Part 5

Observing the success of the Ammonia in the case which I have mentioned above, I had recourse to it myself in the same manner, but found it so disagreeable to the stomach, that it frequently produced vomiting. This indeed removed the tendency to Night-Mare, but it equally prevented my rest. I tried some of the other alkaline salts, but with no better success; the reason of which was, I believe, that I drank them dissolved in some cold liquor, upon an empty stomach, at the time that the disease was most troublesome to me, that is, early in the morning. Finding the stomach reject the alkalies in this simple form, I made a variety of attempts to render them palatable, and at length hit on the method of dissolving them in ale, or porter, and fixed on the Carbonate of Soda as the most agreeable of them. This experiment proved of more service to me than I expected; for I soon found it to be, not a nauseous draught, like the aqueous solution, but a delicious beverage, which I could drink with great pleasure; for the porter or ale, which is generally greatly inclining to acidity, was much benefited and improved by it. The carbonate of soda becomes partially decomposed by the acid of the liquor, and parts with a great portion of its carbonic acid gas, which causes the liquor to foam up, and imparts to it the appearance and flavour of bottled porter or ale. Having thus ameliorated the malt liquor itself, I grew fond of it, and drank as much every day as would receive about a drachm of the carbonate of soda, only at my meals; but whenever I found that sense of oppression about the præcordia which indicated the predisposition to Night-Mare, I had immediate recourse to a large dose of the soda, and always obtained relief. This salt not only corrects the acidity in the _primæ viæ_, but likewise brings away by stool a quantity of viscid slimy matter, so acrid, as to burn and excoriate the parts as it passes out. As I constantly persisted in the use of this alkaline salt, and got rid of this trash from the body, my appetite, which had long been lost and depraved, returned, and the digestive organs performed their functions again with ease and success. But still the propensity to acidifying remains, and a cautious attention to diet, and to the evacuations is always necessary. By perseverance in a plan founded on these principles, I found my enemy at length subdued, and brought under a degree of control which I had never hoped to obtain, and this circumstance has induced me to give to the world, (and more particularly to those labouring under the same disease,) my opinions and advice. By a close attention to the latter, I do not doubt but they will succeed in driving from their couch this fiend of night, this enemy of repose.

A small work was published on this subject about half a century ago by Bond, who places his principal dependence for cure on blood-letting. I do not deny but there are subjects in whom this remedy might be admissible, and perhaps advantageous; but I do not doubt, at the same time, that in far the greatest number of persons habitually affected with this disease, it would add fresh vigour to the monster, while it drains the vital powers of the struggling patient, and increases his danger. Bond carried this practice to a great length in his own person, but did not cure the disease. It is at best but a doubtful and a dangerous remedy. To those persons who are only occasionally subject to it, and who are generally most alarmed at it, as the disease comes upon them unexpectedly, and without their being always able to assign any cause for it, it appears difficult to apply a remedy, as the mischief is generally over before they are aware of its approach. A little attention however to the state of the digestive organs will generally point out to them, that it was connected with indigestion, flatulence, or costiveness; or perhaps all these together: frequently it is the consequence of having eaten some particular kind of food, which experience shews always to disagree with the stomach. There are certain kinds of food which will constantly produce this disease in such as are at all liable to it. Hildesheim, in his _Spiceleg. De Affectibus Capitis_, says: _Qui scire cupit, quid sit Incubus? is ante somnum comedat castaneas, et superbibat vinum fæculentum._ “He who wishes to know what Night-Mare is, let him eat chestnuts before going to sleep, and drink after them feculent wine.” I found by experience in the West Indies, that eating a particular fruit, called the alligator pear, would at any time of the day produce Night-Mare. This is a pulpy fruit, which, when cut into, resembles a custard, and is frequently spread upon bread, and eaten instead of butter, whence it has obtained amongst military men the name of subaltern’s butter, and it is certainly no contemptible substitute for fresh butter. I used frequently to eat it beat up with the juice of Seville oranges and sugar, in which case its action was almost instantaneous. So great a propensity to sleep came upon me, that I could not resist the temptation, though well aware of the consequences; so that I generally kept some person by me to awake me as soon as the Night-Mare came on, which was always in the course of a few minutes. I have frequently shewn this experiment to my medical friends, as I have hinted above. The articles most likely in this country to produce Night-Mare, I conceive to be cucumbers, nuts, apples, and all such things as generally produce flatulence. Whenever a person has discovered the offending article, it is certainly prudent to abstain from it, more especially in the evening. If however that state of stomach and bowels which gives rise to Night-Mare, should be perceived, there will be just reason to apprehend that it will occur, and it will be advisable to have recourse to some preventative. The paroxysm of Night-Mare does not always immediately follow the eating any improper food, b℥ut sometimes several days elapse before its attack. In this case it is easier to foresee, and consequently to prevent it. The signs by which its approach may be known, are unusual drowsiness, disagreeable dreams, and disturbed sleep, with wind in the stomach and bowels. In this case I would recommend immediate recourse to be had to the carbonate of soda, as I have described above, or to the following draught, which may be taken at bedtime.

