a considerable
sum of money was the more unpleasant to him, because he had a stray
consciousness that it was not due, though he was unable to recover any
evidence in support of his belief. ‘You are right, my son,’ replied the
paternal shade; ‘I did acquire right to these teinds, for payment of which
you are now prosecuted. The papers relating to the transaction are in the
hands of Mr. ----, a writer (or attorney), who is now retired from
professional business, and resides at Inveresk, near Edinburgh. He was a
person whom I employed on that occasion for a particular reason, but who
never, on any other occasion, transacted business on my account. It is
very possible,’ pursued the vision, ‘that Mr. ---- may have forgotten a
matter which is now of a very old date; but you may call it to his
recollection by this token--that when I came to pay his account there was
difficulty in getting change for a Portugal piece of gold, and that we
were forced to drink out the balance at a tavern.’

“Mr. R. awaked in the morning with all the events of the vision impressed
on his mind, and thought it worth while to ride across the country to
Inveresk, instead of going straight to Edinburgh. When he came there he
waited on the gentleman mentioned in the dream, a very old man; without
saying anything of the vision, he inquired whether he remembered having
conducted such a matter for his deceased father. The old gentleman could
not at first bring the circumstance to his recollection, but, on mention
of the Portugal piece of gold, the whole returned upon his memory; he made
an immediate search for the papers and recovered them, so that Mr. R.
carried to Edinburgh the documents necessary to gain the cause which he
was on the verge of losing.”

A friend has related to me some circumstances in his own case similar to
the above, and illustrating the same points. In the course of his practice
as a lawyer, it became necessary for him to ascertain the exact age of a
client, who was also his cousin. Their grandfather had been a rather
eccentric personage, who had taken a great deal of notice of both his
grandsons--his only direct descendants. He died when they were boys. My
friend often told his cousin that if his grandfather were alive there
would be no difficulty at getting at the desired information, and that he
had a dim recollection of having seen a record kept by the old gentleman,
and of there being some peculiarity about it which he could not recall.
Several months elapsed, and he had given up the idea of attempting to
discover the facts of which he had been in search, when, one night, he
dreamed that his grandfather came to him and said: “You have been trying
to find out when J---- was born; don’t you recollect that one afternoon
when we were fishing I read you some lines from an Elzevir Horace, and
showed you how I had made a family record out of the work by inserting a
number of blank leaves at the end? Now, as you know, I devised my library
to the Rev. ---- ----. I was a d----d fool for giving him books which he
will never read! Get the Horace, and you will discover the exact hour at
which J---- was born.” In the morning all the particulars of this dream
were fresh in my friend’s memory. The reverend gentleman lived in a
neighboring city; my friend took the first train, found the copy of
Horace, and at the end the pages constituting the family record, exactly
as had been described to him in the dream. By no effort of his memory,
however, could he recollect the incidents of the fishing excursion.

Dr. Macnish,[73] in stating his opinion that dreams are uniformly the
resuscitation or re-embodiment of thoughts which have formerly, in some
shape or other, occupied the mind, relates the following example from his
own experience:

“I lately dreamed that I walked upon the banks of the great canal in the
neighborhood of Glasgow. On the side opposite to that on which I was, and
within a few feet of the water, stood the splendid portico of the Royal
Exchange. A gentleman whom I knew was standing upon one of the steps, and
we spoke to each other. I then lifted a large stone and poised it in my
hand, when he said that he was certain I could not throw it to a certain
spot, which he pointed out. I made the attempt, and fell short of the
mark. At this moment a well-known friend came up, whom I knew to excel at
_putting_ the stone; but, strange to say, he had lost both his legs, and
walked upon wooden substitutes. This struck me as exceedingly curious, for
my impression was that he had only lost one leg, and had but a single
wooden one. At my desire he took up the stone, and, without difficulty,
threw it beyond the point indicated by the gentleman upon the opposite
side of the canal. The absurdity of this dream is extremely glaring, and
yet, on strictly analyzing it, I find it to be wholly composed of ideas
which passed through my mind on the previous day, assuming a new and
ridiculous arrangement. I can compare it to nothing but to cross reading
in the newspapers, or to that well-known amusement which consists in
putting a number of sentences, each written on a separate piece of paper,
into a hat, shaking the whole, then taking them out, one by one, as they
come, and seeing what kind of medley the heterogeneous compound will make
when thus fortuitously put together. For instance, I had, on the above
day, taken a walk to the canal along with a friend. On returning from it,
I pointed out to him a spot where a new road was forming, and where, a few
days before, one of the workmen had been overwhelmed by a quantity of
rubbish falling upon him, which fairly chopped off one of his legs, and so
much damaged the other that it was feared amputation would be necessary.
Near this very spot there is a park, in which, about a month previously, I
practiced throwing the stone. On passing the Exchange, on my way home, I
expressed regret at the lowness of its situation, and remarked what a fine
effect the portico would have were it placed upon more elevated ground.
Such were the previous circumstances, and let us see how they bear upon
the dream. In the first place, the canal appeared before me. 2. Its
situation is an elevated one. 3. The portico of the Exchange occurring to
my mind as being placed too low became associated with the elevation of
the canal, and I placed it close by on a similar altitude. 4. The
gentleman I had been walking with was the same whom in the dream I saw
standing upon the steps of the portico. 5. Having related to him the story
of the man who lost one limb and had a chance of losing another, this idea
brings before me a friend with a pair of wooden legs, who, moreover,
appears in connection with patting the stone, as I knew him to excel at
that exercise. There is only one other element in the dream which the
preceding events will not account for, and that is the surprise at the
individual referred to having more than one wooden leg. But why should he
have even one, seeing that in reality he is limbed like other people? This
also I can account for. Two years ago he slightly injured his knee while
leaping a ditch, and I remember jocularly advising him to get it cut off.
I am particular in illustrating this point with regard to dreams, for I
hold that if it were possible to analyze them all, they would invariably
be found to stand in the same relation to the waking state as the above
specimen. The more diversified and incongruous the character of a dream,
and the more remote from the period of its occurrence the circumstances
which suggested it, the more difficult does its analysis become; and, in
point of fact, this process may be impossible, so totally are the elements
of the dream often dissevered from their original sense, and so
ludicrously huddled together.”

A dream which Professor Maas,[74] of Halle, relates as having occurred to
himself, affords an excellent example of the dependence of dreams upon
actual events, and shows how these latter are distorted and perverted by
the imagination of the sleeper.

“I dreamed once,” he says, “that the Pope visited me. He commanded me to
open my desk, and he carefully examined all the papers it contained. While
he was thus employed, a very sparkling diamond fell out of his triple
crown into my desk, of which, however, neither of us took any notice. As
soon as the Pope had withdrawn I retired to bed, but was soon obliged to
rise on account of a thick smoke, the cause of which I had yet to learn.
Upon examination I discovered that the diamond had set fire to the papers
in my desk, and burned them to ashes.”

In analyzing the circumstances which gave rise to this dream, Professor
Maas relates the following events, which constituted its basis:

“On the preceding evening I was visited by a friend with whom I had a
lively conversation upon Joseph II.’s suppression of monasteries and
convents. With this idea, though I did not become conscious of it in the
dream, was associated the visit which the Pope publicly paid the Emperor
Joseph, at Vienna, in consequence of the measures taken against the
clergy; and with this again was combined, however faintly, the
representation of the visit which had been paid me by my friend. These two
events were, by the subreasoning faculty, compounded into one, according
to the established rule--that things which agree in their parts also
correspond as to the whole; hence the Pope’s visit was changed into a
visit paid to me. The subreasoning faculty, then, in order to account for
this extraordinary visit, fixed upon that which was the most important
object in my room--namely, the desk, or rather the papers which it
contained. That a diamond fell out of the triple crown was a collateral
association, which was owing merely to the representation of the desk.
Some days before, when opening the desk, I had broken the crystal of my
watch, which I held in my hand, and the fragments fell among the papers;
hence no further attention was paid to the diamond being a representation
of a collateral series of things. But afterwards the representation of the
sparkling stone was again excited, and became the prevailing idea; hence
it determined the succeeding association. On account of its similarity it
excited the representation of fire, with which it was confounded; hence
arose fire and smoke. But in the event the writings only were burned, not
the desk itself, to which, being of comparatively little value, the
attention was not directed.”

Feuchtersleben[75] takes the same view of dreaming as that enunciated in
this chapter. Thus he says:

“Dreaming is nothing more than the occupation of the mind in sleep with
the pictorial world of fancy. As the closed or quiescent senses afford it
no materials, the mind, ever active, must make use of the store which
memory retains; but as its motor influence is likewise organically
impeded, it cannot independently dispose of this store. Thus arises a
condition in which the mind looks, as it were, on the play of the images
within itself, and manifests only a faint or partial reaction.”

Locke[76] contends that “the dreams of a sleeping man are all made up of
the waking man’s ideas oddly put together.”

Observation and reflection show us that the mind originates nothing during
sleep; it merely remembers--and often in the most chaotic manner--the
thoughts, the fancies, the impressions which have been imagined or
received by the individual when awake. Sometimes ideas are reproduced in
dreams exactly as they have occurred to us in our waking moments, and this
may take place night after night with scarcely the alteration of a single
circumstance. A friend informs me that he is very subject to dreams of
this character, and that on some occasions the repetition has taken place
as many as a dozen times.

A very striking instance of this kind occurred to me a few years since,
and made a deep impression on my mind. I had just read Schiller’s ode to
Laura, as translated by Sir E. Bulwer Lytton, beginning,

  “Who and what gave to me the wish to woo thee?”

and admired it as a striking piece of versification conveying some noted
philosophical ideas in a forcible and beautiful manner. The following
night I had a very vivid dream of a condition of pre-existence, in which I
imagined myself to be. The connection between the dream and the poem I had
been reading was sufficiently well marked, and did not astonish me. I was,
however, surprised to find that the next night I had exactly the same
dream, and that it was repeated three times subsequently on consecutive
nights.

The dependence of dreams upon ideas which we have had when awake was well
known to the ancients. Thus Lucius Accius,[77] a poet who lived more than
a hundred and fifty years before the Christian era, says:

  “Quae in vita usurpant homines, cogitant, curant, vident
   Quaeque agunt vigilantes, agitantque casi cui in somno accidant,
   *   *   *   *   *   *   Minus mirum est.”

Lucretius[78] declares that during sleep we are amused with things which
have made us weep when awake; that circumstances which have pleased us are
recalled to our minds; that objects are presented to us which occupied our
thoughts long before; and that recent events appear still more vividly
before us.

Petronius Arbiter[79] cites Epicurus to the same effect. Tryphæna having
declared that she had had a dream in which there appeared to her the image
of Neptune she had seen at Baiæ, “Hence you may perceive,” observed
Eumolpus, “what a divine man is Epicurus, who so ingeniously ridiculed
these sports of fancy.

  “When in a dream presented to our view
   Those airy forms appear so like the true,
   No prescient shrine, no god the vision sends,
   But every breast its own delusion lends.
   For when soft sleep the body wraps in ease,
   And from the inactive mass the fancy frees,
   What most by day affects, at night returns;
   Thus he who shakes proud states, and cities burns,
   Sees showers of darts, forced lines, disordered wings,
   Blood-reeking fields, and deaths of vanquished kings;
   He that by day litigious knots untied,
   And charmed the drowsy bench to either side,
   By night a crowd of cringing clients sees,
   Smiles on the fools and kindly takes their fees;
   The miser hides his wealth, new treasure finds;
   Through echoing woods his horn the huntsman winds;
   The sailor’s dream wild scenes of wreck describes;
   The wanton lays her snares; the adultress bribes;
   Hounds in full cry, in sleep, the hare pursue;
   And hapless wretches their old griefs renew.”[80]

It is related of an ancient tyrant that one of his courtiers described to
him a dream in which the courtier had assassinated his master. “You could
not,” exclaimed the tyrant, “have dreamed this without having previously
thought of it,” and then ordered his immediate execution.

Now besides this foundation of dreams upon circumstances which have
transpired during our waking moments, they may arise, as has already been
intimated, from impressions made upon the mind during sleep. Sensations
may be so intense as to be partially appreciated by the brain, and yet not
strong enough to cause sleep to be interrupted. In such cases the
imagination seizes the imperfect perception and weaves it into a tissue of
incongruous fancies, which, however, generally bear a more or less
definite relation to the character of the sensorial impression. Many
examples of dreams thus produced are on record, and many others have come
under my own observation. The interest which attaches to phenomena of this
character must be my excuse for quoting some of the more remarkable
instances of this kind which have been brought to my attention.

The following are related by Abercrombie:[81]

During the alarm excited in Edinburgh by the apprehension of a French
invasion almost every man was a soldier, and all things had been arranged
in expectation of the landing of the enemy. The first notice was to be
given by the firing of a gun from the Castle, and this was to be followed
by a chain of signals calculated to arouse the country. The gentleman to
whom the dream occurred was a zealous volunteer, and, being in bed between
two and three o’clock in the morning, dreamt of hearing the signal gun. He
imagined that he went at once to the Castle, witnessed the proceeding for
displaying the signals, and saw and heard all the preparations for the
assemblage of the troops. At this time he was roused by his wife, who
awoke in a fright, in consequence of a similar dream. The origin of both
dreams was ascertained in the morning to be the noise produced by the
falling of a pair of tongs in the room above.

A gentleman dreamt that he had enlisted as a soldier, joined his regiment,
deserted, was apprehended, carried back, condemned to be shot, and at last
led out to execution. At this instant a gun was fired, and he awoke, to
find that a noise in the adjoining room had both produced the dream and
awakened him.

The next is a very extraordinary case.

The subject was an officer in the expedition to Louisburg, in 1758. During
his passage in the transport his companions were in the habit of amusing
themselves at his expense. They could produce in him any kind of dream by
whispering in his ear, especially if this was done by a friend with whose
voice he was familiar. Once they conducted him through the whole process
of a quarrel which ended in a duel, and when the parties were supposed to
have met a pistol was put into his hand, which he fired, and was awakened
by the report. On another occasion they found him asleep on the top of a
locker in the cabin, when they made him believe he had fallen overboard,
and exhorted him to save himself by swimming. Then they told him that a
shark was pursuing him, and entreated him to dive for his life. He
instantly did so, and with so much force as to throw himself from the
locker upon the cabin floor, by which he was much bruised, and awakened of
course. After the landing of the army at Louisburg, his friends found him
one day asleep in his tent, and evidently much annoyed by the cannonading.
They then made him believe that he was engaged, when he exhibited great
fear, and showed a decided disposition to run away. Against this they
remonstrated, but at the same time increased his fears by imitating the
groans of the wounded and the dying; and when he asked, as he often did,
who was hit, they named his particular friends. At last they told him that
the man next himself in his company had fallen, when he instantly sprang
from his bed, rushed out of his tent, and was roused from his danger and
his dream by falling over the tent-cords.

A friend informs me that he has a brother who will carry on a conversation
with any person who whispers to him in his sleep, and that his emotions
are then very readily excited by any pitiful story that may be told him.
Upon awaking, he has a distinct recollection of his dreams, which are
always connected with the ideas communicated.

I recollect very distinctly the particulars of a dream which I had several
years since, and which was due to an impression conveyed to the brain
through the ear. The dream also illustrates the point previously brought
forward, that a definite conception of time does not enter into the
phenomena of dreams.

I dreamed that I had taken passage in a steamboat from St. Louis to New
Orleans. Among the passengers was a man who had all the appearance of
being very ill with consumption. He looked more like a ghost than a human
being, and moved noiselessly among the passengers, noticing no one, though
attracting the attention of all. For several days nothing was said between
him and any one, till one morning, as we approached Baton Rouge, he came
to where I was sitting on the guards and began a conversation by asking me
what time it was. I took out my watch, when he instantly took it from my
hand and opened it. “I, too, once had a watch,” he said; “but see what I
am now.” With these words he threw aside the large cloak he habitually
wore, and I saw that his ribs were entirely bare of skin and flesh. He
then took my watch, and, inserting it between his ribs, said it would make
a very good heart. Continuing his conversation he told me that he had
resolved to blow up the vessel the next day, but that as I had been the
means of supplying him with a heart he would save my life. “When you hear
the whistle blow,” he said, “jump overboard, for in an instant afterward
the boat will be in atoms.” I thanked him, and he left me. All that day
and the next I endeavored to acquaint my fellow-passengers with the fate
in store for them, but discovered that I had lost the faculty of speech. I
tried to write, but found that my hands were paralyzed. In fact I could
adopt no means to warn them. While I was making these ineffectual efforts,
I heard the whistle of the engine; I rushed to the side of the boat to
plunge overboard, and awoke. The whistle of a steam saw-mill near my house
had just begun to sound, and had awakened me. My whole dream had been
excited by it, and could not have occupied more than a few seconds.

The following account[82] shows how a dream may be set in action by the
sense of smell.

“On one occasion during my residence at Birmingham I had to attend many
patients at Coventry, and for their accommodation I visited that place one
day in every week. My temporary residence was at a druggist’s shop in the
market-place. Having on one occasion, now to be mentioned, a more than
usual number of engagements, I was obliged to remain one night, and a bed
was provided for me at the residence of a cheesemonger in the same
locality. The house was very old, the rooms very low, and the street very
narrow. It was summer-time, and during the day the cheesemaker had
unpacked a box or barrel of strong old American cheese; the very street
was impregnated with the odor. At night, jaded with my professional
labors, I went to my dormitory, which seemed filled with a strong, cheesy
atmosphere, which affected my stomach greatly, and quite disturbed the
biliary secretions. I tried to produce a more agreeable atmosphere to my
olfactory sense by smoking cigars, but did not succeed. At length, worn
out with fatigue, I tried to sleep, and should have succeeded, but for a
time another source of annoyance prevented me doing so; for in an old wall
behind my head, against which my ancient bed stood, there were numerous
rats gnawing away in real earnest. The crunching they made was indeed
terrific, and I resisted the drowsy god from a dread that these voracious
animals would make a forcible entrance, and might take personal liberties
with my flesh.

“But at length ‘tired nature’ ultimately so overpowered me that I slept in
a sort of fever. I was still breathing the cheesy atmosphere, and this,
associated with the marauding rats, so powerfully affected my imagination
that a most horrid dream was the consequence. I fancied myself in some
barbarous country, where, being charged with a political offense, I was
doomed to be incarcerated in a large cheese. And although this curious
prison-house seemed most oppressive, it formed but part of my sufferings;
for scarcely had I become reconciled to my probable fate than to my horror
an army of rats attacked the monster cheese, and soon they seemed to have
effected an entrance, and began to fix themselves in numbers upon my naked
body. The agony I endured was increased by the seeming impossibility to
drive them away, and, fortunately for my sanity, I awoke, but with a hot
head and throbbing temples, and a sense of nausea from the extremely
strong odor of the cheese.”

I have on two occasions that I recollect had dreams which were due to
odors. On one of them the smell of gas escaping in the room excited the
dream of a chemical laboratory; on the other the smell of burning cloth
caused me to dream of a laundry, and of one of the women ironing a
blanket, which she scorched with a hot iron. A lady informs me that a
similar odor produced in her a dream of the house being on fire and the
impossibility of her escaping by reason of all her clothes being burned
up.

Dreams are very readily excited through impressions made on the special
nerves of sensation. Instances are given of persons sleeping with bottles
of hot water applied to their feet dreaming of walking on burning lava, or
some other hot substance. A patient related to me the particulars of a
dream which occurred to him while he was asleep with a vessel of hot water
applied to the soles of his feet. He had, just before going to sleep,
read in the evening paper an account of the capture of an English
gentleman by Italian brigands. He dreamt that while crossing the Rocky
Mountains he had been attacked by two Mexicans, who, after a long fight,
had succeeded in taking him alive. They conveyed him very hurriedly to
their camp, which was situated in a deep gorge. Here they told him that
unless he revealed to them the means of making gold from copper they would
submit him to torture. In vain he plead ignorance of any such process.
Pulling off his boots and stockings they held his naked feet to the fire
till he shrieked with agony, and awoke to find that the blanket which was
wrapped around the tin vessel containing the hot water had become
disarranged, and that his feet were in direct contact with the hot metal.

In another case, that of a lady whose lower limbs were paralyzed,
artificial heat was applied during the night to her feet. Frequently her
dreams had reference to this circumstance. On one occasion she dreamed
that she was transformed into a bear, and was being taught to dance by
being made to stand on hot plates of iron. On another, that the house was
on fire, and that the floors were so hot as to burn her feet in her
efforts to escape. Again, that she was wading through a stream of water
which came from a hot spring in the Central Park.

Another patient, a lady, subject to neuralgic attacks of great severity,
frequently had the lancinating pains give rise to dreams in which she was
stabbed with daggers, cut with knives, torn with pincers, etc.

Not long since I had an attack of erysipelas, in which the disease
included the head and face. The pain was not severe, and yet it was
sufficient to give rise to the following dream:

I dreamed that I was taking a cold bath, and that while thus engaged a
Turk, armed with a pair of long pincers, came into the room and began to
pull the hair out of my head. I remonstrated, but was unable to offer any
material resistance, for the reason that the water in which I was lying
suddenly froze, leaving me imbedded in a solid cake of ice. In order to
facilitate his operations, the Turk sponged my head with boiling water,
and then, finding the use of the pincers rather slow work, shaved the hair
off with a red-hot razor. He then rubbed an ointment on the naked scalp,
composed of sulphur, phosphorus, and turpentine, to which he immediately
applied fire. Taking me in his arms he rushed down stairs into the street,
lighting his way with the flame from my burning head. He had not gone far
before he fell down in a fit, and in his struggles gave me a severe blow
between the eyes which instantly deprived me of sight.

When I awoke in the morning I had a very distinct recollection of this
dream. The incidents were in part due to the fact that I had, two or three
days previously, been reading an account of the insanity of Mohammed, and
of his being subject to attacks of epilepsy.

The sense of taste is not, for obvious reasons, so productive of dreams as
the other senses, but the experiments of M. Maury and myself, to which
fuller reference will presently be made, show that strong excitations made
upon it are transmitted to the brain; and the following instance, which
has recently come under my immediate observation, is an interesting case
in point.

A young lady had, in her early childhood, contracted the habit of going to
sleep with her thumb in her mouth. She had tried for several years to
break herself of the practice, but all her attempts were in vain, for even
when by strong mental effort she succeeded in getting to sleep without the
usual accompaniment, it was not long before the unruly member was in its
accustomed place. Finally she hit upon the plan of covering the offending
thumb with extract of aloes just before she went to bed, hoping that if
she put it into her mouth she would instantly awake. But she slept on
through the night, and in the morning found her thumb in her mouth and all
the extract of aloes sucked off. During the night, however, she dreamed
that she was crossing the ocean in a steamer made of wormwood, and that
the vessel was furnished throughout with the same material. The plates,
the dishes, tumblers, chairs, tables, etc. were all of wormwood, and the
emanations so pervaded all parts of the ship that it was impossible to
breathe without tasting the bitterness. Everything that she ate or drank
was likewise, from being in contact with wormwood, so impregnated with the
flavor that the taste was overpowering. When she arrived at Havre she
asked for a glass of water for the purpose of washing the taste from her
mouth, but they brought her an infusion of wormwood, which she gulped down
because she was thirsty, though the sight of it excited nausea. She went
to Paris and consulted a famous physician, M. Sauve Moi, begging him to do
something which would extract the wormwood from her body. He told her
there was but one remedy, and that was ox gall. This he gave her by the
pound, and in a few weeks the wormwood was all gone, but the ox gall had
taken its place, and was fully as bitter and disagreeable. To get rid of
the ox gall she was advised to take counsel of the Pope. She accordingly
went to Rome, and obtained an audience of the Holy Father. He told her
that she must make a pilgrimage to the plain where the pillar of salt
stood, into which Lot’s wife was transformed, and must eat a piece of the
salt as big as her thumb. During her journey in search of the pillar of
salt she endured a great many sufferings, but finally triumphed over all
obstacles, and reached the object of her journey. What part to take was
now the question. After a good deal of deliberation she reasoned that as
she had a bad habit of sucking her thumb, it would be very philosophical
to break off this part from the statue, and thus not only get cured of
the bitterness in her mouth, but also of her failing. She did so, put the
piece of salt into her mouth, and awoke to find that she was sucking her
own thumb.

It might be supposed that the brain during sleep is not excitable through
the sense of sight. Many examples, however, are on record of dreams being
thus produced, and several very interesting cases have come under my own
observation. Among them are the following:

A gentleman of a nervous and irritable disposition informed me that he had
dreamed of being in heaven and being dazzled by the brilliancy of
everything around him. So great was the light that he hastened to escape
from the pain which it caused in his eyes. In the efforts which he made he
struck his head against the bedpost, and awoke to find that the fire which
he had left smouldering on the hearth had kindled into a bright flame, the
light from which fell full in his face.

Another, who had been under my care for epilepsy, dreamed that his room
was entered by burglars, and that with lighted candles in their hands they
were searching his drawers and trunks. He related his dream the following
morning, and was told by his mother that she had gone into his room the
previous night, and had held a lighted candle close to his face in order
to see whether or not he was sound asleep.

No one has more philosophically studied the mode of production of dreams
than M. Maury[83] in his remarkable work to which reference has already
been made. I propose, therefore, to place a brief outline of his
experiments and views before the reader.

Just before falling asleep, and immediately before becoming fully awake,
many persons are subject to hallucinations partaking of many of the
characteristics belonging to dreams. To them the name of hypnagogic
(ῦπνος, _sleep_, and ἀγωγεύς, _leader_) hallucinations has been given,
_i.e._ hallucinations which lead to sleep. Previous to M. Maury’s
investigations, the phenomena in question had attracted some attention
from German and French physiologists, but M. Maury’s investigations, many
of which were performed upon himself, throw more light upon the subject
than it has hitherto received.

According to M. Maury, the persons who most frequently experience these
hypnagogic hallucinations are those who are of an excitable constitution,
and are generally predisposed to hypertrophy of the heart, pericarditis,
and cerebral affections. This may be true, but in two most remarkable
instances which have come under my observation, the type of organization
was the very reverse of this.

In M. Maury’s own case he finds that the hallucinations are more numerous
and more vivid when he experiences, as is frequent with him, a disposition
to cerebral congestion. Thus, when he has headache, nervous pains in the
eyes, the ears, and the nose, and vertigo, the hallucinations make their
appearance as soon as he closes his eyelids. Loss of sleep and severe
intellectual exertions invariably produce them, as do also _cafe noir_ and
champagne, which, by causing headache and insomnia, strongly predispose
him to the hypnagogic hallucinations. On the contrary, calmness of mind,
rest, and country air lessen his liability to them. From the inquiries
made of others by M. Maury, the results of his own experience, as well as
from my own observations, I am well convinced that the hypnagogic
hallucinations are directly the result of an increase in the amount of
blood circulating through the brain rather than to actual congestion as he
supposes. They therefore indicate the existence of a condition unfavorable
to sound sleep. In the chapter devoted to the consideration of wakefulness
the phenomena accompanying cerebral hyperæmia will be more fully
considered.

The theory which M. Maury proposes in order to account for the existence
of hypnagogic hallucinations further presupposes that as the power of the
attention immediately before sleep begins to be diminished, and the mind
cannot therefore voluntarily and logically arrange its thoughts, it
abandons itself to the imagination, and that thus fancies arise and
disappear unchecked by the other mental faculties. This absence of the
attention need not be of long duration, a second, or even a shorter period
being sufficient. Thus he lay down, and the attention which had been
fully aroused soon became weakened; images appeared, and these partially
reawakened the attention, and the current of his thoughts was resumed, to
be replaced again by hallucinations, and this continued till he was fully
asleep. As an example, he states that on the 30th of November, 1847, he
was reading aloud the _Voyage dans la Russie Méridionale_, by M. Hommaire
de Hell. He had just finished a line when he closed his eyes
instinctively. In this short instant of sleep he saw hypnagogically, but
with the rapidity of light, the figure of a man clothed in a brown robe,
and with a hood on his head like a monk. The appearance of this image
reminded him that he had shut his eyes and ceased reading. He immediately
opened his eyelids and resumed his book. The interruption was practically
nothing, for the person to whom he was reading did not perceive it.

M. Maury gives numerous examples of these hypnagogic hallucinations, all
tending to show that they are induced by a congested condition of the
cerebral vessels, and that thus, according to the views I have set forth
relative to the condition of the brain in sleep, they are not to be
regarded as precursors of that state, but of stupor.

In two very interesting cases of these hallucinations, which have come
under my notice, they were brought about by any cause which increased the
quantity of blood in the brain, or retarded the flow of blood from this
organ. Thus, a glass of champagne, or a few drops of laudanum, would
induce them, as also would the recumbent posture, with the head rather
low.

As showing how readily dreams can be excited by impressions made upon the
senses, M. Maury caused a series of experiments to be performed upon
himself when asleep, which afforded very satisfactory results, and which
are interesting in connection with the points already discussed in the
present chapter.

