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.