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INSOMNIA; 
 
 AND OTHER 
 
 Disorders of Sleep. 
 
 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, 111. 
 
 CHICAGO: 
 W. T. KEENER, 
 
 96 WASHINGTON STEEET. 
 
 1885. 
 
COPYRIGHT, 1885. 
 
 B. B. DONXBLLEY & 60N8, PEINTEB8, CHICAGO. 
 
PREFACE. 
 
 Tired Nature's sweet restorer, balmy sleep. 
 
 — YOTTNG. 
 
 The regularly recurring incidence of natural sleep 
 forms one of tlie most important subjects for physio- 
 logical inyestigation. Were it an event of rare occur- 
 rence, 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 observa- 
 tion of the bodily and mental changes which accom- 
 pany 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 
 
 (iii) 
 
IV PREFACE. 
 
 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 ; dwell- 
 ing 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 imagina- 
 tion. 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. Words- 
 
PREFACE. V 
 
 worth 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 pro- 
 duced by sleep — Effect of sleep upon the processes of respira- 
 tion, circulation, calorification, secretion, and nutrition — Conse- 
 quences 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 Kohl- 
 schiiter to estimate the degree of variation — Alternation of day 
 and night considered as a cause of sleep — Diminution of sensa- 
 tion a cause of sleep — Illustrative observation by Strumpell— 
 Fatigue a cause of sleep — Hypothesis of Obersteiner regarding 
 the cause of sleep — Hypothesis of Pfluger — Production of arti- 
 ficial sleep by impregnation of the brain with narcotic sub- 
 stances — 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 — Observa- 
 tions 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 Som- 
 meil — Coma — Lethargy — Apparent death — Lucid lethargy. 
 
 (vii) 
 
Vlll CONTENTS. 
 
 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 — Hypersemia of the brain — Anaemia 
 and starvation of the brain — Effects of tea and coffee — Effect of 
 alcohol — Inflammations, degenerations, and tumors affecting 
 the brain — Excitement of the brain by diseased conditions of 
 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 cere- 
 bral circulation — Remedial agents — Nervous stimulants and 
 nervous sedatives — Heat — Baths — Massage — Electricity — 
 Counter-irritants — Food — Digitalis— Camphor — Musk— Vale- 
 rian — Cannabis indica — Belladonna — Hyoscyamus — Stramo- 
 nium — Phosphorus — Acids —Opium— Cold — Alcohol — Paral- 
 dehyde — 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 respira- 
 tory organs — In asthma — In renal diseases — In diseases of the 
 liver — In gastro-intestinal diseases — In febrile conditions — In 
 rheumatism and gout — In lithsemia — In syphilis — In disorders 
 of nutrition — During pregnancy and after parturition — In 
 spasmodic diseases — In childhood — In old age. - - - 92 
 
CONTENTS. IX 
 
 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 wakmg — Experi- 
 ence 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. - - - - - ii6 
 
 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 somnam- 
 bulic paroxysm — Illustrative cases — Occasional recollection of 
 incidents connected with the somnambulic dream— Resem- 
 blances 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. - . . . i66 
 
X CONTENTS. 
 
 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 — Rudi- 
 mentary states of hypnotism — Investigations of the Society for 
 Psychical Research — Mind-reading — Physiological explanation 
 of the process — Charcot's observations on artificial somnam- 
 bulism — Cataleptic variety of the hypnotic state — Lethargic 
 variety — Somnambulic variety — Hypnotic clairvoyance — 
 Exalted sensibility of the brain in hypnotic states — Suscepti- 
 bility to suggestions from without — Phenomena of so-called 
 spiritualism — Table-rapping — Planchette — Therapeutical em- 
 ployment of hypnotism — Metaphysical healing. - . - 212 
 
CHAPTEE I. 
 
 THE NATURE AND CAUSE OP 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 univer- 
 sally observed in all healthy animals ; and its recur- 
 rence is intimately associated with the diurnal revolu- 
 tion 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 influ- 
 ence of such repose points clearly to the restorative 
 
 (1) 
 
2 INSOMNIA. 
 
 character of the physiological processes which persist 
 during the suspension of consciousness. It also ren- 
 ders evident the final cause of that periodical interrup- 
 tion of activity which the brain experiences in com- 
 mon with every other living structure. 
 
 Sleep is usually preceded for some time by a feeling 
 of sleepiness. This sensation, like the analogous sen- 
 sations of hunger and thirst, represents in some meas- 
 ure the progressive diminution of energy throughout 
 the entire body ; but it is chiefly expressive of the fail- 
 ure of cerebral energy. It produces a sense of gen- 
 eral heaviness and intellectual dullness; the special 
 senses become less alert, the eyelids droop, numerous 
 groups of muscles experience the spasmodic contrac- 
 tion of yawning, the head drops forward and is recov- 
 ered 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 intro- 
 ductory 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 per- 
 mitted 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 per- 
 
THE INVASION OF SLEEP. 3 
 
 sistent. Eeleased in considerable measure from the 
 control of the brain, the reflex energy of the spinal 
 cord is at first somewhat exalted. Witness the fibril- 
 lary twitching of the muscles, and the convulsive state, 
 which may often be observed during the stage of som- 
 nolence after severe fatigue. The uneasy sleeper may 
 even be roused to complete wakefulness by such invol- 
 untary movements. But, as sleep becomes more pro- 
 found, the reflex functions of the cord are also weak- 
 ened.^ As the sensory organs retire from action, 
 the intellectual faculties lose their equilibrium. First, 
 the power of volition ceases. Then the logical asso- 
 ciation of ideas comes to an end. The reasonino- 
 faculty disappears, and judgment is suspended. We 
 become, therefore, no longer capable of surprise or 
 astonishment at the vagaries of memory and of imag- 
 ination, the only faculties that remain in action. To 
 their more or less unfettered activity we owe the pre- 
 sentation in consciousness of those disorderly pictures 
 which, occurring in this stage of imperfect sleep, have 
 been termed hypnagogic hallucinations.^ 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 atten- 
 tion may produce a partial awakening; but, usually, 
 the subsidence of cerebral function is progressive and 
 rapid. The fire of imagination fades, the field of con- 
 sciousness becomes less and less vividly illuminated, 
 the entire nervous apparatus yields to the advancing 
 tide, and, finally, the dominion of sleep is fully con- 
 
 ^ Rosenbach, Zeitschr. f. klin. med, 1881. Brain, Vol. IV, p. 138. 
 ' Alfred Maury, Le Sonntieil et les Reves, Chap. IV. 
 
INSOMNIA. 
 
 firmed. The sleeper knows nothing of the external 
 world, and has lost all consciousness of his own exist- 
 ence. But the duration of profound repose is brief. 
 From the end of the first hour the depth of sleep, at 
 first, rapidly, then, more gradually, subsides. Dreams 
 disturb its tranquility, mental activity increases, the 
 power of volition revives, and, at the end of six or 
 eight hours, the individual is once more awake. The 
 subjoined diagram, borrowed from the Dictionaire 
 Encyclopedique des Sciences M6dicales, will facilitate 
 the apprehension of these successive phases in the 
 course of sleep: 
 
 6 
 S3 
 
 eS 
 
 o 
 
 6 
 
 CO 
 
 o 
 o 
 
 aa 
 
 C 
 
 o 
 
 > 
 
 a 
 "5) 
 
 eS 
 S 
 
 at 
 
 9 
 
 o 
 
 c3 
 > 
 
 a 
 ■p 
 
 :3 
 
 o 
 
 •a 
 
 u 
 
 a?' 
 
 02 
 
 « 
 
 1 1 
 
 
 
 Normal life. 
 
 1 1 
 
 
 
 1 1 1 
 
 
 First stage of sleep — Hypnagogic hal- 
 lucinations. 
 
 1 1 " 
 
 ^^ 
 
 1 1 
 
 
 
 Second stage of sleep — Dreaming. 
 
 
 
 
 
 
 
 
 Third stage of sleep. 
 
 ^^^^^^^^ 
 
 1 
 
 ^^_ 
 
 
 
 
 Profound sleep. 
 
 ^^ 
 
 
 
 First stage of waking. 
 
 1 1 ■ 
 
 
 
 Second stage of waking — Dreams. 
 
 
 1 1 
 
 1 1 1 
 
 
 Third stage of waking— Hypnagogic 
 hallucinations. 
 
 1 1 1 
 
 till 
 
 Complete awakening. 
 
 1 1 1 1 
 
RESPIRATION DURING SLEEP. o 
 
 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 physi- 
 ologists 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 reduc- 
 tion of physiological activity: 
 
 Respiration. — The process of breathing is con- 
 ducted 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^ that during sleep this number was 
 diminished by about one-fourth. The same fact has 
 been recorded by other observers.^ Mosso has also 
 noted the fact ^ that there is a change in the type of 
 respiration, the movements during sleep become less 
 diaphragmatic and more largely costal. He further- 
 more observed that during the waking period the 
 act of inspiration consumed 8-12 of the complete 
 
 ' Hermann's Handbuch der Physiologie, Vol. IV, Part II, p. g8. 
 ' Handbuch der Kinderkrankheiten, Vol. I, p. 346. 
 ^ Handbuch der Physiologie, Vol. IV, Pt. II, p 217. 
 
6 INSOMNIA. 
 
 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. Notwith- 
 standing 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.' 
 
 Circulation. — During sleep the heart beats less fre- 
 quently than during the waking hours. Though a 
 portion of this delay must be attributed to the recum- 
 bent position, sleep does still further retard the move- 
 ment of the heart. My own observations upon children 
 in bed exhibit a difference of twelve to sixteen beats 
 between the pulsations Avhen awake and asleep. Ac- 
 cording to Trousseau^ the average number of pulsa- 
 tions observed in a group o f 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 cliildren, 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^ indicate that among very young children the 
 difference between the pulse of sleep and the pulse 
 of wakefulness may equal forty beats. According to 
 
 ' op. at., pp, 142 and 456. 
 
 ^ Die. Encyc. des Sci. MM., Art. Sommeil, pp. 277. 
 
 ^Quoted by Vierordt, Handbuch der Kinderkrankheiten, Vol. I, p 307. 
 
TEMPERATURE DURING SLEEP. 7 
 
 Guy (loc. cit) the pulse is more variable in the morn- 
 ing than during the afternoon or evening. 
 
 Temperature. — Aside from the almost hourly fluc- 
 tuations of the bodily temperature, a noticeable sink- 
 ing 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. Bous- 
 singault found ^ that a dove which consumed 255 mille- 
 grammes 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 ' 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 chil- 
 dren during the first twelve days after birth, showed 
 an average fall of 0°.38 C. during the hours of sleep. 
 Eight children, between ^Ye and sixteen months old, 
 exhibited a similar depression of 0°.56C. ; while ten 
 children, ranging in age from twenty months to four 
 years of age, averaged 0°.34C. 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 in- 
 fluence of sleep, because it is true that the diurnal 
 variations of temperature which are conditioned by 
 
 ^ Die. Encyc. des. Med., le serie, t. XV, p. 75. 
 "^ Handbuck der Kinderkrankheiten, Vol. I, p. 383. 
 
8 INSOMNIA. 
 
 the vital activities of every animal might be sufficient 
 to account for these differences. The experiments of 
 Horvath' are more convincing. This observer found 
 that the marmots upon which he experimented were ac- 
 customed 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 ther- 
 mometer 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 °r. * * 
 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 mois- 
 ture. Hence the stickiness of the margins of the eye- 
 lids during the sleep of a patient suffering with conjunc- 
 tivitis. He can open his eyes, on awaking, only after 
 sufficient time has elapsed to revive the lachrymal flow. 
 Exner*^ remarks the diminution of pathological secre- 
 tion 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 
 
 ' Carpenter's Physiology, 8th edition, p. 560. 
 
 "^ Handbuch det Physiologic, Vol. II, Pt. II, p, 297. 
 
EFFECT OF SLEEP ON NUTRITION. 9 
 
 Yaij with the contents of the alimentary canal ; but in 
 general they are considerably diminished, and diges- 
 tion is correspondingly retarded during the hours of 
 sleep. The quantity of urine is lessened during sleep. ^ 
 The elimination of urea and of other excrementitious 
 matters is less during the night than by day.^ Unless 
 increased by disease, or by accidental circumstances 
 connected with atmospheric temperature and unneces- 
 sary clothing, the perspiration is also diminished. 
 
 Nutrition. — All the molecular processes of nutri- 
 tion are reduced by sleep. The lowering of the bodily 
 temperature has been already indicated. The observa- 
 tions of Helmholtz^ indicate that the actual libera- 
 tion 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 ^ 
 of Boussingault, Henneberg, Scharling, E. Smith, 
 Liebermeister, Pettenkofer, Yoit, and LeAvin, clearly 
 indicate the fact that during sleep less oxygen 
 is absorbed, and less carbonic acid gas is dis- 
 charged, by the tissues. Yoit 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 noctur- 
 nal half of the day. Artificial sleep occasioned by 
 chloral hydrate produced a similar reduction in the 
 consumption of oxygen and in the formation of car- 
 
 * Quincke, Archiv. f. Experim. Pathol., Vol. VII, p. 115. 
 ^Carpenter's Physiology, 8th edition, p. 526, Handbuch der Kinder- 
 krankheiten, 2d edition. Vol. I, p. 373. 
 
 ^ Die. Encyc. des Sci. Med., Ille Serie, Vol. X, p. 268. 
 ^Handbuch der Physio logie. Vol. V, p. 142-156. 
 
10 INSOMNIA. 
 
 bonic acid gas. Under the influence of morphine 
 the reduction of COg. reached 27 per cent., and the 
 diminution of oxygen amounted to 84 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 rela- 
 tion between the metamorphosis of the non-nitrogen- 
 ous elements of the tissues and the amount of bodily 
 activity. 
 
 The experiments of Pettenkofer and Yoit, 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 mole- 
 cular 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 ob- 
 tained. 
 
 It must not, however, be inferred that the general 
 reduction of tissue-change, which has thus been estab- 
 lished, during the hours of sleep, is evidence of a uni- 
 versal and uniform reduction of function throughout 
 the body. Sleep seldom falls at once with equal force 
 upon every organ ; its invasion is progressive. Con- 
 sequently, certain structures may be fast asleep, while 
 
STATE OF THE SPECIAL SENSES IX SLEEP. 11 
 
 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 appa- 
 ratus 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 drooj), or the muscles 
 of the neck give way in the act of nodding. The 
 senses of touch and of taste fail noxt 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 some- 
 times 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-fac- 
 tory or rendering establishment, may in like manner 
 disturb the slumbers of thousands of people. 
 
 The sense of hearing seems to be the most persist- 
 ent of all the special senses. It is not a very uncom- 
 mon 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 
 
12 INSOMNIA. 
 
 its own music. As a general rule, however, it is note- 
 worthy 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 conscious- 
 ness ceases. The muscles of respiration and of circu- 
 lation 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 per- 
 ception being dependent upon sensation, it is to be 
 observed that the range of perception diminishes so 
 
SLEEP AND THE MENTAL FUNCTIONS. 13 
 
 soon as the organs of sense begin to yield. Its in- 
 tensity 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 con- 
 nection 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 struc- 
 tures 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 dis- 
 turbed, and the order of their subsidence may be con- 
 siderably varied ; but, as a general rule, the physiologi- 
 cal relations of the faculties are respected, so that as 
 sensation diminishes, perception fails, the conception 
 of ideas is correspondingly hindered, and the associa- 
 tion 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 rea- 
 soning faculty or of forming those judgments upon 
 which every act of volition is based. When the brain 
 
14 INSOMNIA. 
 
 « 
 has at length been so far overwhelmed that physical 
 
 impressions can no longer reach the field of conscious- 
 ness, 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 instru- 
 ment of thought. This conclusion has been ques- 
 tioned 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 forget- 
 ful of all similar processes that occurred during undis- 
 turbed 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. 
 
MENTAL ACTION DURING SLEEP. 15 
 
 It may also be objected with equal reason that the 
 dreams which unquestionably occupy the field of con- 
 sciousness at the instant of waking are probably ex- 
 cited 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 interrup- 
 tion 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 phenome- 
 nal manifestation. When a physical force ceases to 
 exhibit itself in an active state, and passes into a poten- 
 tial 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 
 
16 INSOMNIA. 
 
 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' has made a rough estimate of the 
 soundness of sleep by comparing the loudness of 
 the noises necessary to wake the subject of experi- 
 ment at regular intervals during the course of the 
 night. He arranged a gong with a pendulum attach- 
 ment, and noted the length of the stroke which pro- 
 duced 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 remain- 
 ing ten half hours of the experiment were occu- 
 pied by a comparatively light and gradually diminish- 
 ing 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 
 
 ' Kohlschiitter, Messungen der Festigkeit des Schlafes. Dissert. Leip- 
 zig, 1862, und Zeitsch'ift f. rat. Med.. 1863. Quoted, Hermann's 
 Handbuch der Physiologie, Vol. II, Pt. II, p. 295. 
 
THE CAUSES OF SLEEP. 17 
 
 wakefulness are mo si frequent during the early 
 watches of the morning. 
 
 When considering the causes of sleep it is needful 
 to exclude fi'om view those artificial varieties of sleep 
 that are produced by the various narcotic drugs, as well 
 as the counterfeits of sleep which result from dis- 
 eased conditions of the body. It is comparatively easy 
 to frame hypotheses in explanation of such interrup- 
 tions of our conscious life; but, when we attempt to 
 formulate a theory which shall satisfactorily account 
 for the occurrence of natural sleep in healthy ani- 
 mals, the task becomes exceedingly difficult. 
 
 First among the causes of sleep may be reckoned 
 the alternation of day and night. With the disappear- 
 ance 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 testi- 
 fies 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 
 2 
 
18 INSOMNIA. 
 
 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 need- 
 ful to satisfy the demand for rest. 
 