1st Experiment. He caused himself to be tickled with a feather on the lips
and inside of the nostrils. He dreamed that he was subjected to a horrible
punishment. A mask of pitch was applied to his face, and then torn roughly
off, taking with it the skin of his lips, nose, and face.

2d Experiment. A pair of tweezers was held at a little distance from his
ear, and struck with a pair of scissors. He dreamed that he heard the
ringing of bells; this was soon converted into the tocsin, and this
suggested the days of June, 1848.

3d Experiment. A bottle of eau de Cologne was held to his nose. He dreamed
that he was in a perfumer’s shop. This excited visions of the East, and he
dreamed that he was in Cairo in the shop of Jean Marie Farina. Many
surprising adventures occurred to him there, the details of which were
forgotten.

4th Experiment. A burning lucifer match was held close to his nostrils. He
dreamed that he was at sea (the wind was blowing in through the windows),
and that the magazine of the vessel blew up.

5th Experiment. He was slightly pinched on the nape of the neck. He
dreamed that a blister was applied, and this recalled the recollection of
a physician who had treated him in his infancy.

6th Experiment. A piece of red-hot iron was held close enough to him to
communicate a slight sensation of heat. He dreamed that robbers had got
into the house, and were forcing the inmates, by putting their feet to the
fire, to reveal where their money was. The idea of the robber suggested
that of the Duchess d’Abrantes, who he supposed had taken him for her
secretary, and in whose memoirs he had read some account of bandits.

7th Experiment. The word _parafagaramus_ was pronounced in his ear. He
understood nothing, and awoke with the recollection of a very vague dream.
The word _maman_ was next used many times. He dreamed of different
subjects, but heard a sound like the humming of bees. Several days after,
the experiment was repeated with the words _Azor_, _Castor_, _Léonore_. On
awaking, he recollected that he had heard the last two words, and had
attributed them to one of the persons who had conversed with him in his
dream.

Another experiment of the same kind showed like the others that it was the
sound of the word and not the idea it conveyed which was perceived by the
brain. Then the words _chandelle_, _haridelle_, were pronounced many times
in rapid succession in his ear. He awoke suddenly, saying to himself,
_c’est elle_. It was impossible for him to recall what idea he had
attached to this dream.

8th Experiment. A drop of water was allowed to fall on his forehead. He
dreamed that he was in Italy, that he was very warm, and that he was
drinking the wine of Orvieto.

9th Experiment. A light, surrounded with a piece of red paper, was
repeatedly placed before his eyes. He dreamed of a tempest and lightning,
which suggested the remembrance of a storm he had encountered in the
English Channel in going from Merlaix to Havre.

These observations are very instructive. They show conclusively that one
very important class of our dreams is due to our bodily sensations. I have
frequently performed analogous experiments on others, and had them
practiced on myself, and have rarely failed in obtaining decided results.
They strongly inculcate the truth of the conclusions arrived at in the
foregoing chapter, and they serve as important data in enabling us to
understand the division of the subject next to be considered.

In regard to the immediate cause of dreams the opinions of authors are
very diverse. The older writers ascribe them to the rise of vapors from
the stomach, to the visitation of demons, and other fanciful causes.
Bishop Bull[84] declares that he knows from his own experience that
dreams are to be ascribed “to the ministry of those invisible instruments
of God’s providence that guide and govern our affairs and concerns, viz.,
the angels of God;” and Bishop Ken held a similar view.

It would neither be possible nor profitable to refer at greater length to
views which positive physiology has overturned. Observation and experiment
have aided us greatly in arriving at definite conclusions on this subject,
and the instances quoted on page 30 of this treatise, even if standing
alone uncontradicted, would go far toward guiding us in the right path. On
page 37 I have referred to the case of a man who, some time after
receiving a severe injury of the head by which a considerable portion of
the skull was lost, came under my professional care. Standing by his
bedside one evening, just after he had gone to sleep, I observed the scalp
slightly rise from the chasm in which it was deeply depressed. I was sure
he was going to awake, but he did not, and very soon he became restless
and agitated, while continuing to sleep. Presently he began to talk, and
it was evident that he was dreaming. In a few minutes the scalp sank down
to its ordinary level when he was asleep, and he became quiet. I called
his wife’s attention to the circumstance, and desired her to observe this
condition thereafter when he slept. She subsequently informed me that she
could always tell when he was dreaming from the appearance of the scalp.

My opinion, therefore, is that dreams are directly caused by an increased
activity of the cerebral circulation over that which exists in profound
sleep. This activity is probably sometimes local and at others general,
and never equals that which prevails in the condition of wakefulness, when
the functions of the brain are at their maximum of energy. This view is
further supported by a consideration of the state of the brain in sleep
and wakefulness, the condition of dreaming being, in a measure, an
intermediate one. Illustrations of the effects produced by a notable
increase in the quantity of blood circulating through the brain will be
given in the chapter on wakefulness. All of these, it will be perceived,
have a direct bearing on the question now under consideration.



CHAPTER VI.

MORBID DREAMS.


Morbid or pathological dreams are divided by Macario[85] into three
classes: the prodromic, or those which precede diseases; the symptomatic,
or those which occur in the course of diseases; and the essential, or
those which constitute the main features of diseases. As this
classification is natural and simple, I propose to follow it in the
remarks I shall have to make on the subject.

PRODROMIC DREAMS.--There appears to be no doubt that diseases are
sometimes preceded by dreams which indicate with more or less exactitude
the character of the approaching morbid condition. Many instances of the
kind which have been reported--especially by the earlier authors--are,
however, in all probability merely coincidences; and in others the
relation between the character of the dream and that of the disease is by
no means clear.

Many cases of dreams indicating the nature of a malady which had not yet
developed itself are referred to by Macario.[86] The instance of Galen’s
patient, who dreamed that his leg had become converted into stone, and who
was soon afterward paralyzed in that member, has already been cited.

The learned Conrad Gesner dreamed that he was bitten in the left side by a
venomous serpent. In a short time a severe carbuncle appeared on the
identical spot, and death ensued in five days.

M. Teste, formerly minister of justice and then of public works under
Louis Philippe, and who finally died in the Conciergerie, dreamed three
days before his death that he had had an attack of apoplexy. Three days
afterward he died suddenly of that disease.

A young woman saw in a dream objects apparently confused and dim as
through a thin cloud, and was immediately thereafter attacked with
amblyopia, and threatened with loss of sight.

A woman, who had been under the care of M. Macario, dreamed at about the
period of her menstrual flow that she spoke to a man who could not answer
her, for the reason that he was dumb. On awaking she discovered that she
had lost her voice.

Macario himself dreamed one night that he had a severe pain in his throat.
On awaking he felt very well; but a few hours subsequently was attacked
with severe tonsillitis.

Arnold, of Villanova, dreamed that a black cat bit him in the side. The
next day a carbuncle appeared on the part bitten.

Dr. Forbes Winslow[87] gives several similar instances. A patient had, for
several weeks before an attack of apoplexy, a series of frightful dreams,
in one of which he imagined he was being scalped by Indians. Others dreamt
of falling down precipices, and of being torn to pieces by wild beasts.
One gentleman dreamed that his house was in flames, and that he was
gradually being consumed to a cinder. This occurred a few days before an
attack of inflammation of the brain. A person, prior to an attack of
epilepsy, dreamt that he was severely lacerated by a tiger; and another,
just before a seizure, dreamt that he was attacked by murderers, and that
they were knocking out his brains with a hammer.

A barrister, for several years before an attack of cerebral paralysis, was
in the habit of awaking from sleep in a condition of great alarm and
terror without being able to explain the reason for his apprehension. Dr.
Beddoes attended a patient whose first fit succeeded a dream of being
crushed by an avalanche.

Gratiolet[88] cites additional examples. Thus, Roger d’Oxteryn, Knight of
the Company of Douglas, went to bed in good health. Toward the middle of
the night, he saw in a dream a man affected with the plague and entirely
naked, who attacked him with fury, threw him to the ground after a severe
contest, and, holding him between his thighs, vomited into his mouth.
Three days afterward he was seized with the plague and died. He also
alludes to a case detailed by Gunther, in which a woman dreamt that she
was being flogged with a whip, and on awaking found that she had marks on
her body resembling the scars made by the lash.

The existence of diseases of the heart and larger vessels is often
revealed by frightful dreams when there is no other evidence of their
presence. Macario states that a young lady was under his care in whom
violent palpitations of the heart were preceded by painful dreams. She
subsequently died of disease of the heart.

Moreau (de la Sarthe),[89] in a very elaborate treatise on dreams, relates
the case of a French nobleman, whom he had attended during several months
for threatened chronic pericarditis, and who was at first tormented every
night by painful and frightful dreams. These dreams, attracting attention,
gave the earliest indication of the real condition, and excited fears as
to the result, which were soon verified.

He cites another case in illustration of the fact that periodical
hemorrhages are sometimes preceded by morbid dreams. A physician had, in
his youth, been subject to periodical hemorrhages, but without dreams or
other trouble during sleep. As he advanced in years, the hemorrhages were
not so frequent, but were always preceded by a condition of general
irritation, characterized during wakefulness by heat of skin and frequency
of the pulse, and during sleep by painful dreams. These dreams almost
always related to violent actions, such as giving and receiving heavy
blows, walking on a volcano, or being precipitated into lakes of fire.

Many cases of insanity being preceded by frightful dreams are on record.
Falret,[90] in calling attention to the remarkable analogy which exists
between mental alienation and dreams, says that it is an incontestable
fact that insanity is often preceded by significant dreams, and that these
constitute the whole essence of the disorder by becoming firmly fixed in
the patient’s mind. Thus, he relates that Odier of Geneva was consulted in
1778 by a lady, who, during the night preceding the outbreak of her
insanity, dreamed that her step-mother approached her with a dagger in
order to kill her. This dream made so strong an impression upon her that
she ultimately accredited it as true, and thus became the victim of a
delusion which rendered her a lunatic. He declares that numerous similar
instances have come under his observation, and refers to the case of a
young lady, subject to periodical attacks of mental derangement, whose
paroxysms are always preceded by notable dreams.

Morel[91] affirms that many patients before becoming completely insane
have frightful dreams, which they regard as evidences that they are about
to lose their reason. Sometimes they are afraid to go to sleep on account
of the terrifying apparitions which then visit them.

The following cases, related by Dr. Forbes Winslow,[92] are interesting in
this connection:

“A gentleman, who had previously manifested no appreciable symptoms of
mental disorder, or even of disturbed and anxious thought, retired to bed
apparently in a sane state of mind. Upon arising in the morning, to the
intense terror of his wife, he was found to have lost his senses! He
exhibited his insanity by asserting that he was going to be tried for an
offense which he could not clearly define, and of the nature of which he
had no right conception. He declared that the officers of justice were in
hot pursuit of him,--in fact, he maintained that they were actually in the
house. He begged and implored his wife to protect him. He walked about the
bed-room in a state of great agitation, apprehension, and alarm, stamping
his feet, and wringing his hands in the wildest agony of despair. Upon
inquiring into the history of the case, his wife said that she had not
observed any symptoms that excited her suspicions as to the state of her
husband’s mind, but upon being questioned very closely, she admitted that
during the previous night he appeared to have been under the influence of
what she considered to be the nightmare, or a frightful dream. While
apparently asleep he cried out several times, evidently in great distress
of mind, ‘Don’t come near me!’ ‘Take them away!’ ‘Oh, save me; they are
pursuing me!’ It is singular that in this case the insanity which was
clearly manifested in the morning appeared like _a continuation of the
same character and train of perturbed thought that existed during his
troubled sleep_ when, according to the wife’s account, he was evidently
dreaming.”

Dr. Winslow’s second case is equally to the point: “I am indebted to a
medical friend for the particulars of the following case. During the
winter of 1849 he was called to see H. B., about five or six o’clock in
the morning. The patient was the wife of a tailor and mother of three
children. At this time she was rather emaciated and debilitated in bodily
health, and anemic in appearance. She was of a religious turn of mind, and
belonged to the Wesleyan persuasion. On the morning of the narrator’s
visit, he found the woman in a state of great mental excitement and under
the influence of hallucinations. She had gone to bed apparently well, but
during the night was the subject of a vivid dream, imagining that she saw
her sister, long since dead and to whom she was much attached, suffering
the pains of hell. When quite awake, no one could persuade her that she
had been under the influence of an agitated dream. She stoutly persisted
in maintaining the reality of her vision. During the whole of that day she
was clearly insane; but on the following morning her mind appeared to have
recovered its balance. She continued tolerably well, mentally, for four
years, with the exception of her occasionally having moments of
despondency arising from real or fancied troubles.” * * *

The further particulars of this case, relating as they do to another
division of the subject,--“sleep-drunkenness,” as the Germans designate
it,--will be considered under that head.

Without pretending to indorse all the conclusions of Albers,--as set forth
in the following summary, and which I quote from a very learned and
philosophical writer,[93]--there is no doubt that some of his dicta are
well founded.

“Lively dreams are in general a sign of the excitement of nervous action.

“Soft dreams are a sign of slight irritation of the head; often in nervous
fevers announcing the approach of a favorable crisis.

“Frightful dreams are a sign of determination of blood to the head.

“Dreams about fire are in women signs of an impending hemorrhage.

“Dreams about blood and red objects are signs of inflammatory conditions.

“Dreams about rain and water are often signs of diseased mucous membranes
and dropsy.

“Dreams of distorted forms are frequently a sign of abdominal obstructions
and diseases of the liver.

“Dreams in which the patient sees any part of the body especially
suffering, indicate disease in that part.

“Dreams about death often precede apoplexy, which is connected with
determination of blood to the head.

“The nightmare (incubus ephialtes), with great sensitiveness, is a sign of
determination of blood to the chest.”

A very interesting paper on dreaming, by Dr. Thomas More Madden,[94] has
been recently published, and from it I make the following extract:

“Intermittent fever is often announced, several days before any of the
recognized symptoms set in, by persistent dreams of terrifying character.
I have experienced this in my own person, and heard it confirmed by other
sufferers on the African Coast. The following case of morbid dreaming
ushering in yellow fever, I subjoin in the words of the gentleman to whom
it occurred, himself a medical man holding a high official position on the
Gold Coast where it occurred.

“‘In the early part of 1840, I was an inmate of Cape Coast Castle, and as
some repairs were then being made in the castle, the room assigned to me
was that in which the ill-fated L. E. L. (Mrs. Maclean), the wife of the
governor of Cape Coast, had been found dead, poisoned by prussic acid, not
very long previously. I had known her in London, and had been intimately
acquainted with her history and much interested in it. Her body had been
found on the floor near the door and in front of a window. After a
fatiguing excursion to some of the adjoining British settlements on the
Coast, having retired to rest, I awoke disturbed by a dream of a very
vivid character, in which I imagined that I saw the dead body of the lady
who had died in that chamber lying on the floor before me. On awaking the
image of the corpse kept possession of my imagination. The moon was
shining brightly into the part of the room where the body had been found,
and there, as it seemed to me on awaking, it lay pale and lifeless as it
appeared to me in my dream.

“‘After some minutes I started up, determined to approach the spot where
the body seemed to be. I did so, not without terror, and walking over the
very spot on which the moon was shining, the fact all at once became
evident and obvious that no body was there--that I must have been dreaming
of one. I returned to bed, and had not long fallen asleep when the same
vivid dream recurred; the same waking disturbance occurring while awake.
As long as I lay gazing on the floor I could not dispossess my mind of
that appalling vision; but when I started up and stood erect it vanished
at the first glance.

“‘Again I returned to bed, dozed, dreamt again of poor L. E. L.’s
lamentable end, and of her remains in the same spot; again awoke, and
arose with the same strange results.

“‘There was no more disturbance that night of which, at least, I was
conscious, but when morning came fever was on me in unmistakable force in
its worst form, and partial delirium set in the same night. I was reduced
to the last extremity about the third or fourth night of my illness, when
a conviction seized on my mind that it was absolutely essential to my life
that I should not pass another night in Cape Coast Castle. I caused the
negro servant I had fortunately brought out with me from England to have a
litter prepared for me at dawn, and stretched on this litter, hardly able
to lift hand or foot, I was carried out of my bed by four native soldiers,
and was conveyed to the house of a merchant, and countryman of mine, to
whose care and kindness I owe my life. So much for a visionary precursor
of fever on the west coast of Africa.’

“In neuralgia, disturbed dreaming is occasionally a prominent symptom. In
an obscure case I was led to make what I believe to be a true diagnosis
from the indications furnished by the patient’s dreams. The individual in
question is a man, aged about 45, of an anemic habit, confined by a
sedentary occupation, who, for many years, had suffered from hemicrania,
which lately had become more intense, and the intervals shorter. A couple
of days before the attack his sleep becomes broken by unpleasant dreams,
and when the paroxysm has attained its height, he invariably dreams that
he is the helpless victim of a persecutor, who finishes a series of
torments by driving a stake through his skull. During his recovery from
each attack, he states that his dreams are of a most agreeable character,
though so vague that he cannot give any account of them. The frequent
repetition of his dreams leads me to conclude that there is some osseous
growth within the cranium, and that the vascular distention accompanying
the neuralgic attack occasions pressure upon this, giving rise to the
sensation I have referred to, while the subsequent feeling of comfort
results from that pressure being removed.”

A case has been recently published[95] in which the dream immediately
preceded, or perhaps even accompanied, the morbid action. A German, aged
45, of a nervo-sanguineous temperament, went to bed at 11 P. M., feeling
as well as usual. Between 12 and 1 o’clock he dreamed that he saw his
child lying at his side, dead. He was very much frightened, and at once
awoke, to find that his tongue was paralyzed, and that he could not talk.
The faculty of speech and the ability to move the tongue remained impaired
for four months.

For several years past I have made inquiries of patients and others
relative to their dreams, and have thus collected a large amount of
material bearing upon the subject. With reference to the point under
consideration, the data in my possession are exceedingly important and
interesting. Among the cases which have come under my observation of
diseases being preceded by morbid dreams, are the following:

A gentleman, two days before an attack of hemiplegia, dreamed that he was
cut in two exactly down the mesial line, from the chin to the perineum. By
some means union of the divided surfaces was obtained, but he could only
move one side. On awaking, a little numbness existed in the side which he
had dreamed was paralyzed. This soon passed off, and ceased to engage his
attention. The following night he had a somewhat similar dream, and the
next day, toward evening, was seized with the attack which rendered him
hemiplegic.

Another dreamed one night that a man dressed in black and wearing a black
mask came to him and struck him violently on the leg. He experienced no
pain, however, and the man continued to beat him. In the morning he felt
nothing, with the exception of a slight headache. Nothing unusual was
observed about the leg, and all went on well, until on the fifth day he
had an apoplectic attack, accompanied with hemiplegia, including the leg
which he had in his dream imagined to have been struck.

A lady, aged forty, who had been a great sufferer from rheumatism for many
years, dreamt one afternoon, while sitting in her chair in front of the
fire, that a boy threw a stone at her, which, striking her on the face,
inflicted a very severe injury. The next day violent inflammation of the
tissues around the facial nerve as it emerges from the stylo mastoid
foramen set in, and paralysis of the nerve followed, due to effusion of
serum, thickening, and consequent pressure.

A young lady dreamt that she was seized by robbers and compelled to
swallow melted lead. In the morning she felt as well as usual, but toward
the middle of the day was attacked with severe tonsillitis.

A young man informed me that a day or two before being attacked with acute
meningitis, he had dreamed that he was seized by banditti while traveling
in Spain, and that they had taken his hair out by the roots, causing him
great pain.

A lady of decided good sense had an epileptic seizure, which was preceded
by a singular dream. She had gone to bed feeling somewhat fatigued with
the labors of the day, which had consisted in attending three or four
morning receptions, winding up with a dinner party. She had scarcely
fallen asleep, when she dreamed that an old man clothed in black
approached her, holding an iron crown of great weight in his hands. As he
came nearer, she perceived that it was her father, who had been dead
several years, but whose features she distinctly recollected. Holding the
crown at arm’s length, he said: “My daughter, during my lifetime I was
forced to wear this crown; death relieved me of the burden, but it now
descends to you.” Saying which, he placed the crown on her head and
disappeared gradually from her sight. Immediately she felt a great weight
and an intense feeling of constriction in her head. To add to her
distress, she imagined that the rim of the crown was studded on the inside
with sharp points which wounded her forehead, so that the blood streamed
down her face. She awoke with agitation, excited, but felt nothing
uncomfortable. Looking at the clock on the mantle-piece, she found that
she had been in bed exactly thirty-five minutes. She returned to bed and
soon fell asleep, but was again awakened by a similar dream. This time the
apparition reproached her for not being willing to wear the crown. She had
been in bed this last time over three hours before awaking. Again she fell
asleep, and again at broad daylight she was awakened by a like dream.

She now got up, took a bath, and proceeded to dress herself with her
maid’s assistance. Recalling the particulars of her dream, she
recollected that she had heard her father say one day, that in his youth,
while being in England, his native country, he had been subject to
epileptic convulsions consequent on a fall from a tree, and that he had
been cured by having the operation of trephining performed by a
distinguished London surgeon.

Though by no means superstitious, the dreams made a deep impression upon
her, and her sister, entering the room at the time, she proceeded to
detail them to her. While thus engaged, she suddenly gave a loud scream,
became unconscious, and fell upon the floor in a true epileptic
convulsion. This paroxysm was not a very severe one. It was followed in
about a week by another; and, strange to say, this was preceded as the
other by a dream of her father placing an iron crown on her head and of
pain being thereby produced. Since then several months have elapsed, and
she has had no other attack, owing to the influence of the bromide of
potassium which she continues to take.

In the case of a gentleman now under my treatment for epilepsy, the fits
are invariably preceded by dreams of difficulties of the head, such as
decapitation, hanging, perforation with an auger, etc.

A lady, previous to an attack of sciatica, dreamed that she had caught her
foot in a spring-trap, and that before she could be freed it was necessary
to amputate the member. The operation was performed; but as she was
released, a large dog sprang at her and fastened his teeth in her thigh.
She screamed aloud and awoke in her terror. Nothing unusual was perceived
about the leg; but, on getting up in the morning, there was slight pain
along the course of the sciatic nerve, and this before evening was
developed into well-marked sciatica.

Insanity is frequently preceded by frightful dreams, and I have advanced
several examples to this effect from the experience of others. We should
naturally expect that very often the first manifestations of a diseased
brain should appear during sleep. But dreams are of such a varied
character, and so thoroughly irreconcilable with the normal mental
phenomena of the wakeful state, that it is difficult to say that such or
such a dream is evidence of a diseased mind. As, in some of the cases I
have brought forward, a dream may take so firm a hold of the reason as to
be the exciting cause of insanity, and not simply a sign of its approach,
I am disposed, from my own experience, to regard the frequent repetition
of the same dream as often indicative of a disordered mind, when very
close observation would fail to reveal other evidences. There are,
however, exceptions to this statement, as has been shown in the previous
chapter.

Several cases, in which insanity was preceded by terrifying dreams, have
come under my observation. In one of them a lady dreamed that she had
committed murder, under circumstances of great atrocity. She cut up the
dead body, but could not, with all her efforts, divide the head, which
resisted her blows, with an axe and other instruments. Finally she filled
the nose, eyes, and mouth with gunpowder, and applied a match. Instead of
exploding, smoke issued slowly from the orifices of the skull, and was
resolved into a human form, which turned out to be that of a police
officer sent to arrest her. She was imprisoned, tried, and sentenced to
execution, by being drowned in a lake of melted sulphur. While the
preparations were being made for the punishment she awoke. She related the
particulars of her dream to several friends, but it apparently made no
great impression on her mind. The next night she dreamed of somewhat
similar circumstances, and for several nights subsequently. On the sixth
day, without any premonition, she attempted to kill herself by plunging a
pair of scissors into her throat, and since that time to her death, which
took place a few months subsequently, was constantly insane.

In this case there was no direct analogy between the character of her
dream and the type of insanity which ensued. It cannot, therefore, be said
that the dream produced the mental aberration. On the contrary, the dream
was in all probability the first evidence of deranged cerebral action,--a
condition which subsequently became developed into positive insanity.

The following case is similar to the foregoing in its general features:

A gentleman who had been unfortunate in some business speculations,
shortly afterward became insane. Previous to this event he was troubled
with frightful dreams, which gave him a great deal of annoyance, and
frequently caused him to awake in terror. One of them occurred several
times, and was of the following character. He dreamed that he was engaged
to be married to a lady of beauty and wealth, and who was, moreover,
possessed of great musical talent. One evening, as he in his dream was
paying her a visit, she placed herself at the piano and began to sing. He
remarked that he did not admire the piece of music she was singing, and
asked her to sing something else. She indignantly refused. Angry words
followed, and in the midst of the dispute she drew a dagger from her bosom
and stabbed herself to the heart. As he rushed forward, horror-struck, to
her assistance, her friends entered the room, and found him with the
dagger in his hand. He was accused of murdering the lady, and,
notwithstanding his protestations of innocence, was tried, found guilty,
and sentenced to be hung. He always awoke at the point when preparations
were being made for his execution.

A dream may make such a strong impression on the mind as to subsequently
constitute the essential feature of the insane condition. This point has
already been elucidated to some extent in the preceding pages. The
following cases, however, are from my own records of practice.

A gentleman awoke in the middle of the night, and, calling his wife, told
her he had dreamed that a large fortune had been left him by a miner in
California. He then went to sleep again, but in the morning again repeated
the dream to his wife, and said that “there might be something in it.” She
laughed, and remarked that she “hoped it might prove true.” About the time
the California steamer was expected, the gentleman was observed to become
very anxious and excited, and was continually talking of his expected
fortune. At last the steamer arrived. He then began asking the postman for
letters from California, went several times a day to the post-office to
make like inquiries, and finally went aboard the steamer and questioned
the officers on the same subject. Then he was sure the letter had
miscarried, and would sit for hours in the most profound melancholy. He
was now recognized by his family as a monomaniac, and strenuous efforts
were made to cure him of his delusion, but they were unsuccessful; and
although now apparently sane on other subjects, he still holds the
erroneous idea which was first given him in his dream of several years
ago.

A young lady was brought to me in July, 1868, who had been rendered insane
by a dream which took place a few months before I saw her. She went to bed
one night in good health and spirits, though somewhat fatigued in
consequence of having skated a good deal the previous afternoon. In the
morning she told her mother she had committed the “unpardonable sin,” and
that there was consequently no hope of her salvation. She based her idea
on a dream she had had, in which an angel appeared to her, and sorrowfully
informed her of her sin and her destiny. When asked to tell what her sin
was, she refused to do so, saying it was too shocking and atrocious to
talk about. She kept to her delusion, and soon settled into a sort of
melancholic stupor, from which it was impossible entirely to rouse her.
Under the use of arsenic, and the acid phosphate of lime of Prof.
Horsford, she gradually recovered her reason.

The manner in which prodromic dreams are excited is very simple. The
ancients and some modern writers have regarded them as prophetic; but the
true explanation does not require so severe a tax on our powers of belief.
In the previous chapter, it was shown that very slight impressions made
upon the senses during sleep are exaggerated by the partially awakened
brain. The first evidence of approaching paralysis may be a very minute
degree of numbness--so minute that the brain when awake and engaged with
the busy thoughts of active life fails to appreciate it. During sleep,
however, the brain is quiescent, till some exciting cause sets it in
uncontrollable action, and dreaming results. Such a cause may be the
incipient numbness of a limb. A dream of its being turned into stone, or
cut off, or violently struck, is the consequence. The disease goes on
developing, and soon makes its presence unmistakable.

This explanation applies _mutatis mutandis_ to all prodromic dreams. They
are invariably based upon actual sensations, unless we except the rare
cases which are simply coincidences.

SYMPTOMATIC DREAMS.--Morbid dreams are so generally met with in the course
of disease, especially in that of the brain and nervous system, that I
never examine a patient without questioning him closely on this point. The
information thus obtained is always valuable, and sometimes constitutes
the most important feature of the investigation.

_Fevers_ are very often accompanied by frightful dreams. According to
Moreau (de la Sarthe),[96] their occurrence indicates that the attack will
be long, and that there is probably some organic affection present. My own
experience agrees with that of Macario,[97] to the effect of not
confirming these opinions. I have, however, generally observed that the
frequency and intensity of the morbid dreams were in proportion to the
severity of the fever.

_Diseases of the heart_ are very generally attended with disagreeable
dreams. They are usually short, and, as Macario remarks, relate to
approaching death. The patient starts from sleep in terror, and sometimes
it is difficult to convince him of the reality of his visions.

_Dyspepsia and other diseases of the intestinal canal_ often give rise to
morbid dreams. They are usually accompanied by a sense of impending
suffocation, and ordinarily consist of frightful images, such as devils,
demons, strange animals and the like. The presence of worms in the
intestines is likewise a frequent cause of such dreams.

In _chlorosis_ dreams are very common. Occasionally they are of a pleasant
character, but in the majority of cases they are the reverse of this.

