MORBID DREAMS.

Morbid or pathological dreams are divided by Macario[85] into three classes: the prodromic, or those which precede diseases; the symptomatic, or those which occur in the course of diseases; and the essential, or those which constitute the main features of diseases. As this classification is natural and simple, I propose to follow it in the remarks I shall have to make on the subject.

Prodromic Dreams.—There appears to be no doubt that diseases are sometimes preceded by dreams which indicate with more or less exactitude the character of the approaching morbid condition. Many instances of the kind which have been reported—especially by the earlier authors—are, however, in all probability merely coincidences; and in others the relation between the character of the dream and that of the disease is by no means clear.

Many cases of dreams indicating the nature of a malady which had not yet developed itself are referred to by Macario.[86] The instance of Galen’s patient, who dreamed that his leg had become converted into stone, and who was soon afterward paralyzed in that member, has already been cited.

The learned Conrad Gesner dreamed that he was bitten in the left side by a venomous serpent. In a short time a severe carbuncle appeared on the identical spot, and death ensued in five days.

M. Teste, formerly minister of justice and then of public works under Louis Philippe, and who finally died in the Conciergerie, dreamed three days before his death that he had had an attack of apoplexy. Three days afterward he died suddenly of that disease.

A young woman saw in a dream objects apparently confused and dim as through a thin cloud, and was immediately thereafter attacked with amblyopia, and threatened with loss of sight.

A woman, who had been under the care of M. Macario, dreamed at about the period of her menstrual flow that she spoke to a man who could not answer her, for the reason that he was dumb. On awaking she discovered that she had lost her voice.

Macario himself dreamed one night that he had a severe pain in his throat. On awaking he felt very well; but a few hours subsequently was attacked with severe tonsillitis.

Arnold, of Villanova, dreamed that a black cat bit him in the side. The next day a carbuncle appeared on the part bitten.Dr. Forbes Winslow[87] gives several similar instances. A patient had, for several weeks before an attack of apoplexy, a series of frightful dreams, in one of which he imagined he was being scalped by Indians. Others dreamt of falling down precipices, and of being torn to pieces by wild beasts. One gentleman dreamed that his house was in flames, and that he was gradually being consumed to a cinder. This occurred a few days before an attack of inflammation of the brain. A person, prior to an attack of epilepsy, dreamt that he was severely lacerated by a tiger; and another, just before a seizure, dreamt that he was attacked by murderers, and that they were knocking out his brains with a hammer.

A barrister, for several years before an attack of cerebral paralysis, was in the habit of awaking from sleep in a condition of great alarm and terror without being able to explain the reason for his apprehension. Dr. Beddoes attended a patient whose first fit succeeded a dream of being crushed by an avalanche.

Gratiolet[88] cites additional examples. Thus, Roger d’Oxteryn, Knight of the Company of Douglas, went to bed in good health. Toward the middle of the night, he saw in a dream a man affected with the plague and entirely naked, who attacked him with fury, threw him to the ground after a severe contest, and, holding him between his thighs, vomited into his mouth. Three days afterward he was seized with the plague and died. He also alludes to a case detailed by Gunther, in which a woman dreamt that she was being flogged with a whip, and on awaking found that she had marks on her body resembling the scars made by the lash.

The existence of diseases of the heart and larger vessels is often revealed by frightful dreams when there is no other evidence of their presence. Macario states that a young lady was under his care in whom violent palpitations of the heart were preceded by painful dreams. She subsequently died of disease of the heart.

Moreau (de la Sarthe),[89] in a very elaborate treatise on dreams, relates the case of a French nobleman, whom he had attended during several months for threatened chronic pericarditis, and who was at first tormented every night by painful and frightful dreams. These dreams, attracting attention, gave the earliest indication of the real condition, and excited fears as to the result, which were soon verified.

He cites another case in illustration of the fact that periodical hemorrhages are sometimes preceded by morbid dreams. A physician had, in his youth, been subject to periodical hemorrhages, but without dreams or other trouble during sleep. As he advanced in years, the hemorrhages were not so frequent, but were always preceded by a condition of general irritation, characterized during wakefulness by heat of skin and frequency of the pulse, and during sleep by painful dreams. These dreams almost always related to violent actions, such as giving and receiving heavy blows, walking on a volcano, or being precipitated into lakes of fire.

Many cases of insanity being preceded by frightful dreams are on record. Falret,[90] in calling attention to the remarkable analogy which exists between mental alienation and dreams, says that it is an incontestable fact that insanity is often preceded by significant dreams, and that these constitute the whole essence of the disorder by becoming firmly fixed in the patient’s mind. Thus, he relates that Odier of Geneva was consulted in 1778 by a lady, who, during the night preceding the outbreak of her insanity, dreamed that her step-mother approached her with a dagger in order to kill her. This dream made so strong an impression upon her that she ultimately accredited it as true, and thus became the victim of a delusion which rendered her a lunatic. He declares that numerous similar instances have come under his observation, and refers to the case of a young lady, subject to periodical attacks of mental derangement, whose paroxysms are always preceded by notable dreams.Morel[91] affirms that many patients before becoming completely insane have frightful dreams, which they regard as evidences that they are about to lose their reason. Sometimes they are afraid to go to sleep on account of the terrifying apparitions which then visit them.