 Prominent among the causes which predispose to 
 sleep at night is the cessation of a majority of the sen- 
 sations that are continually pouring in upon the brain 
 during the period of daylight. Hence the necessity for 
 seclusion in darkened rooms, from which the noises of 
 the daytime are shut out, if one would sleep during the 
 long days of the arctic summer, or if one would enjoy 
 a midday nap at any season of the year. The close 
 dependence of wakefulness upon the constant activity 
 of the organs of sensation, is well illustrated by a case 
 related in Hermann's Handbuch der Physiologie, Vol. 
 II, Part 2, p. 295. A young man had been reduced by 
 disease to such a condition of general anaesthesia that 
 the right eye and the left ear were the only remaining 
 paths of sensation between his brain and the external 
 world. Whenever the sound eye and ear were band- 
 aged 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. 
 
THE CAUSES OF SLEEP. 19 
 
 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 atten- 
 tion. Every muscle must be suffered to rest for a 
 time after contraction before it can be again con- 
 tracted. Even the heart and the muscles of respira- 
 tion 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 op- 
 erations performed without anaesthetics. The depress- 
 ing emotions, even, may so fatigue the brain as to 
 induce sound sleep through reaction from previous 
 
20 INSOMNIA. 
 
 excitement. Every wearied portion of the body must 
 rest; and when the brain thus rests, sleep is the con- 
 sequence. 
 
 Impressed by the force of such considerations, 
 certain physiologists' have reasoned from the analo- 
 gies suggested by a study of the results of mus- 
 cular fatigue, and have suggested an hypothesis 
 accounting for the occurrence of sleep by a sup- 
 posed loading of the cerebral tissues with the acid 
 products of their own disassimilation during wake- 
 ful 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 excess- 
 ive presence of lactic acid and its sodic compounds 
 might be the real cause of cerebral torpor and sleep. 
 Could this hypothesis be proved, ordinary sleep would 
 take its place along with the states of unconsciousness 
 induced by anaesthetics and hypnotics, and the lactate 
 of sodium should be found the very best of medicines 
 for the relief of wakefulness. Its administration for 
 this purpose, however, has yielded only the most dis- 
 cordant and unsatisfactory results. The fatigue the- 
 ory, 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 
 
 ' 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. 
 
THE CAUSES OF SLEEP. 21 
 
 by Pfltiger.^ According to this view, the state of 
 wakefuhiess 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 chem- 
 ical combination, forming " explosive compounds," 
 whose precise composition is not fully understood. 
 When for any reason the supply of oxygen is insuffi- 
 cient, as in hemorrhage, producing cerebral anaemia, 
 or in impregnation of the red blood corpuscles with 
 carbonic oxide or chloroform, or other substances capa- 
 ble of excluding oxygen from the hemoglobin of the 
 corpuscle, the cerebral tissues are imperfectly reno- 
 vated. The explosive constituents of the cortical pro- 
 toplasm are then inadequately renewed after mental 
 activity, and the sensitive portions of the brain are no 
 longer fitted to manifest the highest forms of intelli- 
 gent activity. But, when nothing interferes with 
 healthy nutrition, the requisite degree of instability 
 in the protoplasm of the brain is effected by intussus- 
 ception of oxygen. Under the influence of the vari- 
 ous 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 exter- 
 nal world. 
 
 That the capacity for thus signalling across the 
 
 * Theorie des Schlafes. Arch. £. d. ges. Physiol. X, 468. 
 
22 INSOMNIA. 
 
 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 intelli- 
 gence 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 Strtimpell. 
 
 The dependence of the waking state upon the pres- 
 ence and activity of a sujficient quantity of a peculiarly 
 unstable form of protoplasm in the brain is an hypothe- 
 sis which presents no great dilB&culty of comprehen- 
 sion. But how may we explain the lapse from the 
 intelligent vivacity of that waking state into the un- 
 conscious inactivity of sleep? I have elsewhere' dis- 
 cussed the manner in which artificial sleep is produced 
 by impregnation of the brain with anaesthetic sub- 
 stances that interfere with sensibility, and finally pro- 
 duce 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 
 
 ^ Artificial Ancesthesia and AncBsthetics, pp. 15-17. 
 
THE CAUSES OF SLEEP. 23 
 
 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 pass- 
 age from wide awakefulness into a condition of deep 
 sleep, such as may be commonly observed among sail- 
 ors and others who have formed the habit of going at 
 once to sleep at regularly recurring hours of the day 
 or night. Certain wiiters have endeavored to account 
 for this fact by imagining a special mechanism at the 
 base of the brain (choroid plexuses of the fourth ven- 
 tricle, etc.,) by means of which the current of the 
 blood through the brain may be voluntarily dimin- 
 ished, with a consequent arrest of conscious activity. 
 But, still adhering to the hypothesis of Pfltiger, we shall 
 obtain a clearer explanation of the facts by considering 
 the phenomena connected with the succession of impres- 
 sions upon the organs of sense. It has been ascertained* 
 that such impressions must persist for a certain meas- 
 urable length of time in order to excite conscious per- 
 ception. A sound must be prolonged for at least f our- 
 teen-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-hun- 
 dredths 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 
 
 * Carpenter's Physiology, 8th ed., p. 852. 
 
24 INSOMNIA. 
 
 of a second are necessary. It is, therefore, perfectly 
 reasonable to suppose that when the " explosive ma- 
 terial" 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 conscious- 
 ness. 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 con- 
 tinual 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 dan- 
 ger 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 occu- 
 pied by the protoplasmic substance of the brain. Re- 
 turning, 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 condi- 
 tion ; his nervous organs store up in sleep a supply of 
 oxygenated protoplasm sufficient only for an active 
 
CEREBRAL ANEMIA, 25 
 
 period of four or five houi's; so tliat, 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, com- 
 paratively 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 over- 
 whelmed by the products of active exertion. 
 
 That analogous, though not identical, predisposi- 
 tion 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 under- 
 take to cure a popliteal aneurism — ^by placing tourni- 
 quets on the arteries leading to the afPected part. But 
 the mere fact that syncope produces unconsciousness 
 does not prove that "cerebral anaemia" should be 
 elevated to the rank of the principal cause of natural 
 sleep. The nervous process is the primary factor. 
 
26 INSOMNIA. 
 
 The circulation of the blood is everywhere under the 
 immediate control of the nervous system. Conse- 
 quently, 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 adjust- 
 ments 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.' 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 com- 
 pare that portion of its course with the coincident cir- 
 culation 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 cere- 
 bral 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 
 
 ' Sulla Circolazione del Sangue nel Cervello dell ' Uomo. Abstract in 
 Brain, Vol. IV, p. loo. 
 
CEREBRAL CIRCULATION IN SLEEP. 27 
 
 diminution in the number of respirations, and a fall 
 of six or eight beats in the pulse. The volume of the 
 brain and its temjDerature 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 demon- 
 strated by the use of the plethosphygmograph. The 
 extreme sensitiveness of the nervous centers was fur- 
 ther 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 circula- 
 tion, 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 
 
28 INSOMNIA. 
 
 abolish consciousness and to excite convulsive move- 
 ments. 
 
 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 inva- 
 riably secondary to the excitement of nerve tissue. 
 Sleep, therefore, must be regarded as the cause, rather 
 than the consequence, of the so-called cerebral anae- 
 mia which obtains in the substance of the brain during 
 repose. This condition of "anaemia" is nothing more 
 than the relatively lower state of circulation which 
 may be remarked in every organ of the body during 
 periods of inactivity. Every impression upon the sen- 
 sory structures of the brain occasions a corresponding 
 liberation of motion in those structures. The move- 
 ment 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 dilata- 
 tion of its vessels, and increased irritability of the cor- 
 tical instrument of perception. This becomes the 
 
THE CAUSE OF SLEEP. 29 
 
 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 mov- 
 able 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 accumu- 
 lation of an excess of the waste-products of intra- 
 molecular oxidation during functional activity — prod- 
 ucts 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 intru- 
 sion of substances derived from without — substances 
 which, like the natural refuse of the living cells, more 
 or less completely hinder the processes of oxygena- 
 tion 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 re- 
 main 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 
 
30 INSOMNIA. 
 
 this seems to constitute their normal condition. They 
 are either excessively fat, red-faced, and soaked with 
 beer, or they are pale, anaemic, and pnlpy, 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 dis- 
 eases 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 die 
 sommeil. It is characterized by daily paroxysms of 
 somnolence which tend to become more and more con- 
 tinuous 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,' an Eng- 
 lish surgeon who practised in Sierra Leone, and to 
 the monograph by Guerin,^ a French naval surgeon, 
 who had enjoyed exceptional opportunities for observa- 
 tion 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 
 
 ^Transactions of the London Epidemiological Society^ Vol. I, p. ii6. 
 "* De la maladie du sommeil, 1869. 
 
MALADIE DU SOMMEIL. 31 
 
 gradual, commencing with a slight frontal neadache. 
 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 intel- 
 lectual 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 coma- 
 tose, and dies quietly. Sometimes, however, the evo- 
 lution 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 nega- 
 tive results ; the sinuses and larger vessels of the brain 
 are engorged with blood, but no evidence of inflam- 
 mation is anywhere apparent. The other organs pre- 
 sent no pathological alterations whatever. These 
 observations seem to indicate that the disease origi- 
 nates in some form of general blood-poisoning, rather 
 than in any local inflammation or degeneration. Dr. 
 
32 INSOMNIA. 
 
 Clark has called attention to an enlargement of the 
 cervical glands as a feature of the malady. According 
 to Dr. G. H. Bachelder/ 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 
 Bolids within the cranium are capable — may become 
 the cause of coma. Toxaemic conditions of the cir- 
 culating 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 fre- 
 quent periods of repose. Like normal sleep, the coma- 
 tose condition admits considerable variation of inten- 
 
 * T^ Medical Record, July i, 1882, p. 23. 
 
LETHARGY. 33 
 
 sity. 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 con- 
 cludes 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 counte- 
 nance 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 im- 
 perceptible. Uncomplicated with hysteria, the ' dis- 
 order is rapidly fatal, but, according to Rosenthal,' 
 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 infant- 
 ile 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 irri- 
 
 ^ Real. Encyc. der ges. Heilkunde^ VIII, 276. 
 3 
 
34 INSOMNIA. 
 
 tation, followed by a complete recovery. Still more 
 instructive is the case, narrated by Rosenthal/ of a 
 young woman, twenty-four years of age, who, in con- 
 sequence 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 rais- 
 ing her eyelids, the pupils gave no reaction to light; 
 the limbs remained perfectly flaccid, and the radial 
 arteries were pulseless. Careful auscultation, how- 
 ever, 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 contrac- 
 tions. 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 read- 
 ily 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 dis- 
 
 ^Op. cit, p. 276. 
 
LUCID LETHARGY. 35 
 
 tinguished 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 circum- 
 stances. Observation of the changes in muscular tem- 
 perature 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 inhi- 
 bition 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 excite- 
 ment, 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 leth- 
 argy. The patient was a female physician, about 
 thirty years of age, unmarried, and consumptively 
 inclined. During the course of a long and wearisome 
 
36 INSOMNIA. 
 
 hospital service, she was prostrated with typhoid fever. 
 Placing herself under the immediate care of my inform- 
 ant, she was also attended by several of the most emi- 
 nent physicians in the city. After a long and exhaust- 
 ing 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 pre- 
 served. 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 authenti- 
 cated, but the limits of the present chapter will not 
 permit a discussion which properly belongs to an 
 investigation of the phenomena of trance. The im- 
 portant fact for present consideration is the persist- 
 
LUCID LETHARGY. 37 
 
 ence of conscious life, despite the appearance of death. 
 In this preservation of consciousness, notwithstanding 
 the temporary suspension of certain kinds of sensibil- 
 ity and the power of voluntary motion, may be discov- 
 ered a relationship between the phenomena of lucid 
 lethargy and various disturbances of sleep, which will 
 be considered in a succeeding chapter. 
 
CHAPTER IL 
 
 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 Henkt IV, Second Part. 
 
 We have seen that the condition of normal sleep is 
 determined by a peculiar molecular state of the sub- 
 stance of the brain — a modification regularly alternat- 
 ing 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 move- 
 ments 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 develop- 
 ment, 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 extra- 
 ordinary effort of the will be kept awake beyond a cer- 
 tain 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 in- 
 
 (38) 
 
CAUSES OF INSOMNIA. 39 
 
 vestigation of morbid conditions of the bodily func- 
 tions. 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 con- 
 ditions operating in association with each other. We 
 may, therefore, consider, I, Insomnia caused hy irrita- 
 tion of the peripheral portions of the sensory apparatus; 
 and, II, Insomnia caused hy morbid states of the central 
 nervous organs. 
 
 I. Insomnia caused by irritation of the peri- 
 pheral 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. — Promi- 
 nent 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 pro- 
 found. 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 sun- 
 light. 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 North- 
 
40 INSOMNIA. 
 
 ern 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' says: "We longed for darkness 
 and for night. Do what we could to darken the win- 
 dows 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 dark- 
 ness, 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 wakeful- 
 ness. 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 in- 
 ferior grade of social life. 
 
 Sudden illumination of the sleeping room will fre- 
 quently awaken the sleeper. During the great fire in 
 Chicago, A. D. 1871, many persons were thus aroused 
 
 M Summer in Norway, by John Dean Caton, pp. 251 and 311. 
 
EFFECTS OF NOISE. 4=1 
 
 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 lan- 
 tern 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 illumi- 
 nating the sky by night. Dreams, also, are not unfre- 
 quently excited by the incidence of light upon the 
 closed eyelids.^ 
 
 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 be- 
 come 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 por- 
 tions 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. 
 
 ^ A. Maury, op. cit., p. 156. 
 
42 INSOMNIA. 
 
 Thus a steady and monotonous noise may, if long con- 
 tinued, 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 sud- 
 denly stopped! A recent traveler in Guiana' relates 
 a curious experience with an Indian magician who un- 
 dertook 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 par- 
 ticular that an odor which might severely annoy one 
 person, would pass almost unnoticed by another. 
 Large cities are sometimes invaded by overwhelming 
 
 ^ Among the Indians of Guiana. By Everard F. Tm Thurn. 
 
EFFECT OF ODORS, SAVORS, AND HEAT. 43 
 
 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 build- 
 ing. Less energetic odors may disturb the depth of 
 sleep without actually waking the patient. Thus 
 Maury records^ that when he was made to inhale the 
 vapor of cologne water while asleep, he dreamed of be- 
 ing 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 irritatinsr 
 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,^ we recognize a 
 sixth sense — ^the sense of temperature — it must be ad- 
 mitted 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. ^tna when a bottle of hot water was placed 
 against his feet, in bed, on account of some slight 
 
 * Le Sommeil et les Reves, p. 154. 
 ^ .Vature, Vol. XXIX, pp. 438-462. 
 
44 INSOMNIA. 
 
 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 wakeful- 
 ness 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 punkali-ivallah sits and pulls the 
 string while his master sleeps. So powerful is the 
 force of habit in the organization of the automatic ap- 
 paratus of the body that, though these punkah-pullers 
 often fall asleep, they still continue, without interrup- 
 tion, 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 atmos- 
 phere. Dampness interferes with the process of ex- 
 halation from the surface of the body, which, conse- 
 quently, tends to become overheated. The tissues, 
 under such circumstances, are imperfectly defecated, 
 and rapidly pass into a condition of imperfect nutri- 
 tion. 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 nee- 
 
RELIEF BY COOL AIR. 45 
 
 essary to seek a temporary retreat among the high- 
 lands and mountains, in order to find a climate suffi- 
 ciently 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 pro- 
 cured on anyVarm day in summer by embarking, at 
 Chicago, upon one of the steamboats bound to Macki- 
 nac. 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 bril- 
 liant cabins. The children have left their woes be- 
 hind, and, for the first time, in many weeks, perhaps, 
 they and their weary mothers sleep the sleep of inno- 
 cence 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 
 
46 INSOMNIA. 
 
 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 atmos- 
 phere 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.' Clouds are sometimes positive and 
 sometimes negative. According to Fonssagrives ^ 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 ^ Avho 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 dis- 
 agreeable effects upon persons of a nervous tempera- 
 ment. According to Fonssagrives [loc. cit.) such 
 patients frequently experience, during the prevalence 
 of storms which traverse great distances, a high de- 
 gree of insomnia, together with headache, pains in the 
 
 ' Ganot's Physics. 
 
 ' Die. Eiicyc. des Set. MM. , Art. Climat. 
 
 ^ Comptes-rendus Acad, des Sci., 1840, t. XI, p. 823. 
 
EFFECTS OF COLD. 47 
 
 limbs, joints, and old injuries, and a general indefinable 
 sensation of discomfort. S. Weir Mitchell has care- 
 fully traced the connection between these phenomena 
 and the variations of barometric pressure which accom- 
 pany the revolving storms that cross the continent in a 
 northeasterly direction. ^ 
 
 Though the effect of a high atmospheric tempera- 
 ture 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 patho- 
 logical process, and, therefore, must not be mistaken 
 for natural sleep. It may result either from cerebral 
 congestion, or from cardiac exhaustion, and is character- 
 ized by an extraordinary bodily temperature and a high 
 rate of mortality.^ So elaborate are the arrangements 
 for the preservation of a uniform temperature through- 
 out the body that it is practically impossible for a sun- 
 stroke 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 wake- 
 fulness. 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 
 
 ^Am.Journ. Med Sci., April, 1877, p. 305. 
 
 ^A remarkable illustration of this will be found related in The 
 Lancet, July 26, 1884, p. 112. 
 
48 INSOMNIA. 
 
 of the tissues is sufficient to arouse the brain to wake- 
 fulness, 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 cere- 
 brum, and produces wakefulness, very much as disten- 
 tion 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.' As the temperature of the 
 air diminishes, in winter, animals like the marmot fall 
 into a species of sleep. Their movements of respira- 
 tion and circulation are greatly reduced, and their 
 bodily temperature falls, though it always remains 
 several degrees above the temperature of the surround- 
 ing 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. H 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 
 
 "^ Die. Encyc. des Sci. M^d., Art. Froid, p. 139. 
 
