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Title: Insomnia; and Other Disorders of Sleep

Author: Henry M. Lyman

Release date: August 7, 2013 [eBook #43415]

Language: English

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  INSOMNIA;
  AND OTHER
  DISORDERS OF SLEEP.


  BY HENRY M. LYMAN, A.M., M.D.,
  Professor of Physiology, and of Diseases
  of the Nervous System, in Rush Medical
  College; Professor of Theory and Practice
  of Medicine, in the Woman's Medical
  College; and Physician to the Presbyterian
  Hospital, Chicago, Ill.


  CHICAGO:
  W. T. KEENER,
  96 WASHINGTON STREET.
  1885.




COPYRIGHT, 1885.

R. R. DONNELLEY & SONS, PRINTERS, CHICAGO.




PREFACE.

  Tired Nature's sweet restorer, balmy sleep.
                                      --YOUNG.


The regularly recurring incidence of natural sleep forms one of the most
important subjects for physiological investigation. Were it an event of
rare occurrence, it would excite a degree of astonishment and alarm equal
to the agitation now experienced by the spectator of an ordinary attack of
syncope or of epileptic convulsion. But, so completely does the recurrence
of sleep harmonize with all the other facts of life that we are as
indifferent to its nature as we are to every other healthy function of the
body. It is only when the mind has undertaken a critical observation of
the bodily and mental changes which accompany and condition the phenomenon
that we begin to comprehend its wonderful character. Ushered in by a
waning activity of body and mind that no effort of the will can long
resist, nothing could more forcibly suggest the idea of approaching
dissolution if, from the very earliest period of unconscious infancy, we
had not been accustomed to the dominion of this imperious necessity. The
remarkable likeness between the fading of consciousness in sleep and its
extinction in death has, in all ages and among all people, arrested the
attention of poets and philosophers of every degree.

            Soft repose,
  A living semblance of the grave,

sang old Thomas Miller; and, describing, in Milton's stately verse, the
close of his first day in the garden of Eden, Adam says:

                    Gentle sleep
  First found me, and with soft oppression seized
  My drowsy sense, untroubled, though I thought
  I then was passing to my former state
  Insensible, and forthwith to dissolve.

        How wonderful is death,
        Death and his brother, Sleep!

exclaims Shelley, echoing the marvellous strains that have come down to us
from the days of Homer and Hesiod. In that venerable literature Sleep and
Death are represented as twin brothers, sons of Night; dwelling in the
lower world of spirits, whence they come forth to perform the will of the
Olympian Gods.

The prosaic genius of our scientific generation no longer tolerates such
lively exercise of the imagination. The splendid anthropomorphism of the
Hebrew poet, looking out upon the silent night, and cheering his soul with
the sonorous exclamation,

  Behold, he that keepeth Israel
  Shall neither slumber nor sleep

    *       *       *       *

  For so he giveth his beloved sleep,

has become a mere memory of childhood. Wordsworth understood the full
significance of this change when he wrote:

  There was a time when meadow, grove, and stream,
  The earth, and every common sight,
          To me did seem
      Apparelled in celestial light,
  The glory and the freshness of a dream.
  It is not now as it has been of yore;
          Turn whereso'er I may,
              By night or day,
  The things which I have seen I now can see no more!
      ... I know, where'er I go,
  That there has passed away a glory from the earth.

If, however, despite the loss of much that was beautiful and attractive in
the myths of antiquity, we take advantage of the

  Years that bring the philosophic mind,

we shall surely find in the scientific investigation of sleep enough to
awaken "thoughts too deep for" words.




CONTENTS.


  CHAPTER I. THE NATURE AND CAUSE OF SLEEP.

    Definition of sleep--The invasion of sleep--The hypnagogic
    state--Depth and duration of sleep--Diagrammatic
    illustration of the phases of sleep--Modifications of
    physiological functions produced by sleep--Effect of sleep
    upon the processes of respiration, circulation,
    calorification, secretion, and nutrition--Consequences of
    the progressive invasion of the nervous system by sleep--
    Effect upon the organs of special sense--Effects observed
    in the muscular apparatus of the body--Condition of
    intellectual functions during the invasion of sleep--Does
    the mind ever sleep?--Arguments adduced by Sir William
    Hamilton and others to prove the continued activity of the
    mind during the sleep of the brain--Reasons for supposing
    that the mind may sleep--Variability of the depth of
    sleep--Experiments of Kohlshüter to estimate the degree of
    variation--Alternation of day and night considered as a
    cause of sleep--Diminution of sensation a cause of sleep--
    Illustrative observation by Strümpell--Fatigue a cause of
    sleep--Hypothesis of Obersteiner regarding the cause of
    sleep--Hypothesis of Pflüger--Production of artificial
    sleep by impregnation of the brain with narcotic
    substances--Analogous production of natural sleep by
    accumulation of cerebral waste-products--Observations
    regarding the duration of sensory impressions requisite for
    the excitement of conscious perception--Difference between
    syncope and sleep--Observations of Mosso regarding the
    state of the cerebral circulation during sleep--Cause of
    the change in the cerebral circulation during sleep--
    Molecular conditions necessary for the production of
    sleep--Somnolence--Sleeping Dropsy, or Maladie du Sommeil--
    Coma--Lethargy--Apparent death--Lucid lethargy.                      1


  CHAPTER II. INSOMNIA, OR WAKEFULNESS.

    Causes of insomnia--Affections of the organs of special
    sense--Effects of light--Effect of sound--Impressions upon
    the organs of smell and taste--Disturbances caused by a
    high temperature--Atmospheric and electrical disturbances--
    Effects produced by cold--Hibernation of animals--
    Disturbances of sleep occasioned by painful sensations--
    Disorders of the sympathetic nerves--Morbid states of the
    central nervous organs--Disorders of circulation and
    nutrition--Hyperæmia of the brain--Anæmia and starvation of
    the brain--Effects of tea and coffee--Effect of alcohol--
    Inflammations, degenerations, and tumors affecting the
    brain--Excitement of the brain by diseased conditions of
    the blood.                                                          38


  CHAPTER III. REMEDIES FOR INSOMNIA.

    Serious consequences of insomnia--Its relation to cerebral
    diseases--Treatment of insomnia by moderation and control
    of the cerebral circulation--Remedial agents--Nervous
    stimulants and nervous sedatives--Heat--Baths--Massage--
    Electricity--Counter-irritants--Food--Digitalis--Camphor--
    Musk--Valerian--Cannabis indica--Belladonna--Hyoscyamus--
    Stramonium--Phosphorus--Acids--Opium--Cold--Alcohol--
    Paraldehyde--Ether--Chloroform--Chloral--Butylchloral
    hydrate--Amyl nitrite--Opium and opiates--Bromides--Hops--
    Gelsemium--Conium.                                                  56


  CHAPTER IV. TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.

    Insomnia in acute affections of the brain--In insanity--In
    chronic alcoholism and delirium tremens--In diseases of the
    heart and blood-vessels--In angina pectoris--In diseases of
    the respiratory organs--In asthma--In renal diseases--In
    diseases of the liver--In gastro-intestinal diseases--In
    febrile conditions--In rheumatism and gout--In lithæmia--In
    syphilis--In disorders of nutrition--During pregnancy and
    after parturition--In spasmodic diseases--In childhood--In
    old age.                                                            92


  CHAPTER V. DREAMS.

    Physiology of perception and of dreaming--Definition of the
    act of dreaming--Revery--Production of illusions and
    hallucinations by drugs and by disease--Effects of
    hasheesh--Effects of acute disease--Association of ideas--
    Memory of past sensations--Dreams produced by excitement of
    the different organs of sense--Persistence of
    dream-impressions after waking--Experience of M.
    Baillarger--Of Professor Jessen--Belief of savages in the
    reality of dreams--Sensory dreams--Intellectual dreams--
    Repetition of dreams--Incoherence of dreams--Cause of the
    superior vividness of certain dreams--Duration of dreams--
    Dreams excited by morbid states of the body--Prophetic
    dreams--Their causes--Clairvoyant dreams--Hallucinatory
    dreams--Sir Edmund Hornby's experience--Hallucinations--
    Case related by Dr. E. H. Clarke--Revelation through
    dreams--Revival of memory in dreams.                               116


  CHAPTER VI. SOMNAMBULISM.

    Causes of somnambulism--Physiology of somnambulism--
    Varieties of the disorder--Maury's classification--
    Classification of Ball and Chambard--Diagrammatic
    representation of their classification--Somnambulic
    lethargy--Illustrative cases--Somnambulic dreams--Night
    terrors--Somnolentia or sleep-drunkenness--Sleep-walking--
    Illustrative cases--Condition of the special senses in
    somnambulism--Relation of memory to the somnambulic
    paroxysm--Illustrative cases--Occasional recollection of
    incidents connected with the somnambulic dream--
    Resemblances between the somnambulic state and the
    condition of post-epileptic mania--Somnambulic visions--J.
    P. Frank's case--Mesnet's case--Somnambulic life--Its
    likeness with the double-consciousness of certain forms of
    epilepsy--Illustrative cases--General theory of
    somnambulism.                                                      166


  CHAPTER VII. ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.

    Antiquity of the phenomena of hypnotism--Modern
    observations--Physical conditions favorable to the
    phenomena--Methods of inducing the hypnotic state--Duration
    of hypnotic sleep--Rudimentary states of hypnotism--
    Investigations of the Society for Psychical Research--
    Mind-reading--Physiological explanation of the process--
    Charcot's observations on artificial somnambulism--
    Cataleptic variety of the hypnotic state--Lethargic
    variety--Somnambulic variety--Hypnotic clairvoyance--
    Exalted sensibility of the brain in hypnotic states--
    Susceptibility to suggestions from without--Phenomena of
    so-called spiritualism--Table-rapping--Planchette--
    Therapeutical employment of hypnotism--Metaphysical healing.       212




CHAPTER I.

THE NATURE AND CAUSE OF SLEEP.

  Worn out, friend, is every theory,
  But green the golden tree of life.
                              --GOETHE.


Natural sleep is that condition of physiological repose in which the
molecular movements of the brain are no longer fully and clearly projected
upon the field of consciousness. This condition is universally observed in
all healthy animals; and its recurrence is intimately associated with the
diurnal revolution of the earth, and the succession of day and night. The
disappearance of daylight is, for the majority of living creatures, the
signal for cessation of active life. Though its onset may be for a time
delayed by an effort of the will, the need of rest at length overcomes all
opposition, and the most untoward circumstances cannot then prevent the
access of unconsciousness. The story of the sailor-boy, sleeping on "the
high and giddy mast," is familiar to every one. An officer in the United
States Navy has assured me of more than one instance in which men had
fallen asleep under his own eyes, oppressed by exhaustion, during the roar
of a long continued bombardment. Thus produced, the relation of cause and
effect between weariness and sleep becomes very apparent. The refreshing
influence of such repose points clearly to the restorative character of
the physiological processes which persist during the suspension of
consciousness. It also renders evident the final cause of that periodical
interruption of activity which the brain experiences in common with every
other living structure.

Sleep is usually preceded for some time by a feeling of sleepiness. This
sensation, like the analogous sensations of hunger and thirst, represents
in some measure the progressive diminution of energy throughout the entire
body; but it is chiefly expressive of the failure of cerebral energy. It
produces a sense of general heaviness and intellectual dullness; the
special senses become less alert, the eyelids droop, numerous groups of
muscles experience the spasmodic contraction of yawning, the head drops
forward and is recovered with a jerk, the limbs relax, and the whole body
tends to assume a position convenient for repose. Every school-boy who has
been compelled to pass an evening hour at a dull lecture, under the eye of
a martinet monitor, will testify to the suffering which attends any
unusual prolongation of this period. But, if the natural course of events
be not obstructed, the stage of mere sleepiness is soon passed, and the
introductory stage of sleep is entered. This is a state in which the
individual is neither awake nor fully asleep. It is known as the
hypnagogic state. During this period the phenomena of simple sleepiness
become exaggerated to such a degree that the attitude of repose is assumed
without effort if the body be permitted to follow the natural inclination
of its different members. The eyes close, the other senses become
inactive, though the sense of hearing is the most persistent. Released in
considerable measure from the control of the brain, the reflex energy of
the spinal cord is at first somewhat exalted. Witness the fibrillary
twitching of the muscles, and the convulsive state, which may often be
observed during the stage of somnolence after severe fatigue. The uneasy
sleeper may even be roused to complete wakefulness by such involuntary
movements. But, as sleep becomes more profound, the reflex functions of
the cord are also weakened.[1] As the sensory organs retire from action,
the intellectual faculties lose their equilibrium. First, the power of
volition ceases. Then the logical association of ideas comes to an end.
The reasoning faculty disappears, and judgment is suspended. We become,
therefore, no longer capable of surprise or astonishment at the vagaries
of memory and of imagination, the only faculties that remain in action. To
their more or less unfettered activity we owe the presentation in
consciousness of those disorderly pictures which, occurring in this stage
of imperfect sleep, have been termed hypnagogic hallucinations.[2] During
the early moments of this period an observant person may often retain a
power of reasoning sufficient to remark the fact of dreaming, and this
effort of attention may produce a partial awakening; but, usually, the
subsidence of cerebral function is progressive and rapid. The fire of
imagination fades, the field of consciousness becomes less and less
vividly illuminated, the entire nervous apparatus yields to the advancing
tide, and, finally, the dominion of sleep is fully confirmed. The sleeper
knows nothing of the external world, and has lost all consciousness of his
own existence. But the duration of profound repose is brief. From the end
of the first hour the depth of sleep, at first, rapidly, then, more
gradually, subsides. Dreams disturb its tranquility, mental activity
increases, the power of volition revives, and, at the end of six or eight
hours, the individual is once more awake. The subjoined diagram, borrowed
from the Dictionaire Encyclopédique des Sciences Médicales, will
facilitate the apprehension of these successive phases in the course of
sleep:

  +============================================================+
  | Organic Life.                                              |
  |    | Conscious Life.                                       |
  |    |    | Imaginative Faculties.                           |
  |    |    |    | Coördinative Faculties.                     |
  |    |    |    |    | Special Sensation and Voluntary Motion.|
  |----+----+----+----+----+-----------------------------------|
  |XXXXXXXXXXXXXXXXXXXXXX  | Normal life.                      |
  |------------------------------------------------------------|
  |XXXXXXXXXXXXXXXXX       |First stage of sleep--Hypnagogic   |
  |                        |  hallucinations.                  |
  |------------------------------------------------------------|
  |XXXXXXXXXXXX            |Second stage of sleep--Dreaming.   |
  |------------------------------------------------------------|
  |XXXXXXX                 |Third stage of sleep.              |
  |------------------------------------------------------------|
  |XX                      |Profound sleep.                    |
  |------------------------------------------------------------|
  |XXXXXXX                 |First stage of waking.             |
  |------------------------------------------------------------|
  |XXXXXXXXXXXX            |Second stage of waking--Dreams.    |
  |------------------------------------------------------------|
  |XXXXXXXXXXXXXXXXX       |Third stage of waking--Hypnagogic  |
  |                        |  hallucinations.                  |
  |------------------------------------------------------------|
  |XXXXXXXXXXXXXXXXXXXXXX  |Complete awakening.                |
  +------------------------------------------------------------+

It was formerly believed that during the time of sleep all the processes
of assimilation and nutrition throughout the body are increased,--in
short, that it is the season of repair for the waste of tissue incurred
during the hours of wakeful activity. While it is true that in sleep the
expenditure of force is greatly reduced, the more exact researches of
modern physiologists indicate a universal reduction in the rate of all the
vital processes. The final result, however, is a general renewal of
energy, because the aggregate income of the tissues is greater than their
outgo during the suspension of conscious activity. The following
observations make very apparent the fact of a reduction of physiological
activity:

_Respiration._--The process of breathing is conducted with greater
deliberation during the period of sleep. This reduction is one of the most
notable of the circumstances that first attract the attention of the
spectator who observes a sleeping person. The average number of
respirations per minute, in an adult of twenty-five to thirty years of
age, is sixteen. Quetelet remarked[3] that during sleep this number was
diminished by about one-fourth. The same fact has been recorded by other
observers.[4] Mosso has also noted the fact[5] that there is a change in
the type of respiration, the movements during sleep become less
diaphragmatic and more largely costal. He furthermore observed that during
the waking period the act of inspiration consumed 8-12 of the complete
respiratory phase, but during sleep it was prolonged till it occupied
10-12 of the same cycle. The interval between the end of expiration and
the commencement of inspiration was also obliterated by sleep.
Notwithstanding this relative increase of inspiratory motion, the quantity
of air that passes through the lungs is considerably reduced by reason of
the diminished action of the diaphragm. A corresponding reduction of the
gaseous exchanges between the blood and the external air has been
determined by the experiments of Pettenkofer and Voit, Boussingault,
Lewin, and other equally competent observers.[6]

_Circulation._--During sleep the heart beats less frequently than during
the waking hours. Though a portion of this delay must be attributed to the
recumbent position, sleep does still further retard the movement of the
heart. My own observations upon children in bed exhibit a difference of
twelve to sixteen beats between the pulsations when awake and asleep.
According to Trousseau[7] the average number of pulsations observed in a
group of thirty children, varying in age from fifteen days to six months,
was 140 when awake and 121 when asleep. In another group of twenty-nine
children, between the ages of six months and twenty-one months, the
average was 128 when awake and 112 when asleep. The observations of Hohl
and Allix[8] indicate that among very young children the difference
between the pulse of sleep and the pulse of wakefulness may equal forty
beats. According to Guy (_loc. cit._) the pulse is more variable in the
morning than during the afternoon or evening.

_Temperature._--Aside from the almost hourly fluctuations of the bodily
temperature, a noticeable sinking of the temperature-curve is observed
during the hours of sleep. This alone is sufficient to indicate a
diminished rate of combustion in the tissues. Boussingault found[9] that a
dove which consumed 255 millegrammes of carbon every hour while awake,
oxidized only 162 millegrammes when asleep. Scharling also observed that
the quantities of carbon successively oxidized by the same man when asleep
and awake bore to each other the ratio of 1:1.237. The observations of
Demme[10] indicate that increase of bodily temperature during the hours of
sleep must be considered as the result of pathological processes in the
tissues. The observations of Allix (_loc. cit._), made upon sixteen
children during the first twelve days after birth, showed an average fall
of 0°.38 C. during the hours of sleep. Eight children, between five and
sixteen months old, exhibited a similar depression of 0°.56 C.; while ten
children, ranging in age from twenty months to four years of age, averaged
0°.34 C. less when asleep than when awake.

The well-known experiments of Chossat, who found that the temperature of
pigeons was from 0°.70 C. to 0°.90 C. higher at noon than at midnight, may
not be considered satisfactory evidence of the depressing influence of
sleep, because it is true that the diurnal variations of temperature which
are conditioned by the vital activities of every animal might be
sufficient to account for these differences. The experiments of
Horvath[11] are more convincing. This observer found that the marmots upon
which he experimented were accustomed to sleep during the winter for about
four days continuously, and would then remain awake for an equal length of
time. "During the sleeping period they can be cooled down to such a degree
that a thermometer introduced into the rectum to the depth of an inch and
a half indicated only 3°F. above the freezing point. The temperature rose
rapidly after the animal awoke, so that in the course of an hour it was
3°F. higher; at the close of the second hour 9°F. higher, and at the end
of the next half hour about 27°F. * * Neither respiration nor the muscular
movements were correspondingly augmented." This observation clearly shows
the powerful influence of cerebral activity upon the liberation of heat
within the body.

_Secretion._--The functions of the numerous glands throughout the body are
diminished during sleep. The tears dry up, and the cornea receives less
moisture. Hence the stickiness of the margins of the eyelids during the
sleep of a patient suffering with conjunctivitis. He can open his eyes, on
awaking, only after sufficient time has elapsed to revive the lachrymal
flow. Exner[12] remarks the diminution of pathological secretion in nasal
catarrh during the hours of sleep. The mouth in like manner ceases to
receive its full quota of saliva, and its cavity quickly dries if the lips
remain open. The secretions of the gastro-intestinal glands vary with the
contents of the alimentary canal; but in general they are considerably
diminished, and digestion is correspondingly retarded during the hours of
sleep. The quantity of urine is lessened during sleep.[13] The elimination
of urea and of other excrementitious matters is less during the night than
by day.[14] Unless increased by disease, or by accidental circumstances
connected with atmospheric temperature and unnecessary clothing, the
perspiration is also diminished.

_Nutrition._--All the molecular processes of nutrition are reduced by
sleep. The lowering of the bodily temperature has been already indicated.
The observations of Helmholtz[15] indicate that the actual liberation of
heat in the tissues is but little more than one-third of the amount set
free in an equal period of time during the waking hours. The numerous
experiments[16] of Boussingault, Henneberg, Scharling, E. Smith,
Liebermeister, Pettenkofer, Voit, and Lewin, clearly indicate the fact
that during sleep less oxygen is absorbed, and less carbonic acid gas is
discharged, by the tissues. Voit found that while, during the daytime, 435
grammes of oxygen were taken in by a working man, only 326 grammes were
needed by the same individual during the nocturnal half of the day.
Artificial sleep occasioned by chloral hydrate produced a similar
reduction in the consumption of oxygen and in the formation of carbonic
acid gas. Under the influence of morphine the reduction of CO_{2.} reached
27 per cent., and the diminution of oxygen amounted to 34 per cent. of the
quantities furnished during wakeful activity. The comparatively small
reduction (only 6 per cent.) in the decomposition of the nitrogenous
elements of the body during the same period, exhibits the close relation
between the metamorphosis of the non-nitrogenous elements of the tissues
and the amount of bodily activity.

The experiments of Pettenkofer and Voit, to which allusion has just been
made, serve also to illustrate the fact that all tissue changes are
increased by every excitement of the sensory organs of the body, but are
diminished by the subsidence of peripheral irritations. Hence the
importance of quiet and darkness when we seek to induce that state of the
body in which molecular processes should reach their minimum. Since every
act of perception is attended by an outburst of refuse matter from the
nervous tissue, the quantity of such excrementitious discharge in any
given period of time becomes in some sort a measure of the vital activity
of the organism. Conclusive proof of the diminution of vital function
during sleep is thus obtained.

It must not, however, be inferred that the general reduction of
tissue-change, which has thus been established, during the hours of sleep,
is evidence of a universal and uniform reduction of function throughout
the body. Sleep seldom falls at once with equal force upon every organ;
its invasion is progressive. Consequently, certain structures may be fast
asleep, while others are partly awake,--while still other portions of the
organism may be in a condition of activity greatly in excess of their
ordinary wakeful function. Upon this fact depend the phenomena of dreams
and the various forms of somnambulism. The special senses are usually
overcome by sleep before the muscular apparatus yields, and the
cerebro-spinal nervous centres are the last of all to succumb. The eyes,
for example, cease to see clearly before the eyelids droop, or the muscles
of the neck give way in the act of nodding. The senses of touch and of
taste fail next in order, as in the case of the infant gourmand, who may
be seen falling asleep at supper,--his mouth yet filled with untasted
sweets from the table before him. The sense of smell is more persistent,
and its exercise is sometimes an obstacle to the invasion of sleep.
Witness the effect of powerful odors upon certain persons. The perfume of
flowering plants in the sleeping chamber is sometimes decidedly annoying
on this account. A lady of my acquaintance was once awakened out of a
sound sleep by the smell of tobacco smoke from the pipe of a thoughtless
burglar who had quietly entered a distant apartment of the house. A sudden
change of wind, deluging a city with the vapors of a glue-factory or
rendering establishment, may in like manner disturb the slumbers of
thousands of people.

The sense of hearing seems to be the most persistent of all the special
senses. It is not a very uncommon thing for persons to be awakened by the
sound of their own snoring; or, if not actually aroused by the noise, to
remain in a condition of repose which seems to be sustained and cheered by
the regular rhythm of its own music. As a general rule, however, it is
noteworthy that, when not wholly dormant, each sense finds its sphere of
activity greatly narrowed by the fact of sleep. Consequently the range of
perception, if not wholly obliterated, is greatly limited during the time
of sleep.

While it is true that sleep arrests the voluntary activities of the
muscles, it is also a fact that all the muscles do not yield at once or in
equal degree. The extensors of the neck, and the supporters of the spinal
column, are the first to fail. The patient begins to nod, and is inclined
to fall forward, before consciousness ceases. The muscles of respiration
and of circulation continue to contract, though at a diminished rate. The
vermicular movements of the intestinal coats persist, and in certain
conditions of ill-health their exaggerated contractions may become a cause
of imperfect repose. Reflex movements may always be excited during natural
sleep. Tickling the sole of the foot will cause retraction of the limb;
and before the complete establishment of sleep, a certain exaltation of
the spinal reflexes may be observed. Young children may frequently be seen
in the act of suction with their lips, as if at the breast; and the smile
of the sleeping infant is a matter of daily remark in every nursery. The
influence of dreams as an excitant of muscular movement will be hereafter
discussed.

The variation of intellectual function which appears in sleep serves to
measure its profundity and to indicate the extent of its invasion. The act
of perception being dependent upon sensation, it is to be observed that
the range of perception diminishes so soon as the organs of sense begin
to yield. Its intensity may not immediately fail, but the breadth of its
scope is narrowed. Sometimes, however, the act of conscious perception is
arrested before the organs of sense are sealed. The sleepy reader may
continue to eye the page before him, perhaps even to read aloud for a
considerable time after he has ceased to derive any meaning from the words
of the book. In such cases the organs of perception and conception and
association of ideas slumber before the bonds of connection between the
will and the muscular organs have been completely relaxed. Such an example
affords a valuable illustration of the division of the brain into separate
mechanisms which, though most intimately related, are nevertheless
partially independent of each other. Sleep may operate like an invasive
disease, falling with unequal incidence upon the different structures that
make up the mass of the brain, paralyzing one portion, while simply
benumbing another, and even arousing to excessive activity a third.
Consequently the intellectual functions may be very unequally disturbed,
and the order of their subsidence may be considerably varied; but, as a
general rule, the physiological relations of the faculties are respected,
so that as sensation diminishes, perception fails, the conception of ideas
is correspondingly hindered, and the association of such ideas as are
still projected upon the field of consciousness becomes more imperfect.
The loss of the power of association implies the destruction of memory and
the impossibility of exercising the reasoning faculty or of forming those
judgments upon which every act of volition is based. When the brain has
at length been so far overwhelmed that physical impressions can no longer
reach the field of consciousness, all manifestation of intellectual life
is at an end, and the sleeper sleeps a dreamless sleep that leaves no
trace behind.

It is assumed in the last sentence that the brain may become so far
transformed by sleep that it ceases for the time to be capable of function
as the instrument of thought. This conclusion has been questioned by the
very highest authorities. Sir William Hamilton, Exner, and many others
have instituted numerous experiments to test the possibility of a
dreamless sleep. Causing themselves to be suddenly aroused at all hours of
the night, they invariably found themselves at the instant of awaking
occupied with the course of a dream. Hence it has been inferred that the
mind is always alert, even when the body is most thoroughly asleep. In
explanation of the fact that consciousness contains after deep sleep no
trace of such mental activity, it is claimed that the act of dreaming of
which we are aware at the moment of waking is proof of intellectual
function during the moments which preceded that incident, and that we are
merely forgetful of all similar processes that occurred during undisturbed
sleep. The unconsciousness of sleep, according to this theory, is not
real--it is only apparent through failure of the memory. If this be true,
memory is the only intellectual faculty of whose inaction we can be sure.
The period of deep sleep might then be, for all we know to the contrary, a
period of the most intense and exalted mental activity. But, if so, it is
quite worthless as a constituent of our conscious existence. It may also
be objected with equal reason that the dreams which unquestionably occupy
the field of consciousness at the instant of waking are probably excited
by the impressions which terminate sleep. The process of waking, though
often very greatly hurried, is by no means absolutely instantaneous. As we
shall learn, the time requisite for the evolution of a dream may be
indefinitely brief. Consequently, it seems better in all such instances to
assign the period of dreaming to the time of diminishing slumber that
corresponds to the disturbance by which sleep was terminated.

The only reason for any hesitation in the acceptance of such a proposition
consists in the reluctance of many philosophers to admit the possibility
of any interruption in the active life of a spiritual being, such as man
is conceived to be. But it is difficult to comprehend any valid reason for
the denial of such interruption. Every form of force, of which we have any
knowledge, is subject to fluctuations in the course of its phenomenal
manifestation. When a physical force ceases to exhibit itself in an active
state, and passes into a potential modification, we are not compelled to
regard it as extinguished. It is merely latent or inhibited, but always
ready to take its place again among the kinetic forces of nature. In like
manner there seems to be no good reason why that spiritual force or
congeries of forces which constitutes the mind of man may not experience
analogous transformations in successive periods of action and of repose.
Such periods of rest occur in sleep, in coma, in disease and
disorganization of the brain. The mind sleeps, it does not cease to
exist--probably not even when death dissolves its material substratum.

That the depth of sleep is exceedingly variable is evident in the
experience of every one. A German physiologist[17] has made a rough
estimate of the soundness of sleep by comparing the loudness of the noises
necessary to wake the subject of experiment at regular intervals during
the course of the night. He arranged a gong with a pendulum attachment,
and noted the length of the stroke which produced a sound sufficiently
loud to awaken the patient. In this way the different degrees of intensity
of the awakening noise could be calculated, and the corresponding depth of
sleep could be estimated. It was thus concluded that the depth of sleep
increases rapidly during the first hour, at the end of which time it has
reached its maximum. During the next half hour it diminishes as rapidly as
it had increased in the first half hour. During the next hour it still
further diminishes, almost as much as it increased during the second half
hour. The remaining ten half hours of the experiment were occupied by a
comparatively light and gradually diminishing slumber, until the vanishing
point of sleep was reached at the expiration of eight hours from its
commencement. This observation corresponds with the general opinion that
sleep is deepest in the early part of the night. For the same reason
dreams and wakefulness are most frequent during the early watches of the
morning.

When considering the causes of sleep it is needful to exclude from view
those artificial varieties of sleep that are produced by the various
narcotic drugs, as well as the counterfeits of sleep which result from
diseased conditions of the body. It is comparatively easy to frame
hypotheses in explanation of such interruptions of our conscious life;
but, when we attempt to formulate a theory which shall satisfactorily
account for the occurrence of natural sleep in healthy animals, the task
becomes exceedingly difficult.

First among the causes of sleep may be reckoned the alternation of day and
night. With the disappearance of sunlight all nature sinks into a
condition of repose.

       "The night brings sleep
        To the greenwoods deep,
  To the bird of the woods its nest;
        To care soft hours,
        To life new powers,
  To the sick and the weary--rest!"

In this tendency to nightly inaction man shares with all other living
creatures. His body thus testifies to the intimacy of its relations with
all portions of the solar system. Originated in the tropical regions of
the earth, where day and night are nearly equal, we find in all parts of
the world the same hereditary need of a period of rest, nearly coincident
with the duration of the shorter nights of the tropical year. Had the
birth-place of primeval man been situated within the Arctic circle, it is
probable that his hours of sleep might have differed considerably from
the number now needed by the average individual. So powerful are the
necessities thus dependent upon the harmony between our organization and
the movements of the earth, that if the habit be formed of sleeping at
other hours than those which are usually devoted to that purpose, the full
complement of sleep is still needful to satisfy the demand for rest.

Prominent among the causes which predispose to sleep at night is the
cessation of a majority of the sensations that are continually pouring in
upon the brain during the period of daylight. Hence the necessity for
seclusion in darkened rooms, from which the noises of the daytime are shut
out, if one would sleep during the long days of the arctic summer, or if
one would enjoy a midday nap at any season of the year. The close
dependence of wakefulness upon the constant activity of the organs of
sensation, is well illustrated by a case related in Hermann's _Handbuch
der Physiologie_, Vol. II, Part 2, p. 295. A young man had been reduced by
disease to such a condition of general anæsthesia that the right eye and
the left ear were the only remaining paths of sensation between his brain
and the external world. Whenever the sound eye and ear were bandaged so as
to cut off all communication with the brain, the patient invariably fell
asleep in the course of two or three minutes after the interruption of
sensation. In like manner, some people, even in perfect health, are able
to sleep at any time by simply lying down and closing the eyes. Such
persons, however, are not often very highly gifted in the intellectual
sphere. They generally belong to a class of men whose lives are laborious
and liable to great irregularity and fatigue. Such people labor in the
open air, where every organ of sense is in a state of continual
excitement. As soon, therefore, as they can find a quiet corner from which
the commotion of the elements is excluded, it is only necessary to close
the eyes--the principal avenue of communication with the outside
world--and sleep begins at once. This is especially true if severe bodily
exertion has preceded the opportunity for repose.

Fatigue of any sort is one of the most energetic causes of sleep. The
impossibility of long sustained exertion is a fact almost too familiar to
attract attention. Every muscle must be suffered to rest for a time after
contraction before it can be again contracted. Even the heart and the
muscles of respiration must be allowed to enjoy regular periods of repose
many times each minute. These are examples of local rest, not involving
the entire body. But if the whole body participate in any violent action,
every part will manifest a consequent disposition to rest. Witness the
effects of the venereal act. Every muscle is relaxed; the brain, which has
officiated as the supreme source of energy, experiences exhaustion, and
sleep frequently terminates the voluptuous paroxysm. In like manner,
sensations of severe pain, if sufficiently prolonged, become a cause of
sleep. Prisoners upon the rack have slept through sheer exhaustion while
undergoing the horrors of torture. Little children frequently fall into a
deep sleep immediately after painful, though comparatively bloodless,
surgical operations performed without anæsthetics. The depressing
emotions, even, may so fatigue the brain as to induce sound sleep through
reaction from previous excitement. Every wearied portion of the body must
rest; and when the brain thus rests, sleep is the consequence.

Impressed by the force of such considerations, certain physiologists[18]
have reasoned from the analogies suggested by a study of the results of
muscular fatigue, and have suggested an hypothesis accounting for the
occurrence of sleep by a supposed loading of the cerebral tissues with the
acid products of their own disassimilation during wakeful activity. The
acid reaction of the brain and of the nerves after exertion, corresponding
with the development of acids in the muscular tissues during contraction,
suggested the probability that an excessive presence of lactic acid and
its sodic compounds might be the real cause of cerebral torpor and sleep.
Could this hypothesis be proved, ordinary sleep would take its place along
with the states of unconsciousness induced by anæsthetics and hypnotics,
and the lactate of sodium should be found the very best of medicines for
the relief of wakefulness. Its administration for this purpose, however,
has yielded only the most discordant and unsatisfactory results. The
fatigue theory, moreover, is insufficient, since it furnishes no
explanation of the invincible stupefaction produced by cold, nor does it
render intelligible the unbroken sleep of the unborn child.

Far more comprehensive is the hypothesis advanced by Pflüger.[19]
According to this view, the state of wakefulness is maintained by a
certain degree of activity in the cortical substance of the brain. Like
all other bodily organs, this substance is renovated by the assimilation
of nutrient materials derived from the blood. By this process oxygen is
stored up in chemical combination, forming "explosive compounds," whose
precise composition is not fully understood. When for any reason the
supply of oxygen is insufficient, as in hemorrhage, producing cerebral
anæmia, or in impregnation of the red blood corpuscles with carbonic oxide
or chloroform, or other substances capable of excluding oxygen from the
hemoglobin of the corpuscle, the cerebral tissues are imperfectly
renovated. The explosive constituents of the cortical protoplasm are then
inadequately renewed after mental activity, and the sensitive portions of
the brain are no longer fitted to manifest the highest forms of
intelligent activity. But, when nothing interferes with healthy nutrition,
the requisite degree of instability in the protoplasm of the brain is
effected by intussusception of oxygen. Under the influence of the various
nervous impressions which reach the brain, the unstable protoplasmic
compounds break up into simpler forms. The motion thus liberated by these
"explosions" of excitable matter is, in some way at present utterly
inconceivable, projected upon the field of consciousness where the mind
dwells; and we are thus brought into conscious relation with the external
world.

That the capacity for thus signalling across the gulf which divides
matter from mind is the result of a certain perfection and complexity of
physical structure is rendered probable by the utter failure of the
infra-cortical organs alone to impress the conscious intelligence by any
amount of independent activity. The same thing is also indicated by the
unconscious sleep of the rudimentary foetal brain, and by the brevity of
the intervals of wakefulness which mark the life of the new born babe.
That this capacity is dependent upon a special mobility of the atoms of
the brain, is shown by the speedy cessation of intelligence which follows
great reduction of temperature, as in hibernation, or during exposure to
severe frost. That its exercise is largely dependent upon the activity of
the senses is proved by interference with their function, as in the case
above quoted (see p. 18) from the observations of Strümpell.

The dependence of the waking state upon the presence and activity of a
sufficient quantity of a peculiarly unstable form of protoplasm in the
brain is an hypothesis which presents no great difficulty of
comprehension. But how may we explain the lapse from the intelligent
vivacity of that waking state into the unconscious inactivity of sleep? I
have elsewhere[20] discussed the manner in which artificial sleep is
produced by impregnation of the brain with anæsthetic substances that
interfere with sensibility, and finally produce stupefaction, by hindering
the normal processes of intra-molecular oxidation in the protoplasm of the
nervous tissues. The same general line of argument may be extended to
cover the action of every narcotic agent with which the living substance
of the body may become surcharged. Accepting, then, the hypothesis
advocated by Obersteiner and Preyer, it becomes an easy thing to account
for the gradual onset of sleep by supposing an accumulation of the
"fatigue producing" products of intra-molecular oxidation. But we cannot
thus explain the rapid and, as it were, voluntary passage from wide
awakefulness into a condition of deep sleep, such as may be commonly
observed among sailors and others who have formed the habit of going at
once to sleep at regularly recurring hours of the day or night. Certain
writers have endeavored to account for this fact by imagining a special
mechanism at the base of the brain (choroid plexuses of the fourth
ventricle, etc.,) by means of which the current of the blood through the
brain may be voluntarily diminished, with a consequent arrest of conscious
activity. But, still adhering to the hypothesis of Pflüger, we shall
obtain a clearer explanation of the facts by considering the phenomena
connected with the succession of impressions upon the organs of sense. It
has been ascertained[21] that such impressions must persist for a certain
measurable length of time in order to excite conscious perception. A sound
must be prolonged for at least fourteen-hundredths of a second, a ray of
light must agitate the retina for about eighteen to twenty-hundredths of a
second, an ordinary contact with the surface of the skin must continue
from thirteen to eighteen-hundredths of a second, in order to awaken any
knowledge of sound and light and tactile sensation. For the simplest act
of perception from two to four-hundredths of a second are necessary. It
is, therefore, perfectly reasonable to suppose that when the "explosive
material" of the brain has been sufficiently "dampened" by the
accumulation of acid refuse which accompanies prolonged cerebral effort,
the impressions of sense may no longer suffice to excite in the cortical
protoplasm vibrations of sufficient length, or following each other in
sufficiently rapid succession, to sustain consciousness. The cortex of the
brain may then be likened to a body of water into which bubbles of
partially soluble gas are introduced from below. When the bubbles are
large, and when they follow each other rapidly, a continual effervescence
is maintained upon the surface of the water. But if the size of the
bubbles be reduced, or if the solvent capacity of the liquid be increased,
the surface will become almost, if not quite, perfectly tranquil. In some
such way, without any great danger of error, may we picture forth the
manner in which the generation of ideas in the field of consciousness is
related to the molecular movements in the space occupied by the
protoplasmic substance of the brain. Returning, now, to the rapid
induction of sleep, we find that it is usually the experience of people
who lead an active life in the open air, and are compelled to endure
frequent interruption of their rest. The sailor who is trained to work
four hours on deck, and then to sleep four hours below, has been virtually
transformed by this habit into a denizen of a planet where the days and
the nights are each but four hours long. His bodily functions become
accommodated to this condition; his nervous organs store up in sleep a
supply of oxygenated protoplasm sufficient only for an active period of
four or five hours; so that, when the watch on deck is ended, he is in a
state as well qualified for sleep as a laborer on shore at the close of a
day of twelve or fifteen hours. Moreover, the majority of those who can
thus easily fall asleep are individuals whose waking life is almost
entirely sustained by external impressions. So soon, therefore, as such
excitants are shut out by closing the eyes in a place of shelter from the
sounds and turmoil of the air, comparatively little remains for the
stimulation of ordinary consciousness, and sleep readily supervenes
through mere lack of cerebral excitement, especially if the excitable
matter of the brain has been previously overwhelmed by the products of
active exertion.

That analogous, though not identical, predisposition to unconsciousness
may also be rapidly induced by modifications of the cerebral circulation
is proved by the sudden reduction of cerebral excitability and
consciousness which occurs during the act of fainting. In this counterfeit
presentment of sleep the important part played by variations of the blood
current through the brain is so conspicuous that certain writers have
attempted to show that genuine sleep is the result of a diminution in the
flow of blood to the cortex of the brain. An ingenious physician has even
attempted to relieve insomnia very much as a surgeon might undertake to
cure a popliteal aneurism--by placing tourniquets on the arteries leading
to the affected part. But the mere fact that syncope produces
unconsciousness does not prove that "cerebral anæmia" should be elevated
to the rank of the principal cause of natural sleep. The nervous process
is the primary factor. The circulation of the blood is everywhere under
the immediate control of the nervous system. Consequently, every change in
the condition of the nervous structures is followed by a corresponding
change in the state of the circulating apparatus. Wherever an organ is
aroused to activity, so delicate are the adjustments by which it is
connected with the brain and with the heart that it is at once irrigated
by an increased flow of blood. When its functional activity subsides, the
same mechanism provides for a corresponding reduction in the supply of
blood to its tissues. The brain itself forms no exception to this law.
This has been admirably shown by the observations of Professor Mosso, of
Turin.[22] The learned professor enjoyed the rare opportunity of observing
three individuals who had suffered the loss of a considerable portion of
the bony walls of the cranium, exposing the surface of the cerebrum, and
affording a view of the pulsation of the vessels of the brain. With the
aid of the cardiograph, the sphygmograph, the hydrosphygmograph, and the
plethosphygmograph, it became possible to register the circulation of the
blood in the brain, and to compare that portion of its course with the
coincident circulation in other parts of the body. It was thus shown that
every increase of emotional or intellectual activity was attended by an
increase in the activity of the cerebral circulation. This increase was
procured at the expense of other portions of the body, which exhibited a
coincident reduction in the amount of blood received from the heart. The
occurrence of sleep caused a diminution in the number of respirations,
and a fall of six or eight beats in the pulse. The volume of the brain and
its temperature were at the same time slightly reduced, through the
diversion of blood from the head to other regions of the body. The
consequent dilatation of the vessels in the extremities was readily
demonstrated by the use of the plethosphygmograph. The extreme
sensitiveness of the nervous centers was further illustrated by the fact
that if, during sleep, a ray of light were directed upon the eyelids, or
if any organ of sense were moderately excited without waking the patient,
his respiration was at once accelerated; the heart began to beat more
rapidly, the vessels of the extremities contracted, and the blood flowed
more freely into the brain. Similar results accompanied the act of
dreaming. The return of full consciousness on waking was followed by an
immediate increase in the activity of the intra-cranial circulation.