The following cases, related by Dr. Forbes Winslow,[92] are interesting in this connection:

“A gentleman, who had previously manifested no appreciable symptoms of mental disorder, or even of disturbed and anxious thought, retired to bed apparently in a sane state of mind. Upon arising in the morning, to the intense terror of his wife, he was found to have lost his senses! He exhibited his insanity by asserting that he was going to be tried for an offense which he could not clearly define, and of the nature of which he had no right conception. He declared that the officers of justice were in hot pursuit of him,—in fact, he maintained that they were actually in the house. He begged and implored his wife to protect him. He walked about the bed-room in a state of great agitation, apprehension, and alarm, stamping his feet, and wringing his hands in the wildest agony of despair. Upon inquiring into the history of the case, his wife said that she had not observed any symptoms that excited her suspicions as to the state of her husband’s mind, but upon being questioned very closely, she admitted that during the previous night he appeared to have been under the influence of what she considered to be the nightmare, or a frightful dream. While apparently asleep he cried out several times, evidently in great distress of mind, ‘Don’t come near me!’ ‘Take them away!’ ‘Oh, save me; they are pursuing me!’ It is singular that in this case the insanity which was clearly manifested in the morning appeared like a continuation of the same character and train of perturbed thought that existed during his troubled sleep when, according to the wife’s account, he was evidently dreaming.”

Dr. Winslow’s second case is equally to the point: “I am indebted to a medical friend for the particulars of the following case. During the winter of 1849 he was called to see H. B., about five or six o’clock in the morning. The patient was the wife of a tailor and mother of three children. At this time she was rather emaciated and debilitated in bodily health, and anemic in appearance. She was of a religious turn of mind, and belonged to the Wesleyan persuasion. On the morning of the narrator’s visit, he found the woman in a state of great mental excitement and under the influence of hallucinations. She had gone to bed apparently well, but during the night was the subject of a vivid dream, imagining that she saw her sister, long since dead and to whom she was much attached, suffering the pains of hell. When quite awake, no one could persuade her that she had been under the influence of an agitated dream. She stoutly persisted in maintaining the reality of her vision. During the whole of that day she was clearly insane; but on the following morning her mind appeared to have recovered its balance. She continued tolerably well, mentally, for four years, with the exception of her occasionally having moments of despondency arising from real or fancied troubles.” * * *

The further particulars of this case, relating as they do to another division of the subject,—“sleep-drunkenness,” as the Germans designate it,—will be considered under that head.

Without pretending to indorse all the conclusions of Albers,—as set forth in the following summary, and which I quote from a very learned and philosophical writer,[93]—there is no doubt that some of his dicta are well founded.

“Lively dreams are in general a sign of the excitement of nervous action.

“Soft dreams are a sign of slight irritation of the head; often in nervous fevers announcing the approach of a favorable crisis.

“Frightful dreams are a sign of determination of blood to the head.“Dreams about fire are in women signs of an impending hemorrhage.

“Dreams about blood and red objects are signs of inflammatory conditions.

“Dreams about rain and water are often signs of diseased mucous membranes and dropsy.

“Dreams of distorted forms are frequently a sign of abdominal obstructions and diseases of the liver.

“Dreams in which the patient sees any part of the body especially suffering, indicate disease in that part.

“Dreams about death often precede apoplexy, which is connected with determination of blood to the head.

“The nightmare (incubus ephialtes), with great sensitiveness, is a sign of determination of blood to the chest.”

A very interesting paper on dreaming, by Dr. Thomas More Madden,[94] has been recently published, and from it I make the following extract:

“Intermittent fever is often announced, several days before any of the recognized symptoms set in, by persistent dreams of terrifying character. I have experienced this in my own person, and heard it confirmed by other sufferers on the African Coast. The following case of morbid dreaming ushering in yellow fever, I subjoin in the words of the gentleman to whom it occurred, himself a medical man holding a high official position on the Gold Coast where it occurred.

“‘In the early part of 1840, I was an inmate of Cape Coast Castle, and as some repairs were then being made in the castle, the room assigned to me was that in which the ill-fated L. E. L. (Mrs. Maclean), the wife of the governor of Cape Coast, had been found dead, poisoned by prussic acid, not very long previously. I had known her in London, and had been intimately acquainted with her history and much interested in it. Her body had been found on the floor near the door and in front of a window. After a fatiguing excursion to some of the adjoining British settlements on the Coast, having retired to rest, I awoke disturbed by a dream of a very vivid character, in which I imagined that I saw the dead body of the lady who had died in that chamber lying on the floor before me. On awaking the image of the corpse kept possession of my imagination. The moon was shining brightly into the part of the room where the body had been found, and there, as it seemed to me on awaking, it lay pale and lifeless as it appeared to me in my dream.

“‘After some minutes I started up, determined to approach the spot where the body seemed to be. I did so, not without terror, and walking over the very spot on which the moon was shining, the fact all at once became evident and obvious that no body was there—that I must have been dreaming of one. I returned to bed, and had not long fallen asleep when the same vivid dream recurred; the same waking disturbance occurring while awake. As long as I lay gazing on the floor I could not dispossess my mind of that appalling vision; but when I started up and stood erect it vanished at the first glance.

“‘Again I returned to bed, dozed, dreamt again of poor L. E. L.’s lamentable end, and of her remains in the same spot; again awoke, and arose with the same strange results.

“‘There was no more disturbance that night of which, at least, I was conscious, but when morning came fever was on me in unmistakable force in its worst form, and partial delirium set in the same night. I was reduced to the last extremity about the third or fourth night of my illness, when a conviction seized on my mind that it was absolutely essential to my life that I should not pass another night in Cape Coast Castle. I caused the negro servant I had fortunately brought out with me from England to have a litter prepared for me at dawn, and stretched on this litter, hardly able to lift hand or foot, I was carried out of my bed by four native soldiers, and was conveyed to the house of a merchant, and countryman of mine, to whose care and kindness I owe my life. So much for a visionary precursor of fever on the west coast of Africa.’

“In neuralgia, disturbed dreaming is occasionally a prominent symptom. In an obscure case I was led to make what I believe to be a true diagnosis from the indications furnished by the patient’s dreams. The individual in question is a man, aged about 45, of an anemic habit, confined by a sedentary occupation, who, for many years, had suffered from hemicrania, which lately had become more intense, and the intervals shorter. A couple of days before the attack his sleep becomes broken by unpleasant dreams, and when the paroxysm has attained its height, he invariably dreams that he is the helpless victim of a persecutor, who finishes a series of torments by driving a stake through his skull. During his recovery from each attack, he states that his dreams are of a most agreeable character, though so vague that he cannot give any account of them. The frequent repetition of his dreams leads me to conclude that there is some osseous growth within the cranium, and that the vascular distention accompanying the neuralgic attack occasions pressure upon this, giving rise to the sensation I have referred to, while the subsequent feeling of comfort results from that pressure being removed.”