It would be difficult to mention a disease which is not, at some time or
other of its career, an exciting cause of morbid dreams. The most
interesting examples, however, are met with in cases of _insanity and
other cerebral affections_, and frequently the delusions of the dreams are
so mixed up with those which arise during the waking condition, that the
patient is unable to separate them and to determine which are the
consequence of erroneous sensations received when awake, and which are the
results of dreams. The careful examination of almost any insane persons
will also show that they incorporate the fancies of their dreams with the
realities of everyday life. Indeed, the relations of dreaming to insanity
are so interesting and important as to have attracted the marked attention
of alienists and psychologists.

Cabanis[98] gives Cullen the credit of being the first to point out the
similarity between the phenomena of dreaming and those of delirium, and
himself enters at length into the full discussion of the several questions
involved. A very little reflection will suffice to convince the reader
that the two conditions are strikingly alike. In dreams we never
distinguish the false from the real; the judgment, if exercised at all,
acts in the most erratic manner; we are rarely surprised at the occurrence
of the most improbable circumstances; our characters for the time being
often undergo a radical change, and we perform imaginary acts in our sleep
which are altogether at variance with our actual dispositions. The
hallucinations of sleep we accept as realities just as the insane
individual believes in all the erroneous impressions made upon his senses.
The dreaming person is, in fact, the victim of delusions which, during the
existence of his condition, have a firm hold on his mind and render him in
no essential particular different from the one who suffers from mental
unsoundness. The incoherence present in dreams, and the evident dependence
of the various images upon the suggestion of previous images, are likewise
phenomena of the insane state.

Even in persons perfectly sane, dreams often produce a very powerful
influence on the mind. Most of us have, on awaking, felt pleased or
disturbed from reflecting upon the circumstances of a dream we have had
during the night, and occasionally the impression has remained through the
entire day. With children this influence is still more strongly shown. As
Sir Henry Holland[99] remarks, the corrections from reason and experience
are less complete in them than in adults. As a consequence, they not
infrequently confuse their dream-visions with the facts of their lives,
and regard the former as real events. The hallucinations of dreams are
also occasionally continued during wakefulness, and hence some persons
have, on awaking, seen the images which had been present to them in their
sleep.

The celebrated Benedict de Spinoza[100] was once the subject of an
illusion which had its starting-point in a dream. He dreamed that he was
visited by a tall, thin, and black Brazilian, diseased with the itch. He
awoke, and thought he saw such an image standing beside him.

Muller,[101] in referring to such instances, says:

“I have myself also very frequently seen these phantasms, but am now less
liable to them than formerly. It has become my custom when I perceive such
images, immediately to open my eyes, and direct them upon the wall or
surrounding objects. The images are then still visible, but quickly fade.
They are seen whichever way the head is turned, but I have not observed
that they moved with the eyes. The answers to the inquiries which I make
every year of the students attending my lectures as to whether they have
experienced anything of the kind, have convinced me that it is a
phenomenon known to comparatively few persons. For among a hundred
students, two or three only, and sometimes only one, have observed it.
This rarity of the phenomena is, however, more apparent than real. I am
satisfied that many persons would perceive these spectres if they learned
to observe their sensations at the proper times. There are, however,
undoubtedly many individuals to whom they never appear, and in my own case
they now sometimes fail to show themselves for several months at a time,
although in my youth they occurred frequently. Jean Paul recommended the
watching of the phantasms which appear to the closed eyes as a means of
inducing sleep.”

If such phenomena take place in persons of healthy brains, the greater
liability of the insane to experience them will readily be admitted.

The character of dreams, as Macario[102] remarks, varies according to the
type of insanity to which the patient is subject. In melancholia they are
ordinarily sad and depressing, and leave a deep and lasting impression; in
expansive monomania they are gay and exciting; in mania they give evidence
of the extraordinary mental excitement and activity of the subject, and in
duration they are vague, fleeting, and occur but seldom.

ESSENTIAL MORBID DREAMS.--Under this head are comprehended the various
forms of frightful dreams which are ordinarily designated under the name
of nightmare. It has been my good fortune to have had the opportunity of
carefully studying the phenomena of this singular affection in several
persons of intelligence, and I propose, therefore, detailing the results
of my own experience, after a short historical retrospect, which I hope
will not prove uninteresting.

Nightmare is characterized by the existence during sleep of a condition of
great uneasiness, the principal features of which are a sense of
suffocation, a feeling of pain or of constriction in some part of the
body, and a dream of a painful character. There are thus two essential
elements of the affection--the bodily and the mental.

At a very early period the phenomena of nightmare attracted the attention
of physicians. Hippocrates[103] describes it in the following words: “I
have often seen persons in their sleep utter groans and cries, appear as
if suffocated, and throw themselves wildly about until they finally waked.
Then they were in their right minds, but were, nevertheless, pale and
weak.”

The general opinion held at that time was that the phenomena of nightmare
were due to excess of bile and dryness of the blood. This view originated
with Hippocrates, but was more or less modified by subsequent writers.

After the establishment of Christianity, the conviction began to prevail
that during an attack of nightmare the subject was visited by a demon,
who, for the time being, took possession of his body. Oribasius, in the
fourth century, combated this idea, and endeavored to show that it was a
severe disease, which, if not cured, might lead to apoplexy, mania, or
epilepsy. He located it in the head.

Aetius also denied the existence of demoniacal agency in nightmare. He
considered it as a prelude to epilepsy, mania, or paralysis.

During the middle ages nightmare was attributed to the power of the devil.
Imps, male and female, called incubi and succubi respectively, were
supposed to be the active agents in producing the affection. The treatment
was in accordance with the theory, and consisted of prayers and exorcisms.
Not unfrequently the subject of the disease perished at the stake for the
alleged crime of having sexual intercourse with incubi or succubi,
according to sex.

Even in later times many persons have been found who believed implicitly
in the reality of the visions which they experienced during an attack of
nightmare. Thus Jansen[104] relates that a clergyman came to consult him.
“Monsieur,” said he, “if you do not help me I shall certainly go into a
decline, as you see I am thin and pale,--in fact, I am only skin and bone;
naturally I am robust, and of good appearance; now I am scarcely more than
the shadow of a man.”

“What is the matter with you?” said Jansen. “And to what do you attribute
your disease?”

“I will tell you,” answered the clergyman, “and you will assuredly be
astonished at my story. Almost every night a woman, whose figure is not
unknown to me, comes and throws herself on my breast, and embraces me with
such power that I can scarcely breathe. I endeavor to cry out, but she
stifles my voice, and the more I try the less successful I am. I can
neither use my arms to defend myself, nor my legs to escape. She holds me
bound and immovable.”

“But,” said the doctor, “what you relate is not in the least surprising.
Your visitor is an imaginary being, a shade, a phantom, an effect of your
imagination.”

“Not so!” exclaimed the patient. “I call God to witness that I have seen
with my own eyes the being of whom I speak, and I have touched her with my
hands. I am awake, and in the full possession of my faculties, when I see
this woman before me. I feel her as she attacks me, and I try to contend
with her, but fear, anxiety, and languor prevent me. I have been to every
one asking for aid to bear up against my horrible fate, and, among others,
I have consulted an old woman, who has the reputation of being very
skillful, and something of a sorceress. She directed me to urinate toward
daylight, and to immediately cover the _pot de chambre_ with the boot of
my right foot. She assured me that on the very day I would do this the
woman would pay me a visit.

“Although this seemed to me very ridiculous, and although my religion was
altogether against my making any such experiment, I was finally induced,
by reflecting on my sufferings, to follow the advice I had received. I did
so, and, sure enough, on the same day the wicked woman who had so
tormented me came to my apartment, complaining of a horrible pain in the
bladder. All my entreaties and threats, however, were unavailing to induce
her to cease her nocturnal visits.”

Jansen at first could not turn this gentleman from his insane idea, but,
finally, after two hours’ conversation, he made him have some just
conception of the nature of his disease, and inspired him with the hope
of a cure.

Epidemics of nightmare have been noticed, and it likewise sometimes
prevails endemically under certain peculiar forms. Thus vampirism, a
belief in which exists in different parts of the world, is nothing but a
kind of nightmare. Charles Nodier[105] gives some interesting details on
this point, which I do not hesitate to transcribe.

In Morlachia there is scarcely a hamlet which has not several _vukodlacks_
or vampires, and there are some, every family of which has its
_vukodlack_, just as every Alpine family has its cretin. The cretin,
however, has a physical infirmity, and with it a morbid state of the brain
and nervous system, which destroys his reason, and prevents him
appreciating his degraded condition. The _vukodlack_, on the contrary,
appreciates all the horror of his morbid perception; he fears and detests
it; he combats it with all his power; he has recourse to medicine, to
prayers, to division of a muscle, to the amputation of a limb, and
sometimes even to suicide. He demands that after his death his children
shall pierce his heart with a spike, and fasten his corpse to the coffin,
so that his dead body, in the sleep of death, may not be able to follow
the instinct of the living body. The _vukodlack_ is, moreover, often a man
of note, often the chief of the tribe, the judge, or the poet.

Through the sadness which is due to the recollection of his nocturnal
life, the _vukodlack_ exhibits the most generous and lovable traits of
character. It is only during his sleep, when visited with his terrible
dreams, that he is a monster, digging up the dead with his hands, feeding
on their flesh, and waking those around him with his frightful cries.

The superstition is that during this state of morbid dreaming the soul of
the sleeper quits the body to visit the cemeteries, and feast upon the
remains of the recently dead.

In Dalmatia the belief is current that there are sorcerers whose delight
is to tear out the hearts of lovers, and to cook and eat them. Nodier
relates the story of a young man about to be married, who was the constant
victim of nightmare, during which he dreamed that he was surrounded by
these sorcerers, ready to pluck his heart from his breast, but who often
awakened just as they were about to proceed to extremities. In order to be
effectually relieved from their visitations, he was advised to avail
himself of the company of an old priest, who had never previously heard of
these horrible dreams, and who did not believe that God would give such
power to the enemies of mankind. After using various forms of exorcism,
the priest went peacefully to sleep in the same room with the patient whom
he was commissioned to defend against the sorcerers. Hardly, however, had
sleep descended upon his eyelids than he thought he saw the demons
hovering over the bed of his friend, alight, and, laughing horribly,
throw themselves on his prostrate body, and with their claws tear open his
breast, and, seizing his heart, devour it with frightful avidity. Unable
to move from his bed, or to utter a sound, he was forced to witness this
terrible scene. At last he awoke to see no one but his companion, pale and
haggard, staggering toward him, and finally falling dead at his feet.

These two men, adds Nodier, had had similar attacks. What the one dreamed
he saw, the other dreamed he had experienced.

As an instance of like dreams occurring to many persons at the same time,
the circumstances related by Laurent[106] are worthy of notice.

“The first battalion of the regiment of Latour d’Auvergne, of which I was
Surgeon-major, while in garrison at Palmi, in Calabria, received orders to
march at once to Tropea in order to oppose the landing from a fleet which
threatened that part of the country. It was in the month of June, and the
troops had to march about forty miles. They started at midnight, and did
not arrive at their destination till seven o’clock in the evening, resting
but little on the way, and suffering much from the heat of the sun. When
they reached Tropea, they found their camp ready and their quarters
prepared, but as the battalion had come from the farthest point, and was
the last to arrive, they were assigned the worst barracks, and thus eight
hundred men were lodged in a place which, in ordinary times, would not
have sufficed for half their number. They were crowded together on straw
placed on the bare ground, and being without covering, were not able to
undress. The building in which they were placed was an old, abandoned
abbey, and the inhabitants had predicted that the battalion would not be
able to stay there all night in peace, as it was frequented by ghosts,
which had disturbed other regiments quartered there. We laughed at their
credulity; but what was our surprise to hear, about midnight, the most
frightful cries issuing from every corner of the abbey, and to see the
soldiers rushing terrified from the building. I questioned them in regard
to the cause of their alarm, and all replied that the devil lived in the
building; that they had seen him enter by an opening into their room,
under the figure of a very large dog, with long black hair, and, throwing
himself upon their chests for an instant, had disappeared through another
opening in the opposite side of the apartment. We laughed at their
consternation, and endeavored to prove to them that the phenomenon was due
to a very simple and natural cause, and was only the effect of their
imagination; but we failed to convince them, nor could we persuade them to
return to their barracks. They passed the night scattered along the
sea-shore, and in various parts of the town. In the morning I questioned
anew the non-commissioned officers and some of the oldest soldiers. They
assured me that they were not accessible to fear; that they did not
believe in dreams or ghosts, but that they were fully persuaded they had
not been deceived as to the reality of the events of the preceding night.
They said they had not fallen asleep when the dog appeared, that they had
obtained a good view of him, and that they were almost suffocated when he
leaped on their breasts. We remained all day at Tropea, and the town being
full of troops, we were forced to retain the same barracks, but we could
not make the soldiers sleep in them again, without our promise that we
would pass the night with them. I went there at half-past eleven with the
commanding officer; the other officers were, more for curiosity’s sake
than anything else, distributed in the several rooms. We scarcely expected
to witness a repetition of the events of the preceding night, for the
soldiers had gone to sleep, reassured by the presence of their officers,
who remained awake. But about one o’clock, in all the rooms at the same
time, the cries of the previous night were repeated, and again the
soldiers rushed out to escape the suffocating embrace of the big black
dog. We had all remained awake, watching eagerly for what might happen,
but, as may be supposed, we had seen nothing.

“The enemy’s fleet having disappeared, we returned next day to Palmi.
Since that event we have marched through the Kingdom of Naples in all
directions and in all seasons, but the phenomena have never been
reproduced. We are of opinion that the forced march which the troops had
been obliged to make during a very hot day, by fatiguing the organs of
respiration, had weakened the men, and consequently disposed them to
experience these attacks of nightmare. The constrained position in which
they were obliged to lie, the fact of their being undressed, and the bad
air they were obliged to breathe, doubtless aided in the production.”

A gentleman was, not long since, under my professional charge who was very
subject to attacks of nightmare. Though remarkable for his personal
courage, he confessed that during his paroxysms he was the most arrant
coward in the world. Indeed, so powerful an impression had his frequent
frightful dreams made upon him, that he was afraid to go to sleep, and
would often pass the night engaged in some occupation calculated to keep
him awake.

The dreams which he had were always of such a character as to inspire
terror, and generally related to demons and strange animals, which seated
themselves on his chest, and tried to tear open his throat. They came on a
few minutes after he fell asleep, and lasted sometimes for more than an
hour. During their continuance he remained perfectly still and quiet,
giving no evidence of the tumult within, beyond the appearance of a cold
sweat over the whole surface of the body. When he awoke, as he always did
when the climax was reached, he started from the bed with a bound, and
with all the evidences of intense fright. After that he was safe for the
remainder of the night.

I am acquainted with another case in which there are no very obvious
physical symptoms.

Ordinarily, however, the sufferer groans, and tosses about the bed; he
appears to be endeavoring to speak, and to escape from his imaginary
danger; his face, neck, and chest are flushed; a cold perspiration
appears, especially on his forehead, and he is sometimes seized with a
general trembling of the whole body. The respiration appears to be
particularly disturbed; he gasps for air, and occasionally the breathing
is stertorous. As to the pulse, strange as it may appear, there is rarely
any marked change from the healthy standard, beyond the slight
irregularity induced by the disorder of the respiration.

Among the mental symptoms, in addition to the fear with which he is
filled, the sufferer is most sensibly impressed with a sense of his utter
helplessness. His will is actively engaged in endeavoring to bring his
muscles into action, but they cannot be made to obey its behests, and he
consequently feels himself powerless to escape from the enemies which
attack him.

In regard to the kind of images which make their appearance, there is more
or less uniformity. Generally they consist of animals, such as hogs, dogs,
monkeys, or nondescripts created by the imagination of the dreamer. At
other times they are demons of various forms. A gentleman, whose case came
under my notice, was visited almost nightly by a huge black walrus, which
appeared to roll off of a large cake of ice, and, crawling up the bed, to
throw itself on his chest. Another was tormented by an animal, half lion
and half monkey, which seemed to fasten its claws in his throat while
seated on his breast.

At other times there are no images, but only painful delusions, in which
the dreamer is placed in dangerous positions, or suffers some kind of
torturing operation. Thus a lady informs me that she is subject to
frequent attacks of nightmare, during which she imagines she is standing
on the top of a high mast, and in extreme fear of falling off. Again she
is dragged through a key-hole by some invisible power; and again has her
nose and mouth so tightly closed that she can get no breath of air.

The _causes_ of nightmare may be divided into the _exciting_ and the
_immediate_. The _exciting causes_ are very numerous. Unusual fatigue,
either of mind or of body, recent emotional disturbance, such as that
produced by fright, anxiety, or anger, and intense mental excitement of
any kind may produce it. I have known a young lady to have a severe attack
the night after a school examination, in which she had been unduly tasked.
Another young lady is sure to be attacked after witnessing a tragedy
performed. A young man, who was under my care for a painful nervous
affection, always had a paroxysm of nightmare during the first sleep after
delivering an address, which he was obliged to do every month for a year
or more.

Fullness of the stomach, or the eating of indigestible or highly
stimulating food late in the evening, will often cause nightmare. As
Motet[107] remarks: “One of the best-established causes is repletion of
the stomach, and slowness and difficulty of digestion. Let an individual,
habitually systematic, depart for one day from the accustomed regularity
of his meals, let him change the hour of his dinner, and go to bed before
the work of digestion is completed, and it is probable that his sleep will
be troubled, and that nightmare will be the consequence of his
indiscretion. The painful feeling will be induced by distention of the
stomach, by anxiety, and by the restraint given to the movements of the
diaphragm.”

Feculent food would appear to be especially powerful in causing nightmare,
and according to Motet, strong liquors and sparkling wines and coffee are
equally so. I have several times known it produced by the New England dish
of baked pork and beans, and by green Indian-corn eaten just before going
to bed.

Various morbid affections, such as diseases of the heart, aneurism of the
large arteries, affections of the brain or spinal cord, and diseases of
the digestive or urinary apparatus are often exciting causes of nightmare.
It may originate from painful sensations in any part of the body. Some
women, about the time of the menstrual flow, are particularly liable to
paroxysms of this morbid dreaming.

Whatever interferes with the respiration or the easy flow of blood to and
from the head may bring on an attack of nightmare. I have known it caused
by the collar of the night-gown being too tight, and by the pillow being
under the head and not under the shoulders, thus putting the head at such
an angle with the body as to constrict the blood-vessels of the neck, and
by the head falling over the side of the bed. I have not been able to
ascertain that sleeping upon the back or on the left side predisposes to
the affection, unless in those cases in which the former position causes
snoring from relaxation of the soft palate.

The _immediate cause_ of nightmare is undoubtedly the circulation of blood
through the brain which has not been sufficiently aerated. The appearance
of the sufferer is sufficient to indicate this, as the condition of the
cerebral vessels and all the exciting causes act either by retarding the
flow of the venous blood from the brain, or by impeding the respiratory
movements. The effects of emotion, of mental fatigue, and of severe and
long-continued muscular exertion are such that the nervous influence to
the muscles of respiration is increased, or the muscles themselves are
debilitated through this general fatigue of the organism. Fullness of the
stomach acts mechanically, by interfering with the action of the
diaphragm, and constriction about the neck directly increases the flow of
blood through the brain. Certain diseases of the heart and lungs act upon
the function of respiration, and thus interfere with the due oxygenation
of the blood.

The _treatment_ of morbid dreams presents no points of any difficulty.
When they are the result of impressions made during sleep upon the nerves,
and are the forerunners of disease, it is not very likely that physicians
will be consulted as to their cure. Undoubtedly, however, much can be done
to abate them when they belong to the category of prodromic dreams, as
well as when they are symptomatic of existing disease. Hygienic measures,
such as open-air exercise, attention to diet, and warm baths, and the use
of the oxide of zinc and bromide of potassium, will do much to lessen the
irritability of the nervous system, and to diminish any hyperæmic
condition of the brain.

Nightmare often requires more active management, though even here we will
ordinarily find the measures above mentioned the most effectual that can
be taken for its treatment. Of course the exciting cause must be
ascertained if possible, and means taken to remove it. This is not always
an easy matter, and frequently cannot be accomplished without a
considerable alteration in the course of life followed by the patient, and
more or less sacrifice on his part. Among hygienic measures, I have
several times found relief follow a sojourn at the sea-shore, and ocean
bathing. Change of air is almost invariably beneficial, and moderate
physical exercise, just to the point of fatigue, can scarcely be dispensed
with. A gentleman, at this moment under my care, has been cured by a
course of gymnastic training, which he took at my instance. The food of
those subject to nightmare should always be plain, easily digestible, and
moderate in quantity. Alcoholic beverages should always be sparingly
taken, especially just before going to bed. Any article of food or drink
known to produce the paroxysm, should of course be omitted altogether.

As to medicines, the whole round of so-called antispasmodics is usually
tried by routine physicians. I have never seen them do any good. Iron and
bitter tonics are indicated in cases of anæmia or exhaustion. As the
disease is sometimes induced in children by the presence of worms in the
alimentary canal, diligent inquiry should be made relative to symptoms
indicating irritation from these parasites, and if they are found to
exist, anthelmintics should be administered.

A case of intermittent nightmare, occurring every alternate night, in a
young lady, was recently under my care. No exciting causes could be
discovered, except the probable one of malaria. The affection yielded at
once to the sulphate of quinia.

Ferrez[108] has published the details of a case of intermittent nightmare
occurring in the person of a Spanish officer, who was attacked after
passing forty-two nights at the bedside of a sick daughter. Every night,
at the same hour, he was awakened by frightful dreams, which, irritating
his brain, produced cramps, convulsive movements, an afflux of blood to
the cerebral tissues, a sadness which he could not conquer, and a
continual and powerful feeling of approaching death.

The patient, though of strong constitution, became enfeebled and
emaciated. His countenance was pale, the pupils contracted, and his whole
appearance showing the exhaustion consequent upon the battle which he was
obliged continually to fight with his disease. He composed at this time
some verses, describing in graphic terms the deplorable condition of his
mind and body.

Gymnastics, temperance in eating and drinking, and the study of poetry,
failed to give him relief. Finally he consulted Dr. Ferrez, who advised
him to reveal his state to his family, who hitherto had been kept in
ignorance of his malady, to continue his gymnastics moderately, not to eat
in the evening, to drink only cold water, to use friction over the whole
surface of the body, to apply mustard plasters to the extremities, to
sleep with his head elevated and uncovered, to bathe his head frequently
during the night with cold water, to give up the study of poetry, and to
devote himself to mathematics and political economy. These measures were
rigorously carried out; but his daughter, who had been the involuntary
cause of his disease, prescribed a better remedy than all the others. She
had him waked at midnight, before the occurrence of his paroxysm, and thus
broke up the habit.

Perhaps no one medicine is so uniformly successful in the ordinary forms
of nightmare as the bromide of potassium, administered in doses of from
twenty to forty grains, three times a day. I have seen a number of cases
which had resisted all hygienic measures, and the simple removal of the
apparent cause, yield to a few doses of this remedy.

When the affection has lasted a long time, it is more difficult to break
up the acquired habit. In these cases, the plan so successfully employed
by the daughter of the Spanish officer will almost invariably succeed.

Finally, persons subject to nightmare should so train the mind as to
employ the intellectual faculties systematically, by engaging in some
study requiring their full exercise. The action of the emotions should be
as much as possible controlled, and the reading of sensational stories, or
hearing sensational plays, should be discouraged. By severe mental
training, individuals can do much to regulate the character of their
dreams. It is a well-recognized fact, that intense thought upon subjects
which require the highest degree of intellectual action is not favorable
to the production of dreams of any kind.



CHAPTER VII.

SOMNAMBULISM.


The phenomena exhibited by a person in the condition of somnambulism are
so wonderful, that they have from the earliest times excited the
superstitious feelings of the ignorant, and claimed the most serious
attention of the learned. To see an individual apparently asleep to the
greater part of surrounding objects, yet so keenly awake to others as to
be able to perform the most intricate actions without the aid of the
senses, is so greatly at variance with the common experience of mankind,
as to call up feelings of astonishment, and perhaps of awe, in the minds
both of the vulgar and those accustomed to scientific investigation. In
those times, when the marvelous exercised so powerful an influence over
mankind, and when all phenomena out of the ordinary course of everyday
life were regarded as supernatural, it was the prevailing belief that the
somnambulist was possessed. Modern science has at last dispelled this
idea, and though it has not yet been able to furnish a rational theory of
somnambulism which will account for all the manifestations of the
affection, it has done much toward elucidating the functions of different
parts of the nervous system, and thus to prepare our minds for a full
understanding of the subject.

Somnambulism has been defined[109] as “a condition in which certain senses
and faculties are suppressed or rendered thoroughly impassive, while
others prevail in most unwonted exaltation; in which an individual, though
asleep, feels and acts most energetically, holding an anomalous species of
communication with the external world, awake to objects of attention, and
most profoundly torpid to things at the time indifferent; a condition
respecting which most commonly the patient on awaking retains no
recollection; but on any relapse into which, a train of thought and
feeling related to and associated with the antecedent paroxysm will very
often be developed.”

This definition, though unnecessarily long and by no means perfect, will
nevertheless suffice for a general description of the chief phenomena of
the affection. It accords with the generally received theory. My own views
of the nature of somnambulism will appear in the course of the following
remarks.

In the introduction to his classical work on the subject under
consideration, Bertrand[110] classifies the different kinds of
somnambulism according to their causes. He recognizes--

1. A particular nervous temperament which predisposes individuals
otherwise in good health to paroxysms of somnambulism during their
ordinary sleep.

2. It is sometimes produced in the course of certain diseases, of which it
may be considered a symptom or a crisis.

3. It is often seen in the course of the proceeding necessary to bring on
the condition known as animal magnetism.

4. It may result as the consequence of a high degree of mental exaltation.
It is in this case contagious by imitation to such persons as are
submitted to the same influence.

From these four divisions of causes, Bertrand makes four kinds of
somnambulism--the essential, the symptomatic, the artificial, and the
ecstatic. As he wrote nearly twenty years before the publication of Mr.
Braid’s remarkable researches, he was of course unacquainted with that
form of artificial somnambulism now known as hypnotism, and which may
properly be included in his third class. I shall simplify his arrangement
by dividing the several kinds of somnambulism into two classes--the
natural and artificial.

_Natural somnambulism_ may occur in persons who exhibit no marked
deviations from the standard of health, and in whom there is no very
evident nervous excitability. It is usually, though not always,
manifested during ordinary sleep, and it is common for authors to speak of
it as being necessarily connected with a dream. Thus, Macario[111] says it
is a sleep in which the nervo-motor system and all the other organs are
put in action under the influence of a dream. A few cases cited from other
authors, and from my own experience, will tend to the more complete
elucidation of the symptoms of this curious affection. Bertrand[112]
quotes the following instance from the _Encyclopædia_:

“The Archbishop of Bordeaux has informed me that when at the seminary he
was acquainted with a young ecclesiastic who was a somnambulist. Curious
to ascertain the nature of the malady, he went every night to the chamber
in which the young man slept. He saw, among other things, that the
ecclesiastic got up, took paper, and composed and wrote sermons. When he
had finished a page, he read it aloud--if one can apply the term to an
action done without the aid of sight. When a word displeased him, he wrote
the necessary corrections with great exactness. I have seen the beginning
of one of his sermons which he wrote in the somnambulistic state, and
thought it well composed and correctly written; but there was an
alteration which surprised me. Having used the expression _ce divin
enfant_, he thought as he read it over that he would change the word
_divin_ for _adorable_. He therefore effaced the first word, and wrote the
second above it. He then perceived that the word _ce_ properly placed
before _divin_ would not do before adorable; he therefore added a _t_ to
the preceding letters, so that the expression read _cet adorable enfant_.
The same person, an eye-witness of these facts, in order to ascertain
whether or not the somnambulist made use of his eyes, put a card under his
chin in such a manner as to prevent his seeing the paper on the table; but
he still continued to write. Wishing still to discover whether or not he
distinguished different objects placed before him, the Archbishop took
away the paper on which he wrote and substituted several other kinds at
different times; but he always perceived the change because the pieces
were of various sizes. When a piece exactly like his own was placed before
him he used it, and wrote his corrections on the places corresponding to
those on his own paper. It was by this means that portions of his
nocturnal compositions were obtained. These the Archbishop has had the
goodness to send to me. The most astonishing among them was a piece of
music written with great exactitude. A cane had served him for a
ruler--the clef, the flats, and the sharps were all in their right places.
All the notes were first made as circles, and then those which required it
were blackened with ink. The words were all written below. Once they were
in such large characters that they did not come directly under their
proper notes. He soon, however, perceived his error, and corrected it by
effacing what he had written and writing it over again.