The extreme susceptibility of the brain to influences proceeding from
artificial disturbances in the circulation, was exhibited in the case of
one of Professor Mosso's patients. By compression of the carotid arteries,
unconsciousness was induced, and an attack of convulsions was aroused. In
no other part of the body can a corresponding disturbance of function be
so quickly produced by similar means. A limb may be rendered bloodless for
nearly half an hour, by the application of an elastic bandage, and yet its
sensory nerves will remain capable of transmitting impressions from the
periphery. But in this case, compression of the carotids for only eight
seconds was sufficient to abolish consciousness and to excite convulsive
movements.

In all such observations it is worthy of note that the nervous impression
is the primary event so long as artificial disturbances are not intruded.
The changes of blood-pressure and circulation were invariably secondary to
the excitement of nerve tissue. Sleep, therefore, must be regarded as the
cause, rather than the consequence, of the so-called cerebral anæmia which
obtains in the substance of the brain during repose. This condition of
"anæmia" is nothing more than the relatively lower state of circulation
which may be remarked in every organ of the body during periods of
inactivity. Every impression upon the sensory structures of the brain
occasions a corresponding liberation of motion in those structures. The
movement thus initiated arouses the vaso-dilator nerves of the cerebral
vessels and excites the vaso-constrictor nerves of all other portions of
the vascular apparatus. Hence the superior vascularity of the brain so
long as the organs of sense are fresh and receptive. Hence the diminishing
and varying vascularity of the different departments of the brain as sleep
becomes more or less profound. These modifications of the brain and of its
circulation are well illustrated by the effects of a moderate degree of
cold applied to the cutaneous nerves of the body, as not unfrequently
happens when the night grows cool towards morning. The disturbance of the
sensitive nerves of the skin is transmitted to the brain. The excitement
of this organ causes dilatation of its vessels, and increased irritability
of the cortical instrument of perception. This becomes the starting point
for the projection of impulses upon the field of consciousness, producing
dreams, or even a complete awakening from sleep.

The cause of sleep must, therefore, be sought in the molecular structure
of the brain, rather than in fluctuations of the blood-current. In the
present state of our knowledge it must be negatively represented as the
consequence of a deficiency in the amount of movable oxygen in the nervous
tissue. This deficiency may be the result of immaturity, as in the foetus,
or in the new-born infant; or it may result from the accumulation of an
excess of the waste-products of intra-molecular oxidation during
functional activity--products which hinder the further passage of oxygen
into stable combination with the oxidizable elements of protoplasm. Sleep
thus produced differs from the artificial sleep induced by narcotic drugs,
in the fact that its cause is self-generated by the instrument of thought,
while narcotic stupor is caused by the intrusion of substances derived
from without--substances which, like the natural refuse of the living
cells, more or less completely hinder the processes of oxygenation and
oxidation within the tissues of the body. Hence the states of healthy
sleeping and waking must necessarily be self-limited and regularly
successive; while the state of narcotism is purely accidental, and its
duration exactly corresponds with the variable length of the period during
which the body may remain impregnated with the hypnotic agent.

Certain morbid forms of sleep further illustrate its dependence upon the
persistence of depression in the functional activity of the brain. For
some persons this seems to constitute their normal condition. They are
either excessively fat, red-faced, and soaked with beer, or they are pale,
anæmic, and pulpy, with flabby muscles and a feeble circulation. They fall
asleep whenever left to themselves, and never seem to be fully aroused to
active life. The fat boy who figures so amusingly in The Pickwick Papers,
furnishes a life-like picture of this variety of _somnolence_.

The introductory stage of the eruptive fevers is often characterized by
somnolence. It also frequently appears as the forerunner of coma in the
various diseases which terminate in unconsciousness and death. A singular
example of this has been observed among the negro inhabitants of the
Atlantic coast of tropical Africa. The disorder is known to English
writers as _sleeping dropsy_; by the French it is called _maladie du
sommeil_. It is characterized by daily paroxysms of somnolence which tend
to become more and more continuous and profound until they are finally
merged in fatal coma. For our knowledge of the disease we are chiefly
indebted to the description by Clark,[23] an English surgeon who practised
in Sierra Leone, and to the monograph by Guerin,[24] a French naval
surgeon, who had enjoyed exceptional opportunities for observation among
the laborers who had been carried from Africa to the island of Martinique.
Similar cases have been occasionally reported in other regions of the
world, but it is among the Africans that it has been principally remarked.
The onset of the malady is gradual, commencing with a slight frontal
headache. After a few days a disposition to sleep after meals is noted.
This becomes increasingly urgent, and the intervals of sleep are prolonged
until at length the patient becomes continually soperose. The waking
periods are marked by a sluggish state of the intellectual faculties. The
pulse is not accelerated, and it remains full and soft. The veins of the
sclerotic are turgid, and the eyeball seems unusually prominent. The
temperature does not increase, but rather tends to diminish its figure.
The skin is dry and moderately cool. The tongue continues moist, and is
covered with a white fur. The bowels and the bladder are regularly
emptied, and the appetite persists with considerable vigor. Finally, the
patient becomes completely comatose, and dies quietly. Sometimes, however,
the evolution of the disease is less tranquil. Epileptiform convulsions,
followed by progressively deepening periods of coma, interrupt its course,
and a continuous muscular agitation marks the closing scene. At the same
time the pulse grows weaker and more frequent until its movements cease in
death. Recovery is almost unknown, though the duration of the disease
often varies from three months to a year or longer. Examination of the
body after death yields very negative results; the sinuses and larger
vessels of the brain are engorged with blood, but no evidence of
inflammation is anywhere apparent. The other organs present no
pathological alterations whatever. These observations seem to indicate
that the disease originates in some form of general blood-poisoning,
rather than in any local inflammation or degeneration. Dr. Clark has
called attention to an enlargement of the cervical glands as a feature of
the malady. According to Dr. G. H. Bachelder,[25] the native physicians
cure the disease by extirpation of the affected glands. He has also
observed an initial lesion in the nasal mucous membrane. If this be
confirmed, the malady will take its place among the forms of somnolence
produced by infection of the blood.

Between the profound unconsciousness of natural sleep and _coma_ may be
placed the distinction that the one is always the consequence of healthy
physiological processes, while the other is always the result either of
injury, of disease, or of some form of intoxication. Comatose
unconsciousness may be the result of cerebral compression caused by injury
of the head, or by the presence of an inflammatory exudation.
Intra-cranial tumors, embolisms, thrombi, diseases of the cerebral
arteries, and degenerations of the brain,--in short, every morbid change
of which the liquids and the solids within the cranium are capable--may
become the cause of coma. Toxæmic conditions of the circulating fluids of
the body may benumb the brain with comatose sleep. Few diseases,
therefore, exist without the possibility of coma as one of their
consequences--a coma which, however, must not be confounded with the
genuine sleep which sometimes occupies the larger part of convalescence
from acute illness. During such convalescence there is a reversion to the
infantile type of nutrition with all its need of prolonged and frequent
periods of repose. Like normal sleep, the comatose condition admits
considerable variation of intensity. The patient may sometimes be
partially roused, as from the coma of alcoholic intoxication, and he may
finally recover complete consciousness; but very often the reverse is the
fact. The coma deepens into paralysis of the respiratory centres, and
death concludes existence without the slightest manifestation of
sensibility or intelligence.

_Lethargy_ is a pathological variety of sleep, in which the repose of the
body is even more complete than in coma. The victim of coma often presents
a countenance suffused with blood; the pulse beats vigorously, and
respiration may become stertorous. But in lethargy the abolition of bodily
movement is almost absolute. In the milder forms of this disorder the
patient may be partially roused, so as to attempt an answer when
addressed, appearing like a person in very deep sleep; but in the majority
of cases he remains insensible, unconscious, and utterly irresponsive to
ordinary forms of irritation. Respiration and circulation are reduced to a
minimum, and may, even for a time, become imperceptible. Uncomplicated
with hysteria, the disorder is rapidly fatal, but, according to
Rosenthal,[26] hysterical lethargy is never mortal.

Many examples of this disease have been afforded by the records of
apparent death. I am well acquainted with a lady who, in early childhood,
had been laid out for burial at the supposed termination of some infantile
illness. Her mother alone insisted that the child was still alive. After
some time spent in weeping and expostulation, she applied a blister to the
thorax of the babe. This soon excited evidences of painful irritation,
followed by a complete recovery. Still more instructive is the case,
narrated by Rosenthal,[27] of a young woman, twenty-four years of age,
who, in consequence of violent emotional excitement, became unconscious,
and presented no signs of life, though tested by placing a mirror before
the mouth, and by dropping melted sealing-wax upon the skin. On raising
her eyelids, the pupils gave no reaction to light; the limbs remained
perfectly flaccid, and the radial arteries were pulseless. Careful
auscultation, however, detected a very feeble and intermittent sound in
the cardiac region. The walls of the chest exhibited no movement, but the
lateral surfaces of the abdomen presented a slow and almost imperceptible
oscillation. Gentle faradization of the muscles and nerves of the face,
arm, and hand, excited definite muscular contractions. By this method
Rosenthal became satisfied that, although the patient had remained for
thirty-two hours in this condition, she was only apparently dead. In fact,
after continuing forty-four hours in a state of suspended animation, she
awoke spontaneously, made a rapid recovery, and seemed to enjoy as
comfortable health as an excitable, nervous temperament would permit.

Certain authors make a distinction between lethargy and apparent death;
but the difference is one of degree rather than of kind. The movements of
respiration and of circulation, though greatly enfeebled, are readily
observed in ordinary forms of lethargy; but in apparent death the pulse
can no longer be discovered, and nothing more than the faintest sound can
be distinguished in the region of the heart. It, therefore, becomes
important to have within reach a crucial test of the persistence of
general vitality. Such evidence, according to Rosenthal, is furnished by
the faradaic current. Within two or three hours after actual death, the
muscles cease to respond to the induced current; but in apparent death
this form of electro-muscular contractility never disappears. Every other
test that has been proposed has failed under certain circumstances.
Observation of the changes in muscular temperature during electrical
excitation is a method better adapted to the laboratory than for clinical
practice.

_Lucid lethargy._--In certain cases of apparent death the patient exhibits
all the external appearance of suspended animation, but the power of
conscious perception does not cease. The senses of sight and hearing
remain, and are, perhaps, intensified by inhibition of the power of
voluntary movement. The sufferer sees and hears; perception, emotion,
memory, the power of reasoning, judgment, volition, all persist. Only the
power of executing voluntary movements is lacking.

The victims of this variety of apparent death are usually women, or men
who are characterized by a feminine nervous organization. Great mental
excitement, fatigue, semi-starvation, and exhausting diseases, are the
principal exciting causes of the event. The following case, related by my
friend, Dr. P. S. Hayes, of Chicago, illustrates the phenomena of lucid
lethargy. The patient was a female physician, about thirty years of age,
unmarried, and consumptively inclined. During the course of a long and
wearisome hospital service, she was prostrated with typhoid fever.
Placing herself under the immediate care of my informant, she was also
attended by several of the most eminent physicians in the city. After a
long and exhausting illness she appeared to be dying. In the presence of
her physician, and surrounded by her relatives, she ceased to breathe. The
pulse stopped, life seemed to have gone out. Bottles of hot water were
applied to the limbs, and various restoratives were employed. After a
considerable time she began again to breathe, and a gradual recovery
followed. During the whole time of apparent death, consciousness had been
preserved. She seemed to be looking down from a point above her bed; she
could see the doctor feeling for her pulse, and was grieved by the sorrow
of her friends. Ordinary sensation was temporarily suspended, and she
could not distinguish the contact of the hot-water bottles that were
applied to her limbs, though actually scalded by their excessive heat.
Borne upon the wings of an excited imagination, she thought herself
permitted to look into heaven, but was not suffered to enter its gates. In
this exaltation of the imagination the reasoning faculties also shared, so
that certain philosophical problems which had previously baffled her
intellect were now perfectly comprehensible, and the memory of their
solution persisted after recovery.

Many similar narratives have been duly authenticated, but the limits of
the present chapter will not permit a discussion which properly belongs to
an investigation of the phenomena of trance. The important fact for
present consideration is the persistence of conscious life, despite the
appearance of death. In this preservation of consciousness,
notwithstanding the temporary suspension of certain kinds of sensibility
and the power of voluntary motion, may be discovered a relationship
between the phenomena of lucid lethargy and various disturbances of sleep,
which will be considered in a succeeding chapter.




CHAPTER II.

INSOMNIA, OR WAKEFULNESS.

              Sleep, gentle sleep,
  Nature's soft nurse, how have I frighted thee
  That thou no more wilt weigh mine eyelids down
  And steep my senses in forgetfulness?
                                  --KING HENRY IV, SECOND PART.


We have seen that the condition of normal sleep is determined by a
peculiar molecular state of the substance of the brain--a modification
regularly alternating with that by means of which the condition of
wakefulness is sustained. We have also seen that sleep is liable to
variations in its intensity, and that its course may be partially
interrupted by dreams, or even by a more or less complete resumption of
the movements of locomotion, constituting the different varieties of
somnambulism. Our attention must now be directed to the consideration of
those greater disturbances of sleep which either serve to prevent its full
development, or else to actually interrupt its course, rendering it
incomplete and fragmentary, or even abolishing it altogether. But,
inasmuch as the healthy brain, when associated with a healthy body, can
only by an extraordinary effort of the will be kept awake beyond a certain
period, and then only for a short time beyond the ordinary interval of
wakefulness, it follows that the study of the usual causes of insomnia
must be an investigation of morbid conditions of the bodily functions.
Sleeplessness, therefore, must result, 1st, from a disturbance of the
peripheral sensory organs of the nervous system; 2nd, from disordered
conditions of the sensory nerves and nerve tracts; 3rd, from morbid states
of the brain; 4th, from any or all of these conditions operating in
association with each other. We may, therefore, consider, I, _Insomnia
caused by irritation of the peripheral portions of the sensory apparatus_;
and, II, _Insomnia caused by morbid states of the central nervous organs_.


I. INSOMNIA CAUSED BY IRRITATION OF THE PERIPHERAL PORTIONS OF THE SENSORY
APPARATUS.

Irritation of the sensory apparatus may be ranked in three classes:

    1. Affections of the organs of special sense.

    2. Affections of the nerves of common sensation.

    3. Affections of the sympathetic nerves.

1. _Affections of the organs of special sense._--Prominent among these is
the effect of light upon the eye. The darkness of night favors sleep; the
presence of light hinders its incidence and renders it less profound.
During the gloom of a total eclipse animals seek their shelter; birds hide
themselves in their nests; domestic fowls arrange themselves upon the
roost, and seem quite disconcerted by the speedy return of sunlight.
Children often find it difficult to sleep in an illuminated room. I have
known nurses who would sit with a wakeful infant under a powerful gaslight
till after midnight, and then would express their surprise that the baby
persisted in gazing at the flame instead of going quietly to sleep. The
inhabitants of Northern Europe find it necessary to darken their sleeping
rooms during the long polar day; and travelers in such regions often
suffer for want of the natural sleep which only darkness affords. Judge
Caton, writing of his travels in Norway[28] says: "We longed for darkness
and for night. Do what we could to darken the windows to keep out the
light, still it was not night as nature makes it, and which the habit of a
lifetime had rendered necessary to sound repose. Artificial darkness,
especially when incomplete, is as far from night as artificial light is
from day.... These sunny nights can hardly conduce to health, they steal
away so much of sleep. One does not readily get sleepy in the sunshine,
and then we are so apt to forget to look at the watch to see if it is time
to retire."

In the tropical regions of the world it is usual for the inhabitants to
sleep during the middle of the day; but they take great pains to exclude
the light from their houses during the hours of sleep. The Pacific
Islanders cover their faces with the bed clothes for the purpose of
excluding the light while attempting to sleep. Repose thus obtained in the
daytime often serves to convert the night into a season of wakefulness.
The Africans sleep and dream away the heated hours of the day, and give up
considerable portions of the night to festivity in the open air--a
practice which undoubtedly contributes to the permanence of an inferior
grade of social life.

Sudden illumination of the sleeping room will frequently awaken the
sleeper. During the great fire in Chicago, A. D. 1871, many persons were
thus aroused from their slumbers as the flames lighted up the streets
adjoining their houses. One of my acquaintances was awakened one night by
a flash of light from the lantern of a burglar who was moving noiselessly
about her chamber. The experience of almost every one will testify to the
effects of sheet-lightning silently illuminating the sky by night. Dreams,
also, are not unfrequently excited by the incidence of light upon the
closed eyelids.[29]

The sense of hearing is one of the most persistent of the special senses
during the incidence of sleep. It is perhaps the most excitable of these
senses during the period of repose. Long after the subject has become
immersed in sleep his auditory apparatus remains sensitive to sounds.
Dreams are often produced by impressions upon the ear. Often in sleep it
seems as if the sense of hearing remained wakeful and watchful for
expected signals, as when an alarm clock serves to arouse the sleeper at
an appointed hour. Sometimes the sleeper may be shaken and tumbled about
in his bed without waking, but if he be addressed by name he will usually
reply. It is scarcely probable that the auditory apparatus is any more
wakeful than other portions of the nervous system, but its external
portions remain during sleep more completely exposed and adapted to the
reception of impressions than is possible for the eye and for the organs
of touch and taste.

The persistent sensitiveness of the ear during sleep is not so much a
capacity for noticing sounds as a sensibility to variations in sonorous
impressions. Thus a steady and monotonous noise may, if long continued,
serve to render one sleepy; but the sudden cessation of the same sound
will awaken every one. Slowly lulled to sleep by the incessant rumble of
the engine upon one of the old-fashioned Long Island Sound steamboats, how
immediate the awakening of a whole cabin full of people, when the wheels
were suddenly stopped! A recent traveler in Guiana[30] relates a curious
experience with an Indian magician who undertook to cure him of a slight
headache and fever. The method of cure consisted in placing the patient at
night in his hammock, while the magician kept up a hideous succession of
yells and shouts, shaking the walls and roof of the house with an uproar
which never ceased for six hours. Before long the patient passed into a
kind of fitful sleep or stupor, during which he seemed to be suspended in
a surging ocean of sound. When the noise died away, as if growing fainter
in the distance, he would rouse up into a semi-conscious state, but when
it again increased he would fall back into stupor. At last, when the noise
finally ceased, he awoke completely, but without the slightest relief from
headache--an experience quite illustrative of the manner in which the
brain may be affected by sound.

It is not often that the sense of smell becomes the avenue of impressions
that interfere with sleep. So different are the capacities of individuals
in this particular that an odor which might severely annoy one person,
would pass almost unnoticed by another. Large cities are sometimes invaded
by overwhelming stenches from the various factories which spring up in
their neighborhood. While it is seldom true that the vapors discharged by
such establishments are directly deleterious to health, they may become
indirectly a cause of ill-health through the wakefulness occasioned by
them among weakly invalids. The smell of smoke in a bed-chamber sometimes
serves to awaken a sleeper, giving warning of the outbreak of a fire in
the building. Less energetic odors may disturb the depth of sleep without
actually waking the patient. Thus Maury records[31] that when he was made
to inhale the vapor of cologne water while asleep, he dreamed of being in
the shop of a perfumer.

Excitement of the sense of taste would, doubtless, operate in a similar
manner; but it is so difficult to arouse this sense without at the same
time irritating the nerves of common sensation about the mouth, that very
little can be said regarding the matter. Dreams of gustatory sensations
are usually of subjective origin, dependent upon some reflex movement, or
upon some agitation of the organ of memory, within the brain.

If, with Sir William Thompson,[32] we recognize a sixth sense--the sense
of temperature--it must be admitted that through the varying sensations of
heat and cold, sleep can be greatly disturbed. Every one will recall to
mind the story told by Dugald Stewart, of a gentleman who dreamed of
walking over heated lava on Mt. Ætna when a bottle of hot water was placed
against his feet, in bed, on account of some slight indisposition. The
temperature of the air is one of the most important factors in the
determination of sleep. A high temperature keeps every one awake--a fact
well known among the unfortunate denizens of the garrets in our great
cities. Not only is wakefulness the direct result of heat, but it is
aggravated and embittered by the accompaniments of a torrid
climate--insects, foul air, and cutaneous disorders. In the East Indies,
so difficult is sleep under such conditions that the wealthy inhabitants
compel their servants to cool them all night with the _punkah_, a large,
swinging fan, suspended above the bed, and kept in motion by means of a
cord leading outside of the bed-room to the verandah, where the
_punkah-wallah_ sits and pulls the string while his master sleeps. So
powerful is the force of habit in the organization of the automatic
apparatus of the body that, though these punkah-pullers often fall asleep,
they still continue, without interruption, the successive movements by
which the fan is kept in operation.

The evil effects of a high temperature are greatly aggravated by the
presence of humidity in the atmosphere. Dampness interferes with the
process of exhalation from the surface of the body, which, consequently,
tends to become overheated. The tissues, under such circumstances, are
imperfectly defecated, and rapidly pass into a condition of imperfect
nutrition. This depresses all the functions of the body, and renders the
nervous system inordinately irritable. Sleep cannot be profound and
refreshing, because of the over-excitable state of the brain. During the
long, hot season in tropical countries, it often becomes necessary to
seek a temporary retreat among the highlands and mountains, in order to
find a climate sufficiently dry and cool to furnish the condition for
refreshing sleep. For the same reason many of the inhabitants of the
Southern United States are forced to spend the summer months in the
invigorating atmosphere of Minnesota and Northern Michigan. One of the
most delightful of experiences may be procured on any warm day in summer
by embarking, at Chicago, upon one of the steamboats bound to Mackinac. At
the wharf, in the hottest and dirtiest part of the city, all is dust,
perspiration, and discomfort. The wide cabins are filled with people who
are tired, thirsty, and discouraged. Sickly, squalling babies swarm in
numbers sufficient to drive one mad. As the sun goes down, the
signal-whistle sounds, head-lines and stern-lines are quickly cast off,
the propeller churns the mire behind the boat. Slowly swings the huge
fabric away from the shore, gliding between the walls of sun-scorched
brick that line the stream on either side. At last the light-house at the
mouth of the river is passed, and we are out upon the blue waves of Lake
Michigan, with a heavenly breeze searching every crack and cranny of the
hull. New life animates every form, and presently a great silence pervades
the brilliant cabins. The children have left their woes behind, and, for
the first time, in many weeks, perhaps, they and their weary mothers sleep
the sleep of innocence and peace.

The dependence of a high atmospheric temperature upon the direction of the
wind renders the course of the aerial currents a matter of great
importance in relation to sleep. The southerly winds which, in the
northern hemisphere, are hot and enervating, always produce an increase of
wakefulness. The winds that blow from the heated deserts of Africa,
Arabia, and Australia, are greatly dreaded upon this account, as well as
for the other numerous discomforts which fly in their train. Their
cessation, and their replacement by a cool, polar current brings relief at
once. The changes thus produced in the electrical condition of the
atmosphere doubtless contribute more than is usually known to these
results. A cloudless sky gives evidence of positive electricity, which is
much stronger in winter than in summer.[33] Clouds are sometimes positive
and sometimes negative. According to Fonssagrives[34] the atmospheric
electricity is positive during northerly winds, and negative during the
prevalence of winds from the southerly quarters of the horizon. Great
disturbances of the electrical condition of bodies is often observed
during the occurrence of the sirocco in North Africa. Arago has related
the case of an officer in the French army[35] who saw sparks of
electricity leaping from his epaulettes at every blast of the sirocco
encountered on a march in the neighborhood of Algiers. Such atmospheric
disturbances often produce very disagreeable effects upon persons of a
nervous temperament. According to Fonssagrives (_loc. cit._) such patients
frequently experience, during the prevalence of storms which traverse
great distances, a high degree of insomnia, together with headache, pains
in the limbs, joints, and old injuries, and a general indefinable
sensation of discomfort. S. Weir Mitchell has carefully traced the
connection between these phenomena and the variations of barometric
pressure which accompany the revolving storms that cross the continent in
a northeasterly direction.[36]

Though the effect of a high atmospheric temperature is unfavorable to
sleep, an excessive temperature produces the opposite condition. Stupor
rather than sleep is the consequence of insolation and of exposure to
great heat from artificial sources. This is a pathological process, and,
therefore, must not be mistaken for natural sleep. It may result either
from cerebral congestion, or from cardiac exhaustion, and is characterized
by an extraordinary bodily temperature and a high rate of mortality.[37]
So elaborate are the arrangements for the preservation of a uniform
temperature throughout the body that it is practically impossible for a
sunstroke to occur unless the regulative apparatus has been previously
deranged by ill-health.

Excessive cold operates in like manner to produce a condition of stupor
that tends to a fatal termination. But moderate degrees of cold act as
excitants of wakefulness. By effecting a contraction of the vessels of the
skin cutaneous circulation is impeded. The venous side of the circulatory
apparatus becomes overloaded with blood; the exhalation of carbonic acid
and the production of heat are reduced. The discomfort that results from
this disturbance of the natural functions of the tissues is sufficient to
arouse the brain to wakefulness, just as an imperfect oxidation of the
blood serves to excite the respiratory centre in the medulla oblongata. It
is hardly necessary to allude in this connection to the increased flow of
blood through the brain occasioned by this as by every other excitement of
the sensorium. Local refrigeration of any portion of the body thus acts as
a painful excitant of the cerebrum, and produces wakefulness, very much as
distention of the intestines with gas will keep one awake. It is for this
reason almost impossible to sleep with cold feet. Conditions of this sort
are pathological, and are far in excess of the agreeable coolness which
favors sleep. The effects of progressive diminution of the temperature of
the air are well illustrated by the hibernation of animals.[38] As the
temperature of the air diminishes, in winter, animals like the marmot fall
into a species of sleep. Their movements of respiration and circulation
are greatly reduced, and their bodily temperature falls, though it always
remains several degrees above the temperature of the surrounding air. So
long as the average degree of cold is maintained, the little creature
sleeps naturally; but, if the air becomes extraordinarily cold, the
physiological repose of the animal is disturbed. _It becomes uneasy, wakes
up, and seeks a warmer retreat._ Too great a degree of cold thus becomes a
cause of wakefulness. If the animal under these circumstances fails to
secure protection against a falling temperature, it passes into a state of
lethargy that is often fatal--a pathological condition being substituted
for the physiological sleep of ordinary hibernation. In like manner the
human animal may experience the threefold effects of refrigeration: first
a pleasing coolness that favors sleep; then an uneasy sensation of cold
which causes wakefulness; and, finally, a lethargy that paralyzes all the
functions of the body and terminates in death.

2. _Affections of the nerves of common sensation._--Chief among the causes
of sleeplessness thus produced is pain. This is a modification of feeling,
caused by excessive or extraordinary excitement of the peripheral nerves
of sensation. The seat of the excitement may be in the skin or in the
deeper tissues of the body. Cutaneous pain may be caused by the activity
of various insects, like flies, mosquitos, fleas and bedbugs, or by the
presence of certain parasites, such as the itch-mite, or by ordinary
diseases of the skin, of which notable examples are found in erysipelas,
erythema, urticaria, lichen, prurigo, certain varieties of eczema and
psoriasis. The troublesome forms of pruritus which accompany icterus, or
which may occur without any clearly defined cause, are frequent causes of
wakefulness. The last mentioned disorder must, however, be sometimes
recognized as a consequence of central nervous disorder, rather than a
result of peripheral disease. Witness the frightful itching sometimes
experienced during the progress of chronic myelitis. All kinds of
injuries, wounds, ulcers, and other local inflammations are common causes
of insomnia by reason of the painful impressions transmitted from them to
the brain. Hence the great importance of anodynes and hypnotic remedies in
the course of surgical practice. Diseases or injuries of the various
peripheral nerves are notable causes of sleeplessness. Witness the
horrible wakefulness caused by neuritis and by neuralgia. The development
of neuromata in the stumps of amputated limbs may thus become a most
painful cause of insomnia. Inflammations which encroach upon sensitive
nerves produce intense pain with consequent loss of sleep. Of this very
conspicuous examples are furnished by spinal meningitis, and by the
effects of local periostitis causing compression of the branches of the
fifth pair of nerves.

3. _Affections of the sympathetic nerves._--So much still remains to be
learned concerning the pathological functions of the sympathetic nerves
that it is impossible to assign with any great degree of precision the
exact amount of interference with sleep that may depend upon disordered
conditions of this portion of the nervous system. Since their principal
functions consist in the regulation of the flow of blood and lymph
throughout the body, and in the control of the processes of nutrition,
calorification, secretion and excretion, it follows that any considerable
derangement of their healthy action must be represented by a corresponding
disturbance of the brain. This may reach the field of consciousness in the
form of pain, and thus may become a cause of sleeplessness. In all the
phenomena of inflammation sympathetic nerves play an active part. In
certain portions of the body, as in the principal viscera, and in the
periosteal covering of the bones, they are the interstitial nerves of the
structures. When the body is in a healthy condition these nerves convey
impulses of a sensory character which do not reach the cerebral organ of
conscious sensation. But in certain morbid states they become inordinately
sensitive, and they then serve to convey and probably also to magnify
sensations to an extent that may cause exquisite pain with all its
consequences. Witness the pain experienced during the various forms of
colic. Rheumatic inflammations, pleurisy, pericarditis, peritonitis,
cystitis, metritis, ovaritis, gastro-enteritis, and other similar diseases
owe their principal suffering to the affection of the sympathetic nerves
connected with the respective organs which become the seat of pain.
Including with the sympathetic nerve the pneumogastric nerve, which
occupies a functional position between the strictly peripheral and the
ganglionic nerves, all the various forms of pain and uneasiness
experienced in the region of the heart and of the lungs may be assigned to
this system of nerves. Thus the various species of respiratory
disturbance, such as asthma and dyspnoea from any cause, and the forms of
palpitation and other cardiac disorder may become causes of wakefulness.
In like manner the vague and uneasy sensations associated with certain
varieties of dyspepsia are frequent sources of sleeplessness, not merely
by reason of the pain which they occasion, but also because of the general
disorders of nutrition with which they are associated.


II. INSOMNIA CAUSED BY MORBID STATES OF THE CENTRAL NERVOUS ORGANS.

So intimately connected are the spinal cord and the brain that their
disorders may properly be considered together. These may be classified as:

    1. Disorders of circulation and nutrition.

    2. Inflammations and degenerations.

    3. Neoplastic encroachments.

_Disorders of circulation and nutrition._--Hyperæmia of the brain is a
frequent cause of wakefulness. This may be maintained by an unconscious
effort of the organ of the will under the influence of any great and
unusual excitement of the mind. So soon as the mental excitement is
allayed, the excessive afflux of blood subsides, and the brain becomes
fitted for sleep. But, if excitement be too far prolonged, the nutrition
of the nervous centres suffers, and the regulative apparatus of the
cerebral circulation becomes exhausted, so that the brain cannot rest,
because its inhibitory centres have lost their power of control over the
lower ganglia of the organ. The cerebro-spinal centres are then in a
condition analogous to that of a locomotive engine on which the engineer
can no longer regulate the production and distribution of steam. Such a
condition is usually the result of numerous antecedent causes. Long hours
of work, scanty or improper food, insufficient sleep, bad hygienic
surroundings and habits, with indulgence in the use of narcotics and
stimulants, are among the most common causes of the disorder.

Active hyperæmia of the nervous centers has been above mentioned as the
consequence of cerebral function under unfavorable conditions. But, as the
disorder persists, its type undergoes a change. We still speak of the
disorder as functional in its character, but it continually tends to
become organic. No visible alterations, perhaps, can be detected, but,
evidently, there are radical changes in the substance of the nervous
tissue. Nutrition suffers throughout the body to a degree that attracts
attention. The blood diminishes in quantity and quality, till the patient
becomes notably anæmic. In this condition the brain is inordinately
excitable. It is incapable of sustained activity, and the patient may even
be oppressed by an inclination to constant drowsiness; yet he will be
unable to sleep soundly, and his sleep will be continually agitated by
dreams. This state is one of the constant accompaniments of slow
starvation. The molecular structure of the nervous organs seems to be so
slightly constructed, under such circumstances, that its equilibrium is
disturbed by the most trifling incidents. It may be likened to a lofty
wall of bricks laid up without mortar--"if a fox go up," the entire
structure may be thrown down with a tremendous noise. Thus the anæmic and
irritable brain will react excessively under the slightest impression;
consciousness is invaded by perceptions which would never arise under
normal conditions of the nervous tissue; and the mind is continually
aroused. This form of wakefulness is very frequent among women who have
become anæmic, and among patients who are slowly convalescing from
exhausting diseases.

It is impossible in every instance to decide whether a given state of
wakefulness is the result of cerebral hyperæmia or anæmia. In the one case
the persistence of wakeful activity of the mind is due to excitement of
the cerebral cells, accompanied by a lavish irrigation of their substance
with the plasma of the blood. In the other case the excitement is
occasioned, not so much by increased afflux of the blood, as by a morbid
instability of the nervous substance. The outcome in both cases is very
similar--mental excitement and wakefulness.

In a third class of cases the agitation of the brain is produced by the
direct action of certain chemical agents upon the cortical substance. Tea
and coffee are familiar examples of such agents. The caffeine, by virtue
of which they produce their effect, when transported to the brain, enters
into combination with its protoplasm in such a way as to stimulate
molecular movement. Perception is thus quickened, and the mind is aroused.
Sleep is postponed until the effect of the stimulant has subsided. This
form of wakefulness is quite different from that produced by alcoholic
drinks. These operate, when taken in small quantities, to favor cerebral
equilibrium--and consequent equanimity--by producing a general dilatation
of the smaller blood-vessels. Their anæsthetic influence is favorable to
sleep, under such circumstances. But, if frequently repeated, these doses
of alcohol modify the nutrition of the nervous system until, at last, a
condition of irritable weakness is reached, in which wakefulness of a most
distressing character is experienced.

_Inflammations, degenerations, and neoplasms._--The early stages of
inflammation involving the central nervous organs are marked by that form
of insomnia which is associated with active hyperæmia. The headache and
painful delirium which accompany the different varieties of meningitis,
are causes of a wakefulness that persists until the brain is merged in the
coma of compression. The interstitial changes which cause the various
forms of insanity, are in like manner causes of wakefulness. Local
injuries and degenerations of brain-substance, tubercular deposits upon
the meningies, and all the different forms of intra-cranial tumor, are
causes of wakefulness, both by reason of the direct irritation which they
produce, and by reason of the circulatory disturbances which arise in
their neighborhood.

Finally, it must be observed that wakefulness may result from excitement
of the brain by irritating substances transported through the blood from
distant centers of disease in remote organs of the body, or derived from
articles that have been absorbed with the food and drink, or with the air
that enters the lungs. Thus wakefulness may accompany cutaneous disorders
that interfere with perspiration. Imperfect elimination through the liver,
kidneys and intestines, leaves the blood charged with excrementitious
substances which arouse the brain to wakefulness. In like manner, various
poisons, like lead, arsenic, etc., different miasms of telluric origin,
the products of putrefaction, and the various animal contagia, may produce
insomnia by their prejudicial effect upon the nutrition of the nervous
structures throughout the body.




CHAPTER III.

REMEDIES FOR INSOMNIA.

        O, true apothecary!
  Thy drugs are quick.
                      --ROMEO AND JULIET.


An occasional attack of wakefulness may fall to the lot of any one as a
consequence of the various disturbances of health or equanimity of mind to
which all are liable. Occurring as an accident in a state of health, it
produces merely a feeling of lassitude and weariness during the subsequent
day. This soon disappears, after a night of refreshing sleep, and the
subject is nothing worse for the incident. But the recurrence of the
disorder is a thing to be deprecated, not only for the reason that it
denotes a departure from the physiological order of life, but because its
frequent repetition prevents the adequate repair of the tissues of the
body. The great function of nutrition suffers as a consequence, and the
patient rapidly falls into a condition of premature old age. When this
takes place as a result of some temporary error of hygiene, or as a
consequence of diseases which admit of successful treatment, the patient
may be restored to health by judicious management, but lost youth and
elasticity of the tissues can never be fully regained. The most formidable
cases of insomnia are those for which no adequate cause can be recognized
in the habits, mode of life, and state of health of the patient. Grave
and permanent disorder of the brain is then to be feared. Such wakefulness
is a frequent precursor of acute meningitis in children and adults. It
frequently ushers in the early, insidious, formative stage of tubercular
meningitis, and of the infective fevers--notably typhoid fever. It forms
one of the most suspicious symptoms among the introductory phenomena of
insanity; and during the course of protracted diseases, its intrusion is
an omen of most unfavorable augury. It will, therefore, be found useful to
consider with some degree of detail the circumstances under which insomnia
may occur, and the best means of averting its onset.

A severely logical reference to previous doctrines regarding the condition
of the brain during sleep, has led many authors to consider the
therapeutical treatment of insomnia chiefly as a matter of modification of
the cerebral circulation. Sleep has been supposed to depend upon a
comparatively bloodless state of the brain, and wakefulness upon the
contrary state. For such theorists the treatment of insomnia consists very
simply in the use of agents which are supposed to be efficacious in
reducing the flow of blood through the head. Tourniquets, placed upon the
carotid arteries, occupy a position of great honor in the _armamentarium_
of such people. Recognizing the fact that changes in the force of the
circulation accompany and sustain every change in the activity of the
cerebral cortex, we, however, attach the greatest importance to the
condition of the nervous substance itself. For a clear understanding of
the proper mode of medication, it is important to ascertain whether the
cerebral substance is in a state of normal activity, or whether it is in a
state of healthy, but excessive, activity, or whether its seeming
excitement is merely the result of irritable weakness. Since these
opposite conditions may declare themselves during the course of any
disease in which insomnia may become a troublesome phenomenon, it is
impossible to make a classification of diseases upon the basis of these
different states of the brain. It will, therefore, be found more useful to
consider the subject of sleeplessness as it ordinarily presents itself
during the clinical progress of the several forms of disease. It will,
then, appear that the type of insomnia is liable to variation with the
course of each individual malady; and its treatment must vary accordingly.

Before proceeding to a discussion of the therapeutics of insomnia in
connection with particular diseases, it will be advantageous to pass
briefly in review the different remedies which are useful in the treatment
of wakefulness. These may be divided into two classes: Nervous stimulants,
and nervous sedatives. Among the first may be also reckoned food, heat,
baths, and counter-irritants. Like all nervous stimulants, they promote
the complete and harmonious action of all parts of the nervous system,
favoring that equilibrium of the circulation which is most favorable to
the development of sleep. The second class of agents comprises all such
remedies as act directly upon the nervous tissue of the brain, depressing
its functional activity, and hushing to rest those particular organs
which, by their undue excitement, serve to keep the remainder in a state
of wakefulness. All these substances produce decided effects upon the
spinal cord and the peripheral nerves, but it is their operation upon the
brain which principally interests us in connection with insomnia.

NERVOUS STIMULANTS.

  Heat.
  Baths.
  Massage.
  Electricity.
  Counter-irritants.
  Food.
  Digitalis.
  Camphor.
  Musk.
  Valerian.
  Cannabis indica.
  Belladonna.
  Hyoscyamus.
  Stramonium.
  Phosphorus.
  Acids.
  Opium.

NERVOUS SEDATIVES.

  Cold.
  Alcohol.
  Paraldehyde.
  Ether.
  Chloroform.
  Chloral.
  Butylchloral hydrate.
  Amyl nitrite.
  Opium and opiates.
  Bromides.
  Hops.
  Gelsemium.
  Conium.


NERVOUS STIMULANTS.

It may at first sight seem to be a contradiction in terms when it is
asserted that sleep may result from the administration of a nervous
stimulant. This does occur, but only indirectly, and as a consequence of a
restoration of energy to those portions of the nervous system which serve
to moderate the activity of the organ of the mind--the cortex of the
cerebrum.

_Heat_, for example, is an undoubted stimulant. When added to the body in
quantity sufficient to overcome chilliness, it tends to equalize the
circulation of the blood, and produces throughout the body a nervous
equilibrium that prevents any particular organ or member from arousing the
others to wakefulness.

_Baths._--The application of heat in the form of a warm bath constitutes
one of the most admirable means of tranquilizing the brain. Children who
are restless at night are delightfully soothed by a warm bath every night
and morning. The water should be of an _agreeable_ temperature--this is
better than any exact figure upon the scale of a thermometer--and the bath
should not last lounger than ten minutes. Similar baths exercise a happy
effect upon adult patients who are moderately feverish, nervous, and
wakeful. If strong enough, they may take a full bath at bedtime; but if
too feeble to leave the bed, gentle sponging with warm water will prove
most refreshing, and will usually be followed by restful sleep. The
well-known derivative effects of hot foot baths scarcely need to be more
than mentioned in this connection.

Turkish baths form an invaluable adjuvant in the treatment of chronic
cases of insomnia arising from rheumatic, gouty, and dyspeptic disorders
of the health. The copious perspiration induced by the heated air of the
hot chamber is depurative, while the cold douche and the massage with
which the bath is concluded have a powerful effect to stimulate all the
functions of the body. By this means the brain is enabled to resume a
healthier mode of action, and sleep follows as a matter of course.

_Massage._--This constitutes a process of rubbing and kneading the body.
It has been practiced from time immemorial among the oriental races and
the Pacific Islanders as a means of relief from fatigue of every kind.
Among the Japanese the practice of massage is a monopoly in the hands of
the blind, who are thus enabled to support themselves. Various
modifications of the oriental method have been introduced under the names
of _percussion_, _shampooing_, and the _Swedish movement cure_. They all
possess the common features of friction applied with the hand to the skin,
compression of the muscles with the hands, and passive movements of the
different articulations of the limbs and body. For effecting all these
processes nothing has yet surpassed the Sandwich Island _lomi-lomi_ as
practised by the court-retainers of the ancient chiefs. As a means of
relieving fatigue, and of removing muscular soreness, after violent
exertions of every kind, it is far superior to the imitations performed by
European and American professional _masseurs_ and _masseuses_. Nervous
headaches, the pains that accompany spinal irritation, and all conditions
of restlessness and wakefulness which depend upon exhaustion are relieved
by this method. The well-known soothing influence of a mother's hand
stroking the face and forehead of her sleepless child, is an example of
only one of the effects thus produced by the skillful _masseur_. These
salutary results must be assigned to the uniform friction of the skin,
causing the liberation of heat, and modifying the electrical conditions of
the body. By this, the impressions derived from the peripheral nerves are
reduced to a more harmonious series. The circulation of blood and lymph is
rendered more active in the substance of the muscles, and all the
processes of nutrition are thus stimulated to a degree that restores the
equilibrium of function throughout the nervous system. Being no longer
irritated by suffering portions of the body with which it is connected,
the brain then yields to the effects of its own fatigue, and sleep
supervenes.