A case has been recently published[95] in which the dream immediately preceded, or perhaps even accompanied, the morbid action. A German, aged 45, of a nervo-sanguineous temperament, went to bed at 11 P. M., feeling as well as usual. Between 12 and 1 o’clock he dreamed that he saw his child lying at his side, dead. He was very much frightened, and at once awoke, to find that his tongue was paralyzed, and that he could not talk. The faculty of speech and the ability to move the tongue remained impaired for four months.

For several years past I have made inquiries of patients and others relative to their dreams, and have thus collected a large amount of material bearing upon the subject. With reference to the point under consideration, the data in my possession are exceedingly important and interesting. Among the cases which have come under my observation of diseases being preceded by morbid dreams, are the following:

A gentleman, two days before an attack of hemiplegia, dreamed that he was cut in two exactly down the mesial line, from the chin to the perineum. By some means union of the divided surfaces was obtained, but he could only move one side. On awaking, a little numbness existed in the side which he had dreamed was paralyzed. This soon passed off, and ceased to engage his attention. The following night he had a somewhat similar dream, and the next day, toward evening, was seized with the attack which rendered him hemiplegic.

Another dreamed one night that a man dressed in black and wearing a black mask came to him and struck him violently on the leg. He experienced no pain, however, and the man continued to beat him. In the morning he felt nothing, with the exception of a slight headache. Nothing unusual was observed about the leg, and all went on well, until on the fifth day he had an apoplectic attack, accompanied with hemiplegia, including the leg which he had in his dream imagined to have been struck.

A lady, aged forty, who had been a great sufferer from rheumatism for many years, dreamt one afternoon, while sitting in her chair in front of the fire, that a boy threw a stone at her, which, striking her on the face, inflicted a very severe injury. The next day violent inflammation of the tissues around the facial nerve as it emerges from the stylo mastoid foramen set in, and paralysis of the nerve followed, due to effusion of serum, thickening, and consequent pressure.

A young lady dreamt that she was seized by robbers and compelled to swallow melted lead. In the morning she felt as well as usual, but toward the middle of the day was attacked with severe tonsillitis.

A young man informed me that a day or two before being attacked with acute meningitis, he had dreamed that he was seized by banditti while traveling in Spain, and that they had taken his hair out by the roots, causing him great pain.

A lady of decided good sense had an epileptic seizure, which was preceded by a singular dream. She had gone to bed feeling somewhat fatigued with the labors of the day, which had consisted in attending three or four morning receptions, winding up with a dinner party. She had scarcely fallen asleep, when she dreamed that an old man clothed in black approached her, holding an iron crown of great weight in his hands. As he came nearer, she perceived that it was her father, who had been dead several years, but whose features she distinctly recollected. Holding the crown at arm’s length, he said: “My daughter, during my lifetime I was forced to wear this crown; death relieved me of the burden, but it now descends to you.” Saying which, he placed the crown on her head and disappeared gradually from her sight. Immediately she felt a great weight and an intense feeling of constriction in her head. To add to her distress, she imagined that the rim of the crown was studded on the inside with sharp points which wounded her forehead, so that the blood streamed down her face. She awoke with agitation, excited, but felt nothing uncomfortable. Looking at the clock on the mantle-piece, she found that she had been in bed exactly thirty-five minutes. She returned to bed and soon fell asleep, but was again awakened by a similar dream. This time the apparition reproached her for not being willing to wear the crown. She had been in bed this last time over three hours before awaking. Again she fell asleep, and again at broad daylight she was awakened by a like dream.

She now got up, took a bath, and proceeded to dress herself with her maid’s assistance. Recalling the particulars of her dream, she recollected that she had heard her father say one day, that in his youth, while being in England, his native country, he had been subject to epileptic convulsions consequent on a fall from a tree, and that he had been cured by having the operation of trephining performed by a distinguished London surgeon.

Though by no means superstitious, the dreams made a deep impression upon her, and her sister, entering the room at the time, she proceeded to detail them to her. While thus engaged, she suddenly gave a loud scream, became unconscious, and fell upon the floor in a true epileptic convulsion. This paroxysm was not a very severe one. It was followed in about a week by another; and, strange to say, this was preceded as the other by a dream of her father placing an iron crown on her head and of pain being thereby produced. Since then several months have elapsed, and she has had no other attack, owing to the influence of the bromide of potassium which she continues to take.

In the case of a gentleman now under my treatment for epilepsy, the fits are invariably preceded by dreams of difficulties of the head, such as decapitation, hanging, perforation with an auger, etc.

A lady, previous to an attack of sciatica, dreamed that she had caught her foot in a spring-trap, and that before she could be freed it was necessary to amputate the member. The operation was performed; but as she was released, a large dog sprang at her and fastened his teeth in her thigh. She screamed aloud and awoke in her terror. Nothing unusual was perceived about the leg; but, on getting up in the morning, there was slight pain along the course of the sciatic nerve, and this before evening was developed into well-marked sciatica.

Insanity is frequently preceded by frightful dreams, and I have advanced several examples to this effect from the experience of others. We should naturally expect that very often the first manifestations of a diseased brain should appear during sleep. But dreams are of such a varied character, and so thoroughly irreconcilable with the normal mental phenomena of the wakeful state, that it is difficult to say that such or such a dream is evidence of a diseased mind. As, in some of the cases I have brought forward, a dream may take so firm a hold of the reason as to be the exciting cause of insanity, and not simply a sign of its approach, I am disposed, from my own experience, to regard the frequent repetition of the same dream as often indicative of a disordered mind, when very close observation would fail to reveal other evidences. There are, however, exceptions to this statement, as has been shown in the previous chapter.