SENSORY DISTURBANCES. 49 
 
 of ordinary hibernation. In like manner the human 
 animal may experience the threefold effects of refrig- 
 eration : 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 bed- 
 bugs, 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, ery- 
 thema, 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 peri- 
 pheral disease. Witness the frightful itching some- 
 times experienced during the progress of chronic 
 myelitis. All kinds of injuries, wounds, ulcers, and 
 other local inflammations are common causes of in- 
 somnia by reason of the painful impressions trans- 
 mitted from them to the brain. Hence the great 
 importance of anodynes and hypnotic remedies in the 
 course of surgical practice. Diseases or injuries of 
 4 
 
50 INSOMNIA. 
 
 the various peripheral nerves are notable causes of 
 sleeplessness. Witness the horrible wakefulness 
 caused by neuritis and by neuralgia. The develop- 
 ment 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 yierves. — So much 
 still remains to be learned concerning the pathological 
 functions of the sympathetic nerves that it is impossi- 
 ble to assign with any great degree of precision the 
 exact amount of interference with sleep that may de- 
 pend upon disordered conditions of this portion of the 
 nervous system. Since their principal functions con- 
 sist in the regulation of the flow of blood and lymph 
 throughout the body, and in the control of the pro- 
 cesses of nutrition, calorification, secretion and excre- 
 tion, it follows that any considerable derangement of 
 their healthy action must be represented by a cor- 
 responding 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 phe- 
 nomena 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 
 
MORBID STATES OF THE NERVOUS SYSTEM. 51 
 
 reach the cerebral organ of conscious sensation. But 
 in certain morbid states they become inordinately sen- 
 sitive, 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, peri- 
 tonitis, 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 pneumo- 
 gastric 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 moebid states of the cen- 
 tral NEEVOUS 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. 
 
52 INSOMNIA. 
 
 2. Inflammations and degenerations. 
 
 3. Neoplastic encroachments. 
 
 Disorders of circulation and nutrition. — Hyperaemia 
 of the brain is a frequent cause of wakefulness. This 
 may be maintained by an unconscious effort of the 
 organ of the will under the influence of any great and 
 unusual excitement of the mind. So soon as the men- 
 tal 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 pro- 
 duction and distribution of steam. Such a condition 
 is usually the result of numerous antecedent causes. 
 Long hours of work, scanty or improper food, insuf- 
 ficient 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 hypersemia of the nervous centers has been 
 above mentioned as the consequence of cerebral func- 
 tion under unfavorable conditions. But, as the disor- 
 der 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 nerv- 
 ous tissue. Nutrition suffers throughout the body to 
 
IRRITABILITY OF THE BRAIN. 53 
 
 a degree that attracts attention. The blood diminishes 
 in quantity and quality, till the patient becomes nota- 
 bly anaemic. In this condition the brain is inordinately 
 excitable. It is incapable of sustained activity, and 
 the patient may even be oppressed by an inclination to 
 constant drowsiness; yet he will be unable to sleep 
 soundly, and his sleep will be continually agitated by 
 dreams. This state is one of the constant accompani- 
 ments of slow starvation. The molecular structure of 
 the nervous organs seems to be so slightly constructed, 
 under such circumstances, that its equilibrium is dis- 
 turbed by the most trifling incidents. It may be 
 likened to a lofty wall of bricks laid up without mor- 
 tar — "if a fox go up," the entire structure may be 
 thrown down with a tremendous noise. Thus the 
 ansemic and irritable brain will react excessively under 
 the slightest impression; consciousness is invaded by 
 perceptions which would never arise under normal con- 
 ditions of the nervous tissue ; and the mind is continu- 
 ally aroused. This form of wakefulness is very fre- 
 quent among women who have become anaemic, and 
 among patients who are slowly convalescing from 
 exhausting diseases. 
 
 It is impossible in every instance to decide whether a 
 given state of wakefulness is the result of cerebral hy- 
 peraemia or anaemia. In the one case the persistence of 
 wakeful activity of the mind is due to excitement of the 
 cerebral cells, accompanied by a lavish irrigation of 
 their substance with the plasma of the blood. In the 
 other case the excitement is occasioned, not so much 
 by increased afflux of the blood, as by a morbid insta- 
 bility of the nervous substance. The outcome in both 
 
54 INSOMNIA. 
 
 cases is very similar — mental excitement and wake- 
 fulness. 
 
 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 cofiPee 
 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 Avakeful- 
 ness is quite different from that produced by alcoholic 
 drinks. These operate, when taken in small quanti- 
 ties, to favor cerebral equilibrium — and consequent 
 equanimity — ^by producing a general dilatation of the 
 smaller blood-vessels. Their anaesthetic influence is 
 favorable to sleep, under such circumstances. But, if 
 frequently repeated, these doses of alcohol modify the 
 nutrition of the nervous system until, at last, a condi- 
 tion of irritable weakness is reached, in which 
 wakefulness of a most distressing character is expe- 
 rienced. 
 
 Inflammations, degenerations, and neoplasms. — The 
 early stages of inflammation involving the central nerv- 
 ous organs are marked by that form of insomnia whicli 
 is associated with active hypersemia. 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 com- 
 pression. The interstitial changes which cause the 
 various forms of insanity, are in like manner causes of 
 
MAL - NUTRITION OF THE BRAIN. 55 
 
 wakefulness. Local injuries and degenerations of 
 brain-substance, tubercular deposits upon the menin- 
 gies, 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 neigh- 
 borhood. 
 
 Finally, it must be observed that wakefulness may 
 result from excitement of the brain by irritating sub- 
 stances 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 elimina- 
 tion through the liver, kidneys and intestines, leaves 
 the blood charged with excrementitious substances 
 which arouse the brain to wakefulness. In like man- 
 ner, various poisons, like lead, arsenic, etc., different 
 miasms of telluric origin, the products of putrefaction, 
 and the various animal contagia, may produce insom- 
 nia 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 Jttliet. 
 
 An occasional attack of wakefulness may fall to the 
 lot of any one as a consequence of the various disturb- 
 ances 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 dis- 
 appears, 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 suc- 
 cessful 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 
 
 (56) 
 
SIGNIFICANCE OF INSOMNIA. 57 
 
 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 treat- 
 ment 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 armamentari- 
 um 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 condi- 
 tion of the nervous substance itself. For a clear 
 understanding of the proper mode of medication, it is 
 
58 INSOMNIA. 
 
 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 de- 
 clare themselves during the course of any disease in 
 which insomnia may become a troublesome phenome- 
 non, it is impossible to make a classification of dis- 
 eases upon the basis of these different states of the 
 brain. It will, therefore, be found more useful to con- 
 sider the subject of sleeplessness as it ordinarily pre- 
 sents 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 therapeu- 
 tics 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 devel- 
 opment of sleep. The second class of agents com- 
 prises 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 
 
REMEDIES FOR INSOMNIA. 
 
 59 
 
 remainder in a state of wakefulness. All these sub- 
 stances produce decided effects upon the spinal cord 
 and the peripheral nerves, but it is their operation 
 upon the brain which principally interests us in con- 
 nection with insomnia. 
 
 Nervous Stimulants 
 
 Nervous Sedatives. 
 
 Heat. 
 
 Cold. 
 
 Baths. 
 
 Alcohol. 
 
 Massage. 
 
 Paraldehyde. 
 
 Electricity. 
 
 Ether. 
 
 Counter-irritants. 
 
 Chloroform 
 
 Food. 
 
 Chloral. 
 
 Digitalis. 
 
 Butylchloral hydrate, 
 
 Camplior. 
 
 Amyl nitrite, 
 
 Musk. 
 
 Opium and opiates. 
 
 Valerian. 
 
 Bromides. 
 
 Cannabis indica. 
 
 Hops. 
 
 Belladonna. 
 
 Gelsemium. 
 
 Hyoscyamus. 
 
 Conium. 
 
 Stramonium. 
 
 
 Phosphorus. 
 
 
 Acids 
 
 • 
 
 Opium, 
 
 
 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 over- 
 come chilliness, it tends to equalize the circulation of 
 
60 INSOMNIA. 
 
 the blood, and produces throughout the body a nerv- 
 ous 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 agree- 
 able temperature — ^this is better than any exact figure 
 upon the scale of a thermometer — and the bath should 
 not last logger than ten minutes. Similar baths exer- 
 cise 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 clfi'ohic 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 re- 
 sume 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 
 
MASSAGE. 61 
 
 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 intro- 
 duced under the names of percussion, shampooing, and 
 the Swedish movement cure. They all possess the com- 
 mon 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 con- 
 ditions 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 de- 
 rived 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 
 
B2 INSOMNIA. 
 
 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 connnected, the brain then yields to the 
 effects of its own fatigue, and sleep supervenes. 
 
 EledricUy 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,' 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 con- 
 tinued employment of electricity is needful to effect 
 those changes in cerebral nutrition which are necessary 
 for a permanent cure of insomnia. In cases of sleep- 
 lessness 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 irrUation and insomnia. 
 
 Counter -irrif ants are substances which are applied 
 to the surface of the body for the purpose of com- 
 municating 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 pre- 
 sented; notably a most ingenious argument by Dr. T. 
 Lauder Brunton '^ in favor of the theory of inhibition 
 
 "^ Medical and Surgical Electricity, 4th ed., p. 413. 
 "^Nature, March, 1883, 
 
COUNTER - IRRITANTS. 63 
 
 by interference of vibrations — impulses from the peri- 
 phery interfering with vibrations originating in morbid 
 conditions of the central nervous organs — very much 
 as darkness is produced by the interference of lumi- 
 nous undulations, and silence is effected by interfer- 
 ence of sonorous waves in the atmosphere. This 
 hypothesis is the one that is most conformable to the 
 present requirements of science, and is hereby ac- 
 cepted 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 crotwi 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 power- 
 fully 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 chan- 
 nels 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 insom- 
 
64 INSOMNIA. 
 
 nia, its cause lies in an irritable weakness of the nerv- 
 ous 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 wake- 
 fulness may be established which will add to the dan- 
 gers 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 prop- 
 erly 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 jpepionized 
 with advantage by gently heating one pint of milk 
 Avith 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 alimen- 
 tary 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 con- 
 siderable portion of the daily food of the nomad tribes 
 of Central Asia, and it is highly esteemed among the 
 
KOUMISS. 65 
 
 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 stom- 
 ach. 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 pro- 
 ceeds 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 pre- 
 pared 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 possi- 
 
66 INSOMNIA. 
 
 ble 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 quan- 
 tity 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 ex- 
 haustion. 
 
 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 repre- 
 sent 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. x4.s 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 with- 
 out 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 
 
DIGITALIS — CAMPHOR — MUSK. 67 
 
 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 tablespoonf ul, 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 im- 
 proves, delirium ceases, and sleep occurs. 
 
 Camphor. — This substance is not an hypnotic, but 
 it forms a valuable addition to various hypnotic com- 
 pounds. It is a cerebral stimulant, and aids in the 
 establishment of that nervous tranquility which favors 
 the incidence of sleep. It may, therefore, be advan- 
 tageously associated with opiates in the restlessness 
 and insomnia of exhaustion. Tully's Powder, a valua- 
 ble substitute for Dover's Powder, contains camphor. 
 This renders it preferable to the ordinary opiates in 
 typhoid fever, and in other exhausting diseases. 
 
 Musk, the dried secretion of the preputial follicles 
 of the musk-deer, is a substance which, on account of 
 its high price, is rarely used as an hypnotic. Given 
 in doses of ten grains, every two or three hours, it is 
 exceedingly valuable (Stille and Maisch) for the relief 
 of " all those nervous phenomena which are represented 
 by the term ataxia, and among them subsultus ten- 
 dinum, mild muttering delirium, floccitation, muscae 
 volitantes, and hiccough, with a small, frequent, tremu- 
 lous or irregular pulse, without coma and without col- 
 lapse. Under these circumstances musk tends to pro- 
 duce refreshing sleep, while it calms muscular spasm 
 and favors perspiration, while the pulse grows fuller, 
 more regular, and less frequent. ... In propor- 
 
68 INSOMNIA. 
 
 tion 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 am- 
 monia." 
 
 Valerian and its different preparations form a typi- 
 cal 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 pro- 
 duces, 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, im- 
 possible 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 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 
 
BELLADONNA. 69 
 
 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. Ac- 
 cording to Stille and Maisch, the Avakefulness 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 dis- 
 ease 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 asso- 
 ciation with opiates seems to increase their hypnotic 
 effect, while at the same time neutralizing their dis- 
 agreeable action. According to Curci,^ it opposes the 
 tendency of opiates to cause cerebral hypersemia. For 
 this reason it is generally advisable to combine sul- 
 phate of atropia with sulphate of morphia for hypo- 
 dermic use. Of the former 1-100 — 1-80 grain may 
 
 * Lo Sperimentaie, April, 1884. 
 
70 INSOMNIA. 
 
 be used with ^ grain of the latter. Certain patients 
 are exceedingly intolerant of belladonna and its de- 
 rivatives, 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 ad- 
 mitted 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 bella- 
 donna present many points of similarity. Their alka- 
 loids are almost identical in chemical and physiologi- 
 cal properties. The extract of belladonna is consider- 
 ably 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 de- 
 lirium, 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. 
 
 Sframonium. — This is another of the solanaceous 
 
STRAMONIUM — PHOSPHORUS — ACIDS. 71 
 
 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 pre- 
 pared, to effect a similar result by furnishing the drug 
 in a convenient form for use. Tobacco and lobelia 
 operate in a very similar manner upon all spasmodic 
 affections of the respiratory passages ; but their energy 
 is almost too great for the comfort of the patient. 
 
 Phosphorus. — Bartholow has recommended this 
 drug in " cases of wakefulness dependent on cerebral 
 anaemia and exhaustion," and in " the wakefulness of 
 the aged, accompanied with muscular cramps, feeble- 
 ness 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. In- 
 directly, 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 
 
72 INSOMNIA. 
 
 apparatus, acids are often useful. Their topical effects 
 upon the mucous membrane of the stomach are stimu- 
 lant 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 ^\ei 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 ex- 
 perimental use has never given satisfactory results. 
 Phosphoric acid has been used in the same way, with 
 very similar effects. An impure solution of phos- 
 phoric acid, known as Horsford^s Acid Phosphate, has 
 been extensively used for its supposed hypnotic prop- 
 erties. 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 ser- 
 vice 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 — COLD. 73 
 
 NEEVOUS 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 Handhuch der 
 Allgemeinen Therapie. The English reader will find 
 the subject treated at sufficient length in Einger's 
 Handbook of Therapeutics. 
 
 According to Ringer, the sitz-bath, taken at a tem- 
 perature between 60° and 80° F., is very useful to 
 soothe " an irritable restless state of the nervous sys- 
 tem." 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 
 
74 INSOMNIA. 
 
 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 prac- 
 tice. 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 correspond- 
 ing 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 con- 
 siderable 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 de- 
 
COLD BATHS — ANESTHETICS. 75 
 
 layecl, 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. Scaicely 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 
 f oui' 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 consider- 
 able portion of the danger in fevers might be obviated. 
 Great discretion, however, is necessary in the applica- 
 tion 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 tempera- 
 ture of the patient should be carefully noted, and its 
 reduction below the normal standard should never 
 be permitted. 
 
 Ancesiheiics. — All anaesthetics are hypnotics. In 
 other words, they possess the power to abolish con- 
 sciousness, and thus to produce a condition resembling 
 sleep. This is effected by the direct action of the an- 
 aesthetic substance upon the cellular structure of the 
 
76 INSOMNIA. 
 
 brain, reducing the molecular movements of the living 
 protoplasm below the degree requisite for the ex- 
 citement of consciousness. This sedative effect is 
 preceded by a brief period of cerebral exaltation, occa- 
 sioned by the disturbances caused by the first intro- 
 duction of the drug into the current of the circulation. ' 
 It is with the subsequent hypnotic effect only that we 
 are now concerned. Of the numerous anaesthetic sub-, 
 stances that have been discovered, but few compara- 
 tively 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. Dis- 
 tilled liquors produce the effect of alcohol in its sim- 
 plest form; wines, containing various forms of ether, 
 arouse the nervous system more thoroughly and agree- 
 ably 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 ren- 
 der them peculiarly appropriate in cases that require 
 nourishment as well as rest. The considerable quan- 
 tity in which they must be taken, renders them incon- 
 venient 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, 
 
 ^ Artijicial Aticesthesia and Anasthetics, pp. 20-28. William Wood 
 & Co., New York, 1881. 
 
ALCOHOL. 77 
 
 such as may be experienced in advanced stages of the 
 infective fevers. In such cases the heart is weak- 
 ened, the pulse is rapid and feeble, the muscular appa- 
 ratus is wasted and irritable, the blood is diminished 
 in volume and tends to accumulate in the venous 
 channels. Under such conditions the patient is usu- 
 ally delirious, tossing from side to side, and quite de- 
 prived 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 famil- 
 iar 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 dimin- 
 ish or subside altogether. Sometimes, however, a con- 
 trary result is observed. Alcohol should then be 
 administered with a sparing hand, and it will proba- 
 bly be necessary to resort to the bromides or other 
 cerebral sedatives. 
 
 The great exhaustion which is manifested in delir- 
 ium 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 administra- 
 tion of capsicum with that of alcohol. According to 
 Einger, 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 tem- 
 porarily suspended. In like manner the " rheumatic " 
 pains which afflict the overworked and underfed poor 
 
78 INSOMNIA. 
 
 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 
 erastro-intestinal secretion. The use of wine contain- 
 ing 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 fol- 
 low 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 nec- 
 essary 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 intoxi- 
 
PARALDEHYDE. 79 
 
 eating dose of alcohol must be avoided, if its truly 
 hypnotic effect be desired. 
 
 Paraldehyde. — This is a derivative from ethyl alco- 
 hol. It is, when pure, a colorless liquid, with an 
 agreeable odor, somewhat like that of ether. It is sol- 
 uble 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^ recommends the 
 following formula: 
 
 Paraldehyde, - - - Gr. 20.0 
 
 Spirit, . - - _ 100.0 
 
 Syr. SimpL, - - _ - 75.0 
 
 Tr. Vanilla, . - _ 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 chlo- 
 ral 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 
 
 ^ Bull. gen. de Tk&ap., 1884, 2° Livr. 
 
