Part 3

This is certainly a just account of the appearance of the Stomach, when it is distended in a dead Body, where the Integuments of the Abdomen, and all resistance to the Stomach’s rising, is taken away: but, if we consider the Stomach distended by any means in a living Body, where these Integuments still remain in an active state, and resist the motion of the Stomach forwards and upwards; then a great part of its pressure must fall on the Aorta, and confirm the old opinion. That part of the Diaphragm, through which the Oesophagus passes, must be the center of motion in this case; and allowing, that the Stomach moves a little upwards and forwards, in a distended state, yet, as the Abdominal Viscera are in such a fluid or fluctuating condition, that place, which may be deserted by the distention of the Stomach, will be fill’d up by the Pancreas; and by this means, the Aorta may suffer as great a pressure as if it was immediately in contact with the Stomach: the argument, which that industrious Gentleman adds, may be owing to the peculiarity of his own constitution; viz. “Imo vero aucti a pastu veneris stimuli demonstrant, eo tempore motum Sanguinis in Aortam descendentem potius majorem esse, quam minorem[24]”.

Doctor Haller seems to have levell’d the force of this argument against a full Stomach being any cause of the Nightmare; but I might mention many facts here to prove the contrary, and among the rest, might add my own case; but, to avoid prolixity, I shall confine myself to one instance.

A corpulent Clergyman, about fifty years old, who is very fond of strong beer and flesh suppers, but so subject to the Night-mare, that he is obliged to stint himself to a certain quantity every night; whenever he happens to take an over-dose, he groans so loudly that he often awakes all the People in the house. He has assur’d me, that, in these fits, he imagin’d the Devil came to his bedside, seiz’d him by the Throat, and endeavour’d to choak him. Next day he observ’d the black impressions of his hard Fingers on his Neck. After being at a wedding or christening, he never escapes it; and his Servant is oblig’d to watch him all the next night, and rescue him from the Paws of Satan, whose dreadful approach always makes him roar loud enough to awake the Servant, if he should happen to be asleep. The Servant told me, he always found his Master lying on his Back in the fit.

Hoffman says, “[25]Plethoricos omni cura fugere opportet decubitum supinum, facile enim Incubo premuntur, cujus causa a Sanguinis stagnatione in Pulmones deducenda est.”

Doctor Haller assigns a different reason for heavy suppers preventing rest, viz. “[26]Sed etiam cibi immeabiles particulæ in Cerebro minus facile trajactæ, comprimendo Medullam somnum minus benignum faciunt.”

It is remarkable, that this Disorder attacks People only in sleep; which, Doctor Young says[27], is owing to the effect that sleep has in increasing all the symptoms of a Plethora. It is true, that sleep retards the motion of the Blood, and checks the serous secretions. “[28].In vasis vero serosis, Lymphaticis et Nervosis circulatio parva, et sæpe nulla est.”

There is no occasion to go about proving that the secretion of urine is lessened in bed, for common experience sufficiently evinces it. And it appears, by the experiments of Doctor Robinson[29] and Gorter[30], that perspiration is considerably less in the night than in the day. It must be allow’d, that the heat of the bed-cloaths will rarify the Blood, and also contribute to an universal distension of the Vessels: but all these seem to be rather the effects of lying quiet in a warm bed, than of sleep alone. If so, People might be as readily seiz’d with the Night-mare while they are awake in these circumstances, as when they are asleep, which never happens.

I really can find no way of accounting for this Phænomenon, unless we have recourse to the Soul, or that active principle within us, whose operations, during sleep, are either greatly impeded, or altogether suspended. It is therefore less sensible of any uneasiness in the Body than when we are awake, and the faculties of the Mind are in action, which is compell’d, by some innate necessity, to avoid any pain, as soon as it perceives it in the Body.

While we are awake, lie on our Backs, and feel any uneasiness in that position, we immediately alter it: but, in sleep, we are not so soon conscious of the Blood’s stoppage in the Lungs, nor have we the means of removing that dangerous obstruction so much in our power, because the voluntary motions are then suspended, without which, the position of the Body cannot be changed, nor the cause of the obstruction remov’d.

The insensibility of the Lungs too may contribute to render the obstruction greater, before the Mind becomes conscious of it; for we don’t find, that obstructions and inflammations of the Lungs are attended with such an acute pain, as when these Disorders attack other parts of the Body, the Liver, Spleen, and Omentum excepted.