Several cases, in which insanity was preceded by terrifying dreams, have come under my observation. In one of them a lady dreamed that she had committed murder, under circumstances of great atrocity. She cut up the dead body, but could not, with all her efforts, divide the head, which resisted her blows, with an axe and other instruments. Finally she filled the nose, eyes, and mouth with gunpowder, and applied a match. Instead of exploding, smoke issued slowly from the orifices of the skull, and was resolved into a human form, which turned out to be that of a police officer sent to arrest her. She was imprisoned, tried, and sentenced to execution, by being drowned in a lake of melted sulphur. While the preparations were being made for the punishment she awoke. She related the particulars of her dream to several friends, but it apparently made no great impression on her mind. The next night she dreamed of somewhat similar circumstances, and for several nights subsequently. On the sixth day, without any premonition, she attempted to kill herself by plunging a pair of scissors into her throat, and since that time to her death, which took place a few months subsequently, was constantly insane.

In this case there was no direct analogy between the character of her dream and the type of insanity which ensued. It cannot, therefore, be said that the dream produced the mental aberration. On the contrary, the dream was in all probability the first evidence of deranged cerebral action,—a condition which subsequently became developed into positive insanity.

The following case is similar to the foregoing in its general features:A gentleman who had been unfortunate in some business speculations, shortly afterward became insane. Previous to this event he was troubled with frightful dreams, which gave him a great deal of annoyance, and frequently caused him to awake in terror. One of them occurred several times, and was of the following character. He dreamed that he was engaged to be married to a lady of beauty and wealth, and who was, moreover, possessed of great musical talent. One evening, as he in his dream was paying her a visit, she placed herself at the piano and began to sing. He remarked that he did not admire the piece of music she was singing, and asked her to sing something else. She indignantly refused. Angry words followed, and in the midst of the dispute she drew a dagger from her bosom and stabbed herself to the heart. As he rushed forward, horror-struck, to her assistance, her friends entered the room, and found him with the dagger in his hand. He was accused of murdering the lady, and, notwithstanding his protestations of innocence, was tried, found guilty, and sentenced to be hung. He always awoke at the point when preparations were being made for his execution.

A dream may make such a strong impression on the mind as to subsequently constitute the essential feature of the insane condition. This point has already been elucidated to some extent in the preceding pages. The following cases, however, are from my own records of practice.A gentleman awoke in the middle of the night, and, calling his wife, told her he had dreamed that a large fortune had been left him by a miner in California. He then went to sleep again, but in the morning again repeated the dream to his wife, and said that “there might be something in it.” She laughed, and remarked that she “hoped it might prove true.” About the time the California steamer was expected, the gentleman was observed to become very anxious and excited, and was continually talking of his expected fortune. At last the steamer arrived. He then began asking the postman for letters from California, went several times a day to the post-office to make like inquiries, and finally went aboard the steamer and questioned the officers on the same subject. Then he was sure the letter had miscarried, and would sit for hours in the most profound melancholy. He was now recognized by his family as a monomaniac, and strenuous efforts were made to cure him of his delusion, but they were unsuccessful; and although now apparently sane on other subjects, he still holds the erroneous idea which was first given him in his dream of several years ago.

A young lady was brought to me in July, 1868, who had been rendered insane by a dream which took place a few months before I saw her. She went to bed one night in good health and spirits, though somewhat fatigued in consequence of having skated a good deal the previous afternoon. In the morning she told her mother she had committed the “unpardonable sin,” and that there was consequently no hope of her salvation. She based her idea on a dream she had had, in which an angel appeared to her, and sorrowfully informed her of her sin and her destiny. When asked to tell what her sin was, she refused to do so, saying it was too shocking and atrocious to talk about. She kept to her delusion, and soon settled into a sort of melancholic stupor, from which it was impossible entirely to rouse her. Under the use of arsenic, and the acid phosphate of lime of Prof. Horsford, she gradually recovered her reason.

The manner in which prodromic dreams are excited is very simple. The ancients and some modern writers have regarded them as prophetic; but the true explanation does not require so severe a tax on our powers of belief. In the previous chapter, it was shown that very slight impressions made upon the senses during sleep are exaggerated by the partially awakened brain. The first evidence of approaching paralysis may be a very minute degree of numbness—so minute that the brain when awake and engaged with the busy thoughts of active life fails to appreciate it. During sleep, however, the brain is quiescent, till some exciting cause sets it in uncontrollable action, and dreaming results. Such a cause may be the incipient numbness of a limb. A dream of its being turned into stone, or cut off, or violently struck, is the consequence. The disease goes on developing, and soon makes its presence unmistakable.

This explanation applies mutatis mutandis to all prodromic dreams. They are invariably based upon actual sensations, unless we except the rare cases which are simply coincidences.

Symptomatic Dreams.—Morbid dreams are so generally met with in the course of disease, especially in that of the brain and nervous system, that I never examine a patient without questioning him closely on this point. The information thus obtained is always valuable, and sometimes constitutes the most important feature of the investigation.

Fevers are very often accompanied by frightful dreams. According to Moreau (de la Sarthe),[96] their occurrence indicates that the attack will be long, and that there is probably some organic affection present. My own experience agrees with that of Macario,[97] to the effect of not confirming these opinions. I have, however, generally observed that the frequency and intensity of the morbid dreams were in proportion to the severity of the fever.

Diseases of the heart are very generally attended with disagreeable dreams. They are usually short, and, as Macario remarks, relate to approaching death. The patient starts from sleep in terror, and sometimes it is difficult to convince him of the reality of his visions.