“One night, in the middle of winter, he imagined himself to be walking on
the bank of a river and seeing a child fall in. The severity of the
weather did not prevent him from determining to save it. He threw himself
on his bed in the posture of a man swimming, went through all the motions,
and, after becoming well fatigued with the severity of this exercise, he
felt a bundle of the bedclothes, which he took to be the drowning child.
He seized it with one hand, while he continued to swim with the other, in
order to regain the bank of the imaginary river. Finally, he placed the
bundle in a place which he evidently determined to be dry land, and rose,
shivering, with his teeth chattering as though he had emerged from icy
water. He remarked to the by-standers that he was frozen, that he would
die of cold, and that his blood was like ice. He then asked for a glass of
brandy in order to restore his vitality; but there being none at hand, a
glass of water was given him instead. He, however, detected the difference
and asked peremptorily for brandy--calling attention to the great danger
he incurred from the cold. Some brandy was finally obtained. He drank it
with much satisfaction, and remarked that he felt much better.
Nevertheless, he did not awake, and, returning to bed, slept tranquilly
the rest of the night.”

Gassendi[113] had in his service a young man who every night arose in his
sleep, descended into the cellar and drew some wine from a cask.
Frequently he went out into the streets in the middle of the night,
sometimes even he went into the country and walked on stilts, in order to
cross a rapid stream which ran around the city. If he happened to awake
from his sleep after having crossed this torrent, he was afraid to recross
it so as to return home. Gassendi relates that when this man waked in the
course of his perambulations he suddenly found himself in darkness, but as
he had the faculty of remembering all that had taken place during his
dream, and of recognizing the place where he found himself, he was able to
grope his way to his bed. The darkness, therefore, which was an obstacle
to the exercise of his sight when he was awake, was no impediment when he
was in the state of somnambulism.

Dr. Prichard[114] cites from Muratori[115] the cases of Forari and
Negretti, which are curious instances of the affection in question.

“Signor Augustin Forari was an Italian nobleman, dark, thin, melancholic,
and cold-blooded, addicted to the study of the abstract sciences. His
attacks occurred at the waning of the moon, and were stronger in the
autumn and winter than in the summer. An eye-witness, Vigneul Marville,
gave the following description of them:

“One evening, toward the end of October, we played at various games after
dinner; Signor Augustin took a part in them along with the rest of the
company, and afterward retired to repose. At eleven o’clock, his servant
told us that his master would walk that night, and that we might come and
watch him. I examined him after some time with a candle in my hand. He was
lying upon his back and sleeping with open, staring, unmoved eyes. We were
told that this was a sure sign that he would walk in his sleep. I felt his
hands and found them extremely cold, and his pulse beat so slowly that his
blood appeared not to circulate. We played a tric-trac till the spectacle
began. It was about midnight, when Signor Augustin drew aside the
bed-curtains with violence, arose and put on his clothes. I went up to him
and held the light under his eyes. He took no notice of it, although his
eyes were open and staring. Before he put on his hat, he fastened on his
sword-belt, which hung on the bedpost; his sword had been removed. Signor
Augustin then went in and out of several rooms, approached the fire,
warmed himself in an arm-chair, and went thence into a closet where he had
his wardrobe. He sought something in it, put all the things into disorder,
and, having set them right again, locked the door and put the key into his
pocket. He went to the door of the chamber, opened it and stepped out on
the staircase. When he came below, one of us made a noise by accident; he
appeared frightened, and hastened his steps. His servant desired us to
move softly and not to speak, or he would become out of his mind; and
sometimes he ran as if he were pursued, if the least noise was made by
those standing around him. He then went into a large court and to the
stable, stroked his horse, bridled it, and looked for the saddle to put on
it. As he did not find it in the accustomed place, he appeared confused.
He then mounted his horse and galloped to the house-door. He found this
shut, dismounted and knocked with a stone, which he picked up, several
times at the door. After many unsuccessful efforts, he remounted and led
his horse to the watering-place--which was at the other end of the
court--let him drink, tied him to a post and went quietly to the house.
Upon hearing a noise, which the servants made in the kitchen, he listened
attentively, went to the door and held his ear to the keyhole. After some
time he went to the other side, and into a parlor in which was a
billiard-table. He walked around it several times and acted the motions of
a player. He then went to a harpsichord, on which he was accustomed to
practice, and played a few irregular airs. After having moved about for
two hours, he went to his room and threw himself upon his bed, clothed as
he was, and the next morning we found him in the same state; for as often
as his attack came on he slept afterward from eight to ten hours. The
servants declared that they could only put an end to his paroxysms either
by tickling him on the soles of his feet, or by blowing a trumpet in his
ears.”

The history of Negretti was published separately by two physicians,
Righellini and Pigatti, who were both eye-witnesses of the curious facts
which they relate.

“Negretti was about twenty-four years old, was a sleep-walker from his
eleventh year; but his attacks only occurred in the month of March,
lasting at farthest till the month of April. He was a servant of the
Marquis Luigi Sale. On the evening of the 16th of March, 1740, after going
to sleep on a bench in the kitchen, he began first to talk, then walked
about, went to the dining-room and spread a table for dinner, placed
himself behind a chair with a plate in his hand as if waiting on his
master. After waiting until he thought his master had dined, he removed
the table, put away all the materials in a basket, which he locked in a
cupboard. He afterward warmed a bed, locked up the house, and prepared for
his nightly rest. Being then awakened, and asked if he remembered what he
had been doing, he answered no. This, however, was not always; he often
recollected what he had been doing. Pigatti says he would awake when water
was thrown into his face, or when his eyes were forcibly opened. According
to Maffei, he then remained sometimes faint and stupid. Righellini
assured Muratori that his eyes were firmly closed during the paroxysm, and
that when a candle was put near to them, he took no notice of it.
Sometimes he struck himself against the wall and even hurt himself
severely. Hence it would seem that he was directed in his movements by
habit, and had no actual perception of external objects. This is confirmed
by the assurance that if anybody pushed him, he got out of the way and
moved his arms rapidly about on every side; and that when he was in a
place of which he had no distinct knowledge, he felt with his hands all
the objects about him, and displayed much inaccuracy in his proceedings;
but in places to which he was accustomed he was under no confusion, but
went through his business very cleverly. Pigatti shut a door through which
he had just passed; he struck himself against it in returning. The writer
last mentioned was confident that Negretti could not see. He sometimes
carried about with him a candle, as if to give him light in his
employment; but on a bottle being substituted, took it and carried it,
fancying that it was a candle. He once said during his sleep that he must
go and hold a light to his master in his coach. Righellini followed him
closely, and remarked that he stood still at the corners of the streets
with his torch in his hand not lighted, and waited awhile in order that
the coach which he supposed to be following might pass through the place
where light was required. On the eighteenth of March he went through
nearly the same process as before in laying a table, etc., and then went
to the kitchen and sat down to supper. Signor Righellini observed him, in
company with many other cavalieri very curious to see him eat. At once he
said, as recollecting himself, ‘How can I so forget? To-day is Friday and
I must not dine.’ He then locked up everything and went to bed. On another
occasion he ate several cakes of bread and some salad which he had just
before demanded of the cook. He then went with a lighted candle into the
cellar and drew wine, which he drank. All these acts he performed as
usual, and carried a tray upon which were wineglasses and knives, turning
obliquely when passing through a narrow doorway, but avoiding any
accident.”

Macario[116] cites from I. Franck the case of a young peasant, aged about
sixteen, and endowed with a degree of intelligence above his age and
condition, who was rendered somnambulic by the grief caused by the sudden
death of his father. A few weeks after this event, he dreamed that he saw
two unknown and frightful-looking men who advanced slowly toward his bed,
and in menacing language ordered him to rise immediately and accompany
them, threatening that if he refused they would return the following night
and take him by force. This dream had so strong an effect upon him that he
became melancholic. Two days afterward, while he was sleeping quietly, he
dreamed that his father’s spirit came to him, accompanied by the two men
who had previously visited him, and ordered them to seize his son,
notwithstanding his resistance, and to carry him off.

The young man dreamed that he was transported through a delightful country
of vast extent; he heard the harmonious sounds from flutes and other
musical instruments; he saw young people dancing on the charming plains,
and he ate to satiety of delicious viands. Immediately the scene changed;
his father’s spirit disappeared, and his ferocious companions carried him
high up into the air and then suddenly let him fall into a barrel. The
servants returning with the cows, found the young man in the stable shut
up in an empty barrel, scantily covered, and almost dead with cold and
fright. Restored by frictions and warmth, he had no recollection of
anything connected with his situation beside the dream above recorded. At
the end of a week, he again rose from bed in his sleep, but finding the
door locked, he returned and remained quiet. In a short time the disease
ceased entirely.

The same author also quotes from Franck the case of a Jewish tailor, who,
during the attacks of somnambulism to which he was subject, recited in a
low voice his customary prayers in Hebrew. When he came to certain parts
he raised his voice, called out aloud, and imitated the gestures of the
rabbis in the synagogues. While thus engaged his eyes were wide open, and
the pupils insensible to the stimulus of light. Then his face became pale,
he presented the appearance of weeping, his whole body was covered with a
cold, profuse sweat, and his pulse rose to 130. This crisis was followed
by a tranquil prayer, to which sooner or later another access of fury
succeeded; and this series continued for an hour or two, or till his
prayers had been repeated for the prescribed period.

When strongly shaken he awoke with a startled manner, but if left to
himself fell asleep again, and resumed his prayers at the place where he
had been interrupted. When awake he declared that he had no recollection
of what had happened during his sleep. The paroxysms appeared every day
except Tuesday. The patient had a brother who was also a somnambulist.

These cases will give an idea of somnambulism as it has been witnessed by
other observers, or as its phenomena have impressed them. The following
instances of the disease have come under my own notice.

A young lady, of great personal attractions, had the misfortune to lose
her mother by death from cholera. Several other members of the family
suffered from the disease, she alone escaping, though almost worn out with
fatigue, excitement, and grief. A year after these events, her father
removed from the West to New York, bringing her with him and putting her
at the head of his household. She had not been long in New York, before
she became affected with symptoms resembling those met with in chorea. The
muscles of the face were in almost constant action, and though she had not
altogether lost the power to control them by her will, it was difficult at
times for her to do so. She soon began to talk in her sleep, and finally
was found one night by her father, as he came home, endeavoring to open
the street-door. She was then, as he said, sound asleep, and had to be
violently shaken to be aroused. After this she made the attempt every
night to get out of bed, but was generally prevented by a nurse who slept
in the same room with her, and who was awakened by the noise she made in
the room.

Her father now consulted me in regard to the case, and invited me to the
house in order to witness the somnambulic acts for myself. One night,
therefore, I went to his residence and waited for the expected
manifestations. The nurse had received orders not to interfere with her
charge on this occasion, unless it was evident that injury would result,
and to notify us of the beginning of the performance.

About twelve o’clock she came down stairs and informed us that the young
lady had risen from her bed and was about to dress herself. I went up
stairs, accompanied by her father, and met her in the upper hall partly
dressed. She was walking very slowly and deliberately, her head elevated,
her eyes open, her lips unclosed, and her hands hanging loosely by her
side. We stood aside to let her pass. Without noticing us, she descended
the stairs to the parlor, we following her. Taking a match, which she had
brought with her from her own room, she rubbed it several times on the
under side of the marble mantle-piece until it caught fire, and then,
turning on the gas, lit it. She next threw herself into an arm-chair and
looked fixedly toward a portrait of her mother which hung over the
mantle-piece. While she was in this position, I carefully examined her
countenance, and performed several experiments with the view of
ascertaining the condition of the senses as to activity.

She was very pale, more so than was natural to her; her eyes were wide
open and did not wink when the hand was brought suddenly in close
proximity to them; the muscles of the face, which when she was awake were
almost constantly in action, were now perfectly still; her pulse was
regular in rhythm and force, and beat 82 per minute, and the respiration
was uniform and slow.

I held a large book between her eyes and the picture she was apparently
looking at, so that she could not possibly see it. She nevertheless
continued to gaze in the same direction as if no obstacle were interposed.
I then made several motions as if about to strike her in the face. She
made no attempt to ward off the blows, nor did she give the slightest sign
that she saw my actions. I touched the cornea of each eye with a
lead-pencil I had in my hand, but even this did not make her close her
eyelids. I was entirely satisfied that she did not see--at least with her
eyes.

I held a lighted sulphur-match under her nose, so that she could not avoid
inhaling the sulphurous acid gas which escaped. She gave no evidence of
feeling any irritation. Cologne and other perfumes, and smelling-salts
likewise failed to make any obvious impression on her olfactory nerves.

Through her partially opened mouth, I introduced a piece of bread soaked
in lemon-juice. She evidently failed to perceive the sour taste. Another
piece of bread, saturated with a solution of quinine, was equally
ineffectual. The two pieces of bread remained in her mouth for a full
minute, and were then chewed and swallowed.

She now arose from her chair and began to pace the room in an agitated
manner; she wrung her hands, sobbed, and wept violently. While she was
acting in this way, I struck two books together several times so as to
make loud noises close to her ears. This failed to interrupt her.

I then took her by the hand and led her back to the chair in which she had
previously been sitting. She made no resistance, but sat down quietly and
soon became perfectly calm.

Scratching the back of her hand with a pin, pulling her hair, and pinching
her face, appeared to excite no sensation.

I then took off her slippers, and tickled the soles of her feet. She at
once drew them away, but no laughter was produced. As often as this
experiment was repeated, the feet were drawn up. The spinal cord was
therefore awake.

She had now been down stairs about twenty minutes. Desiring to awake her,
I shook her by the shoulders quite violently for several seconds, without
success. I then took her head between my hands and shook it. This proved
effectual in a little while. She awoke suddenly, looked around her for an
instant, as if endeavoring to comprehend her situation, and then burst
into a fit of hysterical sobbing. When she recovered her equanimity, she
had no recollection of anything that had passed, or of having had a dream
of any kind.

A gentleman of very nervous temperament informs me that upon one occasion
he dreamed that his place of business was on fire. He got up in his sleep,
dressed himself, and walked a distance of over a mile to his store. He was
aroused by the private watchman, who stopped him while in the act of
looking through the grating of the door, under the impression at first
that he had caught a burglar.

A young lady who some time since was under my care for intense periodical
headaches, informed me that, just previous to each attack, she walked in
her sleep, but had never any recollection of what she did while in the
somnambulic state. Her mother stated that when her daughter was in this
condition, she did not use her eyes, although they were wide open, nor
did she appear to hear loud noises made close to her ears.

In relation to the activity of the senses during somnambulism, there is
great diversity of opinion among those who have studied the affection.
This is doubtless due to the fact that somnambulists differ among
themselves as regards the use they make of their senses--some availing
themselves of the aid they can derive from these sources, while others do
not appear to employ them at all.

Thus it is stated that Negretti kept his eyes closed, and yet when a box
of snuff was handed to him, he took a pinch without hesitation; and the
young ecclesiastic whose case I have already quoted, performed even more
complex acts than this.

Castelli, a young somnambulist and a student of pharmacy, performed many
astonishing acts during his paroxysms. One night he was found in the
somnambulic condition, translating a passage from the Italian into French,
and searching out the words in a dictionary. Prichard[117] assumes from
this fact that he must have seen the words. He states further, that
somnambulists have been known to write and even to correct their
compositions, and to do other acts which could not possibly have been
performed without sight. While it is certainly true that somnambulists
have done all these things, it is equally certain that they have often
performed them without the aid of their eyes. In the case of Castelli, a
candle was on the table, which some one who saw him extinguished. He
immediately arose, and lighted it, although there was no occasion for his
doing so, as the room was well lit with other candles.[118] These he had
not observed, but was only cognizant of the one which he probably did not
see, but which was in relation with him through some more subtle channel.

Many somnambulists are known to have acted as though they saw in rooms
which were perfectly dark. A gentleman informs me that his wife frequently
walks in her sleep, and performs many somnambulic acts in entire darkness.
On one occasion she went into a dark closet, and, opening a trunk, began
to arrange the contents. It contained clothing of various kinds, which had
been put into it the day before without being sorted. She classified all
the articles, such as stockings, handkerchiefs, shirts, etc., without
making a single mistake--and without the possibility of being assisted by
light sufficient for ordinary eyesight.

Bertrand[119] refers to the case of a young lady who was accustomed to
rise from her bed in a state of somnambulism and to write in complete
darkness. A remarkable feature of this instance was, that if the least
light, even that of the moon, entered the room, she was unable to write.
She could only do so in the most perfect obscurity.

In the case of the young lady, the particulars of which, with my
experiments, I have related, the sense of sight was certainly not
employed, nor were the other senses awake to ordinary excitations.

On the other hand, it is evident that some somnambulists make use of their
eyes and their other organs of sense in the ordinary way, when the
excitations made upon them are in relation with the train of thought or
ecstatic condition which prevails.

Macario,[120] in reference to this point, says:

“Somnambulists are insensible to external impressions, except those which
are in relation with their ideas, their thoughts, and their feelings. It
is thus that persons, the subjects of somnambulism, will pass before
objects or individuals without seeing them, although they may have their
eyes open. This phenomenon occurs often to individuals who are fully
awake, although in a less degree. Thus when we are strongly preoccupied
with any subject, the objects which surround us make no impression on our
senses or our mind. Archimedes while meditating on a discovery, was an
entire stranger to all that was going on around him. A part only of his
brain was awake and active. While thus engaged, Syracuse was taken by the
enemy, and he was not diverted from his thoughts either by the chant of
victory by the conqueror, or by the cries and groans of the wounded and
the dying.”

As regards the sense of hearing, it is doubtless true that somnambulists
rarely exercise it. There have been cases in which replies have been made
to questions; but such answers have been given automatically, and not as
if the mind took cognizance of the subject. A person intently engaged in
reading, will often answer questions without suffering his train of
thought to be interrupted. When he has ceased his study, he is surprised
when told that he has been conversing.

The sense of taste appears to be very inactive in general, though in a few
cases it has been manifested. The same is true in even a greater degree
with the sense of smell.

The sense of touch is very differently affected, for so far from being
diminished in its action, it is invariably unduly exalted. Though the eyes
do not see, the ears hear, the tongue taste, or the nose smell, the
somnambulist has one sense which is fully awake, and by which he is
enabled to guide himself through the most devious passages in dangerous
paths.

In this fact it appears to me we have a strong argument in favor of the
theory of somnambulism which I have already referred to, and which appears
to me to be supported by much additional evidence. I propose this view not
without hesitation; but much study of the phenomena of somnambulism, and
of analogous states of the nervous system, has certainly tended to
convince me of its general correctness, and I am not without the hope that
other students of neurology will find it reconcilable with their
observations and experiments.

In my opinion, somnambulism is a condition of the organism in which
through profound sleep the action of the encephalic ganglia is so
materially lessened that the spinal cord becomes able to control and
direct the body in its movements.

That the spinal cord even in the waking state constantly exercises this
power, is a matter of common observation. I have already alluded to some
of the facts which establish this proposition; but, for the purpose of
giving as complete and connected a view as possible of all the points
which bear upon the theory of somnambulism above enunciated, I shall not
hesitate to recall them to the recollection of the reader, and to bring
forward other circumstances which appear to be in relation with the
question.

If an individual engaged in reading a book allows his mind to be diverted
to some other subject than that of which he is reading, he continues to
see the words, which make no impression upon his brain, and he turns over
the leaf whenever he reaches the bottom of a page with as much regularity
as though he comprehended every word he has read. He suddenly, perhaps,
brings back his mind to the subject of his book, and then he finds that
he has perused several pages without having received the slightest idea of
their contents.

Again: when, for instance, we are walking in the street and thinking of
some engrossing circumstance, we turn the right corners and find ourselves
where we intended to go, without being able to recall any events connected
with the act of getting there.

In such instances as these--and many others might be adduced--the brain
has been occupied with a train of thought so deeply that it has taken no
cognizance or superintendence of the actions of the body. The spinal cord
has received the several sensorial impressions, and has furnished the
nervous force necessary to the performance of the various physical acts
concerned in turning over the leaves, avoiding obstacles, taking the right
route, and stopping in front of the right door.

All cases of what are called “absence of mind” belong to the same
category. Here the brain is completely preoccupied with a subject of
absorbing interest, and does not take cognizance of the events which are
transpiring around. An individual, for instance, is engaged in solving an
abstruse mathematical problem. The whole power of the brain is taken up in
this labor, and is not diverted by circumstances of minor importance.
Whatever actions these circumstances may require, are performed through
the force originating in the spinal cord.

The phenomena of reverie are similar in some respects to those of
somnambulism. In this condition the mind pursues a train of reasoning
often of the most fanciful character, but yet so abstract and intense,
that though actions may be performed by the body, they have no relation
with the current of thought, but are essentially automatic, and made in
obedience to sensorial impressions which are not perceived by the brain.
Thus a person in a state of reverie will answer questions, obey commands
involving a good deal of muscular action, and perform other complex acts,
without disturbing the connection of his ideas. When the state of mental
occupation has disappeared, there is no recollection of the acts which may
have been performed. Memory resides in the brain and can only take
cognizance of those things which make an impression on the mind, or of
those ideas which originate in the encephalon.

In the case of a person performing on a piano, and at the same time
carrying on a conversation, we have a most striking illustration of the
diverse though harmonious action of the brain and spinal cord. Here the
mind is engaged with ideas, and the spinal cord directs the manipulations
necessary to the proper rendering of the musical composition. A person who
is not proficient in the use of this instrument, cannot at the same time
play and converse with ease, because the spinal cord has not yet acquired
a sufficient degree of automatism, and the mind cannot be divided in its
action.

Darwin gives a very striking example of the independent action of the
brain and spinal cord. A young lady was playing on the piano a very
difficult musical composition, which she performed with great skill and
care, though she was observed to be agitated and preoccupied. When she had
finished, she burst into tears. She had been intently watching the
death-struggles of a favorite bird. Though her brain was thus absorbed,
the spinal cord had not been diverted from the office of carrying on the
muscular and automatic actions required by her musical performance.

The brain cannot entertain two ideas or initiate two acts at the same
time. A person cannot, for example, think of a lamp and a book
simultaneously; the thought of the one and the thought of the other will
be found to alternate by any one who feels inclined to make the
experiment, and not to exist at the same time. Neither can the brain think
and simultaneously will. Whatever volitional acts it performs, are
distinct from thought, and clearly separated from it by the element of
time.

Now in all sleep there is more or less somnambulism, because the brain,
according as the sleep is more or less profound, is more or less removed
from the sphere of action. If this quiescent state of the brain is
accompanied, as it frequently is in nervous and excitable persons, by an
exalted condition of the spinal cord, we have the higher order of
somnambulic phenomena produced, such as walking and the performance of
complex and apparently systematic movements; if the sleep of the brain be
somewhat less profound, and the spinal cord less excitable, the
somnambulic manifestations do not extend beyond sleep-talking; a still
less degree of cerebral inaction and spinal irritability produces simply a
restless sleep and a little muttering; and when the sleep is perfectly
natural, and the nervous system of the individual well balanced, the
movements do not extend beyond changing the position of the head and limbs
and turning over in bed.

As regards the power of the spinal cord to supply the nervous force
requisite for the performance of such actions as those specified, I do not
think there can be any question. Much observation and many experiments
have convinced me that the importance of the spinal cord as a center of
intellection and volition has been unwarrantably ignored. It is of course
not a matter for doubt that the faculty of consciousness is latent in the
spinal cord so long as the brain is in a state of activity, and that the
faculty of memory does not reside in it at all. When the brain acts, it
ordinarily assumes the control of the cord; but there are times,
especially during the course of certain diseases, when the latter obtains
the mastery over the superior organ and dominates with terrible power.

The actions initiated by the spinal cord are more or less automatic in
their character--though not altogether so. The motions of a frog deprived
of its brain, show a certain amount of intellection and volition. That
they are not more extensive is probably due to the fact that all the
organs of the senses, except that of touch, have been removed with the
brain. In persons engaged in intense thought and performing actions not in
accordance therewith, the impressions made upon the organs of the senses
are not appreciated by the brain, but pass through its substance to the
spinal cord with which they are in connection by continuity of structure,
and which initiates the subsequent actions.

In the somnambulic individual the brain is still more incapable of
receiving sensorial impressions. Whatever sense is therefore exercised
during the condition of somnambulism, owes its activity to the spinal
cord; but in most cases of the state in question, the brain is so
profoundly asleep that it does not even transmit impressions to the cord,
and hence there are no sensations at all, except that of touch, unless the
irritations capable of exciting them are extraordinarily great.

In artificial somnambulism--the hypnotism of Braid--the spinal cord
acquires a very high degree of susceptibility to sensorial impressions,
and the brain is even more incapable than in natural somnambulism of
asserting its superiority. But the consideration of this interesting
branch of the subject does not enter into the plan of the present work.

The _causes_ of somnambulism are generally to be found inherent in the
organism of the individual, though they may be excited to activity by
many circumstances which are capable of exhausting the nervous system or
producing emotional disturbance. Young persons are more subject than those
of maturer age, and there are few children who do not exhibit at some time
or other manifestations of the condition in question, such as muttering
and talking in their sleep, laughing, crying, or getting out of bed.
Persons of the nervous temperament are those most liable to be affected.
In four cases of chorea which have come under my care, the subjects were
sleep-walkers in their youth, and the young lady whose case I have related
was choreic at the time.

In regard to the _treatment_ there is not much to be said. In the great
majority of cases the affection yields readily to appropriate measures;
the most efficacious of which consists in means adapted to break up the
habit. This may be done by waking the patient before the expected
paroxysm, or by placing a tub of cold water so that the feet will be put
into it on the attempt to leave the bed. Full exercise in the open air,
the avoidance of luxurious habits, and sleeping with the head well raised,
are always beneficial.

Of medicines, I have no experience except with the bromide of potassium,
and those calculated to improve the tone of the nervous system. The former
I have used in two cases with entire success. One of them was that of the
young lady, the details of whose case I have related; the other that of a
gentleman, forty years of age, who became somnambulic from mental
excitement, due to the extensive business operations in which he was
engaged. Large doses of this remedy--forty to sixty grains taken at
bedtime, and smaller doses, ten to thirty grains, taken twice through the
day--broke up the habit entirely in a few weeks. Among the other remedies,
I have employed phosphorus, strychnia, and iron with manifest advantage.
Cold baths are generally useful. I am acquainted with a young lady who
cured herself by taking a cold bath every night just before going to bed.
The so-called antispasmodics can scarcely be useful.

Much may be done also by suitable mental training. The reading of exciting
fictions, and the witnessing of sensational theatrical exhibitions, are
always prejudicial to persons subject to attacks of somnambulism.



CHAPTER VIII.

THE PATHOLOGY OF WAKEFULNESS.


As nations advance in civilization and refinement, affections of the
nervous system become more frequent, because progress in these directions
is necessarily accompanied by an increase in the wear and tear of those
organs through which perceptions are received and emotions excited; and,
in addition, the mode of life, as regards food, clothing, occupation, and
habits, is being constantly removed farther from that standard which a
regard for hygienic considerations would establish as most advantageous.
If, as we have every reason to believe, each thought involves the
destruction of a certain amount of nervous tissue, we can very well
understand why, as we go forward in enlightenment and in all the elements
of material and intellectual progress, we are at the same time, unless we
also advance in the knowledge of the laws of our being, hurrying ourselves
with rapid strides to a state of existence in which there is neither waste
nor repair.

I am far, however, from desiring to be understood as intimating that a
high state of civilization is antagonistic to long life or health. What is
lost in these directions as regards the nervous system is more than made
up by the increased provision afforded for comfort in other ways. But
while we have improved the hygienic condition of our cities and dwellings;
while we as a rule clothe our bodies according to the principles of
sanitary science and common sense; and while cleanliness of person has
become the rule, and filthiness the exception, we have made little or no
progress in the hygienic management of those organs which place us in
relation with the world, and a healthy condition of which is so essential
to our happiness.

Among the many derangements in the normal operation of the nervous system,
induced by irregular or excessive cerebral action, those which relate to
the function of sleep are certainly not the least in importance, whether
regard be had to the actual comfort of the individual or to the serious
consequences to which they may give rise. To the consideration of some of
these morbid conditions I propose to devote the remainder of the present
volume, and first to inquire into the most important of them, wakefulness
or insomnia.

As a symptom of various diseases which affect the human organism,
wakefulness is sufficiently well recognized by systematic writers on the
practice of medicine, though, even here, it is very certain that its
pathology has seldom been clearly made out. As a functional disorder of
the brain, arising from inordinate mental activity, it has received
scarcely any notice. This neglect has, doubtless, been in a great measure
due to the fact that it is only within late years that the condition in
question has become so common as to attract much attention. At present
there are, probably, but few physicians engaged in extensive practice in
any of our large cities who do not in the course of the year meet with
several cases of obstinate wakefulness, unaccompanied, in the early stages
at least, by any other prominent disorder of the system.