The Night-mare may sometimes seize very plethoric Persons, when they don’t lie directly on the Back; for part of the Heart’s weight may fall on the Pulmonary Veins, in a lateral position of the Body.

By way of a brief recapitulation of what has been offer’d concerning the Causes in general of this Disorder, I shall conclude this Chapter with the following corollaries.

COR. 1. That they who have a very sensible system of Fibres, and are soon affected by a stimulus, are least subject to the Night-mare.

COR. 2. That sluggish, inactive constitutions are most liable to it.

COR. 3. That the severity of the fit will be always proportional to the sensibility of the Fibres, and the quantity of Blood.

COR. 4. That the duration of a fit will be proportional to the sensibility and vigour of the constitution.

COR. 5. That they who sup sparingly, and never sleep on their Backs, are seldom or never afflicted with it.

COR. 6. That it is most common in those seasons of the year, which most increase the volume of the Fluids: hence spring and autumn are its most fertile periods.

CHAP. VI.

_Of the Prognostics of this Disorder._

Lest this Disorder should be thought altogether the work of Imagination, and necessary precautions should be neglected to prevent frequent returns of it; I have collected the sentiments of the ancient Physicians concerning its consequences; whose authority, in this Disease, as well as in many others, I believe, we may safely rely on; because they were wholly ignorant of its immediate cause, and had no favourite theory to support, but faithfully related facts of this kind as they really appear’d.

We find that most of the old observators who have mention’d the Night-mare, reckon it a forerunner of some terrible Disorder: I shall here translate these quotations, for the benefit of my English readers, and add the originals by way of notes, for the perusal of the learned.

“We should endeavour to stop it in the beginning; for, when it returns every night, it portends either Madness, the Epilepsy, or a Mortification[31].”

“The Night-mare is a Disorder which attacks People sleeping, and is of no trifling nature, but precedes dreadful Disorders; viz. the Epilepsy, a kind of Melancholy, and an Apoplexy; and if it returns frequently, it shews that they are not far off[32].”

“The Disease call’d the Night-mare is not a Dæmon, but rather the fore-runner of the Epilepsy, Madness, or a Mortification. We should stop it in the beginning; for, when it continues long, and returns often, it produces some of the above-mention’d Disorders[33].”

“If they, whom the Night-mare seizes in sleep, have cold Sweats, and a palpitation of the Heart after they awake, they are very bad symptoms. They who are long affected with it, have great reason to fear some desperate Disorder of the Head, viz. a Vertigo, an Apoplexy, Madness, a Palsy, an Epilepsy, or some sudden Death: and there are many instances of People being found dead in their beds of this Disorder[34].”

The celebrated Boerhaave has mention’d the Night-mare among the principal symptoms of an Apoplexy[35].

In order to illustrate these prognostics by modern instances, I have collected several cases, but shall confine myself to the two following.

CASE I.

A Gentleman, about thirty years old, of a full sanguineous habit, and a little intemperate, was tormented with the Night-mare almost every night for two years. He bled often, which gave him short ease; but was at length seiz’d with an Apoplexy, while he had the glass in one Hand and the pipe in the other, and expir’d immediately.

CASE II.

A Gentleman, about forty-five years old, of a corpulent phlegmatic habit of Body, and an inactive disposition of Mind, complain’d of a vast oppression which he felt in his sleep; upon which he consulted a Physician, who prescrib’d both bleeding and purging, to be repeated as often as it return’d. This prescription was follow’d with success at first, but it became so often necessary, that the patient was not able to bear such evacuations. He therefore was obliged to sleep in a chair all night, to avoid the Night-mare. But one night he ventur’d to bed, and was found half dead in the morning. He continued paralytic two years; and after taking the round of Bath and Bristol, &c. to no purpose, he died an Idiot.

“—D. Abraham Schonnichel, who was a Captain of horse in the Emperor’s army, and being fond of drink, was afflicted with the Night-mare as often as he lay on his Back, after taking many medicines it became less frequent. But when, on account of his intemperance, it return’d, I order’d his Chamberlain to rouse him whenever he heard him groan, in sleep; by which means, the fits were shorten’d, but about two years after he died of an Epilepsy[36].”