_Electricity_ is chiefly useful in those cases where it is impossible to
discover anything but cerebrasthenia as the cause of wakefulness.
According to Beard and Rockwell,[39] sleep may result from the use of any
one of the different methods of electrization. The passage of a moderate
current, either galvanic or faradaic, through any portion of the body
often produces a temporary feeling of sleepiness; but the long continued
employment of electricity is needful to effect those changes in cerebral
nutrition which are necessary for a permanent cure of insomnia. In cases
of sleeplessness caused by worry and overwork, great benefit is often
experienced from the daily passage of the faradaic current from the back
of the neck, or from the pit of the stomach, to the feet. Static
electricity, and the electric bath, are also very effective in many cases
of so-called _spinal irritation_ and insomnia.

_Counter-irritants_ are substances which are applied to the surface of the
body for the purpose of communicating to the superficial sensory nerves
impulses (irritation) which may serve to inhibit the morbid functions of
distant or central nervous structures. Various explanations of this
process have been presented; notably a most ingenious argument by Dr. T.
Lauder Brunton[40] in favor of the theory of inhibition by interference
of vibrations--impulses from the periphery interfering with vibrations
originating in morbid conditions of the central nervous organs--very much
as darkness is produced by the interference of luminous undulations, and
silence is effected by interference of sonorous waves in the atmosphere.
This hypothesis is the one that is most conformable to the present
requirements of science, and is hereby accepted as the most satisfactory
explanation of the action of counter-irritants.

The drugs in general use for the purpose of counter-irritation are
_cantharides_, _capsicum_, _mustard_, _thapsia_, _turpentine_, _aconite_,
and _croton oil_. _Cups_, _leeches_, and certain special applications of
_electricity_, also owe much of their virtue to the same power of
modifying functions at a distance. Under the influence of all these agents
the molecular vibrations of the brain may be profoundly influenced; pain
may be annulled, and sleep be procured. The circulation of the blood is so
powerfully affected by these measures that their good effects are usually
attributed to the circulatory changes thus produced. But, as in all other
modifications of the circulation, the nervous tissues and the vascular
channels must first be reached by influences unconnected with the blood
itself before its current can be diverted from one region to another. The
inhibitory action upon the nervous organs is the primary effect. The
diversion of the circulation is a secondary consequence, by which,
undoubtedly, the degree of nervous change can be estimated, and by which
the inhibitory effects in the brain are intensified and sustained.

_Food._--In a considerable number of cases of insomnia, its cause lies in
an irritable weakness of the nervous tissues. Exhausted by overwork, or
debilitated by the loss of blood, or half-starved during the course of a
long illness like typhoid fever, a condition of wakefulness may be
established which will add to the dangers experienced by the patient. In
this state there is great restlessness--the sufferer experiences no severe
pain, but he cannot lie still. This form of sleepless agitation is often
encountered during the later stages of exhausting diseases; and, if not
properly treated, it soon leads to a fatal termination. The most important
remedy for such distress is found in food. This must be soluble,
diffusible, stimulant, and nutritive. Milk, alcohol, eggs, and meat-juice,
are the typical representatives of such food. _Milk_ should be as fresh as
possible, and should be slightly salted, in order to hinder the formation
of hard curds in the stomach. For young children it may be _peptonized_
with advantage by gently heating one pint of milk with five grains of
sodium carbonate and five grains of pancreatic extract dissolved in half a
pint of water. The mixture may be sufficiently warmed by placing it in a
bottle immersed for half an hour in a jug of hot water (Fairchild). By
this process the milk is partly digested before it is drank, thus
relieving the alimentary canal of a corresponding amount of work.

Furnished in the form of _koumiss_, milk is not only presented in a
digestible form, but the alcohol and the acids yielded by its fermentation
are powerful aids to the process of digestion. Fermented milk forms a
considerable portion of the daily food of the nomad tribes of Central
Asia, and it is highly esteemed among the Russians in the treatment of
pulmonary consumption. It is useful in all diseases affecting the
digestive organs, and can often be tolerated, even by very young children,
when nothing else will remain in the stomach. Considerable mystery is made
of its preparation by those who sell it for an enormous price; but its
composition is really very simple, and its actual cost is within the reach
of every one. The following formula for its preparation has given great
satisfaction to many of my patients:

Dilute five quarts of milk with three quarts of hot water. When lukewarm,
add half a cupfull of sugar of milk (which can be obtained from any
wholesale druggist), and one bottle of well fermented koumiss (or a little
yeast). Stir the mixture thoroughly, and let it stand in an open jar, at a
temperature of about 72° F., till it begins to curdle. Then stir in half a
cupfull of pulverized coffee sugar, and cork tightly in champagne bottles
with the best velvet corks. The bottles should be kept quite cool, as
fermentation proceeds very briskly, and will break the containers if left
in a warm room. A large ice-box is the best receiver during hot weather.
The koumiss thus prepared is ready for use at the end of a week. It may be
most conveniently drawn from the bottle with a champagne tap. The entire
cost of the article need not exceed seven cents a bottle.

Sleeplessness caused by chronic dyspepsia will often yield to a diet of
koumiss, when every other remedy has failed. When the stomach is very
intolerant, it should at first be taken in very small doses, repeated as
often as every hour. It will soon become possible for the same patient to
drink two or three quarts each day.

_Eggs_ form one of the most nutritious and easily digested articles of
diet. They should be taken uncooked, beaten up with milk to which a small
quantity of wine or spirits and sugar have been added. A glass of eggnogg,
thus prepared, is invaluable in the insomnia of fevers and other
conditions of exhaustion.

_Meat-juice_ can be procured in numerous forms. The various soluble
extracts of meat, Valentine's liquid extract of beef, Murdoch's liquid
food, all represent the juice that oozes from rare beef. Its nutritive
value is not very great, but it possesses considerable energy as a
stimulant. Meat juice, therefore, occupies an important place as an
excitant of those functions which must be aroused in order to secure the
proper digestion of other articles of food. It should, therefore, be
administered in connection with them. As the ordinary meat extracts are
frequently very unpalatable, they may be administered in fresh broth or
soup, to which they give body and energy without unpleasantly affecting
their savory taste.

Neurasthenic patients, whose insomnia results from physical exhaustion,
should never retire at night without taking some form of light and easily
digested food. A simple slice of bread, or a piece of plain sponge-cake,
with a glass of koumiss, forms an excellent model for such a meal.

_Digitalis_ is only indirectly useful as an hypnotic. In cases of cardiac
disease, with enfeeblement of the heart, dyspnoea, dropsy, and
sleeplessness, digitalis is often of the greatest service. It has also
been highly recommended in delirium tremens. Administered in the form of
an infusion, it has been given in doses of a tablespoonful, every four
hours, with apparently good effect. Its use is indicated in cases
characterized by weakness of the heart, with a rapid and feeble pulse.
Under its influence the state of the circulation improves, delirium
ceases, and sleep occurs.

_Camphor._--This substance is not an hypnotic, but it forms a valuable
addition to various hypnotic compounds. It is a cerebral stimulant, and
aids in the establishment of that nervous tranquility which favors the
incidence of sleep. It may, therefore, be advantageously associated with
opiates in the restlessness and insomnia of exhaustion. Tully's Powder, a
valuable substitute for Dover's Powder, contains camphor. This renders it
preferable to the ordinary opiates in typhoid fever, and in other
exhausting diseases.

_Musk_, the dried secretion of the preputial follicles of the musk-deer,
is a substance which, on account of its high price, is rarely used as an
hypnotic. Given in doses of ten grains, every two or three hours, it is
exceedingly valuable (Stillé and Maisch) for the relief of "all those
nervous phenomena which are represented by the term _ataxia_, and among
them subsultus tendinum, mild muttering delirium, floccitation, muscæ
volitantes, and hiccough, with a small, frequent, tremulous or irregular
pulse, without coma and without collapse. Under these circumstances musk
tends to produce refreshing sleep, while it calms muscular spasm and
favors perspiration, while the pulse grows fuller, more regular, and less
frequent.... In proportion as ataxic prevail over adynamic phenomena is
musk advantageous." Such conditions are chiefly encountered in typhus,
typhoid fever, the eruptive fevers, and pneumonia. Musk is very
efficacious for the relief of "wakefulness resulting from combined mental
and bodily fatigue--such cases, in fact, as are benefitted by valerian,
camphor, asafetida, and ammonia."

_Valerian_ and its different preparations form a typical class of agents
which indirectly favor sleep by their gently stimulant effect upon the
brain. They are all useful in quieting that form of hysterical excitement
to which women are liable during the "change of life." That form of
restlessness, usually resulting from fatigue, in which the patient feels
as if she cannot sit still, is often relieved very promptly by the
valerianate of ammonia. Wakefulness caused by neuralgic pains, or by
exhaustion, often yields readily to scruple doses of valerianate of zinc
or ammonia. The elixir of the valerianate of ammonia is a very elegant
preparation of the drug.

_Cannabis Indica._--A cerebral stimulant which produces, at first, an
agreeable exaltation of the mental faculties. This is followed by a
condition of delirium, succeeded in its turn by sleep. It is, therefore,
impossible to use the drug for merely hypnotic purposes; but it is a
useful adjuvant, in small doses, to other hypnotic remedies. Given in
doses of 1/2-1 grain, it may be advantageously associated with opiates, or
with hyoscyamus or belladonna in cases which do not easily tolerate the
preparations of opium. The tannate of cannabin, given in doses varying
from five to ten grains, has been recommended as an hypnotic; but, like
the extract from which it is derived, its effects are rather uncertain.
The pure alkaloid, cannabin, has been recently introduced as a soporific,
in doses of three-quarters of a grain to a grain and a half. According to
Stillé and Maisch, the wakefulness caused by the itching of eczema may be
relieved by the use of cannabis indica. The uneasy sleep attendant upon
ungratified sexual appetite may also be relieved in the same way, since
the drug is decidedly anti-aphrodisiac.

_Belladonna_ is not directly hypnotic, unless given in poisonous doses,
but its medicinal operation tends to overcome certain conditions that
hinder sleep. By its anti-spasmodic effects it relieves many forms of
spasm which would otherwise interfere with sleep. Spasmodic asthma
furnishes an example of such an affection. This may be relieved by the
hypodermic injection of atropine. Whooping cough is another disease which
may be largely controlled by the internal administration of the drug,
especially by inhalation of a spray that has been medicated with
belladonna. Neuralgia, especially the form that involves the head, face,
and intercostal nerves, is greatly mitigated by the use of belladonna, or
its alkaloid, atropia. Its association with opiates seems to increase
their hypnotic effect, while at the same time neutralizing their
disagreeable action. According to Curci,[41] it opposes the tendency of
opiates to cause cerebral hyperæmia. For this reason it is generally
advisable to combine sulphate of atropia with sulphate of morphia for
hypodermic use. Of the former 1-100--1-80 grain may be used with 1/4
grain of the latter. Certain patients are exceedingly intolerant of
belladonna and its derivatives, a fact that must be kept in mind,
especially when using the alkaloid, atropia. Fatal consequences are very
rare, but uncomfortable dryness of the throat, dilatation of the pupils,
and some degree of delirium are not uncommon. At the same time it must be
admitted that in many instances relief from suffering is not obtained
until these physiological effects of the drug have been manifested.

_Hyoscyamus._--As might be inferred from their close botanical
relationship, hyoscyamus and belladonna present many points of similarity.
Their alkaloids are almost identical in chemical and physiological
properties. The extract of belladonna is considerably stronger than the
extract of hyoscyamus. Like other solanaceous plants, this is powerfully
narcotic and anodyne. Sleep is produced only by the use of the drug in
large doses, which also tend to excite delirium, sometimes even reaching
to the height of maniacal fury. Children tolerate hyoscyamus in doses
proportionally larger than can be taken by adults. By many physicians it
is considered the hypnotic _par excellence_ for children. In the various
forms of insanity the tranquilizing influence of hyoscyamus is highly
esteemed. The derivative preparations, hyoscyamine and hyoscyamia, are
preferable for use in this class of cases. The first may be given in doses
of 1-16--1 grain; the latter is much more powerful, and should be given in
doses not exceeding 1-100 grain until the degree of its tolerance has been
ascertained.

_Stramonium._--This is another of the solanaceous plants, possessing many
qualities like those found in belladonna. It is not directly hypnotic.
Poisonous doses produce delirium and persistent insomnia. But its
anti-spasmodic effect upon the paroxysm of nervous asthma renders it
indirectly hypnotic in that affection. For the relief of bronchial spasm
the smoke of the dried leaves should be inhaled in considerable quantity.
It may be smoked in a pipe; or, mixed with saltpetre, it may be made to
smoulder upon a tin plate, while the smoke is drawn by inspiration into
the lungs. Various kinds of medicated pastiles have been prepared, to
effect a similar result by furnishing the drug in a convenient form for
use. _Tobacco_ and _lobelia_ operate in a very similar manner upon all
spasmodic affections of the respiratory passages; but their energy is
almost too great for the comfort of the patient.

_Phosphorus._--Bartholow has recommended this drug in "cases of
wakefulness dependent on cerebral anæmia and exhaustion," and in "the
wakefulness of the aged, accompanied with muscular cramps, feebleness of
memory, giddiness, and trembling of the voluntary muscles on exertion." In
minute doses, it is true that phosphorus acts as an irritant of nervous
tissue. It promotes destructive changes in the tissues of the body, and
thus produces a temporary excitement which may favor the processes of
nutrition. Indirectly, it may thus prove beneficial in many cases of
cerebral exhaustion; but as a direct hypnotic it will be found of very
little service. It should be given in doses of 1-100 grain every four
hours.

_Acids._--In those forms of sleeplessness which are dependent upon
disordered conditions of the digestive apparatus, acids are often useful.
Their topical effects upon the mucous membrane of the stomach are
stimulant and alterative; hence they are useful in atonic dyspepsia, where
there is deficient secretion of the gastric juice. In such cases
_hydrochloric acid_ and _lactic acid_ are useful. The first should be
given, in doses of five drops diluted with half a pint of water, after
each meal. Lactic acid may be given in doses of one or two teaspoonfuls,
similarly diluted. It has been asserted, on theoretical grounds, that
lactic acid and the lactate of sodium are directly hypnotic, but its
experimental use has never given satisfactory results. _Phosphoric acid_
has been used in the same way, with very similar effects. An impure
solution of phosphoric acid, known as _Horsford's Acid Phosphate_, has
been extensively used for its supposed hypnotic properties. It assists
digestion, stimulates the kidneys, and by its general diffusion promotes
molecular activity throughout the body. It is thus indirectly beneficial
in cases of insomnia. No small part of the benefits thus obtained must,
however, be ascribed to the water with which these acids are diluted. When
the liver becomes sluggish in its action, nitric acid, in doses of five
drops diluted with half a pint of water, may be taken every four hours
with great advantage. Thus used, the mineral acids may often yield
invaluable service in the treatment of insomnia occasioned by cachectic
conditions of the body--notably such as are produced by malaria, oxaluria,
and the so-called phosphatic and rheumatic diatheses.


NERVOUS SEDATIVES.

The remedies thus far considered are but indirectly hypnotic in their
effects, though exceedingly valuable as agents for the production of
conditions favorable to sleep. We may now pass to the consideration of a
class of remedies which operate more directly upon the brain to depress
its energy. They are, therefore, called nervous sedatives, and they
include the majority of narcotic substances.

_Cold._--The operation of cold upon the body has already been sufficiently
considered. It only remains to note the effects of cold applied through
the agency of baths and local refrigerants. A full account of the theory
and practice of hydrotherapeutics can be found in the second volume of Von
Ziemssen's _Handbuch der Allgemeinen Therapie_. The English reader will
find the subject treated at sufficient length in Ringer's _Handbook of
Therapeutics_.

According to Ringer, the sitz-bath, taken at a temperature between 60° and
80° F., is very useful to soothe "an irritable restless state of the
nervous system." It should be employed once or twice a day, from five to
thirty minutes at a time. Among other beneficial consequences is the
promotion of quiet sleep.

For the relief of the pungent heat and restlessness which add so much to
the danger of the specific fevers cold baths have been highly recommended.
These have been employed with great energy in many of the German
hospitals; and often with great benefit to the patient. The preferable
method is the one advised by Von Ziemssen and Immerman. The patient is
placed in a tub of water at 95° F. This is very gradually cooled down, in
the course of half an hour, to 60° F. The bath should be repeated from
three to five times a day, according to the temperature of the patient. By
this method of treatment the patient is made more comfortable; he becomes
less restless or delirious, and secures a larger amount of refreshing
sleep.

The difficulty of administering such a laborious course of baths outside
of a well equipped hospital renders its adoption almost impossible in
private practice. Here the physician must rely upon assiduous sponging
with water of an agreeable temperature. In severe cases, such as measles
before the appearance of the eruption, scarlet fever during the period of
heat and agitation, and typhoid fever during the corresponding stage,
great benefit will be derived from the cold wet sheet. In order to humor
the prejudices of the laity, this should be wrung out of warm water and
applied with sufficient deliberation to insure its considerable loss of
heat. A blanket should first be spread upon an empty bed; the wet sheet
should be spread over the blanket. The patient must be placed naked upon
the sheet, which should then be drawn around the entire body, and the
blanket may be folded around the whole package. Children generally insist
upon leaving their arms uncovered. This may be allowed with safety in many
cases, but generally a wet napkin should cover the upper part of the chest
and the neck which cannot be reached with the sheet when the arms are
exposed. After remaining from half an hour to two hours in the pack, the
patient becomes comparatively cool and quiet, and the eruption, if
delayed, begins to appear. Sleep often occurs as an immediate consequence
of the relief thus obtained.

Similar good results may be secured by the use of cold affusion in cases
of high temperature and great restlessness. I well remember a little boy,
about eight years old, whom I once found rolling and tossing and burning
up with scarlet fever. Calling for an empty wash-tub, I had him stripped
and placed upright in the tub. I then began to pour cold water over him
from a large pitcher. Scarcely had the water touched his skin, before he
seized the pitcher, and began to drink from it. He was permitted to
completely slake his thirst, and then the affusion was resumed. After four
or five gallons of water had been thus poured over him, he was wiped dry,
and was returned to his bed, where he immediately turned upon his side,
and fell into a peaceful sleep. A few more affusions relieved him from
danger, and he made a rapid recovery. Were people less afraid of such
measures, a considerable portion of the danger in fevers might be
obviated. Great discretion, however, is necessary in the application of
such treatment, for Ringer states that he has "seen a child, suffering
from scarlet fever, killed by an over-energetic employment of cold." The
temperature of the patient should be carefully noted, and its reduction
below the normal standard should never be permitted.

_Anæsthetics._--All anæsthetics are hypnotics. In other words, they
possess the power to abolish consciousness, and thus to produce a
condition resembling sleep. This is effected by the direct action of the
anæsthetic substance upon the cellular structure of the brain, reducing
the molecular movements of the living protoplasm below the degree
requisite for the excitement of consciousness. This sedative effect is
preceded by a brief period of cerebral exaltation, occasioned by the
disturbances caused by the first introduction of the drug into the current
of the circulation.[42] It is with the subsequent hypnotic effect only
that we are now concerned. Of the numerous anæsthetic substances that have
been discovered, but few comparatively have been found sufficiently
manageable and safe for general use. These are alcohol, paraldehyde,
ether, compound spirits of ether, chloroform, chloral, butylic chloral,
and amylic nitrite.

_Alcohol._--The hypnotic effect of alcoholic drinks is very decided,
though not speedily manifested unless the beverage be taken in
considerable quantity. Distilled liquors produce the effect of alcohol in
its simplest form; wines, containing various forms of ether, arouse the
nervous system more thoroughly and agreeably than the pure alcoholic
stimulants. Beer and porter are rendered more powerfully narcotic by the
active principle of hops which they contain. The nutritive substances held
in solution by these last render them peculiarly appropriate in cases that
require nourishment as well as rest. The considerable quantity in which
they must be taken, renders them inconvenient for use in cases of severe
illness. Wines and distilled liquors are then most available.

Alcohol is principally useful as an hypnotic when wakefulness is
associated with great bodily exhaustion, such as may be experienced in
advanced stages of the infective fevers. In such cases the heart is
weakened, the pulse is rapid and feeble, the muscular apparatus is wasted
and irritable, the blood is diminished in volume and tends to accumulate
in the venous channels. Under such conditions the patient is usually
delirious, tossing from side to side, and quite deprived of sleep. An
ounce of brandy, repeated at intervals varying according to the severity
of the symptoms, and given with milk and egg, in the familiar form of
eggnogg, will often quiet this harassing restlessness, and will procure
refreshing sleep. The temperature of the patient will then decline; the
tongue will grow moist; and the delirium will diminish or subside
altogether. Sometimes, however, a contrary result is observed. Alcohol
should then be administered with a sparing hand, and it will probably be
necessary to resort to the bromides or other cerebral sedatives.

The great exhaustion which is manifested in delirium tremens sometimes
requires the use of alcohol to support the patient, so that sleep may be
procured. It is in such cases advisable to combine the administration of
capsicum with that of alcohol. According to Ringer, capsicum should be
given for this purpose in scruple doses, made into a bolus with honey, and
repeated every three hours.

Wakefulness caused by neuralgic pains is speedily relieved by full doses
of alcohol. The various species of abdominal and pelvic neuralgia may thus
be temporarily suspended. In like manner the "rheumatic" pains which
afflict the overworked and underfed poor may be calmed for a season
sufficient to procure sleep. The obvious dangers attendant upon such
medication, however, need no comment.

Old people not unfrequently suffer with a form of insomnia that is
associated with feeble and painful digestion. This is probably caused by
insufficient gastro-intestinal secretion. The use of wine containing a
large proportion of compound ethers gives relief through the improvement
in digestion consequent upon the stimulant effect of small doses of
alcohol and ether. Under their influence the digestive fluids are more
abundantly secreted, and all the bodily functions are quickened. Such good
results, however, only follow the moderate use of the stimulant. It must
never be taken in quantity sufficient to affect the intellectual
functions, or to disturb any of the normal processes of life. The best
results, so far as digestion is concerned, are obtained by the use of wine
with the meals; but a night-cap, in the form of hot toddy, is sometimes
necessary in addition. This is especially useful if there be any form of
irritative cough or local excitement, such as the aged sometimes
experience.

The insomnia that attends excessive fatigue may be very quickly relieved
by the use of food and alcohol. For this purpose any form of alcoholic
drink will be found useful. The quantity administered should only be
sufficient to produce a uniform and general vascular relaxation. By this
means the circulation is equalized throughout the body, and the brain
passes into a state of tranquil sleep. Any excess in the use of alcohol
under such conditions will be followed by headache and discomfort on
awaking. In all cases the intoxicating dose of alcohol must be avoided,
if its truly hypnotic effect be desired.

_Paraldehyde._--This is a derivative from ethyl alcohol. It is, when pure,
a colorless liquid, with an agreeable odor, somewhat like that of ether.
It is soluble in the proportion of one part in eight or nine of water. It
may be used internally in doses varying from forty-five to one hundred and
sixty grains. A watery solution, containing one part to ten, has been
recommended for internal administration. It may also be given in milk or
in beer. M. Yvon[43] recommends the following formula:

  Paraldehyde, Gr.     20.0
  Spirit,             100.0
  Syr. Simpl.,         75.0
  Tr. Vanillæ,          5.0

An ounce of this mixture contains forty-five grains of paraldehyde. When
taken it should be still further diluted with sweetened water, or with
beer, to obviate, as far as possible, the disagreeable taste of the drug.
Sleep follows after the lapse of about half an hour, and continues from
five to seven hours. The physiological action of the medicine is very
similar to that of chloral hydrate, and its use is indicated in the same
class of cases to which that drug is appropriate. By many it is considered
the preferable hypnotic. It has found considerable employment in the
insane asylums of Europe, and in other institutions where disagreeable
medication is no obstacle to experiment. In private practice the peculiar
taste and smell of the article, and its pungent effect upon the mucous
membranes of the alimentary canal, render its exhibition more difficult.
But the weight of testimony is in its favor as an hypnotic in all cases,
uncomplicated with disease of the stomach, in which insomnia is not
dependent upon pain, and is associated with cerebral hyperæmia. Its
administration is followed by no unpleasant consequences. Among the insane
it is particularly recommended during periods of excitement and
wakefulness. It has been employed with great satisfaction[44] in cases of
insomnia during the course of such varied diseases as emphysema,
bronchitis, phthisis, nervous and spinal disorders, diseases of the heart,
jaundice, chronic rheumatism, and insomnia from other unrecognized causes.
Undoubtedly, with greater skill in its purification and exhibition, it
will become one of the most valuable of hypnotic remedies. Almost useless
for the relief of pain, it is indicated in cases of uncomplicated
insomnia. Having very little power, in moderate doses, to depress the
action of the heart, it is preferable to chloral hydrate in cardiac
diseases and debility. Sleep procured with doses of fifteen to sixty
grains is calm and refreshing, and is not followed by any disagreeable
consequence. A certain degree of tolerance is gradually established, so
that larger doses may become necessary. It has been given in quantities
amounting to three drachms; but, if large doses be given before the
development of tolerance, the patient will experience headache,
uneasiness, nausea, and vomiting, after waking from the sleep thus
induced. Another advantage possessed by paraldehyde consists in the
absence of the period of excitement produced by chloral before the advent
of sleep. It is an hypnotic, without narcotic properties, limiting its
effects chiefly to the brain, and leaving the spinal cord in a condition
nearly like that of natural sleep.

_Ether_, though possessed of the greatest value as an agent for the
production of artificial anæsthesia, is rarely used as a mere hypnotic.
Diluted with alcohol and ethereal oil, it forms the _Compound Spirit of
Ether_, or _Hoffmann's Anodyne_. In this form it is well adapted for
internal administration. It is thus very serviceable in the treatment of
those forms of insomnia associated with nervous irritability and hysteria.
For the relief of wakefulness dependent upon a languid circulation, with
cold feet and flatulence, the anodyne may be given in half-drachm doses
well diluted with ice water, and repeated every fifteen minutes till
relief is obtained. Nearly all forms of painful or spasmodic disturbance
unattended by fever may be thus relieved. For this reason it is
particularly useful in the treatment of uterine colic and in sleeplessness
after childbirth, when opiates cannot be tolerated, or are
contra-indicated on account of their tendency to excite the brain.

_Chloroform_, like ether, is an agent too powerful and too evanescent for
use as a simple hypnotic. But for the relief of intense suffering caused
by nervous irritation and spasm it is without any superior. In certain
minor affections of a spasmodic character it, therefore, forms a valuable
adjuvant to other remedies. Diluted with alcohol it forms the spirit of
chloroform, a remedy which is useful in all cases for which the compound
spirit of ether is usually prescribed. In this form it is an excellent
addition to various mixtures designed for the relief of spasmodic coughs
by which sleep is disturbed. Ringer recommends it in the treatment of the
irritative cough so characteristic of fibroid phthisis. It should also be
used in cases of spasmodic asthma. The asthmatic paroxysm may frequently
be arrested by inhalations of the vapor of chloroform or ether; but,
unfortunately, the lungs soon become tolerant of these agents, and they
then cease to afford relief. The valuable mixture known by the name
_chlorodyne_ owes a considerable portion of its efficacy to the presence
of chloroform as one of its ingredients.

_Chloral._--Until the recent introduction of paraldehyde, chloral hydrate
has for many years held the first rank as an hypnotic. It is particularly
useful in wakefulness occasioned by exhaustion of the nervous centres. The
conclusions of all experienced observers have been most concisely stated
as follows:[45] "Chloral appears to be indicated when sleeplessness is
dependent upon a vascularity due to exhaustion rather than to primary
excitement of the brain; thus it has been found useful when loss of sleep
follows severe and prolonged mental application or excitement of feeling,
or accompanies the general debility following acute diseases attended with
delirium or severe pain, or is associated with acute _mania_, especially
of the puerperal form. The somewhat analogous condition which exists in
_delirium tremens_ is very amenable to this medicine, especially in the
forming stage of the affection known as 'the horrors,' and which so
frequently follows surgical injuries in drunkards; it is useful also when
great nervous excitement and restlessness are associated with extravagant
phantasms. Nevertheless, its depressing effects are to be guarded against
in this affection as in the different forms of insanity." This caution is
directed against the frequent and repeated employment of the article in
chronic cases, on account of the vasomotor paralysis and general cachexia
thus induced. It is now claimed that many of these consequences may be
avoided by the substitution of paraldehyde in the place of chloral, but it
has been shown[46] that similar effects may follow the long continued use
of this substitute.

Chloral is usually administered by the mouth in doses, for adults, of
twenty to thirty grains, dissolved in sweetened peppermint water. If the
first dose does not procure sleep, it may be followed at the expiration of
an hour by a second dose of twenty grains. This seldom fails to induce
refreshing sleep. When the medicine cannot be tolerated by the stomach it
may be given by enema in milk. For this purpose a drachm of chloral should
be suspended with the white of an egg in half a teacupful of milk.

_Butylchloral hydrate._--This substance has been recommended as a
substitute for chloral hydrate, in cases of cardiac weakness, on account
of its being less powerful to depress the action of the heart. It is
principally useful for the relief of facial neuralgia and hemicrania. As
an hypnotic it is seldom used. For this purpose it may be given in a
solution like that of chloral hydrate. For a simple anodyne effect the
medicine may be given in five-grain doses, repeated every half hour or
hour. As a means of procuring sleep it may be given in doses ranging from
fifteen to forty-five grains. Liebreich has given the medicine in drachm
doses, and recommended it as an hypnotic superior to chloral hydrate. It
is useful in the sleeplessness of headaches, neuralgia, dysmenorrhoea, and
chronic phthisis.

_Amyl nitrite._--This drug has been recommended for the relief of insomnia
resulting from the opium habit. Ringer considers it useful in the flushes
of heat and other forms of discomfort which sometimes interfere with the
sleep of women during the change of life. It should be inhaled in the form
of vapor, from a handkerchief upon which five drops have been poured. The
quantity will need to be gradually increased, as the system becomes
tolerant of its effects. The stimulant effect of the medicine renders its
use in this manner probably less dangerous than the similar employment of
chloroform. Unlike the other anæsthetics above mentioned, it causes a
hyperæmic condition of the brain, and is, for this reason, a useful
hypnotic in cases of aortic obstruction with an insufficient cerebral
circulation and consequent wakefulness.

_Opium and opiates._--There seems to be no agreement among experimental
physiologists regarding the manner in which opium produces its effects
upon the body. By some it is ranked as a stimulant; by others it is
considered a sedative. These different opinions are probably due on the
one hand to differences in the dose and strength of the opiates employed,
and on the other to idiosyncrasies on the part of the individuals
subjected to experiment. The soporific effect of the drug appears to
result from its direct action upon the substance of the brain. Under its
influence the blood tends to accumulate in the veins, and loses its bright
arterial hue. Small doses are said to contract the capillaries of the
body, while they are dilated by excessive doses of the drug. From this it
may be inferred that opium acts, like many other narcotics, as an irritant
of the tissues when given in minute quantity, and as a paralyzing agent
when a certain relative amount is exceeded. The experiments of Curci[47]
indicate that under the influence of irritating doses of morphia the brain
becomes hyperæmic.

Opium is a remarkably complex substance, no less than nineteen different
alkaloids having been separated from it. Of these, however, only one has
stood the test of therapeutical experiment--morphia. Several other
constituent alkaloids, notably _codeia_, have been lauded as hypnotics,
but they are, at their best, far inferior to morphia, and may well be
omitted from the list of sleep producers. But, though the soporific
properties of opium are chiefly due to the morphia which it contains,
there are certain points of difference between the action of the two
medicines that often render a choice desirable. According to Stillé and
Maisch,[48] morphia does not stimulate circulation and the nervous system
as much as opium, and its narcotic effects are less decided and speedy,
though its after effects are more enduring. Opium increases the bodily
temperature and sense of heat; morphia produces the last effect, but
diminishes the temperature. Opium at first increases the frequency of the
pulse, while morphia diminishes it. Opium is of the two the less liable to
excite nausea and vomiting; hence the superiority of the tinctures and
aqueous solutions of opium when nausea is specially feared.

Of all the remedies for the relief of pain opiates are the most effectual.
Before the introduction of the alcoholic hypnotics and the bromides, they
constituted the principal agents in the treatment of insomnia. Even at the
present time they are indispensable for the relief of all forms of
sleeplessness dependent upon pain. A combination of chloral hydrate,
sodium bromide, and morphine forms one of the most generally useful
hypnotic compounds ever employed.

Under ordinary circumstances morphia is the preferable opiate for the
relief of insomnia. The sulphate is most frequently employed, but the
acetate and the tartrate have been recommended on account of their
supposed superiority in the formation of solutions that are unirritating
and permanent in their character. The hypodermic method of administration
forms the most prompt and efficient mode of procuring the effect of the
medicine. It should be given in a dose of quarter of a grain about an hour
before the time when sleep is desired. For some patients a longer time is
necessary to develop its hypnotic effect. To children the hypnotic dose
must sometimes be given at three o'clock in the afternoon in order to
induce sleep at nine o'clock in the evening. As the effect of opiates is
highly stimulant to the sweat-glands, and is often productive of nausea,
it is advisable to associate atropine with morphine when thus given. For
an adult the hundredth of a grain of atropine may be given with every
quarter of a grain of morphine. The soothing and agreeable effects of
morphia are thus intensified, while its disagreeable tendencies are
reduced to a minimum. The injection should be made into the loose areolar
tissue between the skin and the muscles. Its location is a matter of
little importance so far as the relief of pain is concerned; but the
neighborhood of the blood vessels should be avoided, since alarming
symptoms have been observed after injection into a vein. The outer aspect
of the arm near the insertion of the deltoid muscle is a favorite site for
puncture. If, for any reason, the hypodermic use of morphia cannot be
employed, it may be introduced into the rectum either in solution or in a
suppository. The bowel should first be washed out with an enema of warm
water; the opiate may then be introduced. The dose thus exhibited need
scarcely exceed that usually given by the mouth; but, if the rectum is not
previously cleansed, a double, or even triple, dose may be required.

As an hypnotic morphia is chiefly useful in phthisis, in cardiac dyspnoea,
in diseases of the stomach which cause insomnia, in fevers with
prostration and delirium, in delirium tremens, in mania, and in the
majority of painful or spasmodic diseases. If the patient be violently
excited, the opiate should be combined with small doses of tartar emetic,
ipecac, or tincture of aconite. But in the chronic diseases it is
desirable to avoid its continuous administration, not only on account of
the risk of creating the opium habit, but also by reason of the injurious
effects of the drug upon digestion and nutrition.

_Codeine_ is a mild hypnotic which may be used in doses about twice as
large as those of morphine. It is expensive and not very efficient, but
may be sometimes prescribed with advantage when moral considerations
render the use of ordinary opiates inexpedient.

_Lactucarium_ may be classed with the weaker opiates. It possesses very
little value. Its fluid extract is sometimes prescribed at night to allay
the cough of pulmonary consumption, so as to favor sleep.

_Bromides._--According to Mitchell, Echeverria, and Bartholow, the
soporific energy of the bromides may be ranked as follows: Lithium bromide
first, sodium bromide second, potassium bromide third. Hammond praises
calcium bromide. Hydrobromic acid is also employed as an hypnotic in
certain cases. As a clinical fact the bromides of sodium and potassium are
most frequently employed for the relief of insomnia. Of these the second
is most useful when sleeplessness is associated with the phenomena of
irritability; the first is less energetic in its effects upon the motor
structures of the body.

The bromides act upon the protoplasmic constituents of the body, directly
inhibiting their functional energy. Upon the spinal cord they act to
diminish reflex excitability. Under their influence the receptivity and
functional capacity of the brain is reduced. The minute blood vessels
contract in consequence of the inactivity of the tissues which they
supply. A lethargic sleep is thus induced.

For the reasons above stated the bromides find their greatest opportunity
for usefulness in cases of over-excitement and exhaustion of the brain.
When the cortical cells have degenerated into a condition of irritable
weakness, characterized by inordinate instability of substance, the
bromides serve to steady the fabric by retarding those movements of
disintegration which produce morbid wakefulness. Almost useless in cases
marked by active congestion of the brain, they are invaluable in the
insomnia produced by excessive mental exertion, care, emotion, worry and
fatigue. The wakefulness of hysteria, of asthenic mania, and of sexual
excitement, is often greatly relieved by the administration of the
bromides. The prodromic stage of delirium tremens, before any violent
outbreak, and the wakefulness of convalescence from acute diseases are
often cured by their use. Mental disturbances and morbid impulses
associated with pregnancy or the puerperal state may be dispelled in the
same way. The screaming fits of night terrors in children are benefitted
by these medicines. They seem to increase the efficacy of chloral,
chloroform, ether, cannabis indica, hyoscyamus, belladonna, and the
opiates.

The hypnotic dose of hydrobromic acid is twenty-five grains, largely
diluted with sweetened water. For this reason, and for its disagreeable
taste, it is not an eligible preparation. Lithium and calcium bromides may
be given in scruple doses every hour or two till sleep is produced. Sodium
and potassium bromides should be given in doses of thirty or forty grains
every two hours.

It is sometimes remarked that instead of favoring sleep the bromides only
increase wakefulness. In such cases opiates and alcoholic stimulants are
usually indicated.

_Hops._--The principal sedative constituent of this plant is the yellow
glandular powder found in the strobiles; this is called _lupulin_. Hops do
not exhibit any directly narcotic property; but they serve to allay
nervous excitement, and thus favor the occurrence of sleep. They are
principally useful in cases of irritability of the bladder and sexual
organs; in dyspepsia caused by irritable weakness of the stomach; and in
the exhaustion of delirium tremens. The infusion is the best preparation
for internal use. It may be taken in doses of one or two ounces, as
required. Lupulin may be given in doses of ten grains or more. Its fluid
extract is prescribed, fifteen or twenty minims in sweetened water
whenever needed. The best method, however, of securing the beneficial
effects of the medicine consists in the administration of a mild beer that
is rich in hops. A glass at bedtime often forms a sufficient hypnotic.

_Gelsemium_ is a very powerful agent for depressing the pulse and the
functional activity of the spinal cord. It thus favors the induction of
sleep in cases attended with violent excitement, such as may be witnessed
in acute mania. It has been employed in the treatment of delirium tremens;
but the poisonous qualities of the plant render its use somewhat
dangerous. The toxic effects are sometimes developed quite suddenly, and
in a manner very alarming to the laity. For these reasons it is not to be
recommended as a soporific, unless the patient can be continually under
the eye of the physician or of an intelligent nurse.

_Conium_ has been found useful in the insomnia of mania, not through any
narcotic property of its own, but by reason of its sedative effects upon
the spinal cord and nerves. Under its influence the excitement of the
patient is so far reduced that other hypnotic remedies can produce their
effect. For this purpose Squibb's fluid extract, in doses of about
one-third of a drachm, or one-sixtieth of a grain of coniine, may be given
sufficiently often to repress excitement. The alkaloid may be given
hypodermically, and in gradually increasing doses. With it should be
associated other remedies, like hyoscyamus and chloral hydrate, in order
to procure sleep.[49]




CHAPTER IV.

TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.

  Take thou this phial, being then in bed,
  And this distilled liquor drink thou off;
  When presently, through all thy veins shall run
  A cold and drowsy humor, which shall seize
  Each vital spirit.
                                --ROMEO AND JULIET.


Excluding from consideration all cases of insomnia arising from painful
injuries or diseases of the external portions of the body, which belong to
the province of surgical therapeutics, we may profitably commence with the
variety of wakefulness that is excited by disorder of the brain and its
membranes. This includes the different forms of meningitis, the cerebral
disturbances which constitute insanity, cerebral exhaustion, and chronic
alcoholism.

_Insomnia in acute affections of the brain._--Acute intra-cranial
inflammations may result from general diseases, like rheumatism, the
eruptive fevers, tubercular infiltration, insolation, the development of
tumors, or syphilitic growths. In all such cases the earlier stages are
marked by a painful exaggeration of cerebral function which renders sleep
impossible. The wakefulness of this stage soon becomes complicated with
delirium; and the whole is finally merged in a fatal coma. Cerebral
excitement is the principal feature which arrests attention. This is
accompanied by an inordinate determination of blood to the head, producing
that cerebral hyperæmia which figures so largely in the works of the
humoral pathologists. The treatment of acute inflammation becomes the best
means of relieving this excitement, allaying the hyperæmia, and procuring
sleep. The treatment should be derivative, counter-irritant, and
calmative. The first indication must be fulfilled by the exhibition of an
active purge. Ten grains of calomel with five grains of sodium bicarbonate
may be given for this purpose. Leeches or wet cups should be applied to
the temples, or to the back of the neck. The feet should be placed for a
short time in a hot foot-bath, and an ice-cap must be drawn over the
scalp. The internal medication must consist of arterial sedatives and
cerebral depressants. For the first, tincture of aconite forms an
admirable example--better even than the tartar emetic so much lauded by
Graves. Aconite may be given with the bromides. When sleeplessness in an
acute meningitis is accompanied by severe pain, an excellent combination
will be found in the following:

  [R.] Morph. Sulph.               gr. 1/4
       Chloral Hydrat,
       Sodii Bromid. a a           [dr] iv.
       Tr. Aconit., rad.           gtt. xxv.
       Tr. Cardam. Co.             [dr]i .
       Aquæ, q. s. ad.             [oz] i.

  Sig.--A teaspoonful every two hours, till relieved.

As the disease progresses, the quantity of morphia should be reduced. In
epidemic cerebro-spinal meningitis, opiates may be safely employed in
much larger doses than are tolerated in the simple forms of the disease.
When in doubt regarding the proper hypnotic the bromides alone should be
used. Chloral hydrate may also be safely employed in the first and second
stages of meningitis; but if given in full doses near the close of the
second stage it sometimes seems to hasten the appearance of coma.

_Insomnia in insanity._--Persistent insomnia is often one of the
premonitory symptoms of insanity. It is likely to present itself as a most
formidable complication at any stage of the disease. To consider aright
the relations that exist between sleeplessness and insanity would far
exceed the limits of this work; we can only review the leading indications
for its treatment. It is occasioned either by an excited state of the
brain, accompanied by hyperæmia and general functional exaltation, or by
an exhausted and irritable condition of the cerebral substance. The first
of these two varieties of wakefulness is encountered in cases of violent
maniacal excitement where the disorder is comparatively recent, and the
bodily vigor has not been depressed by long continued disease. The
indications for treatment call for sedative measures. Leeches behind the
ears and the application of the ice-cap are sometimes of great service.
Derivative action upon the bowels with aloetic purgatives has often
yielded good results. In like manner, hot mustard foot baths are
recommended. The soothing effect of a warm bath at 90°-95° F. is sometimes
sufficient to calm excitement, and to induce sleep. The combined effect of
cold applications to the scalp and a warm bath to the general surface is
still more tranquillizing. This method of treatment is particularly useful
in maniacal forms of insanity, and in certain cases of
melancholia--especially those in which the skin is dry and the secretions
are disordered.