80 INSOMNIA. 
 
 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 hyp- 
 notic in all cases, uncomplicated with disease of the 
 stomach, in which insomnia is not dependent upon 
 pain, and is associated with cerebral hypersemia. Its 
 administration is followed by no unpleasant conse- 
 quences. Among the insane it is particularly recom- 
 mended during periods of excitement and wakefulness. 
 It has been employed with great satisfaction' 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 purifi- 
 cation 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 prefera- 
 ble 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 disa- 
 greeable consequence. A certain degree of tolerance 
 is gradually established, so that larger doses may be- 
 come 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 vom- 
 iting, after waking from the sleep thus induced. An- 
 
 ^ Centralblatt fiir klin. med., 1884. Nr. 12. 
 
ETHER — CHLOROFORM. 81 
 
 other advantage possessed by paraldehyde consists in the 
 absence of the period of excitement produced by chlo- 
 ral before the advent of sleep. It is an hypnotic, with- 
 out 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 ansesthesia, is 
 rarely used as a mere hypnotic. Diluted with alcohol 
 and ethereal oil, it forms the Compomid Spirit of 
 Ether, or Hoffmcmn's Anodyne. In this form it is 
 well adapted for internal administration. It is thus 
 very serviceable in the treatment of those forms of in- 
 somnia 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 treat- 
 ment of uterine colic and in sleeplessness after child- 
 birth, 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, 
 6 
 
82 INSOMNIA. 
 
 a remedy which is useful in all cases for which the com- 
 pound 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. Kinger 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 paralde- 
 hyde, chloral hydrate has for many years held the first 
 rank as an hypnotic. It is particularly useful in wake- 
 fulness occasioned by exhaustion of the nervous cen- 
 tres. The conclusions of all experienced observers 
 have been most concisely stated as follows: ' "Chloral 
 appears to be indicated when sleeplessness is depend- 
 ent 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 iremens is very amenable to this medicine, 
 especially in the forming stage of the affection known 
 
 ' The National Dispensatory, 1884, p. 433. 
 
CHLORAL — BUTYLCHLORAL. «3 
 
 as *the horrors,' and which so frequently follows sur- 
 gical injuries in drunkards ; it is useful eIqo 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 vaso- 
 motor 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 ^ that similar 
 effects may follow the long continued use of this sub- 
 stitute. 
 
 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. 
 
 ButylcMoral 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 
 
 "^Deutsche Med. wochenschr. ,\'^%2)i ^r. 49. 
 
84 INSOMNIA. 
 
 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 sleep- 
 lessness 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 in- 
 creased, 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 anaes- 
 thetics above mentioned, it causes a hypersemic condi- 
 tion of the brain, and is, for this reason, a useful 
 hypnotic in cases of aortic obstruction with an insuf- 
 ficient cerebral circulation and consequent wakeful- 
 ness. 
 
 Opium and opiates. — There seems to be no agree- 
 ment 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 
 
OPIUM AND OPIATES. 85 
 
 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 exces- 
 sive doses of the drug. From this it may be inferred 
 that opium acts, like many other narcotics, as an irri- 
 tant of the tissues when given in minute quantity, and 
 as a paralyzing agent when a certain relative amount 
 is exceeded. The experiments of Curci ^ indicate that 
 under the influence of irritating doses of morphia the 
 brain becomes hypersemic. 
 
 Opium is a remarkably complex substance, no less 
 than nineteen different alkaloids having been separated 
 from it. Of these, however, only one has stood the 
 test of therapeutical experiment — morphia. Several 
 other constituent alkaloids, notably codeia, have been 
 lauded as hypnotics, but they are, at their best, far 
 inferior to morphia, and may well be omitted from the 
 list of sleep producers. But, though the soporific 
 properties of opium are chiefly due to the morphia 
 which it contains, there are certain points of difference 
 between the action of the two medicines that often 
 render a choice desirable. According to Stille and 
 Maisch,^ 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 
 
 ^ Lo Sperimentale , April, 1884. 
 
 ^ The National Dispensatory , 1884, p. 993. 
 
86 INSOMNIA. 
 
 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 supe- 
 riority 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 gen- 
 erally useful hypnotic compounds ever employed. 
 
 Under ordinary circumstances morphia is the 
 preferable opiate for the relief of insomnia. The sul- 
 phate 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 
 
OPIUM AND OPIATES. 8< 
 
 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 hun- 
 dredth 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 
 
88 INSOMNIA. 
 
 of the risk of creating the opium habit, but also by- 
 reason of the injurious effects of the drug upon diges- 
 tion 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 ex- 
 tract 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 constitu- 
 ents of the body, directly inhibiting their functional 
 energy. Upon the spinal cord they act to diminish 
 reflex excitability. Under their influence the recep- 
 tivity and functional capacity of the brain is reduced. 
 The minute blood vessels contract in consequence of 
 the inactivity of the tissues Avhich they supply. A 
 lethargic sleep is thus induced. 
 
BROMIDES. 89 
 
 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 insta- 
 bility 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 ad- 
 ministration 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 
 
90 INSOMNIA. 
 
 sleep the bromides only increase wakefulness. In such 
 cases opiates and alcoholic stimulants are usually in- 
 dicated. 
 
 Hops. — The principal sedative constituent of this 
 plant is the yellow glandular powder found in the 
 strobiles ; this is called lupitUn. Hops do not ^hibit 
 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 irrita- 
 bility 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 sweet- 
 ened water whenever needed. The best method, how- 
 ever, 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, 
 
CONIUM. 91 
 
 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 
 ch'achm, or one-sixtieth of a grain of coniine, may be 
 given sufficiently often to repress excitement. The 
 alkaloid may be given hypodermically, and in gradu- 
 ally increasing doses. With it should be associated 
 other remedies, like hyoscyamus and chloral hydrate, 
 in order to procure sleep. ^ 
 
 * Kiernan, Joiirn, Nerv. and Mental Diseases, Vol. X, p. 234 
 
CHAPTEK IV. 
 
 TBEATMENT 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 Jttliet. 
 
 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 dis- 
 order of the brain and its membranes. This includes 
 the difPerent forms of meningitis, the cerebral disturb- 
 ances 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, tubercu- 
 lar infiltration, insolation, the development of tumors, 
 or syphilitic growths. In all such cases the earlier 
 stages are marked by a painful exaggeration of cere- 
 bral 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 fea- 
 
 (92) 
 
ACUTE AFFECTIONS OF THE BRAIN. 93 
 
 ture which arrests attention. This is accompanied by 
 an inordinate determination of blood to the head, pro- 
 ducing that cerebral hypersemia 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 hyper- 
 aemia, 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 depress- 
 ants. For the first, tincture of aconite forms an ad- 
 mirable 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: 
 
 ^. Morph. Sulph. - - - g^- i 
 
 Chloral Hydrat, - _ - 
 
 Sodii Bromid. aa - - 3iv. 
 
 Tr. Aconit., rad. - - gtt. xxv. 
 
 Tr. Cardam. Co. - - 3i. 
 
 Aquae, q. s. ad. - - - ?i. 
 
 Sig. — A teaspoonf ul every two hours, till relieved. 
 As the disease progresses, the quantity of morphia 
 should be reduced. In epidemic cerebro-spinal menin- 
 
94 INSOMNIA. 
 
 gitis, 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 complica- 
 tion at any stage of the disease. To consider aright 
 the relations that exist between sleeplessness and in- 
 sanity 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 hypersemia 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 com- 
 paratively recent, and the bodily vigor has not been 
 depressed by long continued disease. The indications 
 for treatment call for sedative measures. Leeches be- 
 hind 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 excite- 
 ment, and to induce sleep. The combined effect of 
 cold applications to the scalp and a warm bath to the 
 
INSANITY. 95 
 
 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 secre- 
 tions 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 agita- 
 tion, 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 potas- 
 sium 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 Avhich is at least refreshing, 
 if not curative of the disease. They should not, how- 
 ever, 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 ser- 
 
96 INSOMNIA. 
 
 viceable. 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 hypersemia be present in these cases, it is 
 usually associated with asthenic conditions of the 
 brain, indicated by paleness of the face and weakness 
 of the pulse. The hyperaemic state is then easily over- 
 come 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 em- 
 ployed 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 potas- 
 sium is a useful hypnotic in cases of moderate depres- 
 sion 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 can- 
 nabis indica are rather more than equivalent to a 
 drachm of laudanum as a means of allaying maniacal 
 
CHRONIC ALCOHOLISM.— DELIRIUM TREMENS. 97 
 
 excitement." ' In his recent work,^ 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 (xxgrs.). 
 He also emphasizes the importance of abundant exer- 
 cise in the open air, as the best hypnotic in every case 
 that can be trusted abroad. 
 
 Insomyiia in Chronic Alcoholism and Delirium Tre- 
 mens. — The insomnia of chronic alcoholism is depend- 
 ent 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 con- 
 dition 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 fre- 
 quently employed, but should be avoided if possible, 
 for fear of the opium habit. Chloral hydrate is ex- 
 ceedingly 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 rea- 
 son the use of paraldehyde in such cases is quite 
 inadmissable. 
 
 When chronic alcoholism has culminated in delirium 
 
 "^ Psychological Medicine, Bucknill and Tuke, 4th ed,, p. 731. 
 ^ Clinical Lectures on Mental Diseases. 
 1 
 
98 INSOMNIA. 
 
 tremens, more energetic measures become necessary in 
 order to procure sleep. If the patient be of a vigor- 
 ous 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, some- 
 times 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,^ 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 sopo- 
 rific. In desperate cases it is sometimes necessary to 
 resort to inhalation of ether, but if sudden death should 
 occur, it would be popularly ascribed to the effects of 
 the anaesthetic. By reason of a certain tendency to 
 death from syncope during this disease, it is impru- 
 dent to place such patients under the influence of 
 chloroform or the other stronger anaesthetics. 
 
 Insomnia in diseases of the heart and blood vessels. — 
 I can fully indorse the opinion of Ringer regarding 
 the beneficial effects of morphia in the treatment of 
 the wakefulness caused by advanced diseases of the cir- 
 culatory 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 
 
 ^Ringer's Therapeutics. loth ed., p. 421. 
 
ANGINA PECTORIS. 9-^ 
 
 in severe cases must be gradually increased to a quar- 
 ter 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 dis- 
 tended 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 ob- 
 struction, 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 
 
100 INSOMNIA. 
 
 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 expector- 
 ants 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, irrita- 
 tive 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 unde- 
 sirable. 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. 
 
ASTHMA.— RENAL DISEASE. 101 
 
 One of the most distressing forms of insomnia is 
 occasioned by the different varieties of asthma. Dysp- 
 noea 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, Avill 
 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 recom- 
 mended. 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 ad- 
 dressed 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 reJial 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 
 
102 INSOMNIA. 
 
 connection with sucli arterial sedatives and diaphore- 
 tics as each individual case may require. But the 
 tendency of inflammatory diseases of the kidney to 
 merge in uraemia must not be forgotten, and the 
 soporific must be used in such cases with great cau- 
 tion. 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 ej9&cient 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 efiicient hypnotic. 
 Alcoholic soporifics are not well tolerated when the 
 
GASTRO- INTESTINAL DISEASES. 103 
 
 gastro-intestinal mucous membrane is diseased. Biliary 
 colic demands treatment similar to that that is re- 
 quired in nephritic attacks. Warm baths, fomenta- 
 tions, 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 as- 
 sociated with torpidity of the liver. ^ 
 
 Insomnia in gastro-intestinal diseases. — In acute in- 
 flammatory 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 dis- 
 orders should be managed largely with hygienic treat- 
 ment. The diet should be so regulated as to prevent 
 the liberation of gas in the intestines, for their disten- 
 tion 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 con- 
 ditions 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 
 
 ' C. H. Jones, Functional Nervous Disorders, p. 284. 
 
104 INSOMNIA. 
 
 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 administra- 
 tion 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 inci- 
 dent. 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 satisfac- 
 tory remedy — especially in the febrile attacks to which 
 children are liable. If any evidence of cerebral hyper- 
 semia 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 
 
FEVERS.— RHEUMATISM AND GOUT. 105 
 
 grateful, and often assist in the evolution of a sup- 
 pressed eruption in the exanthematous fevers. 
 
 In the later stages of fever a condition of cerebral 
 exhaustion is sometimes encountered. Irritable weak- 
 ness 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 dura- 
 tion. An elevated temperature requires 'frequent 
 sponging of the body. 
 
 Opium, alcohol, and liquid food, are the best hyp- 
 notics in such cases. The acetum opii and the deodor- 
 ized 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. 
 li. there be evidence of blood stasis, with blueness of 
 the nails, hypostatic pneumonia, etc., musk and strych- 
 nia should be given in place of opium, and the circu- 
 lation should be assisted with carbonate of ammonia, 
 as follows: 
 
 3. 
 
 Ammon. carb., 
 
 - gr. V. 
 
 Spt. chloroform, 
 
 gtt. XX. 
 
 Aq. camphor, 
 
 3 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 rheumcdism and gout. — Opium in a 
 diaphoretic preparation, and associated with alkalies or 
 vdth colchicum, has always been the most approved 
 
106 INSOMNIA. 
 
 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 lUhcemia,^ 
 are not uncommon. They are associated with wakeful- 
 ness 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 hyp- 
 notic drug. 
 
 Insomnia in syphilis. — In advanced stages of syph- 
 ilitic 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 pa- 
 
 ^ Am. /our. Med. Sci., Oct., iSSi, p. 313. 
 
SYPHILIS.— DISORDERS OF NUTRITION. 107 
 
 tients 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 dis- 
 order and impoverishment that is common among the 
 victims of rheumatism, lithaemia, syphilis, malarial 
 poisoning, cancerous dyscrasia, chronic toxaemia of 
 every form, and ordinary anaemia. Imperfect blood 
 supply deteriorates the nutrition of the brain, and ren- 
 ders 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 imme- 
 
108 INSOMNIA. 
 
 diate suffering of the patient will often tax to the utter- 
 most the ingenuity of the physician. Usually, there is . 
 a chronic atonic dyspepsia, or a chronic catarrhal gas- 
 tro-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 develop- 
 ment of incipient scurvy. The kidneys may be ex- 
 cited with small doses of iodide of potassium or chlo- 
 rate 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 disa- 
 greeable 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 
 
PREGNANCY AND PARTURITION. 109 
 
 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 stu- 
 pefaction with large quantities of an exciting nar- 
 cotic. 
 
 Insomnia during pregnancy^ and after parturition. — 
 Closely akin to the insomnia of ansemia is the wakeful- 
 ness 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 suffi- 
 cient to interfere with quiet rest. Loss of blood 
 during parturition, by the induction of temporary anae- 
 mia, may greatly aggravate this condition. 
 
 The suppression of nervous irritability is the prin- 
 cipal indication for treatment. This may be tempora- 
 rily accomplished by the use of the bromides. But these 
 must be reinforced by an ample dietary, with stimu- 
 lant nervines and anti-spasmodics. Good wine, cam- 
 phor, 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 pa- 
 tients who are enfeebled by unfavorable condi- 
 
110 INSOMNIA. 
 
 tions of health, either congenital or acquired. To- 
 gether 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 invet- 
 eracy that renders sleep impossible. Alcohol and 
 chloral hydrate must then be given in large and fre- 
 quent doses. A laryngeal catarrh may excite spas- 
 modic croup — a disorder speedily relieved with chloral 
 hydrate. Old people of a nervous temperament some- 
 times 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 anti- 
 lithic treatment, afford great relief. Iodide of potas- 
 sium, in the majority of asthmatic affections; the bro- 
 mides and gelsemium in cases marked by excitability 
 of the spinal cord; valerian, musk, assafoetida, cam- 
 phor, 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 hypersemic 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,^ 
 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 
 
 ' Handbuch der JCinderkrankheiten, Vol. I., p. 214. 
 
INSOMNIA IX CHILDHOOD. Ill 
 
 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, be- 
 sides 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^ 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 dis- 
 charge of pus enlightens the diagnosis. Persistent 
 wakefulness without evident cause should arouse a sus- 
 picion of incipient tubercular meningitis. Slight 
 elevations of temperature at night sometimes occasion 
 
 ^0/. cit., Vol. I., Pt. 2, p. 153. 
 
112 INSOMNIA. 
 
 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 deli- 
 cate children of a nervous temperament, whose inclina- 
 tions 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 train- 
 ing 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. Fretful- 
 ness 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 in- 
 ternal 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 fre- 
 quently 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 hyoscya- 
 mus 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 
 
OLD AGE. 113 
 
 place occupied by cannabis indica in the medication of 
 adults. 
 
 Insomnia in old age. — The highest physical perfec- 
 tion is reached before the fortieth year of life. Be- 
 tween 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 mod- 
 eration of nervous excitability thus effected permits 
 indulgences of the appetite for food that were im- 
 possible 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 circum- 
 stances this period of life may continue for about 
 twenty years, when old age developes. From the six- 
 tieth to the eightieth year the progress of decline is 
 rapidly accelerated, and life is normally terminated 
 between the eightieth and eighty-fifth years of exist- 
 ence. The rare examples of greater longevity are too 
 few in number to warrant the assumption that a cen- 
 tury 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, 
 8 
 
114 INSOMNIA. 
 
 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 sub- 
 stance of the organ becomes morbidly irritable. In- 
 somnia among the aged often owes its cause to these 
 unwholesome conditions. The biography of the cele- 
 brated Carlyle affords numerous illustrations of this 
 variety of wakefulness. Disease of the cerebral blood 
 vessels sometimes originates a series of changes differ- 
 ing only in degree and intensity from the classical 
 type of chronic periencephalitis. This is character- 
 ized 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 accom- 
 plish 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 
 
OLD AGE. 115 
 
 operations become less vigorous, and the patient passes 
 lengthening periods of time in sleep. This is a genu- 
 ine relapse into the apathy of infancy. The apparatus 
 of thought is worn out, and the old man sinks gradu- 
 ally 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 sub- 
 jects it must be overcome with food and nervous stimu- 
 lants. Since many patients present a combination of 
 these apparently opposite conditions, there is room for 
 a great display of penetration and tact in the manage- 
 ment of complex cases. While seeking for the imme- 
 diate relief of present suffering, the ulterior conse- 
 quences 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. 
 