In my opinion, no one cause is so productive of cerebral affections as
persistent wakefulness, for not only is the brain prevented from obtaining
rest, but it is kept in a state of erethism, which, if not relieved, must
sooner or later end in organic disease. Southey laid the seeds of that
disorder which terminated in the loss of his intellect, by watching at the
bedside of his sick wife during the night, after the excessive literary
labors of the day.[121] Newton’s mind also suffered in the later years of
his life through deprivation of sleep;[122] and Dr. Forbes Winslow, in
remarking on Southey’s case, says: “No brain can remain in permanent
health that has been overtasked by nightly vigils still more than by daily
labor.”[123]

Renaudin,[124] in a very philosophical essay, calls attention to the fact
that persistent wakefulness is sooner or later followed by insanity; and
Maury[125] states his opinion to the same effect. The remarks of Dr.
Ray[126] upon this subject are so apposite that I reproduce them in part,
commending at the same time the little book from which they are taken to
the attention of the reader.

“A periodical renewal of the nervous energies as often as once a day is an
institution of nature, none the less necessary to the well-being of the
animal economy, because in some degree under the control of the will. To
disregard its requirements with impunity is no more possible than it is to
violate any other organic law with impunity, and no man need flatter
himself that he may systematically intrench upon the hours usually devoted
to rest and still retain the freshness and elasticity of his faculties.
With the same kindliness that marks all the arrangements of the animal
economy, this condition is attended with many pleasing sensations and
salutary effects, gently alluring us to seek the renovation which it
offers. ‘While I am asleep,’ says the immortal Sancho Panza, ‘I have
neither fear nor hope; neither trouble nor glory; and blessings on him
who invented sleep,--the mantle that covers all human thoughts; the food
that appeases hunger; the drink that quenches thirst; the fire that warms;
the cold that moderates heat; and, lastly, the general coin that purchases
all things; the balance and weight that make the shepherd equal to the
king and the simple to the wise.’ The ill effects of insufficient sleep
may be witnessed on some of the principal organic functions, but it is the
brain and nervous system that suffer chiefly and in the first instance.
The consequences of a too protracted vigil are too well known to be
mistaken, and many a person is suffering, unconscious of the cause, from
the habit of irregular and insufficient sleep. One of its most common
effects is a degree of nervous irritability and peevishness, which even
the happiest self-discipline can scarcely control. That buoyancy of the
feelings, that cheerful, hopeful, trusting temper that springs far more
from organic conditions than from mature and definite convictions, give
way to a spirit of dissatisfaction and dejection; while the even demeanor,
the measured activity, are replaced either by a lassitude that renders any
exertion painful, or an impatience and restlessness not very conducive to
happiness. Upon the intellectual powers the mischief is still more
serious. They not only lose that healthy activity which combines and
regulates their movements in the happiest manner, but they are no longer
capable of movements, once perfectly easy. The conceptions cease to be
clear and well defined, the power of endurance is weakened, inward
perceptions are confounded with outward unhappiness, and illusory images
obtrude themselves unbidden upon the mind. This kind of disturbance may
pass sooner or later into actual insanity, and many a noble spirit has
been utterly prostrated by habitual loss of rest.”

CASE I.--Some years ago a case similar in several respects to that of
Southey came under my observation. A gentleman of superior mind and of
great powers of application spent from sixteen to eighteen hours each day
in severe literary labor. This of itself would have been a heavy strain to
most persons, but he went regularly to bed and slept soundly six hours
each night, and it is possible that he might have continued this mode of
life for several years without serious inconvenience, when his wife was
suddenly taken ill. His anxiety on her account was very great, and he
spent nearly the whole night by her bedside, sleeping only for about an
hour toward morning. After three weeks passed in this manner, his wife was
pronounced out of danger, but he found it impossible to resume his former
habits. He could neither study nor sleep. The nights were passed in
walking the floor of his chamber or in tossing restlessly on his bed.
There were no pain, no fever, no disorder of any other organ. There was
nothing but ceaseless activity of the mind and an utter inability to
sleep. Stimulants and narcotics only increased the violence of his
symptoms, and every other means employed failed to give relief. The danger
of his situation was pointed out to him and travel recommended. He
followed the advice, and though it was several months before he was
completely relieved, his condition began at once to improve. He was taught
a lesson which has not been without influence, in causing him to task his
mental faculties less severely.

CASE II.--Another, an intimate friend, who occupied an important public
position, gave so much time and attention to his duties, which were of a
highly laborious character, that he deprived himself of the amount of
sleep to which he had previously been accustomed. It was rarely the case
that he got to bed before two or three o’clock in the morning, and then an
hour or two was always occupied in active intellection. The consequence
was that he finally broke down through want of the mental repose so
essential to him. Inflammation of the brain ensued, and this terminated in
acute insanity, from which he died.

It would be easy to bring forward other instances of which I am perfectly
cognizant, or which have been cited by authors in illustration of the
point in question, but it is scarcely necessary to enlarge further upon
this portion of the subject. We should be careful, however, not to mistake
the effect for the cause, an error which is often committed in this as
well as in other matters. It is well known that many cases of insanity are
marked in the early stages by persistent insomnia. Doubtless this is
frequently a consequence of the morbid action already set up in the brain;
but much observation has satisfied me that it is more often the cause of
the cerebral aberration, and that by proper medical treatment the mental
excitement may be generally allayed. Certainly the means most commonly
resorted to in such instances are adopted without the full consideration
so imperatively necessary, and consequently are fully as liable to
increase as to lessen the disturbance.

We cannot employ too much care in doing everything in our power to prevent
the occurrence of those slight attacks of cerebral congestion, which,
though perhaps scarcely observable at the time, are yet fraught with very
serious consequences. Persons have had their whole characters changed by
an apparently trifling interference with the circulation of blood in the
head. A person of my acquaintance was naturally of good disposition,
amiable in his character, and considerate in his dealings with others; but
after an attack of vertigo, attended with unconsciousness of but a few
moments’ duration, his whole mental organization underwent a radical
change. He became deceitful, morose, and exceedingly overbearing and
tyrannical toward all with whom he came in contact, and whom it was safe
for him to maltreat. Tuke and Bucknill[127] refer to the case of a lady
whose character had always been distinguished for conscientiousness, whose
religious education had been of a somber kind, and who, suffering under an
attack of small-pox attended with congestion of the brain, recovered, with
the natural bent of her disposition greatly exaggerated. The irritability
of conscience had become an actual disease, destroying the happiness of
the individual and rendering her incompetent to discharge any of the
duties of life. The same authors also mention the instance of a
distinguished admiral who had always been remarkable for pride and
liability to passionate anger, becoming the subject of cerebral
excitement, loss of sleep, and general feverishness consequent upon the
chagrin caused by a supposed neglect by the government.

In primary insomnia there is always an increase in the quantity of blood
circulating in the brain. This is either absolute or relative. The former
is the case when there has been no exhausting disease, hemorrhage, or
other debilitating influence in operation, and while, though general good
health exists, the amount of blood in the cranium is augmented; the
latter, when from any cause the system has become reduced, and when, while
this condition prevails, a temporary activity takes place in the cerebral
circulation. The first may properly be called active, the latter passive
insomnia. In the one there is more blood in the brain than is normally
present; in the other, though there may be less blood than in health, the
quantity is increased over the amount to which the brain has in a measure
accustomed itself.

Thus if we suppose the cerebral vessels of a healthy brain to contain
ordinarily a pint of blood, and the amount to be increased to a pint and a
half, and continued at this standard for several consecutive days, a state
of active insomnia ensues. If, on the other hand, this pint should be
reduced to a gill by any cause producing general debility, such as
hemorrhage, starvation, or disease, and then by some exciting mental
emotion, the excessive use of alcoholic liquors, or other influence acting
for a considerable period, be increased to half a pint, a condition of
passive insomnia would be produced--the latter condition resulting not
from a disturbance of the normal relation existing between the _intra_ and
_extra_ cranial blood, but of that which has been established by morbific
causes, and to which the organism has become habituated.

CASE III.--The following is a good example of the active form of morbid
wakefulness:

A short time since a gentleman was under my charge in whose case the only
deviation from health which could be perceived was an utter inability to
sleep. Being by profession a broker, and passing his days, and a great
portion of his nights, in the stock and gold rooms, during a period of
great financial excitement, his brain had been kept so continually in a
state of intense action that it was impossible for him, when he went to
bed, to compose his mind so as to allow of sleep ensuing. Thoughts similar
to those which were excited during his business operations were in full
flow, notwithstanding all his efforts to banish them. Calculations were
entered into, and speculations were constantly being formed with as great
or even greater facility than during the day. Many of the latter were of
the most extravagant character, a fact of which he was fully aware at the
time, but he nevertheless found it impossible to refrain from indulging in
them. All his other functions were performed with regularity. His appetite
was good, he took a not inconsiderable amount of exercise, and he
committed no excesses of any kind except as regarded his brain. When I
first saw him he had not slept for six nights, although he had taken large
quantities of brandy, morphine, and laudanum; but beyond a slight feeling
of confusion in his mind at times, and a little pain in his eyeballs, he
experienced no unpleasant sensations during the day. As soon, however, as
his head touched the pillow, and he tried to get to sleep, a feeling of
the most intense uneasiness came over him, while at the same time his face
and ears became hot and flushed. His mental faculties were roused into
increased action; he tossed restlessly from one side of the bed to the
other, and by the time morning came he was thoroughly exhausted, mentally
and physically. A cold bath and a breakfast of two large cups of coffee,
beefsteak and eggs, set him up for the balance of the day, till he retired
to bed, when the phenomena of the previous night would be repeated.

In this case I conceived that the blood-vessels of the brain, from
overdistention, had lost, in a great measure, their contractile power, and
that a larger quantity of blood was, in consequence, circulating within
the cranium than was normal. The vessels were therefore in a condition
very similar to that of a bladder in which, from the desire to urinate
having been too long resisted, contraction cannot be induced even by the
most strenuous exertion of the will. As the gentleman was of strong,
athletic build, and otherwise in full health, blood-letting would
undoubtedly have proved of great service; but, for reasons which will
appear hereafter, I determined to try a remedy less likely to do harm, and
fully as capable of doing good. I administered thirty grains of the
bromide of potassium at six o’clock in the evening, and repeated the dose
at ten, directing him to go to bed half an hour subsequently. The first
dose produced a decided sedative action, and the second was still more
effectual in calming the mental excitement. When he lay down, his mind was
not disturbed by a flow of thoughts, and he fell almost unconsciously into
a quiet sleep, from which he did not awake till near seven o’clock the
following morning. There were no unpleasant symptoms of any kind; on the
contrary, he felt strengthened and refreshed. The next night one dose was
administered at about bedtime, which was also followed by a sound and
invigorating sleep. No further treatment was given, as on the following
night sleep came naturally.

Sir Benjamin Brodie,[128] without, however, making the distinction I have
insisted upon, refers to the active or sthenic type of wakefulness in the
following quotations from a little work which should be in the hands of
all who are interested in the philosophy of the mind.

Speaking of the causes of the wakefulness of some persons, he says: “At
the same time there is no doubt that there is sometimes a morbid condition
of the nervous system, the nature of which we cannot well explain, which
is incompatible with sleep. The patient says, ‘I feel fatigued and wearied
and want to go to sleep, but I cannot sleep.’”

In asserting as he does that this kind of wakefulness is sometimes the
forerunner of mental derangement, Sir Benjamin is supported by many cases
detailed by authors on psychological medicine, and the following, which he
gives,[129] is directly to the point:

“A gentleman of my acquaintance in whose family circumstances had occurred
which were to him sources of intense anxiety, passed six entire days and
nights without sleep. At the end of this time he became affected with
illusions of such a nature that it was necessary to place him in
confinement. After some time he recovered perfectly. He had never shown
any signs of mental derangement before, nor has any one of his family, and
he has never since been similarly affected. This was an extreme case. But
do not examples of the want of sleep, proving very similar results, though
in a very much less degree, occur under our observation constantly? How
altered is the state of mind in any one of us after even two sleepless
nights! Many a person who under ordinary circumstances is cheerful and
unsuspicious, becomes not only irritable and peevish, but also labors
under actual, though transitory, illusions; such, for example, as thinking
that others neglect him or affront him who have not the smallest intention
of doing either the one or the other.”

Cases similar to the following, which is one of the passive variety of
wakefulness, are by no means uncommon.

CASE IV.--A lady, aged about thirty-five, unmarried, and of rather
delicate constitution, consulted me in regard to persistent wakefulness,
with which she had been affected for nearly a month. According to the
account which she gave me, she had received a severe mental shock, which
had not lost its influence when a subject of great anxiety was forced upon
her consideration. Her menstrual period, which had been due about ten days
before she came under my notice, had been anticipated by a week, and the
flow was prolonged much above the ordinary time. She had, therefore, lost
a good deal of blood, and was, in consequence, greatly reduced in
strength. This, conjoined with the exhaustion due to the long-continued
wakefulness, rendered her condition a much more serious one than would
otherwise have been the case.

She had taken large doses of laudanum, of ether, and of valerian, together
with many other medicines, the names of which I do not now recollect,
besides employing a variety of means of traditional efficacy. All had,
however, been useless. Homœopathy was then tried with an equal want of
success. When I first saw her she was nervous and irritable, her hands
trembled violently upon the slightest exertion of their muscles, her eyes
were bloodshot, the pupils contracted, and the lids opened to the widest
possible extent. There was a constant buzzing in the ears, and the sense
of hearing was much more acute than was natural. There was also increased
sensibility of all that portion of the surface of the body (the skin of
the hands, arms, legs, back, and breast) which I submitted to examination
with the æsthesiometer. Her pulse was 98, irritable, small, and weak.

At night all her symptoms were increased in violence. Her mind was filled
with the most grotesque images which it was possible for the imagination
to conceive, and with trains of ideas of the most exaggerated and
improbable character. These succeeded each other with a regularity so well
marked that she was able to foresee the routine night after night. “No
one,” she said, “can imagine the weariness I feel, or the horror with
which I look forward to the long rows of too-familiar phantoms and
thoughts which I know will visit me before morning. There is one set,” she
continued, “which always comes as the clock strikes two. No matter what
may be passing through my mind it is banished by this. It consists of a
woman with very long hair, who sits on a rock by the sea-side, with her
face buried in her hands. Presently a man armed with a long sword comes up
behind her, and, clutching her by the hair, drags her to the ground. He
puts his knee on her breast, and still holding her hair, cuts it off, and
binds her with it, hand and foot. He then commences to pile stones on her,
and continues to do so till she is entirely covered, notwithstanding her
piercing shrieks, which I hear as distinctly as I do real sounds. Turning
then to the sea he cries out, ‘Julia, you are avenged. My vow is
accomplished. Come! come!’ He then draws a dagger from his breast and
stabs himself to the heart. He falls over the pile of stones he has
raised, and instantly hundreds of little devils not more than a foot high
swarm around his body, and finally carry it off through the air. My horror
at all this is extreme. For more than an hour the scene is passing before
me, and though I know it is all purely imaginary, I cannot shake off the
terror it induces.”

I questioned this lady closely, and found that she was very intelligent,
and fully sensible of the unreality of all her visions. There was no
evidence whatever of the slightest tendency to insanity, but there was a
condition present which would surely terminate in the loss of her reason
if not quickly removed. I regarded her symptoms as indicating a state of
passive cerebral congestion, and as calling for stimulants rather than
what are called sedatives. I directed, therefore, that she should take an
ounce of whisky, properly diluted, every hour, commencing six hours before
bedtime; that she should immerse her whole body except her head in water,
at the temperature of 98° F., for half an hour just before retiring for
the night, and, instead of lying down, should sit up in an easy chair and
try to sleep in that position.

I administered the whisky upon the same principle that governs us when we
apply stimulating lotions to an inflamed eye, or give alcoholic liquors in
passive congestions of other parts of the body. The warm bath was
prescribed with a view to its dilating action upon the blood-vessels
exposed to its influence; and the sitting position with the object of
facilitating the flow of blood from the head, and impeding its return
through the carotids and vertebrals.

All these measures I had employed previously with success, in many cases
of inability to sleep due to delirium tremens, and which is almost always
of the passive or asthenic form. In the instance under consideration their
action was all that could be desired. At ten o’clock, having taken the
whisky and bath as directed, she sat down to sleep in a comfortable
chair, and, as her mother informed me, was asleep in less than half an
hour. She awoke about three o’clock, but soon fell asleep again after
another dose of whisky, and remained in this condition till about nine
o’clock in the morning. She then took breakfast, feeling very much
refreshed, but was unable to remain awake longer than two or three hours,
but, taking to her chair, slept soundly till evening. That night she was
again overcome with sleep, and it was passed very much as was the previous
one. No further medicine was required, and after a few nights she went to
bed as had been her custom, and slept soundly till morning. Under the use
of iron and lager beer she recovered her health and strength.

The foregoing cases are given as examples of the two forms of morbid
wakefulness or insomnia to which I wish to call attention. They show that,
though the cause in each variety may be essentially the same, the means of
relief are not altogether identical. It is important, therefore, to
discriminate between them. But the main point upon which it is necessary
to insist is, that in morbid wakefulness, whether occurring in strong or
weak persons, there is always an excessive amount of blood circulating
through the substance of the brain. In the course of the discussion of the
points involved in the physiology of sleep, this subject was incidentally
noticed. In the following chapter, however, it will be dwelt upon with
more particularity.



CHAPTER IX.

THE EXCITING CAUSES OF WAKEFULNESS.


Every cause capable of increasing the amount of blood ordinarily
circulating through the brain may give rise to wakefulness. As these
causes are more or less under the control of the individual, it is
important that they should be fully considered.

An increased amount of blood is attracted to the brain, and wakefulness is
produced:

1st. _By long-continued or excessive intellectual action, or any powerful
emotion of the mind._--Every organ of the body, the condition of which
admits of being ascertained by ocular examination, invariably contains
more blood in its tissues when in a state of activity than when its
functions are temporarily suspended. We are hence, _a priori_, justified
in assuming that the law is equally applicable to the brain, but we are
not forced to rely entirely upon reasoning from analogy. It has been shown
already that during sleep the circulation of blood within the cranium is
at its minimum, both as regards quantity and rapidity, and that as soon as
the individual awakes there is an immediate afflux of this fluid to the
cerebral tissues. All of us are familiar with the facts that, during
severe mental labor, or while under the influence of some exciting
emotion, the vessels of the head and neck become distended, the head feels
full, the face is flushed, and the perspiration of the parts in question
is increased in quantity. Within certain limits the more blood there is in
the brain the more actively its functions are performed, and so well known
is this fact that some persons, who require to exercise the several
faculties of the mind to an extreme degree, make use of stimulating
ingesta for the purpose of accomplishing the object in view.

A moderate degree of cerebral activity is undoubtedly beneficial. Exercise
strengthens the mind and improves its faculties, if it is succeeded by a
proper period of repose, during which the vessels are emptied to some
extent of their contents, and are thus enabled to recover their tone. If,
however, the brain is often kept for long periods on the stretch, during
which the vessels are filled to repletion, they cannot contract even when
the degree of cerebral activity is diminished. Wakefulness results as a
necessary consequence, and every day renders the condition of the
individual worse, because time also brings the force of habit into
operation.

It is not to be denied, however, that many individuals are able to live in
comparative health for long periods with but little or no sleep. Thus it
is stated[130] that Boerhaave did not “close his eyes in sleep for a
period of _six_ weeks, in consequence of his brain being overwrought by
intense thought on a profound subject of study.” Sir Gilbert Blane[131]
says he was informed by General Pichegru, that for a whole year, while
engaged in active campaign operations, he slept but one hour out of the
twenty-four. Such statements as these, however, and others to the same
effect which have been made, must be accepted with some allowance. Many
persons sleep unconsciously, and we all know how common it is for
individuals to deny having slept when we have been eye-witnesses of their
somnolency. I should consider it impossible for a person to enjoy good
health if deprived for even a few weeks of half his ordinary amount of
sleep; and it is very probable that Boerhaave’s standard of health, never
high, was very much lowered by his protracted vigils.

So long as the attention is kept fully aroused, the blood-vessels of the
brain are distended, and it is possible for an individual to remain awake
while this condition exists. When the attention begins to flag, the
tendency is for the vessels to contract, and for sleep to ensue. This
disposition may not, however, be strong enough to restore the full
measure of contractility to vessels that have been long overdistended, and
then insomnia results.

To this increase in the amount of blood circulating in the brain, many
instances of hallucination have been due. It has already been shown that
strong mental emotions determine an augmented flow of blood to the
cerebral vessels, and cause the production of spectral illusions. In all
such cases there is a marked tendency to insomnia present. The account
given by Nicolai, a celebrated German bookseller of the last century, of
his own disorder, is so interesting and appropriate that I quote it in
full. It has never to my knowledge been published in this country.

“During the ten latter months of the year 1790 I had experienced several
melancholy incidents which deeply affected me, particularly in September,
from which time I suffered an almost uninterrupted series of misfortunes
that affected me with the most poignant grief. I was accustomed to be bled
twice a year, and this had been done on the 9th of July but was omitted to
be repeated at the end of the year 1790. I had, in 1783, been suddenly
taken with a violent vertigo, which my physicians attributed to
obstructions in the fixed vessels of the abdomen brought on by a sedentary
life and a continual exertion of the mind. This indisposition was
successfully removed by means of a more strict diet. In the beginning I
had found the use of leeches applied to the arms particularly beneficial,
and they were afterward repeated two or three times annually when I felt
congestions in the head. The last leeches which had been put on previous
to the appearance of the phantasms of which I am about to speak, had been
applied on the 1st of March, 1790; less blood had consequently been
evacuated in 1790 than was usual with me, and from September I was
constantly occupied in business which required the most unremitted
exertions, and which was rendered still more perplexing by frequent
interruptions.

“I had, in January and February of the year 1791, the additional
misfortune to experience several extremely unpleasant circumstances, which
were followed on the 24th of February by a most violent altercation. My
wife and another person came into my apartment in the morning in order to
console me, but I was too much agitated by a series of incidents which had
most powerfully affected my moral feelings to be capable of attending to
them. On a sudden I perceived, at about the distance of ten steps, a form
like that of a deceased person. I pointed at it, asking my wife if she did
not see it. It was natural that she should not see anything; my question,
therefore, alarmed her very much, and she sent immediately for a
physician. The phantom continued for about eight minutes. I grew at length
more calm, and being extremely exhausted, fell into a restless sleep which
lasted about half an hour. The physician ascribed the appearance to
violent mental emotion, and hoped there would be no return; but the
violent agitation of my mind had in some way disordered my nerves and
produced further consequences which deserve a more minute description.

“At four in the afternoon the form which I had seen in the morning
reappeared. I was by myself when this happened, and being rather uneasy at
the incident, went to my wife’s apartment, but there likewise I was
accompanied by the apparition, which, however, at intervals disappeared,
and always presented itself in a standing posture. About six o’clock there
appeared also several walking figures which had no connection with the
first.

“After the first day the figure of the deceased person no longer appeared,
but its place was supplied by many other phantasms, sometimes representing
acquaintances, but mostly strangers. Those whom I knew were composed of
living and deceased persons, but the number of the latter was
comparatively small. I observed that the persons with whom I daily
conversed did not appear as phantasms, these representing chiefly persons
who lived at some distance from me.

“These phantasms seemed equally clear and distinct at all times and under
all circumstances, both when I was by myself and when I was in company,
and as well in the day as at night, and in my own house as well as abroad;
they were, however, less frequent when I was in the house of a friend, and
rarely appeared to me in the street. When I shut my eyes these phantasms
would sometimes vanish entirely, though there were instances when I beheld
them with my eyes closed; yet when they disappeared on such occasions,
they generally returned when I opened my eyes. I conversed sometimes with
my physician and my wife of the phantasms which at the moment surrounded
me. They appeared more frequently walking than at rest, nor were they
constantly present. They frequently did not come for some time, but always
reappeared for a longer or shorter period, either singly or in company,
the latter, however, being most frequently the case. I generally saw human
forms of both sexes, but they usually seemed not to take the smallest
notice of each other, moving as in a market-place where all are eager to
pass through the avenue; at times, however, they seemed to be transacting
business with each other. I saw also several times people on horseback,
dogs and birds. All these phantasms appeared to me in their natural size,
and as distinct as if alive, exhibiting different shades of carnation in
the uncovered parts as well as different colors and fashions in their
dresses, though the colors seemed somewhat paler than in real nature. None
of the figures appeared particularly terrible, comical, or disgusting,
most of them being of an indifferent shape, and some presenting a pleasing
aspect. The longer these phantoms continued to visit me the more
frequently did they return, while at the same time they increased in
number. About four weeks after they had first appeared, I also began to
hear them talk. The phantoms sometimes conversed among themselves, but
more frequently addressed their discourse to me: their speeches were
commonly short and never of an unpleasant turn. At different times there
appeared to me both dear and sensible friends of both sexes, whose
addresses tended to appease my grief, which had not yet wholly subsided:
their consolatory speeches were in general addressed to me when I was
alone. Sometimes, however, I was accosted by these consoling friends while
I was engaged in company, and not unfrequently while real persons were
speaking to me. These consolatory addresses consisted sometimes of abrupt
phrases, and at other times they were regularly executed.

“Though my mind and body were in a tolerable state of sanity all this
time, and these phantasms became so familiar to me that they did not cause
me the slightest uneasiness, and though I even sometimes amused myself
with surveying them, and spoke jocularly of them to my physician and my
wife, I yet did not neglect to use proper medicines, especially when they
began to haunt me the whole day and even at night, as soon as I waked.

“At last it was agreed that leeches should be again applied to me as
formerly, which was actually done, April 20th, 1791, at eleven o’clock in
the morning. No person was with me besides the surgeon, but during the
operation my chamber was crowded with human phantasms of all
descriptions. This continued uninterruptedly till about half an hour after
four o’clock, just when my digestion commenced. I then perceived that they
began to move more slowly. Soon after their color began to fade, and at
seven o’clock they were entirely white. But they moved very little, though
the forms were as distinct as before, growing, however, by degrees more
obscure yet not fewer in number, as had generally been the case. The
phantoms did not withdraw, nor did they vanish, a circumstance which,
previous to that time, had frequently happened. They now seemed to
dissolve in the air, while fragments of some of them continued visible for
a considerable time. About eight o’clock the room was entirely cleared of
my fantastic visitors.

“Since that time I have felt twice or three times a sensation as if these
phantasms were going to reappear, without, however, actually seeing
anything. The same sensation surprised me just before I drew up this
account, while I was examining some papers relative to these apparitions,
which I had drawn up in the year 1791.”

While it is doubtless true that variations in the amount of blood in the
brain are dependent upon nervous action, it is equally certain that this
latter is increased or lessened according as the brain is in a more or
less hyperæmic condition. These factors, therefore, react upon each other,
and consequently the resulting insomnia is more aggravated than would
otherwise be the case.

Instances of insomnia dependent upon intense intellectual exertion have
already been given, but the following, which I extract from my note-book,
will not, I think, prove uninteresting or uninstructive:

CASE V.--A gentleman, aged thirty-nine, unmarried, of correct habits, and
good general health, consulted me on the 19th of April, 1865, in reference
to a peculiar nervous affection with which he had suffered for several
months. He stated to me that, being engaged upon a literary labor of some
importance, he had given the greater part of his time to the studies
necessary to its being carried on with success, and was conscious of
having overtasked his mental powers. So great, however, was his ambition
to excel in his undertaking, that he had persevered notwithstanding the
admonitions of friends, and the still more pointed warnings he had
received from his own sensations. Instead of sleeping, as had been his
custom, from seven to eight hours, he rarely, for nearly a year, had slept
more than four hours out of the twenty-four, and frequently even less than
this. He did not, however, feel the want of sleep. In fact he was never
sleepy, and if this had been the only ill consequence of his severe
application I should probably not have had him under my charge at all, so
little weight did he attach to the condition which it was of the first
importance should be relieved.

The symptom of disordered action which attracted his attention most was an
inability to concentrate his mind upon subjects about which he wished to
write. There was no difficulty in maintaining a connected line of
reasoning, except when he attempted to put his ideas on paper, and then he
found it utterly impossible to direct his thoughts in a methodical way. He
conversed with me very intelligently in reference to his case, and was
perfectly conscious of the difficulty under which he labored. As an
instance of the character of his disease, he said that the day before he
came to see me he had reflected to his entire satisfaction upon certain
points in literature which he was investigating, and that when he came to
read over what he had written he found it was a tissue of the most arrant
nonsense. The subject of his thoughts was the Greek drama, and the ideas
in reference to it, which he communicated to me, were in the highest
degree logical and interesting. He then showed me the first page of what
he had written, and though he was annoyed at the nonsensical strains of
his language, he could not at the same time conceal his amusement at its
utter absurdity. I quote a few lines from this paper.

“The rise of the Greek drama is not to be associated with the Homeric age
of minstrelsy, nor to be discovered in the Cimmerian darkness of the
North. It rests upon a foundation far anterior to either. It is found in
the hearts of those men who look beyond a mere utilitarian idea, and who
are able to conceive of the existence of beauty without the disturbance
due to causes inseparably connected with the barbarism from which Greece
emerged into that mythical age which created a god for every river and
forest, and for every emotion of the heart or element of the mind. Lyric
poetry and philosophy may claim the precedence of antiquity, but the power
that could draw tears from eyes that had never before wept, or cause the
hardened lines of stoicism to relax in smiles, is not to be despised or
even elevated upon a pinnacle of greatness.”