Dyspepsia and other diseases of the intestinal canal often give rise to morbid dreams. They are usually accompanied by a sense of impending suffocation, and ordinarily consist of frightful images, such as devils, demons, strange animals and the like. The presence of worms in the intestines is likewise a frequent cause of such dreams.

In chlorosis dreams are very common. Occasionally they are of a pleasant character, but in the majority of cases they are the reverse of this.

It would be difficult to mention a disease which is not, at some time or other of its career, an exciting cause of morbid dreams. The most interesting examples, however, are met with in cases of insanity and other cerebral affections, and frequently the delusions of the dreams are so mixed up with those which arise during the waking condition, that the patient is unable to separate them and to determine which are the consequence of erroneous sensations received when awake, and which are the results of dreams. The careful examination of almost any insane persons will also show that they incorporate the fancies of their dreams with the realities of everyday life. Indeed, the relations of dreaming to insanity are so interesting and important as to have attracted the marked attention of alienists and psychologists.

Cabanis[98] gives Cullen the credit of being the first to point out the similarity between the phenomena of dreaming and those of delirium, and himself enters at length into the full discussion of the several questions involved. A very little reflection will suffice to convince the reader that the two conditions are strikingly alike. In dreams we never distinguish the false from the real; the judgment, if exercised at all, acts in the most erratic manner; we are rarely surprised at the occurrence of the most improbable circumstances; our characters for the time being often undergo a radical change, and we perform imaginary acts in our sleep which are altogether at variance with our actual dispositions. The hallucinations of sleep we accept as realities just as the insane individual believes in all the erroneous impressions made upon his senses. The dreaming person is, in fact, the victim of delusions which, during the existence of his condition, have a firm hold on his mind and render him in no essential particular different from the one who suffers from mental unsoundness. The incoherence present in dreams, and the evident dependence of the various images upon the suggestion of previous images, are likewise phenomena of the insane state.

Even in persons perfectly sane, dreams often produce a very powerful influence on the mind. Most of us have, on awaking, felt pleased or disturbed from reflecting upon the circumstances of a dream we have had during the night, and occasionally the impression has remained through the entire day. With children this influence is still more strongly shown. As Sir Henry Holland[99] remarks, the corrections from reason and experience are less complete in them than in adults. As a consequence, they not infrequently confuse their dream-visions with the facts of their lives, and regard the former as real events. The hallucinations of dreams are also occasionally continued during wakefulness, and hence some persons have, on awaking, seen the images which had been present to them in their sleep.

The celebrated Benedict de Spinoza[100] was once the subject of an illusion which had its starting-point in a dream. He dreamed that he was visited by a tall, thin, and black Brazilian, diseased with the itch. He awoke, and thought he saw such an image standing beside him.

Muller,[101] in referring to such instances, says:“I have myself also very frequently seen these phantasms, but am now less liable to them than formerly. It has become my custom when I perceive such images, immediately to open my eyes, and direct them upon the wall or surrounding objects. The images are then still visible, but quickly fade. They are seen whichever way the head is turned, but I have not observed that they moved with the eyes. The answers to the inquiries which I make every year of the students attending my lectures as to whether they have experienced anything of the kind, have convinced me that it is a phenomenon known to comparatively few persons. For among a hundred students, two or three only, and sometimes only one, have observed it. This rarity of the phenomena is, however, more apparent than real. I am satisfied that many persons would perceive these spectres if they learned to observe their sensations at the proper times. There are, however, undoubtedly many individuals to whom they never appear, and in my own case they now sometimes fail to show themselves for several months at a time, although in my youth they occurred frequently. Jean Paul recommended the watching of the phantasms which appear to the closed eyes as a means of inducing sleep.”

If such phenomena take place in persons of healthy brains, the greater liability of the insane to experience them will readily be admitted.The character of dreams, as Macario[102] remarks, varies according to the type of insanity to which the patient is subject. In melancholia they are ordinarily sad and depressing, and leave a deep and lasting impression; in expansive monomania they are gay and exciting; in mania they give evidence of the extraordinary mental excitement and activity of the subject, and in duration they are vague, fleeting, and occur but seldom.

Essential Morbid Dreams.—Under this head are comprehended the various forms of frightful dreams which are ordinarily designated under the name of nightmare. It has been my good fortune to have had the opportunity of carefully studying the phenomena of this singular affection in several persons of intelligence, and I propose, therefore, detailing the results of my own experience, after a short historical retrospect, which I hope will not prove uninteresting.

Nightmare is characterized by the existence during sleep of a condition of great uneasiness, the principal features of which are a sense of suffocation, a feeling of pain or of constriction in some part of the body, and a dream of a painful character. There are thus two essential elements of the affection—the bodily and the mental.

At a very early period the phenomena of nightmare attracted the attention of physicians. Hippocrates[103] describes it in the following words: “I have often seen persons in their sleep utter groans and cries, appear as if suffocated, and throw themselves wildly about until they finally waked. Then they were in their right minds, but were, nevertheless, pale and weak.”

The general opinion held at that time was that the phenomena of nightmare were due to excess of bile and dryness of the blood. This view originated with Hippocrates, but was more or less modified by subsequent writers.

After the establishment of Christianity, the conviction began to prevail that during an attack of nightmare the subject was visited by a demon, who, for the time being, took possession of his body. Oribasius, in the fourth century, combated this idea, and endeavored to show that it was a severe disease, which, if not cured, might lead to apoplexy, mania, or epilepsy. He located it in the head.

Aetius also denied the existence of demoniacal agency in nightmare. He considered it as a prelude to epilepsy, mania, or paralysis.

During the middle ages nightmare was attributed to the power of the devil. Imps, male and female, called incubi and succubi respectively, were supposed to be the active agents in producing the affection. The treatment was in accordance with the theory, and consisted of prayers and exorcisms. Not unfrequently the subject of the disease perished at the stake for the alleged crime of having sexual intercourse with incubi or succubi, according to sex.