CHAPTEK 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 per- 
 fectly balanced outcome of the complex polygon of 
 forces which has its seat vrithin the brain. In the 
 waking condition this "moving equilibrium," as it has 
 been happily termed/ 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 con- 
 sequence of the harmonious function of the organs of 
 sense, each one supplementing and correcting the 
 information furnished by the others, a continuous pro- 
 cess of perception and logical thought is maintained. 
 But, along with the procession of ideas which are 
 clearly conceived by the mind, the field of conscious- 
 ness is also invaded by a cloud of half formed percep- 
 tions, which are too imperfect and fleeting to occupy 
 the attention. As in the act of vision, though the 
 
 ' Herbert Spencer, First Principles, p. 486. 
 
 (116) 
 
DREAMS. 117 
 
 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 fur- 
 nishing clear images to the brain, so the eye of the 
 mind comprehends only a few of the impressions 
 which enter the sphere of consciousness. The swarm 
 of unnoticed perceptions, however, is none the less the 
 result of abiding sensory impressions graven in the 
 substance of the brain, from which, through the action 
 of memory, they may at any favorable moment reenter 
 consciousness. Sleep does not wholly arrest this pro- 
 cess. 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 exter- 
 nal 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 redistribu- 
 tion of force, and a proportionate narrowing of the 
 stream of related ideas. Since this process of sup- 
 pression, just mentioned, is not an absolute quantity, 
 but a variable factor, the polygon of physical forces 
 within the brain and the corresponding succession of 
 
118 INSOMNIA. 
 
 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 with- 
 drawn, 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 conscious- 
 ness 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 
 
DREAMS. 119 
 
 to perform some act — he may wish to move his limbs 
 or to cry oiit 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 fee- 
 bleness of impression Avhich 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 judg- 
 ment, 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 wakeful- 
 ness 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 sor- 
 row in connection with the incidents of his vision. 
 
120 INSOMNIA.. 
 
 A dream may, therefore, be defined as the occupa- 
 tion 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 produc- 
 tion 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 cause- 
 less 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 be- 
 came 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, ad- 
 
DREAMS. 121 
 
 miring 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 cere- 
 bral function consisted in an exaltation of certain forms 
 of sensibility while others were depressed. The suc- 
 cession of visual images was initiated by the visible 
 objects around me, but it was enriched by the associa- 
 tion of ideas furnished through the stimulation of 
 memory. The sunset glow, the snow-capped moun- 
 tains, 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 re- 
 minding 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 com- 
 monplace 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 
 
122 INSOMNIA. 
 
 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 asso- 
 ciation 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 esti- 
 mating 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 impres- 
 sions that occupied the mind. 
 
 A somewhat similar process is sometimes experi- 
 enced as a consequence of cerebral disorder uncon- 
 nected 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 un- 
 comfortable 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 occa- 
 sioned by the action of the hasheesh. In both cases 
 there was the same diminution of the intensity of ex- 
 
DREAMS. 123 
 
 ternal 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 asso- 
 ciation 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 con- 
 sciousness could only be perceived as a series of illu- 
 sions. Here, again, was a waking dream, of origin 
 and course analogous to the illusions and hallucina- 
 tions 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, talk- 
 ing 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 ap- 
 paratus 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, 
 
124 INSOMNIA. 
 
 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 atten- 
 tion, 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 arous- 
 ing attention. Such inhibitory impulses are continu- 
 ally 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 volun- 
 tary 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 di'eam 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 ap- 
 paratus of the brain. The superior power of visual 
 
DREAMS. 125 
 
 impressions to attract attention may also serve to ex- 
 plain 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, consti- 
 tute 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 orches- 
 tral 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.^ One of my early school- 
 mates, a boy of remarkably susceptible nervous tem- 
 perament, furnished an excellent example of this spe- 
 cies 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 
 
 'A. Maury. Le Sotmneil et les Rives, p. 154, 
 
126 INSOMNIA. 
 
 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 con- 
 cluded 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. Look- 
 ing 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 par- 
 ticular 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 ' relates that " M. 
 Baillarger dreamed one night that a certain person had 
 been appointed editor of a newspaper; in the morning 
 
 ' On Intelligence , p. 6i. 
 
DREAMS. 127 
 
 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,^ still further illustrates this form of halluci- 
 nation : 
 
 "On a wintry morning," writes the professor, "be- 
 tween five and six o'clock, I was aroused, as I thought, 
 by the head nurse, who reported to me that some peo- 
 ple 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 de- 
 part, 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 in- 
 tended 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 in- 
 quire 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 sui*- 
 prise 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 
 
 'Wharton and Stille's Medical Jurisprudence, Third Edition, Vol. 
 I, p. 482. 
 
128 INSOMNIA.. 
 
 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 mid- 
 dle of the corridor which led to the room of the stew- 
 ard, 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' 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 con- 
 tinuity 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 com- 
 panions, 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 
 
 ^ Amoji^i^ the Indians of Guiana. By Everard F. Im Thurn. Lon- 
 don: 1883, p. 344. 
 
DREAMS. 129 
 
 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 oc- 
 cupy 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 per- 
 ception, 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 compre- 
 hended the fact that it was merely a dream, and re- 
 marked the difference between the intensity of the 
 visual image in this and in other dreams. Such speedy 
 recognition of the hallucination does not always accom- 
 pany the act of waking out of a dream. In some 
 cases, as we shall have occasion to see, the images 
 9 
 
130 INSOMNIA. 
 
 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 disturb- 
 ance, 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 di'eamed 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 mattrass upon which 
 I slept. I seemed to feel the changes of pressure and 
 of contact as distinctly as if awake. The connection 
 
DREAMS. 131 
 
 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 somnambu- 
 lism. Another acquaintance dreamed of being in 
 heaven, and, while there, experienced relief from doubt 
 regarding certain theological doctrines which had pre- 
 viously 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 
 
132 INSOMNIA. 
 
 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 in- 
 coherent elements. But if wakefulness is limited to a 
 particular organ of the body or to a circumscribed ter- 
 ritory of the brain, the resulting impressions in con- 
 sciousness 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 dur- 
 ing 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 prob- 
 ably due to the fact that in childhood I actually wit- 
 nessed 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 re- 
 ceives 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 
 
DREAMS. 133 
 
 cerebral organ, even when they seem to exhibit a 
 fluently connected course. Thus, I di*eamed, one 
 night, that I was walking in a garden filled with pecu- 
 liar 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 let- 
 ter 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 : N- 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 per- 
 son. Indeed, such dreams suggest the doctrine that 
 the condition of a dreamer's brain is functionally iden- 
 tical 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 retrospec- 
 tion enabled me to trace each individual item to its 
 source in memory, and I was able to construct the fol- 
 lowing key to the vision: During the previous even- 
 ing 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 
 
134: INSOMNIA. 
 
 tower at Sarnath, a structure remarkable for the nu- 
 merous 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 busi- 
 ness at last, he would doubtless do well in the future. 
 Hence the kite. I had recently received an interest- 
 ing 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 subscrib- 
 ing for a number of periodical magazines. Hence the 
 Atlantic Monthly; and, as the celebrated Oliver Wen- 
 dell 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 mor- 
 bid element underlying all unusually vivid dreams. It 
 is not merely because of differences in the depth of 
 sleep. The flitting fancies which occupy the intro- 
 duction 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 
 
DREAMS. 135 
 
 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 singu- 
 lar 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 pur- 
 pose. She exclaimed, " Oh, papa! I have never diso- 
 beyed 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 cer- 
 tain that in some instances the succession of images 
 
136 INSOMNIA. 
 
 excited during sleep must be exceedingly rapid. Aber- 
 crombie, in his work on the " Intellecinal Powers and 
 the Investigation of Truth^''^ p. 275, has related several 
 illustrative examples of this fact. In my own experi- 
 ence, one night, as I lay half asleep, I heard the watch- 
 man 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 child- 
 hood. The family were at breakfast in the front par- 
 lor, while I walked through the back rooms, examin- 
 ing 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 exceed- 
 ing twelve feet. This slow growth excited considera- 
 ble surprise on my part. Eeturning to the house, I 
 passed the day with my parents, and, at night, under- 
 took to shut up the house, but could not fasten any of 
 the doors or windows. This caused me great uneasi- 
 ness, for there was a large gypsy camp not far from 
 the east end of the building. My anxiety was pres- 
 ently 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 
 
DREAMS. 137 
 
 by my wife, shaking me, and asking what was the mat- 
 ter, just in time to hear the watchman walking down 
 the front steps, after the completion of the investiga- 
 tion 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 medi- 
 cine, 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 ambas- 
 sador, 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 brill- 
 iance had astonished everyone. I now desired to de- 
 posit 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 
 
138 INSOMNIA. 
 
 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 be- 
 ing 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 discon- 
 cert 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. Hav- 
 ing 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 mag- 
 nificent hall by a beautiful woman who offered to con- 
 duct us through the building. She led us through a 
 series of lofty rooms, splendidly painted, gilded, fres- 
 coed, and furnished with inlaid tables and polished 
 
DREAMS. 139 
 
 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 consist- 
 ing 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 be- 
 fore me was a shining river, pouring down the moun- 
 tain 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 sur- 
 prised 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 
 
140 INSOMNIA. 
 
 being was released from the control of tlie reason and 
 the will. Irritated hj 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 inde- 
 scribable richness and variety of the vision was prob- 
 ably due to the fact of extensive bodily disturbance, 
 opening a wide range of territory from which impres- 
 sions 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. ' But dreams which 
 occupy the mind when sleep is light and partial are 
 excited by cerebral movements which are closely asso- 
 ciated 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 con- 
 nect the thoughts that occupy any portion of our con- 
 scious 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 un- 
 healthy condition of the body, was not at all disagree- 
 able. But it is often the case that disorders of 
 
 'A. Maury, Le Sonimeil et les Reves., p. 219 et seq. 
 
DREAMS. 141, 
 
 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 ^ 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 in- 
 sanity 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 
 
 * Obscure Diseases of the Brain and Mind. Philadelphia, 1866, pp. 
 394-398. 
 
142 INSOMNIA. 
 
 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 can- 
 not 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 mid- 
 dle ages is filled with similar narratives. Coming 
 down to recent times, it is not difficult to gather nu- 
 merous 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 passen- 
 gers. Max Simon' 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* a noble lady 
 dreamed that a wing of the palace in which her chil- 
 dren were sleeping was about to fall down. Starting 
 
 ' Le Monde des Reves, p. 88. 
 * Op. cif., p. 91. 
 
PROPHETIC DREAMS. 143 
 
 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 obedi- 
 ence, 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 .he 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 real- 
 ized, 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 dis- 
 crepancies between vision and result are not recorded, 
 and are soon forgotten. This opinion may very prob- 
 ably 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 
 
144 INSOMNIA. 
 
 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 obser- 
 vations 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 inten- 
 sity 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 dis- 
 turbed to a degree sufficient for the awakening of con- 
 sciousness by causes that would ordinarily be power- 
 less to reveal themselves. Kecording 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 dis- 
 comfort 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 agi- 
 tation 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 door- 
 
DREAMS. 145 
 
 bell would ring. So often was this experience repeated, 
 that I learned to expect a summons whenever awak- 
 ened during the night. Gradually, however, as my 
 health improved with rest, this morbid excitability dis- 
 appeared, and has never been renewed. It seems prob- 
 able that in this example the sensitiveness of the brain 
 during sleep was so great that audible impressions 
 were received with vigor sufficient to awake conscious- 
 ness before they were sufficiently strong to arrest the 
 attention when actually awake. The extreme sensibil- 
 ity of the brain, under certain conditions, to impress- 
 ions from a distance, is further illustrated by the expe- 
 rience of persons laboring under diseases which 
 produce serious departures from a healthy cerebral 
 circulation. Thus, one of my patients, while suJGPering 
 with cerebral hypersemia, could hear children talking 
 half a mile away, at a distance where no one else could 
 hear them. This susceptibility is doubtless the founda- 
 tion 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 convic- 
 tion 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 hap- 
 pened, 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 
 10 
 
146 INSOMNIA. 
 
 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, up- 
 setting 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 halluci- 
 nations of which the immediate cerebral mechanism is 
 the same as that of the ordinary hypnagogic halluci- 
 nation. Thus, the Rev. Canon Warburton relates the 
 following experience ' : 
 
 "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 
 
 ' The Nineteenth Coitury, July, 18S4. p. 71. 
 
CLAIRVOYANT DREAMS. 147 
 
 intended to be home soon after one o'clock. Instead 
 of going to bed, I dozed in an arm-chair, but started 
 np 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. Com- 
 ing 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.' 
 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 
 
 ^Nature, October, i6, 1884, p. 596. 
 
148 INSOMNIA. 
 
 transmitted from one to the other by a diffusion of im- 
 pulses 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 reason- 
 able to believe in the possible existence of a brain so 
 delicately organized as to be capable of reacting to im- 
 pressions 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 ex- 
 alted 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 
 
CLAIRVOYANT DREAMS. 149 
 
 she was startled by the receipt of a message request- 
 ing her to come at once to the house of her nncle, 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 in- 
 vestigated by the Society for Psychical Research. 
 Something similar is frequently observed in connec- 
 tion with the phenomena of hypnotism. The hypno- 
 tised 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 ab- 
 
150 INSOMNIA. 
 
 sent son was sick, and would arrive the next day, at an 
 hour unusual for travelers coming from the South. So 
 vivid was this di'eam, 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,' 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 per- 
 ceive 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," 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 
 
 ' Lebensmagnetismus oder Hypnotisinus, von Dr. E. L. Fischer, pp. 
 
 71-73- 
 
 '^ 71ie Nineteenth Century, July, 1884, p. 89. 
 
HALLUCIXATIONS. 151 
 
 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 
 sajs: 
 
 " They generally availed themselves of the oppor- 
 tunity, 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 ap- 
 pearance 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 hoiu^ 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 vtdfe 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 fre- 
 quently — 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, 
 
152 INSOMNIA. 
 
 * Come in.' The door opened, and, to my surprise, in 
 walked Mr. . I sat up and said, ' You have mis- 
 taken the door ; but the butler has the judgment, so go 
 and get it.' Instead of leaving the room he came to 
 
 the foot edge of the bed. I said, ' Mr. , you forget 
 
 yourself! Have the goodness to walk out directly. 
 This is rather an abuse of my favor.' He looked 
 deadly pale, but was dressed in his usual dress, and 
 was certainly quite sober, and said, ' I know that I am 
 guilty of an unwarrantable intrusion, but finding that 
 you were not in your study I have ventured to come 
 here.' I was losing my temper, but something in the 
 man's manner disinclined me to jump out of bed to 
 eject him by force. So I said, simply, ' This is too 
 bad, really; pray, leave the room at once.' Instead of 
 doing so he put one hand on the foot-rail, and gently, 
 and as if in pain, sat down on the foot of the bed. I 
 glanced at the clock, and saw that it was about twenty 
 minutes past one. I said, ' The butler has had the 
 judgment since half -past eleven ; go and get it.' He said, 
 ' Pray forgive me ; if you knew all the circumstances, 
 you would. Time presses. Pray give me a precis of your 
 judgment, and I will take a note in my book of it,' 
 drawing his reporter's book out of his breast pocket. 
 I said, ' I will do nothing of the kind. Go down stairs, 
 find the butler, and don't disturb me — ^you will wake 
 my wife — otherwise I shall have to put you out ?' He 
 slightly moved his hand. I said, ' Who let you in ? ' 
 He answered, ' No one.' ' Confound it,' I said, ' What 
 the devil do you mean? Are you drunk?' He replied, 
 ' No, and never shall be again ; but I pray your lord- 
 ship give me your decision, for my time is short.' I 
 
EXPERIENCE OF SIR E HORNBY. 153 
 
 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 lasi 
 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 con- 
 sideration 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 
 
154 . INSOMNIA. 
 
 liim. 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 head- 
 ing- 
 
 " ' 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 coro- 
 ner, and desired him to examine Mr. 's wife and ser- 
 vants 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 dis- 
 ease, 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. 
 
EXPERIEXCE OF SIR E. HORNBY. 155 
 
 "I may add that I had examined the butler in the 
 morning — who had given me back the MS. in the en- 
 velope 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 every- 
 thing 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 pre- 
 vented him from walking any distance except slowly; 
 in fact, he almost invariably drove. 
 
 "Edmund Hoenby." 
 
 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 con- 
 nection with several of the minor details of the narra- 
 tive, 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 
 
156 INSOMNIA. 
 
 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 minntes 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 dam- 
 aged, probably by tobacco — for he was a "light sleeper" 
 — waking often, and indulging in the luxury of a cigar- 
 ette 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 in- 
 cident is found in the hypothesis of a dream excited in 
 an irritable brain that had been aroused by the prepa- 
 ration 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 hal- 
 lucination through disease of the brain is related by 
 the late Dr. E. H. Clarke.' One of his patients, a 
 
 ' Visions: A Stiidy of False Sight , p. 39. 
 
HALLUCINATIONS. 157 
 
 vigorous old gentleman, of eighty years, a great lover 
 of music, and a frequent attendant at operas and con- 
 certs, 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 per- 
 sons, 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 musi- 
 cal 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 ex- 
 claimed, '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 
 
158 INSOMNIA. 
 
 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 testi- 
 mony of two witnesses, Mr. A. yielded to the decision 
 of his reason, and again resolved to go on with the in- 
 vestigation 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 ar- 
 ranged 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 per- 
 formers. One was a large man, who bore some resem- 
 blance 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 Beetho- 
 ven 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 direc- 
 tions, 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 
 
REVELATION. 159 
 
 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 approach- 
 ing departure." 
 
 In this case the patient was suffering from " a mod- 
 erate degree of deafness, persistent tinnitus aurium, 
 occasional vertigo, and slight loss of memory." To- 
 wards the close of life, two or three years later, "inco- 
 herence, delirium, stupor, and the like, indicated with 
 sufficient certainty the presence of severe cerebral dis- 
 ease." The remarkable hallucination which he experi- 
 enced was undoubtedly the product of the morbid 
 changes which were progressing in his brain. 
 
