Part 3

As the Blood must lose most of the motion which it receives from the Heart, in passing through the infinite vascular ramifications, and fine filtres of the Brain, there scarce appears, even in an erect position of the Body, any propelling power to push it back again to the Heart, except we admit the pulsation of the small Arteries belonging to the coats of the Sinuses, and its own gravity. But in an horizontal position, the Blood has not the advantage of its gravity to accelerate its motion through the Jugular Veins; therefore it must move slower, and must be more subject to obstruction in the vessels of the Brain. Hence we see the use of pillows is to promote and facilitate the return of the Blood through the Jugular Veins: hence we may also observe, the uneasiness and danger attending the too common method of making the feet of beds higher than the heads, since a stoppage of the Blood is always productive of dangerous consequences; of which any one may be soon convinc’d by stooping the Head for a short time; and it will appear, that the Blood is by this means collected in the Veins of the Face, which will produce a Vertigo, and, if long continued, may bring on an Apoplexy. Hence we sometimes hear of people dropping down dead, upon stooping to buckle their shoes. These instances should deter some from putting their pillows under their feet, in order to make the Blood settle in their faces, and to decorate the external part of their Heads at the expence of the internal.

Notwithstanding the inconveniences and bad effects which may arise from the Blood’s delay in the Brain, yet, its being sent to the Head in sleep in a greater quantity, may serve many necessary purposes, and render sleep more beneficial and refreshing to animals. First, by distending the Blood-vessels of the Cerebrum, increasing the pressure on that part, and by that means producing sleep. Secondly, by promoting the secretion, and preparing a store of animal spirits to supply the expence of the ensuing day. Thirdly, by gently encreasing the pressure of the Blood-vessels on the Cerebellum, and perhaps determining a greater quantity of the nervous influence to the Heart, respiratory Muscles, and other parts, whose Nerves spring from that fountain of life. This pressure on the Cerebellum may concur with the rarefaction of the fluids, to render the motions of these organs more regular and vigorous in sleep.

To this mechanical pressure on the Cerebellum, the illustrious Van Sweiten seems to attribute the motion of the Heart: “Cerebelli enim actio in Cor per Nervos, pendet ab ipsa actione Cordis per Arterias.”

Tho’ the contraction of the Heart is evidently the efficient cause of the Blood’s motion, and consequently of the secretion of these spirits in the Cerebellum, yet, without these spirits, the action of the Heart could not be performed. These two causes appear to act in a circle, and mutually depend on each other. Hence Hippocrates divin’d, ὁλον το ζωμα κυκλος εστι. These also convey the idea of a perpetuum mobile; since, as long as life lasts, an animal is really such, and far excels any machine that human art has been yet able to make, or (in the opinion of many philosophers) will ever invent.

The laborious Hoffman ascribes a great deal to this pressure on the Brain, where he says, “Declivior cubitus sanguinis regressum quodammodo impedit, quia per venas jugulares descendere debet, quod elatiori capite commodius peragitur. Hinc, capite nimis demisso ac depresso, profundiores somnii cum insomniis, fiunt, universo corpore torpor inducitur. Eadem ratione, si quis facie prona velut in mensa, in somnum delabitur. Ob difficiliorem sanguinis regressum, gravitatem capiti, et ingenio stupiditatem accersit.”

“Sed etiam mechanicæ causæ somnum producunt, compressio nempe Duræ Matris, aut Cerebri, quæcunque nata a Sanguine effuso, inpacto Osse, aquæ in Ventriculis copia.”

These, I hope, are sufficient to shew how far the motion of the fluids may be affected by the horizontal position of the Body; which, if duly consider’d, might be of great service in the practice of Physic; and perhaps many effectual derivations might be made, without drawing a drop of Blood. I saw a remarkable instance of this kind in a gentleman of a full habit, who, being ill of a Fever, talk’d rationally and rav’d alternately, as his head was elevated or depress’d. In acute Diseases, when the motion of the Blood is very rapid through the whole Body, the Brain must suffer greatly, on account of the horizontal position, to which people in such cases are confin’d; because, the Blood rushing violently into the Arteries of the Brain, and its return being retarded by the Jugular Veins, will remarkably contribute to produce delirious symptoms, so frequent in acute Disorders, which might be in some measure prevented, by raising the Head; for, by that means, the motion of the Blood through the Jugular Veins will be increas’d, the pressure on the Brain will be eas’d, and a safe and sudden derivation from the Head may be made, which may produce very happy effects, where no evacuation could be safely attempted.