At the time of writing, his thoughts flowed so rapidly that he was not
conscious of the disconnected nature of his composition. If he stopped,
however, to read it over, he at once saw how thoroughly it misrepresented
his conceptions. No matter what the subject, the same thing happened, and
even the most trivial notes could not be written without language being
used which was either perfectly without relation to the ideas he wished to
communicate, or else in direct opposition to them. For instance, wishing
to obtain a book from a friend, he found he had written the prayer of
Socrates which concludes the Phædrus of Plato. On another occasion,
intending to indite an epistle to a lady who had sent him a volume of her
poems, he discovered, when half through his letter, that he had requested
her to accept one of his own books, and had then gone on to give his views
relative to suicide and matrimony.

Upon questioning him, I ascertained that he went to bed generally about
two o’clock in the morning; that he lay awake for an hour at least, during
which his mind was exceedingly active; and that he rose between six and
seven, took a sponge-bath, and ate a light breakfast. He then went to
work, spending the day in reading, and in dictating to his sister, who
wrote out his language _verbatim_. At six o’clock he dined plainly, and
then again resumed his labors. He drank neither tea, coffee, nor any
alcoholic liquor. Occasionally he took a cup of chocolate at breakfast.

The only indications of a disordered system other than those I have
mentioned were, that his pulse was too frequent (104), that it was
irritable and irregular; that he had had several attacks of slight vertigo
and headache; that his eyes were brilliant and somewhat congested, and
that pressure upon the closed lids caused considerable pain. His bowels,
contrary to what might have been reasonably expected, were regular, and
his appetite was generally good. His urine contained an excess of urea and
of phosphates; oxalate of lime was also present. There was nothing in his
condition which appeared to give him the least anxiety, beyond the
impossibility of controlling his thoughts when writing, and this he
attributed directly to overexertion of his mental powers. He had, however,
tried the effect of suspending his studies for two or three weeks, but had
not perceived that any benefit was derived from this procedure. He had,
therefore, returned to his occupations.

I told him very plainly that, unless he was prepared to forego his
literary labors for several weeks at least, he would be in great danger of
permanent injury to his mind; but that with the avoidance of severe mental
exertion, and by the aid of other measures, I believed he could be
restored. He demurred somewhat to the first condition, but finally
promised to follow my advice implicitly.

Although I was unable to explain the fact that mental aberration should
only be manifested when he wrote, I was confident that his condition was
clearly the result of intense hyperæmia of the brain, and that if this
could be dissipated, and sound, regular, and sufficient sleep be produced,
the mental trouble would also vanish. I therefore directed that half a
dozen dry cups should be applied to the nape of the neck every evening,
that he should take a warm bath directly afterward, and that, while in the
bath, cold water should be poured on his head. Instead of lying down when
he attempted to sleep, I advised that he should assume the sitting
posture, supporting his head on a hair pillow. All literary labor was to
cease. Instead of the books he was in the habit of studying, he was to
read novels. He was to compose himself for sleep at eleven o’clock at
night, and was to rise punctually at seven; take his sponge-bath as usual,
and, after eating a moderate breakfast, to do anything he liked, except
studying or writing, till twelve o’clock, when he was to take a walk for
an hour, then eat a biscuit, read light literature till four, and then
ride on horseback till six, at which hour he was to dine, simply, but to
the extent his appetite prompted him. He had been in the habit of smoking
one cigar a day (after dinner), and I allowed him to continue in this
indulgence.

I am thus particular in stating my instructions, because I determined to
see what could be done by hygienic measures, and others directed to the
relief of the supposed cerebral congestion, without resorting to the use
of drugs, so long as it was probable they would not be required. Opium and
other medicines of the narcotic class would, I was satisfied, do more harm
than good; bromide of potassium I reserved for use, should it become
necessary to employ it.

I have every reason to believe that he complied faithfully with the
directions given him, and ere long marks of decided improvement were
visible. His pulse had fallen to 80, was regular and full; there was no
more headache or vertigo; his eyes had lost their bloodshot appearance,
and above all, his sleep had become sound, and was of from seven to eight
hours’ duration nightly. As soon as he got settled in his easy chair for
the night his eyelids began to close, and he slept steadily on till it was
time for him to get up for the day. Three weeks were necessary to bring
about these results in full, although amendment was manifested from the
first. Yesterday, May 18th, I wrote him a note, requesting his permission
to make use of his case in illustration of this memoir. The following is
his answer: it is the first time he has written a line for a month:

    “MY DEAR DOCTOR:--If, in your opinion, my case is possessed of any
    value in a pathological point of view, I hope you will make such use
    of it as will best serve the ends of science. I make only one
    condition. You know I am a literary man, and that my reputation as a
    student and author would suffer in the estimation of the critics were
    I suspected of insanity. It takes very little to form a foundation for
    such an assumption, and, perhaps, in my case, there would be more
    truth than fiction in the notion as applied to me. With the exception,
    therefore, of giving my name, you are at perfect liberty to dish me up
    for the satisfaction of all your medical friends.

    “I shall come and see you to-morrow, and in the mean time believe me
    ever,

      “Yours sincerely and gratefully,
          “---- ---- ----.”

    “P.S.--I have read the above over, and to my great delight find that I
    have said what I wanted to say. I would stand on my head with joy,
    were it not that you were desirous of keeping as much blood out of my
    noddle as possible. _Laus Deo._ Can I go to work Monday?”

I had no intention of letting him “go to work” on Monday, or for at least
two weeks subsequently. I was of the opinion, however, that after that
time he could resume his labors to a slight extent, and gradually extend
them--not to the limit they formerly reached, but to that degree which,
while they would add to his reputation as a man of learning, would not
exhaust the organ which it was so essential for his objects to preserve in
a condition of unimpaired vigor. The result has been all that either he or
myself could have desired.

CASE VI.--A youth of fifteen was brought to me by his father, on the 16th
of August, to be treated for obstinate wakefulness, the consequence of
severe mental exertion at school several weeks previously. He had not
attended school since the last of June, but had scarcely slept more than
an hour or two each night since that time, according to his own and his
father’s statement. He was a healthy, well-grown lad, with a good
appetite, and nothing unusual in his appearance beyond a slight look of
weariness and anxiety in his face. During the day there were no
hallucinations of any kind, and toward evening he invariably felt
overpowered with sleep. As soon, however, as he lay down he heard voices
repeating extracts from the lessons he had recently been learning, and his
mind became occupied with imaginary scenes in which the gods and goddesses
of mythology and the heroes and poets of antiquity played prominent parts,
and the whole power of his attention was thus kept engaged with these and
other scenes which were formed with astonishing rapidity. Toward morning
he fell into an uneasy slumber, and awoke feeling more weary even than
when he had gone to bed.

Medicines, among which opium was the chief, had been employed without
success. On the contrary, his condition was manifestly rendered worse
through their influence. Laudanum, of which he had taken large quantities,
always caused headache, without producing the least amelioration in his
symptoms. Notwithstanding the palpable connection which existed between
the wakefulness and his former intense mental application, he had been
allowed to continue his studies, and when he came to me had a Latin
grammar in his hand, which he had been diligently studying in the street
railway car!

After some very plain conversation with the father, relative to the great
danger to which he was subjecting his son, by thus inordinately taxing his
mind, I directed the entire cessation of all studies for the present, and
an entire change of associations by a visit to the sea-shore, and free
indulgence in bathing, fishing, and other recreations. I likewise advised
the use, for a few nights, of small doses of bromide of potassium. My
advice was implicitly followed, and a few days since I received a visit
from the boy’s father, and was told by him that his son’s health had been
completely restored. I recommended that the visit to the sea-side should
be prolonged a week or two, that the return to study should be gradual,
and that the boy’s eagerness to learn should be somewhat restrained by
occupations and amusements requiring but little mental exertion.

CASE VII.--An eminent banker consulted me for the purpose of being, as he
said, “put to sleep.” He informed me that he was engaged in a series of
financial operations which, if successful, would be the means of adding
largely to his fortune, but that owing to loss of sleep he was unable to
give them that careful and full attention which their importance demanded.
“I go to bed,” he said, “feeling very much exhausted, and dead with sleep,
but I am kept awake nearly the whole night by the activity of my thoughts,
which run on with a rapidity which astonishes me. Toward morning I get a
little sleep, but I arise unrefreshed, and go to my business with a
feeling of fullness in my head, and a sensation of weariness, which
altogether unfit me for the duties of the day. The consequence is that I
cannot concentrate my attention upon the matters which ought to engage it,
and that I am in danger of losing a great deal of money simply from lack
of mental power to follow the train of operations which I have set in
action.”

On examining this gentleman, I found his face flushed, his eyes bloodshot,
his pulse small, weak, and frequent (104), and his manner excited. He
complained of almost constant vertigo, and a feeling when he walked as
though his feet did not rest firmly on the ground or support his entire
weight. His appetite was capricious, and he maintained his strength mainly
by drinking champagne, of which he imbibed two bottles a day, taking in
addition “brandy and soda,” as occasion seemed to require.

I informed him that his case was a very simple one, and that I could
safely promise to put him to sleep provided he would agree to follow my
directions implicitly.

This he said he would do.

I told him that in the first place he must leave town and travel for a
week, and in the second place take the oxide of zinc. To the first
condition he objected strenuously; but the argument which I adduced, that
if he did not he would probably go to an insane asylum within the period
specified, somewhat startled him, and he yielded a reluctant consent.

He started off that day, and returned in exactly a week, having, as he
said, slept eight hours every night during his absence. All his
disagreeable symptoms had disappeared, and he was enabled to resume his
business with his mental faculties in their full vigor.

       *       *       *       *       *

2d. _Those positions of the body which tend to impede the flow of blood
from the brain, and at the same time do not obstruct its passage through
the arteries, while causing hyperæmia, also produce insomnia._

Several cases have come under my observation in which the influence of
position as affecting the disposition to sleep was well marked. It is very
evident that the recumbent posture is more favorable to a state of
congestion of the brain than the erect, or semi-erect. Individuals who, by
excessive mental exertion, have lessened the contractility of the cerebral
vessels, almost always experience great difficulty in getting to sleep
after lying down, even though previous to so doing they may have been very
drowsy. A gentleman, who was a patient of mine a few weeks since, informed
me that several years ago he had an attack of wakefulness, which lasted
for three or four months, and which was particularly characterized by
inability to sleep while lying in bed. While sitting in his office he
would often fall asleep in his chair, and previous to going to bed he
would be overcome by drowsiness. The moment, however, that he lay down,
his mind was aroused into activity, and all sleepiness disappeared. He
left off work, traveled, and in a short time recovered perfectly. It will
be recollected that in the other cases I have cited in this memoir, the
phenomena were always more strongly marked after the persons affected lay
down; and I have always insisted upon the avoidance of the recumbent
posture as one of the most important means to be employed in the cure of
insomnia. The following is one of the cases referred to above.

CASE VIII.--A gentleman in extensive legal practice requested my advice
for persistent wakefulness, with which he had been affected for several
weeks, in consequence of unremitting attention to a case in which his
sympathies had become greatly interested. For somewhat over a month he
had, as he informed me, slept but for an hour or two each day. After
dinner he was able to procure this much sleep in his chair, but at night,
when he lay down, all his efforts were unavailing. He felt the want of
repose very much, and he described the sensation of weariness of body and
mind as almost insupportable. So great was this desire for sleep that,
notwithstanding repeated disappointments, he was confident each night of
being able to secure it, but invariably as soon as he lay down all
inclination vanished, and he passed the night in that condition of painful
restlessness which had now become horrible to him. There was no very great
mental activity, and no hallucinations of sight, but when his head touched
the pillow a low buzzing sound, which apparently had its origin in the
ears, was heard, and remained there to keep him awake. He could not shut
out this noise, no matter how energetically he endeavored to render
himself oblivious to it, and all the means, such as opium, chloroform, and
alcoholic liquors of various kinds, which he tried in the hope of
obtaining relief, only aggravated the difficulty.

His general health, ordinarily excellent, had latterly began to give way.
His bowels were torpid, he had little or no appetite, and he was almost
daily subject to severe attacks of headache. He was conscious, too, of a
very decided change in his disposition. From having been of rather social
tendencies, he had become morose and gloomy, disliking even the
companionship of his most intimate friends. There was also a very decided
impairment of his memory, and he was sensible of the fact that the power
of concentrating his attention upon subjects of even minor importance was
materially weakened. In conversation he miscalled names, and misplaced
events and things. Thus he called Pittsburg _Pittstown_, said _aunt_
several times when he should have said uncle, and confounded _Newark_ with
New York. By attention to hygienic measures, avoidance of the recumbent
position, and the use of moderate doses of bromide of potassium, he soon
obtained a due amount of sleep, and the other symptoms of a disordered
mental and physical organism gradually disappeared.

Dr. Handfield Jones[132] relates a case in which the influence of position
was strongly marked. “A gentleman aged twenty-four, after considerable
mental strain, experienced the following symptoms: He was thoroughly weary
and drowsy at the close of the day, and felt, as well he might, the need
of nature’s restorer; scarcely, however, had he laid down his head, when
the cerebral arteries began to throb forcibly, and soon all inclination
for sleep was banished, and for hours he lay wide awake, but deadly weary.
The _causa mali_ here was evidently deficient tonicity in the cerebral
arteries, or more exactly paresis of their vasa motor nerves. As the
arteries relaxed they admitted an undue flow of blood to the brain, which
goaded the weary tissue to abnormal action.”

De Boismont[133] refers to a case, on the authority of M. Moreau, in which
an individual was able to obtain hallucinations of sight by inclining his
head a little forward. By this movement the return of blood from the head
was impeded, and thus there was an exaltation of certain of the cerebral
functions. Wakefulness is nothing more than an exaggeration of the normal
functions of the brain. For this organ to act with vigor, an increased
flow of blood is necessary. If this flow is continued, without proper
periods of repose, a state of erethism and insomnia is produced. Instances
have been recorded in which persons have found it necessary to assume the
recumbent position whenever they had any severe mental labor to perform.
The following extract, bearing upon this point, from a work[134] already
quoted, is interesting:

“The posture of supination will unavoidably induce that increased flow of
blood to the brain which, under certain states of this fluid, is so
essential to the production of brilliant waking thoughts; and are indeed
attained so often by another mode--the swallowing of opium.

“A gentleman of high attainment was constantly haunted by a specter when
he retired to rest, which seemed to attempt his life. When he raised
himself in bed _the phantom vanished, but reappeared_ as he resumed the
recumbent position.

“Some persons always retire to bed when they wish to think; and it is well
known that Pope was often wont to ring for pens, ink, and paper in the
night, at Lord Bolingbroke’s, that he might record, ere it was lost, that
most sublime or fanciful poesy which flashed through his mind as he lay in
bed. Such, also, was the propensity of Margaret, Duchess of Newcastle, who
(according to Cibber, or rather Shiel, the _real_ author of the ‘Lives of
the Poets’) kept a great many young ladies about her person, who
occasionally wrote what she dictated. Some of them slept in a room
contiguous to that in which her grace lay, and were ready, at the call of
her bell, to rise any hour of the night to write down her conceptions,
lest they should escape her memory.

“Henricus ab Heeres (in his ‘Obs. Med.’) says that when he was a professor
he used to rise in the night, open his desk, compose much, shut his desk,
and again to bed. On his waking, he was conscious of nothing but the
happy result of his composition.

“The engineer Brindley even retired to bed for a _day or two_, when he was
reflecting on a grand or scientific project.

“I deny not that the darkness or stillness of night may have had some
influence during this inspiration. I may also allow that some individuals
compose best while they are walking, but this _peripatetic_ exertion is
calculated itself to produce what we term determination of blood to the
head. I have heard of a most remarkable instance of the power of position
in influencing mental energy in a German student who was accustomed to
study and compose with his head on the ground, and his feet elevated and
resting against the wall.

“And this is a fragment of a passage from Tissot, on the subject of
monomania.

“----‘Nous avons vu étudier dans cette académie, il n’y a pas long temps,
un jeune homme de mérite, qui _s’étant mis dans la tête_ de découvrir la
quadrature du cercle, est mort, fou, à l’Hôtel Dieu à Paris.’[135]

“You will smile when I tell you that the tints of the landscape are
brighter to our eyes if we _reverse the position of the head_.”

Tissot, in the work to which reference has just been made, cites an
instance in which position was taken advantage of to solve a problem in
mathematics. A gentleman, remarkable for his accuracy in calculation, for
a wager _lay down on a bed_ and wrought, by mere strength of memory, a
question in geometrical progression, while another person, in another
apartment, performed the same operation with pen and ink. When both had
finished, the one who had worked mentally repeated his product, which
amounted to sixteen figures, and, insisting that the other gentleman was
wrong, desired him to read over his different products. On this being done
he pointed out the place where the first mistake lay, and which had run
through the whole. He paid very dearly, however, for gaining his wager, as
for a considerable time he had a swimming in his head, pains in his eyes,
and severe headaches upon attempting any mathematical labor.

Sir Walter Scott has said somewhere, that the half hour _passed in bed_,
after waking in the morning, was the part of the day during which he
conceived his best thoughts.

Dr. Forbes Winslow[136] makes some excellent remarks upon the relations
existing between position and wakefulness. He says:

“In some types of insanity the patient’s mind is altogether absorbed in
the contemplation of a frightful spectral illusion. Under these
circumstances the unhappy sufferer is afraid to close his eyes in sleep
from an intense fear and dread that he will then fall an easy prey to the
horrible phantasms which his morbid imagination has called into existence,
and which, he imagines, follow him in all his movements. The patient so
afflicted declares he will not sleep, and resolutely repudiates and
perseveringly ignores all disposition to slumber. On many occasions he
obstinately refuses to go to bed, or to place himself in a recumbent
position. He will battle with his attendant if he attempts to convey him
to bed. He insists on remaining in the chair, in standing in an erect
position all night, and often determinately walks about the room when
those near him are in profound repose. In these cases the hallucinations
appear to be most exquisitely and acutely vivid when the patient is placed
in a recumbent position, on account, it is supposed, of the mechanical
facilities thus afforded for the blood gravitating freely to the head.

“A gentleman who appeared free during the day from any acute
hallucinations, never could lie on his back without being distressingly
harassed by a number of frightful imps, whom he imagined to be dancing
fantastically around him during the night. Under these circumstances,
undisturbed sleep, while in bed, could never be obtained. He was in the
habit of sleeping in an arm-chair for some time in consequence of these
symptoms. He, however, eventually recovered, and has been for several
years entirely free from all hallucinations.”

It has frequently occurred to me to notice the increase in the number and
intensity of the hallucinations of patients affected with delirium tremens
as soon as they assumed the recumbent position. The difficulty of sleeping
is in such cases always correspondingly augmented.

       *       *       *       *       *

3d. _An increased amount of blood is determined to the brain, and
wakefulness is produced by certain substances used as food or medicine._

Daily experience assures us of the truth of this proposition. In general
terms, it may be said that all those substances which, when ingested into
the system, increase the force and frequency of the heart’s action, cause
also a hyperæmic condition of the brain and tend to the supervention of
wakefulness.

Chief among these agents are to be placed alcohol, opium, belladonna,
stramonium, Indian hemp, tea, and coffee. It is true that the first two of
these, when taken in large quantities, sometimes give rise to a comatose
condition. This, however, as has already been shown, is not a consequence
of an increased amount of blood in the brain, but results from the
circulation in that organ of blood which has not been duly oxygenated by
respiration. My experiments on this head have been many, and show
conclusively that neither alcohol nor opium possesses any stupefying
effect, if means be taken to insure the full aeration of the blood. If,
however, these substances be administered beyond a certain limit, they so
act upon the nerves which supply the respiratory muscles as to interfere
with the process of respiration, and hence the blood is not sufficiently
subjected to the action of the atmosphere. Unaerated blood therefore
circulates in the brain, and coma--not sleep--is produced.

No substance is capable of acting as a direct hypnotic, except that which
lessens the amount of blood in the brain. In small doses alcohol and opium
do this indirectly, through their stimulating properties exerted upon
overdistended blood-vessels, as has been shown in regard to the first
named in a case already cited; but they never so act upon the healthy
brain. In the normal state of this organ their action in small doses is
always that of excitants. The word “small” is of course used in a relative
sense. What is a small dose for one person may be a large one for another,
and _vice versa_.

In this connection it is scarcely necessary to dwell at any length upon
the wakefulness produced by delirium tremens from the excessive ingestion
of alcohol or opium. In the _post-mortem_ examinations--four only--which I
have made of individuals dying from this affection as the result of the
immediate use of alcohol, the brain was invariably found congested. Either
hyperæmia or its consequence, effusion of serum, is the ordinary
pathological condition discovered in such cases.

In regard to opium, most practitioners have doubtless noticed the effect
which it and its preparations frequently produce in preventing sleep. I
have known one dose of half a grain of opium keep a patient awake for
three consecutive days and nights, during the whole of which period
intense mental excitement was present. As is well known, the Malays, when
they wish _to run amuck_, bring on the necessary degree of cerebral
stimulation by the use of opium. During the condition thus produced
insomnia is always present. It is certainly true, however, that in
moderately large doses opium acts as a direct hypnotic, and the same may
be said of other narcotics.

Belladonna, stramonium, and Indian hemp likewise produce congestion of the
brain and wakefulness. The latter, under the name of hashish,[137] is
still used in the East to bring on a state of delirium, and, if rumor is
to be credited, has its votaries in this country. Tea and coffee act in a
similar but far less powerful manner. As one of the results of experiments
with these substances, instituted upon myself, I found that the
circulation of the blood was rendered more active.[138] Their influence in
preventing sleep is well known to the generality of people, and this
effect is doubtless entirely due to their action upon the heart and
blood-vessels by which the amount of blood in the brain is increased. In
persons of fair and thin skins, who are not accustomed to the use of
either of these beverages, the face can be seen to flush after they have
been taken; and I have frequently met with persons in whom their use was
always followed by suffusion of the eyes, and a feeling of fullness within
the head. Their power to increase the force and brilliancy of our
thoughts, and to sustain the mind under depressing influences, has long
been recognized, and is to be ascribed to the same cause as that which
prevents sleep.

       *       *       *       *       *

4th. _Wakefulness is also caused by functional derangements of certain
organs of the body, whereby an increase in the amount of blood in the
brain is produced._

Under this head are embraced those cases of sleeplessness due to exalted
sensibility of the nervous system. They are chiefly met with in persons
of feeble constitution. The slightest impression made upon the skin, or
any other organ of sense, is converted into a sensation out of all
proportion to the exciting cause. There is thus a condition of general
hyperæsthesia which greatly tends to the prevention of sound and
refreshing sleep. The following case illustrates very well the phenomena
of the state in question:

CASE IX.--A lady recently came under my care for extreme wakefulness, the
result, as she correctly supposed, of debility. During the month of August
she had resided in a malarious region, and had had a series of attacks of
intermittent fever before she would consent to take quinine for its cure.
By the time the disease was conquered she had become very much reduced,
and her constitution had received a shock from which it will probably not
recover for several years. I saw her for the first time on the 26th of
September, and she was then so feeble that she was unable to be out of her
bed for more than an hour or two each day. Her nervous system was in an
exceedingly irritable condition, the least noise startled her, she was
unable to bear the full light of day, and so sensitive was her skin, that
the light clothes she wore caused her the greatest uneasiness. She
informed me that she had scarcely slept for seventeen days and nights, and
though I received this statement with some grains of allowance, I was very
sure, from her general appearance, that she was suffering from insomnia.
At night the feeling of general discomfort was greatly increased, the
weight of the bedclothes was insupportable, and she passed the hours
tossing restlessly on her bed or in walking the floor. By morning she was
feverish, irritable, and thoroughly exhausted. A cup of coffee and a
little buttered toast constituted her breakfast, after which she felt
somewhat revived.

Conceiving that all the symptoms were referable to debility and passive
cerebral congestion, I advised nutritious food, tonics, stimulants,
exercise in the open air, the warm bath, cold water to the head, and the
avoidance of the recumbent posture. Amendment began almost immediately,
and by the end of a week the hyperæsthesia had disappeared, and she slept
soundly and sufficiently.

In reference to this form of wakefulness, Dr. Handfield Jones[139] makes
some judicious observations. He says: “A girl recently under my care with
very various and marked signs of prostration of nerve-power, suffered for
many months with exceedingly restless nights, the cause of which appeared
to be chiefly great hyperæsthesia. Although she improved materially in
other respects, she did not sleep well until she was removed from London
to a healthy part of the country. I have had several patients, two
especially, both temperate males, who for a length of time were quite
dependent for good rest at night on wine taken either on going to bed or
in the course of the night. * * * It is not easy to form a precise idea of
the state of the nervous centers in which a ‘nightcap,’ as above
mentioned, is so effectual in procuring sleep. Debility is certainly one
marked pattern of it, but there must be surely another, even more
important, as the most profound debility does not, by any means, always
interfere with sound sleep, nay, rather seems to conditionate it. This
other element, we are much disposed to think, is hyperæsthesia, or
irritability, which, as already noticed, commonly increases _pari passu_
with weakness. The condition may be compared with that of neuralgia, when
it is beginning to give way under treatment, and is so readily reproduced
by anything which causes exhaustion. Now, as the stimulant recruits the
exhausted nerve force, the hyperæsthesia ceases, and the brain tissue
subsides into a state of calm repose. It may be added here that it is
often well to give not only a stimulant, but also some digestible
nourishment about the time of going to rest, or even in the course of the
night when debility to a serious extent exists. It is quite certain that a
craving empty stomach is by no means favorable to quiet slumber, and in
this point of view moderate suppers are far from being unsuitable to many
invalids. I well remember the case of a lady who, the night after a
natural confinement, woke up with severe gastric disorder and flatulence,
which resisted various medications, but subsided immediately after a
plate of cold meat and some brandy and water. Among the various
soporifics, I doubt if there be any more potent, especially for the weakly
and hyperæsthetic, than prolonged exposure to the cold open air. This
should be so managed as not to cause great fatigue, and if well timed and
followed by a sufficient meal, it will be found an admirable preparation
for sound nightly slumber.”

In the foregoing remarks it is perceived that Dr. Jones fails to recognize
the state of passive congestion of the brain which in cases such as he
describes, and in many similar ones which have come under my care, is
almost invariably present. It is this feature which, in addition to the
debility, gives so marked a character to the species of insomnia under
consideration. The hyperæsthesia, like the wakefulness, is merely a result
of the cerebral hyperæmia.

Several cases of insomnia, the result of disordered menstruation, have
come under my observation. We can very well understand how, in women
suffering from suppression of this function, a slight degree of cerebral
hyperæmia and consequent wakefulness should result. About the climacteric
time of life, when irregularities in the menstrual flow are very common,
there is quite generally extreme sleeplessness as each period approaches,
which is not ordinarily relieved till the catamenia make their appearance.
In such cases measures directed to the relief of the existent congestion
of the brain will generally prove effectual in causing natural sleep.

Irregular or deficient action of the heart and blood-vessels is a frequent
cause of wakefulness. One of the principal results of such disordered
action of the circulatory organs is coldness of the extremities, and an
attendant condition of repletion of the central vessels. As a consequence
there is in these cases almost invariably great wakefulness. As Dr.
Cheyne[140] has remarked, many a delicate female, from going to bed with
cold feet, is deprived of hours of sleep in the early part of the night,
and thereby falls into nervous complaints, obstinate dyspepsia, and
uterine irregularity, who might have escaped had the circulation of the
surface of the body been properly sustained.

There are cases, however, of habitual cold feet, accompanied by
wakefulness, which are not so much due to deficient power in the heart as
to disordered nervous action. But, whatever the cause, there is always,
while the condition exists, an excessive amount of blood in the cranial
vessels. An instance of the kind came under my observation several years
ago in the person of an army officer, of strong constitution and otherwise
of good health. Heat applied to the extremities gave only temporary
relief, and stimulants taken internally were equally inefficacious. He was
finally entirely cured by the repeated passage of the direct galvanic
current through the sciatic and crural nerves and their branches.

Indigestion is quite a common cause of wakefulness, even when no marked
disagreeable sensations are experienced in the digestive organs. A full
meal, especially if it be of highly seasoned or otherwise improper food,
will often keep the offending individual awake the greater part of the
night. We know that apoplexy is especially apt to occur soon after the
stomach has been overloaded with food. The return of the blood from the
head is impeded, and the rupture of an intercranial vessel, or an effusion
of serum, is the result of the cerebral congestion. Insomnia is a milder
effect of the same cause.

There are several other abnormal conditions of the system in which
wakefulness plays an important part, but their consideration would lead us
into the discussion of the phenomena of many diseases of which it is
simply a symptom, or of secondary consequence. The remarks which have been
made in regard to it have reference to its existence as an evidence of
slight cerebral congestion, and therefore as being of sufficient
importance to demand the aid of both physician and patient in effecting
its cure.