Even in later times many persons have been found who believed implicitly in the reality of the visions which they experienced during an attack of nightmare. Thus Jansen[104] relates that a clergyman came to consult him. “Monsieur,” said he, “if you do not help me I shall certainly go into a decline, as you see I am thin and pale,—in fact, I am only skin and bone; naturally I am robust, and of good appearance; now I am scarcely more than the shadow of a man.”

“What is the matter with you?” said Jansen. “And to what do you attribute your disease?”

“I will tell you,” answered the clergyman, “and you will assuredly be astonished at my story. Almost every night a woman, whose figure is not unknown to me, comes and throws herself on my breast, and embraces me with such power that I can scarcely breathe. I endeavor to cry out, but she stifles my voice, and the more I try the less successful I am. I can neither use my arms to defend myself, nor my legs to escape. She holds me bound and immovable.”

“But,” said the doctor, “what you relate is not in the least surprising. Your visitor is an imaginary being, a shade, a phantom, an effect of your imagination.”

“Not so!” exclaimed the patient. “I call God to witness that I have seen with my own eyes the being of whom I speak, and I have touched her with my hands. I am awake, and in the full possession of my faculties, when I see this woman before me. I feel her as she attacks me, and I try to contend with her, but fear, anxiety, and languor prevent me. I have been to every one asking for aid to bear up against my horrible fate, and, among others, I have consulted an old woman, who has the reputation of being very skillful, and something of a sorceress. She directed me to urinate toward daylight, and to immediately cover the pot de chambre with the boot of my right foot. She assured me that on the very day I would do this the woman would pay me a visit.

“Although this seemed to me very ridiculous, and although my religion was altogether against my making any such experiment, I was finally induced, by reflecting on my sufferings, to follow the advice I had received. I did so, and, sure enough, on the same day the wicked woman who had so tormented me came to my apartment, complaining of a horrible pain in the bladder. All my entreaties and threats, however, were unavailing to induce her to cease her nocturnal visits.”

Jansen at first could not turn this gentleman from his insane idea, but, finally, after two hours’ conversation, he made him have some just conception of the nature of his disease, and inspired him with the hope of a cure.

Epidemics of nightmare have been noticed, and it likewise sometimes prevails endemically under certain peculiar forms. Thus vampirism, a belief in which exists in different parts of the world, is nothing but a kind of nightmare. Charles Nodier[105] gives some interesting details on this point, which I do not hesitate to transcribe.

In Morlachia there is scarcely a hamlet which has not several vukodlacks or vampires, and there are some, every family of which has its vukodlack, just as every Alpine family has its cretin. The cretin, however, has a physical infirmity, and with it a morbid state of the brain and nervous system, which destroys his reason, and prevents him appreciating his degraded condition. The vukodlack, on the contrary, appreciates all the horror of his morbid perception; he fears and detests it; he combats it with all his power; he has recourse to medicine, to prayers, to division of a muscle, to the amputation of a limb, and sometimes even to suicide. He demands that after his death his children shall pierce his heart with a spike, and fasten his corpse to the coffin, so that his dead body, in the sleep of death, may not be able to follow the instinct of the living body. The vukodlack is, moreover, often a man of note, often the chief of the tribe, the judge, or the poet.Through the sadness which is due to the recollection of his nocturnal life, the vukodlack exhibits the most generous and lovable traits of character. It is only during his sleep, when visited with his terrible dreams, that he is a monster, digging up the dead with his hands, feeding on their flesh, and waking those around him with his frightful cries.

The superstition is that during this state of morbid dreaming the soul of the sleeper quits the body to visit the cemeteries, and feast upon the remains of the recently dead.

In Dalmatia the belief is current that there are sorcerers whose delight is to tear out the hearts of lovers, and to cook and eat them. Nodier relates the story of a young man about to be married, who was the constant victim of nightmare, during which he dreamed that he was surrounded by these sorcerers, ready to pluck his heart from his breast, but who often awakened just as they were about to proceed to extremities. In order to be effectually relieved from their visitations, he was advised to avail himself of the company of an old priest, who had never previously heard of these horrible dreams, and who did not believe that God would give such power to the enemies of mankind. After using various forms of exorcism, the priest went peacefully to sleep in the same room with the patient whom he was commissioned to defend against the sorcerers. Hardly, however, had sleep descended upon his eyelids than he thought he saw the demons hovering over the bed of his friend, alight, and, laughing horribly, throw themselves on his prostrate body, and with their claws tear open his breast, and, seizing his heart, devour it with frightful avidity. Unable to move from his bed, or to utter a sound, he was forced to witness this terrible scene. At last he awoke to see no one but his companion, pale and haggard, staggering toward him, and finally falling dead at his feet.

These two men, adds Nodier, had had similar attacks. What the one dreamed he saw, the other dreamed he had experienced.

As an instance of like dreams occurring to many persons at the same time, the circumstances related by Laurent[106] are worthy of notice.