Cœlus Aurelianus says[37], that this disease was epidemic and kill’d many at Rome.

As the Romans took little breakfast or dinner, but made supper their principal meal, ’tis probable, that they were very subject to the Night-mare, especially during the Saturnalia, when they held all their repotia or drinking-matches, and indulged themselves in all kinds of intemperance at night.

Galen says, “That the Night-mare is a kind of an Epilepsy, which happens in sleep; and that if it continues long, it will turn to a real Epilepsy[38].”

“An accidental Night-mare is not dangerous; but if it be habitual, it threatens an Epilepsy, Apoplexy, or Melancholy, especially if the Person be subject to a Vertigo in the day-time. If it attacks one between sleeping and waking, it denotes the Epilepsy to be very near; but it is remarkably dangerous, when a cold Sweat, a palpitation of the Heart, a Spasm, or a Fainting fit, succeed it[39].”

“Hoffman mentions the Night-mare among the Symptoms of an Apoplexy, that was cur’d by an over-dose of Camphire[40].”

From these concurring authorities, and the instances that have been given, we have sufficient reason to believe, that the above Diseases often succeed frequent fits of the Night-mare. It is highly probable, that the stagnation of the Blood (which occasions it) in the Pulmonary Veins, right Ventricle, Vena Cava, and the Sinuses of the Brain, may form obstinate obstructions, and leave the rudiments of Polypi in these parts; which may afterwards produce fatal effects. From the situation of the lateral Sinuses, it appears, that in a supine position of the Body, the Blood must move out of them, contrary to its own gravity. Hence, by their turgescence, the Cerebellum may be compress’d, and the animal functions impeded. It was probably to prevent this pressure on the Cerebellum, and to promote the return of the Blood from the Head, that Nature has plac’d these reservoirs in the upper part of the Heads of Quadrupeds.

“If this disorder grows more severe, there is danger of being suffocated in the very fit, and of its producing an Apoplexy or some terrible disorder of the Head, either by pouring Blood into the Ventricles, or substance of the Brain, or by obstructing the Carotid Arteries, or Choroid Plexus: therefore such Diseases are to be prevented by proper methods[41].”

Does not this disease kill many who go to bed in perfect health, and are found dead in the morning? Does not the Night-mare carry many drunkards out of this world? Is it not a species of an Apoplexy? Is it not the final cure of all chronic Diseases?

CHAP VII.

_Of the Cure._

When People are found in a fit of the Night-mare, the most effectual remedy is to rouse them as soon as possible, by changing the position of the Body, and applying some keen stimulus immediately, such as pricking with a pin, speaking loud, &c. and if they recover the least degree of voluntary motion, the happy crisis is for that time obtain’d, as Actuarius and Willis observ’d.

I have often been so much oppress’d by this enemy of rest, that I would have given ten thousand worlds like this for some Person that would either pinch, shake, or turn me off my Back; and I have been so much afraid of its intolerable insults, that I have slept in a chair all night, rather than give it an opportunity of attacking me in an horizontal position.

Doctor Lower relates a remarkable similar case, which I shall here translate. He says, “[42]I knew a Gentleman, who, in every other respect, enjoy’d perfect health, but was so subject to the Night-mare, that, whenever he slept on his Back, he was seiz’d with it in such a violent manner, that he was oblig’d to keep a Servant in the same bed with him; who, upon hearing his Master groan and Sigh (with which Symptoms it us’d to begin) immediately turn’d him on his Side; by which means it was, and may be always, remov’d.”

’Tis observable, that people are rous’d out of a fit of the Night-mare, sometimes, by sound alone. I remember to have been under it, when a Servant came in the morning to make a fire, and let the coal-box fall at the door; the noise of which effectually reliev’d me. The vibrations or undulations of the air beating upon the drum of the Ear, may act as a successful stimulus in this case.

As this Disease seems to arise immediately from a supine position of the Body in sleep, we should take care to prevent it before we fall asleep, by composing the Body on either Side. The sagacious Hoffman observes, that the safest posture in sleep, is on either Side, with the Head rais’d, and the Limbs bent inwards to the trunk of the Body[43].