CHAPTER X.

THE TREATMENT OF WAKEFULNESS.


The principles which should prevail in the treatment of wakefulness are
indicated to some extent by the remarks which have already been made. If
the views which I have given relative to the pathology of this affection
be correct, there can be no doubt in regard to the means to be employed
for its cure. Happily, theory and practice are in perfect accord in
respect to the therapeutical measures to be adopted. These may be arranged
into two classes:

1st. Those which by their tendency to soothe the nervous system, or to
distract the attention, diminish the action of the heart and
blood-vessels, or correct irregularities in their function, and thus
lessen the amount of blood in the brain.

2d. Those which directly, either mechanically or through a specific effect
upon the circulatory organs, produce a similar effect.

Under the first head are embraced many agencies which from time immemorial
have been known to cause sleep. Among them are music, monotonous sounds,
gentle frictions of the surface of the body, soft undulatory movements,
the repetition by the insomnolent of a series of words till the attention
is diverted from the exciting emotion which engages it, and many others of
similar character which individuals have devised for themselves. In slight
cases the measures belonging to this class often prove effectual, but in
persistent insomnia they are generally altogether nugatory.

Under the second head we shall find comprehended the means which are
chiefly to be relied on in the treatment of cases of morbid wakefulness.

Chief among them are embraced those measures which tend to improve the
general health of the patient, and which are chiefly of a hygienic
character. Whatever causes produce an irritable condition of the nervous
system, indirectly at least increase the disposition to wakefulness. It is
important, therefore, that these should be thoroughly understood and
avoided, and I accordingly propose to consider them at some length.

_Food._--While it is an error to suppose, as is generally done, that a
moderately full meal, eaten shortly before bedtime, is necessarily
productive of wakefulness, there is no doubt that this condition is
induced by an excessive quantity of irritating or indigestible food. A
hearty supper of plainly cooked and nutritious food rather predisposes to
sleep. Most of us have experienced the drowsiness which so often follows
dinner. This is due to the fact that the process of digestion requires an
increased amount of blood in the organs which perform it, and
consequently the brain receives a less quantity. A tendency to sleep is
therefore induced. It is a natural and healthy predisposition, and when
yielded to moderately conduces to a more complete assimilation of the food
than would otherwise take place. When, however, the food ingested is not
such as is merely sufficient for the wants of the system, but is
inordinate in amount, or irritating in quality, the hypnotic effect is
neutralized, and often a state of wakefulness supervenes, from the fact
that the quantity of blood circulating in the brain is augmented instead
of being diminished. This last result is induced either by the pressure of
the overloaded stomach upon the abdominal vessels or through a reflex
action on the heart, by which it is excited to increased activity.

In young children, who are very susceptible to the influence of causes
acting upon the nervous system, we often see both sleep and wakefulness
result as direct effects of eating. When the quantity of milk taken has
not been excessive, the child quietly drops asleep at the breast. On the
contrary, when a superabundance has been ingested, it either remains awake
or the sleep is disturbed. In adults it is, as has already been mentioned,
not uncommon for apoplexy to ensue upon a large meal of improper food.

In order, therefore, that a disposition to wakefulness may be removed, it
is essential that attention should be paid to the diet of the affected
individual. As a rule, people are underfed. This is especially the case
with women, who too generally indulge in what may be called “slops,” to
the exclusion of good, solid, nutritious food derived in great part from
the animal kingdom. By such a faulty diet the tone of the system is
lowered, and local congestions of different parts of the body are
produced. If the brain be one of these, wakefulness results.

Most of the cases of insomnia which occur in women are of the passive
variety, and require not only nutritious food, but _stimulants_. Of the
latter, _whisky_ is generally to be preferred as acting rapidly, as less
likely to disagree with the stomach than many kinds of wine, and as being
purer than the stuff ordinarily sold as brandy. As a good stimulant, and
at the same time tonic, nothing can be preferable to _Tarragona wine_,
drunk at dinner to the extent of a glass or two. It possesses all the
essential qualities of pure port, and is much more reliable and wholesome
than the mixture of elderberry juice and alcohol which passes for this
latter wine. Next to Tarragona wine must be ranked good _lager beer_.

Although the effect of _coffee_ is generally such as to induce
sleeplessness, there are cases in which its action is directly the
reverse. I have had several slight cases of passive wakefulness under my
care which were entirely and speedily cured by a cup of strong coffee
taken for three or four nights in succession at bedtime. It is especially
useful in females of languid circulation, and a consequent tendency to
internal congestions.

Stimulants such as those mentioned, and others which might be noticed, it
must be clearly understood are only useful in the asthenic or passive form
of insomnia; in the sthenic or active form of the affection they are
altogether inadmissible, and if employed will certainly increase the
difficulty.

The good effects of moderate but regular _physical exercise_ in
dissipating wakefulness can scarcely be overestimated. It is almost
impossible to produce any permanently beneficial influence without the aid
of this powerful tonic. To be of any material service, the exercise should
be taken in the open air, and should extend to the point of inducing a
slight feeling of fatigue.

The _warm bath_ is also a very valuable means of determining blood from
the head, and calming nervous irritability. Frequently, especially in
children, I have found that simply putting the feet in water of the
temperature of 100° F. has been sufficient to induce a sound and healthy
sleep, when laudanum and other means have failed.

_Cold water_, applied directly to the scalp, is often of great effect in
diminishing the amount of blood in the brain. It is not admissible in the
asthenic form of wakefulness. When the individual is strong, the heart
beating with force and frequency, and the mental excitement great, its
influence is almost invariably good. The exact temperature is a matter
for the judgment of the physician. I have often used it as cold as ice
could make it, 32° F., or thereabouts.

In the action of cold water, applied to the head in cases of insomnia, we
have another proof of the real nature of this affection. It is known that
in Thibet mothers place their wakeful children in such positions as will
admit of a small stream of cold water falling from a slight elevation upon
the head. I have in some work--on which I cannot now lay my hands--read a
very full account of this custom, and seen a cut representing the process.
The children very soon fall into a quiet sleep. I have often seen the
application of the cold _douche_ to the heads of refractory prisoners
bring on a deep sleep.

The effects of _position_ in aid of other remedies have also been alluded
to. I make use of its advantages in all severe cases of insomnia which
come under my charge, and we have, in its efficacy, additional
confirmation of the correctness of the theory that the condition of the
brain in such cases is one of hyperæmia.

Among the more purely medicinal agents, _bromide of potassium_ occupies
the first place, and can almost always be used with advantage to diminish
the amount of blood in the brain, and to allay any excitement of the
nervous system that may be present in the sthenic form of insomnia. That
the first named of these effects follows its use, I have recently
ascertained by experiments upon living animals, the details of which will
be given at another time. Suffice it now to say, that I have administered
it to dogs whose brains had been exposed to view by trephining the skull,
and that I have invariably found it to lessen the quantity of blood
circulating within the cranium, and to produce a shrinking of the brain
from this cause. Moreover, we have only to observe its effects upon the
human subject to be convinced that this is one of the most important
results of its employment. The flushed face, the throbbing of the carotids
and temporals, the suffusion of the eyes, the feeling of fullness in the
head, all disappear as if by magic under its use. It may be given in doses
of from ten to thirty grains--the latter quantity is seldom required, but
may be taken with perfect safety in severe cases.

Another very admirable preparation is the _oxide of zinc_. This substance
appears to be especially beneficial in those cases of wakefulness due to
excessive mental exertion or anxiety of mind. I usually prescribe it in
doses of two grains, three times a day, the last dose being taken just at
bedtime.

_Opium_ I very seldom employ in the treatment of wakefulness, from the
facts that its effects vary so greatly in accordance with the dose, and
that its action is not limited to the simple induction of sleep. There are
cases, however, in which its influence is decidedly beneficial. Care
should be taken to give it in sufficiently large but not excessive
quantities. The influence of opium in lessening the amount of blood in
the brain is very distinctly recognized by Dr. Handfield Jones, and also
by Dr. Alfred Stillé.[141] Both these authors account in this manner for
its hypnotic effect. As has been shown, my own experiments tend strongly
to confirm this reasoning.

_Hyoscyamus_ is more generally admissible. It is especially indicated in
those cases which are accompanied by great nervous irritability. It is
difficult to obtain any preparation of this drug which retains its
virtues. I have usually employed the tincture in doses of from one to two
drachms. I do not think, however, that it possesses any advantages over
bromide of potassium, or that it is even equal in any respect to this
agent.

In regard to _valerian_, _assafœtida_, and other _antispasmodics_, I have
nothing to say in commendation. _Tonics_ are, however, almost always
useful, even in the active form of the affection. Among them _quinine_ and
_iron_ are more generally indicated.

When wakefulness is a consequence of functional derangement of distant
organs, the measures of relief must be directed to the cure of the primary
disease, in order to produce any permanent alleviation of the cerebral
difficulty.

In those cases of insomnia dependent upon severe and long-continued mental
exertion, all means will fail to remedy the trouble unless the affected
individual consents to use his brain in a rational manner. Proper
intervals of relaxation should be insisted upon, and in some cases it may
be necessary to suspend all intense intellectual effort for a time. When
the means will permit, travel can always be undertaken with advantage. It
is surprising sometimes to see how rapidly the brain recovers its tone,
and the system generally recuperates through the change of associations
and scenes incident to travel.

The disposition of the age seems to be to ignore the fact that the nervous
system can exhaust itself by excessive intellectual labor. A short time
since intelligence was received from abroad that one of the most
distinguished men of Great Britain had committed suicide, in consequence
of insanity produced by overexertion of his mind. Thus one more victim is
added to the long list of those who have disregarded the laws of their
being; and again we are reminded that there is a limit to the exercise of
our intellectual powers, beyond which we cannot pass with safety.[142]



CHAPTER XI.

SOMNOLENCE.


Somnolence or drowsiness is generally regarded, when persistent, as being
more strongly indicative of organic changes in the structure of the brain
than is any other derangement of sleep.

This opinion is mainly, if not entirely, due to the fact that it is
confounded with stupor, from which, both in its causes and effects, as has
already been shown, it differs in every essential respect.

Somnolence is nothing more than an inordinate tendency to sleep. When
manifested in a slight degree it is difficult, without careful examination
and a thorough inquiry into the history of the case, to distinguish it
from moderate stupor. It is of course very important that the distinction
should be made; for, in reality, somnolence is ordinarily no very serious
disorder, and is generally symptomatic of eccentric disease, whereas
stupor almost invariably results from organic brain affections, from
cerebral injuries, or the circulation of poisoned blood through the
encephalic blood-vessels.

Whatever lessens the amount of blood normally circulating through the
cerebral vessels, tends to the production of somnolence. It is hence a
condition frequently witnessed in those whose powers of life have been
reduced by long-continued disease, by excesses of various kinds, or by
affections which essentially consist in enfeeblement of the organism. It
is generally met with in the aged, in whom the circulatory organs have
lost their pristine vigor.

Many cases of very troublesome and persistent somnolence, having an origin
such as I have mentioned, have come under my notice: ordinarily they
present no difficult features of treatment, the indications being to
increase the tone of the system by stimulants, tonics, nutritious food,
and moderate exercise in the open air. These measures will invariably
succeed if there be no organic difficulty.

Somnolence, however, is sometimes due to structural changes which
interfere with the free passage of blood through the cerebral vessels. It
may hence be caused by emboli, which, obstructing the arteries, prevent
the normal amount of blood reaching the brain substance. It may also be
caused by tumors, which, pressing on the arteries supplying the brain, act
in like manner. In such cases it is of secondary importance.

A very curious affection, known as the “Sleepy Disease,” has been
described as endemic in certain regions of Africa. The following
extract[143] gives a graphic description of the malady:

“Having procured a guide, we crossed the river, and at the mouth of
Logan’s Creek we exchanged our boat for a large canoe, in which we
followed the windings of the deep and narrow inlet for nearly two miles.
This brought us to a village of six huts. Without ceremony we entered the
dwelling of the old queen (who was busied about her household affairs),
and looked around for her granddaughter, to see whom was the principal
object of our excursion. On my former visit to Maumee’s town, four or five
months ago, this girl excited a great deal of admiration by her beauty and
charming simplicity. She was then thirteen or fourteen years of age--a
bright mulatto, with large and soft black eyes, and the most brilliantly
white teeth in the world. Her figure, though small, is perfectly
symmetrical. She is the darling of the old queen, whose affections exhaust
themselves upon her with all the passionate fire of her temperament, and
the more unreasonably because the girl’s own mother is dead.

“We entered the hut, as I have said, without ceremony, and looked about us
for the beautiful granddaughter; but, on beholding the object of our
search, a kind of remorse and dread came over us, such as often affects
those who intrude upon the awfulness of slumber. The girl lay asleep in
the adjoining apartment, on a mat that was spread over the hard ground,
and with no pillow beneath her cheek. One arm was by her side, the other
above her head, and she slept so quietly, and drew such imperceptible
breath, that I scarcely thought her alive.

“With some little difficulty she was aroused, and awoke with a frightened
cry,--a strange and broken murmur,--as if she were looking dimly out of
her sleep, and knew not whether our figures were real, or only the
fantasies of a dream. Her eyes were wild and glassy, and she seemed to be
in pain. While awake, there was a nervous twitching about her mouth and in
her fingers; but, being again extended upon the mat, and left to herself,
these symptoms of disquietude passed away, and she almost immediately sank
again into the deep and heavy sleep in which we found her. As her eyes
gradually closed their lids, the sunbeams struggling through the small
crevices between the reeds of the hut glimmered down about her head.
Perhaps it was only the nervous motion of her fingers, but it seemed as if
she were trying to catch the golden rays of the sun and make playthings of
them, or else to draw them into her soul and illuminate the slumber that
looked so misty and dark to us.

“This poor doomed girl had been suffering--no, not suffering; for, except
when forcibly aroused, there appeared to be no uneasiness,--but she had
been lingering two months in a disease peculiar to Africa: it is called
the ‘Sleepy Disease,’ and is considered incurable. The persons attacked by
it are those who take little exercise, and live principally on vegetables,
particularly cassady and rice. Some ascribe it altogether to the cassady,
which is supposed to be strongly narcotic--not improbably the climate has
much influence, the disease being most prevalent in low and marshy
situations. Irresistible drowsiness continually weighs down the patient,
who can be kept awake only for the few moments necessary to take a little
food. When this lethargy has lasted three or four months, death comes with
a tread that the patient cannot hear--and makes the slumber but a little
more sound.

“I found the aspect of Maumee’s beautiful granddaughter inconceivably
affecting. It was strange to behold her so quietly involved in sleep from
which it might be supposed she would awake so full of youthful life, and
yet to know that this was no refreshing slumber, but a spell in which she
was fading away from the eyes that loved her. Whatever might chance, be it
grief or joy, the effect would be the same. Whoever should shake her by
the arm--whether the accents of a friend fell fully on the ear, or those
of strangers like ourselves,--the only response would be that troubled
cry, as of a spirit that hovered on the confines of both worlds and could
have sympathy with neither. And yet, withal, it seemed so easy to cry to
her, ‘Awake! Enjoy your life! Cast off this noontide slumber!’ But only
the peal of the last trumpet will summon her out of that mysterious
sleep.”

Another and later account of this singular disease has recently been given
by M. Dumoutier,[144] surgeon in the French Navy.

According to this observer, the affection commonly called the
“sleep-disease” (maladie du sommeil) is met with only among the negroes of
the coast, and principally those of the Gaboon and of Congo, becoming more
rare towards the north. The most prominent symptoms are an irresistible
tendency to sleep, and a feeling of torpor and numbness. The patient does
not complain of pain, and yet there is a general weakness of the limbs,
the gait is tottering, the sensibility is perverted, and the hands
imperfectly grasp the objects they attempt to seize. During the sleep the
fecal matters and the urine are passed involuntarily. The respiration is
normal, and the digestion regular. These were the principal symptoms
observed in those cases which came under M. Dumoutier’s notice: observing
the disease only in the persons of captives coming from the interior, he
ascribes it to nostalgia, _ennui_, and other moral causes. Two autopsies
made by his colleagues revealed no abnormal condition of the brain, the
spinal cord, or their membranes.

The treatment employed--quinia, strychnia, and iron--had no effect. A
temporary improvement was obtained by causing the patients to take part in
the amusements of their companions. Electricity seemed likewise to retard
somewhat the progress of the disease.

The fact that no organic difficulty of the brain was discovered after
death, is strong proof that the somnolency was due to some cause affecting
the intra-cranial circulation. That the amount of blood was lessened, and
that thus a permanent anæmia of the brain was produced, can scarcely be
doubted, when regard is had to the observations and experiments recorded
in the foregoing pages of this work. Probably the primary derangement was
seated in the sympathetic nerve and its ganglia, it having been well
settled by familiar observations, and by recent contributions to
physiology and pathology, that one of the chief functions of this system
is to regulate the caliber of the blood-vessels, and thus to determine the
amount of blood circulating through an organ or part of the body.

Numerous cases of protracted sleep are on record. Some of them are
evidently fanciful and exaggerated, but others are doubtless well founded.
One of the most remarkable of these is related, among many others, by
Wanley.[145]

“One Samuel Chelton, of Finsbury, near Bath, a laboring man, about
twenty-five years of age, of a robust habit of body, not fat, but fleshy,
and of dark-brown hair, happened, on the 13th of May, 1694, and without
visible cause, to fall into a very profound sleep, out of which he could
by no means be aroused by those about him till after a month’s time, when
he arose of himself and went to his husbandry business as usual. He slept,
ate, and drank as before, but did not speak a word till about a month
after. All the time he slept, victuals and drink stood by him, which were
spent every day, and used by him, as was supposed, though no person saw
him eat or drink all the while. After this period he continued free from
drowsiness or sleepiness till the 9th of April, 1696, when he fell into
his sleeping fit again, as he had done before. After some time his friends
were prevailed on to try what effect medicines might have upon him.
Accordingly, Mr. Gills, an apothecary, bled, blistered, cupped, and
scarified him, and used all the external irritating medicines he could
think of, but to no purpose; and after the first fortnight he was never
observed to open his eyes: victuals stood by him as before, which he ate
of now and then, but no one ever saw him eat or evacuate, though he did
both very regularly, as he had occasion; and sometimes he was found fast
asleep with the pot in his hand in bed, and sometimes with his mouth full
of meat. In this manner he lay about ten weeks, and then he could eat
nothing at all, for his jaws seemed to be set, and his teeth clinched so
close that, notwithstanding all the art that could be used with
instruments, his mouth could not be opened to put anything into it to
support him. At last, those about him observing a hole in his teeth, made
by holding his pipe, they now and then poured some tent into his mouth
through a quill. And this was all he took for six weeks and four days; but
it amounted to no more than three pints or two quarts. He had made water
only once, and never had a stool all that time.

“On the 7th of August, which was seventeen weeks from the 9th of April,
when he began to sleep, he awaked, put on his clothes, and walked about
the room, not knowing he had slept above a night; nor could he be
persuaded he had lain so long, till, going into the fields, he found
everybody busy getting in their harvest, and he remembered very well when
he fell asleep that they were sowing their barley and oats, which he then
saw ripe and fit to be cut down. There was one thing remarkable: though
his blood was somewhat wasted with lying so long in bed and fasting for
about six weeks, yet a gentleman assured Dr. Oliver that when he saw
him--which was the first day of his coming abroad--he looked brisker than
ever he saw him in his life before; and on asking him whether the bed had
made him sore, he assured this gentleman that he never felt this or any
other inconvenience, and that he had not the least remembrance of anything
that passed, or what was done to him, all that while. So that he went
again to his husbandry, as he was wont to do, and remained well till
August 17th, 1697, when, in the morning, he complained of a shivering and
a coldness in his back. He vomited once or twice, and the same day fell
into his sleeping fit again. Dr. Oliver, going to see him, found him
asleep, with a cup of beer and a piece of bread and cheese upon a stool by
his bed, within his reach. The doctor felt his pulse, which at that time
was regular, and he also found his heart beat very regular, and his
breathing easy and free. The doctor only observed that his pulse beat a
little too strong. He was in a breathing sweat, and had an agreeable
warmth all over his body. The doctor then put his mouth to his ear, and
called him as loud as he could several times by his name, pulled him by
the shoulders, pinched his nose, stopped his nose and mouth together as
long as he could without choking him, but to no purpose, for all this time
he did not give the least sign of being sensible. The doctor lifted up his
eyelids, and found his eyeballs drawn up under his eyebrows and fixed
without any motion. The doctor then held under one nostril, for a
considerable time, a vial with spirits of sal ammoniac, extracted from
quicklime; he then injected it several times up the same nostril; and
though he had poured into it almost half an ounce of this fiery spirit, it
only made his nose run, and his eyelids shiver and tremble a little. The
doctor, finding no success with this, crammed that nostril with white
powder of hellebore, and waited some time in the room to see what effects
all these together might have upon him; but he never gave any sign that he
felt what the doctor had done, nor discovered any manner of uneasiness, by
stirring any part of his body, that the doctor could observe.

“After all these experiments the doctor left him, being pretty well
satisfied that he was asleep, and no sullen counterfeit, as some people
supposed. On the doctor’s relating what he had observed, several gentlemen
from Bath went out to see him, and found him in the same condition the
doctor had left him in the day before, only his nose was inflamed and very
much swelled, and his lips and the inside of his nostrils were blistered
and scabby, occasioned by the spirits and the hellebore. About ten days
after the doctor had seen him, Mr. Woolner, an apothecary, finding his
pulse beat very high, drew about fourteen ounces of blood from the arm,
and tied it up, and left it as he found him; and Mr. Woolner assured the
doctor that he never made the least motion when he pricked him, nor all
the while his arm was bleeding. Several other experiments were tried by
those who went to see him from Bath, but all to no purpose. The doctor saw
him again the latter end of September, and found him just in the same
position, lying in his bed, but his pulse now was not so strong, nor had
he any sweats, as when the doctor saw him before. He tried him again by
stopping his nose and mouth, but to no purpose; and a gentleman ran a
large pin into his arm to the very bone, but he gave no signs of his being
sensible to what was done to him. During all this time the doctor was
assured that nobody had seen him either eat or drink, though they watched
him as closely as possible,--but food and drink always stood by him, and
they observed that sometimes once a day, and sometimes once in two days,
all was gone. It was further observed that he never dirtied his bed, but
always went to the pot. In this manner he lay till the 19th of November,
when his mother, hearing him make a noise, immediately ran up to him and
found him eating. She asked him how he did. He replied, ‘Very well, thank
God.’ She asked him again which he liked best, bread and butter, or bread
and cheese. He answered, ‘Bread and cheese.’ Upon this the woman,
overjoyed, left him to acquaint his brother, and both coming straight up
into the chamber to speak to him, they found him as fast asleep as ever,
and could not by any means awake him. From this time to the end of
January, or beginning of February, he did not sleep so profoundly as
before; for, when they called him by his name, he seemed to hear them, and
became somewhat sensible, though he could not make them any answer. His
eyes were not shut so close, and he had frequently great tremblings of his
eyelids, upon which they expected every day that he would awake, which did
not happen till about the time mentioned, when he awoke perfectly well,
but remembered nothing that had happened all the while. It was observed
that he was very little altered in his flesh; he only complained that the
cold hindered him more than usual, but he presently went to his labor, as
he had done before.”

The case of Mary Lyall is quoted by Macnish, from the 8th volume of the
Transactions of the Royal Society of Edinburgh, as follows:[146]

“This woman fell asleep on the morning of the 27th of June, and continued
in that state till the evening of the 30th of the same month, when she
awoke and remained in her usual way till the 1st of July, when she again
fell asleep, and continued so till the 8th of August. She was bled,
blistered, immersed in the hot and cold bath, and stimulated in almost
every possible way, without having any consciousness of what was going on.
For the first seven days she continued motionless, and exhibited no
inclination to eat. At the end of that time she began to move her left
hand, and, by pointing to her mouth, signified a wish for food. She took
readily what was given to her. Still she evinced no symptoms of hearing,
and made no other kind of bodily movement than of her left hand. Her right
hand and arm particularly appeared completely dead and bereft of feeling,
and even when pricked with a pin, so as to draw blood, never shrunk in the
least degree. At the same time she instantly drew back her left arm
whenever it was touched by the point of the pin. She continued to take
food whenever it was offered to her. For the first two weeks her pulse
generally stood at 50, during the third and fourth week about 60, and on
the day before her recovery at 70 or 72. Her breathing was soft and almost
imperceptible, but during the night-time she occasionally drew it more
strongly, like a person who has just fallen asleep. She evinced no symptom
of hearing till about four days before her recovery. On being
interrogated after this event upon her extraordinary state, she mentioned
that she had no knowledge of anything that had happened--that she had
never been conscious of either having needed or received food, or of
having been blistered; and expressed most surprise on finding her head
shaved. She had merely the idea of having passed a long night in sleep.”

Many other cases might be referred to; but as their general features are
similar to the two cited, it is unnecessary to quote them. The following
instance occurring in this country presents some features of interest. It
is reported by Dr. C. A. Hart,[147] of this city.

“Miss Susan C. Godsy, aged 22, of bilious temperament, has been in a
somnolent state since 1849, being then eight years of age. Up to within a
year of that period she had enjoyed excellent health, she being then
attacked with intermittent fever, in the treatment of which opium was
extensively used. This was erroneously supposed to have induced her
present condition. Soon after her recovery, excessive somnolency began to
develop itself, which in 1857 became more profound after an attack of
scarlatina anginosa, followed by measles. The lucid intervals will occur
from four to six times a day, and last for from five to six minutes; at
which periods she will generally take some nourishment, and then relapse
into a profound slumber, from which it is impossible to arouse her.

“In point of general physique there is nothing specially worthy of note,
except the comparative plumpness during such a long maintenance of the
recumbent posture, with very little muscular exercise. She is about the
average height of her sex, with cranial development possibly a little in
excess. The hands and feet are both exceedingly small, the nails of which
have not grown any since her present condition began.

       *       *       *       *       *

“The catamenia commenced between the fourteenth and fifteenth years, and
are generally very irregular and painful; but, when anything like
regularity is attained, the flow occurs about every six weeks.

       *       *       *       *       *

“None of the special senses are in the least diminished or perverted;
there has been neither squinting nor excessive dilatation of the pupils.
The irides both respond readily to the stimulus of light. While
interrogating the mother, a convulsive movement of the entire body took
place, apparently more violent in the upper than in the lower extremities.
The arms, hands, and feet were in rapid motion. At the subsidence of this,
consciousness was established; and the young lady herself, being
questioned about her condition, replied in a clear and comprehensible
manner, though merely using monosyllables. When asked if she suffered any
pain in her head, she replied yes, but without locating it; if in the
back, yes; if about the chest or abdomen, no. She was lucid about five
minutes, during which time a number of questions were asked her, but
without eliciting any further information. She took no food or medicine
during this interval of consciousness, and went to sleep while being
questioned, remaining in that state during the rest of the time we were
there--about half an hour--her rest being perfectly tranquil with the
exception of a slight convulsive movement.”

These cases of protracted sleep present many analogies with the condition
of hibernation which certain of the lower animals enter into at stated
periods. Doubtless the state of the brain is the same, and is one of
anæmia.

It has never been my fortune to witness a case of protracted sleep.
Regarding the starting-point of the disorder as being situated in the
sympathetic system, I should be disposed to employ the direct galvanic
current in the treatment--placing the positive pole over the sympathetic
nerve in the neck, and the negative over the opposite scapula. This I
would do, using a battery of thirty-two or a less number of pairs, every
day, for from five to ten minutes.



CHAPTER XII.

SOMNOLENTIA, OR SLEEP DRUNKENNESS.


By somnolentia, or sleep drunkenness, is understood a condition in which
some of the mental faculties and senses are fully aroused, others
partially so, while others remain as they are in profound sleep. It is
therefore an imperfect sleep, or rather a combination of wakefulness and
sleep. The phenomena peculiar to it are frequently met with in children,
in whom they may be excited through the influence of a dream, but which at
other times have no such origin. The condition in question is only induced
by the sudden waking of a person.

A very excellent account of sleep drunkenness, in its medico-legal
relations, is given by Wharton and Stillé,[148] who have quoted several
interesting cases from German and other authors, which I do not hesitate
to transfer to these pages.

“A sentry fell asleep during his watch, and, being suddenly aroused by the
officer in command, attacked the latter with his sword, and would have
killed him but for the interposition of the by-standers. The result of the
medical examination was, that the act was involuntary and irresponsible,
being the result of a violent confusion of mind consequent upon the sudden
waking from a profound sleep.

“A day-laborer killed his wife with a wagon-tire, the blow being struck
immediately on his starting up from a deep sleep from which he was
forcibly awakened. In this case there was collateral evidence that the
defendant was seized, on awaking, with a delusion that a ‘woman in white’
had snatched his wife from his side and was carrying her away, and that
his agony of mind was so great that his whole body was bathed in
perspiration.