“The first battalion of the regiment of Latour d’Auvergne, of which I was Surgeon-major, while in garrison at Palmi, in Calabria, received orders to march at once to Tropea in order to oppose the landing from a fleet which threatened that part of the country. It was in the month of June, and the troops had to march about forty miles. They started at midnight, and did not arrive at their destination till seven o’clock in the evening, resting but little on the way, and suffering much from the heat of the sun. When they reached Tropea, they found their camp ready and their quarters prepared, but as the battalion had come from the farthest point, and was the last to arrive, they were assigned the worst barracks, and thus eight hundred men were lodged in a place which, in ordinary times, would not have sufficed for half their number. They were crowded together on straw placed on the bare ground, and being without covering, were not able to undress. The building in which they were placed was an old, abandoned abbey, and the inhabitants had predicted that the battalion would not be able to stay there all night in peace, as it was frequented by ghosts, which had disturbed other regiments quartered there. We laughed at their credulity; but what was our surprise to hear, about midnight, the most frightful cries issuing from every corner of the abbey, and to see the soldiers rushing terrified from the building. I questioned them in regard to the cause of their alarm, and all replied that the devil lived in the building; that they had seen him enter by an opening into their room, under the figure of a very large dog, with long black hair, and, throwing himself upon their chests for an instant, had disappeared through another opening in the opposite side of the apartment. We laughed at their consternation, and endeavored to prove to them that the phenomenon was due to a very simple and natural cause, and was only the effect of their imagination; but we failed to convince them, nor could we persuade them to return to their barracks. They passed the night scattered along the sea-shore, and in various parts of the town. In the morning I questioned anew the non-commissioned officers and some of the oldest soldiers. They assured me that they were not accessible to fear; that they did not believe in dreams or ghosts, but that they were fully persuaded they had not been deceived as to the reality of the events of the preceding night. They said they had not fallen asleep when the dog appeared, that they had obtained a good view of him, and that they were almost suffocated when he leaped on their breasts. We remained all day at Tropea, and the town being full of troops, we were forced to retain the same barracks, but we could not make the soldiers sleep in them again, without our promise that we would pass the night with them. I went there at half-past eleven with the commanding officer; the other officers were, more for curiosity’s sake than anything else, distributed in the several rooms. We scarcely expected to witness a repetition of the events of the preceding night, for the soldiers had gone to sleep, reassured by the presence of their officers, who remained awake. But about one o’clock, in all the rooms at the same time, the cries of the previous night were repeated, and again the soldiers rushed out to escape the suffocating embrace of the big black dog. We had all remained awake, watching eagerly for what might happen, but, as may be supposed, we had seen nothing.

“The enemy’s fleet having disappeared, we returned next day to Palmi. Since that event we have marched through the Kingdom of Naples in all directions and in all seasons, but the phenomena have never been reproduced. We are of opinion that the forced march which the troops had been obliged to make during a very hot day, by fatiguing the organs of respiration, had weakened the men, and consequently disposed them to experience these attacks of nightmare. The constrained position in which they were obliged to lie, the fact of their being undressed, and the bad air they were obliged to breathe, doubtless aided in the production.”

A gentleman was, not long since, under my professional charge who was very subject to attacks of nightmare. Though remarkable for his personal courage, he confessed that during his paroxysms he was the most arrant coward in the world. Indeed, so powerful an impression had his frequent frightful dreams made upon him, that he was afraid to go to sleep, and would often pass the night engaged in some occupation calculated to keep him awake.

The dreams which he had were always of such a character as to inspire terror, and generally related to demons and strange animals, which seated themselves on his chest, and tried to tear open his throat. They came on a few minutes after he fell asleep, and lasted sometimes for more than an hour. During their continuance he remained perfectly still and quiet, giving no evidence of the tumult within, beyond the appearance of a cold sweat over the whole surface of the body. When he awoke, as he always did when the climax was reached, he started from the bed with a bound, and with all the evidences of intense fright. After that he was safe for the remainder of the night.

I am acquainted with another case in which there are no very obvious physical symptoms.

Ordinarily, however, the sufferer groans, and tosses about the bed; he appears to be endeavoring to speak, and to escape from his imaginary danger; his face, neck, and chest are flushed; a cold perspiration appears, especially on his forehead, and he is sometimes seized with a general trembling of the whole body. The respiration appears to be particularly disturbed; he gasps for air, and occasionally the breathing is stertorous. As to the pulse, strange as it may appear, there is rarely any marked change from the healthy standard, beyond the slight irregularity induced by the disorder of the respiration.

Among the mental symptoms, in addition to the fear with which he is filled, the sufferer is most sensibly impressed with a sense of his utter helplessness. His will is actively engaged in endeavoring to bring his muscles into action, but they cannot be made to obey its behests, and he consequently feels himself powerless to escape from the enemies which attack him.

In regard to the kind of images which make their appearance, there is more or less uniformity. Generally they consist of animals, such as hogs, dogs, monkeys, or nondescripts created by the imagination of the dreamer. At other times they are demons of various forms. A gentleman, whose case came under my notice, was visited almost nightly by a huge black walrus, which appeared to roll off of a large cake of ice, and, crawling up the bed, to throw itself on his chest. Another was tormented by an animal, half lion and half monkey, which seemed to fasten its claws in his throat while seated on his breast.

At other times there are no images, but only painful delusions, in which the dreamer is placed in dangerous positions, or suffers some kind of torturing operation. Thus a lady informs me that she is subject to frequent attacks of nightmare, during which she imagines she is standing on the top of a high mast, and in extreme fear of falling off. Again she is dragged through a key-hole by some invisible power; and again has her nose and mouth so tightly closed that she can get no breath of air.

The causes of nightmare may be divided into the exciting and the immediate. The exciting causes are very numerous. Unusual fatigue, either of mind or of body, recent emotional disturbance, such as that produced by fright, anxiety, or anger, and intense mental excitement of any kind may produce it. I have known a young lady to have a severe attack the night after a school examination, in which she had been unduly tasked. Another young lady is sure to be attacked after witnessing a tragedy performed. A young man, who was under my care for a painful nervous affection, always had a paroxysm of nightmare during the first sleep after delivering an address, which he was obliged to do every month for a year or more.

Fullness of the stomach, or the eating of indigestible or highly stimulating food late in the evening, will often cause nightmare. As Motet[107] remarks: “One of the best-established causes is repletion of the stomach, and slowness and difficulty of digestion. Let an individual, habitually systematic, depart for one day from the accustomed regularity of his meals, let him change the hour of his dinner, and go to bed before the work of digestion is completed, and it is probable that his sleep will be troubled, and that nightmare will be the consequence of his indiscretion. The painful feeling will be induced by distention of the stomach, by anxiety, and by the restraint given to the movements of the diaphragm.”

