A Treatise on the Incubus, or Night-Mare, Disturbed Sleep, Terrific Dreams and Nocturnal Visions

I am aware however of the obscurity and difficulty of this subject itself, as well as the difficulty of expressing in accurate language, the ideas which arise in my own mind concerning it. I have used the term paralysis in speaking of the state of the diaphragm and other muscles during the paroxysm of Night-Mare; this expression however, must be understood in a different manner from that in which it is usually applied in medicine; for in Night-Mare there remains always a consciousness of the inability to move the muscles, and constant attempt at the same time to move them; this appears to be as constantly impeded by some external force acting against the efforts of the will: thus, when my hand and arm are lying uncovered, and in a position which easily admits of moving it, I am able, by repeated exertions, at length to raise it and bring it to my head, but the effort which it requires is equal to what in the waking state, would raise a covering, which might be laid over it, of twenty pounds weight: should a part of the sheet, or even a handkerchief be lying over the arm thus situated, the difficulty would be greatly increased; and the operation, if effected, would so much exhaust me, that I should be obliged to desist for some time from any further struggling, and the respiration at the same time would be greatly accelerated. Nothing of this kind occurs in paralysis, properly so called; for the patient is not even able to direct any effort of the will to the paralyzed muscles, and frequently is scarcely conscious of their existence. These two kinds of paralysis evidently differ considerably from one another, and ought not to be expressed by the same term.

In giving my opinion of the causes of Night-Mare, I feel still more embarrassed for proper terms to express my ideas, than in explaining its nature. I have already said, that I conceived the ancient physicians to be well acquainted both with its nature, cause, and mode of cure; it might be well to take some notice here of their opinions, especially as to the causes which produce the disease, and the means by which it may be removed, as these two things depend in a great measure on one another. In order to render these opinions understood by those who have never read any of the ancient writers of medicine, from a mistaken idea of their not being worth the reading, I must premise, that they considered the nerves to be the conductors of a certain subtile fluid, by means of which the muscles are made to contract, and all the animal functions are performed; this they denominated the animal spirits, and were of opinion that it was secreted from the blood by the brain. This secretion they supposed, like all the other secretions, could only be pure, when the blood from which it was formed was healthy and proper; and that the goodness and purity of this latter fluid depended on its being elaborated by healthy organs out of proper materials. Consequently, that good blood could never be formed out of an unwholesome diet, nor even out of the most wholesome food badly digested. This induced them to pay great attention to the state of the digestive organs, and to the diet of patients, and their observations led to these conclusions; 1st. That the half digested, or ill digested food, furnished a smaller proportion of good blood than nature required, but a large proportion of excrementitious, half digested matter: 2ndly. That some portion of this matter would be taken up by the lacteal vessels into the circulation, and deprave the blood, and consequently all the secretions, more or less: 3dly. That different kinds of humors resulted from this condition of the digestive organs; the principal of which, and the only one we have here to deal with, is the pituitous humor, of which they enumerated several kinds, and to the presence of which they attributed most of the diseases of the human body. That kind of Pituita, to which most of the ancient physicians attributed the production of Night-Mare and deranged sleep, was called the Pituita Acida, which was found to be generated in great abundance in the stomachs and intestines of all patients subject to Night-Mare: this was supposed to enter into the circulation, and to cause some derangement in the functions of the nerves and animal spirits, by obstructing the free motion of the latter, and rendering the former bad conductors. They had various opinions respecting the manner in which this obstruction was effected, and also as to the part where it took place; some making the brain the seat of this affection, others the lungs and diaphragm. But without entering into the merits of their respective theories, we shall pass on to their ideas of the indication of cure. I cannot however pass over this part of the subject without noticing Willis’s opinion of it, and the ingenious hypothesis by which he attempts to explain this difficult subject. There are few physicians who have left so splendid a monument of talents, learning, and industry, for the admiration of posterity, as Willis has done; and although an English physician, and flourishing in the British court, there is no country in Europe in which his works are less known and admired than in that in which they were published. In his work de anima brutorum, of which no man will ever repent the reading, he treats of this disease in a distinct chapter, cap. vi. and places the seat of it in the cerebellum. The following short extract will give some idea of his hypothesis:

“Quamobrem Ephialtis paroxysmum induci putamus, quatenus inter dormiendum, una cum succo nerveo, materies quædam incongrua cerebello instillata, quæ spiritus in prima scaturigine torporem, sive narcosin quandam inducens, eos mox a functionum suarum muniis paululum cessare cogit, proinde ut ab altero velut lethargo intra cerebellum excitato, actiones vitales eclipsin brevem patiantur; qua durante, partim a præcordiorum obstrictorum lucta, partimque a sanguine in iis plurimum aggesto, et stagnante, gravamen istud, ac velut molis incumbentis, sensus infertur; deinde quoniam cæteræ omnes totius corporis facultates a cordis motu dependent, idcirco hoc impedito, et suppresso, illæ statim deliquia, aut inordinationes subeunt, præsertim vero quià sanguinis in cerebrum, pro spirituum animalium fomite, effluxus interrumpitur, propterea mox horum effluxus in systema nervosum supprimitur, adeo ut laborantes, dum pectoris molem imaginariam excutere satagunt, nec corpus nec membrum aliquod movere possint; nimirum quia spirituum (donec sanguinis affluxu destituuntur) irradiatio in partes motrices inhibetur: interim qui in cerebro resident, huc, illuc, lati, phantasmata confusa, et ex molestia a præcordiis impressa, horrenda spectorum insomnia concipiunt.”

It appears evident, from the mode of treatment to which this disease gives way, that the primary cause, in whatever manner it may act, has its seat in the digestive organs; nor can any difference, or even error, in explaining its modus agendi, in any manner invalidate this doctrine. The ancient physicians seem tolerably well to agree on this point, and consider Night-Mare as a species of epilepsy, arising from a superabundance of acid humor in the primæ viæ, and their treatment was entirely directed to the evacuation and correction of that humor. If they were mistaken in their pathological ideas of this affection, they were at all events successful in their treatment; and it was usually their practice to reason from the cure to the cause of a disease, a safe mode of reasoning in medicine. Experience had taught them that a long train of diseases originated from this cause, and a little observation will suffice to convince any man, unprejudiced by medical theories, that Night-Mare originates from no other cause than a defect in the digestive process, whereby the food, which should be converted into good chyle, is transformed into a half-digested mass of acid matter, which is productive of heart-burn, acid eructations, flatulence, and intolerable gripings, with the whole train of dyspeptic and hypochondriacal symptoms. There are many stomachs which convert every thing they receive instantly into an acid, and such will be generally found to be the case with persons subject to habitual Night-Mare, or frightful dreams, and disturbed sleep. Such stomachs too are frequently distended with some acid gas, and I have often found the paroxysm of Night-Mare to be the consequence of this distension alone, and to be immediately removed by any thing which would dispel the gas, such as a glass of peppermint cordial, or gin, or any carminative medicine. A medical gentleman in Norfolk, who laboured under an inveterate disease of the digestive organs for several years, which in the end proved fatal, was dreadfully tormented by the most pertinacious paroxysms of Night-Mare, which threatened suffocation, had recourse to a solution of Ammonia in warm water, which he always drank when the paroxysms of Night-Mare began to disturb him; for whenever they did begin, they always continued to torment him, every time he fell asleep. The success of this plan very far exceeded his expectations. The immediate effect of the medicine was to send up a great quantity of wind from the stomach, which was succeeded by a profuse perspiration, and tranquil, undisturbed sleep.

I have always found, in my own case, that Night-Mare was accompanied with distension of the stomach and bowels by flatus, constipation, and acid eructations.

In this state of things every thing which is eaten or drank becomes instantly acid; and even the saliva in the mouth, I have often observed to have an acid taste. I have made repeated inquiries of others who were habitually subject to Night-Mare, and have always found them to be complaining of the same symptoms, although they had no idea that these were any way connected with the disease in question. A closer examination into the state of my own health, soon convinced me that my Night-Mare, which was become so alarming as to induce the greatest fear of epilepsy, was altogether depending on the state of dyspepsia under which I was labouring, and which was always greatly increased by remaining at sea, until at length it incapacitated me for my duty; attacking me in the daytime, affecting my memory, and threatening the most serious consequences. Under these circumstances I was twice invalided, and on retiring into the country, in a few months recovered my health, so that the Night-Mare, which was before habitual, and made its attacks whenever I went to sleep, was now become in a measure accidental, and depending upon causes more within my command. It was still however very severe, and returned on the slightest degree of irregularity of living, and on going to sea again, became worse than ever, accompanied with severe palpitations of the heart, and great irregularity in the pulse. It was under these circumstances that I began first to pay attention to that acidifying principle which I found to exist in the organs of digestion, and to try upon myself the effects of those remedies which have proved so successful in combating this monster, that has so long proved the enemy of my repose.

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.