 These cases form an ascending series which illus- 
 trates the receptive and constructive capacities of the 
 human brain when its sensory apparatus has become 
 unusually or morbidly excitable. But this preter- 
 natural mobility may display itself in other depart- 
 ments besides those of mere sense-perception. The 
 sphere of pure intellect may thus be invaded by ideas 
 springing from impressions which address the reason- 
 ing 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. 
 
160 INSOMNIA. 
 
 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 interven- 
 tion 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 illumina- 
 tion 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 hus- 
 band 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 
 
REVELATION. 161 
 
 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 revela- 
 tion, a dream like this is quite as worthy of similar 
 estimation. They both occurred as the result of analo- 
 gous 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 be- 
 tween 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 compar- 
 atively limited circle of ideas which are thus produced, 
 greatly increases the intensity of the resulting impres- 
 sions 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 dark- 
 ness 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 
 11 
 
1B2 INSOMNIA. 
 
 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. ' 
 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 discov- 
 ered 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 follow- 
 ing 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 
 
 ^Inquiries concerning the Intellectual Po7uers, tenth edition, p. 283. 
 
REMINISCENCE. 163 
 
 was unable to recover any evidence in support of Ms 
 belief. ' You are right, my son,' replied the paternal 
 shade ; ' I did acquire right to these teinds, for pay- 
 ment 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 gen- 
 tleman 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. E. carried to Edinburo^h the documents 
 necessary to gain the cause which he was on the verge 
 of losing." 
 
164 INSOMTSri^. 
 
 Here it would be a valuable addition to knowl- 
 edge if the parties in the history just related could be 
 subjected to intelligent interrogation. Enough, how- 
 ever, may be discovered in the narrative to render it 
 certain that the dream was merely a revival in con- 
 sciousness 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 con- 
 nected with the Portugal piece of gold. In the law- 
 yer's case the cerebral register only needed the stimu- 
 lus 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 func- 
 tion 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 
 
REMINISCENCE. 165 
 
 Sir John Falstaff. Dr. Kush' 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. ^ Sleep and dissolution 
 operate alike to release the lower levels of the mne- 
 monic 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. 
 
 ^ Medical Inquiries and Observations upon Diseases of the Mind, 
 p. 277. 
 
 ' Loc. cit. 
 
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 amus- 
 ing 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 nerv- 
 ous 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 rela- 
 tionship 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 conse- 
 quence of transitory functional disturbances of the 
 brain connected with the period of convalescence from 
 
 (166) 
 
SOMNAMBULISM. ' 1B7 
 
 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 predis- 
 posing cause of the phenomena, for the majority of 
 people can sustain injuries of the head, or of the peri- 
 pheral nervous system, and can pass through all kinds 
 of illness without exhibiting any tendency to somnam- 
 bulism. 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 peculiari- 
 ties of sex are not sufficient to produce any great pre- 
 ponderance 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 hered- 
 itary attribute which may be handed down from gen- 
 eration to generation. Occurring in the experience of 
 young children, it frequently ceases when they arrive 
 at years of maturity. Not always, however, thus ceas- 
 ing 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 deep- 
 est sleep. As a consequence of this fact, conscious- 
 ness is seldoni affected by the molecular play of the 
 brain during the somnambulic excursion. The sleep- 
 
168 • INSOMNIA. 
 
 walker 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 phe- 
 nomena of somnambulism necessitate the participation 
 of a larger number of faculties than are needed for 
 the production of a dream, but their activities are 
 coordinated upon a plane, so to speak, lower than the 
 platform upon which the elements of dreams are 
 arranged. Consequently, though the elements of the 
 somnambulic process may be far more numerous and 
 various than the elements of a dream, they may be less 
 capable of rising into the realm of consciousness. Such 
 a process may differ from the phenomena of ordinary 
 life only in the fact of unconsciousness ; and, when con- 
 cluded, 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 pro- 
 cesses, 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 indefi- 
 nite number of combinations ; consequently the forms 
 and degrees of somnambulism present a very great 
 variety of manifestation. Maury ' 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, 
 
 ' Le Sommeil et ies Reves, p. 248. 
 
SOMNAMBULISM. 169 
 
 somjiiation, a state in which the patient unconsciously 
 performs such actions as have become so far habitual 
 that, though complicated in their character, they con- 
 stitute genuine cerebral reflexes. Third, noctamhitlism, 
 or sleep-walking, in which the action, though compli- 
 cated 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.^ 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 imagina- 
 tive faculties (imagination and memory), associated 
 with the coordinative faculties (attention, judgment, 
 volition), are sufficiently stimulated to maintain a state 
 of consciousness, they show that the first stage of sleep 
 consists in the suppression of bodily motion and sensi- 
 bility. The second stage consists in the further sup- 
 pression of the coordinative faculties. The third stage 
 is marked by the loss of memory and imagination. In 
 
 ^ Die. Encyc. des Sci. M^d., Article Somnambulisme Xaturel. 
 
170 INSOMNIA. 
 
 the most profound and perfect sleep the functions of 
 organic life alone remain. The process of awaking 
 consists in the revival of the faculties in the inverse 
 order of their extinction. Dreams occur during the 
 period in which motion, sensation, and the coordinative 
 faculties are in abeyance; but somnambulism may 
 accompany each of the stages of sleep. Its simplest 
 form is perhaps the rarest; corresponding to Maury's 
 fifth variety. In this form the functions of organic 
 life are intact ; motion and sensibility seem unchanged ; 
 the intellectual faculties display their usual activity; 
 but the ordinary consciousness is never aroused. So 
 far as the normal life of the subject is concerned, he is 
 active, sensible, intelligent, but unconscious ; and when 
 the paroxysm is terminated memory contains no 
 account of its events. Such paroxysms may occur but 
 once in the life-time of an individual, or they may be 
 repeated at stated intervals, constituting an alternate 
 succession of mental states without connection in con- 
 sciousness. 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 com- 
 plete suppression of the coordinative faculties of the 
 mind. Memory and imagination, released in great 
 measure from the control of the higher intellectual 
 faculties, and excited by such vestiges of sensation as 
 still persist, create a species of delirium in which 
 mutilated sensations, half formed thoughts and dispro- 
 portioned volitions combine to produce a variety of 
 
SOMNAMBULISM. 171 
 
 actions. In this condition the patient dreams, and acts 
 out his dream. He is a somnambulic dreamer. 
 
 In the third degree of somnambulism, conscious- 
 ness 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 hypno- 
 tism. 
 
 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 som- 
 nambulic dream. 
 
 Such is the classification of MM. Ball and' Cham- 
 bard. It possesses the merit of great precision and 
 clearness. If the warning which its authors them- 
 selves 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 remem- 
 bered that between these pronounced and definite forms 
 exist a great number of intermediate degrees. Partial 
 revivals and temporary resurrections of the higher 
 
172 
 
 INSOMNIA. 
 
 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 : 
 
 
 <t-i 
 13 
 o 
 
 a 
 <a 
 bo 
 
 o 
 
 .t: a 
 
 11 
 
 Coordinative Faculties: 
 
 Attention, Judgment, 
 
 Volition. 
 
 EC 
 
 oo 
 V 
 
 a 
 
 Oi 
 
 a 
 o 
 o 
 
 00 
 
 a 
 o 
 O 
 
 
 1 1 1 
 
 
 1 1 1 
 
 Somnambulic life 
 
 1 1 1 
 
 
 
 1 1 
 
 ^^^ 
 
 Somnambulic dream 
 
 1 1 
 
 
 
 
 1 
 
 Somnambulic automatism 
 
 1 
 
 
 
 
 ^^^m(nn 
 
 1 
 
 Somnambulic lethargy 
 
 - 
 
 
 
 
 
 
 The close parallel between this diagram and the 
 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 differ- 
 
SOMNAMBULIC LETHARGY. 173 
 
 ence 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, som- 
 nambulism, — perhaps even of insanity. That the 
 affection is hereditary is a matter of common observa- 
 tion. 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 noc- 
 tambulist, 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 som- 
 nambulist. 
 
 Eeturning now to the classification adopted by Ball 
 and Ohambard, it will be found interesting to consider 
 a f-ew 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 accident- 
 ally 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 con- 
 tinued about five weeks, when she became completely 
 lethargic, and was transferred to my care. In this 
 condition she remained unconscious, almost perfectly 
 
1<^ INSOMNIA. 
 
 insensible, with pupils somewhat contracted and slug- 
 gish before the light, with a feeble and slightly accel- 
 erated 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 com- 
 plete 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,' 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 noto- 
 
 "^ The Lancet, Dec. 22, 1883, p. 1,078, and Jan. 5, 1884, p 5. 
 
SOMNAMBULIC LETFIARGY. 175 
 
 riety, either before the attack or since its termination. 
 The moral atmosphere, in short, surrounding the phe- 
 nomena, is altogether unfavorable to exaggeration and 
 imposture, for which, indeed, no reasonable motive can 
 be assigned. Nevertheless, under these very common - 
 place 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 sus- 
 pended 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 relig- 
 ious ecstasy and profound mental emotion. She be- 
 comes for th^ long period of over one hundred and sixty 
 days continuously an almost mindless automaton, con- 
 nected with the external world only through a few 
 insignificant reflexes and through the organic func- 
 tions. 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; 
 
176 INSOMNIA. 
 
 the singing, laughing, weeping, adoring ecstasies of 
 hysteria and of religious excitement were wholly want- 
 ing; nor Avere there during many months such inter- 
 vals of normal consciousness as are observed in almost 
 all the recorded cases of hysterical coma and of cata- 
 lepsy. The statue-like pose, moreover, and the flexi- 
 hilitas 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 j 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 betray- 
 ing only natural emotion; she persists in maintaining 
 that the whole period of the apparent unconsciousness 
 is a complete blank to her recollection. She is grate- 
 ful for her recovery, but manifests no craving for sym- 
 pathy, 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 hered- 
 itary 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 
 
SOMNAMBULISM. 177 
 
 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 neighbor- 
 hood. These two forms of lethargy sometimes alter- 
 nate in the experience of the same individual, consti- 
 tuting a portion of the indefinitely varied manifestations 
 of hystero-epilepsy. Grasset relates the case^ of a little 
 girl, ten years old, who suffered Avith 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 ordin- 
 ary 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 suck- 
 ing, 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; 
 
 ^Brain, Jan., 1884, p. 454. 
 12 
 
178 INSOMNIA. 
 
 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 spasmod- 
 ically. 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 every- 
 thing told her," 
 
 Somnambulic Dreams. — The preceding cases illus- 
 trate 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 expres- 
 sion. Starting probably from the same portion of the 
 brain, the physiological dream sets in motion the cor- 
 tical 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. Con- 
 sequently, the somnambulist retains no recollection of 
 the incidents of his dream. 
 
 The simplest form of this atfection is presented by 
 the restless child who talks, cries out, and brandishes 
 
NIGHT TERRORS. 179 
 
 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 nerv- 
 ous 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 con- 
 stipation ; 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. Some- 
 times .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 remem- 
 brance of the unpleasant event. 
 
 Such paroxysms occur during the early part of the 
 
180 INSOMNIA. 
 
 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 cer- 
 tain 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, 
 
SLEEP - DRUNKENNESS. 181 
 
 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 uneasi- 
 ness 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 observa- 
 tion for undoubted insanity, was in like manner aroused 
 out of sleep by a supposed noise, probably heard in a 
 dream. With a pistol in each hand, he commenced 
 firing wildly in every direction, fatally wounding his 
 wife who was in bed at his side. When completely 
 awakened he had no recollection of what had occurred, 
 and was overwhelmed by the event. 
 
 Wharton and Stille ^ 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 responsi- 
 bility 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 move- 
 ments with which he was occupied at the moment of 
 falling asleep, as in the case of Galen, who, though 
 
 ^- Medical Jurisprudence, 3d ed., Vol. I, pp. 464-471. 
 
182 INSOMNIA. 
 
 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 con- 
 nected 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. Some- 
 times the events of the day have evidently suggested 
 the deeds of the night. One of my little acquaint- 
 ances 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 puz- 
 zling 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.' It illustrates a majority of the facts 
 
 ^ Le Monde lies Reves, p. 257. 
 
SOMNAMBULISM. 183 
 
 which have been already brought forward, and will 
 well reward careful consideration. '' A young clergy- 
 man 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 accu- 
 racy 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 somnam- 
 bulist 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 simi- 
 lar piece was substituted, he accepted it as his own, 
 and wrote down the corrections at the points which 
 
184 INSOMNIA. 
 
 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 com- 
 positions 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 
 i;ii 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 exer- 
 cise, 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 
 
SOMNAMBULISM. 185 
 
 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 decep- 
 tion, 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. Not- 
 withstanding all these incidents, he did not wake, but 
 went to bed, and slept most profoundly." 
 
 An equally instructive case is related by my dis- 
 tinguished colleague. Prof. J. Adams Allen. ^ 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 dilapi- 
 dated 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 suc- 
 ceeded. 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 
 
 ' Chicago Aledical Journal, iS6g, p. 650. 
 
186 INSOMNIA. 
 
 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 perse- 
 vere, 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 som- 
 nambulic 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 antici- 
 pations 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 
 
SOMNAMBULISM. 187 
 
 liad 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 som- 
 nambulism, 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 illustra- 
 tive of minute anatomy and histology, for use in class 
 demonstrations. He entered into the work Avith 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 Carpen- 
 ter's Physiology, illustrating the tubular arrangement, 
 etc., were ready. He had an engagement for the even- 
 ing, 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 sing- 
 ing (and, by the way, the guitar was about as dilapi- 
 dated 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 per- 
 fectly, 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 
 
188 INSOMNIA. 
 
 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 occu- 
 pied 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 mid- 
 liight 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 acquaint- 
 ances 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 
 
SOMNAMBULISM. 189 
 
 not feeling well, was pretty blue, and wished lie 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, exchang- 
 ing 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, notwith- 
 standing 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, 
 
190 INSOMNIA. 
 
 or fatigue, he would be sure to be up and doing some- 
 thing 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 prac- 
 tice 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 improve- 
 ment commenced, and was answered, ' Immediately 
 after taking the powders which he had given in the 
 night.' The truth flashed upon him at once, but con- 
 cealing 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 
 
SOMNAMBULISM. 191 
 
 ordinary vision is not necessary to guide the move- 
 ments 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 hypersesthetic condition of the senses in 
 certain other forms of nervous disorder, it is not sur- 
 prising 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 somnam- 
 bulist does derive some information through the me- 
 dium 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 coin- 
 cides 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 
 
192 INSOMNIA. 
 
 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, how- 
 ever, 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 occu- 
 pied 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 somnam- 
 bulic sleep. On awaking she had no idea of anything 
 
SOMNAMBULISM. 193 
 
 that had occurred, but during a subsequent paroxysm 
 she told her mother all that had happened.^ In cer- 
 tain cases a dim recollection of some particular inci- 
 dent may be retained, as in the case of my patient 
 Avho 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 hold- 
 ing up his fingers before her eyes. Meeting the phy- 
 sician, 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 charac- 
 ter. Another somnambulic patient one night rushed 
 into her mother's room, violently accusing her of steal- 
 ing 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 cele- 
 brated case related by Mesnet, the natural propensities 
 of the individual seem to be released from all restraint, 
 
 ' Maury, Le Sommeil et les Rives, p. 234. 
 13 
 
194 INSOMNIA. 
 
 and brutal instincts guide the actions of the somnam- 
 bulist, 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 conse- 
 quences of such actions. His condition closely resem- 
 bles 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 close- 
 ness 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 atten- 
 tion 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 remem- 
 bered experience was a pure illusion. The members 
 
SOMNAMBULISM. 195 
 
 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 somnam- 
 bulic experience. 
 
 In like manner as it is often remarked that certain 
 dreams betray a condition of unusual cerebral excite- 
 ment, 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 occu- 
 pied 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, ^ and in certain periods of the 
 paroxysms observed by Mesnet (p. 198). Frank's 
 patient was a healthy and well nurtured young Ger- 
 man girl, who during the wars of 1812 had been terri- 
 bly 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 som- 
 nambulic 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 
 
 ' Pathologic interne. 
 
196 INSOMNIA. 
 
 about a minute. She then seemed to have decided 
 what to do; from an imaginary cartridge-box behind 
 her back she pulled out a cartridge, bit off the end, 
 poured out the powder upon her fist as if she were 
 priming a musket. She then went through the motions 
 of loading a gun, ramming down the wad with an 
 imaginary ramrod, and cried out in French, a language 
 which she had never heard before: "Marche! Ou est 
 le baron? Sacre nom de Dieu!" Repeating the 
 violent ejaculations and threats addressed by the 
 soldiers to her father, she exhibited the utmost terror; 
 her body was covered with a cold sweat, and she seemed 
 ready to faint away. At this moment she woke up, 
 called impatiently for her handkerchief, with which 
 she wiped the perspiration from her face, and resumed 
 her ordinary avocations as if nothing had happened." 
 
 Still more remarkable was the case reported by Dr. 
 Mesnet.' From the excellent translation prepared by 
 T. J. Huse, M. D.,^ the following sketch has been out- 
 lined : 
 
 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 
 
 ^/-' Union MMicale, July 21st and 23d, 1874. 
 
 ^ Chicago Jou7-n. of Nervous aiid Mental Diseases^ Vol. II, p. 48. 
 