Some ingenious men have imagin’d, that the bending of the Limbs in sleep is owing to the strong tendency which the flexor Muscles have to contraction; but I humbly suppose, it is rather a voluntary motion, intended to fix the Body on the Side, without the continued action of any of the voluntary Muscles afterwards; for without the flexion of the Joints in sleep, it would be a kind of labour to keep the Body pois’d on such an narrow surface. To demonstrate this, I shall avoid mathematics, and appeal to common sense, for an easy experiment. Suppose one should endeavour to poise a thin plate of tin on its edge upon a smooth, level table; if he be not an expert equilibrist, he will find it difficult; but if he bends the plate, then the problem becomes as easy as the well known method of making an egg stand on its end.

This easy method, which nature has contriv’d to preserve the human Body on its side, is a sufficient recommendation of that position, and a strong precaution against lying on the Back, which is the posture of dead Bodies.

Before any regular or effectual plan of curing, or rather preventing, this Disease, can be propos’d, it will be always necessary to consider minutely the primary or pre-disposing causes of it, formerly mention’d.

If the primary cause be a weakness of the Fibres, then strengthening or astringent medicines are proper; which, by increasing the cohesion of the constituent particles of the Solids, will make the Fibres more dense, brace them up to a proper pitch, and quicken their vibrations. The principal Medicines of this class are iron, and its preparations, the Bark, the wild Valerian-root, and the cold Bath.

If it arises from an inertia or indolence of the Solids, nervous medicines will best answer that indication; which, by stimulating the lazy inactive Fibres, will increase their elasticity, invigorate their contractions, accelerate the motion, and break the tenacity of the Blood.

If the Blood be too thick, attenuants should be us’d, such as, spiritus Mendereri[44], vegetable subacid liquors, saponaceous medicines, and plenty of vinegar at meals, which, according to the great Boerhaave, is a powerful diluent[45].

A Plethora or redundance of Blood, is certainly the most general cause of the Night-mare, and requires immediate evacuations, which principally consist in bleeding or purging. But the former is most effectual. However, Bleeding should not be often repeated, unless absolutely necessary, lest, it should become a custom, which might, at the same time, procure a short intermission, and increase the cause of the Disease; and also prove inconvenient and dangerous; for if, at any establish’d period, Bleeding should be omitted, then the person is expos’d to all the bad effects of a Plethora, enumerated by Boerhaave, viz. Inflammations, Suppurations, Gangrenes and Death[46].

It is well known, that nothing genenerates Blood faster, or contributes more to a Plethora, than bleeding often, which some are fond of, without assigning any reason for it, except its being a custom, which experience proves a very bad one.

Van Sweiten says, “He saw a Woman, who, being subject to violent affections of the Mind, was bled above sixty times in one year. She by that means grew very fat, and increas’d her weight 150 pounds in a few months. By bleeding often new Blood was generated, and the necessity of bleeding became more frequent, ’till she was so far relax’d, that she fell into a Dropsy[47].”

He adds, “That bleeding, which some use by way of precaution, is a bad custom, since it weakens the Solids, and renders the Body more subject to a fresh accumulation of Fluids.”

Experience has convinced me of the truth of this observation; for, while I practis’d bleeding every month or six weeks, I found the Night-mare return’d on me at these periods, rather aggravated than abated. My bad success made me alter my method; and, instead of drawing eight or ten ounces of blood at once, I drew twenty, and liv’d low, on thin, astringent diet, for a few days afterwards; in which time the dilated vessels contracted themselves, and resisted the sudden distension, which taking large quantities of nourishing diet, after plentiful evacuations, must always produce; as our medical Bard justly expresses it,

“Too greedily th’ exhausted Veins absorb The recent Chyle[48].”

By observing Boerhaave’s method of curing a Plethora, viz. using a thin, light diet after bleeding, and gradually prolonging the time between each evacuation, I have reduc’d my bleedings to one every autumn; and (thank Heaven) have in a great measure conquer’d that Monster of the night, which so often threaten’d me with immediate destruction.

Experience also assures us, that large evacuations may be made by strong purges; such as Jalap, Scammon. &c. which greatly dissolve, and diminish the quantity of the Blood.

Hence, we see the reason why Paulus Egeneta justly prescrib’d Scammony in this Disease[49]. But in this kind of evacuations, Boerhaave’s salutary rule should be also observ’d; viz. “Omissione sensim introducta.”

