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ON THE INCUBUS, OR NIGHT-MARE.




  J. M'Creery, Printer,
  Black Horse Court, London.




  A TREATISE ON THE INCUBUS,

  OR

  Night-Mare,
  DISTURBED SLEEP, TERRIFIC DREAMS,
  AND NOCTURNAL VISIONS.

  WITH THE MEANS OF REMOVING THESE
  DISTRESSING COMPLAINTS.


  BY JOHN WALLER,
  SURGEON OF THE ROYAL NAVY.


  LONDON:
  PRINTED FOR E. COX AND SON, ST. THOMAS'S STREET,
  BOROUGH.

  1816.




INTRODUCTION.


The enjoyment of comfortable and undisturbed sleep, is certainly to be
ranked amongst the greatest blessings which heaven has bestowed on
mankind; and it may be considered as one of the best criterions of a
person enjoying perfect health. On the contrary, any disturbance which
occurs in the enjoyment of this invaluable blessing, may be considered a
decisive proof of some derangement existing in the animal economy, and a
consequent deviation from the standard of health. Indeed it is astonishing
how slight a deviation from that standard may be perceived, by paying
attention to the circumstance of our sleep and dreams. This may be more
clearly demonstrated by attending carefully to the state of persons on the
approach of any epidemic fever or other epidemic disease, and indeed of
every kind of fever, as I have repeatedly witnessed; when no other signs
of a deviation from health could be perceived, the patient has complained
of disturbed rest and frightful dreams, with Night-Mare, &c. Hence the
dread which the vulgar, in all ages and countries, have had of what they
call _bad_ dreams; experience having proved to them, that persons,
previously to being attacked with some serious or fatal malady, had been
visited with these kind of dreams. For this reason they always dread some
impending calamity either to themselves or others, whenever they occur;
and, so far as relates to themselves, often not without reason. Frightful
dreams, however, though frequently the forerunners of dangerous and fatal
diseases, will yet often occur when the disturbance of the system is
comparatively trifling, as they will generally be found to accompany every
derangement of the digestive organs, particularly of the stomach, of the
superior portion of the intestinal canal, and of the biliary system.
Children, whose digestive organs are peculiarly liable to derangement, are
also very frequently the subjects of frightful dreams, and partial
Night-Mares; which are frequently distressing enough to them. They are
still more so to grown up people, as they generally arise from a more
serious derangement of the system. Those who are subject to them will
agree with me in opinion, that they are by no means to be ranked amongst
the lesser calamities to which our nature is liable.

There are many persons in the world to whom it is no uncommon occurrence,
to rise from their bed in the morning more wearied and exhausted, both in
mind and body, than when they retired to it the evening before: to whom
sleep is frequently an object of terror rather than comfort, and who seek
in vain for relief from the means usually recommended by Physicians. To
such persons I dedicate this little work; for their information I have
laid down, in as clear terms as the subject will admit, the history of
those diseases, which, by depriving us of the benefit of sleep, and
driving rest from our couch, often render life itself miserable, and lay
the foundation of formidable, and sometimes of fatal diseases. Amongst
those affections which thus break in upon our repose, the most formidable
and the most frequent is the disease called Night-Mare; the history of
which, with its various modifications, I have endeavoured to give with as
much accuracy as possible, and have attempted also to investigate its
nature and immediate causes, as well as to point out the best mode of
obtaining relief. Very little assistance could be obtained in this
undertaking, from the writings of modern Physicians, who have paid little
or no attention to it: those of the sixteenth and seventeenth centuries,
seem to have well understood both its causes and cure, but differed much
amongst themselves respecting its nature, as will ever be the case when
we attempt to reason on any subject which is above our comprehension. I
have availed myself of all the light which these illustrious men could
throw upon the subject, which is not a little; but my principal
information respecting it has arisen from a personal acquaintance with the
disease itself, for a long series of years, having been a victim to it
from my earliest infancy. I have never met with any person who has
suffered to so great an extent from this affection, or to whom it was
become so habitual. To eradicate thoroughly a disease so deeply rooted and
of so long duration, cannot be expected: but I have so far succeeded as to
bring it under great control, and to keep myself free from its attacks for
several months together; or indeed scarcely ever to be disturbed by it
at all, but when I have deviated from those rules which experience has
proved to be sufficient to secure me from all danger of it.