Feculent food would appear to be especially powerful in causing nightmare, and according to Motet, strong liquors and sparkling wines and coffee are equally so. I have several times known it produced by the New England dish of baked pork and beans, and by green Indian-corn eaten just before going to bed.

Various morbid affections, such as diseases of the heart, aneurism of the large arteries, affections of the brain or spinal cord, and diseases of the digestive or urinary apparatus are often exciting causes of nightmare. It may originate from painful sensations in any part of the body. Some women, about the time of the menstrual flow, are particularly liable to paroxysms of this morbid dreaming.

Whatever interferes with the respiration or the easy flow of blood to and from the head may bring on an attack of nightmare. I have known it caused by the collar of the night-gown being too tight, and by the pillow being under the head and not under the shoulders, thus putting the head at such an angle with the body as to constrict the blood-vessels of the neck, and by the head falling over the side of the bed. I have not been able to ascertain that sleeping upon the back or on the left side predisposes to the affection, unless in those cases in which the former position causes snoring from relaxation of the soft palate.

The immediate cause of nightmare is undoubtedly the circulation of blood through the brain which has not been sufficiently aerated. The appearance of the sufferer is sufficient to indicate this, as the condition of the cerebral vessels and all the exciting causes act either by retarding the flow of the venous blood from the brain, or by impeding the respiratory movements. The effects of emotion, of mental fatigue, and of severe and long-continued muscular exertion are such that the nervous influence to the muscles of respiration is increased, or the muscles themselves are debilitated through this general fatigue of the organism. Fullness of the stomach acts mechanically, by interfering with the action of the diaphragm, and constriction about the neck directly increases the flow of blood through the brain. Certain diseases of the heart and lungs act upon the function of respiration, and thus interfere with the due oxygenation of the blood.

The treatment of morbid dreams presents no points of any difficulty. When they are the result of impressions made during sleep upon the nerves, and are the forerunners of disease, it is not very likely that physicians will be consulted as to their cure. Undoubtedly, however, much can be done to abate them when they belong to the category of prodromic dreams, as well as when they are symptomatic of existing disease. Hygienic measures, such as open-air exercise, attention to diet, and warm baths, and the use of the oxide of zinc and bromide of potassium, will do much to lessen the irritability of the nervous system, and to diminish any hyperÆmic condition of the brain.

Nightmare often requires more active management, though even here we will ordinarily find the measures above mentioned the most effectual that can be taken for its treatment. Of course the exciting cause must be ascertained if possible, and means taken to remove it. This is not always an easy matter, and frequently cannot be accomplished without a considerable alteration in the course of life followed by the patient, and more or less sacrifice on his part. Among hygienic measures, I have several times found relief follow a sojourn at the sea-shore, and ocean bathing. Change of air is almost invariably beneficial, and moderate physical exercise, just to the point of fatigue, can scarcely be dispensed with. A gentleman, at this moment under my care, has been cured by a course of gymnastic training, which he took at my instance. The food of those subject to nightmare should always be plain, easily digestible, and moderate in quantity. Alcoholic beverages should always be sparingly taken, especially just before going to bed. Any article of food or drink known to produce the paroxysm, should of course be omitted altogether.

As to medicines, the whole round of so-called antispasmodics is usually tried by routine physicians. I have never seen them do any good. Iron and bitter tonics are indicated in cases of anÆmia or exhaustion. As the disease is sometimes induced in children by the presence of worms in the alimentary canal, diligent inquiry should be made relative to symptoms indicating irritation from these parasites, and if they are found to exist, anthelmintics should be administered.

A case of intermittent nightmare, occurring every alternate night, in a young lady, was recently under my care. No exciting causes could be discovered, except the probable one of malaria. The affection yielded at once to the sulphate of quinia.

Ferrez[108] has published the details of a case of intermittent nightmare occurring in the person of a Spanish officer, who was attacked after passing forty-two nights at the bedside of a sick daughter. Every night, at the same hour, he was awakened by frightful dreams, which, irritating his brain, produced cramps, convulsive movements, an afflux of blood to the cerebral tissues, a sadness which he could not conquer, and a continual and powerful feeling of approaching death.

The patient, though of strong constitution, became enfeebled and emaciated. His countenance was pale, the pupils contracted, and his whole appearance showing the exhaustion consequent upon the battle which he was obliged continually to fight with his disease. He composed at this time some verses, describing in graphic terms the deplorable condition of his mind and body.

Gymnastics, temperance in eating and drinking, and the study of poetry, failed to give him relief. Finally he consulted Dr. Ferrez, who advised him to reveal his state to his family, who hitherto had been kept in ignorance of his malady, to continue his gymnastics moderately, not to eat in the evening, to drink only cold water, to use friction over the whole surface of the body, to apply mustard plasters to the extremities, to sleep with his head elevated and uncovered, to bathe his head frequently during the night with cold water, to give up the study of poetry, and to devote himself to mathematics and political economy. These measures were rigorously carried out; but his daughter, who had been the involuntary cause of his disease, prescribed a better remedy than all the others. She had him waked at midnight, before the occurrence of his paroxysm, and thus broke up the habit.

Perhaps no one medicine is so uniformly successful in the ordinary forms of nightmare as the bromide of potassium, administered in doses of from twenty to forty grains, three times a day. I have seen a number of cases which had resisted all hygienic measures, and the simple removal of the apparent cause, yield to a few doses of this remedy.

When the affection has lasted a long time, it is more difficult to break up the acquired habit. In these cases, the plan so successfully employed by the daughter of the Spanish officer will almost invariably succeed.

Finally, persons subject to nightmare should so train the mind as to employ the intellectual faculties systematically, by engaging in some study requiring their full exercise. The action of the emotions should be as much as possible controlled, and the reading of sensational stories, or hearing sensational plays, should be discouraged. By severe mental training, individuals can do much to regulate the character of their dreams. It is a well-recognized fact, that intense thought upon subjects which require the highest degree of intellectual action is not favorable to the production of dreams of any kind.