Let us next take a view of the Heart, and consider how it may be affected by the various positions of the Body, particularly the supine one, in which the Night-mare generally invades.

The Heart is placed above the Diaphragm: the greater part of it lies in the left cavity of the Breast: its apex or point is turn’d towards the extremity of the sixth true Rib, where its pulsations are commonly felt: it adheres to the Lungs by its large vessels, and is connected to the Diaphragm by the Pericardium.

Thus the Heart is suspended in the Breast; and therefore must be subject to the laws of pendulous bodies, which alter their situation according to the different directions of their centers of gravity.

From the above just description of the human Heart, ’tis evident, that when the Body is erect, the parts of the Heart which are commonly called the right and left, ought to be more properly call’d the anterior and posterior.

Hence, when the Body is plac’d on the Back, these become the superior and inferior parts of the Heart.

That the Heart alters its situation in the Breast according to the different positions of the Body, and the different directions of its center of gravity, may be prov’d by the following easy experiments.

If the Finger be applied to that part of the Ribs where the pulsation is felt in an erect position; and if, at the same time, the Diaphragm be contracted strongly, the beatings become immediately weaker, because the Heart is pulled downwards by the Diaphragm.

If one lies on the left side, the point of the Heart is felt beating nearer the Spine of the Back; if we turn on our Backs, it is scarce perceptible; and if we lie on the right side, it intirely vanishes.

These alterations of the Heart’s situation in the Breast, are more remarkable in some persons than in others; and in general I have found, by repeated tryals, that they were most considerable in those who were most subject to the Night-mare.

When the Body lies supine, the Heart necessarily falls on the Vertebræ of the Spine; and therefore, by its own gravity, must compress the left Auricle and Pulmonary Veins, which, at that time, lie directly under its basis; and, by that means, the course of the Blood through the Lungs will be stop’d. Thus the Blood will be collected in the Pulmonary Vessels, and the right, or rather superior Ventricle, not being able to discharge itself into the Pulmonary Artery, will be oppressed by the Blood returning from the Extremities; which, being gather’d in the vessels about the superior part of the Heart, will increase its gravity, and consequently augment the cause of the obstruction. In this manner the return of the Blood from the Head will be prevented, the tender dilatable vessels of the Brain will be over-distended, the nervous influence obstructed, and the vital motions, in a great measure, if not altogether, stopt. This I take to be a real fit of the Night-mare, and in this manner it appears to be produc’d.

CHAP. III.

An account of the Symptoms.

Having now discover’d what appears, to me, to be the immediate cause of the Night-mare, viz. the pressure of the Heart on the left or inferior Auricle and Pulmonary Veins, which stops the motion of the Blood through the Lungs, and occasions a general stagnation; let us examine how that hypothesis will account for the several Phænomena or Symptoms, mention’d formerly in the description of this Disease.

The first Symptoms that occur in that catalogue, are frightful Dreams, which generally are the forerunners of this Disorder. “In hoc genere (Somniorum) est Εφιαλτης quem publica persuasio quiescentes opinatur invadere, ac sentientes pondere suo gravare.”

I shall not here undertake to solve that Phænomenon, which has so long puzzled the Metaphysicians, nor pretend to account for all kinds of dreams in a mechanical manner.