No. 1. ℞. _Potassæ Carbonatis._ gr. x. _Tinct. Cardam. Comp._ f. Ʒ iij. _Syrupi Simplicis._ f. Ʒ j. _Aquæ Menth. Pip._ f. ℥ j. _M. fiat haustus._

Or this,

No. 2. ℞. _Ammon. pp._ gr. x. _Tinct. Capsici._ f. Ʒ j. _Syr. Croci._ f. Ʒ j. _Aqua Cinnamom._ f. Ʒ x. _M. fiat haustus._

Should these medicines not produce any relaxation of the bowels, it would be necessary to take next morning a dose of some of the neutral purging salts, or, what will answer equally well, the following aperient draught.

No. 3. ℞. _Magnesiæ._ _Pulv. Rhabarb._ a. gr. xv. _Potassæ Carbonat._ gr. viij. _Syr. Simpl._ f. Ʒ j. _Aquæ Menth. Pip._ f. Ʒ xj. _M. fiat haustus._

To those persons however, who are habitually subject to Night-Mare, I would advise the frequent repetition of one or other of the draughts, No. 1 or No. 2, for several nights in succession, after which the aperient draught, No. 3, may be taken, if necessary. And this plan I would recommend to be adopted whenever the symptoms of predisposition mentioned above are perceived, paying great attention at the same time to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking of bad wine. Of eatables, those which are most prejudicial, are all fat and greasy meats, most vegetables, fruit, and pastry. These ought to be avoided, or eaten with caution. The same thing may be said of salted meats, for which dyspeptic patients have frequently a remarkable predilection, but which are not, on that account, the less noxious. Moderate exercise contributes in a superior degree to promote the digestion of food, and prevent the formation of flatulence: to those however who are necessarily confined to a sedentary employment, I would recommend particularly to avoid applying to study, or any other sedentary occupation immediately after eating. If a strong propensity to sleep should occur after dinner, it will be certainly better to indulge it a little, as the process of digestion frequently goes on much better asleep than awake. I have always felt at sea an irresistible propensity to sleep after dinner, whenever the dyspeptic symptoms were considerable, and I never, in any one instance, was attacked with Night-Mare under those circumstances.

There is no circumstance to which the sufferers under this disease ought to pay more attention than to their sleep, for every irregularity in this particular, will increase the violence of the disease. It is almost always produced by sleeping too long, frequently by sleeping too sound, and generally after having lain long awake in the night. These things ought therefore to be carefully avoided. Going to bed before the usual hour is a frequent cause of Night-Mare, as it either occasions the patient to sleep too long, or to lie awake in the night. Passing a whole night, or part of a night, without rest, likewise gives birth to the disease, as it occasions the patient on the succeeding night to sleep too sound. Indulging in sleep too late in the morning is an almost certain method to bring on the paroxysm; and it should be remembered, that the more frequently the paroxysm returns, the greater strength it acquires. I am aware that the propensity to sleep is at this time almost irresistible, and indeed, without rising from bed, it is altogether so; but a little resolution is required to be employed here.