Cold affusions and shower baths have been employed for their revulsive and
sedative effect in mania. This mode of treatment is sometimes effectual,
but is not without risk.

The medicinal treatment of insomnia is frequently facilitated by the
measures above indicated. In cases of great excitement with restlessness
and bodily agitation, it is desirable to arrest the movements which are
wearying the patient and keeping him awake. This may be accomplished by
the use of conium, as indicated by Kiernan (_loc. cit._). Twenty minims of
Squibb's fluid extract may be given for the first dose. Half this quantity
should be repeated every half hour until the patient becomes quite calm.
Bromide of potassium and hydrate of chloral in drachm doses should be
given in connection with conium. Recently, paraldehyde has been employed
as a substitute for chloral. These remedies reduce cerebral excitement,
and favor the induction of sleep which is at least refreshing, if not
curative of the disease. They should not, however, be used habitually, for
fear of producing the characteristic consequences of over-dosing with such
drugs.

The varieties of insanity in which depression and exhaustion are the
prominent features require different management. Nutritious food,
alcoholic restoratives and stimulant doses of opiate remedies are most
serviceable. The sleeplessness of melancholia and of paretic dementia may
be thus relieved. Opium may be given in the form of a pill, or in the
deodorized tincture. The old fashioned "black-drop" is highly esteemed by
some. Others prefer the salts of morphia. If cerebral hyperæmia be present
in these cases, it is usually associated with asthenic conditions of the
brain, indicated by paleness of the face and weakness of the pulse. The
hyperæmic state is then easily overcome by the administration of alcohol
or of chloral with an opiate. If opiates alone are given in cases of
insanity with great depression, there is danger that death by syncope may
occur, precisely as it sometimes happens in delirium tremens when treated
with large and frequent doses of opium.

Cases are occasionally encountered which receive no relief from opiates.
The remedy seems only to aggravate the existing irritability and insomnia.
For such patients the tincture of hyoscyamus may be employed in doses
ranging from two to four or even six drachms. Associated with bromide of
potassium and hydrate of chloral, it has been used with great success.
Spitzka prefers the simple tincture rather than the fashionable alkaloid,
hyoscyamia.

Cannabis indica associated with bromide of potassium is a useful hypnotic
in cases of moderate depression and excitement. Clouston finds as a result
of his experiments that "forty-five grains of bromide of potassium and
forty-five minims of the tincture of cannabis indica are rather more than
equivalent to a drachm of laudanum as a means of allaying maniacal
excitement."[50] In his recent work,[51] the same author deprecates the
use of opiates in states of depression, and advises the substitution of
tincture of cannabis indica (x min.) and bromide of potassium (xx grs.).
He also emphasizes the importance of abundant exercise in the open air, as
the best hypnotic in every case that can be trusted abroad.

_Insomnia in Chronic Alcoholism and Delirium Tremens._--The insomnia of
chronic alcoholism is dependent upon the extensive morbid changes produced
in the digestive apparatus and in the nervous system by the habitual use
of alcoholic drinks. Sleep becomes greatly disturbed and unrefreshing. It
is frequently broken by horrible dreams. The successful treatment of this
condition requires complete abandonment of the use of alcohol, and a
general correction of the condition of the alimentary canal. For the
immediate relief of insomnia, full doses of bromide of sodium will be of
service. Strong infusions of hops may be given _ad libitum_. Cannabis
indica, in the form of the extract, so as to avoid the use of alcohol in
the tincture, is of service. Hypodermic injections of morphia are
frequently employed, but should be avoided if possible, for fear of the
opium habit. Chloral hydrate is exceedingly useful, but should be given in
milk, and as seldom as possible, for fear of adding to the injuries
already sustained by the stomach. For the same reason the use of
paraldehyde in such cases is quite inadmissable.

When chronic alcoholism has culminated in _delirium tremens_, more
energetic measures become necessary in order to procure sleep. If the
patient be of a vigorous constitution, and if the delirium be very active,
tartar emetic with morphia may be given, as advised by Graves. Large doses
of tincture of digitalis, sometimes reaching an ounce every four hours,
were used by Jones, of Jersey. Capsicum, in scruple doses every three
hours, is said to induce sleep in many cases of delirium,[52] especially
in exhausted conditions of the circulatory organs. Hydrate of chloral and
bromide of sodium, each in scruple doses, may be given every two hours.
Opiates should be used with moderation, and all attempts to induce
profound narcosis should be avoided. Drachm doses of tincture of cannabis
indica and of compound spirit of ether, may be given when a diffusible
stimulant must be associated with the soporific. In desperate cases it is
sometimes necessary to resort to inhalation of ether, but if sudden death
should occur, it would be popularly ascribed to the effects of the
anæsthetic. By reason of a certain tendency to death from syncope during
this disease, it is imprudent to place such patients under the influence
of chloroform or the other stronger anæsthetics.

_Insomnia in diseases of the heart and blood vessels._--I can fully
indorse the opinion of Ringer regarding the beneficial effects of morphia
in the treatment of the wakefulness caused by advanced diseases of the
circulatory organs, "In such a case, the comfort afforded by a hypodermic
injection is almost incredible.... In cardiac dyspnoea, a sixth of a grain
twice or three times a week often suffices, but the dose and frequency in
severe cases must be gradually increased to a quarter of a grain each
night. Doctors are often afraid to administer morphia in the case of a
patient propped up in bed, with livid ears, nose and nails, with distended
jugulars and dropsical extremities, with weak, frequent and irregular
pulse. They dread lest the morphia should weaken the heart, make the
patient worse, if not kill him outright. This fear is quite groundless,"
if the opiate be given in moderate doses. It is the stimulant effect of
the medicine that is safe and useful.

When wakefulness is caused by _angina pectoris_, or by simple cardiac
neuralgia, such as sometimes follows excessive use of tobacco, relief may
be obtained through the exhibition of alcoholic stimulants, hydrate of
chloral, or nitrite of amyl. These remedies act more speedily than
morphia, and may be associated with it, to the great advantage of the
patient. They should not be habitually used, however, in cases of cardiac
exhaustion, as their chronic employment favors accumulation of blood in
the right side of the heart, with a tendency to paralysis of the cardiac
muscles. It is in stenosis of the coronary arteries, and in aortic
obstruction, that nitrite of amyl and nitro-glycerine are most useful. The
insomnia that results from the remote consequences of these diseases is
often relieved by remedies which assist the circulation of blood. For this
purpose digitalis is the most useful stimulant in mitral disease;
nitro-glycerine, in aortic valvular lesion.

_Insomnia in diseases of the respiratory organs._--Pleuritic pain and its
consequent wakefulness may be relieved with opiates, guarded by
appropriate vascular sedatives. Dover's powder, or morphia and aconite,
form excellent examples of the remedies most useful, so long as the lungs
are not overwhelmed by excessive exudations into the pleural cavities.
Pneumonia and bronchitis are accompanied by wakefulness, in their earlier
stages, as a consequence of harassing cough. This may be allayed by the
judicious use of expectorants and sedatives. If symptoms of asphyxia
appear, indicated by blueness of the lips and nails, opiates should never
be given. Respiratory stimulants are then indicated, and sleep must be
allured by the use of alcoholic beverages and moderate doses of chloral
hydrate, with musk and camphor. The early, irritative cough of incipient
pulmonary consumption may be soothed with camphor and opium. Paregoric and
a demulcent, like Iceland moss tea, or flaxseed tea slightly acidulated
with lemon-juice, form an excellent type of such a compound. But the
chronic duration of the disease renders the constant use of opiates
undesirable. Chloral hydrate, for the same reason, cannot be given without
intermission. It is well in such cases to employ the different alcoholic
beverages at bedtime. Inhalation of warm vapor, and respiration of air
charged with ether, or carbolic acid, will often quiet an irritative
cough. In advanced cases belladonna is useful, to check the profuse
sweating and to calm the thoracic pain that hinders sleep. In the later
stages of the disease, when relief from suffering is the only end in view,
morphia and dilute hydrocyanic acid will often render quite tolerable the
few remaining nights of life.

One of the most distressing forms of insomnia is occasioned by the
different varieties of asthma. Dyspnoea is the feature that is common to
them all, and is the principal exciting cause of wakefulness. In recent
cases, which are characterized by spasm, the various anti-spasmodics are
useful. Tincture of lobelia, tartar emetic, and ipecac, are of great
service. Inhalations of ether or of chloroform, or of nitrite of amyl,
will often cut short a paroxysm; but the nervous system soon becomes
tolerant of their action. Chloral hydrate and alcoholic stimulants are
less vigorous, and cannot be long tolerated by the stomach, especially if
there be a gouty diathesis behind the disease. The fumes of burning
pastiles containing nitre and stramonium leaves are often of great service
if so breathed as to thoroughly fill the lungs with the smoke. In like
manner, the smoke from smouldering nitre-paper, or from cigarettes that
have been dipped in an arsenical solution, is sometimes useful. Air
charged with ozone has been found curative in some inveterate cases.
Hyoscyamus, belladonna, and tobacco, have been recommended. It may even
become necessary to employ hypodermic injections of morphia.

If, however, the disease should resist all these anti-spasmodics and
soporifics, besides the remedies addressed to the predisposing causes of
the malady, the only thing that remains is a change of locality. Many very
desperate cases have thus been restored to health and comfort.

_Insomnia in renal disease._--In the acute forms of renal disorder this is
usually caused by pain and fever. It is, therefore, to be relieved with
opiates given in connection with such arterial sedatives and diaphoretics
as each individual case may require. But the tendency of inflammatory
diseases of the kidney to merge in uræmia must not be forgotten, and the
soporific must be used in such cases with great caution. For this reason
hyoscyamus is often preferable to an opiate. In extreme dropsical
conditions the measures that are useful for the reduction of anasarca
constitute the most efficient means for the induction of sleep. In
nephritic colic pain is too severe to admit of any rest while it lasts.
The general treatment of colic is all that can occupy the attention until
relief is secured. The dyspnoea and wakefulness sometimes experienced in
advanced cases of Bright's disease may be greatly relieved by the
judicious use of morphia, very much as in the similar disorder occasioned
by chronic diseases of the heart.

_Insomnia in diseases of the liver._--Inasmuch as the majority of these
diseases interfere with the formation and proper discharge of bile it is
desirable to avoid, as far as possible, the use of opiates in the
disturbances of sleep that are so commonly consequent upon disorder of the
liver. Simple restlessness at night can usually be obviated by the
ordinary treatment that is remedial of the disease by which it is caused.
But it often happens that hypnotic remedies must also be employed.
Hyoscyamus, belladonna, chloral hydrate, and compound spirit of ether, are
frequently useful. Sometimes when the evacuations exhibit a deficiency of
biliary coloring matter, a grain of opium, with a few grains of calomel,
forms a very efficient hypnotic. Alcoholic soporifics are not well
tolerated when the gastro-intestinal mucous membrane is diseased. Biliary
colic demands treatment similar to that that is required in nephritic
attacks. Warm baths, fomentations, and a broad belt of oiled silk around
the body, are very grateful, and are favorable to the induction of sleep.
A course of nitro-muriatic acid, internally and externally, is often
useful when wakefulness is associated with torpidity of the liver.[53]

_Insomnia in gastro-intestinal diseases._--In acute inflammatory
conditions of the stomach and bowels, sleep must be invited by the use of
opiates. Bismuth and morphia, with hydrocyanic acid, are the favorite
means of obtaining relief. Opium in solid form is sometimes preferable
when a slowly developed and long continued impression is desired. Warm
baths and hot poultices also give great relief.

In all chronic affections of the alimentary canal opiates must be used
with great caution, for fear of the opium habit, unless the case be
incurable. Cancer of the stomach requires their free use. The milder
disorders should be managed largely with hygienic treatment. The diet
should be so regulated as to prevent the liberation of gas in the
intestines, for their distention in this way is fatal to refreshing sleep.
A gentle aperient or a large injection of warm water, often proves itself
decidedly soporific in such cases. Catarrhal conditions of the mucous
membrane prohibit the entire class of alcoholic and ethereal soporifics.
Nervous and atonic dyspepsias are often benefitted by the use of bitter
beer, and by drachm doses of brandy or whisky largely diluted. These
should be taken at mealtime, or with food at bedtime. A glass of hot
water shortly before retiring is often useful.

The relief of insomnia in dyspeptic derangement, however, must not be
sought through the administration of anodynes and hypnotics alone. Only
when the entire life of the patient has been regulated upon a
physiological basis can refreshing sleep be obtained. Change of habits,
change of occupation, change of locality--these are the only curative
measures in a vast number of the cases of wakefulness that occur in modern
life. Alcohol, tobacco, tea, coffee, foul air, late hours, and mental
excitement, are the principal causes which must be abolished before
healthy sleep can be enjoyed.

_Insomnia in febrile conditions._--In the early stages of all acute fevers
wakefulness is a very common incident. It is then occasioned by irritation
of the brain, and must, therefore, be relieved with opiates. If the
patient is not depressed by the disease, the opium should be associated
with tartar emetic or aconite, or ipecac. Dover's powder is very useful in
such conditions. In malarial fevers wakefulness should be combatted with
full doses of quinine in addition to the opiate. Gelsemium is sometimes a
very satisfactory remedy--especially in the febrile attacks to which
children are liable. If any evidence of cerebral hyperæmia be observed, it
is well to give chloral hydrate and the bromides. Hyoscyamus, belladonna,
and cannabis indica are useful when the pupils are contracted and when
spasmodic symptoms are present. Lukewarm baths, wet packs, and cool
sponging are exceedingly grateful, and often assist in the evolution of a
suppressed eruption in the exanthematous fevers.

In the later stages of fever a condition of cerebral exhaustion is
sometimes encountered. Irritable weakness caused by starvation of the
brain is the prominent feature. The pulse is small and weak. The patient
tosses and rolls from side to side. He is perhaps greatly emaciated by an
illness of considerable duration. An elevated temperature requires
frequent sponging of the body.

Opium, alcohol, and liquid food, are the best hypnotics in such cases. The
acetum opii and the deodorized tincture of opium are among the best
preparations of the drug, by reason of their stimulant effect. The
equivalent of two grains of opium with a full glass of eggnogg, will often
procure sleep for such a patient. If there be evidence of blood stasis,
with blueness of the nails, hypostatic pneumonia, etc., musk and strychnia
should be given in place of opium, and the circulation should be assisted
with carbonate of ammonia, as follows:

  [R.] Ammon. carb.,          gr. v.
       Spt. chloroform,       gtt. xx.
       Aq. camphor,           [oz] ss.

To be given in a little milk, as required. Chloral and the bromides are of
comparatively little value in all cases where there is considerable
depression of the vital forces.

_Insomnia in rheumatism and gout._--Opium in a diaphoretic preparation,
and associated with alkalies or with colchicum, has always been the most
approved remedy for sleeplessness in the acute forms of these painful
diseases. Salicylic acid and the salicylates have in great measure
superseded the use of opiates for the relief of pain and wakefulness in
rheumatism, but they are not always efficient. Opiates, with or without
chloral, must then be used. Sometimes a painful case that has resisted all
other remedial agents yields promptly to the action of a series of
blisters. The chronic forms of rheumatism require the use of stimulant
diaphoretics, anodyne liniments containing chloroform and belladonna, and
chloral hydrate, or even a Dover's powder, at night.

Acute gout is rarely seen in this country, but its rudimentary forms,
described by Da Costa as _lithæmia_,[54] are not uncommon. They are
associated with wakefulness of a very troublesome character, which only
yields to a persistent and long continued course of treatment directed
against the diathesis. Careful regulation of the diet, change of air, and
anti-arthritic remedies, are of infinitely greater service than any
particular hypnotic drug.

_Insomnia in syphilis._--In advanced stages of syphilitic cachexia, a
variety of wakefulness independent of pain is sometimes observed. It is
marked by a tendency to wake at a fixed hour of the night, frequently
about two o'clock in the morning, after which time sleep is impossible.
The symptoms of constitutional disease are not prominent in these cases,
but the history and the evident cachexia make their nature apparent. They
usually yield to a mercurial treatment. In their comparative freedom from
severe pain, such patients present a striking contrast to certain cases
of syphilitic rheumatism, or neuralgia. The nocturnal suffering in such
instances is frightful. It can be finally overcome by anti-syphilitic
treatment; but, while waiting for the radical cure, palliatives are
needed. Chlorodyne and similar combinations of all the anodyne drugs
afford the most effectual means of relief. I have sometimes found it
necessary to increase the dose until the characteristic delirium produced
by solanaceous drugs was manifested. The relief thus procured sometimes
continues for many days after the cessation of hypnotic medication.

_Insomnia in various disorders of nutrition._--The wakefulness experienced
by syphilitic patients is not peculiar to their cachexia. It is a result
of blood disorder and impoverishment that is common among the victims of
rheumatism, lithæmia, syphilis, malarial poisoning, cancerous dyscrasia,
chronic toxæmia of every form, and ordinary anæmia. Imperfect blood supply
deteriorates the nutrition of the brain, and renders it so excitable that
sleep is interrupted so soon as the period of profound repose is past.
This occupies about four hours (see p. 16), hence the patient who falls
asleep at ten o'clock is ready to wake up at two in the morning, and only
sleeps again, if at all, when wearied with tossing till daylight. Such
patients often derive great benefit from a morning nap thus obtained
between the hours of five and seven.

The most successful treatment of this variety of insomnia is that form of
medication which is addressed to the particular cause of the cachexia or
dyscrasia. But the palliative treatment necessitated by the immediate
suffering of the patient will often tax to the uttermost the ingenuity of
the physician. Usually, there is a chronic atonic dyspepsia, or a chronic
catarrhal gastro-enteritis, or a combination of both conditions, to be
remedied. Gently stimulating laxatives are needed for the relief of these
disorders. An animal diet is most easily digested. Milk and rare
beefsteaks supply this form of nutriment, to which must be added oranges,
grapes and lemons, to prevent the development of incipient scurvy. The
kidneys may be excited with small doses of iodide of potassium or chlorate
of potassium. Only after a considerable course of elimination are "tonics"
admissible. For the immediate relief of the insomnia by which the patient
is exhausted, a rather complex method is needful. Such subjects often pass
the day in tolerable comfort, but, as evening advances, the wearied brain
becomes irritable, and bedtime finds the patient in an excited state which
cannot be easily overcome by large and repeated doses of chloral.
Paraldehyde is too disagreeable to be used with impunity, and only towards
morning does the sufferer yield to the narcotism induced by successive
doses of chloral and bromide. A night thus occupied adds nothing to the
vigor of the individual, and its frequent repetition will most surely lead
to starvation of the nerve-centers,--perhaps to consequent
"chloral-mania."

When the tendency to cerebral irritation becomes thus apparent, great
assistance can be obtained by a resort to the use of opium, combined with
tartar emetic and camphor. A pill containing one grain each of opium and
camphor, with one-twelfth or one-sixteenth of a grain of tartar emetic,
should be given early in the evening. This calms the brain, and prepares
the way for a moderate dose of chloral at bedtime. In this way sleep can
be procured with much less expenditure of nervous force and medicine than
is wasted in the ordinary routine method. The rest thus obtained is
followed by less depression than when it follows stupefaction with large
quantities of an exciting narcotic.

_Insomnia during pregnancy, and after parturition._--Closely akin to the
insomnia of anæmia is the wakefulness experienced by hysterical subjects.
The irritable weakness of their brains renders them peculiarly liable to
disturbances of sleep. The state of pregnancy often serves to fill their
nights with excitement sufficient to interfere with quiet rest. Loss of
blood during parturition, by the induction of temporary anæmia, may
greatly aggravate this condition.

The suppression of nervous irritability is the principal indication for
treatment. This may be temporarily accomplished by the use of the
bromides. But these must be reinforced by an ample dietary, with stimulant
nervines and anti-spasmodics. Good wine, camphor, valerian, hyoscyamus,
cannabis indica, and occasional doses of opium, will generally suffice to
induce the needful repose. If confinement in bed precludes muscular
movement for any length of time, passive exercise must be secured through
the aid of massage.

_Insomnia in spasmodic diseases._--This class of ailments will usually be
encountered among patients who are enfeebled by unfavorable conditions of
health, either congenital or acquired. Together with the specific
treatment appropriate to the particular disorder, it often becomes
necessary to make use of hypnotic remedies against sleeplessness. Thus
chorea may sometimes reach a degree of inveteracy that renders sleep
impossible. Alcohol and chloral hydrate must then be given in large and
frequent doses. A laryngeal catarrh may excite spasmodic croup--a disorder
speedily relieved with chloral hydrate. Old people of a nervous
temperament sometimes experience paroxysms of a similar character,
interfering with sleep whenever they suffer a catarrhal attack. Liberal
doses of assafoetida and a Dover's powder at night, associated with a
course of antilithic treatment, afford great relief. Iodide of potassium,
in the majority of asthmatic affections; the bromides and gelsemium in
cases marked by excitability of the spinal cord; valerian, musk,
assafoetida, camphor, and carbonate of ammonia, in cases of cerebro-spinal
weakness and irritability; oxide of zinc, quinine, and chloral hydrate,
when weariness and exhaustion are connected with a hyperæmic condition of
the brain; such are the principal remedies against this variety of
insomnia. Convulsions, if frequently repeated, may be subdued by the
inhalation of ether or chloroform, until a sufficient quantity of the
bromide of potassium can be introduced into the system.

_Insomnia in childhood._--According to Vierordt,[55] the duration of sleep
in the first week of life is only interrupted by the act of nursing.
During the first month the infant should sleep at least two hours after
each meal, waking only three or four hours out of the twenty-four. This
period gradually increases; but, when a year old, the healthy child still
sleeps more than he wakes. During the second and third years, he should
sleep for ten or eleven hours at night, besides a nap of two hours in the
daytime. After the fourth or fifth year, the daily nap may be
discontinued. The fifth and sixth years require ten hours of sleep at
night. From the seventh to the eleventh year, nine hours are needed. After
the twelfth year, eight hours are sufficient.

The causes of wakefulness are as numerous among children as among adults.
Jacobi[56] insists upon the importance of attention to the ventilation of
the bed-chamber, and to the quality of the bed. Everything must be light,
airy and cool. He gives utterance to universal experience when he asserts
that great heat can be endured by day without harm, if only the night
brings coolness and rest.

Hunger is sometimes a cause of wakefulness among young children. Partial
starvation endured for a considerable time induces somnolence. The
opposite condition of repletion may also excite wakefulness through
painful distension of the stomach and bowels. Earache, terminating in
abscess, often prevents sleep, sometimes without discovery of the cause
until a discharge of pus enlightens the diagnosis. Persistent wakefulness
without evident cause should arouse a suspicion of incipient tubercular
meningitis. Slight elevations of temperature at night sometimes occasion
sleeplessness, which may be overcome with quinine in doses of two to five
grains at bedtime.

Wakefulness sometimes occurs merely as the result of a bad habit. This is
usually observed among delicate children of a nervous temperament, whose
inclinations have never been thwarted. Such patients have been sometimes
cured, after the failure of a long and expensive course of treatment with
homoeopathic globules, by the adoption of a systematic moral training
reinforced by an occasional forcible application of the parental hand to
the gluteal region of the child. Of course such a method must not be
recommended without certain knowledge that no lurking disease of the
nervous system has escaped detection. Fretfulness and wakefulness are not
associated with proper living and good health. Their cause must generally
be sought upon the surface of the body and in its internal cavities.

Much relief in the insomnia of children can be obtained from the use of
lukewarm baths at bedtime. Supper should be a light but sufficient meal.
Every disorder of digestion should be regulated as it occurs. Painful
affections may be quieted with Dover's powder. Feverish and irritable
conditions yield frequently to aperients, or to gelsemium and quinine.
Night terrors and screaming fits should be calmed with chloral hydrate and
the bromide of sodium. As a general sedative and hypnotic for children
hyoscyamus has an excellent reputation. It may be given in considerable
doses with perfect safety and the best results. For patients in early life
it seems to fill the place occupied by cannabis indica in the medication
of adults.

_Insomnia in old age._--The highest physical perfection is reached before
the fortieth year of life. Between this age and the forty-fifth year man's
vigor begins to decline. The power of accommodation diminishes,
necessitating the use of spectacles; adipose tissues begin to load the
body; the hair grows thin, and begins to bleach. The processes of
nutrition and of disassimilation become more sluggish; the appetites and
passions gradually subside. Sometimes the moderation of nervous
excitability thus effected permits indulgences of the appetite for food
that were impossible during earlier years--the nervous dyspeptic can
tolerate dainties which would formerly have been unendurable. Less
disturbed by the solicitations of sense, the powers of reasoning and of
judgment enlarge their authority. Under favorable circumstances this
period of life may continue for about twenty years, when old age develops.
From the sixtieth to the eightieth year the progress of decline is rapidly
accelerated, and life is normally terminated between the eightieth and
eighty-fifth years of existence. The rare examples of greater longevity
are too few in number to warrant the assumption that a century of years is
the physiological complement of life.

As old age advances, the time of sleep is slightly abridged. The moderated
activity of the body requires only a diminished rate of repair to make
good the waste of the tissues. Less sleep, therefore, is needed. But the
liability of age to the incidence of arthritic diseases, rheumatism, and
disorders of the heart, blood vessels, digestive apparatus, and urinary
organs, renders the period of decline particularly subject to those
varieties of sleeplessness which depend upon such derangements of health.
The nutrition of the brain suffers under such circumstances, and the
substance of the organ becomes morbidly irritable. Insomnia among the aged
often owes its cause to these unwholesome conditions. The biography of the
celebrated Carlyle affords numerous illustrations of this variety of
wakefulness. Disease of the cerebral blood vessels sometimes originates a
series of changes differing only in degree and intensity from the
classical type of chronic periencephalitis. This is characterized by many
of the minor phenomena of general paresis, only occasionally rising to the
level of that disease. Wakefulness is one of the most troublesome symptoms
of this disorder. Its management requires attention to all the details of
excretion and nutrition. The diet must be carefully selected with
reference to failure of the digestive function. Milk and water should be
preferred for drink, and the great emunctory organs of the body must be
carefully stimulated and sustained. A judicious choice of climate may
accomplish much for the comfort of the patient. The mild, insular climate
of Florida, or of New Providence, or of the Sandwich Islands, affords
superior advantages for the relief of sleepless sufferers in the northern
temperate zone of the American continent, who need the soothing influence
of a continual open air bath.

During the latest stages of decline, when the cortex of the brain has
become considerably atrophied, the opposite of wakefulness is experienced.
Intellectual operations become less vigorous, and the patient passes
lengthening periods of time in sleep. This is a genuine relapse into the
apathy of infancy. The apparatus of thought is worn out, and the old man
sinks gradually into the sleep from which there is no awakening.

The treatment of insomnia, therefore, resolves itself into the removal of
all special and temporary causes of wakefulness, with attention to the
general hygiene of the patient, and careful regulation of his diet,
habits, and occupation. Pain must be quelled with anodynes. Cerebral
excitement must be calmed, in sthenic cases, with anti-spasmodics and
sedatives--in asthenic subjects it must be overcome with food and nervous
stimulants. Since many patients present a combination of these apparently
opposite conditions, there is room for a great display of penetration and
tact in the management of complex cases. While seeking for the immediate
relief of present suffering, the ulterior consequences of treatment must
always be kept in view, and the particular cachexia or dyscrasia must be
thoroughly appreciated by the physician in his choice of remedies.




CHAPTER V.

DREAMS.

  Behold, this dreamer cometh!
                        GENESIS, XXXVII, 19.


The harmonious activity of all parts of the nervous system is
indispensable to the highest exercise of the conscious mind. Healthy
intellectual life is the perfectly balanced outcome of the complex polygon
of forces which has its seat within the brain. In the waking condition
this "moving equilibrium," as it has been happily termed,[57] is sustained
by the convergent impulses which are continually entering the brain
through the pathways afforded by the several senses. Our waking hours are
occupied with the ideas and with the associated trains of thought which
are thus projected upon the field of consciousness. As a consequence of
the harmonious function of the organs of sense, each one supplementing and
correcting the information furnished by the others, a continuous process
of perception and logical thought is maintained. But, along with the
procession of ideas which are clearly conceived by the mind, the field of
consciousness is also invaded by a cloud of half formed perceptions, which
are too imperfect and fleeting to occupy the attention. As in the act of
vision, though the periphery of the visual field is crowded with a whole
world of objects dimly perceived without challenging particular attention,
only the center of that field furnishing clear images to the brain, so the
eye of the mind comprehends only a few of the impressions which enter the
sphere of consciousness. The swarm of unnoticed perceptions, however, is
none the less the result of abiding sensory impressions graven in the
substance of the brain, from which, through the action of memory, they may
at any favorable moment reënter consciousness. Sleep does not wholly
arrest this process. A certain amount of projection into the field of
consciousness continues, even during profound repose; and the ideas thus
aroused form the material of our dreams.

It has already been remarked that the invasion of sleep is not an
instantaneous process. One by one the senses fall asleep, and long before
the final cessation of their activity, sleepiness hinders their function.
Hence a progressive narrowing of the range of external perception; hence a
reduction of the vividness of impressions derived from the outside world;
hence, also, a simplification of the actions and reactions which
constitute the "polygon of forces" active within the brain. But the
suppression of certain lines in this polygon does not suppress life, nor
does it necessarily destroy consciousness. It only occasions a
redistribution of force, and a proportionate narrowing of the stream of
related ideas. Since this process of suppression, just mentioned, is not
an absolute quantity, but a variable factor, the polygon of physical
forces within the brain and the corresponding succession of ideas in
consciousness must necessarily be in a state of continual change.
Consequently, our dreams must be as variable as the clouds that drift upon
the currents of the air. As, on a hot day in summer, when the equatorial
draught has ceased to guide the wind, we may observe all manner of local
tides among the masses of vapor which arise from the earth, so, in sleep,
when the guiding influence of the senses is withdrawn, the ideas that
still arise are chiefly dependent for their origin and association upon
the automatic and endogenous activities of the brain. Undisturbed by
impulses from the external world, the brain seems then to become more
sensitive to impressions that have their origin within the body. An
overloaded stomach, an enfeebled heart, a turgid sexual apparatus, or an
irritable nervous ganglion, may become the source of irregular and
uncompensated impulses which, without disturbing the organs of special
sense, may invade the cerebral cortex, and may there set in motion a whole
battery of mechanisms whose influence upon consciousness would remain
quite unnoticed were the external senses in full operation.

Still another cause for the production of dreams is to be found in the
more or less complete suspension of the power of volition which
accompanies sleep. Every act of attention is the result of exercise of the
will. But the perfect exercise of the will is dependent upon the perfect
development and wakefulness of the brain. So soon as sleep begins to
invade the brain, the will begins to lose its normal incitement to action,
and finally it becomes almost wholly disconnected from the muscular
organs. In this state the sleeper may desire to perform some act--he may
wish to move his limbs or to cry out aloud, but he can move neither hand
nor foot, he cannot utter a sound. In other instances a partial connection
between the will and the locomotive organs persists, and various orderly
movements can still be produced. In like manner the control of the will
over the succession and association of ideas may be either wholly, or only
partially, lost in sleep. The deeper the sleep the more complete the loss
of such control; hence the greater incoherence as well as feebleness of
impression which is characteristic of dreams when sleep is profound. The
vivid and panoramic succession of visual conceptions which constitutes a
"vision," occurs during light and partial sleep, when the will is still
capable of in some measure guiding the procession of ideas.

For a similar reason the higher faculty of judgment, and especially the
power of arriving at moral conclusions, is in great measure suspended
during sleep. Like the power of volition, the activity of the moral sense
is dependent upon a certain functional perfection in the brain. When the
capacity of the brain is depressed by drugs or by disease, or by sleep,
the moral sensibilities are the first to disappear. Hence the non-moral
character of the impressions usually experienced during the act of
dreaming. We feel neither surprise nor regret at the incidents of ordinary
dreams. It is only when the border line of wakefulness is reached that the
dreamer feels ashamed of walking naked in his dream, or feels compunction
for an act of crime, or experiences emotions of joy or sorrow in
connection with the incidents of his vision.

A dream may, therefore, be defined as the occupation of the field of
consciousness during sleep by a succession of ideas more or less
completely withdrawn from the guidance of the senses and from the control
of the will. A great variety of dreams may thus be admitted, ranging all
the way from those products of mere absence of mind which constitute
_revery_, down to the faintest and feeblest stirrings of consciousness
which have been always observed during the act of waking from the
profoundest sleep.

Considerable light may be thrown upon the production of dreams if we
consider attentively the manner in which illusions and hallucinations are
excited by the use of drugs or by disease during the waking state. When
engaged in experimenting upon myself with different medicines, I once took
a dose of hasheesh sufficient to produce the peculiar effects of the drug.
Sitting quietly in my chair, the first unusual sensation was an agreeable
feeling of coolness diffusing itself over the surface of the body, as if
some one were gently fanning me on a hot day. A feeling of causeless
amusement began to occupy my mind. I seemed to be smiling all over without
any apparent reason for hilarity. Then the walls of the room in which I
sat seemed to recede to a vast distance. My attention became riveted upon
a little picture which hung against the wall before me. It was a sunset
scene, painted upon a canvas scarcely larger than my hand. As the wall
upon which it was placed seemed to recede, the canvas expanded until I
beheld a glorious landscape bounded by a range of snow-capped mountains
flushed with purple light from the setting sun. As I sat, admiring this
splendid scene, the gilded frame of the painting became alive with winged
fairies and cherubs, peeping out from behind the moulding, and bending
over its margin to look into the picture. Then the ceiling of the room and
the sky of the picture seemed to blend in one common expanse of ethereal
blue; the sunlight faded from the mountain peaks; stars began to appear in
the firmament; the little imps and fairies disappeared; and, presently,
everything resumed its natural appearance.

In this experience the departure from healthy cerebral function consisted
in an exaltation of certain forms of sensibility while others were
depressed. The succession of visual images was initiated by the visible
objects around me, but it was enriched by the association of ideas
furnished through the stimulation of memory. The sunset glow, the
snow-capped mountains, the starry sky, were familiar objects, suggested
from memory by the items grouped in the picture. In like manner, the
cherubs who climbed upon its gilded frame were merely the glorified
products of memory, probably suggested by the fact that it was a _picture_
upon which my attention was fixed--one picture reminding me of others
which I had seen. The loss of proportion in the view--the exaggeration and
distortion of all the relations of time and space, which made the unreal
seem real, and conferred grandeur upon commonplace objects, was
undoubtedly occasioned by a modification in the molecular structure of the
organs of special sense and of perception under the influence of hasheesh.
The change thus effected was of a character to diminish the force of
sensory impressions derived through the aid of the muscles and nerves of
the eye and the ear and the skin, while at the same time exaggerating the
processes of memory and association in connection with impressions
originating within the brain. In this way was produced a sort of confusion
between the external world and the ideal world within, rendering it
difficult to distinguish the one from the other. Hence the impossibility
of estimating aright the relation of time and space to the visual
impressions upon which attention was fixed. The result was a waking dream
which differed from ordinary revery chiefly in the intensity of the
impressions that occupied the mind.

A somewhat similar process is sometimes experienced as a consequence of
cerebral disorder unconnected with the effects of drugs. During the
invasion of measles, having taken no medicine but sage tea, I remember, as
night approached, a strange succession of illusions. My head seemed to
expand to the size of a bushel basket; then it would slowly contract
again. My body seemed to grow out of shape into the most distorted forms
of rickets. Audible sounds seemed to come from the most remote distances.
Impending shadows of a great darkness hovered over the bed. Waves of heat,
and tingling darts of numbness traversed my limbs. These singular and
rather uncomfortable sensations continued until relieved by an ordinary
Dover's powder.

In this experience the confusion of ideas, though less agreeable, was
essentially similar to that occasioned by the action of the hasheesh. In
both cases there was the same diminution of the intensity of external
sensation accompanied by an exaggeration of internal impressions. The
brain and the nerves were in a condition of irritable weakness, caused by
disease, which interfered with the normal generation and association of
ideas. Having thus partially escaped from the control of the senses and
the will, the mutilated succession of ideas which reached the field of
consciousness could only be perceived as a series of illusions. Here,
again, was a waking dream, of origin and course analogous to the illusions
and hallucinations which accompany every form of delirium.

It is not alone under the influence of disease or of drugs that the
automatic action of the brain furnishes ideas for the inspection of the
mind. Riding, one day, in a street-car, and reading a philosophical work,
I came upon a paragraph devoted to a discussion of the doctrine of the
association of ideas. Immediately, out of memory, flashed a momentary
vision of the quarter deck of the old frigate, United States, upon which
appeared the figure of a very small midshipman, talking to a gigantic
personage, the captain of the ship. This was an incident which I had
actually witnessed forty years before. I was, at first, somewhat puzzled
in the attempt to account for the occurrence of a vision so apparently
incongruous with the subject matter of the book; but a little reflection
convinced me that the exciting cause of this seemingly involuntary act of
memory was really the idea of association suggested by the book. This had
unconsciously aroused the apparatus of association in the brain, and the
particular scene thus brought before the mind had been further suggested
by the circumstance that the last object, external to the printed page,
upon which I had fixed my attention, was a large ship, lying in the river,
near the bridge, just crossed by the car in which I rode.

Numerous other examples of a similar character might be related to
illustrate the fact that the brain is a reservoir of sensory impressions,
some of which, at the moment of their original incidence, have aroused the
mind to a greater or less degree of conscious attention, and have then all
lapsed into a latent or potential condition. But, though latent, they are
none the less persistent, and only await the suppression of other
inhibitory forces to become once more capable of arousing attention. Such
inhibitory impulses are continually furnished by the action of the sensory
organs on the one hand, and by the energy of the mind upon the other. So
soon, therefore, as the organs of sense and of voluntary impulse are
sealed with sleep, if the remaining portions of the brain are still
operative, and are left to their own unrestrained activity, a more or less
disorderly series of ideas occupies the mind. This constitutes a dream.
The difference, therefore, between waking thought and a dream is analogous
to the difference between a page upon which the words have been arranged
in a rational order, and another page upon which some of the same words
have been set down at random. Inasmuch as the majority of our sensations
are derived through the organs of sight, and since the larger portion of
the sensory region of the cortex of the brain is concerned in the act of
vision, it is no more than might be expected that the ideas suggested in
sleep should generally proceed from the visual apparatus of the brain. The
superior power of visual impressions to attract attention may also serve
to explain the fact that the majority of dreams are composed of images
that were originally perceived in the act of vision. Hence our dreams, for
the most part, constitute a series of pictures undisturbed by sound, or by
other forms of sensation. But this is not always so. It is highly probable
that when the organs of external sense are allowed to sleep without
disturbance, our dreams consist of visual impressions alone. But, if any
unusual sound, or smell, or other sensation is experienced during sleep,
it may penetrate the field of consciousness, and may become the starting
point of a dream quite filled with sounds. Thus a young lady, who had
passed the evening at a musical concert, was aroused, soon after retiring,
by the striking of a clock which had been recently placed in her chamber.
At the moment of waking, she was dreaming of an orchestral performance of
Wagner's music. Doubtless the dream was suggested by the unaccustomed
sound of the clock.

The possibility of thus suggesting, and in some degree guiding, the form
and course of a dream, has been often demonstrated.[58] One of my early
schoolmates, a boy of remarkably susceptible nervous temperament,
furnished an excellent example of this species of direction. Tickling his
nose with a straw made him dream that a dragon-fly was assaulting his
face. On another occasion, a few drops of vinegar placed upon his tongue
caused him to dream of eating oranges. Again, one of his companions
roguishly breathing in his ear the statement that the schoolmaster was
after him with a long rattan, he bounded out of bed, and could scarcely
be restrained from bursting out of doors in his evident alarm. I was
myself awakened, one night, by the ringing, as it seemed, of my doorbell;
but, hastening at once to the door, no one was there. As I was expecting a
call from a certain patient, I concluded that the bell had been rung by an
impatient messenger who could not wait. Falling again asleep, I was a
second time startled by a similar ring. Looking out of the window above
the door, it was evident that no one was there. I finally concluded that
the sound must have been perceived in a dream, and I recalled the fact
that each time, as I woke, the sound of a carriage, passing the house, had
attracted my attention. Undoubtedly, the state of expectancy in which I
was sleeping had operated as the predisposing cause of dreaming, and the
noise of wheels upon the pavement had served as the exciting cause of a
dream in which the sound-vibrations communicated to the brain had produced
by an association of ideas the particular perception which, though asleep,
I was waiting to receive.

In certain cases the impression produced by a dream is so vivid that a
considerable time after waking must elapse before it can be relegated to
its true position in the world of hallucinations. Dreaming, once, that my
wife called to me from another room, I instantly awoke; and only the fact
that she was with me could satisfy me that it was all a dream. Taine[59]
relates that "M. Baillarger dreamed one night that a certain person had
been appointed editor of a newspaper; in the morning he believed it to be
true, and mentioned it to several persons who were interested to hear
it;--the effect of the dream persisted all the forenoon, as strongly as
that of a real sensation; at last, about three o'clock, as he was stepping
into his carriage, the illusion passed off; he comprehended that he had
been dreaming."

The following incident from the experience of Prof. Jessen, physician to
the insane asylum in Homheim, near Kiel,[60] still further illustrates
this form of hallucination:

"On a wintry morning," writes the professor, "between five and six
o'clock, I was aroused, as I thought, by the head nurse, who reported to
me that some people had come for one of the male patients, and who at the
same time asked me whether I had any particular orders to give. I replied
that the patient might depart, and after he had left the room I turned
around to go to sleep again. All at once it struck me that I had
previously not heard anything regarding the intended departure of this
patient, but that only the prospective departure of a woman of the same
name had been reported to me. This compelled me to inquire more
particularly after the circumstances, and accordingly I lighted a candle,
rose, dressed myself, and went to the room of the head nurse. To my
surprise I found him only half dressed, and, in reply to my inquiry after
the people who had called for the patient, he said, with an expression of
astonishment, that he did not know anything of it, as he had but just left
his bed, and no one had called him. This answer did not arouse my
consciousness, but I rejoined that then the steward must have been in my
room, and that I should accordingly go to see and ask him regarding the
matter. When descending a few steps in the middle of the corridor which
led to the room of the steward, I suddenly became conscious of having
dreamed only what until that moment I had believed to be an experience
whose reality I had not doubted in the least."