The various kinds of disturbed sleep taken notice of in this little work,
are all so many modifications of Night-Mare, and may be all remedied by
observing the rules here laid down, as they will be found to originate
from one or other of the causes here specified. The regimen and treatment
I have recommended are directed to the root of the disease, that is, to
the hypochondriac or hysteric temperament; for Night-Mare, disturbed
sleep, terrific dreams, &c. may be considered only as symptoms of great
nervous derangement, or hypochondriasis, and are a sure sign that this
disease exists to a great extent. Thus, while the patient is seeking, by
the means recommended, to get rid of his Night-Mare, he will find his
general health improving, and the digestive organs recovering their proper
tone.




THE INCUBUS, &c.


This disease, vulgarly called Night-Mare, was observed and described by
physicians and other writers at a very early period. It was called by the
Greeks, [Greek: ephialtes], and by the Romans, _Incubus_, both of which
names are expressive of the sensation of weight and oppression felt by the
persons labouring under it, and which conveys to them the idea of some
living _being_ having taken its position on the breast, inspiring terror,
and impeding respiration and all voluntary motion. It is not very
surprising that persons labouring under this extraordinary affection,
should ascribe it to the agency of some daemon, or evil spirit; and we
accordingly find that this idea of its immediate cause has generally
prevailed in all ages and countries. Its real nature has never been
satisfactorily explained, nor has it by any means met with that attention
from modern physicians which it merits: indeed it scarcely seems to be
considered by them as a disease, or to deserve at all the attention of a
physician. Those, however, who labour under this affection to any great
degree, can bear testimony to the distress and alarm which it occasions;
in many cases rendering the approach of night a cause of terror, and life
itself miserable, from the dread of untimely suffocation. The little
attention paid to this disease by medical men, has left the subjects of it
without a remedy, and almost without hope. Its nature and its cause have
been altogether misunderstood by those who have lately given any opinion
upon it. It appears a general opinion that it only happens to persons
lying upon the back, and who have eaten large suppers; the causes of it
have consequently been traced to mechanical pressure upon the lungs,
arising from a full stomach; and a change of position, together with the
avoiding eating any supper, has been thought all that was necessary to
prevent its attack. To those, however, who are unfortunately afflicted
with it to any degree, it is well known by experience, that no change of
position, or abstinence, will secure them from the attacks of this
formidable disturber of the night. As I have so long been an unfortunate
victim to this enemy of repose, and have suffered more from its repeated
attacks than any other person I have ever met with, I hope to be able to
throw some light on the nature of this affection, and to point out some
mode of relief to the unfortunate victims of it.

The late Dr. Darwin, who had an admirable talent for explaining the
phenomena of animal life in general, is of opinion, that this affection is
nothing more than sleeping too sound; in which situation of things the
power of volition, or command over the muscles of voluntary motion, is too
completely suspended; and that the efforts of the patient to recover this
power, constitute the disease we call Night-Mare. In order to reconcile
this hypothesis with the real state of things, he is obliged to have
recourse to a method not unusual amongst theoretic philosophers, both in
medicine and other sciences--that is, when the hypothesis does not exactly
apply to the phenomenon to be explained by it, to twist the phenomenon
itself into such a shape as will make it fit, rather than give up a
favourite hypothesis. Now, in order to mould the Night-Mare into the
proper form, to make this hypothesis apply to it, he asserts, first, that
it only attacks persons when very sound asleep; and secondly, that there
cannot exist any difficulty of breathing, since the mere suspension of
volition will not produce any, the respiration going on as well asleep as
awake; so that he thinks there must needs be some error in this part of
the account. Any person, however, that has experienced a paroxysm of
Night-Mare, will be disposed rather to give up Dr. Darwin's hypothesis
than to mistrust his own feelings as to the difficulty of breathing, which
is far the most terrific and painful of any of the symptoms. The dread of
suffocation, arising from the inability of inflating the lungs, is so
great, that the person, who for the first time in his life is attacked by
this "worst phantom of the night," generally imagines that he has very
narrowly escaped death, and that a few seconds more of the complaint would
have inevitably proved fatal. This disease, although neglected by modern
physicians, was well described and understood by those of the seventeenth
century, as well as by the Greeks and Romans.[1] There are few affections
more universally felt by all classes of society, yet it is seldom at
present considered of sufficient consequence to require medical advice. To
those nevertheless who, from sedentary habits, and depraved digestion, are
the most frequent subjects of it, it is a source of great anxiety and
misery, breaking in upon their repose, and filling the mind with constant
alarms for more serious consequences, "making night hideous," and
rendering the couch, which is to others the sweet refuge from all the
cares of life, to them an object of dread and terror. To such persons, any
alleviation of their sufferings will be considered an act of philanthropy;
as they are now in general only deterred from applying to the
practitioners of medicine for relief, from the idea that their case is out
of the reach of medicine.