“A young man, named A. F., about twenty years of age, was living with his
parents in great apparent harmony, his father and himself being alike
distinguished for their great fondness for hunting. In consequence of
danger from nocturnal attacks, they were in the habit of taking their arms
with them into their chambers when they went to bed. On the afternoon of
September 1st, 1839, the father and son having just returned from hunting,
their danger became the subject of particular conversation. The next day
the hunting was repeated, and on their return, after taking supper with
every evidence of good feeling, they retired for the night, the son to his
own room, and his father and mother to theirs. Both father and son took
their loaded arms with them. At one o’clock the father got up to go into
the entry, and on his return jarred against the door, on which the son
instantly sprang up, seized his gun, and discharged it at his father,
giving him a fatal wound in the breast, at the same time exclaiming, ‘Dog,
what do you want here?’ The father immediately fell to the ground; and the
son, then recognizing him, sank on the floor, crying, ‘Oh, Jesus! it is my
father!’

“The evidence was that the whole family were subject to great restlessness
in their sleep, and that the defendant in particular was affected with a
tendency to be easily distressed by dreams, which lasted for about five
minutes, on waking, before their effect was entirely dissipated. His own
version of the affair was: ‘I must have fired the gun in my sleep; it was
moonshine, and we were accustomed to talk and walk in our sleep. I
recollect hearing something jar; I jumped up, seized my gun, and fired
when I heard the noise; I recollect seeing nothing, nor am I conscious of
having spoken. The night was so bright that everything could have been
seen. I must have been under the delusion that thieves had broken in.’ The
opinion of the medical experts was, that the act was committed during the
condition of sleep drunkenness, and that, accordingly, it was not that of
a free and responsible agent.”

The same authors quote the following case of Dr. Meister, from Herke’s
Zeitschrift:

“I was obliged,” says the doctor, “to take a journey of eight miles on a
very hot summer’s day--my seat being with my back to the horses, and the
sun directly in my face. On reaching the place of destination, and being
very weary and with a slight headache, I laid myself down, with my clothes
on, on a couch. I fell at once asleep, my head having slipped under the
back of the settee. My sleep was deep, and, as far as I can recollect,
without dreams. When it became dark, the lady of the house came with a
light into the room. I suddenly awoke, but, for the first time in my life,
without collecting myself. I was seized with a sudden agony of mind, and,
picturing the object which was entering the house as a specter, I sprang
up and seized a stool, which, in my terror, I would have thrown at the
supposed shade. Fortunately I was recalled to consciousness by the
firmness and tact of the lady herself, who, with the greatest presence of
mind, succeeded in composing my attention until I was entirely awakened.”

Hoffbauer[149] relates the particulars of a case which has passed into the
annals of medical jurisprudence as one of great importance.

“Bernard Schidmaizig awoke suddenly at midnight. At the same moment he saw
a frightful phantom (at least so his imagination depicted it) standing
near him. That which appeared to his vision seemed to be a veritable
specter; and fear and the darkness of the night prevented him recognizing
anything with distinctness. With a feeble voice, he twice called out, ‘Who
goes there?’ He received no answer, and imagined that the apparition was
approaching him. Deprived for the instant of his reason, he jumped from
his bed, seized a hatchet which he generally kept near him, and with this
weapon attacked the imaginary specter. To see this apparition, to cry,
‘Who goes there?’ to seize the hatchet, were all done in a moment: he had
not an instant for reflection. At the first blow the phantom was struck to
the earth; Schidmaizig heard a deep groan. This sound, and the noise of
the imaginary phantom falling to the ground, fully awakened him; and
suddenly the thought struck him that he had assaulted his wife, who slept
with him. He threw himself on his knees, raised the head of the wounded
person, saw the injury he had inflicted, and the blood which flowed, and
with a voice full of anguish cried, ‘Susannah! Susannah! come to
yourself!’ He then called his eldest daughter, aged about eight
years--ordered her to see if her mother was recovering, and to tell her
grandmother what he had done. It was in reality his wife; and she died the
next day from the effects of the blow.”

As Hoffbauer remarks, “This man did not enjoy the free use of his senses;
he did not know what he saw; he believed that he was repulsing a sudden
attack. He very soon recognized the place where he ordinarily slept; it
was natural that he should seize his hatchet,--since he had taken the
precaution to place it near him,--but the idea of his wife, and of the
possibility of having killed her, were the last thoughts that entered his
mind.”

Seafield[150] quotes from the Express (London) of January 5th, 1859, the
following case of sleep drunkenness:

“Yesterday the Marylebone Police Court was crowded to excess, in
consequence of a report which had been circulated, that a woman was in
custody for killing her child by throwing it from a first-floor window
into the street. The rumor in regard to the murder happily turned out to
be untrue; but it will be seen from the subjoined evidence that it was a
providential circumstance that the lives of three children were not
sacrificed by their mother while acting under the influence of a dream.

“At two o’clock the prisoner, Esther Griggs, was placed at the bar before
Mr. Broughton.

“Mr. Lewis, of Ely Place, appeared for her; and Mr. Tubbs, relieving
officer of Marylebone, attended on behalf of the board of guardians of the
parish, to watch the case.

“The prisoner, who evidently felt the serious situation in which she was
placed, was seated during the proceedings.

“The first witness called was Sergeant Simmons, 20 D, who said, ‘At
half-past one o’clock this morning, while on duty in East Street,
Manchester Square, I heard a female voice exclaim, “Oh, my children! Save
my children!” I went to the house, No. 71, from whence the cries
proceeded, and the landlord opened the door. I went up-stairs, accompanied
by two other constables, and, while making our way to the first floor, I
heard the smashing of glass. I knocked at the door, which I found was
fastened, and said, “Open it; the police are here.” The prisoner, who was
in her night-dress, kept on exclaiming, “Save my children!” and at length,
after stumbling over something, let me and my brother officers in. When we
entered, we found the room in total darkness; and it was only by the aid
of our lanterns that we could distinguish anything in the room. On the bed
there was a child five years old, and another, three years of age, by her
side. Everything in the room was in confusion. She kept crying out,
“Where’s my baby? Have they caught it? I must have thrown it out of the
window.” The baby must have been thrown out as I was going up-stairs; for
before getting into the room I heard something fall. I left a constable in
charge of the prisoner; and I ascertained that the child which had been
thrown from the window had been taken to the infirmary of Marylebone
Workhouse. She told me she had been dreaming that her little boy had said
that the house was on fire, and that what she had done was with the view
of preventing her children from being burned to death. I have no doubt,’
added the witness, ‘that if I and the other constable had not gone to the
room all three of the children would have been thrown into the street.’

“Mr. Broughton.--‘How long do you suppose the cry of “Oh, save my
children!” continued?’

“Witness.--‘I should think about five minutes.’ (In continuation, he said
he went to 38 Harley Street, where the husband lives, in the service of a
gentleman, and gave him information of what had occurred. The injured
infant was only eighteen months old.)

“By Mr. Lewis.--‘From the excited state in which the prisoner was, I did
not at the time take her into custody. She went to the infirmary along
with her husband, to see how the child was going on, and what hurt it had
sustained. I had understood that the surgeon had said it was a species of
nightmare which the prisoner was laboring under when the act was
committed. The window had not been thrown up. The child was thrust through
a pane of glass, the fragments of which fell into the street.’

“Humphreys, 180 D.--‘I heard the breaking of glass, and saw what I
imagined to be a bundle come out of the window, and, on taking it up, I
found it to be a female infant. There was blood running from its temples,
and it was insensible. I took it to the infirmary.’

“Pollard, 314 D.--‘I heard loud cries of “Oh, save my children!” and when
I was in her room she said, “Has anybody caught my baby Lizzie?” One of
the little boys, about three years old, and who was clinging to his
mother, had blood upon his clothes. He had upon his breast some marks,
which appeared to have been caused by cuts from glass. He left me to take
care of the prisoner while he went for her husband. She told me she had no
wish to hurt any of her children, and that it was all through a dream.’

“Mr. Henry Tyrwhitt Smith, surgeon of the Marylebone Infirmary, was next
called, and said, ‘That when the infant was brought to him, soon after one
in the morning, he found, upon examining it, that it was suffering from
concussion of the brain. It was quite insensible, and decidedly in danger
now. The parietal bone is broken, and death might ensue in the event of an
effusion of blood on the brain.’

“By Mr. Lewis.--‘I cannot say that I have not heard of an instance where
parties have committed acts to which a dream had impelled them.’

“Mr. Lewis submitted to the magistrate that there had been no attempt to
murder the infant. The prisoner had always evinced a kindly feeling toward
her children, and he (the learned gentleman) hoped that the magistrate
would allow the husband to have her under his care during the temporary
remand which would of course take place. The dream under which the act
was committed showed that she had not, at the time, any consciousness of
what she was doing.

“Mr. Tubbs said he did not attend in the capacity of a prosecutor, but he
appeared on behalf of the board of guardians; and he put it to the
magistrate whether there would be any objections, under the circumstances,
to allow the prisoner to be bailed, her husband being security for her
reappearance.

“Mr. Broughton _considered that it would be a most dangerous doctrine to
lay down, to say that because a person was dreaming while committing an
offense, that they were not culpable for their acts_. A woman, on these
grounds, might get up in the middle of the night and cut her husband’s
throat, and, when brought up for the offense, turn round and say that she
had done the act while under the influence of a dream. He (the worthy
magistrate) considered the case to be one of a serious nature; and in the
event of death ensuing, an inquest would be held on the body. He could not
think of taking bail in so serious a case, but would remand the prisoner
till Tuesday next, and during her present excited state she would be taken
care of in the infirmary.

“The prisoner was then removed to the cells by Ansted, the jailer, sobbing
most bitterly.

“The recorder, at the subsequent sessions at the Central Criminal Court,
in his address to the grand jury, took a somewhat more rational view of
the case than that entertained by Mr. Broughton.

“‘If the prisoner,’ said the recorder, ‘really did the act under the idea
that it was the best mode of insuring the safety of the child, it appeared
to him that, under such circumstances, it would be a question whether the
grand jury would be justified in coming to the conclusion that the
criminal was guilty of a criminal act.’

“The grand jury threw out the bill.”

Several cases of sleep drunkenness have come under my own notice.

A gentleman was roused one night by his wife, who heard the street-door
bell ring. He got up, and, without paying attention to what she said,
dragged the sheets off of the bed, tore them hurriedly into strips, and
proceeded to tie the pieces together. She finally succeeded in bringing
him to himself, when he said he thought the house was on fire, and he was
providing means for their escape. He did not recollect having had any
dream of the kind, but was under the impression that the idea had occurred
to him at the instant of his awaking.

Another was suddenly aroused from a sound sleep by the slamming of a
window shutter by the wind. He sprang instantly from his bed, and, seizing
a chair that was near, hurled it with all his strength against the window.
The noise of the breaking of glass fully awakened him. He explained that
he imagined some one was trying to get into the house and had let his
pistol fall on the floor, thereby producing the noise which had startled
him.

A lady informed me that upon one occasion she had gone to bed very tired,
but was suddenly startled from her sleep by a voice calling her by name.
Without stopping a moment, she arose, put on her shoes and stockings, lit
a candle, took a loaded pistol from a shelf near her husband’s head,
cocked it, and was leaving the room, the pistol in one hand and the candle
in the other, when she was seized by her husband. She turned, recognized
him at once, and would have fallen to the floor had he not caught her in
his arms. Her husband, who slept in the same bed with her, had heard one
of the children cry in an adjoining room, and had called her. She, hearing
his voice, had partially awakened, but had conceived the idea that he had
called to her from another part of the house, where some danger menaced
him. She had acted upon this supposition, and was perfectly conscious of
every movement she had made.

It does not appear that some persons are more liable to attacks of sleep
drunkenness than others. Neither do I know of any means by which its
occurrence could be prevented. It is a natural phenomenon, to which all
are liable. It is more important in its medico-legal relations than any
other.



APPENDIX.

ADDITIONAL OBSERVATIONS RELATIVE TO THE PHYSIOLOGY OF SLEEP.[151]


Since the chapter on the Physiology of Sleep was written, I have, by
additional experiments, satisfied myself that the theory then enunciated
is correct in every essential particular.

By means of an instrument adapted to show the extent of cerebral pressure,
and which I first described nearly two years ago, I have been enabled to
arrive at very positive results. In every instance the pressure was
lessened during sleep and was increased during wakefulness. The
experiments were performed upon dogs and rabbits. Briefly, the instrument
consists of a brass tube, which is screwed into a round hole made in the
skull with a trephine. Both ends of this tube are open, but into the upper
is screwed another brass tube, the lower end of which is closed by a piece
of very thin sheet india-rubber, and the upper end with a brass cap, into
which is fastened a glass tube. This inner arrangement contains colored
water, and to the glass tube a scale is affixed.

This second brass tube is screwed into the first, till the thin rubber
presses upon the dura mater and the level of the colored water stands at
0, which is in the middle of the scale. Now, when the animal goes to
sleep, the liquid falls in the tube, showing that the cerebral pressure
has been diminished,--an event which can only take place in consequence of
a reduction in the quantity of blood circulating through the brain. As
soon as the animal awakes, the liquid rises at once. Nothing can exceed
the conclusiveness of experiments of this character. No mere theorizing
can avail against them.



FOOTNOTES:

[1] See the author’s Treatise on Hygiene, page 92.

[2] La Théorie des Songes. Paris, 1766, p. 206.

[3] On Obscure Diseases of the Brain, etc. London, 1860, p. 604, note.

[4] Physiologie de la Pensée. Recherche Critique des Rapports du Corps à
l’Esprit. Deuxième édition. Paris, 1862, t. ii. p. 440.

[5] Du Sommeil, des Rêves et du Somnambulisme, etc. Lyon, 1857, p. 14.

[6] Observations in Medicine. Second Series, p. 27.

[7] Art. _Sleep_. Cyclopedia of Anatomy and Physiology, vol. iv. part 1,
p. 681.

[8] Chapters on Mental Physiology. London, 1852, p. 105.

[9] Essays on Life, Sleep, Pain, etc. Philadelphia, 1852, pp. 63 and 64.

[10] Epilepsy and Epileptiform Seizures. London, 1858, p. 123.

[11] Nouveaux Éléments de la Science de l’Homme. 3me édition. Paris, 1858,
vol. ii. p. 7, et seq.

[12] Rapports du Physique et du Morale de l’Homme. Paris, 1824, p. 379.

[13] The Physiology of Common Life. New York, 1860, vol. ii. p. 305.

[14] Philosophy of Sleep. Second edition, 1850, p. 5.

[15] The Haven of Health, chiefly made for the comfort of Students, and
consequently for all those that have a care for their health, etc. By
Thomas Cogan, Master of Arts and Batchelor of Physic. London, 1612, p.
332.

[16] Sketches of the Philosophy of Life. London, 1819, p. 262.

[17] Elements of Physiology. Translated by John Elliotson, M.D., etc. 4th
edition. London, 1828, p. 191.

[18] Op. cit. p. 282, et seq.

[19] Northern Journal of Medicine, No. 1, 1844, p. 34.

[20] The Philosophy of Mystery. London, 1841, p. 283.

[21] British and Foreign Medico-Chirurgical Review, Am. ed., April, 1855,
p. 404.

[22] American Journal of the Medical Sciences, October, 1860, p. 399.

[23] The Physiology of Sleep. By Arthur E. Durham. Guy’s Hospital Reports,
3d Series, vol. vi. 1860, p. 149.

[24] Recherches sur la Système Nerveux Cerebro-Spinal, sa Structure, ses
Fonctions et ses Maladies. Paris, 1865, p. 448.

[25] Cyclopedia of Practical Medicine, article _Cold_.

[26] Cyclopedia of Anatomy and Physiology, vol. iv., part 1, p. 681,
article _Sleep_.

[27] Essays on Life, Sleep, and Pain. Philadelphia, 1852, p. 87.

[28] The Doctor, etc., edited by Rev. John Wood Warter. London.

[29] Op. cit., p. 5.

[30] Rapports du Physique et du Morale de l’Homme. Paris, 1825, tome ii.
p. 381.

[31] Medicina Statica; or Rules of Health, etc. London, 1676, p. 106 et
seq.

[32] Op. cit., p. 6.

[33] Op. cit., tome ii. p. 385.

[34] An Essay concerning Human Understanding. Book ii. sect. 17.

[35] Encyclopedia Americana,--Philadelphia, 1832, vol. xii. p. 143, art.
Tartini; and L’Imagination considérée dans ses Effets directs sur l’Homme
et les Animaux, etc. Par J. B. Demangeon. Seconde édition. Paris, 1829, p.
161.

[36] The Soul and the Future Life. Appendix viii. Quoted by Seafield in
“The Literature and Curiosities of Dreams,” etc. London, 1865. Vol. ii. p.
229.

[37] Confessions of an English Opium-eater. Boston, 1866, p. 109.

[38] Journal of Psychological Medicine and Mental Pathology. July, 1859,
p. 44.

[39] Inquiries concerning the Intellectual Powers and the Investigation of
Truth. Tenth edition. London, 1840, p. 304.

[40] History of Dreams, Visions, Apparitions, etc. Philadelphia, 1855, p.
184.

[41] Macario, Du Sommeil, des Rêves et du Somnambulisme. Paris, 1857, p.
59.

[42] Op. cit., tome ii. p. 395.

[43] Ancient Metaphysics. Quoted in Dr. Forbes Winslow’s Medical Critic
and Psychological Journal. No. vi., April, 1862, p. 206.

[44] Op. cit., p. 283.

[45] Dream Thought and Dream Life. Medical Critic and Psychological
Journal, No. vi., April, 1862, p. 199.

[46] Account of the Life and Writings of Thomas Reid, D.D., p. cxliv.,
prefixed to Essays on the Powers of the Human Mind. By Thomas Reid, D.D.,
etc. Edinburgh, 1803, vol. i.

[47] Dissertations, Moral and Critical. London, 1783, art. Dreaming, p.
222.

[48] Syntagma Philosophicum. Pars 71, Lib. viii. Opera Omnia, tome i.
Lugduni, 1658.

[49] Philosophy of Mystery. London, 1841, p. 208.

[50] Op. cit., p. 286.

[51] Psychologie; oder der Wissenschaft von Subjectiven Geist. 2ten
Auflage. Ebberfeld, 1843, p. 144.

[52] The Principles of Medical Psychology, etc. Sydenham Society
Translation, p. 167.

[53] Elements of Physiology. Translated from the German, with Notes, by
William Baly, M.D., etc. London, 1842, vol. ii. p. 1417.

[54] Op. cit., p. 1418.

[55] Psychological Inquiries. Part i. London, 1856, p. 153.

[56] Du Sommeil--Mélanges Philosophiques. Seconde édition. Paris, 1838, p.
301.

[57] Sleep Psychologically considered with reference to Sensation and
Memory. New York, 1850, p. 74.

[58] An Inquiry into the Nature of Sleep and Death. London, 1834, p. 152.
(Reprinted from the Philosophical Transactions for 1833.)

[59] Zoonomia; or, The Laws of Organic Life. Am. ed., vol. i.
Philadelphia, 1818, p. 153.

[60] Elements of the Philosophy of the Human Mind. Am. ed. Boston, 1818,
vol. i. p. 184.

[61] Op. cit., t. ii. p. 376, et seq. Article Du Sommeil en particulier.

[62] An Essay Concerning Human Understanding, chapter xxi. section 30.

[63] Essays on the Powers of the Human Mind, vol. iii. Edinburgh, 1803, p.
77.

[64] Op. cit., p. 155.

[65] An Essay Concerning the Human Understanding, book ii. section 17.

[66] Op. et loc. cit., section 11.

[67] Historia Naturalis, lib. x. cap. lxxv., “De Somno Animalium.”

[68] De defectu oraculorum.

[69] De Vita, xii. Cæsarum, Nero, cap. xlvi.

[70] Op. cit., p. 63.

[71] Lectures on Metaphysics, vol. i. p. 323.

[72] Inquiries Concerning the Intellectual Powers and the Investigation of
Truth. Tenth edition. London, 1840, p. 283.

[73] Op. cit., p. 10.

[74] Quoted in Dendy’s Philosophy of Mystery. London, 1841, p. 225.

[75] The Principles of Medical Psychology, etc. Sydenham Society
Translation. London, 1847, p. 163.

[76] Op. cit., book ii. sec. 17.

[77] Cited by M. l’Abbé Richard in _La Théorie des Songes_. Paris, 1766,
p. 32.

[78] De Rerum Natura, l. iv. v. 959.

[79] Satyricon. Bohn’s edition. London, 1854, p. 307.

[80] In the above quotation I have slightly altered Kelly’s version in
Bohn’s edition of Petronius. The original Latin is fully as forcible and
true to nature as the translation.

[81] Op. cit., p. 275, et seq.

[82] Journal of Psychological Medicine. July, 1856.

[83] Le Sommeil et les Rêves; Études Psychologiques, etc. Troisième
édition. Paris, 1865.

[84] Sermon on the Office of the Holy Angels toward the Faithful, quoted
by Seafield. Op. cit., vol. i. p. 157.

[85] Op. cit., p. 86.

[86] Op. cit., p. 88, et seq.

[87] On Obscure Diseases of the Brain and Disorders of the Mind, etc.,
London, 1860, p. 611, et seq.

[88] Anatomie Comparée du Système Nerveux, etc. Par MM. Leuret et
Gratiolet. Paris, 1839-1857, t. ii. 517, et seq.

[89] Art. Rêves, in Grand Dictionnaire de Médecine.

[90] Des Maladies Mentales et des Asiles d’Aliénés, etc., Paris, 1864, p.
221.

[91] Traité des Maladies Mentales, Paris, 1860, p. 457.

[92] On Obscure Diseases of the Brain and Disorders of the Mind, etc.,
London, 1860, p. 614.

[93] The Principles of Medical Psychology. Being the Outlines of a Course
of Lectures, by Baron Ernst von Feuchtersleben, M.D. Sydenham Society
Translation, p. 198.

[94] Medical Press and Circular; also Quarterly Journal of Psychological
Medicine and Medical Jurisprudence, vol. i. p. 276.

[95] Medical Investigator; also Quarterly Journal of Psychological
Medicine, etc., April, 1868, p. 405.

[96] Op. cit., art. _Rêves_.

[97] Op. cit., p. 95.

[98] Rapports du Physique et du Morale de l’Homme. Paris, 1824, tome
second, p. 359.

[99] Chapters on Mental Physiology. London, 1852, p. 126.

[100] B. D. S. Opera Posthuma, 1677, Epistola xxx. p. 471. In the course
of this letter to his friend, Peter Balling, Spinoza says:

“Quum quodam mane, lucesente jam cælo, ex somnio gravissima evigilarem
imagines, quæ mihi in somnio occurrerant, tam vividè ob oculos
versabantur, ac si res finissent veræ, et præsertim cujusdam nigri et
scabiosi Brasiliani, quem nunquam antea videram. Hæc imago partem maximam
disparebat, quando, ut me alia re oblectarem, oculus in librum, vel aliud
quid defigibam; quamprimium verò oculos à tali objecto rursus avertebam,
sine attentione in aliquid oculos defigendo, mihi eadem ejusdem Æthiopis
imago eâdem vividètate, et per vices apparebat, donec paulatim circa caput
disparetet.”

[101] Elements of Physiology, translated by Baly, vol. ii. p. 1394.

[102] Op. cit., p. 93.

[103] Περὶ ἱερῆς νοσο.

[104] Quoted from I. Franck by Macario, op. cit., p. 100.

[105] De quelques Phénomènes du Sommeil. Œuvres Complets, tome v. p.
170-175.

[106] Grand Dictionnaire de Médecine, t. xxxiv., art. Incubi, par M.
Parent.

[107] Nouveau Dictionnaire de Médecine et de Chirurgie Pratiques, tome
sixième, Paris, 1867, art. Cauchemar.

[108] Gazette Médicale de Lyon, 15 Mai, 1856; also Macario, op. cit., p.
104.

[109] British and Foreign Medico-Chirurgical Review, April, 1845, vol.
xix. p. 441.

[110] Traité du Somnambulisme et des différentes Modifications qu’il
présente. Paris, 1823.

[111] Op. cit., p. 117.

[112] Op. cit., p. 2.

[113] Quoted by Bertrand, op. cit., p. 15.

[114] Cyclopædia of Practical Medicine. American edition, vol. iv. p. 196,
article Somnambulism.

[115] Della Forza della Fantasia Umana. Venezia, 1766.

[116] Op. cit., p. 127.

[117] Article Somnambulism, in the Cyclopædia of Practical Medicine, vol.
iv. p 198, American edition.

[118] Bertrand, op. cit., p. 17.

[119] Op. cit., p. 18.

[120] Op. cit., p. 132.

[121] The Scenery and Poetry of the English Lakes. By Charles Mackay,
LL.D.

[122] Life of Sir Isaac Newton. By Sir David Brewster, vol ii. p. 240.

[123] On Obscure Diseases of the Brain, etc. London, 1860, p. 609.

[124] Sur l’Influence Pathologique de l’Insomnie. Annales
Médico-Psychologiques, 3me Série, t. iii. p. 384, et seq.

[125] Le Sommeil et les Rêves. 3me éd. Paris, 1865, p. 9.

[126] Mental Hygiene. Boston, 1863, p. 97.

[127] A Manual of Psychological Medicine, etc. London, 1858, p. 375.

[128] Psychological Inquiries. Third edition, London, 1856, p. 141.

[129] Op. cit. p. 142.

[130] On Obscure Diseases of the Brain, etc. By Forbes Winslow, M.D.
London, 1860, p. 604.

[131] Medical Logic, p. 81, quoted in Cyclopedia of Anatomy and
Physiology, vol iv. part i. p. 686.

[132] Clinical Observations on Functional Nervous Disorders. London, 1864,
p. 284.

[133] A History of Dreams, Visions, Apparitions, etc. American edition.
Philadelphia, 1855.

[134] The Philosophy of Mystery. By Walter Cooper Dendy. London, 1841,
page 290.

[135] It is perhaps scarcely necessary to call attention to the fact that
Mr. Dendy has altogether mistaken the signification of the words in the
above quotation from Tissot, printed in italics. He appears to think they
mean _being put on his head_, a translation which would make very great
nonsense out of the whole extract. The words will be found in Tissot’s
_Avis aux Gens de Lettres et aux Personnes sédentaires sur leur Santé_,
Paris, 1768, p. 28, and in English, in a translation entitled “_A Treatise
on the Diseases of Literary and Sedentary Persons_,” Edinburgh, 1772, p.
26. The work is well worthy of attention even at this day, as containing
many most interesting facts and important suggestions.

[136] On Obscure Diseases of the Brain, etc., p. 607.

[137] The word _assassin_ is derived from the word _hashish_, from the
fact that a sect in the East called _Assassins_ made use of _hashish_ to
induce the temporary insanity during which their crimes were perpetrated.
See _History of the Assassins_, by the Chevalier Joseph von Hammer,
translated from the German by O. C. Wood, M.D., London, 1835, p. 233,
note.

[138] Physiological Memoirs, 1863, p. 24, _et seq._

[139] On Functional Nervous Disorders. London, 1864, p. 282.

[140] Cyclopedia of Practical Medicine, vol. iv., art. Wakefulness.

[141] Therapeutics and Materia Medica, 2d edition, Philadelphia, 1864,
vol. ii. page 659.

[142] The instance alluded to, that of Admiral Fitzroy, is thus commented
upon by the _Spectator_ of May 6th, 1865:

“Admiral Fitzroy, the well-known meteorologist, committed suicide on
Monday morning at his own house. He had overworked himself of late; found
that he was losing his memory; became sleepless, and resorted to opium to
obtain ease, which aggravated his symptoms. His doctor had warned him that
he ran great risk of paralysis, but from a false tenderness did not at
once compel him to give up labor.”

The _London Review_ of the same date says: “He (Admiral Fitzroy) acquired
that terrible inability to sleep, which is one of the most dreadful of
those means by which nature avenges the abuse of the mental powers, and he
was forced to take opium at night; at one time to an extent which
threatened serious consequences.”

[143] Journal of an African Cruiser, quoted in Curiosities of Modern
Travel, London, 1846, p. 239.

[144] Gazette des Hôpitaux, Oct. 13, 1868.

[145] Wonders of the Little World, etc., London, 1806, vol. ii. p. 394;
quoted from Universal Magazine, vol. viii. p. 312.

[146] Op. cit.

[147] New York Medical Journal, December, 1867.

[148] A Treatise on Medical Jurisprudence, Philadelphia, 1855, p. 120.

[149] Médecine légale relative aux Aliénés et aux Sourds-Muets, ou les
Lois appliquées aux Désordres de l’Intelligence. Traduit de l’Allemande
par A. M. Chambeyron, avec des Notes par MM. Esquirol et Itard. Paris,
1827, p. 256.

[150] The Literature and Curiosities of Dreams, etc., London, 1865, vol.
ii. p. 332.

[151] See New York Medical Gazette and Quarterly Journal of Psychological
Medicine and Medical Jurisprudence, January, 1869, p. 47.





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