Those who are habitually subject to the attacks of Night-Mare ought never to sleep alone, but to have always some person near them and within reach, so as to be immediately awoke by their groans or struggles; and the person to whom this office may be entrusted, should be instructed to rouse the patient as early as possible, that the paroxysm may not have time to gain strength; for the frequent repetition of the paroxysms gives greater strength to the disease, and that in proportion to the length of their duration. A long and obstinate paroxysm of Night-Mare will be found to differ not much from Epilepsy, and I have seen some to which it would be difficult to apply the proper appellation. The patient cannot pay too much attention to this circumstance, that is, the prevention, as much as possible, of the paroxysms: _crescit eundo_. If he has not the means at hand of preventing the paroxysms when they make their appearance, it will be better to rise and walk about for an hour, or until the sense of weight about the præcordia shall have disappeared. I have before observed, that any thing which will procure the discharge of a quantity of wind from the stomach, will for the time, put off the return of Night-Mare: I have frequently effected it by a glass of common gin, when nothing else was at hand; but either of the draughts, No. 1 or 2, will more effectually answer the purpose, and for that reason should be kept in readiness by such as are frequent sufferers from this disease. But it is not the temporary relief from the paroxysms merely, that the patient ought to keep in view, but the permanent amendment of his constitution, and the preventing, as much as possible, the formation of that trash in the alimentary canal, which gives rise to it. The tendency to convert every thing into an acid that exists in the stomachs of these patients, is generally too obstinate to be easily removed; it will require a long perseverance in the plan here laid down in order to eradicate the disease. Indeed I would recommend them never to drink any malt liquor without a portion of the Carbonate of soda, or some other alkaline salt in it, and to pay the greatest attention to regularity and choice of diet. One of the draughts, No. 1 or 2, or any thing of the same nature which may be found more agreeable, should be taken whenever the dyspeptic symptoms are at all urgent, and repeated as often as occasion may require. Costiveness should be always obviated by such means as the patient finds most agreeable to himself. If the constant use of the Soda will not keep the bowels sufficiently open, aperients must be had recourse to, and the draught, No. 3, will, I think, answer the purpose sufficiently, if not, its strength maybe increased. Where there is much languor and debility, with loss of appetite, I would recommend the _Pilulæ Ferri Comp._ of the London Pharmacopæia, and a decoction of bark, or infusion of Gentian or Quassia, but the cure cannot be wholly entrusted to tonics.

By steadily persisting in the plan above laid down, I have succeeded in bringing this monster under some kind of control, so as to be able to commit myself to the arms of sleep with a degree of confidence unknown to me for years before; and if in consequence of irregularity, fatigue or ill health, I am occasionally visited by this fiend of darkness, I fly with equal confidence to the antidote, which fails to chase him from my couch.

What has been said with respect to the treatment of Night-Mare, will apply equally to the other kinds of disturbed sleep which I have noticed in this work. They originate from the same cause, and will be removed by the same remedies. In children, frightful dreams frequently result from worms, and consequently will be remedied by any kind of treatment which removes the worms themselves, and with them the trash which forms their nest. This trash of itself frequently exists without the worms, and produces all the symptoms which they occasion, and amongst others, Night-Mare and disturbed sleep. By the treatment above recommended it will be evacuated, and its further formation prevented.

If any unfortunate sufferer from this distressing complaint shall obtain relief by the method here laid down, the end of writing this little Treatise will be fully answered, which is to restore the blessings of repose to those who are deprived of it by this hideous fiend.

FINIS.

FOOTNOTES:

[1] The learned Theophilus Bonetus observes, that this disease was unknown to Hippocrates and Galen.--Vide _Polyath. Lib. ii. Cap. xxviii. De Incubo et Catalepsi_. Unknown it could not be to such observers of nature, although they may not have written upon it. In the book however, ascribed to Galen, entitled “De Utilitate Respirationis,” the following short, but comprehensive notice, is to be found concerning it.--_Et Ephialtes quædam Epilepsia, quæ fit in somno: fit autem ex mistione tanquam Epilepsia. Ideoque non in vigilante, sed in dormiente: ut enim, prædictum est somnus et epilepsia fiunt in eodem loco, et ex simili causâ: unde Aristoteles dicit epilepsiam esse somnum quendam: verum ephialtes longo tempore perdurans in Epilepsiam convertitur._

[2] Memorat denique Silimachus Hippocratis sectator, contagione quâdam, plurimos ex istâ passione, (i. e. Incubo) velut lue, apud Urbem Romam confectos.--_Cœl. Aurel. lib. i. cap. iii._ de Incubone.

[3] _Forrestus incubo affectus putabat, pectus suum comprimi a cane nigro, unde respirare non potuit, utut fæmina videret esse somnium fallax, uti de se refert._--L. 10. Obs. 51.