However, every one knows that the harmony and connection between the Body and the Mind are so establish’d and constituted, while they are united, that the Diseases of the one always affect the other in a very sensible manner; and experience daily demonstrates, that violent passions of the mind produce Fevers, Fainting Fits, and other severe effects on the Body; e. contra, violent shocks of the Body, acute Diseases, &c. frequently disturb, and raise strange commotions in the Mind, or at least excite extravagant, wild ideas in it. Accordingly we find, that the most eminent Physicians have not scrupl’d to assert, that these effects are often owing to Obstructions and Inflammations of the Membranes of the Brain. If so, may not the violent distentions of the Vessels of the Brain (which always precedes and attends a fit of the Night-mare) make such strong impressions on the origin of the Nerves, or Sensorium Commune, as to occasion hideous associations of ideas, and form frightful spectres in the imagination? Are not these monstrous dreams intended as a stimulus to rouse the sentient principle in us, that we might alter the position of the Body, and by that means avoid the approaching danger? Is not the horizontal posture of the Body, which produces a Plethora in the Vessels of the Brain, and many odd sensations, the most general cause of dreams? Do they ever dream, who sleep in an erect position? Are not the luxurious and the plethoric most subject to disagreeable dreams? Is not the motion and titillation of the Animalculæ in Semine Masculino, the cause of the agreeable dreams which attend nocturnal emissions? Have females such emissions in sleep? Does not perfect sleep consist in a total suspension of the operations of the Mind? May not dreaming, in general, be consider’d as a Disorder of the Body, and justly attributed to some cause, which stimulates the Sensorium Commune, and prevents perfect rest? Do people that sleep after much fatigue, ever dream?

The vast oppression on the Breast, and immobility of the Body, which are always felt in this Disorder, probably arise from the quantity of Blood collected in the Lungs, Vena Cava, right Ventricle, and Auricle of the Heart; nor does the Mind appear to be mistaken in this case, as some have imagined; for it seems the same with regard to the Mind, whether the real action of the Muscles be constrain’d by a superior external force, or the influence of it over these Muscles be hinder’d by an internal cause. In a fit of the Night-mare, the Mind, conscious of the dangerous situation of the Body, in vain endeavours to alter it, because its power over the Voluntary Muscles is some way suspended, by the obstruction of the Blood; yet the Mind may exert itself as much as if it strove to remove the greatest obstacle. In this case the Mind generally ascribes the immobility of the Body to some great weight laid on the Breast; whereas the cause is really internal: and people judge of the greatness of the oppression, according to the efforts nature makes to overcome the obstruction of the Blood in the Lungs.

Besides, in heavy or profound sleep, the voluntary motions are generally stop’d. Hence, when people awake suddenly, they are for some time Paralytic, before the Animal Spirits obey the commands of the Mind, and actuate the Muscles in the usual manner.

The indistinct Voice is probably owing to the same cause; for the Muscles of the Tongue and Larynx, which form distinct sounds, are of the voluntary class, which, as was said before, are generally suspended in sleep.

The collapsing of the Lungs, which are, at this time, overloaded with Blood, will exclude the air, that necessary medium of sounds, and sole vehicle of voice.

Heavy sighs and groans are the emphatic expressions of nature in distress, and generally arise from some obstruction in the Lungs; but in a fit of the Night-mare there appears a great accumulation of Blood in the vessels of that part, whence these Symptoms are easily accounted for. It may be observ’d of sighing in general, that when the attention of the Mind is deeply engag’d to any particular object or sensation, and either neglects or is restrain’d from exerting its influence over the organs of respiration, the Blood is stop’d in the Lungs, so that it becomes necessary to draw in a large Chestful of air, in order to give the Blood a free passage from the right Ventricle of the Heart to the left. Hence Melancholy persons, profound Mathematicians, and fond pining Lovers, are most subject to that affection. Such people are also very liable to many Hypochondriac and Chronic Diseases; which often proceed from a defective respiration, or a too slow motion of the Blood through those parts which are agitated by the alternate dilatation and contraction of the Thorax. Hence the Liver and Spleen and the Lungs themselves must suffer most when the attention of the Mind is engag’d by some Disease of its own, and it becomes less sensible of the Disorders of the Body. Hence people in Grief, &c. labour under a double Disease, which, on account of the anxiety, weight, and oppression that is felt from the Blood stagnating about the Heart, is commonly termed Heart-breaking.