SOMNAMBULISM. 197 
 
 manifest periodical attacks of somnambulism, at inter- 
 vals 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 caf6, 
 and while in the hospital had made himself useful and 
 agreeable. The somnambulic attacks which he experi- 
 enced 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 allow^ed 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 conscious- 
 
198 INSOMNIA. 
 
 ness or feeling. He ate voraciously without discern- 
 ment, 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 Hos- 
 pital, 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 
 Avere 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 com- 
 plete expression of an hallucination called up by an 
 illusion of touch, which, giving to a cane the proper- 
 ties of a gun, awakened in this person remembrances 
 
SOMNAMBULISM 199 
 
 of liis 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, how- 
 ever, 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 hears 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, with- 
 out 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 icriting; for at that moment he began to ran- 
 sack 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 recom- 
 mended himself to his commanding^ officer for his orood 
 conduct and bravery, and made ^plication for the 
 
200 INSOMNIA. 
 
 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 imme- 
 diately break off the line he had begun; he still con- 
 tinued 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 patieMV 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 
 
SOMNAMBULISM. 201 
 
 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 extin- 
 guished 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 pre- 
 senting 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 inter- 
 pose 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 impres- 
 
202 INSOMNIA. 
 
 sions from all objects in personal relation with him- 
 self through the touch, and does not receive impres- 
 sions, on the contrary, from things external to him ; he 
 perceives his own match, hut does not perceive mine^ 
 
 During the course of this observation the patient 
 gave evidence that the memory of his former occupa- 
 tion as a professional singer had been revived. He 
 began to hum some of the familiar airs, and then pro- 
 ceeded 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 with- 
 out 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 permit- 
 ted 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 him- 
 self 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 
 
SOMNAMBULISM. 203 
 
 listened with pleasure. This first selection termina- 
 ted, 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 sen- 
 sation.'- 
 
 The conclusions which may be drawn from this 
 remarkable history have been sufficiently expressed by 
 Dr. Mesnet^ 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 intel- 
 lectual actions properly so called, but it also some- 
 times awakens some instinctive excitation which 
 surrenders the individual without any defence, and 
 destitute of rational discernment, to the most deplora- 
 ble impulses. He acts with the semblance of a free- 
 dom 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 ques- 
 tion 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 
 
 ^ Loc. cit. 
 
204 INSOMNIA. 
 
 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 sugges- 
 tions. The history of the patient just related, illus- 
 trates the manner in which the actions of a somnam- 
 bulic 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 obser- 
 vations 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 exhib- 
 ited 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 
 
SOMNAMBULIC LIFE. 205 
 
 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 continu- 
 ity 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 
 lesults 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, put- 
 ting up for the night at taverns and farm houses, and 
 apparently behaving like any other respectable citi- 
 zen. 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 
 
206 INSOMNIA. 
 
 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 care- 
 ful observation is employed, the truly somnambulic 
 character of the paroxysm may easily be overlooked. 
 Thus, the true nature of the affection was not sus- 
 pected by the early attendants of the patient who 
 became the subject of lethargic stupor, as l-elated on 
 page 173. Under the influence of powerful drugs act- 
 ing 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 sub- 
 jected to a considerable surgical operation, and only 
 ceased to appear conscious at the expiration of five 
 weeks, when she passed into the lethargic state previ- 
 ously 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 sensa- 
 tions, 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' relates a similar case of a young lady who 
 '* unexpectedly, and without any forewarning, fell into 
 a profound sleep which continued several hours beyond 
 
 ^ Philosophy of Sleep, p. 167. 
 
SOMNAMBULIC LIFE. 207 
 
 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 Avith 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 super- 
 vened. 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 dis- 
 tinct 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 mat- 
 ters), 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 embarrass- 
 ment. By simply knowing whether she is in the old 
 
208 INSOMNIA 
 
 or new state, they regulate the intercourse, and govern 
 themselves accordingly." 
 
 Another remarkable case was reported at length by 
 Dr. Azam, of Bordeaux. ' The principal facts are given 
 in a translation by Dr. J. I. Tucker in the Chicago 
 Journal of Nervous and Menial Disease.'^ The patient 
 was a young woman who began to exhibit the symp- 
 toms 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, fol- 
 lowed 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 fiiist 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. 
 
 ^ Revue Scietitifique , May 20, Sept. i6, 1876; Dec. 22, 1877; March 
 8, 1879. 
 
 » Vol. Ill, p. 584. 
 
SOMISrAMRULIC LIFE. 209 
 
 Memory, during normal life, was limited .to anterior 
 normal periods. As time advanced, this peculiar mode 
 of existence became an increasing source of inconveni- 
 ence and mental distress, often leading tlie superficial 
 observer to suppose that she was insane. 
 
 This case differs from the others in the circum- 
 stance 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,^ 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, there- 
 fore, 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 my- 
 self, 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 
 
 * Chapters on Mental Physiology, p. i6o. 
 14 
 
210 INSOMNIA. 
 
 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, conse- 
 quently, as easily forgotten as the dreams which are 
 developed during sleep. 
 
 Such, then, are the principal characteristics of som- 
 nambulism — a state in which dreams are supplemented 
 by more or less complete and appropriate action; ordi- 
 narily 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 hallucina- 
 tions which constitute the dream. In the simpler 
 forms of noctambulism only the automatic locomotive 
 apparatus is awakened, and the sleeper moves in accord- 
 ance 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 pur- 
 pose, 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 gen- 
 
SOMNAMBULISM. 211 
 
 erally 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 ordi- 
 nary 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 ^ that the principal cause of f orgetf ulness 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 conse- 
 quences, 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 vibra- 
 tions. But when the entire brain has been completely 
 reawakened, the residual vibrations of those elements 
 which yielded the physical basis of the dream, and 
 
 ^ Le Sommeil et ks Reves, p. 226. 
 
212 INSOMNIA. 
 
 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, how- 
 ever, the somnambulist who, while awake, had forgot- 
 ten 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 suc- 
 cessive 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 quies- 
 cence. 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 inac- 
 tivity which supervenes when the whole brain is awake, 
 their residual motion could disturb the sphere of con- 
 
SOMNAMBULISM. 213 
 
 sciousness. Hence the time occupied by their som- 
 nambulic 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 move- 
 ments 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. 
 
CHAPTEK 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 Salpetri^re Hos- 
 pital, 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 
 
 (214) 
 
HYPNOTISM. 215 
 
 reason the larger number of qualified subjects is 
 furnished by the female sex — especially by those who 
 possess the hysterical temperament. Frequent repeti- 
 tion 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, ^ 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 Ifospitals of Paris (Charcot and Richer), conse- 
 quently, 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 l^rain 
 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 hyp- 
 notized 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 neces- 
 
 "^ Lancet, July 29, 1882, p. 164. 
 
216 INSOMNIA. 
 
 sarj for distinct vision, affords a very efficient means 
 of inducing artificial somnambulism. Certain persons 
 may be readily hypnotized by gently pressing the eye- 
 lids 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 impres- 
 sions derived directly from the sphere of conscious- 
 ness. 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 col- 
 umn of figures, or trying to read a dull book, is some- 
 times 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 evolu- 
 tion 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 expecta- 
 tion, 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 
 
HYPNOTISM. 217 
 
 monks of Mi 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 move- 
 ments 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 pufP of air upon the face. 
 
 The simplest phenomena connected with the hyp- 
 notic state are those transferences of cerebral percep- 
 tions which have been investigated by the Society for 
 Psychical Research.^ Certain sensitive persons, when 
 blindfolded, are capable of reproducing with consider- 
 able 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 
 
 * Transactions of the Society, etc., Vols. I, II, III. 
 
218 INSOMNIA. 
 
 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 con- 
 centrating 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 influ- 
 ence 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 atten- 
 tion 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 appa- 
 ratus of ordinary mankind. The more complicated 
 forms of artificial somnambulism result from the com- 
 plication and exaggeration of the results of this inor- 
 dinate sensitiveness through the agency of artificial 
 sleep. As in natural somnambulism, so in the hyp- 
 notic state, certain organs become totally anaesthetic, 
 while the sensibility of others is wonderfully exalted. 
 Cutaneous sensation may be completely abolished, and 
 the patient may become utterly insensible to every 
 painful impression. The reflex functions may be 
 
HYPNOTISM. 219 
 
 either suppressed or exaggerated, and the special 
 senses of sight and hearing may be exalted to the 
 highest degree. While in this condition the hyperses- 
 thetic condition of the brain renders the subject pecul- 
 iarly 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,^ three principal types of arti- 
 ficial somnambulism may be remarked among the 
 hysterical subjects upon whom he experimented: (1) 
 th.Q cataleptic, (2) the lethargic, and (3) the somnam- 
 hulic. 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 Chi- 
 nese gong, may suffice to induce the cataleptic state. 
 Dumontpallier^ 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 condi- 
 tion of hypnotic lethargy has been previously devel- 
 oped. If only one eye be thus opened, the correspond- 
 ing 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 
 
 ^ Le Progrh MMical, Feb. i8, 1882, p. 124. 
 '^ Le Progres Medical, March 25, 1882, p. 223. 
 
220 INSOMNIA. 
 
 ceases, the skin becomes insensible, but tlie special 
 senses, particularly those of sight and hearing, main- 
 tain 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 them- 
 selves, the limbs remain motionless. 
 
 The lethargic state may be induced by simply press- 
 ing 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 con- 
 tractures 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 spe- 
 cies of lethargy may always be annulled. By the 
 approach of a magnet to a contractured limb, the 
 rigidity may be completely transferred to the corre- 
 sponding muscles upon the opposite side of the body. If 
 upon a limb of a lethargic subject who has been ren- 
 
HYPNOTISM 221 
 
 dered 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 trans- 
 ferred 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 observa- 
 tion recorded by Dumontpallier.^ 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 tele- 
 phone; and, if a microphone be introduced into the 
 circuit, the incidence of a ray of light upon the instru- 
 ment, or even its reflection from the conjunctival 
 surface of the eye of a spectator, will arouse a respon- 
 sive muscular contraction. Charcot has also seen mus- 
 cular 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 sug- 
 gestion. 
 
 ^ Le Progres Medical, Jan. 14, 1882, p. 25. 
 
222 INSOMNIA. 
 
 The somnambulic states may be directly induced by 
 fixed attention with the eyes, by feeble and monoto- 
 nous 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 leth- 
 argic 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 experi- 
 ments, 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 affec- 
 tion of the consciousness of the subject. The eyes and 
 the eyelids behave as in the lethargic state. The sub- 
 ject 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 
 
HYPNOTISM. 223 
 
 a chair and tlie back of the head upon another, not 
 only could the entire weight of the body be thus sup- 
 ported, 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 insen- 
 sibility 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 some- 
 times remarked. Thus, Cohn' discovered that a patient 
 who was naturally color-blind, was able, when unilat- 
 erally 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 accommoda- 
 tion is also present, and is one of the earliest demon- 
 strable 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 phe- 
 nomena of hypnotism, and, on the other, of much 
 credulity, extending even to a belief in the existence 
 of supernatural and miraculous powers. The extra- 
 ordinary character of these experiences is well illus- 
 trated 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 "Way land's 
 Intellectual Philosophy. ' ' 
 
 ^ Brain, Vol. Ill, p. 394. 
 
224 INSOMNIA. 
 
 " 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 authori- 
 ties 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 
 
HYPNOTISM. 225 
 
 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 dur- 
 ing 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 
 coTner 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 longi- 
 tudes 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 
 15 
 
226 INSOMNIA. 
 
 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 acquaint- 
 ance with each other must have reduced the chances of 
 simulation to the lowest degree. When carefully con- 
 sidered, 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 con- 
 dition 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 somnam- 
 bulism 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 hypno- 
 
HYPNOTISM. 227 
 
 tized subject who walks, jumps, lies down, executes 
 every variety of pantomime, in obedience to the com- 
 mands of his director. Somewhat more complicated 
 are the actions that are developed through excitement 
 of the imitative faculties. Every movement of the 
 director ihat can he perceived by the subject will be at 
 once rejoroduced. Dr. Fischer relates ^ 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 pas- 
 sions 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, con- 
 sciousness is not abolished, and the subsequent recol- 
 lection 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 percep- 
 tion during a "seance." To this inferior grade of self- 
 induced hypnotism belong all those conditions of 
 sensory hypersesthesia by means of which certain per- 
 sons 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 
 
 ^ op. cit., p. 1 8. 
 
228 INSOMNIA. 
 
 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,' 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 expres- 
 sion, her responses became entirely uncertain and 
 destitute of conformity witli fact. 
 
 The induction of the hypnotic state, if not too often 
 repeated, is sometimes of considerable service in the 
 
 ' Le Sommeil et les Reves, p. 361. 
 
HYPNOTISM. 229 
 
 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,' Wiehe,^ Rieger,^ 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,'* "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." 
 
 ^ Op. cit. 
 
 '^Berlin. Klin. Wochensckr, January, 1884, 
 
 ^ Der Hypnotismiis, Jena, 1884. 
 
 '^ Brain, July, 1884, p. 278. 
 
 THE END. 
 
INDEX. 
 
 Page. 
 
 Acids -- 71 
 
 hydrobromic 88 
 
 hydrochloric 72 
 
 hydrocyanic -- 100 
 
 hydrocyanic, in gastric disease — 103 
 
 lactic 72 
 
 nitric 72 
 
 nitro-muriatic, in hepatic insom- 
 nia 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 som- 
 meil - 30 
 
 Alcohol 76 
 
 effect of , upon the brain _ 54 
 
 in angina pectoris 99 
 
 in asthma 101 
 
 ia chorea lio 
 
 In dyspepsia 103 
 
 in fever 10.5 
 
 in hepatic diseases 102 
 
 Allen, Prof. J. Adams, case of som- 
 nambulism observed by ..- 185 
 
 Allix, observations of, regarding 
 
 bodily temperature in sleep. ... 7 
 Allix and Hohl, observations of, re- 
 garding the pulse in sleep . 6 
 
 Aloetic purgatives in insanity 94 
 
 Ammonia, in fever 105 
 
 Amyl nitrite 84 
 
 in angina pectoris 99 
 
 in asthma -- 101 
 
 Anaemia of the brain 53 
 
 Anaesthetics 75 
 
 Angelic visitors, delusions regarding, 129 
 
 Angina pectoris - 99 
 
 Anti-spasmodic effects of be la- 
 
 donna - .- 69 
 
 Apparent death — 34 
 
 crucial test of 35 
 
 Arabia, effects of wind from the 
 
 deserts of 46 
 
 Arago, observations of, regarding at- 
 mospheric electricity 46 
 
 Arsenic, in asthma 101 
 
 Atropia - 69 
 
 Atropine, use of, with opiates 87 
 
 Page. 
 
 Aniticial 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 
 
 Assafoetlda, 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 
 
 Atmo&i:)heric electricity, effects of.. 46 
 
 Australia, effect of winds from the 
 
 deserts of — 46 
 
 Azam, a case of somnambulic life ob- 
 served 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 9'^ 
 
 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 
 
 (231) 
 
232 
 
 INSOMNIA. 
 
 Page. 
 
 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 im- 
 pressions. . 124 
 
 Brandy, use of, in wakefulness 77 
 
 Bromide of potassium, use of, in 
 
 insanity 95 
 
 of sodium, use of, in chronic alco- 
 holism - 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 clairvoy- 
 ance -. -- 224 
 
 Bronchitis, insomnia caused by 100 
 
 insomnia of, relieved with paral- 
 dehyde 80 
 
 Brunton, Dr. T. Lauder, his theory 
 
 of counter-irritation 62 
 
 Butylchloral hydrate 83 
 
 iJuschick, experience of, in waking 
 
 before earthquakes 144 
 
 Caffeine, efifect of, upon the brain. 54 
 
 Camphor - 67 
 
 use of, in asphyxia 100 
 
 use of, in fevers 105 
 
 use of. In the Insomnia of cach- 
 exia 108 
 
 use of, after parturition 109 
 
 Cannabin 69 
 
 Cannabin tannate 68 
 
 Cannabis indica 68 
 
 anti-aphrudlsiac 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 hyos- 
 
 cyamus 113 
 
 Cantharldes 6:i 
 
 Capsicum 63 
 
 Pagk. 
 
 Capsicum, use of, in the insomnia of 
 
 delirium tremens 77, 
 
 Carbolic acid, vapor of, for relief of 
 
 cough 
 
 Carbon, oxidation of, during sleep. 
 Carbonic acid gas, discharge of, 
 
 during sleep 
 
 Cardiac debility, use of butylchloral 
 
 in 
 
 Cardiac disease, insomnia of, treated 
 
 with paraldehyde 
 
 treated with digitalis 
 
 Cardiac dyspnoea, relieved with opi- 
 ates 87, 
 
 Cardiac neuralgia 
 
 Carotid arteries, compression of, for 
 
 relief of insomnia. 25,27, 
 
 Cataleptic form of artificial som- 
 nambulism 
 
 Catarrh, nasal, effect of sleep upon. 
 Caton, Judge John D., on .the diffi- 
 culty of sleep during the con- 
 tinuous daylight of summer in 
 
 Norway 
 
 Cerebral activity, effect of, upon 
 
 bodily temperature 
 
 Cerebral ana?mia and its cause dur- 
 ing sleep ...25, 
 
 use of phosphorus for 
 
 Cerebral circulation, dependence of 
 
 consciousness upon 25 
 
 during sleep, observations upon, by 
 
 Professor Mosso 
 
 Cerebral exhaustion, benefited by 
 
 the use of phosphorus 
 
 in fever 
 
 Cerebral hyperaemia, effects of 
 
 insomnia of, treatment with paral- 
 dehyde 
 
 Cerebral irritation in cachectic states 
 Cerebro-spinal meningitis, use of 
 
 opiates in 
 
 Cerebro-spinal weakness 
 
 Change of life, use of valerian dur- 
 ing 
 
 Chicago, embarkation from 
 
 the great fire in 
 
 Child-birth, insomnia after 
 
 Chl.iral 
 
 Chloral hydrate, influence of, upon 
 
 oxidation in the tissues 
 
 association of, with morphia and 
 
 bromides 
 
 use of, in angina pectoris 
 
 use of, in asthma 
 
 use of. In cachexias with insom- 
 nia - 
 
 use of. In chorea 
 
 use of, in chronic alcoholism 
 
 use of, in delirium tremens 
 
 use of, in fevers 
 
 use of, in hepatic diseases 
 
 use of, in insanity 
 
 use of, in meningitis 
 
 use of, in night terrors 
 
 use of, in respiratory diseases... 
 Chlorodyne 
 
 98 
 100 
 
 9 
 
 83 
 
 80 
 66 
 
 98 
 99 
 
 57 
 
 219 
 
 40 
 
 28 
 71 
 
 27 
 
 26 
 
 71 
 105 
 145 
 
 80 
 108 
 
 93 
 110 
 
 68 
 45 
 
 40 
 81 
 
 82 
 
 86 
 
 99 
 
 101 
 
 109 
 
 110 
 
 97 
 
 98 
 
 104 
 
 102 
 
 95 
 
 94 
 
 112 
 
 100 
 
 82 
 
INDEX. 
 