In some instances the fact of having dreamed is never recognized, and the
dreamer carries through life the delusion that his vision was an actual
occurrence. Among the Indians of Guiana, and the same thing is true of
many other savages, dreams are looked upon as actual events in which the
dreamer is visited by spirits or even by other living men. A recent
English traveler[61] says: "It becomes important, therefore, fully to
recognize the complete belief of the Indian in the reality of his
dream-life, and in the unbroken continuity of this with his working life.
It is easy to show this belief by many incidents which came under my
notice. For instance, one morning, when it was important to me to get away
from a camp on the Essequibo River, at which I had been detained for some
days by the illness of some of my Indian companions, I found that one of
the invalids, a young Macusi, though better in health, was so enraged
against me that he refused to stir, for he declared that, with great want
of consideration for his weak health, I had taken him out during the night
and had made him haul the canoe up a series of difficult cataracts.
Nothing could persuade him that this was but a dream, and it was some time
before he was so far pacified as to throw himself sulkily into the bottom
of the canoe. At that time we were all suffering from a great scarcity of
food, and hunger having its usual effect in producing vivid dreams,
similar effects frequently occurred. More than once the men declared in
the morning that some absent men, whom they named, had come during the
night and had beaten or otherwise maltreated them; and they insisted upon
much rubbing of the bruised parts of their bodies."

It is highly probable that from these facts, and from others of a similar
character, may be derived the true explanation of many of the supposed
examples of intercourse with divine or angelic persons which occupy so
important a place in early mythology. An incident in the childhood of the
prophet Samuel can scarcely admit of any other interpretation. In other
cases, notwithstanding the intensity of the dream, its true character is
recognized by the dreamer during the very act of vision. Thus, I once
dreamed that I saw a young girl standing before me. So vivid was the
perception, that the actual presence of such a person could not have
produced a more perfect impression upon the waking brain. Yet, at the same
instant, I comprehended the fact that it was merely a dream, and remarked
the difference between the intensity of the visual image in this and in
other dreams. Such speedy recognition of the hallucination does not always
accompany the act of waking out of a dream. In some cases, as we shall
have occasion to see, the images which have figured in a dream are still
perceived for a certain period of time after awaking.

The majority of dreams are composed of visual images. The dreamer looks
upon a picture which changes silently before his eyes, without appealing
to any other sense than that of sight. But in certain cases any other
sense may become excited, producing illusions or hallucinations as perfect
as the images of healthy vision. They may be suggested by external
impressions, as in my dream of a ring at the door bell, which proved to be
an auditory illusion excited by the sound of passing carriage wheels; or
they may, at least apparently, find their starting point in accidental
states of the bodily organization. If attention be paid to this matter, it
will be observed that all unusual modes of dreaming, and all extraordinary
vividness of dream-impressions can be connected with some departure from
the physiological conditions of quiet sleep. Either disease, or
exhaustion, or emotional disturbance, or narcotic intoxication of the
brain may be noted as the immediate cause of such derangement of the
cerebral functions. After drinking several cups of coffee before retiring,
I dreamed of a large yellow flower which exhaled a very fragrant odor.
During the same night I also dreamed of drinking wine, which agreeably
excited the senses of taste and of smell. Upon another occasion, having
been disturbed by the entrance of burglars into my house, I dreamed that a
burglar was fumbling under my pillow, and was raising my head and
shoulders with the mattress upon which I slept. I seemed to feel the
changes of pressure and of contact as distinctly as if awake. The
connection of voluptuous illusions with erotic dreams is too familiar to
require particular mention.

Dreams are not always limited to the revival and combination of the images
of sensation. Intellectual combinations are sometimes thus presented to
the mind. The most familiar illustrations of this fact are furnished by
the experience of mathematicians who have worked out mathematical problems
in their dreams. One of my patients, an expert book-keeper, dreamed of
adding up six columns of figures at once. In the morning he still
remembered his dream; and, on adding up the columns, found that he had
actually produced the right sum in each case. A college student of my
acquaintance, who was puzzled by a geometrical proposition, wrote out the
correct solution during his sleep. This was something more than simple
dreaming; it trenched upon actual somnambulism. Another acquaintance
dreamed of being in heaven, and, while there, experienced relief from
doubt regarding certain theological doctrines which had previously
exercised his mind. I have myself composed several sentences during the
course of a dream, and have, while dreaming, sometimes esteemed them
worthy of preservation; but my waking recollection has never coincided in
this particular with the opinions formed during sleep.

Great difference between dreams may be remarked in their coherence and
continuity of evolution. Some are composed of the most inconsistent
elements without order or logical arrangement. In others the incidents
follow very closely in the line of a natural and rational development, so
that the dreamer seems to be present as a spectator of a perfectly
coherent drama. It is probable that these differences depend upon
variations in the degree of completeness with which the different parts of
the brain and of the body are overwhelmed by sleep. If different and
widely separated portions are sufficiently wakeful to suggest ideas to the
mind, the resulting congeries will consist of discordant and incoherent
elements. But if wakefulness is limited to a particular organ of the body
or to a circumscribed territory of the brain, the resulting impressions in
consciousness should be correspondingly restricted, and will manifest a
more orderly connection with each other. In some cases a tendency to
simultaneous wakefulness of particular portions of the cerebral register
seems to become habitual, so that the same set of ideas may be often
renewed in the same order during sleep, constituting a repetition of the
same dream. In this way I have frequently dreamed of a volcanic eruption
of molten lava from a lofty mountain. This frequent revival of the same
train of images is probably due to the fact that in childhood I actually
witnessed a volcanic outbreak, and that a very highly colored picture of
Vesuvius in eruption hangs in my sitting room, so that my brain has become
profoundly impressed with this particular image. When other portions of
the brain are asleep, if the special region concerned with this picture be
aroused, the mind receives the same impression which it received when
first excited by that portion of the organ of memory.

As a general thing, however, dreams do not possess any such compactness
and coherence. They are usually derived from many different portions of
the cerebral organ, even when they seem to exhibit a fluently connected
course. Thus, I dreamed, one night, that I was walking in a garden filled
with peculiar oriental shrubbery. In this garden I discovered one of my
brothers and a friend, who is widely known in literary circles, engaged in
flying a kite. With great adroitness they had succeeded in causing the
kite-string to describe in the air the outline of the letter Z. I
congratulated them on the adoption of so truly scientific a method of
kite-flying; telling them, also, that I had once succeeded in making a
kite-string describe a fourth line, thus: [Symbol] As they expressed
surprise at this, I told them that in the May number of the Atlantic
Monthly, for 1883, they would find an article on this method of
kite-flying, written by Oliver Wendell Holmes.

Nothing can seem more absurd than such a sequence of ideas. They follow
each other without a break, yet without any logical coherence, very like
the order in which ideas arise to occupy the mind of an insane person.
Indeed, such dreams suggest the doctrine that the condition of a dreamer's
brain is functionally identical with what obtains in certain forms of
insanity. At first sight it would seem as if such a dream could have no
possible basis in fact. But a brief retrospection enabled me to trace each
individual item to its source in memory, and I was able to construct the
following key to the vision: During the previous evening I had been
examining a number of East Indian photographs. Among the most remarkable
of them was a picture of the glorious gardens of the Taj, at Agra. Another
represented the ruined Buddhist tower at Sarnath, a structure remarkable
for the numerous triangular figures carved as ornaments upon its sides.
Hence the garden and the zigzag kite-string in the dream. During the day
before, while conversing with a neighbor regarding the financial
misfortunes of an acquaintance, I had remarked that if he had stopped
kite-flying, and had settled down to legitimate business at last, he would
doubtless do well in the future. Hence the kite. I had recently received
an interesting letter from my literary friend in which he had mentioned my
brother. Hence the two principal actors of the dream. Just before
retiring, that night, I had discussed with my wife the subject of
subscribing for a number of periodical magazines. Hence the Atlantic
Monthly; and, as the celebrated Oliver Wendell Holmes was the author most
intimately associated in my mind with that periodical, his introduction
among the characters of the dream followed most naturally in accordance
with the law of the association of ideas.

The question is continually asked, why are certain dreams so vivid and so
easily remembered, while others are of the faintest and most evanescent
character? My own experience leads me to believe that there is a morbid
element underlying all unusually vivid dreams. It is not merely because of
differences in the depth of sleep. The flitting fancies which occupy the
introduction and the termination of sleep, rarely possess any power to fix
the attention or to linger in memory. But, if the body be disturbed by
anything which causes a departure from the even course of health, such as
follows unusual or violent emotion, or an attack of illness, or an
insufficient alimentation, or great and sudden changes of atmospheric
pressure, the visions of the night become wonderfully exaggerated in every
particular. During a voyage at sea, while suffering considerably with
thirst, one night I dreamed that a fountain of sparkling water suddenly
appeared before me. A young girl dipped a pitcher in the flowing stream,
and held it out, all dripping with delicious coolness, for me to drink.
Pressing eagerly forward, I awoke, to find myself sitting up in my narrow
berth, with hands extended for the draught. Every narrative of shipwreck
is filled with similar experiences. Slow starvation is always accompanied
by dreams of singular intensity and persistence. As an illustration of the
corresponding influence of previous emotion, I may cite the experience of
a friend who had been greatly shocked by reading the account of the manner
in which the lunatic, Freeman, had killed his little son in imitation of
Abraham's contemplated sacrifice of Isaac. This gentleman dreamed that he
was about to sacrifice his favorite daughter. He called her to him; told
her that he was about to cut off her head as a religious sacrifice; and
took up the knife for that purpose. She exclaimed, "Oh, papa! I have never
disobeyed you yet!" and extended her neck, to receive the fatal stroke,
when he awoke, trembling in every limb, and drenched with perspiration.
For a long time the horror of this dream affected him as terribly as if it
had been an actual experience.

It is usually difficult to arrive at any exact estimate of the time
occupied by a dream; but it appears certain that in some instances the
succession of images excited during sleep must be exceedingly rapid.
Abercrombie, in his work on the "_Intellectual Powers and the
Investigation of Truth_," p. 275, has related several illustrative
examples of this fact. In my own experience, one night, as I lay half
asleep, I heard the watchman on his round, as usual, examining the
fastenings of my front door. At once I began to dream that I was
revisiting my father's house, the home of my childhood. The family were at
breakfast in the front parlor, while I walked through the back rooms,
examining the doors and the windows, and found it impossible to close and
to fasten them. I then took a bath, dressed myself, and walked out into a
large garden behind the house. It was filled with tropical trees, of which
some were young. The old ones, which I recognized after an absence of
thirty years, astonished me by their surprising luxuriance. A lovely,
trailing convolvulus, in full bloom, attracted my admiration. After
walking for some time I came upon a plum tree which was very small when I
left home, and had now reached a height not exceeding twelve feet. This
slow growth excited considerable surprise on my part. Returning to the
house, I passed the day with my parents, and, at night, undertook to shut
up the house, but could not fasten any of the doors or windows. This
caused me great uneasiness, for there was a large gypsy camp not far from
the east end of the building. My anxiety was presently justified by a
noise in the parlor. Hastening to the door, and looking into the room, I
saw a large painting disappearing through a hole in the wall next to the
encampment of thieves. I immediately cried out, to frighten away the
robbers; and was awakened by my wife, shaking me, and asking what was the
matter, just in time to hear the watchman walking down the front steps,
after the completion of the investigation which had suggested my dream.

Another experience may serve to illustrate the fact that dreams are
greatly intensified by illness, and that their duration may be exceedingly
brief. Suffering, one night, from an attack of intestinal colic, marked by
a rapid succession of painful paroxysms, between which, however, I fell
asleep without the aid of medicine, I dreamed in one of these snatches of
slumber that I was walking with my brother on the road to the volcano of
Kilauea. In my hand were four diamond shirt buttons. They were white, and
were covered with fine asbestos wool. My brother's wife expressed serious
doubts regarding their value; but I at once reminded her that the Emperor
of China had given to the English Ambassador, for presentation to the
Queen of England, a number of diamonds which were so rough and so cheap in
appearance that the ambassador, who was also a marquis, could not suppress
his contempt as he received the gift. But, when carried to London, and cut
by the royal jewelers, their brilliance had astonished everyone. I now
desired to deposit my diamonds with a jeweler, for safe-keeping. My
brother recommended a house near the volcano, but I had seen another, a
few squares further up the road, and accordingly resorted thither. Not
finding any satisfactory evidence of business, I retraced my steps to the
place first recommended. Entering the door, I found myself in a narrow
room, with a long, low counter on one side. Behind this were several men,
and several cases filled with jewelry. I handed my buttons to a large,
good-looking fellow, who was bustling around in his shirt-sleeves. He
immediately put one of the jewels into his mouth, when I heard something
crack, as if either his teeth or the diamond had split. Consoling myself
with the recollection that, if broken, a diamond could be mended with
cement, I asked for a certificate of deposit. While this was being
written, the entire building slipped away from over us, and glided down
the slope of the mountain, towards the ocean, leaving us, and all that had
been within the house, uncovered in the open air. This did not disconcert
any one. The jeweler finished his writing; I pocketed the receipt, and
with my brother pursued our walk through the mountain forests beyond the
crater of the volcano. Presently we arrived at an eminence from which we
could look down upon the ocean, and could see the line of the coast
prolonged for many miles on either side of a cape of land. The western
coast was very grand--mountain promontories rising behind each other as
far as the eye could reach. Having feasted our eyes with this magnificent
panorama of earth and sea and sky, we turned away in the direction of a
grove, in which was visible a large building of stone, with castellated
walls, and turrets with pointed roofs at the corners. My brother informed
me that this was a German settlement, called Little Clacius. Approaching
the castle, we were received in a magnificent hall by a beautiful woman
who offered to conduct us through the building. She led us through a
series of lofty rooms, splendidly painted, gilded, frescoed, and furnished
with inlaid tables and polished chairs. On either side were ranged large
vases, in which grew what I seemed instinctively to recognize by the name
of the Lace Mimosa--each plant consisting of a flat sheet of green
lace-work, like a coralline, studded with lovely pale yellow blossoms.
Passing through three such rooms, we entered a fourth, across the floor of
which our fair guide whirled herself with a pirouette into the presence of
a young woman clad in a richly figured dressing-gown, drawn lightly around
her form as she sat in an easy chair, nursing her baby. We were formally
introduced to this lady, who received us with the most evident
indifference, a circumstance which gave us no concern, for the view from
the open window at once engrossed my attention. Directly before me was a
shining river, pouring down the mountain side and falling about fifteen
feet into a deep dark pool that widened beneath the window from which I
gazed. High banks, covered with magnificent trees, sloped down into the
water, and cast their shadows across its rippling surface, forming a most
charming landscape. The breadth of the scene, the depth of the coloring,
the perfection and the multiplicity of all the details that pressed upon
the attention, could not have been surpassed in vividness by any real
existence. I was admiring the view, and was beginning to feel surprised
that so large a river could exist in such a place, when I was suddenly
awakened by a renewal of the intermittent pain.

In this example each individual detail could have been easily traced to
its source in memory. Pictures, and actually existent scenery furnished
the detached items which were combined in a brain that for the time being
was released from the control of the reason and the will. Irritated by
painful sensations the brain was inordinately excitable, and sleep was
less profound. Hence the remarkable intensity of the pictures which were
presented to the eye of the mind. The indescribable richness and variety
of the vision was probably due to the fact of extensive bodily
disturbance, opening a wide range of territory from which impressions were
communicated to the morbidly sensitive brain. The unusual permanence of
the whole dream in memory may be explained by the observation of Maury,
that the ease with which dreams are recollected varies inversely with the
depth of the sleep in which they occur. Dreams which are produced in sound
sleep are seldom recalled after waking, because they are but slightly
connected with impressions received by the brain during wakefulness.[62]
But dreams which occupy the mind when sleep is light and partial are
excited by cerebral movements which are closely associated with external
impressions that originate either at the moment of awaking or immediately
after that event; consequently, the bond of union between the ideas of the
dream and our waking ideas is nearly if not quite as perfect as the bonds
which serve to connect the thoughts that occupy any portion of our
conscious life. Hence such dreams are more easily reproduced from memory
by any disposition that arouses a retrograde association of ideas.

The dream above related, though excited by an unhealthy condition of the
body, was not at all disagreeable. But it is often the case that disorders
of particular organs serve to originate visions with special and evident
characteristics related to their source. Thus, one of my patients, during
an attack of uterine and hemorrhoidal congestion, would dream that a heavy
weight had been laid upon the lower part of the abdomen. On another
occasion, having gone to sleep, apparently in perfect health, she dreamed
of a terrible pain in the head, and that her husband and a physician were
applying a cupping glass to the back of her neck. This woke her up, and
she found that she was actually suffering with a very severe headache.
Another lady, shortly after confinement, dreamed that her baby had teeth,
and that it was biting her nipple. Next day she discovered a tender spot
in the breast, which rapidly developed a mammary abscess. Forbes
Winslow[63] has collected a considerable number of similar cases. In
certain instances not only have dreams been originated by special local
pain, but the incipient stages of insanity have been revealed by
exaggerated dreams. One of my patients, for a considerable time before the
evolution of an attack of melancholia, would dream, every night, that a
big black dog came into her bed. Another, who suffered with cardiac
palpitation, caused by excessive tea-drinking, was often visited in sleep
by a mocking imp who seated himself upon the pit of her stomach, and
pressed her ribs together with his hands.

The distress or alarm which accompanies such dreams is sometimes
sufficient to arouse the sleeper. Often, however, he strives, in his
vision, to escape from some impending horror, or to lift up his voice in
a cry for help, but the will is powerless to reach the necessary muscles,
and no movement results. In such cases the portion of the brain in which
the will resides is awake, but the conducting fibres which intervene
between the cortex of the brain and the locomotive ganglia in the
cerebro-spinal axis are asleep, and cannot be sufficiently aroused to
transmit the impulses derived from the action of the will.

In all ages of the world a belief in the prophetic character of certain
dreams has prevailed. Numerous examples are recorded in which a warning
intimation of approaching disaster has been thus received. Thus the holy
evangelist, St. Matthew, relates that Joseph, the husband of Mary, was
guided by dreams to escape with his family from the murderous designs of
Herod and of his son Archelaus. The literature of the middle ages is
filled with similar narratives. Coming down to recent times, it is not
difficult to gather numerous examples of dreams which have been excited by
presentiments of good or evil. A lady who was about to embark upon the
ill-fated steamer Arctic, dreamed so vividly of shipwreck that she refused
to take passage, and thus escaped the frightful disaster which overwhelmed
the ship and its numerous passengers. Max Simon[64] relates the case of a
lady who, in spite of a similar warning, embarked upon a steamship and
lost her life, through the explosion of the boiler during the voyage. On
another occasion[65] a noble lady dreamed that a wing of the palace in
which her children were sleeping was about to fall down. Starting up, she
called her waiting maids, and insisted that they should bring the children
to her chamber. The women endeavored to calm her agitation, quoting an old
proverb to the effect that "dreams go by contraries." As she persisted in
her commands, they feigned obedience, but soon returned to say that the
young princes were sleeping too quietly to be removed. The princess would
not be thus composed; and at last the servants reluctantly brought the
little boys from their room. They had scarcely reached their mother's
apartments, when the disaster of which she had dreamed was realized, and
the bedroom from which they had just been carried, was crushed into a mass
of ruins.

The ancient explanation of such events consisted in a reference to the
Deity, who was supposed to address his favorites through the medium of
dreams. The modern skeptical explanation views all such revelations as
mere accidents. Among the myriads of dreamers, say the "five-sense
philosophers," the infinite variety of combinations which disturb the
brain during sleep, cannot fail to produce occasionally such coincidences.
When these are of a striking character, the seemingly prophetic vision is
remembered, but the cases of discrepancies between vision and result are
not recorded, and are soon forgotten. This opinion may very probably be
correct in the vast majority of instances; but, if so, we are not in a
position to assert any scientific demonstration of the fact. There is,
moreover, so far as the ancient religious view is concerned, a certain
transcendental sense in which it is true that God may guide his creatures
through the agency of dreams, as well as in a thousand other different
ways; but this metaphysical process we can no more comprehend than we can
understand or explain the interaction of mind and matter in the brain. The
psycho-physiologist must content himself, at present, with the attempt to
show that it may not be incompatible with natural law for coming events to
cast their shadows before them through the forms of a dream. The following
observations lend color to such a possibility.

The extraordinary susceptibility of the brain during certain conditions of
sleep has already been noted as a cause for the superior vividness of
coloring and intensity of action which sometimes characterizes our dreams.
In this respect a slightly morbid condition of the brain, comparable to
the effects of hasheesh, probably exists. In such cases the brain may be
disturbed to a degree sufficient for the awakening of consciousness by
causes that would ordinarily be powerless to reveal themselves. Recording
his experience of an earthquake at Lesina, in the night of Sept. 8, 1884,
Buschick states, in the Journal of the Austrian Meteorological Society,
that a few seconds before the shock he was awakened with a feeling of
strange discomfort and apprehension. Once before, on a similar occasion,
he had been in like manner aroused from sleep just before the commencement
of an earthquake, probably by a feeble and ordinarily imperceptible
agitation of the soil. At a time when I was for many months severely
overtasked, I always woke up in the night whenever about to receive a call
to a patient. Before the sound of footsteps became audible on the
sidewalk, I would wake. Presently some one would be heard, approaching the
house, and then the doorbell would ring. So often was this experience
repeated, that I learned to expect a summons whenever awakened during the
night. Gradually, however, as my health improved with rest, this morbid
excitability disappeared, and has never been renewed. It seems probable
that in this example the sensitiveness of the brain during sleep was so
great that audible impressions were received with vigor sufficient to
awake consciousness before they were sufficiently strong to arrest the
attention when actually awake. The extreme sensibility of the brain, under
certain conditions, to impressions from a distance, is further illustrated
by the experience of persons laboring under diseases which produce serious
departures from a healthy cerebral circulation. Thus, one of my patients,
while suffering with cerebral hyperæmia, could hear children talking half
a mile away, at a distance where no one else could hear them. This
susceptibility is doubtless the foundation of many well authenticated
cases of presentiment. Another of my patients, a lady of remarkably
sensitive nervous organization, though otherwise in apparently good
health, was one evening lying alone upon her bed. Suddenly, she became
greatly agitated with the conviction that something had happened to her
husband, who had not yet returned from his place of business. He
presently, however, came quietly into the house, and greeted his wife as
usual. She exclaimed at once, "What has happened to you, my dear?"
"Nothing," he replied. "Yes," she said, "something has happened, just now;
I felt that you were in trouble." "Oh, yes," answered he, after a moment's
reflection, "as I was passing by the park, on my way home, two men tried
to stop my horse, but I whipped up, and got away from them without any
trouble."

On another occasion the same patient was one day suddenly oppressed by a
conviction that something had happened to her mother and sister, who were
driving together at some distance from home. After a short time they
actually returned in a sorry plight, without their carriage. The horse had
run away, upsetting them upon the road.

In all these cases it is worthy of remark that there was present an
unusual degree of cerebral erethism. Solicitude, weariness, anxiety,
inordinate irritability of the brain. It is possible that under such
conditions one may hear premonitory sounds, may in some sort feel distant
agitations which our healthy organs are usually incapable of apprehending.
When such a brain during sleep is unoccupied with the ordinary objects of
sensation, feeble impulses, which usually remain unnoticed, may sometimes
suffice to arrest the attention. We may thus explain the possibility of
impressions derived from distant events passing into the consciousness of
a dreamer, and arousing hallucinations of which the immediate cerebral
mechanism is the same as that of the ordinary hypnagogic hallucination.
Thus, the Rev. Canon Warburton relates the following experience[66]:

"Somewhere about the year 1848 I went up from Oxford to stay a day or two
with my brother.... When I got to his chambers I found a note on the table
apologising for his absence, and saying that he had gone to a dance
somewhere in the West End, and intended to be home soon after one
o'clock. Instead of going to bed, I dozed in an arm-chair, but started up
wide awake exactly at one, ejaculating, 'By Jove, he's down!' and seeing
him come out of a drawing-room into a brightly illuminated landing,
catching his foot in the edge of the top stair, and falling headlong, just
saving himself by his elbows and hands. (The house was one which I had
never seen, nor did I know where it was.) Thinking very little of the
matter, I fell a-doze again for half an hour, and was awakened by my
brother suddenly coming in and saying, 'Oh, there you are! I have just had
as narrow an escape of breaking my neck as I ever had in my life. Coming
out of the ball-room, I caught my foot, and tumbled full length down the
stairs.'"

An incident of this character might very properly be ranked as a mere
coincidence, were it not for the fact that it is one only of a
considerable number of well attested acts of vision connected either with
the hypnagogic state or with the act of dreaming itself. The comparative
rarity of such events lends them a marvelous aspect; yet there is really
nothing about them any more wonderful or preternatural than the
demonstrated possibility of telegraphic signaling across the sea without
the intervention of an electric wire.[67] Under ordinary circumstances a
metallic conductor must serve as the avenue of communication between
distant stations; but if a sufficiently sensitive piece of apparatus be
placed in contact with the water on either side of an arm of the sea,
communications may be transmitted from one to the other by a diffusion of
impulses through the entire body of water.

In like manner we ordinarily see and hear and feel as a consequence of
cerebral excitement occasioned by specific impressions concentrated
through the organs of sight and hearing and touch. But it is quite
reasonable to believe in the possible existence of a brain so delicately
organized as to be capable of reacting to impressions which are too
diffuse and too feeble to arouse the ordinary apparatus of sensation. With
such a brain it might be possible to experience perception without
eye-sight. Evidence furnished by the facts of somnambulism and hypnotism
indicates that the receptivity of the brain may become temporarily exalted
to a degree which warrants the inference that clairvoyance itself may be
thus brought within the capacity of certain peculiarly sensitive
organizations. The same extraordinary receptivity occasionally seems to
attend the act of dreaming. For example, one of my acquaintances, a lady
of a highly wrought nervous temperament, the wife of a distinguished
physician in a neighboring State, dreamed one night that a favorite
cousin, a beautiful little girl, who lived at a distance of twelve or
fifteen miles, was very dangerously ill. She saw the child lying on its
mother's lap, evidently at the point of death, when some one brought a tub
of warm water and proceeded to give the patient a bath. This revived the
little one so that she recovered. The dream made a very considerable
impression upon my friend, by reason of its peculiar character, and
because dreaming was for her a very unusual experience. Next morning she
rose as usual, but during the forenoon she was startled by the receipt of
a message requesting her to come at once to the house of her uncle, as his
little daughter had been taken suddenly ill with the croup, and had
expired during the preceding night. Hastening to the bereaved household,
she found her aunt sitting with the dead child on her lap, precisely as
she had appeared in the dream. The little girl had been suddenly attacked
during the night, and, as she lay gasping in her mother's arms, some one
advised a warm bath, and brought a tub of water into the room for that
purpose. Unfortunately, just as they were hopefully preparing to dip the
child into the water, she had ceased to breathe.

The lack of conformity between the conclusion of this dream and the actual
fact reminds one of the blurring of the images that are transferred from
one brain to another in the acts of telepathy recently investigated by the
Society for Psychical Research. Something similar is frequently observed
in connection with the phenomena of hypnotism. The hypnotised subject does
not always perceive clearly or wholly the sensation that is suggested by
the agent who operates upon his brain.

For another example of apparently clairvoyant dreaming, I am indebted to a
friend, a well-known gentleman of unimpeachable veracity, who, when a
young man in the army, during the war of the great rebellion, was taken
very ill, and was sent home to New England from one of the most remote
outposts of the campaign. No one of his family had the slightest
information or suspicion of his illness, until the night before his
arrival, when his father dreamed that the absent son was sick, and would
arrive the next day, at an hour unusual for travelers coming from the
South. So vivid was this dream, and so powerful was its influence upon the
mind of the dreamer, that he went at the specified hour to the railway
station, with a carriage full of blankets and pillows, to receive his son.
When the train arrived, and the invalid actually appeared, the mutual
astonishment of father and son can better be imagined than described.

In a recent work on hypnotism,[68] Fischer has related several personal
experiences of a similar transfer of impressions during the waking state.
It is highly probable that if such impressions are received by a sleeping
brain, they may operate like other suggestive irritants to produce dreams,
which may be sometimes so vigorously projected upon the consciousness of
the dreamer that he may be awakened, and may still perceive the evolution
of his dream as an hallucination, even after waking. Thus, on one
occasion, during a malarial fever, I dreamed of seeing a friend who lived
at a great distance. So vivid was the impression that I started up awake;
and there, at the foot of the bed, in broad daylight, was my friend,
looking calmly at me. Several seconds, at least, were required to
dissipate the vision. In an article already quoted,[69] Sir Edmund Hornby,
late Chief Judge of the Supreme Consular Court of China and Japan, "who
describes himself as 'a lawyer by education, family, and tradition,
wanting in imagination, and no believer in miracles,'" relates his
experience of a similar spectral visitation. After stating that "it was
his habit at Shanghai to allow reporters to come to his house in the
evening, to get his written judgment for the next day's paper," he says:

"They generally availed themselves of the opportunity, especially one
reporter, who was also the editor of an evening paper. He was a peculiar
man, reticent about himself, and I imagine had a history. In appearance he
was also peculiar. I only knew him as a reporter, and had no other
relations with him. On the day when the event occurred, in 1875 or 1876, I
went to my study an hour or two after dinner, and wrote out my judgment.
It was then about half-past eleven. I rang for the butler, gave him the
envelope, and told him to give it to the reporter who should call for it.
I was in bed before twelve. I am a very light sleeper, and my wife a very
heavy one. Indeed, it is difficult to rouse her out of her first sleep.
The bed--a French one--faced the fire-place; on the mantel-piece was a
clock, and the gas in the chandelier was turned down, but only so low as
to admit of my seeing the time at any time of the night, for--waking
easily and frequently--I often smoked a cigarette before I went to sleep
again, and always desired to know the hour.

"I had gone to sleep, when I was awakened by hearing a tap at the study
door, but thinking it might be the butler--looking to see if the fire were
safe and the gas turned off--I turned over with the view of getting to
sleep again. Before I did so, I heard a tap at my bed-room door. Still
thinking it might be the butler, who might have something to say, I said,
'Come in.' The door opened, and, to my surprise, in walked Mr. ----. I sat
up and said, 'You have mistaken the door; but the butler has the judgment,
so go and get it.' Instead of leaving the room he came to the foot edge of
the bed. I said, 'Mr. ----, you forget yourself! Have the goodness to walk
out directly. This is rather an abuse of my favor.' He looked deadly pale,
but was dressed in his usual dress, and was certainly quite sober, and
said, 'I know that I am guilty of an unwarrantable intrusion, but finding
that you were not in your study I have ventured to come here.' I was
losing my temper, but something in the man's manner disinclined me to jump
out of bed to eject him by force. So I said, simply, 'This is too bad,
really; pray, leave the room at once.' Instead of doing so he put one hand
on the foot-rail, and gently, and as if in pain, sat down on the foot of
the bed. I glanced at the clock, and saw that it was about twenty minutes
past one. I said, 'The butler has had the judgment since half-past eleven;
go and get it.' He said, 'Pray forgive me; if you knew all the
circumstances, you would. Time presses. Pray give me a _précis_ of your
judgment, and I will take a note in my book of it,' drawing his reporter's
book out of his breast pocket. I said, 'I will do nothing of the kind. Go
down stairs, find the butler, and don't disturb me--you will wake my
wife--otherwise I shall have to put you out!' He slightly moved his hand.
I said, 'Who let you in?' He answered, 'No one.' 'Confound it,' I said,
'What the devil do you mean? Are you drunk?' He replied, 'No, and never
shall be again; but I pray your lordship give me your decision, for my
time is short.' I said, 'You don't seem to care about _my_ time, and this
is the last time I will ever allow a reporter in my house.' He stopped me
short, saying, 'This is the _last_ time I shall ever see you anywhere.'

"Well, fearful that this commotion might arouse and frighten my wife, I
shortly gave him the gist of my judgment in as few words as I could. He
seemed to be taking it down in short-hand; it might have taken two or
three minutes. When I finished, he rose, thanked me for excusing his
intrusion and for the consideration I had always shown him and his
colleagues, opened the door and went away. I looked at the clock; it was
on the stroke of half-past one.

(Lady Hornby now awoke, thinking she had heard talking; and her husband
told her what had happened, and repeated the account when dressing next
morning.)

"I went to the court a little before ten. The usher came into my room to
robe me, when he said, 'A sad thing happened last night, sir. Poor ----was
found dead in his room.' I said, 'Bless my soul! dear me! What did he die
of, and when?' 'Well, sir, it appears he went up to his room as usual at
ten to work at his papers. His wife went up about twelve to ask him when
he would be ready for bed. He said, "I have only the judge's judgment to
get ready, and then I have finished." As he did not come, she went up
again, about a quarter to one, to his room and peeped in, and thought she
saw him writing, but she did not disturb him. At half-past one she again
went to him and spoke to him at the door. As he did not answer she thought
he had fallen asleep, so she went up to rouse him. To her horror he was
dead. On the floor was his note book, which I have brought away. She sent
for the doctor, who arrived a little after two, and said he had been dead,
he concluded, about an hour.' I looked at the note book. There was the
usual heading:

    "'In the Supreme Court, before the Chief Judge.

    ---- _v._ ----

    "'The Chief Judge gave judgment this morning in this case to the
    following effect'--and then followed a few lines of indecipherable
    shorthand.

    "I sent for the magistrate who would act as coroner, and desired him
    to examine Mr. ----'s wife and servants as to whether Mr. ---- had
    left his home, or could possibly have left it without their knowledge,
    between eleven and one on the previous night. The result of the
    inquest showed he died of some form of heart disease, and had not, and
    could not have left the house without the knowledge of at least his
    wife, if not of his servants. Not wishing to air my 'spiritual
    experience' for the benefit of the press or the public, I kept the
    matter at the time to myself, only mentioning it to my Puisne Judge
    and to one or two friends; but when I got home to tiffin I asked my
    wife to tell me as nearly as she could remember what I had said to her
    during the night, and I made a brief note of her replies and of the
    facts.

    "As I said then, so I say now--I was not asleep, but wide awake. After
    a lapse of nine years my memory is quite clear on the subject. I have
    not the least doubt, I saw the man--have not the least doubt that the
    conversation took place between us.

    "I may add that I had examined the butler in the morning--who had
    given me back the MS. in the envelope when I went to the court after
    breakfast--as to whether he had locked the door as usual, and if any
    one could have got in. He said that he had done everything as usual,
    adding that no one could have got in if even he had not _locked_ the
    door, as there was no handle outside--which there was not. I examined
    the coolies and other servants, who all said they opened the door as
    usual that morning--turned the key and undid the chains, and I have no
    doubt they spoke the truth. The servants' apartments were separated
    from the house, but communicated with it by the gallery at the back,
    some distance from the entrance hall.

    "The reporter's residence was about a mile and a quarter from where I
    lived, and his infirmities prevented him from walking any distance
    except slowly; in fact, he almost invariably drove.

        "EDMUND HORNBY."

The publication of this remarkable story led to its correction in several
important particulars. From the _North China Herald_ (August, 1884) it
appears that not only was Sir Edmund's memory defective in connection with
several of the minor details of the narrative, but he had also been either
wholly misinformed, or was quite forgetful regarding the actual time of
the editor's death. That person was, in fact, alive and in his usual
health at the time of his supposed apparition in the judge's chamber, and
did not die till between eight and nine o'clock on the same morning. He
had "attended a temperance committee meeting the night before, and had
left about half-past ten in good health and excellent spirits.... He
slept at home, rose shortly before eight, and visited his office to
arrange some _matter_ for that day's paper. He then returned to his room
to dress, and in a few minutes afterward was found dead upon the floor."

Between these conflicting witnesses it is of course impossible to decide.
But for our purpose that is quite unnecessary. It is clear that Sir Edmund
believed that the visible image of an acquaintance had appeared before him
in his chamber at night. It is also evident that the judge was a man whose
nerves had been damaged, probably by tobacco--for he was a "light
sleeper"--waking often, and indulging in the luxury of a cigarette during
the course of the night. If we may credit the writer in the _Herald_, his
brain was in a process of deterioration, proved by the decidedly
treacherous character of his memory. The whole story, therefore, becomes
exceedingly instructive as an illustration of the manner in which a belief
in apparitions may be originated. The most probable explanation of the
incident is found in the hypothesis of a dream excited in an irritable
brain that had been aroused by the preparation of the manuscript which had
occupied the thoughts of the judge immediately before retiring for the
night. The course of this dream was so vivid that the sleeper awoke, but
continued, like some other dreamers similarly awakened, to witness the
evolution of his vision in the form of a genuine hallucination. A
remarkable example of a similar production of hallucination through
disease of the brain is related by the late Dr. E. H. Clarke.[70] One of
his patients, a vigorous old gentleman, of eighty years, a great lover of
music, and a frequent attendant at operas and concerts, retired one night
at the usual hour, and in his usual health. He soon fell asleep, "and
slept well till about two A. M., when he was awakened by the sound of
music, which seemed to come from the street near his house. Thinking a
serenade was going on, he got up to ascertain where it was, but discovered
nothing. The sound ceased when he arose. On returning to bed, he heard the
sound of music again, and was at the same time surprised by the appearance
of three persons, standing near each other in his chamber, opposite the
foot of his bed. It was his habit to sleep with the gaslight burning
feebly, near the head of his bed. He turned the gas on to its full power,
and inspected the intruders. They appeared to be musicians, who were
humming and singing, as if in preparation for a musical performance. He
rang a bell, which summoned his man servant. John soon arrived, and was
ordered to put the strangers out. 'There is nobody here, sir,' was John's
reply to the order. For a moment Mr. A. was not only amazed, but alarmed.
'What!' he exclaimed, 'do you see no one there?' 'No one,' said John. 'Go
where those chairs are, and move them,' was Mr. A.'s next direction. John
did so. The strangers stepped aside, but did not go out. By this time Mr.
A. had gathered his wits about him, and was satisfied that he was the
victim of a hallucination; and he determined to observe its phenomena
carefully. Accordingly, he bade his servant depart, and prepared to watch
his visitors. But they were so life-like and human, that he was again
staggered, and recalling John, told him to go for the house-keeper. She
soon came, and on being interrogated, confirmed John's statements that
there were no strangers in the chamber and no sounds to be heard.
Convinced by the testimony of two witnesses, Mr. A. yielded to the
decision of his reason, and again resolved to go on with the investigation
of the strange phenomena. The musicians had now resumed their position,
near the window and opposite the foot of the bed. Mr. A. turned the light
of the gas full upon them. He looked at his watch, which marked the hour
of half-past two. He then arranged his pillows, so as to sit almost
upright in bed, and waited for the next scene of the play. He was able to
note the size, form, dress, and faces of the performers. One was a large
man, who bore some resemblance to Brignoli. The two others were of less
size, and shorter stature than their companions. All were habited in dress
coats, with white waist coats, and wore white cravats and white gloves.
After a little time spent in coughing and clearing their throats, they
began to sing. They sang at first a few simple airs, 'Sweet Home' among
others. They then attempted more difficult music, and gave selections from
Beethoven and Mozart. Between the pieces they chatted with each other in a
foreign language, which Mr. A. took to be Italian, but they did not
address him. Occasionally they changed their position, turned in various
directions, and part of the time sat down. Mr. A. said the singing was
excellent; he had rarely heard better. After the first feeling of surprise
and amazement had passed away, he enjoyed the music exceedingly. The
performance continued in this way for some time, when it suddenly came to
an end. The singing ceased, and the singers vanished. He looked at his
watch, and found that the time was four o'clock. The concert in his brain
had lasted nearly an hour and a half, almost the length of an ordinary
concert. He reflected for a while upon this strange occurrence, but not
being able to arrive at any satisfactory explanation of it, he turned his
gas down and went to sleep. The next morning he called at my office, as
previously stated, to ascertain if possible what pranks his brain had been
playing, and if he should regard them as warning of his approaching
departure."

In this case the patient was suffering from "a moderate degree of
deafness, persistent tinnitus aurium, occasional vertigo, and slight loss
of memory." Towards the close of life, two or three years later,
"incoherence, delirium, stupor, and the like, indicated with sufficient
certainty the presence of severe cerebral disease." The remarkable
hallucination which he experienced was undoubtedly the product of the
morbid changes which were progressing in his brain.

These cases form an ascending series which illustrates the receptive and
constructive capacities of the human brain when its sensory apparatus has
become unusually or morbidly excitable. But this preternatural mobility
may display itself in other departments besides those of mere
sense-perception. The sphere of pure intellect may thus be invaded by
ideas springing from impressions which address the reasoning faculties
alone, so that in sleep a dream may lead the judgment to decisive
conclusions that were scarcely recognized or heeded during the hours of
wakefulness. In this way we may learn to understand how the anxieties
experienced by the husband of the Virgin Mary may have ripened into a
dream, of intensity sufficient to guide his subsequent action. Nothing
could be more natural for one, like him, ignorant of physiology and of
second causes in general, than the ascription of such an event to the
immediate intervention of the Great First Cause--the only cause which he
could rationally apprehend. Hence the universal primitive belief that in
dreams God spake to man. Upon this belief was laid the foundation of many
of the religious convictions which have grown and ripened with the
progress of the race until their shadowy origin has been well nigh
forgotten.

Many are wont to affirm that the age of illumination through the
intervention of dreams is past, but there is no good reason for the belief
that such dreams may not still occur. A lady, carefully educated in the
doctrines of the popular theology, had been very much distressed by the
unruly behavior of her only child, a little imp who had scarcely learned
to talk. While thus depressed in spirits she dreamed that the Day of
Judgment had come. She found herself with her husband and child and the
whole human race assembled upon the face of the earth, waiting in agony
for the awful decision of their fate. Finally the heavens were opened, and
Jesus appeared, dividing the wicked from the good. As he drew near the
place where she was standing, she could no longer endure her anxiety
regarding the destiny of her daughter; she rushed forward, and implored
the Divine Judge to spare her child. With a look of ineffable compassion
he assured the trembling suppliant that her prayer was granted, and she
awoke in a state of great agitation, but much comforted as to the future
of her little girl, who in due course of time grew up to be a very
exemplary young woman. Now, if the dream of Joseph was a revelation, a
dream like this is quite as worthy of similar estimation. They both
occurred as the result of analogous conditions of the brain and mind, and
were both excited by second causes of a similar character. It is
impossible for any one to show that the relation between the First Cause
and either set of second causes was any more intimate and special in one
case than in the other.