It is a very well known fact, however, that this affection is by no means
free from danger. I have known one instance in which a paroxysm of it
certainly proved fatal, and I have heard of several others. I do not doubt
indeed but that this happens oftener than is suspected, where persons have
been found dead in their beds, who had retired to rest in apparent health.
I do not know that any late writer has observed a fatal case of
Night-Mare, but we find a circumstance recorded by Coelius Aurelianus, who
is supposed to have lived a short time before Galen, which, if true, is
very remarkable; and I know no reason why it should be doubted. Yet I am
aware that in the age in which we live, it is a common practice, not
merely to doubt, but to contradict every fact recorded by ancient writers,
which, if admitted, would militate against any received theory. Coelius
Aurelianus, however, informs us, upon the authority of _Silimachus_, a
follower of Hippocrates, that this affection was once epidemic at Rome,
and that a great number of persons in that city died of it.[2]

A young man, of sober habits, about thirty years of age, by trade a
carpenter, had been all his life subject to severe attacks of Night-Mare.
During the paroxysm he frequently struggled violently, and vociferated
loudly. Being at Norwich for some business, which detained him there
several weeks, he one night retired to bed in apparent good health;
whether he had eaten supper, or what he had taken previously to going to
bed, or during the day, I cannot now remember. In the night, or towards
morning, he was heard by some of the family in the house where he lodged
to vociferate and groan as he had been accustomed to do during the
paroxysms of Night-Mare; but as he was, after no great length of time,
perfectly quiet, no person went to his assistance. In the morning,
however, it was soon observed that he did not, as usual, make his
appearance, and on some person going into his room, he was found dead,
having thrown himself by his exertions and struggles out of bed, with his
feet, however, still entangled among the bed-clothes. This patient, and
the circumstances attending his death, were very well known to me, and I
have not the least doubt that it was Night-Mare which proved fatal to him.
A similar case has been related to me by a person deserving of credit,
and I do not doubt but they are of more frequent occurrence than is
generally supposed. It may appear surprising to some, that a person should
struggle with so much violence as to throw himself out of bed, and yet not
shake off the Night-Mare, since, in general, it is sufficient to call a
person by his name, and he will recover. This is indeed true in common
cases, and in every case it is of much more service than any exertions
which the patient himself can make. I once at sea, in a paroxysm of
Night-Mare, threw myself out of my cot, and it nearly cost me my life. Had
any person been near to have taken hold of my hand, and have called to me,
I should have been easily recovered, whilst, notwithstanding my struggles,
and the violence with which I fell out of my cot, I lay nevertheless for
some time partly upon a chest, and partly upon the cot, without being able
to recover myself. I cannot help thinking that, but for the violent
motion of the ship (as it was blowing a gale of wind), and the noise from
every thing about me, that paroxysm of Night-Mare would have proved fatal.
The disease had then gained very much upon me, and was at its greatest
height.

Although instances of a fatal termination of this disease may be rare; it
is not so, to find it degenerate into Epilepsy, of which it is frequently
the forerunner, and to which, when it has become habitual, it appears to
bear a great affinity. There is however a great difference in the degree
of danger, between an accidental and an habitual Night-Mare, which we
shall have occasion to notice hereafter.

