Certain authors make a distinction between lethargy and apparent death; but the difference is one of degree rather than of kind. The movements of respiration and of circulation, though greatly enfeebled, are readily observed in ordinary forms of lethargy; but in apparent death the pulse can no longer be discovered, and nothing more than the faintest sound can be distinguished in the region of the heart. It, therefore, becomes important to have within reach a crucial test of the persistence of general vitality. Such evidence, according to Rosenthal, is furnished by the faradaic current. Within two or three hours after actual death, the muscles cease to respond to the induced current; but in apparent death this form of electro-muscular contractility never disappears. Every other test that has been proposed has failed under certain circumstances. Observation of the changes in muscular temperature during electrical excitation is a method better adapted to the laboratory than for clinical practice.
Lucid lethargy.—In certain cases of apparent death the patient exhibits all the external appearance of suspended animation, but the power of conscious perception does not cease. The senses of sight and hearing remain, and are, perhaps, intensified by inhibition of the power of voluntary movement. The sufferer sees and hears; perception, emotion, memory, the power of reasoning, judgment, volition, all persist. Only the power of executing voluntary movements is lacking.
The victims of this variety of apparent death are usually women, or men who are characterized by a feminine nervous organization. Great mental excitement, fatigue, semi-starvation, and exhausting diseases, are the principal exciting causes of the event. The following case, related by my friend, Dr. P. S. Hayes, of Chicago, illustrates the phenomena of lucid lethargy. The patient was a female physician, about thirty years of age, unmarried, and consumptively inclined. During the course of a long and wearisome hospital service, she was prostrated with typhoid fever. Placing herself under the immediate care of my informant, she was also attended by several of the most eminent physicians in the city. After a long and exhausting illness she appeared to be dying. In the presence of her physician, and surrounded by her relatives, she ceased to breathe. The pulse stopped, life seemed to have gone out. Bottles of hot water were applied to the limbs, and various restoratives were employed. After a considerable time she began again to breathe, and a gradual recovery followed. During the whole time of apparent death, consciousness had been preserved. She seemed to be looking down from a point above her bed; she could see the doctor feeling for her pulse, and was grieved by the sorrow of her friends. Ordinary sensation was temporarily suspended, and she could not distinguish the contact of the hot-water bottles that were applied to her limbs, though actually scalded by their excessive heat. Borne upon the wings of an excited imagination, she thought herself permitted to look into heaven, but was not suffered to enter its gates. In this exaltation of the imagination the reasoning faculties also shared, so that certain philosophical problems which had previously baffled her intellect were now perfectly comprehensible, and the memory of their solution persisted after recovery.
Many similar narratives have been duly authenticated, but the limits of the present chapter will not permit a discussion which properly belongs to an investigation of the phenomena of trance. The important fact for present consideration is the persistence of conscious life, despite the appearance of death. In this preservation of consciousness, notwithstanding the temporary suspension of certain kinds of sensibility and the power of voluntary motion, may be discovered a relationship between the phenomena of lucid lethargy and various disturbances of sleep, which will be considered in a succeeding chapter.
CHAPTER II.
INSOMNIA, OR WAKEFULNESS.
| Sleep, gentle sleep, Nature’s soft nurse, how have I frighted thee That thou no more wilt weigh mine eyelids down And steep my senses in forgetfulness? —King Henry IV, Second Part. |
We have seen that the condition of normal sleep is determined by a peculiar molecular state of the substance of the brain—a modification regularly alternating with that by means of which the condition of wakefulness is sustained. We have also seen that sleep is liable to variations in its intensity, and that its course may be partially interrupted by dreams, or even by a more or less complete resumption of the movements of locomotion, constituting the different varieties of somnambulism. Our attention must now be directed to the consideration of those greater disturbances of sleep which either serve to prevent its full development, or else to actually interrupt its course, rendering it incomplete and fragmentary, or even abolishing it altogether. But, inasmuch as the healthy brain, when associated with a healthy body, can only by an extraordinary effort of the will be kept awake beyond a certain period, and then only for a short time beyond the ordinary interval of wakefulness, it follows that the study of the usual causes of insomnia must be an investigation of morbid conditions of the bodily functions. Sleeplessness, therefore, must result, 1st, from a disturbance of the peripheral sensory organs of the nervous system; 2nd, from disordered conditions of the sensory nerves and nerve tracts; 3rd, from morbid states of the brain; 4th, from any or all of these conditions operating in association with each other. We may, therefore, consider, I, Insomnia caused by irritation of the peripheral portions of the sensory apparatus; and, II, Insomnia caused by morbid states of the central nervous organs.