The wonderful exaltation of certain faculties during the unequal sleep of
the different organs of the mind, is usually to be considered as something
relative rather than absolute. But there is little reason to doubt that
sometimes the excitement of the waking portions of the brain does really
transcend the ordinary functional capacity of the structure. Under such
conditions the undivided concentration of attention upon the comparatively
limited circle of ideas which are thus produced, greatly increases the
intensity of the resulting impressions upon the mind in consciousness.
Hence the grandeur of the visions which may thus arise; hence, also, the
possibility of their construction in accordance with fact rather than with
fancy; as in the case of the visions of the ancient Hebrew prophets. As
the darkness of night, by shutting out the earth from sight, opens our
eyes to the glory of the starry sky, so, in like manner, sleep, by closing
the senses against the distractions of the external world, may sometimes
afford the conditions enabling a richly gifted intellect to comprehend the
course and the destination of those deep and silent streams of thought
which move on, unnoticed during the hours of wakeful life.

Whatever may be true of this matter of fore-sight, it is certain that
under similar conditions the memory of past events may be so quickened as
to yield results quite comparable with actual clairvoyance. A good
illustration of this has been recorded by Abercrombie.[71] A gentleman
named Rowland had been prosecuted for certain arrears of tithe which he
believed had been long previously paid by his deceased father. "But, after
an industrious search among his father's papers, an investigation of the
public records, and a careful inquiry among all persons who had transacted
law business for his father, no evidence could be discovered to support
his defence. The period was now near at hand when he conceived the loss of
his lawsuit to be inevitable, and he had formed his determination to ride
to Edinburgh next day and make the best bargain he could in the way of
compromise. He went to bed with this resolution, and, with all the
circumstances of the case floating upon his mind, had a dream to the
following purpose: His father, who had been many years dead, appeared to
him, as he thought, and asked him why he was disturbed in his mind. In
dreams men are not surprised at such apparitions. Mr. R. thought that he
informed his father of the cause of his distress, adding that the payment
of a considerable sum of money was the more unpleasant to him because he
had a strong consciousness that it was not due, though he was unable to
recover any evidence in support of his belief. 'You are right, my son,'
replied the paternal shade; 'I did acquire right to these teinds, for
payment of which you are now prosecuted. The papers relating to the
transaction are in the hands of Mr. ----, a writer (or attorney), who is
now retired from professional business, and resides at Inveresk, near
Edinburgh. He was a person whom I employed on that occasion for a
particular reason, but who never, on any other occasion, transacted
business on my account. It is very possible,' pursued the vision, 'that
Mr. ---- may have forgotten a matter which is now of a very old date; but
you may call it to his recollection by this token--that when I came to pay
his account there was difficulty in getting change for a Portugal piece of
gold, and that we were forced to drink out the balance at a tavern.'

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

Here it would be a valuable addition to knowledge if the parties in the
history just related could be subjected to intelligent interrogation.
Enough, however, may be discovered in the narrative to render it certain
that the dream was merely a revival in consciousness of knowledge that had
been long previously forgotten. There was a vague recollection of some
such information evidently struggling for recognition; otherwise Mr. R.
could not have held the belief in spite of the lack of evidence, that his
father had paid the tithes in dispute. He had probably heard from his
father some account of a transaction which had taken place so long before
that the only surviving actor, the aged lawyer, had forgotten everything
about it, and could only recall the event through the associations
connected with the Portugal piece of gold. In the lawyer's case the
cerebral register only needed the stimulus afforded by the association of
ideas, in order to make it again place before the mind impressions which
had long subsided below the level of consciousness. For Mr. R., sleep
afforded the limitation of cerebral function needful for a concentration
of attention sufficient to penetrate to the level of the residual
vibrations which persisted as the sole representatives of the original
impressions through which his knowledge of the event had been primitively
obtained. Parallel examples are furnished by the cases of individuals who,
upon their death-beds, during the dissolution of the brain, have resumed a
long disused vocabulary, speaking the language and thinking the thoughts
of their childhood. "He 'babbled of green fields,'" said Mistress Quickly,
narrating the closing scenes in the life of the famous Sir John Falstaff.
Dr. Rush[72] relates the case of a learned Italian gentleman who, "in the
beginning of the yellow fever which terminated his life, ... spoke English
only; in the middle of the disease, he spoke French only; but on the day
of his death, he spoke only in the language of his native country." In
like manner the old Swedish settlers in Philadelphia who had forgotten
their native language, or, at least, had not spoken it for half a century,
would pray in Swedish on their death-beds.[73] Sleep and dissolution
operate alike to release the lower levels of the mnemonic apparatus from
the overshadowing influence of later impressions, so that, like an ancient
palimpsest, it presents once more its long-forgotten characters for
inspection by the mind.




CHAPTER VI.

SOMNAMBULISM.

    A great perturbation in nature! to receive at once the benefit of
    sleep, and do the effects of watching.                 --MACBETH.


We have seen that in certain cases dreams manifest a tendency to pass into
action. Thus, the dream with which I was on one occasion occupied became
so amusing that I was awakened by a paroxysm of laughter that continued
for some time after the termination of the dream. Sometimes the actions
which are thus determined become more complicated, but do not suffice to
arouse the sleeper. He continues to dream, and to act out his dream. This
constitutes the ordinary form of somnambulism. It is a special affection
of the nervous system encountered chiefly among persons of a decidedly
neurotic constitution--especially among the victims of hysteria, epilepsy,
and insanity. Sometimes occurring in cases apparently characterized by
perfect health, it will usually be discovered by careful inquiry that the
subject is nevertheless connected by near relationship with a neurotic
stock. In a third class of patients the neuropathic diathesis is not
congenital, but is the acquired result of particular injuries or diseases
of the head. It is also observed sometimes as a consequence of transitory
functional disturbances of the brain connected with the period of
convalescence from diseases that profoundly affect the nutrition of the
nervous system. In all cases, however, it is probable that a special
nervous temperament exists as a predisposing cause of the phenomena, for
the majority of people can sustain injuries of the head, or of the
peripheral nervous system, and can pass through all kinds of illness
without exhibiting any tendency to somnambulism. As the nervous
temperament is the peculiar property of children and of the female sex, it
is among them that the affection is usually observed. Before the age of
puberty, however, the differential peculiarities of sex are not sufficient
to produce any great preponderance in either direction; and small boys
are, therefore, perhaps as frequently somnambulistic as their little
sisters. Like other neuropathic disorders, this predisposition is
frequently met with as an hereditary attribute which may be handed down
from generation to generation. Occurring in the experience of young
children, it frequently ceases when they arrive at years of maturity. Not
always, however, thus ceasing as a consequence of improvement in the
general health, but because of the substitution of some more serious
disorder.

The phenomena of ordinary somnambulism are manifested, like the dreams out
of which they arise, during the period of sleep. But, while dreams most
frequently occur during the later portion of the night, after the deepest
sleep is past, somnambulism usually occurs in the earlier part of the
night, during the deepest sleep. As a consequence of this fact,
consciousness is seldom affected by the molecular play of the brain during
the somnambulic excursion. The sleepwalker knows nothing, and remembers
nothing of the incidents in which he has been an active agent; while the
dreamer seems to be more nearly awake. His consciousness is partially
aroused by the play of memory and of imagination, and he can remember the
spectacle which constituted his dream. The phenomena of somnambulism
necessitate the participation of a larger number of faculties than are
needed for the production of a dream, but their activities are coördinated
upon a plane, so to speak, lower than the platform upon which the elements
of dreams are arranged. Consequently, though the elements of the
somnambulic process may be far more numerous and various than the elements
of a dream, they may be less capable of rising into the realm of
consciousness. Such a process may differ from the phenomena of ordinary
life only in the fact of unconsciousness; and, when concluded, it leaves
no traces in the memory of the waking state. In other instances, on the
contrary, so many nervous functions may be suppressed, and so great may be
the intensity of the remaining cerebral processes, that the resulting
phenomena scarcely differ from an ordinary dream in which consciousness is
aroused, and the waking memory is durably impressed. Between these
extremes lie opportunities for an indefinite number of combinations;
consequently the forms and degrees of somnambulism present a very great
variety of manifestation. Maury[74] reduces these to five principal forms:
First, simple movement of the limbs in connection with that partial sleep
of the intellectual faculties which produces ordinary dreams. Second,
_somniation_, a state in which the patient unconsciously performs such
actions as have become so far habitual that, though complicated in their
character, they constitute genuine cerebral reflexes. Third,
_noctambulism_, or sleep-walking, in which the action, though complicated
in its character, and different from the ordinary waking occupations of
the patient, appears to be the result of automatic processes, constituting
a dream that is acted out in time and space. Fourth, _somnambulism_ with
exaltation of the faculties, producing delirium with conscious movements
during the crisis. Fifth, _somnambulic life_, or double consciousness, in
which, with the exception of certain special modifications of
intelligence, the conduct of the patient during the paroxysm does not
perceptibly differ from that of the waking state, so that the subject
seems to experience two successive though disconnected personalities.

The exact relation between these different degrees of somnambulism has
been further elucidated by MM. Ball and Chambard.[75] Starting with the
proposition that normal healthy existence is a state in which the
functions of organic life furnish a basis for nervous sensibility and
motion, by means of which the imaginative faculties (imagination and
memory), associated with the coördinative faculties (attention, judgment,
volition), are sufficiently stimulated to maintain a state of
consciousness, they show that the first stage of sleep consists in the
suppression of bodily motion and sensibility. The second stage consists in
the further suppression of the coördinative faculties. The third stage is
marked by the loss of memory and imagination. In the most profound and
perfect sleep the functions of organic life alone remain. The process of
awaking consists in the revival of the faculties in the inverse order of
their extinction. Dreams occur during the period in which motion,
sensation, and the coördinative faculties are in abeyance; but
somnambulism may accompany each of the stages of sleep. Its simplest form
is perhaps the rarest; corresponding to Maury's fifth variety. In this
form the functions of organic life are intact; motion and sensibility seem
unchanged; the intellectual faculties display their usual activity; but
the ordinary consciousness is never aroused. So far as the normal life of
the subject is concerned, he is active, sensible, intelligent, but
unconscious; and when the paroxysm is terminated memory contains no
account of its events. Such paroxysms may occur but once in the life-time
of an individual, or they may be repeated at stated intervals,
constituting an alternate succession of mental states without connection
in consciousness. This is called the somnambulic life, or double
consciousness, several examples of which will be related upon another
page.

The second form of somnambulism results from the abolition of
consciousness and the more or less complete suppression of the
coördinative faculties of the mind. Memory and imagination, released in
great measure from the control of the higher intellectual faculties, and
excited by such vestiges of sensation as still persist, create a species
of delirium in which mutilated sensations, half formed thoughts and
disproportioned volitions combine to produce a variety of actions. In
this condition the patient dreams, and acts out his dream. He is a
somnambulic dreamer.

In the third degree of somnambulism, consciousness and the entire range of
intellectual faculties have disappeared. The individual resembles a
creature from which the cerebral hemispheres have been removed. He is
little better than a living automaton, guided only by impressions received
from without. In this condition the movements of the body may become
wholly responsive to the will of another--a prominent characteristic of
artificial somnambulism or hypnotism.

A fourth degree of somnambulism is marked by the disappearance of
consciousness, intellect, sensibility, and the power of motion. Only the
lower functions of organic life remain. The patient merely lives, he
neither thinks nor acts. This constitutes the state of somnambulic
lethargy, a condition which differs from deep sleep only in the fact that
under the influence of external impulses or of partial awaking it may
easily pass into the second form of the affection, the somnambulic dream.

Such is the classification of MM. Ball and Chambard. It possesses the
merit of great precision and clearness. If the warning which its authors
themselves utter against its too literal acceptance be respected, it will
be found to afford a very convenient explanation of the manner in which
the various degrees of somnambulism are reached. But it must be remembered
that between these pronounced and definite forms exist a great number of
intermediate degrees. Partial revivals and temporary resurrections of the
higher faculties of the mind may intrude themselves among the activities
which depend upon lower functions; as, for example, when the ordinary
unconsciousness of lethargy is briefly interrupted by an event which may
remain permanently fixed in memory after waking, even though all other
concurrent incidents were unnoticed and left no trace behind. Keeping this
caution in mind, the following diagram will be found useful:

  +=======================================================================+
  |           |Organic|Sensibility:|Imaginative|Coördinative|Consciousness|
  |           | Life  |   Motion   | Faculties:|  Faculties:|             |
  |           |       |            |   Memory, |  Judgment, |             |
  |           |       |            |Imagination| Attention, |             |
  |           |       |            |           |  Volition  |             |
  |-----------|-----------------------------------------------------------|
  |Normal life|XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX       |
  |-----------|-----------------------------------------------------------|
  |Somnambulic|                                                           |
  | life      |XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                   |
  |-----------|-----------------------------------------------------------|
  |Somnambulic|                                                           |
  | dream     |XXXXXXXXXXXXXXXXXXXXXXXXXX                                 |
  |-----------|-----------------------------------------------------------|
  |Somnambulic|                                                           |
  | automatism|XXXXXXXXXXXXXX                                             |
  |-----------|-----------------------------------------------------------|
  |Somnambulic|                                                           |
  | lethargy  |XX                                                         |
  +-----------------------------------------------------------------------+

The close parallel between this diagram and the one on page 4, which
illustrates the course of sleep, will be at once remarked. The difference
between the two states cannot be thus diagrammatically expressed. It is
the difference between sleep in a healthy, normal subject, and sleep as
modified by the somnambulistic temperament. This may be either the result
of disease or of congenital defect of cerebral organization. What the
particular structural difference may be, it must be impossible to decide,
until it shall become possible to state the reason why one brain shall
behave only in a normal manner, while another presents all the vagaries of
hysteria, somnambulism,--perhaps even of insanity. That the affection is
hereditary is a matter of common observation. One of my patients who is
somnambulistic--walking in his sleep, climbing over the roof of his house,
etc.--is the son of a father who was also a noctambulist, and who once
fractured his leg by falling from a step as he was walking down stairs in
his sleep. A grand-daughter is both a somniloquist and a somnambulist.

Returning now to the classification adopted by Ball and Chambard, it will
be found interesting to consider a few illustrative examples of the
different forms and degrees of the affection under consideration.

_Somnambulic Lethargy._--This condition represents the form which
outwardly resembles profound sleep. It may occur as a paroxysm without
relation to other forms of the affection, or, according to my own
observation, more frequently associated with other forms of somnambulism.
Thus, one of my patients, a lady about thirty-five years of age, having
accidentally fallen into the hands of a noted empiric, by whom, for a
slight attack of tonsillitis, she was vigorously dosed with atropia,
digitalis and calabar bean, finally passed into a somnambulic state
corresponding to the somnambulic life of the preceding table. This
continued about five weeks, when she became completely lethargic, and was
transferred to my care. In this condition she remained unconscious, almost
perfectly insensible, with pupils somewhat contracted and sluggish before
the light, with a feeble and slightly accelerated pulse, a moderately
elevated temperature, bowels and bladder insensible to their contents,
mouth and throat filled with an offensive mucous secretion. By great
urgency she could be sufficiently roused to open her mouth, so as to
permit cleansing the cavity, and to swallow liquid food. Swallowing was
effected very slowly, and only after the liquid had remained for some time
in the fauces. At the end of about three weeks the patient began to
exhibit more vitality. She could be more easily aroused, began to dream
and to have hallucinations that were finally prolonged out of sleep into
wakefulness. In the course of a few hours she was fully herself again,
after eight weeks of unconsciousness.

This form of lethargy is characterized by the complete unconsciousness
which persists during its course. Its duration is variable, sometimes
continuing for a few minutes only; sometimes lasting through many days and
weeks. Dr. W. T. Gairdner, Professor of Medicine in the University of
Glasgow,[76] reports the case of a woman who remained for over one hundred
and sixty days in a condition of lethargic stupor. "The patient was the
mother of a family, and had lived a strictly domestic and (up to a short
time before her seizure) healthy and regular life. There were no peculiar
moral and religious problems to perplex the situation. There was no
history of inveterate hysteria, or of long continued rapt contemplation;
nor has there been the slightest evidence of any craving after notoriety,
either before the attack or since its termination. The moral atmosphere,
in short, surrounding the phenomena, is altogether unfavorable to
exaggeration and imposture, for which, indeed, no reasonable motive can be
assigned. Nevertheless, under these very commonplace conditions,
concurring with some degree of melancholy or mental despondency after
delivery, but during a convalescence otherwise normal, Mrs.
McI----presents to our notice a condition of suspended consciousness and
disordered innervation in no degree less extreme than the 'trances' or
cataleptic attacks which have been recorded as the result of the most
aggravated hysteria, or as the miracles of religious ecstasy and profound
mental emotion. She becomes for the long period of over one hundred and
sixty days continuously an almost mindless automaton, connected with the
external world only through a few insignificant reflexes and through the
organic functions. She is fed, almost without resistance, through the
stomach-tube; she defecates and urinates (during much the greater part of
the time) unconsciously; she is absolutely passive as regards everything
that demands spontaneous movement, and betrays almost no sign of
sensation, general or special, when subjected to the severest tests that
can be applied short of physical injury. But while her senses were thus
shut, and her volitions in suspense to an extent much beyond ordinary
sleep, there was, nevertheless, a _sleep within the sleep_. The
periodicity of day and night was maintained by some change in the
condition of the innervation, of which snoring was the sole indication.
She was not convulsed, nor paralyzed, nor delirious; the singing,
laughing, weeping, adoring ecstasies of hysteria and of religious
excitement were wholly wanting; nor were there during many months such
intervals of normal consciousness as are observed in almost all the
recorded cases of hysterical coma and of catalepsy. The statue-like pose,
moreover, and the _flexibilitas cerea_ of typical catalepsy, are absent in
this case. The return to consciousness was followed or accompanied by a
return of all the normal functions of mind and body; there is now no
incoherence, nor even distorted perceptions, as of a dream-life occupying
the somnolent imagination for months, and therefore all the more hard to
reconcile with realities. She is self-possessed, but unobtrusive, easily
managed, and betraying only natural emotion; she persists in maintaining
that the whole period of the apparent unconsciousness is a complete blank
to her recollection. She is grateful for her recovery, but manifests no
craving for sympathy, and no tendency, as yet, to revert to any morbid
condition of despondency, such as was described at the commencement of the
attack. In connection with this last point, although there is no evidence
of her having been personally insane, it is not to be denied that her
family history contains strong presumptions of a hereditary predisposition
bearing in that direction."

These cases must not be confounded with the examples of _lucid lethargy_,
to which allusion has been made in a previous chapter. Somnambulic
lethargy is a condition in which the cerebrum is wholly inert. In lucid
lethargy, although there is complete loss of general sensibility and of
the power of voluntary motion, the field of consciousness is continually
enlightened by perceptions derived from one or more of the special senses,
so that the subject is conscious of much that transpires in his immediate
neighborhood. These two forms of lethargy sometimes alternate in the
experience of the same individual, constituting a portion of the
indefinitely varied manifestations of hystero-epilepsy. Grasset relates
the case[77] of a little girl, ten years old, who suffered with various
forms of hysteria, which were finally replaced by attacks of stupor,
lasting several hours. After a time these crises of "nervous sleep" were
transformed into more ordinary attacks of somnambulism, in which,
"although the child's eyes are shut, she sees and hears everything during
the crises, knows who comes into the room by their step and walk. If
anything unpleasant is said to her, or if they threaten to wet her, or
make her smell something, she gets angry, and pushes everything violently
away that is offered to her. She replies by signs to all questions, and if
she wants anything, asks for it by gesture: if she wants to drink, she
puts her finger to her lips as if in the act of sucking, and if not
understood, becomes irritated, gets up, and leads the father or mother to
the sideboard or cupboard, where the things she wants are, and always with
the eyes shut. She is able to go through the whole house, I do not say
quite alone, because they do not allow her to walk alone, but with help,
and she directs the way wherever she wishes to go. During the crises she
even sometimes amuses herself with a little dog, which she makes jump over
a stick resting on the cross-bars of two chairs opposite each other; and
according as she wishes the dog to jump higher or lower, she moves the
stick to the lower or higher bars of the chairs, and that with eyes always
shut spasmodically. During the whole attack she cannot talk; but towards
the end she speaks, although not yet recovered from her state of
somnambulism. When the crisis is over, the child remembers nothing of what
she has said or done in her sleep, and is much surprised at everything
told her."

_Somnambulic Dreams._--The preceding cases illustrate the variable
character of the manifestations of somnambulism, and may also serve as an
introduction to the more common form of the affection, in which the
patient experiences a dream, probably excited by the same causes that
produce ordinary dreams, and also acts out his dream. The differences
between an ordinary dream and a somnambulic dream lie in the fact that the
one produces an often vivid impression upon consciousness and memory,
while the other is entirely expended upon the organs of external
expression. Starting probably from the same portion of the brain, the
physiological dream sets in motion the cortical structures which are in
immediate relation with conscious memory; the impulses of the somnambulic
dream, on the contrary, are directed towards the lower portions of the
nervous system, where they serve to excite the organs of locomotion and
expression, which are destitute of every form of mnemonic register.
Consequently, the somnambulist retains no recollection of the incidents of
his dream.

The simplest form of this affection is presented by the restless child who
talks, cries out, and brandishes its fists in sleep. In the majority of
instances these manifestations create little more disturbance than the
half uttered yelping of a dog that barks in its sleep. But in some cases
the outbreak assumes a distressing, if not an alarming character,
constituting the affection known by the name of _night terrors_. The
disorder is usually observed in young children of a highly nervous
temperament, before the conclusion of their second dentition. The little
patients are generally of neurotic lineage. Insanity, hysteria,
neurasthenia, epilepsy, chorea, and nervous dyspepsia, are often
discovered among their near relatives. Not unfrequently they have been, or
will become, choreic. The attack is often preceded by symptoms of
indigestion and constipation; but the exciting cause may be usually traced
in the commotion of a brain that has been wearied by the exertions of the
previous day. The child starts up out of an apparently sound sleep, crying
with seeming alarm, calling for his mother, and staring wildly around,
with every possible expression of terror. Sometimes he jumps from his
couch, and runs headlong into a corner, or seeks concealment under the
bed, as if escaping from some frightful object. The eyes are open, tears
flow, perspiration covers the skin, there is the greatest excitement, and
the little one, clinging convulsively to its parent, will not be quieted.
Only after a number of minutes does the child seem to recover the power of
recognizing his friends. Presently, however, he lies down, and falls
immediately asleep, waking in the morning without the slightest
remembrance of the unpleasant event.

Such paroxysms occur during the early part of the night, one or two hours
after bedtime, when sleep is passing from its maximum intensity to an
inferior degree of depth. This, moreover, is the time when the controlling
power of the sensory apparatus over other portions of the nervous system
has already reached its minimum. The spinal centres and those
intra-cranial ganglia which do not share in the full measure of this
repose are therefore in a condition of relative exaltation. Disturbances
of internal origin, consequently, produce inordinate excitement of these
waking portions of the nervous apparatus. The abnormal quality of this
excitement is attested both by the history of the patient, and by the fact
that it does not pervade the whole brain. The distribution of motion
through the cerebrum is hindered, so that certain portions of the organ
remain asleep while other regions are thrown into a state of tumultuous
uproar. Such disconnection of the different organs of the nervous system,
by withdrawing particular ganglia from the inhibitory influence of the
other centres, gives opportunity for violent explosions of nervous force.

Somewhat similar in their origin are those acts of unconscious violence
which sometimes occur during the process of sudden awakening out of sound
sleep. The patient is usually a deep but uneasy sleeper, who is only
aroused imperfectly and with difficulty when the attempt to awaken him is
made. Under such circumstances the disturbance to which he is subjected
serves as the exciting cause of a dream which, like the ordinary
somnambulist, he puts into action before he is fully waked. On recovering
complete consciousness, he may retain no recollection of the events of
his dream, and may also experience as great a degree of astonishment at
the results of his violence as if he had taken no part in its display. A
gentleman of my acquaintance, who had suffered considerable uneasiness
regarding burglars, was, one night, startled by a noise in his room.
Jumping up suddenly, he grasped a pistol and fired it in the direction of
a figure dimly perceived near the bed. On waking fully out of sleep, he
found that he had inflicted a wound upon the hand of his wife whose
movements had disturbed him. Another unfortunate, who was once under my
observation for undoubted insanity, was in like manner aroused out of
sleep by a supposed noise, probably heard in a dream. With a pistol in
each hand, he commenced firing wildly in every direction, fatally wounding
his wife who was in bed at his side. When completely awakened he had no
recollection of what had occurred, and was overwhelmed by the event.

Wharton and Stillé[78] have collected a number of similar examples of this
disorder, to which the term _somnolentia_ or _sleep-drunkenness_ has been
applied. Its connection with morbid disturbance of the brain is usually
very evident. Obviously, the moral responsibility of the agent in such
cases is identical with that of the ordinary somnambulist, or of the
subject of epileptic mania.

Ordinarily, however, the somnambulic dream is less agitated. The patient
merely continues the movements with which he was occupied at the moment of
falling asleep, as in the case of Galen, who, though long an unbeliever
of the tales regarding sleepy soldiers who had unconsciously continued to
march with their comrades, at last found himself in a similar manner
walking a considerable distance after he had been overtaken by sleep while
journeying on foot. In other cases the phenomena though intimately
connected with the daily occupations of the subject, present themselves in
a form somewhat detached from the waking life. Such are the common
experiences of children who get out of bed, and walk around the house,
seeking their playthings, or pulling their clothes out of the drawers in
which they have been laid. Sometimes the events of the day have evidently
suggested the deeds of the night. One of my little acquaintances will
leave her bed, walk into another room, seat herself by her mother's
work-basket, thread a needle, and proceed to sew up the imaginary holes in
her dress. One of my early playmates, in like manner, after puzzling over
a difficult sum in arithmetic, before retiring, arose in his sleep, took
paper and a pencil from his mother's desk, and proceeded before her eyes
to work out the correct answer. Another, tempted probably by a vision of
ripe grapes upon the trellis, climbed out of his window upon the roof of a
shed. Unfortunately, the certainty with which somnambulists usually direct
their movements seemed to fail him. He fell heavily to the ground, where
he awoke to find himself seriously injured.

An excellent example of a still more complicated series of actions during
somnambulism is quoted by P. Max Simon.[79] It illustrates a majority of
the facts which have been already brought forward, and will well reward
careful consideration. "A young clergyman was in the habit of getting up
in his sleep, taking paper, composing and writing sermons. When he had
finished a page, he would read it over, if an action performed without the
assistance of sight can be called _reading_. If dissatisfied with
anything, he would blot it out, and then write the corrections with great
accuracy in their appropriate place above the line. In one of these
sermons he made a correction which was quite remarkable. Having in one
place written the words _ce divin enfant_, on revising the page he decided
to substitute the word _adorable_ instead of the word _divin_. He
therefore blotted out this last word and placed the other immediately over
it; then, perceiving the word _ce_, which was proper enough before the
word _divin_, lacked the terminal letter _t_ that was needed before a
vowel, he very adroitly added the necessary letter, so that the amended
sentence correctly read _cet adorable enfant_. In order to ascertain
whether the somnambulist made any use of his eyes, a cardboard was placed
under his chin in such a way as to completely obstruct the view of the
paper upon the table; but he continued to write without paying any
attention to the obstacle. In order to ascertain whether he was aware of
the presence of the objects which were before his eyes, the paper upon
which he was writing was taken away, and a number of other sheets were
successively slipped into its place; but he always noticed the
substitution, because they differed in size. When an exactly similar piece
was substituted, he accepted it as his own, and wrote down the corrections
at the points which corresponded exactly with the writing upon the page
which had been removed. It was by means of this ingenious stratagem that
some of his nocturnal compositions were preserved.

"The most astonishing thing of all," continues the author of this article,
"was the exact composition of music. A cane served him as a ruler. With it
he ruled at equal distances the five necessary lines, putting in their
proper place the clef, the flats and the sharps. Finally, he inscribed the
notes, at first all in outline, but, when he had finished, he blackened
those which should be dark. The words of the song were written below. On
one occasion he happened to write them with too large a hand, so that they
were not placed directly under their corresponding notes. He soon
perceived this defect, and, in order to amend it, he blotted out what he
had done by drawing his hand over it, and then rewrote the line of music
lower down the page with all the precision imaginable.

"Another singular thing of a different sort, which was not less
remarkable. One night, in the middle of winter, he dreamed that he was
walking on the bank of a river, and saw a child fall into the water where
he was drowning. The severity of the cold did not hinder him from hurrying
to the rescue. He threw himself at full length upon his bed, in the
position of a man who is swimming, and imitated all his movements. After
having fatigued himself for some time with this exercise, he felt a
portion of the coverlid gathered in a heap on one corner of the bed. He
believed this to be the child; grasped it in one hand, and with the other
went through the motions of swimming back to the bank of the supposed
river. There he laid down his burden, and came out, shivering and
chattering his teeth as if he were really getting out of an icy river. To
the bystanders he said that he was freezing, and would die of cold, that
his blood was all turned to ice; he must have a glass of brandy to warm
him. Not having any, they gave him some water which chanced to be in the
room; he tasted it, recognized the deception, and called, with greater
emphasis than before, for brandy, insisting upon the magnitude of the
danger which threatened his health. A glass of liquor was finally given to
him; he drank it with pleasure, and spoke of the great relief which it
afforded him. Notwithstanding all these incidents, he did not wake, but
went to bed, and slept most profoundly."

An equally instructive case is related by my distinguished colleague,
Prof. J. Adams Allen.[80] The subject of the observation was a medical
student who resided in Professor Allen's house during a portion of the
time covered by the narrative.

"About the summer of 1847, a somewhat dilapidated bass-viol, which was a
kind of heir-loom in the family, was brought into the house, and he
devoted spare moments to learning how to play upon it. Unfortunately, the
antiquity of the instrument had told upon its keys, and unless they were
wetted at each time of use, it would not remain in tune. He was
determined, however, to command its notes, and succeeded. His somnambulic
walks, thereafter, led him from his chamber to the parlor, and to the
bass-viol, and the family would be awakened in the small hours by the
inevitable tuning up prelude, mingled with slipping of the old keys, and
quiet objurgations upon his part. Sometimes the bridge would fall down
when the keys slipped, and sometimes a string would snap or escape from
the keys, nevertheless he would persevere, repair damages, tune up, and
then execute all varieties of music of which the machine was capable, not
unfrequently accompanying it with his voice. All this would be done in
total darkness. When any one entered the room with a light, he took not
the least notice, although when spoken to he would reply in monosyllables
or with considerable asperity. His face was usually flushed, although
sometimes pale--the features immobile and passive, the eye open, pupil
dilated, the surface glazed, and the lids apparently motionless. The
extremities warm and the pulse full, frequent and soft. Very often the
skin would be bathed with free perspiration. Remarkably sensitive to
titillations when awake, there seemed total absence of reflex movements
from this cause whilst in the somnambulic state.

"As he extended his acquaintance with music and musical instruments, his
feats became wonderful. Whilst in attendance upon the Medical College at
La Porte, the household looked forward with high anticipations to the
hours when his skillful touch of the melodeon would wake them. He had a
voice of the purest tone and very considerable compass, in fact of rare
sweetness. I am enabled to say from a multitude of observations, that he
played with a precision and skill while asleep that he could not
approximate while awake. Besides this, he would execute music which he
had heard, perhaps, but once, the evening previous or after a long
interval--no note of which he could recall in his waking moments. His
memory here seemed wonderfully exalted. If interrupted, he was irritable
in the extreme, but would go on with his music exactly from the point of
interruption.

"Among the numberless exhibitions of his somnambulism, I have time only to
notice a few of the most striking.

"Whilst attending lectures at Ann Arbor, where I was then lecturing on
Physiology, I requested his assistance in enlarging some of the drawings
illustrative of minute anatomy and histology, for use in class
demonstrations. He entered into the work with great zeal, and proved very
expert and rapid in execution. One evening, previous to the day on which I
was about to lecture on the kidney, I wished the cuts in Carpenter's
Physiology, illustrating the tubular arrangement, etc., were ready. He had
an engagement for the evening, but said he would try and prepare them in
the morning. During the night he rose, dressed himself, played a few tunes
on the guitar, part of the time singing (and, by the way, the guitar was
about as dilapidated as the bass-viol before noticed, and he had to knot
one or two of the strings first), and then arranged the drawing paper,
prepared his India ink and brushes, took the parallels and pencils and
laid off the space, and worked for half an hour or more rapidly and
perfectly, nearly completing the figures on pp. 596 and 597 of Carpenter's
Principles, in the edition of 1853.... These drawings are now in the
series used for illustration in Rush Medical College. Although we had a
light in the room while watching him, he went on with his work entirely
regardless of it. Before completing the work, he went to bed and slept
until the usual hour in the morning, when at the breakfast he asked if he
had been up in the night, as he had _dreamed_ that he had. This was the
only time he ever remembered even dreaming about being up or occupied in
anything. He had by this time become so fully aware of his habits, that
nothing of the sort astonished him. Shortly after this he went to spend
the night with a fellow student, but a little after midnight he rose,
dressed himself, and went out, followed by the other gentleman, walked
down to the Exchange Hotel, where there were a number of his acquaintances
and others waiting for a train of cars due at that time. Some one rallied
him on his being out so late, but being cautioned by his companion, they
did not attempt to awake him, but watched his movements. On being invited,
he took a glass of ale, and then said he would only have time to go home
and get his dinner before the afternoon lecture hour. He walked with his
friend to our door, and was indignant to find it locked. His room-mate (a
cousin) admitted him and awakened myself and wife. He asked if dinner was
ready, and seemed astonished that it was not; then said he would get a
drink of water and be off, 'for old D. (one of the faculty) would be mad
if he was late.' I told him he had plenty of time and he need not be in a
hurry. He then walked into the kitchen, drank a tumblerful of water, and,
looking up to the clock, although it was totally dark, remarked the time,
and started for the front door. I then told him that I was not feeling
well, was pretty blue, and wished he would sit down and play euchre with
us. This seemed to please him, and he took off his overcoat and said he
had as lief play until 'old D.' was through lecturing, as to go.

"His cousin sat down at the table with us, and we played 'three-handed
(cut-throat) euchre.' He paid not the slightest attention to us, although
we passed the cards backwards and forwards between us, exchanging hands,
and everything we could do to attract his attention. He dealt the cards in
his turn, correctly, and played 'according to Hoyle.' In one hand, spades
were trumps, and he held the jack of clubs. Clubs being led, he first
threw down this jack, then quickly picked it up, saying, 'I forgot that
was the left bower.' It is somewhat humiliating to record that,
notwithstanding our tricks and devices, he beat us in the game.

"On its conclusion, he got up hastily and insisted upon going to the
college. We only prevented him this time, by throwing water in his
face--the only method, by the way, in which we could awake him without
great violence. Pungent odors, ammonia, camphor, etc., he seemed to
disregard, or merely pushed away the object.

"On regaining consciousness, he always appeared like one stunned, or
suffering from a severe shock. The influence upon the pulse and nervous
system was always so severe, that we never awaked him at these times if we
could avoid it.

"Whenever a little out of health, as from trifling attacks of indigestion,
or after watching with the sick, or fatigue, he would be sure to be up
and doing something notable in the somnambulic state.

"One of the most remarkable of his exploits occurred several years after
the incident just given. I think it was in 1860 or 1861.... In the rounds
of his practice he had a patient, about whom he was very anxious. It was
in the coldest winter weather, and the residence of the patient was about
two miles distant. Visiting him early in the evening, he found him in a
state so unsatisfactory, that he informed the family that if he did not
find him better the next visit, he should change the medicine entirely. On
rising the next morning, he went to the barn to put his horse to the
cutter for an early start. He was a little puzzled at finding things
somewhat misplaced, but supposed some person had been at the stable in
search of a missing article. On visiting the patient, he was gratified to
find a marked improvement. He inquired when the improvement commenced, and
was answered, 'Immediately after taking the powders which he had given in
the night.' The truth flashed upon him at once, but concealing his
emotion, he inquired, with as careless an air as he could assume, 'About
what time was it when I was here?' They replied, 'Between two and three
o'clock.' This proved to have been the case, as he was afterwards told by
the family where he boarded. He had been giving the patient some fluid
medicine, which he ordered discontinued, and then put up several powders,
such as he had concluded upon the night previous, combining them as usual,
and administering the first one himself."

The foregoing examples illustrate the fact that ordinary vision is not
necessary to guide the movements of the somnambulist. Sometimes the
patient walks about with open eyes; on other occasions they are firmly
closed. It is generally admitted that the tactile and muscular senses are
greatly exalted, so that they furnish guiding sensations which are
sufficient to direct the most complicated movements. The history of the
medical student observed by Dr. Allen shows how preternaturally sensitive
the organs of vision may become--actually seeing the clock in the dark
during the somnambulic paroxysm. When one considers the remarkably
hyperæsthetic condition of the senses in certain other forms of nervous
disorder, it is not surprising that sensory impressions which would be
wholly neglected in a healthy waking state, may become sufficient to
excite perceptions and to guide the movements which they have aroused. It
is undoubtedly true that in certain cases the somnambulist does derive
some information through the medium of the eyes--does really see; but it
is also a fact that he only sees, hears, tastes and feels the objects
which are immediately related with the action of his dream. It appears
also that an impression derived from any organ of sense may suffice to
arouse any other or all of the internal organs of perception, so that the
patient seems to see, to hear, and even to taste objects which he knows
only through the sense of touch. Sometimes the image thus externalized
coincides with the actual reality; but often this is not the case, as, in
the experience of the young clergyman, the somnambulist seemed to see the
paper which he only perceived through contact with his fingers. The image
thus created corresponded exactly with the external fact; but when a
similar contact with a pile of bed-clothes excited the illusion of a
drowning child in his grasp, the internal image did not in the least
correspond with the external object, and he probably derived no
information through the sense of sight in either case. In another
instance, however, as we shall learn upon another page, the subject is so
far dependent upon the sense of sight that its obstruction is sufficient
to arrest his movements, as certainly as if he were awake.

Ordinarily the memory is not impressed by the events of the somnambulic
dream, but we have already learned that it is sometimes affected precisely
as in common dreaming. One of my little acquaintances could not find her
night-dress when she went to bed one night. She was therefore obliged to
wear a gown that was old and ragged. Later in the evening her sister
discovered the missing garment, and laid it over a chair in the bed-room.
In the morning the night-dresses had changed place, and the ragged one
occupied the chair. This occasioned considerable surprise, until the child
remembered that during the night she had dreamed that two of her playmates
had come to sleep with her, and that she felt so mortified at being seen
in a ragged dress that she got out of bed and changed her night-gown.
Sometimes the events of a somnambulic paroxysm are remembered during a
subsequent attack, though they are forgotten during the interval, as in a
case, reported by Macario, of a young girl who had been violated during
somnambulic sleep. On awaking she had no idea of anything that had
occurred, but during a subsequent paroxysm she told her mother all that
had happened.[81] In certain cases a dim recollection of some particular
incident may be retained, as in the case of my patient who was for eight
weeks in the somnambulic state. On recovery, the only thing that she could
remember was a momentary glimpse of some one who was holding up his
fingers before her eyes. Meeting the physician, subsequently to her
recovery, who had thus attempted to arouse her attention, she recognized
in his countenance the features which had momentarily impressed her
consciousness during the period of somnambulic life.

It is seldom observed that somnambulism is attended with dangerous
tendencies, yet they are sometimes present. One of my patients once took
by mistake ninety grains of chloral at a single dose. While under its
effects she got out of bed, walked into her sister's room, shook her fist
in her face, and swore furiously at her. On awaking, next morning, she was
greatly shocked by the account of this dreadful behavior, so utterly at
variance with her usual temper and character. Another somnambulic patient
one night rushed into her mother's room, violently accusing her of
stealing her pocket-book, and threatening vengeance if it were not
returned. Such patients sometimes mislay the articles with which they
occupy themselves during a paroxysm, and on waking they erroneously infer
that they have been robbed. Sometimes, as in the celebrated case related
by Mesnet, the natural propensities of the individual seem to be released
from all restraint, and brutal instincts guide the actions of the
somnambulist, who then steals, or eats and drinks with the voracity of a
savage. Ball and Chambard (_loc. cit._) have collected a number of
examples in which impulses to suicide or other forms of violence were
manifested under such circumstances. Obviously, where the moral sense is
asleep, and where the affection is the result of causes beyond the control
of the patient, he cannot be held morally responsible for the consequences
of such actions. His condition closely resembles that of the victim of
epileptic mania who delivers himself during a paroxysm to all degrees of
furious and homicidal violence, without retaining the slightest
recollection of the fact after its conclusion. The closeness of the
parallel between these two disorders is rendered further apparent by the
circumstance that although all memory of the events of epileptic mania is
usually abolished, it does sometimes persist after the termination of the
attack. Thus, one of my epileptic patients for a time manifested symptoms
of insanity after every fit. During one of these paroxysms he imagined
that the sparrows on the housetop were all singing a particular tune which
had attracted his attention shortly before the convulsion. Then it seemed
to him that the breathing of his sleeping child whispered the same tune.
Placing his hand upon the bosom of his wife, her breathing assumed the
same musical character. Calling upon his family to listen to the wonderful
music, they all asserted that they too could hear it. It was a
considerable time after his recovery before he could be convinced that
this vividly remembered experience was a pure illusion. The members of
his family had been cautioned against contradicting their father during
his paroxysms; consequently, when he asked if they could hear the melody
which delighted him, they answered affirmatively, and thus confirmed him
in his delusion. To the ordinary form of epileptic mania such paroxysms
sustain a relation similar to that subsisting between ordinary dreams and
the somnambulic experience.

In like manner as it is often remarked that certain dreams betray a
condition of unusual cerebral excitement, so do certain cases of
somnambulism manifest a delirious exaltation of the faculties in action.
This characteristic often belongs to the night-terrors of children. It is
a condition in which the brain is occupied by the scenery of a vivid and
highly dramatic vision which dominates the actions of the subject. This
was most conspicuously shown in the following case, from J. P. Frank,[82]
and in certain periods of the paroxysms observed by Mesnet (p. 198).
Frank's patient was a healthy and well nurtured young German girl, who
during the wars of 1812 had been terribly alarmed by a party of French
soldiers who had broken into the house and threatened to kill her father.
The next day at the same hour she passed into a somnambulic state, which
lasted till sunset. After a brief introductory period of agitation, she
uttered a deep sigh, which was rather a sob than a sigh, and fell into a
profound sleep. Presently she smiled, her countenance seemed lighted with
inspiration, her right arm was raised in the air, and the left was
directed towards the earth. In this cataleptic attitude she remained for
about a minute. She then seemed to have decided what to do; from an
imaginary cartridge-box behind her back she pulled out a cartridge, bit
off the end, poured out the powder upon her fist as if she were priming a
musket. She then went through the motions of loading a gun, ramming down
the wad with an imaginary ramrod, and cried out in French, a language
which she had never heard before: "Marche! Ou est le baron? Sacré nom de
Dieu!" Repeating the violent ejaculations and threats addressed by the
soldiers to her father, she exhibited the utmost terror; her body was
covered with a cold sweat, and she seemed ready to faint away. At this
moment she woke up, called impatiently for her handkerchief, with which
she wiped the perspiration from her face, and resumed her ordinary
avocations as if nothing had happened.