’Tis needless here to take notice of all the ill-adapted farrago of Medicines prescrib’d by many of the old Physicians, who did not know the cause of this Disorder.

I cannot understand why Piony was reckon’d, by them, such a famous specific for the Night-mare, which, taken internally, is only a gentle attenuant: and ’tis very surprising, that Doctor Willis should be so superstitious as to recommend balls made of Piony and Corral to be tied about the Neck, by way of a sacred nostrum against this Disease[50].

Temperate living is certainly the most effectual method of preventing this and many other Disorders. Vegetable and flesh meat of easy digestion; thin, subacid, diluent liquors, taken in moderate quantities; light or no suppers; brisk exercise of all kinds; high pillows, and sleeping on the Side, are the most sovereign Prophylactics, or preventives.

If People subject to the Night-mare be so fond of heavy flesh-suppers, that they can neither rest with them nor without them, they should sup early, and sit up or exercise two or three hours afterwards; and when they go to bed, they should lie on the right Side, that the food may have the advantage of its own gravity in passing out of the Stomach into the Guts. In that position the Heart will fall on the Mediastinum, which, being a flexible Membrane, will be an easier support to the Heart than if it play’d against the hard Ribs, which is always the consequence of lying on the left Side.

When the fair Sex is oppress’d with this Disorder, and the precedent cause is an obstruction of the Catamenia, the defect of that natural discharge may be supply’d by a moderate bleeding; and proper remedies should be us’d to clear the obstructed tubes, and open the flood-gates to promote the ebb of the next full tide. But if the cause be common to both sexes, the same methods may be follow’d, proper allowance being made for the delicacy of the female constitution.

Excessive drinking at night, as well as excessive eating, should be avoided; but of the two evils, the former is the lesser, as our British Celsus observes:

“Tutior autem est in potione, quam in esca, intemperantia[51].”

As intoxication subjects People to most dreadful fits of this Disorder, as well as to many other accidents, it should, by all means, be shun’d. Lucretius has so well painted its bad effects, that, I presume, my polite reader will think his description of it neither tedious nor foreign.

Denique cur, Hominem cum vini vis penetravit Acris et in Venas discessit deditus ardor, Consequitur gravitas membrorum? Præpidiuntur Crura vacillanti? tardescit Lingua? madet mens? Nant Oculi? clamor singultus, jurgia gliscunt? Et jam cætera de genere hoc quæcunq; sequuntur?

Lib. 3.

Besides, when wine’s quick force has pierc’d the Brain, And the brisk heat’s diffus’d thro’ every Vein, Why do the members all grow dull and weak? The Tongue not with its usual swiftness speak? The Eye-balls swim? the Legs not firm and straight, But bend beneath the Body’s natural weight: Unmanly quarrels, noise, and sobs deface The powers of Reason, and usurp their place.

CREECH.

As Nature is the subject of Physic and Poetry, we find, that the sons of Homer and Esculapius generally agree in giving salutary instructions to Mankind; but as the former convey their admonitions in the most agreeable manner, I shall conclude this Essay with two quotations from them.

The first Physicians by debauch were made, Excess began, and sloth sustains the trade: By chace our long-liv’d Fathers earn’d their food, Toil strung their Nerves and purify’d their Blood, &c.

DRYDEN.

Quæ virtus et quanta, boni, sit vivere parvo, (Nec meus hic sermo est, sed quem præcepit Ofellus, Rusticus, abnormis sapiens, crassaque Minerva) Discite, non inter lances, mensasque nitentes; Cum stupet insanis acies fulgoribus, & cum Adclinis falsis animus meliora recusat.

* * * * *

Accipe nunc, victus tenuis quæ, quantaque secum Adferat, imprimis valeas bene: nam variæ res Ut noceant Homini, credas, memor illius escæ Quæ simplex olim tibi sederit, at simul assis Miscueris elixa, simul conchylia turdis; Dulcia se in Bilem vertent, Stomachoque tumultum Lenta ferat pituita. Vides, ut pallidus omnis Cæna desurgat dubia? quin corpus onustum Hesternis vitiis, animumque prægravat una Atque adfigit humo divinæ particulam auræ. Alter, ubi dicto citius curata sopori Membra dedit, vegetus præscripta ad munia surgit.