I shall begin by describing this affection as it most commonly occurs,
pointing out the various degrees and varieties of it, and the persons most
subject to it. Its remote and proximate causes will be the next subject of
consideration, and lastly the means necessary to be pursued for avoiding
it, as well as those likely to afford immediate relief.

This affection has been very elegantly and correctly described both by
physicians and poets. There are two descriptions of the latter kind which
I cannot help placing before the reader; the first is given by the Prince
of Latin Poets; the other by one, (not the least,) of our own country.

  _Ac veluti in somnis, oculos ubi languida pressit
  Nocte quies, nequidquam avidos extendere cursus
  Velle videmur, et in mediis conatibus aegri
  Succidimus; non lingua valet, non corpore notae
  Sufficiunt vires, nec vox aut verba sequuntur._
            VIRGIL. _AEneid. Lib. xii. v. 909. et sequent._

  In broken dreams the image rose
  Of varied perils, pains, and woes;
  His steed now flounders in the brake,
  Now sinks his barge upon the lake;
  Now leader of a broken host,
  His standard falls, his honour's lost.
  Then--from my couch may heavenly might
  Chase that worst phantom of the night!
            LADY OF THE LAKE, Canto 1. xxiii.

In tracing out the symptoms and mode of attack, I shall particularize
those symptoms which I have experienced in my own person, and take notice
likewise of those described by other writers on the subject.

First then, this disease attacks always during sleep. This is a truth of
which I am now well assured, although frequently the evidence of my senses
has apparently produced a contrary conviction. Whatever may be the
situation of the patient at the moment previous to the invasion of the
disease, he is at that moment asleep, although the transition from the
waking to the sleeping state may be so rapid as to be imperceptible. I
will explain this part of the subject more fully by and by, at present we
will assume the fact, and proceed to enumerate the symptoms. If the
patient be in a profound sleep, he is generally alarmed with some
disagreeable dream; he imagines that he is exposed to some danger, or
pursued by some enemy which he cannot avoid; frequently he feels as
though his legs were tied, or deprived of the power of motion; sometimes
he fancies himself confined in some very close place, where he is in
danger of suffocation, or at the bottom of a cavern or vault from which
his return is intercepted. It will not unfrequently happen, that this is
the whole of the sensation which the disease, for the time, produces, when
it goes off without creating any further annoyance: the patient either
falls into an oblivious slumber, or the alarming dream is succeeded by one
more pleasant. In this case the disease is not fully formed, but only
threatens an invasion; it proves however that the pre-disposition to it
exists, and that the person is in danger of it. But when the paroxysm does
actually take place, the uneasiness of the patient in his dream rapidly
increases, till it ends in a kind of consciousness that he is in bed, and
asleep; but he feels to be oppressed with some weight which confines him
upon his back and prevents his breathing, which is now become extremely
laborious, so that the lungs cannot be fully inflated by any effort he can
make. The sensation is now the most painful that can be conceived; the
person becomes every instant more awake and conscious of his situation: he
makes violent efforts to move his limbs, especially his arms, with a view
of throwing off the incumbent weight, but not a muscle will obey the
impulse of the will: he groans aloud, if he has strength to do it, while
every effort he makes seems to exhaust the little remaining vigour. The
difficulty of breathing goes on increasing, so that every breath he draws,
seems to be almost the last that he is likely to draw; the heart generally
moves with increased velocity, sometimes is affected with palpitation; the
countenance appears ghastly, and the eyes are half open. The patient, if
left to himself, lies in this state generally about a minute or two, when
he recovers all at once the power of volition: upon which he either jumps
up in bed, or instantly changes his position, so as to wake himself
thoroughly. If this be not done, the paroxysm is very apt to recur again
immediately, as the propensity to sleep is almost irresistible, and, if
yielded to, another paroxysm of Night-Mare is for the most part
inevitable.

Where the Disease has not established itself by very frequent recurrence,
the patient generally feels little inconvenience from it when thoroughly
awoke; but where it is habitual, there will generally be felt some
confusion in the head, with singing in the ears, a sense of weight about
the forehead, and, if in the dark, luminous _spectra_ are frequently seen,
such as appear to persons who immediately after gazing on a strong light,
close their eyes. The pulse, I believe, will in all instances be found to
be considerably accelerated; in my own case the motion of the heart
amounts almost to a palpitation.