Still more remarkable was the case reported by Dr. Mesnet.[83] From the
excellent translation prepared by T. J. Huse, M. D.,[84] the following
sketch has been outlined:

The patient, aet. 27 years, received in one of the battles near Sedan,
during the Franco-Prussian war, a bullet wound which fractured the left
parietal bone. His right arm was almost immediately paralyzed; after a few
minutes the paralysis involved the right leg, and he lost consciousness.
It was only after the lapse of three weeks that he recovered his senses.
He was finally taken to Paris, where the paralysis gradually disappeared.
From a period some three or four months after the reception of the injury,
he began to manifest periodical attacks of somnambulism, at intervals of
fifteen to thirty days with an average duration of fifteen to thirty
hours. During the whole of this time his life presented two essentially
distinct phases--the one normal, the other pathological. In the normal
condition he was able to gain a livelihood. He had been a clerk in several
houses, a singer in a _café_, and while in the hospital had made himself
useful and agreeable. The somnambulic attacks which he experienced were
characterized by an instantaneous onset, resulting in the abolition of all
his senses except the tactile sense. Sight was perhaps partially
persistent, for on many occasions he seemed to be impressed by brilliant
objects, but he was obliged to employ the sense of touch in order to
understand their form, volume, etc. During all these crises his gait was
easy, his attitude calm, his countenance peaceful; his eyes were widely
open, with dilated pupils; the forehead and brows were contracted; there
was an incessant nystagmus, indicating a disordered state in the brain; he
was continually mumbling or muttering. When walking in a familiar locality
he moved with perfect freedom; but if in a strange place, or if obstacles
were placed in his way, he examined the obstructions by feeling of them
with his hands, and turned easily aside. If any attempt was made to change
his direction, or to quicken or retard his pace, he allowed himself to be
directed like a mere automaton, continuing to walk in any way thus chosen
for him. He would also eat, drink, smoke, dress himself, walk out, and
retire to bed as usual. These processes seemed to be effected as a result
of previous habit, without any actual consciousness or feeling. He ate
voraciously without discernment, and drank in the same manner ordinary
wine, wine of quinine, water, assafoetida, without exhibiting any evidence
of sensation whatever.

While under treatment in the Saint Antoine Hospital, this patient was
carefully studied by Dr. Mesnet and by Alfred Maury, the celebrated
author. They found that by means of impressions upon his tactile
sensibility it was possible during any one of his paroxysms to suggest
certain modes of action which were reproduced whenever he was again placed
in the same conditions. Thus, "he was promenading in the garden, under a
grove of trees, when some one put back into his hand the cane which he had
let fall a few moments previously. He felt of it, turned his hand several
times around the curved handle of the cane, became attentive, seemed to
listen, and suddenly cried out, 'hurry!' then, 'there they are! there are
at least twenty of them, to the two of us! we shall get the better of
them!' and then, carrying his hand behind his back, as if to get a
cartridge, he went through the movements of loading his musket, crouched
at full length in the grass, concealing his head behind a tree, in the
posture of a sharp-shooter, and following with his gun at his shoulder all
the movements of the enemy whom he seemed to see close at hand. This scene
often repeated in detail during the course of the observations, has seemed
to each of us the most complete expression of an hallucination called up
by an illusion of touch, which, giving to a cane the properties of a gun,
awakened in this person remembrances of his last campaign, and reproduced
the struggle in which he was so grievously wounded."

On another occasion the patient was at the end of a corridor, near a door
that was locked; he "passed his hands over this door, found the knob,
grasped it, and attempted to open it; failing to accomplish this, he
sought for the keyhole, then for the key, which, however, was not there;
then, passing his fingers over the screws which secured the lock, he
endeavored to seize them and turn them for the purpose of detaching the
lock. _This entire series of actions bears witness to an effort of his
mind connected with the object before him._ He was on the point of leaving
the door and turning towards another room, when I held up before his eyes
a bunch of seven or eight keys; he did not see them; I jingled them loudly
at his ear; he did not notice them; placing them in his hand, he
immediately took hold of them, and tried them one by one in the keyhole,
without finding the single one which could fit; he then left the place,
and went into one of the wards, taking in his passage various articles
with which he filled his pockets; at length he came to a little table used
for the records of the wards. He then passed his hands over the table, but
it was empty; in feeling of it, however, he came across the handle of a
drawer; opening it, _he took up a pen, and all at once this pen suggested
to him the idea of writing_; for at that moment he began to ransack the
drawer, taking out and placing on the table several sheets of paper, and
also an inkstand. He then sat down and commenced a letter, in which he
recommended himself to his commanding officer for his good conduct and
bravery, and made application for the military medal. This letter was
written with many mistakes in it, but these were identical as regards
expression and orthography with all that we have seen him make in his
healthy state. While the patient was writing, he aided us in an experiment
that encouraged to immediately examine in what degree the sense of sight
assisted in the performance of this action. The facility with which he
traced his letters, and followed the lines upon the paper, left no doubt
concerning the exercise of vision upon the writing; but, in order to make
the proof satisfactory, we have several times interposed a thick plate of
sheet-iron between his hands and his eyes when he was writing; and,
although all the visual rays were intercepted, he did not immediately
break off the line he had begun; he still continued to trace a few words
written in an almost illegible manner with the letters entangled in each
other; then finally he stopped without manifesting either discontent or
impatience. The obstacle removed, he finished the uncompleted line, and
began another. _The sense of sight was therefore in full activity, and
essential to the written expression of the patient._" Other observations
showed that the sense of sight was only roused at the instance of touch,
and that its exercise remained limited to those objects alone with which
it was actually connected by the touch.

On another occasion he passed through a long ward of patients, "taking
indiscriminately every article that came within his reach, and concealing
them afterwards under the quilt, under a mattress, under a chair-cover,
and under a pile of sheets. Arrived in the garden, he took from his pocket
a book of cigarette papers, opened it, and detached a leaf from it; then
took out his tobacco and rolled a cigarette with the dexterity of one who
is accustomed to this proceeding. He searched for his match-box, lighted
his cigarette with a match, which falling still burning on the ground, he
extinguished by placing his foot upon it; then smoked his cigarette while
strolling back and forth to the entire extent of the garden, without any
of these actions presenting the slightest deviation in their manner from
the ordinary method. Everything that he did was the faithful reproduction
of his ordinary round of life.

"This first cigarette terminated, he prepared to make another, when we
stepped up and began to interpose obstacles.... He searched vainly in his
pocket for his tobacco, as we had filched it. He searched for it in
another pocket, going through all his clothes until he came back to look
for it in the first pocket, when his face expressed surprise. I offered
him his tobacco-pouch, but he did not perceive it; I held it near his
eyes, yet he still did not perceive it; even when I shook it just in front
of his nose, he did not notice it. But when I placed it in contact with
his hand, he seized it and completed his cigarette directly. Just as he
was about to light his cigarette with one of his matches, I blew it out
and offered him instead a lighted match which I held in my own hand; he
did not perceive it; I brought it so close to his eyes as to singe a few
lashes, yet he still did not perceive it, neither did he make the
slightest motion of blinking.... _The patient sees certain objects and
does not perceive others; his sense of sight receives impressions from
all objects in personal relation with himself through the touch, and does
not receive impressions, on the contrary, from things external to him; he
perceives his own match, but does not perceive mine._"

During the course of this observation the patient gave evidence that the
memory of his former occupation as a professional singer had been revived.
He began to hum some of the familiar airs, and then proceeded to his room
in the hospital, where he carefully dressed himself as if for a public
performance. "On his bed he chanced to meet with several numbers of a
periodical romance, which he turned rapidly over without finding that for
which he was searching.... I took one of those numbers, rolled it up, and
putting it into his hand in that condition, satisfied his want by this
semblance of a roll of music, for he then took his cane, and traversed the
ward with a slow step, well contented. When stopped on his way, for the
purpose of taking off the coat he was wearing (which had been foisted on
him by one of the observers), he permitted it without offering any
resistance.... At this moment the sun lit up with a bright ray a glass
window that closed the lodge on the side towards the court.... This ray
must have given him the impression of a footlight, for he at once placed
himself before it, readjusted his toilet, opened the roll of paper which
he carried in his hand, and softly hummed an air, running his eyes over
the pages as he slowly turned them, and marking with his hand a measure
that was perfectly rhythmical. Then he sang aloud, in a highly agreeable
manner, giving his song the correct expression, a patriotic ballad to
which we all listened with pleasure. This first selection terminated, he
sang a second, and afterwards a third. We then saw him take out his
handkerchief to wipe his face. I offered him a wine-glass of a strong
mixture of vinegar and water, which he did not notice; I placed the glass
under his nose without his perceiving the smell of the vinegar; I put it
into his hand, and he drank it without complaining of any unpleasant
sensation."

The conclusions which may be drawn from this remarkable history have been
sufficiently expressed by Dr. Mesnet[85] in the following words:

"The disturbance which these functional perversions of the nervous system
bring into the course of life, extends not only to the organs of sense,
and to intellectual actions properly so called, but it also sometimes
awakens some instinctive excitation which surrenders the individual
without any defence, and destitute of rational discernment, to the most
deplorable impulses. He acts with the semblance of a freedom which he does
not possess; he seems to prepare and to combine certain actions in the
light of conscious volition, when he is in reality only a blind
instrument, obedient to the irresistible mandates of an unconscious
impulse."

The bearing of these conclusions upon the question of the moral
responsibility of the somnambulist needs no further advertisement.

The likeness of certain features of such cases to the phenomena of
hypnotism is worthy of note. In this particular there is an evident
likeness between the cerebral susceptibility of the ordinary dreamer, the
somnambulist, and the hypnotised subject. All are alike in a condition
which renders their imagination and their volition subservient to guiding
sensations from without, so that their movements may be directed by the
will of another. We have seen how the course of an ordinary dream may be
modified by such suggestions. The history of the patient just related,
illustrates the manner in which the actions of a somnambulic dreamer may
be controlled by the will of a spectator. The ordinary phenomena of
hypnotism exhibit the same subjection to the will of another. It is
probable that a considerable part of the superior notoriety which belongs
to this feature of hypnotism, is due merely to the fact that natural
somnambulism is rarely made the object of such experiments and
observations as are daily applied to the subjects of artificial
somnambulism.

_Somnambulic Life._--We come now to the last term of the series, the
simplest, yet perhaps the rarest form of the affection. In this form, the
patient seems perfectly awake; he is in possession of all his senses; he
is capable of sustained and rational volition; he lives and behaves, in
short, like any other person. But his life is divided into periods which
are, so far as consciousness is concerned, completely distinct from each
other. This double-consciousness may be exhibited but once in a lifetime,
or it may be frequently repeated, so that the patient oscillates between
the two states until it becomes doubtful which is the natural condition
and which is the acquired. These states of double-consciousness are
divided from each other by a more or less complete break in the chain of
memory. The residual strata which, so to speak, have been deposited from
the sea of events upon the floor of memory, have become broken and
"faulted." The line of rupture marks the division between the two fields
of consciousness; they no longer lie in the same plane, consequently there
can be little or no continuity of memory between them. The events which
transpire in one state affect the mind so long as, and whenever it is in
connection with the cerebral register which is fitted to that state; as
soon as the connection is shifted, the mind takes cognizance of the events
that are recorded upon the other portion of the register, but, for want of
physical continuity between the different portions of the record, the mind
cannot at once receive a continuously connected report from the entire
organ of recollection. From this results a mode of life essentially
similar to the life of certain epileptics who are ushered by each seizure
into a state of apparently conscious activity of which they have no
recollection after recovery. Thus, one of my epileptic patients, who was
subject to seizures, both of the convulsive and the non-convulsive form of
the disease, on one occasion left home, after a fit, and traveled a
considerable distance into the country, putting up for the night at
taverns and farm houses, and apparently behaving like any other
respectable citizen. It was three weeks before he came to himself. On
recovering his normal consciousness, the period of his wanderings was a
perfect blank in his memory. Such attacks are usually of shorter duration,
and are more frequently associated with hysteria; bearing to the
hysterical paroxysm the same relation which they share with the epileptic
fit. When the predisposing temperament exists, a great variety of
excitations may serve to produce the phenomena, so that unless careful
observation is employed, the truly somnambulic character of the paroxysm
may easily be overlooked. Thus, the true nature of the affection was not
suspected by the early attendants of the patient who became the subject of
lethargic stupor, as related on page 173. Under the influence of powerful
drugs acting upon a highly sensitive nervous organization, she became, at
first, "hystericky." She manifested great distress, complained bitterly of
her sufferings, passed through the ordeal of several consultations, was
subjected to a considerable surgical operation, and only ceased to appear
conscious at the expiration of five weeks, when she passed into the
lethargic state previously described. At the time of my first visit, just
before the commencement of stupor, she walked into the room where I was
waiting, greeted me with her usual affability, gave me some account of her
sensations, and neither did nor said anything that could lead me to
suspect that she was not in her normal frame of mind. But, with the
exception of the single incident mentioned on page 193, the entire period
from the commencement of her medication to the close of the lethargic
stupor was utterly blotted out of her recollection.

Macnish[86] relates a similar case of a young lady who "unexpectedly, and
without any forewarning, fell into a profound sleep which continued
several hours beyond the ordinary term. On waking, she was discovered to
have lost every trace of acquired knowledge. Her memory was _tabula
rasa_--all vestiges, both of words and things, were obliterated and gone.
It was found necessary for her to learn everything again. She even
acquired, by new efforts, the art of spelling, reading, writing, and
calculating; and gradually became acquainted with the persons and objects
around, like a being for the first time brought into the world. In these
exercises she made considerable proficiency. But, after a few months,
another fit of somnolency supervened. On rousing from it, she found
herself restored to the state she was in before the first paroxysm; but
was wholly ignorant of every event and occurrence that had befallen her
afterward. During four years and upwards she has passed periodically from
one state to the other, always after a long and sound sleep.... The former
condition of her existence she now calls the Old State, and the latter the
New State; and she is as unconscious of her double character as two
distinct persons are of their respective natures. For example, in her old
state she possesses all the original knowledge; in her new state only what
she acquired since. If a lady or gentleman be introduced to her in the old
state, or _vice versa_ (and so of all other matters), to know them
satisfactorily she must learn them in both states. In the old state, she
possesses fine powers of penmanship, while in the new, she writes a poor,
awkward hand, not having had time or means to become expert. Both the lady
and her family are now capable of conducting the affair without
embarrassment. By simply knowing whether she is in the old or new state,
they regulate the intercourse, and govern themselves accordingly."

Another remarkable case was reported at length by Dr. Azam, of
Bordeaux.[87] The principal facts are given in a translation by Dr. J. I.
Tucker in the _Chicago Journal of Nervous and Mental Disease_.[88] The
patient was a young woman who began to exhibit the symptoms of hysteria at
the age of puberty, and from that time till the present, a period of
nearly thirty years, she has lived a double life, passing alternately from
normal life into somnambulic life. These transitions were ushered in by a
sharp pain in both temples, followed by a species of stupor, lasting about
ten minutes. She would then open her eyes, apparently awake, and would
remain in the condition of somnambulic life for an hour or two, when the
languor and sleepiness would reappear for a few minutes, after which she
would awaken in her normal state. At first these paroxysms were renewed
every five or six hours; but, as she grew older, they occurred less
frequently, and were greatly prolonged, until, finally, the periods of
somnambulic life considerably exceeded the duration of normal life. During
normal life she was hypochondriacal, hysterical, and a sufferer with
neuralgia. During somnambulic life she was free from pain, lively,
imaginative, and coquettish. While in this state of existence she
remembered the events of her entire life--normal or otherwise; but on
returning to her natural mode of life, she retained no recollection of her
somnambulic periods. Memory, during normal life, was limited to anterior
normal periods. As time advanced, this peculiar mode of existence became
an increasing source of inconvenience and mental distress, often leading
the superficial observer to suppose that she was insane.

This case differs from the others in the circumstance that the period of
somnambulic life was more vigorous and healthy than the ordinary
condition. This seems to suggest an explanation of the forgetfulness which
marked the period of normal life. During that period the functions of the
brain were depressed, so that its molecular movements could not reach the
level of the field of consciousness occupied during the second period.
Other observations, such as that of Sir Henry Holland,[89] who, while
exhausted by fatigue, lost all recollection of the German language until
he was restored by rest and food, indicate that such defects of memory
depend upon a deficient nutrition of the brain substance--a condition
which is undoubtedly associated with an enfeebled cerebral circulation. We
may, therefore, suppose that in Dr. Azam's case the paroxysms of
somnambulic life were induced by periodical discharges of force within the
brain, causing an improvement in the circulation of blood, and a
corresponding gain in health and general vivacity. Such exaltation of the
faculties would be perfectly consistent with an exercise of memory
covering all the events of life. But, when, as in cases like that reported
by Macnish, and by myself, somnambulic life is the result either of
disease or simple somnambulic sleep, it is a condition in which, as in
physiological sleep, the cerebral functions, taken as a whole, are
depressed rather than exalted. The resulting train of ideas is developed
upon a plane below the level of ordinary consciousness, and is,
consequently, as easily forgotten as the dreams which are developed during
sleep.

Such, then, are the principal characteristics of somnambulism--a state in
which dreams are supplemented by more or less complete and appropriate
action; ordinarily without subsequent recollection of either dream or
action. The somnambulic dream usually occurs during or soon after the
period of deepest sleep, when the influences of the external world are
most completely suppressed. Released from the control of its sensory
portion, the remainder of the brain awakens, and becomes aroused to a
condition of relative exaltation. No longer distracted by the
solicitations of external sense, the attention is concentrated upon the
hallucinations which constitute the dream. In the simpler forms of
noctambulism only the automatic locomotive apparatus is awakened, and the
sleeper moves in accordance with the impressions derived from habit, aided
by actual exaltation of the muscular and tactile senses. But, in some of
the more complicated cases, a certain amount of special sensibility seems
to exist. The patient is capable of exercising just that amount of
perception which is necessary to accomplish his purpose, though blind and
deaf and insensible to every other impression. The more complete the
waking of the sense-organs, the closer the resemblance to the condition of
ordinary life, or even to the condition of ecstasy, in which cerebral
exaltation is the prominent feature, and in which the power of
recollection generally persists. Accordingly, it sometimes happens that
the somnambulist can recall the events of his paroxysm. In such cases the
power of recollection is due to the same conditions that control the
recollection of our ordinary dreams. But the phenomena of ordinary
somnambulism are as completely as possible removed from all connection
with the mental actions which arise directly from the operation of the
senses. By reason of such isolation the ordinary association of ideas
affords no help to the memory, and the dream remains in oblivion. Alfred
Maury expresses the opinion[90] that the principal cause of forgetfulness
of the events of somnambulism consists in the exhaustion of the cerebral
elements through the intensity of the excitement to which they have been
subjected during the paroxysm. Doubtless this, in certain cases, may
contribute to the loss of memory, but it should be remembered that the
excitement may be relative rather than absolute. Certain elements wake
while others are asleep; and these waking cells may be aroused to a degree
far in excess of what is usual during the sleep of the brain without
attaining to the level of their diurnal activity. The mind, undisturbed by
external impressions, gives its attention to the operation of these waking
organs, and a dream with all its consequences, somnambulic or otherwise,
is the result. In other words, the plane of consciousness, so to speak, is
lowered in sleep to the level of these molecular vibrations. But when the
entire brain has been completely reawakened, the residual vibrations of
those elements which yielded the physical basis of the dream, and which,
had they originally occurred during the waking state, might have persisted
with energy sufficient to furnish a groundwork for recollection of the
ideas which they had first suggested, are no longer sufficiently forcible
to be felt in consciousness. Recollection of mental states thus generated
must necessarily be impossible under such conditions. Sometimes, however,
the somnambulist who, while awake, had forgotten all the incidents of his
somnambulic experience, can remember, in a subsequent paroxysm, all that
occurred during the preceding attack. Facts of this kind have been
observed in the waking life of certain hysterical persons, but the
apparent doubling of their personality is connected with the waking state,
or with its semblance, while in ordinary somnambulism it is only during
sleep that the alternations of memory and forgetfulness occur. A similar
recollection of previous visions is sometimes experienced in dreams,
showing a close relationship between the dreams of sleep and of
somnambulism. The bond of association between events thus isolated in time
must be sought in a renewal of like conditions of the brain during the
successive periods of somnambulic exaltation. We must suppose that the
molecules which were in a state of excitement during the first paroxysm
are again aroused in a similar manner after a period of waking quiescence.
If, during sleep, their movements, though of an exalted character, have
only just sufficed to arouse consciousness in the form of a dream, it is
scarcely probable that during the phase of comparative inactivity which
supervenes when the whole brain is awake, their residual motion could
disturb the sphere of consciousness. Hence the time occupied by their
somnambulic vigor must remain a blank in memory during the waking state.
But, when the original state of relative exaltation has been reproduced by
a second paroxysm of disorder, if the same molecular movements be in any
way renewed, the conditions of memory are fulfilled; consciousness is once
more aroused as before, and the patient remembers the dream or the events
of the previous attack.




CHAPTER VII.

ARTIFICIAL SOMNAMBULISM OR HYPNOTISM.

  There are more things in heaven and earth, Horatio,
  Than are dreamt of in your philosophy.
                                      --HAMLET.


The phenomena of somnambulism are of apparently spontaneous origin, during
ordinary sleep. But from the remotest antiquity it has been known that
certain persons may be thrown into an artificial sleep which closely
resembles the condition of the somnambulist. Such a degree of
susceptibility is not common to all persons. Heidenhain, experimenting
upon his class of medical students, found only one in twelve who was thus
susceptible. My own experiments lead me to think that American medical
students are less easily influenced in this direction. Charcot, whose
field of observation covers the inmates of the Salpêtrière Hospital, finds
the best examples of the hypnotic state among the hystero-epileptic
females in that asylum. To the experiments of Heidenhain, in Germany, of
Braid, in England, and of Charcot, in France, we are indebted for the most
thoroughly scientific observation and interpretation of the phenomena of
hypnotism.

The antecedent physical condition most favorable to the development of the
hypnotic state is a highly unstable constitution of the nervous system.
For this reason the larger number of qualified subjects is furnished by
the female sex--especially by those who possess the hysterical
temperament. Frequent repetition of hypnotic exercises renders the subject
still more susceptible. Heidenhain was, at first, inclined to the belief
that such experiences were not prejudicial to the health of the subject,
but the observations of Harting, in the University of Utrecht, and of
Milne-Edwards, in Paris,[91] have demonstrated the fact of danger to the
health of animals subjected to similar experiments. Hysterical patients
have often exhibited considerable exhaustion after hypnotic exhibition in
the hospitals of Paris (Charcot and Richer), consequently, it cannot be
admitted that the practice is devoid of risk to the health of the
individual.

Numerous methods of inducing the hypnotic state have been employed. The
greater number consist in artificial modification of the condition of the
brain through the agency of sensory impressions originated upon the
periphery of the body. The simplest form of such influence is presented by
the results of gentle friction of the skin with the palm of the hand or
the tips of the fingers. Many an aching head has thus been relieved, many
a restless sufferer soothed to sleep. In like manner, a susceptible
subject may be hypnotized by any continuous and gentle excitement of the
senses of sight, hearing, and touch. Concentration of the attention upon a
brilliant object, like a piece of polished metal or a small mirror,
especially if it be placed a little above the level of the eyes, and so
near that considerable convergence of the eyeballs is necessary for
distinct vision, affords a very efficient means of inducing artificial
somnambulism. Certain persons may be readily hypnotized by gently pressing
the eyelids together, and at the same time making slight pressure upon the
eyeballs. Others pass into this condition by merely closing their eyes,
and remaining motionless in a quiet room.

The phenomena of artificial somnambulism are frequently developed through
the agency of impressions derived directly from the sphere of
consciousness. The intellectual effort of trying to sit still and think of
nothing is sometimes sufficient to induce the hypnotic state. The ordinary
devices by means of which wakeful people are taught to beguile sleep, by
counting, or by repeating long lists of names, etc., all belong to this
category. Compulsory attention to any continuous intellectual process,
like adding up a column of figures, or trying to read a dull book, is
sometimes effectual. If, with these, or with similar acts of attention, be
associated the expectation that something unusual is about to occur, as
when the individual is aware of being the subject of an experiment, the
evolution of the somnambulic condition is greatly facilitated. Thus, one
of the most recent methods, consists in merely sitting, for half an hour
or more, with the back towards the patient. Attention, curiosity, and
expectation, are thus excited, and a susceptible person soon begins to
manifest some of the numerous and various forms of the hypnotic state.
Heidenhain caused one of his students thus to go to sleep in broad
daylight, by simply assuring him that he should hypnotize him from a
distance at a particular hour of the afternoon. The monks of Mt. Athos
were accustomed to hypnotize themselves by fixing their eyes and their
thoughts upon the navel; hence the reputation of omphaloscopy as an aid to
ecstatic meditation.

The duration of hypnotic sleep is as variable as that of its prototype in
natural somnambulism. The patient usually wakes spontaneously, after a few
minutes or hours. Sometimes, however, the period of insensibility is
greatly prolonged. If it be desirable to awaken the subject of experiment,
a simple reversal of the movements by which sleep was induced may suffice.
The paroxysm may be terminated by almost any sudden and energetic appeal
to the senses, like an electric shock, a sudden illumination of the eye
with vivid light, or a sharp puff of air upon the face.

The simplest phenomena connected with the hypnotic state are those
transferences of cerebral perceptions which have been investigated by the
Society for Psychical Research.[92] Certain sensitive persons, when
blindfolded, are capable of reproducing with considerable accuracy visual
images that have been impressed upon the mind of another. The sensitive
subject is blindfolded and placed before a table with pencil and paper.
Another person then goes out of the room, and gazes at some kind of
drawing, geometrical figure, or other object selected without possibility
of collusion with the subject of experiment. This person then returns to
the room, and places his hand upon the head of the subject, at the same
time fixing his attention upon the mental picture of the object. Presently
the blindfolded subject takes the pencil and reproduces on paper a rough
drawing of the object in question. In some cases it is found possible to
effect this transfer of impressions without actual physical contact,--the
agent merely standing behind the sensitive subject and concentrating his
thought upon the selected object. Closely akin to this is the method of
muscle-reading, popularly known as _mind-reading_. The sensitive is
blindfolded, and then presses against his forehead the hand of the person
by whom he is to be guided. Almost immediately a tremor pervades his
muscles, and he yields all his movements to the guiding influence of the
individual with whom he is in contact. If now an object be concealed in
any place that is known to the agent, the concentration of that person's
attention upon the hiding place suffices to direct the "mind-reader," who
immediately drags his companion to the given locality.

The explanation of these phenomena consists in a recognition of the fact
that certain persons are gifted with nervous organs which are sensitive
and responsive to nervous impulses and muscular movements that are too
delicate for recognition by the percipient apparatus of ordinary mankind.
The more complicated forms of artificial somnambulism result from the
complication and exaggeration of the results of this inordinate
sensitiveness through the agency of artificial sleep. As in natural
somnambulism, so in the hypnotic state, certain organs become totally
anæsthetic, while the sensibility of others is wonderfully exalted.
Cutaneous sensation may be completely abolished, and the patient may
become utterly insensible to every painful impression. The reflex
functions may be either suppressed or exaggerated, and the special senses
of sight and hearing may be exalted to the highest degree. While in this
condition the hyperæsthetic condition of the brain renders the subject
peculiarly susceptible to impressions from the will of another, so that
all his actions are obedient to the guiding influence of the person under
whose control he has passed.

According to Charcot,[93] three principal types of artificial somnambulism
may be remarked among the hysterical subjects upon whom he experimented:
(1) the _cataleptic_, (2) the _lethargic_, and (3) the _somnambulic_. Of
these the first may be developed primarily by any abrupt and powerful
impression upon a sensory organ. Gazing upon a brilliant light, fixing the
eyes upon a piece of polished metal, or upon the shining eyes of a second
person, the sudden clangor of a Chinese gong, may suffice to induce the
cataleptic state. Dumontpallier[94] reports the case of a young woman who
accidentally hypnotized herself by gazing into the mirror before which she
was dressing her hair. This cataleptic state may also be secondarily
induced by merely opening the eyes of a patient in whom a condition of
hypnotic lethargy has been previously developed. If only one eye be thus
opened, the corresponding side of the body alone becomes cataleptic.
Closing the eyes causes the disappearance of this symptom, with complete
restoration of the purely lethargic state. During the cataleptic condition
the several tendinous reflexes disappear, neuro-muscular
hyper-excitability ceases, the skin becomes insensible, but the special
senses, particularly those of sight and hearing, maintain a partial
activity. In this half-awakened state the senses may become avenues of
suggestion from without for the production of movements; but, if left to
themselves, the limbs remain motionless.

The _lethargic state_ may be induced by simply pressing together the
eyelids of the subject, or by causing him to fix his gaze upon some
definite object. The paroxysm begins with a deep inspiration, causing a
peculiar laryngeal sound, followed sometimes by the appearance of a little
foam on the lips. The eyelids are either wholly or partially closed, and
are in a state of continual tremulous motion. The eyeballs are generally
turned upwards and inwards. The muscles are completely relaxed. The
tendinous reflexes are exaggerated; pressure over a muscle, or upon a
nerve, arouses a peculiar contracture of synergic muscles and groups of
muscles that are supplied by the excited nerve trunk. The facial muscles,
however, do not thus become contractured; they merely contract during the
application of the stimulus. If the lethargic subject be rendered
cataleptic by opening the eyes, these contractures persist even after
waking; and they can only be dispelled by renewing the lethargic state
before resorting to pressure upon the antagonistic muscles--the process by
which contractures peculiar to this species of lethargy may always be
annulled. By the approach of a magnet to a contractured limb, the rigidity
may be completely transferred to the corresponding muscles upon the
opposite side of the body. If upon a limb of a lethargic subject who has
been rendered cataleptic by opening the eyes, an Esmarch's band be
applied, pressure over the bloodless muscles excites no contracture until
the band is removed. A contracture is then developed, and it may be
transferred to the opposite limb by the approach of a magnet. To this
phenomenon has been applied the term _latent contracture_.

The extraordinary muscular excitability manifested by these subjects is
further illustrated by an observation recorded by Dumontpallier.[95] If
one end of an India rubber tube, half an inch in diameter, and five or six
yards in length, be applied over a muscle in the leg, and if the other end
be in like manner connected with a watch, every movement of the second
hand will be followed by a slight contraction in the muscle. The same
result follows connection with the wire of a telephone; and, if a
microphone be introduced into the circuit, the incidence of a ray of light
upon the instrument, or even its reflection from the conjunctival surface
of the eye of a spectator, will arouse a responsive muscular contraction.
Charcot has also seen muscular motion upon the opposite side of the body
when a mild galvanic current was applied to the parietal surface of the
skull, presumably over the motor centres of the corresponding half of the
brain.

During these manifestations of muscular hyper-excitability, there is
complete insensibility to pain, but the senses of sight and hearing seem
to preserve some degree of activity. The subject, however, does not often
exhibit any susceptibility to influence by suggestion.

The _somnambulic state_ may be directly induced by fixed attention with
the eyes, by feeble and monotonous excitement of the senses, by passing
the hands over the face and arms of the subject, and by many other
processes of analogous character. This variety constitutes the ordinary
form of hypnotic sleep. It may be very easily developed during either the
lethargic or the cataleptic state as a consequence of pressure or of
gentle friction upon the top of the head. Thus Heidenhain, in the course
of his experiments, caused muscular paralysis by rubbing the scalp.
Friction of one side of the head occasioned paralysis of the opposite side
of the body without notable affection of the consciousness of the subject.
The eyes and the eyelids behave as in the lethargic state. The subject
seems to be asleep, but there is less muscular relaxation than in the
lethargic variety. There is no exaggeration of the tendinous reflexes, and
muscular hyper-excitability is absent. But by lightly touching or
breathing upon the surface of a limb, its muscles may be thrown into a
condition of rigidity which differs from the contracture of the lethargic
state, in the fact that it does not yield to excitement of the
antagonistic muscles, though yielding readily to a sudden repetition of
the same form of excitement by which it was originally produced. Thus a
subject under my own observation who, by pressure upon the eyeballs, was
rendered insensible to every form of painful stimulation, would
immediately pass into a state of perfect rigidity, if his limbs and body
were rubbed for a few seconds with the palm of the hand. While in this
condition, if the heels were placed upon a chair and the back of the head
upon another, not only could the entire weight of the body be thus
supported, but also the additional weight of another full-grown man,
sitting upon his body, without causing any more yielding than if it had
been a log of wood that was lying across the chairs. From the immobility
of the cataleptic state this rigidity differs by its greater degree of
resistance to passive motion. Though insensibility to pain may be
perfectly developed in this state, there is generally an exalted condition
of certain forms of cutaneous sensibility, and of the muscular sense.
Strange perversions of other special senses are sometimes remarked. Thus,
Cohn[96] discovered that a patient who was naturally color-blind, was
able, when unilaterally hypnotized, "to distinguish colors which were
otherwise undistinguishable." Conversely, when the cataleptic state is
induced, the healthy eye becomes incapable of discerning colors. Spasm of
accommodation is also present, and is one of the earliest demonstrable
symptoms of the hypnotic condition.

These remarkable exaggerations and perversions of sensibility have been
the cause on the one hand, of much skepticism regarding the verity of the
phenomena of hypnotism, and, on the other, of much credulity, extending
even to a belief in the existence of supernatural and miraculous powers.
The extraordinary character of these experiences is well illustrated by
the following letter from Lieut. J. M. Brooke, of the United States Navy,
to President Wayland, of Brown University. It may be found in "Wayland's
Intellectual Philosophy."

    "WASHINGTON, Oct. 27th, 1851.

    "SIR--It affords me pleasure to comply with your request, made through
    my brother William, relative to some experiments performed on board
    the United States steamer 'Princeton,' in the latter part of the year
    1847, she being then on a cruise in the Mediterranean. Nathaniel
    Bishop, the subject of the experiments, was a mulatto, about
    twenty-six years of age, in good health, but of an excitable
    disposition. The first experiment was of the magnetic or mesmeric
    sleep, which overpowered him in thirty minutes from the commencement
    of the passes made in the ordinary way, accompanied with a steadfast
    gaze and effort of the will that he should sleep.

    "In this state he was insensible to all voices but mine, unless I
    directed or willed him to hear others; he was also insensible to such
    amount of pain as one might inflict without injury, that is, what
    would have been pain to another. He would obey my directions to
    whistle, dance or sing. When aroused from this sleep he had no
    recollection of what occurred while in it. That such an influence
    could be exerted, I was already aware, having previously witnessed
    satisfactory experiments. Of clairvoyance I had never been convinced;
    indeed, considered it nothing but a sort of dreaming produced by the
    will of the operator. I became aware of its truth rather through
    accident than design.

    "It happened, one day, that some of my brother officers asked a
    question which the others could not answer. Bishop, who had been a few
    moments before in a mesmeric sleep, gave the desired information,
    speaking with confidence and apparent accuracy. As the information
    related to something which it seemed almost impossible to know without
    seeing, we were very much surprised. It struck me that he might be
    clairvoyant; and I at once asked him to tell me the time by a watch
    kept in the binnacle, on the spar or upper deck, we being on the berth
    or lower deck. He answered correctly, as I found upon looking at the
    watch, allowing eight or nine seconds for time occupied in getting on
    deck. I then asked him many questions with regard to objects at a
    distance, which he answered, and, as far as I could ascertain,
    correctly.

    "For example, one evening, while at anchor in the port of Genoa, the
    captain was on shore. I asked Bishop, in the presence of several
    officers, where the captain then was. He replied, 'At the opera with
    Mr. Lester, the consul.' 'What does he say?' I inquired. Bishop
    appeared to listen, and in a moment replied: 'The captain tells Mr.
    Lester that he was much pleased with the port of Xavia; that the
    authorities treated him with much consideration.' Upon this, one of
    the officers laughed, and said that when the captain returned he would
    ask him. He did so, saying, 'Captain, we have been listening to your
    conversation while on shore.' 'Very well,' remarked the captain,
    'what did I say?' expecting some jest. Then the officer repeated what
    the captain had said of Xavia and its authorities. 'Ah,' said the
    captain, 'who was at the opera? I did not see any of the officers
    there.' The lieutenant then explained the matter. The captain
    confirmed its truth, and seemed much surprised, as there had been no
    other communication with the shore during the evening. I may remark
    that we touched at several ports between Xavia and Genoa.

    "On another occasion, an officer being on shore, I directed Bishop to
    examine his pockets; he made several motions with his hands, as if
    actually drawing something from the officer's pockets, saying, 'Here
    is a handkerchief and a box; what a curious thing! full of little
    white sticks with blue ends. What are they, Mr. Brooke?' I replied,
    'Perhaps they are matches.' 'So they are,' he exclaimed. My companion,
    expecting the officer mentioned, went on deck, and meeting him at the
    gangway, asked, 'What have you in your pockets?' 'Nothing,' he
    replied. 'But have you not a box of matches?' 'Oh, yes!' said he. 'How
    did you know it? I bought them just before I came on board. The
    matches are peculiar, made of white wax with blue ends.'

    "The surgeons of the 'Princeton' ridiculed these experiments, upon
    which I requested one of them (Farquharson) to test for himself, which
    he consented to do. With some care he placed Bishop and myself in one
    corner of the apartment, and then took a position some ten feet
    distant, concealing between his hands a watch, the long hand of which
    traversed the dial. He first asked for a description of the watch. To
    which Bishop replied, ''Tis a funny watch, the second hand jumps.'

    "The doctor then asked him to tell the minute and second, which he
    did; directly afterwards exclaiming, 'The second hand has stopped!'
    which was the case, Dr. Farquharson having stopped it. 'Well,' said
    the doctor, 'to what second does it point, and to what hour, and what
    minute is it now?' Bishop answered correctly, adding, ''Tis going
    again.' He then told twice in succession the minute and second.

    "The doctor was convinced, saying that it was contrary to reason, but
    he must believe. I then proposed that the doctor should mark; and
    directed Bishop to look in his mother's house, in Lancaster, Pa.,
    (where he had never been) for a clock; he said there was one, and told
    the time by it; one of the officers calculated the difference in time
    for the longitudes of Lancaster and Genoa, and the clock was found to
    agree within five minutes of the watch time."

Such clairvoyance is very rare; in fact, it is difficult, at first
thought, to believe in its existence. Nor should its alleged possession
be credited in any instance until all possibility of deception has been
excluded. The example just related seems to be, in this respect, one of
the best, for the reason of its occurrence in a little group of men whose
isolation and thorough acquaintance with each other must have reduced the
chances of simulation to the lowest degree. When carefully considered,
moreover, it is apparent that the exaltation of the functions of sight and
of hearing in this case was not different in kind or in degree from that
that has already been recorded in connection with certain cases of natural
somnambulism and of dreaming. The condition of the brain is probably
identical in all such instances; it is the mode of its induction that is
subject to variation. The remarkable feature of the hypnotic state
consists in its production at the pleasure of either the subject or of the
agent under whose control he has passed; whereas the phenomena of natural
somnambulism and of the clairvoyant dream occur only during sleep, and
independently of the will of the patient.

Another singular fact in this connection is the receptivity of the
hypnotized brain for suggestions from the minds of other persons. Usually,
the patient is insensible to all communications which do not emanate from
the agent by whom he is held in control; but in certain cases it is
probable that the brain is more or less open to impressions of a
particular sort from any source. Numerous examples illustrate the manner
in which the course of an ordinary dream may be thus directed. The
hypnotic dream is far more easily modified by suggestions from without.
The simplest examples of this are exhibited by the hypnotized subject who
walks, jumps, lies down, executes every variety of pantomime, in obedience
to the commands of his director. Somewhat more complicated are the actions
that are developed through excitement of the imitative faculties. Every
movement of the director _that can be perceived by the subject_ will be at
once reproduced. Dr. Fischer relates[97] the case of a patient who,
although exceedingly ignorant of the art of music, was able, during the
hypnotic paroxysm, to sing with Jenny Lind all kinds of songs, so
accurately that it was impossible to distinguish their separate voices.
Expression of the various emotions and passions may also be provoked by
merely placing the subject in the several attitudes characteristic of such
feelings.

In the lower grades of the hypnotic state, consciousness is not abolished,
and the subsequent recollection of events during the experience may be
quite perfect. In such cases illusions and hallucinations, that were
excited by suggestions from the controlling mind of another, survive in
memory, and become the causes of serious delusion. Witness, for example,
the manner in which excitable people, partially hypnotized in a so-called
"spiritual circle," believe in the reality of the illusions which have
occupied their powers of perception during a "seance." To this inferior
grade of self-induced hypnotism belong all those conditions of sensory
hyperæsthesia by means of which certain persons are enabled to read the
hidden thoughts of others. This capacity is, essentially, a mere
exaltation of that power which all mankind shares in a greater or less
degree. In every instance it has been remarked that the ordinary "medium"
can only respond correctly to questions for which the true answer is
present in the mind of the questioner. To all other interrogatories the
replies are delivered purely under the influence of random suggestion. In
some cases the pathway of communication lies through actual bodily
contact, as in ordinary "mind-reading," where the invisible molecular
oscillations of the muscular elements of one person serve to guide the
perceptions and movements of another. But, more frequently, the
transmission of ideas is effected through the action of the facial and
ocular muscles. From these organs of expression the "table-rapper," or the
"planchette-writer," reads the unspoken thoughts of the questioner, in a
manner very like, yet vastly more delicate than that by which deaf mutes
are taught to interpret the movements of the lips of persons with whom
they converse. This fact is clearly illustrated by the experience of
Maury,[98] in an interview with a celebrated table-rapper who, without the
slightest hesitation, made known to him the age, name, and date of death
of a brother whom he had lost. She also gave the same information
regarding his father, and pronounced the names of other persons upon whom
he had fixed his attention. But, if he turned away his face, or if he
concealed his eyes so that the woman could no longer scrutinize their
expression, her responses became entirely uncertain and destitute of
conformity with fact.

The induction of the hypnotic state, if not too often repeated, is
sometimes of considerable service in the relief of various functional
disorders of a painful character. This fact, enthusiastically announced,
many years ago, by Dr. Braid, has recently been freshly brought forward
through the experiments of Fischer,[99] Wiehe,[100] Rieger,[101] and
others. In our own country this method of treatment has not yet been
adopted by many in the medical profession, though its efficacy in a
particular class of cases is not denied. Outside of professional circles,
however, it is exploited to a considerable extent under the strange
misnomer of Metaphysical Healing. But, as De Watteville has truly
remarked,[102] "the time is near when the curative influence of hypnotism
will be submitted to the same scrutiny as its physiological and
psychological import has undergone."