 233 
 
 Page. 
 Chlorodyne, use of, in syphilitic neu- 
 ralgia 107 
 
 Chloroform 81 
 
 use of, in asthma 101 
 
 use of, in convulsions llO 
 
 spirit of, in the treatment of 
 
 fevers 105 
 
 Chossat, observations of, on the tem- 
 perature of pigeons ? 
 
 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 explana- 
 tion of 14S 
 
 in dreams 146,143, 149 
 
 in dreaming, and in natural som- 
 nambulism. 226 
 
 in the hypnotic state 224 
 
 Clark, observations of, on the sleep- 
 ing dropsy 30 
 
 Codeia 85 
 
 Codeine 88 
 
 Coffee, eiTects 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 sensa- 
 tions 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 
 
 Crotonoil 63 
 
 Cups, counter irritation with 63, 93 
 
 Curci, observations of, regarding 
 
 belladonna. 69 
 
 regarding morphia 85 
 
 Cutaneous disorders, causes of in- 
 somnia ^ 55 
 
 DaCosta, onlithaemia 106 
 
 Darkness, favorable to sleep 18 
 
 Day andniglit, alternation of, a cause 
 
 of sleep 17 
 
 Death, apparent 84 
 
 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 
 
 vsrith hrnmifies . S9 
 
 Page. 
 Delirium tremens, treatment of, 
 
 with capsicum 77 
 
 with chloral 82 
 
 with digitalis 57 
 
 Delusions, caused by dreams I i28 
 
 Depressing emotions, a cause of sleep i» 
 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 z 
 
 Disease and dissolution, revival of 
 
 memory in 165 
 
 Dover's powder 67, 100, 104, lio", 112 
 
 Double consciousness. - ij04, 206 
 
 Dreams . ng 
 
 analysis of 133 
 
 at the moment of waking 14 
 
 brevity of. 15 
 
 causes of ug 
 
 cause of special vividness of 134 
 
 clairvoyant 146,148, 149 
 
 coherence of 131 
 
 definition of 120 
 
 dependence of, upon partial sleep 
 
 of the brain _. i? 
 
 duration of 135. 
 
 excited by gustatory sensation, 
 
 - 43, 125, 130 
 
 byheat 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 ori- 
 gin of 160 
 
 prophetic. 142, 143 
 
 recollection of. 140 
 
 relation of, to depth of sleep . .... 4 
 relation of, to waking hallucina- 
 tions , 12ft 
 
 resemblance of, to the mental pro- 
 cesses of insanity 133 
 
 revival of memory in 162 
 
 somnambulic. 178 
 
 state of volition during 141 
 
 suggested by externallmpulses. 125, 130 
 
 theory of us 
 
 waking 123. 
 
 Dropsy, treatment of, with digitalis. 66 
 Dumontpallier, case of self-hypno- 
 tism related by 219 
 
 Duration of sleep no- 
 
 Dyspnoea, cardiac. 93 
 
 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, 6a 
 
234 
 
 INSOMNIA. 
 
 Page. 
 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 muskin. 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 
 
 butylchoral 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, re- 
 garding 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 >5 
 
 potential 15 
 
 Frank, J. P., case of somnambulism 
 
 related by - 195 
 
 Functional nervous disorders, treat- 
 ment of with hypnotism 229 
 
 Gairdner, W. T., case of somnambu- 
 lic 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 chil- 
 dren 112 
 
 Generation of Ideas, relation of, to 
 molecular movements in the 
 
 brain 24 
 
 Grasset, case of somnambulism re- 
 lated by I"? 
 
 Gu^rln, observations of, on the mala- 
 
 die du sonimeil 30 
 
 Guiana, delusions among the Indians 
 
 of, founded upon dreams 128 
 
 travels in 42 
 
 Page. 
 Guy, observations of, regarding the 
 
 pulse in sleep 7 
 
 Hallucination, case of, related by Dr. 
 
 E.H. Clarke 156 
 
 experienced by Sir Edmund Horn- 
 by 150 
 
 prQduction 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 leth- 
 argy reported by 35 
 
 Headache - 54 
 
 Hearing, persistence of during sleep, 41 
 
 sense of, during sleep 11 
 
 Heat, a cause of insomnia . 44 
 
 a nervous stimulant 59 
 
 effects of excessive 47 
 
 liberation of, during sleep 9 
 
 Heart, pulsation of, in sleep 6 
 
 Heldenhain, observations of, on hyp- 
 notism 214 
 
 Helmholtz, observations of, on lib- 
 eration of heat during sleep 9 
 
 Hemicrania, treatment of, with butyl- 
 chloral 83 
 
 Henneberg, experiments of, on oxi- 
 dation 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 tem- 
 perature of hibernating mar- 
 mots 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 astlima 101 
 
 use of, in fever 104 
 
 use of. in hepatic diseases... 102 
 
 use of, in Insanity 96 
 
 use of. In insomnia of children 112 
 
 use of, in renal diseases. 102 
 
 Hyperaemia of the brain 52, 54, 110 
 
 Hypnagogic hallucinations 3, 4 
 
 Hypnagogic state 2 
 
 Hypnotic sleep, duration of 217 
 
 Hypnotic sleep, clairvoyance in 224 
 
INDEX. 
 
 235 
 
 Pa&e. 
 
 Hypnotic sleep, 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 Gohn. 223 
 
 observatidns of De Watte ville 229 
 
 observations of Dumontpallier.219, 221 
 
 observations of Fischer 150, 227 
 
 observations of Harting 215 
 
 observations of He.denhain, 214, 
 
 215, 216, 222 
 
 observations of Milne-Edwards 215 
 
 observations of Rieger 229 
 
 observations of Wiehe 229 
 
 receptivity of the brain to sugges- 
 tions during.. 226 
 
 suggestion of ideas during 226 
 
 therapeutical use of 228 
 
 Hysteria, a cause of double conscious- 
 ness 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 mole- 
 cular 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 som- 
 nambulism - 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 ori- 
 gin -- 55 
 
 caused by cutaneous disorders. 49, 55 
 
 caused by dyspepsia 51 
 
 caused by electrical disturbances. 46 
 caused by excrementitious sub- 
 stances 55 
 
 caused by fatigue 78 
 
 caused by heat 44, 46 
 
 caused by heat and humidity 44 
 
 caused by icterus 49 
 
 Page. 
 
 Insomnia, 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 cen- 
 tral 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 
 
 (paused by pneumogastric disorder. 51 
 
 caused by poisons 55 
 
 caused by products of putrefac- 
 tion ... 55 
 
 caiJsed 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 dis- 
 order 50 
 
 Insomnia, occurrence of, after child- 
 birth.... 81 
 
 occurrence of, after parturition... 109 
 occurrence of, during acute affec- 
 tions of the brain 92 
 
 occurrence of, during bronchitis.. 80 
 occurrence of, during cardiac dis- 
 eases 66,80, 87 
 
 occurrence of, during change of 
 
 life in women 84 
 
 occurrence of, dtiring childhood 110 
 
 occurrence of, during chorea 110 
 
 occurrence of, during chronic alco- 
 holism 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 dysmenor- 
 
 rhoea 84 
 
 occurrence of, during emphysema, 80 
 occurrence of, during febrile con- 
 ditions 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 
 
236 
 
 INSOMNIA. 
 
 , Page. 
 Insomnia, occurrence of, during in- 
 sanity 94 
 
 occurrence of, during irritability of 
 
 the bladder 90 
 
 occurrence of, during irritability of 
 
 the sexual organs 90 
 
 occurrence of, during irritative 
 
 dyspepsia 90 
 
 occurrence of, during jaundice 80 
 
 occurrence of , during lithaemia,106, 107 
 occurrence of, during mania, 87, 89, 90 
 occurrence of, during melancholia, 96 
 occurrence of, during mental ex- 
 haustion 89 
 
 occurrence of, during nervous dis- 
 orders - 80 
 
 occurrence of, during neuralgia... 84 
 occurrence of , during old age. .78, 113 
 occurrence of, during opium habit, 84 
 occurrence of, during paretic de- 
 mentia 96 
 
 occurrence of, during phthisis.. 80, 87 
 occurrence of,during pregnancy, 89, 109 
 occurrence of, during the puerperal 
 
 state 89 
 
 occurrence of, during renal dis- 
 eases 101 
 
 occurrence of, during rheumatism 
 
 and gout.... 105, 107 
 
 occurrence of, during sexual excite- 
 ment - 89 
 
 occurrence of, during spasmodic 
 
 diseases 109 
 
 occurrence of, during states of ex- 
 haustion 67 
 
 occurrence of, during syphilis. 106, 107 
 Insomnia, relation of, to states or' 
 
 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 can- 
 nabis indica 69 
 
 Jacobi, A., on wakefulness of chil- 
 dren Ill 
 
 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 
 
 Kohlschiitter, experiments of, to 
 
 measure the depth of sleep 16 
 
 Koumiss 64 
 
 Lactic acid, hypnotic effects of 72 
 
 Lactate of sodium, hypnotic efifects 
 
 of 20, 72 
 
 Lactucarlum 88 
 
 Latent contracture 221 
 
 Leeches, use of 63, 93, 94 
 
 Lethargic form of artificial somnam- 
 bulism -- 220 
 
 Pagb. 
 Lethargy 33 
 
 produced by excessive cold 48 
 
 Lewin, observations of, on respira- 
 tion during sleep 6 
 
 experiments of, on oxidation in 
 
 the tissues 9 
 
 Llebermeister, experiments of, on ox- 
 idation in the tissues 9 
 
 Life, normal 4 
 
 possibility of intermissions in its 
 
 active manifestation. 15 
 
 Light, interfc! ence of, with sleep,40, 41 
 
 Liquors, effects of.. 76 
 
 Lithaemia, a cause of insomnia 106 
 
 Lithium bromide 88 
 
 Lobelia, anti-spasmodic effects of, 71, 101 
 
 Lomi-lomi 61 
 
 Lucid lethargy 35 
 
 contrasted with somnambulic leth- 
 argy 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 hiberna- 
 tion 8 
 
 Massage 60, 109 
 
 Matter and mind, communication 
 
 between 22 
 
 Maury. A., classification of the vari- 
 eties 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 exhaus- 
 tion 209 
 
 exaltation of, in somnambulism 187 
 
 persistence of, in sleep 3 
 
 relation of, to phenomena of som- 
 nambulism 192 
 
 revival of, during disease and dis- 
 solution 165 
 
 revival of, during dreaming 162 
 
 Meningitis 54, 57 
 
 Mental activity during sleep 14 
 
 Mesnet, case of somnambulism re- 
 lated 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 be- 
 tween 22 
 
 alternate states of action and re- 
 pose 15 
 
 sleep of - 15 
 
 state of, during sleep 14 
 
INDEX 
 
 237 
 
 Page. 
 
 Miad-readiiig 218, 227 
 
 Minnesota, summer climate of, favor- 
 
 ableto sleep 45 
 
 Mitchell, S. Weir, observations of, 
 regarding effect of variable bar- 
 ometric pressure .- 47 
 
 Molecular movement, its relation to 
 
 the generation of ideas 24 
 
 Moral responsibility in somnambu- 
 lism 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, affec- 
 tions of 89, 49 
 
 pneumogastric 51 
 
 sympathetic, affections of, causes 
 
 of insomnia 50 
 
 Nervous disorders, insomnia of, re- 
 lieved with paraldehyde 80 
 
 hypnotic treatment of 229 
 
 Nervous irritation, effect of, on tis- 
 sue change 10 
 
 sedatives 58, 59 
 
 stimulants 58, 59 
 
 system, its control over the circu- 
 latory 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, benefi- 
 cial 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 
 
 Opii;m and opiates 84, 98 
 
 Page. 
 Opiates, use of, in treatment of ca- 
 chexias _ 108 
 
 use of , in treatment of fever. . . 104, 105 
 use of, in treatment of gastric dis- 
 ease 103 
 
 use of, in treatment of insanity... 96 
 use of, in treatment of renal dis- 
 eases 102 
 
 use of, in treatment of rheuma- 
 tism 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, regard- 
 ing 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 hyp- 
 notism 217 
 
 Percussion 61 
 
 Perspiration, secretion of, during 
 
 sleep 9 
 
 Pettenkof er, experiments of, on oxi- 
 dation in the tissues 9 
 
 experiments of, on respiration in 
 
 sleep 6 
 
 Pettenkofer and Voit, on tissue 
 
 changes _ 10 
 
 Pfliiger, hypothesis of, regarding the 
 
 cause of sleep 21 
 
 Phosphatic diathesis, a cause of in- 
 somnia 72 
 
 Phosphoric acid 72 
 
 Phosphorus 71 
 
 Phthisis, coagh of, relieved with lac- 
 
 tucarium 88 
 
 Insomnia of, relieved with paralde- 
 hyde - 80 
 
 treatment of, with opiates 87 
 
 Physiological activity, reduction of, 
 
 during sleep 5 
 
 Physiological cause of somnambu- 
 lism ISO 
 
 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, In- 
 vestigations by 149, 217 
 
 Pulse, state of, during sleep 6 
 
 Punkah, use of, to promote sleep 44 
 
 Quetelet, observations of, on respi- 
 ration during sleep - 5 
 
 Quinine and opium, use of, in fever. 104 
 
238 
 
 INSOMNIA. 
 
 Page. 
 
 Reasoning powers, arrest of, during 
 sleep 3 
 
 Recollection of the events of artifi- 
 cial somnambulism 227 
 
 of the events of natural somnam- 
 bulism 188 
 
 Reflex movements during sleep. 12 
 
 Refrigeration, threefold effect of 49 
 
 Relation between molecular move- 
 ment and the generation of ideas 24 
 
 Respiration during sleep 5 
 
 Revelation through dreams 160 
 
 Revery, nature of . 120 
 
 Rheumatic diathesis, a cause of in- 
 somnia 72 
 
 Rosenthal, observations of, regard- 
 ing lethargy 33, 34 
 
 observations regarding apparent 
 
 death — 35 
 
 Rush, Dr., observations of, on the re- 
 vival of memory in dissolution. . 165 
 Sailors, sleeping during a bombard- 
 ment. - 1 
 
 Sailor-boy, sleeping on a mast 1 
 
 Salicylic acid, treatment of rheuma- 
 tism with 106 
 
 Saliva, secretion of, during sleep 8 
 
 Samuel the prophet, dream of. 129 
 
 Sandwich Islands, climate of, for re- 
 lief 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 
 
 Sfcxual organs, irritability of 90 
 
 Shampooing 61 
 
 Simon, P. Max, case of somnambu- 
 lism 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 in- 
 tellectual faculties 13 
 
 effect of , upon consciousness... 13, 14 
 
 fatigue theory of 20 
 
 favored by darkness 18 
 
 Page. 
 Sleep, favored by the suppression of 
 
 sensation is 
 
 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 experi- 
 ments of Kohlschiitter 16 
 
 - Obersteiner's theory of 20 
 
 Pflliger's hypothesis regarding the 
 
 cause of 21 
 
 proceeded 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 
 
 tlie cause of 29 
 
 unequal incidence of, upon differ- 
 ent 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 oxida- 
 tion in the tissues 9 
 
 Snoring, occasional interruption of 
 
 sleep by 11 
 
 Society for Psychical Research, in- 
 vestigations by 149, 217 
 
 Sodium bromide 8-i 
 
 Somniation 169 
 
 Somnambulic dreams 171, 178, 181 
 
 recollections of 188 
 
 Somnambulic form of artificial som- 
 nambulism 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 hy Macarlo 192 
 
 case of, related by Mesnet .. 196 
 
 case of, related by P. Max Simon. 1S2 
 
 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, 16& 
 
IJ^DEX. 
 
 289 
 
 Page. 
 Somnambulism, varieties of, accord- 
 ing to Ball and Chambard 169 
 
 varieties of, diagrammatically ex- 
 hibited- ..1T2 
 
 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 
 
 Striimpell, observations of, regard- 
 ing 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 communi- 
 cation 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 Kesearch. 149 
 Temperature, of the body, during 
 
 sleep 7 
 
 sense of 43 
 
 Thapsia 63 
 
 Theory of sleep, Obersteiner' s 20 
 
 Page. 
 
 Theory of Sleep, Pfliiger's 21 
 
 Preyer'^s _. 20 
 
 Thirst .. .- 2 
 
 Thompson, Sir William, his doctrine 
 
 concerning a sixth sense 43 
 
 Tickling, effect of during sleep 14 
 
 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 mem- 
 branes 55 
 
 Tully's Powder 67 
 
 Tumors of the brain 55 
 
 Turkish baths 60 
 
 Turpentine 6S 
 
 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 com- 
 pression of the carotid arteries.. 27 
 relation of, to modifications of the 
 
 cerebral circulation 25 
 
 Urea, elimination of, during sleep.. 9 
 
 Urine, secretion of, during sleep 9^ 
 
 Uterine colic 81 
 
 Valerian 68, 109 
 
 Valerianate of ammonia 68 
 
 of zinc - 68 
 
 Venereal act, a cause of sleep 19 
 
 Vierordt, observations of, on the 
 
 duration of sleep 110 
 
 Visions, character of. 119 
 
 of the ancient prophets 161 
 
 Voit, observations of, on oxidation in 
 
 the tissues 9 
 
 on respiration during sleep 6 
 
 Volition, cessation of, during sleep.. 3 
 
 Wakefulness 38 
 
 causes of 39 
 
 dependence of, upon instability of 
 
 cerebral protoplasm 22 
 
 Warburton, Rev. Canon, clairvoyant 
 
 dream of - 146 
 
 Weariness, a cause of sleep 1 
 
 Wharton and Stille, on sleep-drunk- 
 enness ...'. 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 
 
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