I do not find this symptom taken notice of by any writer on the subject,
excepting Etmuller, whose accuracy in tracing the history of every disease
allowed no symptom to escape him. When reasoning on the phenomena which
this affection exhibits, "_et cum etiam simul sub respirationis defectu
imminuta plus minus evadat sanguinis circulatio, ob id ab eodem infarcti
pulmones anxietatem insignem praecordiorum inducunt: sicut dum evigilant
tales aegri, cor insignitur palpitat, quod testatur motum
convulsivum_."--This palpitation of the heart grows stronger in proportion
to the length of the paroxysm, or the difficulty the patient finds in
waking himself.

There is, however, another symptom, which, as far as I am able to learn,
is very frequent, though not noticed by medical writers. (_Scilicet._)
_Priapismus interdum vix tolerabilis et aliquamdiu post paroxysmi
solutionem persistens._ I have noticed this symptom here, as I intend
presently to draw some inference from it. A sense of weight at the
stomach, and an unpleasant taste in the mouth will generally be found to
remain after the paroxysm, though seldom noticed, as it is not suspected
to have any connexion with the Night-Mare.

These are the most ordinary symptoms, and such as generally happen in
almost all paroxysms of Night-Mare; there are, however, other symptoms
which occasionally occur, and which sometimes cause no small alarm to the
patient. It frequently happens too, that the paroxysm goes off without the
patient waking, and in that case is productive of strange hallucination to
the person who is not accustomed to these paroxysms. It is by no means an
uncommon thing for the person labouring under Night-Mare to see, or at
least to imagine that he sees, some figure, either human, or otherwise,
standing by him, threatening him, or deriding, or oppressing him. This
circumstance has been productive of considerable misapprehensions and
mistakes, not only with persons of weak minds, but likewise with those
whose intellectual faculties have been greatly improved.--These visions
are various, as are likewise the senses which become thus hallucinated;
not only the sight, but the hearing, and the touch, are frequently imposed
on. These hallucinations have so often occurred to myself, that they have
long been rendered quite familiar, although they are still sometimes
productive of very laughable mistakes. As they are more frequently,
however, of the terrific cast, they act very powerfully on the minds of
those who are not acquainted with them, and produce terrors which I verily
believe sometimes prove fatal. I shall give some instances of these kinds
of visions which I have had from the most indubitable authority, and I do
not doubt but that many readers will find in their own recollections a
number of circumstances apparently incredible, which will easily admit
of the same solution. I must first premise, that the degree of
consciousness during a paroxysm of Night-Mare is so much greater than ever
happens in a dream, that the person who has had a vision of this kind
cannot easily bring himself to acknowledge the deceit, unless, as often
happens, he wakes out of the paroxysm, and finds himself in a very
different place to what he must have been in for such a transaction to
have occurred. When however, all the circumstances of time and place
concur with the vision, which sometimes happens, and the patient does not
wake in the paroxysm, but continues asleep for some time after, the
transactions which occurred during the paroxysm of Night-Mare, and those
of the dreams which took place during profound sleep are so very different
as to the impression they have left on the sensorium, that there is no
possibility of confounding them with one another. Indeed I know no way
which a man has of convincing himself that the vision which has occurred
during a paroxysm of Night-Mare, (if it be consistent in point of time and
place,) is not real, unless he could have the evidence of other persons to
the contrary who were present, and awake at the time, or that these
hallucinations were rendered familiar to him by frequent repetition. I
shall mention some circumstances here, which have occurred to myself and
to others, which will place this subject in a clearer point of view.

The first case of this kind which I shall relate, I had from the mouth of
a person of undoubted veracity, who never understood the nature of the
hallucination; but who, to the day of his death, was convinced that he had
received a supernatural visitation.

Mr. T----, a dissenting minister, was on a journey in Suffolk, and slept
at the house of a friend. He was desired by the master of the family not
to disturb himself in the morning till he was called