THE END.




INDEX.


  Acids, 71
    hydrobromic, 88
    hydrochloric, 72
    hydrocyanic, 100
    hydrocyanic, in gastric disease, 103
    lactic, 72
    nitric, 72
    nitro-muriatic, in hepatic insomnia, 103
    phosphoric, 72

  Aconite, 63, 93, 100

  Africa, maladie du sommeil of, 30
    winds from the deserts of, effect of, 46

  Africans, habits of, regarding sleep, 40
    victims of the maladie du sommeil, 30

  Alcohol, 76
    effect of, upon the brain, 54
    in angina pectoris, 99
    in asthma, 101
    in chorea, 110
    in dyspepsia, 103
    in fever, 105
    in hepatic diseases, 102

  Allen, Prof. J. Adams, case of somnambulism observed by, 185

  Allix, observations of, regarding bodily temperature in sleep, 7

  Allix and Hohl, observations of, regarding the pulse in sleep, 6

  Aloetic purgatives in insanity, 94

  Ammonia, in fever, 105

  Amyl nitrite, 84
    in angina pectoris, 99
    in asthma, 101

  Anæmia of the brain, 53

  Anæsthetics, 75

  Angelic visitors, delusions regarding, 129

  Angina pectoris, 99

  Anti-spasmodic effects of belladonna, 69

  Apparent death, 34
    crucial test of, 35

  Arabia, effects of wind from the deserts of, 46

  Arago, observations of, regarding atmospheric electricity, 46

  Arsenic, in asthma, 101

  Atropia, 69

  Atropine, use of, with opiates, 87

  Artificial sleep, effect of, upon the process of oxidation, 9
    mode of production of, 22

  Artificial somnambulism, 214
    cataleptic form of, 219
    lethargic form of, 220
    recollection of the events of, 227
    somnambulic form of, 222
    three varieties of, 219

  Assafoetida, use of, in insomnia, 110

  Assimilation, rate of, in sleep, 5

  Association of ideas, cessation of, in sleep, 3
    effect of, 123

  Asphyxia, 100

  Asthma, insomnia caused by, 101
    relieved by atropine, 69
    relieved by chloroform, 82
    relieved by ether, 82
    relieved by iodide of potassium, 110
    relieved by lobelia, 71
    relieved by stramonium, 71
    relieved by tobacco, 71

  Atmospheric electricity, effects of, 46

  Australia, effect of winds from the deserts of, 46

  Azam, a case of somnambulic life observed by, 208


  Bachelder, Dr. G. H., observations of, on the maladie du sommeil, 32

  Baillarger, hallucination excited by dreaming, 126

  Ball and Chambard, classification of the varieties of somnambulism, 169

  Baths, use of, as nervous stimulants, 60
    cold, 73, 95
    in fever, 104
    in insomnia, 112
    in scarlet fever, 76
    shower, 95
    warm, 94

  Bartholow, on the use of phosphorus, 71

  Beard and Rockwell, on the use of electricity, 62

  Beer, effect of, 76

  Belladonna, 69, 100
    use of, in asthma, 101
    use of, in fever, 104
    use of, in hepatic diseases, 102

  Bismuth, use of, in gastric diseases, 103

  Bladder, insomnia in irritability of, 90

  Blisters, use of, in rheumatism, 106

  Blood, control of its circulation by the nervous system, 26

  Bombardment, sleep during, 1

  Boussingault, experiments of, on the process of oxidation in the
        tissues, 9
    observations of, on respiration in sleep, 6
    observations of, regarding the bodily temperature in sleep, 7

  Brain, consequences of inordinate excitability of, 159, 161
    exalted receptivity of, during the waking state, 150
    exalted susceptibility of, in sleep and dreaming, 144, 150
    the, its division into separate mechanisms, 13
    the, a reservoir of sensory impressions, 124

  Brandy, use of, in wakefulness, 77

  Bromide of potassium, use of, in insanity, 95
    of sodium, use of, in chronic alcoholism, 97
    of sodium, use of, in delirium tremens, 98

  Bromides, the, 88
    use of, in convulsions, 110
    use of, in delirium, 77
    use of, in fever, 104
    use of, in night terrors, 112
    use of, in pregnancy, and after parturition, 109
    use of, with chloral and morphia, 86

  Brooke, Lieut. J. M., observations of, regarding hypnotic clairvoyance,
        224

  Bronchitis, insomnia caused by, 100
    insomnia of, relieved with paraldehyde, 80

  Brunton, Dr. T. Lauder, his theory of counter-irritation, 62

  Butylchloral hydrate, 83

  Buschick, experience of, in waking before earthquakes, 144


  Caffeine, effect of, upon the brain, 54

  Camphor, 67
    use of, in asphyxia, 100
    use of, in fevers, 105
    use of, in the insomnia of cachexia, 108
    use of, after parturition, 109

  Cannabin, 69

  Cannabin tannate, 68

  Cannabis indica, 68
    anti-aphrodisiac effect of, 69
    use of, in delirium tremens, 98
    use of, in fever, 104
    use of, in insanity, 96, 97
    use of, in pregnancy, 109
    use of, as a substitute for hyoscyamus, 113

  Cantharides, 63

  Capsicum, 63

  Capsicum, use of, in the insomnia of delirium tremens, 77, 98

  Carbolic acid, vapor of, for relief of cough, 100

  Carbon, oxidation of, during sleep, 7

  Carbonic acid gas, discharge of, during sleep, 9

  Cardiac debility, use of butylchloral in, 83

  Cardiac disease, insomnia of, treated with paraldehyde, 80
    treated with digitalis, 66

  Cardiac dyspnoea, relieved with opiates, 87, 98

  Cardiac neuralgia, 99

  Carotid arteries, compression of, for relief of insomnia, 25, 27, 57

  Cataleptic form of artificial somnambulism, 219

  Catarrh, nasal, effect of sleep upon, 8

  Caton, Judge John D., on the difficulty of sleep during the continuous
        daylight of summer in Norway, 40

  Cerebral activity, effect of, upon bodily temperature, 8

  Cerebral anæmia and its cause during sleep, 25, 28
    use of phosphorus for, 71

  Cerebral circulation, dependence of consciousness upon, 25, 27
    during sleep, observations upon, by Professor Mosso, 26

  Cerebral exhaustion, benefited by the use of phosphorus, 71
    in fever, 105

  Cerebral hyperæmia, effects of, 145
    insomnia of, treatment with paraldehyde, 80

  Cerebral irritation in cachectic states, 108

  Cerebro-spinal meningitis, use of opiates in, 93

  Cerebro-spinal weakness, 110

  Change of life, use of valerian during, 68

  Chicago, embarkation from, 45
    the great fire in, 40

  Child-birth, insomnia after, 81

  Chloral, 82

  Chloral hydrate, influence of, upon oxidation in the tissues, 9
    association of, with morphia and bromides, 86
    use of, in angina pectoris, 99
    use of, in asthma, 101
    use of, in cachexias with insomnia, 109
    use of, in chorea, 110
    use of, in chronic alcoholism, 97
    use of, in delirium tremens, 98
    use of, in fevers, 104
    use of, in hepatic diseases, 102
    use of, in insanity, 95
    use of, in meningitis, 94
    use of, in night terrors, 112
    use of, in respiratory diseases, 100

  Chlorodyne, 82
    use of, in syphilitic neuralgia, 107

  Chloroform, 81
    use of, in asthma, 101
    use of, in convulsions, 110
    spirit of, in the treatment of fevers, 105

  Chossat, observations of, on the temperature of pigeons, 7

  Circulation of blood, its regulation by the nervous system, 26
    disorders of, 52
    modified by counter-irritation, 63
    state of, during sleep, 6

  Clairvoyance, hypothetical explanation of, 148
    in dreams, 146, 148, 149
    in dreaming, and in natural somnambulism, 226
    in the hypnotic state, 224

  Clark, observations of, on the sleeping dropsy, 30

  Codeia, 85

  Codeine, 88

  Coffee, effects of, upon the brain, 54

  Cold, a nervous sedative, 73

  Cold baths, 73

  Cold, excessive, a cause of stupor, 47

  Colic, uterine, relief of, 81

  Color-blindness, effect of hypnotism upon, 223

  Coma, 32

  Coniine, 91

  Conium, 90, 95

  Consciousness, duration of the sensations required for its excitement, 23
    state of, during sleep, 14

  Convulsions, excited by compression of the carotid arteries, 27
    treatment of, 110

  Cough, spasmodic, treatment with spirit of chloroform, 82

  Counter irritants, 62

  Croton oil, 63

  Cups, counter irritation with, 63, 93

  Curci, observations of, regarding belladonna, 69
    regarding morphia, 85

  Cutaneous disorders, causes of insomnia, 55


  DaCosta, on lithæmia, 106

  Darkness, favorable to sleep, 18

  Day and night, alternation of, a cause of sleep, 17

  Death, apparent, 34
    test of, 35

  Degeneration of the brain, 55

  Demme, observations of, on bodily temperature in sleep, 7

  Delirium, 54
    excited by hyoscyamus, 70
    excited by stramonium, 71
    of exhaustion, 77
    treatment of, with musk, 67

  Delirium tremens, treatment of, with alcohol, 77
    with bromides, 89
    with capsicum, 77
    with chloral, 82
    with digitalis, 67

  Delusions, caused by dreams, 128

  Depressing emotions, a cause of sleep, 19

  Diagram, illustrating the stages of sleep, 4
    the varieties of somnambulism, 172

  Digitalis, indirectly hypnotic effect of, 66
    treatment of delirium tremens with, 98

  Diminution of energy, represented by sleepiness, 2

  Disease and dissolution, revival of memory in, 165

  Dover's powder, 67, 100, 104, 110, 112

  Double consciousness, 204, 206

  Dreams, 116
    analysis of, 133
    at the moment of waking, 14
    brevity of, 15
    causes of, 118
    cause of special vividness of, 134
    clairvoyant, 146, 148, 149
    coherence of, 131
    definition of, 120
    dependence of, upon partial sleep of the brain, 11
    duration of, 135
    excited by gustatory sensation, 43, 125, 130
      by heat, 43
      by painful diseases, 141
      by sensory impressions during sleep, 29
      by sounds, 41
    incoherence of, 133
    intellectual combinations in, 131
    mode of their production, 124
    primitive belief in the divine origin of, 160
    prophetic, 142, 143
    recollection of, 140
    relation of, to depth of sleep, 4
    relation of, to waking hallucinations, 126
    resemblance of, to the mental processes of insanity, 133
    revival of memory in, 162
    somnambulic, 178
    state of volition during, 141
    suggested by external impulses, 125, 130
    theory of, 116
    waking, 123

  Dropsy, treatment of, with digitalis, 66

  Dumontpallier, case of self-hypnotism related by, 219

  Duration of sleep, 110

  Dyspnoea, cardiac, 98
    treatment of, with digitalis, 66

  Dyspeptic insomnia, 104


  East Indies, climate of, a cause of insomnia, 44

  Eggs, as an article of food, 66

  Electrical test of apparent death, 35

  Electricity, atmospheric, 46
    use of, 62, 63

  Emphysema, insomnia of, relieved with paraldehyde, 80

  Energy, diminution of, represented by sleepiness, 2
    renewal of, by sleep, 5

  Epilepsy, double consciousness in, 205

  Ether, hypnotic effect of, 81
    inhalation of, 98
    use of, in asthma, 101
    use of, in convulsions, 110
    use of, in irritative cough, 100

  Ether, compound spirit of, 81
    use of, in delirium tremens, 98
    use of, in hepatic diseases, 102

  Excrementitious substances, causes of insomnia, 55

  Exhaustion, a cause of sleep, 19
    relief of with alcoholic stimulants, 76
    states of, 64
    use of musk in, 68

  Exner, experiments of, to test the possibility of dreamless sleep, 14

  Eye, state of its secretions during sleep, 8


  Facial neuralgia, treatment of, with butylchloral, 83

  Fainting, a counterfeit of sleep, 25

  Fatigue, a cause of sleep, 19

  Fatigue theory of sleep, 20

  Fevers, eruptive, treatment of with musk, 68
    infective, 57
    typhoid, 57
    treatment of with cold baths, 73

  Flaxseed tea, 100

  Florida, climate of, in insomnia, 114

  Fonssagrives, observations of, regarding atmospheric electricity and
        insomnia, 46

  Food, lack of, a cause of insomnia, 63

  Foot-baths, hot, in the treatment of insomnia, 93, 94

  Force, fluctuations of, 15
    kinetic, 15
    potential, 15

  Frank, J. P., case of somnambulism related by, 195

  Functional nervous disorders, treatment of with hypnotism, 229


  Gairdner, W. T., case of somnambulic lethargy reported by, 174

  Gastro-intestinal glands, state of their secretions during sleep, 8

  Gelsemium, 90
    treatment of fever with, 104
    use of, in the wakefulness of children, 112

  Generation of ideas, relation of, to molecular movements in the brain, 24

  Grasset, case of somnambulism related by, 177

  Guérin, observations of, on the _maladie du sommeil_, 30

  Guiana, delusions among the Indians of, founded upon dreams, 128
    travels in, 42

  Guy, observations of, regarding the pulse in sleep, 7


  Hallucination, case of, related by Dr. E. H. Clarke, 156
    experienced by Sir Edmund Hornby, 150
    production of, by drugs, 120
    sometimes excited by dreams, 126, 150

  Hamilton, Sir William, experiments of, on the possibility of dreamless
        sleep, 14

  Hasheesh, visions excited by, 120

  Hayes, Dr. P. S., case of lucid lethargy reported by, 35

  Headache, 54

  Hearing, persistence of during sleep, 41
    sense of, during sleep, 11

  Heart, pulsation of, in sleep, 6

  Heat, a cause of insomnia, 44
    a nervous stimulant, 59
    effects of excessive, 47
    liberation of, during sleep, 9

  Heidenhain, observations of, on hypnotism, 214

  Helmholtz, observations of, on liberation of heat during sleep, 9

  Hemicrania, treatment of, with butylchloral, 83

  Henneberg, experiments of, on oxidation in the tissues, 9

  Hibernation, phenomena of, 48

  Hoffmann's anodyne, 81

  Hohl and Allix, observations of, on the pulse in sleep, 6

  Holland, Sir Henry, observations of, regarding the loss of memory during
        exhaustion, 209

  Hops, 90
    treatment of chronic alcoholism with, 97

  Hornby, Sir Edmund, experience of hallucination, 150

  Horsford's Acid Phosphate, 72

  Horvath, observations of, on the temperature of hibernating marmots, 8

  Hunger, 2

  Hydrobromic acid, 88

  Hydrochloric acid, useful in atonic dyspepsia, 72

  Hydrocyanic acid, 100
    in gastric diseases, 103

  Hyosciamia, 70, 96

  Hyosciamine, 70

  Hyoscyamus, 70
    use of, after parturition, 109
    use of, in asthma, 101
    use of, in fever, 104
    use of, in hepatic diseases, 102
    use of, in insanity, 96
    use of, in insomnia of children, 112
    use of, in renal diseases, 102

  Hyperæmia of the brain, 52, 54, 110

  Hypnagogic hallucinations, 3, 4

  Hypnagogic state, 2

  Hypnotic sleep, duration of, 217

  Hypnotic sleep, clairvoyance in, 224
    condition of the special senses in, 223
    conditions favorable to, 214
    exaltation of the imitative faculty during, 227
    methods of inducing, 215
    perception during, 149

  Hypnotism, 214
    likeness of, to somnambulism, 203
    observations of Braid, 214, 229
    observations of Charcot, 214, 219, 221
    observations of Cohn, 223
    observations of De Watteville, 229
    observations of Dumontpallier, 219, 221
    observations of Fischer, 150, 227
    observations of Harting, 215
    observations of Heidenhain, 214, 215, 216, 222
    observations of Milne-Edwards, 215
    observations of Rieger, 229
    observations of Wiehe, 229
    receptivity of the brain to suggestions during, 226
    suggestion of ideas during, 226
    therapeutical use of, 228

  Hysteria, a cause of double consciousness, 205

  Hysterical excitement, treatment of, 68


  Ice-cap, in the treatment of acute affections of the brain, 93

  Iceland moss, for the relief of cough, 100

  Ideas, their dependence upon molecular movements in the brain, 24

  Illusions, excited by disease and by drugs, 120, 122

  Imagination, persistence of, in sleep, 3

  Imitative faculties, exaltation of, in hypnotic states, 227

  Immermann, on cold baths, 73

  Impulses to violence during somnambulism, 193

  Im Thurn, Everard F., on dreams among the Indians of Guiana, 128

  Indians, of Guiana, magic practices among, 42

  Inflammations affecting the brain, 54

  Inhalations, medicated, 100

  Injuries of the brain, 55

  Insanity, 54, 57, 70, 133

  Insomnia, 38

  Insomnia, causes of, 39
    caused by aortic obstruction, 84
    caused by asthma, 101
    caused by cardiac disorders, 51
    caused by cold, 47
    caused by contagia of animal origin, 55
    caused by cutaneous disorders, 49, 55
    caused by dyspepsia, 51
    caused by electrical disturbances, 46
    caused by excrementitious substances, 55
    caused by fatigue, 78
    caused by heat, 44, 46
    caused by heat and humidity, 44
    caused by icterus, 49
    caused by inflammations, 50
    caused by insects, 49
    caused by itching in myelitis, 49
    caused by itch-mite, 49
    caused by light, 39
    caused by malaria, 72
    caused by meningitis, 50
    caused by miasms, 55
    caused by morbid states of the central nervous organs, 51
    caused by neuralgia, 50
    caused by neuritis, 50
    caused by neuromata, 50
    caused by oxaluria, 72
    caused by pain, 49
    caused by parasites, 49
    caused by periostitis, 50
    caused by phosphatic diathesis, 72
    caused by pneumogastric disorder, 51
    caused by poisons, 55
    caused by products of putrefaction, 55
    caused by respiratory disorders, 51
    caused by rheumatic diathesis, 72
    caused by sounds, 41
    caused by smells, 42
    caused by stramonium, 71
    caused by sympathetic nerve disorder, 50

  Insomnia, occurrence of, after childbirth, 81
    occurrence of, after parturition, 109
    occurrence of, during acute affections of the brain, 92
    occurrence of, during bronchitis, 80
    occurrence of, during cardiac diseases, 66, 80, 87
    occurrence of, during change of life in women, 84
    occurrence of, during childhood, 110
    occurrence of, during chorea, 110
    occurrence of, during chronic alcoholism, 97
    occurrence of, during chronic phthisis, 84
    occurrence of, during delirium tremens, 87, 90, 97
    occurrence of, during diseases of the heart and blood-vessels, 98
    occurrence of, during diseases of the liver, 102
    occurrence of, during diseases of the respiratory organs, 99
    occurrence of, during disorders of nutrition, 107
    occurrence of, during dysmenorrhoea, 84
    occurrence of, during emphysema, 80
    occurrence of, during febrile conditions and fevers, 87, 104
    occurrence of, during gastric and intestinal disorders, 87, 103
    occurrence of, during gout and rheumatism, 103, 107
    occurrence of, during headache, 84
    occurrence of, during hysteria, 81, 89
    occurrence of, during insanity, 94
    occurrence of, during irritability of the bladder, 90
    occurrence of, during irritability of the sexual organs, 90
    occurrence of, during irritative dyspepsia, 90
    occurrence of, during jaundice, 80
    occurrence of, during lithæmia, 106, 107
    occurrence of, during mania, 87, 89, 90
    occurrence of, during melancholia, 96
    occurrence of, during mental exhaustion, 89
    occurrence of, during nervous disorders, 80
    occurrence of, during neuralgia, 84
    occurrence of, during old age, 78, 113
    occurrence of, during opium habit, 84
    occurrence of, during paretic dementia, 96
    occurrence of, during phthisis, 80, 87
    occurrence of, during pregnancy, 89, 109
    occurrence of, during the puerperal state, 89
    occurrence of, during renal diseases, 101
    occurrence of, during rheumatism and gout, 105, 107
    occurrence of, during sexual excitement, 89
    occurrence of, during spasmodic diseases, 109
    occurrence of, during states of exhaustion, 67
    occurrence of, during syphilis, 106, 107

  Insomnia, relation of, to states of the cerebral circulation, 57
    relief of, by compression of the carotid arteries, 25

  Iodide of potassium, treatment of asthma with, 110

  Ipecac, treatment of asthma with, 101

  Irritability of the brain, 53, 54

  Itching of eczema, relieved with cannabis indica, 69


  Jacobi, A., on wakefulness of children, 111

  Japanese, use of massage among, 61

  Jaundice, insomnia of, treatment with paraldehyde, 80

  Jessen, case of hallucination caused by dreaming, 127

  Joseph, St., dreams of, 142, 160

  Judgment, suspension of, during sleep, 3


  Kohlschütter, experiments of, to measure the depth of sleep, 16

  Koumiss, 64


  Lactic acid, hypnotic effects of, 72

  Lactate of sodium, hypnotic effects of, 20, 72

  Lactucarium, 88

  Latent contracture, 221

  Leeches, use of, 63, 93, 94

  Lethargic form of artificial somnambulism, 220

  Lethargy, 33
    produced by excessive cold, 48

  Lewin, observations of, on respiration during sleep, 6
    experiments of, on oxidation in the tissues, 9

  Liebermeister, experiments of, on oxidation in the tissues, 9

  Life, normal, 4
    possibility of intermissions in its active manifestation, 15

  Light, interference of, with sleep, 40, 41

  Liquors, effects of, 76

  Lithæmia, a cause of insomnia, 106

  Lithium bromide, 88

  Lobelia, anti-spasmodic effects of, 71, 101

  Lomi-lomi, 61

  Lucid lethargy, 35
    contrasted with somnambulic lethargy, 176

  Lupulin, 90


  Macario, case of somnambulism, reported by, 192

  Mackinac, voyage to, 45

  Macnish, case of somnambulic life, reported by, 206

  Maladie du sommeil, 30

  Malaria, treatment of insomnia, caused by, 72

  Mania, use of chloral in, 82

  Marmot, hibernation of, 48
    temperature of, during hibernation, 8

  Massage, 60, 109

  Matter and mind, communication between, 22

  Maury, A., classification of the varieties of somnambulism, 168
    experience of, with table-rapping, 228
    theory of, regarding forgetfulness of the events of somnambulism, 211

  Measles, use of baths in, 74

  Meat juice, 66

  Memory, effect of physical exhaustion, 209
    exaltation of, in somnambulism, 187
    persistence of, in sleep, 3
    relation of, to phenomena of somnambulism, 192
    revival of, during disease and dissolution, 165
    revival of, during dreaming, 162

  Meningitis, 54, 57

  Mental activity during sleep, 14

  Mesnet, case of somnambulism related by, 196

  Metaphysical healing, 229

  Michigan, Lake, voyage upon, 45
    Northern, summer climate of, favorable to sleep, 45

  Milk, peptonized, 64

  Mind and matter, communication between, 22
    alternate states of action and repose, 15
    sleep of, 15
    state of, during sleep, 14

  Mind-reading, 218, 227

  Minnesota, summer climate of, favorable to sleep, 45

  Mitchell, S. Weir, observations of, regarding effect of variable
        barometric pressure, 47

  Molecular movement, its relation to the generation of ideas, 24

  Moral responsibility in somnambulism, 203

  Morphia, 97, 98, 100, 101

  Morphine, influence of, on oxidation in the tissues, 10

  Mosso, Professor, on the circulation of blood during sleep, 26
    on respiration during sleep, 5

  Mouth, condition of, during sleep, 8

  Muscles, effect of sleep upon, 12
    fibrillary twitching of, during sleep, 3

  Muscle-reading, 218

  Musk, 67, 100, 105

  Mustard, 63


  Nasal catarrh, state of secretion during sleep, 8

  Narcotic stupor, 29

  Nerves, of common sensation, affections of, 39, 49
    pneumogastric, 51
    sympathetic, affections of, causes of insomnia, 50

  Nervous disorders, insomnia of, relieved with paraldehyde, 80
    hypnotic treatment of, 229

  Nervous irritation, effect of, on tissue change, 10
    sedatives, 58, 59
    stimulants, 58, 59
    system, its control over the circulatory apparatus, 26

  Neuralgia, cardiac, 99
    treatment of, with alcohol, 77
    treatment of, with belladonna, 69
    treatment of, with preparations of valerian, 68

  Neurasthenic patients, 66

  New Providence, climate of, beneficial in insomnia, 114

  Night and day, alternation of, a cause of sleep, 17

  Night terrors, 179
    treatment of, 89, 112

  Nitric acid, 72

  Noctambulism, 169

  Noise, sleep prevented by, 41

  North China Herald, criticism of Sir E. Hornby's narrative, 155

  Norway, difficulty of sleeping during the summer, 40

  Nutrition, effect of sleep upon, 5, 9
    disorders of, 52


  Obersteiner, his theory of sleep, 20

  Odors, effect of, upon sleep, 11

  Old age, decline of life in, 113

  Omphaloscopy, 217

  Opium and opiates, 84, 98

  Opiates, use of, in treatment of cachexias, 108
    use of, in treatment of fever, 104, 105
    use of, in treatment of gastric disease, 103
    use of, in treatment of insanity, 96
    use of, in treatment of renal diseases, 102
    use of, in treatment of rheumatism, 105

  Oxaluria, insomnia caused by, 72

  Oxygen, absorption of, during sleep, 9

  Ozone, use of, in the treatment of asthma, 101


  Pacific Islanders, habits of, regarding sleep in the daytime, 40
    use of massage among, 61

  Pain, a cause of sleep, 19

  Paraldehyde, 79, 95, 97, 108

  Paregoric, 100

  Perception, effect of, upon nervous tissue, 10
    duration of, necessary to arouse consciousness, 23
    range of, circumscribed by sleep, 12
    transfer of, in telepathy and hypnotism, 217

  Percussion, 61

  Perspiration, secretion of, during sleep, 9

  Pettenkofer, experiments of, on oxidation in the tissues, 9
    experiments of, on respiration in sleep, 6

  Pettenkofer and Voit, on tissue changes, 10

  Pflüger, hypothesis of, regarding the cause of sleep, 21

  Phosphatic diathesis, a cause of insomnia, 72

  Phosphoric acid, 72

  Phosphorus, 71

  Phthisis, cough of, relieved with lactucarium, 88
    insomnia of, relieved with paraldehyde, 80
    treatment of, with opiates, 87

  Physiological activity, reduction of, during sleep, 5

  Physiological cause of somnambulism, 180

  Planchette-writing, 228

  Pleuritic pain, 99

  Pneumogastric nerves, insomnia caused by affections of, 51

  Pneumonia, 68, 100

  Porter, effects of, 76

  Potassium bromide, 88

  Preyer, his theory of sleep, 20

  Psychical Research, Society for, investigations by, 149, 217

  Pulse, state of, during sleep, 6

  Punkah, use of, to promote sleep, 44


  Quetelet, observations of, on respiration during sleep, 5

  Quinine and opium, use of, in fever, 104


  Reasoning powers, arrest of, during sleep, 3

  Recollection of the events of artificial somnambulism, 227
    of the events of natural somnambulism, 188

  Reflex movements during sleep, 12

  Refrigeration, threefold effect of, 49

  Relation between molecular movement and the generation of ideas, 24

  Respiration during sleep, 5

  Revelation through dreams, 160

  Revery, nature of, 120

  Rheumatic diathesis, a cause of insomnia, 72

  Rosenthal, observations of, regarding lethargy, 33, 34
    observations regarding apparent death, 35

  Rush, Dr., observations of, on the revival of memory in dissolution, 165


  Sailors, sleeping during a bombardment, 1

  Sailor-boy, sleeping on a mast, 1

  Salicylic acid, treatment of rheumatism with, 106

  Saliva, secretion of, during sleep, 8

  Samuel the prophet, dream of, 129

  Sandwich Islands, climate of, for relief of insomnia, 114

  Scarlet fever, treatment of, with baths, 74, 75

  Scharling, observations of, regarding bodily temperature during sleep, 7
    experiments of, on oxidation in the tissues, 9

  Screaming fits of children, 112

  Secretion, state of, during sleep, 8

  Sedatives, nervous, 59, 73

  Self-hypnotism, 219

  Sensory excitement, effect of, upon the cerebral circulation, 27, 28

  Sensory organs, condition of, during somnambulism, 191

  Sexual organs, irritability of, 90

  Shampooing, 61

  Simon, P. Max, case of somnambulism related by, 182
    dream related by, 142

  Sleep, affected by certain winds, 45
    artificial, mode of its production, 22
    caused by the alternation of day and night, 17
    caused by depressing emotions, 19
    caused by exhaustion, 19
    caused by fatigue, 19
    caused by painful impressions, 19
    caused by the venereal act, 19
    definition of, 1
    dreamless, 14
    duration of, 4, 110
    effects of its invasion upon the intellectual faculties, 13
    effect of, upon consciousness, 13, 14
    fatigue theory of, 20
    favored by darkness, 18
    favored by the suppression of sensation, 18
    hindered by heat, 44
    hindered by light, 39
    hindered by smells, 42
    hindered by sounds, 41
    introductory stage of, 2
    invasion of, 10, 117
    measure of its depth by the experiments of Kohlschütter, 16
    Obersteiner's theory of, 20
    Pflüger's hypothesis regarding the cause of, 21
    preceded by sleepiness, 2
    Preyer's theory of, 20
    rapid induction of, in certain cases, 24
    relation between the duration of, and the average length of the night,
        17
    stages of, 4
    the cause of, 29
    unequal incidence of, upon different portions of the brain, 13

  Sleep-drunkenness, 180, 181

  Sleepiness, precursive of sleep, 2

  Sleeping dropsy, 30

  Sleeplessness, causes of, 39

  Smells, abolition of sleep by, 42

  Smile, during sleep, 12

  Smith, E., experiments of, on oxidation in the tissues, 9

  Snoring, occasional interruption of sleep by, 11

  Society for Psychical Research, investigations by, 149, 217

  Sodium bromide, 88

  Somniation, 169

  Somnambulic dreams, 171, 178, 181
    recollections of, 188

  Somnambulic form of artificial somnambulism, 222

  Somnambulic lethargy, 171, 173
    contrasted with lucid lethargy, 176

  Somnambulic life, 169, 204
    a case of, 206
    a case of, related by Azam, 208
    a case of, related by Macnish, 206

  Somnambulism, 166
    artificial, 214
    case of, related by Prof. J. Adams Allen, 185
    case of, related by J. P. Frank, 195
    case of, related by Macario, 192
    case of, related by Mesnet, 196
    case of, related by P. Max Simon, 182
    causes of, 166
    condition of sensory organs during, 191
    dependence of, upon partial sleep of the brain, 11
    likeness of, to hypnotism, 203
    moral responsibility in, 203
    phenomena of, 167, 210
    physiological cause of, 180
    relation of memory with events of, 192
    varieties of, according to A. Maury, 168
    varieties of, according to Ball and Chambard, 169
    varieties of, diagrammatically exhibited, 172
    violent impulses during, 193

  Somnolence, 30

  Somnolentia, 180, 181

  Sound, effect of, to hinder sleep, 42
    effect of, to induce sleep, 42

  Spasmodic croup, 110

  Special sense organs, affections of, 39

  Special senses, condition of, during invasion of sleep, 11
    perversion of, during the hypnotic state, 223

  Spinal cord, irritability of, 110
    reflex energy of, during sleep, 3

  Spinal irritation, 62

  Spirit of chloroform, 81

  Spiritual circle, manifestations in, 227

  Stewart, Dugald, observation of, 43

  Stimulants after parturition, 109
    in fever, 105
    nervous, 59

  Stramonium, 70, 101

  Strümpell, observations of, regarding sleep produced by suppression of
        sensation, 18

  Strychnia, 105

  Stupor produced by excessive heat or cold, 47

  Subsultus tendinum, treatment of, with musk, 67

  Suction, involuntary, during infantile sleep, 12

  Suppression of sensation, a cause of sleep, 18

  Swedish movement cure, 61

  Sympathetic nerves, affections of, 39, 50


  Table-rapping, method of communication in, 228

  Tannate of cannabin, 68

  Tartar emetic, use of, in asthma, 101
    use of, in delirium tremens, 98
    use of, in fever, 104
    use of, with opium, 108

  Taste, relation of, to insomnia, 43

  Tea, effect of, upon the brain, 54

  Telegraphy without a wire, through water, 147

  Telepathy, investigation of, by the Society for Psychical Research, 149

  Temperature, of the body, during sleep, 7
    sense of, 43

  Thapsia, 63

  Theory of sleep, Obersteiner's, 20
    Pflüger's, 21
    Preyer's, 20

  Thirst, 2

  Thompson, Sir William, his doctrine concerning a sixth sense, 43

  Tickling, effect of during sleep, 12

  Tobacco, anti-spasmodic effect of, 71, 99, 101

  Transfer of perceptions, 217

  Trousseau, observations of, on the pulse during sleep, 6

  Tuberculosis of the cerebral membranes, 55

  Tully's Powder, 67

  Tumors of the brain, 55

  Turkish baths, 60

  Turpentine, 63

  Typhoid fever, insomnia during, 64
    treatment of, with baths, 74
    treatment of, with musk, 68
    treatment of, with Tully's Powder, 67

  Typhus fever, treatment of, with musk, 68


  Unconsciousness, produced by compression of the carotid arteries, 27
    relation of, to modifications of the cerebral circulation, 25

  Urea, elimination of, during sleep, 9

  Urine, secretion of, during sleep, 9

  Uterine colic, 81


  Valerian, 68, 109

  Valerianate of ammonia, 68
    of zinc, 68

  Venereal act, a cause of sleep, 19

  Vierordt, observations of, on the duration of sleep, 110

  Visions, character of, 119
    of the ancient prophets, 161

  Voit, observations of, on oxidation in the tissues, 9
    on respiration during sleep, 6

  Volition, cessation of, during sleep, 3


  Wakefulness, 38
    causes of, 39
    dependence of, upon instability of cerebral protoplasm, 22

  Warburton, Rev. Canon, clairvoyant dream of, 146

  Weariness, a cause of sleep, 1

  Wharton and Stillé, on sleep-drunkenness, 181

  Whooping-cough, treatment of, with belladonna, 69

  Wind, effect of, upon sleep, 45

  Wine, effects of, 76
    use of, in the insomnia of old age, 78


  Ziemssen, von, on the use of baths, 73




FOOTNOTES:

[1] Rosenbach, _Zeitschr. f. klin. med._ 1881. _Brain_, Vol. IV, p. 138.

[2] Alfred Maury, _Le Sommeil et les Rêves_, Chap. IV.

[3] Hermann's _Handbuch der Physiologie_, Vol. IV, Part II, p. 98.

[4] _Handbuch der Kinderkrankheiten_, Vol. I, p. 346.

[5] _Handbuch der Physiologie_, Vol. IV, Pt. II, p. 217.

[6] _Op. cit._, pp. 142 and 456.

[7] _Dic. Encyc. des Sci. Méd._, Art. SOMMEIL, pp. 277.

[8] Quoted by Vierordt, _Handbuch der Kinderkrankheiten_, Vol. I, p. 307.

[9] _Dic. Encyc. des. Méd._, Ie série, t. XV, p. 75.

[10] _Handbuch der Kinderkrankheiten_, Vol. I, p. 383.

[11] _Carpenter's Physiology_, 8th edition, p. 560.

[12] _Handbuch der Physiologie_, Vol. II, Pt. II, p. 297.

[13] Quincke, _Archiv. f. Experim. Pathol._, Vol. VII, p. 115.

[14] _Carpenter's Physiology_, 8th edition, p. 526, _Handbuch der
Kinderkrankheiten_, 2d edition, Vol. I, p. 373.

[15] _Dic. Encyc. des Sci. Méd._, IIIe Série, Vol. X, p. 268.

[16] _Handbuch der Physiologie_, Vol. V, p. 142-156.

[17] Kohlschütter, _Messungen der Festigkeit des Schlafes. Dissert._
Leipzig, 1862, _und Zeitschrift f. rat. Med._, 1863. Quoted, Hermann's
_Handbuch der Physiologie_, Vol. II, Pt. II, p. 295.

[18] _Obersteiner, Zur Theorie des Schlafes, Zeitschr. f. Psych._ XXIX.
_Preyer, Ueber die Ursachen des Schlafes._ Vortrag. Stuttgart bei Enke.
1877, und centralbl. f. d. Med. Wiss. 1875. S. 577.

[19] _Theorie des Schlafes._ Arch. f. d. ges. Physiol. X, 468.

[20] _Artificial Anæsthesia and Anæsthetics_, pp. 15-17.

[21] _Carpenter's Physiology_, 8th ed., p. 852.

[22] _Sulla Circolazione del Sangue nel Cervello dell'Uomo._ Abstract in
_Brain_, Vol. IV, p. 100.

[23] _Transactions of the London Epidemiological Society_, Vol. I, p. 116.

[24] _De la maladie du sommeil_, 1869.

[25] _The Medical Record_, July 1, 1882, p. 23.

[26] _Real. Encyc. der ges. Heilkunde_, VIII, 276.

[27] _Op. cit._ p. 276.

[28] _A Summer in Norway_, by John Dean Caton, pp. 251 and 311.

[29] A. Maury, op. cit., p. 156.

[30] _Among the Indians of Guiana._ By Everard F. Im Thurn.

[31] _Le Sommeil et les Rêves_, p. 154.

[32] _Nature_, Vol. XXIX, pp. 438-462.

[33] _Ganot's Physics._

[34] _Dic. Encyc. des Sci. Méd._, Art. CLIMAT.

[35] _Comptes-rendus Acad. des Sci._, 1840, t. XI, p. 823.

[36] _Am. Journ. Med. Sci._, April, 1877, p. 305.

[37] A remarkable illustration of this will be found related in _The
Lancet_, July 26, 1884, p. 112.

[38] _Dic. Encyc. des Sci. Méd._, Art. FROID, p. 139.

[39] _Medical and Surgical Electricity_, 4th ed., p. 413.

[40] _Nature_, March, 1883.

[41] _Lo Sperimentale_, April, 1884.

[42] _Artificial Anæsthesia and Anæsthetics_, pp. 20-28. William Wood &
Co., New York, 1881.

[43] _Bull. gén. de Thérap._, 1884, 2{o} Livr.

[44] _Centralblatt für klin. med._, 1884. Nr. 12.

[45] _The National Dispensatory_, 1884, p. 433.

[46] _Deutsche Med. wochenschr._, 1883, Nr. 49.

[47] _Lo Sperimentale_, April, 1884.

[48] _The National Dispensatory_, 1884, p. 993.

[49] Kiernan, _Journ. Nerv. and Mental Diseases_, Vol. X, p. 234.

[50] _Psychological Medicine_, Bucknill and Tuke, 4th ed., p. 731.

[51] _Clinical Lectures on Mental Diseases._

[52] _Ringer's Therapeutics_, 10th ed., p. 421.

[53] C. H. Jones, _Functional Nervous Disorders_, p. 284.

[54] _Am. Jour. Med. Sci._, Oct., 1881, p. 313.

[55] _Handbuch der Kinderkrankheiten_, Vol. I., p. 214.

[56] _Op. cit._, Vol. I., Pt. 2, p. 153.

[57] Herbert Spencer, _First Principles_, p. 486.

[58] A. Maury. _Le Sommeil et les Rêves_, p. 154.

[59] _On Intelligence_, p. 61.

[60] Wharton and Stillé's _Medical Jurisprudence_, Third Edition, Vol. I,
p. 482.

[61] _Among the Indians of Guiana._ By Everard F. Im Thurn. London: 1883,
p. 344.

[62] A. Maury, _Le Sommeil et les Rêves_, p. 219 et seq.

[63] _Obscure Diseases of the Brain and Mind._ Philadelphia, 1866, pp.
394-398.

[64] _Le Monde des Rêves_, p. 88.

[65] _Op. cit._, p. 91.

[66] _The Nineteenth Century_, July, 1884, p. 71.

[67] _Nature_, October, 16, 1884, p. 596.

[68] _Lebensmagnetismus oder Hypnotismus_, von Dr. E. L. Fischer, pp.
71-73.

[69] _The Nineteenth Century_, July, 1884, p. 89.

[70] _Visions: A Study of False Sight_, p. 39.

[71] _Inquiries concerning the Intellectual Powers_, tenth edition, p.
283.

[72] _Medical Inquiries and Observations upon Diseases of the Mind_, p.
277.

[73] _Loc. cit._

[74] _Le Sommeil et les Rêves_, p. 248.

[75] _Dic. Encyc. des Sci. Méd._, Article SOMNAMBULISME NATUREL.

[76] _The Lancet_, Dec. 22, 1883, p. 1,078, and Jan. 5, 1884, p 5.

[77] _Brain_, Jan., 1884, p. 454.

[78] _Medical Jurisprudence_, 3d ed., Vol. I, pp. 464-471.

[79] _Le Monde des Rêves_, p. 257.

[80] _Chicago Medical Journal_, 1869, p. 650.

[81] Maury, _Le Sommeil et les Rêves_, p. 234.

[82] _Pathologie interne._

[83] _L' Union Médicale_, July 21st and 23d, 1874.

[84] _Chicago Journ. of Nervous and Mental Diseases_, Vol. II, p. 48.

[85] _Loc. cit._

[86] _Philosophy of Sleep_, p. 167.

[87] _Revue Scientifique_, May 20, Sept. 16, 1876; Dec. 22, 1877; March 8,
1879.

[88] Vol. III, p. 584.

[89] _Chapters on Mental Physiology_, p. 160.

[90] _Le Sommeil et les Rêves_, p. 226.

[91] _Lancet_, July 29, 1882, p. 164.

[92] _Transactions of the Society_, etc., Vols. I, II, III.

[93] _Le Progrès Médical_, Feb. 18, 1882, p. 124.

[94] _Le Progrès Médical_, March 25, 1882, p. 223.

[95] _Le Progrès Médical_, Jan. 14, 1882, p. 25.

[96] _Brain_, Vol. III, p. 394.

[97] _Op. cit._, p. 18.

[98] _Le Sommeil et les Rêves_, p. 361.

[99] _Op. cit._

[100] _Berlin. Klin. Wochenschr_, January, 1884.

[101] _Der Hypnotismus_, Jena, 1884.

[102] _Brain_, July, 1884, p. 278.




Transcriber's Notes:

Passages in italics are indicated by _italics_.

Superscripted characters are indicated by {superscript}.

Subscripted characters are indicated by _{subscript}.

The original text contains letters with diacritical marks that are not
represented in this text version.

The original text includes Prescription [R.], dram [dr], and ounce [oz]
sybmols.








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